The use of a task through virtual reality in cerebral palsy using two different interaction devices (concrete and abstract) - a cross-sectional randomized study.

BACKGROUND: Cerebral Palsy (CP) is characterised by variable difficulties in muscular action, resulting in inability of the individual to perform functional movement. An option to provide functionality to the individual with CP is the use of computer innovation. The aim of this paper was to verify if there was any performance improvement in a task performed in a virtual environment and if there was transfer to the task performed in the real environment and vice versa in this population. METHODS: A computer program was developed comprising a motor task, but with two possibilities of user interaction: a) concrete interface (with physical contact): in which the individual touches the computer screen to finish the task and b) abstract interface (no physical contact): in which the individual performs a hand movement in front of the Kinect device. Participants were split into two groups. The experimental group consisted of 28 individuals with CP within the ages of 6 and 15 years old. The control group included 28 typically developing individuals mirroring the age and sex of the experimental group. RESULTS: Individuals from both groups were able to improve task performance and retain acquired information. The CP group presented worse performance than the control group in all phases of the study. Further findings showed that the CP group presented better performance in the abstract interface than in the concrete interface, whereas, in the control group, the opposite occurred: their best performance was in the concrete. CONCLUSIONS: Motor tasks performed by individuals with CP through an interface with a more virtual environment feature (abstract interface: Kinect) provided better performance when compared to an interface with a more real characteristic (concrete interface: Touchscreen). TRIAL REGISTRATION: ClinicalTrials.gov Identifier - NCT03352440; Date of registration - November 17, 2017.

Secondary particles formed from the exhaust of vehicles using ethanol-gasoline blends increase the production of pulmonary and cardiac reactive oxygen species and induce pulmonary inflammation.

BACKGROUND: Ethanol vehicles release exhaust gases that contribute to the formation of secondary organic aerosols (SOA). OBJECTIVE: To determine in vivo toxicity resulting from exposure to SOA derived from vehicles using different ethanol-gasoline blends (E0, E10, E22, E85W, E85S, E100). METHODS: Exhaust emissions from vehicles using ethanol blends were delivered to a photochemical chamber and reacted to produce SOA. The aerosol samples were collected on filters, extracted, and dispersed in an aqueous solutions and intratracheally instilled into Sprague Dawley rats in doses of 700 µg/0.2 ml. After 45 min and 4 h pulmonary and cardiac chemiluminescence (CL) was measured to estimate the amount of reactive oxygen species (ROS) produced in the lungs and heart. Inflammation was measured by differential cell count in bronchoalveolar lavages (BAL). RESULTS: Statistically and biologically significant differences in response to secondary particles from the different fuel formulations were detected. Compared to the control group, animals exposed to SOA from gasoline (E0) showed a significantly higher average CL in the lungs at 45 min. The highest CL averages in the heart were observed in the groups exposed to SOA from E10 and pure ethanol (E100) at 45 min. BAL of animals exposed to SOA from E0 and E85S had a significant increased number of macrophages at 45 min. BAL neutrophil count was increased in the groups exposed to E85S (45 min) and E0 (4 h). Animals exposed to E0 and E85W had increased BAL lymphocyte count compared to the control and the other exposed groups. DISCUSSION: Our results suggest that SOA generated by gasoline (E0), followed by ethanol blends E85S and E85W, substantially induce oxidative stress measured by ROS generation and pulmonary inflammation measured by the recruitment of white blood cells in BAL.

Efficacy of different interaction devices using non-immersive virtual tasks in individuals with Amyotrophic Lateral Sclerosis: a cross-sectional randomized trial.

BACKGROUND: Amyotrophic Lateral Sclerosis (ALS) is a rapid progressive neurodegenerative disease, characterized by a selective loss of motor neurons, brain stem and spinal cord which leads to deterioration of motor abilities. Devices that promote interaction with tasks on computers can enhance performance and lead to greater independence and utilization of technology. OBJECTIVE: To evaluate performance on a computer task in individuals with ALS using three different commonly used non-immersive devices. METHOD: Thirty individuals with ALS (18 men and 12 women, mean age 59 years, range 44-74 years) with a mean score of 26, (minimum score of 14 and maximum 41) on the Revised Amyotrophic Lateral Sclerosis Functional Rating Scale (ALSFRS-R) and 30 healthy controls matched for age and gender, participated. All participants were randomly divided into three groups, each using a different device system (motion tracking, finger motion control or touchscreen) to perform three task phases (acquisition, retention and transfer). RESULTS: Both the ALS and control group (CG) showed better performance on the computer task when using the touchscreen device, but there was limited transfer of performance onto the task performed on the Finger Motion control or motion tracking. However, we found that using the motion tracking device led to transfer of performance to the touchscreen. CONCLUSION: This study presents novel and important findings when selecting interaction devices for individuals with ALS to access technology by demonstrating immediate performance benefits of using a touchscreen device, such as improvement of motor skills. There were possible transferable skills obtained when using virtual systems which may allow flexibility and enable individuals to maintain performance overtime. TRIAL REGISTRATION: Registration name: Virtual Task in Amyotrophic Lateral Sclerosis; Registration number: NCT03113630 ; retrospectively registered on 04/13/2017. Date of enrolment of the first participant to the trial: 02/02/2016.

Questionable use of performance testing to predict success in soccer players: comment on Ljach, et al. (2012).

This commentary addresses a prior article by Ljach, et al. (2012) on the topic of talent identification and development in soccer. Despite the potential usefulness of their findings to organize training processes, the predictability of performance testing in talent identification for soccer remains unclear.

Analysis of Heart Rate, Perception of Physical Effort and Performance of Individuals with Down Syndrome Submitted to a Protocol of Virtual Games for Home-Based Telerehabilitation.

Down syndrome (DS) is a genetic condition associated with impairments in several body systems, which may negatively influence the habit of practicing physical activities (PAs), increasing sedentary habits and the risk of comorbidities. Additionally, difficulty in accessing services, financial limitations and lack of interest may interfere with the practice of PAs. Considering the necessity of developing effective treatment alternatives, to increase the possibility of access and the interest of participants, we conducted a study using telerehabilitation with a virtual task to promote PA and analyze the motor performance of DS individuals. Our protocol consisted of 11 sessions of the virtual game called MoveHero. A total of 34 individuals with DS and 34 individuals with typical development participated in the study. Heart rate (HR) and rating of perceived effort (RPE) were collected at rest and during the game. Our results show that virtual reality presents a great possibility to promote PA and a way out of a sedentary lifestyle for DS individuals, considering the enhancement in HR and RPE found during the protocol for both groups. Moreover, our results show positive outcomes regarding motor performance, with significant improvement in the task with practice, demonstrating that individuals with DS are able to improve their motor proficiency with adequate stimuli in the virtual environment.

Gait Training with Functional Electrical Stimulation Improves Mobility in People Post-Stroke.

(1) Background: Stroke is one of the leading causes of disability. To identify the best treatment strategies for people with stroke (PwS), the aim of the current study was to compare the effects of training on a treadmill with functional electrical stimulation (TT-FES) with training on a treadmill (TT), and to analyze the effects of sequence of training on mobility and the parameters of walking ability. (2) Methods: Prospective, longitudinal, randomized and crossover study, in which 28 PwS were distributed into groups, namely the A-B Group (TT-FES followed by TT) and B-A Group (TT followed by TT-FES), using the foot drop stimulator, and were measured with functional tests. (3) Results: We found improved mobility, balance, non-paretic limb coordination, and endurance only in the group that started with TT-FES. However, sensorimotor function improved regardless of the order of training, and paretic limb coordination only improved in the B-A Group, but after TT-FES. These data indicate that the order of the protocols changed the results. (4) Conclusions: Although biomechanical evaluation methods were not used, which can be considered a limitation, our results showed that TT-FES was superior to isolated training on a treadmill with regard to balance, endurance capacity, and coordination of the non-paretic limb.

Cardiac autonomic modulation in response to postural transition during a virtual reality task in individuals with spinal cord injury: A cross-sectional study.

PURPOSE: The postural transition from sitting to standing is a moment of dysautonomic occurrence in individuals with Spinal Cord Injury (SCI). Different tools can be used to minimize this event, such as virtual reality. Thus, we aimed to analyze cardiac autonomic modulation in individuals with SCI during postural transition from the sitting to orthostatism position using a cognitive virtual reality (VR) task. METHODS: Individuals with and without SCI were positioned on the Easy Stand® device, sitting at rest, at 0° considering the angle between the seat and the floor, elevation at 45°, and orthostatism at 90°, for 5 minutes in each position. Heart rate variability (HRV) measures of sympathovagal balance were collected (heart rate receiver: Polar V800). The groups were subdivided into two groups, one that performed VR as an intervention during the postural angle changes and another group that did not perform VR. RESULTS: We evaluated 76 individuals, 40 with a medical diagnosis of SCI and 36 who composed the able-bodied control group without SCI, matched by age and sex. The HRV results showed that the SCI group who performed the task in VR demonstrated no significant difference in parasympathetic activation and global variability between the sitting versus 90° positions. There was better sympathovagal balance in SCI and able-bodied control groups who performed the VR task between the sitting versus 90° positions. CONCLUSION: The use of a VR task seems to contribute to better sympathovagal balance, with the potential to reduce dysautonomia during postural changes.

Virtual reality as a telerehabilitation strategy for people with autism spectrum disorder during the COVID-19 quarantine scenario: physical activity, motor performance and enjoyment.

PURPOSE: People with autism spectrum disorder could benefit from physical activity during the pandemic and COVID-19 restrictions, mainly to maintain adequate physical activity. We aimed to evaluate the feasibility, enjoyment, and potential effect of telerehabilitation using a serious game named 'MoveHero'. MATERIALS AND METHODS: Registered in Clinical Trials (NCT04402034). We adopted a remotely run Telerehabilitation research design with 44 participants recruited: 22 People with ASD people and 22 non-ASD individuals. RESULTS: All participants safely participated, 100% adherence to sessions, ∼60% enjoying the task, and significantly improved performance, with better performance for the NA group at most practice moments. CONCLUSIONS: Our findings support both how to implement a gaming intervention and the need to investigate the efficacy of serious games to motivate moderate intensity physical activity in people with ASD.

A new and thrilling way to promote physical activity is through telerehabilitation to people with Autism Spectrum Disorder.A tool that can possibly influence the mood of people with Autism Spectrum Disorder.Help to implement home-based rehabilitation to people with Autism Spectrum Disorder.

Autonomic Modulation in Duchenne Muscular Dystrophy During a Computer Task: A Prospective Transversal Controlled Trial Assessment by Non-linear Techniques.

Introduction: Due to functional and autonomic difficulties faced by individuals with Duchenne Muscular Dystrophy (DMD), the use of assistive technology is critical to provide or facilitate functional abilities. The key objective was to investigate acute cardiac autonomic responses, by application of Heart Rate Variability (HRV), during computer tasks in subjects with DMD via techniques based on non-linear dynamics. Method: HRV was attained via a Polar RS800CX. Then, was evaluated by Chaotic Global Techniques (CGT). Forty-five male subjects were included in the DMD group and age-matched with 45 in the healthy Typical Development (TD) control group. They were assessed for 20 min at rest sitting, and then 5 min whilst performing the maze task on a computer. Results: Both TD and DMD subjects exhibited a significantly reduced HRV measured by chaotic global combinations when undertaking the computer maze paradigm tests. DMD subjects presented decreased HRV during rest and computer task than TD subjects. Conclusion: While there is an impaired HRV in subjects with DMD, there remains an adaptation of the ANS during the computer tasks. The identification of autonomic impairment is critical, considering that the computer tasks in the DMD community may elevate their level of social inclusion, participation and independence.

Influence of Different Types of Corticosteroids on Heart Rate Variability of Individuals with Duchenne Muscular Dystrophy-A Pilot Cross Sectional Study.

Individuals with Duchenne Muscular Dystrophy (DMD) have an impairment of cardiac autonomic function categorized by parasympathetic reduction and sympathetic predominance. The objective of this study was to assess the cardiac autonomic modulation of individuals with DMD undergoing therapy with Prednisone/Prednisolone and Deflazacort and compare with individuals with DMD without the use of these medications and a typically developed control group. Methods: A cross-sectional study was completed, wherein 40 boys were evaluated. The four treatment groups were: Deflazacort; Prednisone/Prednisolone; no corticoid use; and typical development. Heart Rate Variability (HRV) was investigated via linear indices (Time Domain and Frequency Domain) and non-linear indices Results: The results of this study revealed that individuals with DMD undertaking pharmacotherapies with Prednisolone demonstrated HRV comparable to the Control Typically Developed (CTD) group. In contrast, individuals with DMD undergoing pharmacotherapies with Deflazacort achieved lower HRV, akin to individuals with DMD without any medications, as demonstrated in the metrics: RMSSD; LF (n.u.), HF (n.u.), LF/HF; SD1, α1, and α1/α2, and a significant effect for SD1/SD2; %DET and Ratio; Shannon Entropy, 0 V%, 2 LV% and 2 ULV%. Conclusions: Corticosteroids have the potential to affect the cardiac autonomic modulation in adolescents with DMD. The use of Prednisone/Prednisolone appears to promote improved responses in terms of sympathovagal activity as opposed to Deflazacort.

Comparison Between Conventional Intervention and Non-immersive Virtual Reality in the Rehabilitation of Individuals in an Inpatient Unit for the Treatment of COVID-19: A Study Protocol for a Randomized Controlled Crossover Trial.

Background: The new human coronavirus that leads to COVID-19 (coronavirus disease 2019) has spread rapidly around the world and has a high degree of lethality. In more severe cases, patients remain hospitalized for several days under treatment of the health team. Thus, it is important to develop and use technologies with the aim to strengthen conventional therapy by encouraging movement, physical activity, and improving cardiorespiratory fitness for patients. In this sense, therapies for exposure to virtual reality (VR) are promising and have been shown to be an adequate and equivalent alternative to conventional exercise programs. Aim: This is a study protocol with the aim of comparing the conventional physical therapy intervention with the use of a non-immersive VR software during COVID-19 hospitalization. Methods: Fifty patients hospitalized with confirmed diagnosis of COVID-19 will be divided in two groups under physiotherapy treatment using conventional or VR intervention: Group A: participants with COVID-19 will start the first day of the protocol with VR tasks in the morning and then in the second period, in the afternoon, will perform the conventional exercises (n = 25) and Group B: participants with COVID-19 will start the first day with conventional exercises in the morning and in the second period, in the afternoon, will perform activity with VR (n = 25). All participants will be evaluated with different motor and physiologic scales before and after the treatment to measure improvements. Conclusion: Considering the importance of benefits from physical activity during hospitalization, VR software shows promise as a potential mechanism for improving physical activity. The results of this study may provide new insights into hospital rehabilitation. Trial Registration: ClinicalTrials.gov, identifier: NCT04537858. Registered on 01 September 2020.

Serious Game Platform as a Possibility for Home-Based Telerehabilitation for Individuals With Cerebral Palsy During COVID-19 Quarantine - A Cross-Sectional Pilot Study.

INTRODUCTION: There is a need to maintain rehabilitation activities and motivate movement and physical activity during quarantine in individuals with Cerebral Palsy (CP). OBJECTIVE: This paper sets out to evaluate the feasibility and potential benefits of using computer serious game in a non-immersive virtual reality (VR) implemented and evaluated completely remotely in participants with CP for Home-Based Telerehabilitation during the quarantine period for COVID-19. METHODS: Using a cross-sectional design, a total of 44 individuals participated in this study between March and June 2020, 22 of which had CP (14 males and 8 females, mean age = 19 years, ranging between 11 and 28 years) and 22 typically developing individuals, matched by age and sex to the individuals with CP. Participants practiced a coincident timing game1 and we measured movement performance and physical activity intensity using the rating of perceived exertion Borg scale. RESULTS: All participants were able to engage with the VR therapy remotely, reported enjoying sessions, and improved performance in some practice moments. The most important result in this cross-sectional study was the significant increasing in rating of perceived exertion (through Borg scale) in both groups during practice and with CP presenting a higher rating of perceived exertion. CONCLUSION: Children with CP enjoyed participating, were able to perform at the same level as their peers on certain activities and increased both their performance and physical activity intensity when using the game, supporting the use of serious games for this group for home therapy and interactive games. CLINICAL TRIALS REGISTRATION: https://Clinicaltrials.gov, NCT04402034. Registered on May 20, 2020.

ANALYSIS OF FINE MOTOR CONTROL IN INSTITUTIONALIZED SHELTERED CHILDREN AND ADOLESCENTS THROUGH PERFORMANCE IN COMPUTER SOFTWARE.

OBJECTIVE: To analyze the psychomotor development and the fine motor control of institutionalized and non-institutionalized sheltered children and adolescents. METHODS: A cross-sectional study in which 54 subjects participated and were divided into two groups: 27 institutionalized sheltered children and adolescents (SG) and 27 non-institutionalized sheltered children and adolescents (CG). The psychomotor battery and the Learning and Motor Control software were used to evaluate development and motor control. The analysis of variance was performed for both groups with repetitive measurements for the last factor. RESULTS: The SG presented a total development score inferior to the CG, with differences in tonicity (p=0.041) and body awareness (p=0.039). The longest distance was performed on Task 1 (M=983.9 pixels; diagonal line; distance of 930.053 pixels), with no difference between the groups (p=0.64). Furthermore, the SG presented a greater average time in Task 1 (M=16.12 seconds) when compared with Tasks 2 (M=11.6 seconds; horizontal line; distance of 750 pixels) and 3 (M=10.6; vertical line; distance of 550 pixels), but only marginally different between Tasks 2 and 3 (p=0.055). Regarding the number of correct answers, the CG scored more (M=6.1) when compared with SG (M=4.6), with p<0.05. CONCLUSIONS: The institutionalized individuals showed a psychomotor development inferior to the CG. Furthermore, they presented impairment in fine motor control, covering a larger distance on the task that required the diagonal movement, longer execution time, less correct answers, and more errors.

Virtual reality head-mounted goggles increase the body sway of young adults during standing posture.

The aim of this study was to investigate the effects of wearing virtual reality head-mounted goggles (VR) on body sway in young adults. We run two experiments, in which we compared the body sway while standing during the conditions of 1) wearing and non-wearing VR with eyes-opened (experiment #1), 2) wearing and no-wearing VR with eyes-closed (experiment #2), and 3) wearing VR with eyes-opened when the scene was turned on and off (experiment #2). Forty-four (experiment #1) and fifteen (experiment #2) young adults were instructed to remain as still as possible on a force plate for 60-s and performed three trials in each quiet standing condition. The center of pressure (CoP) displacement, mean velocity, root mean square (RMS), area and median frequency of sway were calculated in both experiments. In the experiment #1, wearing VR condition with eyes-opened largely increased the AP and ML CoP displacement, AP mean velocity, AP and ML RMS, and area (p < 0.05) compared to non-wearing VR with eyes-opened. In the experiment #2, no differences were found for any conditions (eyes-closed and eyes-opened with turned on and off VR scene). In conclusion, wearing VR head-mounted goggles increased body sway of young adults during standing postural task, when the individuals were with eyes-opened. However, the effects of wearing VR head-mounted goggles on body sway disappeared when the individuals were with eyes-closed or the google scene was turned off the scene compared to not wearing VR head-mounted goggles with eyes-closed or turned on scene, respectively.

Use of Augmented Reality with a Motion-Controlled Game Utilizing Alphabet Letters and Numbers to Improve Performance and Reaction Time Skills for People with Autism Spectrum Disorder.

Augmented reality (AR) uses the real-world setting but enables a person to interact with virtual objects. In this study, we aimed to explore the use of alphabet letter and number in an AR task and its influence in reaction time in a population with autism spectrum disorders (ASD) compared with the performance of typical developing (TD) controls. We evaluated reaction time before and after AR tasks that consisted of identifying correct numbers and alphabet letters in 48 people with ASD and 48 with TD controls. Results indicate that total points for TD group were higher (M = 86.4 and M = 79.0) when compared with the ASD group (M = 54.5 and M = 51.5) for alphabet letters and numbers, respectively. Moreover, in analysis of reaction time results, only the ASD group showed an improvement in performance after the practice of an AR task. The control group was faster before (M = 553.7) and after (M = 560.5) when compared with the ASD group (M = 2616.0 and M = 2374.6, respectively). Despite the need for further studies, our results support that there is potential for clinical use of an AR task-based intervention for people with ASD.

Motor learning and transfer between real and virtual environments in young people with autism spectrum disorder: A prospective randomized cross over controlled trial.

Autism spectrum disorder (ASD) is associated with persistent deficits in social communication and social interaction, including impaired multisensory integration, which might negatively impact cognitive and motor skill performance, and hence negatively affect learning of tasks. Considering that tasks in virtual environment may provide an engaging tool as adjuncts to conventional therapies, we set out to compare motor performance between young people with ASD and a typically developing (TD) control group that underwent coincident timing tasks based on Kinect (no physical contact) and on Keyboard (with physical contact) environments. Using a randomized repeated cross-over controlled trial design, 50 young people with ASD and 50 with TD, matched by age and sex were divided into subgroups of 25 people that performed the two first phases of the study (acquisition and retention) on the same device-real or virtual-and then switched to the other device to repeat acquisition and retention phases and finally switched on to a touch screen (transfer phase). Results showed that practice in the virtual task was more difficult (producing more errors), but led to a better performance in the subsequent practice in the real task, with more pronounced improvement in the ASD as compared to the TD group. It can be concluded that the ASD group managed to transfer the practice from a virtual to a real environment, indicating that virtual methods may enhance learning of motor and cognitive skills. A need for further exploration of its effect across a number of tasks and activities is warranted. Autism Res 2020, 13: 307-319. © 2019 International Society for Autism Research, Wiley Periodicals, Inc. LAY SUMMARY: Individuals with autism spectrum disorder are known to have difficulties with learning motor tasks. Considering that performing motor tasks in virtual environment may be an engaging tool as adjuncts to conventional therapies, we aimed to estimate performance in tasks regardless of physical touch. Results showed that participants had more difficulty using the non-touch task; however, virtual training improved performance on the physical (real) task. This result indicates that virtual methods could be a promising therapeutic approach for the ASD population.

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

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

Systematic Review of the Main Motor Scales for Clinical Assessment of Individuals with down Syndrome.

Objective: The aim of the present review was to identify the motor scales currently used to assess individuals with Down Syndrome (DS).Method: PubMed, WOS and BVS databases were systematically searched to identify the most relevant published studies that used motor scales in the evaluation of individuals with DS.Results: Of the 99 studies that met the eligibility criteria in this process, 20 experimental and observational studies were found to fully meet the eligibility criteria.Conclusion: We identified several motor scales including the Alberta Infant Motor Scale (AIMS), Test of Infant Motor Performance (TIMP), BAYLEY, Peabody Gross Motor Scale (PGMS-PDMS-GM), Gross Motor Function Measure (GMFM), Movement Assessment Battery for Children (MABC) and Pediatric Evaluation of Disability Inventory (PEDI).

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

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

Motor learning from virtual reality to natural environments in individuals with Duchenne muscular dystrophy.

PURPOSE: To examine whether performance improvements in the virtual environment generalize to the natural environment. STUDY DESIGN: we had 64 individuals, 32 of which were individuals with DMD and 32 were typically developing individuals. METHODS: The groups practiced two coincidence timing tasks. In the more tangible button-press task, the individuals were required to 'intercept' a falling virtual object at the moment it reached the interception point by pressing a key on the computer. In the more abstract task, they were instructed to 'intercept' the virtual object by making a hand movement in a virtual environment using a webcam. RESULTS AND CONCLUSIONS: For individuals with DMD, conducting a coincidence timing task in a virtual environment facilitated transfer to the real environment. However, we emphasize that a task practiced in a virtual environment should have higher rates of difficulties than a task practiced in a real environment. IMPLICATIONS FOR REHABILITATION Virtual environments can be used to promote improved performance in ?real-world? environments. Virtual environments offer the opportunity to create paradigms similar ?real-life? tasks, however task complexity and difficulty levels can be manipulated, graded and enhanced to increase likelihood of success in transfer of learning and performance. Individuals with DMD, in particular, showed immediate performance benefits after using virtual reality.