Background: Treadmill gait training has been shown to improve gait performance in People with Parkinson’s Disease (PwPD), and in combination with Virtual Reality, it can be an effective tool for gait rehabilitation. The addition of gamification elements can create a more stimulating and adherent intervention. However, implementation of new technologies in healthcare can be challenging. This study aimed to develop and evaluate the feasibility of a treadmill rehabilitation program in a Gamified Virtual Reality Environment (GVRE) for PwPD.Methods: The GVRE was developed following a user-centered design approach, involving both PwPD and physiotherapists in the development and evaluation of the intervention. The intervention consisted of a walking simulation in three different environments (countryside, city, and park), which had a progressive increase in difficulty. To test its feasibility, three sessions were carried out with four PwPD and four physiotherapists. To assess the usability, the System Usability Scale (SUS), Assistive Technology Usability Questionnaire for people with Neurological diseases (NATU Quest) and Simulator Sickness Questionnaire (SSQ) were used. To assess the intervention’s acceptability, feedback and in-game performance was collected from participants.Results: Results showed the feasibility of the intervention, with a SUS score of 74.82 ± 12.62, and a NATU Quest score of 4.49 ± 0.62, and positive acceptability feedback. Participants showed clear preferences for naturalistic environments, and gamification elements were seen as positive. Difficulty settings worked as intended, but lowered enjoyment of the experience in some cases.Conclusions: This intervention was successfully shown as a feasible option for the training of gait under Dual Task conditions for PwPD. It offers a safe and replicable environment in which complex situations can be trained. However, further iterations of the intervention need to be improved in order to guarantee accurate tracking and a more realistic training progression.Trial registration number: NCT05243394–01/20/2022.

Background: Parkinson’s Disease (PD) affects movement and cognition, and physiotherapy, particularly treadmill gait training, has potential in addressing movement dysfunctions in PD. However, treadmill training falls short in addressing cognitive aspects and adherence. Virtual reality (VR) and gamification can enhance motor and cognitive retraining and improve adherence. People with Parkinson’s Disease (PWPD) have decreased motor skill learning efficiency, but tDCS can improve motor and cognitive learning. Methods: 78 participants with PD will be randomly allocated in a 1:1:1 ratio to one of three groups: (1) treadmill + Gamified Virtual Reality Environment (GVRE) + tDCS training group; (2) treadmill + GVRE training group or (3) treadmill training group. Participants will follow a 6-week, 12-session treadmill gait training plan, gradually increasing session duration from 20 to 45 minutes. Participants in (1) and (2) will undergo a GVRE training protocol, with (1) also receiving tDCS for the first 20 minutes of each session. Assessments will occur at baseline, post-intervention, and at a 6-week follow-up. The primary outcome measure will be gait speed during single and dual-task performance. Secondary measures will include additional gait parameters, executive tests for cognitive performance, and clinical outcomes for disease stage, cognitive status, and physical condition. Discussion: This randomized clinical trial presents an innovative neurorehabilitation protocol that aims to improve gait and cognition in PWPD. The study also examines how tDCS can enhance motor and cognitive training. Results could contribute to enhancing the motor and cognitive state of PWPD through a GVRE and tDCS-based neurorehabilitation protocol. Trial registration: NCT05243394. 28/02/2024 –v3.2

Background: Core stability exercises (CSE) have been shown to be effective in improving trunk function in several neurological diseases, but the evidence is scarce on Hereditary Ataxias (HA). Objective: To evaluate the effectiveness of a 5‐week home‐based CSE program in terms of ataxia severity, trunk function, balance confidence, gait speed, lower limb motor function, quality of life, health status and falls rate in HA individuals at short‐ and long‐term. Methods: This is an assessor‐blind randomized controlled clinical trial parallel group 1:1. The individuals were divided in experimental group (EG) performed standard care in addition to CSE, and control group (CG) performed standard care alone. The CSE home‐program was conducted 1‐h/day, 5‐day/week for 5‐week. The assessment was performed at baseline, endpoint (5‐week), and follow‐up (10‐week). The primary outcomes were ataxia severity assessed by the Scale for the Assessment and Rating of Ataxia and trunk function assessed by Spanish‐version of Trunk Impairment Scale 2.0. The secondary outcomes were balance confidence assessed by Activities‐specific Balance Confidence (ABC), gait speed by 4‐meter walk test (4‐MWT), the lower limb motor function by 30‐s sit‐to‐stand, quality of life by EuroQol 5‐dimension 5‐level (EQ‐5D‐5L), health‐status by EQ‐5D and falls rate. Results: Twenty‐three HA individuals were recruited (51.8 ± 11.10 years). Statistically significant group‐time interaction was shown in ABC (F:5.539; P = 0.007), EQ‐5D‐5L Total (F:4.836; P = 0.013), EQ 5D (F:7.207; P = 0.006). Conclusions: No statistical differences between groups for ataxia severity and trunk function were observed. However, were differences for balance confidence, gait speed, quality of life, and falls rate in HA individuals.

Purpose: This study describes the development of a questionnaire for assessing the usability of assistive technologies accessible to people with neurological diseases. Methods: A Delphi study was conducted to identify relevant items for the questionnaire. After that, the content validity was addressed to identify the essential items. Once the questionnaire was designed following the results of the Delphi study and content validity, the reliability, validity, and the Rasch model of the questionnaire were examined. Results: Two rounds of the Delphi study were carried out. A total of 73 participants (42 experts and 31 users) participated in round 1, and 59 people (27 experts and 32 users) in round 2. A total of 53 and 29 items were identified in rounds 1 and 2, respectively. In the content validity, we found nine items above the threshold of 0.58. Finally, ten items were included in the questionnaire. Fifty-one participants participate in the reliability and validity of the questionnaire. The internal consistency reliability of the questionnaire analyzed by Cronbach’s Alpha was α = 0,895. There was moderate to considerable concordance among our questionnaire items test-retest in the Kappa coefficient and a strong association between test-retest in the Spearman’s coefficient ρ = 0.818 (p<0,001). The intraclass correlation coefficient was 0,869 with a 95% confidence interval (0,781;0,923). There was a strong correlation between the total scores of the new questionnaire and other validated questionnaires analyzed with Spearman’s coefficient ρ = 0.756 (p<0,001). The ten items demonstrated a satisfactory fit to the Rasch model. Conclusions: The present study suggested that the new questionnaire is a reliable 10-item usability questionnaire that allows subjective and quick assessment of the usability of assistive technologies by people with neurological diseases.

Background: Low back pain is one of the most common disabling pathologies in humanity worldwide. Physical exercises have been used in recent decades to reduce the pain, improve the functionality of the lumbar spine and avoid relapses. The purpose of the study is to analyze the effect of a program based on re-education exercises involving preactivation of the abdominal transverse muscle compared to conventional treatment in adults with chronic nonspecific low back pain. Methods: A two-arm, single-blind randomized control trial with 35 primary care patients with chronic nonspecific low back pain. Both groups received a 4-week intervention. Data were collected at baseline and at the end of the intervention. Sixteen patients participated in the intervention group, and 19 patients in the control group. Results: For the experimental group, the outcomes of disability and activation of the abdominal transverse muscle decreased significantly (MD -2.9; CI 95% -5.6 to -0.35; η2 = 0.14; p = 0.028) and (MD 2.3; CI 95% 0.91 to 3.67; η2 = 0.25; p = 0.002) respectively, with a large effect size, compared to the control group. There were no differences between the groups in pain intensity, thickness, and resistance of the transverse abdominal muscle. Conclusion: A 4-week specific program based on re-education exercises of the preactivation of the abdominal transverse muscle is more effective than conventional treatment for reducing disability and increasing the activation of the abdominal transverse muscle measured by VAS scale and PBU. Trial registration: Clinicaltrials.gov identifier: NCT03097497. Date of registration: 31/03/2017.

Background: Parkinson disease (PD) is a rapidly growing neurological condition worldwide. While physiotherapy and exercise are effective interventions, the addition of motivational aspects that improve adherence could be beneficial for people with PD. Incorporating technological devices into motor rehabilitation, coupled with gamification elements, could enhance the relevance of rehabilitation and alleviate motor symptoms. Objective: The aim of this scoping review was to identify and classify the technological devices that integrate gamification elements used in motor rehabilitation in PD, and to describe the justification behind the use of these devices and elements in this context. Methods: We conducted a scoping review following the framework proposed by Joanna Briggs Institute, along with the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews) guidelines. Major health science databases (MEDLINE, EMBASE, Scopus, Cochrane, Web of Science, PsycINFO, and Epistemonikos) were systematically searched. Relevant studies were included if they used technological interventions with gamification elements for motor symptom rehabilitation in PD. Gamification elements were extracted and categorized based on established frameworks, and content analysis was used to review the justifications for the use of technologies integrating gamification. Results: A total of 4451 studies were retrieved from the search. After the abstract and full-text screening, 81 studies were eligible for data extraction. The analysis identified 453 gamification elements across studies, with development and accomplishment being the most prominent core drive. Progress/feedback was the most frequently used element (79/81, 98% of studies), followed by points (70/81, 86%) and levels/progression (66/81, 81%). Other notable elements included badges, leaderboards, and customization, while several core drives, like ownership and possession, lacked reported elements. Most interventions were delivered through commercial video game consoles (33/81, 41%), followed by computer-based systems (32/81, 40%). Tablet-based applications and integrated rehabilitation platforms were used in 11% (9/81) and 10% (8/81) of the studies, respectively. The expected roles of technology were clear, but intentional use of gamification was scarce. Conclusions: This scoping review highlights the widespread adoption of technologies integrating gamification elements for motor symptom rehabilitation in individuals with PD. However, it also underscores a critical gap in understanding and justifying gamification mechanics. The current landscape relies heavily on commercial video games and emphasizes performance-based experiences, lacking theoretical grounding.