Advantages of virtual reality in the rehabilitation of balance and gait

Neurology ◽  
2018 ◽  
Vol 90 (22) ◽  
pp. 1017-1025 ◽  
Author(s):  
Desiderio Cano Porras ◽  
Petra Siemonsma ◽  
Rivka Inzelberg ◽  
Gabriel Zeilig ◽  
Meir Plotnik
Keyword(s):  
Virtual Reality ◽  
Motor Learning ◽  
Cochrane Collaboration ◽  
Intervention Programs ◽  
Randomized Controlled ◽  
Methodologic Quality ◽  
Newcastle Ottawa Scale ◽  
Meta Analyses ◽  
Learning Principles ◽  
Ottawa Scale

BackgroundVirtual reality (VR) has emerged as a therapeutic tool facilitating motor learning for balance and gait rehabilitation. The evidence, however, has not yet resulted in standardized guidelines. The aim of this study was to systematically review the application of VR-based rehabilitation of balance and gait in 6 neurologic cohorts, describing methodologic quality, intervention programs, and reported efficacy.MethodsThis study follows the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. VR-based treatments of Parkinson disease, multiple sclerosis, acute and chronic poststroke, traumatic brain injury, and cerebral palsy were researched in PubMed and Scopus, including earliest available records. Therapeutic validity (CONTENT scale) and risk of bias in randomized controlled trials (RCT) (Cochrane Collaboration tool) and non-RCT (Newcastle-Ottawa scale) were assessed.ResultsNinety-seven articles were included, 68 published in 2013 or later. VR improved balance and gait in all cohorts, especially when combined with conventional rehabilitation. Most studies presented poor methodologic quality, lacked a clear rationale for intervention programs, and did not utilize motor learning principles meticulously. RCTs with more robust methodologic designs were widely recommended.ConclusionOur results suggest that VR-based rehabilitation is developing rapidly, has the potential to improve balance and gait in neurologic patients, and brings additional benefits when combined with conventional rehabilitation. This systematic review provides detailed information for developing theory-driven protocols that may assist overcoming the observed lack of argued choices for intervention programs and motor learning implementation and serves as a reference for the design and planning of personalized VR-based treatments.RegistrationPROSPERO CRD42016042051.

Prevalence of Cognitive Impairment and Dementia in Older Adults Living at High Altitude: A Systematic Review and Meta-Analysis

2021 ◽  
pp. 1-11
Author(s):  
Diego Urrunaga-Pastor ◽  
Diego Chambergo-Michilot ◽  
Fernando M. Runzer-Colmenares ◽  
Josmel Pacheco-Mendoza ◽  
Vicente A. Benites-Zapata
Keyword(s):  
Older Adults ◽  
Cognitive Impairment ◽  
High Altitude ◽  
Web Of Science ◽  
Meta Analysis ◽  
Cross Sectional ◽  
Language Restriction ◽  
Newcastle Ottawa Scale ◽  
Meta Analyses ◽  
Ottawa Scale

<b><i>Introduction:</i></b> Dementia is a chronic disease with a variable prevalence throughout the world; however, this could be higher at high-altitude populations. We aimed to summarize the prevalence of cognitive impairment and dementia in older adults living at high altitude. <b><i>Methods:</i></b> We searched in PubMed, Medline, Scopus, Web of Science, and Embase and included the studies published from inception to July 20, 2020, with no language restriction, which reported the frequency of cognitive impairment or dementia in older adults living at high-altitude populations. Random-effects meta-analyses were performed to calculate the overall prevalence and 95% confidence intervals (95% CI) of cognitive impairment and dementia. The risk of bias was evaluated using the Newcastle-Ottawa Scale (NOS) adapted for cross-sectional studies. <b><i>Results:</i></b> Six studies were included (3,724 participants), and 5 of the 6 included studies were carried out in Latin America. The altitude ranged from 1,783 to 3,847 m, the proportion of women included varied from 38.7 to 65.6%, and the proportion of participants with elementary or illiterate educational level ranged from 71.7 to 97.6%. The overall prevalence of cognitive impairment was 22.0% (95% CI: 8–40, <i>I</i><sup>2</sup>: 99%), and the overall prevalence of dementia was 11.0% (95% CI: 6–17, <i>I</i><sup>2</sup>: 92%). In a subgroup analysis according to the instrument used to evaluate cognitive impairment, the prevalence of cognitive impairment was 21.0% (95% CI: 5–42, <i>I</i><sup>2</sup>: 99%) in the MMSE group while the prevalence was 29.0% (95% CI: 0–78) in the non-MMSE group. <b><i>Conclusions:</i></b> The prevalence of cognitive impairment and dementia in older adults living at high altitude is almost twice the number reported in some world regions.

scholarly journals Diabetes as a risk factor for incident peripheral arterial disease in women compared to men: a systematic review and meta-analysis

2020 ◽  
Vol 19 (1) ◽  
Author(s):  
Alyssa Z. Chase-Vilchez ◽  
Isaac H. Y. Chan ◽  
Sanne A. E. Peters ◽  
Mark Woodward
Keyword(s):  
Cardiovascular Disease ◽  
Risk Factor ◽  
Relative Risk ◽  
Meta Analysis ◽  
Arterial Disease ◽  
Excess Risk ◽  
Newcastle Ottawa Scale ◽  
Peripheral Arterial ◽  
Meta Analyses ◽  
Ottawa Scale

Abstract Aims/hypothesis Previous meta-analyses have suggested that diabetes confers a greater excess risk of coronary heart disease, stroke, vascular dementia, and heart failure in women compared to men. While the underlying mechanism that explains such greater excess risk is unknown, in the current meta-analysis we hypothesized that we would find a similar sex difference in the relationship between diabetes and peripheral arterial disease (PAD). Methods PubMed MEDLINE, the Cochrane Database of Systematic Reviews, and Embase were systematically searched for prospective population-based cohort studies, with no restriction on publication date, language, or country. We included studies that reported the relative risk (RR), and its variability, for incident PAD associated with diabetes in both sexes. We excluded studies that did not adjust at least for age, and in which participants had pre-existing PAD. In cases where sex-specific results were not reported, study authors were contacted. Random-effects meta-analyses with inverse variance weighting were used to obtain summary sex-specific RRs and the women: men ratio of RRs for PAD. The Newcastle–Ottawa scale was used to assess study quality. Results Data from seven cohorts, totalling 2071,260 participants (49.8% women), were included. The relative risk for incident PAD associated with diabetes compared with no diabetes was 1.96 (95% CI 1.29–2.63) in women and 1.84 (95% CI 1.29–2.86) in men, after adjusting for potential confounders. The multiple-adjusted RR ratio was 1.05 (95% CI 0.90–1.22), with virtually no heterogeneity between studies (I2 = 0%). All studies scored 6–8, on the Newcastle–Ottawa scale of 0–9, indicating good quality. Eleven of the 12 studies that met review inclusion criteria did not report sex-specific relative risk, and these data were collected through direct correspondence with the study authors. Conclusion/interpretation Consistent with other studies, we found evidence that diabetes is an independent risk factor for PAD. However, in contrast to similar studies of other types of cardiovascular disease, we did not find evidence that diabetes confers a greater excess risk in women compared to men for PAD. More research is needed to explain this sex differential between PAD and other forms of CVD, in the sequelae of diabetes. In addition, we found that very few studies reported the sex-specific relative risk for the association between diabetes and PAD, adding to existing evidence for the need for improved reporting of sex-disaggregated results in cardiovascular disease research.

scholarly journals Emergence of Virtual Reality as a Tool for Upper Limb Rehabilitation: Incorporation of Motor Control and Motor Learning Principles

2015 ◽  
Vol 95 (3) ◽  
pp. 415-425 ◽  
Author(s):  
Mindy F. Levin ◽  
Patrice L. Weiss ◽  
Emily A. Keshner
Keyword(s):  
Virtual Reality ◽  
Motor Control ◽  
Motor Learning ◽  
Upper Limb ◽  
Limb Movement ◽  
Motor Recovery ◽  
Upper Limb Rehabilitation ◽  
Wide Range ◽  
Learning Principles ◽  
Limb Rehabilitation

The primary focus of rehabilitation for individuals with loss of upper limb movement as a result of acquired brain injury is the relearning of specific motor skills and daily tasks. This relearning is essential because the loss of upper limb movement often results in a reduced quality of life. Although rehabilitation strives to take advantage of neuroplastic processes during recovery, results of traditional approaches to upper limb rehabilitation have not entirely met this goal. In contrast, enriched training tasks, simulated with a wide range of low- to high-end virtual reality–based simulations, can be used to provide meaningful, repetitive practice together with salient feedback, thereby maximizing neuroplastic processes via motor learning and motor recovery. Such enriched virtual environments have the potential to optimize motor learning by manipulating practice conditions that explicitly engage motivational, cognitive, motor control, and sensory feedback–based learning mechanisms. The objectives of this article are to review motor control and motor learning principles, to discuss how they can be exploited by virtual reality training environments, and to provide evidence concerning current applications for upper limb motor recovery. The limitations of the current technologies with respect to their effectiveness and transfer of learning to daily life tasks also are discussed.

scholarly journals Motor Learning Principles for Rehabilitation: A Pilot Randomized Controlled Study in Poststroke Patients

2010 ◽  
Vol 24 (6) ◽  
pp. 501-508 ◽  
Author(s):  
Lamberto Piron ◽  
Andrea Turolla ◽  
Michela Agostini ◽  
Carla Silvana Zucconi ◽  
Laura Ventura ◽  
...  
Keyword(s):  
Motor Learning ◽  
Randomized Controlled Study ◽  
Controlled Study ◽  
Randomized Controlled ◽  
Learning Principles

scholarly journals Assessing the quality of studies in meta-analyses: Advantages and limitations of the Newcastle Ottawa Scale

2017 ◽  
Vol 5 (4) ◽  
pp. 80 ◽  
Author(s):  
Claudio Luchini ◽  
Brendon Stubbs ◽  
Marco Solmi ◽  
Nicola Veronese
Keyword(s):  
Newcastle Ottawa Scale ◽  
Meta Analyses ◽  
Ottawa Scale

scholarly journals Anosmia and dysgeusia in SARS-CoV-2 infection: incidence and effects on COVID-19 severity and mortality, and the possible pathobiology mechanisms - a systematic review and meta-analysis

F1000Research ◽  
2021 ◽  
Vol 10 ◽  
pp. 40
Author(s):  
Endang Mutiawati ◽  
Marhami Fahriani ◽  
Sukamto S. Mamada ◽  
Jonny Karunia Fajar ◽  
Andri Frediansyah ◽  
...  
Keyword(s):  
Web Of Science ◽  
Respiratory Infections ◽  
Meta Analysis ◽  
Research Quality ◽  
Future Studies ◽  
Pooled Prevalence ◽  
Protocol Registration ◽  
Newcastle Ottawa Scale ◽  
Meta Analyses ◽  
Ottawa Scale

Background: The present study aimed to determine the global prevalence of anosmia and dysgeusia in coronavirus disease 2019 (COVID-19) patients and to assess their association with severity and mortality of COVID-19. Moreover, this study aimed to discuss the possible pathobiological mechanisms of anosmia and dysgeusia in COVID-19. Methods: Available articles from PubMed, Scopus, Web of Science, and preprint databases (MedRxiv, BioRxiv, and Researchsquare) were searched on November 10th, 2020. Data on the characteristics of the study (anosmia, dysgeusia, and COVID-19) were extracted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline. Newcastle–Ottawa scale was used to assess research quality. Moreover, the pooled prevalence of anosmia and dysgeusia were calculated, and the association between anosmia and dysgeusia in presence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was assessed using the Z test. Results: Out of 32,142 COVID-19 patients from 107 studies, anosmia was reported in 12,038 patients with a prevalence of 38.2% (95% CI: 36.5%, 47.2%); whereas, dysgeusia was reported in 11,337 patients out of 30,901 COVID-19 patients from 101 studies, with prevalence of 36.6% (95% CI: 35.2%, 45.2%), worldwide. Furthermore, the prevalence of anosmia was 10.2-fold higher (OR: 10.21; 95% CI: 6.53, 15.96, p < 0.001) and that of dysgeusia was 8.6-fold higher (OR: 8.61; 95% CI: 5.26, 14.11, p < 0.001) in COVID-19 patients compared to those with other respiratory infections or COVID-19 like illness. To date, no study has assessed the association of anosmia and dysgeusia with severity and mortality of COVID-19. Conclusion: Anosmia and dysgeusia are prevalent in COVID-19 patients compared to those with the other non-COVID-19 respiratory infections. Several possible mechanisms have been hypothesized; however, future studies are warranted to elucidate the definitive mechanisms of anosmia and dysgeusia in COVID-19. Protocol registration: PROSPERO CRD42020223204.

scholarly journals Systematic Review of the Effect of a Zero-Markup Policy for Essential Drugs on Healthcare Costs and Utilization in China, 2015–2021

2021 ◽  
Vol 8 ◽  
Author(s):  
Wen-Yi Liu ◽  
Chia-Hsien Hsu ◽  
Ting-Jun Liu ◽  
Pei-En Chen ◽  
Boyuan Zheng ◽  
...  
Keyword(s):  
Systematic Review ◽  
Healthcare Costs ◽  
Medical Services ◽  
Essential Drugs ◽  
Medical Spending ◽  
Financial Perspective ◽  
Newcastle Ottawa Scale ◽  
The Government ◽  
Meta Analyses ◽  
Ottawa Scale

Objective: This systematic review aimed to discuss the effects of a zero-markup policy for essential drugs (ZPED) on healthcare costs and utilization in China in the years 2015–2021.Methods: We searched the PubMed, Embase, Scopus, and CINAHL databases for all associated studies carried out from January 1, 2015, to May 31, 2021, without any limitations regarding the language the studies were written in. To prevent selection bias, gray documents were tackled by other means. The methodological approaches were assessed by applying the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and the Newcastle-Ottawa Scale (NOS) collaboration tool.Results: Forty studies were selected at first and then 15 studies that met the inclusion criterion. Most of the studies showed a considerable decrease in total medical spending and drug spending in both outpatient and inpatient services. After the implementation of ZPED, studies showed that the medical services increased and total hospital income sustained, despite a decrease in drug revenue. Minimal or no government subsidy is required from a financial perspective.Conclusions: Although, the government could implement ZEPD with lower medical cost and drug cost to patients, and sustained income for health facilities, we have limited understanding of whether the increase in medical services was induced by the provider or was a response to unmet needs in the population. Further, studies using rigorous and advanced methods to study health policy, patient behaviors, provider behaviors, and government decisions are warranted.

scholarly journals Long-Term Nightshift Work and Breast Cancer Risk: An Updated Systematic Review and Meta-Analysis with Special Attention to Menopausal Status and to Recent Nightshift Work

Cancers ◽  
2021 ◽  
Vol 13 (23) ◽  
pp. 5952
Author(s):  
Christine Schwarz ◽  
Ana María Pedraza-Flechas ◽  
Roberto Pastor-Barriuso ◽  
Virginia Lope ◽  
Nerea Fernández de Larrea ◽  
...  
Keyword(s):  
Systematic Review ◽  
Meta Analysis ◽  
Menopausal Status ◽  
Case Control ◽  
Risk Exposure ◽  
Newcastle Ottawa Scale ◽  
Meta Analyses ◽  
Nested Case Control ◽  
Ottawa Scale

This systematic review discusses long-term NSW and female BC risk, with special attention to differences between pre- and postmenopausal BC, to test the association with recent NSW. The review follows PRISMA guidelines (Prospero registry: CRD42018102515). We searched PubMed, Embase, and WOS for case–control, nested case–control, and cohort studies addressing long-term NSW (≥15 years) as risk exposure and female BC as outcome until 31 December 2020. Risk of bias was evaluated with the Newcastle–Ottawa scale. Eighteen studies were finally included (eight cohorts; five nested case–control; five case–control). We performed meta-analyses on long-term NSW and BC risk; overall and by menopausal status; a subanalysis on recent long-term NSW, based on studies involving predominantly women below retirement age; and a dose–response meta-analysis on NSW duration. The pooled estimate for long-term NSW and BC was 1.13 (95%CI = 1.01–1.27; 18 studies, I2 = 56.8%, p = 0.002). BC risk increased 4.7% per 10 years of NSW (95%CI = 0.94–1.09; 16 studies, I2 = 33.4%, p = 0.008). The pooled estimate for premenopausal BC was 1.27 (95%CI = 0.96–1.68; six studies, I2 = 32.0%, p = 0.196) and for postmenopausal BC 1.05 (95%CI = 0.90–1.24,I2 = 52.4%; seven studies, p = 0.050). For recent long-term exposure, the pooled estimate was 1.23 (95%CI = 1.06–1.42; 15 studies; I2 = 48.4%, p = 0.018). Our results indicate that long-term NSW increases the risk for BC and that menopausal status and time since exposure might be relevant.

scholarly journals Do virtual interventions in individuals with cerebral palsy make use of motor learning principles? A systematic review (Preprint)

2020 ◽  
Author(s):  
Marika Demers ◽  
Karen Fung ◽  
Sandeep Subramanian ◽  
Martin Lemay ◽  
Maxime Robert
Keyword(s):  
Systematic Review ◽  
Virtual Reality ◽  
Cerebral Palsy ◽  
Video Games ◽  
Motor Learning ◽  
Upper Limb ◽  
Video Game ◽  
Training Time ◽  
Skills Retention ◽  
Learning Principles

BACKGROUND Increasing evidence supports the use of virtual reality to improve upper limb motor functions in individuals with cerebral palsy. While virtual reality offers the possibility to include key components to promote motor learning, it remains unclear if and how motor learning principles are incorporated in the development of rehabilitation interventions using virtual reality. OBJECTIVE To determine the extent to which motor learning principles are integrated in virtual reality interventions targeting upper limb function in individuals with cerebral palsy. METHODS A systematic review was conducted according to the PRISMA guidelines. The search was done in 10 databases using the key words and variations ‘cerebral palsy’, ‘virtual reality’, ‘video game’ and ‘rehabilitation’. Studies were divided in 2 categories: commercial video games or custom virtual reality system. Study quality was assessed using the Downs and Black checklist. RESULTS The initial search yielded 1497 publications. A total of 26 studies from 30 publications were included, with most studies classified as ‘fair’ on the Downs and Black checklist. The majority of studies provided enhanced feedback, variable practice and used functionally-relevant and motivating virtual tasks. Dosage varied greatly (total training time ranging from 300-3360 minutes) with only 6 studies reporting the number of movement repetitions per session. The difficulty progression, the assessment of skills retention and transfer, were poorly incorporated, especially for the commercial video games. CONCLUSIONS Motor learning principles should be better integrated in the development of future virtual reality systems for optimal upper limb motor recovery in individuals with cerebral palsy. CLINICALTRIAL PROSPERO Registration: #151982

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