Conventional Mirror Therapy versus Immersive Virtual Reality Mirror Therapy: The Perceived Usability after Stroke.

Background: Stroke is a widespread and complex health issue, with many survivors requiring long-term rehabilitation due to upper-limb impairment. This study is aimed at comparing the perceived usability of two feedback-based stroke therapies: conventional mirror therapy (MT) and immersive virtual reality mirror therapy (VR). Methods: The study involved 45 participants, divided into three groups: the stroke survivors (n = 15), stroke-free older adults (n = 15), and young controls (n = 15). Participants performed two tasks using both MT and VR in a semirandom sequence. Usability instruments (SUS and NASA-TLX) were applied at the end of the activities, along with two experience-related questions. Results: The results indicated that both MT and VR had similar levels of perceived usability, with MT being more adaptable and causing less overall discomfort. Conversely, VR increased the perception of task difficulty and prevented participants from diverting their attention from the mirror-based feedback. Conclusion: While VR was found to be less comfortable than MT, both systems exhibited similar perceived usability. The comfort levels of the goggles may play a crucial role in determining the usability of VR for upper limb rehabilitation after stroke.

The 180° Turn Phase of the Timed Up and Go Test Better Predicts History of Falls in the Oldest-Old When Compared With the Full Test: A Case-Control Study.

The 180° turn phase of the test may better differentiate the oldest-old regarding their history of falls. This is a case-control study designed to detect the ability of the 180° turn timed up and go (TUG) phase to detect a history of falls in the oldest-old. Sixty people aged 85 years and older were assessed in their homes. The single-task and dual-task TUG tests were performed using an inertial sensor (G-Walk). Sociodemographic data, physical activity levels, mental status, depressive symptoms, concern for falls occurrence, number of medicines in use, self-perception of balance, and the functional reach test were also assessed. The logistic regressions revealed the 180° turn phase of both the single-task and dual-task TUG was almost three times better than the full TUG test to detect a history of falls, thus providing insights that can be used to better assess functional mobility in the oldest-old.

History of falls alters movement smoothness and time taken to complete a functional mobility task in the oldest-old: A case-control study.

BACKGROUND: Mobility smoothness assessed by the spectral arc length (SPARC) may reflect the complex biomechanical alterations that occur with aging and may help detect functional mobility changes after experiencing falls. Here, we sought to explore whether smoothness of angular velocities of the trunk measured using SPARC metrics in the instrumented timed-up-and-go (iTUG) test are assoacited with a history of falls in the oldest-old. METHODS: A case-control study. The sample consisted of 64 community-dwelling oldest-old individuals who underwent the following assessments: clinical and sociodemographic questionnaire, Mini Mental State Examination (MMSE), Falls Efficacy-questionnaire International (FESI), the Activities-specific Balance Confidence (ABC), Functional Reaching Test (FRT), and the iTUG test. We used an inertial measurement unit (IMU) to obtain trunk angular velocities from the IMU's gyroscope, which was used to calculate mobility smoothness (SPARC). RESULTS: Standard deviation of the mobility smoothness around the anteroposterior axis of rotation (SPARC roll SD) (OR: 6.15 / CI 95 % = 1.58-23.94) and duration (OR: 1.11 / CI 95 % = 1.09-1.22) in the full iTUG test were associated with a history of falls in oldest-old. Using solely the full iTUG duration (59.19 ± 2.18) or SPARC (61.87 ± 2.40) resulted in lower probability to detect a history of falls in comparison with the combined measurement (66.21 ± 2.50). CONCLUSION: SPARC roll SD in the full iTUG may be a relevant biomarker to detect mobility smoothness changes in the oldest-old. This study provides evidence the oldest-old with a history of falls may change their functional mobility, in terms of movement duration and smoothness.

Intersubjectivity and the meaning of Nordic Walking practice in the view of people with Parkinson's disease: a pilot study / Intersubjetividade e o significado da prática do Nordic Walking na visão de pessoas com doença de Parkinson: um estudo piloto

Aims: whilst Nordic Walking (NW) practice is spreading worldwide, few studies have addressed the issue of intersubjectivity and the perception of PD individuals practicing NW and its possible impact on their daily life across different countries and cultures. This pilot study sought to explore the possible relationship between the habit of practicing NW and the perception of functionality and quality of life in the participants' cultural context. Methods: the focus group (FG) technique was used, with 10 individuals participating in a NW program. Results: content analysis revealed five main discourse categories: a) "NW benefits for people with PD"; b) "incorporation of the NW poles in daily life"; c) "Belonging to a NW group as a treatment aid"; d) "how PD people feel about their condition"; and, finally, e) "the present and the future: expectations and issues". Conclusion: in general, NW was found to generates positive content regarding coping with PD, beyond the biomechanical and quantitative functional effects previously studied. We suggest NW might be an important adjuvant resource for improving perceived functionality among people with PD.

Objetivos: embora a prática de Caminhada Nórdica (CN) esteja se espalhando pelo mundo, poucos estudos abordaram a questão da intersubjetividade e a percepção dos indivíduos com doença de Parkinson que praticam CN e seu possível impacto em sua vida diária em diferentes países e culturas. Este estudo piloto buscou explorar a possível relação entre o hábito de praticar CN e a percepção de funcionalidade e de qualidade de vida no contexto cultural dos participantes. Métodos: foi utilizada a técnica de grupo focal, com 10 indivíduos participantes de um programa de CN. Resultados: a análise de conteúdo revelou cinco categorias discursivas principais: a) "Benefícios da CN para pessoas com doença de Parkinson"; b) "incorporação dos bastões de CN na vida diária"; c) "pertencer a um grupo de CN como recurso auxiliar de tratamento"; d) "como as pessoas com doença de Parkinson se sentem sobre sua condição"; e, por fim, e) "o presente e o futuro: expectativas e questões". Conclusão: de maneira geral, a CN gerou conteúdo positivo sobre o enfrentamento da doença de Parkinson, além dos efeitos biomecânicos e funcionais quantitativos previamente estudados. Sugerimos que a CN possa ser um recurso adjuvante importante para melhorar a percepção de funcionalidade em pessoas com doença de Parkinson.

The Performance Index Identifies Changes Across the Dual Task Timed Up and Go Test Phases and Impacts Task-Cost Estimation in the Oldest-Old.

Introduction: Dual tasking is common in activities of daily living (ADLs) and the ability to perform them usually declines with age. While cognitive aspects influence dual task (DT) performance, most DT-cost (DT-C) related metrics include only time- or speed- delta without weighting the accuracy of cognitive replies involved in the task. Objectives: The primary study goal was to weight the accuracy of cognitive replies as a contributing factor when estimating DT-C using a new index of DT-C that considers the accuracy of cognitive replies (P-index) in the instrumented timed up and go test (iTUG). Secondarily, to correlate the novel P-index with domains of the Mini-Mental State Examination (MMSE). Methods: Sixty-three participants (≥85 years old) took part in this study. The single task (ST) and DT iTUG tests were performed in a semi-random order. Both the time taken to complete the task measured utilizing an inertial measurement unit (IMU), and the accuracy of the cognitive replies were used to create the novel P-index. Clinical and sociodemographic data were collected. Results: The accuracy of the cognitive replies changed across the iTUG phases, particularly between the walk 1 and walk 2 phases. Moreover, weighting 0.6 for delta-time (W1) and 0.4 for cognitive replies (W2) into the P-index enhanced the prediction of the MMSE score. The novel P-index was able to explain 37% of the scores obtained by the fallers in the "spatial orientation" and "attention" domains of the MMSE. The ability of the P-index to predict MMSE scores was not significantly influenced by age, schooling, and number of medicines in use. The Bland-Altman analysis indicated a substantial difference between the time-delta-based DT-C and P-index methods, which was within the limits of agreement. Conclusions: The P-index incorporates the accuracy of cognitive replies when calculating the DT-C and better reflects the variance of the MMSE in comparison with the traditional time- or speed-delta approaches, thus providing an improved method to estimate the DT-C.

SPARC Metrics Provide Mobility Smoothness Assessment in Oldest-Old With and Without a History of Falls: A Case Control Study.

Aging-related neuromuscular and neurocognitive decline induces unsmooth movements in daily functional mobility. Here, we used a robust analysis of linear and angular spectral arc length (SPARC) in the single and dual task instrumented timed up-and-go (iTUG) test to compare functional mobility smoothness in fallers and non-fallers aged 85 and older. 64 participants aged 85 and older took part in this case control study. The case group (fallers, n = 32) had experienced falls to the ground in the 6 months prior to the assessment. SPARC analyses were conducted in all phases of the single and dual task iTUGs. We also performed correlation mapping to test the relation of socio-demographic and clinical features on SPARC metrics. The magnitude of between-group differences was calculated using D-Cohen effect size (ES). SPARC was able to distinguish fallers during the single iTUG (ES ≈ 4.18). Turning while walking in the iTUG induced pronounced unsmooth movements in the fallers (SPARC ≈ -13; ES = 3.52) and was associated with the ability to maintain balance in the functional reach task. This information is of importance in the study of functional mobility in the oldest-old and to assess the efficacy of fall-prevention programs.

[Dance as an intervention to improve mobility and balance in elderly: a literature review]. / Dança como uma intervenção para melhorar a mobilidade e o equilíbrio em idosos: uma revisão de literatura.

The aim of the present review was to identify whether dance protocols can benefit mobility and balance in elderly. A literature review was conducted in which 927 potentially relevant studies were identified (published in Portuguese, English, French, German, Spanish or Italian). There was no publication period restriction. After reading the titles, abstracts and review of the exclusion criteria, 15 randomized controlled trials were included. Most of the studies evaluated female subjects, using heterogeneous protocols of intervention and unspecific control groups. In addition, the period of exposure to dance was generally short: 2.6 weekly practices, of 59.1 minutes each, performed through 12.1 weeks. Dance was shown to be beneficial in 77.6% of the evaluated outcomes, exhibiting a moderate effect size for static balance and functional balance; and small effect size for mobility and strength/resistance of the lower limbs. However, future studies with the use of specific control groups and adoption of longer lasting protocols are necessary to evaluate the actual size effect that dance has on the maintenance of mobility and balance in elderly.

Dança como uma intervenção para melhorar a mobilidade e o equilíbrio em idosos: uma revisão de literatura / Dance as an intervention to improve mobility and balance in elderly: a literature review

Resumo O objetivo da presente revisão foi identificar se protocolos de dança podem beneficiar a mobilidade e o equilíbrio em idosos. Foi realizada uma revisão de literatura na qual identificou-se 927 estudos potencialmente relevantes, publicados em português, inglês, francês, alemão, espanhol ou italiano. Não houve restrição de período de publicação. Após a leitura dos títulos, resumos e revisão dos critérios de exclusão, 15 ensaios clínicos controlados e randomizados foram incluídos. A maioria dos estudos avaliaram pessoas do gênero feminino, com protocolos de intervenção heterogêneos e grupos controles pouco específicos. Além disso, o período de exposição à dança foi geralmente curto: aproximadamente 2,6 práticas semanais, de 59,1 minutos cada, realizadas ao longo de 12,1 semanas. A dança mostrou-se benéfica em 77,6% dos desfechos avaliados, exibindo um tamanho de efeito moderado para o equilíbrio estático e equilíbrio funcional; embora pequeno para mobilidade e força/resistência dos membros inferiores. Contudo, estudos futuros com o uso de grupos controles específicos e adoção de protocolos mais duradouros são necessários para avaliar o real tamanho de efeito que a dança possui sobre a manutenção da mobilidade e equilíbrio em idosos.

Abstract The aim of the present review was to identify whether dance protocols can benefit mobility and balance in elderly. A literature review was conducted in which 927 potentially relevant studies were identified (published in Portuguese, English, French, German, Spanish or Italian). There was no publication period restriction. After reading the titles, abstracts and review of the exclusion criteria, 15 randomized controlled trials were included. Most of the studies evaluated female subjects, using heterogeneous protocols of intervention and unspecific control groups. In addition, the period of exposure to dance was generally short: 2.6 weekly practices, of 59.1 minutes each, performed through 12.1 weeks. Dance was shown to be beneficial in 77.6% of the evaluated outcomes, exhibiting a moderate effect size for static balance and functional balance; and small effect size for mobility and strength/resistance of the lower limbs. However, future studies with the use of specific control groups and adoption of longer lasting protocols are necessary to evaluate the actual size effect that dance has on the maintenance of mobility and balance in elderly.

Assessment of patients with multiple sclerosis according to tests of the Multiple Sclerosis Functional Composite / Avaliação de pacientes com esclerose múltipla segundo testes da Multiple Sclerosis Functional Composite

Abstract Introduction: The Multiple Sclerosis Functional Composite (MSFC) is a scale that evaluates the functional and cognitive aspects of patients with multiple sclerosis (MS). Objective: To compare the performance of individuals with the relapsing-remitting form of MS (RRMS) with a group of healthy subjects using the MSFC. Methods: Twenty subjects were investigated in this study, consisting of 10 patients with clinical diagnosis of RRMS and 10 controls with similar gender and age to the group with the disease. The three tests that comprise the MSFC were used for the evaluation of gait, upper limb motor function and cognition (memory and processing speed). Student's t-test was used to assess data with normal distribution and data with skewed distribution were evaluated using the Mann-Whitney test. Results: The results showed that the patients with RRMS took longer to perform the locomotion test (6.91 ± 2.35) compared to the control group (5.16 ± 1.28). The MS group (22.06 ± 5.44) also showed greater difficulty in performing a task with the dominant upper limb compared to the healthy subjects (17.79 ± 2.96). No statistically significant difference was found between the groups in the performance of cognitive tasks (p = .65). Conclusion: The use of the MSFC tests proved valuable for measuring possible motor and cognitive impairments in patients with RRMS. Thus, it is suggested that this scale is adopted in clinical practice, improving therapies for the treatment of MS patients and thereby providing them a better quality of life.

Resumo Introdução: A Multiple Sclerosis Functional Composite (MSFC) é uma escala que avalia aspectos funcionais e cognitivos em pacientes com esclerose múltipla (EM). Objetivo: Comparar o desempenho de indivíduos com a forma surto-remissão de EM (SREM) com um grupo de sujeitos saudáveis utilizando a MSFC. Métodos: Vinte sujeitos foram investigados no presente estudo, desses 10 eram pacientes com diagnóstico clínico SREM e 10 controles com sexo e idade semelhantes ao grupo com a doença. Foram utilizados os três testes que compõem a MSFC para avaliação da marcha, função motora de membros superiores e cognição (memória e velocidade de processamento). Para aferir os dados com distribuição normal utilizou-se o teste t de Student e os dados com distribuição assimétrica foram avaliados pelo Teste de Mann-Whitney. Resultados: Os pacientes com SREM apresentaram um tempo maior para realizar o teste de locomoção (6,91 ± 2,35) quando comparado ao grupo controle (5,16 ± 1,28). Além disso, o grupo com EM (22,06 ± 5,44) também demonstrou maior dificuldade em realizar uma tarefa com o membro superior dominante em relação aos indivíduos saudáveis (17,79 ± 2,96). Entretanto, não foi encontrada diferença estatisticamente significativa entre os grupos na execução das atividades cognitivas (P = 0,65). Conclusão: A aplicação dos testes da MSFC mostrou-se de grande valia para mensurar possíveis comprometimentos motores e cognitivos de pacientes com SREM. Assim, sugere-se que esta escala seja adotada na prática clínica, aprimorando terapias de tratamento dos portadores de EM e desse modo, proporcionando-lhes uma melhor qualidade de vida.