A Low-Cost System Using a Big-Data Deep-Learning Framework for Assessing Physical Telerehabilitation: A Proof-of-Concept.

The consolidation of telerehabilitation for the treatment of many diseases over the last decades is a consequence of its cost-effective results and its ability to offer access to rehabilitation in remote areas. Telerehabilitation operates over a distance, so vulnerable patients are never exposed to unnecessary risks. Despite its low cost, the need for a professional to assess therapeutic exercises and proper corporal movements online should also be mentioned. The focus of this paper is on a telerehabilitation system for patients suffering from Parkinson's disease in remote villages and other less accessible locations. A full-stack is presented using big data frameworks that facilitate communication between the patient and the occupational therapist, the recording of each session, and real-time skeleton identification using artificial intelligence techniques. Big data technologies are used to process the numerous videos that are generated during the course of treating simultaneous patients. Moreover, the skeleton of each patient can be estimated using deep neural networks for automated evaluation of corporal exercises, which is of immense help to the therapists in charge of the treatment programs.

To Resurface or Not to Resurface the Patella in Total Knee Arthroplasty, That Is the Question: A Meta-Analysis of Randomized Controlled Trials.

Background and Objetives: Currently, total knee arthroplasty is one of the most common surgeries, increasing with the increase in life expectancy. Whether or not to replace the patella has been a subject of debate over the years, remaining in controversy and without reaching a consensus. Over the years, different meta-analyses have been carried out in order to provide evidence on the subject, although, in recent times, there have not been many new studies in this regard. Therefore, it is considered necessary that the latest works form part of a new meta-analysis. Materials and Method: We searched the literature using PUBMED, SCOPUS, the Cochrane database and VHL from 2010 to 2020. The search terms used were "patellar" AND "resurfacing" OR "Replacement" and "no resurfacing" OR "no replacement". A meta-analysis was performed with Stata software (Stata version 15.1). Forest plots were generated to illustrate the overall effect of knee arthroplasty interventions. Results: As a result, it was obtained that there is a significantly higher risk of suffering AKP in the non-resurfacing group, in addition to a significant increase in the risk of undergoing a reoperation in the non-resurfacing group. On the other hand, significant differences were obtained in favor of the resurfacing group in both the clinical and Feller KSS, with functional KSS being inconclusive. After analyzing different variables throughout the literature, it does seem clear that the non-resurfacing group may present a higher risk of reoperation than the resurfacing group. Conclusions: For all these reasons, we think that, although it does seem that not replacing the patella can precipitate a reoperation, it is not clear whether this reoperation is a direct consequence of not having replaced the patella. Therefore, in our opinion, the treatment must be individualized for each patient.

Adopting a multidisciplinary telemedicine intervention for fall prevention in Parkinson's disease. Protocol for a longitudinal, randomized clinical trial.

BACKGROUND: Approximately 40-70% of people with Parkinson's disease (PD) fall each year, causing decreased activity levels and quality of life. Current fall-prevention strategies include the use of pharmacological and non-pharmacological therapies. To increase the accessibility of this vulnerable population, we developed a multidisciplinary telemedicine program using an Information and Communication Technology (ICT) platform. We hypothesized that the risk for falling in PD would decrease among participants receiving a multidisciplinary telemedicine intervention program added to standard office-based neurological care. OBJECTIVE: To determine the feasibility and cost-effectiveness of a multidisciplinary telemedicine intervention to decrease the incidence of falls in patients with PD. METHODS: Ongoing, longitudinal, randomized, single-blinded, case-control, clinical trial. We will include 76 non-demented patients with idiopathic PD with a high risk of falling and limited access to multidisciplinary care. The intervention group (n = 38) will receive multidisciplinary remote care in addition to standard medical care, and the control group (n = 38) standard medical care only. Nutrition, sarcopenia and frailty status, motor, non-motor symptoms, health-related quality of life, caregiver burden, falls, balance and gait disturbances, direct and non-medical costs will be assessed using validated rating scales. RESULTS: This study will provide a cost-effectiveness assessment of multidisciplinary telemedicine intervention for fall reduction in PD, in addition to standard neurological medical care. CONCLUSION: In this challenging initiative, we will determine whether a multidisciplinary telemedicine intervention program can reduce falls, as an alternative intervention option for PD patients with restricted access to multidisciplinary care. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT04694443.

Influence of the Use of Wii Games on Physical Frailty Components in Institutionalized Older Adults.

Aging is a multifactorial physiological phenomenon in which cellular and molecular changes occur. These changes lead to poor locomotion, poor balance, and an increased falling risk. This study aimed to determine the impact and effectiveness of the use of the Wii® game console on improving walking speed and balance, as well as its influence on frailty levels and falling risk, in older adults. A longitudinal study was designed with a pretest/post-test structure. The study population comprised people over 75 years of age who lived in a nursing home or attended a day care center (n = 80; 45 women; 84.2 ± 8.7 years). Forty of them were included in the Wii group (20 rehabilitation sessions during 8 consecutive weeks), and the other 40 were in the control group. Falling risk and frailty were evaluated using the Downton scale and Fried scale; balance and walking speed were assessed with the Berg Balance scale and the Gait Speed Test, respectively, as well as the Short Physical Performance Battery (SPPB). The results showed that there was no significant association between Frailty Phenotype and study groups in baseline. However, there was significant association between Frailty Phenotype and study groups at the end of study. Moreover, a significantly higher and negative percentage change (Δ) in the Wii group with respect to the control group on the in falling risk (-20.05 ± 35.14% vs. 7.92 ± 24.53%) and in walking speed (-6.42 ± 8.83% vs. -0.12 ± 4.51%) during study, while there was a higher and positive significant percent change in static balance (6.07 ± 5.74% vs. 2.13 ± 4.64%) and on the SPPB (20.28 ± 20.05% vs. 0.71 ± 7.99%) after 8 weeks of study. The main conclusion of this study was that the use of the Wii® video console for 8 weeks positively influenced walking speed, falling risk, static balance, and frailty levels in older adults. Through a rehabilitation program with the Wii® game console in the older adults, frailty levels are reduced, accompanied by a reduction in falling risk and an increase in static balance and walking speed.

Impact of an Intervention with Wii Video Games on the Autonomy of Activities of Daily Living and Psychological-Cognitive Components in the Institutionalized Elderly.

As people age, the risk of disease increases and deterioration becomes more noticeable. These changes can increase the risk of cognitive impairment, with negative consequences for the quality of life and the ability to perform activities of daily living (ADLs) in older people, which translate into greater dependence and loss of wellness. This study aimed to determine the impact and effectiveness of the use of the Wii® game console (Nintendo Company Limited, Kyoto, Japan) on improving performance of basic and instrumental ADLs, as well as its relationship with cognitive impairment levels and mood in institutionalized older people. A longitudinal study was designed, whose study population consisted of people over 75 years of age who lived in a nursing-home or attended a day care center (n = 80; 45 women). Cognitive status was assessed using Lobo's Mini-Cognitive Examination (MCE) and Global Deterioration Scale (FAST-GDS), while the psychological assessment used the Dementia Apathy Interview and Rating (DAIR), Yesavage scale for Geriatric Depression (EGD-15), and Goldberg Anxiety and Depression Scale (EADG). Differences from T1 to T2 in the control group (control; n = 40; 23 women; 83.25 ± 8.78 years; 76.35 ± 13.54 kg) and in the experimental group (Wii; n = 40; 22 women; 85.05 ± 8.63 years; 74.60 ± 13.01 kg) were evaluated using a paired Student's t-test or Wilcoxon's signed rank test, and a two-way repeated measures analysis of variance (ANOVA) test. Differences in Δ (%) and other tests at T1 and T2 were compared using the independent t-test or Mann-Whitney U test, with the treatment category as a fixed factor. The results showed that the Wii® video console had a positive influence for older people, increasing cognitive status and levels of ADLs, and psychological status. In addition, a positive correlation between performance of ADLs and cognitive status was observed, as well as a negative correlation with the psychological status. Through a rehabilitation program with a Wii® game console in the elderly, depression, anxiety and apathy levels were reduced, accompanied by an increase in memory and attention, as well as in performance of basic and instrumental ADLs.

Relationship of Body Composition with the Strength and Functional Capacity of People over 70 Years.

BACKGROUND: Aging is a multifactorial physiological phenomenon, in which a series of changes in the body composition occur, such as a decrease in muscle mass and bone mineral density and an increase in fat mass. This study aimed to determine the relationship of muscle mass, osteoporosis, and obesity with the strength and functional capacity of non-dependent people over 70 years of age. METHODS: A cross-sectional study was designed, whose study population was all people aged over 70 years, living independently and attending academic and recreational programs. Muscle strength and functional capacity of the participants were assessed by isometric exercises of lower and upper limbs and by four tests taken from the Senior Fitness Test, respectively. Bone mineral density, total mass, fat mass, total lean mass, arms lean mass, legs lean mass, and appendicular lean mass (ALM) was calculated by dual energy X-ray absorptiometry. Differences in muscle strength and functional capacity, according to the sex, muscle mass, mineral bone density and fat mass, were measured by χ2 test, independent samples Student's t-test, analysis of covariance and a 2-factor analysis of covariance; Results: 143 subjects were included in the study group. Men and women with an adequate amount of ALM adjusted for body mass index (BMI) had a maximal dynamic biceps strength in a single repetition, a maximal isometric leg extension strength, a maximal dynamic leg extension strength in a single repetition, a maximum right hand grip strength and maximum hand grip strength (the highest). Significantly higher values were observed in the maximal isometric biceps' strength in men with osteoporosis. Obese men had less isometric strength in the biceps and took longer to perform the chair stand test; Conclusions: Men and women with an adequate amount of ALM adjusted for BMI obtained better results in tests of muscle strength and functional capacity. However, osteoporosis and obesity are not related to these parameters.

Effects of home-based mirror therapy and cognitive therapeutic exercise on the improvement of the upper extremity functions in patients with severe hemiparesis after a stroke: a protocol for a pilot randomised clinical trial.

INTRODUCTION: Neuroplasticity is defined as the capacity of the brain to reorganise new neuronal pathways. Mirror therapy (MT) and cognitive therapeutic exercise (CTE) are two neurorehabilitation techniques based on neuroplasticity and designed to improve the motor functions of the affected upper extremity in patients with severe hemiparesis after a stroke. Home-based interventions are an appropriate alternative to promote independence and autonomy. The objective of this study is to evaluate which of these techniques, MT and CTE, combined with task-oriented training, is more effective in functional recovery and movement patterns of the upper extremities in patients with severe hemiparesis after a stroke. METHODS AND ANALYSIS: This is a home-based, single-blind, controlled, randomised clinical trial with three parallel arms, including 154 patients who had a stroke aged above 18 years. The primary outcome will be the functionality of the affected upper extremity measured using the Fugl-Meyer Assessment. Secondary variables will include cognitive performance, emotional state, quality of life and activities of daily living. During 6 weeks, one of the intervention groups will receive a treatment based on MT and the other one on CTE, both combined with task-oriented training. No additional interventions will be provided to the control group. To assess the progress of patients who had a stroke in the subacute phase, all variables will be evaluated at different visits: initial (just before starting treatment and 4 weeks post-stroke), post-intervention (6 weeks after initial) and follow-up (6 months). ETHICS AND DISSEMINATION: This protocol has been approved by the Institutional Review Board (CEIm-2.134/2.019) and registered at ClinicalTrials.gov (NCT04163666). The results will be disseminated through open-access peer-reviewed journals, conference presentation, broadcast media and a presentation to stakeholders. These study results will provide relevant and novel information on effective neurorehabilitation strategies and improve the quality of intervention programmes aimed at patients after a stroke. TRIAL REGISTRATION NUMBER: ClinicalTrials.gov (NCT04163666).

Influence of Teaching Style on Physical Education Adolescents' Motivation and Health-Related Lifestyle.

According to various WHO reports in 2018, a large number of adolescents worldwide are either overweight or obese. This situation is the result of not following a healthy and balanced diet, combined with a lack of practice of physical activity. In this sense, Physical Education classes could help to solve the problem. The present study seeks to analyze the relationship between the role of the teacher in relation to the structural dimensions of the PE teaching environment and the basic psychological needs and self-motivation of adolescents as determinants of their behaviors related to eating habits and the practice of physical activity. A total of 1127 secondary school adolescents between the ages of 13 and 18 participated in this study. Questionnaires were used: Perceived Autonomy Support Scale, Psychologically Controlling Teaching Scale, Basic Psychological Needs in Physical Education, Frustration of Psychological Needs in PE context, Physical Activity Class Satisfaction Questionnaire, Perceived Locus of Causality Revised, and WHO's Global school-based student health survey. A structural equations model was elaborated to explain the causal relationships between the variables. The results showed that autonomy support positively predicted the three structural dimensions of PE classes, while, in contrast, they were negatively predicted by psychological control. The three structural dimensions positively predicted the satisfaction of psychological needs and negatively predicted the thwarting of psychological needs. Self-determined motivation was positively predicted by the satisfaction of psychological needs and negatively predicted by the thwarting of psychological needs. Finally, self-determined motivation positively predicted healthy eating habits and the practice of physical activity and negatively predicted unhealthy eating habits. Certainly, the results obtained in this study support the postulates of the self-determination theory, demonstrating the predictability of PE class context towards the adoption of healthy lifestyle habits, such as a proper diet and the regular practice of physical activity.