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Özlü A, Üstündağ S, Bulut Özkaya D, Menekşeoğlu AK. Effect of Exergame on Pain, Function, and Quality of Life in Shoulder Impingement Syndrome: A Prospective Randomized Controlled Study. Games Health J 2024; 13:109-119. [PMID: 38394299 DOI: 10.1089/g4h.2023.0108] [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] [Indexed: 02/25/2024] Open
Abstract
Objective: This study aimed to investigate the effect of a virtual reality (VR)-mediated gamified rehabilitation program added to a home exercise program on pain, functionality, and quality of life in shoulder impingement syndrome. Methods: Forty-eight participants with shoulder impingement syndrome were included in this prospective, randomized, single-blind study between January and July 2022. The participants were randomized into two groups: the VR group (n = 24) and the control group (n = 24). All participants were given a home exercise program for 3 weeks, with five sessions per week. The participants in the VR group received 15 sessions (45 minutes each session) of a gamified shoulder exercise program with an immersive VR headset, while those in the control group received 15 sessions (45 minutes each session) of supervised therapeutic exercises. The participants were evaluated and compared before and after treatment using the 36-item Short Form Survey (SF-36), range-of-motion (ROM) measurements, the Visual Analog Scale (VAS), and the Shoulder Pain and Disability Scale (SPADI). Results: At the baseline assessment, the two groups were homogenous regarding demographic and clinical parameters. The post-treatment shoulder extension and adduction ROM was significantly greater in the VR group and the post-treatment pain subscales for SPADI and SF-36 were significantly lower in the VR group. Conclusion: In individuals with shoulder impingement syndrome, a VR-mediated gamified exercise program added to a home exercise program increased shoulder ROM and reduced pain scores. Further clinical studies are needed to prove the long-term efficacy of the addition of VR-mediated gamified exercises to the treatment of this condition in clinical settings.
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Affiliation(s)
- Aysun Özlü
- Department of Physical Medicine and Rehabilitation, Faculty of Medicine, Kutahya Health Sciences University, Kutahya, Turkey
| | - Sema Üstündağ
- Department of Internal Medicine, Faculty of Nursing, Kutahya Health Sciences University, Kutahya, Turkey
| | - Dilan Bulut Özkaya
- Department of Physical Medicine and Rehabilitation, Faculty of Medicine, Kutahya Health Sciences University, Kutahya, Turkey
| | - Ahmet Kıvanç Menekşeoğlu
- Department of Physical Medicine and Rehabilitation, Istanbul Kanuni Sultan Süleyman Training and Research Hospital, Istanbul, Turkey
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Marín-Medina DS, Arenas-Vargas PA, Arias-Botero JC, Gómez-Vásquez M, Jaramillo-López MF, Gaspar-Toro JM. New approaches to recovery after stroke. Neurol Sci 2024; 45:55-63. [PMID: 37697027 PMCID: PMC10761524 DOI: 10.1007/s10072-023-07012-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 08/07/2023] [Indexed: 09/13/2023]
Abstract
After a stroke, several mechanisms of neural plasticity can be activated, which may lead to significant recovery. Rehabilitation therapies aim to restore surviving tissue over time and reorganize neural connections. With more patients surviving stroke with varying degrees of neurological impairment, new technologies have emerged as a promising option for better functional outcomes. This review explores restorative therapies based on brain-computer interfaces, robot-assisted and virtual reality, brain stimulation, and cell therapies. Brain-computer interfaces allow for the translation of brain signals into motor patterns. Robot-assisted and virtual reality therapies provide interactive interfaces that simulate real-life situations and physical support to compensate for lost motor function. Brain stimulation can modify the electrical activity of neurons in the affected cortex. Cell therapy may promote regeneration in damaged brain tissue. Taken together, these new approaches could substantially benefit specific deficits such as arm-motor control and cognitive impairment after stroke, and even the chronic phase of recovery, where traditional rehabilitation methods may be limited, and the window for repair is narrow.
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Affiliation(s)
- Daniel S Marín-Medina
- Grupo de Investigación NeuroUnal, Neurology Unit, Universidad Nacional de Colombia, Bogotá, Colombia.
| | - Paula A Arenas-Vargas
- Grupo de Investigación NeuroUnal, Neurology Unit, Universidad Nacional de Colombia, Bogotá, Colombia
| | - Juan C Arias-Botero
- Grupo de Investigación NeuroUnal, Neurology Unit, Universidad Nacional de Colombia, Bogotá, Colombia
| | - Manuela Gómez-Vásquez
- Grupo de Investigación NeuroUnal, Neurology Unit, Universidad Nacional de Colombia, Bogotá, Colombia
| | - Manuel F Jaramillo-López
- Grupo de Investigación NeuroUnal, Neurology Unit, Universidad Nacional de Colombia, Bogotá, Colombia
| | - Jorge M Gaspar-Toro
- Grupo de Investigación NeuroUnal, Neurology Unit, Universidad Nacional de Colombia, Bogotá, Colombia
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Rivera BD, Nurse C, Shah V, Roldan C, Jumbo AE, Faysel M, Levine SR, Kaufman D, Afable A. Do digital health interventions hold promise for stroke prevention and care in Black and Latinx populations in the United States? A scoping review. BMC Public Health 2023; 23:2549. [PMID: 38129850 PMCID: PMC10734160 DOI: 10.1186/s12889-023-17255-6] [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: 08/13/2023] [Accepted: 11/17/2023] [Indexed: 12/23/2023] Open
Abstract
BACKGROUND Black and Latinx populations are disproportionately affected by stroke and are likely to experience gaps in health care. Within fragmented care systems, remote digital solutions hold promise in reversing this pattern. However, there is a digital divide that follows historical disparities in health. Without deliberate attempts to address this digital divide, rapid advances in digital health will only perpetuate systemic biases. This study aimed to characterize the range of digital health interventions for stroke care, summarize their efficacy, and examine the inclusion of Black and Latinx populations in the evidence base. METHODS We searched PubMed, the Web of Science, and EMBASE for publications between 2015 and 2021. Inclusion criteria include peer-reviewed systematic reviews or meta-analyses of experimental studies focusing on the impact of digital health interventions on stroke risk factors and outcomes in adults. Detailed information was extracted on intervention modality and functionality, clinical/behavioral outcome, study location, sample demographics, and intervention results. RESULTS Thirty-eight systematic reviews met inclusion criteria and yielded 519 individual studies. We identified six functional categories and eight digital health modalities. Case management (63%) and health monitoring (50%) were the most common intervention functionalities. Mobile apps and web-based interventions were the two most commonly studied modalities. Evidence of efficacy was strongest for web-based, text-messaging, and phone-based approaches. Although mobile applications have been widely studied, the evidence on efficacy is mixed. Blood pressure and medication adherence were the most commonly studied outcomes. However, evidence on the efficacy of the various intervention modalities on these outcomes was variable. Among all individual studies, only 38.0% were conducted in the United States (n = 197). Of these U.S. studies, 54.8% adequately reported racial or ethnic group distribution. On average, samples were 27.0% Black, 17.1% Latinx, and 63.4% White. CONCLUSION While evidence of the efficacy of selected digital health interventions, particularly those designed to improve blood pressure management and medication adherence, show promise, evidence of how these interventions can be generalized to historically underrepresented groups is insufficient. Including these underrepresented populations in both digital health experimental and feasibility studies is critical to advancing digital health science and achieving health equity.
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Affiliation(s)
- Bianca D Rivera
- School of Public Health, Downstate Health Sciences University, 450 Clarkson Avenue, Brooklyn, NY, 11203, USA.
| | - Claire Nurse
- School of Public Health, Downstate Health Sciences University, 450 Clarkson Avenue, Brooklyn, NY, 11203, USA
| | - Vivek Shah
- College of Medicine, Downstate Health Sciences University, 450 Clarkson Avenue, Brooklyn, NY, 11203, USA
| | - Chastidy Roldan
- College of Medicine, Downstate Health Sciences University, 450 Clarkson Avenue, Brooklyn, NY, 11203, USA
| | - Adiebonye E Jumbo
- School of Health Professions, Health Informatics Program, Downstate Health Sciences University, 450 Clarkson Avenue, Brooklyn, NY, 11203, USA
| | - Mohammad Faysel
- School of Health Professions, Health Informatics Program, Downstate Health Sciences University, 450 Clarkson Avenue, Brooklyn, NY, 11203, USA
| | - Steven R Levine
- Department of Neurology/Stroke Center, Downstate Health Sciences University, 450 Clarkson Avenue, Brooklyn, NY, 11203, USA
| | - David Kaufman
- School of Health Professions, Health Informatics Program, Downstate Health Sciences University, 450 Clarkson Avenue, Brooklyn, NY, 11203, USA
| | - Aimee Afable
- School of Public Health, Downstate Health Sciences University, 450 Clarkson Avenue, Brooklyn, NY, 11203, USA
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Jo YJ, Kim DH, Kim S, Kim JH, Choi JH, Park JB, Baek YS, Park YG, Kim DY. Effect of Anterioposterior Weight-Shift Training with Visual Biofeedback in Patients with Step Length Asymmetry after Subacute Stroke. J Pers Med 2023; 13:1726. [PMID: 38138953 PMCID: PMC10745098 DOI: 10.3390/jpm13121726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Revised: 12/04/2023] [Accepted: 12/12/2023] [Indexed: 12/24/2023] Open
Abstract
Step length asymmetry is a characteristic feature of gait in post-stroke patients. A novel anterioposterior weight-shift training method with visual biofeedback (AP training) was developed to improve the forward progression of the trunk. This study aimed to investigate the effect of AP training on gait asymmetries, patterns, and gait-related function in subacute stroke patients. Forty-six subacute stroke patients were randomly assigned to the AP training group or the control group. The AP training group received conventional gait training and AP training five times per week for 4 weeks. The control group received the same intensity of conventional gait training with patient education for self-anterior weight shifting. Plantar pressure analysis, gait analysis, energy consumption, and gait-related behavioral parameters were assessed before and after training. The AP training group showed significant improvement in step length asymmetry, forefoot contact area and pressure, Berg balance scale score, and Fugl-Meyer assessment scale of lower extremity score compared to the control group (p < 0.05). However, there was no significant between-group difference with respect to energy cost and kinetic and kinematic gait parameters. In conclusion, AP training may help improve the asymmetric step length in stroke patients, and also improve anterior weight shifting, balance, and motor function in subacute stroke survivors.
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Affiliation(s)
- Yea Jin Jo
- Research Institute of Rehabilitation Medicine, Yonsei University College of Medicine, Seoul 03722, Republic of Korea;
| | - Dae Hyun Kim
- Department of Physical and Rehabilitation Medicine, Center for Prevention and Rehabilitation, Heart Vascular Stroke Institute, Samsung Medical Center, School of Medicine, Sungkyunkwan University, Seoul 06351, Republic of Korea;
| | - Seeun Kim
- School of Mechanical Engineering, Yonsei University, Seoul 03722, Republic of Korea; (S.K.); (J.H.C.); (Y.S.B.)
| | - Jung Hoon Kim
- Construction Robot and Automation Laboratory, Department of Civil and Environmental Engineering, Yonsei University, Seoul 03722, Republic of Korea;
| | - Jong Hyun Choi
- School of Mechanical Engineering, Yonsei University, Seoul 03722, Republic of Korea; (S.K.); (J.H.C.); (Y.S.B.)
| | - Jong Bum Park
- Department of Rehabilitation Medicine, Konyang University College of Medicine, Daejeon 35365, Republic of Korea;
| | - Yoon Su Baek
- School of Mechanical Engineering, Yonsei University, Seoul 03722, Republic of Korea; (S.K.); (J.H.C.); (Y.S.B.)
| | - Yoon Ghil Park
- Department of Rehabilitation Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul 06273, Republic of Korea;
| | - Deog Young Kim
- Department and Research Institute of Rehabilitation Medicine, Yonsei University College of Medicine, Seoul 03722, Republic of Korea
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Hao J, Yao Z, Harp K, Gwon DY, Chen Z, Siu KC. Effects of virtual reality in the early-stage stroke rehabilitation: A systematic review and meta-analysis of randomized controlled trials. Physiother Theory Pract 2023; 39:2569-2588. [PMID: 35801290 DOI: 10.1080/09593985.2022.2094302] [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: 12/19/2021] [Revised: 05/25/2022] [Accepted: 06/20/2022] [Indexed: 10/17/2022]
Abstract
BACKGROUND Virtual reality (VR) is an emerging technology and has shown promising outcomes in stroke rehabilitation. VR can create an enriched environment, facilitate task-specific training, and provide multimodal sensorimotor feedback to augment functional recovery by driving the experience-dependent plasticity, which is prominent in the early-stage after stroke. PURPOSE This review aimed to systematically identify and examine the feasibility and effectiveness of VR intervention applied within one-month after stroke on functional outcomes of patients. METHODS Randomized controlled trials were searched across six databases published between 2000 and 2021. Two independent reviewers conducted study selection, data extraction, and quality assessment. Physiotherapy Evidence Database (PEDro) scale was used to evaluate the quality of included studies. Qualitative synthesis and meta-analysis were conducted to compare VR-based rehabilitation and conventional rehabilitation. RESULTS Seventeen randomized controlled trials were included in this review, and all of them meet the criteria for good quality. The results confirmed the feasibility of applying VR in early stroke rehabilitation. In the meta-analyses, there were no significant differences between VR and control on upper extremity function (SMD = 0.22, P = .10), Activities of Daily Living outcomes (SMD = 0.15, P = .11), balance (SMD = 0.18, P = .86), and cognition (SMD = 0.34, P = .06). CONCLUSION VR is a feasible approach and demonstrates comparable effectiveness in functional outcomes with conventional rehabilitation in patients with stroke at the early-stage. Further research focusing on the application of VR in acute stroke survivors with adequate sample size, additional follow-up evaluation and valid outcome measures are warranted.
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Affiliation(s)
- Jie Hao
- Division of Physical Therapy Education, Department of Health and Rehabilitation Sciences, College of Allied Health Professions, University of Nebraska Medical Center, Omaha, NE, United States
| | - Zixuan Yao
- Division of Physical Therapy Education, Department of Health and Rehabilitation Sciences, College of Allied Health Professions, University of Nebraska Medical Center, Omaha, NE, United States
| | - Kimberly Harp
- McGoogan Health Sciences Library, University of Nebraska Medical CenterLeon S. , Omaha, NE, United States
| | - Dr Yeongjin Gwon
- Department of Biostatistics, College of Public Health, University of Nebraska Medical Center, Omaha, NE, United States
| | - Zhen Chen
- d Department of Neurorehabilitation, the First Rehabilitation Hospital of Shanghai, Shanghai, China
| | - Ka-Chun Siu
- Division of Physical Therapy Education, Department of Health and Rehabilitation Sciences, College of Allied Health Professions, University of Nebraska Medical Center, Omaha, NE, United States
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Sattin D, Parma C, Lunetta C, Zulueta A, Lanzone J, Giani L, Vassallo M, Picozzi M, Parati EA. An Overview of the Body Schema and Body Image: Theoretical Models, Methodological Settings and Pitfalls for Rehabilitation of Persons with Neurological Disorders. Brain Sci 2023; 13:1410. [PMID: 37891779 PMCID: PMC10605253 DOI: 10.3390/brainsci13101410] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 09/27/2023] [Accepted: 09/28/2023] [Indexed: 10/29/2023] Open
Abstract
Given the widespread debate on the definition of the terms "Body Schema" and "Body Image", this article presents a broad overview of the studies that have investigated the nature of these types of body representations, especially focusing on the innovative information about these two representations that could be useful for the rehabilitation of patients with different neurological disorders with motor deficits (especially those affecting the upper limbs). In particular, we analyzed (i) the different definitions and explicative models proposed, (ii) the empirical settings used to test them and (iii) the clinical and rehabilitative implications derived from the application of interventions on specific case reports. The growing number of neurological diseases with motor impairment in the general population has required the development of new rehabilitation techniques and a new phenomenological paradigm placing body schema as fundamental and intrinsic parts for action in space. In this narrative review, the focus was placed on evidence from the application of innovative rehabilitation techniques and case reports involving the upper limbs, as body parts particularly involved in finalistic voluntary actions in everyday life, discussing body representations and their functional role.
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Affiliation(s)
- Davide Sattin
- Istituti Clinici Scientifici Maugeri IRCCS, Health Directorate, Via Camaldoli 64, 20138 Milan, Italy; (D.S.); (M.V.)
| | - Chiara Parma
- Istituti Clinici Scientifici Maugeri IRCCS, Health Directorate, Via Camaldoli 64, 20138 Milan, Italy; (D.S.); (M.V.)
| | - Christian Lunetta
- Istituti Clinici Scientifici Maugeri IRCCS, Neurorehabilitation Department-ALS Unit, Via Camaldoli 64, 20138 Milan, Italy;
| | - Aida Zulueta
- Istituti Clinici Scientifici Maugeri IRCCS, Labion, Via Camaldoli 64, 20138 Milan, Italy;
| | - Jacopo Lanzone
- Istituti Clinici Scientifici Maugeri IRCCS, Neurorehabilitation Department, Via Camaldoli 64, 20138 Milan, Italy; (J.L.); (L.G.); (E.A.P.)
| | - Luca Giani
- Istituti Clinici Scientifici Maugeri IRCCS, Neurorehabilitation Department, Via Camaldoli 64, 20138 Milan, Italy; (J.L.); (L.G.); (E.A.P.)
| | - Marta Vassallo
- Istituti Clinici Scientifici Maugeri IRCCS, Health Directorate, Via Camaldoli 64, 20138 Milan, Italy; (D.S.); (M.V.)
- Center for Clinical Ethics, Biotechnology and Life Sciences Department, Insubria University, 21100 Varese, Italy;
| | - Mario Picozzi
- Center for Clinical Ethics, Biotechnology and Life Sciences Department, Insubria University, 21100 Varese, Italy;
| | - Eugenio Agostino Parati
- Istituti Clinici Scientifici Maugeri IRCCS, Neurorehabilitation Department, Via Camaldoli 64, 20138 Milan, Italy; (J.L.); (L.G.); (E.A.P.)
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Bargeri S, Scalea S, Agosta F, Banfi G, Corbetta D, Filippi M, Sarasso E, Turolla A, Castellini G, Gianola S. Effectiveness and safety of virtual reality rehabilitation after stroke: an overview of systematic reviews. EClinicalMedicine 2023; 64:102220. [PMID: 37745019 PMCID: PMC10514431 DOI: 10.1016/j.eclinm.2023.102220] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 08/22/2023] [Accepted: 09/01/2023] [Indexed: 09/26/2023] Open
Abstract
Background Virtual reality (VR) is an innovative neurorehabilitation modality that has been variously examined in systematic reviews. We assessed VR effectiveness and safety after cerebral stroke. Methods In this overview of systematic reviews, we searched eleven databases (Cochrane Database of Systematic Reviews, EMBASE, MEDLINE, SCOPUS, ISI Web of Science, CINAHL, PsycINFO, Pedro, Otseeker, Healthevidence.org, Epistemonikos) and grey literature from inception to January 17, 2023. Studies eligible for inclusion were systematic reviews published in English that included adult patients with a clinical diagnosis of stroke (acute to chronic phase) undergoing any kind of immersive, semi-immersive or non-immersive VR intervention with or without conventional therapy versus conventional therapy alone. The primary outcome was motor upper limb function and activity. The secondary outcomes were gait and balance, cognitive and mental function, limitation of activities, participation, and adverse events. We calculated the degree of overlap between reviews based on the corrected covered area (CCA). Methodological quality was assessed using the A MeaSurement Tool to Assess systematic Reviews (AMSTAR 2) and the Certainty of Evidence (CoE) using the Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) approach. Discordances between results were examined using a conceptual framework based on the Jadad algorithm. This overview is registered with PROSPERO, CRD42022329263. Findings Of the 58 reviews included (n = 345 unique primary studies), 42 (72.4%) had conducted meta-analysis. More than half of the reviews (58.6%) were published between 2020 and 2022 and many (77.6%) were judged critically low in quality by AMSTAR 2. Most reported the Fugl Meyer Assessment scale (FMA-UE) to measure upper limb function and activity. For the primary outcome, there was a moderate overlap of primary studies (CCA 9.0%) with discordant findings. Focusing on upper limb function (FMA-UE), VR with or without conventional therapy seems to be more effective than conventional therapy alone, with low to moderate CoE and probable to definite clinical relevance. For secondary outcomes there was uncertainty about the superiority or no difference between groups due to substantial heterogeneity of measurement scales (eg, methodological choices). A few reviews (n = 6) reported the occurrence of mild adverse events. Interpretation Current evidence suggests that multiple meta-analyses agreed on the superiority of VR with or without conventional therapy over conventional therapy on FME-UE for upper limb. Clinicians may consider embedding VR technologies into their practice as appropriate with patient's goals, abilities, and preferences. However, caution is needed given the poor methodological quality of reviews. Funding Italian Ministry of Health.
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Affiliation(s)
- Silvia Bargeri
- IRCCS Istituto Ortopedico Galeazzi, Unit of Clinical Epidemiology, Milan, Italy
| | | | - Federica Agosta
- Vita-Salute San Raffaele University, Milan, Italy
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Giuseppe Banfi
- Vita-Salute San Raffaele University, Milan, Italy
- IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
| | - Davide Corbetta
- Vita-Salute San Raffaele University, Milan, Italy
- Department of Rehabilitation and Functional Recovery, IRCCS San Raffaele Scientific Institute, Milan, Italy
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK
| | - Massimo Filippi
- Vita-Salute San Raffaele University, Milan, Italy
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Neurorehabilitation Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Neurophysiology Service, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Elisabetta Sarasso
- Vita-Salute San Raffaele University, Milan, Italy
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics and Maternal Child Health, University of Genoa, Genoa, Italy
| | - Andrea Turolla
- Department of Biomedical and Neuromotor Sciences – DIBINEM, Alma Mater Università di Bologna, Bologna, Italy
- Unit of Occupational Medicine, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Greta Castellini
- IRCCS Istituto Ortopedico Galeazzi, Unit of Clinical Epidemiology, Milan, Italy
| | - Silvia Gianola
- IRCCS Istituto Ortopedico Galeazzi, Unit of Clinical Epidemiology, Milan, Italy
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Turan Kavradim S, Yangöz ŞT, Özer Z. Effectiveness of virtual reality interventions on physiological and psychological outcomes of adults with cardiovascular disease: A systematic review and meta-analysis. J Nurs Scholarsh 2023; 55:949-966. [PMID: 36942847 DOI: 10.1111/jnu.12885] [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: 03/30/2022] [Revised: 08/27/2022] [Accepted: 02/15/2023] [Indexed: 03/23/2023]
Abstract
PURPOSE The aim of this study was to provide evidence of the effectiveness of virtual reality interventions on the physiological and psychological outcomes of adults with cardiovascular disease. DESIGN A systematic review and meta-analysis. METHODS Database searches were carried out in CINAHL, Cochrane Central, Web of Science, PubMed, Scopus, Science Direct, and Ovid without restriction of year up to December 2021. The study was carried out in accordance with PRISMA 2020 and Cochrane 2021 recommendations. The intervention effects were pooled using the random effects model. The Risk of Bias 2 tool was' used to assess the risk of bias. Heterogeneity and publication bias were also assessed. FINDINGS In total, 14 trials were included. The included studies found a significantly higher effect on anxiety (Hedge's g = -0.85, 95% CI: -1.55 to -0.14, p = 0.01) and a medium effect on physical functional capacity (Hedge's g = 0.54, 95% CI: 0.01 to 1.08, p = 0.05), stress (Hedge's g = -0.36, 95% CI: -0.60 to -0.11, p = 0.01), and depression (Hedge's g = -0.39, 95% CI: -0.68 to -0.11, p = 0.01) compared to the control group. The Cochrane GRADE approach showed low level evidence for the effect of virtual reality on anxiety and moderate level evidence for stress, depression, and physical functional capacity. CONCLUSIONS The effect size and grade evaluation results showed that virtual reality may be an effective intervention to reduce anxiety, stress, and depression and to increase physical functional capacity in patients with cardiovascular disease. However, more study is necessary in order to establish evidence. REGISTRATION Registered in the PROSPERO database: PROSPERO international prospective register of systematic reviews Registration number: CRD42022296578.
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Akıncı M, Burak M, Yaşar E, Kılıç RT. The effects of Robot-assisted gait training and virtual reality on balance and gait in stroke survivors: A randomized controlled trial. Gait Posture 2023; 103:215-222. [PMID: 37262976 DOI: 10.1016/j.gaitpost.2023.05.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2023] [Revised: 05/04/2023] [Accepted: 05/16/2023] [Indexed: 06/03/2023]
Abstract
BACKGROUND Stroke survivors often experience balance and gait problems, which can affect their quality of life and independence in daily living activities. Robot-assisted gait training, such as Lokomat with virtual reality, has been found to be effective in improving gait and balance. However, the specific effects of each virtual reality application on balance and spatiotemporal parameters of gait are not yet established. This study aims to investigate the effects of different virtual reality applications on these parameters. RESEARCH QUESTION What are the specific effects of each Lokomat augmented performance feedback application on balance and spatiotemporal parameters of gait in stroke survivors? METHODS The study is a randomized controlled trial conducted with four groups: Control Group, Endurance Group, Attention and Motivation Group, and Activity Timing Group. All participants received six weeks of physiotherapy, and Lokomat groups had additional robot-assisted gait training with Lokomat for three days a week. The Endurance group used Lokomat with Faster, Attention and Motivation Group with Gabarello and Smile, and Activity Timing Group with Curve Pursuit, Treasures, and High Flyer applications. Various tests were used to assess walking and balance in the study (gait analysis, 6-minute walk test, 10-meter walk test, Berg Balance Scale, postural stability, and limits of stability). RESULTS AND SIGNIFICANCE The study involved 56 male stroke survivors (mean age: 60.02 ± 6.83 years, post-stroke time: 238.88 ± 40.88 days). All groups improved walking speed and distance significantly, but Endurance was better (p < 0.001). Balance improved significantly in all groups, but Attention and Motivation was superior in Berg Balance Scale, postural stability, and limits of stability (p < 0.001). The selection of virtual reality applications during robot-assisted gait training according to rehabilitation goals is important for successful rehabilitation, as these applications may have varying effects on balance and walking.
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Affiliation(s)
- Murat Akıncı
- Department of Physiotherapy and Rehabilitation, Institute of Health Sciences, Ankara Yıldırım Beyazıt University, Ankara, Turkey.
| | - Mustafa Burak
- Department of Physical Therapy and Rehabilitation, Faculty of Health Sciences, Fırat University, Elazığ, Turkey
| | - Evren Yaşar
- Department of Physical Therapy and Rehabilitation, Gulhane Faculty of Medicine, University of Health Sciences, Ankara, Turkey
| | - Rabia Tuğba Kılıç
- Department of Physiotherapy and Rehabilitation, Institute of Health Sciences, Ankara Yıldırım Beyazıt University, Ankara, Turkey
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Zhang B, Wong KP, Qin J. Effects of Virtual Reality on the Limb Motor Function, Balance, Gait, and Daily Function of Patients with Stroke: Systematic Review. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:813. [PMID: 37109769 PMCID: PMC10142511 DOI: 10.3390/medicina59040813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Revised: 04/12/2023] [Accepted: 04/19/2023] [Indexed: 04/29/2023]
Abstract
Background and Objectives: This systematic review aimed to clarify the effectiveness of virtual reality rehabilitation on physical outcomes for people with stroke. Materials and Methods: Articles were searched through PubMed, EMBASE, the Cochrane Library, the Physiotherapy Evidence Database, CINAHL, Web of Science, and ProQuest Dissertations and Theses, from inception to 30 April 2022. Methodological quality was scored using the Assessing the Methodological Quality of Systematic Reviews 2 tool. Each systematic review for the outcome of interest was assessed by two independent reviewers using the Grading of Recommendations Assessment, Development, and Evaluation system. Results: Twenty-six articles were selected. These studies evaluated the effectiveness of virtual reality on limb motor function, balance, gait, and daily function in patients with stroke. The findings suggested a beneficial effect of virtual reality; there was a "very low" to "moderate" quality of evidence for improved limb extremity function, balance, and daily function, and a "very low" to "moderate" quality of evidence for improved gait. Conclusions: Despite widespread interest in the use of virtual reality rehabilitation, high-quality evidence for its routine use in stroke treatment is lacking. Further research is needed to determine the treatment modality, duration, and long-term effects of virtual reality on stroke populations.
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Affiliation(s)
- Bohan Zhang
- Centre for Smart Health, School of Nursing, The Hong Kong Polytechnic University, Hong Kong; (B.Z.); (J.Q.)
| | - Ka-Po Wong
- Centre for Smart Health, School of Nursing, The Hong Kong Polytechnic University, Hong Kong; (B.Z.); (J.Q.)
- Department of Applied Social Sciences, The Hong Kong Polytechnic University, Hong Kong
| | - Jing Qin
- Centre for Smart Health, School of Nursing, The Hong Kong Polytechnic University, Hong Kong; (B.Z.); (J.Q.)
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11
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Hao J, Li Y, Swanson R, Chen Z, Siu KC. Effects of virtual reality on physical, cognitive, and psychological outcomes in cancer rehabilitation: a systematic review and meta-analysis. Support Care Cancer 2023; 31:112. [PMID: 36633695 DOI: 10.1007/s00520-022-07568-4] [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: 05/14/2022] [Accepted: 12/28/2022] [Indexed: 01/13/2023]
Abstract
PURPOSE To systematically examine and summarize the current evidence regarding the effects of virtual reality (VR) on physical, cognitive, and psychological outcomes in cancer rehabilitation. METHODS Six bioscience and engineering databases were searched. Two independent reviewers screened the titles and abstracts of 2397 records and retrieved 25 full-text articles. Inclusion criteria included patients with a current or previous diagnosis of cancer; VR was used as an intervention for physical, cognitive, or psychological impairments and functional limitations; and clinical trials with at least two arms and with both pre- and post-intervention assessments. Reviewers assessed methodological quality using the Physiotherapy Evidence Database scale. RESULTS Seventeen studies including 799 patients with cancer were identified. Within-group pooled analysis indicated that patients demonstrated significant improvement in pain (P < 0.001), fatigue (P < 0.001), anxiety (P < 0.001), upper extremity function (P < 0.001), and quality of life (P = 0.008) after VR intervention. Between-group pooled analysis indicated significant improvements with VR in pain (P = 0.004), anxiety (P < 0.001), and upper extremity function (P < 0.001) compared with the control. Three studies reported the positive effects of VR on cognition. CONCLUSIONS VR demonstrates promising effects in physical, cognitive, and psychological aspects of patients with cancer. VR can be incorporated into a comprehensive cancer rehabilitation program to alleviate impairments and functional limitations.
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Affiliation(s)
- Jie Hao
- Division of Physical Therapy Education, Department of Health & Rehabilitation Sciences, College of Allied Health Professions, University of Nebraska Medical Center, Omaha, NE, 68198-4420, USA
| | - Yanfei Li
- Division of Physical Therapy Education, Department of Health & Rehabilitation Sciences, College of Allied Health Professions, University of Nebraska Medical Center, Omaha, NE, 68198-4420, USA
| | - Rebecca Swanson
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, College of Medicine, University of Nebraska Medical Center, Omaha, NE, 68198-6878, USA
| | - Zhen Chen
- Department of Neurorehabilitation, The First Rehabilitation Hospital of Shanghai, Shanghai, China
| | - Ka-Chun Siu
- Division of Physical Therapy Education, Department of Health & Rehabilitation Sciences, College of Allied Health Professions, University of Nebraska Medical Center, Omaha, NE, 68198-4420, USA.
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12
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Darekar A. Virtual Reality for Motor and Cognitive Rehabilitation. Curr Top Behav Neurosci 2023; 65:337-369. [PMID: 37041455 DOI: 10.1007/7854_2023_418] [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] [Indexed: 04/13/2023]
Abstract
Virtual Reality (VR) affords clinicians the ability to deliver safe, controlled, task-specific customised interventions that are enjoyable, motivating and engaging. Elements of training in VR comply with principles of learning implicated in new skill acquisition and re-learning skills post-neurological disorders. However, heterogeneity in the description of VR systems and the description and control of 'active' ingredients of interventions (like dosage, type of feedback, task specificity, etc.) have led to inconsistency in the synthesis and interpretation of evidence related to the effectiveness of VR-based interventions, particularly in post-stroke and Parkinson's Disease (PD) rehabilitation. This chapter attempts to describe VR interventions with respect to their compliance with principles of neurorehabilitation, with the goal of optimising interventions for effective training and facilitation of maximum functional recovery. This chapter also advocates using a uniform framework to describe VR systems to promote homogeneity in literature in order to help in the synthesis of evidence. An overview of the evidence revealed that VR systems are effective in mediating deficits in upper extremity, posture and gait function seen in people post-stroke and PD. Generally, interventions were more effective when they were delivered as an adjunct to conventional therapy and were customised for rehabilitation purposes, in addition to complying with principles of learning and neurorehabilitation. Although recent studies imply that their VR intervention is compliant with principles of learning, only a few explicitly describe how these principles are incorporated as 'active ingredients' of the intervention. Finally, VR interventions targeting community ambulation and cognitive rehabilitation are yet limited and therefore warrant attention.
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13
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Im NG, Oh KR, Kim MG, Lee Y, Lim NN, Cho TH, Ryu SR, Yoon SR. Effect of Low Frequency Cerebellar Repetitive Transcranial Magnetic Stimulation on Balance Impairment in Patients With Cerebral Infarction. Ann Rehabil Med 2022; 46:275-283. [PMID: 36588442 PMCID: PMC9810654 DOI: 10.5535/arm.22058] [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: 06/07/2022] [Accepted: 10/17/2022] [Indexed: 12/27/2022] Open
Abstract
OBJECTIVE To investigate the effect of low frequency cerebellar repetitive transcranial magnetic stimulation (rTMS) on balance impairment in patients with cerebral infarction. METHODS Thirty-two patients were randomly divided into two groups: rTMS group (n=16) and control (n=16). In the rTMS group, treatment was performed five times per week for 2 weeks (10 sessions), and in the control group, a sham coil was used with the sound and sensation of scalp similar to the rTMS coil. Patients in both groups underwent a conventional rehabilitation program. Berg Balance Scale (BBS) was used as the primary outcome measurement. Timed Up and Go test (TUG), 10-m walk test (10mWT), and Activity-specific Balance Confidence scale (ABC) were used as the secondary outcome measurement. All scales were measured at baseline (T0), after 10 sessions of rTMS (T1), and at 4 weeks after treatment completion (T2) by therapists with over 5 years of clinical experience. RESULTS There were significant improvements between T0 and T1, and between T0 and T2, for all assessed items in the rTMS group. Whereas there were significant improvements between T0 and T1, and between T0 and T2, for the BBS and 10mWT in the control group. TUG (-4.87±5.05 vs. -0.50±2.97 seconds) and ABC score (8.10±8.33 vs. 0.16±0.97) were observed significant differences in comparison of the changes from T0 to T1 between the two group. BBS score (4.40±3.66 vs. 1.88±3.14), TUG (-4.87±4.56 vs. -0.62±2.96 seconds) and ABC score (8.22±7.70 vs. -0.09±0.86) differed significantly from T0 to T2 between the two groups. CONCLUSION Our findings suggest that low-frequency cerebellar rTMS is helpful for improving balance in patients with cerebral infarction, and maybe a beneficial treatment for these patients.
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Affiliation(s)
- Nam-Gyu Im
- Department of Rehabilitation Medicine, Gwangju Veterans Hospital, Gwangju, Korea
| | - Kyung-Rok Oh
- Department of Rehabilitation Medicine, Gwangju Veterans Hospital, Gwangju, Korea
| | - Min-gil Kim
- Department of Rehabilitation Medicine, Gwangju Veterans Hospital, Gwangju, Korea
| | - Young Lee
- Veterans Heath Service Medical Center, Seoul, Korea
| | - Na-Na Lim
- Department of Rehabilitation Medicine, Gwangju Veterans Hospital, Gwangju, Korea
| | - Tae-Hwan Cho
- Department of Rehabilitation Medicine, Gwangju Veterans Hospital, Gwangju, Korea
| | - Su-Ra Ryu
- Department of Rehabilitation Medicine, Gwangju Veterans Hospital, Gwangju, Korea
| | - Seo-Ra Yoon
- Department of Rehabilitation Medicine, Gwangju Veterans Hospital, Gwangju, Korea,Corresponding author: Seo-Ra Yoon Department of Rehabilitation Medicine, Gwangju Veterans Hospital, 99 Cheomdanwolbong-ro, Gwangsan-gu, Gwangju 62284, Korea. Tel: +82-62-604- 4733, Fax: +82-62-604-4714, E-mail:
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14
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Fan CC, Choy CS, Huang CM, Chih PS, Lee CC, Lin FH, Guo JL. The effects of a combination of 3D virtual reality and hands-on horticultural activities on mastery, achievement motives, self-esteem, isolation and depression: a quasi-experimental study. BMC Geriatr 2022; 22:744. [PMID: 36096746 PMCID: PMC9467424 DOI: 10.1186/s12877-022-03431-7] [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: 09/29/2021] [Accepted: 08/29/2022] [Indexed: 11/23/2022] Open
Abstract
Background Aging societies are a public health concern worldwide. It is critical to develop strategies that harness technology to enhance older adults’ mastery, achievement motives, self-esteem, isolation and depression effectively. Methods This study aimed to explore the effects of a combination of three-dimensional virtual reality (VR) and hands-on horticultural activities on the psychological well-being of community-dwelling older adults. We used a quasi-experimental design. A total of 62 community-dwelling older adults were recruited and assigned to the experimental (n = 32) and comparison groups (n = 30). The members of the experimental group participated in an 8-week intervention program. Participants of both groups completed before-and-after intervention measurements for outcome variables that included perceived self-esteem, depression, isolation, and mastery and achievement motives, which were analyzed using the generalized estimating equation (GEE). A baseline score of depression was used as an adjustment for the GEE analyses to eliminate the effects of depression on outcomes. Results After controlling age and gender as confounders, GEE analyses indicated that the experimental group showed significant post-intervention improvements in scores for self-esteem (β = 2.18, P = .005) and mastery (β = 1.23, P = .039), compared to the control group. Conclusions This study supported a combination of three-dimensional VR and hands-on horticultural activities on community-dwelling older adults to improve self-esteem and mastery. The findings suggest that the future implementation of a similar program would be feasible and beneficial to community-dwelling older adults. Trial registration The study was posted on www.clinicaltrials.gov (NCT05087654) on 21/10/2021. It was approved by the Institutional Review Board of En Chu Kong Hospital and performed in accordance with the Declaration of Helsinki.
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Affiliation(s)
- Ching-Chih Fan
- Department of Community Medicine, En Chu Kong Hospital, Taipei, Taiwan
| | - Cheuk-Sing Choy
- Department of Community Medicine, En Chu Kong Hospital, Taipei, Taiwan.,Department of Nursing, Yuanpei University of Medical Technology, Hsinchu, Taiwan
| | - Chiu-Mieh Huang
- Institute of Clinical Nursing, College of Nursing, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Po-Sheng Chih
- Department of Community Medicine, En Chu Kong Hospital, Taipei, Taiwan
| | - Chia-Chiang Lee
- Department of Health Promotion and Health Education, College of Education, National Taiwan Normal University, No. 162, Sec. 1, He-ping East Road, Taipei, Taiwan
| | - Fen-He Lin
- Department of Nursing, College of Nursing, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Jong-Long Guo
- Department of Health Promotion and Health Education, College of Education, National Taiwan Normal University, No. 162, Sec. 1, He-ping East Road, Taipei, Taiwan.
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15
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Kashif M, Ahmad A, Bandpei MAM, Farooq M, Iram H, e Fatima R. Systematic review of the application of virtual reality to improve balance, gait and motor function in patients with Parkinson's disease. Medicine (Baltimore) 2022; 101:e29212. [PMID: 35945738 PMCID: PMC9351924 DOI: 10.1097/md.0000000000029212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Virtual reality (VR) is an advanced technique used in physical rehabilitation of neurological disorders, however the effects of VR on balance, gait, and motor function in people with Parkinson's (PD) are still debated. Therefore, the systematic review aimed to determine the role of VR on motor function, balance and gait in PD patients. METHODS A comprehensive search to identify similar randomised controlled trials was conducted targeting 5 databases including Web of Science, PubMed, CINHAL, Cochrane Library, and Physiotherapy Evidence Database. A total of 25 studies were found eligible for this systematic review, and the methodological assessment of the quality rating of the studies was accomplished using the physiotherapy evidence database scale by 2 authors. RESULTS Out of the 25 included studies, 14 studies reported on balance as the primary outcome, 9 studies were conducted to assess motor function, and 12 assessed gait as the primary outcome. Most studies used the Unified Parkinson disease rating scale UPDRS (part-III) for evaluating motor function and the Berg Balance Scale as primary outcome measure for assessing balance. A total of 24 trials were conducted in clinical settings, and only 1 study was home-based VR trainings. Out of 9 studies on motor function, 6 reported equal improvement of motor function as compared to other groups. In addition, VR groups also revealed superior results in improving static balance among patient with PD. CONCLUSION This systemic review found that the use of VR resulted in substantial improvements in balance, gait, and motor skills in patients with PD when compared to traditional physical therapy exercises or in combination with treatments other than physical therapy. Moreover, VR can be used as a supportive method for physical rehabilitation in patients of PD. However, the majority of published studies were of fair and good quality, suggesting a demand for high quality research in this area.
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Affiliation(s)
- Muhammad Kashif
- University Institute of Physical Therapy, Faculty of Allied Health Sciences, University of Lahore, Lahore, Pakistan
- Riphah College of Rehabilitation and Allied Health Sciences, Riphah International University, Faisalabad Campus, Faisalabad, Pakistan
- *Correspondence: Muhammad Kashif, University Institute of Physical Therapy, Faculty of Allied Health Sciences, University of Lahore, Lahore 4200, Pakistan (e-mail: )
| | - Ashfaq Ahmad
- University Institute of Physical Therapy, Faculty of Allied Health Sciences, University of Lahore, Lahore, Pakistan
| | - Muhammad Ali Mohseni Bandpei
- University Institute of Physical Therapy, Faculty of Allied Health Sciences, University of Lahore, Lahore, Pakistan
- Pediatric Neurorehabilitation Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Maryam Farooq
- Riphah College of Rehabilitation and Allied Health Sciences, Riphah International University, Faisalabad Campus, Faisalabad, Pakistan
| | - Humaira Iram
- Riphah College of Rehabilitation and Allied Health Sciences, Riphah International University, Faisalabad Campus, Faisalabad, Pakistan
| | - Rida e Fatima
- Riphah College of Rehabilitation and Allied Health Sciences, Riphah International University, Faisalabad Campus, Faisalabad, Pakistan
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16
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Forsyth L, Bonacci J, Childs C. A pilot randomised control trial of the efficacy of stability-based training with visualisation for people with chronic ankle instability. Med Biol Eng Comput 2022; 60:1199-1209. [PMID: 35247167 PMCID: PMC8933360 DOI: 10.1007/s11517-022-02533-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Accepted: 02/14/2022] [Indexed: 11/23/2022]
Abstract
Chronic ankle instability (CAI) is associated with recurring symptoms that inhibit daily activity. Stability-based rehabilitative training is recommended for CAI. Visualisation (VIS) produces real-time feedback using motion capture and virtual reality. This pilot study aimed to determine the feasibility, adherence, safety, and efficacy of incorporating VIS into stability training for people with CAI. Efficacy was examined through effect of VIS training on dynamic stability, perception of stability, and rehabilitative experience. Individuals with CAI completed a 4-week stability-based training programme with VIS, or without visualisation (NO-VIS). Participants completed the Star Excursion Balance Test (SEBT) and Cumberland Ankle Instability Tool (CAIT) prior to, and after training. Enjoyment of training was recorded using the Physical Activity Enjoyment Scale (PACES-8). Of 17 participants (VIS = 10, NO-VIS = 7), there were 2 drop outs (VIS = 1, NO-VIS = 1). No adverse events were reported, and participant drop-out was due to injury unrelated to the study. The VIS group showed a significantly greater increase in average SEBT reach distance (d = 1.7, p = 0.02). No significant differences were reported for the CAIT or PACES-8. This study supports the feasibility and safety of stability-based training with VIS in those with CAI. The enhanced performance outcome on the SEBT suggests VIS may enhance stability-based training.
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Affiliation(s)
- L Forsyth
- Faculty of Biomedical Engineering, University of Strathclyde, Glasgow, UK.
| | - J Bonacci
- Centre for Sports Research, School of Exercise and Nutrition Science, Deakin University, Geelong, Australia
| | - C Childs
- Faculty of Biomedical Engineering, University of Strathclyde, Glasgow, UK
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17
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Koryakina OV, Moskvina EY, Kovtun OP, Kazaeva AV, Safronov AA. [Evaluation the effectiveness of immersive VR-assisted rehabilitation in a child with chemotherapy-induced neurological complication in acute lymphoblastic leukemia]. Zh Nevrol Psikhiatr Im S S Korsakova 2022; 122:85-89. [PMID: 36170105 DOI: 10.17116/jnevro202212209285] [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] [Indexed: 02/08/2024]
Abstract
Rehabilitation therapy is considered as an actual and complex system of knowledge, in which the main task is the development and implementation of new methods of rehabilitation. In present time, the most perspective rehabilitation program is utilizing virtual reality. A report was made with the utilization of rehabilitation therapy with virtual reality in a child with chemotherapy-induced neurological disorders in acute lymphoblastic leukemia. The child performed a set of exercises using fully immersive virtual reality. Over the course of rehabilitation positive dynamics was observed, namely increased muscle strength in the injured limb from 3 to 5 scores according to the Medical Research Council Weakness Scale. There was improved balance on the Berg Balance Scale from 35 to 42. In addition, there were increased range of active movements, partly restored biomechanics of gait with increased velocity by 2 times. According to the results of testing the psycho-emotional state using the Luscher color test and the graphic technique «Cactus» by M.A. Panfilova, self-esteem, the desire to succeed and independence were improved, the level of auto-aggression was decreased. The results show that rehabilitation using fully immersive virtual reality is probably a perspective tool in addition to traditional rehabilitation. It improves the neurological and psycho-emotional state, raises motivation of patients, which, in turn, helps to increase the effectiveness of rehabilitation therapy and speeds up the rehabilitation process.
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Affiliation(s)
- O V Koryakina
- Ural State Medical University, Yekaterinburg, Russia
- Regional Children Clinical Hospital, Yekaterinburg, Russia
| | - E Yu Moskvina
- Ural State Medical University, Yekaterinburg, Russia
| | - O P Kovtun
- Ural State Medical University, Yekaterinburg, Russia
| | - A V Kazaeva
- The Sverdlovsk Charity Organization Helping Patients with Cancer «Together for life», Yekaterinburg, Russia
| | - A A Safronov
- Regional Children Clinical Hospital, Yekaterinburg, Russia
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Gao Y, Ma L, Lin C, Zhu S, Yao L, Fan H, Gong J, Yan X, Wang T. Effects of Virtual Reality-Based Intervention on Cognition, Motor Function, Mood, and Activities of Daily Living in Patients With Chronic Stroke: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Front Aging Neurosci 2021; 13:766525. [PMID: 34966267 PMCID: PMC8710683 DOI: 10.3389/fnagi.2021.766525] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2021] [Accepted: 11/16/2021] [Indexed: 11/13/2022] Open
Abstract
Background: The efficacy of virtual reality (VR)-based intervention for improving cognition in patients with the chronic stage of stroke is controversial. The aims of this meta-analysis were to evaluate the effect of VR-based training combined with traditional rehabilitation on cognition, motor function, mood, and activities of daily living (ADL) after chronic stroke. Methods: The search was performed in the Cochrane Library (CENTRAL), EBSCO, EMBASE, Medline (OVID), Web of Science databases, PubMed, CINAHL Ovid, and Scopus from inception to May 31, 2021. All included studies were randomized controlled trials (RCTs) examining VR-based intervention combined with traditional rehabilitation for chronic stroke. The main outcomes of this study were cognition, including overall cognition (combined with all cognitive measurement results), global cognition (measured by the Montreal Cognitive Assessment, MoCA, and/or Mini-Mental State Examination, MMSE), and attention/execution. The additional outcomes were motor function, mood, and ADL. Subgroup analyses were conducted to verify the potential factors for heterogeneity. Results: Six RCTs including 209 participants were included for systematic review, and five studies of 177 participants were included in meta-analyses. Main outcome analyses showed large and significant effect size (ES) of VR-based training on overall cognition (g = 0.642; 95% CI = 0.134-1.149; and P = 0.013) and attention/execution (g = 0.695; 95% CI = 0.052-1.339; and P = 0.034). Non-significant result was found for VR-based intervention on global cognition (g = 0.553; 95% CI = -0.273-1.379; and P = 0.189). Additional outcome analyses showed no superiority of VR-based intervention over traditional rehabilitation on motor function and ADL. The ES of VR-based intervention on mood (g = 1.421; 95% CI = 0.448-2.393; and P = 0.004) was large and significant. In the subgroup analysis, large effects for higher daily intensity, higher weekly frequency, or greater dose of VR intervention were found. Conclusion: Our findings indicate that VR-based intervention combined with traditional rehabilitation showed better outcomes for overall cognition, attention/execution, and depressive mood in individuals with chronic stroke. However, VR-based training combined with traditional rehabilitation showed a non-significant effect for global cognition, motor function, and ADL in individuals with chronic stroke.
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Affiliation(s)
- Yong Gao
- Department of Rehabilitation, Shaoxing People’s Hospital (Shaoxing Hospital, Zhejiang University School of Medicine), Shaoxing, China,Yong Gao,
| | - Lu Ma
- Library, Zhejiang Industry Polytechnic College, Shaoxing, China
| | - Changsheng Lin
- School of Rehabilitation Medicine, Nanjing Medical University, Nanjing, China
| | - Shizhe Zhu
- School of Rehabilitation Medicine, Nanjing Medical University, Nanjing, China
| | - Lingling Yao
- Department of Rehabilitation, Shaoxing People’s Hospital (Shaoxing Hospital, Zhejiang University School of Medicine), Shaoxing, China
| | - Hong Fan
- Department of Rehabilitation, Shaoxing People’s Hospital (Shaoxing Hospital, Zhejiang University School of Medicine), Shaoxing, China
| | - Jianqiu Gong
- Department of Rehabilitation, Shaoxing People’s Hospital (Shaoxing Hospital, Zhejiang University School of Medicine), Shaoxing, China
| | - Xiaobo Yan
- Department of Rehabilitation, Shaoxing People’s Hospital (Shaoxing Hospital, Zhejiang University School of Medicine), Shaoxing, China
| | - Tong Wang
- School of Rehabilitation Medicine, Nanjing Medical University, Nanjing, China,Department of Rehabilitation, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China,*Correspondence: Tong Wang,
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Leemhuis E, Giuffrida V, Giannini AM, Pazzaglia M. A Therapeutic Matrix: Virtual Reality as a Clinical Tool for Spinal Cord Injury-Induced Neuropathic Pain. Brain Sci 2021; 11:1201. [PMID: 34573221 PMCID: PMC8472645 DOI: 10.3390/brainsci11091201] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2021] [Revised: 08/31/2021] [Accepted: 09/10/2021] [Indexed: 11/16/2022] Open
Abstract
Neuropathic pain (NP) is a chronic, debilitating, and resistant form of pain. The onset rate of NP following spinal cord injuries (SCI) is high and may reduce the quality of life more than the sensorimotor loss itself. The long-term ineffectiveness of current treatments in managing symptoms and counteracting maladaptive plasticity highlights the need to find alternative therapeutic approaches. Virtual reality (VR) is possibly the best way to administer the specific illusory or reality-like experience and promote behavioral responses that may be effective in mitigating the effects of long-established NP. This approach aims to promote a more systematic adoption of VR-related techniques in pain research and management procedures, highlighting the encouraging preliminary results in SCI. We suggest that the multisensory modulation of the sense of agency and ownership by residual body signals may produce positive responses in cases of brain-body disconnection. First, we focus on the transversal role embodiment and how multisensory and environmental or artificial stimuli modulate illusory sensations of bodily presence and ownership. Then, we present a brief overview of the use of VR in healthcare and pain management. Finally, we discus research experiences which used VR in patients with SCI to treating NP, including the most recent combinations of VR with further stimulation techniques.
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Affiliation(s)
- Erik Leemhuis
- Department of Psychology, Sapienza University of Rome, Via dei Marsi 78, 00185 Rome, Italy
- Body and Action Lab, IRCCS Fondazione Santa Lucia, Via Ardeatina 306, 00179 Rome, Italy
| | - Valentina Giuffrida
- Department of Psychology, Sapienza University of Rome, Via dei Marsi 78, 00185 Rome, Italy
- Body and Action Lab, IRCCS Fondazione Santa Lucia, Via Ardeatina 306, 00179 Rome, Italy
| | - Anna Maria Giannini
- Department of Psychology, Sapienza University of Rome, Via dei Marsi 78, 00185 Rome, Italy
| | - Mariella Pazzaglia
- Department of Psychology, Sapienza University of Rome, Via dei Marsi 78, 00185 Rome, Italy
- Body and Action Lab, IRCCS Fondazione Santa Lucia, Via Ardeatina 306, 00179 Rome, Italy
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Hao J, Xie H, Harp K, Chen Z, Siu KC. Effects of virtual reality intervention on neural plasticity in stroke rehabilitation: a systematic review. Arch Phys Med Rehabil 2021; 103:523-541. [PMID: 34352269 DOI: 10.1016/j.apmr.2021.06.024] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Revised: 06/03/2021] [Accepted: 06/07/2021] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To systematically review and examine the current literature regarding the effects of Virtual Reality (VR)-based rehabilitation on neural plasticity changes in stroke survivors. DATA SOURCES Six bioscience and engineering databases were searched, including Medline via Ebsco, Embase, PsycINFO, IEEE Explore, Cumulative Index of Nursing and Allied Health, and Scopus. STUDY SELECTION Studies reporting on the pre-post assessment of a VR intervention with neural plasticity measures published between 2000-2021 were included. DATA EXTRACTION Two independent reviewers conducted study selection, data extraction and quality assessment. Methodological quality of controlled trials was assessed using the Physiotherapy Evidence Database scale. Risk of bias of pre-post intervention and case studies was evaluated using the National Institutes of Health Quality Assessment Tool. DATA SYNTHESIS Twenty-seven studies (Total n=232) were included. Seven randomized controlled trials were rated as good quality while the two clinical controlled trials were moderate. Based on the risk of bias assessment, one pre-post study and one case study were graded as good quality, one pre-post study and one case study were poor, the other 14 studies were all at fair. After the VR intervention, main neurophysiological findings across studies include: (1) improved interhemispheric balance, (2) enhanced cortical connectivity, (3) increased cortical mapping of the affected limb muscles, (4) the improved neural plasticity measures were correlated to the enhanced behavior outcomes, (5) increased activation of regions in frontal cortex and (6) the mirror neuron system may be involved. CONCLUSIONS Virtual reality induced changes in neural plasticity for stroke survivors. Positive correlations between the neural plasticity changes and functional recovery elucidates the mechanisms of VR's therapeutic effects in stroke rehabilitation. This review prompts systematic understanding of the neurophysiological mechanisms of VR-based stroke rehabilitation and summarizes the emerging evidence for ongoing innovation of VR systems and application in stroke rehabilitation.
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Affiliation(s)
- Jie Hao
- Division of Physical Therapy Education, College of Allied Health Professions, University of Nebraska Medical Center, Omaha, United States
| | - Haoyu Xie
- Division of Physical Therapy Education, College of Allied Health Professions, University of Nebraska Medical Center, Omaha, United States
| | - Kimberly Harp
- Leon S. McGoogan Health Sciences Library, University of Nebraska Medical Center, Omaha, United States
| | - Zhen Chen
- Department of Neurorehabilitation, The First Rehabilitation Hospital of Shanghai, Shanghai, China
| | - Ka-Chun Siu
- Division of Physical Therapy Education, College of Allied Health Professions, University of Nebraska Medical Center, Omaha, United States.
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21
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Takeo Y, Hara M, Shirakawa Y, Ikeda T, Sugata H. Sequential motor learning transfers from real to virtual environment. J Neuroeng Rehabil 2021; 18:107. [PMID: 34193177 PMCID: PMC8247210 DOI: 10.1186/s12984-021-00903-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Accepted: 06/24/2021] [Indexed: 11/24/2022] Open
Abstract
Background Skill acquisition of motor learning between virtual environments (VEs) and real environments (REs) may be related. Although studies have previously examined the transfer of motor learning in VEs and REs through the same tasks, only a small number of studies have focused on studying the transfer of motor learning in VEs and REs by using different tasks. Thus, detailed effects of the transfer of motor skills between VEs and REs remain controversial. Here, we investigated the transfer of sequential motor learning between VEs and REs conditions. Methods Twenty-seven healthy volunteers performed two types of sequential motor learning tasks; a visually cued button-press task in RE (RE task) and a virtual reaching task in VE (VE task). Participants were randomly assigned to two groups in the task order; the first group was RE task followed by VE task and the second group was VE task followed by RE task. Subsequently, the response time in RE task and VE task was compared between the two groups respectively. Results The results showed that the sequential reaching task in VEs was facilitated after the sequential finger task in REs. Conclusions These findings suggested that the sequential reaching task in VEs can be facilitated by a motor learning task comprising the same sequential finger task in REs, even when a different task is applied.
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Affiliation(s)
- Yuhi Takeo
- Department of Rehabilitation, Oita University Hospital, Oita, Japan.,Graduate School of Welfare and Health Science, Oita University, Oita, Japan
| | - Masayuki Hara
- Graduate School of Science and Engineering, Saitama University, 255 Shimo-Okubo, Sakura-ku, 338-8570, Saitama City, Saitama, Japan
| | - Yuna Shirakawa
- Faculty of Welfare and Health Science, Oita University, 700, Dannoharu, 870-1192, Oita, Japan
| | - Takashi Ikeda
- Research Center for Child Mental Development, Kanazawa University, Kanazawa, Japan
| | - Hisato Sugata
- Graduate School of Welfare and Health Science, Oita University, Oita, Japan. .,Faculty of Welfare and Health Science, Oita University, 700, Dannoharu, 870-1192, Oita, Japan.
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22
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Unibaso-Markaida I, Iraurgi I. Commercial videogames in stroke rehabilitation: systematic review and meta-analysis. Top Stroke Rehabil 2021; 29:551-567. [PMID: 34176453 DOI: 10.1080/10749357.2021.1943798] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Objective: The aim of this article was to perform a systematic review of all studies (both observational and experimental) wherein commercial video games were used in comprehensive rehabilitation (both physical and cognitive areas) after stroke.Methods: The Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines were followed, and all observational and experimental studies that met at least six PEDro scale criteria were included. A total of 50 studies were included in the Meta-Analysis. Data analysis was performed using RevMan 5.3 and the bias with JAMOVI.Results: In observational studies, results favored intervention with video games in terms of functionality such as Fulg-Meyer Assessment scores [standard mean difference (SMD) = -0.45; 95% CI = -0.74 to -0.15; p = .94; I2 = 0%)] and when measured in the upper limbs using the Wolf Motor Function Test (SMD = 0.41; 95% CI = 0.07 to 0.74; p = .47; I2 = 0%). Other results showed heterogeneity. In the experimental group, most results tended to favor the experimental group and showed homogeneity, but they were not significant. Fail Safe N was calculated, and the results were not biased.Conclusions: Results tend to favor intervention with commercial video games, but the heterogeneity of the measuring instruments and small sample size do not allow for significant results to be obtained. Future research should provide the number of participants, mean, and standard deviation to facilitate future meta-analyses. Commercial video games appear to be a feasible tool in physical and cognitive stroke rehabilitation.
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Affiliation(s)
| | - Ioseba Iraurgi
- Department of Psychology, University of Deusto, Bilbao, Spain
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23
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Karami B, Koushki R, Arabgol F, Rahmani M, Vahabie AH. Effectiveness of Virtual/Augmented Reality-Based Therapeutic Interventions on Individuals With Autism Spectrum Disorder: A Comprehensive Meta-Analysis. Front Psychiatry 2021; 12:665326. [PMID: 34248702 PMCID: PMC8260941 DOI: 10.3389/fpsyt.2021.665326] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Accepted: 05/12/2021] [Indexed: 11/13/2022] Open
Abstract
In recent years, the application of virtual reality (VR) for therapeutic purposes has escalated dramatically. Favorable properties of VR for engaging patients with autism, in particular, have motivated an enormous body of investigations targeting autism-related disabilities with this technology. This study aims to provide a comprehensive meta-analysis for evaluating the effectiveness of VR on the rehabilitation and training of individuals diagnosed with an autism spectrum disorder. Accordingly, we conducted a systematic search of related databases and, after screening for inclusion criteria, reviewed 33 studies for more detailed analysis. Results revealed that individuals undergoing VR training have remarkable improvements with a relatively large effect size with Hedges g of 0.74. Furthermore, the results of the analysis of different skills indicated diverse effectiveness. The strongest effect was observed for daily living skills (g = 1.15). This effect was moderate for other skills: g = 0.45 for cognitive skills, g = 0.46 for emotion regulation and recognition skills, and g = 0.69 for social and communication skills. Moreover, five studies that had used augmented reality also showed promising efficacy (g = 0.92) that calls for more research on this tool. In conclusion, the application of VR-based settings in clinical practice is highly encouraged, although their standardization and customization need more research.
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Affiliation(s)
- Behnam Karami
- School of Cognitive Sciences, Institute for Research in Fundamental Sciences (IPM), Tehran, Iran
- Cognitive Neuroscience Laboratory, German Primate Center, Goettingen, Germany
- School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Roxana Koushki
- School of Cognitive Sciences, Institute for Research in Fundamental Sciences (IPM), Tehran, Iran
- School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Fariba Arabgol
- School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Behavioral Science Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Maryam Rahmani
- School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Abdol-Hossein Vahabie
- Department of Psychology, Faculty of Psychology and Education, University of Tehran, Tehran, Iran
- Control and Intelligent Processing Center of Excellence (CIPCE), Cognitive Systems Laboratory, School of Electrical and Computer Engineering, College of Engineering, University of Tehran, Tehran, Iran
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24
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Takimoto K, Omon K, Murakawa Y, Ishikawa H. Case of cerebellar ataxia successfully treated by virtual reality-guided rehabilitation. BMJ Case Rep 2021; 14:14/5/e242287. [PMID: 33972306 PMCID: PMC8112436 DOI: 10.1136/bcr-2021-242287] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
A male patient in his 40s was transferred to our hospital for rehabilitation of ataxia after right cerebellar and brainstem infarction. After 3 weeks of conventional physical therapy, his activities of daily life successfully improved with an increase in the functional impedance measure from 101 to 124. However, he still fell short of gaining a higher level of balance function, which was necessary for his job as a standup forklift driver. We introduced virtual reality-guided balance training. The training was performed for approximately 40 min on weekdays for 2 weeks. As a result, the Scale for the Assessment and Rating of Ataxia score decreased from 5 to 1, Functional Balance Scale score improved from 48 to 56, and Mini-Balance Evaluation Systems Test score increased from 20 to 28. The trunk sway disappeared clinically. He regained confidence and returned to work after an additional 2 weeks of physical therapy.
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Affiliation(s)
- Kazuhiro Takimoto
- Rehabilitation Center, Eishinkai Kishiwada Rehabilitation Hospital, Kishiwada, Osaka, Japan
| | - Kyohei Omon
- Rehabilitation Center, Eishinkai Kishiwada Rehabilitation Hospital, Kishiwada, Osaka, Japan.,Department of Cognitive Behavioral Science, Kyoto University Graduate School of Human and Environmental Studies, Kyoto, Japan
| | - Yuichiro Murakawa
- Department of Medical Device Development, mediVR Inc, Toyonaka, Japan.,Division of Occupational Therapy, Department of Human Health Sciences, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Hideo Ishikawa
- Hemoptysis and Pulmonary-Circulation Center, Eishinkai Kishiwada Rehabilitation Hospital, Kishiwada, Osaka, Japan
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25
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Rizzolatti G, Fabbri-Destro M, Nuara A, Gatti R, Avanzini P. The role of mirror mechanism in the recovery, maintenance, and acquisition of motor abilities. Neurosci Biobehav Rev 2021; 127:404-423. [PMID: 33910057 DOI: 10.1016/j.neubiorev.2021.04.024] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Revised: 03/12/2021] [Accepted: 04/20/2021] [Indexed: 10/21/2022]
Abstract
While it is well documented that the motor system is more than a mere implementer of motor actions, the possible applications of its cognitive side are still under-exploited, often remaining as poorly organized evidence. Here, we will collect evidence showing the value of action observation treatment (AOT) in the recovery of impaired motor abilities for a vast number of clinical conditions, spanning from traumatological patients to brain injuries and neurodegenerative diseases. Alongside, we will discuss the use of AOT in the maintenance of appropriate motor behavior in subjects at risk for events with dramatic physical consequences, like fall prevention in elderly people or injury prevention in sports. Finally, we will report that AOT can help to tune existing motor competencies in fields requiring precise motor control. We will connect all these diverse dots into the neurophysiological scenario offered by decades of research on the human mirror mechanism, discussing the potentialities for individualization. Empowered by modern technologies, AOT can impact individuals' safety and quality of life across the whole lifespan.
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Affiliation(s)
- Giacomo Rizzolatti
- Consiglio Nazionale delle Ricerche, Istituto di Neuroscienze, Parma, Italy
| | | | - Arturo Nuara
- Consiglio Nazionale delle Ricerche, Istituto di Neuroscienze, Parma, Italy; Università di Modena e Reggio Emilia, Dipartimento di Scienze Biomediche, Metaboliche, e Neuroscienze, Modena, Italy
| | - Roberto Gatti
- Istituto Clinico Humanitas, Humanitas Clinical and Research Center, Rozzano, Milan, Italy
| | - Pietro Avanzini
- Consiglio Nazionale delle Ricerche, Istituto di Neuroscienze, Parma, Italy; Istituto Clinico Humanitas, Humanitas Clinical and Research Center, Rozzano, Milan, Italy.
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26
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Buche H, Michel A, Piccoli C, Blanc N. Contemplating or Acting? Which Immersive Modes Should Be Favored in Virtual Reality During Physiotherapy for Breast Cancer Rehabilitation. Front Psychol 2021; 12:631186. [PMID: 33897539 PMCID: PMC8060650 DOI: 10.3389/fpsyg.2021.631186] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Accepted: 03/11/2021] [Indexed: 11/13/2022] Open
Abstract
Background Even though virtual reality (VR) is more and more considered for its power of distraction in different medical contexts, the optimal conditions for its use still have to be determined in order to design interfaces adapted to therapeutic support in oncology. Objective The objective of this study was to examine the benefits of VR using two immersion methods (i.e., one participatory, one contemplative) and comparing them with each other in a population of women with breast cancer who have undergone breast surgery, during scar massage sessions. Methods In a physiotherapy center, each patient participated in four experimental conditions in a random order: two sessions used virtual immersion (i.e., one participatory and one contemplative), one session proposed musical listening and the fourth one was a standard session care. The impact of the level of patient involvement in the virtual world was apprehended through the evaluation of the feeling of presence; the estimation of elapsed time of the physiotherapy sessions and particular attention was paid to the evaluation of patient emotional state. Results Our study showed an increase in positive emotions (i.e., joy and happiness) and a decrease in anxiety regardless which support methods were offered. Participatory VR created a feeling of more intense spatial presence. Conclusion Our results highlight the importance of the context in which VR should be offered. The presence of the practitioner and his interactions with the patient can provide a context just as favorable in reducing anxiety as the emotional regulation tools used (VR, music). The use of technological tools should be favored when the practitioner is unavailable during the treatment phase or, even, in order to reduce the monotonous nature of repetitive therapeutic sessions.
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Affiliation(s)
- Hélène Buche
- Laboratoire Epsylon EA 4556, Université Paul Valéry, Montpellier III, Montpellier, France
| | - Aude Michel
- Laboratoire Epsylon EA 4556, Université Paul Valéry, Montpellier III, Montpellier, France.,Montpellier Institut du Sein, Clinique Clémentville, Montpellier, France
| | - Christina Piccoli
- Kinesitherapeute, Montpellier Institut du Sein, Clinique Clémentville, Montpellier, France
| | - Nathalie Blanc
- Laboratoire Epsylon EA 4556, Université Paul Valéry, Montpellier III, Montpellier, France
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27
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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: 35] [Impact Index Per Article: 11.7] [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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28
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Go Virtual to Get Real: Virtual Reality as a Resource for Spinal Cord Treatment. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18041819. [PMID: 33668438 PMCID: PMC7918193 DOI: 10.3390/ijerph18041819] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Revised: 02/08/2021] [Accepted: 02/09/2021] [Indexed: 02/05/2023]
Abstract
Increasingly, refined virtual reality (VR) techniques allow for the simultaneous and coherent stimulation of multiple sensory and motor domains. In some clinical interventions, such as those related to spinal cord injuries (SCIs), the impact of VR on people's multisensory perception, movements, attitudes, and even modulations of socio-cognitive aspects of their behavior may influence every phase of their rehabilitation treatment, from the acute to chronic stages. This work describes the potential advantages of using first-person-perspective VR to treat SCIs and its implications for manipulating sensory-motor feedback to alter body signals. By situating a patient with SCI in a virtual environment, sensorial perceptions and motor intention can be enriched into a more coherent bodily experience that also promotes processes of neural regeneration and plasticity. In addition to the great potential of research, the most significant areas of interest concern is managing neuropathic pain, motor rehabilitation, and psychological well-being.
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29
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Head-Mounted Display-Based Therapies for Adults Post-Stroke: A Systematic Review and Meta-Analysis. SENSORS 2021; 21:s21041111. [PMID: 33562657 PMCID: PMC7915338 DOI: 10.3390/s21041111] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Revised: 02/01/2021] [Accepted: 02/02/2021] [Indexed: 12/14/2022]
Abstract
Immersive virtual reality techniques have been applied to the rehabilitation of patients after stroke, but evidence of its clinical effectiveness is scarce. The present review aims to find studies that evaluate the effects of immersive virtual reality (VR) therapies intended for motor function rehabilitation compared to conventional rehabilitation in people after stroke and make recommendations for future studies. Data from different databases were searched from inception until October 2020. Studies that investigated the effects of immersive VR interventions on post-stroke adult subjects via a head-mounted display (HMD) were included. These studies included a control group that received conventional therapy or another non-immersive VR intervention. The studies reported statistical data for the groups involved in at least the posttest as well as relevant outcomes measuring functional or motor recovery of either lower or upper limbs. Most of the studies found significant improvements in some outcomes after the intervention in favor of the virtual rehabilitation group. Although evidence is limited, immersive VR therapies constitute an interesting tool to improve motor learning when used in conjunction with traditional rehabilitation therapies, providing a non-pharmacological therapeutic pathway for people after stroke.
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30
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Nuara A, Fabbri-Destro M, Scalona E, Lenzi SE, Rizzolatti G, Avanzini P. Telerehabilitation in response to constrained physical distance: an opportunity to rethink neurorehabilitative routines. J Neurol 2021; 269:627-638. [PMID: 33449202 PMCID: PMC7809551 DOI: 10.1007/s00415-021-10397-w] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Revised: 01/02/2021] [Accepted: 01/04/2021] [Indexed: 02/07/2023]
Abstract
Ensuring proper dosage of treatment and repetition over time is a major challenge in neurorehabilitation. However, a requirement of physical distancing to date compromises their achievement. While mostly associated to COVID-19, physical distancing is not only required in a pandemic scenario, but also advised for several clinical conditions (e.g. immunocompromised individuals) or forced for specific social contexts (e.g. people living in remote areas worldwide). All these contexts advocate for the implementation of alternative healthcare models. The objective of this perspective is to highlight the benefits of remote administration of rehabilitative treatment, namely telerehabilitation, in counteracting physical distancing barriers in neurorehabilitation. Sustaining boosters of treatment outcome, such as compliance, sustainability, as well as motivation, telerehabilitation may adapt to multiple neurological conditions, with the further advantage of a high potential for individualization to patient's or pathology's specificities. The effectiveness of telerehabilitation can be potentiated by several technologies available to date: virtual reality can recreate realistic environments in which patients may bodily operate, wearable sensors allow to quantitatively monitor the patient's performance, and signal processing may contribute to the prediction of long-term dynamics of patient recovery. Telerehabilitation might spark its advantages far beyond the mere limitation of physical distancing effects, mitigating criticalities of daily neurorehabilitative practice, and thus paving the way to the envision of mixed models of care, where hospital-based procedures are complementarily integrated with telerehabilitative ones.
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Affiliation(s)
- Arturo Nuara
- Consiglio Nazionale delle Ricerche, Istituto di Neuroscienze, via Volturno 39/E, 43125, Parma, Italy. .,Department of Biomedical, Metabolic, and Neuronal Sciences, University of Modena and Reggio Emilia, Modena, Italy. .,Department of Medicine and Surgery, University of Parma, Parma, Italy.
| | - Maddalena Fabbri-Destro
- Consiglio Nazionale delle Ricerche, Istituto di Neuroscienze, via Volturno 39/E, 43125, Parma, Italy
| | - Emilia Scalona
- Consiglio Nazionale delle Ricerche, Istituto di Neuroscienze, via Volturno 39/E, 43125, Parma, Italy
| | - Stefano Elio Lenzi
- Consiglio Nazionale delle Ricerche, Istituto di Neuroscienze, via Volturno 39/E, 43125, Parma, Italy
| | - Giacomo Rizzolatti
- Consiglio Nazionale delle Ricerche, Istituto di Neuroscienze, via Volturno 39/E, 43125, Parma, Italy.,Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Pietro Avanzini
- Consiglio Nazionale delle Ricerche, Istituto di Neuroscienze, via Volturno 39/E, 43125, Parma, Italy.,Istituto Clinico Humanitas, Rozzano, Italy
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31
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Effects of virtual reality training on occupational performance and self-efficacy of patients with stroke: a randomized controlled trial. J Neuroeng Rehabil 2020; 17:150. [PMID: 33187532 PMCID: PMC7666452 DOI: 10.1186/s12984-020-00783-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Accepted: 11/06/2020] [Indexed: 11/19/2022] Open
Abstract
Background Virtual reality (VR) has been broadly applied in post-stroke rehabilitation. However, studies on occupational performance and self-efficacy as primary outcomes of stroke rehabilitation using VR are lacking. Thus, this study aims to investigate the effects of VR training on occupational performance and self-efficacy in patients with stroke. Methods This was an assessor-blinded, randomized controlled trial. Sixty participants with first-ever stroke (< 1-year onset) underwent rehabilitation in a single acute hospital. Participants were randomly assigned to either the VR group (n = 30) or control group (n = 30). Both groups received dose-matched conventional rehabilitation (i.e., 45 min, five times per week over 3 weeks). The VR group received additional 45-min VR training for five weekdays over 3 weeks. The primary outcome measures were the Canadian Occupational Performance Measure and Stroke Self-Efficacy Questionnaire. Secondary outcome measures included Modified Barthel Index, Fugl-Meyer Assessment-Upper Extremity, and Functional Test for the Hemiplegic Upper Extremity. The assessment was conducted at baseline and after the 3-week intervention. Results A total of 52 participants (86.7%) completed the trial. Significant between-group differences in Stroke Self-Efficacy Questionnaire (Median Difference = 8, P = 0.043) and Modified Barthel Index (Median Difference = 10, P = 0.030) were found; however, no significant between-group differences in Canadian Occupational Performance Measure, Fugl-Meyer Assessment-Upper Extremity, and Functional Test for the Hemiplegic Upper Extremity were noted. No serious adverse reactions related to the program were reported. Conclusions Additional VR training could help improve the self-efficacy and activities of daily living of patients with stroke; however, it was not superior to conventional training in the improvement of upper limb functions, occupational performance, and satisfaction. Nevertheless, VR could be integrated into conventional rehabilitation programs to enhance self-efficacy of patients after stroke. Trial registration This study was successfully registered under the title “Effects of virtual reality training on occupational performance and self-efficacy of patients with stroke” on October 13 2019 and could be located in https://www.chictr.org with the study identifier ChiCTR1900026550.
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32
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Xavier-Rocha TB, Carneiro L, Martins GC, Vilela-JÚnior GDB, Passos RP, Pupe CCB, Nascimento OJMD, Haikal DS, Monteiro-Junior RS. The Xbox/Kinect use in poststroke rehabilitation settings: a systematic review. ARQUIVOS DE NEURO-PSIQUIATRIA 2020; 78:361-369. [PMID: 32520231 DOI: 10.1590/0004-282x20200012] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Accepted: 12/15/2019] [Indexed: 11/22/2022]
Abstract
BACKGROUND Active games based on virtual reality have been widely used in the rehabilitation of many clinical conditions. However, studies on the use of Xbox/Kinect are rare, and technology application in stroke treatment is not clear yet. OBJECTIVE To verify the outcomes (O) analyzed in randomized controlled trials (C; S) that investigated the use of Xbox/Kinect (I) in patients with stroke (P). METHODS This is a systematic literature review that meets PRISMA standards and the eligibility criteria according to the PICOS strategy. The search procedure was performed by two researchers. The research strategy was repeated in case of divergence. Effect size was calculated by Cohen's formula and Hopkins rank. The risk of individual bias was assessed using PEDro Score and Higgins Classification. RESULTS The main outcomes were postural balance and activities of daily living, with four studies addressing these variables. However, only one study showed the effect of Xbox/Kinect intervention on balance as large, as in two other studies evaluating manual dexterity and depression, respectively. CONCLUSION The greater use of Xbox/Kinect in treating patients after stroke is in recovery of balance and motor function, and the evidence support its application. These findings enable the use of virtual reality technology through Xbox/Kinect in rehabilitation programs, focusing on postural balance and motor skills. However, conclusive results are still not possible. Therefore, caution in the use of this technology is required.
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Affiliation(s)
- Túlio Brandão Xavier-Rocha
- Universidade Federal Fluminense, Programa de Pós-Graduação em Neurociências/Neurologia, Rio de Janeiro RJ, Brasil.,Centro Universitário FIPMoc, Montes Claros MG, Brasil
| | - Lara Carneiro
- Higher Institute of Educational Sciences, Penafiel, Portugal.,University Institute of Maia, Maia, Portugal.,Research Centre in Sports Sciences, Health Sciences and Human Development, CIDESD, GERON Research Community, Portugal
| | - Gustavo Celestino Martins
- Universidade Metodista de Piracicaba, Programa de Pós-Graduação em Ciências do Movimento Humano, São Paulo SP, Brasil
| | | | - Ricardo Pablo Passos
- Universidade Metodista de Piracicaba, Programa de Pós-Graduação em Ciências do Movimento Humano, São Paulo SP, Brasil
| | - Camila Castelo Branco Pupe
- Universidade Federal Fluminense, Programa de Pós-Graduação em Neurociências/Neurologia, Rio de Janeiro RJ, Brasil
| | | | - Desirée Sant'Ana Haikal
- Universidade Estadual de Montes Claros, Programa de Pós-Graduação em Ciências da Saúde, Montes Claros MG, Brasil
| | - Renato Sobral Monteiro-Junior
- Universidade Federal Fluminense, Programa de Pós-Graduação em Neurociências/Neurologia, Rio de Janeiro RJ, Brasil.,Universidade Estadual de Montes Claros, Programa de Pós-Graduação em Ciências da Saúde, Montes Claros MG, Brasil
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Video Game-Based Therapy on Balance and Gait of Patients with Stroke: A Systematic Review. APPLIED SCIENCES-BASEL 2020. [DOI: 10.3390/app10186426] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Background: Stroke patients with motor, sensory and cognitive diseases can take profits from information and communication technologies—in particular, from the latest commercial video consoles, which are based on motion capture. These technologies are positioning themselves as complementary therapeutic tools for treating gait and balance disorders. In this paper, a systematic review of the effect of video game-based therapy on balance and gait in stroke patients is shown and compared with other types of treatments. Methods: A systematic review of prospective controlled clinical trials published in the main biomedical databases in English and Spanish between 2005 and 2020 was performed. The systematic review presented in this paper has been done following the Cochrane Manual recommendations and the PRISMA Declaration by two independent reviewers. Data about participants, intervention, outcome measurements and outcome measurement results were extracted. The quality of evidence of each study was assessed using Cochrane’s standard quality assessment format, which includes a description of the risk of bias. Additionally, the Physiotherapy Evidence Database (PEDro) scale was used to assess the methodological quality of each paper. Results: A total of 18 papers, including 479 patients, were included in this systematic review, in which the use of video consoles (in combination with conventional rehabilitation or exclusively) was compared with conventional rehabilitation to treat balance or gait in post-stroke patients. In all studies, a tendency to improve balance was found in both intervention groups, finding, in 10 of 17 studies that analysed it, a better capacity in the experimental group that included video consoles compared to the conventional rehabilitation control group. Regarding gait, in six of seven studies that analysed it, improvements were found in both intervention groups, and these improvements were greater in the experimental group than compared to the control group in three of them. Conclusions: Commercial video game systems, in combination with conventional rehabilitation, have shown positive results on balance and gait in post-stroke patients. There were variations between the trials in terms of the video consoles used and the duration, frequency and number of sessions with commercial video games. Future studies should compare the effects of commercial video game treatments on balance and gait in stroke patients with a nonintervention group to know their real efficacy.
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Zhao Y, Feng H, Wu X, Du Y, Yang X, Hu M, Ning H, Liao L, Chen H, Zhao Y. Effectiveness of Exergaming in Improving Cognitive and Physical Function in People With Mild Cognitive Impairment or Dementia: Systematic Review. JMIR Serious Games 2020; 8:e16841. [PMID: 32602841 PMCID: PMC7367532 DOI: 10.2196/16841] [Citation(s) in RCA: 56] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Revised: 02/19/2020] [Accepted: 04/12/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Individuals with mild cognitive impairment and dementia have impaired physical and cognitive functions, leading to a reduced quality of life compared with those without such impairment. Exergaming, which is defined as a combination of exercise and gaming, is an innovative, fun, and relatively safe way to exercise in a virtual reality or gaming environment. Therefore, exergaming may help people living with mild cognitive impairment or dementia to overcome obstacles that they may experience regarding regular exercise and activities. OBJECTIVE The aim of this systematic review was to review studies on exergaming interventions administered to elderly individuals with mild cognitive impairment and dementia, and to summarize the results related to physical and cognitive functions such as balance, gait, executive function, and episodic memory. METHODS We searched Cochrane Central Register of Controlled Trials (CENTRAL), Medline, Embase, PsycINFO, Amed, and Nursing Database for articles published from the inception of the respective databases to January 2019. We included all clinical trials of exergaming interventions in individuals with mild cognitive impairment and dementia for review. The risk of bias was independently evaluated by two reviewers using the Cochrane Collaboration and Risk of Bias in Non-randomized Studies of Interventions tools. RESULTS Ten studies involving 702 participants were included for review. There was consistent evidence from 7 studies with a low risk of bias showing statistically significant effects of exergaming on cognitive functioning in people with mild cognitive impairment and dementia. With respect to physical function, 3 of 5 full-scale studies found positive results, and the intensity of most games was classified as moderate. CONCLUSIONS Overall, exergaming is an innovative tool for improving physical and cognitive function in people with mild cognitive impairment or dementia, although there is high heterogeneity among studies in terms of the duration, frequency, and gaming platform used. The quality of the included articles was moderate to high. More high-quality studies with more accurate outcome indicators are needed for further exploration and validation of the benefits of exergaming for this population.
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Affiliation(s)
- Yinan Zhao
- Xiangya School of Nursing, Central South University, Changsha, China
| | - Hui Feng
- Xiangya School of Nursing, Central South University, Changsha, China
- Xiangya-Oceanwide Health Management Research Institute, Central South University, Changsha, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Changsha, China
| | - Xinyin Wu
- Xiangya School of Public Health, Central South University, Changsha, China
| | - Yan Du
- School of Nursing, University of Texas Health Science Center, San Antonio, TX, United States
| | - Xiufen Yang
- Xiangya School of Nursing, Central South University, Changsha, China
| | - Mingyue Hu
- Xiangya School of Nursing, Central South University, Changsha, China
| | - Hongting Ning
- Xiangya School of Nursing, Central South University, Changsha, China
| | - Lulu Liao
- Xiangya School of Nursing, Central South University, Changsha, China
| | - Huijing Chen
- Xiangya School of Nursing, Central South University, Changsha, China
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The Effectiveness of Virtual Reality Exercise on Individual's Physiological, Psychological and Rehabilitative Outcomes: A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17114133. [PMID: 32531906 PMCID: PMC7312871 DOI: 10.3390/ijerph17114133] [Citation(s) in RCA: 76] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 05/28/2020] [Accepted: 06/07/2020] [Indexed: 12/24/2022]
Abstract
Objective purpose: This review synthesized the literature examining the effects of virtual reality (VR)-based exercise on physiological, psychological, and rehabilitative outcomes in various populations. Design: A systematic review. Data sources: 246 articles were retrieved using key words, such as "VR", "exercise intervention", "physiological", "psychology", and "rehabilitation" through nine databases including Academic Search Premier and PubMed. Eligibility criteria for selecting studies: 15 articles which met the following criteria were included in the review: (1) peer-reviewed; (2) published in English; (3) randomized controlled trials (RCTs), controlled trials or causal-comparative design; (4) interventions using VR devices; and (5) examined effects on physiological, psychological, and/or rehabilitative outcomes. Descriptive and thematic analyses were used. Results: Of the 12 articles examining physiological outcomes, eight showed a positive effect on physical fitness, muscle strength, balance, and extremity function. Only four articles examined the effects on psychological outcomes, three showed positive effects such that VR exercise could ease fatigue, tension, and depression and induce calmness and enhance quality of life. Nine articles investigated the effects of VR-based exercise on rehabilitative outcomes with physiological and/or psychological outcomes, and six observed significant positive changes. In detail, patients who suffered from chronic stroke, hemodialysis, spinal-cord injury, cerebral palsy in early ages, and cognitive decline usually saw better improvements using VR-based exercise. Conclusion: The findings suggest that VR exercise has the potential to exert a positive impact on individual's physiological, psychological, and rehabilitative outcomes compared with traditional exercise. However, the quality, quantity, and sample size of existing studies are far from ideal. Therefore, more rigorous studies are needed to confirm the observed positive effects.
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Abou L, Malala VD, Yarnot R, Alluri A, Rice LA. Effects of Virtual Reality Therapy on Gait and Balance Among Individuals With Spinal Cord Injury: A Systematic Review and Meta-analysis. Neurorehabil Neural Repair 2020; 34:375-388. [PMID: 32270736 DOI: 10.1177/1545968320913515] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Background and Purpose. The use of virtual reality (VR) therapy among individuals with spinal cord injury (SCI) is a relatively new rehabilitation approach replicating real-life scenarios. The aim of this study was to evaluate the effectiveness of VR therapy for improving gait and balance in individuals with SCI. Methods. Databases of PubMed, Web of Science, Scopus, SportDiscuss, and CINHAL were searched from inception until September 2019. Two independent reviewers screened articles for inclusion, extracted data, and evaluated methodological quality of the trials. Results. Ten trials, including 3 randomized clinical trials (RCTs) and 7 pre-post trials, with a total of 149 participants were analyzed. Meta-analysis of RCTs demonstrated significant improvement in sitting balance (standardized mean difference [SMD] = 1.65; 95% CI 1.21-2.09; P < .01) after VR therapy with conventional rehabilitation compared with only conventional rehabilitation. Also, pre-post studies using VR therapy without a control group showed improvement in standing balance (Berg Balance Scale, MD = 4.22; 95% CI 1.78-6.66; P < .01 and Activities-specific Balance Confidence scale, MD = 8.53; 95% CI 2.52-14.53; P = .01) and a trend for improvement in gait (SMD = 0.34; 95% CI 0.02-0.66; P = .04). Conclusion. This study demonstrated the beneficial effects of VR therapy to enhance sitting and standing balance and showed a trend of gait improvement in individuals with SCI. This conclusion is based on mainly preliminary data and therefore, more RCTs are needed to confirm the effects of the use of VR in individuals with SCI.
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Affiliation(s)
- Libak Abou
- Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Urbana, IL, USA
| | - Vonjiniaina Domohina Malala
- Unité de Formation et de Recherche en Sciences et Techniques des Activités Physiques et Sportives- UFR STAPS, Université Paris Sud, Bures Sur Yvette, Île-de-France, France
| | - Rebecca Yarnot
- Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Urbana, IL, USA
| | - Aditya Alluri
- Department of Molecular and Cellular Biology, University of Illinois at Urbana-Champaign, Urbana, IL, USA
| | - Laura A Rice
- Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Urbana, IL, USA
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Kim KJ, Heo M. Comparison of virtual reality exercise versus conventional exercise on balance in patients with functional ankle instability: A randomized controlled trial. J Back Musculoskelet Rehabil 2020; 32:905-911. [PMID: 30958334 DOI: 10.3233/bmr-181376] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Recently, a variety of virtual reality (VR)-based interventions have been studied. However, they were only partially applied to physical therapy. OBJECTIVE The present study investigated the effects of a VR exercise program by comparing the results of VR and conventional exercise on balance in patients with functional ankle instability (FAI). METHODS Twenty-one participants with symptoms of FAI participated in this study. In the VR training program, the strength and balance exercises were done for 10 minutes each using a program included in the Nintendo Wii Fit Plus for VR intervention. In the conventional program, four ankle strength exercises using the TheraBand and the balance exercises were performed for 10 minutes each. Static and dynamic balance were measured in the overall, anterior-posterior, and medial-lateral directions. RESULTS Static balance in the VR exercise was significantly lower in the overall direction than in the conventional exercise. Dynamic balance in the virtual reality exercise was significantly lower than in the conventional exercise at level 2, level 4, and level 8 balance in the medial-lateral direction. CONCLUSIONS This study has shown that VR exercise is more effective in the overall direction (static) and medial-lateral direction (dynamic) of balance than conventional method in patients with FAI.
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Affiliation(s)
- Ki-Jong Kim
- Department of Occupational Therapy, Woosong University, Daejeon, Korea
| | - Myoung Heo
- Department of Occupational Therapy, Gwangju University, Gwangju, Korea
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Sheehy L, Taillon-Hobson A, Sveistrup H, Bilodeau M, Yang C, Finestone H. Sitting Balance Exercise Performed Using Virtual Reality Training on a Stroke Rehabilitation Inpatient Service: A Randomized Controlled Study. PM R 2020; 12:754-765. [PMID: 31970898 DOI: 10.1002/pmrj.12331] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Accepted: 01/10/2020] [Indexed: 11/05/2022]
Abstract
BACKGROUND Virtual reality training (VRT) is engaging and may enhance rehabilitation intensity. Only one previous study has looked at its use to improve sitting balance after stroke. OBJECTIVE To determine if supplemental sitting balance exercises, administered via VRT, improve control of sitting balance and upper extremity function in stroke rehabilitation inpatients. DESIGN Assessor-blinded, placebo-controlled randomized controlled trial. SETTING Stroke inpatient rehabilitation unit. PARTICIPANTS Seventy-six participants (out of 130 approached) with subacute stroke who could not stand independently were randomized to experimental and control groups. Sixty-nine completed the study. INTERVENTIONS The experimental group did VRT that required leaning and reaching, whereas the control group had their trunk restrained and performed VRT that involved only small upper extremity movements to minimize trunk movement. Both groups performed 10-12 sessions of 30-45 minutes. Participants were assessed pre, post, and 1 month after the sessions by a blinded examiner. OUTCOME MEASURES Function in Sitting Test (FIST, primary outcome measure); Ottawa Sitting Scale; Reaching Performance Scale; Wolf Motor Function Test (WMFT). RESULTS Thirty-three participants completed the experimental intervention and 36 the control. Pre/post differences for FIST were 3.4 (confidence interval [CI] 0.5;6.3) for the experimental group and 5.3 (2.9;7.7) for the control group. There was a significant improvement over time (adjusted for multiple comparisons, P < .006) on most outcome measures except the WMFT Performance Time Scale (control group; P = .007) and grip strength (P = .008); there were no differences between groups (P > .006). CONCLUSIONS Siting balance outcomes were similar for both groups; therefore, this study does not support the use of sitting balance exercises provided via VRT for the rehabilitation of sitting balance after stroke. However, because it is only the second study to investigate VRT for sitting balance and upper extremity function, more research, using more challenging exercises and a greater treatment intensity, is required before definitive conclusions are made.
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Affiliation(s)
- Lisa Sheehy
- Bruyère Research Institute, Ottawa, Ontario, Canada.,School of Rehabilitation Sciences, Faculty of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada
| | | | - Heidi Sveistrup
- Bruyère Research Institute, Ottawa, Ontario, Canada.,School of Rehabilitation Sciences, Faculty of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada.,School of Human Kinetics, Faculty of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada
| | - Martin Bilodeau
- Bruyère Research Institute, Ottawa, Ontario, Canada.,School of Rehabilitation Sciences, Faculty of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada.,School of Human Kinetics, Faculty of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada
| | - Christine Yang
- Stroke Rehabilitation, Bruyère Continuing Care, Ottawa, Ontario, Canada.,Division of Physical Medicine and Rehabilitation, Department of Medicine, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Hillel Finestone
- Stroke Rehabilitation, Bruyère Continuing Care, Ottawa, Ontario, Canada.,Division of Physical Medicine and Rehabilitation, Department of Medicine, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
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Efficacy of Virtual Reality Rehabilitation after Spinal Cord Injury: A Systematic Review. BIOMED RESEARCH INTERNATIONAL 2019; 2019:7106951. [PMID: 31828120 PMCID: PMC6885151 DOI: 10.1155/2019/7106951] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Revised: 08/19/2019] [Accepted: 08/31/2019] [Indexed: 01/01/2023]
Abstract
Background Spinal cord injury (SCI) is often associated with long-term impairments related to functional limitations in the sensorimotor system. The use of virtual reality (VR) technology may lead to increased motivation and engagement, besides allowing a wide range of possible tasks/exercises to be implemented in rehabilitation programs. The present review aims to investigate the possible benefits and efficacy of VR-based rehabilitation in individuals with SCI. Methods An electronically systematic search was performed in multiple databases (PubMed, BVS, Web of Science, Cochrane Central, and Scielo) up to May 2019. MESH terms and keywords were combined in a search strategy. Two reviewers independently selected the studies in accordance with eligibility criteria. The PEDro scale was used to score the methodological quality and risk of bias of the selected studies. Results Twenty-five studies (including 482 participants, 47.6 ± 9.5 years, 73% male) were selected and discussed. Overall, the studies used VR devices in different rehabilitation protocols to improve motor function, driving skills, balance, aerobic function, and pain level, as well as psychological and motivational aspects. A large amount of heterogeneity was observed as to the study design, VR protocols, and outcome measures used. Only seven studies (28%) had an excellent/good quality of evidence. However, substantial evidence for significant positive effects associated with VR therapy was found in most of the studies (88%), with no adverse events (88%) being reported. Conclusion Although the current evidence is limited, the findings suggest that VR-based rehabilitation in subjects with SCI may lead to positive effects on aerobic function, balance, pain level, and motor function recovery besides improving psychological/motivational aspects. Further high-quality studies are needed to provide a guideline to clinical practice and to draw robust conclusions about the potential benefits of VR therapy for SCI patients. Protocol details are registered on PROSPERO (registration number: CRD42016052629).
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Lei C, Sunzi K, Dai F, Liu X, Wang Y, Zhang B, He L, Ju M. Effects of virtual reality rehabilitation training on gait and balance in patients with Parkinson's disease: A systematic review. PLoS One 2019; 14:e0224819. [PMID: 31697777 PMCID: PMC6837756 DOI: 10.1371/journal.pone.0224819] [Citation(s) in RCA: 100] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Accepted: 10/22/2019] [Indexed: 01/20/2023] Open
Abstract
OBJECTIVE In recent years, virtual reality (VR) has been tested as a therapeutic tool in neurorehabilitation research. However, the impact effectiveness of VR technology on for Parkinson's Disease (PD) patients is still remains controversial unclear. In order to provide a more scientific basis for rehabilitation of PD patients' modality, we conducted a systematic review of VR rehabilitation training for PD patients and focused on the improvement of gait and balance. METHODS An comprehensive search was conducted using the following databases: PubMed, Web of Science, Cochrane Library, CINHAL, Embase and CNKI (China National Knowledge Infrastructure).Articles published before 30 December 2018 and of a randomized controlled trial design to study the effects of VR for patients with PD were included. The study data were pooled and a meta-analysis was completed. This systematic review was conducted in accordance with the PRISMA guideline statement and was registered in the PROSPERO database (CRD42018110264). RESULTS A total of sixteen articles involving 555 participants with PD were included in our analysis. VR rehabilitation training performed better than conventional or traditional rehabilitation training in three aspects: step and stride length (SMD = 0.72, 95%CI = 0.40,1.04, Z = 4.38, P<0.01), balance function (SMD = 0.22, 95%CI = 0.01,0.42, Z = 2.09, P = 0.037), and mobility(MD = -1.95, 95%CI = -2.81,-1.08, Z = 4.41, P<0.01). There was no effect on the dynamic gait index (SMD = -0.15, 95%CI = -0.50,0.19, Z = 0.86, P = 0.387), and gait speed (SMD = 0.19, 95%CI = -0.03,0.40, Z = 1.71, P = 0.088).As for the secondary outcomes, compared with the control group, VR rehabilitation training demonstrated more significant effects on the improvement of quality of life (SMD = -0.47, 95%CI = -0.73,-0.22, Z = 3.64, P<0.01), level of confidence (SMD = -0.73, 95%CI = -1.43,-0.03, Z = 2.05, P = 0.040), and neuropsychiatric symptoms (SMD = -0.96, 95%CI = -1.27,-0.65, Z = 6.07, P<0.01), while it may have similar effects on global motor function (SMD = -0.50, 95%CI = -1.48,0.48, Z = 0.99, P = 0.32), activities of daily living (SMD = 0.25, 95%CI = -0.14,0.64, Z = 1.24, P = 0.216), and cognitive function (SMD = 0.21, 95%CI = -0.28,0.69, Z = 0.84, P = 0.399).During the included interventions, four patients developed mild dizziness and one patient developed severe dizziness and vomiting. CONCLUSIONS According to the results of this study, we found that VR rehabilitation training can not only achieve the same effect as conventional rehabilitation training. Moreover, it has better performance on gait and balance in patients with PD. Taken together, when the effect of traditional rehabilitation training on gait and balance of PD patients is not good enough, we believe that VR rehabilitation training can at least be used as an alternative therapy. More rigorous design of large-sample, multicenter randomized controlled trials are needed to provide a stronger evidence-based basis for verifying its potential advantages.
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Affiliation(s)
- Cheng Lei
- Department of Nursing, People’s Hospital of Deyang, Deyang, Sichuan, China
| | - Kejimu Sunzi
- Department of Nursing, People’s Hospital of Deyang, Deyang, Sichuan, China
| | - Fengling Dai
- School of Nursing, Southwest Medical University, Luzhou, Sichuan, China
- Faculty of Nursing, Chiang Mai University, Chiang Mai, Thailand
| | - Xiaoqin Liu
- Department of Nursing, People’s Hospital of Deyang, Deyang, Sichuan, China
| | - Yanfen Wang
- Department of Nursing, People’s Hospital of Deyang, Deyang, Sichuan, China
| | - Baolu Zhang
- School of Nursing, Southwest Medical University, Luzhou, Sichuan, China
| | - Lin He
- Department of Nursing, People’s Hospital of Deyang, Deyang, Sichuan, China
| | - Mei Ju
- School of Nursing, Southwest Medical University, Luzhou, Sichuan, China
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Borrego A, Latorre J, Alcañiz M, Llorens R. Embodiment and Presence in Virtual Reality After Stroke. A Comparative Study With Healthy Subjects. Front Neurol 2019; 10:1061. [PMID: 31649608 PMCID: PMC6795691 DOI: 10.3389/fneur.2019.01061] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Accepted: 09/20/2019] [Indexed: 11/13/2022] Open
Abstract
The ability of virtual reality (VR) to recreate controlled, immersive, and interactive environments that provide intensive and customized exercises has motivated its therapeutic use after stroke. Interaction and bodily presence in VR-based interventions is usually mediated through virtual selves, which synchronously represent body movements or responses to events on external input devices. Embodied self-representations in the virtual world not only provide an anchor for visuomotor tasks, but their morphologies can have behavioral implications. While research has focused on the underlying subjective mechanisms of exposure to VR on healthy individuals, the transference of these findings to individuals with stroke is not evident and remains unexplored, which could affect the experience and, ultimately, the clinical effectiveness of neurorehabilitation interventions. This study determined and compared the sense of embodiment and presence elicited by a virtual environment under different perspectives and levels of immersion in healthy subjects and individuals with stroke. Forty-six healthy subjects and 32 individuals with stroke embodied a gender-matched neutral avatar in a virtual environment that was displayed in a first-person perspective with a head-mounted display and in a third-person perspective with a screen, and the participants were asked to interact in a virtual task for 10 min under each condition in counterbalanced order, and to complete two questionnaires about the sense of embodiment and presence experienced during the interaction. The sense of body-ownership, self-location, and presence were more vividly experienced in a first-person than in a third-person perspective by both healthy subjects (p < 0.001, ηp2 = 0.212; p = 0.005, ηp2 = 0.101; p = 0.001, ηp2 = 0.401, respectively) and individuals with stroke (p = 0.019, ηp2 = 0.070; p = 0.001, ηp2 = 0.135; p = 0.014, ηp2 = 0.077, respectively). In contrast, no agency perspective-related differences were found in any group. All measures were consistently higher for healthy controls than for individuals with stroke, but differences between groups only reached statistical significance in presence under the first-person condition (p < 0.010, ηp2 = 0.084). In spite of these differences, the participants experienced a vivid sense of embodiment and presence in almost all conditions. These results provide first evidence that, although less intensively, embodiment and presence are similarly experienced by individuals who have suffered a stroke and by healthy individuals, which could support the vividness of their experience and, consequently, the effectiveness of VR-based interventions.
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Affiliation(s)
- Adrián Borrego
- Neurorehabilitation and Brain Research Group, Instituto de Investigación e Innovación en Bioingeniería, Universitat Politècnica de València, Valencia, Spain
| | - Jorge Latorre
- Neurorehabilitation and Brain Research Group, Instituto de Investigación e Innovación en Bioingeniería, Universitat Politècnica de València, Valencia, Spain.,NEURORHB-Servicio de Neurorrehabilitación de Hospitales Vithas, Valencia, Spain
| | - Mariano Alcañiz
- Neurorehabilitation and Brain Research Group, Instituto de Investigación e Innovación en Bioingeniería, Universitat Politècnica de València, Valencia, Spain
| | - Roberto Llorens
- Neurorehabilitation and Brain Research Group, Instituto de Investigación e Innovación en Bioingeniería, Universitat Politècnica de València, Valencia, Spain.,NEURORHB-Servicio de Neurorrehabilitación de Hospitales Vithas, Valencia, Spain
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Ng YL, Ma F, Ho FK, Ip P, Fu KW. Effectiveness of virtual and augmented reality-enhanced exercise on physical activity, psychological outcomes, and physical performance: A systematic review and meta-analysis of randomized controlled trials. COMPUTERS IN HUMAN BEHAVIOR 2019. [DOI: 10.1016/j.chb.2019.05.026] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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Li J, Zhong D, Ye J, He M, Liu X, Zheng H, Jin R, Zhang SL. Rehabilitation for balance impairment in patients after stroke: a protocol of a systematic review and network meta-analysis. BMJ Open 2019; 9:e026844. [PMID: 31326927 PMCID: PMC6661695 DOI: 10.1136/bmjopen-2018-026844] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2018] [Revised: 04/24/2019] [Accepted: 06/11/2019] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION Multiple rehabilitation therapies have been reported to be effective for poststroke balance impairment. However, the comparative effectiveness of these rehabilitation therapies is still unclear. Therefore, the aim of this study is to summarise evidence and identify the most effective rehabilitation therapy for poststroke balance impairment. METHODS AND ANALYSIS The following databases will be searched: China Biology Medicine, China National Knowledge Infrastructure, Wan Fang Data, the Chinese Science and Technology Periodical Database, Medline, Excerpt Medical Database (EMBASE), Web of Science, the Cochrane Library, from inception to June 2019. All randomised controlled trials that have used rehabilitation interventions to treat poststroke balance impairment will be included. The primary outcomes are the Berg Balance Scale, the Fugl-Meyer Assessment (balance), the Postural Assessment Scale for Stroke, as well as the function in sitting test, the Sitting Balance Scale, the Ottawa Sitting Scale, the Activities-specific Balance Confidence Scale, the Overall Balance Index and the Brunel Balance Assessment. The secondary outcomes include the Barthel Index, the Functional Ambulation Category Scale, fall rates, the Timed Up and Go test, the MOS 36-Item Short-Form Health Survey, and adverse events. To ensure that all relevant studies are included without personal bias, study selection, data extraction and quality assessment will be performed independently by two reviewers. Risk of bias will be assessed with the Cochrane risk of bias assessment tool. Review Manager V.5.3 software will be used to make bias risk diagram and pairwise meta-analysis, while network data synthesis will be performed using WinBUGS V.1.4.3 and R software. ETHICS AND DISSEMINATION Ethics approval is not required for systematic review and network meta-analysis. The results will be submitted to a peer review journal or at a conference. TRIAL REGISTRATION NUMBER PROSPERO (CRD 42018107441).
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Affiliation(s)
- Juan Li
- School of Health Cultivation and Rehabilitation, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Dongling Zhong
- School of Health Cultivation and Rehabilitation, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Jing Ye
- School of Acupuncture-Moxibustion and Tuina/The Third Affiliated Hospital, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Mingxing He
- School of Health Cultivation and Rehabilitation, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Xicen Liu
- School of Health Cultivation and Rehabilitation, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Hui Zheng
- School of Acupuncture-Moxibustion and Tuina/The Third Affiliated Hospital, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Rongjiang Jin
- School of Health Cultivation and Rehabilitation, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Shao-lan Zhang
- Immunology Teaching and Research Section, Chengdu Medical College, Chengdu, China
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Rehabilitation interventions for improving balance following stroke: An overview of systematic reviews. PLoS One 2019; 14:e0219781. [PMID: 31323068 PMCID: PMC6641159 DOI: 10.1371/journal.pone.0219781] [Citation(s) in RCA: 51] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2018] [Accepted: 07/01/2019] [Indexed: 12/13/2022] Open
Abstract
Background The aim of this study was to synthesize evidence from systematic reviews, to summarise the effects of rehabilitation interventions for improving balance in stroke survivors. Methods We conducted an overview of systematic reviews (SRs). We included Cochrane Systematic Reviews and non-Cochrane Systematic Reviews of randomized-controlled clinical trials and not-randomized clinical trials, in all types of stroke, comparing the effects of interventions, control interventions and no interventions on balance-related outcomes. We conducted a comprehensive search of electronic databases, from inception to December 2017. Data extracted included: number and type of participants, type of intervention, control intervention, method of assessing risk of bias of primary studies, balance outcome measures and results of statistical meta-analyses. Methodological quality of included reviews was assessed using AMSTAR 2. A narrative description of the characteristics of the SRs was provided and results of meta-analyses summarised with reference to their methodological quality. Results 51 SRs (248 primary studies and 10,638 participants) met the inclusion criteria and were included in the overview. All participants were adults with stroke. A wide variety of different balance and postural control outcomes were included. 61% of SRs focussed on the effectiveness of physical therapy, 20% virtual reality, 6% electromechanical devices, 4% Tai-Chi, whole body vibration and circuit training intervention, and 2% cognitive rehabilitation. The methodology of 54% of SRs were judged to be of a “low or critically low” quality, 23% “moderate” quality and 22% “high” quality. Conclusions There are 51 SRs of evidence relating to the effectiveness of interventions to improve balance in people with stroke, but the majority of these are of poor methodological quality, limiting our ability to draw clear implications. Only 22% of these SRs were judged to be of high quality, highlighting the need to address important methodological issues within rehabilitation research.
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The Effects of Virtual Reality Training on Function in Chronic Stroke Patients: A Systematic Review and Meta-Analysis. BIOMED RESEARCH INTERNATIONAL 2019; 2019:7595639. [PMID: 31317037 PMCID: PMC6604476 DOI: 10.1155/2019/7595639] [Citation(s) in RCA: 69] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Revised: 05/20/2019] [Accepted: 05/28/2019] [Indexed: 12/17/2022]
Abstract
Objective The aim of this study was to perform a meta-analysis to examine whether virtual reality (VR) training is effective for lower limb function as well as upper limb and overall function in chronic stroke patients. Methods Three databases, OVID, PubMed, and EMBASE, were used to collect articles. The search terms used were “cerebrovascular accident (CVA),” “stroke”, and “virtual reality”. Consequently, twenty-one studies were selected in the second screening of meta-analyses. The PEDro scale was used to assess the quality of the selected studies. Results The total effect size for VR rehabilitation programs was 0.440. The effect size for upper limb function was 0.431, for lower limb function it was 0.424, and for overall function it was 0.545. The effects of VR programs on specific outcomes were most effective for improving muscle tension, followed by muscle strength, activities of daily living (ADL), joint range of motion, gait, balance, and kinematics. Conclusion The VR training was effective in improving the function in chronic stroke patients, corresponding to a moderate effect size. Moreover, VR training showed a similar effect for improving lower limb function as it did for upper limb function.
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Mohammadi R, Semnani AV, Mirmohammadkhani M, Grampurohit N. Effects of Virtual Reality Compared to Conventional Therapy on Balance Poststroke: A Systematic Review and Meta-Analysis. J Stroke Cerebrovasc Dis 2019; 28:1787-1798. [PMID: 31031145 DOI: 10.1016/j.jstrokecerebrovasdis.2019.03.054] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Revised: 03/13/2019] [Accepted: 03/31/2019] [Indexed: 10/27/2022] Open
Abstract
OBJECTIVE The objective of this study was to systematically review the effect of virtual reality on balance as compared to conventional therapy alone poststroke. METHODS The databases of PubMed, Cochrane, and Ovid were searched using select keywords. The randomized controlled trials published between January 2000 and August 2017 in English language were included if they assessed the effect of virtual reality on balance ability compared to conventional therapy alone in adults' poststroke. The Physiotherapy Evidence Database scale was used to assess the methodological quality. RESULTS Fourteen papers were included in this review. The experimental groups largely (n = 13) used virtual reality in combination with conventional therapy. Among the high quality studies, significant between-group improvement favoring virtual reality in combination with conventional therapy was found on Berg Balance Scale (n = 7) and Timed Up and Go Scale (n = 7) when compared to conventional therapy alone. The studies were limited by low powered, small sample sizes ranging from 14 to 40, and lack of blinding, concealed allocation, and reporting of missing data. Thirteen homogenous (n = 348, I2 = 37.6%, P = .083) studies were included in the meta-analysis using Berg Balance Scale. Significant improvement was observed in the experimental group compared to control group with a medium effect size of .64, confidence interval of .36-.92. CONCLUSIONS The findings of this review indicate that virtual reality when combined with conventional therapy is moderately more effective in improving balance than conventional therapy alone in individuals' poststroke.
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Affiliation(s)
- Roghayeh Mohammadi
- Neuromuscular Rehabilitation Research Center, Semnan University of Medical Sciences, Semnan, Iran.
| | | | - Majid Mirmohammadkhani
- Social Determinants of Health Research Center, Semnan University of Medical Sciences, Semnan, Iran
| | - Namrata Grampurohit
- Department of Occupational Therapy, College of Rehabilitation Sciences, Thomas Jefferson University, Philadelphia, Pennsylvania
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Aramaki AL, Sampaio RF, Reis ACS, Cavalcanti A, Dutra FCMSE. Virtual reality in the rehabilitation of patients with stroke: an integrative review. ARQUIVOS DE NEURO-PSIQUIATRIA 2019; 77:268-278. [DOI: 10.1590/0004-282x20190025] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/15/2018] [Accepted: 12/10/2018] [Indexed: 11/22/2022]
Abstract
ABSTRACT Objective: To describe the intervention protocols to using commercial video games as virtual reality (VR) in rehabilitation of patients with stroke. Methods: Integrative review using the descriptors “rehabilitation”, “virtual reality exposure therapy” and “videogames” in the LILACS and PUBMED databases. Articles published from 2011 to 2018 were selected. Results: We found 1,396 articles, 1,383 were excluded and 13 were selected. Most of the articles were randomized clinical trials published in 2014 or later. The sample size varied from 5–47 adults, or adults and elders, with chronic stroke. The Nintendo Wii® was the most used video game system. The intervention happened two or three times a week, each session lasting from 30 to 60 minutes, over 2–12 weeks. Balance, upper limb motor functions, quality of life and daily living activities were the most common evaluated outcomes. The Fugl-Meyer Assessment, Berg Balance Scale, Timed Up and Go test, Barthel Scale and SF-36 were the most common outcome measurement tools. Conclusions: The studies indicated improvement in dynamic balance, upper limb motor function and quality of life after rehabilitation using VR. The VR was more effective than conventional treatments for the outcome of dynamic balance. Two studies did not find any changes in static balance and daily living activities. Physical aspects and quality of life were the outcomes most evaluated by the researchers; as were the population with chronic strokes and protocols of long duration and low intensity. Few studies targeted immediate VR effects, performance in daily living activities and social participation.
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Affiliation(s)
- Alberto Luiz Aramaki
- Universidade Federal do Triângulo Mineiro, Brasil; NETRAS - Núcleo de Estudos e Pesquisas em Trabalho, Participação Social e Saúde, Brasil
| | | | - Ana Caroline Silva Reis
- NETRAS - Núcleo de Estudos e Pesquisas em Trabalho, Participação Social e Saúde, Brasil; Universidade Federal do Triângulo Mineiro, Brasil
| | | | - Fabiana Caetano Martins Silva e Dutra
- Universidade Federal do Triângulo Mineiro, Brasil; NETRAS - Núcleo de Estudos e Pesquisas em Trabalho, Participação Social e Saúde, Brasil; Universidade Federal do Triângulo Mineiro, Brasil
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Ho TH, Yang FC, Lin RC, Chien WC, Chung CH, Chiang SL, Chou CH, Tsai CK, Tsai CL, Lin YK, Lee JT. Impact of virtual reality-based rehabilitation on functional outcomes in patients with acute stroke: a retrospective case-matched study. J Neurol 2019; 266:589-597. [PMID: 30610428 DOI: 10.1007/s00415-018-09171-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2018] [Revised: 12/22/2018] [Accepted: 12/25/2018] [Indexed: 10/27/2022]
Abstract
BACKGROUND AND OBJECTIVES To date, the efficacy of the virtual reality (VR) application for acute stroke compared with conventional therapy (CT) remains unclear. This retrospective study aims to assess the impact of adjuvant VR technology on multidimensional therapy for patients with acute-stage stroke. METHODS 100 acute ischemic stroke patients with onset within 7 days who underwent combined adjuvant VR-based rehabilitation program and CT (intervention group-VR + CT) were compared to an equal number of cross-matched patients who received CT alone. While the intervention group received 40-min CT plus 20-min VR program (seven times for 1 week), the comparison group received time-matched CT alone. The National Institutes of Health Stroke Scale (NIHSS), modified Rankin Scale (mRS), medical cost-effectiveness, and shortening of hospital stay were used as outcome measures. RESULTS Posttreatment, the VR + CT group revealed significantly improved NIHSS and mRS (P < 0.001), whereas only the mRS improvement was remarkable in the CT group. In between-group comparisons, the intervention group had better improvements of symptom severity (NIHSS percentage improvement from the baseline; 20.18% vs. 4.59%, P < 0.005), functional outcomes (mRS improvement from the baseline; - 0.58 vs. - 0.23, P < 0.001), and reduced medical cost (Taiwan dollar; 49474 vs. 66306, P < 0.005). Furthermore, the VR + CT group reached markedly higher proportion of functional independence in activities of daily living (mRS, 0-2) at discharge compared with the CT group (68% vs. 60%, P < 0.001). CONCLUSIONS This study suggests that the combination of VR-based rehabilitation and traditional therapy could be more effective for neurorehabilitation than CT alone in the early improvement of symptom severity, functional outcomes, and lower medical expenditure in acute stroke patients.
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Affiliation(s)
- Tsung-Han Ho
- Department of Neurology, Tri-Service General Hospital, National Defense Medical Center, No. 325, Section 2, Cheng-Kung Road, Neihu 114, Taipei, Taiwan
| | - Fu-Chi Yang
- Department of Neurology, Tri-Service General Hospital, National Defense Medical Center, No. 325, Section 2, Cheng-Kung Road, Neihu 114, Taipei, Taiwan
| | - Ruei-Ching Lin
- Department of Nursing, Tri-Service General Hospital, National Defense Medical Center, No. 325, Section 2, Cheng-Kung Road, Neihu 114, Taipei, Taiwan
| | - Wu-Chien Chien
- Department of Medical Research, Tri-Service General Hospital, National Defense Medical Center, No. 325, Section 2, Cheng-Kung Road, Neihu 114, Taipei, Taiwan
| | - Chi-Hsiang Chung
- School of Public Health, National Defense Medical Center, No. 325, Section 2, Cheng-Kung Road, Neihu 114, Taipei, Taiwan
| | - Shang-Lin Chiang
- Department of Physical Medicine and Rehabilitation, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, No. 325, Section 2, Cheng-Kung Road, Neihu 114, Taipei, Taiwan
| | - Chung-Hsing Chou
- Department of Neurology, Tri-Service General Hospital, National Defense Medical Center, No. 325, Section 2, Cheng-Kung Road, Neihu 114, Taipei, Taiwan.,Graduate Institute of Medical Sciences, National Defense Medical Center, No. 325, Section 2, Cheng-Kung Road, Neihu 114, Taipei, Taiwan
| | - Chia-Kuang Tsai
- Department of Neurology, Tri-Service General Hospital, National Defense Medical Center, No. 325, Section 2, Cheng-Kung Road, Neihu 114, Taipei, Taiwan.,Graduate Institute of Medical Sciences, National Defense Medical Center, No. 325, Section 2, Cheng-Kung Road, Neihu 114, Taipei, Taiwan
| | - Chia-Lin Tsai
- Department of Neurology, Tri-Service General Hospital, National Defense Medical Center, No. 325, Section 2, Cheng-Kung Road, Neihu 114, Taipei, Taiwan.,Graduate Institute of Medical Sciences, National Defense Medical Center, No. 325, Section 2, Cheng-Kung Road, Neihu 114, Taipei, Taiwan
| | - Yu-Kai Lin
- Department of Neurology, Tri-Service General Hospital, National Defense Medical Center, No. 325, Section 2, Cheng-Kung Road, Neihu 114, Taipei, Taiwan
| | - Jiunn-Tay Lee
- Department of Neurology, Tri-Service General Hospital, National Defense Medical Center, No. 325, Section 2, Cheng-Kung Road, Neihu 114, Taipei, Taiwan. .,Graduate Institute of Medical Sciences, National Defense Medical Center, No. 325, Section 2, Cheng-Kung Road, Neihu 114, Taipei, Taiwan.
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Küçükdeveci AA, Stibrant Sunnerhagen K, Golyk V, Delarque A, Ivanova G, Zampolini M, Kiekens C, Varela Donoso E, Christodoulou N. Evidence-based position paper on Physical and Rehabilitation Medicine professional practice for persons with stroke. The European PRM position (UEMS PRM Section). Eur J Phys Rehabil Med 2019; 54:957-970. [DOI: 10.23736/s1973-9087.18.05501-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
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Tough D, Robinson J, Gowling S, Raby P, Dixon J, Harrison SL. The feasibility, acceptability and outcomes of exergaming among individuals with cancer: a systematic review. BMC Cancer 2018; 18:1151. [PMID: 30463615 PMCID: PMC6249900 DOI: 10.1186/s12885-018-5068-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Accepted: 11/08/2018] [Indexed: 11/25/2022] Open
Abstract
Background Individuals with cancer have reduced quality of life, functionality, range of motion, strength, and an increase in pain and fatigue. Exergaming appears to be an effective rehabilitation tool for Parkinson’s disease, multiple sclerosis and post-stroke patients to improve functionality, balance and quality of life; however, the usefulness of exergaming in individuals with cancer is unknown. The aim of this systematic review is to describe exergaming interventions delivered to adults with a current or previous cancer diagnosis and to report the feasibility, acceptability and outcomes of such interventions. Methods Studies reporting on exergaming interventions delivered to individuals with a current or previous cancer diagnosis were included. 12 electronic databases were searched. Eight articles (seven interventions) were identified. Data were extracted and assessed for quality by two reviewers. Results Three interventions were delivered at hospital, two at home, one at a clinical laboratory, and one did not report. Two interventions were delivered by a physiotherapist, two by an occupational therapist, and one by a nurse, research staff and an exercise physiologist. The Nintendo Wii was used in four of seven studies, whilst the remaining three used the IREX system, BrightArm Duo Rehabilitation System or a custom made exergame. Studies showed that most participants enjoyed the exergaming intervention, and would recommend their use, with some preferring exergaming over standard care interventions. Adherence rates and enjoyment appear greater during exergaming than standard care. Exergaming interventions appear to support improvements balance, function, physical activity levels, strength, fatigue, emotions, cognition and pain. Conclusion Exergaming interventions delivered to individuals with cancer show great heterogeneity; differing in duration, frequency and gaming platform. The disease stage and severity of those included, and the outcome measures assessed also vary widely making it difficult to conclude its effectiveness at this time. However, adherence rates and enjoyment appear greater during exergaming compared to standard care, supporting the feasibility and acceptability of this type of intervention delivery for adults with cancer.
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Affiliation(s)
- Daniel Tough
- School of Health and Social Care, Teesside University, Middlesbrough, TS1 3BX, UK.
| | - Jonathan Robinson
- School of Health and Social Care, Teesside University, Middlesbrough, TS1 3BX, UK
| | - Steven Gowling
- Department of Sport and Exercise Sciences, University of Sunderland, Sunderland, SR1 3SD, UK
| | - Peter Raby
- School of Health and Social Care, Teesside University, Middlesbrough, TS1 3BX, UK
| | - John Dixon
- School of Health and Social Care, Teesside University, Middlesbrough, TS1 3BX, UK
| | - Samantha L Harrison
- School of Health and Social Care, Teesside University, Middlesbrough, TS1 3BX, UK
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