The Effects of Tele-Rehabilitation-Based Dual-Task Upper Extremity Training in Patients With Parkinson's Disease

UPDRS is a reliable and valid scale that assesses cognitive skills, mood, daily living activities, motor skills, motor fluctuations, dyskinesias and autonomic dysfunction and is widely used in clinical studies and research in Parkinson's disease. The motor symptoms section, which is the third section of this scale, will be used.

It is a staging system that provides information quickly in determining the severity and symptoms of Parkinson's disease.

During the test, individuals use only one hand to pick up nine wooden pegs one by one and insert them into the holes as quickly as possible. After inserting all the pegs, they quickly place them back into the container one by one. The timer starts when the individual touches the first peg and ends when the last peg is placed back into the container.

This test assesses the coordination of independent finger movements. In this test, the person is asked to rotate a coin 180 degrees as many times as possible between their thumb, index finger, and middle finger within 10 seconds without dropping it. The person's performance is video recorded and later analyzed. An increase in the number of times the patient rotates the coin within 10 seconds indicates better fine motor skills.

This is a 36-question survey that assesses fine motor skills based on individual self-reports. The survey includes questions related to daily life, such as drinking water, tying shoelaces, brushing teeth, and turning book pages. Each question is scored from 0 (almost impossible) to 4 (easy). The resulting score is converted to a 100-point system. Higher scores indicate good fine motor skills.

Grip strength will be assessed using a Jamar hand dynamometer (JAMAR®, Performance Health Holdings, Inc., USA). During the tests, the individual will be positioned in a chair with the arm at the side of the body, the elbow flexed at 90°, and the wrist in a neutral position. Individuals will be asked to make a fist to assess their grip strength.

It is used to assess executive functions and attention. The test consists of two parts, A and B. In part A, the individual is asked to combine numbers from 1 to 25, and the completion time is recorded. In part B, the individual completes a sequence where each number corresponds to a letter, and the completion time is recorded.

It consists of thirteen items. The assessment is based on anamnesis information regarding how the patient functions in various activities. The presence of sensory complaints that may be related to tremor and parkinsonism is also included in this section as they can affect daily living activities. Each item is evaluated using a scoring system between '0' and '4'.

This test is used to assess the difficulties experienced in daily tasks involving dual task execution. It consists of 19 questions, with a scale of 0 (not difficult at all) to 4 (extremely difficult). A higher overall score indicates a higher perceived level of difficulty when performing dual tasks during daily life activities.

Patient satisfaction with treatment will be assessed post-treatment using a 100 mm long visual-analog scale.

This survey consists of 14 items. It assesses patients' satisfaction levels with the software or system they use for treatment or other remote rehabilitation services. The total score ranges from 14 to 70, with a maximum of 5 points per question. A higher score indicates higher satisfaction.