Physiotherapeutic Approaches in the Rehabilitation of Patients After Severe Acute Respiratory Syndrome Coronavirus 2: A Scoping Review of In-Hospital Until Outpatient Phase.

OBJECTIVES: This scoping review aimed to identify studies that address the use of physical therapy in the rehabilitation of adult and elderly patients after SARS-CoV-2 infection. METHODS: This scoping review was based on Joanna Briggs Institute methodology: participant (P), represented by adult and elderly patients after SARS-CoV-2; concept (C), main physical therapy interventions; and context (C), recovery period after SARS-CoV-2 (in-hospital or outpatient phase). The following information sources were used: MEDLINE/PubMed, Cochrane Library, PEDro, Scopus, CINAHL, Web of Science, Science Direct, and Springer. The search was conducted between December 2019 and November 2021. Rayyan (Qatar Computing Research Institute, QCRI) was used for study selection process and analysis. RESULTS: A total of 7,568 studies were identified; 11 were included in this review. The most frequent physical therapy interventions were those associated with pulmonary, cardiac, musculoskeletal, neurological, and digestive rehabilitation in adult and elderly patients after SARS-CoV-2. Physiotherapy interventions included aerobic exercises, respiratory muscle training, muscle strength training, breathing exercises, early mobilization, balance training, bronchial hygiene maneuvers, body positioning management, flexibility training, cognitive training, neuromuscular electrical stimulation, and trunk exercises. CONCLUSION: Our study demonstrated the growing utility of therapeutic interventions, mainly in improving quality of life, as well as body functions after pulmonary, cardiac, neurological, digestive, and musculoskeletal rehabilitation in patients after SARS-CoV-2.

Muscle Tone Assessment by Machine Learning Using Surface Electromyography.

Muscle tone is defined as the resistance to passive stretch, but this definition is often criticized for its ambiguity since some suggest it is related to a state of preparation for movement. Muscle tone is primarily regulated by the central nervous system, and individuals with neurological disorders may lose the ability to control normal tone and can exhibit abnormalities. Currently, these abnormalities are mostly evaluated using subjective scales, highlighting a lack of objective assessment methods in the literature. This study aimed to use surface electromyography (sEMG) and machine learning (ML) for the objective classification and characterization of the full spectrum of muscle tone in the upper limb. Data were collected from thirty-nine individuals, including spastic, healthy, hypotonic and rigid subjects. All of the classifiers applied achieved high accuracy, with the best reaching 96.12%, in differentiating muscle tone. These results underscore the potential of the proposed methodology as a more reliable and quantitative method for evaluating muscle tone abnormalities, aiming to address the limitations of traditional subjective assessments. Additionally, the main features impacting the classifiers' performance were identified, which can be utilized in future research and in the development of devices that can be used in clinical practice.

Effects of anodal transcranial direct current stimulation over motor cortex on resting-state brain activity in the early subacute stroke phase: A power spectral density analysis.

INTRODUCTION: Despite promising results, the effects of transcranial direct current stimulation (tDCS) in the early stages of stroke and its impact on brain activity have been poorly studied. Therefore, this study aimed to investigate the effect of tDCS applied over the ipsilesional motor cortex on resting-state brain activity in the early subacute phase of stroke. METHODS: This is a pilot, randomized, double-blind, proof-of-concept study. The patients with stroke were randomly assigned into two groups: anodal tDCS (A-tDCS) or sham tDCS (S-tDCS). For A-tDCS, the anode was placed over the ipsilesional motor cortex, while the cathode was placed over the left or right supraorbital area (Fp2 for left stroke or Fp1 for right stroke). For the real stimulation, a constant current of 1.0 mA was delivered for 20 min and then ramped down linearly for 30 s, maintaining a resistance below 10 kΩ. For the sham stimulation, the stimulator was turned on, and the current intensity was gradually increased for 30 s, tapered off over 30 s, and maintained for 30 min without stimulation. Each stimulation was performed for three consecutive sessions with an interval of 1 h between them. The primary outcome was spectral electroencephalography (EEG) analysis based on the Power Spectral Density (PSD) determined by EEG records of areas F3, F4, C3, C4, P3, and P4. Brain Vision Analyzer software processed the signals, EEG power spectral density (PSD) was calculated before and after stimulation, and alpha, beta, delta, and theta power were analyzed. The secondary outcomes included hemodynamic variables based on the difference between baseline (D0) and post-intervention session (D1) values of systolic (SBP) and diastolic (DBP) blood pressure, heart rate (HR), respiratory rate (RR) and peripheral oxygen saturation (SPO2). Mann-Whitney test was used to compare position measurements of two independent samples; Fisher's exact test was used to compare two proportions; paired Wilcoxon signed-rank test was used to compare the median differences in the within-group comparison, and Spearman correlations matrix among spectral power analysis between EEG bands was performed to verify consistency of occurrence of oscillations. Statistical significance was set at P < 0.05. RESULTS: An increase in PSD in the alpha frequency in the P4 region was observed after the intervention in the A-tDCS group, as compared to the placebo group (before = 6.13; after = 10.45; p < 0.05). In the beta frequency, an increase in PSD was observed in P4 (before = 4.40; after = 6.79; p < 0.05) and C4 (before = 4.43; after = 6.94; p < 0.05) after intervention in the A-tDCS group. There was a reduction in PSD at delta frequency in C3 (before = 293.8; after = 58.6; p < 0.05) after intervention in the A-tDCS group. In addition, it was observed a strong relationship between alpha and theta power in the A-tDCS group before and after intervention. However, the sham group showed correlations between more power bands (alpha and theta, alpha and delta, and delta and theta) after intervention. There was no difference in hemodynamic variables between the intra- (before and after stimulation) and inter-groups (mean difference). CONCLUSION: Anodal tDCS over the ipsilesional motor cortex had significant effects on the brain electrical activity in the early subacute stroke phase, increasing alpha and beta wave activities in sensorimotor regions while reducing slow delta wave activity in motor regions. These findings highlight the potential of anodal tDCS as a therapeutic intervention in the early stroke phase.

Decreased functional mobility in individuals with mild to moderate expanded disability status from relapsing multiple sclerosis: Analysis of the Glittre-ADL test.

INTRODUCTION: Multiple sclerosis (MS) is a chronic inflammatory and autoimmune disease that significantly limits an individual's activities of daily living (ADLs) and negatively affects their social participation as it progresses. The impact of activities and participation must be continuously assessed, and the Glittre-ADL is a validated test for MS to assess functional capacity in tasks similar to ADLs. OBJECTIVE: To evaluate whether the Glittre-ADL test is a valid method for assessing functional mobility in individuals with MS and moderate disability or those who use assistive devices. METHODS: This cross-sectional study enrolled 30 individuals in two groups: 1) MS group (n = 15); and 2) healthy control group (n = 15). The MS group underwent three functional mobility tests: 1) Glittre-ADL; 2) Timed 25-Foot Walk (T25FWT); and 3) Timed Up and Go (TUG) while the healthy group underwent only the Glittre-ADL test. RESULTS: An association was found between the Glittre-ADL time and T25FWT (r = 0.78, p < .001) and TUG (r = 0.56, p = .030) times. In the MS group, statistically significant differences were found in time (F = 2.88, p = .038) and speed (F = 5.17, p = .024) between laps. A statistically significant difference was observed between the total time in the MS and control groups (Area Under Curve - AUC: 0.982, p < .0001). A total time > 46.0s represents the reduction of functional performance during ADLs in individuals with MS (sensitivity: 93.3%; specificity: 92.2%). CONCLUSION: The Glittre-ADL test is a valid tool for assessing functional mobility in individuals with MS and mild to moderate disability (EDSS score ≤ 6.5).

Perception of verticality in the post-COVID-19 condition correlates to infection severity.

Background: SARS-CoV-2 infection affects multiple systems, including musculoskeletal, neurological, and respiratory systems. Changes associated with physical inactivity due to prolonged hospitalization can affect the functional capacity of individuals with long coronavirus disease 2019 (COVID-19) or post-COVID-19 condition and may cause changes in some postural control functions, such as verticality. Objectives: This study aimed to evaluate the perception of verticality in individuals with long COVID. Design: Cross-sectional study. Methods: This study included 60 participants with post-COVID-19 condition divided into 2 groups: hospitalized group (n = 24), those hospitalized owing to SARS-CoV-2 infection; and non-hospitalized group (n = 36), those infected with SARS-CoV-2 but not hospitalized. All participants were examined using a post-COVID-19 functional status (PCFS), sit-to-stand test, grip strength assessment, painful and tactile sensory assessments, visual acuity assessment, and vestibular assessment. Verticality perception was evaluated using the subjective visual vertical (SVV) and subjective haptic vertical (SHV) tests. In both tests, the absolute values (positive values only) and true values (positive and negative values) were considered. To verify potential confounders that could influence the verticality of the results, logistic regression models were used for categorical variables and multiple linear regressions were used for continuous variables. For analysis between groups, the independent samples test (Mann-Whitney U test) was used. Results: There were no confounders between clinical variables and verticality in either group. There was a significant increase in absolute SVV (mean deviation [MD]: 2.83; P < .0001) and true SVV (MD: -4.18; P = .005) in the hospitalized group compared to the non-hospitalized group. Furthermore, there was a significant increase in the true SHV (MD: -3.6; P = .026) in the hospitalized group compared to that in the non-hospitalized group. Conclusion: Less accurate visual and haptic verticality perception task performance was observed in hospitalized patients with post-COVID-19 condition.

Effect of the haptic anchors during balancing and walking tasks in older adults: A systematic review.

BACKGROUND: Older adults are benefited from the continuous tactile information to enhance postural control. Therefore, the aim was to evaluate the effect of the haptic anchors during balancing and walking tasks in older adults. METHODS: The search strategy (up to January 2023) was based on the PICOT (older adults; anchor system during balance and walking tasks; any control group; postural control measurements; short and/or long-term effect). Two pairs of reviewers independently examined all titles and abstracts for eligibility. The reviewers independently extracted data from the included studies, assessed the risk of bias, and certainty of the evidence. RESULTS: Six studies were included in the qualitative synthesis. All studies used a 125-g haptic anchor system. Four studies used anchors when standing in a semi-tandem position, two in tandem walking on different surfaces, and one in an upright position after plantar flexor muscle fatigue. Two studies showed that the anchor system reduced body sway. One study showed that the ellipse area was significantly lower for the 50% group (reduced frequency) in the post-practice phase. One study showed that the reduction in the ellipse area was independent of the fatigue condition. Two studies observed reduced trunk acceleration in the frontal plane during tandem waking tasks. The studies had low to moderate certainty of evidence. CONCLUSION: Haptic anchors can reduce postural sway during balance and walking tasks in older adults. Also, positive effects were seen during the delayed post-practice phase after the removal of anchors only in individuals who used a reduced anchor frequency.

Changes in Electrical Brain Activity and Cognitive Functions Following Mild to Moderate COVID-19: A one-Year Prospective Study After Acute Infection.

The coronavirus disease 2019 (COVID-19) can disrupt various brain functions. Over a one-year period, we aimed to assess brain activity and cognitive function in 53 COVID-19 patients and 30 individuals without COVID-19 (or asymptomatic). The Montreal Cognitive Assessment, Trail Making Test Parts A and B (TMT-A and B), and Digit Span Test were used to assess cognitive function. Cognitive variables and electroencephalography (EEG) data (activity, mobility, and complexity) were compared between the groups at rest and during cognitive demand (F3-F7, Fz-F3, Fz-F4, and F4-F8). There was a reduction in F3-F7 activity during the TMT-B in the COVID-19 group at 6-12 months compared to the controls (p = 0.01) at baseline (p = 0.03), a reduction in signal complexity at F3-F7 at rest in the COVID-19 group at baseline and 6-12 months compared to the controls (p < 0.001), and a reduction in Fz-F4 activity at rest from 6-12 months in the post-COVID group compared to baseline (p = 0.02) and 3-6 months (p = 0.04). At 6-12 months, there was a time increase in TMT-A in the COVID-19 group compared to that in the controls (p = 0.04). Some correlations were found between EEG data and cognitive test in both groups. In conclusion, there was a reduction in brain activity at rest in the Fz-F4 areas and during high cognitive demands in the F3-F7 areas. A reduction in signal complexity in F3-F7 at rest was found in the COVID-19 group at 6-12 months after acute infection. Furthermore, individuals with COVID-19 experience long-term changes in cognitive function.

Effect of transcranial direct current stimulation in addition to visuomotor training on choice reaction time and cognition function in amateur soccer players (FAST trial): A randomized control trial.

OBJECTIVES: This study aimed to evaluate the effect of anodal transcranial direct current stimulation (tDCS) over the dorsolateral prefrontal cortex (DLPFC) in addition to visuomotor training (VMT) on choice reaction time (CRT) and cognitive function in amateur soccer players. DESIGN: Single-center, randomized, placebo-controlled, double-blind, parallel-group study. SETTING: Neuroscience and Motor Control Laboratory. PARTICIPANTS: Thirty Brazilian male amateur soccer players, aged 18-30 years. MAIN OUTCOME MEASURES: Participants were allocated to the intervention or control groups. Both groups performed VMT, but the intervention group additionally underwent anodal tDCS over the left dorsolateral prefrontal cortex (DLPFC; F3). The cathodal electrode was positioned in the right supraorbital region (Fp2). The tDCS was applied at 2 mA for 20 min for five consecutive sessions (24 h intervals). The VMT protocol was delivered during the application of tDCS and was composed of kicking a ball for 10 min (between the fifth and fifteenth minutes of the 20 min of tDCS application). The primary outcome was assessed based on changes in CRT during reaching (non-trained limb) and kicking (trained limb) tasks. Secondary outcomes were overall cognitive function measured by the Trail Making Test part A (TMT-A) and part B (TMT-B), and Digit Span Test forward (DSF) and backward (DSB) scores. All outcomes were evaluated before and after the intervention. RESULTS: In the primary outcomes, compared with the control group, the anodal tDCS combined with VMT group had greater reduction in CRT for the rectus femoris (p = 0.007) adjusted for age and baseline performance (F (1,26) = 22,23; p < 0,001) and for the triceps (p = 0.039) adjusted for training frequency (days/week) and baseline performance (F (1,26) = 5,70; p = 0,016). No differences were observed in the CRT of other muscles (anterior deltoid [p = 0.181], brachial biceps [p = 0.130], and vastus medialis [p = 0.074]). And, there were no differences between the groups in terms of cognitive function (TMT-A [p = 0.062]; TMT-B [p = 0.320]; DSF [p = 0.102]; DSB [p = 0.345]). CONCLUSION: Anodal tDCS over the left DLPFC in addition to visuomotor training of a functional task can be an efficient tool for athletes to decrease the CRT of the rectus femoris (trained limb) and triceps (non-trained limb); however, there were no differences between the groups in the others muscles (anterior deltoid, brachial biceps, and vastus medialis), and in terms of cognitive function.

Use of artificial intelligence as an instrument of evaluation after stroke: a scoping review based on international classification of functioning, disability and health concept.

INTRODUCTION: To understand the current practices in stroke evaluation, the main clinical decision support system and artificial intelligence (AI) technologies need to be understood to assist the therapist in obtaining better insights about impairments and level of activity and participation in persons with stroke during rehabilitation. METHODS: This scoping review maps the use of AI for the functional evaluation of persons with stroke; the context involves any setting of rehabilitation. Data were extracted from CENTRAL, MEDLINE, EMBASE, LILACS, CINAHL, PEDRO Web of Science, IEEE Xplore, AAAI Publications, ACM Digital Library, MathSciNet, and arXiv up to January 2021. The data obtained from the literature review were summarized in a single dataset in which each reference paper was considered as an instance, and the study characteristics were considered as attributes. The attributes used for the multiple correspondence analysis were publication year, study type, sample size, age, stroke phase, stroke type, functional status, AI type, and AI function. RESULTS: Forty-four studies were included. The analysis showed that spasticity analysis based on ML techniques was used for the cases of stroke with moderate functional status. The techniques of deep learning and pressure sensors were used for gait analysis. Machine learning techniques and algorithms were used for upper limb and reaching analyses. The inertial measurement unit technique was applied in studies where the functional status was between mild and severe. The fuzzy logic technique was used for activity classifiers. CONCLUSION: The prevailing research themes demonstrated the growing utility of AI algorithms for stroke evaluation.

Can the choice reaction time be modified after COVID-19 diagnosis? A prospective cohort study.

Assessment of cognitive processing speed through choice reaction time (CRT) can be an objective tool to assess cognitive functions after COVID-19 infection. Objective: This study aimed to assess CRT in individuals after acute COVID-19 infection over 1 year. Methods: We prospectively analyzed 30 individuals (male: 9, female: 21) with mild-moderate functional status after COVID-19 and 30 individuals (male: 8, female: 22) without COVID-19. Cognitive and neuropsychiatric symptoms were evaluated using the Montreal Cognitive Assessment (MoCA) and Hospital Anxiety and Depression Scale (HADS), respectively. CRT (milliseconds) was evaluated by finding the difference between the photodiode signal and the electromyographic (EMG) onset latency of anterior deltoid, brachial biceps, and triceps during the task of reaching a luminous target. CRT was evaluated three times over 1 year after COVID-19: baseline assessment (>4 weeks of COVID-19 diagnosis), between 3 and 6 months, and between 6 and 12 months. Results: The multiple comparison analysis shows CRT reduction of the anterior deltoid in the COVID-19 group at 3-6 (p=0.001) and 6-12 months (p<0.001) compared to the control group. We also observed CRT reduction of the triceps at 6-12 months (p=0.002) and brachial biceps at 0-3 (p<0.001), 3-6 (p<0.001), and 6-12 months (p<0.001) in the COVID-19 compared to the control group. Moderate correlations were observed between MoCA and CRT of the anterior deltoid (r=-0.63; p=0.002) and brachial biceps (r=-0.67; p=0.001) at 6-12 months in the COVID-19 group. Conclusions: There was a reduction in CRT after acute COVID-19 over 1 year. A negative correlation was also observed between MoCA and CRT only from 6 to 12 months after COVID-19 infection.

A avaliação da velocidade de processamento cognitivo por meio do tempo de reação de escolha (TRE) pode ser uma ferramenta objetiva para acompanhar as alterações cognitivas após a COVID-19. Objetivo: Avaliar o TRE em pacientes após infecção aguda por COVID-19 ao longo de um ano. Métodos: Foram avaliados 30 indivíduos (sexo masculino: nove; feminino: 21) com estado funcional leve-moderado após infecção por COVID-19 e 30 (sexo masculino: oito; feminino: 22) sem COVID-19. A avaliação foi feita pelo Montreal Cognitive Assessment (MoCA) e pela Escala Hospitalar de Ansiedade e Depressão. O TRE (milissegundos) foi avaliado pela diferença entre o sinal luminoso e a latência de início da atividade muscular (EMG) do deltoide anterior (DA), do bíceps braquial (BB) e do tríceps durante uma tarefa de alcance. O TRE foi avaliado ao longo de um ano: avaliação inicial (>4 semanas após diagnóstico de COVID-19), em 3­6 meses e em 6­12 meses. Resultados: Houve redução do TRE do DA no grupo COVID-19 em 3­6 meses (p=0,001) e 6­12 meses (p<0,001) em comparação com o grupo de controle. Também foi observada redução na TRE do tríceps em 6­12 meses (p=0,002) e do BB em 0­3 meses (p<0,001), 3­6 meses (p<0,001) e 6­12 meses (p<0,001) no grupo COVID-19 em comparação com o grupo de controle. Correlações moderadas foram observadas entre MoCA e TRE do DA (r=-0,63; p=0,002) e BB (r=-0,67; p=0,001) aos 6­12 meses no grupo COVID-19. Conclusões: Houve redução do TRE após COVID-19 ao longo de um ano, além de correlação negativa entre MoCA e TRE no período de seis a 12 meses após COVID-19.

Choice reaction time can be influenced by intervention protocols after stroke: A systematic review.

INTRODUCTION: Post-stroke individuals usually present a delay in choice reaction time (CRT), and it would be important to verify the efficacy in the reduction of CRT after intervention protocols. OBJECTIVE: The main question of this review is 'What are the characteristics of the CRT test and the interventions that decrease the CRT?' STUDY DESIGN: Systematic review. METHODS: The search was performed in March 2019 using the electronic databases, PubMed, Science Direct, Scopus, Web of Science, Lilacs, Cinahal, Cochrane, Ovid, Scielo, PEDro, and Embase. There was no restriction regarding publication dates, and studies written in English that were conducted on poststroke patients and presented CRT results were included. RESULTS: Six studies were included in this systematic review, and the majority showed varied objectives, methodologies, and groups, regarding the number and characteristics of the sample, varying from complex to simple tasks for the CRT evaluation. CONCLUSION: This review suggests the investigation of the CRT in stroke patients with functional tasks using auditory and/or visual stimulus. About the CRT training in stroke patients, this review also suggests bilateral training, including functional tasks, and the use of structural practice blocks, but more studies are needed to better demonstrate the effects of interventions on the CRT. REGISTRATION NUMBER: PROSPERO (protocol no. CRD42017073995).

Effects of transcranial direct current stimulation on balance after ischemic stroke (SANDE trial): Study protocol for a multicentric randomized controlled trial.

BACKGROUND: Among the tools used for motor rehabilitation after stroke, transcranial direct current electrical stimulation (tDCS) aims to modify cortical excitability and improve motor function. Despite promising results, the effects of tDCS on balance after stroke have not yet been assessed using specific protocols. Therefore, this study will aim to evaluate the effects of tDCS and rehabilitation on balance after stroke. METHODS: Eighty-two ischemic stroke patients across two inpatient rehabilitation sites in Brazil will be randomized into one of two treatment programs (anodic tDCS and sham tDCS), both associated with balance training, each 2 days/week, for six weeks and monitored for exertion, repetition and quality of movements. The primary outcome measure is the balance. Secondary outcomes will include clinical and functional measures. Outcome data will be assessed at two time points. DISCUSSION: This trial will contribute to clarify if anodal tDCS is effective when associated with balance training to stroke recovery.

Effect of stem cell treatment on functional recovery of spinocerebellar ataxia: systematic review and meta-analysis.

BACKGROUND: Spinocerebellar ataxia is a hereditary neurodegenerative disease characterized by changes in balance, locomotion and motor coordination. Stem cell therapies are currently being investigated as an alternative to delay the evolution of the disease, and some experimental studies have investigated the effect of stem cell treatment on spinocerebellar ataxia. OBJECTIVES: The aim of this review was to investigate whether the application of stem cells produced an effect on functional recovery in individuals with spinocerebellar ataxia. METHODS: The studies included in this review investigated the efficacy and safety of a protocol for the application of mesenchymal stem cells extracted from umbilical cord and adipose tissue. Two studies used intrathecal route for application and one study used intravenous route. RESULTS: Studies have shown clinical improvement in the scores of the ICARS (International Cooperative Ataxia Rating Scale), ADL (Activities of Daily Living Scale), BBS (Berg Balance Scale) and SARA (Scale for the Assessment and Rating of Ataxia), but lacked statistical significance. CONCLUSIONS: There was low evidence for recommending stem cell therapy in individuals with spinocerebellar ataxia, and no statistical difference was observed for improving functional recovery of patients. Further studies are needed with different designs, largest sample sizes and placebo control, to fully understand anticipated outcomes of cellular therapy for spinocerebellar ataxia.

On the use of histograms of oriented gradients for tremor detection from sinusoidal and spiral handwritten drawings of people with Parkinson's disease.

Parkinson's disease (PD), whose cardinal signs are tremor, rigidity, bradykinesia, and postural instability, gradually reduces the quality of life of the patient, making early diagnosis and follow-up of the disorder essential. This study aims to contribute to the objective evaluation of tremor in PD by introducing and assessing histograms of oriented gradients (HOG) to the analysis of handwriting sinusoidal and spiral patterns. These patterns were digitized and collected from handwritten drawings of people with PD (n = 20) and control healthy individuals (n = 20). The HOG descriptor was employed to represent relevant information from the data classified by three distinct machine-learning methods (random forest, k-nearest neighbor, support vector machine) and a deep learning method (convolutional neural network) to identify tremor in participants with PD automatically. The HOG descriptor allowed for the highest discriminating rates (accuracy 83.1%, sensitivity 85.4%, specificity 80.8%, area under the curve 91%) on the test set of sinusoidal patterns by using the one-dimensional convolutional neural network. In addition, ANOVA and Tukey analysis showed that the sinusoidal drawing is more appropriate than the spiral pattern, which is the most common drawing used for tremor detection. This research introduces a novel and alternative way of quantifying and evaluating tremor by means of handwritten drawings.

Virtual Reality Immersion in Healthy Individuals: Ellipse Sway Area of an Electrical Shuttle Balance.

To assess indirectly the effects of virtual reality (VR) immersion on postural sway in thirteen healthy individuals. The ellipse sway area was recorded with an accelerometer coupled to an electrical shuttle balance under six conditions, varying Romberg and single leg stance (SLS) position with eyes open and eyes closed. The length of the ellipse traveled over 10 s was measured and Romberg and single leg stance (SLS) ratios were calculated. Ellipse sway area was reduced in all positions after VR intervention. Statistical differences were observed in the left SLS ratio 24 hr after comparison to the baseline. A single VR session could reduce ellipse sway area and decrease the visual dependency of posture control indicating increased ability to maintain stable body sway over the shuttle.

Effects of serious games in strength and functionality of patients with ulnar nerve lesion: two single-case reports.

The objective of this study was to investigate the effect of serious games on hand muscle strength and functionality in a series of cases with ulnar nerve damage. Two patients were included in this 16-week intervention study using biofeedback. Electromyography electrodes and dynamometers were used in treatment. Functionality was assessed by Rosen and Lundborg score, Disabilities of the arm, shoulder and hand (DASH) questionnaire and International Classification of Functioning, Disability and Health (ICF). Grip and pinch strength were assessed by dynamometers. Results revealed an increase in sensory domain of Rosen and Lundborg score of the two patients. Patients increased values from the DASH questionnaire; however, they got better results with ICF. Grip strength of the two patients increased; pinch strength varied between patients; key pinch had the best results. Serious games can be effective to enhance hand strength and improve functionality in patients with ulnar nerve damage.

Alpha and beta cortical activity during guitar playing: task complexity and audiovisual stimulus analysis.

PURPOSE: Some studies have explored the relationship between music and cortical activities; however, there are just few studies investigating guitar performance associated with different sensory stimuli. Our aim was to evaluate alpha and beta activity during guitar playing. MATERIALS AND METHOD: Twenty healthy right-handed people participated in this study. Cortical activity was measured by electroencephalogram (EEG) during rest and 4 tasks (1: easy music with an auditory stimulus; 2: easy music with an audiovisual stimulus; 3: complex music with an auditory stimulus; 4: complex music with an audiovisual stimulus). The peak frequency (PF), median frequency (MF) and root mean square (RMS) of alpha and beta EEG signals were assessed. RESULTS: A higher alpha PF at the T3-P3 was observed, and this difference was higher between rest and task 3, rest and task 4, tasks 1 and 3, and tasks 1 and 4. For beta waves, a higher PF was observed at C4-P4 and a higher RMS at C3-C4 and O1-O2. At C4-P4, differences between rest and tasks 2 and 4 were observed. The RMS of beta waves at C3-C4 presented differences between rest and task 3 and at O1-O2 between rest and task 2 and 4. CONCLUSION: The action observation of audiovisual stimuli while playing guitar can increase beta wave activity in the somatosensory and motor cortexes; and increase in the alpha activity in the somatosensory and auditory cortexes and increase in the beta activity in the bilateral visual cortexes during complex music execution, regardless of the stimulus type received. Abbreviations: bpm: beats per minute; C: central; EEG: electroencephalogram; F: frontal; Hz: hertz; LABCOM: Laboratory of Motor Control and Biomechanics; MD: mean difference; MF: median frequency; O: occipital; P: parietal; PF: peak frequency; R: rest; RMS: root mean square; T: temporal; T1: task 1; T2: task 2; T3: task 3; T4: task 4; UFTM: Federal University of Triângulo Mineiro.

Impact of unilateral spatial neglect on chronic patient's post-stroke quality of life.

BACKGROUND: Unilateral spatial neglect (USN) is the prevalent feature in patients with right-sided stroke. It is diagnosed through the behavior inattention test (BIT) and has a negative impact on patients affecting both their functional capacity and quality of life. OBJECTIVE: Here, we aimed to evaluate the impact of USN on the quality of life of patients in the chronic phase of stroke. METHODS: This is a cross-sectional study with stroke patients with USN. After confirming the presence of stroke through neuroimaging examinations and of USN through the BIT, patients' quality of life was evaluated by using the EUROQOL scale. Spearman's correlation was used to validate the correlation between patients' USN and quality of life, with a p < .05 representing significant results. RESULTS: Eighteen individuals were included. When correlating the value of each domain of the EUROQOL scale with the results of the BIT, we observed a negative correlation between mobility (r = -0.97; p = .000), self-care (r = -0.82; p = .013), usual activities (r = -0.87; p = .005); pain or discomfort (r = -0.88; p = .004), anxiety or depression (r = -0.97; p = .000), and EUROQOL total score (r = -0.97, p = .000). CONCLUSION: After a correlation between the overall EUROQOL and BIT scores, we suggest that the higher the USN degree is in stroke patients, the worse their perceived quality of life tends to be.

Is it possible to stabilize the trunk using rhythmic stabilization in the upper limb? A cross-sectional study of asymptomatic individuals.

Objective: The study aim was to evaluate the immediate effect of rhythmic stabilization on local and distant muscles involved in a functional reach. Method: Prospective, observational cross-sectional study. Eight right-handed and non-impaired individuals (4 females and 4 males) aged 18-24 years (21.5 ± 1.58 years) were evaluated. Bilateral electromyographic recording of the biceps brachii, triceps brachii, multifidus lumbar, and rectus abdominis muscles was performed during three different tasks. Task 1 involved functional reach, while Task 2 involved rhythmic stabilization followed by a functional reach. Task 3 was similar to Task 2, but with 3 repetitions before a functional reach. Results: The results showed no difference between the tasks or sides. However, an interaction was observed between each side and muscles, with greater activation of the right multifidus lumbar muscle. Conclusion: Rhythmic stabilization during the task of reaching promotes an increase of multifidus activity ipsilateral to its application. Thus, this particular technique of proprioceptive neuromuscular facilitation can be useful for improving stability of the trunk and can be used in clinical practice for this purpose. Level of Evidence: 5.

Objective Assessment of Bradykinesia Estimated from the Wrist Extension in Older Adults and Patients with Parkinson's Disease.

Parkinson's disease (PD) presents several motor signs, including tremor and bradykinesia. However, these signs can also be found in other motor disorders and in neurologically healthy older adults. The incidence of bradykinesia in PD is relatively high in all stages of the disorder, even when compared to tremor. Thus, this research proposes an objective assessment of bradykinesia in patients with PD (G PD: 15 older adults with Parkinson's disease, 65.3 ± 9.1 years) and older adults (G HV: 12 healthy older adults, 60.1 ± 6.1 years). The severity of bradykinesia in the participants of G PD was assessed using the Unified Parkinson's Disease Rating Scale. Movement and muscular activity were detected by means of inertial (accelerometer, gyroscope, magnetometer) and electromyographic sensors while the participants performed wrist extension against gravity with the forearm on pronation. Mean and standard error of inertial and electromyographic signal parameters could discriminate PD patients from healthy older adults (p value <0.05). In discriminating patients with PD from healthy older adults, the mean sensitivity and specificity were respectively 86.67 and 83.33%. The discrimination between the groups, based on the objective evaluation of bradykinesia, may contribute to the accurate diagnosis of PD and to the monitoring of therapies to control parkinsonian bradykinesia, and opens the possibility for further comparative studies considering individuals suffering from other motor disorders.