Upper Extremity Rehabilitation With Virtual Reality in Parkinson's Disease Patients

The Box and Block Test (BBT) is widely used in neurological rehabilitation to assess upper extremity motor function, gross manual dexterity, and coordination. The test apparatus consists of a partitioned box measuring 53.7 × 25.4 × 8.5 cm and 150 wooden cubes.

During administration, the box is placed in front of the participant with the partition aligned to the midline. The participant is instructed to transfer the cubes from one compartment to the other using the test hand as quickly as possible. At the end of the trial, the therapist records the score by counting the number of cubes successfully transferred.

Position, i.e. proprioceptive sensation, will be evaluated with the "angle repetition test", one of the methods commonly used in the clinic. The person will be positioned in a sitting position with his/her back unsupported and feet touching the floor. The angle repetition test will be performed with a mobile device fixed above the elbow and between the shoulder. The person's eyes will be closed during the assessment to prevent the learning effect and the use of visual reference. After the shoulder is brought to the reference angle, the person is allowed to perceive the angle by waiting 10 seconds. The person will then be asked to bring his/her shoulder to the side of his/her body and then repeat the taught reference angle as he/she perceived it. The absolute value of the angle deviated from the target will be recorded. Measurements in the shoulder joint will be made at 40° and 100° angles.

It is the most frequently used, valid and reliable scale for the assessment of impairments and disabilities in PD. It contains 42 items, consists of 4 sections and assesses patients' mental status, behavior and mental state (4 items), activities of daily living (13 items), motor functions (14 items) and treatment complications (11 items), respectively. Mental status; 16 points, activities of daily living; 52 points, motor functions; 108 points and treatment complications; 23 points, totaling 199 points. Higher scores indicate worsening of the patient's condition. An 8-point change in the total score was found to determine minimal clinically significant change.

It is a questionnaire consisting of a total of 30 questions used to evaluate the ability of the patient with upper extremity problems in activities of daily living and upper extremity functions. The first 21 questions ask about the degree of difficulty in performing various activities of daily living with the dominant limb in the last week, the next 5 questions ask about the degree of pain, numbness, weakness during activities and the last 4 questions ask about the effect of pathologies on sleep, work, social life and psychological status. For each question, the patient marked the appropriate response on a 5-point Likert-type scale. 1 indicates no difficulty, 2 indicates mild difficulty, 3 indicates moderate difficulty, 4 indicates extreme difficulty, and 5 indicates no difficulty at all. The questionnaire is evaluated between 30 and 150 points.

The questions in the PDQ-8 assess the condition of the individual in the last 1 month and are scored between 0 (never) and 4 (always). The total score is converted to a 100-point system and a high score indicates a decrease in quality of life.

The Intrinsic Motivation Inventory (IMI) is used to assess motivation and satisfaction during task performance. It is a multidimensional questionnaire that evaluates interest/enjoyment, perceived competence, pressure/tension, perceived choice, and value/usefulness. Responses are rated on a Likert scale ranging from "not at all true" to "very true." The total motivation score is calculated by summing the item scores.