Effects of Aquatic Tai Chi and Computer Assisted Rehabilitation Environment-Based Virtual Reality Training on Rehabilitation in Patients with Parkinson Disease: A Randomized Controlled Trial.

Objective

To compare aquatic Tai Chi (ATC) and Computer Assisted Rehabilitation Environment (CAREN)-based virtual reality (VR) gait training in individuals with Parkinson disease (PD) and characterize differences in their effects over time.

Design

Single-blind, parallel-group randomized controlled trial.

Setting

Outpatient rehabilitation pool and gait laboratory.

Participants

Fifty older adults with PD (Hoehn-Yahr stage 2-3) and balance impairment were randomly assigned to CAREN (n=24) or ATC (n=26).

Interventions

Participants received ATC or CAREN training for 40 minutes per session, 5 sessions per week, for 12 weeks. MAIN OUTCOME MEASURES Clinical outcomes including the Unified Parkinson's Disease Rating Scale Part III (UPDRS-III), Berg Balance Scale (BBS), Timed Up and Go test (TUG), and 6-minute walk test (6MWT), as well as Spatiotemporal gait parameters and gait symmetry were assessed at baseline and weeks 6, 12, and 24.

Results

Forty participants completed the trial. Both groups improved significantly in clinical function, spatiotemporal gait parameters, and gait symmetry at weeks 6, 12, and 24 compared with baseline. At post-intervention (week 12), the CAREN group showed lower UPDRS-III scores, higher BBS scores, shorter TUG times, and longer 6MWT distances than the ATC group (all P<.05). CAREN demonstrated faster gait speed, longer step length, higher cadence, shorter gait cycle time, and better overall gait symmetry (all P<.05). At follow-up (week 24), CAREN retained significant advantages in BBS, cadence, stance phase, gait cycle time, and hip, knee, ankle, and overall gait symmetry indices.

Conclusions

Both interventions improved gait- and balance-related function in individuals with PD. CAREN produced greater improvements during treatment and maintained advantages at follow-up in selected balance, spatiotemporal gait, and gait symmetry outcomes. CAREN should be prioritized for its earlier improvements and sustained benefits in gait and balance, whereas ATC may serve as a feasible alternative for patients who are unable or unsuitable to participate in VR gait training.