Integrating virtual reality into multidisciplinary care for Parkinson's disease: A narrative review

Parkinson's disease (PD) is a neurodegenerative disorder characterized by both motor and non-motor symptoms, significantly impacting patients' functionality and quality of life. Clinical exercise, as part of a multidisciplinary approach, is gaining a crucial role in PD management. Goal-based exercises, combining physical activity with cognitive tasks, external feedback and cues, motor sequencing strategies and dual-tasking may enhance motor learning processes and guide physiotherapy programs.Virtual reality (VR) and exergaming have also emerged as promising tools in PD rehabilitation, offering challenging activities in multisensory environments. They provide intensive and repetitive training, augmented feedback, and tailored exercises in highly interactive and enriched environments. Clinical studies have presented promising results in people with PD, supported by neuroimaging studies showing distinct brain activation patterns post-VR training. However, heterogeneity in study design and lack of standardized characterization of VR systems hinder further application in PD rehabilitation.In this review, we appraise the distinguishing features between different VR systems, highlight VR-related motor and cognitive training in PD and explore how VR interventions are aligned with principles of neuroplasticity and motor learning in PD.