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Combining treadmill training with gamified virtual reality environments (GVRE) and transcranial direct current stimulation (tDCS) may address both motor and cognitive contributors. This study evaluated the effects and experiences of a cognitive-motor gait training program integrating GVRE and tDCS.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      In this mixed-methods RCT, 23 participants with mild-to-moderate PD were randomized to: (1) treadmill (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u20098), (2) treadmill+GVRE (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u20098), or (3) treadmill+GVRE+tDCS (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u20097). Participants completed 12 sessions over six weeks. Primary outcomes included spatiotemporal gait parameters and executive function under single- and dual-task conditions. Secondary outcomes included balance, motor severity, fear of falling and quality of life. Interviews explored perceived effects and motivational factors.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      The intervention was safe and well tolerated, with high attendance (92%). No statistically or clinically meaningful changes were observed in gait speed. Balance improved across groups (MiniBESTest\u2009+\u20091.48 points;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.0003). A timepoint-specific improvement in cadence during motor dual-task walking was observed in the treadmill+GVRE+tDCS group compared with treadmill. Interviews revealed increased walking confidence and adoption of mobility strategies in complex walking situations.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>This preliminary mixed-methods RCT supports the feasibility and acceptability of combining treadmill training with GVRE and tDCS in people with mild-to-moderate PD. While the intervention did not yield clinically meaningful improvements in gait speed, exploratory outcomes offered insight into participant experiences. Reported gains in confidence, self-monitoring, and walking strategies provide useful context. Findings should be interpreted cautiously. Larger, adequately powered, sham-controlled trials are needed to determine efficacy.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s10072-026-09136-8","type":"journal-article","created":{"date-parts":[[2026,6,12]],"date-time":"2026-06-12T00:11:50Z","timestamp":1781223110000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["A treadmill training program in a gamified virtual reality environment combined with transcranial direct current stimulation in Parkinson\u2019s Disease: Preliminary results of a mixed methods randomized controlled trial"],"prefix":"10.1007","volume":"47","author":[{"given":"Pere","family":"Bosch-Barcel\u00f3","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7037-5033","authenticated-orcid":false,"given":"Carlos","family":"Tersa-Miralles","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Oriol","family":"Mart\u00ednez-Navarro","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria","family":"Masbernat-Almenara","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anni","family":"Pakarinen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Helena","family":"Fern\u00e1ndez-Lago","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,6,12]]},"reference":[{"issue":"11","key":"9136_CR1","doi-asserted-by":"publisher","first-page":"939","DOI":"10.1016\/S1474-4422(18)30295-3","volume":"17","author":"E Dorsey","year":"2018","unstructured":"Dorsey E, Elbaz A, Nichols E, Abd-Allah F, Abdelalim A, Adsuar JC et al (2018) Global, regional, and national burden of Parkinson\u2019s disease, 1990\u20132016: a systematic analysis for the Global Burden of Disease Study 2016. 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