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Uğur F, Sertel M. Wii Fit Exercise's Effects on Muscle Strength and Fear of Falling in Older Adults With Alzheimer Disease: A Randomized Controlled Trial. J Aging Phys Act 2024:1-11. [PMID: 39374914 DOI: 10.1123/japa.2023-0428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Revised: 07/02/2024] [Accepted: 07/12/2024] [Indexed: 10/09/2024]
Abstract
PURPOSE This study aimed to investigate how Wii Fit exercises affect muscle strength and fear of falling in older adults with Alzheimer's disease. METHOD The study included a total of 32 volunteers with Alzheimer's disease, aged 65-80 years. These participants were divided into two groups: the exercise group and the control group. The exercise group received a 30-min (one session) twice-weekly exercise program for 6 weeks with games selected from different categories, such as balance and aerobic exercises, with the Nintendo Wii virtual reality device. During this period, the control group did not receive any treatment, and routine medical treatments continued. At baseline and 6 weeks later, Mini-Mental State Examination, knee extension muscle strength, Timed Up and Go Test, and Tinetti Fall Efficacy Scale results were recorded in the exercise and control groups. RESULTS In intragroup comparison, a statistically significant difference was found in all tests (muscle strength, Timed Up and Go Test, and Tinetti Fall Efficacy Scale) in the exercise group after the exercise program (p < .05), while no significant difference was found in the control group (p > .05). According to the interaction of group and time in the intergroup comparison, there was no difference between the groups (exercise and control group) in muscle strength and Timed Up and Go Test (p > .05), but there was a difference in Tinetti Fall Efficacy Scale (p < .05). CONCLUSIONS This randomized controlled trial supports the claim that Wii Fit exercises can reduce the fear of falling in older adults with Alzheimer's disease.
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Affiliation(s)
- Fatma Uğur
- Faculty of Health Sciences, Department of Physical Therapy and Rehabilitation, Karamanoglu Mehmetbey University, Karaman, Turkey
| | - Meral Sertel
- Faculty of Health Sciences, Department of Physical Therapy and Rehabilitation, Kırıkkale University, Kırıkkale, Turkey
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Doherty F, Lynch P, Powell P, Monaghan K. Feasibility and effectiveness of telerehabilitation on mobility and balance function in multiple sclerosis: A systematic review and meta-analysis. J Neurol Sci 2024; 466:123214. [PMID: 39270413 DOI: 10.1016/j.jns.2024.123214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2024] [Revised: 08/31/2024] [Accepted: 09/02/2024] [Indexed: 09/15/2024]
Abstract
BACKGROUND Multiple Sclerosis (MS) is a chronic neurodegenerative disease of the central nervous system with a significant impact on mobility and balance function. Telerehabilitation is an emerging branch of telemedicine which has the potential to deliver rehabilitation remotely through the use of information and communication technology. The aim of this systematic literature review and meta-analysis is to synthesise and analyse the evidence on the effectiveness of telerehabilitation in improving mobility and balance function in MS and to determine its feasibility. METHODS Four electronic databases (PubMed, the Cochrane Library, Science Direct and Cinahl) were searched in January 2024 using some of the following terms: "Multiple Sclerosis" AND "Telerehabilitation" OR "Exergaming" OR" Virtual Reality". The risk of bias was assessed using the Cochrane Risk of Bias assessment tool. The meta-analysis was conducted using Cochrane Collaboration Review Manager Software (version 5.4.1). RESULTS Five Randomised Controlled Trials were included with a total sample size of 225 participants who had MS. The meta-analyses found significant statistical and clinical effects of telerehabilitation for both Mobility ((P = 0.02; SMD = 0.41; 95 % CI: 0.05, 0.77) and Balance (P = 0.0001; SMD = 0.64; 95 % CI: 0.31, 0.97) outcomes. Feasibility was found to be >90 %. CONCLUSION This review found evidence in favour of telerehabilitation using exergaming and Pilate-based interventions. Further studies are needed with larger sample sizes of high methodological quality. The findings of this review highlight the potential of telerehabilitation to fulfil an unmet need in care pathways which currently exists in MS rehabilitation.
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Affiliation(s)
- Fiona Doherty
- Faculty of Science, Department of Health and Nutritional Science, Atlantic Technical University, Sligo, Ireland; The Health & Biomedical Research Centre (HEAL), Atlantic Technological University Sligo, Ireland; Neuroplasticity Research Group (NRG), Atlantic Technological University, Sligo, Ireland; Neurology Support Centre, Molloway House, Sligo, Ireland.
| | - Peter Lynch
- Faculty of Science, Department of Health and Nutritional Science, Atlantic Technical University, Sligo, Ireland; The Health & Biomedical Research Centre (HEAL), Atlantic Technological University Sligo, Ireland; Neuroplasticity Research Group (NRG), Atlantic Technological University, Sligo, Ireland
| | - Paul Powell
- Neuroplasticity Research Group (NRG), Atlantic Technological University, Sligo, Ireland; Faculty of Engineering, Department of Computing & Electronics, Atlantic Technological University, Sligo, Ireland; Neurology Support Centre, Molloway House, Sligo, Ireland
| | - Kenneth Monaghan
- Faculty of Science, Department of Health and Nutritional Science, Atlantic Technical University, Sligo, Ireland; The Health & Biomedical Research Centre (HEAL), Atlantic Technological University Sligo, Ireland; Neuroplasticity Research Group (NRG), Atlantic Technological University, Sligo, Ireland; Neurology Support Centre, Molloway House, Sligo, Ireland
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Hao J, Crum G, Siu KC. Effects of virtual reality on stroke rehabilitation: An umbrella review of systematic reviews. Health Sci Rep 2024; 7:e70082. [PMID: 39328980 PMCID: PMC11424326 DOI: 10.1002/hsr2.70082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2024] [Revised: 08/03/2024] [Accepted: 09/03/2024] [Indexed: 09/28/2024] Open
Abstract
Background and Aims Virtual reality is an emerging technology in rehabilitation. This umbrella review aimed to identify, critically appraise, and summarize current systematic reviews on the effects of virtual reality on stroke rehabilitation. Methods Five biomedical databases, PubMed, Embase, CINAHL, PsycINFO, and Scopus were searched from inception to December 30th, 2023, for systematic reviews with or without meta-analyses published in English. Two reviewers independently conducted abstract screening, full-text selection, and quality assessments. The methodological quality of included studies was evaluated by the Assessing the Methodological Quality of Systematic Reviews 2. Results were qualitatively synthesized according to domains of function to ascertain the effects of virtual reality intervention on functional improvement within stroke rehabilitation. Results A total of 78 articles were included; 23 were systematic reviews, and 55 were systematic reviews with meta-analyses. Among them, 30 studies were evaluated as critically low quality, 32 as low, 15 as moderate, and one as good. Outcomes regarding upper extremity motor function, upper extremity activity, participation, functional independence, balance, functional mobility, walking speed, and cognitive function were summarized. While positive effects in favor of virtual reality were revealed by a majority of systematic reviews on these outcomes, evidence supporting the significantly different effects of virtual reality compared to conventional rehabilitation on participation and cognitive function was lacking. Conclusion The umbrella review demonstrated promising clinical outcomes regarding the use of virtual reality as an advanced therapeutic approach in stroke rehabilitation to optimize patient care. Future systematic reviews and meta-analyses in this field should adhere to established guidelines to enhance the quality of evidence.
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Affiliation(s)
- Jie Hao
- Department of Health & Rehabilitation Sciences, College of Allied Health Professions University of Nebraska Medical Center Omaha Nebraska USA
| | - Gretchen Crum
- Department of Health & Rehabilitation Sciences, College of Allied Health Professions University of Nebraska Medical Center Omaha Nebraska USA
| | - Ka-Chun Siu
- Department of Health & Rehabilitation Sciences, College of Allied Health Professions University of Nebraska Medical Center Omaha Nebraska USA
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Skrzatek A, Nuic D, Cherif S, Beranger B, Gallea C, Bardinet E, Welter ML. Brain modulation after exergaming training in advanced forms of Parkinson's disease: a randomized controlled study. J Neuroeng Rehabil 2024; 21:133. [PMID: 39103924 DOI: 10.1186/s12984-024-01430-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2024] [Accepted: 07/22/2024] [Indexed: 08/07/2024] Open
Abstract
BACKGROUND Physical activity combined with virtual reality and exergaming has emerged as a new technique to improve engagement and provide clinical benefit for gait and balance disorders in people with Parkinson's disease (PD). OBJECTIVE To investigate the effects of a training protocol using a home-based exergaming system on brain volume and resting-state functional connectivity (rs-FC) in persons with PD. METHODS A single blind randomized controlled trial was conducted in people with PD with gait and/or balance disorders. The experimental (active) group performed 18 training sessions at home by playing a custom-designed exergame with full body movements, standing in front of a RGB-D Kinect® motion sensor, while the control group played using the computer keyboard. Both groups received the same training program. Clinical scales, gait recordings, and brain MRI were performed before and after training. We assessed the effects of both training on both the grey matter volumes (GVM) and rs-FC, within and between groups. RESULTS Twenty-three patients were enrolled and randomly assigned to either the active (n = 11) or control (n = 12) training groups. Comparing pre- to post-training, the active group showed significant improvements in gait and balance disorders, with decreased rs-FC between the sensorimotor, attentional and basal ganglia networks, but with an increase between the cerebellar and basal ganglia networks. In contrast, the control group showed no significant changes, and rs-FC significantly decreased in the mesolimbic and visuospatial cerebellar and basal ganglia networks. Post-training, the rs-FC was greater in the active relative to the control group between the basal ganglia, motor cortical and cerebellar areas, and bilaterally between the insula and the inferior temporal lobe. Conversely, rs FC was lower in the active relative to the control group between the pedunculopontine nucleus and cerebellar areas, between the temporal inferior lobes and the right thalamus, between the left putamen and dorsolateral prefrontal cortex, and within the default mode network. CONCLUSIONS Full-body movement training using a customized exergame induced brain rs-FC changes within the sensorimotor, attentional and cerebellar networks in people with PD. Further research is needed to comprehensively understand the neurophysiological effects of such training approaches. Trial registration ClinicalTrials.gov NCT03560089.
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Affiliation(s)
- Anna Skrzatek
- Institut du Cerveau - Paris Brain Institute - ICM, Sorbonne Université, Inserm, CNRS, 47 bd de l'Hôpital, 75013, Paris, France
| | - Dijana Nuic
- Institut du Cerveau - Paris Brain Institute - ICM, Sorbonne Université, Inserm, CNRS, 47 bd de l'Hôpital, 75013, Paris, France
| | - Saoussen Cherif
- Institut du Cerveau - Paris Brain Institute - ICM, Sorbonne Université, Inserm, CNRS, 47 bd de l'Hôpital, 75013, Paris, France
- Genious Healthcare France, Paris, France
| | - Benoit Beranger
- Institut du Cerveau - Paris Brain Institute - ICM, Sorbonne Université, Inserm, CNRS, 47 bd de l'Hôpital, 75013, Paris, France
- CENIR core facility, Paris Brain Institute, Paris, France
| | - Cecile Gallea
- Institut du Cerveau - Paris Brain Institute - ICM, Sorbonne Université, Inserm, CNRS, 47 bd de l'Hôpital, 75013, Paris, France
- CENIR core facility, Paris Brain Institute, Paris, France
| | - Eric Bardinet
- Institut du Cerveau - Paris Brain Institute - ICM, Sorbonne Université, Inserm, CNRS, 47 bd de l'Hôpital, 75013, Paris, France
- CENIR core facility, Paris Brain Institute, Paris, France
| | - Marie-Laure Welter
- Institut du Cerveau - Paris Brain Institute - ICM, Sorbonne Université, Inserm, CNRS, 47 bd de l'Hôpital, 75013, Paris, France.
- PANAM core facility, Paris Brain Institute, Paris, France.
- Neurophysiology Department, CHU Rouen, Rouen University, Rouen, France.
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Manser P, Herold F, de Bruin ED. Components of effective exergame-based training to improve cognitive functioning in middle-aged to older adults - A systematic review and meta-analysis. Ageing Res Rev 2024; 99:102385. [PMID: 38914262 DOI: 10.1016/j.arr.2024.102385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2024] [Revised: 03/19/2024] [Accepted: 06/17/2024] [Indexed: 06/26/2024]
Abstract
BACKGROUND Exergame-based training is currently considered a more promising training approach than conventional physical and/or cognitive training. OBJECTIVES This study aimed to provide quantitative evidence on dose-response relationships of specific exercise and training variables (training components) of exergame-based training on cognitive functioning in middle-aged to older adults (MOA). METHODS We conducted a systematic review with meta-analysis including randomized controlled trials comparing the effects of exergame-based training to inactive control interventions on cognitive performance in MOA. RESULTS The systematic literature search identified 22,928 records of which 31 studies were included. The effectiveness of exergame-based training was significantly moderated by the following training components: body position for global cognitive functioning, the type of motor-cognitive training, training location, and training administration for complex attention, and exercise intensity for executive functions. CONCLUSION The effectiveness of exergame-based training was moderated by several training components that have in common that they enhance the ecological validity of the training (e.g., stepping movements in a standing position). Therefore, it seems paramount that future research focuses on developing innovative novel exergame-based training concepts that incorporate these (and other) training components to enhance their ecological validity and transferability to clinical practice. We provide specific evidence-based recommendations for the application of our research findings in research and practical settings and identified and discussed several areas of interest for future research. PROSPERO REGISTRATION NUMBER CRD42023418593; prospectively registered, date of registration: 1 May 2023.
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Affiliation(s)
- Patrick Manser
- Motor Control and Learning Group - Institute of Human Movement Sciences and Sport, Department of Health Sciences and Technology, ETH Zurich, Zurich, Switzerland.
| | - Fabian Herold
- Research Group Degenerative and Chronic Diseases, Movement, Faculty of Health Sciences Brandenburg, University of Potsdam, Potsdam 14476, Germany
| | - Eling D de Bruin
- Motor Control and Learning Group - Institute of Human Movement Sciences and Sport, Department of Health Sciences and Technology, ETH Zurich, Zurich, Switzerland; Department of Health, OST - Eastern Swiss University of Applied Sciences, St. Gallen, Switzerland; Division of Physiotherapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Stockholm, Sweden
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Niu N, Hao Y, Cui Y, Li M. Effects of aerobic and resistance exercises on psychological and cognitive functions in patients with post-stroke migraine. Top Stroke Rehabil 2024:1-9. [PMID: 39003757 DOI: 10.1080/10749357.2024.2377515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Accepted: 06/29/2024] [Indexed: 07/16/2024]
Abstract
OBJECTIVE To investigate the impact of a combination of aerobic and resistance exercises on the psychological and cognitive functions of post-stroke migraine patients. METHODS This study recruited 100 patients suffering from post-stroke migraine pain who were admitted to the hospital, categorizing them into a control group (n = 50) and an intervention group (n = 50). The control group received conventional drug treatment, while the intervention group received the exercise-based intervention that combined aerobic exercise with resistance exercise. RESULTS Before treatment, both groups displayed similar Patient Health Questionnaire-9 (PHQ-9), Generalized Anxiety Disorder-7 (GAD-7), Mini-mental State Examination (MMSE) and MoCA scores. However, after the intervention, the intervention group exhibited lower scores on these measures compared to the control group (all p < 0.05). Additionally, there were no discernible disparity in Migraine Disability Assessment (MIDAS) and Headache Impact Test (HIT-6) scores between the two cohorts of patients before treatment (p > 0.05), whereas the intervention group demonstrated significantly lower MIDAS and HIT-6 scores following the intervention (p < 0.05). Although there were no discernible distinctions in National Institute of Health stroke scale (NIHSS) and Stroke Specialized Quality of Life Scale (SS-QOL) measurements between the two patient groups before treatment (p > 0.05), the intervention group exhibited a significant decrease in NIHSS scores and a notable increase in SS-QOL scores after the intervention (p > 0.05). Moreover, the satisfaction rate and overall satisfaction rate were significantly higher in the intervention group (p < 0.05). CONCLUSION The combination of aerobic and resistance exercises demonstrated positive effects on the psychological well-being and overall quality of life for post-stroke migraine patients.
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Affiliation(s)
- Nana Niu
- Department of Neurology, Fourth Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Yanzhe Hao
- Medical Record Department, Fourth Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Yang Cui
- Medical Department, Fourth Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Miao Li
- Department of Neurology, Fourth Affiliated Hospital of Harbin Medical University, Harbin, China
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Huber SK, Knols RH, Held JPO, Betschart M, de Bruin ED. PEMOCS: Evaluating the effects of a concept-guided, PErsonalised, MOtor-Cognitive exergame training on cognitive functions and gait in chronic Stroke-study protocol for a randomised controlled trial. Trials 2024; 25:451. [PMID: 38965612 PMCID: PMC11223407 DOI: 10.1186/s13063-024-08283-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Accepted: 06/21/2024] [Indexed: 07/06/2024] Open
Abstract
BACKGROUND Many stroke survivors remain with residual cognitive and motor impairments despite receiving timely acute and sub-acute rehabilitation. This indicates that rehabilitation following stroke should be continuous to meet the needs of individual stroke patients. Both cognitive and motor functions are essential for mastering daily life and, therefore, should be aimed at with rehabilitation. Exergames, motor-cognitive exercises performed using video games, are an auspicious method to train both motor and cognitive functions and at the same time may foster the long-term motivation for training. This study aims to assess the effect of concept-guided, personalised, motor-cognitive exergame training on cognitive and motor functions in chronic stroke survivors. METHODS This study is a single-blinded, randomised controlled trial. Assessments are performed at baseline, after a 12-week intervention, and at a 24-weeks follow-up. Chronic stroke patients (≥ 18 years old, ≥ 6 months post-stroke) able to stand for 3 min, independently walk 10 m, follow a two-stage command, and without other neurological diseases apart from cognitive deficits or dementia are included. Participants in the intervention group perform the exergame training twice per week for 30 (beginning) up to 40 (end) minutes additionally to their usual care programme. Participants in the control group receive usual care without additional intervention(s). Global cognitive functioning (total Montreal Cognitive Assessment (MoCA) score) is the primary outcome. Secondary outcomes include health-related quality of life, specific cognitive functions, single- and dual-task mobility, and spatiotemporal gait parameters. The target sample size for this trial is 38 participants. Linear mixed models with the post-outcome scores as dependent variables and group and time as fixed effects will be performed for analysis. DISCUSSION Superior improvements in global cognitive functioning and in the abovementioned secondary outcomes in the intervention group compared to the control group are hypothesised. The results of this study may guide future design of long-term rehabilitation interventions after stroke. TRIAL REGISTRATION ClinicalTrials.gov (NCT05524727). Registered on September 1, 2022.
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Affiliation(s)
- S K Huber
- Physiotherapy Occupational Therapy Research Center, Directorate of Research and Education, University Hospital Zurich, Zurich, Switzerland.
- Motor Control and Learning Group, Institute of Human Movement Sciences and Sport, Department of Health Sciences and Technology, ETH Zurich, Zurich, Switzerland.
| | - R H Knols
- Physiotherapy Occupational Therapy Research Center, Directorate of Research and Education, University Hospital Zurich, Zurich, Switzerland
- Motor Control and Learning Group, Institute of Human Movement Sciences and Sport, Department of Health Sciences and Technology, ETH Zurich, Zurich, Switzerland
| | - J P O Held
- Rehabilitation Center Triemli Zurich, Valens Clinics, Zurich, Switzerland
| | - M Betschart
- Department of Health, OST - Eastern Swiss University of Applied Sciences, St. Gallen, Switzerland
- Institute of Therapy and Rehabilitation, Kantonsspital Winterthur, Winterthur, Switzerland
| | - E D de Bruin
- Motor Control and Learning Group, Institute of Human Movement Sciences and Sport, Department of Health Sciences and Technology, ETH Zurich, Zurich, Switzerland
- Department of Health, OST - Eastern Swiss University of Applied Sciences, St. Gallen, Switzerland
- Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy, Karolinska Institutet, Stockholm, Sweden
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Huber SK, Manser P, de Bruin ED. PEMOCS: theory derivation of a concept for PErsonalized MOtor-Cognitive exergame training in chronic Stroke-a methodological paper with an application example. Front Sports Act Living 2024; 6:1397949. [PMID: 38915297 PMCID: PMC11194322 DOI: 10.3389/fspor.2024.1397949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2024] [Accepted: 05/27/2024] [Indexed: 06/26/2024] Open
Abstract
Background Coping with residual cognitive and gait impairments is a prominent unmet need in community-dwelling chronic stroke survivors. Motor-cognitive exergames may be promising to address this unmet need. However, many studies have so far implemented motor-cognitive exergame interventions in an unstructured manner and suitable application protocols remain yet unclear. We, therefore, aimed to summarize existing literature on this topic, and developed a training concept for motor-cognitive exergame interventions in chronic stroke. Methods The development of the training concept for personalized motor-cognitive exergame training for stroke (PEMOCS) followed Theory Derivation procedures. This comprised (1.1) a thorough (narrative) literature search on long-term stroke rehabilitation; (1.2) a wider literature search beyond the topic of interest to identify analogies, and to induce creativity; (2) the identification of parent theories; (3) the adoption of suitable content or structure of the main parent theory; and (4) the induction of modifications to adapt it to the new field of interest. We also considered several aspects of the "Framework for Developing and Evaluating Complex Interventions" by the Medical Research Council. Specifically, a feasibility study was conducted, and refining actions based on the findings were performed. Results A training concept for improving cognitive functions and gait in community-dwelling chronic stroke survivors should consider the principles for neuroplasticity, (motor) skill learning, and training. We suggest using a step-based exergame training for at least 12 weeks, 2-3 times a week for approximately 45 min. Gentile's Taxonomy for Motor Learning was identified as suitable fundament for the personalized progression and variability rules, and extended by a third cognitive dimension. Concepts and models from related fields inspired further additions and modifications to the concept. Conclusion We propose the PEMOCS concept for improving cognitive functioning and gait in community-dwelling chronic stroke survivors, which serves as a guide for structuring and implementing motor-cognitive exergame interventions. Future research should focus on developing objective performance parameters that enable personalized progression independent of the chosen exergame type.
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Affiliation(s)
- Simone K. Huber
- Physiotherapy and Occupational Therapy Research Centre, Directorate of Research and Education, University Hospital Zurich, Zurich, Switzerland
- Motor Control and Learning Group, Institute of Human Movement Sciences and Sport, Department of Health Sciences and Technology, ETH Zurich, Zurich, Switzerland
| | - Patrick Manser
- Motor Control and Learning Group, Institute of Human Movement Sciences and Sport, Department of Health Sciences and Technology, ETH Zurich, Zurich, Switzerland
| | - Eling D. de Bruin
- Motor Control and Learning Group, Institute of Human Movement Sciences and Sport, Department of Health Sciences and Technology, ETH Zurich, Zurich, Switzerland
- Department of Health, OST—Eastern Swiss University of Applied Sciences, St. Gallen, Switzerland
- Division of Physiotherapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Stockholm, Sweden
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Doherty F, Powell P, McBride C, Monaghan K. Physical Telerehabilitation interventions for Gait and balance in Multiple sclerosis: A Scoping review. J Neurol Sci 2024; 456:122827. [PMID: 38134564 DOI: 10.1016/j.jns.2023.122827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Revised: 12/01/2023] [Accepted: 12/02/2023] [Indexed: 12/24/2023]
Abstract
BACKGROUND Gait and balance impairments affects approximately a quarter of people with multiple sclerosis (pwMS) at onset and increases to almost half by five years. Physical rehabilitation has been recognised as the gold standard method to restore physical function in multiple sclerosis (MS). Emerging evidence in the literature is suggesting that a remote therapy rehabilitation platform (Telerehabilitation) is cost-effective, beneficial, and satisfying for patients and health care practitioners. The overarching aim of this review is to identify and summarise the evidence on the different types of telerehabilitation interventions available to manage gait and balance. METHODS This review followed a methodological framework for conducting scoping reviews. PubMed, Science Direct and Web of Science were searched in April 2023 for relevant published literature. The inclusion criteria were peer-reviewed journal articles written in English which included telerehabilitation interventions for pwMS. Search keywords included multiple sclerosis and telerehabilitation. A reviewer screened titles and abstracts and eligible articles were fully reviewed. The included studies were categorised based on the type of intervention. RESULTS Eight studies were included in this review. The participants (n = 355) had an average age of 48 years (SD = 9.9) with 50% who had relapsing remitting multiple sclerosis who were living with MS for 12 years on average. Study designs included randomised control trials (n = 3), pilot studies and feasibility studies (n = 4). Two types of interventions were identified: Exergaming (n = 5) and Web-Based Physical Therapy (n = 2) of which exergaming appeared to be optimal in improving gait and balance. CONCLUSION This scoping review identified and summarised the evidence on telerehabilitation interventions used for gait and balance in MS. The evidence is showing that telerehabilitation could be used as an alternative to conventional rehabilitation methods for improving gait and balance. More robust trials with larger sample sizes are needed to build on the current evidence to enable telerehabilitation to be integrated into care pathways in the future.
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Affiliation(s)
- Fiona Doherty
- Department of Health and Nutritional Science, Atlantic Technical University, Sligo, Ireland; The Health & Biomedical Research Centre (HEAL), Atlantic Technological University Sligo, Ireland; Neuroplasticity Research Group (NRG), Atlantic Technological University, Sligo, Ireland; Neurology Support Centre, Molloway House, Sligo, Ireland.
| | - Paul Powell
- Neuroplasticity Research Group (NRG), Atlantic Technological University, Sligo, Ireland; Faculty of Engineering, Atlantic Technical University, Sligo, Ireland; Neurology Support Centre, Molloway House, Sligo, Ireland
| | - Ciara McBride
- Department of Health and Nutritional Science, Atlantic Technical University, Sligo, Ireland; The Health & Biomedical Research Centre (HEAL), Atlantic Technological University Sligo, Ireland; Neuroplasticity Research Group (NRG), Atlantic Technological University, Sligo, Ireland
| | - Kenneth Monaghan
- Department of Health and Nutritional Science, Atlantic Technical University, Sligo, Ireland; The Health & Biomedical Research Centre (HEAL), Atlantic Technological University Sligo, Ireland; Neuroplasticity Research Group (NRG), Atlantic Technological University, Sligo, Ireland; Neurology Support Centre, Molloway House, Sligo, Ireland
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Eost-Telling C, Yang Y, Norman G, Hall A, Hanratty B, Knapp M, Robinson L, Todd C. Digital technologies to prevent falls in people living with dementia or mild cognitive impairment: a rapid systematic overview of systematic reviews. Age Ageing 2024; 53:afad238. [PMID: 38219225 PMCID: PMC10788098 DOI: 10.1093/ageing/afad238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 09/27/2023] [Indexed: 01/16/2024] Open
Abstract
OBJECTIVE Falls are a common cause of potentially preventable death, disability and loss of independence with an annual estimated cost of £4.4bn. People living with dementia (PlwD) or mild cognitive impairment (MCI) have an increased fall risk. This overview evaluates evidence for technologies aiming to reduce falls and fall risk for PlwD or MCI. METHODS In October 2022, we searched five databases for evidence syntheses. We used standard methods to rapidly screen, extract data, assess risk of bias and overlap, and synthesise the evidence for each technology type. RESULTS We included seven systematic reviews, incorporating 22 relevant primary studies with 1,412 unique participants. All reviews had critical flaws on AMSTAR-2: constituent primary studies were small, heterogeneous, mostly non-randomised and assessed as low or moderate quality. Technologies assessed were: wearable sensors, environmental sensor-based systems, exergaming, virtual reality systems. We found no evidence relating to apps. Review evidence for the direct impact on falls was available only from environmental sensors, and this was inconclusive. For wearables and virtual reality technologies there was evidence that technologies may differentiate PlwD who fell from those who did not; and for exergaming that balance may be improved. CONCLUSIONS The evidence for technology to reduce falls and falls risk for PlwD and MCI is methodologically weak, based on small numbers of participants and often indirect. There is a need for higher-quality RCTs to provide robust evidence for effectiveness of fall prevention technologies. Such technologies should be designed with input from users and consideration of the wider implementation context.
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Affiliation(s)
- Charlotte Eost-Telling
- National Institute for Health and Care Research (NIHR) Older People and Frailty Policy Research Unit, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester M13 9PL, UK
- Division of Nursing, Midwifery and Social Work, School of Health Sciences, The University of Manchester, Manchester M13 9PT, UK
- National Institute for Health and Care Research (NIHR) Applied Research Collaboration Greater Manchester, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester M13 9PL, UK
| | - Yang Yang
- National Institute for Health and Care Research (NIHR) Older People and Frailty Policy Research Unit, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester M13 9PL, UK
- Division of Nursing, Midwifery and Social Work, School of Health Sciences, The University of Manchester, Manchester M13 9PT, UK
| | - Gill Norman
- Division of Nursing, Midwifery and Social Work, School of Health Sciences, The University of Manchester, Manchester M13 9PT, UK
- National Institute for Health and Care Research (NIHR) Applied Research Collaboration Greater Manchester, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester M13 9PL, UK
| | - Alex Hall
- National Institute for Health and Care Research (NIHR) Older People and Frailty Policy Research Unit, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester M13 9PL, UK
- Division of Nursing, Midwifery and Social Work, School of Health Sciences, The University of Manchester, Manchester M13 9PT, UK
| | - Barbara Hanratty
- National Institute for Health and Care Research (NIHR) Older People and Frailty Policy Research Unit, Population Health Sciences Institute, Newcastle University, Newcastle-upon-Tyne NE4 5PL, UK
| | - Martin Knapp
- National Institute for Health and Care Research (NIHR) Older People and Frailty Policy Research Unit, Care Policy and Evaluation Centre, London School of Economics and Political Science, London WC2A 2AE, UK
| | - Louise Robinson
- National Institute for Health and Care Research (NIHR) Older People and Frailty Policy Research Unit, Population Health Sciences Institute, Newcastle University, Newcastle-upon-Tyne NE4 5PL, UK
| | - Chris Todd
- National Institute for Health and Care Research (NIHR) Older People and Frailty Policy Research Unit, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester M13 9PL, UK
- Division of Nursing, Midwifery and Social Work, School of Health Sciences, The University of Manchester, Manchester M13 9PT, UK
- National Institute for Health and Care Research (NIHR) Applied Research Collaboration Greater Manchester, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester M13 9PL, UK
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11
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Tacchino A, Ponzio M, Confalonieri P, Leocani L, Inglese M, Centonze D, Cocco E, Gallo P, Paolicelli D, Rovaris M, Sabattini L, Tedeschi G, Prosperini L, Patti F, Bramanti P, Pedrazzoli E, Battaglia MA, Brichetto G. An Internet- and Kinect-Based Multiple Sclerosis Fitness Intervention Training With Pilates Exercises: Development and Usability Study. JMIR Serious Games 2023; 11:e41371. [PMID: 37938895 PMCID: PMC10666018 DOI: 10.2196/41371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2022] [Revised: 01/30/2023] [Accepted: 07/30/2023] [Indexed: 11/10/2023] Open
Abstract
BACKGROUND Balance impairments are common in people with multiple sclerosis (MS), with reduced ability to maintain position and delayed responses to postural adjustments. Pilates is a popular alternative method for balance training that may reduce the rapid worsening of symptoms and the increased risk of secondary conditions (eg, depression) that are frequently associated with physical inactivity. OBJECTIVE In this paper, we aimed to describe the design, development, and usability testing of MS Fitness Intervention Training (MS-FIT), a Kinect-based tool implementing Pilates exercises customized for MS. METHODS MS-FIT has been developed using a user-centered design approach (design, prototype, user feedback, and analysis) to gain the target user's perspective. A team composed of 1 physical therapist, 2 game programmers, and 1 game designer developed the first version of MS-FIT that integrated the knowledge and experience of the team with MS literature findings related to Pilates exercises and balance interventions based on exergames. MS-FIT, developed by using the Unity 3D (Unity Technologies) game engine software with Kinect Sensor V2 for Windows, implements exercises for breathing, posture, and balance. Feedback from an Italian panel of experts in MS rehabilitation (neurologists, physiatrists, physical therapists, 1 statistician, and 1 bioengineer) and people with MS was collected to customize the tool for use in MS. The context of MS-FIT is traveling around the world to visit some of the most important cities to learn the aspects of their culture through pictures and stories. At each stay of the travel, the avatar of a Pilates teacher shows the user the exercises to be performed. Overall, 9 people with MS (n=4, 44% women; mean age 42.89, SD 11.97 years; mean disease duration 10.19, SD 9.18 years; Expanded Disability Status Scale score 3.17, SD 0.75) were involved in 3 outpatient user test sessions of 30 minutes; MS-FIT's usability was assessed through an ad hoc questionnaire (maximum value=5; higher the score, higher the usability) evaluating easiness to use, playability, enjoyment, satisfaction, and acceptance. RESULTS A user-centered design approach was used to develop an accessible and challenging tool for balance training. All people with MS (9/9, 100%) completed the user test sessions and answered the ad hoc questionnaire. The average score on each item ranged from 3.78 (SD 0.67) to 4.33 (SD 1.00), which indicated a high usability level. The feedback and suggestions provided by 64% (9/14) of people with MS and 36% (5/14) of therapists involved in the user test were implemented to refine the first prototype to release MS-FIT 2.0. CONCLUSIONS The participants reported that MS-FIT was a usable tool. It is a promising system for enhancing the motivation and engagement of people with MS in performing exercise with the aim of improving their physical status.
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Affiliation(s)
- Andrea Tacchino
- Scientific Research Area, Italian Multiple Sclerosis Foundation, Genoa, Italy
| | - Michela Ponzio
- Scientific Research Area, Italian Multiple Sclerosis Foundation, Genoa, Italy
| | - Paolo Confalonieri
- Multiple Sclerosis Center, IRCCS Foundation "Carlo Besta" Neurological Institute, Milan, Italy
| | - Letizia Leocani
- Vita-Salute University & Hospital San Raffaele, Milan, Italy
| | - Matilde Inglese
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa, Italy
- IRCCS San Martino Hospital, Genoa, Italy
| | | | - Eleonora Cocco
- Department of Medical Science and Public health, University of Cagliari, Cagliari, Italy
| | - Paolo Gallo
- Department of Neuroscience, University of Padua, Padua, Italy
| | - Damiano Paolicelli
- Department of Basic Medical Sciences, Neuroscience and Sense Organs, University of Bari, Bari, Italy
| | - Marco Rovaris
- Multiple Sclerosis Center, IRCCS Don Carlo Gnocchi Foundation, Milan, Italy
| | - Loredana Sabattini
- Uosi Multiple Sclerosis Rehabilitation, IRCCS Istituto delle Scienze Neurologiche of Bologna, Bologna, Italy
| | - Gioacchino Tedeschi
- Department of Advanced Medical and Surgical Sciences, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Luca Prosperini
- Department of Neurosciences, S. Camillo-Forlanini Hospital, Rome, Italy
| | - Francesco Patti
- Department of Medical and Surgical Sciences and Advanced Technologies, University of Catania, Catania, Italy
| | | | | | | | - Giampaolo Brichetto
- Scientific Research Area, Italian Multiple Sclerosis Foundation, Genoa, Italy
- Rehabilitation Service of Genoa, Italian Multiple Sclerosis Society, Genoa, Italy
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12
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Rüth M, Schmelzer M, Burtniak K, Kaspar K. Commercial exergames for rehabilitation of physical health and quality of life: a systematic review of randomized controlled trials with adults in unsupervised home environments. Front Psychol 2023; 14:1155569. [PMID: 37333591 PMCID: PMC10272737 DOI: 10.3389/fpsyg.2023.1155569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Accepted: 05/02/2023] [Indexed: 06/20/2023] Open
Abstract
Background Commercial exergames are widely available tools that can support physical rehabilitation at home. However, the effects of the unsupervised use of commercial exergames in home environments are not yet clear. Hence, we provide a systematic review on the effects of unsupervised commercial exergaming at home on adults' physical health (RQ1) and quality of life (RQ2). We also scrutinize adults' experiences with exergaming at home regarding participant support, adherence, and adverse outcomes (RQ3). Methods We searched Web of Science, PsycINFO, PubMed, Embase, and CINAHL for peer-reviewed randomized controlled trials with adults in need of rehabilitation. Overall, 20 studies (1,558 participants, 1,368 analyzed) met our inclusion criteria. The quality of evidence was assessed with the Cochrane risk of bias tool. Results Effects of unsupervised commercial exergaming at home on physical health were higher in seven studies and similar in five studies regarding the respective comparison or control conditions; eight studies reported non-significant findings. Of the 15 studies that also examined effects on quality of life, improvements were higher in seven studies and similar in two studies regarding the respective comparison or control conditions; results were non-significant in six studies. Participant support consisted of setup of the exergaming system, instructions, training, and contact with participants. Adherence was high in eight studies, moderate in six studies, and low in one study. Adverse outcomes related to exergaming were found in four studies and were at most moderate. Concerning the quality of evidence, six studies were related to a high risk of bias due to outcome reporting bias or ceiling effects in the primary outcome. Additionally, 10 studies yielded some concerns, and four studies were related to a low risk of bias. Discussion This systematic review summarizes promising evidence that the unsupervised use of commercial exergames can support and complement rehabilitation measures in home environments. Still, future studies based on larger samples and using more recent commercial exergames are needed to obtain more high-quality evidence on the effects of different exercise prescriptions. Overall, considering the necessary precautions, the unsupervised use of commercial exergames at home can improve the physical health and quality of life in adults with needs for physical rehabilitation. Systematic review registration https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42022341189, identifier: PROSPERO, Registration number: CRD42022341189.
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Hao J, Chen Z, Remis A, He Z. Virtual Reality-Based Rehabilitation to Restore Motor Function in People With Amputation: A Systematic Literature Review. Am J Phys Med Rehabil 2023; 102:468-474. [PMID: 36730652 DOI: 10.1097/phm.0000000000002150] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
ABSTRACT Virtual reality is an emerging technology with accumulating research and clinical evidence in the field of physical rehabilitation. This study aimed to systematically identify and examine the effects of virtual reality on motor function outcomes in patients with amputation to inform clinical decision making on amputation rehabilitation and inform further research endeavors. Five databases were searched, including PubMed, CINAHL, PsycINFO, Embase, and Scopus. After screening for 1052 records, 10 clinical studies were included in this review: four randomized controlled trials, three pre-post single-arm studies, and three case studies; all studies had fair to good methodological quality. Seven studies were for lower extremity amputation, and three were for upper extremity amputation. Results reveal the positive effects of virtual reality on improving motor function in prosthesis training, including balance, gait, and upper extremity outcomes. Participants also report enjoyment during virtual reality intervention as measured by subjective experience. However, it is unclear whether virtual reality can induce better therapeutic outcomes than conventional rehabilitation, given the limited number of controlled studies and conflicting results reported in the included studies. More properly designed randomized controlled trials with adequately powered sample sizes are warranted to elucidate the benefits of virtual reality-based rehabilitation in the amputation population.
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Affiliation(s)
- Jie Hao
- From the College of Allied Health Professions, University of Nebraska Medical Center, Omaha, Nebraska (JH); School of Basic Medical Sciences, Capital Medical University, Beijing, China (ZC); Gate Parkway Primary Care Center, Department of Physical Medicine and Rehabilitation, Mayo Clinic, Jacksonville, Florida (AR); and Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland (ZH)
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14
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Molhemi F, Mehravar M, Monjezi S, Salehi R, Negahban H, Shaterzadeh-Yazdi MJ, Majdinasab N. Effects of exergaming on cognition, lower limb functional coordination, and stepping time in people with multiple sclerosis: a randomized controlled trial. Disabil Rehabil 2023; 45:1343-1351. [PMID: 35443843 DOI: 10.1080/09638288.2022.2060332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
PURPOSE To compare the effects of exergaming versus conventional exercises on cognition, lower-limb functional coordination, and stepping time in people with multiple sclerosis (PwMS). METHODS Thirty-six PwMS were randomly assigned to either intervention (n = 18) or control (n = 18) group and received 18 training sessions during six weeks. The intervention group performed exergames that required multidirectional timed-stepping, weight-shifting, and walking while the control group performed conventional matched exercises. Trail making test (TMT part A, B; TMT-A, TMT-B, TMT B-A), six-spot step test (SSST), and choice stepping reaction time (CSRT-including reaction time (RT), movement time (MVT), and total response time (TRT)) were assessed pre- and post-intervention (short-term), and after three-month follow-up (mid-term). RESULTS The intervention group showed faster TMT-B (p = 0.003) and TMT B-A (p = 0.002) at post-intervention and faster SSST at both post-intervention (p = 0.002) and follow-up (p = 0.04). The CSRT components showed no between-group differences at post-intervention; however, at follow-up, the intervention group had lower TRT (p = 0.046) and MVT (p = 0.015). TMT-A and RT had no significant between-group differences. CONCLUSIONS In short-term, exergames led to more improvements in complex attention, executive function, and lower-limb functional coordination comparing to the matched conventional exercises. In mid-term, exergaming was more effective for improving stepping time and lower-limb functional coordination. However, the two approaches did not show any superiority over each other for improving simple attention and RT.Implications for rehabilitationWhen designed properly, exergames have great potential to improve attention and executive function of people with multiple sclerosis (PwMS), at least in the short-term.Exergames seem like an appropriate option for improving lower limb coordination and decreasing choice stepping response time among PwMS in the mid-term.Exergames do not have superiority in improving the choice stepping reaction time compared to their matched conventional treatment.
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Affiliation(s)
- Farshad Molhemi
- Musculoskeletal Rehabilitation Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
- Student Research Committee, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Mohammad Mehravar
- Musculoskeletal Rehabilitation Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
- Department of Physiotherapy, School of Rehabilitation Sciences, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Saeideh Monjezi
- Musculoskeletal Rehabilitation Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
- Department of Physiotherapy, School of Rehabilitation Sciences, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Reza Salehi
- Department of Rehabilitation Management, Rehabilitation Research Center, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Hossein Negahban
- Department of Physical Therapy, School of Paramedical Sciences, Mashhad University of Medical Sciences, Mashhad, Iran
- Orthopedic Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mohammad-Jafar Shaterzadeh-Yazdi
- Musculoskeletal Rehabilitation Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
- Department of Physiotherapy, School of Rehabilitation Sciences, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Nastaran Majdinasab
- Musculoskeletal Rehabilitation Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
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Rispoli MG, D'Apolito M, Pozzilli V, Tomassini V. Lessons from immunotherapies in multiple sclerosis. HANDBOOK OF CLINICAL NEUROLOGY 2023; 193:293-311. [PMID: 36803817 DOI: 10.1016/b978-0-323-85555-6.00013-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
Abstract
The improved understanding of multiple sclerosis (MS) neurobiology alongside the development of novel markers of disease will allow precision medicine to be applied to MS patients, bringing the promise of improved care. Combinations of clinical and paraclinical data are currently used for diagnosis and prognosis. The addition of advanced magnetic resonance imaging and biofluid markers has been strongly encouraged, since classifying patients according to the underlying biology will improve monitoring and treatment strategies. For example, silent progression seems to contribute significantly more than relapses to overall disability accumulation, but currently approved treatments for MS act mainly on neuroinflammation and offer only a partial protection against neurodegeneration. Further research, involving traditional and adaptive trial designs, should strive to halt, repair or protect against central nervous system damage. To personalize new treatments, their selectivity, tolerability, ease of administration, and safety must be considered, while to personalize treatment approaches, patient preferences, risk-aversion, and lifestyle must be factored in, and patient feedback used to indicate real-world treatment efficacy. The use of biosensors and machine-learning approaches to integrate biological, anatomical, and physiological parameters will take personalized medicine a step closer toward the patient's virtual twin, in which treatments can be tried before they are applied.
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Affiliation(s)
- Marianna G Rispoli
- Institute for Advanced Biomedical Technologies (ITAB) and Department of Neurosciences, Imaging and Clinical Sciences, University G. d'Annunzio of Chieti-Pescara, Chieti, Italy; MS Centre, SS. Annunziata University Hospital, Chieti, Italy
| | - Maria D'Apolito
- Institute for Advanced Biomedical Technologies (ITAB) and Department of Neurosciences, Imaging and Clinical Sciences, University G. d'Annunzio of Chieti-Pescara, Chieti, Italy; MS Centre, SS. Annunziata University Hospital, Chieti, Italy
| | - Valeria Pozzilli
- Institute for Advanced Biomedical Technologies (ITAB) and Department of Neurosciences, Imaging and Clinical Sciences, University G. d'Annunzio of Chieti-Pescara, Chieti, Italy; MS Centre, SS. Annunziata University Hospital, Chieti, Italy
| | - Valentina Tomassini
- Institute for Advanced Biomedical Technologies (ITAB) and Department of Neurosciences, Imaging and Clinical Sciences, University G. d'Annunzio of Chieti-Pescara, Chieti, Italy; MS Centre, SS. Annunziata University Hospital, Chieti, Italy.
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16
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Jäggi S, Wachter A, Adcock M, de Bruin ED, Möller JC, Marks D, Schweinfurther R, Giannouli E. Feasibility and effects of cognitive-motor exergames on fall risk factors in typical and atypical Parkinson's inpatients: a randomized controlled pilot study. Eur J Med Res 2023; 28:30. [PMID: 36647177 PMCID: PMC9841664 DOI: 10.1186/s40001-022-00963-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Accepted: 12/19/2022] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND People with Parkinson`s disease (PD) often suffer from both motor and cognitive impairments. Simultaneous motor and cognitive training stimulates neurobiological processes which are important especially for people with PD. The aim of this study is to test the feasibility and effects of simultaneous cognitive-motor training in form of exergames in the setting of inpatient rehabilitation of persons with PD. METHODS Forty participants (72.4 ± 9.54 years; Hoehn and Yahr stage 1-4) were randomly assigned to either the intervention group, which trained five times a week in addition to the conventional rehabilitation program, or the control group, which underwent the standard rehabilitation treatment only. Primary outcome was feasibility (measured by adherence rate, attrition rate, occurrence of adverse events, system usability scale (SUS), and NASA TLX score). In addition, various cognitive (Go/No-Go test, reaction time test (RTT), color word interference test (D-KEFS) and Trail Making Test A and B (TMT)) and motor (preferred gait speed, maximum gait speed, dual-task gait speed, Short Physical Performance Battery (SPPB), Timed Up and Go (TUG) and 5 times Sit-to-Stand (5xStS)) tests were conducted before and after the intervention phase in order to determine training effects RESULTS: Adherence rate was 97%, there were just two dropouts due to reasons unrelated to the study and there were no adverse events. The mean NASA TLX value was 56.2 and the mean value of the SUS was 76.7. Significant time-group interaction effects were observed for the 5xStS, the SPPB, the RTT, the Go/No-Go test and the D-KEFS 2. DISCUSSION Exergaming, as applied in this study, showed to be feasible, safe and likely effective for the improvement of cognitive and motor functions of PD inpatients. Because of this future randomized controlled trials with a main focus on testing the efficacy of this new intervention are warranted. TRIAL REGISTRATION The study has been registered at ClinicalTrials.gov (ID: NCT04872153).
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Affiliation(s)
- Salome Jäggi
- Department of Health Sciences & Technology, Institute of Human Movement Sciences and Sport, ETH Zurich, Zurich, Switzerland
| | - Annina Wachter
- Department of Health Sciences & Technology, Institute of Human Movement Sciences and Sport, ETH Zurich, Zurich, Switzerland
| | - Manuela Adcock
- Department of Health Sciences & Technology, Institute of Human Movement Sciences and Sport, ETH Zurich, Zurich, Switzerland
| | - Eling D de Bruin
- Department of Health Sciences & Technology, Institute of Human Movement Sciences and Sport, ETH Zurich, Zurich, Switzerland
- Division of Physiotherapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Stockholm, Sweden
- Department of Health, OST - Eastern Swiss University of Applied Sciences, St.Gallen, Switzerland
| | - Jens Carsten Möller
- Parkinson Center, Center for Neurological Rehabilitation, Zihlschlacht, Switzerland
- Department of Neurology, Philipps University, Marburg, Germany
| | - Detlef Marks
- Parkinson Center, Center for Neurological Rehabilitation, Zihlschlacht, Switzerland
| | - Raoul Schweinfurther
- Parkinson Center, Center for Neurological Rehabilitation, Zihlschlacht, Switzerland
| | - Eleftheria Giannouli
- Department of Health Sciences & Technology, Institute of Human Movement Sciences and Sport, ETH Zurich, Zurich, Switzerland.
- Department of Sport, Exercise and Health, Division of Sports and Exercise Medicine, University of Basel, Basel, Switzerland.
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Castelli L, Giovannini S, Iacovelli C, Fusco A, Pastorino R, Marafon DP, Pozzilli C, Padua L. Training-dependent plasticity and far transfer effect enhanced by Bobath rehabilitation in Multiple Sclerosis. Mult Scler Relat Disord 2022; 68:104241. [PMID: 36274281 DOI: 10.1016/j.msard.2022.104241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Revised: 09/21/2022] [Accepted: 10/09/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND Multiple Sclerosis (MS) is a disease that often results in motor and/or cognitive disability. Despite the increasing availability of effective drug therapies, rehabilitation is very important means of counteracting the progression of disability and improving physical function, impacting social participation and improving quality of life. Several rehabilitation approaches can be used in the context of neuro-motor rehabilitation, but there is insufficient evidence for them in the literature. OBJECTIVES This study has the twofold purpose of: (i) investigate whether rehabilitation according to Bobath Concept can improve balance and some aspects of cognitive function in MS patients; (ii) explore whether the ability to improve postural control, an indirect index of adaptive neuroplasticity, is preserved in MS patients and whether it can be improved with rehabilitation. METHOD This is an independent wait-listed study. Forty people with MS (pwMS) were enrolled: patients in the Bobath group underwent 8 weeks of rehabilitation according to the Bobath Concept. For aim 1, pwMS were assessed at baseline (T0), at the end of the 8 weeks of treatment (T1) and after 8 weeks of observation (T2) with motor and cognitive scales. For aim 2, the same 40 pwMS were matched with healthy controls and were subjected to a postural learning task using the force platform at T0, T1 and T2. RESULTS Patients in Bobath group scored better on balance and cognitive function at T1, but this improvement was not maintained at T2. All patients were less accurate than controls in the postural learning task at each assessment; however, patients also demonstrated an increase in accuracy after training, similar to that of healthy controls. The learning curve was better for patients randomized to the active group than the waitlist at T1 time, but this advantage was not maintained at the T2 assessment. CONCLUSION In light of the results, this study supports the use of rehabilitation according to Bobath Concept to improve balance control and some executive functions in MS. Despite worse baseline performance, pwMS were able to learn a postural control task on par with healthy controls. Also, supports the hypothesis that adaptive plasticity is preserved despite MS and can be promoted by rehabilitation.
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Affiliation(s)
- Letizia Castelli
- Department of Aging, Neurological, Orthopaedic and Head-Neck Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
| | - Silvia Giovannini
- Department of Geriatrics and Orthopaedics, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; UOS Riabilitazione Post-acuzie, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy.
| | - Chiara Iacovelli
- Department of Aging, Neurological, Orthopaedic and Head-Neck Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
| | - Augusto Fusco
- UOC Neuroriabilitazione ad Alta Intensità, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
| | - Roberta Pastorino
- Department of Woman and Child Health and Public Health-Public Health Area, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; Section of Hygiene, University Department of Life Sciences and Public Health, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Denise Pires Marafon
- Section of Hygiene, University Department of Life Sciences and Public Health, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Carlo Pozzilli
- Department of Human Neurosciences, Sapienza University, Roma, Italy
| | - Luca Padua
- Department of Geriatrics and Orthopaedics, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; UOC Neuroriabilitazione ad Alta Intensità, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
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18
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Teraz K, Šlosar L, Paravlić AH, de Bruin ED, Marusic U. Impact of Motor-Cognitive Interventions on Selected Gait and Balance Outcomes in Older Adults: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Front Psychol 2022; 13:837710. [PMID: 35783735 PMCID: PMC9245546 DOI: 10.3389/fpsyg.2022.837710] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Accepted: 04/25/2022] [Indexed: 12/02/2022] Open
Abstract
Background Efficient performance of most daily activities requires intact and simultaneous execution of motor and cognitive tasks. To mitigate age-related functional decline, various combinations of motor and cognitive training have shown promising results. The aim of this systematic review and meta-analysis of randomized controlled trials (RCTs) was to evaluate the efficacy of different types of motor-cognitive training interventions (e.g., sequential and simultaneous) on selected functional outcomes in healthy older adults. Methods Six online academic databases were used to retrieve eligible RCTs up to April 2021, following PRISMA guidelines and PICO criteria. A random-effects model was used for all meta-analyses conducted on selected functional outcomes: single- and dual-task gait speed, the Timed Up and Go Test (TUG), and Berg Balance Scale (BBS) score. Effect size (ES) was calculated as Hedges' g and interpreted as: trivial: <0.20, small: 0.20–0.60, moderate: 0.61–1.20, large: 1.21–2.00, very large: 2.01–4.00 or extremely large >4.00. Results From 2,546 retrieved records, 91 RCTs were included for meta-analysis (n = 3,745 participants; 64.7–86.9 years). The motor-cognitive interventions included differed according to the type of training (e.g., sequential, simultaneous with additional cognitive task or exergame training. The results showed that motor-cognitive interventions can improve gait speed under single-task conditions (small ES = 0.34, P = 0.003). The effect of the intervention was moderated by the type of control group (Q = 6.203, P = 0.013): passive (moderate ES = 0.941, P = 0.001) vs. active controls (trivial ES = 0.153, P = 0.180). No significant effect was found for dual-task walking outcomes (P = 0.063). Motor-cognitive intervention had a positive effect on TUG (small ES = 0.42, P < 0.001), where the effect of intervention was moderated by control group [passive (moderate ES = 0.73, P = 0.001) vs. active (small ES = 0.20, P = 0.020)], but not by the type of training (P = 0.064). Finally, BBS scores were positively affected by motor-cognitive interventions (small ES = 0.59, P < 0.001) with however no significant differences between type of control group (P = 0.529) or intervention modality (P = 0.585). Conclusions This study provides evidence for the effectiveness of various types of motor-cognitive interventions on performance-based measures of functional mobility in healthy older adults. With respect to significant effects, gait speed under single-task condition was improved by motor-cognitive interventions, but the evidence shows that this type of intervention is not necessarily more beneficial than motor training alone. On the other hand, motor-cognitive interventions are better at improving multicomponent tasks of dynamic balance and mobility function, as measured by the TUG. Because of substantial heterogeneity and the current limited availability of different types of interventions, the conclusions should be interpreted with caution.
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Affiliation(s)
- Kaja Teraz
- Institute for Kinesiology Research, Science and Research Centre Koper, Koper, Slovenia
- Faculty of Sport, University of Ljubljana, Ljubljana, Slovenia
| | - Luka Šlosar
- Institute for Kinesiology Research, Science and Research Centre Koper, Koper, Slovenia
| | - Armin H. Paravlić
- Institute for Kinesiology Research, Science and Research Centre Koper, Koper, Slovenia
- Faculty of Sport, University of Ljubljana, Ljubljana, Slovenia
- Faculty of Sports Studies, Masaryk University, Brno, Czechia
| | - Eling D. de Bruin
- Institute of Human Movement Sciences and Sport, Department of Health Sciences and Technology, ETH Zurich, Zurich, Switzerland
- Division of Physiotherapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Stockholm, Sweden
- *Correspondence: Eling D. de Bruin
| | - Uros Marusic
- Institute for Kinesiology Research, Science and Research Centre Koper, Koper, Slovenia
- Department of Health Sciences, Alma Mater Europaea – ECM, Maribor, Slovenia
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19
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Hortobágyi T, Ács P, Baumann P, Borbély G, Áfra G, Reichardt-Varga E, Sántha G, Tollár J. Comparative effectiveness of four exercise interventions followed by two years of exercise maintenance in multiple sclerosis: A randomized control trial. Arch Phys Med Rehabil 2022; 103:1908-1916. [PMID: 35584738 DOI: 10.1016/j.apmr.2022.04.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2021] [Revised: 03/25/2022] [Accepted: 04/20/2022] [Indexed: 11/02/2022]
Abstract
OBJECTIVE To determine the effects of Exergaming on quality of life (QoL), motor, and clinical symptoms in Multiple Sclerosis. We compared the effects of exergaming (EXE), balance (BAL), cycling (CYC), proprioceptive neuromuscular facilitation (PNF), and a standard care wait-listed control group (CON) on clinical and motor symptoms and quality of life (QoL) in people with MS (PwMS) and determined the effects of subsequent maintenance programs for 2 years in a hospital setting. DESIGN A randomized clinical trial, using before-after test design. SETTINGS University Hospital Setting PARTICIPANTS: Of 82 multiple sclerosis outpatients, 70 were randomized, and 68 completed the study. INTERVENTIONS The initial high-intensity and -frequency interventions consisted of 25, 1-h sessions over 5 weeks. After the 5-wk-long initial intervention, the 2-year-long maintenance programs followed, consisting of 3 sessions per week, each for 1h. MAIN OUTCOME MEASURES The primary outcome: Multiple Sclerosis Impact Scale (MSIS-29). SECONDARY OUTCOMES Measures five aspects of health-related QoL (EQ-5D index), Beck Depression Inventory, six-minute walk test (6MWT), Berg Balance Scale (BBS), Tinetti Assessment Tool (TAT) and static balance (center of pressure, COP). RESULTS MSIS-29 improved most in EXE (11 points), BAL (6), and CYC (6, all p<0.05). QoL improved most in EXE (3 points) and CYC and BAL (2, all p<0.05). TAT and BBS improved significantly (p<0.05) but similarly (p>0.05) in EXE, BAL, and CYC. 6MWT improved most in EXE (57m), BAL (32m), and CYC (19m all p<0.001). Standing sway did not change. Maintenance programs further increased the initial exercise-induced gains, robustly in EXE. CONCLUSION 25 sessions of EXE, BAL, CYC, and PNF, in this order, improved clinical and motor symptoms and QoL and subsequent, 2-y-long thrice weekly maintenance programs further slowed symptom-worsening and improved QoL. EXE was the most and PNF was the least effective to improve clinical symptoms, motor function, and QoL in PwMS.
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Affiliation(s)
- Tibor Hortobágyi
- Center for Human Movement Sciences, University Medical Center Groningen, University of Groningen, The Netherlands; Somogy County Kaposi Mór Teaching Hospital, Kaposvár, Hungary; Department of Sport Biology, Institute of Sport Sciences and Physical Education, University of Pécs, Hungary; Departments of Epidemiology and Neurosurgery, University Medical Center Groningen, University of Groningen, The Netherlands
| | - Pongrác Ács
- University of Pécs, Faculty of Health Sciences, Doctoral School of Health Sciences, Pécs, Hungary
| | - Petra Baumann
- University of Pécs, Faculty of Health Sciences, Doctoral School of Health Sciences, Pécs, Hungary; Department of Dentistry, Oral and Maxillofacial Surgery, Pécs
| | - Gábor Borbély
- University of Pécs, Faculty of Health Sciences, Doctoral School of Health Sciences, Pécs, Hungary
| | - György Áfra
- University of Pécs, Faculty of Health Sciences, Doctoral School of Health Sciences, Pécs, Hungary
| | - Emese Reichardt-Varga
- University of Pécs, Faculty of Health Sciences, Doctoral School of Health Sciences, Pécs, Hungary
| | - Gergely Sántha
- University of Pécs, Faculty of Health Sciences, Doctoral School of Health Sciences, Pécs, Hungary
| | - József Tollár
- Somogy County Kaposi Mór Teaching Hospital, Kaposvár, Hungary; University of Pécs, Faculty of Health Sciences, Doctoral School of Health Sciences, Pécs, Hungary; Department of Medical Imaging, Faculty of Health Sciences, University of Pécs, Hungary; Széchényi István University, Digital Development Center, Győr, Hungary.
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20
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Lancioni GE, Singh NN, O'Reilly M, Sigafoos J, Alberti G, Desideri L. Programs Using Stimulation-Regulating Technologies to Promote Physical Activity in People With Intellectual and Multiple Disabilities: Scoping Review. JMIR Rehabil Assist Technol 2022; 9:e35217. [PMID: 35389365 PMCID: PMC9031065 DOI: 10.2196/35217] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Revised: 01/04/2022] [Accepted: 03/21/2022] [Indexed: 12/22/2022] Open
Abstract
Background People with intellectual and multiple disabilities tend to engage in very low levels of physical activity. Objective This review paper aims to provide a comprehensive picture of intervention programs using stimulation-regulating technologies to promote forms of physical activity in people with intellectual and multiple disabilities. Methods Following the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) checklist, a scoping review was conducted to identify and provide a synthesis of eligible studies published in English between 2010 and 2021. Studies were identified by searching PubMed, Web of Science, PsycINFO, ERIC, and CINAHL as well as by using Google Scholar and manual searches. Studies were included if they involved individuals with intellectual or multiple disabilities, used stimulation-regulating technology systems to help participants engage in physical activity, and reported data on the impact of the intervention. Results A total of 42 studies met the inclusion criteria. These studies were divided into 2 groups based on whether they pursued the increase in physical activity through technology-aided delivery of brief periods of preferred stimulation contingent on specific responses or the use of video games (exergames) and related auditory and visual stimulation. Subsequently, a narrative synthesis of the studies was provided. Conclusions The evidence reported by the 2 groups of studies is encouraging. However, further research is needed to compare the overall applicability and impact of the intervention strategies proposed by these groups of studies.
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Affiliation(s)
- Giulio E Lancioni
- Department of Neuroscience and Sense Organs, University of Bari, Bari, Italy
| | - Nirbhay N Singh
- Department of Psychiatry and Health Behavior, Augusta University, Augusta, GA, United States
| | - Mark O'Reilly
- Department of Special Education, University of Texas at Austin, Austin, TX, United States
| | - Jeff Sigafoos
- School of Education, Victoria University of Wellington, Wellington, New Zealand
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21
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Calafiore D, Invernizzi M, Ammendolia A, Marotta N, Fortunato F, Paolucci T, Ferraro F, Curci C, Cwirlej-Sozanska A, de Sire A. Efficacy of Virtual Reality and Exergaming in Improving Balance in Patients With Multiple Sclerosis: A Systematic Review and Meta-Analysis. Front Neurol 2021; 12:773459. [PMID: 34956054 PMCID: PMC8702427 DOI: 10.3389/fneur.2021.773459] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Accepted: 11/12/2021] [Indexed: 12/20/2022] Open
Abstract
Multiple sclerosis (MS) is one of the most common causes of neurological progressive disease and can lead to loss of mobility, walk impairment, and balance disturbance. Among several rehabilitative approaches proposed, exergaming and virtual reality (VR) have been studied in the recent years. Active video game therapy could reduce the boredom of the rehabilitation process, increasing patient motivation, providing direct feedback, and enabling dual-task training. Aim of this systematic review was to assess the efficacy of exergaming and VR for balance recovery in patients with MS. PubMed, Scopus, and Web of Science were systematically searched from the inception until May 14, 2021 to identify randomized controlled trials (RCTs) presenting: patients with MS as participants, exergaming and VR as intervention, conventional rehabilitation as comparator, and balance assessment [Berg Balance Scale (BBS)] as outcome measure. We also performed a meta-analysis of the mean difference in the BBS via the random-effects method. Out of 93 records, this systematic review included and analyzed 7 RCTs, involving a total of 209 patients affected by MS, of which 97 patients performed exergaming or VR and 112 patients underwent conventional rehabilitation. The meta-analysis reported a significant overall ES of 4.25 (p < 0.0001), showing in the subgroup analysis a non-significant ES of 1.85 (p = 0.39) for the VR and a significant ES of 4.49 (p < 0.0001) for the exergames in terms of the BBS improvement. Taken together, these findings suggested that balance rehabilitation using exergames appears to be more effective than conventional rehabilitation in patients affected by MS.
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Affiliation(s)
- Dario Calafiore
- Physical Medicine and Rehabilitation Unit, Department of Neurosciences, ASST Carlo Poma, Mantova, Italy
| | - Marco Invernizzi
- Physical and Rehabilitative Medicine, Department of Health Sciences, University of Eastern Piedmont, Novara, Italy
- Translational Medicine, Dipartimento Attività Integrate Ricerca e Innovazione (DAIRI), Azienda Ospedaliera SS. Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
| | - Antonio Ammendolia
- Department of Medical and Surgical Sciences, University of Catanzaro “Magna Graecia”, Catanzaro, Italy
| | - Nicola Marotta
- Department of Medical and Surgical Sciences, University of Catanzaro “Magna Graecia”, Catanzaro, Italy
| | - Francesco Fortunato
- Institute of Neurology, Department of Medical and Surgical Sciences, University of Catanzaro “Magna Graecia”, Catanzaro, Italy
| | - Teresa Paolucci
- Department of Medical, Oral and Biotechnological Sciences, G. D'Annunzio University of Chieti-Pescara, Chieti, Italy
| | - Francesco Ferraro
- Physical Medicine and Rehabilitation Unit, Department of Neurosciences, ASST Carlo Poma, Mantova, Italy
| | - Claudio Curci
- Physical Medicine and Rehabilitation Unit, Department of Neurosciences, ASST Carlo Poma, Mantova, Italy
| | - Agnieszka Cwirlej-Sozanska
- Institute of Health Sciences, College of Medical Sciences of the University of Rzeszow, University of Rzeszow, Rzeszow, Poland
| | - Alessandro de Sire
- Department of Medical and Surgical Sciences, University of Catanzaro “Magna Graecia”, Catanzaro, Italy
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22
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Dalmazane M, Gallou-Guyot M, Compagnat M, Magy L, Montcuquet A, Billot M, Daviet JC, Perrochon A. Effects on gait and balance of home-based active video game interventions in persons with multiple sclerosis: A systematic review. Mult Scler Relat Disord 2021; 51:102928. [PMID: 33845351 PMCID: PMC9764369 DOI: 10.1016/j.msard.2021.102928] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 03/10/2021] [Accepted: 03/23/2021] [Indexed: 12/24/2022]
Abstract
BACKGROUND The current coronavirus disease (COVID-19) pandemic makes it difficult to obtain physical therapy in rehabilitation centres, particularly for persons with multiple sclerosis (pwMS), who are a population at high risk, since viral infections may contribute to MS exacerbations and relapses. Active video games could be a way to maintain physical therapy at home as part of the rehabilitation. The aim of this review is to summarise the current best evidence for the effectiveness of home-based active video games on gait and balance, user compliance, feasibility and safety for pwMS. METHODS We searched for studies in five databases (PubMed, Scopus, Cochrane, CINAHL and Science direct) up to October 2020. Selection of studies, extraction of data and methodological quality assessment through the PEDro scale were made independently by two authors and discussed with a third author. RESULTS Nine studies were included in this systematic review. We found significant improvements in balance; results were mixed concerning mobility, physical activity and gait. Home-based active video games are feasible and safe, with good compliance and adherence. The methodological quality of the studies was moderate (PEDro scale: 5.3 ± 2). CONCLUSION Overall, home-based active video games were found safe and effective improving static and dynamic balance in pwMS. Compliance was good, probably because it is a motivating and enjoyable training. Active video games can be a relevant alternative for physical rehabilitation at home in pwMS. Future studies should follow more rigorous methodological standards (larger sample sizes, more randomised controlled trials) to improve the quality of evidence and include cost-effectiveness in the analysis.
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Affiliation(s)
- Marion Dalmazane
- ILFOMER, Université de Limoges, Limoges, France; HAVAE, EA 6310, Université de Limoges, Limoges, France
| | | | - Maxence Compagnat
- HAVAE, EA 6310, Université de Limoges, Limoges, France; Pôle neuro-sciences tête et cou, service de médecine physique et de réadaptation, hôpital J Rebeyrol, CHU Limoges, Limoges, France
| | - Laurent Magy
- Département de Neurologie, CHU Limoges, Limoges, France
| | | | - Maxime Billot
- PRISMATICS (Predictive Research In Spine/neurostimulation Management And Thoracic Innovation in Cardiac Surgery), Poitiers University Hospital, Poitiers, France
| | - Jean-Christophe Daviet
- HAVAE, EA 6310, Université de Limoges, Limoges, France; Pôle neuro-sciences tête et cou, service de médecine physique et de réadaptation, hôpital J Rebeyrol, CHU Limoges, Limoges, France
| | - Anaick Perrochon
- ILFOMER, Université de Limoges, Limoges, France; HAVAE, EA 6310, Université de Limoges, Limoges, France.
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23
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Voinescu A, Sui J, Stanton Fraser D. Virtual Reality in Neurorehabilitation: An Umbrella Review of Meta-Analyses. J Clin Med 2021; 10:1478. [PMID: 33918365 PMCID: PMC8038192 DOI: 10.3390/jcm10071478] [Citation(s) in RCA: 39] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 03/18/2021] [Accepted: 03/25/2021] [Indexed: 01/08/2023] Open
Abstract
Neurological disorders are a leading cause of death and disability worldwide. Can virtual reality (VR) based intervention, a novel technology-driven change of paradigm in rehabilitation, reduce impairments, activity limitations, and participation restrictions? This question is directly addressed here for the first time using an umbrella review that assessed the effectiveness and quality of evidence of VR interventions in the physical and cognitive rehabilitation of patients with stroke, traumatic brain injury and cerebral palsy, identified factors that can enhance rehabilitation outcomes and addressed safety concerns. Forty-one meta-analyses were included. The data synthesis found mostly low- or very low-quality evidence that supports the effectiveness of VR interventions. Only a limited number of comparisons were rated as having moderate and high quality of evidence, but overall, results highlight potential benefits of VR for improving the ambulation function of children with cerebral palsy, mobility, balance, upper limb function, and body structure/function and activity of people with stroke, and upper limb function of people with acquired brain injury. Customization of VR systems is one important factor linked with improved outcomes. Most studies do not address safety concerns, as only nine reviews reported adverse effects. The results provide critical recommendations for the design and implementation of future VR programs, trials and systematic reviews, including the need for high quality randomized controlled trials to test principles and mechanisms, in primary studies and in meta-analyses, in order to formulate evidence-based guidelines for designing VR-based rehabilitation interventions.
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Affiliation(s)
- Alexandra Voinescu
- Department of Psychology, University of Bath, 10 West, Claverton Down, Bath BA2 7AY, UK;
| | - Jie Sui
- The School of Psychology, King’s College, University of Aberdeen, Aberdeen AB24 3FX, UK;
| | - Danaë Stanton Fraser
- Department of Psychology, University of Bath, 10 West, Claverton Down, Bath BA2 7AY, UK;
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