Although studies exist demonstrating the effects of single-session action observation training on bradykinesia in patients with Parkinson's disease, research investigating the long-term application of such training remains limited. Furthermore, the broader literature indicates that action observation training has typically been conducted in simulated environments or by using recordings obtained from healthy individuals. The aim of the present study is to examine the effects of action observation training, delivered in a fully immersive virtual reality environment using each patient's own 3D motion recordings, on bradykinesia and other disease-related parameters.
Voluntary agreement to participate in the study
Clinical diagnosis of Parkinson's disease confirmed by a neurologist
Ongoing treatment with antiparkinsonian medication
Hoehn and Yahr (H-Y) stage ≤ 3
Presence of additional neurological disorders other than Parkinson's disease
Change in medication dosage within the past month
Score of ≥ 10 on the Simulator Sickness Questionnaire
Presence of amblyopia, strabismus, or pathologies impairing focus, depth perception, or normal 3D vision
Parallel
Patient-Specific VR Action Observation Training
Other interventionParticipants will receive immersive VR action observation training using their own 3D motion recordings captured with an Insta360 camera (Arashi Vision Inc., Shenzhen, China). In Parkinson's patients, only the initial movement sequences without bradykinetic slowing will be selected, and these will be extended to the desired duration using loop playback or ping-pong loop playback in the device's proprietary software. The action observation protocol will consist of the following one-minute tasks: (1) total finger abduction and adduction, (2) fist making and opening, (3) wrist flexion and extension, (4) forearm pronation and supination, and (5) rhythmic striking of the dorsal and palmar surfaces of one hand against the palm of the other. A 1-minute rest will be given between each video. Training will be provided in addition to conventional therapy (35 minutes, 3 days per week for 6 weeks) tailored to individual needs.
Healthy-Model VR Action Observation Training
Other interventionParticipants will receive immersive VR action observation training using 3D video recordings of the same activities performed by healthy individuals, captured with an Insta360 camera (Arashi Vision Inc., Shenzhen, China). Recordings will not require editing or adjustments. The action observation protocol will consist of the same one-minute tasks: (1) total finger abduction and adduction, (2) fist making and opening, (3) wrist flexion and extension, (4) forearm pronation and supination, and (5) rhythmic striking of the dorsal and palmar surfaces of one hand against the palm of the other. A 1-minute rest will be given between each video. Training will be provided in addition to conventional therapy (35 minutes, 3 days per week for 6 weeks) tailored to individual needs.
Spontaneous Movement Rate (SMR
In this study, kinematic parameters of finger movements will be determined from video recordings. A commercial motion analysis software will be used to extract the coordinates of manually marked tracking points, which will then be transferred into tabular form for analysis. To improve the accuracy of marking and tracking, participants will wear fingertip gloves in different colors.The spontaneous movement rate will be calculated from video-recorded finger-tapping tasks. Each cycle consists of a touch duration (TD) and an inter-tapping interval (ITI). SMR will be defined as the inverse of the total duration of one tapping cycle (TD + ITI) and expressed in Hertz (Hz).
Unified Parkinson's Disease Rating Scale (UPDRS)
Disease severity will be assessed using the Unified Parkinson's Disease Rating Scale (UPDRS), the most commonly used valid and reliable instrument for evaluating impairments and disabilities in Parkinson's disease.
Nine-Hole Peg Test (NHPT)
The Nine-Hole Peg Test is a performance-based assessment of manual dexterity. Before the test begins, participants will be instructed and shown how to perform the task once. They will then be asked to pick up the pegs one by one, place them into the holes, and after filling all holes, remove them one by one and place them back into the container.
Disabilities of the Arm, Shoulder and Hand Questionnaire (DASH)
The Disabilities of the Arm, Shoulder and Hand Questionnaire is a 30-item instrument used to evaluate upper extremity function and the impact of upper limb problems on daily activities. The first 21 items assess the degree of difficulty in performing various daily activities with the dominant extremity over the past week. The next 5 items assess the severity of pain, numbness, and weakness experienced during activities. The final 4 items evaluate the impact of upper limb pathology on sleep, work, social life, and psychological status.
Parkinson's Disease Questionnaire (PDQ-8)
Quality of life in Parkinson's disease will be assessed using the Parkinson's Disease Questionnaire (PDQ-39), a disease-specific instrument consisting of 39 items across eight domains: mobility (10 items), activities of daily living (6 items), emotional well-being (6 items), stigma (3 items), social support (3 items), cognition (4 items), communication (3 items), and bodily discomfort (4 items). To reduce participant burden, the PDQ-8, a short form including one representative item from each domain, may also be used. Items in the PDQ-8 evaluate the patient's status over the past month and are scored on a 5-point scale ranging from 0 (never) to 4 (always).
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