Effectiveness of anodal transcranial direct current stimulation to improve muscle strength and motor functionality after incomplete spinal cord injury: a systematic review and meta-analysis.

STUDY DESIGN: Systematic review and meta-analysis. OBJECTIVES: We aimed to investigate the effects of anodal transcranial direct current stimulation (tDCS) against sham on muscle strength and motor functionality after incomplete spinal cord injury (iSCI). SETTING: University of São Paulo, Brazil. METHODS: A preplanned protocol was registered (PROSPERO, CRD42016050444). Pubmed, Embase, Web of Science, Cochrane Central Library and BVS databases were searched independently by two authors up to March 2018. Cochrane Collaboration's Tool was used for the risk of bias assessments. Generic inverse variance and random-effects model were used to calculate pooled effect sizes (ES), 95% confidence intervals (CIs) and p-values in meta-analyses. RESULTS: Six randomized clinical trials met inclusion criteria (n = 78 iSCI individuals) and were included in the meta-analysis. Results showed a marginal significant pooled effect of active tDCS in improving motor functionality with a small ES (SMD = 0.26, 95% CI = -0.00 to 0.53, p = 0.05, I2 = 0%). On the other hand, the pooled effect of active tDCS on muscle strength did not reach statistical significance, in parallel with a small ES (SMD = 0.35, 95% CI = -0.21 to 0.92, p = 0.22, I2 = 0%) when compared with sham tDCS. No significant adverse events were reported. CONCLUSIONS: Overall, there was a significant effect of tDCS in improving motor functionality following iSCI. However, a small ES and the marginal p-value suggest that these results should be interpreted with caution. Further high-quality clinical trials are needed to support or refute the use of tDCS in daily clinical practice.

Assistive technology for communication of older adults: a systematic review.

OBJECTIVE: Describe the use of assistive technology to enhance communication opportunities for older adults. METHODS: A systematic review was conducted in two databases, PubMed and Web of Science, by using two different searches in each. The search was limited to original articles, in English language, including people aged 60 years and older that used any type of assistive technology for communication. The articles found in the initial search were filtered by title, abstracts and the remaining articles were fully read. RESULTS: Eighteen studies were included in this review after the reading of full-texts. Most of the studies included apparently healthy participants with communication limitations due to aging related changes and the others included people with some pathology that prevent them from normal communication. CONCLUSION: Four categories of assistive technology were identified: assistive technology for people with speech problems; robot or videoconferencing systems; Information and Communication Technologies and, other types of assistive technology for communication, such as hearing aids and scrapbooks. Assistive technology for communication of older adults is not only used by people with disabilities that prevent them from usual communication. They are mostly for older adults without a pathological communication problem.

Fractal correlations and linear analyses of heart rate variability in healthy young people with different levels of physical activity.

Changes in cardiac autonomic regulation, expressed by increased sympathetic activity and decreased heart rate variability, have an important relationship with the onset of lethal cardiac phenomena. Therefore, we aimed to evaluate the cardiac autonomic behaviour in young people according to their level of physical activity. Through the International Physical Activity Questionnaire, 55 healthy young non-smokers with no history of previous diseases and whose parents did not suffer from metabolic syndrome were assessed and divided into groups: sedentary (n=12), insufficiently active (n=16), active (n=14), and very active (n=13). We collected respiratory rate, systolic and diastolic blood pressure at rest, and body mass index. Subjects remained supine at rest, and without mental stress for 15 minutes in a controlled environment. Using a cardiofrequency meter (Polar® RS800CX), data were analysed in the time domain, frequency domain, and detrended fluctuation analysis. For the sedentary group, the mean RR and rMSSD were significantly lower, and the insufficiently active group showed higher means, but significantly only for rMSSD. The insufficiently active group showed in the detrended fluctuation analysis that α2 was significantly lower compared with the sedentary, active, and very active groups. We conclude that young, healthy, sedentary individuals present an increased heart rate and that insufficiently active individuals present a decreased fractal correlation and increased parasympathetic activity.

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.

Augmentative and alternative communication in children with Down's syndrome: a systematic review.

BACKGROUND: The use of technology to assist in the communication, socialization, language, and motor skills of children with Down's syndrome (DS) is required. The aim of this study was to analyse research findings regarding the different instruments of 'augmentative and alternative communication' used in children with Down's syndrome. METHODS: This is a systematic review of published articles available on PubMed, Web of Science, PsycInfo, and BVS using the following descriptors: assistive technology AND syndrome, assistive technology AND down syndrome, down syndrome AND augmentative and alternative communication. Studies published in English were selected if they met the following inclusion criteria: (1) study of children with a diagnosis of DS, and (2) assistive technology and/or augmentative and alternative communication analysis in this population. RESULTS: A total of 1087 articles were identified. Thirteen articles met the inclusion criteria. The instruments most used by the studies were speech-generating devices (SGDs) and the Picture Exchange Communication System (PECS). CONCLUSION: Twelve instruments that provided significant aid to the process of communication and socialization of children with DS were identified. These instruments increase the interaction between individuals among this population and their peers, contributing to their quality of life and self-esteem.

Heart Rate Variability and Cardiopulmonary Dysfunction in Patients with Duchenne Muscular Dystrophy: A Systematic Review.

Duchenne muscular dystrophy (DMD) is a genetic recessive disorder with progressive muscle weakness. Despite the general muscle wasting, degeneration and necrosis of cardiomyocytes have been the main causes of morbidity and death in individuals with DMD. Cardiac failure is generally preceded by disturbances in heart rate variability (HRV), and non-invasive measurement of the autonomic nervous system has been an important tool to predict adverse cardiovascular events. Hence, the application of HRV to study autonomic modulation in DMD individuals, and the establishment of correlations between HRV and heart/lung diseases, age, and mortality will have the potential to improve quality of life and life expectancy of individuals with DMD. In order to evaluate the state of the art in this field, we conducted a systematic search in Medline/PubMed and BVS (virtual library in health) databases. We selected 8 studies using pre-defined criteria and meta-analysis revealed decreased parasympathetic activity and increased sympathetic predominance in individuals with DMD as major observations. Moreover, there is a strong association between diminished HRV and myocardial fibrosis with DMD. These patterns are evident in patients at early-stage DMD and become more prominent as disease severity and age increase. Thus, data minning clearly indicates that HRV assessment can be used as a predictor for sudden death in individuals with DMD. The use of the HRV, which is inexpensive, ubiquitously available in clinics and hospitals, and a non-invasive analysis tool, can save lives and decrease the morbity in DMD by alerting care givers to consider autonomic nervous system intervention.

Evaluation of speed-accuracy trade-off in a computer task in individuals with cerebral palsy: a cross-sectional study.

BACKGROUND: Individuals with Cerebral Palsy (CP) present with sensorimotor dysfunction which make the control and execution of movements difficult. This study aimed to verify the speed-accuracy trade-off in individuals with CP. METHODS: Forty eight individuals with CP and 48 with typical development (TD) were evaluated (32 females and 64 males with a mean age of 15.02 ± 6.37 years: minimum 7 and maximum 30 years). Participants performed the "Fitts' Reciprocal Aiming Task v.1.0 (Horizontal)" on a computer with different sizes and distance targets, composed by progressive indices of difficulty (IDs): ID2, ID4a and ID4b. RESULTS: There were no statistical differences between the groups in relation to the slope of the curve (b1) and dispersion of the movement time (r2). However, the intercept (b0) values presented significant differences (F(1.95) = 11.3; p = .001]), with greater movement time in the CP group compared to the TD group. It means that for individuals with CP, regardless of index difficulty, found the task more difficult than for TD participants. Considering CP and TD groups, speed-accuracy trade-off was found when using different indices of difficulty (ID2 and ID4). However, when the same index of difficulty was used with a larger target and longer distance (ID4a) or with a narrow target and shorter distance (ID4b), only individuals with CP had more difficulty performing the tasks involving smaller targets. Marginally significant inverse correlations were identified between the values of b1 and age (r = -0.119, p = .052) and between r2 and Gross Motor Function Classification System (r = -0.280, p = .054), which did not occur with the Manual Ability Classification System. CONCLUSION: We conclude that the individuals with CP presented greater difficulty when the target was smaller and demanded more accuracy, and less difficulty when the task demanded speed. It is suggested that treatments should target tasks with accuracy demands, that could help in daily life tasks, since it is an element that is generally not considered by professionals during therapy. TRIAL REGISTRATION: ClinicalTrials.gov, NCT03002285 , retrospectively registered on 20 Dec 2016.

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.

Clinical characteristics of children with congenital Zika syndrome: a case series.

BACKGROUND: The congenital Zika syndrome involves structural brain changes, including ventriculomegaly, thin cerebral cortices, abnormal gyral pattern, cortical malformations, hypoplasia of the corpus callosum, myelination delay, subcortical diffuse calcifications, brainstem hypoplasia, and microcephaly in newborns. OBJECTIVE: This study aimed to describe the clinical characteristics of children with congenital Zika syndrome; to compare the outcomes of infants infected in the first (1T, n=20) and second trimesters of pregnancy (2T, n=11); to investigate correlations between birth weight, birth and follow-up head circumference, birth gestational age, and gross motor scores. METHODS: Participants were evaluated with Alberta Infant Motor Scale (AIMS) and part A of the Gross Motor Function Measure (GMFM-A). ANOVA compared head circumference, birth gestational age, birth weight, and gross motor performance of 1T and 2T. RESULTS: The correlations were investigated by Pearson correlation coefficients. ANOVA showed differences in birth and follow-up head circumferences. Head circumference was smaller in 1T, compared to 2T. Motor performance was classified as below the fifth percentile in AIMS in all children and 1T showed lower scores in prone, sitting, and total AIMS score, compared to 2T. Children ranged from 8 to 78% on GMFM-A and there was a poorer motor performance of 1T. Nineteen children showed hypertonia, six showed normal tone and six showed hypotonia. Birth head circumference was correlated with AIMS prone postural control. Follow-up head circumference was correlated to prone, supine and total AIMS scores. Smaller head circumference at birth and follow-up denoted poorer postural control. DISCUSSION: Children with congenital Zika syndrome showed microcephaly at birth and follow-up. Smaller head circumferences and poorer motor outcomes were observed in 1T. Infants showed poor visual and motor outcomes. Moderate positive correlations between birth and follow-up head circumference and gross motor function were found.

Effect of Contextual Interference in the Practicing of a Computer Task in Individuals Poststroke.

OBJECTIVES: Sensory and motor alterations resulting from stroke often impair the performance and learning of motor skills. The present study is aimed at investigating whether and how poststroke individuals and age- and sex-matched healthy controls benefit from a contextual interference effect on the practice of a maze task (i.e., constant vs. random practice) performed on the computer. METHODS: Participants included 21 poststroke individuals and 21 healthy controls, matched by sex and age (30 to 80 years). Both groups were divided according to the type of the practice (constant or random) presented in the acquisition phase of the learning protocol. For comparison between the groups, types of practice, and blocks of attempts, the analysis of variance with Tukey's post hoc test (p < 0.05) was used. RESULTS: Poststroke individuals presented longer movement times as compared with the control group. In addition, only poststroke individuals who performed the task with random practice showed improved performance at the transfer phase. Moreover, randomized practice enabled poststroke individuals to perform the transfer task similarly to individuals without any neurological impairment. CONCLUSION: The present findings indicated a significant effect of contextual interference of practice in poststroke individuals, suggesting that applying randomized training must be considered when designing rehabilitation protocols for this population.

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).

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.

Functional skills and caregiver assistance of Brazilian children and adolescents with Down syndrome.

BACKGROUND: Research into the evolution of the functional performance of children and adolescents with DS enables parents and professionals involved in their follow-up to promote their development. OBJECTIVE: To evaluate the functional abilities of children and adolescents with Down syndrome and the assistance offered by their parents/caregivers. METHOD: A cross-sectional study, with 100 children and adolescents with DS whom parents or caregivers were interviewed to complete the Paediatric Evaluation of Disability Inventory (PEDI). Linear regression analyses were performed with the software MedCalc version 16.8.4 and GraphPad Prism version 6.07. RESULTS: Children and adolescents with DS need more time to acquire skills of self-care, mobility and social function. Their parents were able to better identify the difficulties before the children reached 8-years of age. CONCLUSION: Parents can identify the difficulties of their children when they are younger and offer more assistance, but this does not happen when the children are of elementary school age. This suggests that they need professional support that is not restricted to the guidelines and the schools.

Analysis of Different Device Interactions in a Virtual Reality Task in Individuals With Duchenne Muscular Dystrophy-A Randomized Controlled Trial.

There is a need to support individuals with Duchenne Muscular Dystrophy (DMD) to achieve optimal functionality in everyday life and with meaningful tasks and activities, throughout stages of the disease progression. Thus, technological developments have created an exciting opportunity for the use of affordable virtual reality (VR) systems with different kinds of interaction devices, providing an efficient and fun tool for enabling improvement in motor performance. Objective: To compare performance on a virtual task using interfaces with and without physical contact in order to identify functionality by using different devices in individuals with DMD. Methods: One hundred and twenty male individuals took part on this study: 60 with DMD with a mean age of 16 ± 5 (range 9-34 years old) and 60 without DMD in the control group (CG) matched by age. Participants were divided into three groups of 20 individuals each which performed a virtual task in three different interfaces: Kinect®, computer Touch Screen and Leap Motion®, in a cross over design in which all participants used all devices. Motor impairment in the DMD group was measured by using the Motor Function Measurement and Vignos scales. Results: All participants improved performance through practice, regardless of the interface used, although the DMD group had a continuous lower performance compared to the CG. In addition, the DMD group obtained a significant better performance with Leap Motion interface compared to the other interfaces, while the CG presented better performance on Touch Screen interface. Conclusion: Leap Motion provided better performance for individuals with DMD due to enablement of distal muscle function and ease of instrument adjustment using the virtual interface. Therefore, this type of interface should be encouraged for promoting functionality on general tasks using computer systems. Clinical Trial register number: NCT02891434.

Analysis of motor performance in individuals with cerebral palsy using a non-immersive virtual reality task - a pilot study.

PURPOSE: To evaluate the performance improvement of individuals with hemiparesis cerebral palsy (CP) using a virtual task. PARTICIPANTS AND METHODS: Twenty individuals were selected and distributed into two groups. The experimental group (CP group) comprised ten individuals with a medical diagnosis of CP, and ten individuals with typical development (sex- and age-matched) composed the control group (TD group). Both groups followed the same intervention protocol, which included a virtual coincident timing task: the participants performed upper limb movements in front of a computer's webcam and interacted with the task with the aim of virtually intercepting spheres that fell in four rows following the rhythm of a pre-selected song during an 8-minute period. To verify the influence on a real task, pre- and posttests were performed in a similar task, but with physical contact (using the spacebar on the keyboard of a computer). To analyze the data, we evaluated the variable, constant, and absolute errors during the task and in the pre- and posttests. RESULTS: The results showed that there was an improvement in performance between the pre- and posttests; that is, after practicing the task in an environment without physical contact, there was a performance improvement in posttests in the real task, but only for the CP group. Moreover, there were significant differences in precision and accuracy between the two groups, with worse performance in the CP group. CONCLUSION: Individuals with CP presented better performance in the real task after practice in a virtual reality task, albeit with worse performance compared with individuals with TD. This is an interesting result that supports the possible use of virtual tasks for the rehabilitation of individuals with CP.

Test-Retest Reliability and Clinical Feasibility of a Motion-Controlled Game to Enhance the Literacy and Numeracy Skills of Young Individuals with Intellectual Disability.

Games using motion capture from web cameras have become increasingly popular. However, there are no games specifically designed to teach literacy to individuals with intellectual disabilities (ID). The aim of this study was to investigate the feasibility of introducing young individuals with ID to a new augmented reality game, the MoviLetrando, and establish its test-retest reliability to determine its usefulness in teaching the alphabet and motor control skills. The performance of a sample of 88 ID participants (52 males, 36 females, mean ± standard deviation age, 11.2 ± 2.6 years) was measured on two different testing sessions. Five dependent variables (total points, number of correct vowels/numbers, number of mistakes, number of omissions, and average time to reach symbols) were used for data analysis. The intraclass correlation coefficient (ICC), standard error of measurement (SEM), Cronbach's alpha, and Bland-Altman plots were used to estimate the test-retest reliability and measurement precision. Feasibility was assessed by examining recruitment, adherence, and acceptability in both phases of the game. The dependent variables identified in the MoviLetrando demonstrated an ICC of 0.44 to 0.82, suggesting acceptable/good test-retest reliability, respectively. The internal consistency was satisfactory. The small SEM, as well as the narrow width of the 95 percent limits of agreement in the Bland-Altman plots, implied that measurements of these dependent variables were precise and accurate on both the occasions. Excellent test-retest reliability for performance measurement was demonstrated in the ID participants, indicating that the MoviLetrando could be used as an outcome measure for this population.

Heart rate variability in individuals with Down syndrome - A systematic review and meta-analysis.

INTRODUCTION: Down syndrome (DS) results in many changes, including dysfunction in cardiac autonomic modulation. Heart rate variability (HRV) analysis evaluates the autonomic function and it is a predictor of adverse cardiovascular events. OBJECTIVE: To present results of a systematic review and a meta-analysis about heart rate variability in individuals with DS. METHOD: A systematic review was performed on PubMed, PubMed Central and Web of science databases. We included articles that exhibited all the terms: "Down Syndrome", "heart rate variability", "autonomic nervous system", "autonomic dysfunction" and "cardiac autonomic modulation". We conducted the meta-analysis to compare "DS" to "controls" during rest. Random effects models were used, as were appropriate tests for heterogeneity. RESULTS: From 271 studies, 13 were included in our review. These are conducted with volunteers from a wide age range, of either gender, and not taking medications. Meta-analysis displayed that there were no significant differences between the groups at rest, except the RMSSD, which revealed a significant (Z = -2.80, p = 0.005) main effect (Hedge's g = -0.55, 95% CI [-0.93; -0.16]), indicating difference in individuals with DS compared with controls. CONCLUSION: There is autonomic dysfunction in individuals with DS, which may or may not be expressed at rest, but it is usually demonstrated in an autonomic task. Meta-analysis specified that there was no significant alteration between DS and the controls during rest, except RMSSD index which was lower in DS than controls. PROSPERO: CRD42017068647.

The Clinical Utility of Virtual Reality in Neurorehabilitation: A Systematic Review.

BACKGROUND: Virtual reality (VR) experiences (through games and virtual environments) are increasingly being used in physical, cognitive, and psychological interventions. However, the impact of VR as an approach to rehabilitation is not fully understood, and its advantages over traditional rehabilitation techniques are yet to be established. METHOD: We present a systematic review which was conducted according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). During February and March of 2018, we conducted searches on PubMed (Medline), Virtual Health Library Search Portal databases (BVS), Web of Science (WOS), and Embase for all VR-related publications in the past 4 years (2015, 2016, 2017, and 2018). The keywords used in the search were "neurorehabilitation" AND "Virtual Reality" AND "devices." RESULTS: We summarize the literature which highlights that a range of effective VR approaches are available. Studies identified were conducted with poststroke patients, patients with cerebral palsy, spinal cord injuries, and other pathologies. Healthy populations have been used in the development and testing of VR approaches meant to be used in the future by people with neurological disorders. A range of benefits were associated with VR interventions, including improvement in motor functions, greater community participation, and improved psychological and cognitive function. CONCLUSIONS: The results from this review provide support for the use of VR as part of a neurorehabilitation program in maximizing recovery.