Effect of Combined Therapy of Virtual Reality and Transcranial Direct Current Stimulation in Children and Adolescents With Cerebral Palsy: A Study Protocol for a Triple-Blinded Randomized Controlled Crossover Trial.

Background: Transcranial direct current stimulation (tDCS) and therapy-based virtual reality (VR) have been investigated separately. They have shown promise as efficient and engaging new tools in the neurological rehabilitation of individuals with cerebral palsy (CP). However, the recent literature encourages investigation of the combination of therapy tools in order to potentiate clinic effects and its mechanisms. Methods: A triple-blinded randomised sham-controlled crossover trial will be performed. Thirty-six individuals with gross motor function of levels I to IV (aged 4-14 years old) will be recruited. Individuals will be randomly assigned to Group A (active first) or S (sham first): Group A will start with ten sessions of active tDSC combined with VR tasks. After a 1-month washout, this group will be reallocated to another ten sessions with sham tDCS combined with VR tasks. In contrast, Group S will carry out the opposite protocol, starting with sham tDCS. For the active tDCS the protocol will use low frequency tDCS [intensity of 1 milliampere (mA)] over the primary cortex (M1) area on the dominant side of the brain. Clinical evaluations (reaction times and coincident timing through VR, functional scales: Abilhand-Kids, ACTIVLIM-CP, Paediatric Evaluation of Disability Inventory-PEDI- and heart rate variability-HRV) will be performed at baseline, during, and after active and sham tDCS. Conclusion: tDCS has produced positive results in treating individuals with CP; thus, its combination with new technologies shows promise as a potential mechanism for improving neurological functioning. The results of this study may provide new insights into motor rehabilitation, thereby contributing to the better use of combined tDCS and VR in people with CP. Trial Registration: ClinicalTrials.gov, NCT04044677. Registered on 05 August 2019.

Evaluation of speed-accuracy trade-off in a computer task to identify motor difficulties in individuals with Duchenne Muscular Dystrophy - A cross-sectional study.

INTRODUCTION: Individuals with Duchenne Muscular Dystrophy (DMD) present with progressive loss of motor function which can impair both control of speed and accuracy of movement. AIM: to evaluate movement time during a task at various levels of difficulty and to verify whether the level of difficulty affects the speed and/ or accuracy during the task. METHODS: the DMD group comprised of 17 individuals age matched with 17 individuals with typical development (TD group). The task evaluates the relationship between speed and accuracy, consisting of the execution of manual movements (using the mouse of the computer) aimed at a target at three different levels of difficulty (ID). RESULTS: A MANOVA demonstrated statistically significant differences in dispersion data and intercept values between the groups with greater movement time in the DMD group. An ANOVA indicated differences between groups for ID, except for when there was a higher accuracy demand (higher ID). In the other IDs that required lower accuracy demand, individuals in the DMD group had significantly longer movement time when compared to the TD group. CONCLUSION: These results show that the TD and DMD did not differ in the higher ID, therefore it can be concluded that for those with DMD, motor performance is more affected by speed than accuracy of movement.

Virtual reality in multiple sclerosis - A systematic review.

INTRODUCTION: Multiple sclerosis (MS) is an inflammatory disease in which the insulating cover of nerve cells in the brain and spinal cord are damaged. The methods used for motor rehabilitation of patients with neurological problems require the performance of several rehabilitation exercises. Recently, studies related to the use of video game consoles have proliferated in the field of motor rehabilitation. Virtual reality (VR) has been proposed as a potentially useful tool for motoring assessment and rehabilitation. OBJECTIVE: The purpose of this study was to investigate the results shown in previous studies on "Multiple Sclerosis" and "Virtual Reality". METHOD: A bibliographic review was performed without time limitations. The research was carried out using PubMed and BVS databases. Considering keywords, we included articles that showed the terms "Multiple Sclerosis" and "Virtual Reality". The review was according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines RESULTS: The initial search yielded 41 articles. After the duplicates were removed, two authors independently evaluated the title and abstract of each of the articles with the study inclusion criteria. From these, 31 articles were excluded based on the title and abstract. Finally, 10 articles were isolated that met the inclusion criteria. CONCLUSION: VR represents a motivational and effective alternative to traditional motor rehabilitation for MS patients. The results showed that VR programs could be an effective method of patients with MS rehabilitation in multiple cognitive and / or motor deficits. Additional research is needed to support the rehabilitation protocols with VR and increase the effects of treatment.

Motor learning through virtual reality in elderly - a systematic review / Aprendizado motor através de realidade virtual em idosos

INTRODUCTION: Decline in physical function is a common feature of older age and has important outcomes in terms of physical health as it relates to quality of life. Our capacity for motor learning allows us to flexibly adapt movements to an ever-changing environment. The term Virtual Reality refers to a wide variety of methods used to simulate an alternative or virtual world. OBJECTIVE: To analyze the results shown in previous studies on motor learning with Virtual Reality use in elderly participants. METHOD: To select the articles, three steps were followed. A systematic literature review was performed without time limitation. The research was carried out using PubMed, BVS and Web of science; considering the keywords, we included articles that showed the following three terms: elderly, virtual reality and motor learning. RESULTS: The initial search yielded 49 articles. After duplicates were removed, two of the authors independently evaluated the title and abstract of each article against the study inclusion criteria. From these, 45 articles were excluded based on title and abstract. Finally, four articles met the inclusion criteria. CONCLUSION: Although few studies were conducted on motor learning in elderly people through virtual reality and, even fewer were of good quality, it was shown that elderly people, with or without a specific disease, can benefit from interventions based on virtual reality to improve motor learning skills.

INTRODUÇÃO: O Declínio da função física é uma característica comum de idade avançada e tem consequências importantes em termos de saúde física e qualidade de vida. Nossa capacidade de aprendizagem motora nos permite adaptar movimentos a um ambiente em constante mudança. A expressão Realidade Virtual refere-se a uma ampla variedade de métodos usados para simular uma alternativa ao mundo virtual. OBJETIVO: Analisar os resultados apresentados em estudos anteriores sobre aprendizagem motora com o uso de Realidade Virtual em participantes idosos. MÉTODO: Para selecionar os artigos, três etapas foram seguidas. Uma revisão sistemática da literatura foi realizada sem limitação de tempo. A pesquisa foi realizada utilizando PubMed, BVS e Web os Science; considerando-se as palavras-chave, incluímos artigos que apresentaram os três seguintes termos:, realidade virtual idosos e aprendizagem motora. RESULTADOS: A busca inicial rendeu 49 artigos. Depois da remoção de duplicações, dois dos autores avaliaram independentemente o título e o resumo de cada artigo em relação aos critérios de inclusão do estudo. Destes, 45 artigos foram excluídos com base no título e resumo. Finalmente, quatro artigos preencheram os critérios de inclusão. CONCLUSÃO: Embora poucos estudos foram encontrados sobre a aprendizagem motora em pessoas idosas através da realidade virtual e, menos ainda eram de boa qualidade, foi mostrado que as pessoas idosas, com ou sem uma doença específica, podem se beneficiar de intervenções com base na realidade virtual para melhorar a habilidades de aprendizagem motora.