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Physical–cognitive stimulation has emerged as a promising strategy for improving the quality of life of patients with amyotrophic lateral sclerosis (ALS). This case study reports on the use of immersive virtual reality (IVR) as a tool for multisensory stimulation in a woman with ALS (76 years old; 11 years since diagnosis; stage 2). The program consisted of IVR stimulation sessions (three sessions per week for 12 weeks). The results showed that the implementation of the program was feasible and safe (no adverse symptoms on the Simulator Sickness Questionnaire), as well as easy to execute (>80% on the System Usability Scale). Additionally, the participant reported improvements in aspects related to her mental health (44% depression and 20% anxiety) and improvements in her quality of life, and she also maintained her values in her functional capacity. This study presents novel and important findings by demonstrating the feasibility of implementing physical–cognitive stimulation programs with IVR in a person with ALS, allowing for multisensory stimulation with commercially available hardware and software and the generation of benefits in their health-related quality of life and mental health. [ABSTRACT FROM AUTHOR]

Background: Multiple sclerosis is a chronic, inflammatory, neurodegenerative autoimmune disease caused by myelin loss in the central nervous system, which leads to motor and non-motor problems. The main objective of this study was to explore whether an immersive virtual reality (IVR) exercise programme would be feasible as a form of physical therapy for people with MS (pwMS). Methods: 18 participants (13 women; 45.06 years) were assigned to an experimental group (EG, n = 8) and a control group (CG, n = 10). The EG took part in a twice-weekly IVR exergame physical therapy programme—ExeRVIEM programme. A randomised, single-blind clinical trial was conducted and was registered in clinicaltrials (NCT05870254). Results: The intervention was feasible and safe. The participants completed the programme with no adverse effects (no symptoms on the Simulator Sickness Questionnaire), high usability (System Usability Scale 90.31%), and outstandingly positive post-game experiences (Game Experience Questionnaire 3.10/4). In addition, the GE significantly improved several of their functional capacities: increased lower limb strength (Five Times Sit-to-Stand Test p = 0.042), improved functional mobility, and reduced fall risk (Timed Up and Go Test-simple p = 0.009; Timed Up and Go Test-cognitive p = 0.003). There were no statistically significant differences between the groups. Conclusions: The findings support that the use of exergames and IVR as physical therapy in pwMS is feasible and safe. Furthermore, there is the suggestion of possible benefits to participants' functional abilities, all of which position IVR as a promising tool for the rehabilitation of this neurodegenerative pathology affecting young adults. [ABSTRACT FROM AUTHOR]

Intense exercise can be neuromodulatory and neuroprotective against Parkinson's disease (PD). Indoor cycling is a good and safe option for this population, but some barriers (monotonous and repetitive environment, lack of monitoring, and an inability to compete with others) could limit its use. Immersive virtual reality (IVR) could be a possible solution to some of these drawbacks, increasing patient motivation and thus adherence to forced exercise programs using cycloergometers. A double-blind, randomized, controlled clinical trial was conducted to explore the feasibility and effects of the ReViPark program (high-intensity pedaling + IVR for 3 months with two sessions per week) on PD progression. In all, 52 people with PD were allocated to the ReViPark group (n = 30; 70.87 ± 6.67 years) and smart cycloergometer group (n = 22; 70.59 ± 6.67 years). This program was feasible, with no adverse effects (no significant Simulator Sickness Questionnaire symptoms and a low negative experience rating for the Game Experience Questionnaire (0.04/4)), no dropouts, high adherence, and good usability (System Usability Scale score of 82.90%). The ReViPark group showed significant improvements in functionality, quality of life, and disease progression as measured by their balance, gait and risk of falling (Timed Up and Go p = 0.028; Tinetti test p = 0.046), PDQ-39 scores (p = 0.035), and MDS-UPDRS scores (p = 0.001). This program is feasible and could lead to improvements in the functional parameters, quality of life, and symptomatology of the participants. [ABSTRACT FROM AUTHOR]

Immersive virtual reality (IVR) uses customized and advanced software and hardware to create a digital 3D reality in which all of the user's senses are stimulated with computer-generated sensations and feedback. This technology is a promising tool that has already proven useful in Parkinson's disease (PD). The risk of falls is very high in people with PD, and reaction times and processing speed may be markers of postural instability and functionality, cognitive impairment and disease progression. An exploratory study was conducted to explore the feasibility of reaction time tests performed in IVR as predictors of falls. A total of 26 volunteers (79.2% male; 69.73 ± 6.32 years) diagnosed with PD (1.54 ± 0.90 H&Y stage; 26.92 ± 2.64 MMSE) took part in the study. IVR intervention was feasible, with no adverse effects (no Simulator Sickness Questionnaire symptoms). IVR reaction times were related (Spearman's rho) to functionality (timed up and go test (TUG) (rho = 0.537, p = 0.005); TUG-Cognitive (rho = 0.576, p = 0.020); cognitive impairment mini mental state exam (MMSE) (rho = −0.576, p = 0.002)) and the years of the patients (rho = 0.399, p = 0.043) but not with the first PD symptom or disease stage. IVR test is a complementary assessment tool that may contribute to preventing falls in the proposed sample. Additionally, based on the relationship between TUG and reaction times, a cut-off time is suggested that would be effective at predicting the risk of suffering a fall in PD patients using a simple and quick IVR test. [ABSTRACT FROM AUTHOR]

One of the pillars which underpins active aging is found in the performance of physical activity. While adherence to physical activity programs has traditionally been low in older people, immersive virtual reality (IVR) could provide an alternative and complementary training mode. A randomized clinical trial was conducted to explore the feasibility and effects of a 10-week IVR exergame program on physical functions of 24 institutionalized older adults who were allocated to an experimental group (EG n = 13; 85.08 ± 8.48 years) and control group (CG n = 11; 84.82 ± 8.10 years). The IVR intervention was feasible, with no adverse effects being reported (no Simulator Sickness Questionnaire symptoms; low negative experience scores on the Game Experience Questionnaire < 0.34/4), no dropouts, high adherence, and good post-gaming usability (System Usability Scale > 73.96%). The EG showed significant improvements: Tinetti scores for balance (1.84 ± 1.06; p < 0.001), gait (1.00 ± 1.08; p < 0.001), total score (2.84 ± 1.67; p < 0.001), and handgrip (4.96 ± 4.22; p < 0.001) (pre–post assessment). The CG showed significantly worsened compared to the EG: Five times sit-to-stand test, Tinetti scores for balance, gait, and total score, and the Timed Up and Go test total score (post-assessment). The findings show that the IVR intervention is a feasible method to approach a personalized exercise program and an effective way by which to improve physical function in the target population. [ABSTRACT FROM AUTHOR]

Physical exercise has been recognized as an important strategy in the promotion of healthy aging. Positive effects on older adults' motor ability are brought about by engaging their motor skills and promoting sensorimotor learning and cortical plasticity. These processes could be increased with the use of immersive virtual reality (IVR) technology, since the multisensory stimulation is greater. The aim of this study was to explore the usability and balance effects of an IVR exercise program in community-dwelling nonagenarian people. A sample of 12 women were allocated to an experimental group (EG n = 6; 91.67 ± 1.63 years) and a control group (CG n = 6; 90.83 ± 2.64 years). For 10 weeks, the EG used a commercial IVR exergame three times a week. All the sample completed the program without adverse effects (without Simulator Sickness Questionnaire symptoms). Post-gaming usability was good (System Usability Scale 78.33). The EG improved some balance parameters significantly (Tinetti test: balance (10.97 %; Sig = 0.017), gait (9.23%; Sig = 0.047) and total score (10.20%; Sig = 0.014) and maintained total TUG test times (−0.45%)). There were significant differences between groups (Tinetti test: balance (Sig = 0.004) and total score (Sig = 0.0032)). We successfully demonstrated that IVR training is feasible and is an effective and personalized method to enhance balance and to reduce the risk of falls in community-dwelling nonagenarian women. [ABSTRACT FROM AUTHOR]

Parkinson's disease (PD) is a neurological disorder that usually appears in the 6th decade of life and affects up to 2% of older people (65 years and older). Its therapeutic management is complex and includes not only pharmacological therapies but also physiotherapy. Exercise therapies have shown good results in disease management in terms of rehabilitation and/or maintenance of physical and functional capacities, which is important in PD. Virtual reality (VR) could promote physical activity in this population. We explore whether a commercial wearable head-mounted display (HMD) and the selected VR exergame could be suitable for people with mild–moderate PD. In all, 32 patients (78.1% men; 71.50 ± 11.80 years) were a part of the study. Outcomes were evaluated using the Simulator Sickness Questionnaire (SSQ), the System Usability Scale (SUS), the Game Experience Questionnaire (GEQ post-game module), an ad hoc satisfaction questionnaire, and perceived effort. A total of 60 sessions were completed safely (without adverse effects (no SSQ symptoms) and with low scores in the negative experiences of the GEQ (0.01–0.09/4)), satisfaction opinions were positive (88% considered the training "good" or "very good"), and the average usability of the wearable HMD was good (75.16/100). Our outcomes support the feasibility of a boxing exergame combined with a wearable commercial HMD as a suitable physical activity for PD and its applicability in different environments due to its safety, usability, low cost, and small size. Future research is needed focusing on postural instability, because it seems to be a symptom that could have an impact on the success of exergaming programs aimed at PD. [ABSTRACT FROM AUTHOR]

Video games have proven useful in physical rehabilitation therapy. Accessibility, however, is limited for some groups such as the elderly or patients with Parkinson's disease (PD). We explore the potential of fully immersive video games as a rehabilitation tool in PD patients. Four patients with mild-moderate PD (3 males:1 female, 53–71 years) participated in the study. Training consisted in two immersive virtual reality video gaming sessions. Outcomes were evaluated using System Usability Scale (SUS), Simulator Sickness Questionnaire (SSQ), Game Experience Questionnaire-post game (GEQ), an ad hoc satisfaction questionnaire and perceived effort. All participants completed the sessions without adverse effects (100%), without SSQ symptoms reported. Post-gaming SUS was >75% in both sessions (range 75–80%). Post-gaming GEQ scores were 3.3–4.0/4 in both sessions. Immersive virtual reality video gaming is feasible in patients with mild-moderate PD, with positive usability and patient satisfaction, and no adverse effects. [ABSTRACT FROM AUTHOR]