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Exergaming-Based Dexterity Training in Persons With Parkinson Disease

A Pilot Feasibility Study

van Beek, Judith J. W. MSc; van Wegen, Erwin E. H. PhD; Bohlhalter, Stephan MD; Vanbellingen, Tim PhD

Journal of Neurologic Physical Therapy: July 2019 - Volume 43 - Issue 3 - p 168–174
doi: 10.1097/NPT.0000000000000278
Research Articles

Background and Purpose: Many individuals with Parkinson disease (PD) suffer from impaired dexterity, which impacts activities of daily living and quality of life. Exergaming, video game-based training with augmented virtual reality, may have value for improving function. The aim of the present pilot study was to comprehensively evaluate the feasibility of a dexterity training program using exergaming, in individuals with PD.

Methods: Ten participants with PD (aged between 55 and 75 years, Hoehn and Yahr stages II-IV) trained over a period of 4 weeks, twice a week for 30 minutes. Baseline (T0) and postintervention (T1) assessments were done. Primary outcomes with respect to feasibility were the adherence rate, open-end questions, the level of participation (Pittsburgh Rehabilitation Participation Scale), and the usability (System Usability Scale). Dexterous function was measured with the Nine-Hole Peg Test and the Dexterity Questionnaire-24. Upper limb motor impairment was assessed by a modified version of the Movement Disorders Society Unified Parkinson's Disease Rating Scale III. Finally, quality of life was assessed by the 39-item Parkinson's Disease Questionnaire (PDQ-39).

Results: Adherence rate was 99%, motivation increased significantly from 3.9 to 4.8 (Pittsburgh Rehabilitation Participation Scale, P = 0.03), and system usability of the exergaming system was acceptable to very good. Regarding potential efficacy, participants with impaired dexterity at T0 significantly improved in the Nine-Hole Peg Test and the PDQ-39.

Discussions and Conclusions: The outcomes of this pilot study suggest that exergaming is feasible and has potential to improve dexterity in individuals with PD. Its efficacy should be investigated in a properly powered randomized controlled trial.

Video Abstract available for more insights from the authors (see Supplemental Digital Content 1, available at:

Neurocenter, Luzerner Kantonsspital, Lucerne, Switzerland (J.J.W.v.B., S.B., T.V.); Department of Rehabilitation Medicine, Amsterdam Movement Sciences, Amsterdam Neurosciences, Amsterdam UMC, Section VUmc, Amsterdam, the Netherlands (E.E.H.v.W.); and Gerontechnology and Rehabilitation Group, University of Bern, Switzerland (T.V.).

Correspondence: Tim Vanbellingen, PhD, Neurocenter, Luzerner Kantons-spital, Lucerne, Switzerland. (;

This study was supported by the Jacques and Gloria Gossweiler Foundation.

Preliminary results were presented at the Parkinson & Movement Disorder Research Meeting, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland, January 2018.

The authors declare no conflict of interest.

Supplemental digital content is available for this article. Direct URL citation appears in the printed text and is provided in the HTML and PDF versions of this article on the journal's Web site (

© 2019 Academy of Neurologic Physical Therapy, APTA