Usability of exergames as a home-based balance training tool for older adults: protocol for a systematic review.

INTRODUCTION: Exergames are used in the clinical practice of geriatric rehabilitation to increase physical activity levels and motivate players/patients. Their use in the home environment makes it possible to perform fun, engaging and interactive training with a large number of repetitions, thereby reducing the negative repercussions of postural imbalance in older adults. The aim of this systematic review is to collate and analyse evidence on the usability of exergames as a tool for home-based balance training for older adults. METHODS AND ANALYSIS: We will include randomised controlled trials involving healthy older adults (aged 60 years or older) who are described as having impaired static or dynamic balance using any subjective or objective assessment criteria. We will search Web of Science, MEDLINE, Embase, Scopus, ScienceDirect and the Cochrane Library from database inception to December 2022. CLINICALTRIALS: gov, the WHO International Clinical Trials Registry Platform and ReBEC will be searched for ongoing or unpublished trials. Two independent reviewers will screen the studies and extract the data. The findings will be presented in the text and tables, and if possible, relevant meta-analyses will be performed. The risk of bias and the quality of evidence will be assessed based on the recommendations of the Cochrane Handbook and Grading of Recommendations, Assessment, Development and Evaluation, respectively. ETHICS AND DISSEMINATION: Ethical approval was not required because of the nature of this study. Findings will be disseminated through peer-reviewed publications, conference presentations and through clinical rehabilitation networks. PROSPERO REGISTRATION NUMBER: CRD42022343290.

Effects of exergames training on postural balance in patients who had a chronic stroke: study protocol for a randomised controlled trial.

INTRODUCTION: Exergames training, as an additional therapy to standard care, has been widely used for motor recovery after patients who had a stroke, and it is a valuable and positive tool in the rehabilitation of this population. This study describes a single-blind randomised clinical trial that will aim to investigate the effects of exergames training on postural balance in patients with chronic stroke. METHODS AND ANALYSIS: Forty-two individuals with chronic stroke (>6 months), aged 20-75 years, will be randomised into two groups: the experimental group, which will be subjected to an exergames protocol, and control group, which will undergo a kinesiotherapy protocol. Both protocols are based on postural balance. The intervention will consist of 40-minute sessions two times per week for 10 consecutive weeks. The volunteers will be evaluated before the treatment, at the end of the interventions and 8 weeks thereafter. The primary outcome will be postural balance (Berg Balance Scale, Functional Reach Test, Timed Up and Go test and Centre of Pressure variables) and secondary outcomes will include gait (6 m timed walk and Kinovea Software), cortical activation patterns (electroencephalography Emotiv EPOC), functional independence (Functional Independence Measure), quality of life (Stroke-Specific Quality of Life Scale) and motivation (Intrinsic Motivation Inventory). ETHICS AND DISSEMINATION: This protocol was approved by the Ethics Committee of the Federal University of Rio Grande do Norte (number 3.434.350). The results of the study will be disseminated to participants through social networks and will be submitted to a peer-reviewed journal and scientific meetings. TRIAL REGISTRATION NUMBER: Brazilian Registry of Clinical Trials (RBR-78v9hx).

Level of motor, sensory and functional impairment from stroke at admission and hospital discharge in Brazil.

Primary Objective: To compare the level of motor, sensory and functional impairment of individuals hospitalized in a stroke unit in Brazil at the time of admission and the profile observed at hospital discharge. Design: Observational and longitudinal outcome study. Methods and Procedure: We assessed 41 patients with ischemic stroke at admission and hospital discharge by using the National Institute of Health Stroke Scale (NIHSS), Fugl-Meyer Physical Performance Scale (FM), Functional Independence Measure (FIM) and Modified Rankin Scale (mRS) and divided in the group that received or not the thrombolytic therapy. Were used wilcoxon and spearman tests. Results: Significant differences were found between admission and hospital discharge assessment (p < .0001) indicating clinical improvement for individuals submitted to thrombolytic treatment. A moderate correlation was observed for total FM and total FIM (ρ = 0.729; p value<.0001); total FM and motor FIM (ρ = 0.705; p value<.0001); and a moderate negative correlation for NIHSS and total FM (ρ = -0.709; p value<.0001). Strong correlation between motor FIM and total FIM was also observed (ρ = 0.972; p value<.0001). Conclusions: Clinical severity was softened along the hospitalization period. The clinical, motor, sensory and functional characterization enlarges the understanding of the stroke sequelae, besides monitoring the deficits and the level of disability in this population in Brazil.

Método Pilates na pressão arterial de idosos: uma revisão narrativa / Pilates Method on arterial pressure of elderly: a narrative review / Método de Pilates en la presión arterial antigua: una revisión narrative

O objetivo do estudo foi buscar na literatura a influência do Método Pilates na pressão arterial de idosos. Trata-se de uma revisão de literatura científica do tipo narrativa. Foram analisados cinco artigos (três ensaios clínicos randomizados, uma revisão sistemática com metanálise e um texto on-line). Observa-se que o Método Pilates é eficaz na manutenção da pressão arterial de idosos como um coadjuvante a alguma terapia associada.

The aimed of the study was to search the literature for the influence of the Pilates Method on the blood pressure of the elderly. It is a review of scientific literature of the type of narrative. Five articles were analysed (three randomized clinical trials, one systematic review with a meta-analysis and one text online). The Pilates Method is effective in maintaining the blood pressure of the elderly as a coadjuvant to some associated therapy.

El objetivo del estudio fue buscar en la literatura la influencia del Método Pilates en la presión arterial de los ancianos. Se trata de una revisión de la literatura científica del tipo narrativa. Se analizaron cinco artículos (tres ensayos clínicos aleatorizados, una revisión sistemática con metanálisis y un texto en línea). Se observa que el Método Pilates es eficaz en el mantenimiento de la presión arterial de los ancianos como un coadyuvante a alguna terapia asociada.

Electroencephalographic changes using virtual reality program: technical note.

The aim of the study was to describe the technique of an electroencephalographic (EEG) assessment using the Emotiv EPOC® during the performance of a virtual reality motor task and compare theta, alpha, beta and gamma power frequencies between left and right hemispheres. This is technical note in which 9 healthy young subjects were submitted to an evaluation with Emotiv EPOC® during the Nintendo® Wii 'Basic Step' virtual game using the Wii Balance Board (WBB) on a support 13 centimeters high. The Wilcoxon statistical test was applied and pairing between the cerebral hemispheres was performed. Participants had a mean age of 22.55 ± 2.78 years, 77.8% were right-handed, and 22.8% had no experience with the selected virtual game. According to dominancy (right handed n = 7; and left handed n = 2), it was observed that the right-handed individuals showed significantly greater difference in the right hemisphere in the EEG in front region (gamma power in channels AF4, p = 0.028 and F4, p = 0.043) and parietal region (theta and beta power in P8 channel, p = 0.043), while alpha power showed a greater activity in the left hemisphere (P7 channel, p = 0.043). Considering the inter-hemispheric analysis, it was observed that the right hemisphere presented a higher activation potential in the frontal lobe for gamma waves (p = 0.038 for AF3-AF4 channels), and in the temporal lobe for beta and alpha waves (p = 0.021). This study showed that the virtual environment can provide distinct cortical activation patterns considering an inter-hemispheric analysis, highlighting greater activation potential in the right hemisphere.

Perfil Social e Funcional dos Usuários da Estratégia Saúde da Família com Acidente Vascular Encefálico / Social and Functional Profile of Userswith Stroke Assisted by the Family Health Strategy

Objetivo: Analisar o perfil social e funcional dos usuários de Unidade Básica de Saúde/Estratégia Saúde da Família com Acidente Vascular Encefálico (AVE) em Santa Cruz, município do estado do Rio Grande do Norte. Material e Métodos: Tratase de um estudo transversal constituído por 39 indivíduos com diagnóstico clínico de AVE. Foram avaliados o perfil sociodemográfico e o comprometimento cognitivo, funcional e sensório motor através das escalas: Mini Exame do Estado Mental (MEEM), Medida de Independência Funcional (MIF), Escala de Equilíbrio de Berg (EEB), Protocolo de Desempenho Físico Fugl-Meyer (FM), Timed Up and Go (TUG) e a escala de Deambulação Funcional (FAC). Resultados: A idade média dos indivíduos foi 68,94±14,01 anos onde 56,41% eram mulheres, 58,97% casados, 58,97% pardos, 46,15% analfabetos, 41,03% agricultores, 71,79% aposentados e 84,62% residentes em casa própria. O hemisfério cerebral esquerdo (56,41%) e o tipo isquêmico (61,54%) mostraram-se mais prevalentes nesta população. O tempo de lesão após o AVE foi de 6,7±6,9 anos, onde 66,67% apresentaram um único evento. 97,40% dos avaliados apresentavam fatores de risco associados. A Hipertensão Arterial Sistêmica (HAS) (74,35%) foi o de maior destaque. No MEEM observou-se 82,05% da amostra com grave comprometimento cognitivo, 48,72% com pontuação da MIF indicando maior independência funcional, grave comprometimento motorna FM (46,88%) e equilíbrio pobre com significativo risco para quedas na pontuação da EEB (43,59%) e TUG (36%). Conclusão: O elevado acometimento do AVE está relacionado com as características epidemiológicas da região,assim como os déficits funcionais, cognitivos e sensório motores encontrados evidenciando um grave problema de saúde pública. (AU)

Objective: To analyze the social and functional profile of users with stroke assisted by the Primary Care Health Unit/ Family Health Strategy in the city of Santa Cruz, Rio Grande do Norte State, Brazil. Materials and Methods: This was a cross-sectional study including 39 individuals with a clinical diagnosis of stroke. The sociodemographic, cognitive, functional and sensory motor impairment profiles of the users were evaluated using the following tools: Mini-Mental State Examination (MEEM), Functional Independence Measure (MIF), Berg Balance Scale (EEB), Fugl-Meyer Assessment Scale (FM), Timed Up and Go (TUG) and Functional Ambulation Scale (FAC). Results: The mean age of individuals was 68.94±14.01 years, where 56.41% were woman, 58.97% married, 58.97% mixed race, 46.15% illiterate, 41.03% farmers, 71.79% retirees, and 84.62% living in their own house. The leftcerebral hemisphere (56.41%) was the most affected side and ischemic stroke (61.54%) the most prevalent condition in this population. The injury time after stroke was 6.7±6.9 years, and66.67% of the individual shad a single stroke; 97.4% of them presented as sociated risk factors, particularly systemic arterial hypertension (HAS) (74.35%). The MEEM indicated that 82.05% of the sample had severe cognitive impairment; 48.72% of the sample showed MIF score indicative of functional independence; 46.88% showed severe motor impairment in FM; and poor balance with significant risk for falls was found to be 43.59%and 36% based on EEB and TUG scores, respectively. Conclusion: The high prevalence of stroke is related with the epidemiological characteristics of the region as well as with functional, cognitive and sensory motor deficits, which indicates a serious public health problem. (AU)

Avaliação do membro superior pós-acidente vascular encefálico: correlação das escalas Motor Activity Log, Fugl-Meyer e Medida de Independência Funcional / Assessment of upper limb pos-stroke: correlation between Motor Activity Log, FuglMeyer and Functional Independence Measure scales

Objetivo: O objetivo do estudo foi identificar a correlação existente entre as escalas de avaliação do Membro Superior (MS), Motor Activity Log (MAL), Medida de Independência Funcional (MIF) e Escala de desempenho físico de Fugl-Meyer (FM) em indivíduos pósAcidente Vascular Encefálico (AVE). Métodos: Trata-se de um estudo transversal onde 20 indivíduos com AVE crônico foram avaliados por meio de um questionário sócio-demográfico e com as escalas: Mini Exame do Estado Mental (MEEM), MAL, MIF e FM seção MS (FM-MS). O teste de Correlação de Spearman foi utilizado e adotado significância de 5%. Resultados: Os participantes tinham idade média de 63 anos e 55% eram do gênero masculino. O tempo médio de lesão foi de 5 anos, 65% tinham um evento de AVE e predomínio da lesão no hemicorpo direito. Na categorização do MS observou-se moderada qualidade e quantidade de uso, com comprometimento sensório-motor leve e maior independência funcional. Houve boa correlação da FM-MS com MAL qualitativa e quantitativa (p=0,001), MIF motora (p=0,003) e MIF total (p=0,002); assim como, MIF motora com FM punho (p=0,0001) e FM ombro-braço (p=0,004). Foi identificada forte correlação entre FM-MS coordenação-velocidade com MAL quantitativa e qualitativa (p=0,0001) e entre subcategorias da MAL, FM-MS e MIF individualmente (p=0,0001). Conclusão: As subcategorias das três escalas se complementam e estabelecem uma relação fidedigna para predizer o quadro clínico do paciente pós-AVE, sendo reprodutível a sua utilização integrada na prática clínica para desenvolver diagnóstico fisioterapêutico e cinético-funcional. (AU)

Objectives: The aim of the study was to identify the correlation between the assessment scales of the Upper Limb (UL), Motor Activity Log (MAL), Functional Independence Measure (MIF) and Fugl-Meyer Physical Performance Scale (FM) of individuals post-stroke. Methods: This is a cross-secctional study in which 20 individuals with chronic stroke were evaluated using a sociodemographic questionnaire and with the scales: Mini Mental State Examination (MMSE), MAL, MIF and UL section of FM (FM-UL). The spearman correlation test was used and adopted significance of 5%. Results: The participants had mean age of 63 years and 55% were males. The mean time of injury was 5 years, 65% had one stroke event and a predominance of the right half-body lesion. In the categorization of UL, moderate quality and quantity of use were observed, with mild sensorimotor impairment and greater functional independence. There was good correlation of FM-UL with qualitative and quantitative MAL (p=0.001), motor MIF (p = 0.003) and total MIF (p = 0.002); as well as, motor MIF with FM wrist (p = 0.0001) and FM shoulder-arm (p=0.004). It was identified a strong correlation between FM-UL coordinationvelocity with quantitative and qualitative MAL (p = 0.0001) and between sub-categories of MAL, FM-UL and MIF individually (p = 0.0001). Conclusion: The subcategories of the three scales are complementary and establish a reliable relationship to predict the clinical picture of post-stroke patients, being reproducible their utilization in the clinical practice to develop physiotherapeutic and kinetic-functional diagnosis.(AU)

Effects of mirror therapy through functional activites and motor standards in motor function of the upper limb after stroke / Efecto de la terapia del espejo por mediante actividades funcionales y patrones motores em la función del miembro superior después de um accidente cerebrovascular / Efeito da terapia de espelho por meio de atividades funcionais e padrões motores na função do membro superior pós-acidente vascular encefálico

The study aimed to evaluate the effects of mirror therapy through functional activities and motor standards in upper limb function of chronic stroke subjects. Six patients with paresis of the arm within at least six months after stroke were randomly to a group of functional activities (GAF - n=3) and group of motor standards (GPM - n=3). Both groups performed 15 sessions of mirror therapy for 30 minutes, but the first one (GAF) were instructed to do the bilateral and symmetrical movements based on functional activities (i.e. games fitting) and the second one (GAP) made movements based on normal motor patterns (i.e. wrist flexion-extension). There was no statistical significance between pre- and post-treatment for both groups independently. However, analyzing the groups together (n=6), it was observed significance values in the cognitive and total MIF (p=0.002) pre- and post-mirror therapy. This study showed improvement in the functional impairment whatever the type of movement made during the mirror therapy.

El objetivo del estudio fue evaluar los efectos de la aplicación de la terapia de espejo por medio de actividades funcionales y patrones motores del movimiento en la función motora del miembro superior de hemiparéticos crónicos pos-Accidente Vascular Encefálico (AVE). Seis pacientes con hemiparesía del brazo con al menos seis meses pos-AVE fueron asignados de modo aleatorio a un grupo de actividades funcionales (GAF - n=3) y un grupo de patrones motores (GPM - n=3). Ambos grupos realizaron 15 sesiones de terapia del espejo durante 30 minutos, pero el primero (GAF) fue orientado a hacer movimientos bilaterales y simétricos en base a las actividades funcionales (es decir, juegos de encaje) y el segundo (GPM), a hacer movimientos basados ​​en patrones motores normales (es decir, flexión-extensión de la muñeca). No hubo diferencias estadísticamente significativas entre pre y post-tratamiento para ambos grupos de forma independiente. Sin embargo, el análisis de los grupos en conjunto (n=6) demostró valores post-terapia significativos en la Medida de Independencia Funcional (MIF) cognitiva y total (p=0,002) pre y post-terapia de espejo. Este estudio mostró una mejoría en el deterioro funcional en cualquier tipo de movimiento realizado durante la terapia del espejo.

O objetivo do estudo foi avaliar os efeitos da aplicação da terapia de espelho por meio de atividades funcionais e padrões motores do movimento na função motora do membro superior de hemiparéticos crônicos pós-Acidente Vascular Encefálico (AVE). Seis pacientes com hemiparesia do braço com pelo menos seis meses pós-AVE foram randomizados para um grupo de atividades funcionais (GAF - n=3) e um grupo de padrões motores (GPM - n=3). Ambos os grupos realizaram 15 sessões de terapia de espelho por 30 minutos, mas o primeiro (GAF) foi instruído a fazer movimentos bilaterais e simétricos baseados em atividades funcionais (isto é, jogos de encaixe) e o segundo (GPM), a fazer movimentos baseados em padrões motores normais (isto é, flexão-extensão de punho). Não houve significância estatística entre o pré e o pós-tratamento para ambos os grupos de modo independente. No entanto, analisando os grupos em conjunto (n=6), foram observados valores significativos na medida de independência funcional (MIF) cognitiva e total (p=0,002) pré e pós-terapia de espelho. Este estudo mostrou melhora no comprometimento funcional seja qual for o tipo de movimento feito durante a terapia de espelho.