447www.neu ologia.com Re Neu ol 2020; 71 (12): 447-454
ORIGINAL
In oduc ion
Neu ological diso de s a e a common heal h p ob-
lem a ec ing people o di e en ages and sexes all
a ound he wo ld. Du ing he las decades, despi e
inno a i e ea men s and ea ly de ec ion, bo h he
p e alence and he numbe o disabili y-adjus ed
li e-yea s o he popula ion wi h neu ological diso -
de s con inue o inc ease [1]. All o he neu ologi-
cal diso de s which a ec he cen al ne ous sys-
em a e associa ed wi h a dec ease in quali y o li e,
highe disabili y, and a loss o unc ional pe o -
mance, such as gai di icul ies [2].
Pa kinson’s disease (PD) is he mos equen
neu ological a ec a ion in he elde ly, along wi h
demen ia [2]. P e alence in indus ialized coun ies
is es ima ed be ween 0.3-1% in subjec s olde han
60 yea s, and 3% in people o e 80 yea s o age, wi h
incidence a es o be ween 0.08 and 0.18 pe 1,000
people/yea [3]. PD is a p og essi e illness associ-
a ed wi h he dea h o dopamine-p oducing cells,
causing an imbalance be ween neu o ansmi e s
due o an inc ease in ace ylcholine and glu ama e
[4]. I mainly a ec s a pe son’s mo emen s, cha ac-
e ized by emo , igidi y, and b adykinesia, caus-
ing muscle weakness and balance al e a ion [5,6].
This neu ological disease a ec s gai wi h a gai
pa e n equen ly al e ed, leading o di icul ies in
daily ac i i ies. Nowadays, he s anda d physio he a-
py ea men consis s o imp o ing balance skills,
s eng h, and coo dina ion by eaching simple exe -
cises [7], combining wi h obo ic gai assis ance when
possible [8].
This s udy used a ehabili a ion app oach ha
combines imme si e i ual eali y wi h a eadmill
p o iding mechanical body weigh suppo hanks
o a sys em o ha nesses and pulleys. T eadmill ain-
ing is conside ed an e ec i e in e en ion o im-
p o e gai endu ance [9] and gai pa ame e s such as
gai speed, s ide leng h [9,10] in pa ien s wi h PD,
wi hou addi ional isk compa ed o s anda d phys-
io he apy ea men [10]. In pa allel, i ual eali y
Imme si e i ual eali y and an ig a i y eadmill aining
o gai ehabili a ion in Pa kinson’s disease:
a pilo and easibili y s udy
Na alia B andín-De la C uz, Nicolás Seco o, Sand a Cal o, Yacine Benyouce , Pablo He e o, Pablo Bellos a-López
Uni e sidad San Jo ge; Villanue a
de Gállego, Za agoza, España
(N. B andín-De la C uz, N. Seco o,
S. Cal o, P. Bellos a-López).
SPACEMEDEX; Valbonne Sophia-
An ipolis, F ancia (Y. Benyouce ).
Depa amen o de Fisia ía y
En e me ía; Uni e sidad de Za agoza;
Za agoza, Spain (P. He e o).
Co espondencia:
D . Pablo He e o. Depa amen o
de Fisia ía y En e me ía. Facul ad de
Ciencias de la Salud. Uni e sidad
de Za agoza. Domingo Mi al, s/n.
E-50009 Za agoza (Spain).
E-mail:
[email p o ec ed]
Funding:
P.B.L. is suppo ed by he G an FPI
2018 (CPB09/18) om ‘Gobie no
de A agón’ and co- inanced by
‘P og ama Ope a i o FSE A agón
2014-2020’. Aldeb an p o ided
he equipmen , and C oss4Heal h
suppo ed he p ojec ha led o
he de elopmen o Mo ig a i y
(G an Ag eemen 731391, Sub-
G an Ag eemen no. 2018/A05-4).
Acknowledgmen s:
A agon Associa ion o Pa kinson.
Accep ed:
30.10.20.
How o ci e his pape :
B andín-De la C uz N, Seco o N,
Cal o S, Benyouce Y, He e o P,
Bellos a-López P. Imme si e i ual
eali y and an ig a i y eadmill
aining o gai ehabili a ion in
Pa kinson’s disease: a pilo and
easibili y s udy. Re Neu ol 2020;
71: 447-54. doi: 10.33588/
n.7112.2020352.
Ve sión española disponible
en www.neu ologia.com
© 2020 Re is a de Neu ología
In oduc ion. T eadmill aining is conside ed an e ec i e in e en ion o imp o e gai abili y in pa ien s wi h Pa kinson’s
disease (PD). In pa allel, i ual eali y shows p omising in e en ion wi h se e al applica ions in he inpa ien medical
se ing.
Aim. To e alua e he easibili y and p elimina y e icacy o mechanical gai assis ance combined wi h imme si e i ual
eali y in pa ien s wi h PD.
Pa ien s and me hods. This pilo and easibili y s udy ollowed a p e-pos s udy design. The in e en ion consis ed o 12
sessions o 30 minu es, dis ibu ed egula ly o e ou consecu i e weeks. Pa icipan s walked on a eadmill wi h a body-
weigh suppo sys em se a app oxima ely 20% o body weigh and equipped wi h a i ual eali y helme con olled by a
wo-handed joys ick. Feasibili y and in e en ion ou comes we e collec ed a baseline and a e ou weeks o in e en ion.
Resul s. Twel e pa icipan s o 60 pa ien s we e inally en olled. Nine o hem (75%) comple ed he ea men in e en ion
wi h an adhe ence a e o 97%. Two pa icipan s le he s udy, one o hem due o sickness associa ed wi h i ual eali y
and ano he because o a lack o mo i a ion. The e we e signi ican di e ences associa ed wi h small-medium e ec sizes
when compa ing he p e and pos alues o walk dis ance, walk speed, balance, and quali y o li e.
Conclusions. The p esen s udy p o ided p elimina y e idence suppo ing he easibili y o he combina ion o an ig a i y
eadmill and imme si e i ual eali y sys em o he ehabili a ion o pa ien s wi h PD.
Key wo ds. Gai . Pa kinson’s disease. Physical he apy. Quali y o li e. T eadmill aining. Vi ual eali y.
448 www.neu ologia.com Re Neu ol 2020; 71 (12): 447-454
N. B andín-De la C uz, e al
shows p omising in e en ions wi h se e al applica-
ions in he inpa ien medical se ing [11]. Indeed,
ehabili a ion wi h i ual eali y allows he pe son
o wo k on locomo ion diso de s, gai , and balance,
as well as any o he diseases. Vi ual eali y is no ed
as a po en ial he apeu ic ool o imp o e balance
and gai abili y [9,12,13] in pa ien s wi h PD wi hou
any associa ed ad e se e ec s [14]. The combina ion
o bo h exis ing ea men p ocedu es may p o ide
inno a ion in neu ologic ehabili a ion, he e o e
becoming an al e na i e o he s anda d physio he -
apy me hods o gai ehabili a ion. The inno a i e
ea men esul ing om joining mechanical, p op-
iocep i e, and imme si e isual s imuli could ha e
mo e e ec a he cen al le el, and hus imp o e he
au onomy and independence o indi iduals. Besides,
he e a e no p e ious s udies in pa ien s wi h PD o
o he adul neu ological popula ions which ha e
conside ed his he apeu ic combina ion. This s udy
aimed o e alua e he easibili y and p elimina y e -
icacy o mechanical gai assis ance combined wi h
imme si e i ual eali y in pa ien s wi h PD.
Pa ien s and me hods
S udy design
This pilo and easibili y s udy ollowed a p e-pos
s udy design [15], app o ed by he E hics Commi ee
o A agon (CEICA) wi h egis a ion numbe C.P.-
C.I. PI18/386 and egis e ed in ClinicalT ials.go
wi h he iden i ie NCT04117737.
Pa ien s
Each pa ien was in o med abou he na u e o he
s udy, objec i es, and olun a y pa icipa ion, as
well as possible ad e se e ec s ha may occu du -
ing i s implemen a ion, such as muscle a igue, sick-
ness, o nausea. Each pa icipan signed in o med
consen be o e pa icipa ing in he s udy.
Inclusion c i e ia we e: diagnosis o PD by a
neu ological doc o ; an al e a ion o he gai bu
being able o walk independen ly o a dis ance o
a leas 10 me e s; a heigh highe han 150 cm; be-
ing mo e han 18 yea s old. Exclusion c i e ia we e:
being blind; ha ing medical con aindica ions o
walking; being an ampu ee; a his o y o in ake o
alcohol-d ugs; p esen ing o he diseases ha im-
pede he in e en ion. Wi hd awal c i e ia we e:
expe iencing pain du ing walking ha changed he
gai pa e n; e usal o con inue; missing mo e han
wo in e en ions o one assessmen .
P ocedu e
The s udy was execu ed in he A agon Associa ion
o Pa kinson (Za agoza, Spain) o pa ien s wi h PD.
The associa ion in o med all hei membe s o he
possibili y o pa icipa ing h ough in e nal com-
munica ion me hods. Those pa ien s who epo ed
hei willingness o pa icipa e in he s udy we e
codi ied wi h a consecu i e numbe . Pa icipan s
we e consecu i ely assessed o eligibili y acco ding
o a andomized lis . Pa icipan s who ul illed he
inclusion c i e ia we e en olled in he in e en ion
g oup. E e y pa icipan was assessed o all in e -
en ion ou comes a baseline (he ea e called ‘p e’)
and a e 4-weeks (he ea e called ‘pos ’), p ecisely
h ee days a e he end o he in e en ion p o-
g am. The in e en ion began jus a e he baseline
assessmen was comple ed.
In e en ion
The in e en ion consis ed o 12 sessions o 30 min-
u es, dis ibu ed egula ly o e ou consecu i e
weeks (3 sessions pe week) [16-19]. Sessions con-
sis ed o walking a a sel -selec ed com o able
walking speed on a eadmill wi h a body-weigh
suppo sys em se a app oxima ely 20% o body
weigh and equipped wi h a i ual eali y helme
con olled by a wo-handed joys ick (Mo ig a i y,
manu ac u ed by Aldeb an; Cu no, I aly) (Fig. 1).
Be o e and a e each aining session, pa icipan s
pe o med wa m-up and cool-down exe cises o
5-minu es each. The body-weigh suppo discha ge
was selec ed, aking in o accoun p e ious s udies
[18-21]. The i ual en i onmen consis ed o a
Ma ian landscape wi h dunes, ocks, and buildings,
allowing slope changes, obs acles, and ba ie s, e-
spec i ely (Fig. 2). The i ual eali y sys em was
con olled ia he wo-handed joys ick de ice and
was independen o he eadmill speed. The joy-
s icks o e ed he abili y o use bo h hands, u he
enhancing i ual eali y in e ac ion and dual- ask
ehabili a ion. The pa ien was old o explo e he
landscape and mo e o wa d by pushing bo h joy-
s icks simul aneously in he o wa d di ec ion. A
he same ime, he pa ien was ins uc ed o push
bo h joys icks simul aneously o he igh o he le
o change he di ec ion and o e come obs acles.
The pa ien ’s ep esen a ion in he i ual eali y
sys em was designed o s op when he e was no in-
e ac ion wi h he joys icks, al hough he eadmill
ollows unning. Each pa ien was asked o selec
hei com o able speed du ing he wa m-up. Ne -
e heless, he physio he apis esponsible o he
449www.neu ologia.com Re Neu ol 2020; 71 (12): 447-454
Imme si e i ual eali y and an ig a i y eadmill aining
in e en ion adjus ed he eloci y du ing each ses-
sion, depending on he pa ien ’s pe cep ion and a-
igue.
Measu es
Sociodemog aphic and clinical a iables
Pa ien ’s sociodemog aphic da a (gende , age, heigh ,
weigh ) and clinical da a (modi ied Hoehn and Yah
s aging scale [22], numbe o hou s walking by day,
numbe o alls du ing he las week) we e collec ed
a baseline.
Feasibili y o ec ui men and p o ocol adhe ence
Ra es o ec ui men , eligibili y, and adhe ence o
he in e en ion we e egis e ed. One week a e
he end o he in e en ion p og am, an indepen-
den e alua o , blinded o he in e en ion and he
assessmen , conduc ed a sho in e iew ega ding
he pa icipan s’ sa is ac ion and accep abili y o
assessmen and in e en ion p ocedu es. Pa ici-
pan s a ed hei le el o sa is ac ion wi h he in e -
en ion in a 5-poin s Like scale (0: ‘ e y dissa is-
ied’; 1: ‘qui e dissa is ied’; 2: ‘nei he sa is ied no
dissa is ied’; 3: ‘qui e sa is ied’; 4: ‘ e y sa is ied’).
In e en ion ou comes o
in es iga ing p elimina y e icacy
All ou come measu es, a P e and Pos assessmen s,
we e e alua ed by a single physio he apis ained
in he p o ocol. All e alua ions we e pe o med when
pa icipan s we e in he ‘on’ medica ion s a e, ap-
p oxima ely one hou a e he in ake o hei egu-
la medica ion [23].
The p ima y ou come o in es iga ing p elimi-
na y e icacy was gai dis ance, in me e s, by using
he 6 Minu e Walk Tes (6MWT). This es consis s
o measu ing he maximum dis ance ha he sub-
jec can walk a la su ace o 6 minu es [24].
Seconda y ou comes o in es iga ing p elimina y
e icacy we e gai speed, balance, and quali y o li e.
Gai speed, in me e s pe second, was assessed
by using he 10 Me e Walk Tes (10MWT). This
es consis s o asking he subjec o walk a a com-
o able speed a 14-me e s dis ance on a la su ace
and measu ing he ime spen om me e 2 o me-
e 12 ( o emo e he inc ease and dec ease eloci y
phases) [25].
The balance le el was es ima ed by using he Ti-
ne i scale. The Tine i es is a simple and ep o-
ducible scale which is composed o wo subscales,
he balance and gai sec ions. The balance sec ion is
pe o med in si ing and s anding posi ions and
co e s a maximum o 16 poin s, while he gai sec-
ion is pe o med by walking and ep esen s a max-
imum o 12 poin s. To al sco es o e 24 poin s indi-
ca e a low isk o alls, while sco es unde 18 poin s
indica e a high isk o alls [26].
Quali y o li e was assessed by using he 36-I em
Sho -Fo m Heal h Su ey (SF-36) [27]. SF-36 as-
sesses eigh physical and men al heal h domains:
limi a ions in physical ac i i ies because o heal h
p oblems (physical unc ioning); limi a ions in so-
cial ac i i ies because o physical o emo ional
p oblems (social unc ioning); limi a ions in usual
ole ac i i ies because o physical heal h p oblems
( ole physical); bodily pain (bodily pain); psycho-
Figu e 1. Expe imen al image o a pa ien walking on he Mo ig a i y sys em. a) Pos e io iew; b) An-
e io iew.
a b
Figu e 2. Rep esen a i e images o he i ual en i onmen . The en i onmen consis ed o a Ma ian
landscape wi h ocks and buildings (a) o dunes (b).
a b
450 www.neu ologia.com Re Neu ol 2020; 71 (12): 447-454
N. B andín-De la C uz, e al
logical dis ess and well-being (men al heal h); lim-
i a ions in usual ole ac i i ies because o emo ional
p oblems ( ole emo ional); ene gy and a igue ( i-
ali y); and gene al heal h pe cep ions (gene al heal h).
Fo each scale, i em sco es a e coded, summed, and
ans o med, wi h inal alues exp essed as a pe -
cen age anging om 0 (wo s heal h) o 100 (bes
heal h).
Sample size
An es ima ed pilo s udy sample size was conduc -
ed using G*Powe . 3.1.9.2 so wa e, aking in o ac-
coun p e ious da a o minimal de ec able change
o he 6MWT in he popula ion wi h PD [24]. A
o al sample o 12 pa icipan s was equi ed expec -
ing an imp o emen conside ed as la ge e ec size
(Cohen’s d = 0.8), wi h a signi icance le el o 0.05
and a powe o 80%.
S a is ical analysis
Desc ip i e s a is ics we e used o epo da a on
he easibili y o ec ui men and p o ocol adhe -
ence. Va iables we e desc ibed in mean and s an-
da d de ia ion o median and in e qua ile ange.
An in en ion o ea analysis was made by ca ying
o wa d he las alue. The Shapi o-Wilk es o
no mali y showed ha in e en ion a iables did
no ollow a no mal dis ibu ion. The e o e, he
Wilcoxon signed- ank es was used o de e mine
any di e ence be ween p e and pos assessmen
sco es o all in e en ion ou comes. The signi i-
cance le el was se a p < 0.05. Cohen’s d was calcu-
la ed by he s anda dized di e ence be ween p e
and pos means (small e ec : 0.2; medium e ec :
0.5; la ge e ec : 0.8) in hose pa ien s who comple -
ed he in e en ion. The s a is ical analysis was pe -
o med wi h SPSS S a is ics . 25 so wa e.
Resul s
The pa icipan s’ low diag am is p esen ed in ig-
u e 3. Rec ui men commenced in Sep embe 2019
and was comple ed by No embe 2019. O he 60
po en ial pa icipan s who we e in i ed o pa ici-
pa e a Pa kinson A agon, 32 (54%) epo ed hei
willingness o pa icipa e. Po en ial pa icipan s we e
numbe ed and andomly alloca ed o each he a
p io i sample size es ima ion. Thi een pa ien s we e
assessed o eligibili y, and one o hem was exclud-
ed because he pa icipan was no able o wea he
ha ness due o obesi y. In o al, nine pa icipan s
(75%) comple ed he ea men in e en ion and we e
assessed a he 4-week ollow-up. The adhe ence
a e, calcula ed as he a io be ween he sessions
pe o med and he sessions scheduled (12 sessions),
was 97%. D opou s ac oss he s udy we e due o
sickness associa ed wi h i ual eali y a e wo
sessions o in e en ion (n = 2) and because o lack
o mo i a ion a e h ee sessions o in e en ion
(n = 1). The h ee d opou s we e male and had a
sco e o 2-2.5 on he modi ied Hoehn and Yah
s aging scale. Amongs he nine pa icipan s who
comple ed he in e en ion, se en o hem epo ed
being ‘ e y sa is ied’ wi h he in e en ion, while wo
we e ‘qui e sa is ied’. Pa icipan s a o ably high-
ligh ed he secu i y sensa ion o he body weigh
suppo a he same ime hey had o pe o m he
dual- ask consis ing o walking o e he eadmill
and con olling he i ual eali y sys em wi h he
joys ick de ices. In con as , he main sugges ion o
imp o emen conce ned he Ma ian landscape,
which some imes was conside ed mono onous.
Pa icipan s had a mean age o 68.8 ± 7.7 yea s,
and 58% we e male. The mean weigh was 70.2 ±
15.2 kg, and he mean heigh was 162.6 ± 8,2 cm.
Acco ding o he modi ied Hoehn and Yah s aging
Figu e 3. Flow cha .
451www.neu ologia.com Re Neu ol 2020; 71 (12): 447-454
Imme si e i ual eali y and an ig a i y eadmill aining
scale, he e we e ou pa icipan s (33%) a s age 2,
h ee pa icipan s a s age 2.5 (25%), ou pa ici-
pan s (33%) a s age 3, and one pa icipan (8%) a
s age 4. They epo ed a mean o 7.5 ± 4.9 hou s o
walking pe week and a median o 0 alls pe week
(in e qua ile ange: 0-1).
Table shows median sco es o in e en ion ou -
comes a bo h ime poin s. Signi ican di e ences
we e obse ed when compa ing he p e and pos al-
ues o dis ance (p = 0.005; e ec size: 0.3) a 6MWT,
o speed (p = 0.047; e ec size: 0.2) a 10MWT, o
balance (p = 0.044; e ec size: 0.6) a he Tine i
scale, and o physical unc ioning (p = 0.027; e ec
size: 0.4), ole physical (p = 0.049; e ec size: 0.6)
and bodily pain (p = 0.018; e ec size: 0.5) a SF-36.
Figu e 4 shows indi idual changes in he 6MWT,
10MWT, and Tine i scale o pa icipan s who ul-
illed he ea men in e en ion.
Discussion
This s udy e alua ed he easibili y and p elimina y
e icacy o an an ig a i y eadmill combined wi h
imme si e i ual eali y o gai ehabili a ion in
pa ien s wi h PD. The main indings sugges ed ha
12 sessions o 30 minu es, o e ou weeks, we e
accep able and easible o deli e in pe sons wi h
PD. Pa icipan s p esen ed excellen adhe ence o
he in e en ions and epo ed high le els o sa is-
ac ion wi h he in e en ion. The s udy also p o-
ides p elimina y e idence o sugges ha he in-
e en ion may ha e a posi i e impac on gai dis-
ance, gai speed, and quali y o li e.
Simila p o ocols o 3 sessions pe week o 30-45
minu es eadmill aining du ing ou weeks e-
ealed imp o emen s in gai abili y [17-19], mo o
unc ion, balance [16,28], cogni i e pa ame e s, and
dep ession [17] in pa ien s wi h PD. O he s udies
ound simila esul s o ou s o he 6MWT, such as
Picelli e al. [17] ha epo ed an imp o emen o
36 me e s du ing ou consecu i e weeks o ead-
mill aining, Nadeau e al [29] ha showed an in-
c ease be ween 34 o 40 me e s and 29 o 44 me e s
in a pe iod o 12-weeks and 24-weeks, espec i ely.
In his line, de Melo e al [30] ob ained an imp o e-
men o app oxima ely 52 o 87 me e s a e a
3-weekly session du ing 4-weeks o eadmill ain-
ing o in e en ion o imme si e i ual eali y com-
pa ed o a con ol g oup. Howe e , hey did no ex-
plo e he e ec o combined in e en ions.
Conce ning ou seconda y ou comes, pos - ea -
men speeds in he 10MWT we e simila o p e ious
s udies ha implemen ed ei he eadmill [17,18,21,
28] o i ual eali y [31] independen ly. Ne e he-
less, imp o emen s we e in e io because ou base-
line alues we e al eady high. The high baseline
sco es could indica e a ceiling e ec ha made i
di icul o ind di e ences in he p e and pos al-
ues. Some hing simila may ha e occu ed conce n-
ing he Tine i scale, as ini ial sco es we e highe
han baseline alues eached in p e ious s udies in
PD [20,26].
P e ious s udies ha e shown he e ec i eness o
i ual eali y aining in gai [23,30-32], balance
[31,32], and cogni i e unc ion [33], bu wi hou
he in eg a ion o an an ig a i y mechanical sup-
po sys em. Acco ding o he au ho s’ knowledge,
he e a e no p e ious s udies ha combined an an-
ig a i y eadmill wi h imme si e i ual eali y in
pa ien s wi h PD. In his con ex , Mi elman e al
[34] ound ha an in e en ion o 3-weekly sessions
o e six weeks, based on non-imme si e i ual e-
ali y combined wi h a medical eadmill, educed
he isk o alls in olde adul s in he long e m, in-
cluding a sub-g oup o pa ien s wi h PD. One yea
la e , Pe uzzi e al [35] compa ed he same ea -
Table. Median sco es and in e qua ile ange o s udy a iables a p e and pos -assessmen s.
P e (n = 12) Pos (n = 12) pES
6MWT (m) 326 (181-379) 374 (201-394) 0.005 a 0.3
Tine i: o al (0-28) 24 (20.8-25.8) 26 (23.5-27.8) 0.044 a 0.6
Tine i: gai sec ion (0-12) 11 (9.3-12) 12 (11-12) 0.123 0.6
Tine i: balance sec ion (0-16) 13.5 (11.3-14) 14.0 (12.3-15.8) 0.066 0.5
10MWT (m/s) 1.38 (0.85-1.64) 1.39 (0.90-1.65) 0.047 a 0.2
Physical unc ioning (SF-36, 0-100) 48 (21-68) 60 (41-83) 0.027 a 0.4
Social unc ioning (SF-36, 0-100) 63 (50-72) 69 (41-85) 0.263 0.4
Role physical (SF-36, 0-100) 41 (9-74) 63 (31-75) 0.049 a 0.6
Bodily pain (SF-36, 0-100) 46 (24-65) 63 (27-82) 0.018 a 0.5
Men al heal h (SF-36, 0-100) 48 (41-56) 52 (45-64) 0.212 0.4
Role emo ional (SF-36, 0-100) 67 (35-98) 67 (50-100) 0.246 0.4
Vi ali y (SF-36, 0-100) 38 (19-45) 43 (35-50) 0.065 0.6
Gene al heal h (SF-36, 0-100) 38 (30-56) 45 (35-54) 0.234 0.3
6MWT: 6 Minu e Walk Tes ; 10MWT: 10 Me e Walk Tes ; ES: e ec size; SF-36: 36-I em Sho -Fo m Heal h Su -
ey. a Signi ican di e ences be ween p e and pos a e Wilcoxon signed- ank es (p < 0.05).

452 www.neu ologia.com Re Neu ol 2020; 71 (12): 447-454
N. B andín-De la C uz, e al
men agains a eadmill-only based in e en ion in
pa ien s wi h mul iple scle osis and ound ha he
dual- ask in e en ion was e ec i e in imp o ing
balance and spa io empo al pa ame e s o gai .
On he one hand, he imp o emen o pa ien s
in his s udy may be due o he bene i s o eadmill
aining, which simula e he ask o walking, im-
p o ing mo o lea ning, and s eng h o he lowe
ex emi ies. On he o he hand, dual- ask wi h he
i ual eali y sys em could ha e con ibu ed o im-
p o ing mo o unc ion as well as he sel -pe cep-
ion o he pa ien s wi h PD [36].
Ou pilo s udy ollowed a p e-pos s udy design,
which has he s eng h o empo ali y o be able o
sugges ha he ou come is impac ed by he in e -
en ion [15]. Howe e , a andomized con olled ial
design would ha e been a be e al e na i e due o
p e-pos s udies no ha ing con ol o e o he ele-
men s ha a e also changing a he same ime as
he in e en ion is implemen ed. Ne e heless, ch on-
ic diseases, such as PD, wi h ex ended pe iods o
s abili y o clinical signs and symp oms, p o ide
ce ain y ha ou comes imp o emen s a e a ib-
u ed o he speci ic in e en ion a he han he
na u al e olu ion o he disease [15]. Also, cogni-
i e pa ame e s should ha e been conside ed [37];
hus, cogni i e impai men may ha e a subs an ial
con ibu ion o he mani es a ion in di e en pa-
ame e s o gai in PD [38].
The p esen pilo s udy sugges ed ha an in e -
en ion o 12 sessions o e ou weeks o an ig a i y
eadmill combined wi h an imme si e i ual eal-
i y sys em was easible o deli e and accep able o
he ehabili a ion o pa ien s wi h PD. P elimina y
e idence sugges ed ha he p oposed in e en ion
has a posi i e e ec on inc easing gai dis ance, gai
speed, balance, and quali y o li e. Fu u e s udies
should e alua e he impac in he long e m, wi h a
andomized con ol ial design, conside ing bo h
physical unc ioning and cogni i e a iables.
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En enamien o an ig a i a o io e inme si o de ealidad i ual pa a la ehabili ación de la ma cha en la
en e medad de Pa kinson: es udio pilo o y de iabilidad
In oducción. El en enamien o en apiz odan e se conside a una in e ención e icaz pa a mejo a la capacidad de la
ma cha en pacien es con en e medad de Pa kinson (EP). Pa alelamen e, la ealidad i ual se mues a como una in e -
ención p ome edo a con di e sas aplicaciones en el en o no médico hospi ala io.
Obje i o. E alua la iabilidad y la e icacia p elimina de la asis encia mecánica pa a la ma cha combinada con la ealidad
i ual inme si a en pacien es con EP.
Pacien es y mé odos. Es e es udio pilo o y de iabilidad siguió un diseño p e-pos . La in e ención consis ió en 12 sesiones
de 30 minu os, dis ibuidas egula men e du an e cua o semanas consecu i as. Los pa icipan es deambula on sob e un
apiz odan e con un sis ema de desca ga del peso co po al es ablecido ap oximadamen e en el 20% del peso co po al y
equipados con un casco de ealidad i ual con olado po un joys ick pa a cada mano. Las mediciones de iabilidad y a-
amien o se ecopila on al inicio del es udio y después de cua o semanas de in e ención.
454 www.neu ologia.com Re Neu ol 2020; 71 (12): 447-454
N. B andín-De la C uz, e al
Resul ados. De un o al de 60 pacien es, se eclu ó inalmen e a 12 pa icipan es. Nue e de ellos (75%) comple a on el a a-
mien o, con una asa de adhesión del 97%. Dos pa icipan es abandona on el es udio, uno debido a náuseas asociadas con la
ealidad i ual y o o po al a de mo i ación. Hubo di e encias signi ica i as asociadas con un amaño del e ec o pequeño-
mediano al compa a los alo es p e y pos pa a la dis ancia eco ida, elocidad de la ma cha, equilib io y calidad de ida.
Conclusiones. El es udio p opo cionó e idencia p elimina que apoya la iabilidad de la combinación de un apiz odan e
an ig a i a o io y un sis ema de ealidad i ual inme si o pa a la ehabili ación de pacien es con EP.
Palab as cla e. Calidad de ida. En e medad de Pa kinson. En enamien o en apiz odan e. Fisio e apia. Ma cha. Realidad
i ual.