Effect of virtual reality dance exercise on the balance, activities of daily living, and depressive disorder status of Parkinson’s disease patients
Identifieur interne : 000297 ( Pmc/Corpus ); précédent : 000296; suivant : 000298Effect of virtual reality dance exercise on the balance, activities of daily living, and depressive disorder status of Parkinson’s disease patients
Auteurs : Nam-Yong Lee ; Dong-Kyu Lee ; Hyun-Seung SongSource :
- Journal of Physical Therapy Science [ 0915-5287 ] ; 2015.
Abstract
[Purpose] In this study, we examined the effects of virtual reality dance exercise on the balance, activities of daily living and depressive disorder status of Parkinson’s disease patients. [Subjects] Twenty patients were assigned either the experimental group (n = 10) or the control group (n = 10). All participants received 30 minutes of neurodevelopment treatment and 15 minutes of functional electrical stimulation 5 times per week for 6 weeks. The experimental group additionally performed 30 minutes of dance exercise. Balance, activities of daily living, and depressive disorder status were assessed before and after the 6-week treatment period using the Berg balance scale, the Modified Barthel Index, and the Beck Depression Inventory. The paired t-test was used to detect differences before and after treatment, and the independent t-test was used to detect differences between the treatment groups. [Results] The values for balance, activities of daily living, and depressive disorder status significantly differed between before and after treatment in the experimental group, and significantly differed between the experimental group and control group. [Conclusion] Virtual reality dance exercise has a positive effect on balance, activities of daily living, and depressive disorder status of Parkinson’s disease patients.
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DOI: 10.1589/jpts.27.145
PubMed: 25642060
PubMed Central: 4305547
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<record><TEI><teiHeader><fileDesc><titleStmt><title xml:lang="en">Effect of virtual reality dance exercise on the balance, activities of daily
living, and depressive disorder status of Parkinson’s disease patients</title><author><name sortKey="Lee, Nam Yong" sort="Lee, Nam Yong" uniqKey="Lee N" first="Nam-Yong" last="Lee">Nam-Yong Lee</name><affiliation><nlm:aff>NONE</nlm:aff></affiliation></author><author><name sortKey="Lee, Dong Kyu" sort="Lee, Dong Kyu" uniqKey="Lee D" first="Dong-Kyu" last="Lee">Dong-Kyu Lee</name><affiliation><nlm:aff>NONE</nlm:aff></affiliation></author><author><name sortKey="Song, Hyun Seung" sort="Song, Hyun Seung" uniqKey="Song H" first="Hyun-Seung" last="Song">Hyun-Seung Song</name><affiliation><nlm:aff>NONE</nlm:aff></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">PMC</idno><idno type="pmid">25642060</idno><idno type="pmc">4305547</idno><idno type="url">http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4305547</idno><idno type="RBID">PMC:4305547</idno><idno type="doi">10.1589/jpts.27.145</idno><date when="2015">2015</date><idno type="wicri:Area/Pmc/Corpus">000297</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Corpus" wicri:corpus="PMC">000297</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en" level="a" type="main">Effect of virtual reality dance exercise on the balance, activities of daily
living, and depressive disorder status of Parkinson’s disease patients</title><author><name sortKey="Lee, Nam Yong" sort="Lee, Nam Yong" uniqKey="Lee N" first="Nam-Yong" last="Lee">Nam-Yong Lee</name><affiliation><nlm:aff>NONE</nlm:aff></affiliation></author><author><name sortKey="Lee, Dong Kyu" sort="Lee, Dong Kyu" uniqKey="Lee D" first="Dong-Kyu" last="Lee">Dong-Kyu Lee</name><affiliation><nlm:aff>NONE</nlm:aff></affiliation></author><author><name sortKey="Song, Hyun Seung" sort="Song, Hyun Seung" uniqKey="Song H" first="Hyun-Seung" last="Song">Hyun-Seung Song</name><affiliation><nlm:aff>NONE</nlm:aff></affiliation></author></analytic><series><title level="j">Journal of Physical Therapy Science</title><idno type="ISSN">0915-5287</idno><idno type="eISSN">2187-5626</idno><imprint><date when="2015">2015</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><p>[Purpose] In this study, we examined the effects of virtual reality dance exercise
on the balance, activities of daily living and depressive disorder status of Parkinson’s
disease patients. [Subjects] Twenty patients were assigned either the experimental group (n
= 10) or the control group (n = 10). All participants received 30 minutes of
neurodevelopment treatment and 15 minutes of functional electrical stimulation 5 times per
week for 6 weeks. The experimental group additionally performed 30 minutes of dance
exercise. Balance, activities of daily living, and depressive disorder status were assessed
before and after the 6-week treatment period using the Berg balance scale, the Modified
Barthel Index, and the Beck Depression Inventory. The paired t-test was used to detect
differences before and after treatment, and the independent t-test was used to detect
differences between the treatment groups. [Results] The values for balance, activities of
daily living, and depressive disorder status significantly differed between before and after
treatment in the experimental group, and significantly differed between the experimental
group and control group. [Conclusion] Virtual reality dance exercise has a positive effect
on balance, activities of daily living, and depressive disorder status of Parkinson’s
disease patients.</p></div></front><back><div1 type="bibliography"><listBibl><biblStruct><analytic><author><name sortKey="Dibble, Le" uniqKey="Dibble L">LE Dibble</name></author><author><name sortKey="Nicholson, De" uniqKey="Nicholson D">DE Nicholson</name></author><author><name sortKey="Shultz, B" uniqKey="Shultz B">B Shultz</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Holroyd, S" uniqKey="Holroyd S">S Holroyd</name></author><author><name sortKey="Currie, Lj" uniqKey="Currie L">LJ Currie</name></author><author><name sortKey="Wooten, Gf" uniqKey="Wooten G">GF Wooten</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Aarsland, D" uniqKey="Aarsland D">D Aarsland</name></author><author><name sortKey="Andersen, K" uniqKey="Andersen K">K Andersen</name></author><author><name sortKey="Larsen, Jp" uniqKey="Larsen J">JP Larsen</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Ahlskog, Je" 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Suarez</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Chan, Cl" uniqKey="Chan C">CL Chan</name></author><author><name sortKey="Ngai, Ek" uniqKey="Ngai E">EK Ngai</name></author><author><name sortKey="Leung, Pk" uniqKey="Leung P">PK Leung</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Yavuzer, G" uniqKey="Yavuzer G">G Yavuzer</name></author><author><name sortKey="Senel, A" uniqKey="Senel A">A Senel</name></author><author><name sortKey="Atay, Mb" uniqKey="Atay M">MB Atay</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Zhang, L" uniqKey="Zhang L">L Zhang</name></author><author><name sortKey="Abreu, Bc" uniqKey="Abreu B">BC Abreu</name></author><author><name sortKey="Seale, Gs" uniqKey="Seale G">GS Seale</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Hackney, Me" uniqKey="Hackney M">ME Hackney</name></author><author><name sortKey="Earhart, Gm" uniqKey="Earhart G">GM Earhart</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Wu, T" uniqKey="Wu T">T Wu</name></author><author><name sortKey="Hallett, M" uniqKey="Hallett M">M Hallett</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Howe, Te" uniqKey="Howe T">TE Howe</name></author><author><name sortKey="Lovgreen, B" uniqKey="Lovgreen B">B Lövgreen</name></author><author><name sortKey="Cody, Fw" uniqKey="Cody F">FW Cody</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Lee, Sy" uniqKey="Lee S">SY Lee</name></author><author><name sortKey="Lee, Sk" uniqKey="Lee S">SK Lee</name></author><author><name sortKey="Kim, Yh" uniqKey="Kim Y">YH Kim</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Kim, Yn" uniqKey="Kim Y">YN Kim</name></author><author><name sortKey="Lee, Dk" uniqKey="Lee D">DK 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<front><journal-meta><journal-id journal-id-type="nlm-ta">J Phys Ther Sci</journal-id><journal-id journal-id-type="iso-abbrev">J Phys Ther Sci</journal-id><journal-id journal-id-type="publisher-id">JPTS</journal-id><journal-title-group><journal-title>Journal of Physical Therapy Science</journal-title></journal-title-group><issn pub-type="ppub">0915-5287</issn><issn pub-type="epub">2187-5626</issn><publisher><publisher-name>The Society of Physical Therapy Science</publisher-name></publisher></journal-meta><article-meta><article-id pub-id-type="pmid">25642060</article-id><article-id pub-id-type="pmc">4305547</article-id><article-id pub-id-type="publisher-id">jpts-2014-407</article-id><article-id pub-id-type="doi">10.1589/jpts.27.145</article-id><article-categories><subj-group subj-group-type="heading"><subject>Original Article</subject></subj-group></article-categories><title-group><article-title>Effect of virtual reality dance exercise on the balance, activities of daily
living, and depressive disorder status of Parkinson’s disease patients</article-title></title-group><contrib-group><contrib contrib-type="author"><name><surname>Lee</surname><given-names>Nam-Yong</given-names></name><degrees>MSc</degrees><xref ref-type="aff" rid="aff1"><sup>1</sup></xref></contrib><contrib contrib-type="author"><name><surname>Lee</surname><given-names>Dong-Kyu</given-names></name><degrees>MSc</degrees><xref ref-type="aff" rid="aff2"><sup>2</sup></xref><xref rid="cor1" ref-type="corresp"><sup>*</sup></xref></contrib><contrib contrib-type="author"><name><surname>Song</surname><given-names>Hyun-Seung</given-names></name><degrees>MSc</degrees><xref ref-type="aff" rid="aff1"><sup>1</sup></xref></contrib><aff id="aff1"><label>1)</label> Department of Physical Therapy, Graduate School of Physical Therapy, Daejeon University, Republic of Korea</aff><aff id="aff2"><label>2)</label> Department of Physical Therapy, Yeol-Lin Hospital, Republic of Korea</aff></contrib-group><author-notes><corresp id="cor1"><label>*</label>Corresponding author. Dong-Kyu Lee, Department of Physical Therapy, Yeol-Lin Hospital:
570-15 Songchung-dong, Gwangsan-gu, Gwangju 504-704, Republic of
Korea. (E-mail: <email xlink:href="ldkpt@hanmail.net">ldkpt@hanmail.net</email>)</corresp></author-notes><pub-date pub-type="epub"><day>09</day><month>1</month><year>2015</year></pub-date><pub-date pub-type="ppub"><month>1</month><year>2015</year></pub-date><volume>27</volume><issue>1</issue><fpage>145</fpage><lpage>147</lpage><history><date date-type="received"><day>20</day><month>6</month><year>2014</year></date><date date-type="accepted"><day>24</day><month>7</month><year>2014</year></date></history><permissions><copyright-statement>2015©by the Society of Physical Therapy Science</copyright-statement><copyright-year>2015</copyright-year><license license-type="open-access" xlink:href="http://creativecommons.org/licenses/by-nc-nd/3.0/"><license-p>This is an open-access article distributed under the terms of the Creative
Commons Attribution Non-Commercial No Derivatives (by-nc-nd) License. </license-p></license></permissions><abstract><p>[Purpose] In this study, we examined the effects of virtual reality dance exercise
on the balance, activities of daily living and depressive disorder status of Parkinson’s
disease patients. [Subjects] Twenty patients were assigned either the experimental group (n
= 10) or the control group (n = 10). All participants received 30 minutes of
neurodevelopment treatment and 15 minutes of functional electrical stimulation 5 times per
week for 6 weeks. The experimental group additionally performed 30 minutes of dance
exercise. Balance, activities of daily living, and depressive disorder status were assessed
before and after the 6-week treatment period using the Berg balance scale, the Modified
Barthel Index, and the Beck Depression Inventory. The paired t-test was used to detect
differences before and after treatment, and the independent t-test was used to detect
differences between the treatment groups. [Results] The values for balance, activities of
daily living, and depressive disorder status significantly differed between before and after
treatment in the experimental group, and significantly differed between the experimental
group and control group. [Conclusion] Virtual reality dance exercise has a positive effect
on balance, activities of daily living, and depressive disorder status of Parkinson’s
disease patients.</p></abstract><kwd-group><title>Key words</title><kwd>Virtual reality</kwd><kwd>Parkinson's disease</kwd><kwd>Balance</kwd></kwd-group></article-meta></front><body><sec sec-type="intro" id="s1"><title>INTRODUCTION</title><p>Parkinson’s disease (PD) is caused by dopamine deficiency, which negatively affects
cerebral basal ganglia function<xref rid="r1" ref-type="bibr">1</xref><sup>)</sup>. The
progressive chronic neurodegeneration of the brain associated with PD impairs balance and
motor ability. These chronic, negative effects on motor function are accompanied by memory
defects and a decreased ability to understand<xref rid="r1" ref-type="bibr">1</xref>, <xref rid="r2" ref-type="bibr">2</xref><sup>)</sup>. In addition, emotional stability
deteriorates, which results in difficulty with activities of daily living (ADL) and an
increasing feeling of despair and depression; which causes a decline in the quality of life
of a patient<xref rid="r2" ref-type="bibr">2</xref>, <xref rid="r3" ref-type="bibr">3</xref><sup>)</sup>. The treatment of PD with medication prescribed by doctors
replenishes the deficient dopamine level preventing or delaying nerve cell destruction, thus
delaying the progress of the disease<xref rid="r4" ref-type="bibr">4</xref><sup>)</sup>.
However, in cases receiving long-term treatment, disease acceleration, motor disturbance,
cognitive impairment, or autonomic nerve malfunction may develop<xref rid="r5" ref-type="bibr">5</xref><sup>)</sup>.</p><p>Exercise protects and promotes regeneration of damaged nerves, and enhances balance,
physical state, and independency, thereby facilitating ADL. With an appropriate exercise
intensity, dopamine levels can be increased and motor disturbances can be improved<xref rid="r6" ref-type="bibr">6</xref>, <xref rid="r7" ref-type="bibr">7</xref><sup>)</sup>.
Therefore, treatment needs to integrate prescription medicines and exercise therapy.</p><p>Exercises in virtual reality provide visual, auditory, and tactile feedback, and the
exercise intensity can be modified by adjusting the difficulty of interactions and
intensity<xref rid="r8" ref-type="bibr">8</xref>, <xref rid="r9" ref-type="bibr">9</xref><sup>)</sup>. There are no limitations in terms of time or place, thus enabling
continuous active exercise<xref rid="r8" ref-type="bibr">8</xref><sup>)</sup>. Virtual
reality dance exercise has been reported to have a positive effect on cerebral palsy,
dementia, and the recovery of physical function of stroke patients<xref rid="r9" ref-type="bibr">9</xref>,<xref rid="r10" ref-type="bibr">10</xref>,<xref rid="r11" ref-type="bibr">11</xref>,<xref rid="r12" ref-type="bibr">12</xref><sup>)</sup>. However, there
are insufficient studies of the effects of virtual reality dance exercise on PD
patients.</p><p>In this study, we aimed to examine the effect of virtual reality dance exercise on balance,
ADL, and depressive disorder status of PD patients.</p></sec><sec sec-type="methods" id="s2"><title>SUBJECTS AND METHODS</title><p>Twenty participants with PD were randomly assigned to either the experimental group (5
males, 5 females) or the control group (5 males, 5 females). Patients were able to
understand the study requirements and to communicate sufficiently, and could ambulate
independently. All participants were informed about the objectives and method of the study
and agreed to participate. The study protocol was approved by the Institutional Review Board
of Nambu University and was conducted in accordance with the ethical principles of the
Declaration of Helsinki. The general characteristics of the participants are listed in <xref rid="tbl_001" ref-type="table">Table 1</xref><table-wrap id="tbl_001" orientation="portrait" position="float"><label>Table 1.</label><caption><title>General characteristics of each group</title></caption><table frame="hsides" rules="groups"><thead><tr><th valign="top" align="left" rowspan="1" colspan="1"></th><th valign="top" align="center" rowspan="1" colspan="1">EG (n=10)</th><th valign="top" align="center" rowspan="1" colspan="1">CG (n=10)</th></tr></thead><tbody><tr><td align="left" valign="top" rowspan="1" colspan="1">Gender (male/female)</td><td align="center" valign="top" rowspan="1" colspan="1">5/5</td><td align="center" valign="top" rowspan="1" colspan="1">5/5</td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1">Age (years)</td><td align="center" valign="top" rowspan="1" colspan="1">68.4±2.9<sup>a</sup></td><td align="center" valign="top" rowspan="1" colspan="1">70.1±3.3</td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1">Height (cm)</td><td align="center" valign="top" rowspan="1" colspan="1">165.1±9.1</td><td align="center" valign="top" rowspan="1" colspan="1">165.2±8.4</td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1">Weight (kg)</td><td align="center" valign="top" rowspan="1" colspan="1">63.8±10.2</td><td align="center" valign="top" rowspan="1" colspan="1">63.7±10.1</td></tr></tbody></table><table-wrap-foot><p><sup>a</sup>Mean±SD, EG: Experimental Group, CG: Control Group</p></table-wrap-foot></table-wrap>. The age (mean±SD) of the experimental group was 68.4±2.9 years, height was
165.1±9.1 cm, and weight was 63.8±10.2 kg. The age of the control group was 70.1±3.3 years,
height was 165.2±8.4 cm, and weight was 63.7±10.1 kg.</p><p>All participants received 30 minutes of neurodevelopment treatment (NDT) and 15 minutes of
functional electrical stimulation (FES) 5 times per week for 6 weeks. The experimental group
participated in an additional 30 minutes of dance exercise. The virtual reality dance
exercise used the K-Pop Dance Festival (Nintendo Inc., Japan) game for the Wii (Nintendo
Inc., Japan) video game system. Songs liked by patients were selected from the various
categories of K-Pop music included in the software. A strap was used to fix the remote
control to the hands, and the patients tried to mimic the characters on the TV monitor. When
subjects properly mimicked the movement, they felt vibrations from the remote control and
heard the word “perfect” broadcast by the TV speaker.</p><p>Balance was assessed using the Berg balance scale (BBS). The BBS consists of 14 items and
can be divided into balance for sitting, standing, and position changes. The score given
ranges from 0 to 4 points, with a highest possible score of 56 points, and higher scores
indicate better balance. ADL was assessed using the Modified Barthel index (MBI). The MBI
consists of 10 items: 5 points for personal hygiene, 5 points for taking a bath, 10 points
for eating, 10 points for using the toilet, 10 points for ascending stairs, 10 point for
putting on clothes, 10 points for defecation, 10 points for urination, 15 points for
walking, and 15 points for using the bed, with a highest possible score of 100 points. A
score of 0–24 points indicates complete dependence; 25–48, maximum dependence; 50–74,
partial dependence; 75–90, slight dependence; 91–99, minimum dependence; and 100, complete
independence. The presence and severity of depressive disorder was assessed using the Beck
depression inventory (BDI). The BDI consists of 21 items covering emotional and
physiological symptoms. The score ranges from 0 to 3 points, with a highest possible total
of 63 points. A score of 0–9 points indicates no depression; 10–15, light depression; 16–23,
heavy depression; and 24–63, severe depression. The balance scores, ADL score, and
depressive disorder status were recorded before and after the 6 weeks of treatment.</p><p>Data were analyzed using SPPS 12.0 for Windows. Descriptive statistics were used to
describe the general characteristics of the participants. The paired t-test was used to
compare pre- and post-treatment variables, and the independent t-test was used to compare
the treatment groups. The significance level for all tests was α=0.05.</p></sec><sec sec-type="results" id="s3"><title>RESULTS</title><p>The changes in balance are shown in <xref rid="tbl_002" ref-type="table">Table
2</xref><table-wrap id="tbl_002" orientation="portrait" position="float"><label>Table 2.</label><caption><title>Comparison of BBS, MBI, and BDI values between the experimental and control
groups</title></caption><table frame="hsides" rules="groups"><thead><tr><th valign="top" align="left" rowspan="1" colspan="1"></th><th valign="top" align="center" rowspan="1" colspan="1">Group</th><th valign="top" align="center" rowspan="1" colspan="1">Pre</th><th valign="top" align="center" rowspan="1" colspan="1">Post</th><th valign="top" align="center" rowspan="1" colspan="1">D-value</th></tr></thead><tbody><tr><td align="left" valign="top" rowspan="1" colspan="1">BBS</td><td align="center" valign="top" rowspan="1" colspan="1">EG</td><td align="center" valign="top" rowspan="1" colspan="1">46.0±1.3<sup>a</sup></td><td align="center" valign="top" rowspan="1" colspan="1">48.1±3.0*</td><td align="center" valign="top" rowspan="1" colspan="1">2.1±2.3*</td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1"></td><td align="center" valign="top" rowspan="1" colspan="1">CG</td><td align="center" valign="top" rowspan="1" colspan="1">45.0±1.3</td><td align="center" valign="top" rowspan="1" colspan="1">45.4±1.5</td><td align="center" valign="top" rowspan="1" colspan="1">0.4±0.8</td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1">MBI</td><td align="center" valign="top" rowspan="1" colspan="1">EG</td><td align="center" valign="top" rowspan="1" colspan="1">87.9±1.4</td><td align="center" valign="top" rowspan="1" colspan="1">91.1±3.0*</td><td align="center" valign="top" rowspan="1" colspan="1">3.2±3.0*</td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1"></td><td align="center" valign="top" rowspan="1" colspan="1">CG</td><td align="center" valign="top" rowspan="1" colspan="1">87.4±1.7</td><td align="center" valign="top" rowspan="1" colspan="1">88.2±1.8</td><td align="center" valign="top" rowspan="1" colspan="1">0.8±1.6</td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1">BDI</td><td align="center" valign="top" rowspan="1" colspan="1">EG</td><td align="center" valign="top" rowspan="1" colspan="1">20.4±0.9</td><td align="center" valign="top" rowspan="1" colspan="1">18.2±2.0*</td><td align="center" valign="top" rowspan="1" colspan="1">−2.2±1.9*</td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1"></td><td align="center" valign="top" rowspan="1" colspan="1">CG</td><td align="center" valign="top" rowspan="1" colspan="1">21.2±1.3</td><td align="center" valign="top" rowspan="1" colspan="1">20.6±1.5</td><td align="center" valign="top" rowspan="1" colspan="1">−0.6±0.8</td></tr></tbody></table><table-wrap-foot><p><sup>a</sup>Mean±SD, *p<0.05, EG: Experimental Group, CG: Control Group, D-value:
Difference-value, BBS: Berg Balance Scale, MBI: Modified Barthel Index, BDI: Beck
Depression Inventory</p></table-wrap-foot></table-wrap>. After 6 weeks of treatment, balance had significantly improved in the
experimental group (46.0±1.3 to 48.1±3.0; p<0.05), while the control group showed no
significant improvement (45.0±1.3 to 45.4±1.5; p>0.05). Compared to the control group,
balance of the experimental group was significantly enhanced (p<0.05). Changes in ADL are
shown in <xref rid="tbl_002" ref-type="table">Table 2</xref>. After treatment, ADL had
significantly improved in the experimental group (87.9±1.4 to 91.1±3.0; p<0.05), while
ADL of the control group showed no significant improvement (87.4±1.7 to 88.2±1.8;
p>0.05). Compared to the control group, ADL of the experimental group were significantly
enhanced (p<0.05). The changes in depressive disorder status are shown in <xref rid="tbl_002" ref-type="table">Table 2</xref>. After treatment, the depressive disorder
status significantly improved in the experimental group (20.4±0.9 to 18.2±2.0; p<0.05),
while the depressive disorder status of the control group showed no significant improvement
(21.2±1.3 to 20.6±1.5; p>0.05). Compared to the control group, the depressive disorder
status of the experimental group was significantly improved (p<0.05).</p></sec><sec sec-type="discussion" id="s4"><title>DISCUSSION</title><p>This study aimed to examine the effect of virtual reality dance exercise on the balance,
ADL, and depressive disorder status of PD patients. Within-group comparisons demonstrated
that balance improved significantly in the experimental group. The group comparison showed
balance of the experimental group significantly improved relative to the control group. The
present results corroborate those of Esculier et al.<xref rid="r13" ref-type="bibr">13</xref><sup>)</sup>, Yen et al.<xref rid="r14" ref-type="bibr">14</xref><sup>)</sup>and Suarez et al.<xref rid="r15" ref-type="bibr">15</xref><sup>)</sup> who showed that
virtual reality dance exercise enhanced the balance ability of PD patients. Virtual reality
exercise provides visual and auditory feedback while watching the motion of the game
character, thus improving balance through integration of feedback from the scala vestibule
and proprioceptors. Hence, this method can enhance the balance of PD patients<xref rid="r8" ref-type="bibr">8</xref>, <xref rid="r9" ref-type="bibr">9</xref>, <xref rid="r13" ref-type="bibr">13</xref><sup>)</sup>.</p><p>Virtual reality exercise provides active learning and motivation to patients through an
experiential environment<xref rid="r16" ref-type="bibr">16</xref><sup>)</sup>. Yavuzer et
al.<xref rid="r17" ref-type="bibr">17</xref><sup>)</sup> showed that virtual reality dance
exercise significantly enhances functional independence, and Zhang et al.<xref rid="r18" ref-type="bibr">18</xref><sup>)</sup> showed that it resulted in a significant
enhancement of ADL. The present study also found there was a significant enhancement of ADL
of PD patients following their performance of virtual reality dance exercise. Dance exercise
helps to maintain and increase the range and approach of a patient’s movement; it also helps
with switching the direction of movement, when performing two simultaneous but separate
movements in conjunction with music. Moreover, it provides various unpredictable movement
patterns, thus helping PD patients who have impaired ADL<xref rid="r19" ref-type="bibr">19</xref>,<xref rid="r20" ref-type="bibr">20</xref>,<xref rid="r21" ref-type="bibr">21</xref><sup>)</sup>.</p><p>A depressive disorder may be caused by the disease itself or may be a side effect of the
treatment medication itself. Depressive disorder delays the recovery of physical function
and makes it more difficult to perform ADL. Lee et al.<xref rid="r22" ref-type="bibr">22</xref><sup>)</sup> and Kim and Lee<xref rid="r23" ref-type="bibr">23</xref><sup>)</sup> demonstrated that virtual reality exercise reduces the presence and
severity of depressive disorders. The present study corroborates these previous findings
since it showed a beneficial effect of virtual reality exercise on the depressive disorder
status of PD patients. K-Pop virtual reality dance exercise was performed by the subjects of
this study. K-Pop dance utilizes repetitive lyrics and melodies and consists of simple brisk
rhythms and beats. Because these features can be used as a targeted treatment and because
virtual reality exercise can elicit voluntary participation, the K-Pop virtual reality dance
exercise may help improve the depressive disorder status of PD patients<xref rid="r23" ref-type="bibr">23</xref>, <xref rid="r24" ref-type="bibr">24</xref><sup>)</sup>.</p><p>A limitation of this study was that it was conducted with only 20 PD patients, thus making
it difficult to generalize the result to all patients with the disease. Further research
with a larger cohort is needed. Another limitation of this study is a lack of specific
history regarding the treatments the patients received prior to their participation. There
is a need for additional research on the effect of various exercise programs other than
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