Movement analysis of pick-and-place virtual reality exergaming in patients with Parkinson's disease.

BACKGROUND: Reduced coordination of precise small movements of the hand, wrist and fingers in Parkinson's disease (PD) has been mostly solved by medications and deep brain stimulation. The effects have been evaluated by clinical tests only. OBJECTIVE: Virtual reality-based exergaming may enhance fine movements, decrease the medications dosage and provide an additional non-subjective evaluation. METHODS: 3D pick-and-place task (10Cubes) has been developed in a virtual world. The person placed the virtual cubes by the virtual hand, an avatar of the real hand tracked by a Leap Motion Controller (LMC). The system computed the time of manipulating the cube, the total time, the average time, the speed, and the distance. It counted and managed the number of cubes touched, and calculated the hand shake level, i.e. the average tremor index. A pilot test was carried out in a healthy neurologically intact person and a patient with PD using a 3D head-mounted device (HMD) or LCD screen. RESULTS: The results indicate that substantial and also statistically significant (p < 0.05) differences exist between both participants in all objective parameters; the most noteworthy is the average tremor index. However, we found the parameters only marginally different with 2D equipment. CONCLUSIONS: The evaluation system of 10Cubes has proved applicable at an unchanged medication plan, but its clinical effectiveness could be confirmed with a randomized study.