Background and Purpose—
Exercise using virtual reality (VR) has improved balance in adults with traumatic brain injury and community-dwelling older adults. Rigorous randomized studies regarding its efficacy, safety, and applicability with individuals after stroke are lacking. The purpose of this study was to determine whether an adjunct VR therapy improves balance, mobility, and gait in stroke rehabilitation inpatients.
Methods—
A blinded randomized controlled trial studying 59 stroke survivors on an inpatient stroke rehabilitation unit was performed. The treatment group (n=30) received standard stroke rehabilitation therapy plus a program of VR exercises that challenged balance (eg, soccer goaltending, snowboarding) performed while standing. The control group (n=29) received standard stroke rehabilitation therapy plus exposure to identical VR environments but whose games did not challenge balance (performed in sitting). VR training consisted of 10 to 12 thirty-minute daily sessions for a 3-week period. Objective outcome measures of balance and mobility were assessed before, immediately after, and 1 month after training.
Results—
Confidence intervals and effect sizes favored the treatment group on the Timed Up and Go and the Two-Minute Walk Test, with both groups meeting minimal clinical important differences after training. More individuals in the treatment group than in the control group showed reduced impairment in the lower extremity as measured by the Chedoke McMaster Leg domain (
P
=0.04) immediately after training.
Conclusions—
This VR exercise intervention for inpatient stroke rehabilitation improved mobility-related outcomes. Future studies could include nonambulatory participants as well as the implementation strategies for the clinical use of VR.
Clinical Trial Registration—
URL:
http://www.ANZCTR.org.au/
. Unique identifier: ACTRN12613000710729.
The effect of muscle fatigue on quiet standing is equivocal, including its duration/recovery and whether it leads to an increase in attentional demands. The purpose of this study was to assess the effects of ankle and hip muscle fatigue on postural sway and simple reaction time during a unipedal task. Two groups of 14 young adults (mean age=22.50±3.23) had to stand on their dominant leg for 30-s trials before and after fatigue of hip or ankle flexors and extensors. Half of the unipedal trials were performed in a dual-task condition where subjects, in addition to standing, had to respond verbally to an auditory stimulus. Sway area, and sway variability and velocity in the AP and ML planes were calculated using center of pressure data obtained from a force platform. Voice reaction time was recorded seated and during the dual-task condition to assess attentional demands. A main effect of fatigue was found for AP sway variability (p=0.027), AP sway velocity (p=0.017) and ML sway velocity (p=0.004). Both groups showed increased sway velocity in both directions and in reaction time during the dual-task condition (p<0.001), but reaction time did not increase with fatigue. A group by fatigue interaction was found significant for ML sway velocity (p=0.043). Results suggest that hip and ankle fatigue affected postural control in the fatigued plane (AP) but only hip fatigue affected postural control in the non-fatigued plane (ML sway velocity). However, fatigue did not lead to an increase in attentional demands and increased AP and ML sway velocity had recovered within 30min.
Abstract-Persons with dementia (PWD) are known to have difficulty with participation and focus during physical activity. Virtual reality (VR) offers a unique medium for motor learning but has only been used previously for cognitive assessment for PWD. Our study had two objectives: (1) investigate the feasibility and safety of an exercise-based VR training program in PWD, and (2) investigate its effects on balance and mobility. The intervention consisted of daily (5 d/wk, 1 h each) VR training sessions for 2 wk for a single research participant. Clinical balance and mobility measures were assessed 1 wk prior to, during, 1 wk following, and 1 mo after the intervention. Postintervention interviews provided qualitative feedback from the participant and his caregivers. Results indicate that VR training is feasible, safe, and enjoyable for PWD. However, balance and mobility measures were unaffected. VR training is well tolerated in a single research participant with dementia and is an engaging medium for participation in exercise.
The content analysis of exercise interventions in knee osteoarthritis demonstrated low scores for moderate- to high-quality trials. Improved standardized reporting is recommended to ensure knowledge transfer and replication of effective exercise programs for individuals with knee osteoarthritis.
Rationale:
Exercise programs for the management of fibromyalgia are well recognized as being effective. However, the incomplete descriptions of exercise programs make replication and implementation difficult. Also, existing reporting tools have not been validated in relation to pain relief as well as with each other.
Objectives:
This study aimed to evaluate the description of exercise programs in randomized control trials for the management of fibromyalgia using different assessment tools, and the correlations of each tool in relation to effectiveness of pain relief of fibromyalgia, and the correlations between each tool.
Method/Results:
Through a consensus made by two different pairs of reviewers and an arbitrator, the mean total scores for the exercise programs were reported: 10.61/19 for Consensus on Exercise Reporting Template; 4.17/12 for Template for Intervention Description and Replication; 7.05/12 for the Consensus on Therapeutic Exercise Training; and 2.50/4 (aerobic) and 2.36/5 (flexibility and resistance) for the 2016 American College of Sports Medicine guidelines. This demonstrates generally low reporting scores (less than 60% out of the total number of items were reported). Overall, low correlations (Cohen’s kappa value, ranging from −0.47 (poor) to 0.313 (fair)) were found between all tools and pain relief. Good to excellent correlations (0.680–0.908) among the reporting tools were shown.
Conclusion:
Incomplete descriptions of exercise programs were consistently shown among the randomized clinical trials assessed in this study. The overall weak correlations demonstrated that the reporting tools have the limited ability to determine whether exercise programs were or were not effective for pain relief among individuals with fibromyalgia.
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