Effectiveness of Virtual Reality in Balance Training for Fall Prevention in Older Adults: Systematic Review.

OBJECTIVE: The purpose of this study was to determine the effectiveness of virtual reality (VR) in balance training for the prevention of falls in older adults. METHODS: We included studies with experimental designs, cohort studies, and quasi-experimental studies of older adults who underwent balance training associated with the use of VR for the prevention of falls. The comparison of control and intervention groups in the studies reported statistically significant improvements in terms of balance for VR. RESULTS: The effects and benefits from the use of VR were seen by the fourth week of intervention, with significant improvements in balance and lower fall rates, the improvements became greater for groups using VR. CONCLUSIONS: The benefits presented by the studies were related not only to balance but also to fear of falling, reaction time, gait, physical fitness, independence in activities of daily living, muscle strength, and even quality of life.

Effectiveness of Hydrotherapy on Neuropathic Pain and Pain Catastrophization in Patients With Spinal Cord Injury: Protocol for a Pilot Trial Study.

BACKGROUND: Neuropathic pain (NP) is one of the most frequent spinal cord injury (SCI) complications. Pain, quality of life, and functionality are associated and can lead to pain catastrophization. Pharmacological management of patients with NP secondary to SCI is widely known and there is increasing evidence in the area. Nevertheless, nonpharmacological management is not fully elucidated since its efficacy is inconclusive. OBJECTIVE: We hypothesize that (1) hydrotherapy is effective in reducing NP secondary to SCI. Additionally, our secondary hypotheses are that (2) hydrotherapy decreases the catastrophization of NP, and that (3) hydrotherapy improves life quality and minimizes the degree of disability, when compared to physical therapy. METHODS: A sample of approximately 20 participants will be randomly assigned to either the intervention (hydrotherapy) or control group (standard physical therapy). Both interventions will be administered twice a week over a 9-week period (18 sessions in total). Primary outcomes are changes in neuropathic pain perception and pain catastrophization. Secondary outcomes are changes in disability and quality of life scores. They will be assessed at baseline and follow-up at 4 weeks after discharge. Validated Spanish language scales that will be used are the following: Numerical Pain Rating Scale, Pain Catastrophization, Health-related Quality of life, and the World Health Organization's Disability Assessment Schedule 2.0. Generalized mixed linear models will be used for comparing baseline and postintervention means of each group and their differences, together with 95% CIs and P values. A P value of less than .05 will be considered significant. RESULTS: Recruitment began in April 2019, and we recruited the last participants by December 2019, with 10 individuals assigned to hydrotherapy and 8 to physical therapy (control). Results from this study will be disseminated via scientific publication, in ClinicalTrials.gov, and in national and international conferences in the latter half of 2022. CONCLUSIONS: This trial will explore the effects of hydrotherapy on neuropathic pain, together with functionality and quality of life, in patients with SCI. Furthermore, this study aims to evaluate these therapeutic modalities, including perception variables, and mental processes, which may affect the clinical condition and rehabilitation outcomes in these patients. Hydrotherapy is likely to be a safe, efficient, and cost-effective alternative to the current standard of care for NP secondary to SCI, with comparable results between the two. TRIAL REGISTRATION: ClinicalTrials.gov NCT04164810; https://clinicaltrials.gov/ct2/show/NCT04164810. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/37255.

Efecto de un programa de realidad virtual para mejorar la estabilidad de tronco en lanzadores de bala y jabalina paralímpicos. Un estudio de casos / Effect of a virtual reality program to improve trunk stability in Paralympic shot put and javelin throwers. A case study

Introducción: El deporte paralímpico se originó como parte de procesos de re-habilitación para personas que tuvieran discapacidad. Durante la ejecución de las disciplinas paralímpicas el control motor en la región del tronco y en especial del abdomen es de gran importancia para prevenir lesiones y mejorar el registro de la marca deportiva. Son muchas las herramientas utilizadas por los entrenadores de-portivos para mejorar la fuerza muscular y por consiguiente la estabilidad de tronco, buscando disminuir el riesgo en el ámbito deportivo. Sin embargo, las investigaciones sobre el uso de realidad virtual, junto con plataformas de estabilometría para el en-trenamiento de deportistas paralímpicos con lesiones físicas, son escasas.Objetivo: Establecer el efecto de un programa de entrenamiento del tronco apoya-do en realidad virtual en deportistas de alto rendimiento paralímpicos, lanzadores de bala y jabalina con lesiones físicas y que compiten en sillas de lanzamiento. Materiales y método: La investigación fue diseñada como un estudio cuasiex-perimental intrasujeto. Se evaluaron cinco sujetos deportistas paralímpicos de alto rendimiento con discapacidad física. Se empleó un software de realidad virtual que incluye patrones y juegos lúdicos ajustables en tiempo e intensidad y una platafor-ma de bipedestación dinámico como parte del equipo de intervención, ajustable al paciente, que permite reeducar el equilibrio, la propiocepción, fortalecer y lograr el control del tronco. Las variables de análisis fueron el nivel del desplazamiento ante-roposterior y lateral del tronco y los cambios en el volumen de acción. Se realizó una evaluación inicial, una intervención que duró de seis semanas y la evaluación final. Resultados: En las evaluaciones iniciales de todos los atletas se observó una ten-dencia al desplazamiento en sentido posterior. En la evaluación final, los rangos de desplazamiento aumentan en casi todos los sujetos con excepción del sujeto 5, cuyos valores permanecen casi estables tanto en las evaluaciones iniciales como las finales. La diferencia en el desplazamiento entre la prueba inicial y final en promedio de los participantes fue de 6.26 grados. Conclusiones: los resultados positivos del entrenamiento del tronco apoyado en realidad virtual para los participantes constituyen un aporte al conocimiento sobre el tema y abren la posibilidad de incluir esta tecnología en protocolos de entrenamiento en deporte paralímpico.

Introduction: Paralympic sport originated as part of rehabilitation processes for people with disabilities. During the execution of Paralympic disciplines, motor con-trol in the trunk region and especially in the abdomen is of great importance to prevent injuries and improve the registration of the sports record. There are many tools used by sports coaches to improve muscle strength and therefore trunk stability to reduce the risk in the sports field. However, research on the use of virtual reality along with stabilometry platforms for the training of Paralympic athletes with phys-ical injuries are scarce.Objective: To establish the effect of a trunk training program supported by virtual reality in high performance Paralympic athletes, shot put and javelin throwers with physical injuries who compete in throwing frames. Materials and method: The research was designed as an intrasubject quasi-ex-perimental study. Five high-performance Paralympic athletes with physical disabili-ties were evaluated. A virtual reality software that includes patterns and playful games adjustable in time and intensity and a dynamic standing platform were used as part of the intervention equipment, adjustable to the patient, which allows reeducating balance, proprioception, strengthening, and achieving trunk control. The variables of analysis were the level of anteroposterior and lateral displacement of the trunk and changes in the volume of action. An initial evaluation, an intervention that lasted six weeks, and a final evaluation were carried out. Results: In the initial evaluations of all athletes, a tendency towards posterior dis-placement was observed. In the final evaluation, the displacement ranges increase in almost all subjects except for subject 5, which showed values that remain almost sta-ble in both the initial and final evaluations. The difference in displacement between the initial and final test on average of the participants was 6.26 degrees. Conclusions: the positive results of trunk training supported by virtual reality for the participants constitute a contribution to the knowledge on the subject and open the possibility of including this technology in training protocols in Paralympic sports.

Sistema de biofeedback para rehabilitación de marcha asistida por un exoesqueleto / Biofeedback System for Exoskeletqn Assisted Gait Rehabilitation / Sistema de biofeedback para reabilitação de marcha assistida por um exoesqueleto

Resumen Los robots proporcionan nuevas formas de terapia para pacientes con desórdenes neurológicos. Las terapias de marcha asistidas con exoesqueletos pueden incrementar la duración y la intensidad de los entrenamientos para los pacientes y reducir el esfuerzo físico del terapeuta. Sin embargo, el uso de estos dispositivos para el entrenamiento de la marcha limita la interacción física entre el terapeuta y el paciente, en comparación con la terapia manual. Una apropiada realimentación de las funciones corporales y biomecánicas en la interacción con el sistema robótico facilita la evaluación del desempeño del paciente, motivándolo en el reaprendizaje de la marcha con resultados superiores. Este artículo presenta el diseño de una interfaz de usuario para un exoesqueleto de miembros inferiores para asistencia en la marcha y en terapias de rehabilitación. Se consideraron aspectos técnicos y clínicos para proporcionar ventajas del exoesqueleto durante las terapias, estableciendo una herramienta de apoyo para la configuración, monitoreo y registro de los parámetros involucrados. Se propuso un esquema de realimentación sensorial para el paciente acerca de la actividad muscular, la presión ejercida en diferentes puntos de los pies y algunas variables biomecánicas. Finalmente, se valida la herramienta con sujetos sanos por medio de un test de usabilidad propuesto.

Abstract The inclusion of robots in rehabilitation allow advantages for generate newer therapies in neurologic disorder patients. Assistive gait therapies using robots, like exoskeletons, allow increase the time and intensity training for patients while the strenuous labor of therapist is reduced. However, the physic interaction between therapist and patient in training with robots is limited, in relation to the traditional manual therapy. An appropriated feedback of biological and biomechanics functions in the robot interaction during training provides an easier performance evaluation of the patient for the therapist. Further, biofeedback gives a motivation to the patient and encourages him for gait relearning with higher effects than conventional. This paper presents a user interface design for a lower limb exoskeleton for human gait assistance in rehabilitation. Clinical and technical criteria for increasing the advantages of the exoskeleton in therapy were considered. A biofeedback scheme about muscle activity, plantar pressure and some biomechanics variables, for the patient is proposed. Finally, a validation for this tool with healthy subjects by a usability test was carried out.

Resumo A inclusão de robôs na reabilitação fornecem vantagens que promovem novas formas de terapia em pacientes com desordens neurológicas. Terapias de marcha assistidas por exoesqueletos permitem o aumento da duração e da intensidade dos exercícios com os pacientes, reduzindo o esforço físico dos terapeutas. Não entanto, o uso desses dispositivos para o treino da marcha limita a interação física entre o terapeuta e paciente, em comparação com a terapia manual. Uma apropriada realimentação das funções corporais e biomecânicas na interação com o sistema robótico facilita a avaliação do progresso do paciente, motiva e incentiva ao paciente na reaprendizagem da marcha gerando efeitos superiores aos convencionais. Neste artigo apresenta-se o desenho de uma interface de usuário para um exoesqueleto de membros inferiores para assistência na marcha e nas terapias de reabilitação. São considerados aspectos técnicos e clínicos para fornecer maiores vantagens do exoesqueleto durante as terapias, estabelecendo uma ferramenta de suporte para configuração, monitoramento e registro dos parâmetros envolvidos. Foi proposto um sistema de realimentação sensorial para o paciente sobre a atividade muscular, a pressão em diferentes pontos dos pés e algumas variáveis biomecânicas. Finalmente, é apresentada a ferramenta de validação para indivíduos saudáveis utilizando um teste de usabilidade proposto.