Immersive Virtual Tasks with Motor and Cognitive Components: A Feasibility Study of Adults and Older Adult Fallers and Nonfallers.

The objective of the present study was to compare the feasibility, safety, and satisfaction of an immersive virtual reality system developed specifically for cognitive-sensory-motor training among older adult fallers and nonfallers and adult individuals. This was a cross-sectional observational study, and 20 adults, 20 nonfaller older adults, and 20 faller older adults were assessed. The primary outcome was feasibility assessed with safety and satisfaction measures. Safety outcomes were associated with adverse events occurred during the experience with the immersive virtual reality system (IVRS), assessed through the Simulator Sickness Questionnaire and by registering the falls, pain, or any discomfort reported by the participants. Satisfaction was assessed with a structured questionnaire, answered after 10 minutes of experiencing the IVRS. The dates were assessed with one-way analysis of variance or the Kruskal-Wallis test and Bonferroni post hoc test. The results showed that the IVRS was safe and the participants related good satisfaction with the system. Most of participants related no symptoms (93.6 percent) or light cybersickness symptoms (6.0 percent). There were no occurrences of falls or pain associated with the IVRS. The IVRS was feasible for adults and nonfaller and faller older adults.

Comparison of the Effects of an Exergame-Based Program with Conventional Physiotherapy Protocol Based on Core Areas of the European Guideline on Postural Control, Functional Mobility, and Quality of Life in Patients with Parkinson's Disease: Randomized Clinical Trial.

Introduction: Impairment of postural control and functional mobility are debilitating symptoms of Parkinson's disease (PD). In addition to limiting performance in activities of daily living, it is associated with a higher prevalence of falls in this population. Particularly, dysfunction in postural control does not respond to dopaminergic replacement therapy, but physiotherapy can improve this outcome in patients with PD. Objective: The aim of this study was to analyze the effects of training based on Kinect Adventures games compared with a conventional physiotherapy protocol based on the core areas of the European physiotherapy guideline in patients with PD on postural control, functional mobility, self-perception of confidence in the balance, quality of life (QoL), lower limb muscle strength, transfer skill and motor function, as well as to observe adherence and safety interventions. Methods: Thirty-eight patients diagnosed with idiopathic PD were randomized into two groups, and performed 14 training sessions, twice a week for 60 minutes. The primary outcome assessed postural control using the Mini-Balance Evaluation Systems Test (Mini-BESTest). The following were evaluated as secondary outcomes: limit of stability; balance functional reserve and center of pressure area by computerized posturography; functional mobility by the Timed Up and Go test; self-confidence in balance through the Activities-specific Balance Confidence scale; QoL through the Parkinson's Disease Questionnaire; lower limb muscle strength by the Five Times Sit-To-Stand test; and motor function by the Unified Parkinson's Disease Rating Scale. Results: Patients completed training sessions with high rates of safety and adherence. After training, there was a significant improvement in postural control, motor function, and QoL. Conclusion: Both interventions proved to be safe, applicable, and effective to improve postural control, QoL, and motor function in patients with PD. However, there was no difference between the effects of Kinect Adventures games and conventional physiotherapeutic protocol in patients with PD. Brazilian Registry of Clinical Trials (RBR-27kqv5).

Effects of the Interactive Videogame Nintendo Wii Sports on Upper Limb Motor Function of Individuals with Post-Polio Syndrome: A Randomized Clinical Trial.

Objective: To compare the effects of an upper limb videogame-based training with a training based on similar motor demands on upper limb function, dexterity, functionality, balance, fatigue, and pain in post-polio syndrome (PPS) and to assess the acceptability, feasibility, and safety of the intervention. Materials and Methods: This is a randomized, parallel, single-blind clinical trial. Thirty-nine individuals were randomized into Interactive Videogames Group (IVG, n = 19) and Active Exercises Group (AEG, n = 20). Participants performed two weekly sessions (50 minutes each), totaling 14 sessions with the aim of providing mild to moderate intensity. IVG practiced four Nintendo Wii Sport games (tennis, golf, boxing, and bowling). The AEG performed similar movements required for IVG. Primary outcome: upper limb motor function-Motor Function Measure-32. Secondary outcomes: dexterity-Box and Block test; functionality-Functional Independence Measure; balance-Functional Reach Test, muscle fatigue-Fatigue Severity Scale, upper limb pain-Visual Analogue Scale for pain, acceptability, applicability, and safety. Analysis of group, time, interaction between groups, and time effects was performed through repeated-measures analysis of variance (2 × 3) and Bonferroni post hoc test with alpha of 0.05. Results: Interactive videogames were safe, feasible, and acceptable. Both groups showed similar postintervention improvement on motor function, functionality, balance, pain, and fatigue, with maintenance over the follow-up period. There was an interaction effect between the groups on dexterity and the IVG demonstrated better performance compared with the AEG. Final Considerations: The similar positive clinical effects of the interactive video games on PPS upper limb function and its superior effects on dexterity support its use as a safe and feasible intervention. Particularly when it comes to chronic patients, who require long-term physical therapy, new and stimulating interventions may contribute to the rehabilitation process and improve their engagement in the treatment. Registered on the Brazilian Clinical Trials platform under number RBR-8S2NBF.

Kinect Adventures versus physical exercise on depressive symptoms of older adults: A pilot study / Kinect Adventures versus exercício físico sobre sintomas depressivos em idosos: Um estudo piloto

Abstract Introduction: Depressive and anxiety disorders are considered the main cause of emotional suffering and decrease of quality of life among older adults. It has been suggested that the practice of physical exercise can be a treatment option for anxiety and depression. Alternative approaches such serious games show promise for reducing depression symptoms. Objective: To compare the effect of virtual reality, in the form of commercially available interactive Kinect Adventures video games, compared to a standard physical exercise program on depressive symptoms of older adults. Method: This is a pilot study, parallel group, single-blind randomized controlled pilot trial that recruited two intervention groups: Interactive Video Game Kinect Adventures (IVG, n=8) versus usual physical exercise program (PEP, n=6). The two groups completed a seven week program with a total of fourteen 60-minute sessions divided into two sessions a week. The IVG completed individual training sessions using the Microsoft Xbox Kinect Adventures games and the PEP performed a group exercise program. Depression symptoms were measured using the Geriatric Depression Scale (GDS-15). This measure was assessed pre-intervention, post intervention and at 30-day follow-up. Results: There was a significant effect of assessment without group effect or interaction between factors, in the GDS-15 (RM-ANOVA, P < 0.0001). Both groups showed improvement in the GDS-15 post intervention assessment that was maintained after 30-day follow-up (Bonferroni post hoc test, P < 0.05). Conclusion: The results of this study suggest that both Interactive Kinect Adventures video games and physical exercise provide beneficial effects on depressive symptoms of older adults.

Resumo Introdução: Os transtornos depressivos e de ansiedade são considerados a principal causa de sofrimento emocional e diminuição da qualidade de vida de idosos. Foi sugerido que a prática de exercício físico pode ser um tratamento para depressão. Abordagens alternativas, como jogos interativos, podem reduzir sintomas depressivos. Objetivo: Comparar o efeito da realidade virtual, na forma de videogames interativos Kinect Adventures disponíveis comercialmente, em comparação com um programa de exercícios físicos padrão sobre sintomas depressivos de idosos. Método: Trata-se de um estudo piloto, grupos paralelos, experimental, controlado, randomizado, cego através de dois grupos de intervenção: Interactive Video Game Kinect Adventures (IVG, n = 8) versus programa de exercício físico (PEF, n = 6). Os dois grupos completaram um programa de sete semanas com um total de 14 sessões de 60 minutos divididas em duas sessões por semana. O IVG concluiu sessões de treinamento individuais usando os jogos Microsoft Xbox Kinect Adventures e o PEF realizou um programa de exercícios em grupo. Os sintomas de depressão foram mensurados através da Escala de Depressão Geriátrica (GDS-15). Essas medidas foram avaliadas pré-intervenção, pós-intervenção e no seguimento de 30 dias. Resultados: Houve um efeito significativo da avaliação sem efeito grupo ou interação entre fatores, no GDS-15 (RM-ANOVA, P <0,0001). Ambos os grupos apresentaram melhora na avaliação pós-intervenção GDS-15, que foi mantida após 30 dias de acompanhamento (teste post hoc de Bonferroni, P <0,05). Conclusão: Os resultados deste estudo sugerem que os jogos interativos Kinect Adventures e o exercício físico proporcionam efeitos positivos nos sintomas depressivos de idosos.

Reliability, Validity, and Ability to Identity Fall Status of the Berg Balance Scale, Balance Evaluation Systems Test (BESTest), Mini-BESTest, and Brief-BESTest in Older Adults Who Live in Nursing Homes.

BACKGROUND AND PURPOSE: In any given year, 28% to 35% of older adults experience falls. In nursing home environments, the annual rate of falls increases to 30% to 50%. Our objective was to verify and compare the reliability, validity, and ability to identify falls of the Berg Balance Scale (BBS), Balance Evaluation Systems Test (BESTest), Mini-BESTest, and Brief-BESTest for older adults who live in nursing homes. METHODS: This was a cross-sectional study. Older adults (n = 49; aged 62-90 years; mean = 77.8; standard deviation = 7.2) were recruited from a nonprofit nursing home. All participants were assessed by 2 physiotherapists using the BBS, BESTest, Mini-BESTest, and Brief-BESTest. The interrater and test-retest (7-14 days) reliability were assessed using intraclass correlation coefficients (ICCs [2, 1]). Minimal detectable changes at the 95% confidence level were established. To analyze each test's ability to identify fall status, we used receiver operating characteristic (ROC) curves, whose statistical significance we verified using the area under the ROC curve (AUC) and respective 95% confidence intervals (CIs). The diagnostic likelihood ratios (positive and negative) and 95% CI were used to verify posttest probability. We used Fagan's nomogram to show the posttest probability of each balance test. Validity was assessed using kappa coefficients and the prevalence-adjusted bias-adjusted kappa (PABAK). RESULTS: Interrater and test-retest reliability for the total scores were good to excellent across all 4 tests (ICC interrater value = 0.992-0.994 and ICC test-retest value = 0.886-0.945). All tests were also able to identify fall status (AUC = 0.712-0.762) and were in good agreement with each other (kappa coefficient for individuals with fall risk = 0.679-0.957 and individuals with no fall risk = 0.135-0.143; PABAK = 83.7%-98%). CONCLUSION: All balance tests presented similar reliability, reproducibility, and validity. This suggests that any of these tests can be used in clinical practice. However, the Brief-BESTest is the quickest and easiest test to perform.

Effects of Kinect Adventures Games Versus Conventional Physical Therapy on Postural Control in Elderly People: A Randomized Controlled Trial.

OBJECTIVE: To compare the effectiveness of Kinect Adventures games versus conventional physiotherapy to improve postural control (PC), gait, cardiorespiratory fitness, and cognition of the elderly. In addition, we evaluated the safety, acceptability, and adherence to the interventions. MATERIALS AND METHODS: The study was a randomized clinical trial in which 46 elderly individuals were selected, mean age 69.3 (5.34) years. Participants were allocated to the Kinect Adventures Training Group (KATG) or the Conventional Physical Therapy Group (CPTG), 23 individuals in each group. Participants of both groups participated in 14 training sessions lasting 1 hour each, twice a week. The KATG practiced four Kinect Adventures games. The CPTG participated in conventional physiotherapy. The primary outcome was PC: Mini-Balance Evaluation Systems Test (Mini-BESTest), and secondary outcomes were gait: Functional Gait Assessment (FGA), cardiorespiratory fitness: Six-minute step test (6MST), and cognition: Montreal Cognitive Assessment (MoCA). Acceptability was assessed through a questionnaire created by the researchers themselves. Adherence was assessed by the "frequency of the number of elderly individuals who completed the interventions and safety through the presence of adverse effects." Participants were assessed immediately pre- and posttreatment and fourth week after the end of the treatment. Statistical analysis was done through repeated-measures analysis of variance and Tukey post hoc test. RESULTS: Both groups presented a significant improvement in the PC (Mini-BEST), gait (FGA), and cognition (MoCA) posttreatment that was maintained at fourth week after treatment (post hoc Tukey test; P < 0.05). Regarding cardiorespiratory fitness (6MST), the KATG presented improvement posttreatment and maintenance of the results in the fourth week after treatment. CPTG showed improvement only in fourth week after treatment (post hoc Tukey tests; P < 0.05). Regarding the acceptability, the questionnaire showed that both groups were satisfied with regard to the proposed interventions. There was 91% adherence in both training sessions. Regarding the safety, 34% and 26% of the individuals of the KATG and CPTG, respectively, presented adverse effects of delayed muscle pain in the lower limbs after the first session only. CONCLUSION: There were no significant differences between the KATG and CPTG; both interventions provided positive effects on PC, gait, cardiorespiratory fitness, and cognition of the elderly.

Effects of virtual rehabilitation on cognition and quality of life of patients with Parkinson's disease / Efeitos da reabilitação virtual na cognição e qualidade de vida de pacientes com doença de Parkinson / Efectos de la rehabilitación virtual en la cognición y calidad de vida de pacientes con enfermedad de Parkinson

Abstract Introduction: Parkinson's disease causes progressive decline of motor and cognitive functions leading to a decrease in the independence and quality of life of people affected. Training through virtual reality is proving effective, as it promotes cognitive and motor stimuli, which can be beneficial for these individuals, improving their quality of life. Objective: To analyze the effects of virtual reality on the cognition and quality of life of patients with Parkinson's disease. Methods: A total of 11 individuals with a mean age of 65 (9.6) years classified in stages 1 to 3 of the Hoehn and Yahr Scale participated in this study. The subjects participated in fourteen sessions lasting one hour, twice a week for seven weeks in which they practiced four games of Kinect Adventures!. They were evaluated before, immediately after the intervention and 30 days after the intervention. Cognition was assessed using the Montreal Cognitive Scale (MoCA) and quality of life was assessed using the Parkinson's Disease Questionnaire (PDQ-39). Results: Only PDQ-39 activities from the domain of daily living demonstrated a statistically significant improvement. The MoCA scores, in general, remained the same. Conclusion: Although virtual reality training promoted improvement in PDQ-39 activities in the daily life domain, it was not effective in the other domains assessed for quality of life and cognition.

Resumo Introdução: A doença de Parkinson provoca declínio progressivo das funções motoras e cognitivas, levando a uma diminuição da independência e da qualidade de vida das pessoas acometidas. O treinamento por meio de realidade virtual tem se mostrando eficaz, pois promove estímulos cognitivos e motores, o que pode ser benéfico para estes indivíduos, melhorando sua qualidade de vida. Objetivo: Analisar os efeitos da realidade virtual na cognição e qualidade de vida de pacientes com Doença de Parkinson. Métodos: Tratou-se de uma série de casos. Participaram deste estudo onze indivíduos com média de idade de 65 (9,6) anos classificados nos estádios 1 a 3 da Escala Hoehn e Yahr. Os indivíduos participaram de quatorze sessões com duração de uma hora, duas vezes por semana durante sete semanas no qual praticaram quatro jogos do Kinect Adventures!. Eles foram avaliados antes, imediatamente após a intervenção e 30 dias após a intervenção. A cognição foi avaliada por meio da Escala Cognitiva de Montreal (MoCA) e a qualidade de vida foi avaliada por meio do Questionário de Doença de Parkinson (PDQ-39). Resultados: Somente as atividades do PDQ-39 do domínio da vida diária demonstraram melhoria estatisticamente significante. Os escores da MoCA, em geral, permaneceram os mesmos. Conclusão: Embora o treinamento da realidade virtual tenha promovido melhoria nas atividades do PDQ-39 no domínio de vida diária, não foi efetivo nos outros domínios avaliados quanto à qualidade de vida e cognição.

Resumen Introducción: La enfermedad de Parkinson provoca una disminución progresiva de las funciones motoras y cognitivas, llevando a una disminución de la independencia y de la calidad de vida de las personas afectadas. El entrenamiento por medio de la realidad virtual se ha demostrado eficaz, pues promueve estímulos cognitivos y motores, lo que puede ser beneficioso para estos individuos, mejorando su calidad de vida. Objetivo: Analizar los efectos de la realidad virtual en la cognición y calidad de vida de pacientes con enfermedad de Parkinson. Métodos: Se trata de una serie de casos, participaron de este estudio once individuos con una media de edad de 65 (9,6) años clasificados en los estadios 1 a 3 de la escala Hoehn y Yahr. Los individuos participaron en catorce sesiones de una hora, dos veces a la semana durante siete semanas en las que practicaron cuatro juegos de Kinect Adventures!. Se evaluaron antes, inmediatamente después de la intervención y 30 días después de la intervención. La cognición fue evaluada por medio de la Escala Cognitiva de Montreal (MoCA) y la calidad de vida fue evaluada a través del Cuestionario de Enfermedad de Parkinson (PDQ-39). Resultados: Sólo las actividades del PDQ-39 del dominio de la vida diaria demostraron una mejora estadísticamente significativa. Los escores de la MoCA, en general, permanecieron iguales. Conclusión: Aunque el entrenamiento de la realidad virtual ha promovido una mejora en las actividades del PDQ-39 en el ámbito de la vida diaria, no fue efectivo en los otros ámbitos evaluados en cuanto a la calidad de vida y cognición.

Impacto do treinamento sensório-motor com plataforma vibratória no equilíbrio e na mobilidade funcional de um indivíduo idoso com sequela de acidente vascular encefálico: relato de caso / Efecto del entrenamiento sensorial-motor con plataforma vibratoria en el balance y en la movilidad funcional de una persona mayor con secuela de accidente cerebrovascular: un relato de caso / Impact of sensorimotor training with whole body vibration platform on balance and functional mobility of an elderly individual after a stroke: case report

RESUMO A incidência de acidente vascular encefálico (AVE) aumenta com o envelhecimento e pode ter como consequência alterações sensitivas e motoras, as quais limitam a capacidade funcional, em função da redução do equilíbrio e da mobilidade. Diferentes recursos vêm sendo utilizados na prática fisioterapêutica para a recuperação do equilíbrio e da mobilidade, como treinamento sensório-motor e treinamento com plataforma vibratória. O objetivo deste estudo foi investigar o efeito de um protocolo de treinamento sensório-motor com plataforma vibratória no equilíbrio e na mobilidade funcional de um indivíduo idoso com sequela de AVE. Um indivíduo idoso, do gênero feminino, com 72 anos de idade e com sequela de AVE participou deste estudo. A avaliação do equilíbrio foi realizada por meio da Escala de Equilíbrio de Berg (EEB) e a avaliação da mobilidade por meio do teste Timed Up and Go (TUG). As variáveis dependentes para acompanhamento foram: pontuação obtida na EEB e tempo de execução do TUG. Após a avaliação inicial, a idosa realizou um protocolo de treinamento sensório-motor com plataforma vibratória, composto por 10 sessões, de 45 minutos cada. Na avaliação final, os resultados indicaram um aumento da pontuação na EEB (avaliação inicial = 41 pontos e avaliação final = 51 pontos) e uma redução no tempo de execução do TUG (avaliação inicial = 14 segundos e avaliação final = 9 segundos) na idosa com sequela de AVE. Com base nesses resultados, é possível concluir que o treinamento proposto foi efetivo para a melhora do equilíbrio e da mobilidade funcional da idosa com sequela de AVE.

RESUMEN La incidencia del accidente cerebrovascular (ACV) aumenta con el envejecimiento, y su consecuencia puede ser las alteraciones sensoriales y motoras, que restringen la capacidad funcional, debido a la reducción del balance y de la movilidad. En la práctica fisioterapéutica para recuperarles a los sujetos el balance y la movilidad, se están utilizando diversos recursos, tales como el entrenamiento sensorial-motor y el entrenamiento con plataforma vibratoria. Este estudio se propone a investigar el efecto de un protocolo de entrenamiento sensorial-motor con plataforma vibratoria en el balance y en la movilidad funcional de una persona mayor con secuela del ACV. Participó del estudio una persona mayor, mujer, con 72 años de edad y con secuela del ACV. Se realizó la evaluación del balance mediante la Escala de Equilibrio de Berg (EEB) y la evaluación de la movilidad a través del test Timed Up and Go (TUG). Las variables dependientes para análisis fueron: la puntuación obtenida en la EEB y el tiempo de ejecución del TUG. Tras la evaluación inicial, la participante realizó un protocolo de entrenamiento sensorial-motor con plataforma vibratoria, compuesto de 10 sesiones, de 45 minutos cada una. En la evaluación final, los resultados de la participante señalaron un aumento de la puntuación en la EEB (evaluación inicial = 41 puntos y evaluación final = 51 puntos) y una reducción en el tiempo de ejecución del TUG (evaluación inicial = 14 segundos y evaluación final = 9 segundos). Según estos resultados, se concluye que el entrenamiento propuesto produjo efecto en la mejora del balance y de la movilidad funcional de la participante con secuela del ACV.

ABSTRACT The incidence of cerebrovascular accident (CVA) increases with aging and can result in sensory and motor changes, which limit functional capacity due to the reduction in balance and mobility. Different resources are being used by physical therapists in their practice to recover balance and mobility, such as sensorimotor training and training with a vibrating platform. The objective of this study was to investigate the effect of a sensorimotor training protocol with vibrating platform on the balance and functional mobility of an older adult with CVA sequela. An older adult, of the female sex, aged 72 years and with CVA sequela participated in this study. The assessment of balance was performed through the Berg Balance Scale (BBS) and the assessment of mobility through the Timed Up and Go Test (TUG). The dependent variables for monitoring were: score obtained through BBS and execution time of TUG. After the initial assessment, the older adult went through a sensorimotor training protocol with a vibration platform, comprised of 10 sessions of 45 minutes. With the final assessment, the results showed an increase in the scores of BBS (initial assessment = 41 points; final assessment = 51 points) and a reduction in the execution time of TUG (initial assessment = 14 seconds; final assessment = 9 seconds) in the older adult with CVA sequela. Based on these results, we can conclude that the proposed training was effective for the improvement of balance and functional mobility of the older adult with CVA sequela.