key: cord-0772712-gcl0ud71
authors: Srivastav, Adarsh Kumar; Samuel, Asir John
title: E-Rehabilitation: One solution for patients with Parkinson's disease in COVID-19 era
date: 2020-06-04
journal: Parkinsonism Relat Disord
DOI: 10.1016/j.parkreldis.2020.05.021
sha: 0256a8e5d7cf9e96e11e53b7bf427d47163c23a9
doc_id: 772712
cord_uid: gcl0ud71

nan

TEXT 2 Dear Sir, 3 Neurorehabilitation is hampered due to social distancing and fear due to the chance of 4 getting coronavirus disease, 2019 . Home-based or community-based and 5 outpatient-based rehabilitation are restricted temporarily to protect both patients and caregivers 6 from COVID-19 infection. Lack of physical activities during lockdown may lead to worsening of 7 various motor and non-motor symptoms in patients with Parkinson's disease (PD) [1] . Therefore, 8 to reduce the spread of the virus, digital rehabilitation (E-Rehabilitation) strategies should be 9 adopted as an alternative mode to deliver rehabilitation services at the community level. The 10 main advantage of E-Rehabilitation is that it provides clinical and rehabilitation support to 11 community by overcoming geographical barriers through the electronic communication mode

[2]. Advanced rehabilitation techniques are difficult to access by patients living in rural areas due 13 to its high cost, which eventually lead to failures in maintaining the intensity and frequency of 14 rehabilitation. Use of E-Rehabilitation might enhance the outcomes, quality of life and proven its 15 efficacy in many conditions [3] . exercises are that they stimulate movement utilizing computer-based games in a VR environment 24 which then allows for skills practice, motivation, motor and cognitive learning in an interactive 25 and safe environment. This enhances adaptability and reduces medical costs. By engage in long-26 term exercises at home with goal-oriented practice and intensive therapy, it improves adherence 27 and helps patients who are prone to dropping out from regular rehabilitation protocol. VR has 28 certain limitations, such as reduced safety due to minimal direct supervision, cybersickness, 29 cognitive overload, an inappropriate level of context of exercise and loss of human touch. To 30 increase game performance, the patient might start using compensatory movements, thereby 31 reducing true training effects. Therefore, to achieve successful results, VR should be applied 32 with guidance on duration, frequency, intensity and targeted motor skills. E-virtual rehab helps to 33 increase self-practice by use of advance games, graphics, sensors, immersive technologies and 34 enables real-life activity by providing guidance and immersing the patients into therapeutic 35 activity with remote access.

The role of android mobile or iPhone Operating System (iOS) based mobile health 37 applications are found to be more useful during this COVID-19 era of PD rehabilitation. The list 38 of mobile health applications used for treatment in patients with PD are tabulated in Table 1 . Manage the difficulty in salivation

Epidemiology and treatment of Parkinson's disease in 60

Digital physical therapy in the COVID-19 pandemic

This brief report or correspondence was submitted as an assignment by the first author [Dr. 

None of the authors have conflict of interest to declare.