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Lubetzky AV, Kelly J, Wang Z, Gospodarek M, Fu G, Sutera J, Hujsak BD. Contextual sensory integration training via head mounted display for individuals with vestibular disorders: a feasibility study. Disabil Rehabil Assist Technol 2020; 17:74-84. [PMID: 32421374 DOI: 10.1080/17483107.2020.1765419] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Purpose: Virtual reality (VR) interventions can simulate real-world sensory environments. The purpose of this study was to test the feasibility of a novel VR application (app) developed for a Head Mounted Display (HMD) to target dizziness, imbalance and sensory integration in a functional context for patients with vestibular disorders. Here we describe the design of the app as well as self-reported and functional outcomes in vestibular patients before and after participating in vestibular rehabilitation using the app.Material and methods: Our app includes a virtual street, airport, subway or a park. The clinician controls the visual and auditory load including several levels of direction, amount and speed of virtual pedestrians. Clinicians enrolled 28 patients with central (mild-traumatic brain injury [mTBI] or vestibular migraine) and peripheral vestibular disorders. We recorded the Simulator Sickness Questionnaire, Visual Vertigo Analogue Scale (VVAS), Dizziness Handicap Inventory (DHI), Activities-Specific Balance Confidence Scale (ABC), 8-foot up and go (8FUG) and Four-Step Square Test (FSST) before and after the intervention.Results: Within the 15 patients who completed the study, 12 with peripheral hypofunction showed significant improvements on the VVAS (p = 0.02), DHI (p = 0.008) and ABC (p = 0.02) and a small significant improvement on the FSST (p = 0.015). Within-session changes in symptoms were minimal. Two patients with mTBI showed important improvements, but one patient with vestibular migraine, did not.Conclusion: HMD training within increasingly complex immersive environments appears to be a promising adjunct modality for vestibular rehabilitation. Future controlled studies are needed to establish effectiveness.IMPLICATIONS FOR REHABILITATIONVirtual Reality allows for gradual introduction of complex semi-real visual environments.Within VR training patients can re-learn to maintain balance when presented with a sensory conflict in a safe environment.Head Mounted Display training appears to be a promising adjunct modality for vestibular rehabilitation.Portability and affordability of the hardware and software enhance the potential clinical outreach.
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Affiliation(s)
- Anat V Lubetzky
- Department of Physical Therapy, Steinhardt School of Culture, Education and Human Development, New York University, New York, NY, USA
| | - Jennifer Kelly
- Vestibular Rehabilitation, New York Eye and Ear Infirmary of Mount Sinai, New York, NY, USA
| | - Zhu Wang
- Future Reality Lab, Department of Computer Science, Courant Institute of Mathematical Sciences, New York University, New York, NY, USA
| | - Marta Gospodarek
- Department of Music and Performing Arts Professions, Steinhardt School of Culture, Education and Human Development, New York University, New York, NY, USA
| | - Gene Fu
- Vestibular Rehabilitation, New York Eye and Ear Infirmary of Mount Sinai, New York, NY, USA
| | - John Sutera
- Department of Physical Therapy, Steinhardt School of Culture, Education and Human Development, New York University, New York, NY, USA.,Vestibular Rehabilitation, New York Eye and Ear Infirmary of Mount Sinai, New York, NY, USA
| | - Bryan D Hujsak
- Vestibular Rehabilitation, New York Eye and Ear Infirmary of Mount Sinai, New York, NY, USA
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Objective evaluation of Nintendo Wii Fit Plus balance program training on postural stability in Multiple Sclerosis patients: a pilot study. Int J Rehabil Res 2020; 43:199-205. [DOI: 10.1097/mrr.0000000000000408] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Immediate Effects of Ankle-Foot Orthosis Using Wire on Static Balance of Patients with Stroke with Foot Drop: A Cross-Over Study. Healthcare (Basel) 2020; 8:healthcare8020116. [PMID: 32354201 PMCID: PMC7349351 DOI: 10.3390/healthcare8020116] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Revised: 04/21/2020] [Accepted: 04/22/2020] [Indexed: 12/13/2022] Open
Abstract
The aim of this study was to investigate the immediate static balance effects of bare foot, UD-Flex ankle–foot orthosis (AFO), and AFO using wire (AOW) of patients with stroke with foot drop. Seventeen patients with stroke with foot drop (8 men and 9 women) were randomized to three conditions (bare foot, UD-Flex AFO, or AOW made with a flexible material). Static balance was assessed using the Zebris (Zebris GmbH, Isny, Germany) and BioRescue (RM Ingenierie, Rodez, France) pressure platform by a single examiner, who did not design the AOW. The order of testing with the equipment was random. The center of pressure path length (mm) measured using Zebris showed significant differences among the three conditions (bare foot, 484.47 ± 208.42; UD-Flex AFO, 414.59 ± 144.43; AOW, 318.29 ± 157.60) (p < 0.05). The bare-foot condition was not significantly different from the UD-Flex AFO condition (p > 0.05), but was significantly different from the AOW condition (p < 0.05). The surface area ellipse (mm2) measured using BioRescue showed significant differences among the three conditions (bare foot, 241.35 ± 153.76; UD-Flex AFO, 277.41 ± 381.83; AOW, 68.06 ± 48.98) (p < 0.05). The bare-foot condition was not significantly different from the UD-Flex AFO condition (p > 0.05), but the AOW condition was significantly different from the bare-foot (p < 0.05) and from the UD-Flex AFO conditions (p < 0.05). We suggest using the AOW made of flexible materials and wire instead of the UD-Flex AFO to improve immediate static balance of patients with stroke with foot drop after stroke. Further studies on the effects of dynamic balance and gait are required.
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Ozkul C, Guclu-Gunduz A, Yazici G, Atalay Guzel N, Irkec C. Effect of immersive virtual reality on balance, mobility, and fatigue in patients with multiple sclerosis: A single-blinded randomized controlled trial. Eur J Integr Med 2020. [DOI: 10.1016/j.eujim.2020.101092] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Maggio MG, De Luca R, Manuli A, Buda A, Foti Cuzzola M, Leonardi S, D'Aleo G, Bramanti P, Russo M, Calabrò RS. Do patients with multiple sclerosis benefit from semi-immersive virtual reality? A randomized clinical trial on cognitive and motor outcomes. APPLIED NEUROPSYCHOLOGY-ADULT 2020; 29:59-65. [PMID: 31920097 DOI: 10.1080/23279095.2019.1708364] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Multiple sclerosis (MS) is a demyelinating disease of autoimmune originate. A large proportion of patient present with cognitive deficits that negatively affect their quality of life, thus, a proper cognitive rehabilitation is mandatory. The aim of this study is to evaluate the effect of semi-immersive virtual reality training (sVRT) on neuropsychological and motor recovery individuals suffering from MS. We enrolled 60 MS patients, randomized into either the control group (CG: 30) undergoing a conventional cognitive training, or the experimental group (EG: 30), which performed sVRT. Cognitive and motor outcomes were investigated through clinical and neuropsychological scales before (T0) and at the end (T1) of each different training. Only in the EG, we observed a significant improvement in cognitive parameters and motor scores. Our data demonstrate that VR cognitive training could potentiate MS patients' rehabilitation outcome, with positive results on both motor and cognitive performance.
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Affiliation(s)
- Maria Grazia Maggio
- Robotic and Behavioral Neurehabilitation Laboratory, IRCCS Centro Neurolesi "Bonino-Pulejo", Messina, Italy
| | - Rosaria De Luca
- Robotic and Behavioral Neurehabilitation Laboratory, IRCCS Centro Neurolesi "Bonino-Pulejo", Messina, Italy
| | - Alfredo Manuli
- Robotic and Behavioral Neurehabilitation Laboratory, IRCCS Centro Neurolesi "Bonino-Pulejo", Messina, Italy
| | - Antonio Buda
- Robotic and Behavioral Neurehabilitation Laboratory, IRCCS Centro Neurolesi "Bonino-Pulejo", Messina, Italy
| | - Marilena Foti Cuzzola
- Robotic and Behavioral Neurehabilitation Laboratory, IRCCS Centro Neurolesi "Bonino-Pulejo", Messina, Italy
| | - Simona Leonardi
- Robotic and Behavioral Neurehabilitation Laboratory, IRCCS Centro Neurolesi "Bonino-Pulejo", Messina, Italy
| | - Giangaetano D'Aleo
- Robotic and Behavioral Neurehabilitation Laboratory, IRCCS Centro Neurolesi "Bonino-Pulejo", Messina, Italy
| | - Placido Bramanti
- Robotic and Behavioral Neurehabilitation Laboratory, IRCCS Centro Neurolesi "Bonino-Pulejo", Messina, Italy
| | - Margherita Russo
- Robotic and Behavioral Neurehabilitation Laboratory, IRCCS Centro Neurolesi "Bonino-Pulejo", Messina, Italy
| | - Rocco Salvatore Calabrò
- Robotic and Behavioral Neurehabilitation Laboratory, IRCCS Centro Neurolesi "Bonino-Pulejo", Messina, Italy
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Improving motor performance in Parkinson’s disease: a preliminary study on the promising use of the computer assisted virtual reality environment (CAREN). Neurol Sci 2019; 41:933-941. [DOI: 10.1007/s10072-019-04194-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Accepted: 12/10/2019] [Indexed: 12/21/2022]
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Hayes S, Galvin R, Kennedy C, Finlayson M, McGuigan C, Walsh CD, Coote S. Interventions for preventing falls in people with multiple sclerosis. Cochrane Database Syst Rev 2019; 11:CD012475. [PMID: 31778221 PMCID: PMC6953359 DOI: 10.1002/14651858.cd012475.pub2] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND Multiple sclerosis (MS) is one of the most prevalent diseases of the central nervous system with recent prevalence estimates indicating that MS directly affects 2.3 million people worldwide. Fall rates of 56% have been reported among people with MS in a recent meta-analysis. Clinical guidelines do not outline an evidence-based approach to falls interventions in MS. There is a need for synthesised information regarding the effectiveness of falls prevention interventions in MS. OBJECTIVES The aim of this review was to evaluate the effectiveness of interventions designed to reduce falls in people with MS. Specific objectives included comparing: (1) falls prevention interventions to controls and; (2) different types of falls prevention interventions. SEARCH METHODS We searched the Trials Register of the Cochrane Multiple Sclerosis and Rare Diseases of the CNS Group, Cochrane Central Register of Controlled Trials (2018 Issue 9); MEDLINE (PubMed) (1966 to 12 September 2018); Embase (EMBASE.com) (1974 to 12 September 2018); Cumulative Index to Nursing and Allied Health Literature (EBSCOhost) (1981 to 12 September 2018); Latin American and Caribbean Health Science Information Database (Bireme) (1982 to 12 September 2018); ClinicalTrials.gov; and World Health Organization International Clinical Trials Registry Platform; PsycINFO (1806 to 12 September 2018; and Physiotherapy Evidence Database (1999 to 12 September 2018). SELECTION CRITERIA We selected randomised controlled trials or quasi-randomised trials of interventions to reduce falls in people with MS. We included trials that examined falls prevention interventions compared to controls or different types of falls prevention interventions. Primary outcomes included: falls rate, risk of falling, number of falls per person and adverse events. DATA COLLECTION AND ANALYSIS Two review authors screened studies for selection, assessed risk of bias and extracted data. We used a rate ratio (RaR) and 95% confidence interval to compare falls rate between groups. For risk of falling, we used a risk ratio (RR) and 95% CI based on the number of fallers in each group. MAIN RESULTS A total of 839 people with MS (12 to 177 individuals) were randomised in the 13 included trials. The mean age of the participants was 52 years (36 to 62 years). The percentage of women participants ranged from 59% to 85%. Studies included people with all types of MS. Most trials compared an exercise intervention with no intervention or different types of falls prevention interventions. We included two comparisons: (1) Falls prevention intervention versus control and (2) Falls prevention intervention versus another falls prevention intervention. The most common interventions tested were exercise as a single intervention, education as a single intervention, functional electrical stimulation and exercise plus education. The risk of bias of the included studies mixed, with nine studies demonstrating high risk of bias related to one or more aspects of their methodology. The evidence was uncertain regarding the effects of exercise versus control on falls rate (RaR of 0.68; 95% CI 0.43 to 1.06; very low-quality evidence), number of fallers (RR of 0.85; 95% CI 0.51 to 1.43; low-quality evidence) and adverse events (RR of 1.25; 95% CI 0.26 to 6.03; low-quality evidence). Data were not available on quality of life outcomes comparing exercise to control. The majority of other comparisons between falls interventions and controls demonstrated no evidence of effect in favour of either group for all primary outcomes. For the comparison of different falls prevention interventions, the heterogeneity of intervention types across studies prohibited the pooling of data. In relation to secondary outcomes, there was evidence of an effect in favour of exercise interventions compared to controls for balance function with a SMD of 0.50 (95% CI 0.09 to 0.92), self-reported mobility with a SMD of 16.30 (95% CI 9.34 to 23.26) and objective mobility with a SMD of 0.28 (95% CI 0.07 to 0.50). Secondary outcomes were not assessed under the GRADE criteria and results must be interpreted with caution. AUTHORS' CONCLUSIONS The evidence regarding the effects of interventions for preventing falls in MS is sparse and uncertain. The evidence base demonstrates mixed risk of bias, with very low to low certainty of the evidence. There is some evidence in favour of exercise interventions for the improvement of balance function and mobility. However, this must be interpreted with caution as these secondary outcomes were not assessed under the GRADE criteria and as the results represent data from a small number of studies. Robust RCTs examining the effectiveness of multifactorial falls interventions on falls outcomes are needed.
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Affiliation(s)
- Sara Hayes
- University of LimerickSchool of Allied Health, Ageing Research Centre, Health Research InstituteLimerickIreland
| | - Rose Galvin
- University of LimerickDepartment of Clinical Therapies, Faculty of Education and Health SciencesCastletroyLimerickIreland
| | - Catriona Kennedy
- Robert Gordon UniversitySchool of Nursing and MidwiferyGarthdee RoadAberdeenUKAB10 7QG
| | - Marcia Finlayson
- Queen's UniversitySchool of Rehabilitation Therapy31 George StreetKingstonONCanada
| | - Christopher McGuigan
- St. Vincent's University Hospital & University College DublinDepartment of NeurologyElm ParkDublinIreland
| | - Cathal D Walsh
- Department of Mathematics and StatisticsHealth Research Institute (HRI) and MACSIUniversity of LimerickIreland
| | - Susan Coote
- University of LimerickDepartment of Clinical Therapies, Faculty of Education and Health SciencesCastletroyLimerickIreland
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Freitas L, de Araújo Val S, Magalhães F, Marinho V, Ayres C, Teixeira S, Bastos VH. Virtual reality exposure therapy for neuro-psychomotor recovery in adults: a systematic review. Disabil Rehabil Assist Technol 2019; 16:646-652. [PMID: 31746256 DOI: 10.1080/17483107.2019.1688400] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
OBJECTIVE To analyse the virtual reality applications in the subjects' neuro-psychomotor functions rehabilitation with motor and/or neuropsychiatric impairment. METHODS The search was carried out in nine databases (Scopus, PubMed, Web of Science, ScienceDirect, Cochrane Library, CINAHL, PsycINFO, LILACS, and SciELO), from December 2017 to March 2019. An additional manual search was performed, taking into consideration references of the included papers, through the same eligibility criteria. The methodological quality of the included papers was evaluated using the Physiotherapy Evidence Database (PEDro). RESULTS One hundred and twenty-two papers were selected by the initial screening, but only 33 studies participated in the final inclusion in the study (11 clinical trials and 14 experimental studies). The data extracted were: the proposed objective, the sample population, the neurological condition treated, the VR modality used in the procedures and the study intervention period. CONCLUSIONS Virtual reality supports the rehabilitation process of neuro-psychomotor functions, allowing potential gains in the patients' recovery. Therefore, its development facilitates its availability and access in the future.Implications for rehabilitationIt has minimal adverse effects during the virtual therapies performance, such as the presence of vertigo related to cybersickness conditions, suggesting virtual reality as a safe rehabilitation tool, compared to other therapies.Virtual reality use is useful and effective in helping the rehabilitation process of motor, cognitive and psychosocial functions.It plays a role as an adjunctive and complementary therapy in the neuro-psychomotor rehabilitation process to obtain a clinically significant result.
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Affiliation(s)
- Luan Freitas
- Brain Mapping and Functionality Laboratory, Federal University of Piauí, Parnaíba, Brazil
| | - Sabrina de Araújo Val
- Brain Mapping and Functionality Laboratory, Federal University of Piauí, Parnaíba, Brazil
| | - Francisco Magalhães
- Neuro-Innovation Technology and Brain Mapping Laboratory, Federal University of Piauí, Parnaíba, Brazil.,The Northeast Biotechnology Network, Federal University of Piauí, Teresina, Brazil
| | - Victor Marinho
- Neuro-Innovation Technology and Brain Mapping Laboratory, Federal University of Piauí, Parnaíba, Brazil.,The Northeast Biotechnology Network, Federal University of Piauí, Teresina, Brazil
| | - Carla Ayres
- Neuro-Innovation Technology and Brain Mapping Laboratory, Federal University of Piauí, Parnaíba, Brazil
| | - Silmar Teixeira
- Neuro-Innovation Technology and Brain Mapping Laboratory, Federal University of Piauí, Parnaíba, Brazil.,The Northeast Biotechnology Network, Federal University of Piauí, Teresina, Brazil
| | - Victor Hugo Bastos
- Brain Mapping and Functionality Laboratory, Federal University of Piauí, Parnaíba, Brazil.,The Northeast Biotechnology Network, Federal University of Piauí, Teresina, Brazil
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Arntzen EC, Øberg GK, Gallagher S, Normann B. Group-based, individualized exercises can provide perceived bodily changes and strengthen aspects of self in individuals with MS: a qualitative interview study. Physiother Theory Pract 2019; 37:1080-1095. [PMID: 31657262 DOI: 10.1080/09593985.2019.1683923] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Background: Group-based physiotherapy is effective for individuals with MS; nevertheless individualization within groups is questioned and little is known regarding individuals´ experiences with individualization in small groups.Objective: We aimed to explore the short- and long-term experiences of individuals with MS participating in a 6-week, group-based, individualized physiotherapy-intervention.Methods: Within a randomized controlled trial (RCT), 25 in-depth interviews with a strategic sample of 13 people (9 women; age 25-79 years old; European Disability Status Scale (EDSS) 1-6.5) were conducted at weeks 7 and 30 using systematic text condensation, with dynamic systems theory and phenomenology as analytical frameworks.Results: The main categories were: 1) movement control, orientation and insights: Bodily improvements were associated with targeted exercises, specific adjustments by the physiotherapist, emotional engagement and re-access to activities; and 2) the individual within the group: Equal distributions of one-to-one interactions and attention were important for experiencing success. Less attention and improvements turned attention toward own disability. Physical changes felt particularly emotional short term, implying that individuals' feelings of ownership and control of body and movement, new views of themselves and changed affordances in daily life were involved.Conclusion: Equally distributed attention and engagement, targeted exercises and hands-on adjustments resulting in visible and perceived bodily changes were experienced as key factors of individualization in small groups.
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Affiliation(s)
| | | | - Shaun Gallagher
- The Lillian and Morrie Moss Chair of Excellence in Philosophy, Department of Philosophy, University of Memphis, Memphis, TN, USA
| | - Britt Normann
- Department of Physiotherapy, Nordland Hospital Trust, Bodø, Norway.,UiT, The Arctic University of Norway, Tromsø, Norway
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Byrnes KL, Whillier S. Effects of Nonpharmaceutical Treatments on Symptom Management in Adults With Mild or Moderate Multiple Sclerosis: A Meta-analysis. J Manipulative Physiol Ther 2019; 42:514-531. [DOI: 10.1016/j.jmpt.2018.12.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2018] [Revised: 11/08/2018] [Accepted: 12/03/2018] [Indexed: 10/25/2022]
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Feys P, Straudi S. Beyond therapists: Technology-aided physical MS rehabilitation delivery. Mult Scler 2019; 25:1387-1393. [DOI: 10.1177/1352458519848968] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
In the last decade, rehabilitation technology has been developed, investigated, and entered specialized clinical settings. In this chapter, we first discuss the potential of rehabilitation technology to support the achievement of key factors in motor recovery, such as delivering massed practice with good movement quality but also question task-specificity and cognitive motor control mechanisms. Second, we discuss available technology-supported rehabilitation methods for improving gait, balance and fitness, and upper limb function. Finally, we discuss considerations in relation to the professional workforce in order to deliver optimal rehabilitation.
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Affiliation(s)
- Peter Feys
- REVAL/BIOMED, Faculty of Rehabilitation Sciences, UHasselt, Diepenbeek, Belgium
| | - Sofia Straudi
- Neuroscience and Rehabilitation Department, Ferrara University Hospital, Ferrara, Italy
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Cano Porras D, Sharon H, Inzelberg R, Ziv-Ner Y, Zeilig G, Plotnik M. Advanced virtual reality-based rehabilitation of balance and gait in clinical practice. Ther Adv Chronic Dis 2019; 10:2040622319868379. [PMID: 31489154 PMCID: PMC6710712 DOI: 10.1177/2040622319868379] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2019] [Accepted: 07/06/2019] [Indexed: 11/16/2022] Open
Abstract
Background Extensive research shows that virtual reality (VR) enhances motor learning and has advantages in balance and gait rehabilitation of neurological patients. There is still uncertainty, however, as for the practicality and efficacy of VR in long-term clinical routine. The objective of this study was to report on 3 years of clinical practice conducting VR-based rehabilitation of balance and gait in a large medical center. Methods This retrospective study systematically analyzed clinical records of patients who received VR-based rehabilitation in a large rehabilitation center during 3 years. We evaluated the effect of VR-based rehabilitation treatments on balance and gait, cognitive dual-task load, patient's balance confidence (ABC-scale) and perception of suitability. Patients were either neurological patients, allocated to five groups: Parkinson's disease (PD), poststroke (PS), multiple sclerosis, traumatic brain injury, and 'other conditions', or non-neurological patients. Results Records of 167 patients were analyzed. The availability of multiple VR systems and environments contributed to highly personalized interventions that tailored specific deficits with therapeutic goals. VR-based rehabilitation significantly improved balance and gait (measured by 10-Meter Walk Test, Timed-Up-and-Go, Berg Balance Scale, and Mini BESTest). Patients with PD and PS decreased dual-task cost while walking. Patients increased balance confidence and deemed VR suitable for rehabilitation. Conclusions Our results suggest that VR-based rehabilitation is practicable and effective in clinical routine. Functional measures of balance and gait show significant improvements following VR-based interventions. Clinical approaches should exploit VR advantages for promoting motor learning and motivation. This study serves to aid transition to long-term clinical implementation of VR.
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Affiliation(s)
- Desiderio Cano Porras
- Center of Advanced Technologies in Rehabilitation, Sheba Medical Center, Ramat Gan, Tel HaShomer, Israel
| | - Hadar Sharon
- Center of Advanced Technologies in Rehabilitation, Sheba Medical Center, Ramat Gan, Tel HaShomer, Israel
| | - Rivka Inzelberg
- Center of Advanced Technologies in Rehabilitation, Sheba Medical Center, Tel HaShomer, Israel
| | - Yitzhak Ziv-Ner
- Department of Orthopedic Rehabilitation, Sheba Medical Center, Tel HaShomer, Israel
| | - Gabriel Zeilig
- Department of Neurological Rehabilitation, Sheba Medical Center, Tel HaShomer, Israel
| | - Meir Plotnik
- Center of Advanced Technologies in Rehabilitation, Sheba Medical Center, Derech Sheba 2, Ramat Gan, Tel HaShomer 52621, Israel
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Effects of a Game-Based Virtual Reality Video Capture Training Program Plus Occupational Therapy on Manual Dexterity in Patients with Multiple Sclerosis: A Randomized Controlled Trial. JOURNAL OF HEALTHCARE ENGINEERING 2019; 2019:9780587. [PMID: 31178989 PMCID: PMC6501239 DOI: 10.1155/2019/9780587] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Accepted: 03/21/2019] [Indexed: 11/17/2022]
Abstract
Neurorehabilitation is a fundamental aspect in the treatment approach for multiple sclerosis (MS), in which new technologies have gained popularity, especially the use of virtual reality (VR). The aim of this paper is to analyze an occupational therapy (OT) intervention compared with OT + VR (OT + VR) on the manual dexterity of patients with MS. 26 MS subjects were initially recruited from an MS patient association and randomized into two groups. The OT group received 20 conventional OT sessions distributed in two sessions per week. The OT + VR group received 20 sessions of VR interventions, twice weekly and lasting 30 minutes, consisting of VR games accessed via the online web page motiongamingconsole.com, in addition to the conventional OT sessions. Pre- and postintervention assessments were based on the Purdue Pegboard Test, the Jebsen-Taylor Hand Function Test, and the Grooved Pegboard Test. Clinical improvements were found regarding the precision of movements, the execution times, and the efficiency of certain functional tasks in the Purdue Pegboard Test and Jebsen-Taylor Hand Function Test tests in the OT + VR group. Although significant differences were not found in the manual dexterity between the OT and OT + VR groups, improvements were found regarding the precision and effectiveness of certain functional tasks.
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Virtual reality in multiple sclerosis rehabilitation: A review on cognitive and motor outcomes. J Clin Neurosci 2019; 65:106-111. [PMID: 30898488 DOI: 10.1016/j.jocn.2019.03.017] [Citation(s) in RCA: 87] [Impact Index Per Article: 17.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2019] [Revised: 03/08/2019] [Accepted: 03/11/2019] [Indexed: 12/26/2022]
Abstract
Multiple sclerosis (MS) is a demyelinating neurodegenerative disease with lesions involving the central nervous system. Clinical symptoms consist of disturbances in motor activity (e.g., weakness, spasticity, and tremor), sensory functioning (e.g., pain), visual functions (e.g., diplopia and optic neuritis), besides different cognitive (attention deficit and executive dysfunction) and behavioral abnormalities. This review aims to evaluate the role of VR tools in cognitive and motor rehabilitation of MS patients. Studies performed between 2010 and 2017 and fulfilling the selected criteria were searched on PubMed, Scopus, Cochrane and Web of Sciences databases, by combining the terms "VR rehabilitation" and "MS". Our findings showed that, following the use of VR training, MS patients presented a significant improvement in motor (especially gait and balance) and cognitive function (with regard to executive and visual-spatial abilities, attention and memory skills). This review supports the idea that rehabilitation through new VR tools could positively affect MS patients' outcomes, by boosting motivation and participation with a better response to treatment.
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De Luca R, Portaro S, Le Cause M, De Domenico C, Maggio MG, Cristina Ferrera M, Giuffrè G, Bramanti A, Calabrò RS. Cognitive rehabilitation using immersive virtual reality at young age: A case report on traumatic brain injury. APPLIED NEUROPSYCHOLOGY-CHILD 2019; 9:282-287. [DOI: 10.1080/21622965.2019.1576525] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Schuster-Amft C, Eng K, Suica Z, Thaler I, Signer S, Lehmann I, Schmid L, McCaskey MA, Hawkins M, Verra ML, Kiper D. Effect of a four-week virtual reality-based training versus conventional therapy on upper limb motor function after stroke: A multicenter parallel group randomized trial. PLoS One 2018; 13:e0204455. [PMID: 30356229 PMCID: PMC6200191 DOI: 10.1371/journal.pone.0204455] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2018] [Accepted: 08/20/2018] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Virtual reality-based training has found increasing use in neurorehabilitation to improve upper limb training and facilitate motor recovery. OBJECTIVE The aim of this study was to directly compare virtual reality-based training with conventional therapy. METHODS In a multi-center, parallel-group randomized controlled trial, patients at least 6 months after stroke onset were allocated either to an experimental group (virtual reality-based training) or a control group receiving conventional therapy (16x45 minutes within 4 weeks). The virtual reality-based training system replicated patients´ upper limb movements in real-time to manipulate virtual objects. Blinded assessors tested patients twice before, once during, and twice after the intervention up to 2-month follow-up for dexterity (primary outcome: Box and Block Test), bimanual upper limb function (Chedoke-McMaster Arm and Hand Activity Inventory), and subjective perceived changes (Stroke Impact Scale). RESULTS 54 eligible patients (70 screened) participated (15 females, mean age 61.3 years, range 20-81 years, time since stroke 3.0±SD 3 years). 22 patients were allocated to the experimental group and 32 to the control group (3 drop-outs). Patients in the experimental and control group improved: Box and Block Test mean 21.5±SD 16 baseline to mean 24.1±SD 17 follow-up; Chedoke-McMaster Arm and Hand Activity Inventory mean 66.0±SD 21 baseline to mean 70.2±SD 19 follow-up. An intention-to-treat analysis found no between-group differences. CONCLUSIONS Patients in the experimental and control group showed similar effects, with most improvements occurring in the first two weeks and persisting until the end of the two-month follow-up period. The study population had moderate to severely impaired motor function at entry (Box and Block Test mean 21.5±SD 16). Patients, who were less impaired (Box and Block Test range 18 to 72) showed higher improvements in favor of the experimental group. This result could suggest that virtual reality-based training might be more applicable for such patients than for more severely impaired patients. TRIAL REGISTRATION ClinicalTrials.gov NCT01774669.
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Affiliation(s)
- Corina Schuster-Amft
- Research Department, Reha Rheinfelden, Rheinfelden, Switzerland
- Institute for Rehabilitation and Performance Technology, Bern University of Applied Sciences, Burgdorf, Switzerland
| | - Kynan Eng
- Institute of Neuroinformatics, University of Zurich and ETH Zurich, Zurich, Switzerland
| | - Zorica Suica
- Research Department, Reha Rheinfelden, Rheinfelden, Switzerland
| | - Irene Thaler
- Department of Physiotherapy, Insel Group, Bern University Hospital, Berne, Switzerland
| | - Sandra Signer
- Physiotherapy Department, Buergerspital Solothurn, Solothurn, Switzerland
| | - Isabelle Lehmann
- Department of Physiotherapy, Insel Group, Bern University Hospital, Berne, Switzerland
| | - Ludwig Schmid
- Research Department, Reha Rheinfelden, Rheinfelden, Switzerland
- Physiotherapy Department, Zurcher RehaZentrum Lengg, Zurich, Switzerland
| | - Michael A. McCaskey
- Research Department, Reha Rheinfelden, Rheinfelden, Switzerland
- Institute of Human Movement Sciences, ETH Zurich, Zurich, Switzerland
| | - Miura Hawkins
- Institute of Neuroinformatics, University of Zurich and ETH Zurich, Zurich, Switzerland
| | - Martin L. Verra
- Department of Physiotherapy, Insel Group, Bern University Hospital, Berne, Switzerland
| | - Daniel Kiper
- Institute of Neuroinformatics, University of Zurich and ETH Zurich, Zurich, Switzerland
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Streicher MC, Alberts JL, Sutliff MH, Bethoux F. Effects and feasibility of virtual reality system vs traditional physical therapy training in multiple sclerosis patients. INTERNATIONAL JOURNAL OF THERAPY AND REHABILITATION 2018. [DOI: 10.12968/ijtr.2018.25.10.522] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Background/Aims: Traditionally, physical therapy for gait and balance training takes place in a gym setting, which may not fully reproduce situations in everyday activities. The Computer Assisted Rehabilitation ENvironment system provides an immersive virtual environment, allowing a simulation of complex conditions conducive to gait and balance training. The purpose of this study was to determine: (1) the feasibility and safety of using the Computer Assisted Rehabilitation ENvironment system for physical therapy sessions with multiple sclerosis patients, and (2) pre-post treatment changes observed with the Computer Assisted Rehabilitation ENvironment system compared to traditional physical therapy. Findings: Data from functional outcome measures Berg Balance Scale, Timed Up and Go test, Timed 25-Foot Walk, and 6-Minute Walk Test were extracted from the medical records of 62 patients with multiple sclerosis who had at least three physical therapy sessions in either environment. Statistically significant within-group improvements were observed for all outcome measures in the physical therapy Computer Assisted Rehabilitation ENvironment system group (P<0.05), and only for Berg Balance Scale in the traditional physical therapy group. There was a significant between-group difference in favour of physical therapy with the Computer Assisted Rehabilitation ENvironment system for the Timed 25-Foot Walk (P=0.022). Conclusions: The results suggest the Computer Assisted Rehabilitation ENvironment system is a safe and effective tool for physical therapy-led gait and balance training for individuals with multiple sclerosis.
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Affiliation(s)
- Matthew C Streicher
- Research engineer, Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Jay L Alberts
- Director of Cleveland Clinic Concussion Center, Cleveland Clinic Foundation, Center for Neurological Restoration, Cleveland, Ohio, USA
| | - Matthew H Sutliff
- Rehabilitation manager, Cleveland Clinic Foundation, Center for Neurological Restoration, Cleveland, Ohio, USA
| | - Francois Bethoux
- Director of Rehabilitation Services, Cleveland Clinic Foundation, Mellen Center for Multiple Sclerosis Treatment and Research, Cleveland, Ohio, USA
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Prasertsakul T, Kaimuk P, Chinjenpradit W, Limroongreungrat W, Charoensuk W. The effect of virtual reality-based balance training on motor learning and postural control in healthy adults: a randomized preliminary study. Biomed Eng Online 2018; 17:124. [PMID: 30227884 PMCID: PMC6145375 DOI: 10.1186/s12938-018-0550-0] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2018] [Accepted: 08/30/2018] [Indexed: 12/14/2022] Open
Abstract
Background Adults with sedentary lifestyles seem to face a higher risk of falling in their later years. Several causes, such as impairment of strength, coordination, and cognitive function, influence worsening health conditions, including balancing ability. Many modalities can be applied to improve the balance function and prevent falling. Several studies have also recorded the effects of balance training in elderly adults for fall prevention. Accordingly, the aim of this study is to define the effect of virtual reality-based balance training on motor learning and postural control abilities in healthy adults. Methods For this study, ten subjects were randomly allocated into either the conventional exercise (CON) or the virtual reality (VR) group. The CON group underwent physical balance training, while the VR group used the virtual reality system 4 weeks. In the VR group, the scores from three game modes were utilized to describe the effect of motor learning and define the learning curves that were derived with the power law function. Wilcoxon Signed Ranks Test was performed to analyze the postural control in five standing tasks, and data were collected with the help of a force plate. Results The average score was used to describe the effect of motor learning by deriving the mathematical models for determining the learning curve. Additionally, the models were classified into two exponential functions that relied on the aim and requirement skills. A negative exponential function was observed in the game mode, which requires the cognitive-motor function. In contrast, a positive exponential function was found in the game with use of only the motor skill. Moreover, this curve and its model were also used to describe the effect of learning in the long term and the ratio of difficulty in each game. In the balance performance, there was a significant decrease in the center of pressure parameters in the VR group, while in the CON group, there was a significant increase in the parameters during some foot placements, especially in the medio-lateral direction. Conclusion The proposed VR-based training relies on the effect of motor learning in long-term training though different kinds of task training. In postural analysis, both exercise programs are emphasized to improve the balance ability in healthy adults. However, the virtual reality system can promote better outcomes to improve postural control post exercising. Trial registration Retrospectively registered on 25 April 2018. Trial number TCTR20180430005 Electronic supplementary material The online version of this article (10.1186/s12938-018-0550-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Thunyanoot Prasertsakul
- Department of Biomedical Engineering, Faculty of Engineering, Mahidol University, Nakhon Pathom, 73170, Thailand
| | - Panya Kaimuk
- Department of Biomedical Engineering, Faculty of Engineering, Mahidol University, Nakhon Pathom, 73170, Thailand
| | - Wipawee Chinjenpradit
- Physical Medicine and Rehabilitation, Cardiac Rehabilitation, Bumrungrad International Hospital, Bangkok, Thailand
| | | | - Warakorn Charoensuk
- Department of Electrical Engineering, Faculty of Engineering, Mahidol University, Phuttamonthon 4 Road., Nakhon Pathom, 73170, Thailand.
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Carpinella I, Nardone A, Bonora G, Bowman T, Cattaneo D, Rabuffetti M, Ferrarin M. Counteracting Postural Perturbations Through Body Weight Shift: a Pilot Study Using a Robotic Platform in Subjects with Parkinson's Disease. IEEE Trans Neural Syst Rehabil Eng 2018; 26:1794-1802. [PMID: 30072335 DOI: 10.1109/tnsre.2018.2862463] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/28/2024]
Abstract
Abnormalities of body-weight transfer occur during several motor tasks in people with Parkinson's disease (PwPD). In this study, a novel robotic paradigm for assessment and training of dynamic balance was developed and applied to twelve healthy subjects (HS) and ten PwPD to verify its feasibility and to assess the capability of PwPD to counteract postural perturbations through body-weight shifts. At variance with other robotic paradigms, subjects had to react as fast as possible to the perturbation, bringing the platform back to the horizontal and keeping it until the end of the task. Four randomized perturbations, obtained varying the platform equilibrium angle from 0° to ±6° in sagittal (backward, forward) and frontal (right, left) planes, were repeated 3 times. Compared to HS, PwPD showed, in all perturbation directions, increased delay in counteraction phase onset (p<=0.01), prolonged time to stabilize the platform (p<=0.02), and higher deviation of the final plate inclination from the horizontal (p<=0.04), the deviation being larger during sagittal perturbations. PwPD showed also larger (p=0.01) postural sway around the stabilization angle following frontal perturbations. Results are in keeping with known hypo- and bradykinesia as well as proprioceptive and kinesthetic impairments in PD. We suggest that the proposed approach is feasible and might be included in balance evaluation and training in PD.
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Peterson SM, Furuichi E, Ferris DP. Effects of virtual reality high heights exposure during beam-walking on physiological stress and cognitive loading. PLoS One 2018; 13:e0200306. [PMID: 29979750 PMCID: PMC6034883 DOI: 10.1371/journal.pone.0200306] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2018] [Accepted: 06/22/2018] [Indexed: 11/25/2022] Open
Abstract
Virtual reality has been increasingly used in research on balance rehabilitation because it provides robust and novel sensory experiences in controlled environments. We studied 19 healthy young subjects performing a balance beam walking task in two virtual reality conditions and with unaltered view (15 minutes each) to determine if virtual reality high heights exposure induced stress. We recorded number of steps off the beam, heart rate, electrodermal activity, response time to an auditory cue, and high-density electroencephalography (EEG). We hypothesized that virtual high heights exposure would increase measures of physiological stress compared to unaltered viewing at low heights. We found that the virtual high height condition increased heart rate variability and heart rate frequency power relative to virtual low heights. Virtual reality use resulted in increased number of step-offs, heart rate, electrodermal activity, and response time compared to the unaltered viewing at low heights condition. Our results indicated that virtual reality decreased dynamic balance performance and increased physical and cognitive loading compared to unaltered viewing at low heights. In virtual reality, we found significant decreases in source-localized EEG peak amplitude relative to unaltered viewing in the anterior cingulate, which is considered important in sensing loss of balance. Our findings indicate that virtual reality provides realistic experiences that can induce physiological stress in humans during dynamic balance tasks, but virtual reality use impairs physical and cognitive performance during balance.
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Affiliation(s)
- Steven M Peterson
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, Michigan, United States of America
| | - Emily Furuichi
- School of Kinesiology, University of Michigan, Ann Arbor, Michigan, United States of America
| | - Daniel P Ferris
- J. Crayton Pruitt Family Department of Biomedical Engineering, University of Florida, Gainesville, Florida, United States of America
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Martini DN, Zeeboer E, Hildebrand A, Fling BW, Hugos CL, Cameron MH. ADSTEP: Preliminary Investigation of a Multicomponent Walking Aid Program in People With Multiple Sclerosis. Arch Phys Med Rehabil 2018; 99:2050-2058. [PMID: 29958906 DOI: 10.1016/j.apmr.2018.05.023] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2017] [Revised: 05/05/2018] [Accepted: 05/14/2018] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To evaluate the effect of the Assistive Device Selection, Training and Education Program (ADSTEP) on falls and walking and sitting activity in people with multiple sclerosis (PwMS). DESIGN Randomized controlled trial. SETTING Veterans affairs medical center. PARTICIPANTS PwMS (N=40) using a walking aid at baseline who had fallen in the previous year. INTERVENTIONS Participants were randomly assigned to ADSTEP or control. ADSTEP had 6 weekly, 40-minute, 1-on-1 sessions with a physical therapist, starting with walking aid selection and fitting, followed by task-oriented progressive gait training. Control was usual medical care with the option of ADSTEP after the study. MAIN OUTCOME MEASURES The following were assessed at baseline, intervention completion, and 3 months later: falls, timed Up and Go, timed 25-foot walk, 2-minute walk, Four Square Step Test, International Physical Activity Questionnaire, Quebec User Evaluation of Satisfaction with Assistive Technologies, Multiple Sclerosis Walking Scale-12, Activities-Specific Balance Confidence Scale, and Multiple Sclerosis Impact Scale-29. Effect on these outcomes was estimated by a 2-by-2 repeated measures general linear model. RESULTS Fewer ADSTEP than control participants fell (χ2=3.96, P<.05. number needed to treat =3.3). Time spent sitting changed significantly differently with ADSTEP than with control from baseline to intervention completion (F=11.16, P=.002. ADSTEP: reduced 87.00±194.89min/d; control: increased 103.50±142.21min/d; d=0.88) and to 3-month follow-up (F=9.25, P=.004. ADSTEP: reduced 75.79±171.57min/d; control: increased 84.50±149.23min/d; d=0.79). ADSTEP yielded a moderate effect on time spent walking compared to control at 3-month follow-up (P>.05. ADSTEP 117.53±148.40min/d; control 46.43±58.55min/d; d=0.63). CONCLUSIONS ADSTEP prevents falls, reduces sitting, and may increase walking in PwMS.
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Affiliation(s)
- Douglas N Martini
- Department of Neurology, Oregon Health & Science University, Portland, OR
| | - Eline Zeeboer
- Department of Neurology, Oregon Health & Science University, Portland, OR
| | | | - Brett W Fling
- Department of Health and Exercise Science, Colorado State University, Fort Collins, CO
| | - Cinda L Hugos
- Department of Neurology, Oregon Health & Science University, Portland, OR; Veterans Affairs Portland Health Care System, Portland, OR
| | - Michelle H Cameron
- Department of Neurology, Oregon Health & Science University, Portland, OR; Veterans Affairs Portland Health Care System, Portland, OR.
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Casuso-Holgado MJ, Martín-Valero R, Carazo AF, Medrano-Sánchez EM, Cortés-Vega MD, Montero-Bancalero FJ. Effectiveness of virtual reality training for balance and gait rehabilitation in people with multiple sclerosis: a systematic review and meta-analysis. Clin Rehabil 2018; 32:1220-1234. [PMID: 29651873 DOI: 10.1177/0269215518768084] [Citation(s) in RCA: 58] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
OBJECTIVE To evaluate the evidence for the use of virtual reality to treat balance and gait impairments in multiple sclerosis rehabilitation. DESIGN Systematic review and meta-analysis of randomized controlled trials and quasi-randomized clinical trials. METHODS An electronic search was conducted using the following databases: MEDLINE (PubMed), Physiotherapy Evidence Database (PEDro), Cochrane Database of Systematic Reviews (CDSR) and (CINHAL). A quality assessment was performed using the PEDro scale. The data were pooled and a meta-analysis was completed. This systematic review was conducted in accordance with the (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) PRISMA guideline statement. It was registered in the PROSPERO database (CRD42016049360). RESULTS A total of 11 studies were included. The data were pooled, allowing meta-analysis of seven outcomes of interest. A total of 466 participants clinically diagnosed with multiple sclerosis were analysed. Results showed that virtual reality balance training is more effective than no intervention for postural control improvement (standard mean difference (SMD) = -0.64; 95% confidence interval (CI) = -1.05, -0.24; P = 0.002). However, significant overall effect was not showed when compared with conventional training (SMD = -0.04; 95% CI = -0.70, 0.62; P = 0.90). Inconclusive results were also observed for gait rehabilitation. CONCLUSION Virtual reality training could be considered at least as effective as conventional training and more effective than no intervention to treat balance and gait impairments in multiple sclerosis rehabilitation.
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Gesundheit 4.0 – Wie gehts uns denn morgen? Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2018; 61:334-339. [DOI: 10.1007/s00103-018-2702-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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Lubetzky AV, Kary EE, Harel D, Hujsak B, Perlin K. Feasibility and reliability of a virtual reality oculus platform to measure sensory integration for postural control in young adults. Physiother Theory Pract 2018; 34:935-950. [PMID: 29364733 DOI: 10.1080/09593985.2018.1431344] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND Using Unity for the Oculus Development-Kit 2, we have developed an affordable, portable virtual reality platform that targets the visuomotor domain, a missing link in current clinical assessments of postural control. Here, we describe the design and technical development as well as report its feasibility with regards to cybersickness and test-retest reliability in healthy young adults. METHOD Our virtual reality paradigm includes two functional scenes ('City' and 'Park') and four moving dots scenes. Twenty-one healthy young adults were tested twice, one to two weeks apart. They completed a simulator sickness questionnaire several times per session. Their postural sway response was recorded from a forceplate underneath their feet while standing on the floor, stability trainers, or a Both Sides Up (BOSU) ball. Sample entropy, postural displacement, velocity, and excursion were calculated and compared between sessions given the visual and surface conditions. RESULTS Participants reported slight-to-moderate transient side effects. Intra-Class Correlation values mostly ranged from 0.5 to 0.7 for displacement and velocity, were above 0.5 (stability trainer conditions) and above 0.4 (floor mediolateral conditions) for sample entropy, and minimal for excursion. CONCLUSION Our novel portable VR platform was found to be feasible and reliable in healthy young adults.
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Affiliation(s)
- Anat V Lubetzky
- a Department of Physical Therapy, Steinhardt School of Culture Education and Human Development , New York University , New York , NY , USA
| | - Erinn E Kary
- a Department of Physical Therapy, Steinhardt School of Culture Education and Human Development , New York University , New York , NY , USA
| | - Daphna Harel
- b Center for the Promotion of Research Involving Innovative Statistical Methodology, Steinhardt School of Culture Education and Human Development , New York University , New York , NY , USA
| | - Bryan Hujsak
- c Vestibular Rehabilitation, The Ear Institute, Hearing and Balance Center , The New York Eye and Ear Infirmary of Mount Sinai , New York , NY , USA
| | - Ken Perlin
- d Computer Science Department, Courant Institute of Mathematical Sciences , New York University , New York , NY , USA
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Abstract
Postural control can be improved with balance training. However, the nature and duration of the training required to enhance posture remains unclear. We studied the effects of 5 min of a self-initiated balance exercise along a single axis on postural control in healthy individuals. Postural control was measured before and after a 5-min period where members of the experimental group were asked to lean their entire body forward and backward and members of the control group were asked to remain seated. A significant improvement for sway velocity, a postural control variable significantly associated with an increased risk of falls, was found in the experimental group following the body sway exercise. These data suggest that a basic exercise can rapidly improve postural control and reduce the risk of falls.
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76
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Kim M, Collins SH. Step-to-Step Ankle Inversion/Eversion Torque Modulation Can Reduce Effort Associated with Balance. Front Neurorobot 2017; 11:62. [PMID: 29184493 PMCID: PMC5694462 DOI: 10.3389/fnbot.2017.00062] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2017] [Accepted: 10/19/2017] [Indexed: 11/25/2022] Open
Abstract
Below-knee amputation is associated with higher energy expenditure during walking, partially due to difficulty maintaining balance. We previously found that once-per-step push-off work control can reduce balance-related effort, both in simulation and in experiments with human participants. Simulations also suggested that changing ankle inversion/eversion torque on each step, in response to changes in body state, could assist with balance. In this study, we investigated the effects of ankle inversion/eversion torque modulation on balance-related effort among amputees (N = 5) using a multi-actuated ankle-foot prosthesis emulator. In stabilizing conditions, changes in ankle inversion/eversion torque were applied so as to counteract deviations in side-to-side center-of-mass acceleration at the moment of intact-limb toe off; higher acceleration toward the prosthetic limb resulted in a corrective ankle inversion torque during the ensuing stance phase. Destabilizing controllers had the opposite effect, and a zero gain controller made no changes to the nominal inversion/eversion torque. To separate the balance-related effects of step-to-step control from the potential effects of changes in average mechanics, average ankle inversion/eversion torque and prosthesis work were held constant across conditions. High-gain stabilizing control lowered metabolic cost by 13% compared to the zero gain controller (p = 0.05). We then investigated individual responses to subject-specific stabilizing controllers following an enforced exploration period. Four of five participants experienced reduced metabolic rate compared to the zero gain controller (−15, −14, −11, −6, and +4%) an average reduction of 9% (p = 0.05). Average prosthesis mechanics were unchanged across all conditions, suggesting that improvements in energy economy might have come from changes in step-to-step corrections related to balance. Step-to-step modulation of inversion/eversion torque could be used in new, active ankle-foot prostheses to reduce walking effort associated with maintaining balance.
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Affiliation(s)
- Myunghee Kim
- Experimental Biomechatronics Laboratory, Mechanical Engineering, Carnegie Mellon University, Pittsburgh, PA, United States
| | - Steven H Collins
- Experimental Biomechatronics Laboratory, Mechanical Engineering, Carnegie Mellon University, Pittsburgh, PA, United States.,Robotics Institute, Carnegie Mellon University, Pittsburgh, PA, United States.,Department of Mechanical Engineering, Stanford University, Stanford, CA, United States
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Shirota C, van Asseldonk E, Matjačić Z, Vallery H, Barralon P, Maggioni S, Buurke JH, Veneman JF. Robot-supported assessment of balance in standing and walking. J Neuroeng Rehabil 2017; 14:80. [PMID: 28806995 PMCID: PMC5556664 DOI: 10.1186/s12984-017-0273-7] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2016] [Accepted: 06/08/2017] [Indexed: 11/10/2022] Open
Abstract
Clinically useful and efficient assessment of balance during standing and walking is especially challenging in patients with neurological disorders. However, rehabilitation robots could facilitate assessment procedures and improve their clinical value. We present a short overview of balance assessment in clinical practice and in posturography. Based on this overview, we evaluate the potential use of robotic tools for such assessment. The novelty and assumed main benefits of using robots for assessment are their ability to assess 'severely affected' patients by providing assistance-as-needed, as well as to provide consistent perturbations during standing and walking while measuring the patient's reactions. We provide a classification of robotic devices on three aspects relevant to their potential application for balance assessment: 1) how the device interacts with the body, 2) in what sense the device is mobile, and 3) on what surface the person stands or walks when using the device. As examples, nine types of robotic devices are described, classified and evaluated for their suitability for balance assessment. Two example cases of robotic assessments based on perturbations during walking are presented. We conclude that robotic devices are promising and can become useful and relevant tools for assessment of balance in patients with neurological disorders, both in research and in clinical use. Robotic assessment holds the promise to provide increasingly detailed assessment that allows to individually tailor rehabilitation training, which may eventually improve training effectiveness.
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Affiliation(s)
- Camila Shirota
- Rehabilitation Engineering Lab, Institute of Robotics and Intelligent Systems, Department of Health Sciences and Technology, ETH Zürich, Lengghalde 5, 8092, Zürich, Switzerland
| | - Edwin van Asseldonk
- Department of Biomechanical Engineering, MIRA, University of Twente, Drienerlolaan 5, 7522 NB, Enschede, The Netherlands
| | - Zlatko Matjačić
- University Rehabilitation Institute, Republic of Slovenia, Linhartova 51, SI-1000, Ljubljana, Slovenia
| | - Heike Vallery
- Faculty of Mechanical, Maritime and Materials Engineering, Delft University of Technology, Mekelweg 2, 2628 CD, Delft, The Netherlands
| | - Pierre Barralon
- Health Division, Tecnalia Research and Innovation, Paseo Mikeletegi 1, 20009, Donostia-San Sebastian, Spain
| | - Serena Maggioni
- Sensory-Motor Systems Lab, Institute of Robotics and Intelligent Systems, Department of Health Sciences and Technology, ETH Zürich, Sonneggstrasse 3, 8092, Zürich, Switzerland.,Hocoma AG, Industriestrasse 4a, 8604, Volketswil, Switzerland
| | - Jaap H Buurke
- Roessingh Research and Development, Roessinghsbleekweg 33b, 7522 AH, Enschede, The Netherlands
| | - Jan F Veneman
- Health Division, Tecnalia Research and Innovation, Paseo Mikeletegi 1, 20009, Donostia-San Sebastian, Spain.
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Calabrò RS, Russo M, Naro A, De Luca R, Leo A, Tomasello P, Molonia F, Dattola V, Bramanti A, Bramanti P. Robotic gait training in multiple sclerosis rehabilitation: Can virtual reality make the difference? Findings from a randomized controlled trial. J Neurol Sci 2017; 377:25-30. [PMID: 28477702 DOI: 10.1016/j.jns.2017.03.047] [Citation(s) in RCA: 73] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2017] [Revised: 02/24/2017] [Accepted: 03/28/2017] [Indexed: 01/28/2023]
Abstract
Gait, coordination, and balance may be severely compromised in patients with multiple sclerosis (MS), with considerable consequences on the patient's daily living activities, psychological status and quality of life. For this reason, MS patients may benefit from robotic-rehabilitation and virtual reality training sessions. Aim of the present study was to assess the efficacy of robot-assisted gait training (RAGT) equipped with virtual reality (VR) system in MS patients with walking disabilities (EDSS 4.0 to 5.5) as compared to RAGT without VR. We enrolled 40 patients (randomized into two groups) undergoing forty RAGT±VR sessions over eight weeks. All the patients were assessed at baseline and at the end of the treatment by using specific scales. Effect sizes were very small and non-significant between the groups for Berg Balance Scale (-0.019, CI95% -2.403 to 2.365) and TUG (-0.064, 95%CI -0.408 to 0.536) favoring RAGT+VR. Effects were moderate-to-large and significant for positive attitude (-0.505, 95%CI -3.615 to 2.604) and problem-solving (-0.905, 95%CI -2.113 to 0.302) sub-items of Coping Orientation to Problem Experienced, thus largely favoring RAGT+VR. Our findings show that RAGT combined with VR is an effective therapeutic option in MS patients with walking disability as compared to RAGT without VR. We may hypothesize that VR may strengthen RAGT thanks to the entrainment of different brain areas involved in motor panning and learning.
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Affiliation(s)
| | - Margherita Russo
- IRCCS Centro Neurolesi "Bonino-Pulejo", C.da Casazza SS. 113, Messina, Italy
| | - Antonino Naro
- IRCCS Centro Neurolesi "Bonino-Pulejo", C.da Casazza SS. 113, Messina, Italy
| | - Rosaria De Luca
- IRCCS Centro Neurolesi "Bonino-Pulejo", C.da Casazza SS. 113, Messina, Italy
| | - Antonino Leo
- IRCCS Centro Neurolesi "Bonino-Pulejo", C.da Casazza SS. 113, Messina, Italy
| | | | - Francesco Molonia
- IRCCS Centro Neurolesi "Bonino-Pulejo", C.da Casazza SS. 113, Messina, Italy
| | - Vincenzo Dattola
- IRCCS Centro Neurolesi "Bonino-Pulejo", C.da Casazza SS. 113, Messina, Italy
| | - Alessia Bramanti
- IRCCS Centro Neurolesi "Bonino-Pulejo", C.da Casazza SS. 113, Messina, Italy
| | - Placido Bramanti
- IRCCS Centro Neurolesi "Bonino-Pulejo", C.da Casazza SS. 113, Messina, Italy
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79
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Ida H, Mohapatra S, Aruin A. Control of vertical posture while elevating one foot to avoid a real or virtual obstacle. Exp Brain Res 2017; 235:1677-1687. [PMID: 28271221 DOI: 10.1007/s00221-017-4929-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2016] [Accepted: 02/21/2017] [Indexed: 11/26/2022]
Abstract
The purpose of this study is to investigate the control of vertical posture during obstacle avoidance in a real versus a virtual reality (VR) environment. Ten healthy participants stood upright and lifted one leg to avoid colliding with a real obstacle sliding on the floor toward a participant and with its virtual image. Virtual obstacles were delivered by a head mounted display (HMD) or a 3D projector. The acceleration of the foot, center of pressure, and electrical activity of the leg and trunk muscles were measured and analyzed during the time intervals typical for early postural adjustments (EPAs), anticipatory postural adjustments (APAs), and compensatory postural adjustments (CPAs). The results showed that the peak acceleration of foot elevation in the HMD condition decreased significantly when compared with that of the real and 3D projector conditions. Reduced activity of the leg and trunk muscles was seen when dealing with virtual obstacles (HMD and 3D projector) as compared with that seen when dealing with real obstacles. These effects were more pronounced during APAs and CPAs. The onsets of muscle activities in the supporting limb were seen during EPAs and APAs. The observed modulation of muscle activity and altered patterns of movement seen while avoiding a virtual obstacle should be considered when designing virtual rehabilitation protocols.
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Affiliation(s)
- Hirofumi Ida
- Department of Sports and Health Management, Jobu University, Isesaki, Gunma, Japan.
| | - Sambit Mohapatra
- Department of Physical Therapy, University of Montana, Missoula, MT, USA
| | - Alexander Aruin
- Department of Physical Therapy, University of Illinois at Chicago, Chicago, IL, USA
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80
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Paillard T. Plasticity of the postural function to sport and/or motor experience. Neurosci Biobehav Rev 2017; 72:129-152. [DOI: 10.1016/j.neubiorev.2016.11.015] [Citation(s) in RCA: 103] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2016] [Revised: 10/27/2016] [Accepted: 11/15/2016] [Indexed: 11/27/2022]
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81
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Cofré Lizama LE, Khan F, Lee PVS, Galea MP. The use of laboratory gait analysis for understanding gait deterioration in people with multiple sclerosis. Mult Scler 2016; 22:1768-1776. [DOI: 10.1177/1352458516658137] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2016] [Revised: 05/25/2016] [Accepted: 06/12/2016] [Indexed: 11/16/2022]
Abstract
Laboratory gait analysis or three-dimensional gait analysis (3DGA), which uses motion capture, force plates and electromyography (EMG), has allowed a better understanding of the underlying mechanisms of gait deterioration in patients with multiple sclerosis (PwMS). This review will summarize the current knowledge on multiple sclerosis (MS)-related changes in kinematics (angles), kinetics (forces) and electromyographic (muscle activation) patterns and how these measures can be used as markers of disease progression. We will also discuss the potential causes of slower walking in PwMS and the implications for 3DGA. Finally, we will describe new technologies and methods that will increase precision and clinical utilization of 3DGA in PwMS. Overall, 3DGA studies have shown that functionality of the ankle joint is the most affected during walking and that compensatory actions to maintain a functional speed may be insufficient in PwMS. However, altered gait patterns may be a strategy to increase stability as balance is also affected in PwMS.
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Affiliation(s)
- L Eduardo Cofré Lizama
- Department of Medicine, Royal Melbourne Hospital, The University of Melbourne, Parkville, VIC, Australia
| | - Fary Khan
- Department of Medicine, Royal Melbourne Hospital, The University of Melbourne, Parkville, VIC, Australia/Department of Rehabilitation Medicine, Royal Melbourne Hospital, Parkville, VIC, Australia/School of Public Health and Preventive Medicine, Monash University, Clayton, VIC, Australia
| | - Peter VS Lee
- Department of Mechanical Engineering, The University of Melbourne, Parkville, VIC, Australia
| | - Mary P Galea
- Department of Medicine, Royal Melbourne Hospital, The University of Melbourne, Parkville, VIC, Australia/Department of Rehabilitation Medicine, Royal Melbourne Hospital, Parkville, VIC, Australia
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