JMIR Publications

ABSTRACT

Background:

Slowness in voluntary movements is a hallmark feature of Parkinson's disease (PD). Despite its clinical relevance, methods for objectively quantifying slowness outside clinical settings remain limited. Serious games represent a promising alternative, allowing the extraction of motor performance metrics unobtrusively during naturalistic interactions. However, evidence on the effectiveness of these games in discriminating motor performance between individuals with and without PD is still scarce.

Objective:

The present study aimed to objectively assess slowness using the RehaBEElitation serious game, based on in-game estimated measurements.

Methods:

The experimental and control groups (EG and CG) consisted of fifteen individuals with PD in the ON and OFF states of medication, as well as fifteen healthy people, respectively, with matched ages and sexes. All participants played each phase of the game on the easiest level. Slowness was evaluated by detecting the voluntary movement of the gyroscope signals using Singular Spectrum Analysis (SSA), a time series decomposition method. The response time (RT) and angular velocity (AV) of the participants while playing RehaBEElitation were estimated. Group-level comparisons were performed to investigate the presence of slowness patterns across conditions. The Kruskal-Wallis test and Wilcoxon signed-rank test with Bonferroni correction were used to confirm the differences between groups, and the effect size was estimated using eta squared (η²). Spearman correlation analyses were conducted to examine associations between the RT and AV and the MDS-UPDRS motor items.

Results:

Groups were age-homogeneous (p > 0.05). Participants with PD had significantly higher scores on MDS-UPDRS Part III in the OFF state compared to the ON state of medication (p < 0.05). RT was generally shorter and AV higher in controls than in participants with PD. In the PD group, RT decreased and AV increased from OFF to ON states, reflecting an improvement in motor performance. Significant differences in RT were observed between groups in all phases of the game, with effect sizes ranging from small to moderate (η² = 0.0239–0.0650). AV differed markedly between groups in Phase 4, with a large effect size (η² = 0.404). Correlation analyses revealed weak positive associations between RT and MDS-UPDRS items, while AV showed strong negative correlations with each motor item and the summary score for bradykinesia.

Conclusions:

The findings demonstrate that RT and AV extracted from the game can detect motor differences related to slowness, indicating that the RehaBEElitation serious game can serve as an alternative and objective tool for monitoring motor performance in daily life in an entertaining way. This approach offers potential application in clinical and home settings, expanding access to more continuous, digital and sensitive assessments of symptom progression. Clinical Trial: Ethics committee for human research of the Federal University of Uberlandia (protocol number: 43229921.8.0000.5152).