Effectiveness, usability, and cost-benefit of a virtual reality-based telerehabilitation program for balance recovery after stroke: a randomized controlled trial - The authors respond

Response to the letter "Effectiveness, Usability, and Cost-Benefit of a Virtual Reality-Based Telerehabilitation Program for Balance Recovery After Stroke: A Randomized Controlled Trial" by Lise Worthen-Chaudhari https://dx.doi.org/10.1016/j.apmr.2015.03.025 a letter on "Effectiveness, usability, and cost-benefit of a virtual reality-based telerehabilitation program for balance recovery after stroke: a randomized controlled trial". Archives of Physical Medicine and Rehabilitation. 96(3):418-425. doi:10.1016/j.apmr.2014.10.019. http://hdl.handle.net/10251/63762Llorens Rodríguez, R.; Noé Sebastián, E.; Colomer, C.; Alcañiz Raya, ML. (2015). Effectiveness, usability, and cost-benefit of a virtual reality-based telerehabilitation program for balance recovery after stroke: a randomized controlled trial - The authors respond. Archives of Physical Medicine and Rehabilitation. 96(8):1544-1547. doi:10.1016/j.apmr.2015.04.006S1544154796

Body schema plasticity after stroke: Subjective and neurophysiological correlates of the rubber hand illusion

[EN] Stroke can lead to motor impairments that can affect the body structure and restraint mobility. We hypothesize that brain lesions and their motor sequelae can distort the body schema, a sensorimotor map of body parts and elements in the peripersonal space through which human beings embody the reachable space and ready the body for forthcoming movements. Two main constructs have been identified in the embodiment mechanism: body-ownership, the sense that the body that one inhabits is his/her own, and agency, the sense that one can move and control his/her body. To test this, the present study simultaneously investigated different embodiment subcomponents (body-ownership, localization, and agency) and different neurophysiological measures (galvanic skin response, skin temperature, and surface electromyographic activity), and the interaction between them, in clinically-controlled hemiparetic individuals with stroke and in healthy subjects after the rubber hand illusion. Individuals with stroke reported significantly stronger body-ownership and agency and reduced increase of galvanic skin response, skin temperature, and muscular activity in the stimulated hand. We suggest that differences in embodiment could have been motivated by increased plasticity of the body schema and pathological predominance of the visual input over proprioception. We also suggest that differences in neurophysiological responses could have been promoted by a suppression of the reflex activity of the sympathetic nervous system and by the involvement of the premotor cortex in the reconfiguration of the body schema. These results could evidence a body schema plasticity promoted by the brain lesion and a main role of the premotor cortex in this mechanism.This work was supported by Ministerio de Economia y Competitividad of Spain (Project NeuroVR, TIN2013-44741-R, Project REACT, TIN2014-61975-EXP, and Grant BES-2014-068218), and by Universitat Politecnica de Valencia (Grant PAID-10-14).Llorens Rodríguez, R.; Borrego, A.; Palomo, P.; Cebolla, A.; Noé-Sebastián, E.; Bermúdez I Badia, S.; Baños Rivera, RM. (2017). Body schema plasticity after stroke: Subjective and neurophysiological correlates of the rubber hand illusion. Neuropsychologia. 96:61-69. https://doi.org/10.1016/j.neuropsychologia.2017.01.00761699

When, How, and to What Extent Are Individuals with Unresponsive Wakefulness Syndrome Able to Progress? Neurobehavioral Progress

[EN] Accurate estimation of the neurobehavioral progress of patients with unresponsive wakefulness syndrome (UWS) is essential to anticipate their most likely clinical course and guide clinical decision making. Although different studies have described this progress and possible predictors of neurobehavioral improvement in these patients, they have methodological limitations that could restrict the validity and generalization of the results. This study investigates the neurobehavioral progress of 100 patients with UWS consecutively admitted to a neurorehabilitation center using systematic weekly assessments based on standardized measures, and the prognostic factors of changes in their neurobehavioral condition. Our results showed that, during the analyzed period, 34% of the patients were able to progress from UWS to minimally conscious state (MCS), 12% of the total sample (near one third from those who progressed to MCS) were able to emerge from MCS, and 10% of the patients died. Transition to MCS was mostly denoted by visual signs, which appeared either alone or in combination with motor signs, and was predicted by etiology and the score on the Coma Recovery Scale-Revised at admission with an accuracy of 75%. Emergence from MCS was denoted in the same proportion by functional communication and object use. Predictive models of emergence from MCS and mortality were not valid and the identified predictors could not be accounted forThis research was funded by the program RISE-Marie-Slodowska-Curie of the European Commission (Grant agreement 778234), by Conselleria de Educacion, Investigacion, Cultura y Deporte of Generalitat Valenciana (SEJI/2019/017), and by Vicerrectorado de Investigacion, Innovacion y transferencia of Universitat Politecnica de Valencia (PAID-06-18)Noé Sebastián, E.; Ferri, J.; Olaya, J.; Navarro, MD.; O'valle, M.; Colomer Font, C.; Moliner, B.... (2021). When, How, and to What Extent Are Individuals with Unresponsive Wakefulness Syndrome Able to Progress? Neurobehavioral Progress. Brain Sciences. 11(1):1-16. https://doi.org/10.3390/brainsci11010126S11611

Combined Transcranial Direct Current Stimulation and Virtual Reality-Based Paradigm for Upper Limb Rehabilitation in Individuals with Restricted Movements. A Feasibility Study with a Chronic Stroke Survivor with Severe Hemiparesis

[EN] Impairments of the upper limb function are a major cause of disability and rehabilitation. Most of the available therapeutic options are based on active exercises and on motor and attentional inclusion of the affected arm in task oriented movements. However, active movements may not be possible after severe impairment of the upper limbs. Different techniques, such as mirror therapy, motor imagery, and non-invasive brain stimulation have been shown to elicit cortical activity in absence of movements, which could be used to preserve the available neural circuits and promote motor learning. We present a virtual reality-based paradigm for upper limb rehabilitation that allows for interaction of individuals with restricted movements from active responses triggered when they attempt to perform a movement. The experimental system also provides multisensory stimulation in the visual, auditory, and tactile channels, and transcranial direct current stimulation coherent to the observed movements. A feasibility study with a chronic stroke survivor with severe hemiparesis who seemed to reach a rehabilitation plateau after two years of its inclusion in a physical therapy program showed clinically meaningful improvement of the upper limb function after the experimental intervention and maintenance of gains in both the body function and activity. The experimental intervention also was reported to be usable and motivating. Although very preliminary, these results could highlight the potential of this intervention to promote functional recovery in severe impairments of the upper limb.This study was funded in part by Ministerio de Economia y Competitividad of Spain (Project TIN2014-61975-EXP and Grant BES-2014-068218) and by Universitat Politecnica de Valencia (Grant PAID-10-14 and Grant PAID-10-16).Fuentes Calderón, MA.; Borrego, A.; Latorre Grau, J.; Colomer Font, C.; Alcañiz Raya, ML.; Sánchez-Ledesma, MJ.; Noé-Sebastián, E.... (2018). Combined Transcranial Direct Current Stimulation and Virtual Reality-Based Paradigm for Upper Limb Rehabilitation in Individuals with Restricted Movements. A Feasibility Study with a Chronic Stroke Survivor with Severe Hemiparesis. Journal of Medical Systems. 42(5):1-9. https://doi.org/10.1007/s10916-018-0949-yS19425Invernizzi, M., Negrini, S., Da, S. C., Lanzotti, L., Cisari, C., and Baricich, A., The value of adding mirror therapy for upper limb motor recovery of subacute stroke patients: A randomized controlled trial. Eur. J. Phys. Rehabil. Med. 49:311–317, 2013.Park, Y., Chang, M., Kim, K.-M., and An, D.-H., The effects of mirror therapy with tasks on upper extremity function and self-care in stroke patients. J. Phys. Ther. Sci. 27:1499–1501, 2015. https://doi.org/10.1589/jpts.27.1499 .Pollock, A., Farmer, S. E., Brady, M. C., Langhorne, P., Mead, G. E., Mehrholz, J., and van Wijck, F., Interventions for improving upper limb function after stroke. Cochrane Database Syst. Rev. 11, 2014. https://doi.org/10.1002/14651858.CD010820.pub2 .Barker, R. N., Gill, T. J., and Brauer, S. G., Factors contributing to upper limb recovery after stroke: A survey of stroke survivors in Queensland Australia. Disabil. Rehabil. 29:981–989, 2007. https://doi.org/10.1080/09638280500243570 .Bayona, N. A., Bitensky, J., Salter, K., and Teasell, R., The role of task-specific training in rehabilitation therapies. Top. Stroke Rehabil. 12:58–65, 2005. https://doi.org/10.1310/BQM5-6YGB-MVJ5-WVCR .Coupar, F., Pollock, A., Rowe, P., Weir, C., and Langhorne, P., Predictors of upper limb recovery after stroke: a systematic review and meta-analysis. Clin. Rehabil. 26:291–313, 2012. https://doi.org/10.1177/0269215511420305 .Hunter, S. M., Crome, P., Sim, J., and Pomeroy, V. M., Effects of Mobilization and Tactile Stimulation on Recovery of the Hemiplegic Upper Limb: A Series of Replicated Single-System Studies. Arch. Phys. Med. Rehabil. 89:2003–2010, 2008. https://doi.org/10.1016/j.apmr.2008.03.016 .Colomer, C., Noé, E., and Llorens, R., Mirror therapy in chronic stroke survivors with severely impaired upper limb function: A randomized controlled trial. Eur. J. Phys. Rehabil. Med. 52:271–278, 2016.Lum, P. S., Mulroy, S., Amdur, R. L., Requejo, P., Prilutsky, B. I., and Dromerick, A. W., Gains in upper extremity function after stroke via recovery or compensation: Potential differential effects on amount of real-world limb use. Top. Stroke Rehabil. 16:237–253, 2009. https://doi.org/10.1310/tsr1604-237 .Taub, E., Uswatte, G., Mark, V. W., and Morris, D. M. M., The learned nonuse phenomenon: implications for rehabilitation. Eura. Medicophys. 42:241–256, 2006.Deconinck, F. J. A., Smorenburg, A. R. P., Benham, A., Ledebt, A., Feltham, M. G., and Savelsbergh, G. J. P., Reflections on Mirror Therapy: A Systematic Review of the Effect of Mirror Visual Feedback on the Brain. Neurorehabil. Neural Repair. 29:349–361, 2014. https://doi.org/10.1177/1545968314546134 .Lindberg, P. G., Schmitz, C., Engardt, M., Forssberg, H., and Borg, J., Use-dependent up- and down-regulation of sensorimotor brain circuits in stroke patients. Neurorehabil. Neural Repair. 21:315–326, 2007. https://doi.org/10.1177/1545968306296965 .Thieme, H., Bayn, M., Wurg, M., Zange, C., Pohl, M., and Behrens, J., Mirror therapy for patients with severe arm paresis after stroke--a randomized controlled trial. Clin. Rehabil. 27:314–324, 2013. https://doi.org/10.1177/0269215512455651 .Dettmers, C., Benz, M., Liepert, J., and Rockstroh, B., Motor imagery in stroke patients, or plegic patients with spinal cord or peripheral diseases. Acta Neurol. Scand. 126:238–247, 2012. https://doi.org/10.1111/j.1600-0404.2012.01680.x .Kimberley, T. J., Khandekar, G., Skraba, L. L., Spencer, J. A., Van Gorp, E. A., and Walker, S. R., Neural substrates for motor imagery in severe hemiparesis. Neurorehabil. Neural Repair. 20:268–277, 2006. https://doi.org/10.1177/1545968306286958 .Pascual-Leone, A., The neuronal correlates of mirror therapy: an fMRI study on mirror induced visual illusions in patients with stroke. J. Neurol. Neurosurg. Psychiatry. 82:393–398, 2011. https://doi.org/10.1136/jnnp.2009.194134 .Gatti, R., Rocca, M. A., Fumagalli, S., Cattrysse, E., Kerckhofs, E., Falini, A., and Filippi, M., The effect of action observation/execution on mirror neuron system recruitment: an fMRI study in healthy individuals. Brain Imaging Behav. 11:565–576, 2017. https://doi.org/10.1007/s11682-016-9536-3 .Bonato, C., Miniussi, C., and Rossini, P. M., Transcranial magnetic stimulation and cortical evoked potentials: A TMS/EEG co-registration study. Clin. Neurophysiol. 117:1699–1707, 2006. https://doi.org/10.1016/j.clinph.2006.05.006 .Grundmann, L., Rolke, R., Nitsche, M. A., Pavlakovic, G., Happe, S., Treede, R. D., Paulus, W., and Bachmann, C. G., Effects of transcranial direct current stimulation of the primary sensory cortex on somatosensory perception. Brain Stimul. 4:253–260, 2011. https://doi.org/10.1016/j.brs.2010.12.002 .von Rein, E., Hoff, M., Kaminski, E., Sehm, B., Steele, C. J., Villringer, A., and Ragert, P., Improving motor performance without training: the effect of combining mirror visual feedback with transcranial direct current stimulation. J. Neurophysiol. 113:2383–2389, 2015. https://doi.org/10.1152/jn.00832.2014 .Kim, Y. J., Ku, J., Cho, S., Kim, H. J., Cho, Y. K., Lim, T., and Kang, Y. J., Facilitation of corticospinal excitability by virtual reality exercise following anodal transcranial direct current stimulation in healthy volunteers and subacute stroke subjects. J. Neuroeng. Rehabil. 11:124, 2014. https://doi.org/10.1186/1743-0003-11-124 .S. Bermúdez i Badia, G.G. Fluet, R. Llorens, J.E. Deutsch, Virtual Reality for Sensorimotor Rehabilitation Post Stroke: Design Principles and Evidence. In: Neurorehabilitation Technol., Second edi, Springer, 2016: pp. 573–603. https://doi.org/10.1007/978-3-319-28603-7_28 .Im, H., Ku, J., Kim, H. J., and Kang, Y. J., Virtual reality-guided motor imagery increases corticomotor excitability in healthy volunteers and stroke patients. Ann. Rehabil. Med. 40:420–431, 2016. https://doi.org/10.5535/arm.2016.40.3.420 .Colomer, C., Llorens, R., Noé, E., and Alcañiz, M., Effect of a mixed reality-based intervention on arm, hand, and finger function on chronic stroke. J. Neuroeng. Rehabil. 13, 2016. https://doi.org/10.1186/s12984-016-0153-6 .Grimm, F., Naros, G., and Gharabaghi, A., Closed-Loop Task Difficulty Adaptation during Virtual Reality Reach-to-Grasp Training Assisted with an Exoskeleton for Stroke Rehabilitation. Front. Neurosci. 10:518, 2016. https://doi.org/10.3389/fnins.2016.00518 .Poole, A., and Ball, L. J., Eye Tracking in Human-Computer Interaction and Usability Research: Current Status and Future Prospects. Encycl. Human-Computer Interact.:211–219, 2005. https://doi.org/10.4018/978-1-59140-562-7 .R. Merletti, A. Botter, A. Troiano, E. Merlo, M.A. Minetto, Technology and instrumentation for detection and conditioning of the surface electromyographic signal: State of the art, Clin. Biomech. 24 (2009) 122–134. https://doi.org/10.1016/j.clinbiomech.2008.08.006 .Trojano, L., Moretta, P., Loreto, V., Cozzolino, A., Santoro, L., and Estraneo, A., Quantitative assessment of visual behavior in disorders of consciousness. J. Neurol. 259:1888–1895, 2012. https://doi.org/10.1007/s00415-012-6435-4 .Trojano, L., Moretta, P., Loreto, V., Santoro, L., and Estraneo, A., Affective saliency modifies visual tracking behavior in disorders of consciousness: A quantitative analysis. J. Neurol. 260:306–308, 2013. https://doi.org/10.1007/s00415-012-6717-x .Sanford, J., Moreland, J., Swanson, L. R., Stratford, P. W., and Gowland, C., Reliability of the Fugl-Meyer assessment for testing motor performance in patients following stroke. Phys. Ther. 73:447–454, 1993. https://doi.org/10.1177/1545968304269210 .Lang, C. E., Edwards, D. F., Birkenmeier, R. L., and Dromerick, A. W., Estimating Minimal Clinically Important Differences of Upper-Extremity Measures Early After Stroke. Arch. Phys. Med. Rehabil. 89:1693–1700, 2008. https://doi.org/10.1016/j.apmr.2008.02.022 .Brooke, J., SUS - A quick and dirty usability scale. Usability Eval. Ind. 189:4–7, 1996. https://doi.org/10.1002/hbm.20701 .McAuley, E., Duncan, T., and Tammen, V. V., Psychometric Properties of the Intrinsic Motivation Inventory in a Competitive Sport Setting: A Confirmatory Factor Analysis. Res. Q. Exerc. Sport. 60:48–58, 1989. https://doi.org/10.1080/02701367.1989.10607413 .Page, S. J., Fulk, G. D., and Boyne, P., Clinically important differences for the upper-extremity Fugl-Meyer Scale in people with minimal to moderate impairment due to chronic stroke. Phys. Ther. 92:791–798, 2012. https://doi.org/10.2522/ptj.20110009 .R. Teasell, Evidence-Based Review of Stroke Rehabilitation - Background Concepts in Stroke Rehabilitation, 2016. http://www.ebrsr.com/evidence-review/3-background-concepts-stroke-rehabilitation .Cameirão, M. S., Badia, S. B. I., Duarte, E., Frisoli, A., and Verschure, P. F. M. J., The combined impact of virtual reality neurorehabilitation and its interfaces on upper extremity functional recovery in patients with chronic stroke. Stroke. 43:2720–2728, 2012. https://doi.org/10.1161/STROKEAHA.112.653196 .K.E. Laver, S. George, S. Thomas, J.E. Deutsch, M. Crotty, Virtual reality for stroke rehabilitation. In: Cochrane Database Syst. Rev., 2015: pp. 1–107. https://doi.org/10.1002/14651858.CD008349.pub3 .Lefebvre, S., Laloux, P., Peeters, A., Desfontaines, P., Jamart, J., and Vandermeeren, Y., Dual-tDCS Enhances Online Motor Skill Learning and Long-Term Retention in Chronic Stroke Patients. Front. Hum. Neurosci. 6:343, 2012. https://doi.org/10.3389/fnhum.2012.00343 .Lindenberg, R., Renga, V., Zhu, L. L., Nair, D., and Schlaug, G., Bihemispheric brain stimulation facilitates motor recovery in chronic stroke patients. Neurology. 75:2176–2184, 2010. https://doi.org/10.1212/WNL.0b013e318202013a .K. Figlewski, J.U. Blicher, J. Mortensen, K.E. Severinsen, J.F. Nielsen, H. Andersen, Transcranial Direct Current Stimulation Potentiates Improvements in Functional Ability in Patients With Chronic Stroke Receiving Constraint-Induced Movement Therapy, Stroke. (2016). http://stroke.ahajournals.org/content/early/2016/11/29/STROKEAHA.116.014988.abstract .Lee, S. J., and Chun, M. H., Combination transcranial direct current stimulation and virtual reality therapy for upper extremity training in patients with subacute stroke. Arch. Phys. Med. Rehabil. 95:431–438, 2014. https://doi.org/10.1016/j.apmr.2013.10.027 .Viana, R. T., Laurentino, G. E. C., Souza, R. J. P., Fonseca, J. B., Silva Filho, E. 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Current validity of diagnosis of permanent vegetative state: a longitudinal study in a sample of patients with altered states of consciousness

[EN] Introduction Altered states of consciousness have traditionally been associated with poor prognosis. At present, clinical differences between these entities are beginning to be established. Method Our study included 37 patients diagnosed with vegetative state/unresponsive wakefulness syndrome (UWS) and 43 in a minimally conscious state (MCS) according to the Coma Recovery Scale¿Revised (CRS-R). All patients were followed up each month for at least 6 months using the CRS-R. We recorded the time points when vegetative state progressed from `persistent¿ to `permanent¿ based on the cut-off points established by the Multi-Society-Task-Force: 12 months in patients with traumatic injury and 3 months in those with non-traumatic injury. A logistic regression model was used to determine the factors potentially predicting which patients will emerge from MCS. Results In the UWS group, 23 patients emerged from UWS but only 9 emerged from MCS. Of the 43 patients in the MCS group, 26 patients emerged from that state during follow-up. Eight of the 23 patients (34.7%) who emerged from UWS and 17 of the 35 (48.6%) who emerged from MCS recovered after the time points proposed by the Multi-Society-Task-Force. According to the multivariate regression analysis, aetiology (P < .01), chronicity (P = .01), and CRS-R scores at admission (P < .001) correctly predicted emergence from MCS in 77.5% of the cases. Conclusions UWS and MCS are different clinical entities in terms of diagnosis and outcomes. Some of the factors traditionally associated with poor prognosis, such as time from injury and likelihood of recovery, should be revaluated.[ES] Introducción Los estados alterados de conciencia han sido considerados tradicionalmente como cuadros clínicos de pronóstico infausto. En la actualidad, sabemos que dichos estados engloban distintas entidades clínicas cuyo perfil diferencial empieza a reconocerse. Método Se incluyeron 37 pacientes con el diagnóstico de estado vegetativo o síndrome de vigilia sin respuesta (SVSR) y 43 en estado de mínima conciencia (EMC) de acuerdo con la Coma Recovery Scale-Revised (CRS-R). Todos los pacientes fueron evaluados mensualmente con la CRS-R durante al menos 6 meses. Se evaluó el momento de superar cada estado considerando los puntos de corte de «irreversibilidad» (12 meses para los casos de origen traumático y 3 para los no traumáticos), tradicionalmente establecidos por la Multi-Society-Task-Force. Se empleó un modelo de regresión logística para determinar las variables predictoras de superar el EMC. Resultados Un total de 23 pacientes en SVSR superaron este estado, pero solo 9 superaron el EMC. De los 43 pacientes en EMC al ingreso, 26 lograron superarlo. Ocho de los 23 (34,7%) pacientes que superaron el SVSR y 17 de los 35 (48,6%) que superaron el EMC lo hicieron más allá del punto de «irreversibilidad». La etiología (p < 0,01), la cronicidad (p = 0,01) y la puntuación en la CRS-R (p < 0,001) predijeron la salida de EMC en el modelo multivariante con un 77,5% de acierto. Conclusiones Tanto el SVRS como el EMC son entidades clínicamente diferenciadas en términos diagnósticos y pronósticos. Algunos criterios clásicos relacionados con el mal pronóstico de estos estados en términos de tiempo y posibilidades de recuperación deben ser reevaluados.Noé -Sebastián, E.; Olaya, J.; Colomer Font, C.; Moliner, B.; Ugart, P.; Llorens Rodríguez, R.; Rodríguez -Sánchez-Leiva, C.... (2019). Validez actual del diagnóstico de estado vegetativo permanente : estudio longitudinal en una muestra clínica de pacientes en estado alterado de conciencia. Neurología. 34(9):589-595. https://doi.org/10.1016/j.nrl.2017.04.004S58959534

Determining cut-off points in functional assessment scales in stroke

[EN] BACKGROUND: A wide variety of well-validated assessment scales of functioning and disability have been developed for stroke population. However, these instruments have limitations in their interpretation. Therefore, determining cut-off points for their categorization becomes necessary. OBJECTIVES: To determine cut-off points for the BI, FIM and FAM scales to differentiate clinical disability categories and to establish the relationship between mRS and DOS scales. METHODS: One hundred and six adults with ischemic or haemorrhagic stroke were mainly recruited from a rehabilitation facility (Hospitales Nisa, Valencia, Spain). RESULTS: A high correlation was observed between the DOS and mRS scales (Kendall's tau-b = 0.475; p = 0.000) although a certain amount of disagreement between the two scales was detected. The cut-off points were 62.90 (95% CI, 57.26-69.29) and 21.30 (95% CI, 16.34-26.03) for the BI; 70.62 (95% CI, 66.65-75.22) and 38.29 (95% CI, 34.07-42.25) for the FIM; and 116.07 (95% CI, 110.30-122.68) and 66.02 (95% CI, 59.20-72.35) for the FAM. CONCLUSION(S): DOS was observed to be more demanding than the mRS, in terms of patient independence. Additionally, the lower cut-off points separating the levels of severe and moderate disability in the BI, FIM and FAM were determined. These findings would facilitate practitioners clinical interpretation of disability levels in post-stroke patients.Balasch I Bernat, M.; Balasch Parisi, S.; Noe Sebastian, E.; Dueñas Moscardo, L.; Ferri Campos, J.; Lopez Bueno, L. (2015). Determining cut-off points in functional assessment scales in stroke. NeuroRehabilitation. 37(2):165-172. doi:10.3233/NRE-151249S16517237

Behavioral and neurophysiological changes after an attentional virtual rehabilitation program in stroke patients

Galvao Carmona, A.; Vázquez Marrufo, M.; Llorens Rodríguez, R.; Noé Sebastián, E. (2016). Behavioral and neurophysiological changes after an attentional virtual rehabilitation program in stroke patients. Revista de Neurologia. 62((Congreso 1)):80-80. http://hdl.handle.net/10251/81840S808062(Congreso 1

BioTrak virtual reality system: effectiveness and satisfaction analysis for balance rehabilitation in patients with brain injury

[EN] Objective: To study effectiveness of and satisfaction with a virtual reality-based balance rehabilitation system (BioTrak) for patients with acquired brain injury (ABI). Material and methods: Ten patients with chronic hemiparesis (chronicity > 6 months) following an ABI completed a 20-session programme using the balance reaching-task module of the BioTrak system. All patients were assessed at baseline, at the end of treatment and one month later with the Berg Balance Scale (BBS), the Tinetti Performance-Oriented Mobility Assessment (POMA), and the computerised posturography tool NedSVE/IBV. The posturography study included analysis of sensory indexes, limits of stability and rhythmic weight shift. The usability study was conducted using an ad hoc questionnaire. Results: Repeated measures ANOVA showed a significant improvement in BBS (P < .01), TBS (P < .01), vestibular index (P < .05), and anterior-posterior weight shift (P < .05); a trend in the same direction was also found for medial lateral weight shift (P = .059). The post-hoc analysis revealed significant improvement between the initial and final assessments for BBS, POMA and anterior-posterior weight shift control; gains remained a month after completing the programme. The system showed a high degree of usability in terms of presence, immersion and user-friendliness, and there was a significant absence of adverse effects. Conclusion: Our results confirm the utility of virtual reality systems for balance rehabilitation in this population. Usability data suggest that BioTrak could be adapted for use in multiple rehabilitation settings by a high number of patients. © 2011 Sociedad Española de NeurologíaEste estudio fue financiado por el Centro para el Desarrollo Tecnológico Industrial (proyecto TEREHA, IDI-20110844) y parcialmente financiado por el Ministerio de Educación y Ciencia de Espana, ˜ proyecto Game Teen (TIN2010-20187), proyectos Consolider-C (SEJ2006-14301/PSIC), «CIBER de Fisiopatología de la Obesidad y Nutrición, una iniciativa del ISCIII», el Programa de Excelencia PROMETEO (Generalitat Valenciana, Consellería de Educación, 2008-157).Llorens Rodríguez, R.; Colomer Font, C.; Alcañiz Raya, ML.; Noé Sebastián, E. (2013). BioTrak: análisis de efectividad y satisfacción de un sistema de realidad virtual para la rehabilitación del equilibrio en pacientes con daño cerebral. Neurología. 28(5):1-8. doi:10.1016/j.nrl.2012.04.016S1828

Study of the recovery patterns of elderly subacute stroke patients in an interdisciplinary neurorehabilitation unit

Copyright © 2015 National Stroke Association. Published by Elsevier Inc. All rights reserved.[EN] Background: This study seeks to establish the facts of the improvement over time in elderly poststroke patients. Methods: A retrospective study was performed with regard to 106 subacute stroke patients aged older than 65 years, who were treated in an interdisciplinary neurorehabilitation unit. Three assessment points were established (on admission, 6 months post-onset, and 12 months post-onset), with the scores relative to 10 assessment scales having been collected at each point. Results: By means of a principal component analysis, a first component was obtained, which is taken to represent a combined index of the 10 scales and to express the overall health status of the patient. An analysis of variance of this first component enabled a clear improvement trend to be identified, with this being more marked during the first 6-month period (72.7%) than the second 6-month period (27.3%). Conclusions: The elderly stroke patients underwent an interdisciplinary rehabilitation program lasting 1 year, experimented an initial period of rapid recovery during the first 6 months followed by a less marked period of improvement. However, no stabilization period in the patients' progress was found.Balasch I Bernat, M.; Balasch Parisi, S.; Noé Sebastián, E.; Dueñas Moscardo, L.; Ferri Campos, J.; Lopez Bueno, L. (2015). Study of the recovery patterns of elderly subacute stroke patients in an interdisciplinary neurorehabilitation unit. Journal of Stroke and Cerebrovascular Diseases. 24(10):2213-2218. doi:10.1016/j.jstrokecerebrovasdis.2015.05.014S22132218241