Digital healthcare using augmented reality glasses can help people with Parkinson’s disease train their walking and balance at home. The therapy is feasible, safe and user-friendly, with high levels of adherence.
This is according to research by psychologist Lotte Hardeman and Stroll.co colleagues.
Augmented-reality glasses are ‘smart’ glasses. They enrich the real world with visual, digital objects—such as the basketballs and the hoop in the image above. These are also referred to as holograms. These holograms remain in a fixed position within the real world, even when you move around. The rest of your surroundings remains clearly visible.
Physiotherapy at home with augmented reality
The number of people with Parkinson’s disease is increasing, while the number of healthcare professionals is declining. Digital healthcare can help reduce pressure on healthcare services, improve access to care and give patients greater control over their treatment. However, this form of care is still rarely used in everyday practice.
Hardeman and colleagues investigated whether augmented reality glasses (AR glasses) could support people with Parkinson’s in performing walking and balance exercises at home. This form of therapy, known as exergaming, exercises as games, combines digital training at home with therapy in the clinic. The therapist prescribes a training program remotely via a web portal.
She also investigated how patients, physiotherapists and exercise therapists experience home-based therapy, and whether the technology could be used for other training goals, such as physical fitness and cognitive function.
Home-based training offers potential
The results show that exergaming therapy could develop into a form of home-based therapy that addresses several training goals simultaneously., Hardeman and colleagues write.
Besides walking and balance, the therapy can be extended to include motor-cognitive exercises and training at moderate to high intensity. According to Hardeman and colleagues, the technology therefore offers opportunities to combine different aspects of movement and cognition.
Patients and therapists generally find home-based training acceptable. Digital therapy can therefore provide an accessible (at home) and flexible (anywhere at any time) addition to physiotherapy delivered in a clinical setting.
However, implementation of digital care requires attending to the needs and barriers for different stakeholders, such as patients and therapists. For example, the importance of maintaining the therapeutic relationship for providing movement feedback at home and the differences between users in physical capacity and motor symptom severity.
Organisation and funding require attention
According to Hardeman and colleagues further research is needed to establish the effectiveness of the therapy and how it can be implemented sustainably on a wider scale. For sustained implementation, the added value of the intervention to different stakeholders (patients and therapists, but also physiotherapy practices and the wider healthcare system) is an important indicator. For example, it is necessary to determine how remote digital Parkinson’s care can be organised within clinical practice and beyond, on a system level, to add value.
The research raises several questions. Could digital therapy at home make physiotherapy more accessible and easier for people with Parkinson’s disease to maintain? Could this form of home-based digital therapy, with prescriptions and monitoring provided remotely, save therapist time and how should work processes be changed? Does the home-delivery scenario add economic value for clinical practices and the healthcare system as a whole? At the same time, could delivering therapy digitally, reduce pressure on therapists and improve their job satisfaction?
Acceptability among therapists and implementation in physiotherapy practices is partly dependent on the time investment for therapy delivery and funding opportunities. However, the current funding model does not allow for digital care delivered at home, which partly prevents physiotherapy practices to adopt digital home-based care.
Six weeks of training with AR glasses
The research consisted of experimental studies, interviews and focus groups. Participants with Parkinson’s trained with the AR glasses for six weeks, five times a week for 30 minutes per session, as a supplement to their usual physiotherapy. Therapists could adjust the difficulty level, type of game, frequency and duration of the training.
Walking and balance tests were carried out at the movement laboratory of Vrije Universiteit Amsterdam (VU) before and after the training period. Measurements were also taken at participants’ homes to determine the intensity of the games. Interviews and focus groups explored the experiences of patients and therapists. In addition, Hardeman collaborated with other researchers on a consensus paper on motor-cognitive therapy.