Effects of Aquatic Tai Chi and Computer Assisted Rehabilitation Environment-Based Virtual Reality Training on Rehabilitation in Patients with Parkinson Disease: A Randomized Controlled Trial

OBJECTIVE: To compare aquatic Tai Chi (ATC) and Computer Assisted Rehabilitation Environment (CAREN)-based virtual reality (VR) gait training in individuals with Parkinson disease (PD) and characterize differences in their effects over time. DESIGN: Single-blind, parallel-group randomized controlled trial. SETTING: Outpatient rehabilitation pool and gait laboratory. PARTICIPANTS: Fifty older adults with PD (Hoehn-Yahr stage 2-3) and balance impairment were randomly assigned to CAREN (n=24) or ATC (n=26). INTERVENTIONS: Participants received ATC or CAREN training for 40 minutes per session, 5 sessions per week, for 12 weeks. MAIN OUTCOME MEASURES: Clinical outcomes including the Unified Parkinson's Disease Rating Scale Part III (UPDRS-III), Berg Balance Scale (BBS), Timed Up and Go test (TUG), and 6-minute walk test (6MWT), as well as Spatiotemporal gait parameters and gait symmetry were assessed at baseline and weeks 6, 12, and 24. RESULTS: Forty participants completed the trial. Both groups improved significantly in clinical function, spatiotemporal gait parameters, and gait symmetry at weeks 6, 12, and 24 compared with baseline. At post-intervention (week 12), the CAREN group showed lower UPDRS-III scores, higher BBS scores, shorter TUG times, and longer 6MWT distances than the ATC group (all P<.05). CAREN demonstrated faster gait speed, longer step length, higher cadence, shorter gait cycle time, and better overall gait symmetry (all P<.05). At follow-up (week 24), CAREN retained significant advantages in BBS, cadence, stance phase, gait cycle time, and hip, knee, ankle, and overall gait symmetry indices. CONCLUSIONS: Both interventions improved gait- and balance-related function in individuals with PD. CAREN produced greater improvements during treatment and maintained advantages at follow-up in selected balance, spatiotemporal gait, and gait symmetry outcomes. CAREN should be prioritized for its earlier improvements and sustained benefits in gait and balance, whereas ATC may serve as a feasible alternative for patients who are unable or unsuitable to participate in VR gait training.