Aplicabilidade da realidade virtual no equilíbrio de indivíduos com doença de Parkinson em sessões de fisioterapia: uma revisão sistemática

Abstract

Parkinson's disease is a degenerative, chronic and progressive disease that affects the central nervous system. It is caused by the death of neurons that produce dopamine in substantia nigra, manifested by cardinal signs such as bradykinesia, rigidity, tremor at rest and postural instability. These symptoms may affect postural balance, and therefore physiotherapy is indicated for the rehabilitation of their patients. However, the continuous rehabilitation program can become discouraging and decrease patient compliance. Thus, virtual reality - a technology that simulates reality through a computer, allowing the creation of a three-dimensional space from a proposed objective -, when associated with physical therapy, has therapeutic potential in relation to rehabilitation. Thus, the present study aims to systematically review the effects of virtual reality-based rehabilitation compared with conventional physical therapy in the treatment of balance in individuals with Parkinson's disease. A systematic literature review was performed according to the Ministry of Health's Preferred Reporting Items for Systematic Reviews and Meta-Analyzes Checklist and the Methodological Guidelines: Systematic review and meta-analysis of randomized controlled trials from the Ministry of Health. The search was performed in the databases MEDLINE, LILACS, Cochrane CENTRAL and PEDro, without restriction of publication date and language, from January to October 2019, with the combination of the descriptors and their respective terms, which are: Parkinson Disease , Virtual Reality and Physical Therapy Modalities; Parkinson's Disease, Postural Balance and Virtual Reality; and Parkinson's Disease, Postural Balance and Video Game. In the researches 256 articles were found, and through the inclusion and exclusion criteria and reading the abstracts and the complete manuscripts, seven articles were selected. From the included studies, it was observed that both intervention groups were beneficial for postural balance, without significant differences between the results. Although virtual reality has the advantages of immediate auditory / visual feedback, knowledge of performance and results, and high repetition in a complex environment, which can be a further stimulus for patients, both interventions is recommended. Among the limitations, we highlight the small sample size of the studies, poorly specific evaluations without reference values for this population and the short follow-up period. Also, the heterogeneity of studies that affect the possible generalizations for this population. Thus, further research on this subject with greater methodological rigor is suggested and experimental studies with serious games to specifically treat the symptoms of Parkinson's disease.