Background: Parkinson's disease (PD) is the second most prevalent neurodegenerative disorder, impairing balance and motor function. Virtual reality (VR) and motor imagery (MI) are emerging techniques for rehabilitating people with PD. VR and MI combination have not been studied in PD patients. This study was conducted to investigate the combined effects of VR and MI techniques on the balance, motor function, and activities of daily living (ADLs) of patients with PD.Methods: This study was a single-centered, two-armed, parallel-designed randomized controlled trial. A total of 44 patients of either gender who had idiopathic PD were randomly allocated into two groups using lottery methods. Both groups received Physical therapy (PT) treatment, while the experimental group (N: 20) received VR and MI in addition to PT. Both groups received assigned treatment for three days a week on alternate days for 12 weeks. The Unified Parkinson’s Disease Rating Scale (UPDRS) (parts II and III), Berg Balance Scale (BBS), and Activities-specific Balance Confidence (ABC) Scale were used as outcome measures for motor function, balance, and ADLs. The baseline, 6^th, and 12^thweeks of treatment were assessed, with a 16^thweek follow-up to measure retention. The data was analysed using SPSS 24.Results: The experimental group showed significant improvement in motor function than the control group on the UPDRS part III, with 32.45±3.98 vs. 31.86±4.62 before and 15.05±7.16 vs. 25.52±7.36 at 12-weeks, and ap-value < 0.001. At 12 weeks, the experimental group's BBS scores improved from 38.95±3.23 to 51.36±2.83, withp-value < 0.001. At 12 weeks, the experimental group's balance confidence improved considerably, from 59.26±5.87to 81.01±6.14, with ap-value of < 0.001. The experimental group's ADL scores improved as well, going from 22.00±4.64 to 13.07±4.005 after 12 weeks, with ap-value of < 0.001.Conclusion: VR with MI techniques in addition to routine PT significantly improved motor function, balance, and ADLs in PD patients compared to PT alone.Trial registration: IRCT20200221046567N1. Date of registration: 01/04/2020

Background: Stroke is a neurological disorder with a vascular cause, such as cerebral infarction or hemorrhage, and causes dizziness, balance, and gait impairments in patients. Vestibular rehabilitation therapy (VRT) involves a variety of exercises that can improve balance, gait, and gaze stability in stroke patients by affecting the vestibular system and improving dynamic balance. By providing a virtual environment, the use of virtual reality (VR) can aid stroke patients in improving their balance and gait. Objective: This study aimed to evaluate the comparative effects of vestibular rehabilitation with virtual reality on dizziness, balance, and gait in patients with subacute stroke. Methods: The randomized clinical trial involved 34 subacute stroke patients randomly assigned to 2 groups; 1 received VRT and the other VR treatment. To assess mobility and balance, the Time Up and Go test was used, the Dynamic Gait Index was used to assess the gait, and the Dizziness Handicap Inventory was used to determine the level of dizziness symptoms. Each group received 24 sessions of allocated treatment, 3 sessions every week for 8 weeks. Using SPSS 20, both groups pretest and posttest readings were analyzed and compared. Results: Between the VR and VRT groups, balance (P−.01) and gait (P−.01) were significantly improved in the VR group, while dizziness was significantly improved in the VRT group with P < .001. On within-group comparison, both groups showed significant improvements in balance, gait, and dizziness with P < .001. Conclusion: Both vestibular rehabilitation therapy and VR improved dizziness, balance, and gait in subacute stroke patients. However, VR was more effective in improving balance and gait among patients with subacute strokes.

Background: Parkinson’s disease is the second most common neurological disease, affecting balance, motor function, and activities of daily living. Virtual reality and motor imagery are two emerging approaches for the rehabilitation of patients with Parkinson’s disease. This study aimed to determine the combined effects of virtual reality and motor imagery techniques with routine physical therapy on the motor function components of individuals with Parkinson’s disease. Methods: The study was a prospective, two-arm, parallel-design randomized controlled trial. Forty-four patients with idiopathic Parkinson’s disease were randomly assigned to one of two groups. Virtual reality and motor imagery were given together with physical therapy in the experimental group (N: 20), while physical therapy treatment alone was given in the control group (N: 21). Both groups received allocated treatment for 12 weeks, 3 days a week, on alternate days. Motor function was assessed at baseline, six weeks, twelve weeks, and sixteen weeks after discontinuing treatment with the Unified Parkinson’s Disease Rating Scale part III. SPSS 24 was used to analyze the data. Results: Study results indicate that the experimental group showed significant improvements in the motor function components: tremor at rest at the 6th week (p = 0.028), 12th week (p = 0.05), and 16th week (p = 0.001), rigidity at the 6th week (p = 0.03), 12th week (p = 0.000), and 16th week (p = 0.001), posture at the 12th week (p = 0.005) and 16th week (p = 0.004), and gait at the 6th week with a p-value of (p = 0.034). Conclusions: This study demonstrated that virtual reality and motor imagery training in combination with routine physical therapy can significantly improve resting tremors, rigidity, posture, gait, and body bradykinesia in individuals with PD in comparison to patients receiving only routine physical therapy.

Background: Parkinson’s Disease (PD) is the second most common progressive neurodegenerative disorder, mostly affecting balance and motor function caused mainly by a lack of dopamine in the brain. The use of virtual reality (VR) and motor imagery (MI) is emerging as an effective method of rehabilitation for people with Parkinson’s disease. Motor imagery and virtual reality have not been compared in patients with Parkinson’s disease. This randomized clinical trial is unique to compare the effects of virtual reality with routine physical therapy, motor imagery with routine physical therapy, and routine physical therapy alone on balance, motor function, and activities of daily living in patients with Parkinson’s disease. Methods: A total of sixty patients with Parkinson’s disease were randomized into three groups using lottery method; twenty with virtual reality therapy in addition to physical therapy (group A = VR + RPT), twenty with imagery therapy in addition to physical therapy (group B = MI + RPT), and twenty were treated with only routine physical therapy (group C = RPT). All patients were evaluated using the Unified Parkinson’s Disease Rating Scale (UPDRS) for motor function and activities of daily living, the Berg balance scale (BBS) for balance, and the Activities-specific Balance Confidence Scale (ABCs) for balance confidence at baseline, six and twelve weeks, and one month after treatment discontinuation. The one-way ANOVA was used to compare the outcomes between three groups, and the repeated measures ANOVA was used to compare the outcomes within each of the three groups at a significance level of p-value = 0.05. Results: According to UPDRS III, the VR + RPT group showed significant improvement in motor function, compared to the MI + RPT and RPT groups, as the Mean ± SD at baseline was 33.95 ± 3.501 and at the 12-week assessment was 17.20 ± 9.451 with a p-value = 0.001. In the VR + RPT group, the BBS score at baseline was 37.15 ± 3.437 and at 12th week was 50.10 ± 4.897 with a p-value = 0.019. Among the VR + RPT group, the ABCS score showed significant improvement as the M ± SD at baseline was 57.95 ± 4.629, and at the 12th week was 78.59 ± 6.386 with a p-value = 0.010. At baseline, the UPDRS II for activities of daily living in the VR + RPT group was 25.20 ± 3.036 and at 12th week it was 15.30 ± 2.364 with p-value of 0.000. Conclusion: The current study found that the combination of VR and RPT proved to be the most effective treatment method for improving balance, motor function, and activities of daily living in patients with Parkinson’s disease when compared to MI + RPT or RPT alone.

Background: Virtual reality (VR) is an advanced technique used in physical rehabilitation of neurological disorders, however the effects of VR on balance, gait, and motor function in people with Parkinson’s (PD) are still debated. Therefore, the systematic review aimed to determine the role of VR on motor function, balance and gait in PD patients. Methods: A comprehensive search to identify similar randomised controlled trials was conducted targeting 5 databases including Web of Science, PubMed, CINHAL, Cochrane Library, and Physiotherapy Evidence Database. A total of 25 studies were found eligible for this systematic review, and the methodological assessment of the quality rating of the studies was accomplished using the physiotherapy evidence database scale by 2 authors. Results: Out of the 25 included studies, 14 studies reported on balance as the primary outcome, 9 studies were conducted to assess motor function, and 12 assessed gait as the primary outcome. Most studies used the Unified Parkinson disease rating scale UPDRS (part-III) for evaluating motor function and the Berg Balance Scale as primary outcome measure for assessing balance. A total of 24 trials were conducted in clinical settings, and only 1 study was home-based VR trainings. Out of 9 studies on motor function, 6 reported equal improvement of motor function as compared to other groups. In addition, VR groups also revealed superior results in improving static balance among patient with PD. Conclusion: This systemic review found that the use of VR resulted in substantial improvements in balance, gait, and motor skills in patients with PD when compared to traditional physical therapy exercises or in combination with treatments other than physical therapy. Moreover, VR can be used as a supportive method for physical rehabilitation in patients of PD. However, the majority of published studies were of fair and good quality, suggesting a demand for high quality research in this area.

Objective The objective of the study was to evaluate the computer workstation settings and the prevalence of musculoskeletal (MSK) related problems in computer users of bank. Methods A cross-sectional study was conducted among100 computer users of State Bank of Pakistan, Faisalabad and National Bank of Pakistan, Faisalabad from March to December 2017. Inclusion criteria of the study were male and female bank workers, age between 25–60 years who use desktop computers for at least 3 h a day and had at least 6 months working experience. Cornell Musculoskeletal Discomfort Questionnaire (CMDQ) was used to determine prevalence of MSK problems while Rapid Office Strain Assessment (ROSA) tool was used to evaluate Computer Work-Station (CWS) ergonomic parameters. The data was analyzed by descriptive statistics and variant correlation using SPSS version 20. Results The mean CMDQ was higher (43.0 ±33.6) in female than male (16.9±20.8) and there was significant association between gender and total discomfort (P=0.001). The discomfort was higher among females then males. The body parts reported to have the most significant levels of discomfort was the neck and head (mean 3.595±7.49), lower back (2.75±5.39) and right shoulder (mean 2.15±4.32).About 40% subjects suffered from neck pain while the remaining body parts having discomfort were right shoulder (39%), left shoulder (37%), and low back (36%).Almost 90% of the participants had ROSA score greater than 5 that shows that most individuals were at higher risk of ergonomics hazardous. Conclusion The results of the present study demonstrated that MSK discomfort is common among computer users of bank employees and neck, shoulder and lower back region were at greater risk. MSK discomfort was higher in females. Workers are exposed to ergonomic hazards and need immediate improvement.