Valeska Gatica-Rojas

Virtual reality interface devices in the reorganization of neural networks in the brain of patients with neurological diseases.

Two key characteristics of all virtual reality applications are interaction and immersion. Systemic interaction is achieved through a variety of multisensory channels (hearing, sight, touch, and smell), permitting the user to interact with the virtual world in real time. Immersion is the degree to which a person can feel wrapped in the virtual world through a defined interface. Virtual reality interface devices such as the Nintendo® Wii and its peripheral nunchuks-balance board, head mounted displays and joystick allow interaction and immersion in unreal environments created from computer software. Virtual environments are highly interactive, generating great activation of visual, vestibular and proprioceptive systems during the execution of a video game. In addition, they are entertaining and safe for the user. Recently, incorporating therapeutic purposes in virtual reality interface devices has allowed them to be used for the rehabilitation of neurological patients, e.g., balance training in older adults and dynamic stability in healthy participants. The improvements observed in neurological diseases (chronic stroke and cerebral palsy) have been shown by changes in the reorganization of neural networks in patients’ brain, along with better hand function and other skills, contributing to their quality of life. The data generated by such studies could substantially contribute to physical rehabilitation strategies.

Effects of a Nintendo Wii exercise program on spasticity and static standing balance in spastic cerebral palsy

ABSTRACT Objective: This study sought to evaluate the effects of a Nintendo Wii Balance Board (NWBB) intervention on ankle spasticity and static standing balance in young people with spastic cerebral palsy (SCP). Methods: Ten children and adolescents (aged 72–204 months) with SCP participated in an exercise program with NWBB. The intervention lasted 6 weeks, 3 sessions per week, 25 minutes for each session. Ankle spasticity was assessed using the Modified Modified Ashworth Scale (MMAS), and static standing balance was quantified using posturographic measures (center-of-pressure [CoP] measures). Pre- and post-intervention measures were compared. Results: Significant decreases of spasticity in the ankle plantar flexor muscles (p < 0.01). There was also a significant reduction in the CoP sway area (p = 0.04), CoP mediolateral velocity (p =0.03), and CoP anterior–posterior velocity (p = 0.03). Conclusion: A 6-session NWBB program reduces the spasticity at the ankle plantar flexors and improves the static standing balance in young people with SCP.

Does Nintendo Wii Balance Board improve standing balance? A randomised controlled trial in children with cerebral palsy.

BACKGROUND Evidence on the effect of systemic exercise programs to improve the standing balance with the Nintendo Wii system is very limited and its post-treatment effectiveness is unknown in cerebral palsy (CP) patients. AIM Primary aim was to compare the effect of Nintendo Wii balance board (Wii-therapy) and standard physiotherapy (SPT), on the performance of standing balance in children and adolescents with CP. Secondary aim was to determine the post-treatment effectiveness of Wii-therapy and SPT. DESIGN Two-arm, matched-pairs, parallel-groups, randomized, controlled clinical trial. SETTING Outpatient Rehabilitation Centre in the city of Talca. POPULATION Patients with CP type spastic hemiplegia (SHE) and spastic diplegia (SDI), aged 7 to 14 years, and level I or II of GMFCS or GMFCS-ER. Were excluded patients with FSIQ<80, epilepsy, previous surgeries and application of Botulinum Toxin-A in the lower limb, uncorrected vision and hearing disorders. METHODS Thirty-two CP patients (10.7±3.2 years old) were randomly assigned to either Wii-therapy (SDI=7; SHE=9) or SPT intervention (SDI=7; SHE=9). In each group, patients received three sessions per week over a period of 6 weeks. Standing balance was assessed at baseline and every 2 weeks. Additionally, two follow-up assessments (4 additional weeks) were performed to determine post-treatment effectiveness. Standing balance was quantified on force platform obtaining the outcomes area of center-of-pressure (CoP) sway (CoPSway), standard deviation in the medial-lateral (SDML) and the anterior-posterior (SDAP) directions, and velocity in both directions (VML and VAP). RESULTS Compared to SPT, Wii-therapy significantly reduced the CoPSway (P=0.02) and SDAP in the eyes-open condition (P=0.01). However, the effects wane after 2-4 weeks. Post-hoc analysis revealed that only SHE children benefited from Wii-therapy. CONCLUSIONS Wii-therapy was better than SPT in improving standing balance in patients with CP, but improves the balance only in SHE patients. Also, Wii-therapy effectiveness waned 2-4 weeks after the end the intervention. CLINICAL REHABILITATION IMPACT A systematic exercise program like Wii-therapy using the Nintendo Wii Balance Board device can be considered to improves the standing balance in patients with CP, specifically in the SHE type. This program is easy to transfer to physiotherapists and rehabilitation centers.

Influence of fatigue and velocity on the latency and recruitment order of scapular muscles

OBJECTIVES To determine the influence of velocity and fatigue on scapular muscle activation latency and recruitment order during a voluntary arm raise task, in healthy individuals. DESIGN Cross-sectional study. SETTING University laboratory. PARTICIPANTS Twenty three male adults per group (high-velocity and low-velocity). MAIN OUTCOME MEASURES Onset latency of scapular muscles [Anterior deltoid (AD), lower trapezius (LT), middle trapezius (MT), upper trapezius (UT), and serratus anterior (SA)] was assessed by surface electromyography. The participants were assigned to one of two groups: low-velocity or high-velocity. Both groups performed a voluntary arm raise task in the scapular plane under two conditions: no-fatigue and fatigue. RESULTS The UT showed early activation (p < 0.01) in the fatigue condition when performing the arm raise task at a high velocity. At a low velocity and with no muscular fatigue, the recruitment order was MT, LT, SA, AD, and UT. However, the recruitment order changed in the high-velocity with muscular fatigue condition, since the recruitment order was UT, AD, SA, LT, and MT. CONCLUSIONS The simultaneous presence of fatigue and high-velocity in an arm raise task is associated with a decrease in the UT activation latency and a modification of the recruitment order of scapular muscles.

Update on the effects of graded motor imagery and mirror therapy on complex regional pain syndrome type 1: A systematic review

Graded motor imagery (GMI) and mirror therapy (MT) is thought to improve pain in patients with complex regional pain syndrome (CRPS) types 1 and 2. However, the evidence is limited and analysis are not independent between types of CRPS. The purpose of this review was to analyze the effects of GMI and MT on pain in independent groups of patients with CRPS types 1 and 2. Searches for literature published between 1990 and 2016 were conducted in databases. Randomized controlled trials that compared GMI or MT with other treatments for CRPS types 1 and 2 were included. Six articles met the inclusion criteria and were classified from moderate to high quality. The total sample was composed of 171 participants with CRPS type 1. Three studies presented GMI with 3 components and three studies only used the MT. The studies were heterogeneous in terms of sample size and the disorders that triggered CRPS type 1. There were no trials that included participants with CRPS type 2. GMI and MT can improve pain in patients with CRPS type 1; however, there is not sufficient evidence to recommend these therapies over other treatments given the small size and heterogeneity of the studied population.

Effectiveness of a Nintendo Wii balance board exercise programme on standing balance of children with cerebral palsy: A randomised clinical trial protocol

Background Patients with cerebral palsy (CP) typically receive limited physical therapy services. However, the Nintendo Wii system offers a simple and affordable mode of virtual reality therapy. There are no clinical trials assessing the Nintendo Wii balance board for improving standing balance in CP. Methods This randomised clinical trial will evaluate the effectiveness of an 18-session/six-week protocol using Wii therapy (W-t) compared with conventional therapy (C-t) in Chilean CP patients. The C-t group will perform the typical exercises prescribed by physical therapists for 40 min each session. W-t will consist of a virtual reality training session using the Nintendo Wii balance board console for 30 min each session. The primary outcome variable is the area of centre-of-pressure (CoP) sway (CoPSway). The secondary outcomes are the standard deviation (SDML; SDAP) and velocity (VML; VAP) of CoP in the ML and AP directions. For a mean difference of 21.5 cm2 (CoPSway) between the groups, we required a minimum of 16 participants in each group. Data will be collected at baseline (week 0), during the study (weeks 2 and 4), at the end of the study (week 6), and during the follow-up (weeks 8 and 10). Measurements of postural control during quiet standing for both groups will be assessed on a force platform AMTI OR67. Discussion This is the first trial that measures and compares the effects of a Nintendo Wii Balance Board exercise programme on standing balance in children with cerebral palsy compared to conventional therapy.

Change in functional balance after an exercise program with Nintendo Wii in Latino patients with cerebral palsy: a case series

[Purpose] This study aimed to explore the possibility of improving functional balance using an exercise program with Nintendo and the Balance Board peripheral in subjects with cerebral palsy. [Subjects and Methods] This study included 4 male outpatients of a neurological center. All participants received an exercise program based on the use of Nintendo with the Balance Board peripheral. Training consisted of three 25-min sessions per week for 6 weeks. Each session was guided by a physical therapist. Timed up-and-go and one-leg standing tests were conducted before and after the intervention. [Results] All subjects showed significant improvements in the results of the timed up-and-go test. However, there were no significant changes in the results of the one-leg standing test. [Conclusion] The exercise protocol involving Nintendo with the Balance Board peripheral appears to improve functional dynamic balance in patients with cerebral palsy. However, static functional balance does not improve after 6 weeks of training.

Correlation between center of pressure and functional balance in non-faller elderly practitioners of Tai Chi Chuan.

[Purpose] This study aimed to determine the correlation between center of pressure and functional balance in non-faller elderly practitioners of Tai Chi. [Subjects and Methods] For the study, nine non-faller elderly practitioners of Tai Chi who were able to maintain a standing posture and walk independently were recruited. Timed one-leg standing and timed up-and-go tests were used as functional balance tests and force platform to measure the center of pressure. The Pearson correlation coefficient was calculated for the timed up-and-go/timed one-leg standing test scores and center of pressure parameter values. [Results] None of the correlations was statistically significant, but moderate correlations were observed between the pairs timed one-leg standing/sway area of center of pressure, timed one-leg standing/standard deviation of center of pressure in the mediolateral direction, timed one-leg standing/mean velocity of center of pressure in the anteroposterior direction, and timed up-and-go test sway area of center of pressure. [Conclusion] Timed one-leg standing is more appropriate than timed up-and-go test for the measurement of functional balance in non-faller elderly practitioners of Tai Chi.

Short-Term Effects of Kinesio Taping on Muscle Recruitment Order During a Vertical Jump: A Pilot Study

CONTEXT Kinesio taping is commonly used in sports and rehabilitation settings with the aim of prevention and treatment of musculoskeletal injuries. However, limited evidence exists regarding the effects of 24 and 72 hours of kinesio taping on trunk and lower limb neuromuscular and kinetic performance during a vertical jump. OBJECTIVE The purpose of this study was to analyze the short-term effects of kinesio taping on height and ground reaction force during a vertical jump, in addition to trunk and lower limb muscle latency and recruitment order. DESIGN Single-group pretest-posttest. SETTING University laboratory. PARTICIPANTS Twelve male athletes from different sports (track and field, basketball, and soccer). INTERVENTIONS They completed a single squat and countermovement jump at basal time (no kinesio taping), 24, and 72 hours of kinesio taping application on the gluteus maximus, biceps femoris, rectus femoris, gastrocnemius medialis, and longissimus. MAIN OUTCOME MEASURES Muscle onset latencies were assessed by electromyography during a squat and countermovement jump, in addition to measurements of the jump height and normalized ground reaction force. RESULTS The kinesio taping had no effect after 24 hours on either the countermovement or squat jump. However, at 72 hours, the kinesio taping increased the jump height (P = .02; d = 0.36) and normalized ground reaction force (P = .001; d = 0.45) during the countermovement jump. In addition, 72-hour kinesio taping reduced longissimus onset latency (P = .03; d = 1.34) and improved muscle recruitment order during a countermovement jump. CONCLUSIONS These findings suggest that kinesio taping may improve neuromuscular and kinetic performance during a countermovement jump only after 72 hours of application on healthy and uninjured male athletes. However, no changes were observed on a squat jump. Future studies should incorporate a control group to verify kinesio tapings effects and its influence on injured athletes.