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• A virtual reality action observation and motor imagery (VR-AOMI) task was developed. • Effect of VR-AOMI on neuroplasticity was evaluated in twenty healthy adults. • The foundational basis for an early form of LTP synaptic plasticity was quantified. • VR-AOMI was safe, well tolerated, and increased capacity for neuroplasticity. Neuroplasticity is important for learning, development and recovery from injury. Therapies that can upregulate neuroplasticity are therefore of interest across a range of fields. We developed a novel virtual reality action observation and motor imagery (VR-AOMI) intervention and evaluated whether it could enhance the efficacy of mechanisms of neuroplasticity in the human motor cortex of healthy adults. A secondary question was to explore predictors of the change in neuroplasticity following VR-AOMI. A pre-registered, pilot randomized controlled cross-over trial was performed. Twenty right-handed adults (13 females; mean age: 23.0 ± 4.53 years) completed two experimental conditions in separate sessions; VR-AOMI and control. We used intermittent theta burst stimulation (iTBS) to induce long term potentiation-like plasticity in the motor cortex and recorded motor evoked potentials at multiple timepoints as a measure of corticospinal excitability. The VR-AOMI task did not significantly increase the change in MEP amplitude following iTBS when compared to the control task (Group × Timepoint interaction p = 0.17). However, regression analysis identified the change in iTBS response following VR-AOMI was significantly predicted by the baseline iTBS response in the control task. Specifically, participants that did not exhibit the expected increase in MEP amplitude following iTBS in the control condition appear to have greater excitability following iTBS in the VR-AOMI condition (r = −0.72, p < 0.001). Engaging in VR-AOMI might enhance capacity for neuroplasticity in some people who typically do not respond to iTBS. VR-AOMI may prime the brain for enhanced neuroplasticity in this sub-group. [ABSTRACT FROM AUTHOR]

Rationale: There is a lack of consensus in the literature related to what is assessed clinically by physical therapists in people with neurological disorders. Aims: This mixed‐methods systematic review aimed to identify domains that physiotherapists routinely assess in people with neurological conditions in clinical settings and explored factors influencing assessment domains including country, clinical setting, therapist experience and neurological condition. Method: Five databases were searched from 1946 to 31st January 2023. Studies with any design reporting on domains assessed by a physiotherapist, in people with neurological conditions in any clinical setting, were included. Independent reviewers assessed eligibility and risk of bias using relevant McMaster critical appraisal tools. Data were extracted and synthesised following the Joanna Briggs Institute approach for mixed systematic reviews. Results: A total of 23 (16 quantitative, 7 qualitative) studies involving 3134 participants were included. The studies were rated as high (n = 14) or medium (n = 9) quality. The domains of function (n = 14); postural alignment and symmetry (n = 11); gait (n = 11); balance (n = 9), and muscle strength (n = 8) were most frequently included in assessments. Five key themes were identified from the qualitative studies: the clinical reasoning process, clinical use of standardised measures, utilisation of the senses, clinician experience and information gathering. There was minimal data on how country, clinical setting, therapist experience and neurological condition influence inclusion of assessed domains. Conclusion: Five domains were most frequently included in assessment: function; postural alignment and symmetry; gait; muscle strength; and balance. This limited number of domains is in stark contrast to the full neurological physiotherapy assessment recommended by expert textbooks. Further research is needed to understand the reasons why this might be so. [ABSTRACT FROM AUTHOR]

Background: Eye tracking technologies and methodologies have advanced significantly in recent years. Specifically, the use of eye tracking to measure oculomotor and psychophysiological constructs quantitatively is gaining momentum. Reaction time has been measured in a number of different ways, from a simple response to a stimulus to more challenging choice or discrimination responses to stimuli. Traditionally, reaction time is measured from the beginning of a stimulus event to a response event and includes both visual and motor response times. Eye tracking technology can provide a more discrete measurement of reaction time to include visual components such as visual latencies and visual speed and can identify whether the person was looking at the target area when a stimulus was presented. The aim of this paper was to examine the reliability of the simple reaction time, choice reaction time, and discriminate reaction time tests measured using eye tracking technology. Additionally, we sought to establish performance norms and examine gender differences in reaction time in the general population. A final objective was to conduct a preliminary comparison of reaction time measures across different populations, including non-athletes, athletes, and individuals who had sustained a traumatic brain injury. Methods: A sample of 125 participants was recruited to undertake test-retest reliability, analysed using Cronbach's alpha and intraclass correlation coefficients. A different data set of 1893 individuals, including athletes (n = 635), non-athletes (n = 627), and people with traumatic brain injury (n = 631) was compared using MANOVA to explore group differences in reaction time. Results: Results demonstrated that overall, the tests had good test-retest reliability. No significant differences were found for gender. Significant differences were found between groups, with athletes performing best overall. Reaction times of people with traumatic brain injury were overall much more variable, showing very large standard deviations, than those of the non-athletes and athletes. Conclusions: Future research should consider the accuracy of eye movements and various demographic variables within groups. [ABSTRACT FROM AUTHOR]

Virtual and Augmented Reality hardware has become more affordable in the past three years, largely due to the availability of affordable sensors and smartphone displays as well as financial investments and buy-in through the entertainment industry. Many new consumer devices are now available to researchers, clinicians and software developers. With so many options available, planning a Virtual Rehabilitation project and selecting appropriate hardware components can be a challenge. This paper presents a stepwise selection process for Virtual and Augmented Reality hardware. The process is described through an example project in which clinical and technical implications of each hardware choice are discussed. [ABSTRACT FROM AUTHOR]

In the past 2 decades, researchers have demonstrated the potential for virtual reality (VR) technologies to provide engaging and motivating environments for stroke rehabilitation interventions. Much of the research has been focused on the exploratory phase, and jumps to intervention efficacy trials and scale-up evaluation have been made with limited understanding of the active ingredients in a VR intervention for stroke. The rapid pace of technology development is an additional challenge for this emerging field, providing a moving target for researchers developing and evaluating potential VR technologies. Recent advances in customized games and cutting-edge technology used for VR are beginning to allow for researchers to understand and control aspects of the intervention related to motivation, engagement, and motor control and learning. This article argues for researchers to take a progressive, step-wise approach through the stages of intervention development using evidence-based principles, take advantage of the data that can be obtained, and utilize measurement tools to design effective VR interventions for stroke rehabilitation that can be assessed through carefully designed efficacy and effectiveness trials. This article is motivated by the recent calls in the field of rehabilitation clinical trials research for carefully structured clinical trials that have progressed through the phases of research. [ABSTRACT FROM AUTHOR]

Purpose: This paper details a brief history and rationale for the use of virtual reality (VR) technology for clinical research and intervention, and then focuses on game-based VR applications in the area of rehabilitation. An analysis of the match between rehabilitation task requirements and the assets available with VR technology is presented. Key messages and implications: Low-cost camera-based systems capable of tracking user behavior at sufficient levels for game-based virtual rehabilitation activities are currently available for in-home use. Authoring software is now being developed that aims to provide clinicians with a usable toolkit for leveraging this technology. This will facilitate informed professional input on software design, development and application to ensure safe and effective use in the rehabilitation context. Conclusion: The field of rehabilitation generally stands to benefit from the continual advances in VR technology, concomitant system cost reductions and an expanding clinical research literature and knowledge base. Home-based activity within VR systems that are low-cost, easy to deploy and maintain, and meet the requirements for 'good' interactive rehabilitation tasks could radically improve users' access to care, adherence to prescribed training and subsequently enhance functional activity in everyday life in clinical populations. [ABSTRACT FROM AUTHOR]

Thirty percent of older adults fall every year. One of the most effective methods to help prevent falls is participation in a regular fitness or exercise program to build and maintain capacities. Few exercise programs for older adults utilize the advances in technology and gaming for fitness. Fifteen older adults currently involved in a fitness program for seniors at California State University-Fullerton participated in focus groups. The focus groups explored perceptions of health and wellness, the use of and access to technology, and ideas for the development of a game for fitness. The data were analyzed using open coding and the themes that emerged from the data were used in the design of a prototype game. Nineteen older adults participated in an iterative user testing process of the prototype game. The iterative user testing process involved several cycles of user testing and changes to the prototype. The feedback from the user testing process as well as the focus groups will be summarized and explored in this paper. Details of a preliminary game will be presented with a focus on access to technology for older adults, participation as means for prevention and building capacities. [ABSTRACT FROM AUTHOR]

To explore the effectiveness of smartphone apps for the self-management of low back pain in adults. Prospectively registered systematic review of randomised controlled trials (2008–) published in English. Studies investigating smartphone apps for the self-management of low back pain (adults ≥18 years), including ≥1 NICE low back pain and sciatica clinical guideline-recommended component and functioning without health professional input were included. Outcomes were pain, function, quality of life and adherence. Six studies were included (n = 2100 participants). All comparator groups incorporated some form of management (n = 3 physiotherapy, n = 2 GPs, n = 1 not specified). Three studies reported a significant decrease in pain intensity in the intervention group compared with the control. One study reported no significant difference between groups in pain self-efficacy. One study reported a significant reduction in disability (function) in the intervention group compared with the control. Two studies reported no between-group differences in quality of life. One study reported no correlation between adherence (app use) and change in pain intensity and one study reported that app use mediated the effect of teleconsultations on pain improvements. Inconclusive evidence exists for the use of smartphone applications for the self-management of low back pain. Further research is needed. Smartphone apps have the potential to improve outcomes for people with LBP aligned with current self-management guidelines. There is a paucity of literature exploring smartphone apps for LBP self-management and current evidence is inconclusive for smartphone app use without supported care. Commercially available smartphone apps are not well regulated for content or alignment with evidence-based guidelines and recommendations. Further evaluation of commercially available apps is required to guide and instil confidence in consumers and health professionals that consumer-accessible apps may lead to improved outcomes. [ABSTRACT FROM AUTHOR]

Explore smartphone apps that may be recommended by clinicians for the self-management of low back pain. Prospectively registered systematic assessment of self-contained apps for self-management of low back pain on the Google Play and Apple App stores (Oceania), including ≥1 NICE low back pain and sciatica clinical guideline-recommended component and functioning without health professional input. Outcomes were quality (Mobile App Rating Scale; MARS), and self-management (Self-Management Support Checklist; SMS-14) and behaviour change potential (App Behaviour Change Scale; ABACUS). 25 apps were included. The average quality of included apps was acceptable (Mean MARS score of 3.9 out of a maximum possible 5). The self-management support and behaviour change potential of included apps appeared low (mean SMS-14 score was 3.4/14; mean ABACUS score was 5.4/21). The apps showed no significant correlation between app consumer ratings and MARS scores. App quality was significantly correlated with app price (p = 0.049) but not consumer ratings, however, these findings were based on a small number of studies and the overall model was not significant. Smartphone apps for the self-management of low back pain are of average to good quality, with questionable potential for self-management and behaviour change. Clinicians should consider that few apps were designed to specifically incorporate self-management support and behaviour change potential when recommending apps to clients. Further development in these areas of app design would be of benefit. Smartphone apps have the potential to improve LBP self-management outcomes, however, apps are not well regulated and the quality of information and advice provided is often low quality. The findings from this systematic assessment indicate that LBP self-management apps have limited self-management support and behaviour change potential features. Recommendation of current smartphone apps for LBP should take into consideration that although apps are of acceptable quality they are not specifically designed with self-management support and behaviour change principles. App quality does not appear to be associated with consumer ratings, however, there may be a positive association between app price and quality which requires further investigation. [ABSTRACT FROM AUTHOR]

Background: Multimodal training may induce positive effects in different physical domains. Compared to unimodal training, multimodal training allows similar effect sizes at lower overall training volumes. Studies are needed to investigate the potential value of multimodal training with systematic training, especially compared to other exercise-based interventions. This study aimed to compare the effects of a multimodal training with an outdoor walking program, on postural control, muscle strength, and flexibility in community-dwelling older adults. Methods: This study is a pragmatic controlled clinical trial. We compared two real community exercise groups: a multimodal group (n = 53) and an outdoor, overground walking group (n = 45). Both groups participated in 32 sessions of training, twice a week, over 16 weeks. Participants were evaluated using the Mini-Balance Evaluation Systems Test (Mini-BESTest), Handgrip, 5-Times Sit-to-Stand Test, 3-meter Gait Speed Test, and Sit and Reach Test. Results: There was an interaction effect between evaluation and group in the Mini- BESTest with difference between pre and post-intervention only in multimodal group. Regarding gait speed, there was an interaction effect between evaluation and group with difference between pre and post-intervention only in the walking group. In the Sit and Reach Test: there was interaction effect between evaluation and group with difference between pre and post-intervention only in the walking group. Conclusion: The multimodal training improved postural control, while an outdoor walking program improved gait speed and flexibility. Both interventions improved muscle strength without between-group differences. [ABSTRACT FROM AUTHOR]

Objective: Rehabilitation for adults with traumatic brain injury (TBI) incorporates client-centred goal-setting and motivational support to achieve goals. However, face-to-face rehabilitation is time-limited. New therapy approaches which leverage care are warranted. Conversational agents (CAs) offer a human–computer interface with which a person can converse. This study tested the feasibility, usability and acceptability of using a novel CA – RehabChat – alongside brain injury rehabilitation. Design: Mixed methods, single case design, feasibility pilot trial. Setting: Ambulatory and community brain injury rehabilitation. Participants: Adults with TBI receiving brain injury rehabilitation and clinicians providing this care. Intervention: Following 1:1 training, client–clinician dyads used RehabChat for two weeks alongside usual care. Main measures: Pre-post clinical measures (Motivation for Traumatic Brain Injury Rehabilitation Questionnaire, Rehabilitation Therapy Engagement Scale, Brain Injury Rehabilitation Trust Motivation Questionnaire-Relative, Brain Injury Rehabilitation Trust Motivation Questionnaire-Self) repeated measures (Hospital Anxiety and Depression Scale, researcher-developed wellbeing screening questions); and post-intervention (System Usability Scale (SUS), semi-structured 1:1 interview). Results: Six participants (two clients and four clinicians) completed training. Two client–clinician dyads completed the intervention. Two other clinicians used RehabChat in a mock client–clinician session. SUS scores indicated good usability. Client well-being did not deteriorate. No adverse events were experienced. Interviews indicated RehabChat was feasible, acceptable and easy to use; and supported motivation, goal-setting and completing practice activities. Conclusions: RehabChat was feasible and acceptable to use alongside usual ambulatory and community brain injury rehabilitation, had good usability and supported client needs. Further testing of RehabChat with a larger cohort for longer duration is warranted. [ABSTRACT FROM AUTHOR]

Background: Understanding the clinical course of low back pain is essential to informing treatment recommendations and patient stratification. Our aim was to update our previous systematic review and meta-analysis to gain a better understanding of the clinical course of acute, subacute and persistent low back pain. Methods: To update our 2012 systematic review and meta-analysis, we searched the Embase, MEDLINE and CINAHL databases from 2011 until January 2023, using our previous search strategy. We included prospective inception cohort studies if they reported on participants with acute (< 6 wk), subacute (6 to less than 12 wk) or persistent (12 to less than 52 wk) nonspecific low back pain at study entry. Primary outcome measures included pain and disability (0–100 scale). We assessed risk of bias of included studies using a modified tool and assessed the level of confidence in pooled estimates using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) tool. We used a mixed model design to calculate pooled estimates (mean, 95% confidence interval [CI]) of pain and disability at 0, 6, 12, 26 and 52 weeks. We treated time in 2 ways: time since study entry (inception time uncorrected) and time since pain onset (inception time corrected). We transformed the latter by adding the mean inception time to the time of study entry. Results: We included 95 studies, with 60 separate cohorts in the systematic review (n = 17 974) and 47 cohorts (n = 9224) in the meta-analysis. Risk of bias of included studies was variable, with poor study attrition and follow-up, and most studies did not select participants as consecutive cases. For the acute pain cohort, the estimated mean pain score with inception time uncorrected was 56 (95% CI 49–62) at baseline, 26 (95% CI 21–31) at 6 weeks, 22 (95% CI 18–26) at 26 weeks and 21 (95% CI 17–25) at 52 weeks (moderate-certainty evidence). For the subacute pain cohort, the mean pain score was 63 (95% CI 55–71) at baseline, 29 (95% CI 22–37) at 6 weeks, 29 (95% CI 22–36) at 26 weeks and 31 (95% 23–39) at 52 weeks (moderate-certainty evidence). For the persistent pain cohort, the mean pain score was 56 (95% CI 37–74) at baseline, 48 (95% CI 32–64) at 6 weeks, 43 (95% CI 29–57) at 26 weeks and 40 (95% CI 27–54) at 52 weeks (very low–certainty evidence). The clinical course of disability was slightly more favourable than the clinical course of pain. Interpretation: Participants with acute and subacute low back pain had substantial improvements in levels of pain and disability within the first 6 weeks (moderate-certainty evidence); however, participants with persistent low back pain had high levels of pain and disability with minimal improvements over time (very low–certainty evidence). Identifying and escalating care in individuals with subacute low back pain who are recovering slowly could be a focus of intervention to reduce the likelihood of transition into persistent low back pain. Protocol registration: PROSPERO — CRD42020207442 [ABSTRACT FROM AUTHOR]

Background: Infectious disease outbreaks disrupt inpatient clinical care and have an impact on staff and patients' ability to communicate with each other and with the wider community. Digital technology may offer opportunities for communication in the inpatient setting during infectious disease outbreaks. Aim: This scoping review aimed to investigate the use of digital technology in the inpatient setting to promote communication in the early stages of an infectious disease outbreak. Methods: There were three aspects to this scoping review: (1) a database search of Ovid MEDLINE (MEDLINE), Cumulative Index of Nursing and Allied Health Literature (CINAHL), Association for Computing Machinery Digital Library (ACM) and IEEE Xplore (IEEE) exploring peer-reviewed articles, (2) a gray literature search, and (3) a media search. Results: Results focused on the early stages of the COVID-19 pandemic. Thirty-eight peer-reviewed articles were extracted from the database search. There were three main areas of investigation: study characteristics, technology features, and benefits and barriers. Forty-four websites were searched for the gray literature search focusing on policy and guidance. Eighteen media articles were retrieved focusing on patients' use of technology and community involvement. Conclusion: Results demonstrate the diverse use of digital technology in the inpatient setting to facilitate communication during the early stages of the COVID-19 pandemic. However, the articles provide limited data to allow readers to fully understand and reproduce described actions. Furthermore, there was limited guidance to support clinicians to communicate using digital technology to create trusting therapeutic relationships. Areas for future development include standard reporting process for technology hardware, software, and content; and structured reporting and evaluation of the implementation of technologies. [ABSTRACT FROM AUTHOR]

Supporting behaviour change is important in health promotion and disease prevention. Motivational Interviewing (MI) is a core behaviour change counselling skill for health professionals to support people to make and maintain behaviour changes. MI is taught across many university courses and as continuing professional development. There is a need to provide repeatable MI training for health professionals and students that is accessible, affordable, and standardised and allows practise opportunities. This study tested the feasibility of asynchronous online MI training and using a virtual client interaction for practising MI skills. Postgraduate students (n = 22) from university health courses participated in the study. Participants completed questionnaires and interacted with a virtual client prior to and post-online training. Outcomes included MI skills (analysed using the Motivational Interviewing Treatment Integrity (MITI) code, version 4.2.1), attitudes towards behaviour change counselling, and acceptability of the online course. System usability of the virtual client interaction was evaluated using the System Usability Scale. There was a statistically significant improvement in both Relational and Technical MITI Scores, and in attitudes towards behaviour change counselling, from Pre-Course to Post-Course. Participants viewed the online course positively. System usability scored in the 90–95 percentile range. Results support the feasibility of providing MI training online and using virtual clients to facilitate the process. Further research is needed on the transferability of MI skills learned online to real world settings. [ABSTRACT FROM AUTHOR]

The number of older adults unable to transfer or ambulate independently is increasing. High support chairs enable people experiencing loss of mobility to be mobile, but current chair designs are associated with global functional loss and pressure ulcers. This pilot study compared the functionality of a traditional design high support chair to a new design of motorised high support chair: 1) a motion laboratory study compared joint angles and pressure at the hip, knee, ankle, elbow and spine when pushing each chair, and 2) a pressure mapping study compared the interface pressure when older people with limited mobility used the chairs. Significant reduction in joint angles for the person pushing the chair (degree difference range -3.6 to 14.2) and decreased seated pressure (w/kg difference range -0.2 to 2.1) for the seated user were identified for the motorised chair. Longitudinal investigations are required to determine if the significant differences identified in this pilot study result in less manual handling injuries and pressure areas. [ABSTRACT FROM AUTHOR]

Aim: To present the first iteration of the caring life‐course theory. Background: Despite requiring care from birth to death, a person's universal or fundamental care needs and the subsequent care provision, either by self or others, has yet to be presented within a life‐course perspective. Accurately describing the care people require across their lifespan enables us to identify who, what type, how and where this care should be provided. This novel perspective can help to legitimise a person's care needs and the support they require from wider care systems and contexts. Design: Discussion paper outlines theory development. We adopted an inductive approach to theory development, drawing upon existing literature and the team's diverse experiences. Our theoretical insights were refined through a series of collaborative meetings to define the theory's constructs, until theoretical saturation was reached. Discussion: Fourteen constructs are identified as essential to the theory. We propose it is possible, using these constructs, to generate caring life‐course trajectories and predict divergences in these trajectories. The novel contribution of the theory is the interplay between understanding a person's care needs and provision within the context of their lifespan and personal histories, termed their care biography, and understanding a person's care needs and provision at specific points in time within a given care network and socio‐political context. Impact for Nursing: The caring life‐course theory can provide a roadmap to inform nursing and other care industry sectors, providing opportunities to integrate and deliver care from the perspective of the person and their care history, trajectories and networks, with those of professional care teams. It can help to shape health, social and economic policy and involve individuals, families and communities in more constructive ways of talking about the importance of care for improved quality of life and healthy societies. [ABSTRACT FROM AUTHOR]

Background: Post-stroke survivors with right hemisphere injury have more impairments in postural control and balance. However, the impact of the hemisphere injured on the process of balance reacquisition has not been fully explored. We hypothesized that stroke survivors could learn balance tasks (H1), but right hemisphere damaged patients would show poor motor learning if compared to left hemisphere damaged patients (H2) Objective: To investigate whether the brain-damaged side after stroke affects the learning of a balance task. Methods: Three groups were recruited: twenty stroke survivors (ten left and ten right hemisphere damage) and twenty healthy volunteers. The participants practiced a balance task for thirty minutes, four consecutive days. The task was the Table Tilt game (NintendoTM Company), which induces balance demands with a progression of complexity. Motor performance was assessed at baseline, post-practice and after one week (retention test). Accuracy, errors, and complexity of the task achieved during the trial were assessed Results: Participants in all groups improved their performance (p <.001) and maintained it at the retention test. The control group showed better performance if compared to the right and left hemisphere damaged stroke survivors (p <.05). There was no difference between individuals with right and left hemisphere damaged, but the right hemisphere damaged patients demonstrated more errors at higher levels of complexity Conclusion: Stroke survivors can learn balance tasks (H1), and the right hemisphere damaged patients demonstrate more errors than those with left hemisphere injury in higher complexity conditions (H2). [ABSTRACT FROM AUTHOR]

Abstract: We present the Flexible Action and Articulated Skeleton Toolkit (FAAST), a middleware software framework for integrating full-body interaction with virtual environments, video games, and other user interfaces. This toolkit provides a complete end-to-end solution that includes a graphical user interface for custom gesture creation, sensor configuration, skeletal tracking, action recognition, and a variety of output mechanisms to control third party applications, allowing virtually any PC application to be repurposed for gestural control even if it does not explicit support input from motion sensors. To facilitate intuitive and transparent gesture design, we define a syntax for representing human gestures using rule sets that correspond to the basic spatial and temporal components of an action. These individual rules form primitives that, although conceptually simple on their own, can be combined both simultaneously and in sequence to form sophisticated gestural interactions. In addition to presenting the system architecture and our approach for representing and designing gestural interactions, we also describe two case studies that evaluated the use of FAAST for controlling first-person video games and improving the accessibility of computing interfaces for individuals with motor impairments. Thus, this work represents an important step toward making gestural interaction more accessible for practitioners, researchers, and hobbyists alike. [Copyright &y& Elsevier]

Numerous reports indicate that the incidence of posttraumatic stress disorder (PTSD) in returning OEF/OIF military personnel is creating a significant healthcare challenge. These findings have served to motivate research on how to better develop and disseminate evidence-based treatments for PTSD. Virtual Reality delivered exposure therapy for PTSD has been previously used with reports of positive outcomes. This article details how virtual reality applications are being designed and implemented across various points in the military deployment cycle to prevent, identify and treat combat-related PTSD in OIF/OEF Service Members and Veterans. The summarized projects in these areas have been developed at the University of Southern California Institute for Creative Technologies, a U.S. Army University Affiliated Research Center, and this paper will detail efforts to use virtual reality to deliver exposure therapy, assess PTSD and cognitive function and provide stress resilience training prior to deployment. [ABSTRACT FROM AUTHOR]

Background: Recently, interactive video games (IVGs) have been used as a health-care intervention that provides both exercise and cognitive stimulation. Several studies have shown that IVGs can improve postural control, gait, cognition, and functional independence in elderly people and patients with neurological disease. However, there is a lack of evidence about the effects of IVGs on frail and pre-frail elderly people. The aim of this study was to evaluate the feasibility, safety, and acceptability of playing Nintendo Wii Fit Plus™ (NWFP) interactive video games, and the functional outcomes (postural control, gait, cognition, mood, and fear of falling) in frail and pre-frail older adults.Methods: This study is a randomized controlled, parallel-group, feasibility trial. Participants were frail and pre-frail older adults randomly assigned to the experimental group (EG, n = 15) or control group (CG, n = 15). Participants in the EG performed 14 training sessions, lasting 50 min each, twice a week. In each training session, participants played five of 10 selected games, with two attempts at each game. Participants in the CG received general advice regarding the importance of physical activity. All participants were assessed on three occasions by a blinded physical therapist: before and after intervention, and 30 days after the end of the intervention (follow-up). We assessed the feasibility (score of participants in the games), acceptability (game satisfaction questionnaire), safety (adverse events during training sessions), and functional outcomes: (1) postural control (Mini-BESTest); (2) gait (Functional Gait Assessment); (3) cognition (Montreal Cognitive Assessment); (4) mood (GDS-15); and (5) fear of falling (FES-I).Results: Participants in the EG improved their scores in all 10 games, reported that they understood and enjoyed the tasks of the games, and presented few adverse events during the practice. There was a significant improvement in the Mini-BESTest and Functional Gait Assessment in the EG when compared with the CG (p < 0.05).Conclusion: The use of NWFP was feasible, acceptable, and safe for frail older adults and improved their postural control and gait. There were no effects on cognition, mood, or fear of falling. This trial was registered in the Brazilian Registry of Clinical Trials (RBR-823rst) on 11 June 2016. [ABSTRACT FROM AUTHOR]