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Ehioghae M, Montoya A, Keshav R, Vippa TK, Manuk-Hakobyan H, Hasoon J, Kaye AD, Urits I. Effectiveness of Virtual Reality-Based Rehabilitation Interventions in Improving Postoperative Outcomes for Orthopedic Surgery Patients. Curr Pain Headache Rep 2024; 28:37-45. [PMID: 38032538 DOI: 10.1007/s11916-023-01192-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/20/2023] [Indexed: 12/01/2023]
Abstract
PURPOSE OF REVIEW The surge in orthopedic surgeries strains the US healthcare system, necessitating innovative rehabilitation solutions. This review examines the potential of virtual reality (VR)-based interventions for orthopedic rehabilitation. RECENT FINDINGS The effectiveness of VR-based interventions in orthopedic surgery patients is scrutinized. While some studies suggest better patient-reported outcomes and satisfaction, mixed results emerge from others, demonstrating comparable or varied results compared to traditional rehabilitation. The underlying mechanisms of VR-based rehabilitation are elucidated, showing its positive impact on proprioception, pain management, agency, and balance. Challenges of unfamiliarity, patient engagement, and drop-out rates are identified, emphasizing the need for tailored approaches. VR technology's immersive environments and multisensory experiences offer a novel approach to addressing functional deficits and pain post-surgery. The conclusion drawn is that VR-based rehabilitation complements rather than replaces conventional methods, potentially aiding in pain reduction and functional improvement. VR-based rehabilitation holds promise for enhancing orthopedic surgery outcomes, presenting a dynamic approach to recovery. Its potential to reshape healthcare delivery and reimbursement structures underscores its significance in modern healthcare. Overall, VR-based rehabilitation offers a promising avenue for optimizing postoperative recovery in orthopedic surgery patients.
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Affiliation(s)
- Mark Ehioghae
- Medical College of Wisconsin, 8701 W Watertown Plank Rd, Milwaukee, WI, 53226, USA.
| | - Alexis Montoya
- , Eastern Virginia Medical School 825 Fairfax Ave, Norfolk, VA, 23507, USA
| | - Ritwik Keshav
- , Eastern Virginia Medical School 825 Fairfax Ave, Norfolk, VA, 23507, USA
| | - Tarun K Vippa
- University of Arizona College of Medicine-Phoenix, 475 N 5th St, Phoenix, AZ, 85004, USA
| | - Hayk Manuk-Hakobyan
- Cedars Sinai Medical Center, 8700 Beverly Blvd #5725, Los Angeles, CA, 90048, USA
| | - Jamal Hasoon
- McGovern Medical School, The University of Texas Health Science Center at Houston, 7000 Fannin Street, Houston, TX, 77030, USA
| | - Alan D Kaye
- Louisiana State University Health Shreveport, 1501 Kings Highway, Shreveport, LA, 71103, USA
| | - Ivan Urits
- Southcoast Health Pain Management, 100 Rosebrook Way, Wareham, 02571, USA
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Paravlic A, Šlosar L, Abazovic E, Marusic U. Effects of digital-based interventions on muscular strength in adults: a systematic review, meta-analysis and meta-regression of randomized controlled trials with quality of evidence assessment. Ann Med 2023; 55:2230886. [PMID: 37452683 PMCID: PMC10901531 DOI: 10.1080/07853890.2023.2230886] [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: 03/30/2023] [Revised: 06/01/2023] [Accepted: 06/24/2023] [Indexed: 07/18/2023] Open
Abstract
BACKGROUND In the last three decades, both medical and sports science professionals have recognized the considerable potential of digital-based interventions (DBI) to enhance the health-related outcomes of their practitioners. OBJECTIVES This study aimed to investigate the effectiveness and potential moderators of DBI on measures of muscular strength. METHODS Six databases (PubMed/MEDLINE, Web of Science, SportDiscus, Embase, Cochrane Register of Controlled Trials and Google Scholar) were searched for eligible studies up to June 2022. The GRADE, PEDRO, and TIDieR checklists were used to assess the quality of evidence, methodology, and completeness of intervention descriptions, respectively. RESULTS A total of 56 studies were included in the meta-analysis (n = 2346), and participants were classified as healthy (n = 918), stroke survivors (n = 572), diagnosed with other neurological disorders (n = 683), and frail (n = 173). The DBI showed a small effect (standardized mean difference [SMD] = 0.28, 95% CI 0.21 to 0.31; p < 0.001) on strength, regardless of the type of intervention, control group, or tested body part. More specifically, while splitting the studies into different subgroups, a meta-analysis of 19 studies (n = 918) showed a small effect (SMD = 0.38, 95% CI 0.12 to 0.63; p = 0.003) on strength in the asymptomatic population. Similarly, small but positive effects of DBI were observed for stroke survivors (SMD = 0.34, 95% CI 0.13 to 0.56; p = 0.002), patients diagnosed with other neurological disorders (SMD = 0.17, 95% CI 0.03 to 0.32; p = 0.021), and the frail population (SMD = 0.25, 95% CI 0.0 to 0.5; p = 0.051). Sub-group analysis and meta-regression revealed that neither variable modified the effects of the DBI on measures of strength. CONCLUSIONS Overall, DBI may serve as an effective method to improve measures of strength in adults, regardless of their health status as well as the type of digital device, the presence of human-computer interaction, and the age of participants. In addition, the DBI was found to be more effective than traditional training or rehabilitation methods.KEY MESSAGESDigital-based intervention (DBI) is effective in improving measures of muscular strength in adults regardless of participants' health statusDBIs were equally effective for strength improvements in lower and upper limbsAlthough, DBIs were found to be effective in improving muscular strength, most studies did not follow strength training guidelines when prescribing the interventions.
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Affiliation(s)
- Armin Paravlic
- Faculty of Sport, University of Ljubljana, Ljubljana, Slovenia
- Science and Research Centre Koper, Institute for Kinesiology Research, Koper, Slovenia
- Faculty of Sports Studies, Masaryk University, Brno, Czech Republic
| | - Luka Šlosar
- Science and Research Centre Koper, Institute for Kinesiology Research, Koper, Slovenia
- Department of Health Sciences, Alma Mater Europaea – ECM-, Maribor, Slovenia
| | - Ensar Abazovic
- Faculty of Sport and Physical Education, University of Sarajevo, Sarajevo, Bosnia and Herzegovina
| | - Uros Marusic
- Science and Research Centre Koper, Institute for Kinesiology Research, Koper, Slovenia
- Department of Health Sciences, Alma Mater Europaea – ECM-, Maribor, Slovenia
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Schwell G, Kozol Z, Tarshansky D, Einat M, Frenkel-Toledo S. The effect of action observation combined with high-definition transcranial direct current stimulation on motor performance in healthy adults: A randomized controlled trial. Front Hum Neurosci 2023; 17:1126510. [PMID: 36936614 PMCID: PMC10014919 DOI: 10.3389/fnhum.2023.1126510] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2022] [Accepted: 02/14/2023] [Indexed: 03/05/2023] Open
Abstract
Action observation (AO) can improve motor performance in humans, probably via the human mirror neuron system. In addition, there is some evidence that transcranial direct current stimulation (tDCS) can improve motor performance. However, it is yet to be determined whether AO combined with tDCS has an enhanced effect on motor performance. We investigated the effect of AO combined with high-definition tDCS (HD-tDCS) targeting the inferior parietal lobe (IPL) and inferior frontal gyrus (IFG), the main aggregates of the human mirror neuron system, on motor performance in healthy adults and compared the immediate vs. 24-h retention test effects (anodal electrodes were placed over these regions of interest). Sixty participants were randomly divided into three groups that received one of the following single-session interventions: (1) observation of a video clip that presented reaching movement sequences toward five lighted units + active HD-tDCS stimulation (AO + active HD-tDCS group); (2) observation of a video clip that presented the same reaching movement sequences + sham HD-tDCS stimulation (AO + sham HD-tDCS group); and (3) observation of a video clip that presented neutral movie while receiving sham stimulation (NM + sham HD-tDCS group). Subjects' reaching performance was tested before and immediately after each intervention and following 24 h. Subjects performed reaching movements toward units that were activated in the same order as the observed sequence during pretest, posttest, and retest. Occasionally, the sequence order was changed by beginning the sequence unexpectedly with a different activated unit. Outcome measures included mean Reaching Time and difference between the Reaching Time of the unexpected and expected reaching movements (Delta). In the posttest and retest, Reaching Time and Delta improved in the AO + sham HD-tDCS group compared to the NM + HD-sham tDCS group. In addition, at posttest, Delta improved in the AO + active HD-tDCS group compared to the NM + sham HD-tDCS group. It appears that combining a montage of active HD-tDCS, which targets the IPL and IFG, with AO interferes with the positive effects of AO alone on the performance of reaching movement sequences.
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Affiliation(s)
- Gidon Schwell
- Department of Physical Therapy, School of Health Sciences, Ariel University, Ariel, Israel
| | - Zvi Kozol
- Department of Physical Therapy, School of Health Sciences, Ariel University, Ariel, Israel
| | - David Tarshansky
- Department of Physical Therapy, School of Health Sciences, Ariel University, Ariel, Israel
| | - Moshe Einat
- Department of Electrical and Electronic Engineering, Ariel University, Ariel, Israel
| | - Silvi Frenkel-Toledo
- Department of Physical Therapy, School of Health Sciences, Ariel University, Ariel, Israel
- Department of Neurological Rehabilitation, Loewenstein Rehabilitation Medical Center, Ra’anana, Israel
- *Correspondence: Silvi Frenkel-Toledo,
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Riquelme-Hernández C, Reyes-Barría JP, Vargas A, Gonzalez-Robaina Y, Zapata-Lamana R, Toloza-Ramirez D, Parra-Rizo MA, Cigarroa I. Effects of the Practice of Movement Representation Techniques in People Undergoing Knee and Hip Arthroplasty: A Systematic Review. Sports (Basel) 2022; 10:sports10120198. [PMID: 36548495 PMCID: PMC9782171 DOI: 10.3390/sports10120198] [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: 11/15/2022] [Revised: 11/23/2022] [Accepted: 11/24/2022] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVE To analyze the effects of movement representation techniques (MRT) combined with conventional physical therapy (CFT) in people undergoing knee and hip arthroplasty compared to conventional physical therapy alone in terms of results in physical and functionality variables, cognitive function, and quality of life. METHODOLOGY the review was carried out according to the criteria of the PRISMA statement, considering studies in the electronic databases PubMed/Medline, Pubmed Central/Medline, Web of Science, EBSCO, and ScienceDirect. RESULTS MRT plus CFT generated therapeutic effects in some aspects of the physical variables: 100% pain (7 of 7 studies); 100% strength (5 out of 5 studies); range of motion 87.5% (7 out of 8 studies); 100% speed (1 of 1 study), functional variables: 100% gait (7 of 7 studies); functional capacity 87.5% (7 out of 8 studies); cognitive variables: 100% motor visualization ability (2 out of 2 studies); cognitive performance 100% (2 of 2 studies); and quality of life 66.6% (2 of 3 studies). When comparing its effects with conventional physical therapy, the variables that reported the greatest statistically significant changes were motor visualization ability, speed, pain, strength and gait. The most used MRT was motor imagery (MI), and the average time extension of therapies was 3.5 weeks. CONCLUSIONS movement representation techniques combined with conventional physical therapy are an innocuous and low-cost therapeutic intervention with therapeutic effects in patients with knee arthroplasty (KA) and hip arthroplasty (HA), and this combination generates greater therapeutic effects in physical, functional, and cognitive variables than conventional physical therapy alone.
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Affiliation(s)
| | - Juan Pablo Reyes-Barría
- Escuela de Kinesiología, Departamento de Salud, Universidad de los Lagos, Puerto Montt 5480000, Chile
- Clínica Resilient, Puerto Montt 5480000, Chile
| | | | | | | | - David Toloza-Ramirez
- Exercise and Rehabilitation Sciences Institute, School of Speech Therapy, Faculty of Rehabilitation Sciences, Universidad Andres Bello, Santiago 7591538, Chile
- Interdisciplinary Center for Neuroscience, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago 8320000, Chile
| | - Maria Antonia Parra-Rizo
- Faculty of Health Sciences, Valencian International University (VIU), 46002 Valencia, Spain
- Department of Health Psychology, Faculty of Social and Health Sciences, Campus of Elche, Miguel Hernández University (UMH), 03202 Elche, Spain
- Correspondence: (M.A.P.-R.); (I.C.)
| | - Igor Cigarroa
- Escuela de Kinesiología, Facultad de Salud, Universidad Santo Tomás, Los Ángeles 4440000, Chile
- Correspondence: (M.A.P.-R.); (I.C.)
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O’Shea H. Mapping relational links between motor imagery, action observation, action-related language, and action execution. Front Hum Neurosci 2022; 16:984053. [DOI: 10.3389/fnhum.2022.984053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Accepted: 10/07/2022] [Indexed: 11/06/2022] Open
Abstract
Actions can be physically executed, observed, imagined, or simply thought about. Unifying mental processes, such as simulation, emulation, or predictive processing, are thought to underlie different action types, whether they are mental states, as in the case of motor imagery and action observation, or involve physical execution. While overlapping brain activity is typically observed across different actions which indicates commonalities, research interest is also concerned with investigating the distinct functional components of these action types. Unfortunately, untangling subtleties associated with the neurocognitive bases of different action types is a complex endeavour due to the high dimensional nature of their neural substrate (e.g., any action process is likely to activate multiple brain regions thereby having multiple dimensions to consider when comparing across them). This has impeded progress in action-related theorising and application. The present study addresses this challenge by using the novel approach of multidimensional modeling to reduce the high-dimensional neural substrate of four action-related behaviours (motor imagery, action observation, action-related language, and action execution), find the least number of dimensions that distinguish or relate these action types, and characterise their neurocognitive relational links. Data for the model comprised brain activations for action types from whole-brain analyses reported in 53 published articles. Eighty-two dimensions (i.e., 82 brain regions) for the action types were reduced to a three-dimensional model, that mapped action types in ordination space where the greater the distance between the action types, the more dissimilar they are. A series of one-way ANOVAs and post-hoc comparisons performed on the mean coordinates for each action type in the model showed that across all action types, action execution and concurrent action observation (AO)-motor imagery (MI) were most neurocognitively similar, while action execution and AO were most dissimilar. Most action types were similar on at least one neurocognitive dimension, the exception to this being action-related language. The import of the findings are discussed in terms of future research and implications for application.
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Drole K, Paravlic AH. Interventions for increasing return to sport rates after an anterior cruciate ligament reconstruction surgery: A systematic review. Front Psychol 2022; 13:939209. [PMID: 36072023 PMCID: PMC9443932 DOI: 10.3389/fpsyg.2022.939209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2022] [Accepted: 07/29/2022] [Indexed: 11/17/2022] Open
Abstract
Background An injury followed by surgery poses many challenges to an athlete, one of which is rehabilitation, with the goal of returning to sport. While total restoration of physical abilities is a primary goal for most athletes, psychosocial factors also play an important role in the success of an athlete's return to sport (RTS). The purpose of this review was to examine the effectiveness of exercise and psychosocial interventions on RTS rates, which might be one of the most important outcomes for elite athletes. Methods To carry out this review, PubMed, SAGE Journals, Web of Science, SPORTDiscus, ScienceDirect, and Google Scholar databases were searched from inception to July 2022. The inclusion criteria consisted exercise or psychosocial intervention for athletes after anterior cruciate ligament reconstruction (ACLR), with reporting RTS rates as an outcome. Results From 1032 identified articles, four reports (N = 130) met inclusion criteria, all of which examined the recovery after ACLR. The mean MINORS score for the included studies was 16.3 ± 6.1, of which non-comparative studies scored 11.0 ± 1.4, while comparative studies scored 21.5 ± 0.7. There were consistent findings for benefits of exercise and psychosocial interventions on RTS rates. Return to preinjury rates in the reviewed studies vary between 63 and 95% with lower % observed in female athletes and with shorter follow-up. Interventional studies reporting RTS rates with a larger sample size and longer follow-up are needed. Conclusion Physical and psychological function, as well as social support can be influenced by appropriate interventions, indicating future work on rehabilitation programs for return to preinjury might consider taking the holistic approach addressing those.
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Affiliation(s)
- Kristina Drole
- Faculty of Sport, Institute of Kinesiology, University of Ljubljana, Ljubljana, Slovenia
| | - Armin H Paravlic
- Faculty of Sport, Institute of Kinesiology, University of Ljubljana, Ljubljana, Slovenia.,Science and Research Centre Koper, Institute for Kinesiology Research, Koper, Slovenia.,Faculty of Sports Studies, Masaryk University, Brno, Czechia
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