Neuro rehabilitation effectiveness based on virtual reality and tele rehabilitation in people with multiple sclerosis in Argentina: Reavitelem study.

Virtual Reality (VR) has emerged as a new treatment approach in neurorehabilitation (NR). REAVITELEM Study is a specific NR intervention program based on VR at center (VRC) and tele-rehabilitation (TR) in Argentina. Methods First national multicenter study with a 12-week program intervention of VRC and TR. Participants were assessed at baseline, at 6th and 12th week. Phase I: recruitment and gather of 5 NR Centers from Argentina by the coordinator center (INEBA) to unify evaluation and intervention criteria. Phase II, all centers completed VRC an TR programs. Intervention was 30-minute session, twice a week for 12 weeks. Outcome measures: Expanded Disability Status Scale (EDSS), Fist and Key Pinch Dynamometry, Beck Depression Inventory-Fast Screen, Fatigue Severity Scale, Functional Independence Measure (FIM), International Questionnaire investigating Quality of life in MS (MusiQol) and a Visual Analogue Scale (VAS) of satisfaction after treatment. Results A total of 54 PWMS (23 males) were recruited for VRC. Afterwards, 14 completed TR. The mean age for VRC was 44.72 (SD ± 13.74) and 41.71 (SD ± 10.5) for TR. The median EDSS was 4, 75 for VR. At VRC, 42 have RRMS, 8 have SPMS and 4 PPMS. At TR, 13 have RRMS and 1 have SPMS. The VAS reported an excellent level of satisfaction after treatment with an average of 9, 02 (SD±1.35) in VRC and 9.42 (SD±0.66) in TR. There were significant differences for MusiQol, which improved from baseline to the post-intervention assessment at VRC (p=<0.001) and at TR (p = 0.004) as well as FIM post-intervention assessment at VCR (p = 0.02) and TR (p = 0.04). Conclusion this study suggest that the NR treatment based on VR in MS in Argentina, is an additional effective tool, which favors improvements in the level of functioning in activities of daily living, quality of life, mood, and satisfaction with the treatment.

Post-stroke rehabilitation of the ankle joint with a low cost monoarticular ankle robotic exoskeleton: Preliminary results.

Introduction: Stroke generates a high rate of disability and, in particular, ankle spasticity is a sequelae that interferes with the execution of daily activities. Robotic devices have been proposed to offer rehabilitation treatments to recover control of ankle muscles and hence to improve gait function. Objective: The aim of this study is to investigate the effects of passive stretching, combined with active and resisted movement, accompanied by visual feedback, by means of playful interactive software using a low-cost monoarticular robot (MEXO) in patients with stroke sequelae and spastic ankle. Methods: An open, uncontrolled, non-randomised, quasi-experimental study of 6 weeks duration has been completed. A protocol has been defined to determine the usability, safety and potential benefits of supplementary treatment with the MEXO interactive system in a group of patients. Nine volunteer patients with sequelae of stroke who met the inclusion criteria were included. They received conventional treatment and in addition also received treatment with the MEXO monoarticular robot three times a week during 6 weeks. Each session consisted of 10 min of passive stretching followed by 20 min of active movement training with visual feedback (10 min active without resistance, 10 min with resistance) and a final phase with 10 min of passive stretching. The following variables were measured pre- and post-treatment: joint range of motion and ankle muscle strength, monopodal balance, muscle tone, gait ability and satisfaction with the use of assistive technology. Results: Statistically significant improvements were obtained in joint range measured by goniometry and in balance measured by monopodal balance test. Also in walking capacity, through the measurement of travelled distance. Discussion and significance: Device usability and patient safety were tested. Patients improved joint range and monopodal balance. The MEXO exoskeleton might be a good alternative for the treatment of spastic ankle joint in people with a stroke sequela.