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Trebilcock M, Shrubsole K, Worrall L, Ryan B. Pilot trial of the online implementation intervention Aphasia Nexus: Connecting Evidence to Practice. INTERNATIONAL JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2024; 26:16-27. [PMID: 36562756 DOI: 10.1080/17549507.2022.2153918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
PURPOSE Aphasia Nexus: Connecting Evidence to Practice is a theoretically-based online implementation intervention designed to overcome the barriers related to the implementation of intensive and comprehensive aphasia services. The objective was to establish the feasibility of incorporating Aphasia Nexus within routine clinical practice through an evaluation of: (1) its potential to positively influence the intensity and/or comprehensiveness of aphasia services; (2) the ability of selected outcome measures to capture changes to factors influencing implementation; and (3) the acceptability of the website to on-site speech-language pathologists (SLPs). METHOD A single arm pre-post pilot trial was conducted within an Australian health service. The design collected qualitative and quantitative pre-post data in the form of therapy logs, behaviour change questionnaires, and a post-intervention focus group. Data were collected one week prior to, and one week following, a 12 week implementation period where participating SLPs (n = 5) were provided access to the Aphasia Nexus website. RESULT Quantitative data revealed improvements in the median time per patient with aphasia from 65 to 115 minutes per week (intensity/dose), an additional 50 minutes per week. SLPs trialled at least one new therapy approach (Attentive Reading and Constrained Summarisation) and service delivery model (group therapy) representing an increase in the comprehensiveness of their services to patients. SLPs perceived a reduction in the barriers associated with the promotion of new aphasia services. Qualitative analysis of focus group discussion revealed that participants considered Aphasia Nexus in the overarching theme of practice efficiency (obtaining the best outcome from the least amount of effort) and the sub-themes of accessible therapy resources and the prioritisation of time. CONCLUSION Overall, Aphasia Nexus was considered a useful clinical tool with the potential to positively influence clinical aphasia practice. These results will inform further implementation intervention refinements and will inform the methodology of future research.
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Affiliation(s)
- Megan Trebilcock
- School of Health and Rehabilitation Sciences, University of Queensland, Brisbane, Australia
- School of Allied Health, Australian Catholic University, North Sydney, Australia
| | - Kirstine Shrubsole
- School of Health and Rehabilitation Sciences, University of Queensland, Brisbane, Australia
- Faculty of Health, Southern Cross University, Gold Coast, Australia
- The Queensland Aphasia Research Centre, The University of Queensland, Brisbane, Australia
| | - Linda Worrall
- School of Health and Rehabilitation Sciences, University of Queensland, Brisbane, Australia
- The Queensland Aphasia Research Centre, The University of Queensland, Brisbane, Australia
- Centre of Research Excellence in Aphasia Recovery and Rehabilitation, Australia
| | - Brooke Ryan
- School of Health and Rehabilitation Sciences, University of Queensland, Brisbane, Australia
- Centre of Research Excellence in Aphasia Recovery and Rehabilitation, Australia
- Discipline of Clinical Psychology, Graduate School of Health, University of Technology Sydney, Utimo, Australia
- Curtin School of Allied Health, Curtin University, Perth, Australia
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Ferron A, Robert MT, Fortin W, Bau O, Cardinal MC, Desgagné J, Saussez G, Bleyenheuft Y, Levac D. Virtual Reality and Active Video Game Integration within an Intensive Bimanual Therapy Program for Children with Hemiplegia. Phys Occup Ther Pediatr 2023; 44:410-426. [PMID: 37846035 DOI: 10.1080/01942638.2023.2259462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Accepted: 09/11/2023] [Indexed: 10/18/2023]
Abstract
AIMS To describe the nature of custom and non-custom virtual reality and active video game (VR/AVG) implementation within a Hand-Arm Bimanual Intensive Therapy Including Lower Extremities (HABIT-ILE) intervention program for children with hemiplegia. METHODS Six children aged 8-11 years participated in a 10-day HABIT-ILE intervention (65 h; 6.5 planned VR/AVG hours). VR/AVG implementation details were recorded daily and summarized with descriptive statistics; active motor engagement was quantified as minutes of active game participation. Post-intervention interviews with interventionists were analyzed with qualitative content analysis. RESULTS On average, participants received 79% of the planned VR/AVG dosage (314/400 planned minutes, range 214-400 min), of which the per-session active motor engagement average was 68% (27 min, SD 12 min). Participation involved equivalent amounts of custom (49%) and non-custom (51%) VR/AVG system use. Material and verbal adaptations facilitated alignment with HABIT-ILE principles. Interventionists identified type of task (gross versus fine motor), children's perceived motivation, and VR/AVG attributes as factors influencing active motor engagement and alignment with HABIT-ILE principles. CONCLUSIONS Describing individual and technological challenges of VR/AVG integration within HABIT-ILE can advance knowledge about VR/AVG use in intensive interventions and identify directions for subsequent research.
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Affiliation(s)
- Audrey Ferron
- Centre Hospitalier Universitaire Sainte-Justine - Research Center, Montreal, Canada
| | | | - William Fortin
- Centre Hospitalier Universitaire Sainte-Justine - Research Center, Montreal, Canada
| | - Odette Bau
- Centre Hospitalier Universitaire Sainte-Justine - Marie Enfant Rehabilitation Center, Montreal, Canada
| | - Marie-Claude Cardinal
- Centre Hospitalier Universitaire Sainte-Justine - Marie Enfant Rehabilitation Center, Montreal, Canada
| | - Julie Desgagné
- Centre Hospitalier Universitaire Sainte-Justine - Marie Enfant Rehabilitation Center, Montreal, Canada
| | - Geoffroy Saussez
- Institute of Neuroscience, Université catholique de Louvain, Louvain, Belgium
| | - Yannick Bleyenheuft
- Institute of Neuroscience, Université catholique de Louvain, Louvain, Belgium
| | - Danielle Levac
- Centre Hospitalier Universitaire Sainte-Justine - Research Center, Montreal, Canada
- Faculty of Medicine, University of Montreal, Montreal, Canada
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Molhemi F, Mehravar M, Monjezi S, Salehi R, Negahban H, Shaterzadeh-Yazdi MJ, Majdinasab N. Effects of exergaming on cognition, lower limb functional coordination, and stepping time in people with multiple sclerosis: a randomized controlled trial. Disabil Rehabil 2023; 45:1343-1351. [PMID: 35443843 DOI: 10.1080/09638288.2022.2060332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
PURPOSE To compare the effects of exergaming versus conventional exercises on cognition, lower-limb functional coordination, and stepping time in people with multiple sclerosis (PwMS). METHODS Thirty-six PwMS were randomly assigned to either intervention (n = 18) or control (n = 18) group and received 18 training sessions during six weeks. The intervention group performed exergames that required multidirectional timed-stepping, weight-shifting, and walking while the control group performed conventional matched exercises. Trail making test (TMT part A, B; TMT-A, TMT-B, TMT B-A), six-spot step test (SSST), and choice stepping reaction time (CSRT-including reaction time (RT), movement time (MVT), and total response time (TRT)) were assessed pre- and post-intervention (short-term), and after three-month follow-up (mid-term). RESULTS The intervention group showed faster TMT-B (p = 0.003) and TMT B-A (p = 0.002) at post-intervention and faster SSST at both post-intervention (p = 0.002) and follow-up (p = 0.04). The CSRT components showed no between-group differences at post-intervention; however, at follow-up, the intervention group had lower TRT (p = 0.046) and MVT (p = 0.015). TMT-A and RT had no significant between-group differences. CONCLUSIONS In short-term, exergames led to more improvements in complex attention, executive function, and lower-limb functional coordination comparing to the matched conventional exercises. In mid-term, exergaming was more effective for improving stepping time and lower-limb functional coordination. However, the two approaches did not show any superiority over each other for improving simple attention and RT.Implications for rehabilitationWhen designed properly, exergames have great potential to improve attention and executive function of people with multiple sclerosis (PwMS), at least in the short-term.Exergames seem like an appropriate option for improving lower limb coordination and decreasing choice stepping response time among PwMS in the mid-term.Exergames do not have superiority in improving the choice stepping reaction time compared to their matched conventional treatment.
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Affiliation(s)
- Farshad Molhemi
- Musculoskeletal Rehabilitation Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
- Student Research Committee, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Mohammad Mehravar
- Musculoskeletal Rehabilitation Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
- Department of Physiotherapy, School of Rehabilitation Sciences, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Saeideh Monjezi
- Musculoskeletal Rehabilitation Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
- Department of Physiotherapy, School of Rehabilitation Sciences, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Reza Salehi
- Department of Rehabilitation Management, Rehabilitation Research Center, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Hossein Negahban
- Department of Physical Therapy, School of Paramedical Sciences, Mashhad University of Medical Sciences, Mashhad, Iran
- Orthopedic Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mohammad-Jafar Shaterzadeh-Yazdi
- Musculoskeletal Rehabilitation Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
- Department of Physiotherapy, School of Rehabilitation Sciences, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Nastaran Majdinasab
- Musculoskeletal Rehabilitation Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
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Cardenas A, Petrevska M, Biddiss E, Fehlings D. Clinician perspectives on the implementation of inpatient cycling-based exergames for children with cerebral palsy: A qualitative study. Dev Neurorehabil 2022; 25:531-541. [PMID: 35815548 DOI: 10.1080/17518423.2022.2099474] [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] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To understand the perspectives of key stakeholder clinicians in implementing inpatient cycling-based exergames for children with cerebral palsy (CP) into pediatric rehabilitation. METHODS Sixteen clinicians (nurses, physiotherapists, recreational therapists) that participated in a study exploring the feasibility of implementing cycling-based exergames for inpatient children with CP were interviewed. Clinicians' responses were coded using the Theoretical Domains Framework (TDF). Beliefs were generated from each response and relevant domains were identified. RESULTS Ten domains from the TDF were identified as relevant. Key enablers to clinician participation in future implementation included revision of clinician roles and responsibilities, the belief that children with CP will benefit from exergames, and the belief in potential applicability to other pediatric populations. Barriers included clinician limited time and exergame responsibilities not aligning with perceived clinician roles. CONCLUSIONS This study identifies key barriers and enablers that future inpatient pediatric rehabilitation settings should consider when incorporating exergames into rehabilitation practice.
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Affiliation(s)
- Analyssa Cardenas
- Holland Bloorview Kids Rehabilitation Hospital, Toronto, ON, Canada.,Rehabilitation Sciences Institute, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Marina Petrevska
- Holland Bloorview Kids Rehabilitation Hospital, Toronto, ON, Canada.,Rehabilitation Sciences Institute, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Elaine Biddiss
- Holland Bloorview Kids Rehabilitation Hospital, Toronto, ON, Canada.,Institute of Biomaterials & Biomedical Engineering, Faculty of Engineering, University of Toronto, Toronto, ON, Canada
| | - Darcy Fehlings
- Holland Bloorview Kids Rehabilitation Hospital, Toronto, ON, Canada.,Rehabilitation Sciences Institute, Faculty of Medicine, University of Toronto, Toronto, ON, Canada.,Department of Paediatrics, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
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Wormley ME, Romney W, Veneri D, Oberlander A. Doctoral physical therapy students’ increased confidence following exploration of active video gaming systems in a problem-based learning curriculum in the United States: a pre- and post-intervention study. JOURNAL OF EDUCATIONAL EVALUATION FOR HEALTH PROFESSIONS 2022; 19:7. [PMID: 35468667 PMCID: PMC9247715 DOI: 10.3352/jeehp.2022.19.7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Accepted: 04/19/2022] [Indexed: 06/14/2023]
Abstract
PURPOSE Active video gaming (AVG) is used in physical therapy (PT) to treat individuals with a variety of diagnoses across the lifespan. The literature supports improvements in balance, cardiovascular endurance, and motor control; however, evidence is lacking regarding the implementation of AVG in PT education. This study investigated doctoral physical therapy (DPT) students’ confidence following active exploration of AVG systems as a PT intervention in the United States. METHODS This pretest-posttest study included 60 DPT students in 2017 (cohort 1) and 55 students in 2018 (cohort 2) enrolled in a problem-based learning curriculum. AVG systems were embedded into patient cases and 2 interactive laboratory classes across 2 consecutive semesters (April–December 2017 and April–December 2018). Participants completed a 31-question survey before the intervention and 8 months later. Students’ confidence was rated for general use, game selection, plan of care, set-up, documentation, setting, and demographics. Descriptive statistics and the Wilcoxon signed-rank test were used to compare differences in confidence pre- and post-intervention. RESULTS Both cohorts showed increased confidence at the post-test, with median (interquartile range) scores as follows: cohort 1: pretest, 57.1 (44.3–63.5); post-test, 79.1 (73.1–85.4); and cohort 2: pre-test, 61.4 (48.0–70.7); post-test, 89.3 (80.0–93.2). Cohort 2 was significantly more confident at baseline than cohort 1 (P<0.05). In cohort 1, students’ data were paired and confidence levels significantly increased in all domains: use, Z=-6.2 (P<0.01); selection, Z=-5.9 (P<0.01); plan of care, Z=-6.0 (P<0.01); set-up, Z=-5.5 (P<0.01); documentation, Z=-6.0 (P<0.01); setting, Z=-6.3 (P<0.01); and total score, Z=-6.4 (P<0.01). CONCLUSION Structured, active experiences with AVG resulted in a significant increase in students’ confidence. As technology advances in healthcare delivery, it is essential to expose students to these technologies in the classroom.
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Affiliation(s)
| | - Wendy Romney
- Department of Physical Therapy & Human Movement Science, Sacred Heart University, Fairfield, CT, USA
| | - Diana Veneri
- Department of Physical Therapy & Human Movement Science, Sacred Heart University, Fairfield, CT, USA
| | - Andrea Oberlander
- Department of Physical Therapy & Human Movement Science, Sacred Heart University, Fairfield, CT, USA
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Zanatta F, Giardini A, Pierobon A, D'Addario M, Steca P. A systematic review on the usability of robotic and virtual reality devices in neuromotor rehabilitation: patients' and healthcare professionals' perspective. BMC Health Serv Res 2022; 22:523. [PMID: 35443710 PMCID: PMC9020115 DOI: 10.1186/s12913-022-07821-w] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Accepted: 03/14/2022] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND The application of virtual reality (VR) and robotic devices in neuromotor rehabilitation has provided promising evidence in terms of efficacy, so far. Usability evaluations of these technologies have been conducted extensively, but no overviews on this topic have been reported yet. METHODS A systematic review of the studies on patients' and healthcare professionals' perspective through searching of PubMed, Medline, Scopus, Web of Science, CINAHL, and PsychINFO (2000 to 2021) was conducted. Descriptive data regarding the study design, participants, technological devices, interventions, and quantitative and qualitative usability evaluations were extracted and meta-synthetized. RESULTS Sixty-eight studies were included. VR devices were perceived as having good usability and as a tool promoting patients' engagement and motivation during the treatment, as well as providing strong potential for customized rehabilitation sessions. By contrast, they suffered from the effect of learnability and were judged as potentially requiring more mental effort. Robotics implementation received positive feedback along with high satisfaction and perceived safety throughout the treatment. Robot-assisted rehabilitation was considered useful as it supported increased treatment intensity and contributed to improved patients' physical independence and psychosocial well-being. Technical and design-related issues may limit the applicability making the treatment difficult and physically straining. Moreover, cognitive and communication deficits were remarked as potential barriers. CONCLUSIONS Overall, VR and robotic devices have been perceived usable so far, reflecting good acceptance in neuromotor rehabilitation programs. The limitations raised by the participants should be considered to further improve devices applicability and maximise technological rehabilitation effectiveness. TRIAL REGISTRATION PROSPERO registration ref. CRD42021224141 .
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Affiliation(s)
- Francesco Zanatta
- Department of Psychology, University of Milano-Bicocca, Milan, Italy
| | - Anna Giardini
- Information Technology Department, Istituti Clinici Scientifici Maugeri IRCCS, Pavia, Italy
| | - Antonia Pierobon
- Psychology Unit of Montescano Institute, Istituti Clinici Scientifici Maugeri IRCCS, Montescano, Italy.
| | - Marco D'Addario
- Department of Psychology, University of Milano-Bicocca, Milan, Italy
| | - Patrizia Steca
- Department of Psychology, University of Milano-Bicocca, Milan, Italy
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Feitosa JA, Fernandes CA, Casseb RF, Castellano G. Effects of virtual reality-based motor rehabilitation: a systematic review of fMRI studies. J Neural Eng 2021; 19. [PMID: 34933281 DOI: 10.1088/1741-2552/ac456e] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Accepted: 12/21/2021] [Indexed: 11/11/2022]
Abstract
BACKGROUND The use of virtual reality (VR) as a rehabilitation tool has been shown to induce motor and cognitive improvements in different populations. Functional magnetic resonance imaging (fMRI) has been used to investigate neuroplasticity resulting from these treatments. We hypothesize that VR rehabilitation induces functional improvement and brain changes that can be detected by fMRI. OBJECTIVE To systematically review the effects of VR intervention on the cortical reorganization measured by fMRI and associated with functional improvement. METHODS We performed a systematic review of studies published between 2005 and 2021. Papers were retrieved from six databases using the following keywords: "motor rehabilitation", "fMRI" and "virtual reality". Case studies, pre-post studies, cross-sectional studies, and randomized controlled trials published were included. Manuscripts were assessed by The NIH Study Quality Assessment Tools to determine their quality. RESULTS Twenty-three articles met our eligibility criteria: 18 about VR rehabilitation in stroke and five on other clinical conditions (older adults, cerebral palsy, and Parkinson's disease). Changes in neural patterns of activation and reorganization were revealed in both the ipsilesional and the contralesional hemispheres. Results were located mainly in the primary motor cortex, sensorimotor cortex and supplementary motor area in post-stroke patients in the acute, subacute, and chronic rehabilitation phases, and were associated with functional improvement after VR intervention. Similar effects were observed in older adults and in patients with other neurological diseases with improved performance. CONCLUSION Most stroke-related studies showed either restoration to normal or increase of activation patterns or relateralization at/to the ipsilesional hemisphere, with some also reporting a decrease in activity or extent of activation after VR therapy. In general, VR intervention demonstrated evidence of efficacy both in neurological rehabilitation and in performance improvement of older adults, accompanied by fMRI evidence of brain reorganization.
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Affiliation(s)
- Jamille A Feitosa
- University of Campinas, Institute of Physics Gleb Wataghin, R. Sérgio Buarque de Holanda, nº 777, Campinas, SP, 13083-872, BRAZIL
| | - Corina A Fernandes
- University of Campinas, Institute of Physics Gleb Wataghin, R. Sérgio Buarque de Holanda, nº 777, Campinas, SP, 13083-872, BRAZIL
| | - Raphael F Casseb
- University of Campinas, Neuroimaging Laboratory - Rua Vital Brasil, 251, Cidade Universitaria "Zeferino Vaz", Campinas, SP, Brazil, Campinas, 13083-888, BRAZIL
| | - Gabriela Castellano
- Department of Cosmic Rays and Chronology, University of Campinas - UNICAMP, Institute of Physics Gleb Wataghin, R. Sérgio Buarque de Holanda, nº 777, Cidade Universitária, Campinas, SP, 13083-859, BRAZIL
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Yousefi Babadi S, Daneshmandi H. Effects of virtual reality versus conventional balance training on balance of the elderly. Exp Gerontol 2021; 153:111498. [PMID: 34311059 DOI: 10.1016/j.exger.2021.111498] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Revised: 07/20/2021] [Accepted: 07/20/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVE The aging population is growing in the world, and the reduction in physical function caused by this is an important issue that, particularly, causes a disorder of balance and an increased risk of falling. This study aimed at the comparison between the effects of virtual reality training (VRT) and Conventional balance training (CBT) on the balance of the elderly. METHODS The present study was conducted on 36 elderly (men and women) who are living in nursing homes. Participants were randomly divided into three groups: virtual reality training (6 males, 6 females; age = 66.5 ± 3.8 years), Conventional balance training (6 males, 6 females; age = 67.5 ± 3.1 years), and control (5 males, 7 females; age = 66.7 ± 3.2 years). Each group participated in a 60-min session, 3 times per week, for 9 weeks. To assess the participants' balance, the balance tests were used on single-leg stance (SLS) with open and closed eyes, Functional reach test (FRT), Timed up and Go Test (TUG), and Fullerton Advance Balance Scale (FABS). Data analysis was done using paired t-test and analysis of covariance by SPSS software version 24 at the significant level (P = 0.05). RESULTS In both groups (VRT, CBT), SLS with open and closed eyes, FRT, TUG, and FABS were significantly improved (P˂0.05). After the intervention, changes in both groups were similar (P > 0.05), which indicates that neither VRT and CBT training methods were superior to the other. CONCLUSION According to the results of this study, it seems that a virtual reality training program can be used as a new training method to improve the elderly's balance in daily programs of nursing homes.
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Affiliation(s)
- Saeed Yousefi Babadi
- Faculty of Physical Education and Sport Sciences, Department of Sport Injuries & Corrective Exercises, University of Guilan, Rasht, Iran.
| | - Hassan Daneshmandi
- Faculty of Physical Education and Sport Sciences, Department of Sport Injuries & Corrective Exercises, University of Guilan, Rasht, Iran
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Espy D, Reinthal A, Dal Bello-Haas V. A Clinical Decision-Making Framework for the Use of Video Gaming as a Therapeutic Modality. Front Neurol 2021; 12:610095. [PMID: 34122293 PMCID: PMC8193226 DOI: 10.3389/fneur.2021.610095] [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: 09/25/2020] [Accepted: 04/13/2021] [Indexed: 11/24/2022] Open
Abstract
Virtual reality and video gaming offer modulation of more exercise and motor learning parameters simultaneously than other modalities; however, there is a demonstrated need for resources to facilitate their effective use clinically. This article presents a conceptual framework to guide clinical-decision making for the selection, adaptation, modulation, and progression of virtual reality or gaming when used as a therapeutic exercise modality, and two cases as exemplars. This framework was developed by adapting the steps of theory derivation, whereby concepts and parent theories are brought together to describe a new structure or phenomenon of interest. Specifically, motor learning theory, integrated motor control theory, Gentile's Taxonomy of Tasks, and therapeutic exercise principles were integrated to develop this framework. It incorporates person (body segment), environmental, and task demands; each demand is comprised of realm, category, choice, and continuum parameters as motor training considerations and alternatives for decision-making. This framework: (1) provides structure to guide clinical decisions for effective and safe use of virtual reality or gaming to meet therapeutic goals and requirements, (2) is a concise and organized method to identify, document, and track the therapeutic components of protocols and client progression over time; (3) can facilitate documentation for reimbursement and communication among clinicians; and, (4) structures student learning, and (5) informs research questions and methods.
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Affiliation(s)
- Debbie Espy
- School of Health Sciences, Cleveland State University, Cleveland, OH, United States
| | - Ann Reinthal
- School of Health Sciences, Cleveland State University, Cleveland, OH, United States
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Deutsch JE, James-Palmer A, Damodaran H, Puh U. Comparison of neuromuscular and cardiovascular exercise intensity and enjoyment between standard of care, off-the-shelf and custom active video games for promotion of physical activity of persons post-stroke. J Neuroeng Rehabil 2021; 18:63. [PMID: 33853608 PMCID: PMC8045246 DOI: 10.1186/s12984-021-00850-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Accepted: 03/16/2021] [Indexed: 12/04/2022] Open
Abstract
Background Active video games have been embraced for the rehabilitation of mobility and promotion of physical activity for persons post-stroke. This study seeks to compare carefully matched standard of care stepping activities, off-the-shelf (non-custom) active video games and custom active video games that are either self-paced or game-paced for promoting neuromuscular intensity and accuracy, cardiovascular intensity, enjoyment and perceived effort. Methods Fifteen persons (ages 38–72) with mild to moderate severity in the chronic phase post-stroke (average 8 years) participated in a single group counter balanced repeated measures study. Participants were included if they were greater than 6 months post-stroke, who could walk 100 feet without assistance and stand unsupported for three continuous minutes. They were excluded if they had cardiac, musculoskeletal or neurologic conditions that could interfere with repeated stepping and follow instructions. In a single session located in a laboratory setting, participants executed for 8.5 min each: repeated stepping, the Kinect-light race game, two custom stepping games for the Kinect, one was repeated and self-paced and the other was random and game paced. Custom video games were adjusted to the participants stepping volume. Ten-minute rest periods followed the exercise during which time participants rested and completed the PACES an enjoyment questionnaire. Participants were instrumented with a metabolic cart and heart rate sensor for collection of cardiovascular intensity (METs and % of max HR) data. Stepping frequency, accuracy and pattern were acquired via video. Data were analyzed using a RMANOVA and post-hoc comparison with a Holm's/Sidak correction. Results Neuromuscular intensity (repetitions) was significantly greater for the off-the-shelf and self-paced custom game, however accuracy was greater for the custom games. Cardiovascular intensity for all activities took place in the moderate intensity exercise band. Enjoyment (measured with a questionnaire and rankings) was greater for the custom active video games and rate of perceived exertion was lower for the custom active video games. Conclusions Custom active video games provided comparable intensity but better accuracy, greater enjoyment and less perceived exertion than standard of care stepping activities and a carefully matched off-the-shelf (non-custom) video game. There were no differences between the game-paced and self-paced custom active video games. Trial registration: NCT04538326.
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Affiliation(s)
- Judith E Deutsch
- Rivers Lab, Department of Rehabilitation and Movement Science, Rutgers School of Health Professions, 65 Bergen Street, Newark, NJ, 07101, USA.
| | - Aurora James-Palmer
- Rivers Lab, Department of Rehabilitation and Movement Science, Rutgers School of Health Professions, 65 Bergen Street, Newark, NJ, 07101, USA.,Motor Behavior Lab, Department of Rehab and Movement Science, Rutgers School of Health Professions, 65 Bergen Street, Newark, NJ, 07101, USA
| | - Harish Damodaran
- Rivers Lab, Department of Rehabilitation and Movement Science, Rutgers School of Health Professions, 65 Bergen Street, Newark, NJ, 07101, USA
| | - Urska Puh
- Department of Physiotherapy, Faculty of Health Sciences, University of Ljubljana, Ljubljana, Slovenia
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Moore JL, Mbalilaki JA, Graham ID. Knowledge Translation in Physical Medicine and Rehabilitation: A Citation Analysis of the Knowledge-to-Action Literature. Arch Phys Med Rehabil 2021; 103:S256-S275. [PMID: 33556348 DOI: 10.1016/j.apmr.2020.12.031] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Revised: 12/15/2020] [Accepted: 12/28/2020] [Indexed: 01/08/2023]
Abstract
OBJECTIVES To (1) provide an overview of the use of the Knowledge-to-Action Cycle (KTA) to guide a clinical implementation project; (2) identify activities performed in each phase of the KTA; and (3) provide suggestions to improve KTA activities in physical medicine and rehabilitation. DATA SOURCES Google Scholar and PubMed were searched through December 31, 2019. STUDY SELECTION Two reviewers screened titles, abstracts, and full-text articles to identify published studies that used the KTA to implement a project. DATA EXTRACTION Two reviewers examined full-text articles. Data extraction included activities performed in each phase of the KTA, including measurements used to evaluate the project's effectiveness. DATA SYNTHESIS Commonly performed KTA activities were identified and country of study, area of rehabilitation, and other factors related to the use of the KTA in rehabilitation were described. A total of 46 articles that met the study's inclusion criteria provided an overview of the use of the KTA in rehabilitation. Strengths and weaknesses of the articles are discussed and recommendations for improved KTA use are provided. CONCLUSIONS Implementation of evidence-based practice requires focused engineering and efforts. This review provides an overview of the knowledge translation activities occurring in physical medicine and rehabilitation and considerations to improve knowledge translation research and practice.
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Affiliation(s)
- Jennifer L Moore
- Southeastern Norway Regional Center for Knowledge Translation in Rehabilitation, Oslo, Norway; Institute for Knowledge Translation, Carmel, IN, United States.
| | - Julia A Mbalilaki
- Southeastern Norway Regional Center for Knowledge Translation in Rehabilitation, Oslo, Norway
| | - Ian D Graham
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
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12
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Chen B, Liang RQ, Chen RY, Xu FY. The effect of virtual reality training on the daily participation of patients: A meta-analysis. Complement Ther Med 2021; 58:102676. [PMID: 33561530 DOI: 10.1016/j.ctim.2021.102676] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Revised: 01/10/2021] [Accepted: 01/29/2021] [Indexed: 10/22/2022] Open
Abstract
BACKGROUND Virtual reality (VR) training are regarded as promising new tools for rehabilitation, but the effect on patients' daily participation is controversial. This study aimed to evaluate the effect of virtual reality (VR) training on different types of patients' daily participation through a meta-analysis. METHODS The PubMed, Cochrane central register of controlled trials, Embase, and web science databases were searched for studies published through September 2020. Thirty-five randomized controlled trials of virtual reality (VR) training compared with conventional treatment, Other electronic rehabilitation systems, usual care for various types of patients were included. All of the studies were available in English. Standardized mean differences (SMD), 95 % confidence intervals (CI), publication bias, and heterogeneity were calculated. RESULTS The Virtual reality (VR) training group is better than the control group in daily participation improvement on all types of patients. There was a small, significant effect(p<0.001; SMD = 0.25[95 %CI,0.14 to 0.36], I2 = 0.00 %). Observing only the type of Stroke, the VR training group is still better than the control group in improving patients' daily participation (p<0.001, SMD = 0.24[95 %CI, 0.11 to 0.37], I2 = 0.00 %). Using the cumulative Meta-analysis method to observe the included literature according to the timeline, Using the cumulative Meta-analysis method to observe the included literature according to the timeline, and it has only achieved positive results since 2015 (Nam-YoNg Lee 2015, p = 0.048, SMD = 0.22[95 %CI,0.00 to 0.44]). The heterogeneity of the studies was not detected, but there is obvious publication bias. CONCLUSIONS Because of controversy over obvious publication bias, we need to be cautious about the conclusion that VR is better than the control group in promoting the patient's daily participation.
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Affiliation(s)
- Bo Chen
- Department of Rehabilitation, The Affiliated Hospital of Southwest Medical University, Sichuan, Luzhou, 646000, China.
| | - Rui-Qi Liang
- The Affiliated Hospital of Southwest Medical University, Sichuan, Luzhou, 646000, China
| | - Ru-Yan Chen
- Department of Rehabilitation, The Affiliated Hospital of Southwest Medical University, Sichuan, Luzhou, 646000, China
| | - Fang-Yuan Xu
- Department of Rehabilitation, The Affiliated Hospital of Southwest Medical University, Sichuan, Luzhou, 646000, China.
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13
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da Silva TD, da Silva PL, Valenzuela EDJ, Dias ED, Simcsik AO, de Carvalho MG, Fontes AMGG, Alberissi CADO, de Araújo LV, Brandão MVDC, Dawes H, Monteiro CBDM. Serious Game Platform as a Possibility for Home-Based Telerehabilitation for Individuals With Cerebral Palsy During COVID-19 Quarantine - A Cross-Sectional Pilot Study. Front Psychol 2021; 12:622678. [PMID: 33633648 PMCID: PMC7901904 DOI: 10.3389/fpsyg.2021.622678] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Accepted: 01/04/2021] [Indexed: 12/22/2022] Open
Abstract
Introduction There is a need to maintain rehabilitation activities and motivate movement and physical activity during quarantine in individuals with Cerebral Palsy (CP). Objective This paper sets out to evaluate the feasibility and potential benefits of using computer serious game in a non-immersive virtual reality (VR) implemented and evaluated completely remotely in participants with CP for Home-Based Telerehabilitation during the quarantine period for COVID-19. Methods Using a cross-sectional design, a total of 44 individuals participated in this study between March and June 2020, 22 of which had CP (14 males and 8 females, mean age = 19 years, ranging between 11 and 28 years) and 22 typically developing individuals, matched by age and sex to the individuals with CP. Participants practiced a coincident timing game1 and we measured movement performance and physical activity intensity using the rating of perceived exertion Borg scale. Results All participants were able to engage with the VR therapy remotely, reported enjoying sessions, and improved performance in some practice moments. The most important result in this cross-sectional study was the significant increasing in rating of perceived exertion (through Borg scale) in both groups during practice and with CP presenting a higher rating of perceived exertion. Conclusion Children with CP enjoyed participating, were able to perform at the same level as their peers on certain activities and increased both their performance and physical activity intensity when using the game, supporting the use of serious games for this group for home therapy and interactive games. Clinical Trials Registration https://Clinicaltrials.gov, NCT04402034. Registered on May 20, 2020.
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Affiliation(s)
- Talita Dias da Silva
- Departamento de Medicina (Cardiologia), Escola Paulista de Medicina da Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil.,Grupo de Pesquisa e Aplicações Tecnológicas em Reabilitação da Escola de Artes, Ciências e Humanidades da Universidade de São Paulo (PATER EACH USP), São Paulo, Brazil.,Faculdade de Medicina, Universidade Cidade de São Paulo (UNICID), São Paulo, Brazil
| | - Paula Lumy da Silva
- Fundação Hermínio Ometto (FHO-UNIARARAS), São Paulo, Brazil.,Departamento de Fisioterapia, Fonoaudiologia e Terapia Ocupacional, Faculdade de Medicina, Universidade de São Paulo (FOFITO - USP), São Paulo, Brazil
| | - Elisa de Jesus Valenzuela
- Departamento de Fisioterapia, Fonoaudiologia e Terapia Ocupacional, Faculdade de Medicina, Universidade de São Paulo (FOFITO - USP), São Paulo, Brazil
| | - Eduardo Dati Dias
- Grupo de Pesquisa e Aplicações Tecnológicas em Reabilitação da Escola de Artes, Ciências e Humanidades da Universidade de São Paulo (PATER EACH USP), São Paulo, Brazil
| | - Amanda Orasmo Simcsik
- Grupo de Pesquisa e Aplicações Tecnológicas em Reabilitação da Escola de Artes, Ciências e Humanidades da Universidade de São Paulo (PATER EACH USP), São Paulo, Brazil
| | - Mariana Giovanelli de Carvalho
- Departamento de Medicina (Cardiologia), Escola Paulista de Medicina da Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil.,Grupo de Pesquisa e Aplicações Tecnológicas em Reabilitação da Escola de Artes, Ciências e Humanidades da Universidade de São Paulo (PATER EACH USP), São Paulo, Brazil
| | - Anne Michelli Gomes Gonçalves Fontes
- Departamento de Fisioterapia, Fonoaudiologia e Terapia Ocupacional, Faculdade de Medicina, Universidade de São Paulo (FOFITO - USP), São Paulo, Brazil
| | - Camila Aparecida de Oliveira Alberissi
- Grupo de Pesquisa e Aplicações Tecnológicas em Reabilitação da Escola de Artes, Ciências e Humanidades da Universidade de São Paulo (PATER EACH USP), São Paulo, Brazil
| | - Luciano Vieira de Araújo
- Grupo de Pesquisa e Aplicações Tecnológicas em Reabilitação da Escola de Artes, Ciências e Humanidades da Universidade de São Paulo (PATER EACH USP), São Paulo, Brazil
| | - Murilo Vinícius da Costa Brandão
- Grupo de Pesquisa e Aplicações Tecnológicas em Reabilitação da Escola de Artes, Ciências e Humanidades da Universidade de São Paulo (PATER EACH USP), São Paulo, Brazil
| | - Helen Dawes
- Institute of Nursing and Allied Health Research, Oxford Brookes University, Oxford, United Kingdom.,Department of Clinical Neurology, University of Oxford, Oxford, United Kingdom
| | - Carlos Bandeira de Mello Monteiro
- Grupo de Pesquisa e Aplicações Tecnológicas em Reabilitação da Escola de Artes, Ciências e Humanidades da Universidade de São Paulo (PATER EACH USP), São Paulo, Brazil.,Departamento de Fisioterapia, Fonoaudiologia e Terapia Ocupacional, Faculdade de Medicina, Universidade de São Paulo (FOFITO - USP), São Paulo, Brazil
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Demers M, Martinie O, Winstein C, Robert MT. Active Video Games and Low-Cost Virtual Reality: An Ideal Therapeutic Modality for Children With Physical Disabilities During a Global Pandemic. Front Neurol 2020; 11:601898. [PMID: 33381077 PMCID: PMC7767913 DOI: 10.3389/fneur.2020.601898] [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: 09/01/2020] [Accepted: 11/26/2020] [Indexed: 12/27/2022] Open
Abstract
Current guidelines against spread of coronavirus (COVID-19) interrupt non-essential rehabilitation services. Thus, individuals with physical disabilities such as children with cerebral palsy can no longer benefit from physical rehabilitation during this undetermined period. Using either a synchronous or asynchronous format, in collaboration with a therapist via telerehabilitation, we suggest that active video games and low-cost virtual reality are a promising delivery mode for at-home rehabilitation in the context of a global pandemic. This therapeutic modality, incorporated into an at-home individualized treatment plan, provides a means to lessen the impact of an interruption in rehabilitation services while not loosing the pre-pandemic, in-person physical activity gains. Growing evidence supports active video games and low-cost virtual reality as viable therapeutic interventions for children with physical disabilities. These technologies are especially well-accepted by pediatric populations for the ludic and motivating features that lend themselves to nearly seamless incorporation into telerehabilitation. Advantages for rehabilitation of active video games and low-cost virtual reality include a rich, challenging, multi-modal training environment in which high numbers of movement repetitions can be accomplished, and a unique opportunity to foster engaged practice actions that go beyond household activities. We offer suggestions for the clinician about how to adopt active video games and low-cost virtual reality into your practice during a global pandemic.
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Affiliation(s)
- Marika Demers
- Division of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles, CA, United States
| | - Ophélie Martinie
- Center for Interdisciplinary Research in Rehabilitation and Social Integration, Quebec City, QC, Canada
- Department of Rehabilitation, Laval University, Quebec City, QC, Canada
| | - Carolee Winstein
- Division of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles, CA, United States
| | - Maxime T. Robert
- Center for Interdisciplinary Research in Rehabilitation and Social Integration, Quebec City, QC, Canada
- Department of Rehabilitation, Laval University, Quebec City, QC, Canada
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15
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Basha MA, Aboelnour NH, Aly SM, Kamel FAH. Impact of Kinect-based virtual reality training on physical fitness and quality of life in severely burned children: a monocentric randomized controlled trial. Ann Phys Rehabil Med 2020; 65:101471. [PMID: 33316436 DOI: 10.1016/j.rehab.2020.101471] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2020] [Revised: 11/02/2020] [Accepted: 11/18/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND Pediatric burns lead to persistent and detrimental muscle breakdown, weakness and poor quality of life, so rehabilitation is integral for improving physical and psychological outcomes. However, children with burns are a major challenge to a rehabilitation team. To overcome these challenges, enjoyable and interesting interventions are suggested. OBJECTIVE We aimed to determine the impact of the Xbox Kinect on cardiopulmonary fitness, muscle strength, lean mass, quality of life and enjoyment in severely burned children after hospital discharge. METHODS This was a randomized controlled trial in a single centre. Participants (n= 40 children) with burn injuries were randomized to the Xbox training group (n=20) or control group (n=20) during 12 weeks. All children received a home programme rehabilitation and Xbox training children received Xbox training. Outcomes included cardiopulmonary fitness (VO2peak), muscle strength (peak torque), lean mass (whole-body and regional), quality of life and physical activity enjoyment at baseline, immediately after hospital discharge, and 12 weeks after the intervention. RESULTS The mean (SD) age of the 40 children was 12.97 (1.42) years and total body surface area of burn was 51% (5). The groups did not differ in characteristics at baseline (P < 0.05). After 12 weeks of the intervention, the groups significantly differed in VO2peak, peak torque, quality of life (p<0.001), lean mass and leg lean mass (p<0.05) in favour of Xbox training. The mean difference in VO2peak, peak torque, lean mass and leg lean mass was 3.25 (2.1; 4.5) ml/kg/min, 7.5 (5.8; 9.2) Nm, 1.81 (0.5; 3.1) kg, and 1.1 (0.1; 2.1) kg, respectively. Lean trunk mass did not significantly differ between groups (p=0.07). The Xbox training group reported significantly more enjoyment than did the control group (p<0.001). CONCLUSION Xbox Kinect training can increase cardiopulmonary fitness, muscle strength, lean mass and quality of life in burned children. It is one of the most enjoyable, motivated and efficient treatment modalities that should be widely introduced into the pediatric burn rehabilitation.
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Affiliation(s)
- Maged A Basha
- Department of Physical Therapy, College of Medical Rehabilitation, Qassim University, Buraidah, Qassim, Saudi Arabia; Department of Physical Therapy, ElSahel Teaching Hospital, General Organization for Teaching Hospitals and Institutes, Cairo, Egypt.
| | - Nancy H Aboelnour
- Department of Physical Therapy for Surgery, Faculty of Physical Therapy, Cairo University, Cairo, Egypt
| | - Sobhy M Aly
- Department of Biomechanics, Faculty of Physical Therapy, Cairo University, Cairo, Egypt
| | - Fatma Alzahraa H Kamel
- Department of Physical Therapy, College of Medical Rehabilitation, Qassim University, Buraidah, Qassim, Saudi Arabia; Department of Physical Therapy for Surgery, Faculty of Physical Therapy, Cairo University, Cairo, Egypt
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16
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Effects of Virtual Reality vs Conventional Balance Training on Balance and Falls in People With Multiple Sclerosis: A Randomized Controlled Trial. Arch Phys Med Rehabil 2020; 102:290-299. [PMID: 33161005 DOI: 10.1016/j.apmr.2020.09.395] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Revised: 09/03/2020] [Accepted: 09/26/2020] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To assess the efficacy of virtual reality (VR)-based vs conventional balance training on the improvement of balance and reduction of falls in people with multiple sclerosis (PwMS). DESIGN Single-blinded, randomized, controlled trial. SETTING Musculoskeletal Rehabilitation Research Center, Ahvaz Jundishapur University of Medical Sciences. PARTICIPANTS PwMS (N=39), randomized into VR (n=19) and control (n=20) groups. INTERVENTION The VR group performed exergames using Kinect, while the control group accomplished conventional balance exercises. Both groups received 18 training sessions for 6 weeks. MAIN OUTCOME MEASURES Limits of stability, timed Up and Go (TUG) test, and 10-m walk tests with and without cognitive task and their dual-task costs (DTCs), Berg Balance Scale, Multiple Sclerosis Walking Scale-12, Fall Efficacy Scale-International, Activities-specific Balance Confidence Scale, and fall history were obtained pre- and post intervention and after a 3-month follow-up. RESULTS At both post intervention and follow-up, TUGcognitive and DTCs on the TUG were significantly lower and the 10-m walkcognitive was significantly higher in the VR group. At follow-up, reaction time and the number of falls demonstrated significant differences favoring the VR group, whereas the directional control revealed significant difference in favor of the control group (P<.05). The other outcomes showed no statistically significant difference at post intervention or follow-up. CONCLUSIONS Both the VR-based and conventional balance exercises improved balance and mobility in PwMS, while each acted better in improving certain aspects. VR-based training was more efficacious in enhancing cognitive-motor function and reducing falls, whereas conventional exercises led to better directional control. Further studies are needed to confirm the effectiveness of recruiting VR-based exercises in clinical settings.
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17
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Weber H, Barr C, Gough C, van den Berg M. How Commercially Available Virtual Reality-Based Interventions Are Delivered and Reported in Gait, Posture, and Balance Rehabilitation: A Systematic Review. Phys Ther 2020; 100:1805-1815. [PMID: 32691059 DOI: 10.1093/ptj/pzaa123] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Revised: 01/31/2020] [Accepted: 04/20/2020] [Indexed: 01/19/2023]
Abstract
OBJECTIVE Virtual reality (VR) technologies are increasingly used in physical rehabilitation; however, it is unclear how VR interventions are being delivered, and, in particular, the role of the therapist remains unknown. The purpose of this study was to systematically evaluate how commercially available VR technologies are being implemented in gait, posture, and balance rehabilitation, including justification, content, procedures, and dosage of the intervention and details of the therapist role. METHODS Five databases were searched between 2008 and 2018. Supervised interventional trials with >10 adult participants using commercially available VR technologies to address mobility limitations were independently selected by 2 authors. One author extracted reported intervention characteristics into a predesigned table and assessed methodological quality, which was independently verified by a second author. A total of 29 studies were included. RESULTS Generally, minimal clinical reasoning was provided to justify technology or activity selection, with recreational systems and games used most commonly (n = 25). All but 1 study used a single interventional technology. When explicitly described, the intervention was delivered by a physical therapist (n = 14), a therapist assistant (n = 2), both (n = 1), or an occupational therapist (n = 1). Most studies reported supervision (n = 12) and safeguarding (n = 8) as key therapist roles, with detail of therapist feedback less frequently reported (n = 4). Therapist involvement in program selection, tailoring, and progression was poorly described. CONCLUSION Intervention protocols of VR rehabilitation studies are incompletely described and generally lack detail on clinical rationale for technology and activity selection and on the therapist role in intervention design and delivery, hindering replication and translation of research into clinical practice. Future studies utilizing commercially available VR technologies should report all aspects of intervention design and delivery and consider protocols that allow therapists to exercise clinical autonomy in intervention delivery. IMPACT STATEMENT The findings of this systematic review have highlighted that VR rehabilitation interventions targeting gait, posture, and balance are primarily delivered by physical therapists, whose most reported role was supervision and safeguarding. There was an absence of detail regarding complex clinical skills, such as tailoring of the intervention and reasoning for the choice of technology and activity. This uncertainty around the role of the therapist as an active ingredient in VR-based rehabilitation hinders the development of implementation guidelines. To inform the optimal involvement of therapists in VR rehabilitation, it is essential that future studies report on all aspects of VR intervention design and delivery.
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Affiliation(s)
- Heather Weber
- College of Nursing and Health Sciences, Flinders University, GPO Box 2100, Adelaide 5001, Australia
| | | | - Claire Gough
- College of Nursing and Health Sciences, Flinders University
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18
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Decavele S, Ortibus E, Van Campenhout A, Molenaers G, Jansen B, Omelina L, Franki I. The Effect of a Rehabilitation Specific Gaming Software Platform to Achieve Individual Physiotherapy Goals in Children with Severe Spastic Cerebral Palsy: A Randomized Crossover Trial. Games Health J 2020; 9:376-385. [PMID: 32614723 DOI: 10.1089/g4h.2019.0097] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Cerebral palsy (CP) is the most common cause of permanent neurological disabilities in children. Many children require long-term daily physiotherapy (PT), and videogaming is a promising tool to increase motivation in rehabilitation. The short- and medium-term effects of an intervention with rehabilitation specific videogames were evaluated on individually defined therapy goals, gross motor function, and motivation. Thirty-two children with bilateral spastic CP, Gross Motor Function Classification level III-IV, and 6-15 years were randomized into an intervention group (regular PT and gaming) or a control group (regular PT), followed by a crossover. The effects of both training periods (each 12 weeks) were compared using the Goal Attainment Scale (GAS), Trunk Control Measurement Scale (TCMS), Pediatric Balance Scale (PBS), Gross Motor Function Measure-88 (GMFM-88), and Dimensions of Mastery Motivation Questionnaire (DMQ). After 3 months follow-up, children were retested using the GMFM, TCMS, and PBS. The GAS change scores were significantly higher after the intervention compared to the control period (8.5 and 2.4, P < 0.001). The change scores for standing exercises (3.85 and 0.22, P = 0.04) and dynamic sitting balance (5.9 and -1.7, P < 0.001) were also significantly higher. After 3 months follow-up the results did not persist. A combined approach of regular PT and rehabilitation specific gaming showed significant effects on individually defined therapy goals, dynamic sitting balance, and standing exercises. However, the lack of persistent effect indicates that continuous individual goal-oriented PT with the addition of gaming is needed.
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Affiliation(s)
- Sophie Decavele
- CP Reference Centre, University Hospital Leuven, Leuven, Belgium
| | - Els Ortibus
- CP Reference Centre, University Hospital Leuven, Leuven, Belgium
- Department of Development and Regeneration, University of Leuven (KU Leuven), Leuven, Belgium
| | - Anja Van Campenhout
- CP Reference Centre, University Hospital Leuven, Leuven, Belgium
- Department of Development and Regeneration, University of Leuven (KU Leuven), Leuven, Belgium
- Department of Orthopedics, University Hospital Leuven, Leuven, Belgium
| | - Guy Molenaers
- CP Reference Centre, University Hospital Leuven, Leuven, Belgium
- Department of Development and Regeneration, University of Leuven (KU Leuven), Leuven, Belgium
- Department of Orthopedics, University Hospital Leuven, Leuven, Belgium
| | - Bart Jansen
- Department of Electronics and Informatics, Vrije Universiteit Brussel, Brussels, Belgium
- Imec, Leuven, Belgium
| | - Lubos Omelina
- Department of Electronics and Informatics, Vrije Universiteit Brussel, Brussels, Belgium
- Imec, Leuven, Belgium
| | - Inge Franki
- CP Reference Centre, University Hospital Leuven, Leuven, Belgium
- Department of Development and Regeneration, University of Leuven (KU Leuven), Leuven, Belgium
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SUN TIENLUNG, LEE CHIAHSUAN, LAI CHUNGLIANG, JIANG BERNARDC. CORRELATING COMMON CLINICAL POSTURAL STABILITY MEASUREMENTS WITH BALANCE ASSESSMENTS. J MECH MED BIOL 2020. [DOI: 10.1142/s0219519419500672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Postural stability assessments are typically used for training and tracking. The training results of stroke patients are investigated in terms of task execution and experimental methods. However, the selection of evaluation and training tools has not been discussed in depth. To explore the postural stability evaluation index, we used a range of widely applied assessment tools in occupational therapy. Methods: We studied the rehabilitation of 15 patients who had suffered chronic strokes for at least two years. The tools include the Timed Up and Go Test, which is used by rehabilitation professionals in postural stability evaluations, the biodex balance evaluation instrument, and a Kinect game developed for virtual reality therapy. Results: We propose an active and a passive assessment model. For training, we recommend combining active and passive assessments for confirmations. For assessments, the evaluation tool should be selected according to the postural stability task (active or passive). In the predictive models, if the different tools are considered simultaneously, static postural stability should be used as the main investigation. We suggest that by first studying the tools used to investigate postural stability assessments, balance assessments in stroke patients can also be improved.
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Affiliation(s)
- TIEN LUNG SUN
- Department of Industrial Engineering and Management, Yuan Ze University, 135 Yuan Tung Road, Chungli District, Taoyuan 320, Taiwan, R. O. C
| | - CHIA HSUAN LEE
- Department of Industrial Management, National Taiwan University of Science and Technology, No. 43, Sec. 4, Keelung Road, Da’an District, Taipei 106, Taiwan, R. O. C
| | - CHUNG LIANG LAI
- Department of Physical Medicine and Rehabilitation, Taichung Hospital, Ministry of Health and Welfare, Taichung, Taiwan
- Department of Occupational Therapy, Asia University, Taichung, Taiwan
| | - BERNARD C. JIANG
- Department of Industrial Management, National Taiwan University of Science and Technology, No. 43, Sec. 4, Keelung Road, Da’an District, Taipei 106, Taiwan, R. O. C
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Lanza G, Casabona JA, Bellomo M, Cantone M, Fisicaro F, Bella R, Pennisi G, Bramanti P, Pennisi M, Bramanti A. Update on intensive motor training in spinocerebellar ataxia: time to move a step forward? J Int Med Res 2020; 48:300060519854626. [PMID: 31537137 PMCID: PMC7579332 DOI: 10.1177/0300060519854626] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Some evidence suggests that high-intensity motor training slows down the severity of spinocerebellar ataxia. However, whether all patients might benefit from these activities, and by which activity, and the underlying mechanisms remain unclear. We provide an update on the effect and limitations of different training programmes in patients with spinocerebellar ataxias. Overall, data converge of the finding that intensive training is still based either on conventional rehabilitation protocols or whole-body controlled videogames ("exergames"). Notwithstanding the limitations, short-term improvement is observed, which tends to be lost once the training is stopped. Exergames and virtual reality can ameliorate balance, coordination, and walking abilities, whereas the efficacy of adapted physical activity, gym, and postural exercises depends on the disease duration and severity. In conclusion, although a disease-modifying effect has not been demonstrated, constant, individually tailored, high-intensity motor training might be effective in patients with degenerative ataxia, even in those with severe disease. These approaches may enhance the remaining cerebellar circuitries or plastically induce compensatory networks. Further research is required to identify predictors of training success, such as the type and severity of ataxia and the level of residual functioning.
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Affiliation(s)
- Giuseppe Lanza
- Department of Surgery and Medical-Surgical Specialties,
University of Catania, Catania, Italy
- Department of Neurology IC, Oasi Research Institute – IRCCS,
Troina, Italy
- Giuseppe Lanza, Via Santa Sofia, 78 – 95125,
Catania, Italy.
| | | | - Maria Bellomo
- School of Human and Social Science, University Kore of Enna,
Enna, Italy
| | - Mariagiovanna Cantone
- Department of Neurology, Sant’Elia Hospital, ASP Caltanissetta,
Caltanissetta, Italy
| | - Francesco Fisicaro
- Department of Medical and Surgical Sciences and Advanced
Technologies, University of Catania, Catania, Italy
| | - Rita Bella
- Department of Medical and Surgical Sciences and Advanced
Technologies, University of Catania, Catania, Italy
| | - Giovanni Pennisi
- Department of Surgery and Medical-Surgical Specialties,
University of Catania, Catania, Italy
| | | | - Manuela Pennisi
- Department of Biomedical and Biotechnological Sciences,
University of Catania, Catania, Italy
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Banerjee-Guénette P, Bigford S, Glegg SMN. Facilitating the Implementation of Virtual Reality-Based Therapies in Pediatric Rehabilitation. Phys Occup Ther Pediatr 2020; 40:201-216. [PMID: 31416381 DOI: 10.1080/01942638.2019.1650867] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Aims: Evaluate the impact of a multifaceted knowledge translation (KT) strategy for the implementation of virtual reality (VR) intervention by rehabilitation clinicians in a pediatric hospital setting.Methods: Eleven therapists were recruited and completed a questionnaire on perceptions on VR usage. A multifaceted KT strategy was implemented over five months. VR usage was tracked and clinician perceptions were reassessed. Baseline characteristics were summarized using descriptive statistics and a Wilcoxon signed rank sum test evaluated changes pre- and post-KT.Results: Perceived ease of use, behavioral control, self-efficacy, and barriers to use improved significantly post-KT; however, intention to use did not. Usage was higher pre-KT than the last two months of KT. Pre-KT, barriers included system setup and use, knowledge of games, and lack of resources, whereas post-KT, they were the lack of appropriate patients and patient-specific experience. KT supports and patient engagement were reasons for continued use.Conclusions: This study highlights the importance of supporting clinicians when implementing VR in clinical rehabilitation. Clinicians benefit from experiential and individualized learning opportunities, peer-led coaching, and hands-on training. Whether these strategies translate to increased usage and how usage is influenced by environmental factors (i.e. lack of appropriate clients) warrants additional research.
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Affiliation(s)
| | - Sarah Bigford
- Development and Rehabilitation, Children's Hospital of Eastern Ontario, Ottawa, ON, Canada
| | - Stephanie M N Glegg
- Sunny Hill Health Centre for Children, Vancouver, BC, Canada.,Occupational Science and Occupational Therapy, The University of British Columbia, Vancouver, BC, Canada
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22
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Clark WE, Sivan M, O'Connor RJ. Evaluating the use of robotic and virtual reality rehabilitation technologies to improve function in stroke survivors: A narrative review. J Rehabil Assist Technol Eng 2019; 6:2055668319863557. [PMID: 31763052 PMCID: PMC6854750 DOI: 10.1177/2055668319863557] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2018] [Accepted: 06/18/2019] [Indexed: 12/14/2022] Open
Abstract
This review evaluates the effectiveness of robotic and virtual reality technologies used for neurological rehabilitation in stroke survivors. It examines each rehabilitation technology in turn before considering combinations of these technologies and the complexities of rehabilitation outcome assessment. There is high-quality evidence that upper-limb robotic rehabilitation technologies improve movement, strength and activities of daily living, whilst the evidence for robotic lower-limb rehabilitation is currently not as convincing. Virtual reality technologies also improve activities of daily living. Whilst the benefit of these technologies over dose-controlled conventional rehabilitation is likely to be small, there is a role for both technologies as part of a broader rehabilitation programme, where they may help to increase the intensity and amount of therapy delivered. Combining robotic and virtual reality technologies in a rehabilitation programme may further improve rehabilitation outcomes and we would advocate randomised controlled trials of these technologies in combination.
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Affiliation(s)
- William E Clark
- Academic Department of Rehabilitation Medicine, Leeds Institute of Rheumatic and Musculoskeletal Medicine, Faculty of Medicine and Health, University of Leeds, Leeds, UK
| | - Manoj Sivan
- Academic Department of Rehabilitation Medicine, Leeds Institute of Rheumatic and Musculoskeletal Medicine, Faculty of Medicine and Health, University of Leeds, Leeds, UK.,National Demonstration Centre for Rehabilitation Medicine, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Rory J O'Connor
- Academic Department of Rehabilitation Medicine, Leeds Institute of Rheumatic and Musculoskeletal Medicine, Faculty of Medicine and Health, University of Leeds, Leeds, UK.,National Demonstration Centre for Rehabilitation Medicine, Leeds Teaching Hospitals NHS Trust, Leeds, UK.,National Institute of Health Research Devices for Dignity MedTech Co-operative, Royal Hallamshire Hospital, Glossop Road, Sheffield, UK
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23
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Barriers, Facilitators and Interventions to Support Virtual Reality Implementation in Rehabilitation: A Scoping Review. PM R 2019; 10:1237-1251.e1. [PMID: 30503231 DOI: 10.1016/j.pmrj.2018.07.004] [Citation(s) in RCA: 53] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2018] [Revised: 06/05/2018] [Accepted: 07/01/2018] [Indexed: 11/20/2022]
Abstract
Virtual reality and active video games (VR/AVGs) are promising rehabilitation tools because of their potential to facilitate abundant, motivating, and feedback-rich practice. However, clinical adoption remains low despite a growing evidence base and the recent development of clinically accessible and rehabilitation-specific VR/AVG systems. Given clinicians' eagerness for resources to support VR/AVG use, a critical need exists for knowledge translation (KT) interventions to facilitate VR/AVG integration into clinical practice. KT interventions have the potential to support adoption by targeting known barriers to, and facilitators of, change. This scoping review of the VR/AVG literature uses the Theoretical Domains Framework (TDF) to (1) structure an overview of known barriers and facilitators to clinical uptake of VR/AVGs for rehabilitation; (2) identify KT strategies to target these factors to facilitate adoption; and (3) report the results of these strategies. Barriers/facilitators and evaluated or proposed KT interventions spanned all but 1 and 2 TDF domains, respectively. Most frequently cited barriers/facilitators were found in the TDF domains of Knowledge, Skills, Beliefs About Capabilities, Beliefs About Consequences, Intentions, Goals, Environmental Context and Resources, and Social Influences. Few studies empirically evaluated KT interventions to support adoption; measured change in VR/AVG use did not accompany improvements in self-reported skills, attitudes, and knowledge. Recommendations to target frequently identified barriers include technology development to meet end-user needs more effectively, competency development for end-users, and facilitated VR/AVG implementation in clinical settings. Subsequent research can address knowledge gaps in both clinical and VR/AVG implementation research, including on KT intervention effectiveness and unexamined TDF domain barriers. LEVEL OF EVIDENCE: IV.
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Lanza G, Casabona JA, Bellomo M, Cantone M, Fisicaro F, Bella R, Pennisi G, Bramanti P, Pennisi M, Bramanti A. Update on intensive motor training in spinocerebellar ataxia: time to move a step forward? J Int Med Res 2019. [PMID: 31537137 DOI: 10.1177/0300060519854626.] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Some evidence suggests that high-intensity motor training slows down the severity of spinocerebellar ataxia. However, whether all patients might benefit from these activities, and by which activity, and the underlying mechanisms remain unclear. We provide an update on the effect and limitations of different training programmes in patients with spinocerebellar ataxias. Overall, data converge of the finding that intensive training is still based either on conventional rehabilitation protocols or whole-body controlled videogames ("exergames"). Notwithstanding the limitations, short-term improvement is observed, which tends to be lost once the training is stopped. Exergames and virtual reality can ameliorate balance, coordination, and walking abilities, whereas the efficacy of adapted physical activity, gym, and postural exercises depends on the disease duration and severity. In conclusion, although a disease-modifying effect has not been demonstrated, constant, individually tailored, high-intensity motor training might be effective in patients with degenerative ataxia, even in those with severe disease. These approaches may enhance the remaining cerebellar circuitries or plastically induce compensatory networks. Further research is required to identify predictors of training success, such as the type and severity of ataxia and the level of residual functioning.
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Affiliation(s)
- Giuseppe Lanza
- Department of Surgery and Medical-Surgical Specialties, University of Catania, Catania, Italy.,Department of Neurology IC, Oasi Research Institute - IRCCS, Troina, Italy
| | | | - Maria Bellomo
- School of Human and Social Science, University Kore of Enna, Enna, Italy
| | - Mariagiovanna Cantone
- Department of Neurology, Sant'Elia Hospital, ASP Caltanissetta, Caltanissetta, Italy
| | - Francesco Fisicaro
- Department of Medical and Surgical Sciences and Advanced Technologies, University of Catania, Catania, Italy
| | - Rita Bella
- Department of Medical and Surgical Sciences and Advanced Technologies, University of Catania, Catania, Italy
| | - Giovanni Pennisi
- Department of Surgery and Medical-Surgical Specialties, University of Catania, Catania, Italy
| | | | - Manuela Pennisi
- Department of Biomedical and Biotechnological Sciences, University of Catania, Catania, Italy
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Sun Y, Wang H, Bo S. Altered topological connectivity of internet addiction in resting-state EEG through network analysis. Addict Behav 2019; 95:49-57. [PMID: 30844604 DOI: 10.1016/j.addbeh.2019.02.015] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2018] [Revised: 01/17/2019] [Accepted: 02/14/2019] [Indexed: 10/27/2022]
Abstract
The results of some neuroimaging studies have revealed that people with internet addiction (IA) exhibit structural and functional changes in specific brain areas and connections. However, the understanding about global topological organization of IA may also require a more integrative and holistic view of brain function. In the present study, we used synchronization likelihood combined with graph theory analysis to investigate the functional connectivity (FC) and topological differences between 25 participants with IA and 27 healthy controls (HCs) based on their spontaneous EEG activities in the eye-closed resting state. There were no significant differences in FC (total network or sub-networks) between groups (p > .05 for all). Graph analysis showed significantly lower characteristic path length and clustering coefficient in the IA group than in the HC group in the beta and gamma bands, respectively. Altered nodal centralities of the frontal (FP1, FPz) and parietal (CP1, CP5, PO3, PO7, P5, P6, TP8) lobes in the IA group were also observed. Correlation analysis demonstrated that the observed regional alterations were significantly correlated with the severity of IA. Collectively, our findings showed that IA group demonstrated altered topological organization, shifting towards a more random state. Moreover, this study revealed the important role of altered brain areas in the neuropathological mechanism of IA and provided further supportive evidence for the diagnosis of IA.
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Seo NJ, Crocher V, Spaho E, Ewert CR, Fathi MF, Hur P, Lum SA, Humanitzki EM, Kelly AL, Ramakrishnan V, Woodbury ML. Capturing Upper Limb Gross Motor Categories Using the Kinect® Sensor. Am J Occup Ther 2019; 73:7304205090p1-7304205090p10. [PMID: 31318673 DOI: 10.5014/ajot.2019.031682] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
IMPORTANCE Along with growth in telerehabilitation, a concurrent need has arisen for standardized methods of tele-evaluation. OBJECTIVE To examine the feasibility of using the Kinect sensor in an objective, computerized clinical assessment of upper limb motor categories. DESIGN We developed a computerized Mallet classification using the Kinect sensor. Accuracy of computer scoring was assessed on the basis of reference scores determined collaboratively by multiple evaluators from reviewing video recording of movements. In addition, using the reference score, we assessed the accuracy of the typical clinical procedure in which scores were determined immediately on the basis of visual observation. The accuracy of the computer scores was compared with that of the typical clinical procedure. SETTING Research laboratory. PARTICIPANTS Seven patients with stroke and 10 healthy adult participants. Healthy participants intentionally achieved predetermined scores. OUTCOMES AND MEASURES Accuracy of the computer scores in comparison with accuracy of the typical clinical procedure (immediate visual assessment). RESULTS The computerized assessment placed participants' upper limb movements in motor categories as accurately as did typical clinical procedures. CONCLUSIONS AND RELEVANCE Computerized clinical assessment using the Kinect sensor promises to facilitate tele-evaluation and complement telehealth applications. WHAT THIS ARTICLE ADDS Computerized clinical assessment can enable patients to conduct evaluations remotely in their homes without therapists present.
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Affiliation(s)
- Na Jin Seo
- Na Jin Seo, PhD, is Associate Professor, Division of Occupational Therapy, Department of Health Professions, and Associate Professor, Department of Health Science and Research, Medical University of South Carolina, Charleston;
| | - Vincent Crocher
- Vincent Crocher, PhD, is Research Associate, School of Engineering, University of Melbourne, Parkville, Victoria, Australia. At the time of the study, he was Postdoctoral Researcher, Department of Industrial and Manufacturing Engineering, University of Wisconsin-Milwaukee
| | - Egli Spaho
- Egli Spaho, DPT, is Physical Therapist, Ascension All Saints Hospital, Racine, Wisconsin. At the time of the study, he was Research Assistant, Department of Kinesiology, University of Wisconsin-Milwaukee
| | - Charles R Ewert
- Charles R. Ewert, BS, is Associate Software Engineer, Northwestern Mutual, Milwaukee, Wisconsin. At the time of the study, he was Research Assistant, Department of Computer Science, University of Wisconsin-Milwaukee
| | - Mojtaba F Fathi
- Mojtaba F. Fathi, PhD, is Research Associate, Department of Mechanical Engineering, University of Wisconsin-Milwaukee
| | - Pilwon Hur
- Pilwon Hur, PhD, is Assistant Professor, Department of Mechanical Engineering, Texas A&M University, College Station
| | - Sara A Lum
- Sara A. Lum, MS, OTR/L, is Occupational Therapist, Wake Forest Baptist Medical Center, Winston-Salem, North Carolina. At the time of the study, she was Student, Division of Occupational Therapy, Department of Health Professions, Medical University of South Carolina, Charleston
| | - Elizabeth M Humanitzki
- Elizabeth M. Humanitzki, MS, OTR/L, is Occupational Therapist, Coastal Therapy Services Inc., Charleston, South Carolina. At the time of the study, she was Student, Division of Occupational Therapy, Department of Health Professions, Medical University of South Carolina, Charleston
| | - Abigail L Kelly
- Abigail L. Kelly, MS, is Instructor, Department of Stomatology, Medical University of South Carolina, Charleston. At the time of the study, she was Research Associate, Department of Public Health Sciences, Medical University of South Carolina, Charleston
| | - Viswanathan Ramakrishnan
- Viswanathan Ramakrishnan, PhD, is Professor, Department of Public Health Sciences, Medical University of South Carolina, Charleston
| | - Michelle L Woodbury
- Michelle L. Woodbury, PhD, OTR/L, is Associate Professor, Division of Occupational Therapy, Department of Health Professions, and Associate Professor, Department of Health Science and Research, Medical University of South Carolina, Charleston
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Levac DE, Pradhan S, Espy D, Fox E, Deutsch JE. Usability of the 'Kinect-ing' with Clinicians Website: A Knowledge Translation Resource Supporting Decisions About Active Videogame Use in Rehabilitation. Games Health J 2018; 7:362-368. [PMID: 30179519 PMCID: PMC11074719 DOI: 10.1089/g4h.2017.0159] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Objective: Commercially available active videogames (AVGs) are promising rehabilitation options, but lack of familiarity with game options may limit clinical integration. We evaluated content and format usability of the 'Kinect-ing' with Clinicians (KwiC) website, an online tool that characterizes commercially available games to support clinical decision-making about Kinect™ game use for rehabilitation. Materials and Methods: This study is a cross-sectional online survey of physical therapists (PTs). Participants selected a case scenario and reviewed the KwiC resource for information about five Kinect games. Based on this interaction, participants selected two games that would meet case scenario goals and answered Likert scale and open-ended questions about KwiC usability and usefulness of the content in guiding game selection for clinical case scenarios. Results: Twenty-five PTs participated, six of whom had previous AVG experience. All KwiC items achieved prespecified consensus of 80% "agree" or "strongly agree" on statements evaluating ease of understanding, usefulness, and format usability. There were no differences in ratings between those with and without AVG experience. Participants most appreciated the videos illustrating game play. Eighty-four percent strongly agreed that the KwiC helped them to make a decision about their case scenario. Participants suggested improving the KwiC by including more information about game use with rehabilitation populations. Conclusions: Positive usability feedback supports continued KwiC development efforts to add additional games, expand information about use specific to clinical populations, and broaden the online format to allow opportunities for clinicians to provide feedback and suggestions. We will then evaluate utility of the KwiC in clinical practice.
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Affiliation(s)
- Danielle E. Levac
- Department of Physical Therapy, Movement and Rehabilitation Sciences, Bouvé College of Health Sciences, Northeastern University, Boston, Massachusetts
| | - Sujata Pradhan
- Division of Physical Therapy, Department of Rehabilitation Medicine, University of Washington, Seattle, Washington
| | - Debbie Espy
- Physical Therapy Program, School of Health Sciences, Cleveland State University, Cleveland, Ohio
| | - Emily Fox
- Department of Physical Therapy, University of Florida, Gainesville, Florida
- Brooks Clinical Research Center, Brooks Rehabilitation, Jacksonville, Florida
| | - Judith E. Deutsch
- Department of Rehabilitation and Movement Sciences, School of Health Professions, Rutgers University, Newark, New Jersey
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Sápi M, Domján A, Fehérné Kiss A, Pintér S. Is Kinect Training Superior to Conventional Balance Training for Healthy Older Adults to Improve Postural Control? Games Health J 2018; 8:41-48. [PMID: 30153062 DOI: 10.1089/g4h.2018.0027] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVE To investigate the effects of balance training to improve postural control in adults older than 60. Our aim was to find out if Kinect training is superior to the conventional balance training in aspects of functional balance tests and posturography measurements testing postural stability through visual feedback. MATERIALS AND METHODS Thirty subjects participated in the Kinect training group (29 women and 1 man), practiced Kinect Adventures and Sports, 23 volunteers (22 women and 1 man) attended the conventional balance training, and 22 participants (18 women and 4 men) were allocated to the no-intervention control group. Both interventions lasted for 6 weeks, three times a week, and 30 minutes per session. The Four-Square Step Test, Functional Reach Test, Timed Up and Go test, Timed Up and Go cognitive dual-task test were measured, and for the assessment of the limit of stability (LOS), we used computerized posturography. Measurements were taken before the training at baseline and 6 weeks after (follow-up) the interventions. Statistical analysis was done through two-factor mixed analysis of variance and Newman-Keuls post hoc test. RESULTS Both training groups showed progress in the follow-up measurements; however, more statistically significant improvements were found in favor of the Kinect balance training group (Timed Up and Go test [P < 0.05], Timed Up and Go cognitive dual-task test [P < 0.05], Four-Square Step Test [P < 0.05], Functional Reach Test [P < 0.05], LOS movement velocity [P < 0.05]). CONCLUSION Our results suggest that Kinect balance training may be a preferable and safe method for the healthy older adults to improve postural control and reduce the possibility of falling.
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Affiliation(s)
- Mariann Sápi
- 1 Department of Orthopaedics, Physiotherapy Centre, University of Szeged, Szeged, Hungary
| | - Andrea Domján
- 2 Department of Physiotherapy, Faculty of Health Sciences and Social Studies, University of Szeged, Szeged, Hungary
| | - Anna Fehérné Kiss
- 1 Department of Orthopaedics, Physiotherapy Centre, University of Szeged, Szeged, Hungary
| | - Sándor Pintér
- 3 Department of Traumatology, Faculty of Medicine, University of Szeged, Szeged, Hungary
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Lozano EI, Potterton JL. The use of Xbox Kinect™ in a Paediatric Burns Unit. SOUTH AFRICAN JOURNAL OF PHYSIOTHERAPY 2018; 74:429. [PMID: 30135921 PMCID: PMC6093127 DOI: 10.4102/sajp.v74i1.429] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2017] [Accepted: 01/31/2018] [Indexed: 01/01/2023] Open
Abstract
Background The popularity of video game use in burns rehabilitation has grown because, in addition to facilitating maintenance of range of motion (ROM), the virtual imaging characteristics of these games provide distraction from pain. Objectives The effect of using Xbox Kinect™ as an adjunct to physiotherapy in a Paediatric Burns Unit (PBU) has not been established. This study aimed to investigate the effect of using the Xbox Kinect™ on outcomes of children in the PBU at Chris Hani Baragwanath Academic Hospital. Methods This non-equivalent, post-test only control group study took place over a period of 14 months. The control group received standard physiotherapy management and the experimental group received standard physiotherapy management and additional Xbox Kinect™. Outcome measures were ROM, Activities Scale for Kids (ASK©p) and a modified Wong-Baker FACES® enjoyment rating scale. Outcomes were assessed at discharge and then 1 week post-discharge at the usual follow-up appointment. Results Sixty-six children participated in this study. More than 50% of the burns were because of hot water, followed by flame burns (30%) and electrical burns (12%). The addition of Xbox Kinect™ was effective in achieving higher active ROM (AROM) between discharge and follow-up (p < 0.01). Fun and enjoyment (p < 0.01) was found to be significantly higher in the children who participated in Xbox Kinect™. Total body surface area (TBSA%) (p = 0.03), age (p = 0.05) and AROM (p = 0.04) were significantly associated with ASK©p scores. Conclusion The use of the Xbox Kinect™ has been shown to be a beneficial and useful adjunct to burns rehabilitation in this paediatric burns population. Clinical implications Currently, there is limited information and research on interventions for children with burns in South Africa. The addition of Xbox Kinect™ to standard physiotherapy in-patient care was both enjoyable and effective and should be considered where funding is available.
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Affiliation(s)
- Eleonora I Lozano
- Department of Physiotherapy, University of the Witwatersrand, South Africa.,Chris Hani Baragwanath Academic Hospital, Johannesburg, South Africa
| | - Joanne L Potterton
- Department of Physiotherapy, University of the Witwatersrand, South Africa
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Valdés BA, Glegg SMN, Lambert-Shirzad N, Schneider AN, Marr J, Bernard R, Lohse K, Hoens AM, Van der Loos HFM. Application of Commercial Games for Home-Based Rehabilitation for People with Hemiparesis: Challenges and Lessons Learned. Games Health J 2018; 7:197-207. [PMID: 29565694 DOI: 10.1089/g4h.2017.0137] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE To identify the factors that influence the use of an at-home virtual rehabilitation gaming system from the perspective of therapists, engineers, and adults and adolescents with hemiparesis secondary to stroke, brain injury, and cerebral palsy. MATERIALS AND METHODS This study reports on qualitative findings from a study, involving seven adults (two female; mean age: 65 ± 8 years) and three adolescents (one female; mean age: 15 ± 2 years) with hemiparesis, evaluating the feasibility and clinical effectiveness of a home-based custom-designed virtual rehabilitation system over 2 months. Thematic analysis was used to analyze qualitative data from therapists' weekly telephone interview notes, research team documentation regarding issues raised during technical support interactions, and the transcript of a poststudy debriefing session involving research team members and collaborators. RESULTS Qualitative themes that emerged suggested that system use was associated with three key factors as follows: (1) the technology itself (e.g., characteristics of the games and their clinical implications, system accessibility, and hardware and software design); (2) communication processes (e.g., preferences and effectiveness of methods used during the study); and (3) knowledge and training of participants and therapists on the technology's use (e.g., familiarity with Facebook, time required to gain competence with the system, and need for clinical observations during remote therapy). Strategies to address these factors are proposed. CONCLUSION Lessons learned from this study can inform future clinical and implementation research using commercial videogames and social media platforms. The capacity to track compensatory movements, clinical considerations in game selection, the provision of kinematic and treatment progress reports to participants, and effective communication and training for therapists and participants may enhance research success, system usability, and adoption.
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Affiliation(s)
- Bulmaro A Valdés
- 1 RREACH (Robotics for Rehabilitation Exercise and Assessment in Collaborative Healthcare) Lab, Department of Mechanical Engineering, The University of British Columbia , Vancouver, Canada
| | - Stephanie M N Glegg
- 2 Sunny Hill Health Centre for Children , Therapy Department, Vancouver, Canada
| | - Navid Lambert-Shirzad
- 1 RREACH (Robotics for Rehabilitation Exercise and Assessment in Collaborative Healthcare) Lab, Department of Mechanical Engineering, The University of British Columbia , Vancouver, Canada
| | - Andrea N Schneider
- 3 Abilities Neurological Rehabilitation , Department of Occupational Therapy, Surrey, Canada
| | - Jonathan Marr
- 1 RREACH (Robotics for Rehabilitation Exercise and Assessment in Collaborative Healthcare) Lab, Department of Mechanical Engineering, The University of British Columbia , Vancouver, Canada
| | - Renee Bernard
- 1 RREACH (Robotics for Rehabilitation Exercise and Assessment in Collaborative Healthcare) Lab, Department of Mechanical Engineering, The University of British Columbia , Vancouver, Canada
| | - Keith Lohse
- 4 Department of Health, Kinesiology, and Recreation, and Department of Physical Therapy and Athletic Training, University of Utah College of Health , Salt Lake City, Utah
| | - Alison M Hoens
- 5 Department of Physical Therapy, University of British Columbia , Vancouver, Canada
| | - H F Machiel Van der Loos
- 1 RREACH (Robotics for Rehabilitation Exercise and Assessment in Collaborative Healthcare) Lab, Department of Mechanical Engineering, The University of British Columbia , Vancouver, Canada
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Nguyen AV, Ong YLA, Luo CX, Thuraisingam T, Rubino M, Levin MF, Kaizer F, Archambault PS. Virtual reality exergaming as adjunctive therapy in a sub-acute stroke rehabilitation setting: facilitators and barriers. Disabil Rehabil Assist Technol 2018. [DOI: 10.1080/17483107.2018.1447608] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
- Ai-Vi Nguyen
- School of Physical and Occupational Therapy, McGill University, Montreal, Canada
| | - Yau-Lok Austin Ong
- School of Physical and Occupational Therapy, McGill University, Montreal, Canada
| | - Cindy Xin Luo
- School of Physical and Occupational Therapy, McGill University, Montreal, Canada
| | - Thiviya Thuraisingam
- School of Physical and Occupational Therapy, McGill University, Montreal, Canada
| | - Michael Rubino
- School of Physical and Occupational Therapy, McGill University, Montreal, Canada
| | - Mindy F. Levin
- School of Physical and Occupational Therapy, McGill University, Montreal, Canada
- CISSS Laval, Jewish Rehabilitation Hospital, Laval, Canada
| | - Franceen Kaizer
- CISSS Laval, Jewish Rehabilitation Hospital, Laval, Canada
- Interdisciplinary Research Centre in Rehabilitation (CRIR), Montreal, Canada
| | - Philippe S. Archambault
- School of Physical and Occupational Therapy, McGill University, Montreal, Canada
- CISSS Laval, Jewish Rehabilitation Hospital, Laval, Canada
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Pradhan S. The use of commercially available games for a combined physical and cognitive challenge during exercise for individuals with Parkinson's disease - a case series report. Physiother Theory Pract 2018. [PMID: 29521568 DOI: 10.1080/09593985.2018.1444118] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Complexity of an animal's environment has been shown to affect structural and functional changes in the brain. Evidence from animal models of Parkinson's disease (PD) suggests that exercising in an enriched environment may protect against the onset of Parkinsonian symptoms in rats that are exposed to 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine. The variety of activities and visual interfaces that can be created using commercially available gaming devices provide cognitively stimulating as well as physically challenging environments for exercise. This case series will: 1) elaborate on the rationale behind selection of specific games to target common deficits seen in PD; and 2) present preliminary results on clinical outcomes from three pilot participants who each completed six sessions of exercise. All three participants had mild to moderate PD. They were functionally independent individuals leading an active lifestyle. Participants were tested on the outcome measures before and after the six exercise sessions. On average, participants showed a 33.8% (22.8) improvement in functional reach test, 12.7% (35.0) improvement in single limb stance (SLS) time-right leg, 55.2% (33.9) improvement in SLS time-left leg, 11.9% (7.3) improvement in 6-min walk test, 2% (6.8) improvement in self-selected gait speed (GS), and 8.0% (5.8) improvement in fastest possible GS. Further investigation is warranted to study if these effects can be replicated over a longer exercise intervention and in a larger group, and if these effects are maintained at follow-up testing after the enriched exercise intervention is discontinued.
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Affiliation(s)
- Sujata Pradhan
- a Department of Rehabilitation Medicine, Division of Physical Therapy , University of Washington , Seattle , WA
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Abstract
BACKGROUND Virtual reality and interactive video gaming have emerged as recent treatment approaches in stroke rehabilitation with commercial gaming consoles in particular, being rapidly adopted in clinical settings. This is an update of a Cochrane Review published first in 2011 and then again in 2015. OBJECTIVES Primary objective: to determine the efficacy of virtual reality compared with an alternative intervention or no intervention on upper limb function and activity.Secondary objectives: to determine the efficacy of virtual reality compared with an alternative intervention or no intervention on: gait and balance, global motor function, cognitive function, activity limitation, participation restriction, quality of life, and adverse events. SEARCH METHODS We searched the Cochrane Stroke Group Trials Register (April 2017), CENTRAL, MEDLINE, Embase, and seven additional databases. We also searched trials registries and reference lists. SELECTION CRITERIA Randomised and quasi-randomised trials of virtual reality ("an advanced form of human-computer interface that allows the user to 'interact' with and become 'immersed' in a computer-generated environment in a naturalistic fashion") in adults after stroke. The primary outcome of interest was upper limb function and activity. Secondary outcomes included gait and balance and global motor function. DATA COLLECTION AND ANALYSIS Two review authors independently selected trials based on pre-defined inclusion criteria, extracted data, and assessed risk of bias. A third review author moderated disagreements when required. The review authors contacted investigators to obtain missing information. MAIN RESULTS We included 72 trials that involved 2470 participants. This review includes 35 new studies in addition to the studies included in the previous version of this review. Study sample sizes were generally small and interventions varied in terms of both the goals of treatment and the virtual reality devices used. The risk of bias present in many studies was unclear due to poor reporting. Thus, while there are a large number of randomised controlled trials, the evidence remains mostly low quality when rated using the GRADE system. Control groups usually received no intervention or therapy based on a standard-care approach. PRIMARY OUTCOME results were not statistically significant for upper limb function (standardised mean difference (SMD) 0.07, 95% confidence intervals (CI) -0.05 to 0.20, 22 studies, 1038 participants, low-quality evidence) when comparing virtual reality to conventional therapy. However, when virtual reality was used in addition to usual care (providing a higher dose of therapy for those in the intervention group) there was a statistically significant difference between groups (SMD 0.49, 0.21 to 0.77, 10 studies, 210 participants, low-quality evidence). SECONDARY OUTCOMES when compared to conventional therapy approaches there were no statistically significant effects for gait speed or balance. Results were statistically significant for the activities of daily living (ADL) outcome (SMD 0.25, 95% CI 0.06 to 0.43, 10 studies, 466 participants, moderate-quality evidence); however, we were unable to pool results for cognitive function, participation restriction, or quality of life. Twenty-three studies reported that they monitored for adverse events; across these studies there were few adverse events and those reported were relatively mild. AUTHORS' CONCLUSIONS We found evidence that the use of virtual reality and interactive video gaming was not more beneficial than conventional therapy approaches in improving upper limb function. Virtual reality may be beneficial in improving upper limb function and activities of daily living function when used as an adjunct to usual care (to increase overall therapy time). There was insufficient evidence to reach conclusions about the effect of virtual reality and interactive video gaming on gait speed, balance, participation, or quality of life. This review found that time since onset of stroke, severity of impairment, and the type of device (commercial or customised) were not strong influencers of outcome. There was a trend suggesting that higher dose (more than 15 hours of total intervention) was preferable as were customised virtual reality programs; however, these findings were not statistically significant.
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Affiliation(s)
- Kate E Laver
- Flinders UniversityDepartment of Rehabilitation, Aged and Extended CareLevel 1, C Block, Repatriation General Hospital, Daws Road, Daw ParkAdelaideSouth AustraliaAustralia5041
| | - Belinda Lange
- Flinders UniversitySchool of Health Sciences, Discipline of PhysiotherapyAdelaideAustralia
| | - Stacey George
- Flinders UniversityDepartment of Rehabilitation, Aged and Extended CareLevel 1, C Block, Repatriation General Hospital, Daws Road, Daw ParkAdelaideSouth AustraliaAustralia5041
| | - Judith E Deutsch
- Rutgers UniversityDepartment of Rehabilitation and Movement ScienceNewarkNew JerseyUSA
| | - Gustavo Saposnik
- University of TorontoDepartment of Medicine (Neurology), St Michael's HospitalTorontoCanadaM5C 1R6
| | - Maria Crotty
- Flinders UniversityDepartment of Rehabilitation, Aged and Extended CareLevel 1, C Block, Repatriation General Hospital, Daws Road, Daw ParkAdelaideSouth AustraliaAustralia5041
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Virtual Reality and Serious Games in Neurorehabilitation of Children and Adults: Prevention, Plasticity, and Participation. Pediatr Phys Ther 2017; 29 Suppl 3:S23-S36. [PMID: 28654475 PMCID: PMC5488703 DOI: 10.1097/pep.0000000000000387] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Use of virtual reality (VR) and serious games (SGs) interventions within rehabilitation as motivating tools for task specific training for individuals with neurological conditions are fast-developing. Within this perspective paper we use the framework of the IV STEP conference to summarize the literature on VR and SG for children and adults by three topics: Prevention; Outcomes: Body-Function-Structure, Activity and Participation; and Plasticity. Overall the literature in this area offers support for use of VR and SGs to improve body functions and to some extent activity domain outcomes. Critical analysis of clients' goals and selective evaluation of VR and SGs are necessary to appropriately take advantage of these tools within intervention. Further research on prevention, participation, and plasticity is warranted. We offer suggestions for bridging the gap between research and practice integrating VR and SGs into physical therapist education and practice.
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Chanpimol S, Seamon B, Hernandez H, Harris-Love M, Blackman MR. Using Xbox kinect motion capture technology to improve clinical rehabilitation outcomes for balance and cardiovascular health in an individual with chronic TBI. Arch Physiother 2017; 7:6. [PMID: 28824816 PMCID: PMC5560163 DOI: 10.1186/s40945-017-0033-9] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2017] [Accepted: 05/09/2017] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Motion capture virtual reality-based rehabilitation has become more common. However, therapists face challenges to the implementation of virtual reality (VR) in clinical settings. Use of motion capture technology such as the Xbox Kinect may provide a useful rehabilitation tool for the treatment of postural instability and cardiovascular deconditioning in individuals with chronic severe traumatic brain injury (TBI). The primary purpose of this study was to evaluate the effects of a Kinect-based VR intervention using commercially available motion capture games on balance outcomes for an individual with chronic TBI. The secondary purpose was to assess the feasibility of this intervention for eliciting cardiovascular adaptations. METHODS A single system experimental design (n = 1) was utilized, which included baseline, intervention, and retention phases. Repeated measures were used to evaluate the effects of an 8-week supervised exercise intervention using two Xbox One Kinect games. Balance was characterized using the dynamic gait index (DGI), functional reach test (FRT), and Limits of Stability (LOS) test on the NeuroCom Balance Master. The LOS assesses end-point excursion (EPE), maximal excursion (MXE), and directional control (DCL) during weight-shifting tasks. Cardiovascular and activity measures were characterized by heart rate at the end of exercise (HRe), total gameplay time (TAT), and time spent in a therapeutic heart rate (TTR) during the Kinect intervention. Chi-square and ANOVA testing were used to analyze the data. RESULTS Dynamic balance, characterized by the DGI, increased during the intervention phase χ2 (1, N = 12) = 12, p = .001. Static balance, characterized by the FRT showed no significant changes. The EPE increased during the intervention phase in the backward direction χ2 (1, N = 12) = 5.6, p = .02, and notable improvements of DCL were demonstrated in all directions. HRe (F (2,174) = 29.65, p = < .001) and time in a TTR (F (2, 12) = 4.19, p = .04) decreased over the course of the intervention phase. CONCLUSIONS Use of a supervised Kinect-based program that incorporated commercial games improved dynamic balance for an individual post severe TBI. Additionally, moderate cardiovascular activity was achieved through motion capture gaming. Further studies appear warranted to determine the potential therapeutic utility of commercial VR games in this patient population. TRIAL REGISTRATION Clinicaltrial.gov ID - NCT02889289.
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Affiliation(s)
- Shane Chanpimol
- Neurology Service, Veterans Affairs Medical Center, Washington, DC USA
- Physical Medicine and Rehabilitation Service, Veterans Affairs Medical Center, Washington, DC USA
| | - Bryant Seamon
- Physical Medicine and Rehabilitation Service, Veterans Affairs Medical Center, Washington, DC USA
- Muscle Morphology, Mechanics and Performance Laboratory, Clinical Research Center - Human Performance Research Unit, Veterans Affairs Medical Center, Washington, DC USA
| | - Haniel Hernandez
- Physical Medicine and Rehabilitation Service, Veterans Affairs Medical Center, Washington, DC USA
- Muscle Morphology, Mechanics and Performance Laboratory, Clinical Research Center - Human Performance Research Unit, Veterans Affairs Medical Center, Washington, DC USA
| | - Michael Harris-Love
- Muscle Morphology, Mechanics and Performance Laboratory, Clinical Research Center - Human Performance Research Unit, Veterans Affairs Medical Center, Washington, DC USA
- Geriatrics and Extended Care Service/Research Service, Veterans Affairs Medical Center, Washington, DC USA
- Department of Exercise and Nutritional Sciences, Milken Institute School of Public Health, The George Washington University, Washington, DC USA
| | - Marc R. Blackman
- Research Service, Veterans Affairs Medical Center, Washington, DC USA
- Departments of Medicine, Biochemistry and Molecular Medicine, George Washington University School of Medicine, Washington, DC USA
- Departments of Medicine and Rehabilitation Medicine, Georgetown University School of Medicine, Washington, DC USA
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Han DH, Kim SM, Bae S, Renshaw PF, Anderson JS. Brain connectivity and psychiatric comorbidity in adolescents with Internet gaming disorder. Addict Biol 2017; 22:802-812. [PMID: 26689148 DOI: 10.1111/adb.12347] [Citation(s) in RCA: 56] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2015] [Revised: 11/04/2015] [Accepted: 11/11/2015] [Indexed: 01/14/2023]
Abstract
Prolonged Internet video game play may have multiple and complex effects on human cognition and brain development in both negative and positive ways. There is not currently a consensus on the principle effects of video game play neither on brain development nor on the relationship to psychiatric comorbidity. In this study, 78 adolescents with Internet gaming disorder (IGD) and 73 comparison subjects without IGD, including subgroups with no other psychiatric comorbid disease, with major depressive disorder and with attention deficit hyperactivity disorder (ADHD), were included in a 3 T resting state functional magnetic resonance imaging analysis. The severity of Internet gaming disorder, depression, anxiety and ADHD symptoms were assessed with the Young Internet Addiction Scale, the Beck Depression Inventory, the Beck Anxiety Inventory and the Korean ADHD rating scales, respectively. Patients with IGD showed an increased functional correlation between seven pairs of regions, all satisfying q < 0.05 False discovery rates in light of multiple statistical tests: left frontal eye field to dorsal anterior cingulate, left frontal eye field to right anterior insula, left dorsolateral prefrontal cortex (DLPFC) to left temporoparietal junction (TPJ), right DLPFC to right TPJ, right auditory cortex to right motor cortex, right auditory cortex to supplementary motor area and right auditory cortex to dorsal anterior cingulate. These findings may represent a training effect of extended game play and suggest a risk or predisposition in game players for over-connectivity of the default mode and executive control networks that may relate to psychiatric comorbidity.
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Affiliation(s)
- Doug Hyun Han
- Department of Psychiatry; Chung-Ang University Hospital; Seoul South Korea
| | - Sun Mi Kim
- Department of Psychiatry; Chung-Ang University Hospital; Seoul South Korea
| | - Sujin Bae
- Industry Academic Cooperation Foundation; Chung-Ang University; Seoul South Korea
| | | | - Jeffrey S. Anderson
- Departments of Radiology and Bioengineering; University of Utah; Salt Lake City UT USA
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Lee M, Heo HH, Oh S, Kim E, Yoon B. Patient-centered evaluation of home-based rehabilitation developed using community-based participatory research approach for people with disabilities: a case series. Disabil Rehabil 2016; 40:238-248. [PMID: 27848248 DOI: 10.1080/09638288.2016.1250121] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
PURPOSE The purpose of this study was to evaluate the effectiveness of the locally tailored and individualized home-based rehabilitation (HBR) program developed using the community-based participatory research (CBPR) approach, in terms of perceived health in patients with different levels of social engagement, and to explore the perceived facilitators and barriers to rehabilitation. METHOD A concurrent mixed-method design was employed. Four patients participated in the combined therapist- and self-delivered HBR program for 5 months. The perceived health outcomes were quantitatively assessed at baseline, after the therapist-delivered intervention period, and at 1 and 3 months after the self-delivered intervention period. Then, in-depth individual interviews were conducted to explore the facilitators and barriers to rehabilitation. RESULTS The perceived health of patients who were fully or partially engaged in society was increased during the therapist-delivered intervention period, and maintained the increased level during the self-delivered intervention period, whereas that of patients who were rarely or not engaged dropped again to lower than the baseline. These results were caused by differentiated facilitators and barriers to rehabilitation depending on the level of social engagement. CONCLUSIONS Applying tailored strategies to patients with differing levels of social engagement is recommended to further optimize the local relevance of the HBR program. Implications for rehabilitation A community-based participatory research approach can provide an opportunity to enhance local relevance through community-academic partnerships, in developing a home-based rehabilitation (HBR) program for the people with disabilities. For community therapists, enhancing the local relevance of the HBR program, applying tailored strategies to patients with differing levels of social engagement is recommended because the perceived health of the HBR program can be different owing to differing perceived facilitators and barriers to rehabilitation, depending on the level of social engagement. For patients with rare or no engagement in society, satisfying their need for interaction with the therapists and helping them cope with their wrong belief about the possibility of their recovery is important to encourage behavioral change and perceived physical improvements.
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Affiliation(s)
- Minyoung Lee
- a Department of Physical Therapy, College of Health Sciences , Korea University , Seoul , South Korea
| | - Hyun-Hee Heo
- b Department of Public Health Sciences , Graduate School, Korea University , Seoul , South Korea
| | - Sejun Oh
- a Department of Physical Therapy, College of Health Sciences , Korea University , Seoul , South Korea
| | - Eunseung Kim
- c Department of Physical Therapy, Jung-gu Public Health Center , Seoul , South Korea
| | - BumChul Yoon
- a Department of Physical Therapy, College of Health Sciences , Korea University , Seoul , South Korea
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Levac D, Glegg SMN, Sveistrup H, Colquhoun H, Miller PA, Finestone H, DePaul V, Harris JE, Velikonja D. A knowledge translation intervention to enhance clinical application of a virtual reality system in stroke rehabilitation. BMC Health Serv Res 2016; 16:557. [PMID: 27716179 PMCID: PMC5052802 DOI: 10.1186/s12913-016-1807-6] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2015] [Accepted: 09/30/2016] [Indexed: 12/20/2022] Open
Abstract
Background Despite increasing evidence for the effectiveness of virtual reality (VR)-based therapy in stroke rehabilitation, few knowledge translation (KT) resources exist to support clinical integration. KT interventions addressing known barriers and facilitators to VR use are required. When environmental barriers to VR integration are less amenable to change, KT interventions can target modifiable barriers related to therapist knowledge and skills. Methods A multi-faceted KT intervention was designed and implemented to support physical and occupational therapists in two stroke rehabilitation units in acquiring proficiency with use of the Interactive Exercise Rehabilitation System (IREX; GestureTek). The KT intervention consisted of interactive e-learning modules, hands-on workshops and experiential practice. Evaluation included the Assessing Determinants of Prospective Take Up of Virtual Reality (ADOPT-VR) Instrument and self-report confidence ratings of knowledge and skills pre- and post-study. Usability of the IREX was measured with the System Usability Scale (SUS). A focus group gathered therapist experiences. Frequency of IREX use was recorded for 6 months post-study. Results Eleven therapists delivered a total of 107 sessions of VR-based therapy to 34 clients with stroke. On the ADOPT-VR, significant pre-post improvements in therapist perceived behavioral control (p = 0.003), self-efficacy (p = 0.005) and facilitating conditions (p =0.019) related to VR use were observed. Therapist intention to use VR did not change. Knowledge and skills improved significantly following e-learning completion (p = 0.001) and was sustained 6 months post-study. Below average perceived usability of the IREX (19th percentile) was reported. Lack of time was the most frequently reported barrier to VR use. A decrease in frequency of perceived barriers to VR use was not significant (p = 0.159). Two therapists used the IREX sparingly in the 6 months following the study. Therapists reported that client motivation to engage with VR facilitated IREX use in practice but that environmental and IREX-specific barriers limited use. Conclusions Despite increased knowledge and skills in VR use, the KT intervention did not alter the number of perceived barriers to VR use, intention to use or actual use of VR. Poor perceived system usability had an impact on integration of this particular VR system into clinical practice. Electronic supplementary material The online version of this article (doi:10.1186/s12913-016-1807-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Danielle Levac
- Department of Physical Therapy, Movement Sciences and Rehabilitation, Bouve College of Health Sciences, Northeastern University, 407c Robinson Hall, 360 Huntington Ave, Boston, MA, 02115, USA.
| | - Stephanie M N Glegg
- Therapy Department, Sunny Hill Health Centre for Children, 3644 Slocan Street, Vancouver, BC, V5M 3E8, Canada
| | - Heidi Sveistrup
- School of Rehabilitation Sciences, Faculty of Health Sciences, University of Ottawa, 200 Lees (A121), Ottawa, ON, K1S 5S9, Canada
| | - Heather Colquhoun
- Department of Occupational Science and Occupational Therapy, University of Toronto, 160-500 University Ave Toronto, Ontario, M5G 1V7, Canada
| | - Patricia A Miller
- School of Rehabilitation Sciences, Faculty of Health Sciences, McMaster University, Institute of Applied Health Sciences, Room 403, 1400 Main St. West, Hamilton, ON, L8S 1C7, Canada
| | - Hillel Finestone
- Bruyere Research Institute, Élisabeth Bruyère Hospital, Bruyère Continuing Care, 43 Bruyère Street, Ottawa, ON, K1N 5C8, Canada
| | - Vincent DePaul
- School of Rehabilitation Therapy, Queen's University, Louise D. Acton Building, 31 George Street, Kingston, ON, K7L 3 N6, Canada
| | - Jocelyn E Harris
- School of Rehabilitation Science, McMaster University, IAHS Building Room 403, 1400 Main Street West, Hamilton, ON, L8S 1C7, Canada
| | - Diana Velikonja
- Hamilton Health Sciences, Regional Rehabilitation Centre, 300 Wellington St. North, Hamilton, ON, Canada.,Department of Psychiatry and Behavioural Neurosciences, DeGroote School of Medicine, McMaster Univerity, 12 Main Street West, Hamilton, ON, l8S 1C7, Canada
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Seo NJ, Fathi MF, Hur P, Crocher V. Modifying Kinect placement to improve upper limb joint angle measurement accuracy. J Hand Ther 2016; 29:465-473. [PMID: 27769844 PMCID: PMC6701865 DOI: 10.1016/j.jht.2016.06.010] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2016] [Revised: 06/02/2016] [Accepted: 06/19/2016] [Indexed: 02/03/2023]
Abstract
STUDY DESIGN Repeated measures. INTRODUCTION The Kinect (Microsoft, Redmond, WA) is widely used for telerehabilitation applications including rehabilitation games and assessment. PURPOSE OF THE STUDY To determine effects of the Kinect location relative to a person on measurement accuracy of upper limb joint angles. METHODS Kinect error was computed as difference in the upper limb joint range of motion (ROM) during target reaching motion, from the Kinect vs 3D Investigator Motion Capture System (NDI, Waterloo, Ontario, Canada), and compared across 9 Kinect locations. RESULTS The ROM error was the least when the Kinect was elevated 45° in front of the subject, tilted toward the subject. This error was 54% less than the conventional location in front of a person without elevation and tilting. The ROM error was the largest when the Kinect was located 60° contralateral to the moving arm, at the shoulder height, facing the subject. The ROM error was the least for the shoulder elevation and largest for the wrist angle. DISCUSSION Accuracy of the Kinect sensor for detecting upper limb joint ROM depends on its location relative to a person. CONCLUSION This information facilitates implementation of Kinect-based upper limb rehabilitation applications with adequate accuracy. LEVEL OF EVIDENCE 3b.
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Affiliation(s)
- Na Jin Seo
- Division of Occupational Therapy, Department of Health Professions, Medical University of South Carolina, Charleston, SC, USA; Department of Health Sciences and Research, Medical University of South Carolina, Charleston, SC, USA.
| | - Mojtaba F Fathi
- Department of Mechanical Engineering, University of Wisconsin-Milwaukee, Milwaukee, WI, USA
| | - Pilwon Hur
- Department of Mechanical Engineering, Texas A&M University, College Station, TX, USA
| | - Vincent Crocher
- The Melbourne School of Engineering, The University of Melbourne, Melbourne, Victoria, Australia
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Threapleton K, Drummond A, Standen P. Virtual rehabilitation: What are the practical barriers for home-based research? Digit Health 2016; 2:2055207616641302. [PMID: 29942551 PMCID: PMC6001226 DOI: 10.1177/2055207616641302] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2015] [Accepted: 02/22/2016] [Indexed: 01/01/2023] Open
Abstract
Virtual reality technologies are becoming increasingly accessible and affordable to deliver, and consequently the interest in applying virtual reality within rehabilitation is growing. This has resulted in the emergence of research exploring the utility of virtual reality and interactive video gaming interventions for home use by patients. The aim of this paper is to highlight the practical factors and difficulties that may be encountered in research in this area, and to make recommendations for addressing these. Whilst this paper focuses on examples drawn mainly from stroke rehabilitation research, many of the issues raised are relevant to other conditions where virtual reality approaches have the potential to be applied to home-based rehabilitation.
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Affiliation(s)
- Kate Threapleton
- School of Health Sciences, University of Nottingham, Nottingham, UK
| | - Avril Drummond
- School of Health Sciences, University of Nottingham, Nottingham, UK
| | - Penny Standen
- Division of Rehabilitation and Ageing, University of Nottingham, Nottingham, UK
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Leiker AM, Miller M, Brewer L, Nelson M, Siow M, Lohse K. The Relationship Between Engagement and Neurophysiological Measures of Attention in Motion-Controlled Video Games: A Randomized Controlled Trial. JMIR Serious Games 2016; 4:e4. [PMID: 27103052 PMCID: PMC4858597 DOI: 10.2196/games.5460] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2015] [Revised: 01/25/2016] [Accepted: 01/26/2016] [Indexed: 12/20/2022] Open
Abstract
Background Video games and virtual environments continue to be the subject of research in health sciences for their capacity to augment practice through user engagement. Creating game mechanics that increase user engagement may have indirect benefits on learning (ie, engaged learners are likely to practice more) and may also have direct benefits on learning (ie, for a fixed amount of practice, engaged learners show superior retention of information or skills). Objective To manipulate engagement through the aesthetic features of a motion-controlled video game and measure engagement’s influence on learning. Methods A group of 40 right-handed participants played the game under two different conditions (game condition or sterile condition). The mechanics of the game and the amount of practice were constant. During practice, event-related potentials (ERPs) to task-irrelevant probe tones were recorded during practice as an index of participants’ attentional reserve. Participants returned for retention and transfer testing one week later. Results Although both groups improved in the task, there was no difference in the amount of learning between the game and sterile groups, countering previous research. A new finding was a statistically significant relationship between self-reported engagement and the amplitude of the early-P3a (eP3a) component of the ERP waveform, such that participants who reported higher levels of engagement showed a smaller eP3a (beta=−.08,
P=.02). Conclusions This finding provides physiological data showing that engagement elicits increased information processing (reducing attentional reserve), which yields new insight into engagement and its underlying neurophysiological properties. Future studies may objectively index engagement by quantifying ERPs (specifically the eP3a) to task-irrelevant probes.
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Abstract
Cerebral palsy is the most common cause of childhood-onset, lifelong physical disability in most countries, affecting about 1 in 500 neonates with an estimated prevalence of 17 million people worldwide. Cerebral palsy is not a disease entity in the traditional sense but a clinical description of children who share features of a non-progressive brain injury or lesion acquired during the antenatal, perinatal or early postnatal period. The clinical manifestations of cerebral palsy vary greatly in the type of movement disorder, the degree of functional ability and limitation and the affected parts of the body. There is currently no cure, but progress is being made in both the prevention and the amelioration of the brain injury. For example, administration of magnesium sulfate during premature labour and cooling of high-risk infants can reduce the rate and severity of cerebral palsy. Although the disorder affects individuals throughout their lifetime, most cerebral palsy research efforts and management strategies currently focus on the needs of children. Clinical management of children with cerebral palsy is directed towards maximizing function and participation in activities and minimizing the effects of the factors that can make the condition worse, such as epilepsy, feeding challenges, hip dislocation and scoliosis. These management strategies include enhancing neurological function during early development; managing medical co-morbidities, weakness and hypertonia; using rehabilitation technologies to enhance motor function; and preventing secondary musculoskeletal problems. Meeting the needs of people with cerebral palsy in resource-poor settings is particularly challenging.
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Morel M, Bideau B, Lardy J, Kulpa R. Advantages and limitations of virtual reality for balance assessment and rehabilitation. Neurophysiol Clin 2015; 45:315-26. [PMID: 26527045 DOI: 10.1016/j.neucli.2015.09.007] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2015] [Revised: 09/14/2015] [Accepted: 09/15/2015] [Indexed: 10/22/2022] Open
Abstract
Virtual reality (VR) is now commonly used in many domains because of its ability to provide a standardized, reproducible and controllable environment. In balance assessment, it can be used to control stimuli presented to patients and thus accurately evaluate their progression or compare them to different populations in standardized situations. In balance rehabilitation, VR allows the creation of new generation tools and at the same time the means to assess the efficiency of each parameter of these tools in order to optimize them. Moreover, with the development of low-cost devices, this rehabilitation can be continued at home, making access to these tools much easier, in addition to their entertaining and thus motivating properties. Nevertheless, and even more with low-cost systems, VR has limits that can alter the results of the studies that use it: the latency of the system (the delay cumulated on each step of the process from data acquisition on the patients to multimodal outputs); and distance perception, which tends to be underestimated in VR. After having described why VR is an essential tool for balance assessment and rehabilitation and illustrated this statement with a case study, this review discusses the previous works in the domain with regards to the technological limits of VR.
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Affiliation(s)
- M Morel
- M2S laboratory, University of Rennes 2, ENS Rennes, Campus de Ker Lann, avenue Robert-Schuman, 35170 Bruz, France; ISIR laboratory, CNRS, UPMC, 4, place Jussieu, 75005 Paris, France.
| | - B Bideau
- M2S laboratory, University of Rennes 2, ENS Rennes, Campus de Ker Lann, avenue Robert-Schuman, 35170 Bruz, France
| | - J Lardy
- M2S laboratory, University of Rennes 2, ENS Rennes, Campus de Ker Lann, avenue Robert-Schuman, 35170 Bruz, France
| | - R Kulpa
- M2S laboratory, University of Rennes 2, ENS Rennes, Campus de Ker Lann, avenue Robert-Schuman, 35170 Bruz, France
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A Review on Technical and Clinical Impact of Microsoft Kinect on Physical Therapy and Rehabilitation. J Med Eng 2014; 2014:846514. [PMID: 27006935 PMCID: PMC4782741 DOI: 10.1155/2014/846514] [Citation(s) in RCA: 164] [Impact Index Per Article: 16.4] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2014] [Revised: 11/03/2014] [Accepted: 11/17/2014] [Indexed: 01/12/2023] Open
Abstract
This paper reviews technical and clinical impact of the Microsoft Kinect in physical therapy and rehabilitation. It covers the studies on patients with neurological disorders including stroke, Parkinson's, cerebral palsy, and MS as well as the elderly patients. Search results in Pubmed and Google scholar reveal increasing interest in using Kinect in medical application. Relevant papers are reviewed and divided into three groups: (1) papers which evaluated Kinect's accuracy and reliability, (2) papers which used Kinect for a rehabilitation system and provided clinical evaluation involving patients, and (3) papers which proposed a Kinect-based system for rehabilitation but fell short of providing clinical validation. At last, to serve as technical comparison to help future rehabilitation design other sensors similar to Kinect are reviewed.
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