A novel virtual motor rehabilitation system for Guillain-Barré syndrome. Two single case studies

Validity, responsiveness, floor and ceiling effects of the Berg Balance Scale in patients with Guillain-Barré syndrome

We investigated the measurement properties of the Berg Balance Scale in patients with Guillain-Barré syndrome. A retrospective analysis was performed of 81 patients with Guillain-Barré syndrome of age 17-84 years who had completed inpatient rehabilitation over a 5-year period. They were assessed with the Berg Balance Scale, the 10 Meter Walk Test, and the 6 Minute Walk Test at admission and discharge. The concurrent validity of the Berg Balance Scale was confirmed by very good correlations with the 10 Meter Walk Test at admission and discharge (ρ = 0.83 and 0.78, respectively) and by excellent and very good correlations with the 6 Minute Walk Test at admission (ρ = 0.91) and discharge (ρ = 0.77). The predictive validity of the Berg Balance Scale for the 10 Meter Walk Test and the 6 Minute Walk Test at discharge was moderate (ρ = 0.62 and 0.61, respectively) and very good (ρ = -0.87) for length of stay. The minimal clinically important difference of the Berg Balance Scale was estimated to be 10 points. The scale was highly responsive to changes in balance (Cohen's d 0.9). No floor effect was identified. A ceiling effect was identified only at discharge. The Berg Balance Scale is feasible in patients with Guillain-Barré syndrome at admission and discharge from rehabilitation. However, a ceiling effect may occur at discharge in patients with high levels of balance.

Intradialytic virtual reality exercise: Increasing physical activity through technology

Intradialytic exercise can improve physical function and health-related quality of life (HRQoL) in hemodialysis (HD) patients, but is not implemented in routine clinical practice. Virtual reality (VR) exercise has resulted in benefits in non-dialysis contexts, but implementation in HD patients has been limited. The aim of this review was to provide an overview of VR, present the results of a 12-week intradialytic VR exercise intervention, and compare VR to conventional exercise. The secondary aim was to review the effect of VR exercise during the last 30 minutes of the HD session on hemodynamic stability. We conclude that VR exercise during HD is safe and can improve physical function and HRQoL, and can be performed safely toward the end of the HD session.

The feasibility, acceptability and outcomes of exergaming among individuals with cancer: a systematic review

Background

Individuals with cancer have reduced quality of life, functionality, range of motion, strength, and an increase in pain and fatigue. Exergaming appears to be an effective rehabilitation tool for Parkinson’s disease, multiple sclerosis and post-stroke patients to improve functionality, balance and quality of life; however, the usefulness of exergaming in individuals with cancer is unknown. The aim of this systematic review is to describe exergaming interventions delivered to adults with a current or previous cancer diagnosis and to report the feasibility, acceptability and outcomes of such interventions.

Methods

Studies reporting on exergaming interventions delivered to individuals with a current or previous cancer diagnosis were included. 12 electronic databases were searched. Eight articles (seven interventions) were identified. Data were extracted and assessed for quality by two reviewers.

Results

Three interventions were delivered at hospital, two at home, one at a clinical laboratory, and one did not report. Two interventions were delivered by a physiotherapist, two by an occupational therapist, and one by a nurse, research staff and an exercise physiologist. The Nintendo Wii was used in four of seven studies, whilst the remaining three used the IREX system, BrightArm Duo Rehabilitation System or a custom made exergame. Studies showed that most participants enjoyed the exergaming intervention, and would recommend their use, with some preferring exergaming over standard care interventions. Adherence rates and enjoyment appear greater during exergaming than standard care. Exergaming interventions appear to support improvements balance, function, physical activity levels, strength, fatigue, emotions, cognition and pain.

Conclusion

Exergaming interventions delivered to individuals with cancer show great heterogeneity; differing in duration, frequency and gaming platform. The disease stage and severity of those included, and the outcome measures assessed also vary widely making it difficult to conclude its effectiveness at this time. However, adherence rates and enjoyment appear greater during exergaming compared to standard care, supporting the feasibility and acceptability of this type of intervention delivery for adults with cancer.

Immersion of virtual reality for rehabilitation - Review

Virtual reality (VR) shows promise in the application of healthcare and because it presents patients an immersive, often entertaining, approach to accomplish the goal of improvement in performance. Eighteen studies were reviewed to understand human performance and health outcomes after utilizing VR rehabilitation systems. We aimed to understand: (1) the influence of immersion in VR performance and health outcomes; (2) the relationship between enjoyment and potential patient adherence to VR rehabilitation routine; and (3) the influence of haptic feedback on performance in VR. Performance measures including postural stability, navigation task performance, and joint mobility showed varying relations to immersion. Limited data did not allow a solid conclusion between enjoyment and adherence, but patient enjoyment and willingness to participate were reported in care plans that incorporates VR. Finally, different haptic devices such as gloves and controllers provided both strengths and weakness in areas such movement velocity, movement accuracy, and path efficiency.

The Effect of Balance Training on Postural Control in Patients with Parkinson's Disease Using a Virtual Rehabilitation System

OBJECTIVES

Parkinson's disease (PD) is a progressive neurodegenerative disorder characterized by motor clinical alterations among others. Postural problems have serious consequences for patients, not only limiting their daily life but also increasing some risks, like the risk of fall. Inadequate postural control and postural instability is a major problem in PD patients. A Virtual Motor Rehabilitation System (VMR) has been tested in patients with PD in the intervention period. Our purpose was to analyze the evolution of the spatial postural control during the intervention period, to see if there are any changes caused precisely by this intervention.

METHODS

Ten people with PD carried out 15 virtual rehabilitation sessions. We tested a groundbreaking system based on Virtual Motor Rehabilitation in two periods of time (baseline evaluation and final evaluation). In the training sessions, the participants performed a customizable treatment using a low-cost system, the Active Balance Rehabilitation system (ABAR). We stored the pressure performed by the participants every five hundredths of a second, and we analyzed the patients' pressure when they maintained their body on the left, on the right, and in the center in sitting position. Our system was able to measure postural control in every patient in each of the virtual rehabilitation sessions.

RESULTS

There are no significant differences in the performance of postural control in any of the positions evaluated throughout the sessions. Moreover, the results show a trend to an improvement in all positions. This improvement is especially remarkable in the left/right positions, which are the most important positions in order to avoid problems such as the risk of fall. With regard to the suitability of the ABAR system, we have found outstanding results in enjoyment, success, clarity, and helpfulness.

CONCLUSIONS

Although PD is a progressive neurodegenerative disorder, the results demonstrate that patients with PD maintain or even improve their postural control in all positions. We think that the main factor influencing these results is that patients use more of their available cognitive processing to improve their postural control. The ABAR system allows us to make this assumption because the system requires the continuous attention of patients, promoting cognitive processing.

Influence of Exercise on Patients with Guillain-Barré Syndrome: A Systematic Review

Purpose: To evaluate the effects of exercise interventions on improving physical outcomes in patients with Guillain-Barré syndrome (GBS). Methods: The PubMed database was searched for articles published up to and including February 2015. Randomized controlled trials (RCTs), case reports, and quasi-experimental and single-subject designs published in English-language, peer-reviewed journals that assessed the impact of physical exercise on patients with GBS were included; study quality was assessed using Sackett's rules of evidence. Data are presented qualitatively and quantitatively using numerical values and percentages. Results: Seven articles were included in the systematic review. One RCT showed that high-intensity relative to lower intensity exercise significantly reduced disability in patients with GBS, as measured with the FIM (p<0.005, r=0.71). Overall, various types of exercise programmes improve physical outcomes such as functional mobility, cardiopulmonary function, isokinetic muscle strength, and work rate and reduce fatigue in patients with GBS. Conclusion: Because of insufficient high-quality literature, making confident conclusions about the effects of exercise interventions on physical outcomes in patients with GBS is not possible. Future research should consider using higher quality study designs to confirm the results outlined in this article.

Virtual Reality to Assess and Treat Lower Extremity Disorders in Post-stroke Patients

INTRODUCTION

This article is part of the Focus Theme of Methods of Information in Medicine on "Methodologies, Models and Algorithms for Patients Rehabilitation".

OBJECTIVES

To identify support of a virtual reality system in the kinematic assessment and physiotherapy approach to gait disorders in individuals with stroke.

METHODS

We adapt Virtual Reality Rehabilitation System (VRRS), software widely used in the functional recovery of the upper limb, for its use on the lower limb of hemiplegic patients. Clinical scales have been used to relate them with the kinematic assessment provided by the system. A description of the use of reinforced feedback provided by the system on the recovery of deficits in several real cases in the field of physiotherapy is performed. Specific examples of functional tasks have been detailed, to be considered in creating intelligent health technologies to improve post-stroke gait.

RESULTS

Both participants improved scores on the clinical scales, the kinematic parameters in leg stance on plegic lower extremity and walking speed > Minimally Clinically Important Difference (MCID).

CONCLUSION

The use of the VRRS software attached to a motion tracking capture system showed their practical utility and safety in enriching physiotherapeutic assessment and treatment in post-stroke gait disorders.

New methodologies for patients rehabilitation

OBJECTIVE

The present editorial is part of the focus theme of Methods of Information in Medicine titled "New Methodologies for Patients Rehabilitation", with a specific focus on technologies and human factors related to the use of Information and Communication Technologies (ICT) for improving patient rehabilitation.

METHODS

The focus theme explores different dimensions of empowerment methodologies for disabled people in terms of rehabilitation and health care, and to explores the extent to which ICT is a useful tool in this process.

RESULTS

The focus theme lists a set of research papers that present different ways of using ICT to develop advanced systems that help disabled people in their rehabilitation process.