Search Results (15)

Background: This scoping review aims to map and summarise physical therapy interventions specifically targeting gait and balance in individuals with Charcot-Marie-Tooth disease (CMT), highlighting commonly applied strategies, methodological limitations, and clinical implications. Charcot-Marie-Tooth disease (CMT) is a hereditary neuropathy characterised by progressive motor and sensory impairment, often resulting in reduced mobility, muscle weakness, balance deficits, and fatigue. Although pharmacological options remain limited, rehabilitation is increasingly recognised as a key component of disease management. However, the scope, type, and effectiveness of rehabilitative interventions in CMT remain poorly mapped. Methods: This scoping review was conducted in accordance with the Joanna Briggs Institute (JBI) methodology and the PRISMA-ScR guidelines. Five databases (PubMed, Cochrane, PEDro, Scopus, and Web of Science) were systematically searched up to March 2024. Studies were eligible if they involved participants with CMT undergoing rehabilitation interventions aimed at improving functional outcomes. Data extraction focused on study characteristics, methods, outcome measures, and results. Results: Eleven studies met inclusion criteria, comprising case reports, cohort studies, and two randomised controlled trials. Interventions included aerobic training, strength and balance exercises, videogame-based home programmes, and multidisciplinary rehabilitation. Most studies reported improvements in walking capacity (e.g., 6MWT, 10MWT), postural balance (e.g., BBS), and lower limb strength (e.g., MRC, dynamometry). Some also showed positive changes in fatigue and quality of life, though data were limited. Methodological heterogeneity and small sample sizes limited comparability and generalisability. Conclusions: Rehabilitation appears to yield meaningful improvements in key functional domains in people with CMT. Tailored, multimodal interventions show promise, though long-term benefits remain underexplored. Future research should adopt standardised protocols and outcome measures to better define best practices and optimise patient care. Full article

International literature in the field of rehabilitation and psychological support is increasingly characterized by the inclusion and use of video games and virtual media, even if the results are controversial. The theoretical basis on which the study presented is based is Video Game Therapy^®. This approach uses commercial video games, which are generally free or available at a relatively low cost. These games possess many essential functions that make them practical as preventive tools or support for integration into traditional therapies. Video Game Therapy^® allows the patient to reflect on emotional containment and cognitive self-regulation to establish a state of mental balance and well-being. It encourages insight and leads the player to reflect on some salient aspects of their character and lifestyle and their emotions and thoughts linked to specific life episodes relived in the game setting. Starting from these premises, the study shows promising results, presenting a single case of a boy with social isolation problems and relational difficulties, in which significant changes were highlighted in the perception, expression, and management of emotions, as well as in metacognition and self-efficacy. Full article

Background: Advances in technology have led to the emergence of new therapeutic methods such as video-game-based therapy (VGBT). This may be a promising new method for improving upper limb function, but the role and proposed uses still need to be clarified. This study aims to investigate the effectiveness of VGBT in children with cerebral palsy (CP) compared to conventional therapy (CT). Methods: A systematic search of five databases was conducted (Cochrane, Embase, Pubmed, Scopus, Web of Science) in January 2024 to identify randomized controlled trials that compared VGBT interventions with CT for children with CP. Our primary outcomes focused on tests on hand functions (HFs) (grip strength, grasp function, manual dexterity tests, hand function questionnaires tests, and upper limb fine motor function tests). A random effects meta-analysis was performed, and ROB2 and GRADE tools were used. Results: Of 2882 articles reviewed, 22 were selected, involving a total of 785 children. Three outcomes were statistically significant in favor of the intervention group: for grasp function, the standardized mean difference (SMD) was 0.80 (95% confidence intervals 0.06, 1.55); for HF questionnaires, the SMD was 0.36 (95% CI 0.04, 0.68); and for HF tests, the SMD was 0.42 (95% CI 0.03, 0.81). The ROB was high risk in two, some concerns for four and low risk in the other cases. The GRADE was moderate in two, while the remaining were low and very low in half of the papers. Conclusions: VGBT has the potential to be an effective tool for rehabilitation of disabled upper limb function in CP as an adjunct to other traditional forms of therapy by integrating it into everyday rehabilitation. Full article

Limitations of pharmaceutical drugs and biologics for chronic diseases (e.g., medication non-adherence, adverse effects, toxicity, or inadequate efficacy) can be mitigated by mobile medical apps, known as digital therapeutics (DTx). Authorization of adjunct DTx by the US Food and Drug Administration and draft guidelines on “prescription drug use-related software” illustrate opportunities to create drug + digital combination therapies, ultimately leading towards drug–device combination products (DTx has a status of medical devices). Digital interventions (mobile, web-based, virtual reality, and video game applications) demonstrate clinically meaningful benefits for people living with Alzheimer’s disease, dementia, rheumatoid arthritis, cancer, chronic pain, epilepsy, depression, and anxiety. In the respective animal disease models, preclinical studies on environmental enrichment and other non-pharmacological modalities (physical activity, social interactions, learning, and music) as surrogates for DTx “active ingredients” also show improved outcomes. In this narrative review, we discuss how drug + digital combination therapies can impact translational research, drug discovery and development, generic drug repurposing, and gene therapies. Market-driven incentives to create drug–device combination products are illustrated by Humira^® (adalimumab) facing a “patent-cliff” competition with cheaper and more effective biosimilars seamlessly integrated with DTx. In conclusion, pharma and biotech companies, patients, and healthcare professionals will benefit from accelerating integration of digital interventions with pharmacotherapies. Full article

Attention deficit hyperactivity disorder (ADHD) is a neurodevelopmental disorder characterized by inattention, hyperactivity, and impulsivity that affects a large number of young people in the world. The current treatments for children living with ADHD combine different approaches, such as pharmacological, behavioral, cognitive, and psychological treatment. However, the computer science research community has been working on developing non-pharmacological treatments based on novel technologies for dealing with ADHD. For instance, social robots are physically embodied agents with some autonomy and social interaction capabilities. Nowadays, these social robots are used in therapy sessions as a mediator between therapists and children living with ADHD. Another novel technology for dealing with ADHD is serious video games based on a brain–computer interface (BCI). These BCI video games can offer cognitive and neurofeedback training to children living with ADHD. This paper presents a systematic review of the current state of the art of these two technologies. As a result of this review, we identified the maturation level of systems based on these technologies and how they have been evaluated. Additionally, we have highlighted ethical and technological challenges that must be faced to improve these recently introduced technologies in healthcare. Full article

This work introduces a new socially assistive robot termed MARIA T21 (meaning “Mobile Autonomous Robot for Interaction with Autistics”, with the addition of the acronym T21, meaning “Trisomy 21”, which is used to designate individuals with Down syndrome). This new robot is used in psychomotor therapies for children with Down syndrome (contributing to improve their proprioception, postural balance, and gait) as well as in psychosocial and cognitive therapies for children with autism spectrum disorder. The robot uses, as a novelty, an embedded mini-video projector able to project Serious Games on the floor or tables to make already-established therapies funnier to these children, thus creating a motivating and facilitating effect for both children and therapists. The Serious Games were developed in Python through the library Pygame, considering theoretical bases of behavioral psychology for these children, which are integrated into the robot through the robot operating system (ROS). Encouraging results from the child–robot interaction are shown, according to outcomes obtained from the application of the Goal Attainment Scale. Regarding the Serious Games, they were considered suitable based on both the “Guidelines for Game Design of Serious Games for Children” and the “Evaluation of the Psychological Bases” used during the games’ development. Thus, this pilot study seeks to demonstrate that the use of a robot as a therapeutic tool together with the concept of Serious Games is an innovative and promising tool to help health professionals in conducting therapies with children with autistic spectrum disorder and Down syndrome. Due to health issues imposed by the COVID-19 pandemic, the sample of children was limited to eight children (one child with typical development, one with Trisomy 21, both female, and six children with ASD, one girl and five boys), from 4 to 9 years of age. For the non-typically developing children, the inclusion criterion was the existence of a conclusive diagnosis and fulfillment of at least 1 year of therapy. The protocol was carried out in an infant psychotherapy room with three video cameras, supervised by a group of researchers and a therapist. The experiments were separated into four steps: The first stage was composed of a robot introduction followed by an approximation between robot and child to establish eye contact and assess proxemics and interaction between child/robot. In the second stage, the robot projected Serious Games on the floor, and emitted verbal commands, seeking to evaluate the child’s susceptibility to perform the proposed tasks. In the third stage, the games were performed for a certain time, with the robot sending messages of positive reinforcement to encourage the child to accomplish the game. Finally, in the fourth stage, the robot finished the games and said goodbye to the child, using messages aiming to build a closer relationship with the child. Full article

Background: Alexander technique private lessons have been shown to reduce chronic neck pain and are thought to work by different mechanisms than exercise. Group classes may also be effective and would be cost-effective. Design: A two-group pre-test/post-test design. Participants were assigned to either a general Alexander technique class or an exercise class designed to target neck pain. Both groups met over 5 weeks for two 60 min sessions/week. Participants: A total of 16 participants with chronic neck pain (aged 50+/−16 years) completed this study. Interventions: The Alexander class used awareness-building methods to teach participants to reduce habitual tension during everyday activities. The exercise class was based on physical therapy standard of care to strengthen neck and back muscles thought to be important for posture. Measures: We assessed neck pain/disability, pain self-efficacy, activation of the sternocleidomastoid muscles during the cranio-cervical flexion test, and posture while participants played a video game. Results: Both groups reported decreased neck pain/disability after the interventions. Sternocleidomastoid activation decreased only in the Alexander group. Conclusion: In this small preliminary study, Alexander classes were at least as effective as exercise classes in reducing neck pain and seemed to work via a different mechanism. Larger, multi-site studies are justified. Full article

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. Full article

Background: Deterioration in upper extremity function has been a common problem among children with cerebral palsy (CP). The present study evaluated the effects of virtual reality (VR)-based rehabilitation combined with conventional occupational therapy (COT) on upper extremity function and caregiver assistance among children with CP. Methods: Medical records of 17 children with CP who regularly participated in a rehabilitation program at Samsung Changwon Hospital were retrospectively reviewed. Ten children received VR-based rehabilitation, which utilized RAPAEL Smart Kids and video games combined with COT. Seven children received COT alone, which was provided by a trained occupational therapist and focused on their upper extremities. Clinical outcomes were determined using the Quality of Upper Extremity Skills Test (QUEST) and Pediatric Evaluation of Disability Inventory (PEDI), which were administered before and 8 weeks after the first intervention session. Results: The smart glove (SG) group showed significant improvements in all QUEST domains and five PEDI domains (p < 0.05), whereas the COT group showed a significant change only in total QUEST scores. A comparison between both groups revealed that the SG group had significantly greater improvements in five QUEST domains and two PEDI domains (p < 0.05). Conclusions: Our results suggest that VR-based rehabilitation combined with COT may improve the upper extremity functions and decrease caregiver burden among children with CP. Full article

Background: Stroke patients with motor, sensory and cognitive diseases can take profits from information and communication technologies—in particular, from the latest commercial video consoles, which are based on motion capture. These technologies are positioning themselves as complementary therapeutic tools for treating gait and balance disorders. In this paper, a systematic review of the effect of video game-based therapy on balance and gait in stroke patients is shown and compared with other types of treatments. Methods: A systematic review of prospective controlled clinical trials published in the main biomedical databases in English and Spanish between 2005 and 2020 was performed. The systematic review presented in this paper has been done following the Cochrane Manual recommendations and the PRISMA Declaration by two independent reviewers. Data about participants, intervention, outcome measurements and outcome measurement results were extracted. The quality of evidence of each study was assessed using Cochrane’s standard quality assessment format, which includes a description of the risk of bias. Additionally, the Physiotherapy Evidence Database (PEDro) scale was used to assess the methodological quality of each paper. Results: A total of 18 papers, including 479 patients, were included in this systematic review, in which the use of video consoles (in combination with conventional rehabilitation or exclusively) was compared with conventional rehabilitation to treat balance or gait in post-stroke patients. In all studies, a tendency to improve balance was found in both intervention groups, finding, in 10 of 17 studies that analysed it, a better capacity in the experimental group that included video consoles compared to the conventional rehabilitation control group. Regarding gait, in six of seven studies that analysed it, improvements were found in both intervention groups, and these improvements were greater in the experimental group than compared to the control group in three of them. Conclusions: Commercial video game systems, in combination with conventional rehabilitation, have shown positive results on balance and gait in post-stroke patients. There were variations between the trials in terms of the video consoles used and the duration, frequency and number of sessions with commercial video games. Future studies should compare the effects of commercial video game treatments on balance and gait in stroke patients with a nonintervention group to know their real efficacy. Full article

Rehabilitation requires repetitive and coordinated movements for effective treatment, which are contingent on patient compliance and motivation. However, the monotony, intensity, and expense of most therapy routines do not promote engagement. Gesture-controlled rehabilitation has the potential to quantify performance and provide engaging, cost-effective treatment, leading to better compliance and mobility. We present the design and testing of a gesture-controlled rehabilitation robot (GC-Rebot) to assess its potential for monitoring user performance and providing entertainment while conducting physical therapy. Healthy participants (n = 11) completed a maze with GC-Rebot for six trials. User performance was evaluated through quantitative metrics of movement quality and quantity, and participants rated the system usability with a validated survey. For participants with self-reported video-game experience (n = 10), wrist active range of motion across trials (mean ± standard deviation) was 41.6 ± 13° and 76.8 ± 16° for pitch and roll, respectively. In the course of conducting a single trial with a time duration of 68.3 ± 19 s, these participants performed 27 ± 8 full wrist motion repetitions (i.e., flexion/extension), with a dose-rate of 24.2 ± 5 ^reps/_min. These participants also rated system usability as excellent (score: 86.3 ± 12). Gesture-controlled therapy using the GC-Rebot demonstrated the potential to be an evidence-based rehabilitation tool based on excellent user ratings and the ability to monitor at-home compliance and performance. Full article

The feasibility, acceptability and preliminary efficacy of computerized cognitive rehabilitation therapy (CCRT) for mitigating neurocognitive decline was evaluated in African adults ≥50 years old. Eighty-one Ugandans with (n = 40) and without (n = 41) chronic human immunodeficiency viruses (HIV) were allocated CCRT—i.e., 20–45-min cognitive training sessions with culturally adapted video games delivered via Captain’s Log Software, or standard of care (SOC). Pre and post (i.e., 8-weeks later) intervention performance based neurocognitive tests, quality of life (QOL) and frailty related phenotype (FRP) were determined in all respondents. Multivariable linear regression estimated CCRT- vs. SOC-related differences (β) in neurocognitive batteries, QOL and FRP. Effect sizes (ES) for estimated β were calculated. CCRT protocol was completed by 92.8% of persons allocated to it. Regardless of HIV status, CCRT was associated with higher performance in learning tests than SOC—interference list (β = 1.00, 95%CI: (0.02, 1.98); ES = 0.43) and delayed recall (β = 1.04, 95%CI: (0.06, 2.02); ES = 0.47). CCRT effect on verbal fluency was clinically important (ES = 0.38), but statistical significance was not reached (β = 1.25, 95%CI: (−0.09, 2.58)). Among HIV-positive adults, clinically important post-CCRT improvements were noted for immediate recall (ES = 0.69), working memory (ES = 0.51), verbal fluency (ES = 0.51), and timed gait (ES = −0.44) tasks. Among HIV-negative adults, CCRT resulted in moderate post-intervention improvement in learning tests (ES = 0.45) and large decline in FRP (ES = −0.71), without a positive effect on simple attention and visuomotor coordination tasks. CCRT intervention is feasible among older Ugandan adults with potential benefit for learning and verbal fluency tests regardless of HIV status and lowering FRP in HIV-negative older adults. Full article

Internet gaming disorder in adolescents and young adults has become an increasing public concern because of its high prevalence rate and potential risk of alteration of brain functions and organizations. Cue exposure therapy is designed for reducing or maintaining craving, a core factor of relapse of addiction, and is extensively employed in addiction treatment. In a previous study, we proposed a machine-learning-based method to detect craving for gaming using multimodal physiological signals including photoplethysmogram, galvanic skin response, and electrooculogram. Our previous study demonstrated that a craving for gaming could be detected with a fairly high accuracy; however, as the feature vectors for the machine-learning-based detection of the craving of a user were selected based on the physiological data of the user that were recorded on the same day, the effectiveness of the reuse of the machine learning model constructed during the previous experiments, without any further calibration sessions, was still questionable. This “high test-retest reliability” characteristic is of importance for the practical use of the craving detection system because the system needs to be repeatedly applied to the treatment processes as a tool to monitor the efficacy of the treatment. We presented short video clips of three addictive games to nine participants, during which various physiological signals were recorded. This experiment was repeated with different video clips on three different days. Initially, we investigated the test-retest reliability of 14 features used in a craving detection system by computing the intraclass correlation coefficient. Then, we classified whether each participant experienced a craving for gaming in the third experiment using various classifiers—the support vector machine, k-nearest neighbors (kNN), centroid displacement-based kNN, linear discriminant analysis, and random forest—trained with the physiological signals recorded during the first or second experiment. Consequently, the craving/non-craving states in the third experiment were classified with an accuracy that was comparable to that achieved using the data of the same day; thus, demonstrating a high test-retest reliability and the practicality of our craving detection method. In addition, the classification performance was further enhanced by using both datasets of the first and second experiments to train the classifiers, suggesting that an individually customized game craving detection system with high accuracy can be implemented by accumulating datasets recorded on different days under different experimental conditions. Full article

Real-time motion capture of the human arm in the home environment has many use cases, such as video game and therapy applications. The required tracking can be based on off-the-shelf Inertial Measurement Units (IMUs) with integrated three-axis accelerometers, gyroscopes, and magnetometers. However, this usually requires a homogeneous magnetic field to correct for orientation drift, which is often not available inside buildings. In this paper, RPMC (Rest Pose Magnetometer-based drift Correction), a novel method that is robust to long term drift in environments with inhomogeneous magnetic fields, is presented. The sensor orientation is estimated by integrating the angular velocity measured by the gyroscope and correcting drift around the pitch and roll axes with the acceleration information. This commonly leads to short term drift around the gravitational axis. Here, during the calibration phase, the local magnetic field direction for each sensor, and its orientation relative to the inertial frame, are recorded in a rest pose. It is assumed that arm movements in free space are exhausting and require regular rest. A set of rules is used to detect when the user has returned to the rest pose, to then correct for the drift that has occurred with the magnetometer. Optical validations demonstrated accurate (root mean square error $RMS=6.1$ °), low latency ( $61\mathrm{m}\mathrm{s}$ ) tracking of the user’s wrist orientation, in real time, for a full hour of arm movements. The reduction in error relative to three alternative methods implemented for comparison was between $82.5\%$ and $90.7\%$ for the same movement and environment. Therefore, the proposed arm tracking method allows for the correction of orientation drift in an inhomogeneous magnetic field by exploiting the user’s need for frequent rest. Full article

The increase in the number of adolescents with internet gaming disorder (IGD), a type of behavioral addiction is becoming an issue of public concern. Teaching adolescents to suppress their craving for gaming in daily life situations is one of the core strategies for treating IGD. Recent studies have demonstrated that computer-aided treatment methods, such as neurofeedback therapy, are effective in relieving the symptoms of a variety of addictions. When a computer-aided treatment strategy is applied to the treatment of IGD, detecting whether an individual is currently experiencing a craving for gaming is important. We aroused a craving for gaming in 57 adolescents with mild to severe IGD using numerous short video clips showing gameplay videos of three addictive games. At the same time, a variety of biosignals were recorded including photoplethysmogram, galvanic skin response, and electrooculogram measurements. After observing the changes in these biosignals during the craving state, we classified each individual participant’s craving/non-craving states using a support vector machine. When video clips edited to arouse a craving for gaming were played, significant decreases in the standard deviation of the heart rate, the number of eye blinks, and saccadic eye movements were observed, along with a significant increase in the mean respiratory rate. Based on these results, we were able to classify whether an individual participant felt a craving for gaming with an average accuracy of 87.04%. This is the first study that has attempted to detect a craving for gaming in an individual with IGD using multimodal biosignal measurements. Moreover, this is the first that showed that an electrooculogram could provide useful biosignal markers for detecting a craving for gaming. Full article