Augmenting Parkinson’s Rehabilitation at Home

Abstract

This thesis focused on the purposeful co-development and early implementation of home-based exergaming therapy with Strolll Rehab, alternated with in-clinic therapy. The therapy targets gait, balance, walking adaptability, and ultimately fall risk. Home-based therapy was asynchronously prescribed and managed by trained therapists as a complement to in-clinic therapy within a hybrid rehabilitation model. The thesis had three aims: to evaluate feasibility and potential efficacy, explore acceptability and fit within healthcare, and extend the scope of the therapy towards higher exercise intensity and motor-cognitive training. Part I – Feasibility Chapters 2 and 3 investigated Reality DTx® (the precursor of Strolll Rehab) in 24 people with Parkinson’s disease (Hoehn & Yahr 2–2.5) in a six-week study. Participants trained five days per week, 30 minutes per day, using five remotely prescribed exergames. The therapy was adjusted weekly based on objective and subjective data. No falls occurred, and adherence was high: 104% of prescribed sessions and 88% of active minutes were completed. User experience was rated above average to excellent. Clinically meaningful improvements were observed in the Five Times Sit-to-Stand, while statistically significant improvements were found in walking-adaptability fall-risk indicators. Overall, the intervention was safe, usable, and potentially effective. Part II – Acceptability and appropriateness People with Parkinson’s disease generally considered the therapy acceptable and a valuable complement to in-clinic physical therapy. However, there was considerable interindividual variation in perceived effectiveness and experienced effort. Supervision by the physical therapist, feedback, and social connection with peers were considered important. Flexibility, greater game variety, and improved visibility of progression could further support long-term adherence. Therapists also saw potential for the therapy but identified practical and organisational barriers. Reimbursement, time investment, suitability across disease stages, and the changing role of the therapist require attention. Successful integration into healthcare therefore requires stakeholder involvement, appropriate implementation strategies, and evaluation of costs, benefits, and time efficiency. Part III – Extending the scope The exergames showed potential to provide moderate-to-vigorous aerobic exercise in addition to gait and balance training. Depending on the measure of exercise intensity, 9 to 14 of 15 participants reached this intensity level. With appropriate exercise settings, the therapy may therefore combine multiple therapeutic goals in the future. The thesis also highlights the need to integrate motor and cognitive training. Combined motor-cognitive exercise may produce synergistic effects, but its implementation in clinical practice remains limited. Emerging technologies such as VR and AR may support this integration. Overall, the findings indicate that home-based AR exergaming therapy is feasible, safe, and promising as a complement to usual care. Further research is needed to establish its effectiveness and support sustainable implementation and scale-up. Continued development, research, and clinical application should therefore proceed in parallel to further bridge the gap between research and practice.