The cognitive exercise smartphone app NeuroNation, which combines personalized tasks and gamification, is useful and feasible for adults with mild Parkinson’s disease, a pilot study concluded. The researchers noted the app was a success in terms of the patients’ perception of its usability and in achieving cognitive improvements, and may be an effective for providing cognitive rehabilitation at home. Despite the small sample size and limited patient population, the researchers recommended further studies with larger groups of patients to evaluate changes in cognition. The pilot study, “Feasibility and usability of a non-immersive virtual reality tele-cognitive app in cognitive rehabilitation of patients affected by Parkinson’s disease,” was published in Psychogeriatrics. Cognitive impairment, ranging from mild thinking problems to dementia, represents one of the most common nonmotor symptoms of Parkinson’s disease. Accordingly, cognitive rehabilitation strategies may help delay cognitive deficits from occurring or getting worse. However, cognitive rehabilitation protocols performed in hospitals or clinics may not be easy for those with movement disorders. As such, performing rehabilitation tasks remotely could be a valid alternative to face-to-face activities. Researchers at the University of Catania, Italy evaluated in a pilot study the feasibility and usability of a smartphone application that combines virtual reality (VR) with cognitive exercises in 16 adult patients with mild Parkinson’s without dementia. The application — NeuroNation-Brain Training — available for free download to a smartphone, is an online brain training program with a combination of personalized tasks and gamification.
The program includes 27 tasks with 250 levels to enhance memory, executive function, attention, logical thinking, and cognitive speed. It can be customized to a user’s personal preferences, strengths, and cognitive potential and provides performance motivation and self-assessment with audio-video feedback. Following an initial face-to-face clinic visit to set the level of difficulty according to the patients’ characteristics, participants performed the training remotely at home for six weeks. The exercise involved three weekly sessions, lasting 20 minutes for a total of 18 sessions. At the end of each week, the program applied a test to determine cognition level and provided a performance report, which was sent to examiners via text message. Weekly telephone consultations were included to resolve any difficulties. After six weeks, participants reported on the feasibility and usability with a questionnaire. All 16 participants (nine men, six women) with a mean age of 58.4 years and a mean disease duration of 4.6 years, completed the training. There were no significant differences between men and women regarding age or education. During the study, all were treated with levodopa, a standard Parkinson’s therapy. The system usability scale questionnaire measured the acceptance of the application regarding hardware, mobile devices, applications, and websites. The usability was based on 10 items rated on a five-point scale from “strongly agree” to “strongly disagree,” with higher scores indicating better usability. After six weeks of cognitive training, the mean system usability scale score across all participants was 83.4, which indicated it was considered “good and promising.” In comparison, scores above 90 are deemed “exceptional.” The goal attainment scaling questionnaire assessed participants’ perception of the goals achieved during the intervention. Each goal, agreed upon by the patient, was evaluated on a five-point scale, from “much worse” to “much better,” with an ultimate outcome of improved cognitive ability.
Compared to before the study, there was a significant improvement in goal attainment scaling scores after six weeks of training, rising from a mean of 38.5 to 65.6. “Our pilot study suggests that cognitive telerehabilitation using a smartphone-based VR app could be an effective way to provide [Parkinson’s disease] patients with home cognitive rehabilitation,” the researchers concluded. “We believe that further studies using larger samples should be promoted, also evaluating changes in cognitive and emotional functioning.”
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