Psychological treatments and psychotherapies in the neurorehabilitation of pain. Evidences and recommendations from the italian consensus conference on pain in neurorehabilitation

BACKGROUND: It is increasingly recognized that treating pain is crucial for effective care within neurological rehabilitation in the setting of the neurological rehabilitation. The Italian Consensus Conference on Pain in Neurorehabilitation was constituted with the purpose identifying best practices for us in this context. Along with drug therapies and physical interventions, psychological treatments have been proven to be some of the most valuable tools that can be used within a multidisciplinary approach for fostering a reduction in pain intensity. However, there is a need to elucidate what forms of psychotherapy could be effectively matched with the specific pathologies that are typically addressed by neurorehabilitation teams. OBJECTIVES: To extensively assess the available evidence which supports the use of psychological therapies for pain reduction in neurological diseases. METHODS: A systematic review of the studies evaluating the effect of psychotherapies on pain intensity in neurological disorders was performed through an electronic search using PUBMED, EMBASE, and the Cochrane Database of Systematic Reviews. Based on the level of evidence of the included studies, recommendations were outlined separately for the different conditions. RESULTS: The literature search yielded 2352 results and the final database included 400 articles. The overall strength of the recommendations was medium/low. The different forms of psychological interventions, including Cognitive-Behavioral Therapy, cognitive or behavioral techniques, Mindfulness, hypnosis, Acceptance and Commitment Therapy (ACT), Brief Interpersonal Therapy, virtual reality interventions, various forms of biofeedback and mirror therapy were found to be effective for pain reduction in pathologies such as musculoskeletal pain, fibromyalgia, Complex Regional Pain Syndrome, Central Post-Stroke pain, Phantom Limb Pain, pain secondary to Spinal Cord Injury, multiple sclerosis and other debilitating syndromes, diabetic neuropathy, Medically Unexplained Symptoms, migraine and headache. CONCLUSIONS: Psychological interventions and psychotherapies are safe and effective treatments that can be used within an integrated approach for patients undergoing neurological rehabilitation for pain. The different interventions can be specifically selected depending on the disease being treated. A table of evidence and recommendations from the Italian Consensus Conference on Pain in Neurorehabilitation is also provided in the final part of the pape

Efeitos da realidade virtual na reabilitação da pessoa após acidente vascular cerebral: Revisão sistemática da literatura

Introdução: O Acidente Vascular Cerebral (AVC) constituiu-se como um distúrbio neurológico que resulta em incapacidades e se associa a um grande impacto na qualidade de vida dos sobreviventes e seus familiares. Os programas de reabilitação, com intervenção diferenciada do enfermeiro especialista, têm vindo a ser cada vez mais atualizados através de técnicas que motivam o doente a frequentá-los, sendo a Realidade Virtual um recurso terapêutico que pode ser utilizado no processo de recuperação. Neste contexto, este estudo tem como principal objetivo determinar os efeitos da terapia baseada na Realidade Virtual na recuperação do membro superior afetado na pessoa pós AVC. Métodos: Foi realizada uma revisão sistemática da literatura, seguindo os princípios de Cochrane Handbook. Como bases de dados recorreu-se à PUBMED, EBSCO, Google Académico e SciELO pesquisando-se estudos publicados entre janeiro de 2007 e abril de 2018, que posteriormente foram avaliados, por dois investigadores de forma independente, respeitando os critérios de inclusão e exclusão previamente estabelecidos. O corpus da revisão ficou constituído por 9 artigos, dos quais apenas 3 reuniam critérios metodológicos para a meta-análise, cujo processamento estatística foi realizado recorrendo ao software RevMan 5.2.8. Resultados: A análise dos estudos demonstra que os programas de reabilitação com Realidade Virtual aumentam a recuperação do membro superior afetado da pessoa pós AVC, assumindo-se como um importante coadjuvante dos programas de reabilitação convencionais. Os doentes sujeitos à estimulação trans-craniana por corrente contínua apresentaram: melhorias na recuperação da função motora do membro superior em 50%; melhoria ao nível dos movimentos ativos e passivos, aumentando a capacidade funcional do membro superior e da amplitude do movimento; melhoria do movimento compensatório, da atividade motora e independência funcional, com efeitos benéficos nos sistemas de neuro-reabilitação. Os resultados da meta-análise atestam que os doentes submetidos a programas de Realidade Virtual atingem melhores resultados funcionais do que os submetidos aos tradicionais programas de reabilitação (standard care) (DM=11,48; IC 95%=-0,46–23,42), todavia, sem diferenças estatisticamente significativas (p=0,06). Conclusão: Partindo dos resultados obtidos, poderá inferir-se que a Realidade Virtual se constitui já como um recurso terapêutico com efeitos, transversalmente positivos, na reabilitação de pessoas após AVC, o que implica novos desafios à enfermagem de reabilitação. Contudo, apesar dos resultados promissores, ainda são necessários novos estudos com amostras mais representativas e melhor qualidade metodológica.Abstract Introduction: Stroke is a neurological disorder that results in disability and is associated with a major impact on the quality of life of survivors and their families. Rehabilitation programs, with differentiated intervention of the specialist nurse, have been increasingly updated through techniques that motivate the patient to attend them, and Virtual Reality is a therapeutic resource that can be used in the recovery process. In this context, this study has as main objective to determine the effects of therapy based on Virtual Reality in the recovery of the affected upper limb in the person after stroke. Methods: A systematic review of the literature was carried out, following the principles of the Cochrane Handbook. As databases, PUBMED, EBSCO, Google Academic and SciELO were searched for studies published between January 2007 and April 2018, which were subsequently evaluated by two researchers independently, respecting the inclusion and exclusion criteria previously settled down. The corpus of the review consisted of 9 articles, of which only 3 met methodological criteria for the meta-analysis, whose statistical processing was performed using RevMan 5.2.8 software. Results: The analysis of the studies demonstrates that Virtual Reality rehabilitation programs increase the recovery of the affected upper limb of the post-stroke person, and is an important adjunct to conventional rehabilitation programs. Patients who underwent transcranial DC pacing showed improvements in recovery of upper limb motor function by 50%. Improvement in the level of the active and passive movements, increasing the functional capacity of the upper limb and the amplitude of the movement; improvement of compensatory movement, motor activity and functional independence, with beneficial effects on neuro-rehabilitation systems. The results of the meta-analysis show that patients submitted to virtual reality programs achieve better functional results than those submitted to standard care programs (DM=11.48, 95% CI=0.46-23,42). However, there was no statistically significant difference (p=0.06). Conclusion: Based on the results obtained, it can be inferred that Virtual Reality is already a therapeutic resource with transversely positive effects on the rehabilitation of people after stroke, which implies new challenges to rehabilitation nursing. However, despite promising results, further studies with more representative samples and better methodological quality are still required

Rehabilitative devices for a top-down approach

In recent years, neurorehabilitation has moved from a "bottom-up" to a "top down" approach. This change has also involved the technological devices developed for motor and cognitive rehabilitation. It implies that during a task or during therapeutic exercises, new "top-down" approaches are being used to stimulate the brain in a more direct way to elicit plasticity-mediated motor re-learning. This is opposed to "Bottom up" approaches, which act at the physical level and attempt to bring about changes at the level of the central neural system. Areas covered: In the present unsystematic review, we present the most promising innovative technological devices that can effectively support rehabilitation based on a top-down approach, according to the most recent neuroscientific and neurocognitive findings. In particular, we explore if and how the use of new technological devices comprising serious exergames, virtual reality, robots, brain computer interfaces, rhythmic music and biofeedback devices might provide a top-down based approach. Expert commentary: Motor and cognitive systems are strongly harnessed in humans and thus cannot be separated in neurorehabilitation. Recently developed technologies in motor-cognitive rehabilitation might have a greater positive effect than conventional therapies

Effectiveness of Virtual Reality for Children and Adolescents with Autism Spectrum Disorder: An Evidence-Based Systematic Review

[EN] Autism Spectrum Disorder (ASD) is a neurodevelopmental disease that is specially characterized by impairments in social communication and social skills. ASD has a high prevalence in children, affecting 1 in 160 subjects. Virtual reality (VR) has emerged as an effective tool for intervention in the health field. Different recent papers have reviewed the VR-based treatments in ASD, but they have an important limitation because they only use clinical databases and do not include important technical indexes such as the Web of Science index or the Scimago Journal & Country Rank. To our knowledge, this is the first contribution that has carried out an evidence-based systematic review including both clinical and technical databases about the effectiveness of VR-based intervention in ASD. The initial search identified a total of 450 records. After the exclusion of the papers that are not studies, duplicated articles, and the screening of the abstract and full text, 31 articles met the PICO (Population, Intervention, Comparison and Outcomes) criteria and were selected for analysis. The studies examined suggest moderate evidence about the effectiveness of VR-based treatments in ASD. VR can add many advantages to the treatment of ASD symptomatology, but it is necessary to develop consistent validations in future studies to state that VR can effectively complement the traditional treatments.Mesa Gresa, P.; Gil Gómez, H.; Lozano Quilis, JA.; Gil-Gómez, J. (2018). Effectiveness of Virtual Reality for Children and Adolescents with Autism Spectrum Disorder: An Evidence-Based Systematic Review. Sensors. 18(8):1-15. https://doi.org/10.3390/s18082486S115188World Health Organizationhttp://www.who.int/en/news-room/fact-sheets/detail/autism-spectrum-disordersColombi, C., & Ghaziuddin, M. (2017). Neuropsychological Characteristics of Children with Mixed Autism and ADHD. Autism Research and Treatment, 2017, 1-5. doi:10.1155/2017/5781781Merriam-Websterhttps://www.merriam-webster.com/dictionary/virtual%20realityBird, M.-L., Cannell, J., Jovic, E., Rathjen, A., Lane, K., Tyson, A., … Smith, S. (2017). A Randomized Controlled Trial Investigating the Efficacy of Virtual Reality in Inpatient Stroke Rehabilitation. Archives of Physical Medicine and Rehabilitation, 98(10), e27. doi:10.1016/j.apmr.2017.08.084Albiol-Pérez, S., Gil-Gómez, J.-A., Muñoz-Tomás, M.-T., Gil-Gómez, H., Vial-Escolano, R., & Lozano-Quilis, J.-A. (2017). The Effect of Balance Training on Postural Control in Patients with Parkinson’s Disease Using a Virtual Rehabilitation System. Methods of Information in Medicine, 56(02), 138-144. doi:10.3414/me16-02-0004Garcia-Palacios, A., Herrero, R., Vizcaíno, Y., Belmonte, M. A., Castilla, D., Molinari, G., … Botella, C. (2015). Integrating Virtual Reality With Activity Management for the Treatment of Fibromyalgia. The Clinical Journal of Pain, 31(6), 564-572. doi:10.1097/ajp.0000000000000196Bekelis, K., Calnan, D., Simmons, N., MacKenzie, T. A., & Kakoulides, G. (2017). Effect of an Immersive Preoperative Virtual Reality Experience on Patient Reported Outcomes. Annals of Surgery, 265(6), 1068-1073. doi:10.1097/sla.0000000000002094Orlosky, J., Itoh, Y., Ranchet, M., Kiyokawa, K., Morgan, J., & Devos, H. (2017). Emulation of Physician Tasks in Eye-Tracked Virtual Reality for Remote Diagnosis of Neurodegenerative Disease. IEEE Transactions on Visualization and Computer Graphics, 23(4), 1302-1311. doi:10.1109/tvcg.2017.2657018Areces, D., Rodríguez, C., García, T., Cueli, M., & González-Castro, P. (2016). Efficacy of a Continuous Performance Test Based on Virtual Reality in the Diagnosis of ADHD and Its Clinical Presentations. Journal of Attention Disorders, 22(11), 1081-1091. doi:10.1177/1087054716629711Phé, V., Cattarino, S., Parra, J., Bitker, M.-O., Ambrogi, V., Vaessen, C., & Rouprêt, M. (2016). Outcomes of a virtual-reality simulator-training programme on basic surgical skills in robot-assisted laparoscopic surgery. The International Journal of Medical Robotics and Computer Assisted Surgery, 13(2), e1740. doi:10.1002/rcs.1740Pulijala, Y., Ma, M., Pears, M., Peebles, D., & Ayoub, A. (2018). Effectiveness of Immersive Virtual Reality in Surgical Training—A Randomized Control Trial. Journal of Oral and Maxillofacial Surgery, 76(5), 1065-1072. doi:10.1016/j.joms.2017.10.002Jarrold, W., Mundy, P., Gwaltney, M., Bailenson, J., Hatt, N., McIntyre, N., … Swain, L. (2013). Social Attention in a Virtual Public Speaking Task in Higher Functioning Children With Autism. Autism Research, 6(5), 393-410. doi:10.1002/aur.1302Mishkind, M. C., Norr, A. M., Katz, A. C., & Reger, G. M. (2017). Review of Virtual Reality Treatment in Psychiatry: Evidence Versus Current Diffusion and Use. Current Psychiatry Reports, 19(11). doi:10.1007/s11920-017-0836-0Liu, X., Wu, Q., Zhao, W., & Luo, X. (2017). Technology-Facilitated Diagnosis and Treatment of Individuals with Autism Spectrum Disorder: An Engineering Perspective. Applied Sciences, 7(10), 1051. doi:10.3390/app7101051Van Bennekom, M. J., de Koning, P. P., & Denys, D. (2017). Virtual Reality Objectifies the Diagnosis of Psychiatric Disorders: A Literature Review. Frontiers in Psychiatry, 8. doi:10.3389/fpsyt.2017.00163Provoost, S., Lau, H. M., Ruwaard, J., & Riper, H. (2017). Embodied Conversational Agents in Clinical Psychology: A Scoping Review. Journal of Medical Internet Research, 19(5), e151. doi:10.2196/jmir.6553Lau, H. M., Smit, J. H., Fleming, T. M., & Riper, H. (2017). Serious Games for Mental Health: Are They Accessible, Feasible, and Effective? A Systematic Review and Meta-analysis. Frontiers in Psychiatry, 7. doi:10.3389/fpsyt.2016.00209Parsons, S. (2016). Authenticity in Virtual Reality for assessment and intervention in autism: A conceptual review. Educational Research Review, 19, 138-157. doi:10.1016/j.edurev.2016.08.001Den Brok, W. L. J. E., & Sterkenburg, P. S. (2014). Self-controlled technologies to support skill attainment in persons with an autism spectrum disorder and/or an intellectual disability: a systematic literature review. Disability and Rehabilitation: Assistive Technology, 10(1), 1-10. doi:10.3109/17483107.2014.921248Ip, H. H. S., Wong, S. W. L., Chan, D. F. Y., Byrne, J., Li, C., Yuan, V. S. N., … Wong, J. Y. W. (2018). Enhance emotional and social adaptation skills for children with autism spectrum disorder: A virtual reality enabled approach. Computers & Education, 117, 1-15. doi:10.1016/j.compedu.2017.09.010Chen, C.-H., Lee, I.-J., & Lin, L.-Y. (2016). Augmented reality-based video-modeling storybook of nonverbal facial cues for children with autism spectrum disorder to improve their perceptions and judgments of facial expressions and emotions. Computers in Human Behavior, 55, 477-485. doi:10.1016/j.chb.2015.09.033Didehbani, N., Allen, T., Kandalaft, M., Krawczyk, D., & Chapman, S. (2016). Virtual Reality Social Cognition Training for children with high functioning autism. Computers in Human Behavior, 62, 703-711. doi:10.1016/j.chb.2016.04.033Lorenzo, G., Lledó, A., Pomares, J., & Roig, R. (2016). Design and application of an immersive virtual reality system to enhance emotional skills for children with autism spectrum disorders. Computers & Education, 98, 192-205. doi:10.1016/j.compedu.2016.03.018Wade, J., Zhang, L., Bian, D., Fan, J., Swanson, A., Weitlauf, A., … Sarkar, N. (2016). A Gaze-Contingent Adaptive Virtual Reality Driving Environment for Intervention in Individuals with Autism Spectrum Disorders. ACM Transactions on Interactive Intelligent Systems, 6(1), 1-23. doi:10.1145/2892636Ke, F., & Lee, S. (2015). Virtual reality based collaborative design by children with high-functioning autism: design-based flexibility, identity, and norm construction. Interactive Learning Environments, 24(7), 1511-1533. doi:10.1080/10494820.2015.1040421Chen, C.-H., Lee, I.-J., & Lin, L.-Y. (2015). Augmented reality-based self-facial modeling to promote the emotional expression and social skills of adolescents with autism spectrum disorders. Research in Developmental Disabilities, 36, 396-403. doi:10.1016/j.ridd.2014.10.015Cheng, Y., Huang, C.-L., & Yang, C.-S. (2015). Using a 3D Immersive Virtual Environment System to Enhance Social Understanding and Social Skills for Children With Autism Spectrum Disorders. Focus on Autism and Other Developmental Disabilities, 30(4), 222-236. doi:10.1177/1088357615583473Kim, K., Rosenthal, M. Z., Gwaltney, M., Jarrold, W., Hatt, N., McIntyre, N., … Mundy, P. (2014). A Virtual Joy-Stick Study of Emotional Responses and Social Motivation in Children with Autism Spectrum Disorder. Journal of Autism and Developmental Disorders, 45(12), 3891-3899. doi:10.1007/s10803-014-2036-7Parsons, S. (2015). Learning to work together: Designing a multi-user virtual reality game for social collaboration and perspective-taking for children with autism. International Journal of Child-Computer Interaction, 6, 28-38. doi:10.1016/j.ijcci.2015.12.002Bai, Z., Blackwell, A. F., & Coulouris, G. (2015). Using Augmented Reality to Elicit Pretend Play for Children with Autism. IEEE Transactions on Visualization and Computer Graphics, 21(5), 598-610. doi:10.1109/tvcg.2014.2385092Bekele, E., Crittendon, J., Zheng, Z., Swanson, A., Weitlauf, A., Warren, Z., & Sarkar, N. (2014). Assessing the Utility of a Virtual Environment for Enhancing Facial Affect Recognition in Adolescents with Autism. Journal of Autism and Developmental Disorders, 44(7), 1641-1650. doi:10.1007/s10803-014-2035-8Escobedo, L., Tentori, M., Quintana, E., Favela, J., & Garcia-Rosas, D. (2014). Using Augmented Reality to Help Children with Autism Stay Focused. IEEE Pervasive Computing, 13(1), 38-46. doi:10.1109/mprv.2014.19Finkelstein, S., Barnes, T., Wartell, Z., & Suma, E. A. (2013). Evaluation of the exertion and motivation factors of a virtual reality exercise game for children with autism. 2013 1st Workshop on Virtual and Augmented Assistive Technology (VAAT). doi:10.1109/vaat.2013.6786186Maskey, M., Lowry, J., Rodgers, J., McConachie, H., & Parr, J. R. (2014). Reducing Specific Phobia/Fear in Young People with Autism Spectrum Disorders (ASDs) through a Virtual Reality Environment Intervention. PLoS ONE, 9(7), e100374. doi:10.1371/journal.pone.0100374Stichter, J. P., Laffey, J., Galyen, K., & Herzog, M. (2013). iSocial: Delivering the Social Competence Intervention for Adolescents (SCI-A) in a 3D Virtual Learning Environment for Youth with High Functioning Autism. Journal of Autism and Developmental Disorders, 44(2), 417-430. doi:10.1007/s10803-013-1881-0Bekele, E., Zheng, Z., Swanson, A., Crittendon, J., Warren, Z., & Sarkar, N. (2013). Understanding How Adolescents with Autism Respond to Facial Expressions in Virtual Reality Environments. IEEE Transactions on Visualization and Computer Graphics, 19(4), 711-720. doi:10.1109/tvcg.2013.42Cai, Y., Chia, N. K. H., Thalmann, D., Kee, N. K. N., Zheng, J., & Thalmann, N. M. (2013). Design and Development of a Virtual Dolphinarium for Children With Autism. IEEE Transactions on Neural Systems and Rehabilitation Engineering, 21(2), 208-217. doi:10.1109/tnsre.2013.2240700Ke, F., & Im, T. (2013). Virtual-Reality-Based Social Interaction Training for Children with High-Functioning Autism. The Journal of Educational Research, 106(6), 441-461. doi:10.1080/00220671.2013.832999Lorenzo, G., Pomares, J., & Lledó, A. (2013). Inclusion of immersive virtual learning environments and visual control systems to support the learning of students with Asperger syndrome. Computers & Education, 62, 88-101. doi:10.1016/j.compedu.2012.10.028Modugumudi, Y. R., Santhosh, J., & Anand, S. (2013). Efficacy of Collaborative Virtual Environment Intervention Programs in Emotion Expression of Children with Autism. Journal of Medical Imaging and Health Informatics, 3(2), 321-325. doi:10.1166/jmihi.2013.1167Wang, M., & Reid, D. (2013). Using the Virtual Reality-Cognitive Rehabilitation Approach to Improve Contextual Processing in Children with Autism. The Scientific World Journal, 2013, 1-9. doi:10.1155/2013/716890Milne, M., Luerssen, M. H., Lewis, T. W., Leibbrandt, R. E., & Powers, D. M. W. (2010). Development of a virtual agent based social tutor for children with autism spectrum disorders. The 2010 International Joint Conference on Neural Networks (IJCNN). doi:10.1109/ijcnn.2010.5596584Loomes, R., Hull, L., & Mandy, W. P. L. (2017). What Is the Male-to-Female Ratio in Autism Spectrum Disorder? A Systematic Review and Meta-Analysis. Journal of the American Academy of Child & Adolescent Psychiatry, 56(6), 466-474. doi:10.1016/j.jaac.2017.03.013Mesa-Gresa, P., Lozano, J. A., Llórens, R., Alcañiz, M., Navarro, M. D., & Noé, E. (2011). Clinical Validation of a Virtual Environment Test for Safe Street Crossing in the Assessment of Acquired Brain Injury Patients with and without Neglect. Lecture Notes in Computer Science, 44-51. doi:10.1007/978-3-642-23771-3_4Spreij, L. A., Visser-Meily, J. M. A., van Heugten, C. M., & Nijboer, T. C. W. (2014). Novel insights into the rehabilitation of memory post acquired brain injury: a systematic review. Frontiers in Human Neuroscience, 8. doi:10.3389/fnhum.2014.00993Pietrzak, E., Pullman, S., & McGuire, A. (2014). Using Virtual Reality and Videogames for Traumatic Brain Injury Rehabilitation: A Structured Literature Review. Games for Health Journal, 3(4), 202-214. doi:10.1089/g4h.2014.001

Effect of virtual reality rehabilitation on functional outcomes for return-to-work patients with Parkinson's disease: an umbrella review of systematic reviews

BACKGROUND: Parkinson's disease (PD) is a neurodegenerative disease characterized by loss of substantia nigra neurons with deficiency of dopamine. The main symptoms are tremor, rigidity and bradykinesia. Rehabilitation has an important role in the treatment of this condition and virtual reality (VR) is one of the most recent tools. OBJECTIVE: The purpose of this umbrella review is to evaluate the effectiveness of VR systems on gait control for return to work in patients with PD. METHODS: The electronic search, for reviews and meta-analysis studies that investigated the effectiveness of VR on gait control in PD patients, was performed through December 2021 using the following databases: PubMed, Scopus, PEDro, and Google Scholar. Mesh terms used were: Job integration/reintegration OR return-to-work AND Parkinson's disease AND virtual reality OR exergame. No limit on the year of publication of the article was used. CONCLUSIONS: A total of 14 articles were included in our analysis. The included evidence shows a stride length improvement in patients treated with VR compared to conventional active treatments. No difference was found in walking speed. Also, the included articles show an improvement on various measures of balance, motor function and severity of PD motor symptoms. In addition, the literature shows an improvement in the quality of life and neuropsychiatric symptoms in patients undergoing VR rehabilitation training. RESULTS: he results of our study suggest that VR rehabilitation improves gait performance, particularly stride length, thus being able to provide an improvement in the quality of life and a more effective return to work training in patients with PD