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Popa LL, Chira D, Strilciuc Ș, Mureșanu DF. Non-Invasive Systems Application in Traumatic Brain Injury Rehabilitation. Brain Sci 2023; 13:1594. [PMID: 38002552 PMCID: PMC10670234 DOI: 10.3390/brainsci13111594] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Revised: 11/10/2023] [Accepted: 11/14/2023] [Indexed: 11/26/2023] Open
Abstract
Traumatic brain injury (TBI) is a significant public health concern, often leading to long-lasting impairments in cognitive, motor and sensory functions. The rapid development of non-invasive systems has revolutionized the field of TBI rehabilitation by offering modern and effective interventions. This narrative review explores the application of non-invasive technologies, including electroencephalography (EEG), quantitative electroencephalography (qEEG), brain-computer interface (BCI), eye tracking, near-infrared spectroscopy (NIRS), functional near-infrared spectroscopy (fNIRS), magnetic resonance imaging (MRI), functional magnetic resonance imaging (fMRI), magnetoencephalography (MEG), and transcranial magnetic stimulation (TMS) in assessing TBI consequences, and repetitive transcranial magnetic stimulation (rTMS), low-level laser therapy (LLLT), neurofeedback, transcranial direct current stimulation (tDCS), transcranial alternative current stimulation (tACS) and virtual reality (VR) as therapeutic approaches for TBI rehabilitation. In pursuit of advancing TBI rehabilitation, this narrative review highlights the promising potential of non-invasive technologies. We emphasize the need for future research and clinical trials to elucidate their mechanisms of action, refine treatment protocols, and ensure their widespread adoption in TBI rehabilitation settings.
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Affiliation(s)
- Livia Livinț Popa
- RoNeuro Institute for Neurological Research and Diagnostic, 400364 Cluj-Napoca, Romania; (L.L.P.); (D.F.M.)
- Department of Neuroscience, Iuliu Hatieganu University of Medicine and Pharmacy, 400083 Cluj-Napoca, Romania
| | - Diana Chira
- RoNeuro Institute for Neurological Research and Diagnostic, 400364 Cluj-Napoca, Romania; (L.L.P.); (D.F.M.)
- Department of Neuroscience, Iuliu Hatieganu University of Medicine and Pharmacy, 400083 Cluj-Napoca, Romania
| | - Ștefan Strilciuc
- Research Center for Functional Genomics, Biomedicine, and Translational Medicine, Iuliu Hațieganu University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania
| | - Dafin F. Mureșanu
- RoNeuro Institute for Neurological Research and Diagnostic, 400364 Cluj-Napoca, Romania; (L.L.P.); (D.F.M.)
- Department of Neuroscience, Iuliu Hatieganu University of Medicine and Pharmacy, 400083 Cluj-Napoca, Romania
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LeMarshall SJ, Stevens LM, Ragg NP, Barnes L, Foster J, Canetti EFD. Virtual reality-based interventions for the rehabilitation of vestibular and balance impairments post-concussion: a scoping review. J Neuroeng Rehabil 2023; 20:31. [PMID: 36869367 PMCID: PMC9985280 DOI: 10.1186/s12984-023-01145-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Accepted: 01/27/2023] [Indexed: 03/05/2023] Open
Abstract
BACKGROUND Concussions and mild traumatic brain injuries are the most common causes of physical and cognitive disability worldwide. Concussion can result in post-injury vestibular and balance impairments that can present up to five years post initial concussion event, ultimately affecting many daily and functional activities. While current clinical treatment aims to reduce symptoms, the developing use of technology in everyday life has seen the emergence of virtual reality. Current literature has failed to identify substantial evidence regarding the use of virtual reality in rehabilitation. The primary aim of this scoping review is to identify, synthesise, and assess the quality of studies reporting on the effectiveness of virtual reality for the rehabilitation of vestibular and balance impairments post-concussion. Additionally, this review aims to summarise the volume of scientific literature and identify the knowledge gaps in current research pertaining to this topic. METHODS A scoping review of six databases (PubMed, Embase, CINAHL, ProQuest, SportDiscus, Scopus) and a grey literature (Google Scholar) was conducted using three key concepts (virtual reality, vestibular symptoms, and post-concussion). Data was charted from studies and outcomes were categorised into one of three categories: (1) balance; (2) gait; or (3) functional outcome measures. Critical appraisal of each study was conducted using the Joanna Briggs Institute checklists. A critical appraisal of each outcome measure was also completed utilising a modified GRADE appraisal tool to summarise the quality of evidence. Effectiveness was assessed using calculations of change in performance and change per exposure time. RESULTS Three randomised controlled trials, three quasi-experimental studies, three case studies, and one retrospective cohort study were ultimately included, using a thorough eligibility criteria. All studies were inclusive of different virtual reality interventions. The ten studies had a 10-year range and identified 19 different outcome measures. CONCLUSION The findings from this review suggests that virtual reality is an effective tool for the rehabilitation of vestibular and balance impairments post-concussion. Current literature shows sufficient but low level of evidence, and more research is necessary to develop a quantitative standard and to better understand appropriate dosage of virtual reality intervention.
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Affiliation(s)
- Soraya J LeMarshall
- Doctor of Physiotherapy, Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Australia
| | - Lachlan M Stevens
- Doctor of Physiotherapy, Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Australia
| | - Nicholas P Ragg
- Doctor of Physiotherapy, Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Australia
| | - Leia Barnes
- Integrated Specialist ENT Service, Logan Hospital, Meadowbrook, Australia
| | - Jacinta Foster
- Integrated Specialist ENT Service, Logan Hospital, Meadowbrook, Australia
| | - Elisa F D Canetti
- Doctor of Physiotherapy, Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Australia. .,Tactical Research Unit, Bond University, Gold Coast, Australia.
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García-Muñoz C, Casuso-Holgado MJ, Hernández-Rodríguez JC, Pinero-Pinto E, Palomo-Carrión R, Cortés-Vega MD. Feasibility and safety of an immersive virtual reality-based vestibular rehabilitation programme in people with multiple sclerosis experiencing vestibular impairment: a protocol for a pilot randomised controlled trial. BMJ Open 2021; 11:e051478. [PMID: 34810187 PMCID: PMC8609940 DOI: 10.1136/bmjopen-2021-051478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Accepted: 10/22/2021] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Vestibular system damage in patients with multiple sclerosis (MS) may have a central and/or peripheral origin. Subsequent vestibular impairments may contribute to dizziness, balance disorders and fatigue in this population. Vestibular rehabilitation targeting vestibular impairments may improve these symptoms. Furthermore, as a successful tool in neurological rehabilitation, immersive virtual reality (VRi) could also be implemented within a vestibular rehabilitation intervention. METHODS AND ANALYSIS This protocol describes a parallel-arm, pilot randomised controlled trial, with blinded assessments, in 30 patients with MS with vestibular impairment (Dizziness Handicap Inventory ≥16). The experimental group will receive a VRi vestibular rehabilitation intervention based on the conventional Cawthorne-Cooksey protocol; the control group will perform the conventional protocol. The duration of the intervention in both groups will be 7 weeks (20 sessions, 3 sessions/week). The primary outcomes are the feasibility and safety of the vestibular VRi intervention in patients with MS. Secondary outcome measures are dizziness symptoms, balance performance, fatigue and quality of life. Quantitative assessment will be carried out at baseline (T0), immediately after intervention (T1), and after a follow-up period of 3 and 6 months (T2 and T3). Additionally, in order to further examine the feasibility of the intervention, a qualitative assessment will be performed at T1. ETHICS AND DISSEMINATION The study was approved by the Andalusian Review Board and Ethics Committee, Virgen Macarena-Virgen del Rocio Hospitals (ID 2148-N-19, 25 March 2020). Informed consent will be collected from participants who wish to participate in the research. The results of this research will be disseminated by publication in peer-reviewed scientific journals. TRIAL REGISTRATION NUMBER NCT04497025.
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Affiliation(s)
| | | | | | | | - Rocío Palomo-Carrión
- Department of Nursery, Physiotherapy and Occupational Therapy, University of Castilla-La Mancha, Toledo, Spain
- GIFTO, Physiotherapy Research Group, Toledo, Spain
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Cook NE, Huebschmann NA, Iverson GL. Safety and Tolerability of an Innovative Virtual Reality-Based Deep Breathing Exercise in Concussion Rehabilitation: A Pilot Study. Dev Neurorehabil 2021; 24:222-229. [PMID: 33126815 DOI: 10.1080/17518423.2020.1839981] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
To examine the safety and tolerability of a virtual reality-based deep breathing exercise for children and adolescents who are slow to recover from concussion. Methods: Fifteen participants (ages 11 to 22; mean = 16.9 years) were recruited from a specialty concussion clinic within a tertiary care medical center. Participants completed a 5-min paced deep breathing exercise administered via a virtual reality headset. Results: Nearly all participants (93.3%) reported the experience was either positive or extremely positive. No participants reported significant discomfort or discontinued the exercise. Three participants reported a mild increase in headache, dizziness, or nausea. Participants reported significant decreases in stress (r =.57), tension (r =.73), fatigue (r =.73), and confusion (r =.67), with large effect sizes, following the deep breathing exercise. Conclusion: A brief, virtual reality-based deep breathing exercise is worthy of additional study as a rehabilitation component for children and adolescents with prolonged concussion recoveries.
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Affiliation(s)
- Nathan E Cook
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA, USA.,Spaulding Rehabilitation Hospital, Spaulding Research Institute, Charlestown, MA, USA.,MassGeneral Hospital for Children Sports Concussion Program, Boston, MA, USA
| | - Nathan A Huebschmann
- Spaulding Rehabilitation Hospital, Spaulding Research Institute, Charlestown, MA, USA.,MassGeneral Hospital for Children Sports Concussion Program, Boston, MA, USA
| | - Grant L Iverson
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA, USA.,Spaulding Rehabilitation Hospital, Spaulding Research Institute, Charlestown, MA, USA.,MassGeneral Hospital for Children Sports Concussion Program, Boston, MA, USA.,Center for Health and Rehabilitation Research, Charlestown, MA, USA
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Aulisio MC, Han DY, Glueck AC. Virtual reality gaming as a neurorehabilitation tool for brain injuries in adults: A systematic review. Brain Inj 2020; 34:1322-1330. [PMID: 32791020 DOI: 10.1080/02699052.2020.1802779] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVE Evidence of the effectiveness of virtual reality (VR) in motor and cognitive rehabilitation for traumatic brain injury (TBI) continues to be mixed. Therefore, we conducted a systematic literature review in accordance with PRISMA guidelines to strategically evaluate the strength of evidence supporting the use of VR as a rehabilitation tool for motor function and cognition in patients with TBI. METHOD The van Tulder criteria were modified to determine the quality of the outcomes of studies deemed eligible for inclusion in the review. OUTCOMES AND RESULTS Twelve studies were considered eligible for inclusion in the systematic review. These studies utilized methods of varying quality such as case and quasi-experimental studies and found moderately positive support for the effectiveness of VR-enhanced rehabilitation for both motor skills and cognitive deficits. CONCLUSIONS AND IMPLICATIONS The varying quality of the included studies provides moderate support for use of VR-enhanced rehabilitation techniques per the van Tulder criteria. This highlights the continued gap in the literature for robust studies that enable providers, policy makers, and the public to draw conclusions about the effectiveness of VR-enhanced rehabilitation for traumatic brain injury. Continued pursuit of analyses in the context of newer immersive VR-enhanced rehabilitation is recommended.
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Affiliation(s)
- Madeline C Aulisio
- Department of Health Management and Policy, College of Public Health , Lexington, KY, USA
| | - Dong Y Han
- Department of Neurology, College of Medicine , Lexington, KY, USA
| | - Amanda C Glueck
- Department of Neurology, College of Medicine , Lexington, KY, USA
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Vestibular Rehabilitation for Dizziness and Imbalance Following Concussion: A Critically Appraised Topic. INTERNATIONAL JOURNAL OF ATHLETIC THERAPY & TRAINING 2019. [DOI: 10.1123/ijatt.2018-0007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Aida J, Chau B, Dunn J. Immersive virtual reality in traumatic brain injury rehabilitation: A literature review. NeuroRehabilitation 2018; 42:441-448. [DOI: 10.3233/nre-172361] [Citation(s) in RCA: 68] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Jared Aida
- Department of Physical Medicine and Rehabilitation, Loma Linda University Health, Loma Linda, CA, USA
| | - Brian Chau
- Department of Veteran Affairs, Loma Linda Healthcare System, Department of Physical Medicine and Rehabilitation, Redlands, CA, USA
| | - Justin Dunn
- Loma Linda University School of Medicine, Loma Linda, CA, USA
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