Use of low-cost virtual reality in the treatment of the upper extremity in chronic stroke: a randomized clinical trial.

BACKGROUND: Chronicity and lack of motivation often go together during the upper limb rehabilitation process in stroke. Virtual reality is a useful tool in this context, providing safe, intensive, individualised treatments in a playful environment. B-cost, easy-to-use devices with personalised and motivating games for a specific population seem to be the most effective option in the treatment of the upper limbs. METHODS: A randomised clinical study with follow-up was carried out to assess the effectiveness of the Leap Motion Controller® device in improving the functionality of the upper limb in patients with chronic stroke. Patients (n = 36) were randomised into a control group that performed conventional therapy and an experimental group that combined the virtual reality protocol with conventional therapy. The outcome measures used were grip strength; the Block and Box Test; the Action Research Arm Test; the Disabilities of the Arm, Shoulder and Hand; as well as a Technology Satisfaction Questionnaire and adherence to treatment. RESULTS: Inter-group statistical analysis showed no significant differences except in subsection D of the Action Research Arm Test. Intra-group analysis showed significant differences in both groups, but the experimental group reached significance in all long-term variables. Satisfaction and adherence levels were very high. CONCLUSIONS: The Leap Motion Controller® system, as a complementary tool, produces improvements in grip strength, dexterity and motor function in patients with chronic stroke. It is perceived as a safe, motivating, and easy-to-use device. CLINICAL REGISTRATION: NCT04166617 Clinical Trials.

Influence of Impaired Upper Extremity Motor Function on Static Balance in People with Chronic Stroke.

BACKGROUND: Stroke is a leading cause of disability, especially due to an increased fall risk and postural instability. The objective of this study was to analyze the impact of motor impairment in the hemiparetic UE on static balance in standing, in subject with chronic stroke. METHODS: Seventy adults with chronic stroke, capable of independent standing and walking, participated in this cross-sectional study. The exclusion criteria included vestibular, cerebellar, or posterior cord lesions. The participants were classified based on their UE impairment using the Fugl-Meyer Assessment of Motor Recovery after Stroke (FMA-UE). A posturographic evaluation (mCTSIB) was performed in the standing position to analyze the center of pressure (COP) displacement in the mediolateral (ML) and anteroposterior (AP) axes and its mean speed with eyes open (OE) and closed (EC) on stable and unstable surfaces. RESULTS: A strong and significant correlation (r = -0.53; p < 0.001) was observed between the mediolateral (ML) center of pressure (COP) oscillation and the FMA-UE, which was particularly strong with eyes closed [r(EO) = 0.5; r(EC) = 0.54]. The results of the multiple linear regression analysis indicated that the ML oscillation is influenced significantly by the FMA-Motor, and specifically by the sections on UE, wrist, coordination/speed, and sensation. CONCLUSIONS: The hemiparetic UE motor capacity is strongly related to the ML COP oscillation during standing in individuals with chronic stroke, with a lower motor capacity associated with a greater instability. Understanding these relationships underpins the interventions to improve balance and reduce falls in people who have had a stroke.

Reliability and agreement of the timed up and go test in children and teenagers with autism spectrum disorder.

ASD patients include a variety of motor deficits; however, these issues have received less scientific attention than other ASD symptoms. Due to understanding and behavioral difficulties, it might be difficult to administer motor assessment measures to children and adolescents with ASD. To evaluate motor challenges in this population, including gait and dynamic balance issues, the timed up and go test (TUG) may be a simple, easy to apply, quick, and inexpensive tool. This test measures in seconds the time it takes for an individual to get up from a standard chair walk 3 m, turn around, walk back to the chair, and sit down again. The study purpose was to evaluate the inter- and intra-rater reliability of TUG test in children and teenagers with ASD. A total of 50 children and teenagers with ASD (43 boys and 7 girls) between 6 and 18 years were included. Reliability was verified by the intraclass correlation coefficient, standard error of measurement, and minimum detectable change. The agreement was analyzed by the Bland-Altman method. A good intra-rater reliability (ICC = 0.88; 95% CI = 0.79-0.93) and an excellent inter-rater reliability (ICC = 0,99; 95% CI = 0.98 to 0.99) were observed. Additionally, Bland-Altman plots demonstrated that there was no evidence of bias in either the replicates or between examiners. Furthermore, the limits of agreement (LOAs) between the testers and test replicates were close, indicating that there was little variation between measurements.       Conclusions: The test TUG showed strong intra- and inter-rater reliability values, low proportion of measurement errors, and lack of significant bias based on by test repetition in children and teenagers with ASD. These results could be clinically useful for assessing balance and the risk of falls in children and teenagers with ASD. However, the present study is not free of limitations, such as the use of a non-probabilistic sampling. What is Known: • People with ASD have a variety of motor deficits that have a prevalence rate almost as common as intellectual disability. In our knowledge, there are no studies that provide data on the reliability of the use of scales or assessment tests in children and adolescents with ASD to measure motor difficulties, such as gait and dynamic balance, in children and teenagers with ASD. • Timed up and go test (TUG) could be a possible tool to measure this motor skills. What is New: • The reliability and agreement of the Timed up and go test in 50 children and teenagers with autism spectrum disorder showed strong intra- and inter-rater reliability values, low proportion of measurement errors, and lack of significant bias based on by test repetition.

A Novel Active Device for Shoulder Rotation Based on Force Control.

This article describes a one-degree-of-freedom haptic device that can be applied to perform three different exercises for shoulder rehabilitation. The device is based on a force control architecture and an adaptive speed PI controller. It is a portable equipment that is easy to use for any patient, and was optimized for rehabilitating external rotation movements of the shoulder in patients in whom this was limited by muscle-skeletal injuries. The sample consisted of 12 shoulder rehabilitation sessions with different shoulder pathologies that limited their range of shoulder mobility. The mean and standard deviations of the external rotation of shoulder were 42.91 ± 4.53° for the pre-intervention measurements and 53.88 ± 4.26° for the post-intervention measurement. In addition, patients reported high levels of acceptance of the device. Scores on the SUS questionnaire ranged from 65 to 97.5, with an average score of 82.70 ± 9.21, indicating a high degree of acceptance. The preliminary results suggest that the use of this device and the incorporation of such equipment into rehabilitation services could be of great help for patients in their rehabilitation process and for physiotherapists in applying their therapies.

Reliability and agreement of the Nine Hole Peg Test in patients with unilateral spastic cerebral palsy.

Upper extremity involvement is one of the most common motor impairments in children with unilateral spastic cerebral palsy (CP). One tool for the assessment of manual function in CP is the Nine Hole Peg Test (NHPT). However, the reliability of the NHPT in patients with unilateral CP is unknown. This study aimed to analyze the intra-rater inter-session reliability of the NHPT in unilateral spastic CP, for its use in clinical practice and research. A total of 27 participants with spastic unilateral CP were included. Reliability was verified by the intraclass correlation coefficient (ICC), standard error of measurement, and minimum detectable change. The agreement was analyzed by the Bland-Altman method. An excellent intra-rater reliability was observed for the non-affected side (ICC = 0.94) and the affected side (ICC = 0.96). The minimal detectable change was 4 and 12 s for the non-affected and affected side, respectively. There were no significant biases between repetitions.   Conclusions: The NHPT showed excellent intra-rater inter-session reliability in patients with spastic unilateral CP. In addition, the test shows adequate agreement and proportionally small errors to assess manual dexterity. What is Known: • The Nine Hole Peg Test (NHPT) is widely used to assess dexterity in patients with neurological conditions. • The NHPT has demonstrated appropriate measurement properties in healthy children and adults with neurological conditions. What is New: • The NHPT presents excellent reliability, small measurement errors, and adequate agreement for the assessment of patients with cerebral palsy. • The measurement error of the NHPT in unilateral cerebral palsy may be up to 13% of the total time to perform it.

Use of the Leap Motion Controller® System in the Rehabilitation of the Upper Limb in Stroke. A Systematic Review.

OBJECTIVES: Upper limb impairment is the most common motor impairment in stroke survivors. The use of new technologies in the field of rehabilitation aims to reduce the impact of functional problems. Our objective is to evaluate the effectiveness of using the Leap Motion Controller® virtual reality system in the treatment of upper limb functionality in people with stroke. MATERIALS AND METHODS: PRISMA guidelines were used to carry out the systematic review. The literature search was restricted to articles written in English or Spanish published from 2012 to December 2020 in Pubmed, Web of Science, Scopus, PEDro and Science Direct. Of the 309 search results, 230 unique references were reviewed after duplicates were removed. The Downs and Black and CONSORT scales were applied to evaluate the methodological quality of the included papers and the degree of evidence and level of recommendation were determined through the Oxford Centre for Evidence-Based Medicine. RESULTS: Six papers with a total of 144 participants were included in this review, with heterogeneity of the sample, assessment measures, protocols, number of sessions and diversity of games applied. The main results of the studies show favourable data after using the Leap Motion Controller® system in the improvement of upper limb functionality in people with stroke. CONCLUSIONS: There is a growing trend in the use of the Leap Motion Controller® device as a tool in the treatment of the upper limb in people with stroke. Nevertheless, the limitations encountered suggest the need for future research protocols with greater scientific rigor.

The Long-Term Maintenance of Upper Limb Motor Improvements Following Transcranial Direct Current Stimulation Combined with Rehabilitation in People with Stroke: A Systematic Review of Randomized Sham-Controlled Trials.

BACKGROUND: The effectiveness of transcranial direct current stimulation (tDCS) in the upper limb (UL) motor rehabilitation of stroke has been widely studied. However, the long-term maintenance of its improvements has not yet been proven. METHODS: A systematic search was conducted in MEDLINE/Pubmed, Web of Science, PEDRo, and Scopus databases from inception to April 2021. Randomized controlled trials were included if they performed a tDCS intervention combined with UL rehabilitation in stroke patients, performed several sessions (five or more), and assessed long-term results (at least three-month follow-up). Risk of bias and methodological quality were evaluated with the Cochrane RoB-2 and the Oxford quality scoring system. RESULTS: Nine studies were included, showing a high methodological quality. Findings regarding UL were categorized into (1) functionality, (2) strength, (3) spasticity. All the studies that showed significant improvements retained them in the long term. Baseline functionality may be a limiting factor in achieving motor improvements, but not in sustaining them over the long term. CONCLUSION: It seems that the improvements achieved during the application of tDCS combined with UL motor rehabilitation in stroke were preserved until the follow-up time (from 3 months to 1 year). Further studies are needed to clarify the long-term effects of tDCS.

Validation of a Hybrid Exoskeleton for Upper Limb Rehabilitation. A Preliminary Study.

Recovery of therapeutic or functional ambulatory capacity in patients with rotator cuff injury is a primary goal of rehabilitation. Wearable powered exoskeletons allow patients to perform repetitive practice with large movements to maximize recovery, even immediately after the acute event. The aim of this paper is to describe the usability, acceptability and acceptance of a hybrid exoskeleton for upper-limb passive rehabilitation using the System Usability Scale (SUS) questionnaire. This equipment, called ExoFlex, is defined as a hybrid exoskeleton since it is made up of rigid and soft components. The exoskeleton mechanical description is presented along with its control system and the way motion is structured in rehabilitation sessions. Seven patients (six women and one man) have participated in the evaluation of this equipment, which are in the range of 50 to 79 years old. Preliminary evidence of the acceptance and usability by both patients and clinicians are very promising, obtaining an average score of 80.71 in the SUS test, as well as good results in a questionnaire that evaluates the clinicians' perceived usability of ExoFlex.

Effects of virtual reality associated with serious games for upper limb rehabilitation inpatients with multiple sclerosis: randomized controlled trial.

BACKGROUND: Dexterity and activities of daily living limitations on the upper limb (UL) represent one of the most common problems in patients with multiple sclerosis (MS). The aim of this study was to evaluate the effectiveness of the specially developed Serious Games that make use of the Leap Motion Controller (LMC) as main user interface for improving UL grip muscle strength, dexterity, fatigue, quality of life, satisfaction and compliance. METHODS: A single-blinded randomized controlled trial was conducted. The sample was randomized into two groups: an experimental group who received treatment based on serious games designed by the research team using the developed LMC based Serious Games for the UL plus conventional rehabilitation, and a control group who received the same conventional rehabilitation for the UL. Both groups received two 60 min sessions per week over a ten-week period. Grip muscle strength, coordination, speed of movements, fine and gross UL dexterity, fatigue, quality of life, satisfaction and compliance were assessed in both groups pre-treatment, post-treatment and in a follow-up period of 1 month without receiving any treatment. RESULTS: In the experimental group compared to the control group, significant improvements were observed in the post-treatment assessment for coordination, speed of movements, fine and gross UL dexterity. Also, significant results were found in the follow-up in coordination, speed of movements, fine and gross for the more affected side. CONCLUSIONS: An experimental protocol using an LMC based Serious Games designed for UL rehabilitation showed improvements for unilateral gross manual dexterity, fine manual dexterity, and coordination in MS patients with high satisfaction and excellent compliance. TRIAL REGISTRATION: This randomized controlled trial has been registered at ClinicalTrials.gov Identifier: NCT04171908 , Nov 2019.

Reliability of Kinovea® Software and Agreement with a Three-Dimensional Motion System for Gait Analysis in Healthy Subjects.

Gait analysis is necessary to diagnose movement disorders. In order to reduce the costs of three-dimensional motion capture systems, new low-cost methods of motion analysis have been developed. The purpose of this study was to evaluate the inter- and intra-rater reliability of Kinovea® and the agreement with a three-dimensional motion system for detecting the joint angles of the hip, knee and ankle during the initial contact phase of walking. Fifty healthy subjects participated in this study. All participants were examined twice with a one-week interval between the two appointments. The motion data were recorded using the VICON Motion System® and digital video cameras. The intra-rater reliability showed a good correlation for the hip, the knee and the ankle joints (Intraclass Correlation Coefficient, ICC > 0.85) for both observers. The ICC for the inter-rater reliability was >0.90 for the hip, the knee and the ankle joints. The Bland-Altman plots showed that the magnitude of disagreement was approximately ±5° for intra-rater reliability, ±2.5° for inter-rater reliability and around ±2.5° to ±5° for Kinovea® versus Vicon®. The ICC was good for the hip, knee and ankle angles registered with Kinovea® during the initial contact of walking for both observers (intra-rater reliability) and higher for the agreement between observers (inter-rater reliability). However, the Bland-Altman plots showed disagreement between observers, measurements and systems (Kinovea® vs. three-dimensional motion system) that should be considered in the interpretation of clinical evaluations.

Validity of a Fully-Immersive VR-Based Version of the Box and Blocks Test for Upper Limb Function Assessment in Parkinson's Disease.

In recent decades, gaming technology has been accepted as a feasible method for complementing traditional clinical practice, especially in neurorehabilitation; however, the viability of using 3D Virtual Reality (VR) for the assessment of upper limb motor function has not been fully explored. For that purpose, we developed a VR-based version of the Box and Blocks Test (BBT), a clinical test for the assessment of manual dexterity, as an automated alternative to the classical procedure. Our VR-based BBT (VR-BBT) integrates the traditional BBT mechanics into gameplay using the Leap Motion Controller (LMC) to capture the user's hand motion and the Oculus Rift headset to provide a fully immersive experience. This paper focuses on evaluating the validity of our VR-BBT to reliably measure the manual dexterity in a sample of patients with Parkinson's Disease (PD). For this study, a group of twenty individuals in a mild to moderate stage of PD were recruited. Participants were asked to perform the physical BBT (once) and our proposed VR-BBT (twice) system, separately. Correlation analysis of collected data was carried out. Statistical analysis proved that the performance data collected by the VR-BBT significantly correlated with the conventional assessment of the BBT. The VR-BBT scores have shown a significant association with PD severity measured by the Hoehn and Yahr scale. This fact suggests that the VR-BBT could be used as a reliable indicator for health improvements in patients with PD. Finally, the VR-BBT system presented high usability and acceptability rated by clinicians and patients.

The Impact of a Novel Immersive Virtual Reality Technology Associated with Serious Games in Parkinson's Disease Patients on Upper Limb Rehabilitation: A Mixed Methods Intervention Study.

BACKGROUND: Parkinson's disease is a neurodegenerative disorder that causes impaired motor functions. Virtual reality technology may be recommended to optimize motor learning in a safe environment. The objective of this paper was to evaluate the effects of a novel immersive virtual reality technology used for serious games (Oculus Rift 2 plus leap motion controller-OR2-LMC) for upper limb outcomes (muscle strength, coordination, speed of movements, fine and gross dexterity). Another objective was to obtain qualitative data for participants' experiences related to the intervention. METHODS: A mixed methods intervention (embedded) study was used, with a qualitative design after a technology intervention (quantitative design). The intervention and qualitative design followed international guidelines and were integrated into the method and reporting subheadings. RESULTS: Significant improvements were observed in strength (p = 0.028), fine (p = 0.026 to 0.028) and gross coordination dexterity, and speed movements (p = 0.039) in the affected side, with excellent compliance (100%) and a high level of satisfaction (3.66 ± 0.18 points out of the maximum of 4). No adverse side effects were observed. Qualitative findings described patients' perspectives regarding OR2-LMC treatment, facilitators and barriers for adherence, OR2-LMC applications, and treatment improvements. CONCLUSIONS: The intervention showed positive results for the upper limbs, with elements of discordance, expansion, and confirmation between qualitative and quantitative results.

Leap motion controlled video game-based therapy for upper limb rehabilitation in patients with Parkinson's disease: a feasibility study.

BACKGROUND: Non-immersive video games are currently being used as technological rehabilitation tools for individuals with Parkinson's disease (PD). The aim of this feasibility study was to evaluate the effectiveness of the Leap Motion Controller® (LMC) system used with serious games designed for the upper limb (UL), as well as the levels of satisfaction and compliance among patients in mild-to-moderate stages of the disease. METHODS: A non-probabilistic sampling of non-consecutive cases was performed. 23 PD patients, in stages II-IV of the Hoehn & Yahr scale, were randomized into two groups: an experimental group (n = 12) who received treatment based on serious games designed by the research team using the LMC system for the UL, and a control group (n = 11) who received a specific intervention for the UL. Grip muscle strength, coordination, speed of movements, fine and gross UL dexterity, as well as satisfaction and compliance, were assessed in both groups pre-treatment and post-treatment. RESULTS: Within the experimental group, significant improvements were observed in all post-treatment assessments, except for Box and Blocks test for the less affected side. Clinical improvements were observed for all assessments in the control group. Statistical intergroup analysis showed significant improvements in coordination, speed of movements and fine motor dexterity scores on the more affected side of patients in the experimental group. CONCLUSIONS: The LMC system and the serious games designed may be a feasible rehabilitation tool for the improvement of coordination, speed of movements and fine UL dexterity in PD patients. Further studies are needed to confirm these preliminary findings.

Automatic Outcome in Manual Dexterity Assessment Using Colour Segmentation and Nearest Neighbour Classifier.

Objective assessment of motor function is an important component to evaluating the effectiveness of a rehabilitation process. Such assessments are carried out by clinicians using traditional tests and scales. The Box and Blocks Test (BBT) is one such scale, focusing on manual dexterity evaluation. The score is the maximum number of cubes that a person is able to displace during a time window. In a previous paper, an automated version of the Box and Blocks Test using a Microsoft Kinect sensor was presented, and referred to as the Automated Box and Blocks Test (ABBT). In this paper, the feasibility of ABBT as an automated tool for manual dexterity assessment is discussed. An algorithm, based on image segmentation in CIELab colour space and the Nearest Neighbour (NN) rule, was developed to improve the reliability of automatic cube counting. A pilot study was conducted to assess the hand motor function in people with Parkinson's disease (PD). Three functional assessments were carried out. The success rate in automatic cube counting was studied by comparing the manual (BBT) and the automatic (ABBT) methods. The additional information provided by the ABBT was analysed to discuss its clinical significance. The results show a high correlation between manual (BBT) and automatic (ABBT) scoring. The lowest average success rate in cube counting for ABBT was 92%. Additionally, the ABBT acquires extra information from the cubes' displacement, such as the average velocity and the time instants in which the cube was detected. The analysis of this information can be related to indicators of health status (coordination and dexterity). The results showed that the ABBT is a useful tool for automating the assessment of unilateral gross manual dexterity, and provides additional information about the user's performance.

Scales to assess gross motor function in stroke patients: a systematic review.

OBJECTIVE: To assess the clinical and psychometric properties of stroke motor assessment scales. DATA SOURCES: The databases consulted for the literature research were MEDLINE, PEDro, ISI Web of Knowledge, and Cumulative Index to Nursing and Allied Health (CINAHL). The search was carried out between March 2011 and January 2014. STUDY SELECTION: Studies that describe and validate a measurement scale designed to assess gross motor function in stroke. The articles were classified according to the levels of evidence and grades of recommendation for diagnosis studies of the Oxford Center for Evidence-Based Medicine. DATA EXTRACTION: General characteristics of the studies, including number of patients, motor function assessment scales analyzed, and their psychometric properties, were collected. DATA SYNTHESIS: After the literature search, 19 articles were included in this review; 32 articles were excluded for not meeting the inclusion criteria. Four of the 19 articles studied the Motor Assessment Scale, 5 the Fugl-Meyer Assessment, 3 investigated the Sodring Motor Evaluation for Stroke Patients, 4 the Stroke Rehabilitation Assessment of Movement, 2 were about the Motricity Index, and 2 about the Rivermead Motor Assessment. All of them were classified as level 2b according to the levels of evidence and grades of recommendation. CONCLUSIONS: All the scales compiled in this review have been shown to be useful both in clinical practice and in terms of research. The most suitable scales to be used in the clinical field would be the short versions of the Fugl-Meyer Assessment and the Stroke Rehabilitation Assessment of Movement. A real consensus about the measurement of gross motor function in patients with stroke is not available in the recent literature.

Balance and motor skills differences between children and teenagers with autism spectrum disorder and neurotypically developing.

This study examined the differences between children and adolescents with autism spectrum disorder (ASD) and neurotypically developing (NTD) in terms of balance, postural control, and motor skills. It also examined which motor skills are most affected and whether scores on different assessment tests in ASD children are correlated. A cross-sectional observational study with two research groups was conducted. Timed up and go test (TUG), short form of Bruininks-Oseretsky test of Motor Proficiency version 2 (SFBOT-2), and pediatric balance scale (PBS) were used. A total of 100 participants 50 with ASD and 50 with NTD engaged in the research. Statistically significant differences were obtained between control group and ASD group in TUG test and in SFBOT-2 standard score and total score (p-value = <0.01). A statistically significant difference (p-value = <0.01) was seen between ASD group's and control group's PBS scores. Poor correlation was noted between TUG and SFBOT-2, as well as between PBS and TUG. A moderate correlation was also found between SFBOT-2 and PBS. Children with ASD present difficulties in motor skills and in static and dynamic balance compared to children with NTD. Differences were observed in the motor skills of strength followed by manual dexterity, running speed and agility, fine motor precision, fine motor integration, and balance. The PBS item that showed the greatest difference between the ASD group and control group was maintaining monopodial support with hands on hips. Finally, poor to moderate correlations were obtained between the different tests with statistically significant differences.

Differences in Motor Development between Preterm Infants and Full-Term Preschool Children.

Although advances in obstetric and neonatal care have improved the survival of preterm infants, many studies document the increased risk of motor and sensory neurodevelopmental abnormalities that can hinder school progress. The aim of this study was to analyze the differences in gross and fine motor development in children born preterm and full term aged 3 to 6 years using the Peabody Developmental Motor Scales 2 (PDMS-II). Fifteen preterm and fifteen term children, matched for age and sex, participated in this study. They were evaluated with the PDMS-II scale. The scores obtained in the PDMS-II scale showed statistically significant differences (p < 0.05) in all subscales except for the "grasping" subscale. No dissimilarities were found between children who attended an early intervention program and those who did not participate, nor was there any correlation between week of gestation and birth weight and motor development in preschool. The results obtained show that differences are found with respect to motor development, with lower scores for those born preterm compared to children born at term. No statistically significant difference was found between preterm children who attended early intervention and those who did not. No correlation was found between motor development at preschool age and birth weight and gestational age.

Impact of reflex locomotion and the Bobath concept on clinical and biomolecular parameters in people with multiple sclerosis: study protocol for a randomized controlled trial.

Introduction: Multiple sclerosis (MS) is a progressive disease with a fluctuating and unpredictable course that has no curative treatment at present. One of its main characteristics is the variety of signs and symptoms that produce a high percentage of patients who present alterations in balance and gait during the development of the disease, decreased muscle strength, spasticity, or decreased pimax. Rehabilitative therapy, especially physiotherapy, is the main course of the treatment of these alterations using reflex locomotion and the Bobath concept as a form of kinesitherapy that activates the preorganized circuits of the central nervous system. Objective: The objective of this study is to evaluate the reflex locomotion and Bobath concept effects on balance, spasticity, reaction time, respiratory parameters, and lacrimal biomolecular markers. Methods and analysis: This is a randomized controlled trial on the effectiveness of two neurorehabilitation techniques in patients with multiple sclerosis conducted at the University of Salamanca. The research will take place at the Faculty of Nursing and Physiotherapy, University of Salamanca. The study will be conducted from June 2023 to June 2024. The reflex locomotion group will receive individual sessions of therapy (n = 27), and the Bobath concept group (n = 27) will receive the same number of sessions. Both groups will receive two sessions per week for 12 months. The measurement variables will be the Berg Balance Scale, the Tardieu Scale, the Cognitfit Program, Maximum Inspiratory Pressure, and Lacrimal Biomarkers. Ethics and dissemination: This study has been approved by the Ethics Committee of the University of Salamanca on March 2023 (ref: 896). Limitations: The main limitations of this study are the selection and number of patients, the delay in implementing the therapy within the initially scheduled period, inadequate sample collection, and inadequate sample processing. Trial registration number: ClinicalTrials.gov; identifier: NCT05558683.

The efficacy of transcranial direct current stimulation on upper extremity motor function after stroke: A systematic review and comparative meta-analysis of different stimulation polarities.

BACKGROUND: The efficacy of transcranial direct current stimulation (tDCS) has been studied extensively. The cathodic (c-tDCS), anodic (a-tDCS), and bihemispheric stimulation have demonstrated efficacy in the management of the paretic upper extremity (UE) after stroke, but it has not been determined which stimulation polarity has, so far, shown the best results. OBJECTIVE: To evaluate the available evidence to determine which tDCS polarity has the best results in improving UE motor function after stroke. METHODS: PubMed, PEDro, Web of Science, EMBASE, and SCOPUS databases were searched. Different Medical Subject Headings (MeSH) terms were combined for the search strategy, to cover all studies that performed a comparison between different tDCS configurations focused on UE motor rehabilitation in people with lived experience of stroke. RESULTS: Fifteen studies remained for qualitative analysis and 12 for quantitative analysis. Non-significant differences with a 95% confidence interval (CI) were obtained for c-tDCS versus a-tDCS (g = 0.10, 95% CI = -0.13; 0.33, p = .39, N = 292), for a-tDCS versus bihemispheric (g = 0.02, 95% CI = -0.46; 0.42, p = .93, N = 81), and for c-tDCS versus bihemispheric (g = 0.09, 95% CI = -0.84; .66, p = .73, N = 100). No significant differences between the subgroups of the meta-analysis were found. CONCLUSIONS: The results of the present meta-analysis showed no evidence that a stimulation polarity is superior to the others in the rehabilitation of UE motor function after stroke. A non-significant improvement trend was observed toward c-tDCS compared to a-tDCS.

Reliability and Validity of the 10-Meter Walk Test (10MWT) in Adolescents and Young Adults with Down Syndrome.

People with Down syndrome (DS) have gait deficits because motor milestones are usually reached later. Decreased gait speed or reduced stride length are some of the main deficits. The main objective of the present work was to assess the reliability of the 10-Meter Walk Test (10MWT) in adolescents and young adults with DS. The objective has been to analyze the construct validity of the 10MWT with the Timed up and go (TUG) test. A total of 33 participants with DS were included. Reliability was verified by intraclass correlation coefficient (ICC). The agreement was analyzed by the Bland-Altman method. Finally, construct validity was evaluated through Pearson correlation coefficient. The 10MWT intra-rater and inter-rater reliability were good (ICC between 0.76 until 0.9) and excellent (ICC > 0.9), respectively. The minimal detectable change for intra-rater reliability was 0.188 m/s. Also, it has demonstrated moderate construct validity (r > 0.5) considering the TUG test. The 10MWT has shown high intra- and inter-rater reliability and validity in adolescent and adults with SD and a moderate construct validity between TUG test and 10MWT.