Enhancing Parkinson's Disease Rehabilitation Through Remote Haptic Guidance: Field Study

Parkinson's disease (PD) is a progressive disorder that affects the central nervous system, causing unintended or uncontrollable movements. PD is the second most common neurodegenerative disease, affecting 1-2 per 1000 of the population. This prevalence has more than doubled from 2.5 million patients in 1990 to 6.1 million patients in 2016. Upcoming shifts toward an aging population will exacerbate this problem and the healthcare burden. People with PD suffer from diverse motor symptoms (e.g., tremors, rigidity, and dystonia) that adversely affect their daily activities and quality of life. Physical rehabilitation can improve motor symptoms by slowing disease progression, thereby enhancing the well-being of those with PD. However, administering physical rehabilitation in an accessible and affordable way has been quite challenging because of person- and system-level barriers to healthcare services. Visits to physical therapists, in particular, require resources supported by a caregiver and one-on-one time with specialists, both of which are costly. These problems are especially prominent for patients in rural areas, thereby serving as a major barrier to equity in access to public health assets.

At-home, technology-based rehabilitation programs could reduce training costs and enhance training accessibility, such as by removing the need for a PD patient to visit a facility in person or to schedule one-on-one therapist time. In particular, patients have responded positively to remote rehabilitation programs (e.g., through Zoom) as an alternative to in-person therapy. As these remote programs do not require special equipment other than a device for video-conferencing software, they are more accessible to broad user populations. Yet, such remote programs lack important components of usual physical rehabilitation - especially motion guidance, assessment, and feedback - during which critical communications are needed between the therapist and patient that include hands-on interactions. Also, such programs still require one-on-one therapist time, which can be costly and not affordable for long-term participation. To overcome such problems, rehabilitation systems using emerging technologies have been explored, including robotics and virtual reality (VR). Current robotics systems, though, are limited to clinical use due to their cost and size. VR-based rehabilitation programs can be good alternatives, but are still expensive and cumbersome to use, and they can cause motion sickness for PD patients. There is thus a clear need for remote rehabilitation programs that are effective, low-cost, easy to use, provide hands-on assistance, and ensure the safety of PD patients.