Virtual reality as a telerehabilitation strategy for people with autism spectrum disorder during the COVID-19 quarantine scenario: physical activity, motor performance and enjoyment.

PURPOSE: People with autism spectrum disorder could benefit from physical activity during the pandemic and COVID-19 restrictions, mainly to maintain adequate physical activity. We aimed to evaluate the feasibility, enjoyment, and potential effect of telerehabilitation using a serious game named 'MoveHero'. MATERIALS AND METHODS: Registered in Clinical Trials (NCT04402034). We adopted a remotely run Telerehabilitation research design with 44 participants recruited: 22 People with ASD people and 22 non-ASD individuals. RESULTS: All participants safely participated, 100% adherence to sessions, ∼60% enjoying the task, and significantly improved performance, with better performance for the NA group at most practice moments. CONCLUSIONS: Our findings support both how to implement a gaming intervention and the need to investigate the efficacy of serious games to motivate moderate intensity physical activity in people with ASD.

A new and thrilling way to promote physical activity is through telerehabilitation to people with Autism Spectrum Disorder.A tool that can possibly influence the mood of people with Autism Spectrum Disorder.Help to implement home-based rehabilitation to people with Autism Spectrum Disorder.

Gait Training with Functional Electrical Stimulation Improves Mobility in People Post-Stroke.

(1) Background: Stroke is one of the leading causes of disability. To identify the best treatment strategies for people with stroke (PwS), the aim of the current study was to compare the effects of training on a treadmill with functional electrical stimulation (TT-FES) with training on a treadmill (TT), and to analyze the effects of sequence of training on mobility and the parameters of walking ability. (2) Methods: Prospective, longitudinal, randomized and crossover study, in which 28 PwS were distributed into groups, namely the A-B Group (TT-FES followed by TT) and B-A Group (TT followed by TT-FES), using the foot drop stimulator, and were measured with functional tests. (3) Results: We found improved mobility, balance, non-paretic limb coordination, and endurance only in the group that started with TT-FES. However, sensorimotor function improved regardless of the order of training, and paretic limb coordination only improved in the B-A Group, but after TT-FES. These data indicate that the order of the protocols changed the results. (4) Conclusions: Although biomechanical evaluation methods were not used, which can be considered a limitation, our results showed that TT-FES was superior to isolated training on a treadmill with regard to balance, endurance capacity, and coordination of the non-paretic limb.

Cardiac autonomic modulation in response to postural transition during a virtual reality task in individuals with spinal cord injury: A cross-sectional study.

PURPOSE: The postural transition from sitting to standing is a moment of dysautonomic occurrence in individuals with Spinal Cord Injury (SCI). Different tools can be used to minimize this event, such as virtual reality. Thus, we aimed to analyze cardiac autonomic modulation in individuals with SCI during postural transition from the sitting to orthostatism position using a cognitive virtual reality (VR) task. METHODS: Individuals with and without SCI were positioned on the Easy Stand® device, sitting at rest, at 0° considering the angle between the seat and the floor, elevation at 45°, and orthostatism at 90°, for 5 minutes in each position. Heart rate variability (HRV) measures of sympathovagal balance were collected (heart rate receiver: Polar V800). The groups were subdivided into two groups, one that performed VR as an intervention during the postural angle changes and another group that did not perform VR. RESULTS: We evaluated 76 individuals, 40 with a medical diagnosis of SCI and 36 who composed the able-bodied control group without SCI, matched by age and sex. The HRV results showed that the SCI group who performed the task in VR demonstrated no significant difference in parasympathetic activation and global variability between the sitting versus 90° positions. There was better sympathovagal balance in SCI and able-bodied control groups who performed the VR task between the sitting versus 90° positions. CONCLUSION: The use of a VR task seems to contribute to better sympathovagal balance, with the potential to reduce dysautonomia during postural changes.

The use of serial casting in the treatment of children with cerebral palsy: a study protocol

Introduction: Cerebral Palsy (CP) is characterized by a disorder of posture and movement, commonly leading to disabling orthopedic alterations, including muscle shortening, especially in the lower limbs. Stretching methods, performed gradually, are necessary to delay the impairment in function from muscle shortening. The use of serial casting aims to promote proper alignment, and an ideal and stable support base, in addition to better bone and joint health, leading to better posture, mobility, muscle function, and, subsequently, increased fitness and health.Objective: evaluate range of motion, postural control, and motor performance in children with CP, using serial casting, as well as to measure its effect on fitness through the autonomic nervous system (ANS).Methods: Sixty children and adolescents with CP, of both sexes, 3 to 12 years of age, will be divided into three groups: Groups A, B, and C, with 20 individuals each. Group A will use serial casting, Group B will use the orthosis continuously (with removal only allowed for bathing), and Group C will use the orthosis in their daily routine. Range of motion of the ankle of first and second resistance levels (R1 and R2), gross motor function measure (GMFM), and balance (measured by BERG scale) will be used in the initial and final assessments, and after 6 months and one year of follow-up. Timed-up-and-go (TUG), load distribution (baropodometry), motor performance measured through a real basketball game and the virtual MoveHero game, analysis of body angulation with "mydartfish", and cardiac autonomic modulation through heart rate variability will be assessed in three different situations: barefoot, with orthosis, and with casting.Conclusion: Serial casting demonstrates the potential to produce positive results in the treatment of individuals with CP regarding better alignment, with consequent motor and autonomic improvement.

Can Individuals Poststroke Improve Their Performance in Reaction and Movement Times in a Nonimmersive Serious Game with Practice? A Cross-Sectional Study.

Objective: To verify if individuals' poststroke and healthy controls would improve their performance in reaction and movement times practicing a serious game task using the upper limb movements. Materials and Methods: We evaluated 30 individuals poststroke and 30 healthy controls, matched for age and sex. We used the "Association Game for Rehabilitation" (AGaR) where participants played by matching a pair of images whose meanings were similar. Hand movements were captured by a Kinect system and poststroke participants used their nonparetic upper limb. Reaction time and movement times (time to select an image and movement time to the target) were measured. Data were analyzed using multiple analysis of variance. Results: Performance improved for both groups across all variables with better performance in movement times than reaction time only for poststroke individuals. Conclusions: Upper limb movements using nonimmersive serious games enhanced motor performance in reaction and movement times for healthy controls and individuals poststroke. ReBEC Trial Registration: RBR-4m4pk; Registeted on 08/24/2018.

Motor learning in visual impaired individuals during a coincident timing task in a non-immersive virtual reality / Aprendizagem motora em indivíduos com deficiência visual em uma tarefa de timing coincident em realidade virtual não imersiva

Introduction: virtual reality (VR) is used nowadays as an assessment and intervention tool in rehabilitation. One of the skills that can be assessed through VR is coincident timing (perceptual-motor ability to execute a motor response in synchrony with an external stimulus). Visually impaired (VI) people require this synchronization of movements with external objects in their daily and leisure activities. Objective: to investigate the performance of VI individuals in a VR coincident timing task. Methods: sixty individuals over 18 years of age participated in this study: 20 with VI, 20 without VI but blindfolded and 20 individuals without VI that used visual feedback (without blindfold). A semi-structured interview and a virtual coincident timing task were used. Results: although VI individuals started the task with the worst performance (Absolute error = VI group 945ms x blindfolded group 591ms x without blindfold group, 557ms), they improved performance throughout the task, as did the other groups, reducing the number of errors (mean absolute error= 698ms to 408ms). Furthermore, all groups presented increased task speed (mean variable error= last acquisition block 408ms x immediate transfer 227ms x late transfer 247ms). Conclusion: individuals with VI had difficulties at the beginning of the proposed task, but with practice they were able to adapt to the task with an improved of performance (observed by the decrease in error time). The auditory feedback was sufficient to allow adaptation to the task which improved participant performance with VI.

Introdução: A realidade virtual (RV) é usada atualmente como ferramenta de avaliação e intervenção na reabilitação. Uma das tarefas motoras possíveis de verificar desempenho por meio da RV é o timing coincidente (habilidade perceptivo-motora de executar uma resposta motora em sincronia com um estímulo externo). Essa sincronização de movimentos com estímulos externos é importante para pessoas com deficiência visual (DV) nas tarefas diárias e de lazer.Objetivo: Investigar o desempenho de indivíduos com DV em uma tarefa de timing coincident em RV não imersiva.Método: Participaram deste estudo 60 indivíduos maiores de 18 anos: 20 com DV, 20 sem DV mas vendados e 20 indivíduos sem DV que utilizaram feedback visual (não vendado). Foi utilizada entrevista semiestruturada e uma tarefa de timing coincident no computador. Resultados: O grupo DV iniciou a tarefa com o pior desempenho (erro absoluto = grupo DV 945ms x grupo vendado 591ms x grupo não vendado 557ms), mas melhoraram ao longo da tarefa. Apesar da dificuldade inicial do grupo com DV, todos os grupos reduziram o número de erros (erro absoluto médio = 698ms para 408ms). Além disso, todos os grupos aumentaram a precisão da tarefa (erro variável médio = último bloco de aquisição 408 ms x transferência imediata 227 ms x transferência tardia 247 ms).Conclusão: Indivíduos com DV apresentaram dificuldades no início da tarefa proposta mas com a prática conseguiram se adaptar a tarefa com melhora no desempenho (observado pela diminuição no tempo de erro). Ou seja, o feedback auditivo foi suficiente para possibilitar adaptação à tarefa e melhora de desempenho dos participantes com DV.

Autonomic modulation at rest and in response to postural change in adolescents with Duchenne muscular dystrophy: a cross-sectional study.

BACKGROUND: Analysis of autonomic modulation after postural change may inform the prognosis and guide treatment in different populations. However, this has been insufficiently explored among adolescents with Duchenne muscular dystrophy (DMD). OBJECTIVE: To investigate autonomic modulation at rest and in response to an active sitting test (AST) among adolescents with DMD. METHODS: Fifty-nine adolescents were included in the study and divided into two groups: 1) DMD group: adolescents diagnosed with DMD; 2) control group (CG): healthy adolescents. Participants' weight and height were assessed. Lower limb function, motor limitations and functional abilities of the participants in the DMD group were classified using the Vignos scale, Egen classification and motor function measurement, respectively. The following variables were assessed before, during and after AST: systolic blood pressure (SBP), diastolic blood pressure (DBP), respiratory rate (f), oxygen saturation and heart rate (HR). To analyze the autonomic modulation, the HR was recorded beat-by-beat. Heart rate variability (HRV) indices were calculated in the time and frequency domains. RESULTS: Differences in relation to groups were observed for all HRV indices, except LF/HF, oxygen saturation, HR and f (p < 0.05). Differences in relation to time and the interaction effect between group and time were observed for RMSSD, SD1, SD2, SD1/SD2, LFms2 and LFnu, HFun, SBP and DBP (p < 0.05). Differences in relation to time were also observed for the indice SDNN, FC and f (p < 0.05). CONCLUSIONS: Performing the AST promoted reduced autonomic modulation and increased SBP, DBP and HR in adolescents with DMD.

Autonomic modulation at rest and in response to postural change in adolescents with Duchenne muscular dystrophy: a cross-sectional study / Modulação autonômica em repouso e em resposta a mudanças posturais em adolescentes com distrofia muscular de Duchenne: um estudo transversal

ABSTRACT Background: Analysis of autonomic modulation after postural change may inform the prognosis and guide treatment in different populations. However, this has been insufficiently explored among adolescents with Duchenne muscular dystrophy (DMD). Objective: To investigate autonomic modulation at rest and in response to an active sitting test (AST) among adolescents with DMD. Methods: Fifty-nine adolescents were included in the study and divided into two groups: 1) DMD group: adolescents diagnosed with DMD; 2) control group (CG): healthy adolescents. Participants' weight and height were assessed. Lower limb function, motor limitations and functional abilities of the participants in the DMD group were classified using the Vignos scale, Egen classification and motor function measurement, respectively. The following variables were assessed before, during and after AST: systolic blood pressure (SBP), diastolic blood pressure (DBP), respiratory rate (f), oxygen saturation and heart rate (HR). To analyze the autonomic modulation, the HR was recorded beat-by-beat. Heart rate variability (HRV) indices were calculated in the time and frequency domains. Results: Differences in relation to groups were observed for all HRV indices, except LF/HF, oxygen saturation, HR and f (p < 0.05). Differences in relation to time and the interaction effect between group and time were observed for RMSSD, SD1, SD2, SD1/SD2, LFms2 and LFnu, HFun, SBP and DBP (p < 0.05). Differences in relation to time were also observed for the indice SDNN, FC and f (p < 0.05). Conclusions: Performing the AST promoted reduced autonomic modulation and increased SBP, DBP and HR in adolescents with DMD.

Resumo Antecedentes: A análise da modulação autonômica após mudanças posturais pode gerar informações prognósticas e orientar o tratamento em diferentes populações. Porém, isso não foi suficientemente explorado em adolescentes com DMD. Objetivo: Investigar a modulação autonômica em repouso e em resposta ao teste ativo sentado (TAS) em adolescentes com DMD. Métodos: 59 adolescentes foram incluídos no estudo e divididos em dois grupos: 1) Grupo DMD: adolescentes com diagnóstico de DMD; 2) Grupo controle: adolescentes saudáveis. O peso e a altura dos participantes foram avaliados. No grupo DMD, a funcionalidade de membros superiores, limitações motoras, e habilidades funcionais foram classificadas pela escala de Vignos, Egen Klassification, e motor function measure respectivamente. Pressão arterial sistólica (PAS), pressão arterial diastólica (PAD), frequência respiratória (f), saturação de oxigênio, e frequência cardíaca (FC) foram avaliadas em repouso, durante e após o TAS. Para analisar a modulação autonômica, a FC foi registrada batimento a batimento. Os índices de variabilidade da frequência cardíaca (VFC) foram calculados nos domínios do tempo e da frequência. Resultados: Diferenças entre os grupos foram observadas para todos os índices da VFC, exceto LF/HF, saturação de oxigênio, FC e f (p<0,05). Diferenças em relação ao tempo e interação entre grupo e tempo foram observadas para RMSSD, SD1, SD2, SD1/SD2, LFms2, LFun, HFnu, SBP e DBP (p<0,05). Diferenças em relação ao tempo foram também observadas para o índice SDNN, FC e f (p<0,05). Conclusões: A realização do TAS promoveu redução da modulação autonômica e aumento da PAS, PAD e FC em adolescentes com DMD.

Análise da velocidade e acurácia de movimentos em indivíduos após acidente vascular encefálico / Speed and accuracy of movement in individuals after stroke

The Stroke might cause alterations in movement control due to the sequels of this process. Objective: Analyze the speed-accuracy trade-off of upper limb movement in individuals with sequels of Stroke through a computer software. Method: It is about a cross-sectional study, the sample was composed of 46 individuals divided into two groups: individuals post-stroke, between the ages of 35 and 83 years old, in which 10 were women and 14 were men; and 22 healthy controls aligned by age and sex, in which 8 were women and 14 were men, evaluated through the instruments: Mini mental state examination, Orpington prognostic scale, Fugl-Meyer Assessment Scale, dynamometer, box of blocks and throught the software "Fitts Reciprocal Aiming Task v.2.0. (Horizontal)", that seeks to understand the motor control of the upper limb, verifying the speed and accuracy of movement through a computer task. Results: The individuals with sequels of Stroke showed a loss in the strength of the palmar grip and manual function. Besides, they showed a longer time in movement in all index of difficulty compared to Control group. However, they showed a similar behaviour to the healthy individuals throughout the execution of the index of difficulty. Conclusion: Thus, it can be concluded that the individuals with sequels of Stroke showed a deficit of the motor control of the upper limb, compared to the healthy individuals, however, these showed the same behavior, with a bigger deficit in the accuracy of movement

The Stroke might cause alterations in movement control due to the sequels of this process. Objective: Analyze the speed-accuracy trade-off of upper limb movement in individuals with sequels of Stroke through a computer software. Method: It is about a cross-sectional study, the sample was composed of 46 individuals divided into two groups: individuals post-stroke, between the ages of 35 and 83 years old, in which 10 were women and 14 were men; and 22 healthy controls aligned by age and sex, in which 8 were women and 14 were men, evaluated through the instruments: Mini mental state examination, Orpington prognostic scale, Fugl-Meyer Assessment Scale, dynamometer, box of blocks and throught the software "Fitts Reciprocal Aiming Task v.2.0. (Horizontal)", that seeks to understand the motor control of the upper limb, verifying the speed and accuracy of movement through a computer task. Results: The individuals with sequels of Stroke showed a loss in the strength of the palmar grip and manual function. Besides, they showed a longer time in movement in all index of difficulty compared to Control group. However, they showed a similar behaviour to the healthy individuals throughout the execution of the index of difficulty. Conclusion: Thus, it can be concluded that the individuals with sequels of Stroke showed a deficit of the motor control of the upper limb, compared to the healthy individuals, however, these showed the same behavior, with a bigger deficit in the accuracy of movement

Motor learning and transfer between real and virtual environments in young people with autism spectrum disorder: A prospective randomized cross over controlled trial.

Autism spectrum disorder (ASD) is associated with persistent deficits in social communication and social interaction, including impaired multisensory integration, which might negatively impact cognitive and motor skill performance, and hence negatively affect learning of tasks. Considering that tasks in virtual environment may provide an engaging tool as adjuncts to conventional therapies, we set out to compare motor performance between young people with ASD and a typically developing (TD) control group that underwent coincident timing tasks based on Kinect (no physical contact) and on Keyboard (with physical contact) environments. Using a randomized repeated cross-over controlled trial design, 50 young people with ASD and 50 with TD, matched by age and sex were divided into subgroups of 25 people that performed the two first phases of the study (acquisition and retention) on the same device-real or virtual-and then switched to the other device to repeat acquisition and retention phases and finally switched on to a touch screen (transfer phase). Results showed that practice in the virtual task was more difficult (producing more errors), but led to a better performance in the subsequent practice in the real task, with more pronounced improvement in the ASD as compared to the TD group. It can be concluded that the ASD group managed to transfer the practice from a virtual to a real environment, indicating that virtual methods may enhance learning of motor and cognitive skills. A need for further exploration of its effect across a number of tasks and activities is warranted. Autism Res 2020, 13: 307-319. © 2019 International Society for Autism Research, Wiley Periodicals, Inc. LAY SUMMARY: Individuals with autism spectrum disorder are known to have difficulties with learning motor tasks. Considering that performing motor tasks in virtual environment may be an engaging tool as adjuncts to conventional therapies, we aimed to estimate performance in tasks regardless of physical touch. Results showed that participants had more difficulty using the non-touch task; however, virtual training improved performance on the physical (real) task. This result indicates that virtual methods could be a promising therapeutic approach for the ASD population.

Systematic Review of the Main Motor Scales for Clinical Assessment of Individuals with down Syndrome.

Objective: The aim of the present review was to identify the motor scales currently used to assess individuals with Down Syndrome (DS).Method: PubMed, WOS and BVS databases were systematically searched to identify the most relevant published studies that used motor scales in the evaluation of individuals with DS.Results: Of the 99 studies that met the eligibility criteria in this process, 20 experimental and observational studies were found to fully meet the eligibility criteria.Conclusion: We identified several motor scales including the Alberta Infant Motor Scale (AIMS), Test of Infant Motor Performance (TIMP), BAYLEY, Peabody Gross Motor Scale (PGMS-PDMS-GM), Gross Motor Function Measure (GMFM), Movement Assessment Battery for Children (MABC) and Pediatric Evaluation of Disability Inventory (PEDI).

Motor learning from virtual reality to natural environments in individuals with Duchenne muscular dystrophy.

PURPOSE: To examine whether performance improvements in the virtual environment generalize to the natural environment. STUDY DESIGN: we had 64 individuals, 32 of which were individuals with DMD and 32 were typically developing individuals. METHODS: The groups practiced two coincidence timing tasks. In the more tangible button-press task, the individuals were required to 'intercept' a falling virtual object at the moment it reached the interception point by pressing a key on the computer. In the more abstract task, they were instructed to 'intercept' the virtual object by making a hand movement in a virtual environment using a webcam. RESULTS AND CONCLUSIONS: For individuals with DMD, conducting a coincidence timing task in a virtual environment facilitated transfer to the real environment. However, we emphasize that a task practiced in a virtual environment should have higher rates of difficulties than a task practiced in a real environment. IMPLICATIONS FOR REHABILITATION Virtual environments can be used to promote improved performance in ?real-world? environments. Virtual environments offer the opportunity to create paradigms similar ?real-life? tasks, however task complexity and difficulty levels can be manipulated, graded and enhanced to increase likelihood of success in transfer of learning and performance. Individuals with DMD, in particular, showed immediate performance benefits after using virtual reality.

A didactic approach to presenting verbal and visual information to children participating in research protocols: the comic book informed assent.

OBJECTIVE: When children participate in research protocols, consent (by a parent or legal guardian) and assent (by the children) must be given. Understanding research protocols can be challenging for an adult and even more difficult for a child. The aim of this study was to describe the development of a comic book created to facilitate children's understanding of informed assent with clear and simple language. METHODS: Five researchers with scores above seven according to the Fehring criteria developed the comic book, avoiding the use of technical terminology. Twenty children between 7 and 12 years old, and enrolled in a larger study, responded using a Likert scale and questions about the clarity of texts and illustrations. The final version met National Health System Resolutions (Resoluções do Conselho Nacional da Saúde - CNS n° 196/1996 and 466/2012). RESULTS: The comic book assent presents a short story containing information about a real study: the invitation to participate, objectives, methods, instruments, procedures, risks, benefits, and the researchers' contact information. Most of the participants answered that they perceived the content of the text to be "Excellent" (40%) and "Very good" (40%), and the illustrations were perceived as "Excellent" (45%) and "Very good" (55%). CONCLUSION: The construction of a simple and clear model of informed assent is possible, and this model should be used in experiments with children.

Heart rate variability in individuals with Down syndrome - A systematic review and meta-analysis.

INTRODUCTION: Down syndrome (DS) results in many changes, including dysfunction in cardiac autonomic modulation. Heart rate variability (HRV) analysis evaluates the autonomic function and it is a predictor of adverse cardiovascular events. OBJECTIVE: To present results of a systematic review and a meta-analysis about heart rate variability in individuals with DS. METHOD: A systematic review was performed on PubMed, PubMed Central and Web of science databases. We included articles that exhibited all the terms: "Down Syndrome", "heart rate variability", "autonomic nervous system", "autonomic dysfunction" and "cardiac autonomic modulation". We conducted the meta-analysis to compare "DS" to "controls" during rest. Random effects models were used, as were appropriate tests for heterogeneity. RESULTS: From 271 studies, 13 were included in our review. These are conducted with volunteers from a wide age range, of either gender, and not taking medications. Meta-analysis displayed that there were no significant differences between the groups at rest, except the RMSSD, which revealed a significant (Z = -2.80, p = 0.005) main effect (Hedge's g = -0.55, 95% CI [-0.93; -0.16]), indicating difference in individuals with DS compared with controls. CONCLUSION: There is autonomic dysfunction in individuals with DS, which may or may not be expressed at rest, but it is usually demonstrated in an autonomic task. Meta-analysis specified that there was no significant alteration between DS and the controls during rest, except RMSSD index which was lower in DS than controls. PROSPERO: CRD42017068647.

Achievement of Virtual and Real Objects Using a Short-Term Motor Learning Protocol in People with Duchenne Muscular Dystrophy: A Crossover Randomized Controlled Trial.

OBJECTIVE: To evaluate whether people with Duchenne muscular dystrophy (DMD) practicing a task in a virtual environment could improve performance given a similar task in a real environment, as well as distinguishing whether there is transference between performing the practice in virtual environment and then a real environment and vice versa. METHODS: Twenty-two people with DMD were evaluated and divided into two groups. The goal was to reach out and touch a red cube. Group A began with the real task and had to touch a real object, and Group B began with the virtual task and had to reach a virtual object using the Kinect system. RESULTS: ANOVA showed that all participants decreased the movement time from the first (M = 973 ms) to the last block of acquisition (M = 783 ms) in both virtual and real tasks and motor learning could be inferred by the short-term retention and transfer task (with increasing distance of the target). However, the evaluation of task performance demonstrated that the virtual task provided an inferior performance when compared to the real task in all phases of the study, and there was no effect for sequence. CONCLUSIONS: Both virtual and real tasks promoted improvement of performance in the acquisition phase, short-term retention, and transfer. However, there was no transference of learning between environments. In conclusion, it is recommended that the use of virtual environments for individuals with DMD needs to be considered carefully.

Influence of severity of traumatic brain injury at hospital admission on clinical outcomes / Influência da gravidade do traumatismo cranioencefálico na admissão hospitalar na evolução clínica / Influencia de la gravedad del traumatismo craneoencefálico en la admisión hospitalaria en la evolución clínica

ABSTRACT Traumatic brain injury (TBI) is a public health problem with high mortality and socioeconomic repercussions. We aimed to investigate the influence of TBI severity on the length of mechanical ventilation (MV) stay and length of hospital stay and on the prevalence of tracheostomy, pneumonia, neurosurgery and death. This retrospective, observational study evaluated medical records of 67 patients with TBI admitted to Irmandade da Santa Casa de Misericórdia de São Paulo. Severity was determined according to the Glasgow Coma Scale (GCS): mild (13-15 points; 36 patients; 53.7%), moderate (9-12 points; 14 patients; 20.9%) or severe (3-8 points; 17 patients; 25.4%). Severe TBI patients had higher prevalence of tracheostomy, pneumonia and neurosurgery. No significant differences were observed between TBI severity, mortality and length of MV stay. However, TBI severity influenced the length of hospital stay. TBI severity at admission, evaluated according to the GCS, influenced the prevalence of tracheostomy, pneumonia, neurosurgery and was associated to prolonged hospital stay.

RESUMO O traumatismo cranioencefálico (TCE) é um problema de saúde pública com muitos casos de mortalidade e repercussões socioeconômicas. Este estudo visa investigar a influência da gravidade do TCE no tempo de ventilação mecânica (VM) e hospitalização, e na prevalência de casos de traqueostomia, pneumonia, neurocirurgia e morte. É um estudo retrospectivo e observacional, que avaliou prontuários de 67 pacientes com TCE na Irmandade Santa Casa de Misericórdia de São Paulo. A gravidade foi avaliada pela escala de Glasgow (ECG): leve (13-15 pontos; 36 pacientes; 53.7%); moderado (9-12 pontos; 14 pacientes; 20.9%); ou grave (3-8 pontos; 17 pacientes; 25.4%). Pacientes com TCE grave apresentaram maior prevalência de traqueostomia, pneumonia e neurocirurgia. Não houve diferença significativa entre gravidade do TCE, óbito e tempo em VM, apesar de a gravidade do TCE ter influenciado o tempo de hospitalização. A gravidade do TCE na admissão, avaliada pela ECG, influenciou a prevalência de traqueostomia, pneumonia, neurocirurgia e de maiores tempos de internação.

RESUMEN El traumatismo craneoencefálico (TCE) es un problema de salud pública con alta mortalidad y repercusiones socioeconómicas. Este estudio ha tenido el objetivo de investigar la influencia de la gravedad del TCE en el tiempo de ventilación mecánica (VM) y de hospitalización y en la prevalencia de traqueotomía, neumonía, neurocirugía y mortalidad. Este estudio retrospectivo, observacional ha evaluado historias clínicas de 67 pacientes con TCE admitidos en Irmandade Santa Casa de Misericórdia de São Paulo. La gravedad ha sido evaluada por la escala de Glasgow (ECG): leve (13-15 puntos; 36 pacientes; el 53,7%), moderado (9-12 puntos; 14 pacientes; el 20,9%) o grave (3-8 puntos; 17 pacientes; el 25,4%). Pacientes con TCE grave han presentado prevalencia más grande de traqueotomía, neumonía y neurocirugía. No ha habido diferencia significativa entre la gravedad del TCE, la mortalidad y el tiempo en VM; mientras tanto, la gravedad del TCE ha influenciado el tiempo de hospitalización. La gravedad del TCE en la admisión, que ha sido evaluada por la ECG, ha influenciado la prevalencia de traqueotomía, neumonía, neurocirugía y ha sido asociada la internación prolongada.

Functional performance comparison between real and virtual tasks in older adults: A cross-sectional study.

INTRODUCTION: Ageing is usually accompanied by deterioration of physical abilities, such as muscular strength, sensory sensitivity, and functional capacity, making chronic diseases, and the well-being of older adults new challenges to global public health. OBJECTIVE: The purpose of this study was to evaluate whether a task practiced in a virtual environment could promote better performance and enable transfer to the same task in a real environment. METHOD: The study evaluated 65 older adults of both genders, aged 60 to 82 years (M = 69.6, SD = 6.3). A timing coincident task was applied to measure the perceptual-motor ability to perform a motor response. The participants were divided into 2 groups: started in a real interface and started in a virtual interface. RESULTS: All subjects improved their performance during the practice, but improvement was not observed for the real interface, as the participants were near maximum performance from the beginning of the task. However, there was no transfer of performance from the virtual to real environment or vice versa. CONCLUSIONS: The virtual environment was shown to provide improvement of performance with a short-term motor learning protocol in a timing coincident task. This result suggests that the practice of tasks in a virtual environment seems to be a promising tool for the assessment and training of healthy older adults, even though there was no transfer of performance to a real environment. TRIAL REGISTRATION: ISRCTN02960165. Registered 8 November 2016.

A didactic approach to presenting verbal and visual information to children participating in research protocols: the comic book informed assent

OBJECTIVE: When children participate in research protocols, consent (by a parent or legal guardian) and assent (by the children) must be given. Understanding research protocols can be challenging for an adult and even more difficult for a child. The aim of this study was to describe the development of a comic book created to facilitate children's understanding of informed assent with clear and simple language. METHODS: Five researchers with scores above seven according to the Fehring criteria developed the comic book, avoiding the use of technical terminology. Twenty children between 7 and 12 years old, and enrolled in a larger study, responded using a Likert scale and questions about the clarity of texts and illustrations. The final version met National Health System Resolutions (Resoluções do Conselho Nacional da Saúde - CNS n° 196/1996 and 466/2012). RESULTS: The comic book assent presents a short story containing information about a real study: the invitation to participate, objectives, methods, instruments, procedures, risks, benefits, and the researchers' contact information. Most of the participants answered that they perceived the content of the text to be "Excellent" (40%) and "Very good" (40%), and the illustrations were perceived as "Excellent" (45%) and "Very good" (55%). CONCLUSION: The construction of a simple and clear model of informed assent is possible, and this model should be used in experiments with children.