# Cueing-assisted gamified augmented-reality home rehabilitation for gait and balance in people with Parkinson disease: feasibility and effectiveness in the clinical pathway

## TL;DR

A new augmented reality platform called Strolll helps Parkinson's patients improve gait and balance through home-based exercises, showing high adherence and safety.

## Contribution

This study demonstrates the feasibility and effectiveness of a gamified AR platform for Parkinson's rehabilitation in real-world clinical settings.

## Key findings

- Strolll showed high adherence and safety with no serious adverse events during 60,000+ exercise minutes.
- Participants improved on the Timed 'Up & Go' and 10-meter walk tests after the AR intervention.
- AR cueing was beneficial for some participants, emphasizing the need for individualized approaches.

## Abstract

Physical therapy is moving toward digitally supported, independent, home-based care to improve therapy accessibility and adherence.

This trial evaluated the clinical feasibility and potential effectiveness of Strolll, an augmented reality (AR) neurorehabilitation platform offering gamified gait-and-balance exercises with optional assistive AR cueing for individuals with Parkinson disease, implemented in real-world clinical practice.

In this pragmatic clinical trial, 15 Dutch health care practices were onboarded, 28 therapists trained, and 100 individuals with Parkinson disease (Hoehn and Yahr stages 1-3) included. All participants followed the T0-usual-care-control-T1-Strolll-intervention-T2 procedure.

The Strolll intervention consisted of 2-week supervised in-clinic training followed by 6 weeks, 5 sessions per week of 30 active minutes each, independent home-based training.

No serious adverse events occurred; only 2 non-injurious falls were reported in >60.000 exercise minutes. Adherence was high (96% session adherence, 91% active minutes/session adherence). Therapists prescribed the program progressively, with significantly higher game-play levels over time. Participants’ exercise performance increased over time. Participants and therapists rated user experience and technology acceptance positively. Timed “Up & Go” test and 10-meter walk test (10MWT) (fast speed) scores improved significantly after the intervention period only. Five times sit-to-stand test, 10MWT (comfortable speed), and Mini Balance Evaluation Systems Test scores improved after both usual-care and intervention periods. Falls Efficacy Scale-International scores showed no significant improvements. AR cueing was deemed beneficial for a subset of participants.

Strolll is a safe, adherable, progressive, usable, and well-accepted therapist-managed, home-based intervention for people with Parkinson disease, with the potential to improve gait, balance, and fall-risk indicators. Findings on the integration of AR cueing highlight the importance of an individualized approach.

Implementing AR rehabilitation technologies like Strolll in the clinical pathway is feasible, offering a safe and scalable way for individuals to train independently, potentially improving accessibility of care and broadening its use to physical activity promotion.

This study was registered at ClinicalTrials.gov (NCT06590987).