The effects of virtual reality-mediated tendon and nerve gliding exercises in the conservative management of carpal tunnel syndrome: a double-blind randomized placebo controlled trial.

BACKGROUND: Carpal tunnel syndrome (CTS) is a common condition resulting from compression of the median nerve at the wrist. First-line treatment typically involves conservative management, which commonly includes splinting and gliding exercises. Emerging evidence suggests the potential benefits of using virtual reality (VR) in rehabilitation. AIM: This study aimed to assess the effects of VR-mediated tendon and nerve gliding exercises on the conservative treatment of CTS, compared to video-assisted (sham virtual) and home-based gliding exercises. DESIGN: This study was a prospective, double-blind, randomized, placebo controlled interventional trial. SETTING: The study was conducted in the Department of Physical Medicine and Rehabilitation at a university hospital. POPULATION: The study included patients with mild to moderate CTS. METHODS: The study included a total of 54 hands from 33 patients. The participants were randomly allocated into three groups: the VR-mediated group (VG), the sham VR-mediated group (SG), and the control (home-based) group (CG). Both intervention groups engaged in gliding exercises utilizing a Leap Motion Controller-based VR system and instructional videos, under the supervision of a physical therapist. The VR system was activated for the VG and deactivated for the SG. Exercises were performed twice weekly for eight weeks. The CG received a brochure describing the gliding exercises. Primary outcomes were symptom severity measured by the Numerical Rating Scale (NRS) and the Boston Carpal Tunnel Questionnaire (BCTQ), along with nerve conduction studies. Secondary outcomes included muscle strength (hand grip, key pinch), sensory measures (static two-point discrimination, vibration), and quality of life. RESULTS: Both the VG and SG showed significant improvements in NRS and BCTQ scores compared to the CG in within-group comparisons. Nighttime symptoms improved significantly in the VG compared to the CG in between-group analyses. Electrophysiological findings showed no significant changes. CONCLUSIONS: An eight-week VR-mediated exercise program may enhance tendon and nerve gliding exercise effectiveness, particularly for nighttime symptoms in CTS patients. CLINICAL REHABILITATION IMPACT: In the future, challenging exercises requiring time and supervision could be effectively performed through VR, offering an alternative to traditional methods.

Land degradation assessment by geo-spatially modeling different soil erodibility equations in a semi-arid catchment.

Land degradation by soil erosion is one of the most serious problems and environmental issues in many ecosystems of arid and semi-arid regions. Especially, the disturbed areas have greater soil detachability and transportability capacity. Evaluation of land degradation in terms of soil erodibility, by using geostatistical modeling, is vital to protect and reclaim susceptible areas. Soil erodibility, described as the ability of soils to resist erosion, can be measured either directly under natural or simulated rainfall conditions, or indirectly estimated by empirical regression models. This study compares three empirical equations used to determine the soil erodibility factor of revised universal soil loss equation prediction technology based on their geospatial performances in the semi-arid catchment of the Saraykoy II Irrigation Dam located in Cankiri, Turkey. A total of 311 geo-referenced soil samples were collected with irregular intervals from the top soil layer (0-10 cm). Geostatistical analysis was performed with the point values of each equation to determine its spatial pattern. Results showed that equations that used soil organic matter in combination with the soil particle size better agreed with the variations in land use and topography of the catchment than the one using only the particle size distribution. It is recommended that the equations which dynamically integrate soil intrinsic properties with land use, topography, and its influences on the local microclimates, could be successfully used to geospatially determine sites highly susceptible to water erosion, and therefore, to select the agricultural and bio-engineering control measures needed.