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Introduction In clinical practice, observational scales are the most common approach used to assess gait pattern in people with neurological disorders. The Gait Assessment and Intervention Tool (GAIT) is an observational gait scale, and it has proved to be the most comprehensive, homogeneous, and objective of all the observational gait scales studied in people with neurological conditions. Objective To study the construct validity of the GAIT in people with multiple sclerosis (MS). Design An observational study was conducted. Setting Multiple Sclerosis Foundation in Madrid (Spain). Patients Thirty-five patients with MS were assessed. Main outcome measure(s) GAIT construct validity was assessed using the following scales: Rivermead Visual Gait Assessment (RVGA), Tinetti Gait Scale (TGS), 10-Meter Walking Test (10MWT), Timed Up&Go (TUG), Hauser Ambulatory Index (HAI), Multiple Sclerosis Walking Scale-12 (MSWS-12), Functional Gait Assessment (FGA), Modified Ashworth Scale (MAS), and Rivermead Mobility Index (RMI). Results A total of 35 subjects with MS were assessed. The correlations between the GAIT and the RVGA were excellent (r > .90) and moderate with TGS (values between -.62 and -.59). Correlations with HAI, FGA, MSWS-12, and RMI were moderate (with values between .57 and .67). Correlations were lower for the velocity scales TUG and MAS. Conclusions The construct validity of the GAIT is high, as a measure of gait coordination in people with MS. Specifically, there was excellent correlation with the RVGA. There was a moderate correlation for the GAIT with measures of functional mobility, but a lesser correlation of the GAIT with measures restricted to temporal gait characteristics (speed measures) or measurements of impairments underlying gait patterns such as balance or muscle tone.

Background Mobile applications may be used to assess gait pattern deviation through mobile smartphones in people with Parkinson’s disease (PD). However, few studies have investigated their psychometrics properties. Research question To study the construct validity and test-retest reliability of the RUNZI® free mobile application in people with mild to moderate PD. Methods Thirty individuals were evaluated with the RUNZI® app and with the 10-meter walking test (10 MW), simultaneously. In addition, the Timed Up & Go test (TUG), Tinetti scale, and the Berg Balance Scale (BBS) were used to study the construct validity. Also, test-retest reliability of the mobile for spatio-temporal gait parameters was explored. Results The correlation indices of the 10 MW test with the RUNZI® app at fast speeds was moderate to excellent (r = .588–.957). At a comfortable speed, the correlation was excellent for walking speed (r = 0.944), moderate for steps (r = 0.780) and stride length (r = 0.760), and poor for cadence (r = .424). Results showed significant correlations between TUG and spatio-temporal gait parameters at fast and comfortable speeds. There were no significant correlations or consistent associations between Tinetti and BBS and RUNZI®. The test-retest reliability was good to excellent for parameters measured with the RUNZI®. Significance Our findings highlight specific opportunities for a free smartphone-based spatio-temporal gait analysis to serve as a complement to conventional gait analysis methods in clinical practice with a moderate to excellent construct validity with the 10 MW test and good to excellent test-retest reliability in PD patients.

Resumen Introduccion El patron de la marcha se ve alterado en los sujetos con amputacion de la extremidad inferior. Para su evaluacion es importante el uso de escalas de observacion de la marcha con una buena validez de contenido. Objetivos Disenar una escala de observacion de la marcha atendiendo a las principales alteraciones de la marcha de los sujetos con amputacion y analizar su validez de contenido. Material y metodos Para obtener una version de la escala se conformo un comite de expertos. El mismo comite se ocupo de la evaluacion de la escala. Se calculo el indice de validez de contenido (IVC), tanto para cada item como para la escala global. Resultados Se seleccionaron las principales alteraciones cinematicas y espaciotemporales para el desarrollo de los items. La escala se compone de 2 secciones y 25 items, con una puntuacion maxima de 35 puntos. Se obtuvo una puntuacion global IVC de 0,90, y un indice de validez para la mayoria de los items con valores superiores a 0,78. Conclusion La Escala observacional de la marcha del sujeto con amputacion de la extremidad inferior ha mostrado una validez de contenido excelente de acuerdo con el IVC obtenido. Futuros estudios deben evaluar su fiabilidad y validez de constructo.

Background: Parkinson’s disease (PD) is the most common neurodegenerative disorder associated with motor and nonmotor symptoms. Drooling, one of the nonmotor symptoms, can be present in 70–80% of patients with PD. The aim of this paper is to study the characteristics of PD patients with drooling compared to those without in terms of age, gender, disease duration, stage of the disease, swallowing difficulties, and health-related quality of life, methods: a cross-sectional study was conducted. The sample was divided into two groups: PD with drooling (n = 32) and PD without drooling (n = 30). Age, gender, disease duration and Hoehn &amp, Yahr (H &amp, Y) stage, Sialorrhea Clinical Scale for Parkinson’s Disease (SCS-PD), the 10-item Eating Assessment Tool (EAT-10), and the 39-item Parkinson’s Disease Questionnaire (PDQ-39) were compared between groups, Results: 62 individuals with PD, 40 men and 22 women (mean age 73 ± 8 years), were included. Overall, 32 patients reported drooling, and 30 did not exhibit it. The ANCOVA found significant differences between groups for the EAT-10 score (0.83, 95% CI = 5.62–9.03, p = 0.016) and SCS-PD score (1.48, 95% CI = 0.86–6.81, p &lt, 0.001). Analysis of the PDQ-39 scores revealed no significant differences between groups for the PDQ-39 total score (p &gt, 0.057) and in all subscales. The inclusion of gender, age, disease duration, and H &amp, Y as covariates did not influence the results (all p &gt, 0.05). Conclusions: drooling is related to swallowing difficulties assessed with EAT-10 but not with health-related quality of life assessed with PDQ-39 in PD patients with drooling compared to PD patients without it. Age, gender, duration of the disease, and the H &amp, Y state of PD patients with and without drooling seem to be similar.

Introduction: the Wisconsin Gait Scale (WGS) has been shown to be a valid and quick tool for analyzing gait in post-stroke people in the clinical setting. Its widespread use has led to versions of the scale in other languages, but so far there has been no version in Spanish. Objective: to conduct a cross-cultural adaptation of the WGS for use in the Spanish-speaking population and to analyze the content validity. Materials and methods: the Spanish version was obtained using the double translation method and back translation method, followed by a review by an expert committee. This expert committee evaluated the content validity index (CVI) for each item on the version obtained and for the entire scale (scale content validity index (S-CVI)). The item content validity index (I-CIV) was calculated as the number of experts whose score had been 3 or 4 divided by the total number of experts. To obtain the S-CVI, the middle of the I-CVI was calculated for all the items on the scale. Results: the Spanish version of the WGS was obtained after the expert committee evaluation. The CVI was excellent for its general assessment (0.91), excellent for 85.7% of its items (≥0.78), and good for 14.3% of the CVI (≥0.72). Conclusions: the Spanish version of the WGS was developed through a process of cross-cultural adaptation from its original English version, and, according to an expert committee, it had an excellent content validity.

Background Multiple sclerosis has considerable effects on patients’ quality of life, limiting their daily activities and influencing their lifestyle. Additionally, adapting to pharmacological treatments represents a challenge for many patients. Objective The aim of this study was to explore the views and experiences of Spanish patients with multiple sclerosis regarding their pharmacological treatment. Methods A qualitative phenomenological study was conducted with 20 patients with Multiple Sclerosis from a hospital Neurology Unit. Data were collected through in-depth interviews and researchers’ field notes. A systematic text condensation analysis was performed. The Consolidated Criteria for Reporting Qualitative Research and the Standards for Reporting Qualitative Research guidelines were followed. Results Twenty patients with Multiple Sclerosis completed the study. The mean age was 39.7 years (SD: 9,17). A thematic description of all the data collected was performed based on four descriptive themes which emerged from the analysed material: a) Undergoing the injections, b) Coping strategies, with two subthemes, resignation and integrating the treatment into their life, c) Other methods of pharmacological administration, and d) Dealing with discomfort. For patients with multiple sclerosis, their experience with pharmacological treatment is an apprenticeship which is sometimes met with resignation and discomfort. Patients must learn to take responsibility for their treatment, seeking other routes of administration, as well as integrating these changes into their daily life. Conclusions Qualitative research offers insight into the way patients with Multiple Sclerosis experience their pharmacological treatment, and may be helpful in establishing a fruitful relationship with these patients.

Resumen: Objetivo: Revisar la evidencia científica sobre la efectividad de la aplicación de estímulos auditivos en la fase de iniciación de la marcha y giro en pacientes con enfermedad de Parkinson. Métodos: Se realizó la búsqueda en las bases de datos Brain, PubMed, Medline, Cinahl, Scopus, Science Direct, Web of Science, Cochrane Database of Systematic Reviews, Biblioteca Cochrane Plus, CENTRAL, Trip Database, PEDro, DARE, OTSeeker y Google Académico. Se incluyeron estudios que analizasen la influencia de estímulos auditivos sobre el inicio y el giro de la marcha independiente en pacientes con enfermedad de Parkinson, publicados entre 2007 y 2016. Su calidad metodológica fue valorada mediante la escala Jadad. Resultados: Se seleccionaron 13 artículos, todos ellos de baja calidad (Jadad ≤ 2) que mostraron resultados positivos en relación con el uso de estímulos auditivos a alta frecuencia e intensidad sobre el inicio de la marcha y la ejecución de giros. En concreto, 1) mejoraron los parámetros espaciotemporales y cinemáticos, 2) disminuyeron la congelación, el tiempo de giro y las caídas y 3) aumentaron la velocidad de iniciación de la marcha, la activación muscular y la velocidad y cadencia de la marcha en los pacientes con EP. Conclusiones: Se requiere un mayor número de estudios y de mayor calidad metodológica para justificar y comprender en qué estadio los pacientes se beneficiarían más de esta señal sensorial, así como el tipo de guía auditiva y la frecuencia de estimulación más eficaz en la fase de iniciación de la marcha y de giro en pacientes con Parkinson. Abstract: Objective: To review the available scientific evidence about the effectiveness of auditory cues during gait initiation and turning in patients with Parkinson's disease. Methods: We conducted a literature search in the following databases: Brain, PubMed, Medline, CINAHL, Scopus, Science Direct, Web of Science, Cochrane Database of Systematic Reviews, Cochrane Library Plus, CENTRAL, Trip Database, PEDro, DARE, OTseeker, and Google Scholar. We included all studies published between 2007 and 2016 and evaluating the influence of auditory cues on independent gait initiation and turning in patients with Parkinson's disease. The methodological quality of the studies was assessed with the Jadad scale. Results: We included 13 studies, all of which had a low methodological quality (Jadad scale score ≤ 2). In these studies, high-intensity, high-frequency auditory cues had a positive impact on gait initiation and turning. More specifically, they 1) improved spatiotemporal and kinematic parameters; 2) decreased freezing, turning duration, and falls; and 3) increased gait initiation speed, muscle activation, and gait speed and cadence in patients with Parkinson's disease. Conclusions: We need studies of better methodological quality to establish the Parkinson's disease stage in which auditory cues are most beneficial, as well as to determine the most effective type and frequency of the auditory cue during gait initiation and turning in patients with Parkinson's disease. Palabras clave: Estímulos auditivos, Enfermedad de Parkinson, Congelación, Giro, Marcha, Iniciación del movimiento, Keywords: Auditory cues, Parkinson's disease, Freezing, Turning, Gait, Movement initiation

Neurorehabilitation is a fundamental aspect in the treatment approach for multiple sclerosis (MS), in which new technologies have gained popularity, especially the use of virtual reality (VR). The aim of this paper is to analyze an occupational therapy (OT) intervention compared with OT + VR (OT + VR) on the manual dexterity of patients with MS. 26 MS subjects were initially recruited from an MS patient association and randomized into two groups. The OT group received 20 conventional OT sessions distributed in two sessions per week. The OT + VR group received 20 sessions of VR interventions, twice weekly and lasting 30 minutes, consisting of VR games accessed via the online web pagemotiongamingconsole.com, in addition to the conventional OT sessions. Pre- and postintervention assessments were based on the Purdue Pegboard Test, the Jebsen-Taylor Hand Function Test, and the Grooved Pegboard Test. Clinical improvements were found regarding the precision of movements, the execution times, and the efficiency of certain functional tasks in the Purdue Pegboard Test and Jebsen-Taylor Hand Function Test tests in the OT + VR group. Although significant differences were not found in the manual dexterity between the OT and OT + VR groups, improvements were found regarding the precision and effectiveness of certain functional tasks.

Background The Gait Assessment and Intervention Tool (G.A.I.T.) has been shown to be a comprehensive and objectively scored tool to assess gait in people with neurologic disease. However, there is only an English version of the scale, the language in which it was developed. Objective To carry out a cross-cultural adaptation of the Gait Assessment and Intervention Tool (G.A.I.T.) scale for its use in the Spanish-speaking population, and to study the content validity of the Spanish version. Design A cross-cultural adaptation and validation study of the G.A.I.T. Setting University Laboratory (Alcorcon, Madrid, Spain). Participants Not applicable. Methods or interventions Cross-cultural adaptation of a scale. Main outcome measurements The Spanish version of the G.A.I.T. was obtained using the double-translation and back-translation method, and a subsequent Expert Committee revision. The Expert Committee studied the content validity of the Spanish G.A.I.T. using the content validity index (CVI). Results The final version of the G.A.I.T. in Spanish was obtained after the cross-cultural process. The CVI was found to be excellent for the overall G.A.I.T. (0.94), and excellent for 87% of its 31 items (≥0.78). CVI was good for 10% of the items (arm swing and toes, CVI ≥0.72). Although 3% of items (shoulder and elbow position) showed CVI = 0.28, these items were retained for completeness. Conclusions The Spanish version of the G.A.I.T. was developed through a cross-cultural adaptation process from its original version in English, and according to an Expert Committee it has an excellent overall content validity.

Objective: To assess the construct validity of the Wisconsin Gait Scale (WGS) in subjects after stroke. Methods: A retrospective observational study was conducted at inpatient rehabilitation hospital. Data from 61 stroke patients was compiled. The Functional Ambulatory Categories (FAC), the Berg Balance Scale (BBS), the Postural Assessment Scale for Stroke Patients (PASS), the Barthel Index (BI) and the Functional Independence Measure (FIM) were selected to analyze the WGS construct validity at four specific time points after stroke (acute, subacute and chronic stages). Spearman correlation coefficients investigated the relationship between WGS and clinical measures. Results: The construct validity of the WGS in patients with stroke at acute stage was moderate with the FAC (r=-.773), the BBS (r=-.676), the PASS (r=-.646) and the FIM (r=-.592). At subacute stage, the construct validity of the WGS was excellent with the FAC (r=-878), the BBS (r=-.882), the PASS (r=-.847) and the BI (r=-.813). The correlation was moderate with the FIM (r=-.693). At six and twelve months, the construct validity of WGS with the FAC, the BBS, the PASS, the BI and the FIM was excellent (r ≥ .8). Conclusion: The WGS has moderate construct validity with walking, balance and functionality scales in patients with acute stroke. The correlation with the FAC, the BBS, the PASS and the BI at subacute and chronic stages was excellent. Sin financiación 2.349 JCR (2019) Q3, 196/272 Neurosciences 0.892 SJR (2019) Q1, 33/140 Biophysics No data IDR 2019 UEM

Background: Observational scales are the most common methodology used to assess postural control and balance in people with stroke. The aim of this paper was to analyse the construct validity of the Postural Assessment Scale for Stroke Patients (PASS) scale in post-stroke patients in the acute, subacute, and chronic stroke phases. (2) Methods: Sixty-one post-stroke participants were enrolled. To analyze the construct validity of the PASS, the following scales were used: the Functional Ambulatory Category (FAC), the Wisconsin Gait Scale (WGS), the Barthel Index (BI) and the Functional Independence Measure (FIM). (3) Results: The construct validity of the PASS scale in patients with stroke at acute phase was moderate with the FAC (r = -0.791), WGS (r = -0.646) and FIM (r = -0.678) and excellent with the BI (r = 0.801). At subacute stage, the construct validity of the PASS scale was excellent with the FAC (r = 0.897), WGS (r = -0.847), FIM (r = -0.810) and BI (r = -0.888). At 6 and 12 months, the construct validity of the PASS with the FAC, WGS, FIM and BI was also excellent. (4) Conclusions: The PASS scale is a valid instrument to assess balance in post-stroke individuals especially, in the subacute and chronic phases (at 6 and 12 months). Sin financiación 3.992 Q2 JCR 2021 0.658 Q2 SJR 2021 No data IDR 2021 UEM

Background: Brain’s is stimulated by Vojta Therapy through selected body areas activating stored innate motor programs which are exported as coordinate movement and muscle contractions to trunk and limbs. The aim of this pilot study is to know the responses at cortical level to a specific tactile input, assessed by electroencephalography (EEG), compared to a sham stimulation, in healthy subjects. Methods: A randomized-controlled trial was conducted. Participants were randomly distributed into two groups: a non-specific tactile input-group (non-STI-group) (n = 20) and a Vojta specific tactile input-group (V-STI-group) (n = 20). The non-STI-group was stimulated in a non specific area (quadriceps distal area) and V-STI-group was stimulated in a specific area (intercostal space, at the mammillary line between the 7th and 8th ribs) according to the Vojta therapy. Recording was performed with EEG for 10 min considering a first minute of rest, 8 min during the stimulus and 1 min after the stimulus. EEG activity was recorded from 32 positions with active Ag/AgCl scalp electrodes following the 10–20 system. The continuous EEG signal was split into consecutive segments of one minute. Results: The V-STI-group showed statistically significant differences in the theta, low alpha and high alpha bands, bilaterally in the supplementary motor (SMA) and premotor (PMA) areas (BA6 and BA8), superior parietal cortex (BA5, BA7) and the posterior cingulate cortex (BA23, BA31). For the V-STI-group, all frequency bands presented an initial bilateral activation of the superior and medial SMA (BA6) during the first minute. This activation was maintained until the fourth minute. During the fourth minute, the activation decreased in the three frequency bands. From the fifth minute, the activation in the superior and medial SMA rose again in the three frequency bands Conclusions: Our findings highlight that the specific stimulation area at intercostal space, on the mammillary line between 7 and 8th ribs according to Vojta therapy differentially increased bilateral activation in SMA (BA6) and Pre-SMA (BA8), BA5, BA7, BA23 and BA31 in the theta, low and high alpha bands in healthy subjects. These results could indicate the activation of innate locomotor circuits during stimulation of the pectoral area according to the Vojta therapy., The authors would like to thank the volunteers for participating in this study.

Aim: The aim of this study was to compare the effects of cervical exercise, motor imagery (MI) and action observation (AO) of cervical exercise actions on conditioned pain modulation and pressure pain thresholds. The second objective was to assess the effects of these interventions on cervical motor activity (ranges of motion and muscle endurance), attention, and the ability to generate motor images. Study design: Single-blinded randomized controlled trial. Materials and methods: Fifty-four healthy subjects were randomly assigned to each group. Response conditioned pain modulation, pressure pain threshold, were the main variables. The secondary outcome measures included, cervical range of motion, Neck flexor endurance test, mental movement representation associated and psychosocial variables. Results: All groups showed significant differences in time factor for all evaluated variables ( p

The aim of this study was to assess the psychometric properties of the mobile application forward head posture in terms of validity, inter- and intra-rater reliability, minimum detectable change, sensitivity, and specificity to measure craniovertebral angle. In total, 44 subjects (mean age 23.30 &plusmn, 4.44 years) were evaluated in the standing position with markers on the tragus and cutaneous prominence of seventh cervical vertebra (C7). We had two experienced and trained physiotherapists assess cervical posture using the mobile application forward head posture and photogrammetry. Intraclass correlation coefficients were used to determine validity and reliability. A contingency table was made to determine sensitivity and specificity. Intra-rater reliability of the mobile application forward head posture had an intraclass correlation coefficient of 0.88. The inter-rater reliability generated an intraclass correlation coefficient of 0.83 to 0.89. Criterion validity data were above 0.82. The minimum detectable change was 4.96&deg, for intra-rater and 5.52&deg, for inter-rater reliability. The smartphone application exhibited 94.4% sensitivity and 84.6% specificity. The smartphone application forward head posture is a valid and reliable tool to measure craniovertebral angle in a standing position and, therefore, could be a useful assessment tool in clinical practice.

Background: Virtual reality (VR) applied to patients with neck pain is a promising intervention to produce positive effects when used alone or combined with exercise. Therefore, the objective of this manuscript is to compare the effects of VR versus exercise treatment on pain intensity, conditioned pain modulation (CPM), temporal summation (TS) and functional and somatosensory outcomes in patients with non-specific chronic neck pain (NS-CNP). Methods: A single-blinded, randomized clinical trial was carried out. A total sample of 44 patients with NS-CNP was randomized into a VR treatment group or neck exercises group. The intervention consisted of two treatment sessions per week, for four weeks and eight sessions. Four measurement moments (at baseline, immediately, 1 month, and 3 months after intervention) were considered. Pain intensity, CPM, TS, functional and somatosensory outcomes were measured. Results: Statistically significant differences were revealed for time factor (F = 16.40, p &lt, 0.01, &eta, p2 = 0.28) and group*time interaction for kinesiophobia (F = 3.89, p = 0.01, &eta, p2 = 0.08) showing post-hoc differences in favor of the VR group at 3 months (p &lt, 0.05, d = 0.65). Significant effects were shown for time factor (p &lt, 0.05) but not for the group*time interaction (p &gt, 0.05) for pain intensity, rotation range of motion (ROM), Neck Disability Index, pain catastrophizing, fear-avoidance beliefs, left side pressure pain threshold (PPT) and anxiety. Statistically significant differences were not found for time factor (p &gt, 0.05) and neither in group*time interaction (p &gt, 0.05) for CPM, TS, right side PPT, flexo-extension and lateral-flexion ROM. Conclusions: Kinesiophobia was the only outcome that showed differences between VR and exercise at 3 months. Nevertheless, pain intensity, CPM, TS, ROM, neck disability, pain catastrophizing, fear-avoidance beliefs, PPT and anxiety did not show differences between both interventions.

Background Dexterity and activities of daily living limitations on the upper limb (UL) represent one of the most common problems in patients with multiple sclerosis (MS). The aim of this study was to evaluate the effectiveness of the specially developed Serious Games that make use of the Leap Motion Controller (LMC) as main user interface for improving UL grip muscle strength, dexterity, fatigue, quality of life, satisfaction and compliance. Methods A single-blinded randomized controlled trial was conducted. The sample was randomized into two groups: an experimental group who received treatment based on serious games designed by the research team using the developed LMC based Serious Games for the UL plus conventional rehabilitation, and a control group who received the same conventional rehabilitation for the UL. Both groups received two 60 min sessions per week over a ten-week period. Grip muscle strength, coordination, speed of movements, fine and gross UL dexterity, fatigue, quality of life, satisfaction and compliance were assessed in both groups pre-treatment, post-treatment and in a follow-up period of 1 month without receiving any treatment. Results In the experimental group compared to the control group, significant improvements were observed in the post-treatment assessment for coordination, speed of movements, fine and gross UL dexterity. Also, significant results were found in the follow-up in coordination, speed of movements, fine and gross for the more affected side. Conclusions An experimental protocol using an LMC based Serious Games designed for UL rehabilitation showed improvements for unilateral gross manual dexterity, fine manual dexterity, and coordination in MS patients with high satisfaction and excellent compliance. Trial registration This randomized controlled trial has been registered at ClinicalTrials.gov Identifier: NCT04171908, Nov 2019.

There is a lack of commercially available low-cost technologies to assess gait clinically in non-controlled environments. As a consequence of this, there has been poor massification of motion measurement technologies that are both objective and reliable in nature. Advances about the study of gait and its interpretation in recent years using inertial sensors have allowed proposing acceptable alternatives for the development of portable and low-cost systems that contribute to people’s health in places and institutions that cannot acquire or maintain the operation of commercially available systems. A system based on a custom single Inertial Measurement Unit and a mobile application is proposed. Thus, an investigation is carried out using methodologies and algorithms found in the literature in order to get the main gait events and the spatial-temporal gait parameters. Twenty healthy Chilean subjects were assessed using a motion capture system simultaneously with the proposed tool. The results show that it is possible to estimate temporal gait parameters with slight differences respect gold--standard. We reach maximum mean differences of -2.35±5.02[step/min] for cadence, 0.03±0.04[sec] for stride time,0.02±0.03[sec] for step time, ±0.02[sec] for a single support time, 0.01±0.02[sec] for double support time and 0.01±0.03[m] for step length. As a result of experimental findings, we propose a new technological tool that can perform gait analysis. Our proposed system is user-friendly, low-cost, and portable. Therefore, we suggest that it could be an attractive technological tool that healthcare professionals could harness to objectively measure gait in environments that are either within the community or controlled. We also suggest that the tool could be used in countries where advanced clinical tools cannot be acquired. Therefore, we propose in this paper that our system is an attractive, alternative system that can be used for gait analysis by health professionals worldwide.

Background: Parkinson&rsquo, s disease is a neurodegenerative disorder that causes impaired motor functions. Virtual reality technology may be recommended to optimize motor learning in a safe environment. The objective of this paper was to evaluate the effects of a novel immersive virtual reality technology used for serious games (Oculus Rift 2 plus leap motion controller&mdash, OR2-LMC) for upper limb outcomes (muscle strength, coordination, speed of movements, fine and gross dexterity). Another objective was to obtain qualitative data for participants&rsquo, experiences related to the intervention. Methods: A mixed methods intervention (embedded) study was used, with a qualitative design after a technology intervention (quantitative design). The intervention and qualitative design followed international guidelines and were integrated into the method and reporting subheadings. Results: Significant improvements were observed in strength (p = 0.028), fine (p = 0.026 to 0.028) and gross coordination dexterity, and speed movements (p = 0.039) in the affected side, with excellent compliance (100%) and a high level of satisfaction (3.66 &plusmn, 0.18 points out of the maximum of 4). No adverse side effects were observed. Qualitative findings described patients&rsquo, perspectives regarding OR2-LMC treatment, facilitators and barriers for adherence, OR2-LMC applications, and treatment improvements. Conclusions: The intervention showed positive results for the upper limbs, with elements of discordance, expansion, and confirmation between qualitative and quantitative results.

In recent decades, gaming technology has been accepted as a feasible method for complementing traditional clinical practice, especially in neurorehabilitation, however, the viability of using 3D Virtual Reality (VR) for the assessment of upper limb motor function has not been fully explored. For that purpose, we developed a VR-based version of the Box and Blocks Test (BBT), a clinical test for the assessment of manual dexterity, as an automated alternative to the classical procedure. Our VR-based BBT (VR-BBT) integrates the traditional BBT mechanics into gameplay using the Leap Motion Controller (LMC) to capture the user&rsquo, s hand motion and the Oculus Rift headset to provide a fully immersive experience. This paper focuses on evaluating the validity of our VR-BBT to reliably measure the manual dexterity in a sample of patients with Parkinson&rsquo, s Disease (PD). For this study, a group of twenty individuals in a mild to moderate stage of PD were recruited. Participants were asked to perform the physical BBT (once) and our proposed VR-BBT (twice) system, separately. Correlation analysis of collected data was carried out. Statistical analysis proved that the performance data collected by the VR-BBT significantly correlated with the conventional assessment of the BBT. The VR-BBT scores have shown a significant association with PD severity measured by the Hoehn and Yahr scale. This fact suggests that the VR-BBT could be used as a reliable indicator for health improvements in patients with PD. Finally, the VR-BBT system presented high usability and acceptability rated by clinicians and patients.

Rigidity is one of the cardinal symptoms of Parkinson’s disease (PD). Present in up 89% of cases, it is typically assessed with clinical scales. However, these instruments show limitations due to their subjectivity and poor intra- and inter-rater reliability. To compile all of the objective quantitative methods used to assess rigidity in PD and to study their validity and reliability, a systematic review was conducted using the Web of Science, PubMed, and Scopus databases. Studies from January 1975 to June 2019 were included, all of which were written in English. The Strengthening the Reporting of observational studies in Epidemiology Statement (STROBE) checklist for observational studies was used to assess the methodological rigor of the included studies. Thirty-six studies were included. Rigidity was quantitatively assessed in three ways, using servomotors, inertial sensors, and biomechanical and neurophysiological study of muscles. All methods showed good validity and reliability, good correlation with clinical scales, and were useful for detecting rigidity and studying its evolution. People with PD exhibit higher values in terms of objective muscle stiffness than healthy controls. Rigidity depends on the angular velocity and articular amplitude of the mobilization applied. There are objective, valid, and reliable methods that can be used to quantitatively assess rigidity in people with PD.

Background: People with Parkinson&rsquo, s disease (PD) present deficits of the active range of motion (ROM), prominently in their trunk. However, if these deficits are associated with axial rigidity, the functional mobility or health related quality of life (HRQoL), remains unknown. The aim of this paper is to study the relationship between axial ROM and axial rigidity, the functional mobility and HRQoL in patients with mild to moderate PD. Methods: An exploratory study was conducted. Non-probabilistic sampling of consecutive cases was used. Active trunk ROM was assessed by a universal goniometer. A Biodex System isokinetic dynamometer was used to measure the rigidity of the trunk. Functional mobility was determined by the Get Up and Go (GUG) test, and HRQoL was assessed with the PDQ-39 and EuroQol-5D questionnaires. Results: Thirty-six mild to moderate patients with PD were evaluated. Significant correlations were observed between trunk extensors rigidity and trunk flexion and extension ROM. Significant correlations were observed between trunk flexion, extension and rotation ROM and GUG. Moreover, significant correlations were observed between trunk ROM for flexion, extension and rotations (both sides) and PDQ-39 total score. However, these correlations were considered poor. Conclusions: Trunk ROM for flexion and extension movements, measured by a universal goniometer, were correlated with axial extensors rigidity, evaluated by a technological device at 30&deg, /s and 45&deg, /s, and functional mobility. Moreover, trunk ROM for trunk flexion, extension and rotations were correlated with HRQoL in patients with mild to moderate PD.

Purpose. To determine the effects of a structured protocol using commercial video games on balance, postural control, functionality, quality of life, and level of motivation in patients with subacute stroke. Methods. A randomized controlled trial was conducted. A control group (n = 25) received eight weeks of conventional rehabilitation consisting of five weekly sessions based on an approach for task-oriented motor training. The experimental group (n = 23) received conventional rehabilitation + video-game based therapy for eight weeks with commercial video games using the Xbox 360° video games console and the Kinect® device with the same total treatment time for both groups. The Modified Rankin Scale, Barthel Index, Tinetti scale, Functional Reach test, Get Up and Go test, Baropodometry, EuroQoL 5D (EQ-5D), satisfaction, adherence, and motivation were used as outcome measures. Results. In the between-group comparison, statistically significant differences were observed in the Modified Rankin scores (p<0.01), the Barthel Index (p=0.05), the Tinetti gait assessment (p=0.02), the Functional Reach test (p<0.01), the Get Up and Go test (p=0.05), the pain/discomfort dimension (p<0.01), and anxiety/depression dimension (p<0.01) of the EQ-5D and the VAS (visual analog scale) (p<0.01) on the perceived health status based on the EQ-5D questionnaire. Regarding the scale of motivation, self-esteem, and adherence, statistically significant differences were achieved in motivation (p<0.01), self-esteem (p<0.01), and adherence (p<0.01) variables. Conclusion. A protocol of semi-immersive video-game based therapy, combined with conventional therapy, may be effective for improving balance, functionality, quality of life, and motivation in patients with subacute stroke. This trial is registered with NCT03528395.

Special Issue: Advances in Human-Computer Interactions: Methods, Algorithms, and Applications. The design and application of Serious Games (SG) based on the Leap Motion sensor are presented as a tool to support the rehabilitation therapies for upper limbs. Initially, the design principles and their implementation are described, focusing on improving both unilateral and bilateral manual dexterity and coordination. The design of the games has been supervised by specialized therapists. To assess the therapeutic effectiveness of the proposed system, a protocol of trials with Parkinson’s patients has been defined. Evaluations of the physical condition of the participants in the study, at the beginning and at the end of the treatment, are carried out using standard tests. The specific measurements of each game give the therapist more detailed information about the patients’ evolution after finishing the planned protocol. The obtained results support the fact that the set of developed video games can be combined to define different therapy protocols and that the information obtained is richer than the one obtained through current clinical metrics, serving as method of motor function assessment. The research leading to these results has received funding from the ROBOHEALTH-A project (DPI2013-47944-C4-1-R) funded by Spanish Ministry of Economy and Competitiveness and from the RoboCity2030-III-CM project (S2013/MIT-2748), funded by Programas de Actividades I+D en la Comunidad de Madrid and cofunded by Structural Funds of the EU.

Rigidity is a cardinal symptom of Parkinson's disease (PD) and is often clinically assessed by passively flexing and extending a patient's limb. Objective measurements had been employed to examine rigidity in PD subjects, including wrist, elbow or knee.This study aimed to investigate the relationship between an objective measurement of trunk rigidity and risk of falls in patients with mild to moderate PD.An isokinetic dynamometer Biodex System 3 was employed to assess trunk rigidity in 36 patients with mild to moderate PD at a University Department in a cross-sectional study. Risk of falls was measured by the Get UpGo test (GUG). Disease severity (Hoehn and Yahr staging score and the Unified Parkinson's Disease Rating Scale III), disease duration and functional status (SchwabEngland activities of daily living scale) were also evaluated.Significant correlations between trunk extensors rigidity at 45°/s and 60°/s and risk of falls were obtained. A correlation between trunk extensors tone at 30°/s and the GUG test almost reached significant almost reached statistical significance (r = 0.306; p = 0,066). Significant correlations between trunk flexors-extensors tone and clinical status, disease duration and functional status at 30°/s, 45°/s and 60°/s were also obtained.The results from this study suggest that the axial rigidity is related to the risk of falls in patients with mild to moderate PD. Further studies are needed with quantitative devices for axial rigidity assessment to determine the relationship between trunk rigidity in PD patients with higher disease severity and risk of falls.

The Gait Assessment and Intervention Tool (GAIT) has been recently developed for gait assessment in patients with stroke, and it is considered as a tool that may identify clinically relevant deviations from normal gait and quantifies relevant changes in gait because of an intervention. The objective was to analyze the GAIT psychometric properties in participants with stroke. A convenience sample of 15 adults with stroke was selected (58.15±7.8 years; 5.38±3.3 years from injury). We used the GAIT for evaluating the gait in patients with stroke. GAIT scoring is based on observations of anterior/posterior and lateral-view video documents. Inter-rater reliability of the GAIT between trained raters was good (intraclass correlation coefficient=0.762; P=0.008; 95% confidence interval=0.749-0.926). The minimal detectable change was 7.68 points (12.39%). Inter-rater reliability for the hip, knee, and ankle items was also good. In conclusion, the current study demonstrated that GAIT has good inter-rater reliability and good internal consistency.

© 2019 IEEE. Opportunities of using Virtual Reality (VR) technology for the automation of clinical procedures in general, and for the assessment of motor function in particular, have not been fully explored in Parkinson' disease (PD). For that purpose, a game-like version of the Box and Blocks Test (BBT) for automatic assessment of hand motor function in VR was built. This system uses the Leap Motion Controller (LMC) for hand tracking and the Oculus Rift for a fully immersive experience. In this paper, we focus on evaluating the capabilities of our VR-BBT to reliably measure the manual dexterity in a sample of PD patients. For this study, a group of nine individuals in mild to moderate stage of PD were recruited. Participants were asked to perform both the physical BBT and the VR-BBT systems. Correlation analysis of collected data was carried out comparing the BBT and VR-BBT assessments. The test-retest reliability was also explored for the scores gathered with the virtual tool. Statistical analysis proved that the performance data collected by the game-like system correlated with the validated measures of the physical BBT, with a strong test-retest reliability. This fact suggests that the virtual version of the BBT could be used as a valid and reliable indicator for health improvements.

Background Gait impairment is one of the main causes of disability in people with multiple sclerosis. The Gait Assessment and Intervention Tool is an observational gait scale that assesses kinematic parameters using video recordings. Objective To study intra- and interrater reliability and the minimal detectable change of the Gait Assessment and Intervention Tool in individuals with multiple sclerosis. Design Observational study. Setting Multiple Sclerosis Foundation. Participants Thirty-five participants with multiple sclerosis were assessed (12 men, 23 women; 47.7 ± 11 y; Expanded Disability Status Scale = 4.32 ± 1.4). Interventions Not applicable. Main outcome measurements Intra- and interrater reliability of the Gait Assessment and Intervention Tool was assessed for each limb using the Intraclass Correlation Coefficient. In addition, the minimal detectable change was calculated. Results The Intraclass Correlation Coefficient for the intrarater reliability was found to be excellent for the total score both for the right side (.91; 95% confidence interval 95% CI .85-.95) and the left side (.93; 95% CI .88-.96). The intraclass correlation coefficient for the interrater reliability was .91 (95% CI .85-.95) for the right side, and .93 (95% CI .88-.96) for the left side. The minimal detectable change for the intrarater reliability was 1.19 points for the right side and .77 for the left side. Conclusions The Gait Assessment and Intervention Tool exhibits excellent intra- and interrater reliability and a small minimal detectable change for people with multiple sclerosis.

Objective Pain is one of the most frequent nonmotor impairments in Parkinson’s disease (PD) and is hypothesized to be associated with altered nociceptive pain processing. Our aims were to investigate differences in widespread pressure pain sensitivity between PD patients with and without pain and healthy controls and to assess the relationship of health-related quality of life and sleep quality with pressure pain sensitivity. Methods Nineteen PD patients with pain (12 men, age = 68 ± 9 years), 19 PD patients without pain (11 men, age = 69 ± 8 years), and 19 matched controls participated. Pressure pain thresholds (PPTs) were assessed bilaterally over the cervical spine, the second metacarpal, and the tibialis anterior by an assessor blinded to the subject’s condition. Patients were assessed in a dopamine-medicated (ON) state. Pain intensity (numerical pain rating scale, 0–10), health-related quality of life (39-item Parkinson’s Disease Questionnaire), and sleep quality (Pittsburgh Sleep Quality Index) were also assessed. Results No significant differences existed between PD patients, with or without pain, and healthy controls on PPTs over the cervical spine, the second metacarpal, or the tibialis anterior muscle (all P > 0.3). PPTs were lower in females than in males in all groups (P Conclusions This study revealed no differences in widespread pressure hyperalgesia between PD patients with or without pain (ON state) and controls. Although dopamine may modulate pain responses, other mechanisms seems to also be implicated in altered nociceptive pain processing in patients with PD.

Falls represent a major public health problem in the elderly population. The Timed Up &amp, Go test (TU &amp, Go) is the most used tool to measure this risk of falling, which offers a unique parameter in seconds that represents the dynamic balance. However, it is not determined in which activity the subject presents greater difficulties. For this, a feature-based segmentation method using a single wireless Inertial Measurement Unit (IMU) is proposed in order to analyze data of the inertial sensors to provide a complete report on risks of falls. Twenty-five young subjects and 12 older adults were measured to validate the method proposed with an IMU in the back and with video recording. The measurement system showed similar data compared to the conventional test video recorded, with a Pearson correlation coefficient of 0.9884 and a mean error of 0.17 &plusmn, 0.13 s for young subjects, as well as a correlation coefficient of 0.9878 and a mean error of 0.2 &plusmn, 0.22 s for older adults. Our methodology allows for identifying all the TU &amp, Go sub&ndash, tasks with a single IMU automatically providing information about variables such as: duration of sub&ndash, tasks, standing and sitting accelerations, rotation velocity of turning, number of steps during walking and turns, and the inclination degrees of the trunk during standing and sitting.

SUMMARY BACKGROUND: To date, there is a lack of prior studies on the use of capacitive resistive monopolar radiofrequency (RF) to treat neck pain. The objective of this study was to investigate the immediate effect of capacitive resistive monopolar radiofrequency (RF=448 kHz), in comparison with a placebo, on (1) reducing neck pain intensity at myofascial trigger points (MTrP), (2) decreasing neck disability and (3) improving cervical range of motion (CROM). METHODS: A randomized, double-blind, placebo-controlled trial (NCT02353195) was carried out. Patients with myofascial chronic neck pain (N=24) with active MTrP in one upper trapezius muscle were randomly divided into two groups: a radio-frequency group, which received eight sessions of a monopolar capacitive resistive radio-frequency application over the upper trapezius muscle, and a placebo group (PG), which received eight sessions of placebo radio-frequency over the same muscle. Visual analog scale (VAS), CROM and Neck Disability Index (NDI) were evaluated after the first session and after the eight sessions. RESULTS: The Wilcoxon test for VAS showed statistically significant differences between baseline, immediately after the first session and after eight sessions (p

Background Non-immersive video games are currently being used as technological rehabilitation tools for individuals with Parkinson’s disease (PD). The aim of this feasibility study was to evaluate the effectiveness of the Leap Motion Controller® (LMC) system used with serious games designed for the upper limb (UL), as well as the levels of satisfaction and compliance among patients in mild-to-moderate stages of the disease. Methods A non-probabilistic sampling of non-consecutive cases was performed. 23 PD patients, in stages II-IV of the Hoehn & Yahr scale, were randomized into two groups: an experimental group (n = 12) who received treatment based on serious games designed by the research team using the LMC system for the UL, and a control group (n = 11) who received a specific intervention for the UL. Grip muscle strength, coordination, speed of movements, fine and gross UL dexterity, as well as satisfaction and compliance, were assessed in both groups pre-treatment and post-treatment. Results Within the experimental group, significant improvements were observed in all post-treatment assessments, except for Box and Blocks test for the less affected side. Clinical improvements were observed for all assessments in the control group. Statistical intergroup analysis showed significant improvements in coordination, speed of movements and fine motor dexterity scores on the more affected side of patients in the experimental group. Conclusions The LMC system and the serious games designed may be a feasible rehabilitation tool for the improvement of coordination, speed of movements and fine UL dexterity in PD patients. Further studies are needed to confirm these preliminary findings.

(1) Background: The aim of the present study was to determine the effects of a virtual reality (VR) program, as a complementary tool to a conventional cardiac rehabilitation (CR) program in phase II of patients with ischemic heart disease compared to a conventional treatment group. (2) Methods: A single blinded randomized clinical trial was conducted. The patients were randomized to a control group (CG) or an experimental group (EG). The EG carried out a training based on VR of aerobic exercise using the XBOX ONE console and Kinect sensor. Ergometry, metabolic equivalents (METS), Functional Independence Measure, 6-min walk test (6MWT), the Short Form Health Survey-36 Questionnaire (SF-36), the Beck Depression Inventory-II, and the degree of satisfaction and adherence to treatment were used as outcome measures. (3) Results: Our results showed no statistically significant differences between the two groups. Statistical analysis within group for the EG showed statistically significant changes in the variables HR final ergometry, ergometry minutes, % ergometry, METS, final HR 6MWT, 6MWT distance, 6MWT number of laps, and for the SF-36 and Beck Depression Inventory-II. (4) Conclusion: A VR-based video game program, as an adjunct tool to a CR program, showed improvements in ergometry, METS, resistance to fatigue and health-related quality of life with excellent adherence and satisfaction perceived by patients with ischemic heart disease in phase II.

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.

Hector Beltran-Alacreu,1,2 Ibai López-de-Uralde-Villanueva,1,2 César Calvo-Lobo,3 Roy La Touche,1,2,4 Roberto Cano-de-la-Cuerda,5 Alfonso Gil-Martínez,1,2,4 David Fernández-Ayuso,6 Josué Fernández-Carnero2,4,5 1Departamento de Fisioterapia, Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, Spain; 2Motion in Brains Research Group, Institute of Neuroscience and Movement Sciences (INCIMOV), Centro Superior de Estudios Universitarios La Salle, Universidad Autonóma de Madrid, Spain; 3Nursing and Physical Therapy Department, Institute of Biomedicine (IBIOMED), Faculty of Health Sciences, Universidad de León, Ponferrada, León, Spain; 4Hospital La Paz Institute for Health Research, IdiPAZ, Madrid, Spain; 5Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Universidad Rey Juan Carlos, Alcorcón, Madrid, Spain; 6“San Juan de Dios” School of Nursing and Physiotherapy, Pontifica de Comillas University, Madrid, Spain Purpose: The main aim of the study was to predict the health-related quality of life (HRQoL) based on physical, functional, and psychological measures in patients with different types of neck pain (NP). Materials and methods: This cross-sectional study included 202 patients from a primary health center and the physiotherapy outpatient department of a hospital. Patients were divided into four groups according to their NP characteristics: chronic (CNP), acute whiplash (WHIP), chronic NP associated with temporomandibular dysfunction (NP-TMD), or chronic NP associated with chronic primary headache (NP-PH). The following measures were performed: Short Form-12 Health Survey (SF-12), Neck Disability Index (NDI), visual analog scale (VAS), State-Trait Anxiety Inventory (STAI), Beck Depression Inventory (BECK), and cervical range of movement (CROM). Results: The regression models based on the SF-12 total HRQoL for CNP and NP-TMD groups showed that only NDI was a significant predictor of the worst HRQoL (48.9% and 48.4% of the variance, respectively). In the WHIP group, the regression model showed that BECK was the only significant predictor variable for the worst HRQoL (31.7% of the variance). Finally, in the NP-PH group, the regression showed that the BECK, STAI, and VAS model predicted the worst HRQoL (75.1% of the variance). Conclusion: Chronic nonspecific NP and chronic NP associated with temporomandibular dysfunction were the main predictors of neck disability. In addition, depression, anxiety, and pain were the main predictors of WHIP or primary headache associated with CNP. Keywords: quality of life, neck pain, disability, depression, anxiety

[Background] The association between motor-related cortical activity and peripheral stimulation with temporal precision has been proposed as a possible intervention to facilitate cortico-muscular pathways and thereby improve motor rehabilitation after stroke. Previous studies with patients have provided evidence of the possibility to implement brain-machine interface platforms able to decode motor intentions and use this information to trigger afferent stimulation and movement assistance. This study tests the use a low-latency movement intention detector to drive functional electrical stimulation assisting upper-limb reaching movements of patients with stroke.Methods: An eight-sessions intervention on the paretic arm was tested on four chronic stroke patients along 1 month. Patients' intentions to initiate reaching movements were decoded from electroencephalographic signals and used to trigger functional electrical stimulation that in turn assisted patients to do the task. The analysis of the patients' ability to interact with the intervention platform, the assessment of changes in patients' clinical scales and of the system usability and the kinematic analysis of the reaching movements before and after the intervention period were carried to study the potential impact of the intervention.Results: On average 66.3 ± 15.7% of trials (resting intervals followed by self-initiated movements) were correctly classified with the decoder of motor intentions. The average detection latency (with respect to the movement onsets estimated with gyroscopes) was 112 ± 278 ms. The Fügl-Meyer index upper extremity increased 11.5 ± 5.5 points with the intervention. The stroke impact scale also increased. In line with changes in clinical scales, kinematics of reaching movements showed a trend toward lower compensatory mechanisms. Patients' assessment of the therapy reflected their acceptance of the proposed intervention protocol.Conclusions: According to results obtained here with a small sample of patients, Brain-Machine Interfaces providing low-latency support to upper-limb reaching movements in patients with stroke are a reliable and usable solution for motor rehabilitation interventions with potential functional benefits., [Methods] An eight-sessions intervention on the paretic arm was tested on four chronic stroke patients along 1 month. Patients' intentions to initiate reaching movements were decoded from electroencephalographic signals and used to trigger functional electrical stimulation that in turn assisted patients to do the task. The analysis of the patients' ability to interact with the intervention platform, the assessment of changes in patients' clinical scales and of the system usability and the kinematic analysis of the reaching movements before and after the intervention period were carried to study the potential impact of the intervention., [Results] On average 66.3 ± 15.7% of trials (resting intervals followed by self-initiated movements) were correctly classified with the decoder of motor intentions. The average detection latency (with respect to the movement onsets estimated with gyroscopes) was 112 ± 278 ms. The Fügl-Meyer index upper extremity increased 11.5 ± 5.5 points with the intervention. The stroke impact scale also increased. In line with changes in clinical scales, kinematics of reaching movements showed a trend toward lower compensatory mechanisms. Patients' assessment of the therapy reflected their acceptance of the proposed intervention protocol., [Conclusions] According to results obtained here with a small sample of patients, Brain-Machine Interfaces providing low-latency support to upper-limb reaching movements in patients with stroke are a reliable and usable solution for motor rehabilitation interventions with potential functional benefits., This research has been supported by Spanish Ministry of Science project HYPER-CSD2009-00067. We acknowledge support of the publication fee by the CSIC Open Access Publication Support Initiative through its Unit of Information Resources for Research (URICI).

The understanding of biomechanical deficits and impaired neural control of gait after stroke is crucial to prescribe effective customized treatments aimed at improving walking function. Instrumented gait analysis has been increasingly integrated into the clinical practice to enhance precision and inter-rater reliability for the assessment of pathological gait. On the other hand, the analysis of muscle synergies has gained relevance as a novel tool to describe the neural control of walking. Since muscle synergies and gait analysis capture different but equally important aspects of walking, we hypothesized that their combination can improve the current clinical tools for the assessment of walking performance.To test this hypothesis, we performed a complete bilateral, lower limb biomechanical and muscle synergies analysis on nine poststroke hemiparetic patients during overground walking. Using stepwise multiple regression, we identified a number of kinematic, kinetic, spatiotemporal and synergy-related features from the paretic and non-paretic side that, combined together, allow to predict impaired walking function better than the Fugl-Meyer Assessment score. These variables were time of peak knee flexion, VAF(total) values, duration of stance phase, peak of paretic propulsion and range of hip flexion. Since these five variables describe important biomechanical and neural control features underlying walking deficits poststroke, they may be feasible to drive customized rehabilitation therapies aimed to improve walking function.This paper demonstrates the feasibility of combining biomechanical and neural-related measures to assess locomotion performance in neurologically injured individuals. (C) 2017 Elsevier Ltd. All rights reserved., This study was funded by the Spanish Ministry for Science and Innovation, in the framework of the project HYPER (CONSOLIDER-INGENIO 2010) "Hybrid Neuroprosthetic and Neurorobotic Devices for Functional Compensation and Rehabilitation of Motor Disorders" (Ref. CSD2009-00067) and the Spanish project ASSOCIATE (Ref. DPI2014-58431-C4-1-R)., info:eu-repo/semantics/publishedVersion

In recent years the combined use of functional electrical stimulation (FES) and robotic devices, called hybrid robotic rehabilitation systems, has emerged as a promising approach for rehabilitation of lower and upper limb motor functions. This paper presents a review of the state of the art of current hybrid robotic solutions for upper limb rehabilitation after stroke. For this aim, studies have been selected through a search using web databases: IEEE-Xplore, Scopus and PubMed. A total of 10 different hybrid robotic systems were identified, and they are presented in this paper. Selected systems are critically compared considering their technological components and aspects that form part of the hybrid robotic solution, the proposed control strategies that have been implemented, as well as the current technological challenges in this topic. Additionally, we will present and discuss the corresponding evidences on the effectiveness of these hybrid robotic therapies. The review also discusses the future trends in this field., This work was supported by the Spanish Ministry of Economy and Competitiveness (projects HYPER-CSD2009-00067 CONSOLIDER-INGENIO 2010, DPI2011-25892, DGA-FSE).

Introduccion. La esclerosis multiple (EM) es una enfermedad neurodegenerativa que produce alteraciones en el equilibrio y la marcha en la mayoria de los pacientes. La realidad virtual se ha propuesto como un abordaje complementario al tratamiento rehabilitador convencional como medio para mejorar dichas alteraciones. Objetivo. Evaluar la eficacia del abordaje mediante realidad virtual, en comparacion con otras intervenciones de neurorrehabilitacion o la no intervencion, en la EM. Pacientes y metodos. Se realiza una revision sistematica de ensayos controlados aleatorizados. Se incluyeron estudios de los ultimos cinco anos que comparasen la intervencion de realidad virtual frente al tratamiento convencional o la no intervencion sobre el equilibrio y la marcha en personas adultas con EM. Se utilizo la escala PEDro para evaluar la calidad metodologica de los estudios incluidos y la escala de Oxford para evaluar el nivel de evidencia y el grado de recomendacion. Resultados. Ocho estudios cumplieron los criterios de elegibilidad. Para el equilibrio, la eficacia de la realidad virtual es, al menos, comparable a la del entrenamiento convencional. Para la marcha, la realidad virtual parece no ser superior en el parametro velocidad, en comparacion con el resto de intervenciones evaluadas. La calidad metodologica de los estudios fue moderada-baja. Conclusiones. La realidad virtual es igual de eficaz que el entrenamiento rehabilitador convencional para mejorar el equilibrio en personas con EM. No se han hallado datos que sugieran que la realidad virtual sea superior a otras intervenciones en la mejora de la velocidad de la marcha, y su eficacia sobre otros parametros de la marcha es aun incierta.

Introduccion. La incidencia del ictus ha aumentado en los ultimos anos, por lo que se destaca el papel en la prevencion e identificacion de factores de riesgo, asi como del analisis de sus costes derivados. En la actualidad, las nuevas tecnologias, concretamente las aplicaciones moviles, podrian considerarse como herramientas con potenciales beneficios en la atencion sanitaria del paciente con ictus. Objetivo. Realizar una revision sistematica sobre la informacion publicada acerca de las aplicaciones moviles potenciales o especificamente disenadas en el ambito del ictus, con el fin de clasificarlas y llevar a cabo una descripcion de sus principales caracteristicas. Pacientes y metodos. Se llevo a cabo una revision sistematica de articulos publicados en ingles, frances y castellano, desde el ano 2007 al 2017, que presentasen, analizasen o validasen sistemas basados en aplicaciones con utilidad o diseno especifico para el ictus. A su vez, se llevo a cabo una busqueda de aplicaciones moviles en los principales mercados de estas. Resultados. Se encontraron un total de 136 aplicaciones para dispositivos moviles relacionadas con el ictus: nueve de habitos saludables, 32 informativas, 38 referentes a valoracion, 35 de tratamiento y 22 especificas. Conclusiones. Se identificaron evidencias con escasa calidad metodologica en relacion con diferentes areas de atencion del paciente con ictus, asi como una amplia oferta de aplicaciones en los diferentes mercados de aplicaciones, por lo que se aboga por la creacion de mecanismos de regulacion en cuanto a la validez de contenido.

Introduccion. Nuevas alternativas terapeuticas estan emergiendo en el ambito de las tecnologias de la informacion y la comunicacion mediante el uso de smartphones o telefonos inteligentes en el abordaje de la esclerosis multiple (EM). Objetivo. Realizar una revision sistematica sobre aplicaciones moviles especificamente disenadas en el ambito de la EM, con el fin de clasificarlas y llevar a cabo una descripcion de sus principales caracteristicas. Sujetos y metodos. Se llevo a cabo una busqueda bibliografica de articulos publicados en ingles y castellano, desde el ano 2012 al 2017, que presentasen, analizasen o validasen un sistema basado en una aplicacion con diseno especifico para la EM. A su vez, se llevo a cabo una busqueda de aplicaciones moviles en los principales mercados de aplicaciones moviles. Resultados. Se encontraron un total de 46 aplicaciones moviles en el campo de la EM, y se clasificaron en 19 aplicaciones informativas, tres de valoracion, cuatro de tratamiento, seis de comunicacion y 14 combinadas. Cuatro fueron de pago y 37 se encontraron unicamente en ingles. Conclusiones. Todos los articulos cientificos incluidos en la presente revision mostraban aplicaciones moviles especificamente disenadas en el ambito de la EM. Sin embargo, la baja calidad metodologica de los articulos incluidos y el hecho de que no existan coincidencias entre las aplicaciones encontradas en la literatura cientifica y en los mercados de aplicaciones hacen que no se pueda recomendar su uso de forma generalizada.

Introduccion. El ictus genera dependencia por los numerosos deficits asociados. El uso de tecnologias de bajo coste para la rehabilitacion neurologica podria ser beneficioso para el tratamiento de estos pacientes. Objetivo. Determinar si el tratamiento combinado mediante un protocolo con realidad virtual semiinmersiva, junto con un abordaje rehabilitador interdisciplinar, mejora el equilibrio y el control postural, la independencia funcional, la calidad de vida, la motivacion, la autoestima y la adhesion a la intervencion en pacientes que han sufrido un ictus en fase subaguda. Pacientes y metodos. Estudio piloto prospectivo longitudinal con valoracion pre y postintervencion. Se seleccionaron 14 participantes ingresados en el Hospital La Fuenfria. La intervencion experimental se realizo durante ocho semanas en combinacion con el tratamiento convencional de fisioterapia y terapia ocupacional. Cada sesion fue incrementandose en tiempo-intensidad y requerimientos motores mediante videojuegos comerciales vinculados a la videoconsola Xbox 360° y el dispositivo Kinect. Resultados. Se obtuvieron mejorias estadisticamente significativas en la escala de Rankin modificada (p = 0,04), baropodometria (distribucion de carga, p = 0,03; superficie de apoyo, p = 0,01), indice de Barthel (p = 0,01), cuestionario EuroQoL 5D (p = 0,01), motivacion (p = 0,02), autoestima (p = 0,01) y adhesion a la intervencion (p = 0,02). Conclusiones. El abordaje rehabilitador complementado con realidad virtual semiinmersiva parece ser util para mejorar el equilibrio y el control postural, la independencia funcional en las actividades basicas de la vida diaria, la calidad de vida, asi como la motivacion y la autoestima, con excelente adhesion a las intervenciones, por lo que podria constituir una herramienta terapeutica coadyuvante en la rehabilitacion neurologica del ictus en fase subaguda.

Poststroke characteristics vary significantly between patients and over time, necessitating the introduction of individualized therapy. To provide the appropriate therapy to a patient at the correct time, several theoretical considerations must be taken into account—from a clear delineation of rehabilitation goals to an understanding of how a certain therapy can influence the underlying neuroplasticity. With regard to the differences between upper and lower limb motor recovery, both domains have experienced a change in perspective on rehabilitation. In gait training, assist-as-needed rehabilitation paradigms have become more pertinent, allowing each patient to find his/her individual walking rhythm and style within healthy boundaries. With the introduction of robotics in upper limb training (with or without virtual reality games that are attached), the amount of training and feedback that is provided to a patient can be increased without a rise in cost. The emerging consensus is to consider the various motor therapies and pharmacological interventions as part of a single, large toolbox instead of separate entities, guiding us toward a more patient-therapist-tailored approach, which is demonstrating tremendous efficacy.

El termino ‘neurorrehabilitacion’ es entendido como el proceso destinado a reducir la deficiencia, la limitacion de la actividad y la restriccion de la participacion que padecen las personas como consecuencia de una enfermedad neurologica, y en el que los profesionales involucrados en dicho ambito tendran como objetivo la reduccion del grado de afectacion funcional del paciente. Debido al desconocimiento que existio en relacion con la capacidad plastica que presenta el sistema nervioso humano, los origenes cientificos de la rehabilitacion neurologica son relativamente recientes, y se situan alrededor de la Segunda Guerra Mundial. Sin embargo, existen indicios de que el neurologo Heinrich Sebastian Frenkel (1860-1931) pudo establecer las bases de la neurorrehabilitacion antes de esa epoca. En relacion con los trabajos realizados y publicados por Frenkel, existen referentes historicos que apoyarian la hipotesis de que, considerando sus metodologias de tratamiento empleadas y documentadas, lo que denomino Ubungstherapie (gimnasia neurologica) podria considerarse la base de la neurorrehabilitacion moderna. Estos conocimientos pudieron haberse tenido en cuenta por multitud de autores que introdujeron dichas experiencias y aprendizajes en los diversos metodos terapeuticos que surgieron con posterioridad, incluso los mas novedosos y tecnologicos, si bien las raices de la neurorrehabilitacion aplicada podrian encontrarse a finales del siglo XIX.

Background: Few portable exoskeletons following the assist-as-needed concept have been developed for patients with neurological disorders. Thus, the main objectives of this proof-of-concept study were 1) to explore the safety and feasibility of an exoskeleton for gait rehabilitation in stroke and multiple sclerosis patients, 2) to test different algorithms for gait assistance and measure the resulting gait changes and 3) to evaluate the user's perception of the device. Methods: A cross-sectional study was conducted. Five patients were recruited (4 patients with stroke and 1 with multiple sclerosis). A robotic, one-degree-of-freedom, portable lower limb exoskeleton known as the Marsi Active Knee (MAK) was designed. Three control modes (the Zero Force Control mode, Mode 1 and Mode 3) were implemented. Spatiotemporal gait parameters were measured by the 10-m walking test (10MWT), the Gait Assessment and Intervention Tool (G.A.I.T.) and Tinetti Performance Oriented Mobility Assessment (gait subscale) before and after the trials. A modified QUEST 2.0 questionnaire was administered to determine each participant's opinion about the exoskeleton. The data acquired by the MAK sensors were normalized to a gait cycle, and adverse effects were recorded. Results: The MAK exoskeleton was used successfully without any adverse effects. Better outcomes were obtained in the 10MWT and G.A.I.T. when Mode 3 was applied compared with not wearing the device at all. In 2 participants, Mode 3 worsened the results. Additionally, Mode 3 seemed to improve the 10MWT and G.A.I.T. outcomes to a greater extent than Mode 1. The overall score for the user perception of the device was 2.8 ± 0.4 95% CI. Conclusions: The MAK exoskeleton seems to afford positive preliminary results regarding safety, feasibility, and user acceptance. The efficacy of the MAK should be studied in future studies, and more advanced improvements in safety must be implemented., G. Puyuelo-Quintana has received financial support by the “Doctorado Industrial” grant of Ministerio de Ciencia, Innovación y Universidades de España (reference DI-16- 08731). A. Plaza-Flores and E. Garces-Castellote have received financial support by the “Doctorado Industrial” grant of Comunidad de Madrid (reference IND2017/TIC-7698 and IND2018/TIC-9618, respectively).