Realidad virtual de bajo coste. Una nueva aplicación para rehabilitación motora de los miembros superiores en patología neurológica: Estudio piloto / Low-cost virtual reality. A new application for upper extremity motor rehabilitation in neurological pathology: Pilot study

Antecedentes y objetivo: El objetivo de este estudio es presentar una nueva aplicación de realidad virtual (RV) de bajo coste basada en el dispositivo Leap Motion Controller (LMC) desarrollada para la rehabilitación motora de miembros superiores tras patología neurológica y mostrar su viabilidad clínica realizando una experiencia piloto. Material y métodos: El LMC permite la interacción con las aplicaciones virtuales mediante la captación de los movimientos de la mano. Se realizó una prueba piloto con cuatro pacientes con afectación de miembros superiores con Upper Extremity Motor Score (UEMS) mayor de 10. Se les valoró con los test Box and Block (BBT) y tarea de escritura del Jebsen-Taylor Hand Function (JTHF) antes y después de la intervención. Resultados: Los pacientes completaron el protocolo de nueve sesiones de 30 minutos de duración dividido en tres sesiones por semana. En el BBT pasaron de 38 (DE 20) cubos antes de la intervención a 44 (DE 21,72) cubos tras finalizarla. En el JTHF pasaron de 28,25 s (DE 8,61) a 26, 75 s (DE 21,72). No hubo diferencias estadísticamente significativas. La usabilidad del dispositivo se valoró con la escala Quebec User Evaluation of Satisfaction with assistive Technology, versión 2.0 (QUEST) siendo la seguridad, efectividad y facilidad de uso los aspectos prioritarios. Conclusión: Se presenta un nuevo desarrollo de RV basado en el dispositivo LMC y se ha comprobado su viabilidad clínica en pacientes neurológicos con afectación de los miembros superiores. Es preciso realizar un estudio clínico con una muestra amplia para valorar su posible efectividad clínica como elemento de tratamiento.(AU)

Background and objectives: The aim of this study is to present a new virtual reality (VR) low cost application based on Leap Motion Controller (LMC) device for upper extremity motor rehabilitation after neurological pathology and to demonstrate its clinical feasibility by carrying out a pilot experience. Material and methods: The LMC allows the interaction with virtual applications by capturing the patient's hand movements. A pilot study was carried out with 4 patients with upper limb impairment reflected with Upper Extremity Motor Score (UEMS) greater than 10. They were assessed using the Box and Block (BBT) and the writing task within the Jebsen-Taylor Hand Function (JTHF) before and after the intervention. Results: All patients completed the 9-session, 30-min protocol divided into 3 sessions per week. They went from an average result of 38 (SD 20) blocks in BBT before the intervention to 44 (SD 21.72) after it. They went from 28.25 s (SD 8.61) to 26.75 s (SD 21.72) in the JTHF. Statistically significant differences were no found. The device usability was assessed by the QUEST scale, being the security, effectiveness and ease to use the aspects that patients considered to be a priority. Conclusión: A new VR development based on the LMC device is presented and the clinical feasibility of its application in neurological patients with upper limb involvement has been proven. A clinical study with a large sample size is needed to assess its potential clinical effectiveness as a treatment element.(AU)

The Impact of Robotic Therapy on the Self-Perception of Upper Limb Function in Cervical Spinal Cord Injury: A Pilot Randomized Controlled Trial.

BACKGROUND: The aim of the present study was to evaluate the impact of robotic therapy in patients with cervical spinal cord injury (SCI), measured on the basis of the patients' self-perception of limited upper limb function and level of independence in activities of daily living. METHODS: Twenty-six patients with cervical SCI completed the treatment after being randomly assigned to the intervention or control group. The training consisted of 40 experimental sessions 1 h in duration, ideally occurring 5 days/week for 8 weeks. In addition to the conventional daily therapy (30 min), the control group received another 30 min of conventional therapy, whereas the intervention group received 30 min of robotic therapy. Patients were evaluated by means of the Capabilities of Upper Extremity Questionnaire (CUE) and Spinal Cord Independence Measure (SCIM) clinical scales. RESULTS: The improvement in the feeding item of SCIM was significantly higher in the intervention group than in the control group after the treatment (2.00 (0.91) vs. 1.18 (0.89), p = 0.03). The correlation between the CUE and SCIM scales was higher at the ending than at baseline for both groups. CONCLUSIONS: Although both groups improved, the clinical relevance related to the changes observed for both assessments was slightly higher in the intervention group than in the control group.

[Low-cost virtual reality. A new application for upper extremity motor rehabilitation in neurological pathology: Pilot study]. / Realidad virtual de bajo coste. Una nueva aplicación para rehabilitación motora de los miembros superiores en patología neurológica: Estudio piloto.

BACKGROUND AND OBJECTIVES: The aim of this study is to present a new virtual reality (VR) low cost application based on Leap Motion Controller (LMC) device for upper extremity motor rehabilitation after neurological pathology and to demonstrate its clinical feasibility by carrying out a pilot experience. MATERIAL AND METHODS: The LMC allows the interaction with virtual applications by capturing the patient's hand movements. A pilot study was carried out with 4 patients with upper limb impairment reflected with Upper Extremity Motor Score (UEMS) greater than 10. They were assessed using the Box and Block (BBT) and the writing task within the Jebsen-Taylor Hand Function (JTHF) before and after the intervention. RESULTS: All patients completed the 9-session, 30-min protocol divided into 3 sessions per week. They went from an average result of 38 (SD 20) blocks in BBT before the intervention to 44 (SD 21.72) after it. They went from 28.25 s (SD 8.61) to 26.75 s (SD 21.72) in the JTHF. Statistically significant differences were no found. The device usability was assessed by the QUEST scale, being the security, effectiveness and ease to use the aspects that patients considered to be a priority. CONCLUSIóN: A new VR development based on the LMC device is presented and the clinical feasibility of its application in neurological patients with upper limb involvement has been proven. A clinical study with a large sample size is needed to assess its potential clinical effectiveness as a treatment element.

Terapia robótica con el exoesqueleto H2 en la rehabilitación de la marcha en pacientes con lesión medular incompleta. Una experiencia clínica / Robot therapy with the H2 exoskeleton for gait rehabilitation in patients with incomplete spinal cord injry. A clinical experience

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[Robot therapy with the H2 exoskeleton for gait rehabilitation in patients with incomplete spinal cord injry. A clinical experience]. / Terapia robótica con el exoesqueleto H2 en la rehabilitación de la marcha en pacientes con lesión medular incompleta. Una experiencia clínica.

BACKGROUND AND OBJECTIVE: Robotic exoskeletons have emerged as a promising tool in gait rehabilitation in patients with a spinal cord injury. The aim of this study was to assess the clinical applicability of a new robotic exoskeleton model (Exo H2) in the rehabilitation of people with incomplete spinal cord injury. MATERIAL AND METHODS: Exo H2 exoskeleton training was performed for 15 sessions in patients with incomplete subacute spinal cord injury. We analysed the appearance of undesirable events and the patient's perception of pain, fatigue and comfort. In addition, a pilot test was carried out on the possible effectiveness of the device by analysing gait characteristics before and after treatment measured by the 10mWT, the 6mWT, the TUG, the WISCI-II, and the impact on the SCIM III scale. RESULTS: Of a group of 8 patients recruited, we were able to analyse data from 4. No undesirable effects were reported. The VAS value was 2.28±1.55 for pain, 3.75±1.55 for fatigue and 4.17±1.68 for comfort. All values improved on the WISCI-I and the TUG and almost all in the 10MWT and in the 6MWT. CONCLUSIONS: The performance of the Exo H2 exoskeleton was robust during a clinical protocol for gait rehabilitation. The treatment was safe, without undesirable effects and with good patient tolerance. These results might justify the performance of clinical trials with an adequate sample size.

Eficacia de la detección percutánea de oxígeno como guía terapéutico-quirúrgica en lesionados medulares con úlceras por presión crónicas: estudio preliminar / Eficacy of percutaneous oxygen detection as therapeutic-surgical guide in spinal cord injury patients with chronic pressure ulcers: preliminary report

En el presente estudio clínico realizamos detección transcutánea de oxígeno (TcpO2) en 11 pacientes consecutivos lesionados medulares parapléjicos crónicos (de más de 1 año de evolución) con úlceras por presión (upp) crónicas de grado IV (de más de 6 meses de evolución). En todos analizamos los valores de la TcpO2 tanto en el momento preoperatorio como postoperatorio, llevando a cabo las siguientes comprobaciones. En la posición 1 preoperatorio (P1-pre: a 1 cm del borde de la upp) los valores obtenidos fueron de 27,28±13,83 mm Hg, mientras que en P1 postoperatorio fueron de 34,96±19,06 (p < 0.05). El valor medio del electrodo de referencia (no1) en el momento preoperatorio (51,63±12,53mm Hg) fue estadísticamente significativo (p < 0.05) al compararlo con el valor obtenido con el electrodo no1 (38,60±14,63 mm Hg) en el postoperatorio. El valor medio del electrodo de referencia (no1) en el momento del preoperatorio (50,07±13,54 mm Hg) es estadísticamente significativo (p < 0.05) al compararlo con los valores medios obtenidos de TcpO2 de las posiciones (P1+P2+P3) de los electrodos no2 (29,17±15,03 mm Hg), no3 (34,51±13,15 mm Hg) y no4 (30,37±17,81 mm Hg) analizados en el preoperatorio. Demostramos con estos hallazgos los niveles hipoxémicos a 1 cm del borde de una upp grado IV y su evolución postoperatoria. De esta forma, la técnica de detección transcutánea de oxígeno puede considerarse una guía terapéutica en la detección y en la monitorización del tratamiento de las upp, con la posibilidad de establecer intervenciones terapéuticas para poder mejorar los niveles de oxígeno detectados en las mismas (AU)

In this clinical study the detection of transcutaneous oxygen has been performed (TcpO2) to 11 consecutive patients with spinal cord injury chronic paraplegics (more than 1 year of evolution) with chronic pressure ulcers grade IV (more than 6 months). In all patients were analyzed preoperative and postoperative TcpO2 values, with the following results. In the preoperative position 1 (P1-pre: to 1 cm of the ulcer edge) values obtained are of 27.28 ± 13.83 mm Hg, while in P1 postoperative were 34.96 ± 19.06 (p < 0.05). The average value of the reference electrode (no 1) preoperative (51.63 ± 12.53 mm Hg) is statistically significant (p < 0.05) when compared with the value obtained with the electrode no1 (38.60 ± 14, 63 mmHg) in the postoperative state. The average value of the reference electrode (no 1) preoperative (50.07 ± 13.54 mm Hg) is statistically significant (p < 0.05) when compared with the average values of the positions (P1, P2, P3) obtained of TcPO2 electrode no 2 (29.17 ± 15.03 mm Hg), no 3 (34.51 ± 13.15 mm Hg) and no 4 (30.37 ± 17.81 mm Hg) analyzed preoperatively. With these findings, we demonstrate hypoxemic levels to 1 cm of chronic pressure ulcers edge grade IV and postoperative progress. Thus, the technique of transcutaneous oxygen detection can be considered as a therapeutic guide in the detection and monitoring of pressure ulcers treatment with the possibility of establish therapeutic interventions to improve the oxygen levels detected in them (AU)