José Eduardo Pompeu

Effect of Nintendo Wii™-based motor and cognitive training on activities of daily living in patients with Parkinson's disease: a randomised clinical trial.

OBJECTIVES To investigate the effect of Nintendo Wii™-based motor cognitive training versus balance exercise therapy on activities of daily living in patients with Parkinsons disease. DESIGN Parallel, prospective, single-blind, randomised clinical trial. SETTING Brazilian Parkinson Association. PARTICIPANTS Thirty-two patients with Parkinsons disease (Hoehn and Yahr stages 1 and 2). INTERVENTIONS Fourteen training sessions consisting of 30 minutes of stretching, strengthening and axial mobility exercises, plus 30 minutes of balance training. The control group performed balance exercises without feedback or cognitive stimulation, and the experimental group performed 10 Wii Fit™ games. MAIN OUTCOME MEASURE Section II of the Unified Parkinsons Disease Rating Scale (UPDRS-II). RANDOMISATION Participants were randomised into a control group (n=16) and an experimental group (n=16) through blinded drawing of names. STATISTICAL ANALYSIS Repeated-measures analysis of variance (RM-ANOVA). RESULTS Both groups showed improvement in the UPDRS-II with assessment effect (RM-ANOVA P<0.001, observed power=0.999). There was no difference between the control group and the experimental group before training {8.9 [standard deviation (SD) 2.9] vs 10.1 (SD 3.8)}, after training [7.6 (SD 2.9) vs 8.1 (SD 3.5)] or 60 days after training [8.1 (SD 3.2) vs 8.3 (SD 3.6)]. The mean difference of the whole group between before training and after training was -0.9 (SD 2.3, 95% confidence interval -1.7 to -0.6). CONCLUSION Patients with Parkinsons disease showed improved performance in activities of daily living after 14 sessions of balance training, with no additional advantages associated with the Wii-based motor and cognitive training. Registered on http://www.clinicaltrials.gov (identifier: NCT01580787).

Motor learning, retention and transfer after virtual-reality-based training in Parkinson's disease - effect of motor and cognitive demands of games: a longitudinal, controlled clinical study

OBJECTIVES To evaluate the learning, retention and transfer of performance improvements after Nintendo Wii Fit™ training in patients with Parkinsons disease and healthy elderly people. DESIGN Longitudinal, controlled clinical study. PARTICIPANTS Sixteen patients with early-stage Parkinsons disease and 11 healthy elderly people. INTERVENTIONS Warm-up exercises and Wii Fit training that involved training motor (shifts centre of gravity and step alternation) and cognitive skills. A follow-up evaluative Wii Fit session was held 60 days after the end of training. Participants performed a functional reach test before and after training as a measure of learning transfer. MAIN OUTCOME MEASURES Learning and retention were determined based on the scores of 10 Wii Fit games over eight sessions. Transfer of learning was assessed after training using the functional reach test. RESULTS Patients with Parkinsons disease showed no deficit in learning or retention on seven of the 10 games, despite showing poorer performance on five games compared with the healthy elderly group. Patients with Parkinsons disease showed marked learning deficits on three other games, independent of poorer initial performance. This deficit appears to be associated with cognitive demands of the games which require decision-making, response inhibition, divided attention and working memory. Finally, patients with Parkinsons disease were able to transfer motor ability trained on the games to a similar untrained task. CONCLUSIONS The ability of patients with Parkinsons disease to learn, retain and transfer performance improvements after training on the Nintendo Wii Fit depends largely on the demands, particularly cognitive demands, of the games involved, reiterating the importance of game selection for rehabilitation purposes.

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

Abstract 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.

Effect of Kinect games on postural control of patients with Parkinson's disease

Parkinsons disease is a neurodegenerative disorder that progressively compromises motor control and cognition. Recently, the new generation of video games has been used to promote motor cognitive training. These studies have shown improvement on postural control, cognition and performance of daily living activities in patients with Parkinsons disease. The purpose of this study was to assess the effects of playing Microsoft Kinect Adventures™ on postural control of patients with Parkinsons disease. The design of study was a case series that was conducted at the Associação Brasil Parkinson, Brazil. Six patients (four males, two female) with Parkinsons disease (Hoehn and Yahr Stages 1 to 3) participated of this study. Patients performed fourteen 60-minute sessions, three times per week, playing four games of Kinect Adventures. The main outcome measures was the Limits of Stability. Secondary outcome was the safety. One patient had back pain during the period of training. The Limits of Stability before training and after training were 118.5 (28.0) and 163.7 (38.3), respectively. The training with Kinect Adventures™ games were safety and promoted improvement on postural control of patients with PD on stages 1 to 3 of Hoehn & Yahr scale.

Virtual Reality for Stroke Rehabilitation.

<LEAP> highlights the findings and application of Cochrane reviews and other evidence pertinent to the practice of physical therapy. The Cochrane Library is a respected source of reliable evidence related to health care. Cochrane systematic reviews explore the evidence for and against the effectiveness and appropriateness of interventions—medications, surgery, education, nutrition, exercises—and the evidence for and against the use of diagnostic tests for specific conditions. Cochrane reviews are designed to facilitate the decisions of clinicians, patients, and others in health care by providing a careful review and interpretation of research studies published in the scientific literature.1 Each article in this PTJ series will summarize a Cochrane review or other scientific evidence resource on a single topic and will present clinical scenarios based on real patients to illustrate how the results of the review can be used to directly inform clinical decisions. This article focuses on the effectiveness of virtual reality for stroke rehabilitation. Can virtual reality systems be incorporated as part of or instead of usual rehabilitation programs for a person after stroke? Stroke is the second leading cause of death around the world and one of the main causes of years living with disability in adults.2,3 A stroke is caused by a disruption of the blood supply to the brain because an artery to the brain is either blocked (ischaemic stroke) or bursts (hemorrhagic stroke), causing damage to the brain tissue.4 After a stroke, physical impairments such as weakness and loss of coordination are common.5,6 These impairments cause limitations in mobility and upper limb activities, restricting the person with stroke from returning to his or her everyday activities.7,8

Lack of accessibility in public transport and inadequacy of sidewalks: effects on the social participation of elderly persons with functional limitations

Abstract Objective: To analyze the association between the decline in the mobility of community dwelling elderly persons in Sao Paulo, Brazil and their capacity to use public transportation, and its impact on their quality of life and social participation. Method: A cross-sectional study was conducted of 32 community dwelling elderly persons, of both genders (59% female), with an average age of 75.5 years (±9.2). The participants were evaluated by functional mobility, risk of falls, fear of falls and independence in activities of daily living. In addition, the perception of the elderly persons of their mobility on public transport and its impact on their social participation was evaluated. The elderly persons were divided into two groups: with mobility impairment and without mobility impairment. The groups were compared using the Fishers Exact, Chi-Squared and Mann-Whitney tests, and the unpaired Students t-test. An alpha level of 0.05 was adopted as a level of statistical significance.

Feasibility, safety, acceptability, and functional outcomes of playing Nintendo Wii Fit PlusTM for frail older adults: A randomized feasibility clinical trial

BACKGROUND 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. METHODS 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). RESULTS 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). CONCLUSION 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.

Interactive Video Gaming Improves Functional Balance in Poststroke Individuals: Meta-Analysis of Randomized Controlled Trials

The main objective of this study was to evaluate the effects of interactive video games on functional balance and mobility in poststroke individuals. The Health Science databases accessed included Medline via PubMed, LILACS, SciELO, and PEDro. The inclusion criteria were as follows: clinical studies evaluating the use of interactive video games as a treatment to improve functional balance and mobility in individuals poststroke and studies published in the Brazilian Portuguese, English, or Spanish language between 2005 and April 2016. PEDro Scale was used to analyze the methodological quality of the studies. The Berg Balance Scale and Timed Up and Go Test (TUGT) data were evaluated using a meta-analysis, the publication bias was assessed by funnel plots, and the heterogeneity of the studies by I 2 statistic. Eleven studies were included in the final analysis. Functional balance improved in individuals treated using interactive video games (mean difference = 2.24, 95% confidence interval [0.45, 4.04], p = .01), but no improvement was observed in mobility as measured by TUGT. The studies presented low heterogeneity (24%). The mean score on the PEDro Scale was 6.2 ± 1.9. Interactive video games were effective in improving functional balance but did not influence the mobility of individuals poststroke.

Two new virtual reality tasks for the assessment of spatial orientation Preliminary results of tolerability, sense of presence and usability

Abstract Spatial orientation is a cognitive domain frequently impaired in Alzheimers Disease and can be one of its earliest symptoms. Objective: This paper describes the results of tolerability, sense of presence and usability of two immersive virtual reality tasks for the assessment of spatial orientation, using VR headset in adults. Methods: 31 healthy adults recruited from university and the local community performed two experimental immersive virtual reality tasks of spatial orientation: the SOIVET-Maze for the assessment of allocentric to egocentric spatial abilities and the SOIVET-Route for the assessment of spatial memory and landmark recognition. Participants completed questionnaires about sense of presence, cybersickness symptoms, technology use profile and motion sickness history. Usability measures were assessed by spontaneous feedback from participants. Results: All participants were able to understand the task instructions and how to interact with the system. Both tasks seemed to induce a strong sense of presence, as assessed by the Witmer and Singer Presence Questionnaires (M=128 and 143 for SOIVET-Maze and SOIVET-Route, respectively). The SOIVET-Route had a small numeric advantage over the SOIVET-Maze tolerability scores assessed by the Cybersickness Questionnaire (M=4.19, SD=5.576 and M=3.52, SD=6.418 for SOIVET-Maze and SOIVET-Route respectively). Also, there were no drop-outs on the SOIVET-Route due to tolerability issues, unlike the SOIVET-Maze, which had two drop-outs. However, this difference was not statistically significant (Z= -.901, p= 0.368, Wilcoxon signed-rank test).

Handgrip strength in judo athletes

INTRODUCAO: A forca de preensao manual e a capacidade da mao em realizar tarefas, imprimir forcas e segurar objetos. Dentre os diversos esportes que utilizam a forca de preensao manual com predominância em sua pratica, um deles e o judo, aonde a forca de preensao manual e imprescindivel para que o judoca consiga se impor ao adversario, pois esta ligada a capacidade de realizacao do golpe. O objetivo deste estudo foi avaliar a forca de preensao manual em atletas de judo.METODOS: O estudo contou com a participacao de 30 judocas, sendo formado por 15 faixas brancas e 15 faixas pretas, que foram submetidos a uma avaliacao da forca de preensao com um dinamometro manual da marca Jamar(r). Foi utilizada a estatistica descritiva (media e desvio-padrao) para analise dos dados antropometricos, o teste tde Student para verificacao da homogeneidade entre os grupos e o Teste de Shapiro-Wilk para verificacao da distribuicao. Para analise de comparacao intra e intergrupos foi utilizado o Teste de Mann-Whitney para amostras independentes (p≤0,05). Os dados foram analisados atraves do software BioEstat 5.0.RESULTADOS: Os resultados demonstraram que os judocas faixas pretas apresentam uma forca de preensao palmar significativamente maior na mao dominante em relacao a nao dominante, e tambem significativamente maior em relacao aos atletas de faixas brancas tanto na mao dominante quanto na mao nao dominante.CONCLUSAO: Atletas de judo faixas pretas tem preensao manual mais forte do que os atletas de faixas brancas, sugerindo que quanto maior o tempo de pratica esportiva na modalidade, maior a forca de preensao manual em ambas as maos.