Combined virtual reality and physical training improved the bimanual coordination of women with multiple sclerosis.
TL;DR: The combination of virtual reality training and conventional physical training with COMB appears to have the potential to speed up the recovery of motor control and rehabilitation of women with MS.
Abstract: As their illness progresses, patients with Multiple Sclerosis (MS) may suffer from motor impairments. In the present study, we examined the effectiveness of three interventions for learning a bimanual coordination task: Virtual reality training (VRT), conventional physical training (CPT), and the combination of VRT and CPT (COMB). A total of 45 women with MS were randomly assigned to one of the following study conditions: VRT, CPT or COMB. Bimanual coordination was assessed at baseline, eight weeks later at study completion, and 4 weeks after that at follow-up. Bimanual coordination improved over time from baseline to study completion and to follow-up. Compared to the VRT and CPT conditions, the COMB condition led to higher coordination accuracy and consistency. The combination thus appears to have the potential to speed up the recovery of motor control and rehabilitation of women with MS.
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TL;DR: There is some evidence that VR is effective in improving motor function in the UL, however, there is no clear consensus on which VR based approaches are the most effective, or the optimum intervention duration and intensity.
Abstract: Background Research on Virtual Reality (VR) based motor rehabilitation for people with multiple sclerosis (MS) is rapidly growing in popularity, although few studies have focused on the upper limb (UL). The aims of this review were to investigate the effect of VR interventions on UL function in people with MS and determine if the type of VR intervention influences intervention effect. Method Five databases (IEEE Xplore, MEDLINE, ProQuest Central (Health & Medical Collection), Science Direct and Web of Science Core Collection) were searched using keywords that relating to MS, VR and UL. Results Ten articles were included, six randomised controlled trials, three cohort studies and one pilot observational study. Both commercial and custom VR technologies were used in interventions, along with combination approaches using robotics, electrical stimulation and occupational therapy. Using the Nine Hole Peg Test, two studies found significant improvements within groups, one found that VR was more effective than another gaming approach. Significant improvements in other UL measures were in the Fugl-Meyer Assessment for the proximal arm; handgrip; perceived strength; Jebsen-Taylor Hand Function Test; Wolf Motor Function Test; active range of motion and trajectory measures after VR intervention. There were conflicting results regarding if VR was more effective than conventional approaches. Conclusion There is therefore some evidence that VR is effective in improving motor function in the UL, however, there is no clear consensus on which VR based approaches are the most effective, or the optimum intervention duration and intensity. Moreover, as many of the studies had non-immersive approaches it is hard to determine how effective immersion based approaches maybe in such specific context.
22 citations
TL;DR: Leap Motion Controller (LMC) is a virtual reality device that can be used in the rehabilitation of central nervous system disease (CNSD) motor impairments as discussed by the authors, and it has been shown to improve upper extremity (UE) motor function.
Abstract: Leap Motion Controller (LMC) is a virtual reality device that can be used in the rehabilitation of central nervous system disease (CNSD) motor impairments. This review aimed to evaluate the effect of video game-based therapy with LMC on the recovery of upper extremity (UE) motor function in patients with CNSD. A systematic review with meta-analysis was performed in PubMed Medline, Web of Science, Scopus, CINAHL, and PEDro. We included five randomized controlled trials (RCTs) of patients with CNSD in which LMC was used as experimental therapy compared to conventional therapy (CT) to restore UE motor function. Pooled effects were estimated with Cohen's standardized mean difference (SMD) and its 95% confidence interval (95% CI). At first, in patients with stroke, LMC showed low-quality evidence of a large effect on UE mobility (SMD = 0.96; 95% CI = 0.47, 1.45). In combination with CT, LMC showed very low-quality evidence of a large effect on UE mobility (SMD = 1.34; 95% CI = 0.49, 2.19) and the UE mobility-oriented task (SMD = 1.26; 95% CI = 0.42, 2.10). Second, in patients with non-acute CNSD (cerebral palsy, multiple sclerosis, and Parkinson's disease), LMC showed low-quality evidence of a medium effect on grip strength (GS) (SMD = 0.47; 95% CI = 0.03, 0.90) and on gross motor dexterity (GMD) (SMD = 0.73; 95% CI = 0.28, 1.17) in the most affected UE. In combination with CT, LMC showed very low-quality evidence of a high effect in the most affected UE on GMD (SMD = 0.80; 95% CI = 0.06, 1.15) and fine motor dexterity (FMD) (SMD = 0.82; 95% CI = 0.07, 1.57). In stroke, LMC improved UE mobility and UE mobility-oriented tasks, and in non-acute CNSD, LMC improved the GS and GMD of the most affected UE and FMD when it was used with CT.
21 citations
TL;DR: The current evidence for VR interventions to improve ULMF in patients with SCI is limited and future studies employing immersive systems to identify the key aspects that increase the clinical impact of VR interventions are needed.
Abstract: Background: Patients with spinal cord injury (SCI) usually present with different motor impairments, including a deterioration of upper limb motor function (ULMF), that limit their performance of activities of daily living and reduce their quality of life. Virtual reality (VR) is being used in neurological rehabilitation for the assessment and treatment of the physical impairments of this condition.
Objective: A systematic review and meta-analysis was conducted to evaluate the effectiveness of VR on ULMF in patients with SCI compared with conventional physical therapy.
Methods: The search was performed from October to December 2019 in Embase, Web of Science, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Scopus, Medline, Physiotherapy Evidence Database (PEDro), PubMed, and Cochrane Central Register of Controlled Trials. The inclusion criteria of selected studies were as follows: (1) comprised adults with SCI, (2) included an intervention with VR, (3) compared VR intervention with conventional physical therapy, (4) reported outcomes related to ULMF, and (5) was a controlled clinical trial. The Cochrane Collaboration’s tool was used to evaluate the risk of bias. The RevMan 5.3 statistical software was used to obtain the meta-analysis according to the standardized mean difference (SMD) and 95% CIs.
Results: Six articles were included in this systematic review. Four of them contributed information to the meta-analysis. A total of 105 subjects were analyzed. All of the studies used semi-immersive or nonimmersive VR systems. The statistical analysis showed nonsignificant results for the Nine-Hole Peg Test (SMD –0.93, 95% CI –1.95 to 0.09), muscle balance test (SMD –0.27, 95% CI –0.82 to 0.27), Motricity Index (SMD 0.16, 95% CI −0.37 to 0.68), Jebsen-Taylor Hand Function Test (JTHFT) subtests (writing, SMD –0.10, 95% CI –4.01 to 3.82; simulated page turning, SMD –0.99, 95% CI –2.01 to 0.02; simulated feeding, SMD –0.64, 95% CI –1.61 to 0.32; stacking checkers, SMD 0.99, 95% CI –0.02 to 2.00; picking up large light objects, SMD –0.42, 95% CI –1.37 to 0.54; and picking up large heavy objects, SMD 0.52, 95% CI –0.44 to 1.49), range of motion of shoulder abduction/adduction (SMD –0.23, 95% CI –1.48 to 1.03), shoulder flexion/extension (SMD 0.56, 95% CI –1.24 to 2.36), elbow flexion (SMD –0.36, 95% CI –1.14 to 0.42), elbow extension (SMD –0.21, 95% CI –0.99 to 0.57), wrist extension (SMD 1.44, 95% CI –2.19 to 5.06), and elbow supination (SMD –0.18, 95% CI –1.80 to 1.44). Favorable results were found for the JTHFT subtest picking up small common objects (SMD –1.33, 95% CI –2.42 to –0.24).
Conclusions: The current evidence for VR interventions to improve ULMF in patients with SCI is limited. Future studies employing immersive systems to identify the key aspects that increase the clinical impact of VR interventions are needed, as well as research to prove the benefits of the use of VR in the rehabilitation of patients with SCI in the clinical setting.
20 citations
Cites background from "Combined virtual reality and physic..."
...Several studies on the use of VR interventions have been carried out in different neurological disorders, such as stroke [14-17], cerebral palsy [18,19], Parkinson disease [20,21], and multiple sclerosis [22-24]....
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TL;DR: In this paper, a systematic review was conducted to analyze the effectiveness of using new technologies in the rehabilitation of multiple sclerosis patients and discuss their potential role during the COVID-19 pandemic.
Abstract: Background and Objectives: The COVID-19 pandemic required the adoption of new technologies to improve access to healthcare at an unprecedented speed, as social distancing became mandatory. The aim of this systematic review was to analyze the effectiveness of using new technologies in the rehabilitation of multiple sclerosis (MS) patients and discuss their potential role during the COVID-19 pandemic. Material and Methods: The studies were identified by searching two online databases-PUBMED and Web of Science. Combinations of the key words "Multiple sclerosis" and "e-health"; "Multiple sclerosis" and "virtual reality"; "Multiple sclerosis" and "telerehabilitation"; "Multiple sclerosis" and "new technologies"; "Multiple sclerosis" and "tele-exercise" were used to find suitable publications. Results: A total of 17 studies were included. Although the overall number of participants in all the studies was 904, two of the studies were conducted on the same group. Thus, a total of 854 participants were involved in the studies included. All participants were diagnosed with MS. In 10 studies, participants had to be diagnosed according to the McDonald criteria. Of the included studies: five involved intervention at participants' home, six were conducted using Xbox Kinect, and seven studies reported no adverse outcomes. Conclusion: The review proves telerehabilitation to be an effective motivational tool to restore and maintain both physical and cognitive function in patients with MS. Remote communication technologies seem to be measures of high effectiveness in rehabilitating and supporting MS patients especially during the COVID-19 pandemic, as the traditional rehabilitation option is less accessible or in some cases inaccessible for these patients.
16 citations
TL;DR: The results obtained showed that virtual reality may not be more effective than conventional physical therapy in improving functional performance in patients with SCI.
Abstract: A spinal cord injury (SCI) usually results in a significant limitation in the functional outcomes, implying a challenge to the performance of activities of daily living The main aim of this study is to analyze the effectiveness of virtual reality to improve functional performance in patients with SCI The search was performed between October and December 2019 in Cumulative Index to Nursing and Allied Health Literature (CINAHL), Medline, Cochrane Central Register of Controlled Trials, Physiotherapy Evidence Database (PEDro), PubMed, Scopus, Web of Science, and Embase The methodological quality of the studies was evaluated through the PEDro scale, and the risk of bias was evaluated with the Cochrane collaboration’s tool Seven articles were included in this systematic review, and five of them in the meta-analysis Statistical analysis showed favorable results for functional performance in control group performing conventional therapy, measured by the functional independence measure (standardized mean difference (SMD)= −070; 95% confidence interval: −125 to −015) Results were inconclusive for other outcomes Most studies have not shown beneficial effects on functional performance compared with conventional physical therapy The results obtained showed that virtual reality may not be more effective than conventional physical therapy in improving functional performance in patients with SCI
13 citations
References
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TL;DR: The application of positron emis sion tomography (PEM) to the study of panic disorder was discussed in this paper, where a focal brain abnormal ity in panic disorder, a severe form of anxiety, was discussed.
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5,387 citations
"Combined virtual reality and physic..." refers background in this paper
...…Training; COMB: combination of VRT and CPT; AE = Absolute error of relative phase (AEw); SD = Standard deviation of relative phase (SDw); Based on Cohen (1992): [T] = Trivial effect size (0.00–0.19); [S] = Small effect size (0.20–0.49); [M] = Medium effect size (0.50–0.79); [L] = Large effect…...
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Book•
01 Jan 1995
TL;DR: This text bridges the gap between research/theory and practice by focusing on the scientific and experimental basis of new motor control theories by specifically illustrating how recent findings and theories can be applied to clinical practice.
Abstract: The proliferation of new research in the field of neuroscience and motor control has made it difficult to keep pace with the latest findings. This text bridges the gap between research/theory and practice by focusing on the scientific and experimental basis of new motor control theories. Specific examples of theoretical models are provided to clearly illustrate how recent findings and theories can be applied to clinical practice. Each chapter includes an outline, key terms in boldface type, active learning boxes, and a chapter summary to ensure maximum comprehension of the material. The text is intended for physiotherapy and occupational therapy students.
1,936 citations
TL;DR: Conditions that give rise to phase shifts among the limbs when an animal changes gait are poorly understood and Coordinated shifts appear to arise because of continuous scaling influences that render the existing mode unstable.
Abstract: Conditions that give rise to phase shifts among the limbs when an animal changes gait are poorly understood. Often a “switch mechanism” is invoked that has a neural basis which remains speculative. Abrupt phase transitions also occur between the two hands in humans when movement-cycling frequency is continuously increased. The asymmetrical out-of-phase mode shifts suddenly to a symmetrical in-phase mode involving simultaneous activation of homologous muscle groups. The boundary between the two coordinative states is indexed by a dimensionless critical number, which remains constant regardless of whether the hands move freely or are subject to resistive loading. Coordinated shifts appear to arise because of continuous scaling influences that render the existing mode unstable. Then, at a critical point, bifurcation occurs and a new stable (and perhaps energetically more efficient) mode emerges.
1,495 citations
"Combined virtual reality and physic..." refers background or methods in this paper
...This is critical because sensory feedback is needed to successfully complete motor coordination tasks (Kelso, 1984; Salter, Wishart, Lee, & Simon, 2004; Serrien, Teasdale, Bard, & Fleury, 1995)....
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...To assess bimanual coordination, we used the following valid and reliable procedure (Kelso, 1984; Kelso, 1997; Norouzi, Hossieni, & Solymani, 2018): Participants sat on an adjustable chair at a table covered by a white laminated poster board (50 cm deep and 86 cm wide; see Figure 2)....
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...First, the in-phase coordination mode refers to mirror-symmetrical movements made simultaneously towards and away from the body midline and involves simultaneous activation of homologous muscle groups (Kelso, 1984; Kelso, 1997; Salter et al., 2004)....
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TL;DR: Virtual training resulted in equivalent or even better real world performance than real training in this simple sensorimotor task, but this finding may not apply to other training tasks.
Abstract: Virtual environments (VEs) are extensively used in training but there have been few rigorous scientific investigations of whether and how skills learned in a VE are transferred to the real world. This research aimed to measure and evaluate what is transferring from training a simple sensorimotor task in a VE to real world performance. In experiment 1, real world performances after virtual training, real training and no training were compared. Virtual and real training resulted in equivalent levels of post-training performance, both of which significantly exceeded task performance without training. Experiments 2 and 3 investigated whether virtual and real trained real world performances differed in their susceptibility to cognitive and motor interfering tasks (experiment 2) and in terms of spare attentional capacity to respond to stimuli and instructions which were not directly related to the task (experiment 3). The only significant difference found was that real task performance after training in a VE was less affected by concurrently performed interference tasks than was real task performance after training on the real task. This finding is discussed in terms of the cognitive load characteristics of virtual training. Virtual training therefore resulted in equivalent or even better real world performance than real training in this simple sensorimotor task, but this finding may not apply to other training tasks. Future research should be directed towards establishing a comprehensive knowledge of what is being transferred to real world performance in other tasks currently being trained in VEs and investigating the equivalence of virtual and real trained performances in these situations.
351 citations
"Combined virtual reality and physic..." refers background in this paper
...Rose, Attree, Brooks, Parslow, and Penn (2000) evaluated the transfer from a virtual environment to the real world in terms of a simple sensorimotor task (Rose et al., 2000)....
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