Background: Children and adolescents with sensorineural hearing loss (SNHL) often experience motor skill disturbances, particularly in balance and gait, due to potential vestibular dysfunctions resulting from inner ear damage. Consequently, several studies have proposed the use of virtual reality-based games as a technological resource for therapeutic purposes, aiming to improve the balance and gait of this population. Objective: The objective of this systematic review is to evaluate the quality of evidence derived from randomized or quasi-randomized controlled trials that employed virtual reality-based games to enhance the balance and/or gait of children and adolescents with SNHL. Methods: A comprehensive search was conducted across nine databases, encompassing articles published in any language until 1 July 2023. The following inclusion criteria were applied: randomized or quasi-randomized controlled trials involving volunteers from both groups with a clinical diagnosis of bilateral SNHL, aged 6–19 years, devoid of physical, cognitive, or neurological deficits other than vestibular dysfunction, and utilizing virtual reality-based games as an intervention to improve balance and/or gait outcomes. Results: Initially, a total of 5984 articles were identified through the searches. Following the removal of duplicates and screening of titles and abstracts, eight studies remained for full reading, out of which three trials met the eligibility criteria for this systematic review. The included trials exhibited a very low quality of evidence concerning the balance outcome, and none of the trials evaluated gait. The meta-analysis did not reveal significant differences in balance improvement between the use of traditional balance exercises and virtual reality-based games for adolescents with SNHL (effect size: −0.48; [CI: −1.54 to 0.57]; p = 0.37; I2 = 0%). Conclusion: Virtual reality-based games show promise as a potential technology to be included among the therapeutic options for rehabilitating the balance of children and adolescents with SNHL. However, given the methodological limitations of the trials and the overall low quality of evidence currently available on this topic, caution should be exercised when interpreting the results of the trials analyzed in this systematic review.

Introduction: The assessment of responsiveness and the Minimum Clinically Important Difference (MCID) is the basis for validating the Maternal perception of Childbirth Fatigue Questionnaire (MCFQ). Objective: To assess the responsiveness and determine the value of the MCID for the MCFQ. Methods: This is an observational study, conducted at HC-UFPE with 50 parturients in active labor. The MCFQ was applied in two moments: in the initial evaluation (EV1), performed at the beginning of labor between 4-6 cm of uterine dilation, and final (EV2), six hours after the first evaluation. Responsiveness was determined by calculating the effect size (ES), and standardized response mean (SRM), considering that values of 0.2, 0.5, and 0.8 points represent respectively small, moderate, or large values of responsiveness. The ability to detect change through the questionnaire was also assessed by the t-test. The level of significance adopted for this analysis was p less than 0.05. The MCID was verified based on the calculation of the standard error of measurement (SEM) index. Results: The MCFQ showed values of 0.4 and 0.6 for ES and SEM respectively and a p-value <0.001, thus showing a good capacity for change. The value of the MCID for this population was seven points. Conclusion: MCFQ presents a potentially significant change with a value of the MCID of seven points after six hours of active labor.

Objectives: Develop a protocol of the use of the Peanut Ball (PB) to evaluate its effectiveness compared to usual care on decreasing maternal fatigue during labor. Methods: This is the development of a randomized clinical trial protocol. Perform an intervention group or use the Peanut Ball through five postures, according to an obstetric assessment. To assess maternal fatigue, the Maternal Perception of Childbirth Fatigue Questionnaire (MCFQ) will be used in the form of an interview. Results: The proposed protocol is according to the evolution of labor: height and positioning of the fetal presentation, erasure and uterine dilation and the presence of early blood flow. Postures with fetal presentation in the upper strait: postures with abduction and external rotation hips will be encouraged using PB. Posture according to the fetal position in the upper strait: posture that cancels gravity will be encouraged: lateral decubitus posture with PB between legs. If the parturient feels like pushing or pushing down with the baby tall and cervix before 8-10 centimeters of uterine dilation, posture that nullifies gravity will be encouraged: lateral decubitus with the aid of the ball, with the hips in abduction and external rotation Conclusion: A specific protocol was developed with the use of Peanut Ball, through an obstetric evaluation, to reduce maternal fatigue during labor.

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