The effects of supervised and non-supervised upper limb virtual reality exercises on upper limb sensory-motor functions in patients with idiopathic Parkinson's disease

Translation, Cross-Cultural Adaptation, and Feasibility of the NHPT-E of Manual Dexterity for the Spanish Population

The Nine-Hole Peg Test (NHPT) is considered a "gold standard" for the measurement of manual dexterity. The aim of this study was the translation and culturally adapting the original version of the NHPT.

MATERIALS AND METHODS

The adaptation was carried out following the standardized translation-retrotranslation guidelines and procedures referred to in the literature and in the International Test Commission (CIT). The final Spanish version of the NHPT (NHPT-E) was administered to 40 healthy adults. We evaluated its feasibility by means of a questionnaire elaborated according to Iraossi's checklist proposal for the pilot test process.

RESULTS

Modifications of expression in the grammatical mode of the verbs were performed, as well as the adaptation of some terms used in the three sections of the original version of the test (General Information, Installation, and Application Instructions). In the pilot study, for 95% of the participants, the NHPT-E is a comfortable test to take, and, for 100% of the evaluators, the test includes all the necessary information, with clear instructions and interpretation of the results.

CONCLUSIONS

The cross-cultural adaptation and pilot study enabled the development of a suitable and viable version of the NHPT-E for use in the Spanish population.

Effects of Upper Limb Exercise or Training on Hand Dexterity and Function in People With Parkinson Disease: A Systematic Review and Meta-analysis

OBJECTIVE

This systematic review investigated the effects of exercise and training on hand dexterity and function outcomes in people with Parkinson disease (PD).

DATA SOURCES

We searched 5 databases (MEDLINE Ovid, CINAHL, PEDro, PubMed, Cochrane Database) from inception to October 2022.

STUDY SELECTION

Included studies were randomized controlled trials delivering upper limb exercise or training interventions to people with PD and evaluating 1 or more upper limb activity outcomes. Two independent reviewers screened 668 articles for inclusion.

DATA EXTRACTION

Two reviewers independently extracted data relating to study participants, intervention characteristics, and key outcomes. Cochrane Risk of Bias and GRADE tools assessed methodological quality of included studies, and strength of evidence for 3 outcomes: hand dexterity, self-reported hand function, and handwriting performance. Meta-analyses synthesized results for within-hand dexterity and self-reported function.

RESULTS

Eighteen randomized controlled trials (n=704) with low to unclear risk of bias were identified. Experimental interventions varied considerably in their approach and treatment dose, and 3 studies focused on training handwriting. Meta-analysis showed moderate quality evidence of a small positive effect on within-hand dexterity (SMD=0.26; 95% CI 0.07, 0.44). Very low-quality evidence pointed toward a nonsignificant effect on self-reported hand function (SMD=0.67; 95% CI -0.40, 1.75). A narrative review of handwriting interventions showed low quality evidence for improved performance after training.

CONCLUSIONS

There is moderate certainty of evidence supporting the use of exercise and training to address dexterity problems, but evidence remains unclear for self-reported hand function and handwriting. Our findings suggest that training could employ task-related approaches. Future research should interrogate aspects of clinical practice such as optimal dose and key ingredients for effective interventions.

Remote Delivery of Allied Health Therapies in Parkinson's Disease

Remote delivery of allied health therapies has long been possible, but adoption has been limited in some disciplines until relatively recently. The COVID-19 pandemic drove dramatic increases in use of remote delivery within allied health. This review summarizes the latest evidence on remotely-delivered physical therapy, occupational therapy, and speech therapy and discusses associated challenges and opportunities.

Effect of Proprioceptive Training Compared With Other Interventions for Upper Limb Deficits in People With Parkinson Disease: A Systematic Review and Meta-analysis of Randomized Controlled Trials

OBJECTIVE

This systematic review and meta-analysis aimed to determine the efficacy of proprioceptive training on hand dexterity, upper limb function, and quality of life (QoL) in people with Parkinson disease (PD) compared with no or other active interventions.

DATA SOURCES

Medline PubMed, Cochrane Library, CINAHL, PEDro, and Web of Science databases were searched to identify published studies until February 2023.

STUDY SELECTION

Peer-reviewed English publications of randomized controlled trials (RCTs) of proprioceptive training conducted among people with PD.

DATA EXTRACTION

Study characteristics, exercise program type and dosage, outcome of interest, and between-group comparisons of post-test results of intervention and comparison groups.

DATA SYNTHESIS

Eight RCTs were included, involving 344 people with PD. Six RCTs contributed to meta-analyses. There was very low certainty of evidence that proprioceptive training may improve dominant hand (standard mean difference [SMD] 0.34, 95% CI 0.08-0.60, P=.01) and non-dominant hand (SMD 0.36, 95% CI 0.10-0.63, P<.01) fine motor dexterity, and dominant hand gross manual dexterity (SMD 1.73, 95% CI 0.30-3.16, P=.02), following 2-8 weeks of proprioceptive training. There was no evidence of effects on non-dominant hand gross manual dexterity, upper limb function, and QoL after proprioceptive training.

CONCLUSIONS

Findings regarding the effect of proprioceptive training on hand dexterity in the short-term are inconclusive. The small sample size likely limited effect detection. Future large RCTs should compare proprioceptive training with no intervention and perform comprehensive biomechanical analysis to gain a clearer idea of its effects. Incorporating longer-duration proprioceptive training programs is also recommended to investigate long-lasting effects.

Effects of a multi-component virtual reality program on motor skills and functional postural control in children with hemiplegic cerebral palsy

Background

Pediatric neurorehabilitation has recently employed virtual reality (VR) technologies as a platform to design and implement novel modalities.

Aims

To evaluate the feasibility of a multi-component VR-based program on motor skills and functional postural control for children with hemiplegic cerebral palsy (HCP).

Methods

A single-case-experimental design was conducted on eight children with HCP (12.33 ± 4.71 years and GMFCS= II, I). The VR-based program consisted of 3 sessions per week for four weeks. Timed Up and Go (TUG) test, Functional Reach Test (FRT), Pediatric Balance Scale (PBS), Activities Scale for Kids (ASK), ABILHAND-Kids, and Box and Block Test (BBT) were used to evaluate functional changes.

Outcomes and results

Statistical analysis showed that improvements in functional postural control were significant on at least one balance measure for seven out of eight participants during the intervention phase. For all participants, a significant increase was observed in the BBT scores. Before-after intervention analysis revealed statistically significant improvements in PBS (z = -2.52, p ≤ 0.01), ABILHAND-Kids (z = -2.25, p ≤ 0.01), and ASK (z = -2.38, p ≤ 0.01).

Conclusions and implications

This study provided early evidence of the effectiveness of the multi-component VR-based program in children with HCP. However, future studies with randomized controlled trial design are needed to evaluate the long-term effects and compare them with conventional rehabilitation practice.