Advantages of using 3D virtual reality based training in persons with Parkinson's disease: a parallel study
Advantages of using 3D virtual reality based training in persons with Parkinson's disease: a parallel study
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DOI：
10.1186/s12984-019-0601-1
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发表时间：
2019-10-17
影响因子：
5.1
通讯作者：
Potisk, Karmen Peterlin
中科院分区：
文献类型：
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作者：
Cikajlo, Imre;Potisk, Karmen Peterlin
帕金森病（PD）是一种缓慢进展的神经退行性疾病。关于PD患者物理治疗成功的报道褒贬不一。我们的目标是调查使用沉浸式3D虚拟现实与非沉浸式2D游戏时的功能改进，动机方面和临床有效性。方法我们设计了一项随机平行研究，纳入97例患者，但只有20名符合条件的参与者随机分为两组；一个使用3D Oculus Rift CV1，另一个使用笔记本电脑。两组都参加了为期3周的10次训练，在虚拟世界中进行捡放任务，需要精确的手部运动来操纵虚拟立方体。采用Leap运动控制器跟踪手部运动轨迹，采用改进的内在动机量表评估训练效果，采用Box & Blocks Test （BBT）和缩短的统一帕金森病评定量表（UPDRS）评估训练前后的临床效果。采用Mack-Skilling非参数统计检验确定差异有统计学意义（p < 0.05），采用Cohen's U3检验确定效应量。结果3D组在平均操作时间（组x时间，p = 0.009）、成功放置立方体数量（组x时间，p = 0.028）、平均震颤（组x时间，p = 0.002）和上肢UPDRS （U3 = 0.35）方面表现出统计学意义上的显著改善。LCD组和3D组通过训练显著提高了BBT评分（U3 = 0.7, U3 = 0.6）。但两组临床试验比较，差异无统计学意义（x组，p = 0.2189, p = 0.2850）。LCD组压力/张力明显降低（U3 = 0.3）， 3D组无变化（U3 = 0.5），组间差异有统计学意义（p = 0.037）。3D组在努力（U3 = 0.75）和感知能力（U3 = 0.9）方面表现出重要的提高。研究结果表明，沉浸式3D技术可以提高兴趣/享受得分，从而更快，更高效地实现功能表现。但2D技术显示较低的压力/张力评分提供类似的临床进展。样本量大得多的研究也可能证实这些方法的临床有效性。
Background Parkinson's disease (PD) is a slowly progressive neurodegenerative disease. There are mixed reports on success of physiotherapy in patients with PD. Our objective was to investigate the functional improvements, motivation aspects and clinical effectiveness when using immersive 3D virtual reality versus non-immersive 2D exergaming. Methods We designed a randomized parallel study with 97 patients, but only 20 eligible participants were randomized in 2 groups; the one using 3D Oculus Rift CV1 and the other using a laptop. Both groups participated in the 10-session 3 weeks training with a pick and place task in the virtual world requiring precise hand movement to manipulate the virtual cubes. The kinematics of the hand was traced with Leap motion controller, motivation effect was assessed with modified Intrinsic Motivation Inventory and clinical effectiveness was evaluated with Box & Blocks Test (BBT) and shortened Unified Parkinson's disease rating scale (UPDRS) before and after the training. Mack-Skilling non-parametrical statistical test was used to identify statistically significant differences (p < 0.05) and Cohen's U3 test to find the effect sizes. Results Participants in the 3D group demonstrated statistically significant and substantially better performance in average time of manipulation (group x time, p = 0.009), number of successfully placed cubes (group x time, p = 0.028), average tremor (group x time, p = 0.002) and UPDRS for upper limb (U3 = 0.35). The LCD and 3D groups substantially improved their BBT score with training (U3 = 0.7, U3 = 0.6, respectively). However, there were no statistically significant differences in clinical tests between the groups (group x time, p = 0.2189, p = 0.2850, respectively). In addition the LCD group significantly decreased the pressure/tension (U3 = 0.3), the 3D did not show changes (U3 = 0.5) and the differences between the groups were statistically different (p = 0.037). The 3D group demonstrated important increase in effort (U3 = 0.75) and perceived competences (U3 = 0.9). Conclusions The outcomes of the study demonstrated that the immersive 3D technology may bring increased interests/enjoyment score resulting in faster and more efficient functional performance. But the 2D technology demonstrated lower pressure/tension score providing similar clinical progress. A study with much larger sample size may also confirm the clinical effectiveness of the approaches.