A new virtual reality tool for unilateral cerebral palsy rehabilitation: Two single-case studies

Abstract

Objective: To examine the “clinical utility” of a new virtual rehabilitation tool in order to treat upper-limb motor deficit in cerebral palsy (CP) patient.

Methods: Single-case experimental designs. Virtual reality intervention was performed in two left unilateral spastic CP adolescent patients. The virtual reality intervention was given for 60 minutes per session, two sessions a day, and 5 days a week over 2 weeks.

Results: For each patient and for both hands, the number of blocks transported within one minute (box and block test scores) is increased. The nonoverlap of all pairs indices for the paretic hand were calculated as 0.95 for subject 1 and 0.93 for subject 2, and the nonoverlap of all pairs indices for the nonparetic hand were calculated, respectively, as 0.92 and 1.

Conclusion: We provide empirical evidence in support of a new simple Virtual Rehabilitation system in CP patient to improve upper-limb motor function.     

Virtual reality in paediatric rehabilitation: A review

Objective: To provide a narrative review of studies regarding the outcomes of Virtual Reality (VR)-based treatment and rehabilitation programmes within the paediatric population.

Methods: Studies related to the use of VR across a number of paediatric areas (e.g. cerebral palsy, autism, foetal alcohol syndrome and attention deficits) were identified and summarized.

Results: Outcomes from the studies reviewed provide preliminary support for the use of VR.

Conclusion: VR may be an effective treatment method for specific disorders, although the generalizability of this literature is hindered by several methodological limitations, such as small samples and the absence of appropriate control participants.     

Applications of augmented reality in the neurosurgical operating room: A systematic review of the literature

Advancements in imaging techniques are key forces of progress in neurosurgery. The importance of accurate visualization of intraoperative anatomy cannot be overemphasized and is commonly delivered through traditional neuronavigation. Augmented Reality (AR) technology has been tested and applied widely in various neurosurgical subspecialties in intraoperative, clinical use and shows promise for the future. This systematic review of the literature explores the ways in which AR technology has been successfully brought into the operating room (OR) and incorporated into clinical practice. A comprehensive literature search was performed in the following databases from inception-April 2020: Ovid MEDLINE, Ovid EMBASE, and The Cochrane Library. Studies retrieved were then screened for eligibility against predefined inclusion/exclusion criteria. A total of 54 articles were included in this systematic review. The studies were sub- grouped into brain and spine subspecialties and analyzed for their incorporation of AR in the neurosurgical clinical setting. AR technology has the potential to greatly enhance intraoperative visualization and guidance in neurosurgery beyond the traditional neuronavigation systems. However, there are several key challenges to scaling the use of this technology and bringing it into standard operative practice including accurate and efficient brain segmentation of magnetic resonance imaging (MRI) scans, accounting for brain shift, reducing coregistration errors, and improving the AR device hardware. There is also an exciting potential for future work combining AR with multimodal imaging techniques and artificial intelligence to further enhance its impact in neurosurgery.     

CommentNeurocognitive sequelae of childhood cancers and their treatment: a comment on Mulhern and Butler

Objective: To explore the feasibility of using low-cost motion interactive games as a home-based intervention for children with cerebral palsy (CP).

Methods: Fourteen children with CP, 6–16 years old, practiced with the EyeToy for PlayStation2® in their homes during 4 weeks. Outcome measures were physical activity monitors, Movement Assessment Battery for Children-2 (mABC-2), Bruininks-Oseretsky Test of Motor Proficiency (sub-test 5?:?6), 1 Minute Walk Test and gaming diaries.

Results: Motivation for practice and compliance of training were high. The children's physical activity increased during the intervention and activity monitors were feasible to use, although data loss may be a concern. According to mABC-2 the children's motor performance improved, but there were both floor and ceiling effects. The two additional motor tests showed only non-significant progress.

Conclusion: It is highly feasible to use motion interactive games in home rehabilitation for children with CP. Specific motor effects need to be further explored.     

Brain oscillatory activity as a biomarker of motor recovery in chronic stroke

In the present work, we investigated the relationship of oscillatory sensorimotor brain activity to motor recovery. The neurophysiological data of 30 chronic stroke patients with severe upper‐limb paralysis are the basis of the observational study presented here. These patients underwent an intervention including movement training based on combined brain–machine interfaces and physiotherapy of several weeks recorded in a double‐blinded randomized clinical trial. We analyzed the alpha oscillations over the motor cortex of 22 of these patients employing multilevel linear predictive modeling. We identified a significant correlation between the evolution of the alpha desynchronization during rehabilitative intervention and clinical improvement. Moreover, we observed that the initial alpha desynchronization conditions its modulation during intervention: Patients showing a strong alpha desynchronization at the beginning of the training improved if they increased their alpha desynchronization. Patients showing a small alpha desynchronization at initial training stages improved if they decreased it further on both hemispheres. In all patients, a progressive shift of desynchronization toward the ipsilesional hemisphere correlates significantly with clinical improvement regardless of lesion location. The results indicate that initial alpha desynchronization might be key for stratification of patients undergoing BMI interventions and that its interhemispheric balance plays an important role in motor recovery.     

Understanding practices of speech-language pathologists in aphasia rehabilitation: a grounded theory study

Background: Social participation is the stated ideal end purpose of rehabilitation, however people with aphasia often have limited social participation following rehabilitation. Despite growing evidence regarding the importance of addressing social participation issues in aphasia rehabilitation, it is unknown how much these issues are considered by speech-language pathologists. More importantly, it is unclear what aphasia rehabilitation practice includes.

Aim: The aim of this study was to understand speech-language pathology practice in aphasia rehabilitation by means of a theoretical model.

Methods & Procedures: Grounded theory was used to structure this research study. Seventeen speech-language pathologists working in different settings of the care continuum of aphasia rehabilitation in Quebec (Canada) were recruited to participate in individual, semi-structured interviews. They were questioned about the ideal end purpose of aphasia rehabilitation and the clinical activities performed in practice. Recorded interviews were transcribed and analysed following an inductive, constructivist-based approach. Categories were identified and a theoretical model was developed.

Outcomes & Results: The main characteristic of the participants’ practice was that it included underlying questions. These questions were either related to the purpose of aphasia rehabilitation or to the clinical activities performed to achieve that purpose. Four central clinical activities were described: counselling; assessing needs and abilities; setting therapy goals; and conducting therapy. Two clinical activities were not systematically performed; thus, they were considered peripheral within practice: including relatives in therapy and considering other parties. The focus of practice was either on language impairment or on social participation of the person with aphasia. Participants expressed different perceptions about the ideal end purpose of aphasia rehabilitation and considered their workplace environment as constraining or encouraging professional autonomy, which had an impact on the focus of practice. Underlying questions led participants to express a need for guidance to orient their practice.

Conclusions: Results contribute to a better understanding of aphasia rehabilitation practice. When deeply motivated by helping the person resume significant life habits, speech-language pathologists’ practice was more likely to be focused on social participation, but questions regarding clinical activities persisted. A future knowledge transfer strategy could help guide and orient speech-language pathologists.     

Virtual Reality in Upper Extremity Rehabilitation of Stroke Patients: A Randomized Controlled Trial

Objective

Virtual reality game system is one of novel approaches, which can improve hemiplegic extremity functions of stroke patients. We aimed to evaluate the effect of the Microsoft Xbox 360 Kinect video game system on upper limb motor functions for subacute stroke patients.

A functional magnetic resonance imaging study of visuomotor processing in a virtual reality‐based paradigm: Rehabilitation Gaming System

The Rehabilitation Gaming System (RGS) has been designed as a flexible, virtual‐reality (VR)‐based device for rehabilitation of neurological patients. Recently, training of visuomotor processing with the RGS was shown to effectively improve arm function in acute and chronic stroke patients. It is assumed that the VR‐based training protocol related to RGS creates conditions that aid recovery by virtue of the human mirror neuron system. Here, we provide evidence for this assumption by identifying the brain areas involved in controlling the catching of approaching colored balls in the virtual environment of the RGS. We used functional magnetic resonance imaging of 18 right‐handed healthy subjects (24 ± 3 years) in both active and imagination conditions. We observed that the imagery of target catching was related to activation of frontal, parietal, temporal, cingulate and cerebellar regions. We interpret these activations in relation to object processing, attention, mirror mechanisms, and motor intention. Active catching followed an anticipatory mode, and resulted in significantly less activity in the motor control areas. Our results provide preliminary support for the hypothesis underlying RGS that this novel neurorehabilitation approach engages human mirror mechanisms that can be employed for visuomotor training.     

Anhedonia in Parkinson's disease: A systematic review of the literature

Anhedonia, defined as lowered ability to experience physical or social pleasure, is a key symptom of several psychiatric illnesses. In this systematic review, we aimed to evaluate the role of anhedonia in Parkinson's Disease and its relationships with other clinical characteristics, dopamine dysfunction, and antiparkinsonian therapy. The database was selected using PubMed Services. Relevant journals were hand‐searched, and the bibliographies of all the important articles were scrutinized to find additional publications. Fifteen studies assessed the topic of anhedonia in Parkinson's disease from 1984 to 2009 and mainly described it as a core symptom of depression in patients with Parkinson's disease. Some studies investigated the relationship between anhedonia and neuropsychological symptoms and found correlations with frontal lobe functions. Reports on the relationship between anhedonia and illness severity or motor symptoms are rather inconclusive. No definitive conclusions can be drawn because few studies have been published on this topic. Nevertheless, some evidence suggests that in Parkinson's disease anhedonia is a secondary phenomenon linked to depression, apathy severity, and frontal lobe dysregulation and that it could respond to antiparkinsonian treatment. Future studies of larger samples of patients are strongly required to definitively clarify the relationship between anhedonia and other clinical features, such as depression, anxiety, apathy, cognition, and motor status. Furthermore, more reliable tools and validated diagnostic criteria are necessary to assess anhedonia in patients with Parkinson's disease. © 2011 Movement Disorder Society     

Effects of virtual reality for stroke individuals based on the International Classification of Functioning and Health: a systematic review

Objective: This review determines the effects of virtual reality interventions for stroke subjects based on the International Classification of Functioning, Disability,and Health (ICF) framework. Virtual reality is a promising tool for therapy for stroke rehabilitation, but the effects of virtual reality interventions on post-stroke patients based on the specific ICF domains (Body Structures, Body Functions, Activity, and Participation) have not been investigated.

Method: A systematic review was conducted, including trials with adults with a clinical diagnosis of a chronic, subacute, or acute stroke. Eligible trials had to include studies with an intervention protocol and follow-up, with a focus on upper limbs and/or lower limbs and/or balance. The Physiotherapy Evidence Database (PEDro) was used to assess the methodological quality of randomized controlled trials. Each trial was separated according to methodological quality into a high-quality trial (PEDro ≥ 6) and a low-quality trial (PEDro ≤ 6). Only high-quality trials were analyzed specifically based on the outcome of these trials.

Results: In total, 54 trials involving 1811 participants were included. Of the papers included and considered high quality, 14 trials evaluated areas of the Body Structures component, 20 trials of the Body Functions domain, 17 trials of the Activity component, and 8 trials of the Participation domain. In relation to ICF Part 2, four trials evaluated areas of the Personal Factors component and one trial evaluated domains of the Environmental Factors component.

Discussion: The effects of virtual reality on stroke rehabilitation based on the ICF framework are positive in Body Function and Body Structure. However, the results in the domains Activity and Participation are inconclusive. More high-quality clinical trials are needed to confirm the effectiveness of virtual reality in the domains of Activity and Participation.     

Developments in autonomic research: a review of the latest literature

Motion sickness is characterized by several autonomic signs: pallor, sweating, loss of appetite, nausea and vomiting. Gastric myoelectrical activity is reduced and gastric emptying delayed, and the high-frequency to low-frequency ratio of heart rate variability increases with motion sickness. Children showing a high incidence of vasovagal syncope during head-up tilt are also more susceptible to motion sickness, arguing strongly for a vestibular contribution to both conditions. Typically, motion sickness is caused by slow oscillatory movements (~0.2 Hz), and is considered by many to be dependent on inputs from the vestibular system. However, given that signs of motion sickness can be induced by moving visual stimuli, changes in inputs from the vestibular system are evidently not required. Indeed, visually induced motion sickness—cybersickness—is common in games relying on virtual reality. Our current understanding of motion sickness is based on the sensory conflict hypothesis, which postulates that sickness occurs when there is a mismatch between the current pattern of sensory inputs about movement of the body and the pattern that is expected on the basis of previous experience. The fluid shift hypothesis, in which shift of fluid into the head (and inner ears) has also been proposed to account for space sickness.     

Examining the benefits of extended reality in neurosurgery: A systematic review

While well-established in other surgical subspecialties, the benefits of extended reality, consisting of virtual reality (VR), augmented reality (AR), and mixed reality (MR) technologies, remains underexplored in neurosurgery despite its increasing utilization. To address this gap, we conducted a systematic review of the effects of extended reality (XR) in neurosurgery with an emphasis on the perioperative period, to provide a guide for future clinical optimization. Seven primary electronic databases were screened following guidelines outlined by PRISMA and the Institute of Medicine. Reported data related to outcomes in the perioperative period and resident training were all examined, and a focused analysis of studies reporting controlled, clinical outcomes was completed. After removal of duplicates, 2548 studies were screened with 116 studies reporting measurable effects of XR in neurosurgery. The majority (82%) included cranial based applications related to tumor surgery with 34% showing improved resection rates and functional outcomes. A rise in high-quality studies was identified from 2017 to 2020 compared to all previous years (p = 0.004). Primary users of the technology were: 56% neurosurgeon (n = 65), 28% residents (n = 33) and 5% patients (n = 6). A final synthesis was conducted on 10 controlled studies reporting patient outcomes. XR technologies have demonstrated benefits in preoperative planning and multimodal neuronavigation especially for tumor surgery. However, few studies have reported patient outcomes in a controlled design demonstrating a need for higher quality data. XR platforms offer several advantages to improve patient outcomes and specifically, the patient experience for neurosurgery.     

Action observation and motor imagery for rehabilitation in Parkinson's disease: A systematic review and an integrative hypothesis

This article discusses recent evidence supporting the use of action observation therapy and motor imagery practice for rehabilitation of Parkinson's disease. A main question that emerges from the review regards the different effectiveness of these approaches and the possibility of integrating them into a single method to enhance motor behaviour in subjects with Parkinson’s disease. In particular, the reviewed studies suggest that action observation therapy can have a positive effect on motor facilitation of patients and that a long-term rehabilitation program based on action observation therapy or motor imagery practice can bring some benefit on their motor recovery. Moreover, the paper discusses how the research on the combined use of action observation and motor imagery for motor improvements in healthy subjects may encourage the combined use of action observation therapy and motor imagery practice for therapeutic aims in Parkinson's disease. To date, this hypothesis has never been experimented.     

The effects of computer-based cognitive rehabilitation in patients with visuospatial neglect following stroke: a systematic review

Objectives: To identify studies concerning the effects of computer based cognitive rehabilitation (CBCR) on visuospatial neglect (VN) after stroke to summarize the current state of knowledge in this research field and make recommendations for future research.

Methods: Four electronic databases were systematically searched. Authors of relevant studies were contacted to detect unpublished data or articles not found by searching databases. Data was extracted from included studies using predefined coding schemes and characteristics and results of individual studies were summarized qualitatively.

Selection criteria: Studies were included if at least 50% of the included patients had a stroke, if the studies explored the effects of CBCR as a primary intervention for rehabilitation of VN and if they included neuropsychological outcome measures for the presence of VN.

Results: Seven studies were included. Six of the seven studies suggested positive effects of CBCR on VN after stroke. However, the study that did not find these effects was also the study with the strongest methodological quality. All included studies consisted of small samples, varied greatly in design and had various methodological limitations.

Conclusion: Because the existing literature is very sparse and studies have various methodological limitations, it is currently not possible to either support or reject the effects of CBCR on VN after stroke. Future studies should aim to compare CBCR with active and passive control conditions and include larger samples in randomized and blinded designs.     

Functioning and disability in bipolar disorders: a systematic review of literature using the ICF as a reference

Ávila CC, Cabello M, Cieza A, Vieta E, Ayuso‐Mateos JL. Functioning and disability in bipolar disorders: a systematic review of literature using the ICF as a reference.
Bipolar Disord 2010: 12: 473–482. © 2010 The Authors. Journal compilation © 2010 John Wiley & Sons A/S. Objectives: To systematically identify and examine the frequency of use of concepts contained in outcome variables across bipolar disorder (BD) studies using the International Classification of Functioning, Disability and Health (ICF) as a reference. Methods: Original studies published between 2000 and 2006 were located on the MEDLINE and PsycINFO databases and selected according to predetermined criteria. Outcome variables were extracted, and concepts contained therein were linked to the ICF. Results: A total of 109 final studies were included. The concepts contained in these studies were linked to 145 different ICF categories. ICF category b152, emotional functions, was the most frequently represented category, appearing in 94% of the publications, followed by b126, temperament and personality functions (73%). E110, products or substances for personal consumption, and e580, health services, systems, and policies, appeared in 68% of the studies. Conclusions: The present systematic review reflects the research focus of the literature on BD in recent years. Most of the studies performed concentrate on body functions rather than activities and participation domains. Experimental studies are mostly pharmacological, reflecting the need to study nonpharmacological interventions. Furthermore, our study shows that outcome variables used in studies with persons with BD can, to a large extent, be mapped to the ICF.