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Grant number: 14/22348-1
Support type:Regular Research Grants
Duration: October 01, 2015 - September 30, 2017
Field of knowledge:Health Sciences - Physiotherapy and Occupational Therapy
Principal researcher:José Eduardo Pompeu
Grantee:José Eduardo Pompeu
Home Institution: Faculdade de Medicina (FM). Universidade de São Paulo (USP). São Paulo , SP, Brazil
Assoc. researchers: Keyte Guedes da Silva


Parkinson's disease (PD) is a neurodegenerative movement disorder that causes progressive deterioration in postural control and cognition that could influence the quality of life. Postural instability in PD is a refractory symptom of the dopaminergic replacement, but several studies have shown positive effects on postural control in this population through conventional physical therapy and the new generation of video games such as Nintendo Wii Fit PlusTM and Microsoft KinectTM. Videogames require body movements of the player associated with the high cognitive demand and intense visual and auditory stimulation that can promote positive effects on postural control, gait and cognition of the elderly and individuals with neurological diseases, among them, patients with PD. However, specifically in relation to the Kinect system, there are only pilot studies with small samples that assessed its effects only through clinical scales. Thus, the effect of the Kinect on the systems of postural control has not yet been elucidated. Thus, the question about the influence of its intense motor, cognitive, visual and auditory stimulation on the Limits in Stability (LOS) and Sensory Integration was not answered. As the Kinect system games require motor responses associated with cognitive performance, there is the hypothesis that this type of training promotes a positive effect on cognition and probably also in attentional management of patients, which could reflect the improvement of postural control and the gait in dual task conditions. However, there are no studies that assessed the effect of Kinect on postural control and gait in conditions of division of attention. Furthermore, there are no randomized clinical trials that compared Kinect with conventional physical therapy in PD patients. Thus, the aim of this study is to analyze the effects of Kinect Adventures! games on (1) postural control, (2) gait adaptability, (3) gait in conditions of focused and divided attention, (4) cognition and (5) quality of life of patients with PD. We will selected 20 patients with idiopathic PD in stages I to III of the Hoehn & Yahr scale, with no signs of dementia, and treated with levodopa or their synergists. All subjects will perform 14 individual sessions (1 hour/session) twice a week for seven weeks. The control group will perform conventional physical therapy, based on the European guideline for physical therapy in PD. The experimental group will practice four games of Kinect system. Both groups will be assessed before and after training and 30 days after the end of the training. The primary outcome will be the area of the Limits of Stability (LOS). Secondary outcomes will be: (1) the area and velocity of the center of pressure (COP) in different sensory conditions: open and closed eyes on a stable surface; eyes closed on unstable surface; saccadic eyes movements and optokinetic stimulation, all measures assessed through posturography. The other secondary motor and cognitive outcome will be: (1) postural control assessed by mini BESTest; (2) the adaptability of gait through the Dynamic Gait Index; (3) Gait in single and dual task condition; (4) cognition with Montreal Cognitive Assessment and (5) the quality of life assessed by Parkinson's Disease Questionnaire (PDQ-39). Normality tests will be applied to the results in order to selected the appropriate statistical test for the distribution and adopted the statistical significance level of alpha of 0.05. (AU)