El metaverso en el mundo de la salud: el futuro presente. Desafíos y oportunidades / The metaverse in the world of health: The present future. Challenges and opportunities

La Organización Mundial de la Salud define la salud digital como la incorporación de tecnologías de información y comunicación para mejorar la salud. En los últimos años, se vio una fuerte aceleración en la adopción de estas herramientas digitales, lo que impactó de lleno en los modelos asistenciales tradicionales. Actualmente, estamos observando el surgimiento de un gran entorno virtual inmersivo llamado metaverso. Su aparición genera nuevas y desafiantes oportunidades en la salud. En este artículo se exploran algunos conceptos relacionados con este campo, se dan ejemplos concretos de su aplicación en pediatría, se mencionan algunas experiencias en el ámbito hospitalario para finalmente adentrarse en los desafíos y oportunidades que emergen.

The World Health Organization has defined "digital health" as the use of information and communication technologies to improve health. In recent years, there has been a strong acceleration in the adoption of these digital tools, which has had a major impact on traditional healthcare models. We are currently witnessing the emergence of a large immersive virtual environment called the "metaverse." Its emergence creates new and challenging opportunities in health care. This article explores some metaverse-related concepts, provides specific examples of its use in pediatrics, describes experiences in the hospital setting, and finally delves into the resulting challenges and opportunities.

Effect of virtual reality on upper limb function after stroke: a study of diffusion tensor imaging / 中国康复理论与实践

ObjectiveTo explore the effect of virtual reality on upper limb function in stroke patients through diffusion tensor imaging (DTI). MethodsFrom September, 2021 to March, 2023, 80 stroke patients in the Fuzhou Second General Hospital were randomly divided into control group (n = 40) and experimental group (n = 40). Both groups received routine rehabilitation, while the experimental group received virtual reality training additionally, for four weeks. They were assessed with Fugl-Meyer Assessment-Upper Extremities (FMA-UE) and Action Research Arm Test (ARAT) before treatment, after treatment and after four-week follow-up; and they were scaned with DTI to measure the fractional anisotropy (FA) and relative anisotropy (RA) of cerebral peduncle and posterior limb of inner capsule of the affected side before and after treatment. ResultsTwo cases dropped in each group. The FMA-UE and ARAT scores increased in both groups after treatment and follow-up (F > 2.790, P < 0.001), and increased more in the experimental group than in the control group (t > 2.297, P < 0.05). FA and RA in the posterior limb of inner capsule increased in both groups after treatment (t > 21.013, P < 0.001), and increased more in the experimental group (t > 2.006, P < 0.05). The d-value of FA of the posterior limb of internal capsule before and after treatment (ΔFA) was positively correlated with the d-value of FMA-UE score (r > 0.362, P < 0.05) in both groups, the ΔFA of the posterior limb of internal capsule was positively correlated with the d-value of ARAT score (r = 0.459, P < 0.01). ConclusionVirtual reality training can promote the recovery of upper limb function in stroke patients, which may associate with the conductivity of posterior limb of inner capsule.

Multisensory Conflict Impairs Cortico-Muscular Network Connectivity and Postural Stability: Insights from Partial Directed Coherence Analysis / 神经科学通报·英文版

Sensory conflict impacts postural control, yet its effect on cortico-muscular interaction remains underexplored. We aimed to investigate sensory conflict's influence on the cortico-muscular network and postural stability. We used a rotating platform and virtual reality to present subjects with congruent and incongruent sensory input, recorded EEG (electroencephalogram) and EMG (electromyogram) data, and constructed a directed connectivity network. The results suggest that, compared to sensory congruence, during sensory conflict: (1) connectivity among the sensorimotor, visual, and posterior parietal cortex generally decreases, (2) cortical control over the muscles is weakened, (3) feedback from muscles to the cortex is strengthened, and (4) the range of body sway increases and its complexity decreases. These results underline the intricate effects of sensory conflict on cortico-muscular networks. During the sensory conflict, the brain adaptively decreases the integration of conflicting information. Without this integrated information, cortical control over muscles may be lessened, whereas the muscle feedback may be enhanced in compensation.

What do retina fellows-in-training think about the vitreoretinal surgical simulator: A multicenter survey

Purpose: To profile vitreoretinal (VR) fellows?in?training from India exposed to the Eyesi surgical simulator, to identify potential barriers to voluntary use, and enumerate the most preferred tools and tasks before incorporating them into a formal skill?transfer curriculum. Methods: A questionnaire consisting of 22 questions was designed and circulated through an online portal (surveymonkey.com) to four different institutes of India having a VR surgical fellowship program and using a functional Eyesi (Haag–Streit) simulator. All fellows and trainees who were exposed to the simulator were eligible to participate, irrespective of time spent on the simulator and exposure to training steps on real patients. The responses collected were private and anonymous. Results: Of the 37 respondents, most (n = 25, 68%) considered surgical simulators to be the best training tool before operating on the human eye. A majority (n = 35, 94.5%) of participants spent <3 h per week on the simulator, which, most (n = 30, 81%) felt was not enough time. The main reasons for this underutilization were work?hour limitations (54.8%), lack of a structured training program (19.3%), or a dedicated supervisor (16.1%). Again, the majority (n = 33, 89%) of participants responded that VR surgical skills acquired during simulator training were transferrable to the operating room, which was reflected by their response (n = 31, 83.7%) that simulator?based training should be made mandatory before operating room exposure. Conclusion: This study gives an insight into the overall practice patterns and preferences in simulation training of surgical VR fellows?in?training across India. It indicates that the simulator is extremely helpful to fellows and if adopted, VR surgical simulators with organized, directed, and supervised sessions will considerably improve the surgical training experience.

La digitalización en la formación odontológica

La implementación de herramientas tecnológicas en la educación odontológica a lo largo de los años ha permitido al estudiante mejorar su desempeño en el ámbito preclínico de su formación, desarrollando habilidades motoras finas; en la actualidad este tema cobra relevancia debido a la coyuntura de salubridad del COVID-19. El objetivo de esta revisión fue describir la digitalización en la formación odontológica, las herramientas tecnológicas que se emplean y la percepción de estudiantes frente a la educación digital en Odontología. Se realizó una revisión electrónica en las bases de datos PubMed, SciELO, LILACS y ScienceDirect, en búsqueda de artículos publicados en inglés y español en el periodo 2015 al 2022. Se revisaron 156 artículos seleccionándose 50 directamente relacionados al tema de estudio. Se concluye que existen diversas herramientas digitales que pueden utilizarse en la formación de profesionales en Odontología; además, el aprendizaje mixto genera mejores resultados que el aprendizaje tradicional, y el aprendizaje en on-line, que fue utilizado durante el confinamiento por la pandemia de la COVID-19, demostró un alto grado de insatisfacción en los estudiantes.

The implementation of technological tools in dental education over the years has allowed the student to improve their performance in the preclinical field of their training, developing fine motor skills, currently this issue has become relevant due to the health situation of COVID-19. The objective was to describe digitalization in dental training, the technological tools used and the students´ perception of digital education in dentistry. An electronic review of the PubMed, SciELO, LILACS and ScienceDirect databases was carry out in search of articles published in English and Spanish in the period 2015 to 2022. One hundred fifty-six articles were reviewed, selecting 50 directly related to the subject of study. It is concluded that there are various digital tools that can be used in the training of professionals in dentistry; furthermore, exclusive online learning generates better results than traditional learning; and exclusive online learning, which was used during the COVID-19 pandemic lockdown, demonstrated a high degree of student dissatisfaction.

O uso de realidade virtual no cateterismo intravenoso periférico em crianças/adolescentes: relato de experiência / The use of virtual reality in peripheral intravenous catheterization in children/adolescents: experience report / El uso de la realidad virtual en el cateterismo intravenoso periférico en niños/adolescentes: reporte de experiencia

Conclusão: a realidade virtual é um recurso que pode ser utilizado como distração durante o cateterismo intravenoso periférico. Para os discentes, houve reflexão sobre o tratamento adequado de enfermagem em pediatria, além do desenvolvimento de habilidades de comunicação e senso crítico

Conclusion: virtual reality is a resource that can be used as a distraction during peripheral intravenous catheterization. For the learners, this experience prompted reflection on appropriate pediatric nursing care, in addition to fostering the development of communication skills and critical thinking

Conclusión: la realidad virtual es un recurso que se puede utilizar como distracción durante la cateterización intravenosa periférica. Para los aprendices, esta experiencia llevó a una reflexión sobre la atención de enfermería pediátrica adecuada, además de fomentar el desarrollo de habilidades de comunicación y pensamiento crítico

O modelo biopsicosocial na reabilitação por gameterapia na paralisia cerebral: revisão sistemática / The biopsychosocial model in gametherapy rehabilitation in cerebral palsy: systematic review

Objetivo: Investigar os efeitos das intervenções com uso de Realidade Virtual (RV) para crianças com Paralisia Cerebral (PC) baseando-se na estrutura da Classificação Internacional de Funcionalidade, Incapacidade de Saúde (CIF). Método: Trata-se de revisão sistemática de ensaios clínicos randomizados, realizada em julho de 2022. Foram investigadas intervenções relacionadas a fisioterapia associada aos jogos de RV para crianças com PC, idade de 6 a 12 anos nas bases de dados: PubMed, Cochrane, MedLine e PEDro. A qualidade metodológica foi avaliada pela Escala PEDro. Foram incluídos 9 estudos envolvendo total de 310 participantes, destes, 5 estavam inseridos em estrutura e funções do corpo, 9 artigos em atividade e nenhum estudo investigaram o componente participação ou fatores contextuais, sendo que alguns foram incluídos em mais do que um componente da CIF. Resultados: A função manual e o equilíbrio corporal foram os desfechos mais avaliados. Como limitação, destaca-se o pequeno número de estudos e a falta de dados sobre os componentes de participação e fatores contextuais. O ponto forte do estudo foi associar a CIF a uma categoria de reabilitação fisioterapêutica para esta população. Conclusão: Pesquisas experimentais recentes relacionadas ao uso da RV na fisioterapia de crianças com PC estão em sua maioria direcionadas ao componente de atividade da CIF. Mais estudos são necessários a fim de investigar se o aprendizado no ambiente terapêutico é transferido no contexto de vida desses indivíduos e se há impacto na participação e funcionalidade. Número de registro na Prospero: CRD42021260011.

Objective: To investigate the effects of interventions using Virtual Reality (VR) for children with Cerebral Palsy (CP) based on the structure of the International Classification of Functioning, Health Disability (ICF). Method: This is a systematic review of randomized clinical trials, carried out in July 2022. Interventions related to physiotherapy associated with VR games for children with CP, aged 6 to 12 years, were investigated in the databases: PubMed, Cochrane, MedLine and PEDro. Methodological quality was assessed using the PEDro Scale. Nine studies were included involving a total of 310 participants, of which 5 were inserted in the structure and functions of the body, 9 articles in activity and no study investigated the participation component or contextual factors, and some were included in more than one component of the CIF. Results: Manual function and body balance were the most appreciated results. As a limitation, the small number of studies and the lack of data on participation components and contextual factors stand out. The strong point of the study was to associate an ICF with a physiotherapeutic rehabilitation category for this population. Conclusion: Recent experimental studies related to the use of VR in the physical therapy of children with CP are mostly focused on the activity component of the ICF. More studies are needed in order to investigate whether learning in the therapeutic environment is transferred in the context of these individuals' lives and whether there is an impact on participation and functionality. Prospero registration number: CRD42021260011

Effect of virtual reality on preoperative anxiety in patients undergoing septorhinoplasty

Abstract Background The aim of this study was to evaluate the effect of a virtual reality video on preoperative anxiety, hemodynamic parameters, and patient satisfaction in patients undergoing septorhinoplasty. Methods This was a prospective, observational cohort trial. Forty patients between the ages of 18-65 who were scheduled for elective septorhinoplasty, with an American Society of Anesthesiologists (ASA) physical status I-II were included in the study. Patients experienced a 15-minute virtual reality (VR) video via a phone using a VR device. A three-dimensional, 360° video depicted the beauty of nature and was accompanied by meditation music. Patients' oxygen saturation values, heart rate, and blood pressure were monitored and recorded. Using the State-Trait Anxiety Inventory scale, anxiety scores and hemodynamic parameters were compared before and after VR application. Results Median anxiety scores decreased significantly from 40.5 to 34 (p< 0.001). VR also had positive effects on hemodynamic parameters. Conclusions VR reduces preoperative anxiety and has positive effects on hemodynamic parameters in patients undergoing septorhinoplasty. We anticipate that VR will be increasingly used as a non-pharmacological preoperative approach in the future.

Eficácia da realidade virtual no manejo da dor pediátrica: contribuições da inovação tecnológica em saúde / Effectiveness of virtual reality in pediatric pain management: contributions of health technological innovation / Eficacia de la realidad virtual en el manejo del dolor pediátrico: aportes de la innovación tecnológica em salud

Avaliar e manejar a dor no período pós-operatório é fundamental, pois a dor aguda, se não ratada, é capaz de alterar diversos sistemas orgânicos. A realidade virtual constitui instrumento promissor de baixo custo para o alívio da dor. Este trabalho objetivou determinar a eficácia da realidade virtual no manejo da dor aguda leve a moderada em pacientes no pós-operatório mediato. Trata-se de um estudo clínico randomizado, realizado em um hospital pediátrico de Curitiba. Os participantes da pesquisa foram randomizados e alocados em dois grupos, submetidos a um vídeo temático relaxante e à realidade virtual. Os dados foram submetidos à análise estatística descritiva e inferencial. A redução da dor proporcionada pela realidade virtual é estatisticamente significativa e superior quando comparada à redução induzida pelo vídeo temático relaxante, podendo otimizar a experiência de hospitalização, com atenção centrada na experiência do paciente, mitigando os efeitos colaterais relacionados ao uso de opioides.

Assessing and managing pain in the post-operative period is essential, as acute pain, if left untreated, can alter several organic systems. Virtual reality is a promising low-cost tool for pain relief. This study aimed to determine the effectiveness of virtual reality in the management of mild to moderate acute pain in patients in the immediate postoperative period. This is a randomized clinical study, carried out in a pediatric hospital in Curitiba. Research participants were randomized and allocated into two groups, and shown a relaxing thematic video and virtual reality. Data were subjected to descriptive and inferential statistical analysis. Pain reduction provided by virtual reality is statistically significant and superior when compared to the reduction induced by the relaxing thematic video, and can optimize the hospitalization experience, with attention focused on the patient's experience, mitigating side effects related to the use of opioids

La evaluación y manejo del dolor en postoperatorio es fundamental. Ya que el dolor agudo, si no se trata, es capaz de alterar varios sistemas. La realidad virtual es un instrumento prometedor de bajo costo para alivio del dolor. Este estudio tuvo como objetivo determinar la efectividad de la realidad virtual en el manejo del dolor agudo en pacientes en postoperatorio inmediato. Se trata de un estudio clínico aleatorizado realizado en un hospital pediátrico de Curitiba. Los sujetos de la investigación fueron aleatorizados y distribuidos en dos grupos, sometidos a un video temático relajante y a la realidad virtual. Los datos fueron sometidos al análisis estadístico descriptivo e inferencial. La reducción del dolor proporcionada por la realidad virtual es estadísticamente significativa y superior en comparación con la reducción inducida por el video temático relajante, que puede optimizar la experiencia de hospitalización, con atención contrada en la experiencia del paciente, mitigando efectos secundarios relacionados con opioides.

Differences in augmented reality games performance between individuals with down syndrome and individuals with typical development

Introduction: Down syndrome is the most common genetic cause of intellectual disability, and the use of augmented reality can be improving the cognitive, motor, and literacy skills of this population Objective: to compare statistical differences in learning between individuals with Down syndrome and individuals with typical development using augmented reality games.Methods: we compared the reaction time before and after the virtual reality tasks, in addition to the performance in these tasks, which consisted of correctly identifying numbers and letters in 46 people with Down syndrome and 46 controls with typical development.Results: our results indicate that the total points for the typical development group were higher (M = 13.0 and 11.9) when compared to the Down syndrome group (M = 6.6 and 4.6) for letters of the alphabet and numbers, respectively. Furthermore, the results indicated that participants in both groups were more accurate in identifying alphabetic symbols when compared to numerical symbols, and both groups were sensitive to the number of symbols presented in each phase. The down syndrome group had a lower performance when compared to the typical development group.Conclusion: despite the need for further studies, our results support the outcome that there is clinical utility of an intervention based on virtual reality tasks for people with Down syndrome. In conclusion, the use of this technology to improve the reaction time of this population is considered useful

Introdução: a síndrome de Down é uma das principais doenças genéticas que causam deficiência intelectual, e o uso da realidade aumentada pode aumentar as habilidades cognitivas, motoras e de aprendizado dessa população. Objetivo: comparar diferenças estatísticas na aprendizagem entre indivíduos com síndrome de Down e indivíduos com desenvolvimento típico usando jogos de realidade aumentada.Métodos: comparamos o tempo de reação antes e depois das tarefas de realidade virtual, além do desempenho nessas tarefas, que consistiam em identificar corretamente números e letras em 46 pessoas com síndrome de Down e 46 controles com desenvolvimento típico.Resultados: nossos resultados indicam que o total de pontos para o grupo de desenvolvimento típico foi maior (M = 13,0 e 11,9) quando comparado ao grupo com síndrome de Down (M = 6,6 e 4,6) para letras do alfabeto e números, respectivamente. Além disso, os resultados indicaram que os participantes de ambos os grupos foram mais precisos na identificação de símbolos alfabéticos quando comparados aos símbolos numéricos, e ambos os grupos foram sensíveis ao número de símbolos apresentados em cada fase. O grupo com síndrome de Down teve desempenho inferior quando comparado ao grupo de desenvolvimento típico.Conclusão: apesar da necessidade de mais estudos, nossos resultados suportam a utilidade clínica de uma intervenção baseada em tarefas de realidade virtual para pessoas com síndrome de Down. Em conclusão, considera-se útil o uso dessa tecnologia para melhorar o tempo de reação dessa população

Efeitos de um treinamento com dispositivo comercial de realidade virtual imersiva sobre a marcha e cognição de pessoas com doença de Parkinson / Effects of a commercial immersive virtual reality device-based training on gait and cognition in people with Parkinson's disease

Objetivo: Avaliar a eficácia e a usabilidade de um treinamento imersivo de realidade virtual usando o Samsung Gear VR OculusTM (SGVR) para marcha e cognitivo em pessoas com doença de Parkinson (DP). Foi realizado um ensaio clínico controlado, quase experimental e cego. Método: Quarenta pessoas com DP foram divididas em dois grupos. O Samsung Gear Virtual Reality Group (VRG) participou de 10 sessões, duas vezes por semana, com duração de uma hora cada, realizando quatro jogos que exigiam movimento da cabeça e deslocamento do centro de gravidade. O grupo controle não recebeu tratamento. Os participantes foram avaliados antes, após a intervenção e 30 dias após a intervenção, com avaliação da marcha por meio do teste Timed Up and Go, teste de caminhada de 10 metros, teste de caminhada de 30 segundos com tarefa simples e dupla e avaliação cognitiva com teste de fluência verbal, dígito para frente e para trás Testes de amplitude e teste Stroop Color. Ao final do treinamento, a VRG respondeu ao questionário System Usabilidade Scale para avaliar a usabilidade do sistema. Resultados: Embora o sistema tenha sido avaliado com excelente usabilidade pelos usuários, não houve efeitos de interação e, portanto, nossos resultados não suportam que o treinamento de realidade virtual imersiva usando jogos SGVR foi superior a nenhum treinamento. Conclusão: No entanto, quando cada grupo foi examinado separadamente, o VRG apresentou melhoras, após a intervenção e 30 dias após a intervenção, para velocidade da marcha (p<0,005 e p<0,001, respectivamente), memória de trabalho, atenção e processamento de informações (p<0,01 em ambos os momentos de avaliação), inibição de resposta, memória de trabalho e de longo prazo (p< 0,01 em 30 dias após a intervenção). A avaliação adicional do dispositivo SGVR é necessária

Objective: Evaluate the effectiveness and the usability of an immersive virtual reality training using Samsung Gear VR OculusTM (SGVR) for gait and cognitive in people with Parkinson's disease (PD). Controlled, quasi-experimental and blinded clinical trial was carried out. Methods: Forty people with PD were divided into two groups. Samsung Gear Virtual Reality Group (VRG) participated in 10 sessions, twice a week, lasting one hour each, performing four games that required head movement and center of gravity shift. Control group didn't receive treatment. Participants were evaluated before, after the intervention and 30 days after intervention, with the Timed Up and Go test, 10 meters walking test, single and dual tasking 30 seconds walking test, verbal fluency test, forward and backward Digit Span tests and Stroop Color test. At the end of the training, VRG responded to the System Usability Scale questionnaire to assess the usability of the system. Results: Even though the system was rated with excellent usability by the users, there were no interaction effects and, therefore, our results do not support that immersive virtual reality training using SGVR games was superior to no training. However, when each group was examined separately, the VRG experienced improvements, after the intervention and 30 days after intervention, for gait velocity (p<0.005, p<0.001, respectively), working memory, attention, and information processing (p<0.01 in both evaluation time points), response inhibition, working and long-term memory (p< 0.01 in 30 days after intervention). Conclusion: Further evaluation of the SGVR device is required

The use of serial casting in the treatment of children with cerebral palsy: a study protocol

Introduction: Cerebral Palsy (CP) is characterized by a disorder of posture and movement, commonly leading to disabling orthopedic alterations, including muscle shortening, especially in the lower limbs. Stretching methods, performed gradually, are necessary to delay the impairment in function from muscle shortening. The use of serial casting aims to promote proper alignment, and an ideal and stable support base, in addition to better bone and joint health, leading to better posture, mobility, muscle function, and, subsequently, increased fitness and health.Objective: evaluate range of motion, postural control, and motor performance in children with CP, using serial casting, as well as to measure its effect on fitness through the autonomic nervous system (ANS).Methods: Sixty children and adolescents with CP, of both sexes, 3 to 12 years of age, will be divided into three groups: Groups A, B, and C, with 20 individuals each. Group A will use serial casting, Group B will use the orthosis continuously (with removal only allowed for bathing), and Group C will use the orthosis in their daily routine. Range of motion of the ankle of first and second resistance levels (R1 and R2), gross motor function measure (GMFM), and balance (measured by BERG scale) will be used in the initial and final assessments, and after 6 months and one year of follow-up. Timed-up-and-go (TUG), load distribution (baropodometry), motor performance measured through a real basketball game and the virtual MoveHero game, analysis of body angulation with "mydartfish", and cardiac autonomic modulation through heart rate variability will be assessed in three different situations: barefoot, with orthosis, and with casting.Conclusion: Serial casting demonstrates the potential to produce positive results in the treatment of individuals with CP regarding better alignment, with consequent motor and autonomic improvement.

The effect of virtual reality technology in children after surgery for concomitant strabismus

Purpose: This study aimed to investigate the effect of virtual reality (VR) technology in children after surgery for concomitant strabismus. Methods: A total of 200 children with concomitant exotropia or concomitant esotropia were randomly divided into a training group and a control group according to the single even number random method (100 cases in each group). Patients in the training group received VR intervention training within 1 week after surgery. Patients in the control group did not receive any training. Results: Six months after the surgery, the orthophoria (the far or near strabismus degree was ?8?) rate was significantly higher in the training group than in the control group (P = 0.001), while the eye position regression rate (compared to the strabismus degree within 1 week after the surgery, the amount of regression >10?) was significantly lower in the training group than in the control group (P = 0.001). Six months after the surgery, the number of children with simultaneous vision and remote stereovision was significantly higher in the training group than in the control group (P = 0.017 and 0.002, respectively). The differences in the number of patients with peripheral stereopsis, macular stereopsis, and stereopsis in macular fovea centralis at 1, 3, and 6 months after the surgery between the training and the control groups were not statistically significant (P = 0.916, 0.274, and 0.302, respectively). Conclusion: The intervention of VR technology after strabismus correction effectively improved children’s visual function and maintained their eye position

Applicability of an immersive virtual reality system to assess egocentric orientation of older adults / Aplicabilidade de um sistema de realidade virtual imersivo para avaliar a orientação egocêntrica de idosos

Abstract Background Spatial orientation is a cognitive domain frequently compromised in patients with Alzheimer disease (AD) and may be one of its first clinical manifestations. Some studies have shown that allocentric integration with egocentric spatial information seems to be impaired in this pathology. There is no consensus on how best to assess spatial orientation and traditional tests lack ecological validity, but, recently, virtual reality (VR) has provided new opportunities for this assessment. Objectives To analyze the applicability and stability of an immersive virtual task developed to assess spatial orientation, the Spatial Orientation in Immersive Virtual Environment Maze Test (SOIVET-Maze) in older adults with and without mild cognitive impairment. Methods Forty-three older adults were included in the study, 24 without cognitive impairment and 19 with mild cognitive impairment. Applicability was assessed by the Witmer and Singer Sense of Presence Questionnaire and a questionnaire for adverse events of cybersickness. To assess stability, participants were assessed twice with an interval of 7 to 14 days, and the intraclass correlation coefficient was calculated between visits. The t test or the Mann-Whitney test was used to compare applicability and stability between groups. Results There was no significant difference between the groups regarding applicability. A strong correlation between the first and second day of testing was found in the mild cognitive impairment group. Conclusion The SOIVET-Maze task showed excellent applicability and good stability, favoring its clinical application for the evaluation of spatial orientation in older adults.

Resumo Antecedentes A orientação espacial é um domínio cognitivo frequentemente comprometido em pacientes com doença de Alzheimer (DA) e pode ser uma das suas primeiras manifestações clínicas. Alguns estudos demonstraram que a integração alocêntrica com informações espaciais egocêntricas parece prejudicada nessa patologia. Não há um consenso sobre qual a melhor forma de avaliar a orientação espacial e os testes tradicionais carecem de validade ecológica; porém, recentemente, a realidade virtual (RV) proporcionou novas oportunidades para esta avaliação. Objetivos Analisar a aplicabilidade e estabilidade de uma tarefa virtual imersiva desenvolvida para avaliar a orientação espacial, o Spatial Orientation in Immersive Virtual Environment Maze Test (SOIVET-Maze) em idosos com e sem comprometimento cognitivo leve. Métodos Quarenta e três idosos foram incluídos no estudo, 24 sem comprometimento cognitivo e 19 com comprometimento cognitivo leve. A aplicabilidade foi avaliada pelo Witmer and Singer Sense of Presence Questionnaire e um questionário para eventos adversos de cybersickness. Para avaliar a estabilidade, os participantes foram avaliados 2 vezes com intervalo de 7 a 14 dias, e o coeficiente de correlação intraclasse foi calculado entre as visitas. O teste t ou o teste de Mann-Whitney foi utilizado para comparar a aplicabilidade e estabilidade entre os grupos. Resultados Não houve diferença significativa entre os grupos quanto à aplicabilidade. Uma forte correlação entre o primeiro e o segundo dia de teste foi encontrada no grupo de comprometimento cognitivo leve. Conclusão A tarefa SOIVET-Maze apresentou excelente aplicabilidade e boa estabilidade, favorecendo sua aplicação clínica para avaliação da orientação espacial em idosos.

Relationship between learning styles and simulation in surgery / Relação entre os estilos de aprendizagem e simulação em cirurgia

Abstract: Introduction: It was found that the good performance in conventional techniques was not transferable to minimally-invasive alternatives, and then simulators were created for improved learning. Objective: To assess whether robotic virtual reality simulation conditions ability for laparoscopy in medical students, associating the VARK tool and Mind Styles to determine whether there is a correlation between learning styles and the ability to develop these skills. Methods: Randomization of 3 groups of medical students was performed, where one of the groups performed a simulation of a surgical knot exercise in the laparoscopy box and another, the same exercise on the robot console. The third group did not simulate. All participants took a practical test in the laparoscopy box and their performances were evaluated. Moreover, a pre-test and a post-test were applied, in addition to the VARK and mind styles methods, to assess whether there was a difference in performance between the different learning styles. Results: The practical test scores were relatively homogeneous between the groups and between the Mind Styles and VARK categories, with no significant difference being found between the groups; therefore, it was not possible to demonstrate that learning styles interfered with the results of this study. There was only a significant difference between the pre-test scores of at least one pair of the groups and between the Laparoscopy and Robotics groups, with a p-value of 0.038. Conclusion: There was no statistical significance between learning styles and performance regarding the proposed tasks.

Resumo: Introdução: Constatou-se que o bom desempenho em técnicas convencionais não se transferia para as minimamente invasivas, e, com isso, foram criados os simuladores para melhor aprendizado. Objetivo: Este estudo teve como objetivo avaliar se a simulação em realidade virtual robótica promove habilidade para laparoscopia em acadêmicos de Medicina, associando a ferramenta VARK e o mind styles (GSD) para determinar se há correlação dos estilos de aprendizagem com a capacidade de desenvolver essas habilidades. Método: Realizou-se randomização de três grupos de acadêmicos de Medicina, em que um dos grupos fez simulação de um exercício de nó cirúrgico na caixa de laparoscopia (CL), e outro, o mesmo exercício no console do robô. O terceiro grupo não participou da simulção. Todos os participantes fizeram um teste prático na CL, e as performances deles foram avaliadas. Ademais, foram aplicados um pré-teste e um pós-teste, além do formulário VARK e GSD, para avaliar se havia diferença de performance entre os diferentes estilos de aprendizagem. Resultado: As notas das provas práticas foram relativamente homogêneas entre grupos e entre as categorias de Mind Styles e do VARK. Como não se encontrou diferença significativa entre os grupos, não foi possível demonstrar que os estilos de aprendizagem interferiram nos resultados deste estudo. Houve apenas diferença significativa entre as notas do pré-teste de pelo menos um par de grupos e entre os grupos laparoscopia e robótica com p-valor 0,038. Conclusão: Não houve significância estatística entre os estilos de aprendizagem e o desempenho nas tarefas propostas.

Repercussões Clínicas da Gameterapia no Manejo do Indivíduo com Fibrose Cística / Clinical repercussions of game therapy in the management of individuals with cystic fibrosis

Introdução: A gameterapia (GT) tem sido utilizada como método para estimular a prática de atividade física em indivíduos com fibrose cística (FC), podendo proporcionar melhora no sistema cardiorrespiratório e na adesão ao tratamento. Objetivo: analisar as repercussões clínicas da gameterapia no manejo de pacientes com FC. Métodos:Conduziu-se uma revisão sistemática de literatura nas seguintes bases de dados: PubMed, Embase, Scopus e MEDLINE via Ovid, utilizando-se os descritores:"Cystic fibrosis","video games" e seus cognatos, por meio da qual se incluíram estudos que descrevessem as repercussões do uso da GT em indivíduos com FC. Resultados: Foram identificados 293 estudos, sendo 7 selecionados ao final. Em 6 estudos, a frequência cardíaca alcançada durante a GT apresentou-se dentro dos padrões recomendados para treinamento. A avaliação do consumo máximo de oxigênio (VO2máx) foi realizada em 3 publicações, e este parâmetro apresentou níveis mais elevados em comparação ao identificado no teste de caminhada de seis minutos. Os consoles mais utilizados foram Nintendo Wii TM e Xbox 360 ™ e a intensidade na realização dos exercícios com a GT esteve entre moderada e intensa. A adesão dos indivíduos quanto a esse recurso também foi verificada, e a GT apresentou-se mais aceitável que outros e foi considerada lúdica. Conclusão: a GT se mostra uma intervenção capaz de gerar respostas fisiológicas que correspondem às necessidades de treinamento, além de maior adesão e satisfação dos indivíduos com FC em sua realização (AU),

Game therapy (GT) has been used as a method to encourage the practice of physical activity in individuals with cystic fibrosis (CF), which may provide improvement in the cardiorespiratory system and treatment adherence. Objective: analyze the clinical repercussions of game therapy in the management of patients with CF. Methods: A systematic review of the literature was carried out in the following databases: PubMed, Embase, Scopus and MEDLINE via Ovid, using the descriptors: "Cystic fibrosis", "video games" and their cognates, through which they included Studies describing the repercussions of the use of GT in individuals with CF were sought. Results: 293 studies were identified, seven of which were selected at the end. In six studies, the heart rate reached during the TG was within the recommended standards for training. The assessment of maximum oxygen consumption (VO2max) was performed in three publications, and this parameter showed higher levels compared to that identified in the six-minute walk test. The most used consoles were Nintendo WiiTM and Xbox 360™and the intensity in carrying out the exercises with the TG was moderate and intense. The individuals' adherence to this resource was also verified, and the GT was more acceptable than others and was considered playful. Conclusion: TG proves to be an intervention capable of generating physiological responses that correspond to training needs and greater adherence and satisfaction of individuals with CF in its performance (AU).

Effect of comfort theory-based nursing care on pain and comfort in women undergoing hysterosalpingography: a randomized controlled trial

SUMMARY OBJECTIVE: This study aims to examine the effect of comfort theory-based nursing care on pain and comfort in women undergoing hysterosalpingography. METHODS: This randomized control trial was conducted on 126 women (42 in each intervention and control group). Virtual reality glasses group (n=42), mobile-assisted education group (n=42), and control group (n=42). The control group received only routine care. Comfort levels were evaluated at the beginning and end of the study using the General Comfort Scale and pain levels evaluated at the beginning and end of the study using the Visual Analog Scale. RESULTS: The comfort theory-based nursing care (virtual reality glasses and mobile-assisted education group) was effective in increasing women's comfort with painful invasive procedures such as hysterosalpingography and reducing pain. CONCLUSION: It is recommended that a nurse be present in the hysterosalpingography process, providing nursing care services continuously and introducing this program to working nurses. Clinical Trial Registration Number: NCT04676932.

Intervenciones cognitivas a través de realidad virtual en personas con Deterioro Cognitivo Leve: Una Revisión Sistemática

Introducción: La posibilidad de reversión del Deterioro Cognitivo Leve (DCL) ha generado diversas investigaciones en búsqueda de tratamiento, entre ellas la estimulación cognitiva a través de realidad virtual (RV). No obstante su uso, no existe aún evidencia acerca de las modalidades y efectos en personas con DCL. Objetivo: Sistematizar las características de los estudios que han utilizado intervenciones cognitivas con RV en personas con DCL, describir sus efectos y establecer recomendaciones para futuras investigaciones en base a las limitaciones reportadas. Métodos: revisión sistemática de estudios publicados entre 2010 y 2020, en las bases de datos Web of Science, Scopus y Pubmed. Resultados: Se identificaron 14 estudios con programas que emplearon mayoritariamente RV de tipo inmersiva, con el "supermercado" como escenario virtual más frecuente. En siete trabajos se intervino una función cognitiva, siendo la memoria y las funciones ejecutivas las más intervenidas. Los instrumentos de evaluación se concentraron en medidas cognitivas, con escasa evaluación de variables neuropsiquiátricas y de calidad de vida. Trece estudios informaron mejoras a nivel cognitivo general o por dominio específico. Conclusiones: La utilización de RV, inmersiva y no inmersiva, ha tenido resultados positivos en el rendimiento cognitivo general o específico por dominio, de personas con DCL, sin embargo, debido a la incipiente y limitada evidencia de su uso en personas con esta patología, no es posible determinar la sostenibilidad de estos resultados y la generalización de estas intervenciones hacia las actividades de la vida diaria. Se recomienda realizar intervenciones con entornos reales y seguimiento post-intervención.

Introduction: The possibility of Mild Cognitive Impairment (MCI) reversal has generated numerous studies in search of treatment, including cognitive stimulation through virtual reality (VR). Despite its use, there is still no evidence about the modalities and effects in people with MCI. Aim: To systematize the characteristics of the studies that have used cognitive interventions with VR cognitive in people with MCI, describe their effects and to establish recommendations for future research based on the limitations reported. Methods: systematic review of studies published between 2010 and 2020, in the Web of Science, Scopus and Pubmed databases. Results: 14 studies were identified with programs that mostly used immersive VR, with the "supermarket" as the most frequent virtual scenario. In seven studies only one cognitive function was involved, with memory and executive functions being the most intervened. The assessment instruments focused on cognitive measures, with little assessment of neuropsychiatric and quality of life variables. Thirteen studies reported improvements on the general cognitive level or by specific domain. Conclusions: The use of immersive and non-immersive VR has had positive results in the general or domain-specific cognitive performance of people with MCI, however, due to the incipient and limited evidence of its use in people with this pathology, it is not possible to determine the sustainability of these results and the generalization of these interventions regarding daily living activities. Interventions with real environments and post-intervention follow-up are recommended.

Realidade virtual na redução da dor em crianças queimadas: Estudo piloto quase-experimental / Virtual reality in pain reduction in burnt children: Quasi-experimental pilot study

OBJETIVO: Descrever a realização do teste piloto de estudo quase-experimental utilizando a realidade virtual (RV) para o alívio da dor durante a troca de curativo de crianças queimadas. MÉTODO: Estudo piloto, quase-experimental, do tipo série temporal interrompida com um grupo. Amostra consecutiva e de conveniência de cinco crianças internadas em um Centro de Tratamento de Queimados no Sul do Brasil, no período de dezembro/2015 a março/2016, que receberam intervenção com RV durante a troca de curativos, por três dias. A dor foi avaliada por meio da escala numérica e de faces. RESULTADOS: A RV foi aplicada três vezes em cada criança. A criança com maior superfície corporal queimada apresentou maiores picos de dor antes, durante e após o curativo. Ademais, as crianças apresentaram diminuição da dor imediatamente após o curativo. CONCLUSÕES: A intervenção com a RV foi considerada importante para as crianças queimadas, visto que tiveram uma diminuição da dor durante e após o procedimento com sua utilização.

OBJECTIVE: To describe the carrying out of the pilot test of a quasi-experimental study using virtual reality (VR) for pain relief during dressing change in burnt children. METHODS: Pilot study, quasi-experimental, interrupted time series type with one group. Consecutive and convenience sample of five children hospitalized at a Burn Treatment Center in southern Brazil, from December/2015 to March/2016, who received intervention with VR during dressing change, for three days. Pain was assessed using the numerical and faces scale. RESULTS: VR was applied three times to each child. The child with the largest body surface area burned had the highest peaks of pain before, during and after the dressing. Furthermore, the children showed a decrease in pain immediately after the dressing. CONCLUSIONS: The intervention with VR was considered important for burned children, as they had a decrease in pain during and after the procedure with its use.

Avaliação do desconforto sensorial causado por estimulação com realidade virtual em voluntários com e sem cinetose / Evaluation of sensory discomfort caused by stimulation with virtual reality in volunteers with and without kinetosis

RESUMO Objetivo comparar os sintomas da cinetose provocados por estímulo de realidade virtual, em voluntários com e sem histórico da doença. Métodos estudo analítico qualitativo e quantitativo, observacional transversal, prospectivo, realizado com voluntários com e sem histórico de cinetose, submetidos à imersão em realidade virtual com o uso de óculos de realidade aumentada. Antes e após a estimulação sensorial, o participante tinha a frequência respiratória (FR), a frequência cardíaca (FC) e pressão arterial sistólica (PAs) e diastólica (PAd) medidas. No primeiro dia, o voluntário foi exposto a um vídeo que simulava uma pessoa dentro de um carro, com predomínio de fluxo visual lateral. Após uma semana, uma animação de montanha russa, com predomínio de fluxo visual frontal. Durante a estimulação sensorial de dez minutos, uma nota de 0 a 10 era dada a cada 30 segundos para a intensidade do desconforto sentido pelo participante. Após, um questionário foi realizado para avaliação dos sintomas de cinetose. Resultados indivíduos com cinetose apresentaram maior intensidade de sintomas, tanto no experimento do carro (p=0,026), como na montanha russa (p=0,035). Não houve correlação entre cinetose e as variáveis FC, FR e PA. Os pacientes com cinetose atribuíram maiores notas de desconforto no curso das experiências, principalmente na experiência da montanha russa. Conclusão indivíduos com cinetose apresentam sintomas mais intensos quando submetidos a estímulos por realidade virtual, se comparados a indivíduos sem a doença.

ABSCTRACT Purpose to compare the symptoms of motion sickness caused by virtual reality stimulation in volunteers with and without history of the disease. Methods qualitative and analytical, observational, cross-sectional, and prospective study, approved by Research Ethics Committee, 3.443.429/19, with volunteers with and without history of motion sickness who were subjected to immersion in VR with the use of virtual reality glasses. Before and after sensory stimulation, the participant had respiratory rate (RF), heart rate (HR) and systolic blood pressure (PAs) and diastolic blood pressure (PAd) measured. On the first day, the volunteer was exposed to a video that simulated a person in a car, with a predominance of lateral visual flow. A week later, an animation of a roller coaster, with a predominance of frontal visual flow. During the 10-minute experiment, a score from 0 to 10 was given every 30 seconds for the intensity of the discomfort felt by the volunteer. A post-questionnaire was conducted to assess motion sickness symptoms. Results individuals with motion sickness history had a higher intensity of symptoms in the car (p = 0.026) and roller coaster experiment (p = 0.035). There was no correlation between motion sickness and the variables HR,FR,PA. Patients with motion sickness gave higher scores of discomfort throughout the experiments, mainly in the roller coaster experience. Conclusion individuals with motion sickness present more intense symptoms when subjected to stimuli by VR compared to controls without disease.