Revolutionizing visual biofeedback therapy in Parkinson disease management: beyond traditional therapy

Abstract

Parkinson's disease (PD) is the second most prevalent age-related neurodegenerative disorder after Alzheimer’s disease, affecting over 6.5 million individuals worldwide. The global prevalence of PD is projected to double within the next 20 to 30 years.¹ Currently, the disease affects approximately one to two individuals per 1,000 people.² In Asia, the highest prevalence of PD is reported in China, accounting for 36% of all neurological disorders.³ In Pakistan, population-based data on the prevalence of Parkinson's disease (PD) remain limited. However, a systematic review of seven studies reported a total of 1,016 cases, including 600 from Khyber Pakhtunkhwa, 85 from Lahore, and 50 from Rawalpindi.⁴ An additional observational study conducted in Islamabad contributed to these findings. The review highlighted a rise in PD cases over the past decade, with a higher prevalence among males compared to females, reflecting global trends.⁵

The PD encompasses both motor and non-motor symptoms (NMS). Motor symptoms include tremors, rigidity, akinesia, postural instability, and balance impairments, while NMS involve cognitive and psychological impairments.⁶ Various exercises are utilized in the management of PD, including traditional physical therapy (PT) approaches such as balance training, strengthening exercises, stretching, and treadmill training. However, traditional PT has limitations, including inadequate follow-up, financial challenges, and concerns regarding patient safety.⁷

To address the limitations of traditional PT, there has been a paradigm shift toward neurological technological advancements.⁸ Among these, Visual Biofeedback Therapy (VBFT) utilizing Wii-Fit exercises has gained significant interest from researchers.⁹ VBFT is a cost-effective device consisting of a balance board and an interactive real-time stimulation interface. It incorporates four components: balance, strength training, yoga, and aerobics. During therapy, PD patients perform exercises displayed on a screen using an avatar, while therapists provide visual cues to guide them.¹⁰ A 2024 meta-analysis demonstrated that VBFT using Wii-Fit exercises significantly improves balance in patients with stage I to IV PD.¹¹

Despite advancements in PD rehabilitation, there remains a lack of data, particularly in Pakistan, regarding the effectiveness of VBFT with Wii-Fit in improving motor functions such as balance and gait in PD patients. VBFT has proven to be more engaging and safer compared to traditional PT, with high patient receptivity and compliance. Beyond motor improvements, VBFT also positively impacts NMS, including cognition and psychological well-being.

By transitioning from traditional PT to VBFT, Parkinson’s patients can benefit from a more holistic and interactive rehabilitation approach. Incorporating VBFT into treatment plans enables healthcare professionals to provide advanced and comprehensive care, addressing the multifaceted needs of PD patients while enhancing their independence and overall quality of life.