Immersive Virtual Environments and Wearable Haptic Devices in rehabilitation of children with neuromotor impairments: a single-blind randomized controlled crossover pilot study.

BACKGROUND: The past decade has seen the emergence of rehabilitation treatments using virtual reality. One of the advantages in using this technology is the potential to create positive motivation, by means of engaging environments and tasks shaped in the form of serious games. The aim of this study is to determine the efficacy of immersive Virtual Environments and weaRable hAptic devices (VERA) for rehabilitation of upper limb in children with Cerebral Palsy (CP) and Developmental Dyspraxia (DD). METHODS: A two period cross-over design was adopted for determining the differences between the proposed therapy and a conventional treatment. Eight children were randomized into two groups: one group received the VERA treatment in the first period and the manual therapy in the second period, and viceversa for the other group. Children were assessed at the beginning and the end of each period through both the Nine Hole Peg Test (9-HPT, primary outcome) and Kinesiological Measurements obtained during the performing of similar tasks in a real setting scenario (secondary outcomes). RESULTS: All subjects, not depending from which group they come from, significantly improved in both the performance of the 9-HPT and in the parameters of the kinesiological measurements (movement error and smoothness). No statistically significant differences have been found between the two groups. CONCLUSIONS: These findings suggest that immersive VE and wearable haptic devices is a viable alternative to conventional therapy for improving upper extremity function in children with neuromotor impairments. Trial registration ClinicalTrials, NCT03353623. Registered 27 November 2017-Retrospectively registered, https://clinicaltrials.gov/ct2/show/NCT03353623.

Feasibility of external rhythmic cueing with the Google Glass for improving gait in people with Parkinson's disease.

New mobile technologies like smartglasses can deliver external cues that may improve gait in people with Parkinson's disease in their natural environment. However, the potential of these devices must first be assessed in controlled experiments. Therefore, we evaluated rhythmic visual and auditory cueing in a laboratory setting with a custom-made application for the Google Glass. Twelve participants (mean age = 66.8; mean disease duration = 13.6 years) were tested at end of dose. We compared several key gait parameters (walking speed, cadence, stride length, and stride length variability) and freezing of gait for three types of external cues (metronome, flashing light, and optic flow) and a control condition (no-cue). For all cueing conditions, the subjects completed several walking tasks of varying complexity. Seven inertial sensors attached to the feet, legs and pelvis captured motion data for gait analysis. Two experienced raters scored the presence and severity of freezing of gait using video recordings. User experience was evaluated through a semi-open interview. During cueing, a more stable gait pattern emerged, particularly on complicated walking courses; however, freezing of gait did not significantly decrease. The metronome was more effective than rhythmic visual cues and most preferred by the participants. Participants were overall positive about the usability of the Google Glass and willing to use it at home. Thus, smartglasses like the Google Glass could be used to provide personalized mobile cueing to support gait; however, in its current form, auditory cues seemed more effective than rhythmic visual cues.

Psychogenic gait disorder: a randomized controlled trial of physical rehabilitation with one-year follow-up.

OBJECTIVE: Psychogenic gait disorder, defined as loss of ability to walk without neurological aetiologies, has poor rehabilitation options that are well documented. Left untreated these patients have substantial and long-lasting dysfunction. The present study examined the effect of a 3-week inpatient rehabilitation programme compared with a waiting list control condition, and whether eventual gains were maintained at 1-month and 1-year follow-up. DESIGN: A cross-over design evaluated the effect of treatment, and a carry-over effect was considered as a long-lasting treatment effect. Treatment consisted of adapted physical activity within a cognitive behavioural framework, and focused on offering an alternative explanation of symptoms, positively reinforcing normal gait and not reinforcing dysfunction. PATIENTS: A total of 60 patients were recruited from neurological departments and were randomly assigned to immediate treatment (intervention) or treatment after 4 weeks (controls). RESULTS: Cross-over design revealed that the mean difference between treatment vs no treatment was 8.4 Functional Independence Measure units (p < 0.001, 95% confidence interval 5.2-11.7), and 6.9 Functional Mobility Scale units (p < 0.001, 95% confidence interval 5.5-8.3). Patients significantly improved their ability to walk and their quality of life after inpatient rehabilitation compared with the untreated control group. The improvements in gait were sustained at 1-month and 1-year follow-up. CONCLUSION: Substantial and lasting improvement can be achieved by inpatient rehabilitation of patients with psychogenic gait, and the gains are maintained during follow-up.

Programa de rehabilitación de pacientes sometidos a trasplante de progenitores hematopoyéticos / Rehabilitation program of patients who have undergone hematopoietic stem cell transplantation

Introducción. La recuperación de la capacidad funcional es un objetivo terapéutico primordial, proponiéndose el ejercicio como terapia coadyuvante, para combatir los efectos del decondicionamiento físico tras el trasplante de células precursoras hematopoyéticas (TPH). Presentamos nuestro estudio con el fin de exponer nuestra experiencia con el protocolo usado en nuestra unidad dentro del enfoque integral de los pacientes sometidos a TPH. Material y métodos. Estudio descriptivo prospectivo, incluyendo a todos aquellos pacientes sometidos a TPH, en el periodo comprendido entre enero de 2011 y julio de 2012, admitidos en el protocolo realizado en nuestro servicio. Revisamos y recopilamos los datos epidemiológicos, demográficos, características de su enfermedad, grado de actividad física y funcionalidad, en un total de 50 casos registrados en nuestra base de datos. Resultados. Edad media de 48,94 años (10-66). Síndrome mielodisplásico como causa más frecuente (30,4%). Todos los pacientes sometidos a trasplante presentaron una pérdida de fuerza, medida por un descenso global medio en el balance muscular de un punto; mientras solo el 24% precisaron tratamiento rehabilitador específico, porque presentaban signos de fragilidad funcional. Todos ellos recibieron recomendaciones respecto a la actividad física y normas higienicodietéticas. La distancia capaz de recorrer se vio considerablemente disminuida, con un 45% únicamente capaz de caminar 0-500 m, frente a un 60% capaz de caminar más de 2 km pretrasplante. No se objetivó aumento de fatiga postrasplante. Conclusiones. Todos los pacientes sometidos a TPH deben participar en un programa de rehabilitación, para prevenir las consecuencias de la inmovilidad y efectos adversos del tratamiento oncohematológico(AU)

Introduction. Recovering functional capacity is a fundamental therapeutic target. Exercise is proposed as an adjuvant therapy to combat the effects of loss of physical conditioning after Hematopoietic Stem Cell Transplantation (HSCT). We present our study in order to describe our experience with the protocol having a comprehensive approach to patients subjected to HSCT which is currently being used in our unit. Material and methods. A descriptive prospective study including all patients who had undergone HSCT, admitted in the protocol from January 2011 to July 2012, was carried out. The epidemiologic and demographic data as well as characteristics of the condition, physical activity level and functionality from 50 cases recorded in the database of our unit were collected and reviewed. Results. Mean age of the sample was 48.94 years (10-66). Myelodysplastic syndrome was the most common cause (30.4%). All patients who underwent transplant showed a loss of strength, measured by a mean global decrease of 1 point in muscle balance, although only 24% required specific rehabilitation treatment due to signs of functional frailty. All of them received recommendations regarding physical activity and hygiene and diet guidelines. The distance the subjects could cover decreased considerably, 45% only being able to walk approximately 0-500 m, while 60% had been able to walk more than 2 km prior to the transplant stage. No increase in fatigue was observed after the transplant. Conclusions. All patients who undergo HSCT should participate in a physical exercise program to prevent the effects of the lack of mobility and the adverse effects of the oncological and hematological treatment(AU)

Limb apraxia in multiple sclerosis: prevalence and impact on manual dexterity and activities of daily living.

OBJECTIVE: To evaluate the prevalence and impact of limb apraxia on manual dexterity and activities of daily living (ADLs) in patients with multiple sclerosis (MS). DESIGN: Survey. SETTING: University hospital. PARTICIPANTS: Consecutive patients (N=76) with clinically isolated syndrome, relapsing-remitting multiple sclerosis (RRMS), secondary progressive multiple sclerosis (SPMS) or primary progressive multiple sclerosis (PPMS), Expanded Disability Status Scale (EDSS) score from 0 to 6.5, and aged from 18 to 70 years were included. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Apraxia was assessed by the apraxia screen of TULIA (AST). The relationship of apraxia with ADLs and manual dexterity was evaluated using a dexterity questionnaire and the coin rotation task, respectively. RESULTS: Overall, limb apraxia was found in 26.3% of patients (mean AST score ± SD, 7.3±1.3; cutoff <9). Apraxia was significantly correlated with higher EDSS scores, longer disease duration, and higher age with the EDSS being predictive. Furthermore, patients with SPMS and PPMS were more apraxic than patients with RRMS. Finally, limb apraxia was significantly associated with impaired ADLs and manual dexterity. CONCLUSIONS: Limb apraxia is a frequent and clinically significant symptom contributing to disability in MS. It should therefore be evaluated and possibly treated, particularly in patients with MS reporting manual difficulties in everyday life.

Clinical and single-photon emission computed tomography study of pure akinesia with freezing of gait.

The clinical syndrome of pure akinesia (PA) is considered the third phenotype of progressive supranuclear palsy (PSP), and is characterized by freezing of gait and prominent speech disturbance without rigidity or tremor. It is frequently considered one of the dopamine resistant motor syndromes, and its pathophysiology remains unclear. We report a patient followed in the Department of Neurology of Razi Hospital, Tunisia, with PA with gait freezing (PAGF) with a frontal hypoperfusion on single photon emission CT and non-responsive dopa therapy. We discuss the clinical features of PAGF and efficiency of treatment options.

Weight bearing on the affected lower limb in residents of a geriatric rehabilitation hospital.

OBJECTIVES: The purpose of the study was to determine whether and to what extent the treatment goal of enhancement of weight bearing on an affected lower limb is achieved in the gait rehabilitation of patients with poststroke hemiparesis, postprosthetic fitting due to unilateral transtibial amputation, or postunilateral hip or knee arthroplasty. DESIGN: Nonrandomized prepost study. Subjects were 26 residents of a geriatric rehabilitation hospital in the initial stage of gait rehabilitation after poststroke hemiparesis (n = 9), unilateral total hip or knee joint replacement (n = 11), or unilateral transtibial amputation with a fitted prosthesis (n = 6). Weight bearing on the hindfoot and forefoot of the affected limb was measured by using the SmartStep system version 2.2.0, at least once a week, both before and immediately after a gait-training session. Measurements were performed with the patients using their assistive devices. RESULTS: In the patients with hemiparesis, there was no significant difference found between the initial pretraining maximal weight bearing on the afflicted limb (39% and 50% of body weight on the hindfoot and forefoot, respectively) and that at discharge (47% and 50% of body weight, respectively). In patients after hip or knee arthroplasty and in those who underwent prosthetic fitting, there was a substantial increase found in the loading of the forefoot, but not of the hindfoot, from the initial evaluation to the time of discharge (from 43% to 54% of body weight, P = 0.05, in the arthroplasty group, and from 49.6% to 69.5%, P = 0.09, in the prosthetic group). CONCLUSIONS: For elderly individuals belonging to the studied diagnostic groups, the goal of enhancing normal weight bearing on the afflicted limb during the time course of 2-3 wks might be unrealistic.

Virtual cues and functional mobility of people with Parkinson's disease: a single-subject pilot study.

In this study, adults with Parkinson's disease (PD) used virtual cueing spectacles (VCS) mimicking kinesia paradoxa in home and community settings to assess the impact on mobility and participation. We used an ABA single-subject design with repeated measures. Six adults with PD, akinesia, and stage III or IV Hoehn and Yahr rating scale status used VCS in their homes and communities for a week or more. Our main outcome measures included participant counts of losses of balance and freezes, pre-/postintervention completion of the Parkinson's Disease Questionnaire-39, observation of baseline and intervention gait, and an interview regarding user satisfaction with VCS. We also assessed participants' preuse baseline and return to baseline. Use of VCS decreased length of freezes as well as number of freezes for some participants. All participants expressed satisfaction with VCS. VCS shows promise in simulating kinesia paradoxa to improve the gait of some adults with PD in the home and community.

Apraxia de la marcha: una secuela adquirida de evolución desfavorable / Apraxia of gait: an acquired sequela with a poor prognosis

Introducción. La apraxia de la marcha es una entidad que no se tiene en cuenta en la práctica de la Neurología infantil. Casos clínicos. Se presentan dos pacientes pediátricos que, tras adquirir la marcha, y a consecuencia de un proceso agudo, perdieron la capacidad de caminar, sin que las intensivas técnicas de rehabilitación hayan podido ayudarles a lo largo de varios años. Las lesiones eran heterogéneas en ambos casos, ya que en el primero resultó afectad la corteza precentral y paracentral a consecuencia de un proceso inflamatorio de tipo encefalítico, y en el otro, los núcleos de la base cerebral y los hipocampos, a consecuencia de una situación de casi ahogamiento a la edad de 15 meses. Conclusión. Se discuten los mecanismos atribuidos a estos trastornos y se hace hincapié en su mal pronóstico a largo plazo

Introduction. Gait apraxia is not used to be considered as a diagnostic entitiy in Pediatric Neurology. Case reports. We present two pediatric patients that, after to have acquired normal gait and in consequence of a acute process, they lost the capacity to walk. In spite of intensive rehabilitation treatement hold along various years, they had not been able to help them. Both injury were very dissimilar; in one of them was affected the precentral and paracentral cortex in consequence of an encephalitic process. In the other, the basal ganglia and the hippocampus after a situation of near-drowning at the age of 15 months. Conclusion. The mechanism of this disorder is discussed and emphasis is done in its badly long-term prognosis

[Using the gait laboratory for the investigation of orthopaedic clinical problems in children]. / Einsatz des Ganglabors bei klinisch-orthopädischen Fragestellungen in der Kinderorthopädie.

AIM OF THE STUDY: We point out multiple applications of a gait laboratory in solving different problems in the children's orthopaedic field. With typical examples we show how biometrical data of the gait laboratory can be helpful to solve problems in orthopaedic examinations. MATERIAL AND METHOD: The range of questions to be solved in the gait laboratory differs from individual diagnostic examinations of a patient up to the control of devices in the functional use at the patient. As a typical example for the individual examination we show the gait analysis in a 14-year-old girl with idiopathic chondrolysis of the hip joint. The functional use of orthopaedic devices will be shown in youths with neuroorthopaedic diseases. As a very special question to the gait lab we describe the supply of children and youths with optimal sport shoes for running. RESULTS: The biometrical measurement techniques generate exact data to solve individual diagnostic and therapeutic questions. Orthopaedic devices can be tested in their functional efficiency and quality. Special questions can be answered very flexible. CONCLUSION: Diagnosis and therapy in orthopaedics and children's orthopaedics rely on exact data. However, details of the dynamics during movement are neither visible to the most experienced orthopaedic surgeon nor can they be documented by conventional diagnostic imaging procedures. The present technical potential of biometric assessment methods allow to precise and correct some empirical knowledge, they open a wide field of new applications in diagnostic and therapeutic examinations.

Locomotor therapy in neurorehabilitation.

Gait rehabilitation is a major aspect of neurological rehabilitation. This review is on locomotor therapy by treadmill stimulation with partial body weight support evolving as a very promising treatment concept over the last years. It enables severely affected patients the repetitive practice of complex gait cycles and thus follows modern aspects of motor learning favoring a task-specific approach. Several studies have shown its potential in patients after stroke, spinal cord injury, M. Parkinson and cerebral palsy. An electromechanical gait trainer relieving the strenuous effort of the therapists and controlling the trunk in a phase-dependent manner is a new alternative.

The effect of foot orthoses on standing foot posture and gait of young children with Down syndrome.

The purpose of this study was to determine if foot orthoses (FOs) immediately affected gait of children with Down Syndrome (DS) and excessively pronated feet. Subjects were 3--6 years old; 16 with DS and 10 without disabilities. Gait of children with DS wearing sneakers was compared with and without FOs and compared to gait of children without disabilities. Ankle moment, walking speed during stance phase, sneaker prints, center of pressure, and transverse plane foot angles were collected and compared. In standing, heel eversion was reduced when the children wore FOs (p=0.000). During gait the transverse plane foot angle decreased indicating more internal rotation with FOs (p=0.000). Trial-to-trial variability of pronation-supination index (p=0.0001), foot length contact (p=0.0001), transverse plane foot angle (p=0.0003), and walking speed (p=0.0001) all decreased with FO use. Trial-to-trial variability of normalized peak ankle moment (p=0.0001), and of phase of peak ankle moment (p=0.0001) increased when the children wore FOs.