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.
To analyze the feasibility, safety, and acceptability of immersive virtual tasks.
The authors recruited 11 young adults and 10 older adults. The participants performed three virtual reaching tasks ...while walking on a virtual path. The descriptive analysis and comparison between participants were performed using the Mann-Whitney U test and chi-square test for nonparametric and nominal variables, respectively. The authors also used analysis of variance for a between-groups comparison for normal variables.
Twenty percent of older adults and 81.8% of young adults completed all three tasks (chi-square test; p = .005). Both groups reported minor symptoms, with no significant differences. The older adults were more motivated to practice the tasks (Mann-Whitney U test; p = .015) and would be more likely to suggest them to others (chi-square test; p = .034).
All three tasks were feasible for young adults. All participants, except for one, had cybersickness. The symptoms were mostly mild and subsided once the interaction was complete.
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.
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.
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.
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.
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).
Frailty can be defined as a medical syndrome with multiple causes and contributors, characterized by diminished strength and endurance and reduced physiological function that increases the ...vulnerability to develop functional dependency and/or death. Studies have shown that the most commonly studied exercise protocol for frail older adults is the multimodal training. Interactive video games (IVGs) involve tasks in virtual environments that combine physical and cognitive demands in an attractive and challenging way. The aim of this study will be to evaluate the feasibility, safety, acceptability, and functional outcomes of playing Nintendo Wii Fit Plus
(NWFP) for frail older adults.
The study is a randomized controlled, parallel group, feasibility trial. Participants will be randomly assigned to the experimental group (EG) and control group (CG). The EG will participate in 14 training sessions, each lasting 50 min, twice a week. In each training session, the participants will play five games, with three attempts at each game. The first attempt will be performed with the assistance of a physical therapist to correct the movements and posture of the patients and subsequent attempts will be performed independently. Scores achieved in the games will be recorded. The participants will be evaluated by a blinded physical therapist at three moments: before and after intervention and 30 days after the end of the intervention (follow-up). We will assess the feasibility, acceptability, safety, and clinical outcomes (postural control, gait, cognition, quality of life, mood, and fear of falling).
Due to the deficiencies in multiple systems, studies have shown that multimodal interventions including motor-cognitive stimulation can improve the mobility of frail elderly adults. IVGs, among them the NWFP, are considered as a multimodal motor-cognitive intervention that can potentially improve motor and cognitive functions in the frail elderly. However, there is still no evidence in the literature that proves the feasibility, safety, acceptability, and functional outcomes of this intervention in frail elderly individuals.
Brazilian Registry of Clinical Trials (RBR-823rst). World Health Organization Trial Registration Data Set (Additional file 1).
Introduction: Aging is characterized by a series of changes and adaptations that occur in the body progressively and irreversibly over the years. One of the consequences of senescence is the deficit ...of maintaining balance, this fact is explained by the involvement of the visual, somatosensory and vestibular systems. Given this scenario, the use of tools that can minimize these declines is of paramount importance. In recent times a resource that has been investigated is virtual reality, this technique stands out for presenting cognitive, motor and cardiorespiratory demands beneficial to the elderly. Objective: The present study aimed to perform a narrative review on the influence of virtual reality on the rehabilitation of balance in healthy elderly. Methods: A bibliographic survey was carried out in Portuguese and English, in the electronic databases: Pubmed, Lilacs, Pedro, Scielo, Scopus and Cochrone. A temporal limiter was applied from 2010 to 2015. Results: We selected 84 articles, however only five fit the criteria of the research. Despite the different methodologies and sample used, all articles selected showed significant improvement in postural balance after virtual reality therapy. However, a lack of standardization of the research protocols can be observed, making it difficult to reach a precise conclusion regarding the real effects of this technique for the study population. Conclusion: Virtual reality therapy was shown to be effective for the rehabilitation of postural balance in healthy elderly individuals. However, such evidence needs to be further investigated in future studies.
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.
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.
This is the first study to have assessed the feasibility of fragile elderly people playing Nintendo Wii Fit Plus™ in order to improve functional outcomes.
The intervention led to improvements in ...postural control and gait, but not cognition, mood, or fear of falling.
The paper gives a detailed description of the protocol, which will facilitate replication of the intervention.
Recently, interactive video games (IVGs) have been used as a health-care intervention that provides both exercise and cognitive stimulation. Several studies have shown that IVGs can improve postural control, gait, cognition, and functional independence in elderly people and patients with neurological disease. However, there is a lack of evidence about the effects of IVGs on frail and pre-frail elderly people. The aim of this study was to evaluate the feasibility, safety, and acceptability of playing Nintendo Wii Fit Plus™ (NWFP) interactive video games, and the functional outcomes (postural control, gait, cognition, mood, and fear of falling) in frail and pre-frail older adults.
This study is a randomized controlled, parallel-group, feasibility trial. Participants were frail and pre-frail older adults randomly assigned to the experimental group (EG, n = 15) or control group (CG, n = 15). Participants in the EG performed 14 training sessions, lasting 50 min each, twice a week. In each training session, participants played five of 10 selected games, with two attempts at each game. Participants in the CG received general advice regarding the importance of physical activity. All participants were assessed on three occasions by a blinded physical therapist: before and after intervention, and 30 days after the end of the intervention (follow-up). We assessed the feasibility (score of participants in the games), acceptability (game satisfaction questionnaire), safety (adverse events during training sessions), and functional outcomes: (1) postural control (Mini-BESTest); (2) gait (Functional Gait Assessment); (3) cognition (Montreal Cognitive Assessment); (4) mood (GDS-15); and (5) fear of falling (FES-I).
Participants in the EG improved their scores in all 10 games, reported that they understood and enjoyed the tasks of the games, and presented few adverse events during the practice. There was a significant improvement in the Mini-BESTest and Functional Gait Assessment in the EG when compared with the CG (p < 0.05).
The use of NWFP was feasible, acceptable, and safe for frail older adults and improved their postural control and gait. There were no effects on cognition, mood, or fear of falling.
This trial was registered in the Brazilian Registry of Clinical Trials (RBR-823rst) on 11 June 2016.
ABSTRACT Parkinson's disease causes a progressive decline of motor and cognitive functions, often affecting postural control. Training through virtual reality has been shown to be effective in ...improving this condition. This study aims to analyse the effects of the Kinect Adventures! games in postural control of people with Parkinson's disease. Ten individuals diagnosed with idiopathic Parkinson's disease, in stages I to III of the Hoehn & Yahr scale, aged between 48 and 73 years, were selected. Fourteen training sessions of one hour each, twice a week, were performed. Individuals were evaluated pre, post-intervention and 30 days after the last session of intervention by a force platform that measured the oscillation area and velocity of the centre of pressure in ten different sensory conditions and the Limits of Stability. Limits of Stability showed a statistically significant increase immediately after the training the 14 sessions, as were observed and there were no significant changes in oscillation area and velocity immediately after the intervention or 30 days after the end of training. The results of this study indicate that the training with Kinect Adventures! Games improve the postural control of people with Parkinson's disease, by increasing the Limits of Stability.
A Doença de Parkinson (DP) causa um declínio progressivo das funções motoras e cognitivas, muitas vezes afetando o controle postural. O treinamento por meio de realidade virtual tem se mostrado ...eficaz na melhoria dessa condição. Este estudo teve como objetivo analisar os efeitos dos Jogos Kinect Adventures no controle postural de pessoas com DP. Foram selecionados dez indivíduos com diagnóstico de DP idiopática, nos estágios I a III da escala de Hoehn & Yahr, com idades entre 48 e 73 anos. Foram realizadas 14 sessões de treinamento de uma hora cada, duas vezes por semana. Os indivíduos foram avaliados pré, pós-intervenção e 30 dias após a última sessão de intervenção. A avaliação foi realizada por meio de uma plataforma de força que mediu a área de oscilação (COP), a velocidade do centro de pressão (VOS) e os Limites de Estabilidade (LOS) em dez diferentes condições sensoriais. Não houve alterações significativas na COP e na VOS imediatamente após a intervenção nem nos 30 dias após o término do treinamento. Os LOS apresentaram um aumento estatisticamente significativo imediatamente apenas após o treinamento nas 14 sessões. Os resultados deste estudo indicam que o treinamento com os Jogos Kinect Adventures melhora o controle postural de pessoas com DP promovendo aumento dos LOS. Palavras-chave: Doença de Parkinson, Equilíbrio Postural, Terapia de Exposição à Realidade Virtual, Jogos de Vídeo
PDF
