Effectiveness of Virtual Reality on Functional Performance after Spinal Cord Injury: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

A spinal cord injury (SCI) usually results in a significant limitation in the functional outcomes, implying a challenge to the performance of activities of daily living. The main aim of this study is to analyze the effectiveness of virtual reality to improve functional performance in patients with SCI. The search was performed between October and December 2019 in Cumulative Index to Nursing and Allied Health Literature (CINAHL), Medline, Cochrane Central Register of Controlled Trials, Physiotherapy Evidence Database (PEDro), PubMed, Scopus, Web of Science, and Embase. The methodological quality of the studies was evaluated through the PEDro scale, and the risk of bias was evaluated with the Cochrane collaboration's tool. Seven articles were included in this systematic review, and five of them in the meta-analysis. Statistical analysis showed favorable results for functional performance in control group performing conventional therapy, measured by the functional independence measure (standardized mean difference (SMD)= -0.70; 95% confidence interval: -1.25 to -0.15). Results were inconclusive for other outcomes. Most studies have not shown beneficial effects on functional performance compared with conventional physical therapy. The results obtained showed that virtual reality may not be more effective than conventional physical therapy in improving functional performance in patients with SCI

A Therapeutic Approach Using the Combined Application of Virtual Reality with Robotics for the Treatment of Patients with Spinal Cord Injury: A Systematic Review

Spinal cord injury (SCI) has been associated with high mortality rates. Thanks to the multidisciplinary vision and approach of SCI, including the application of new technologies in the field of neurorehabilitation, people with SCI can survive and prosper after injury. The main aim of this systematic review was to analyze the effectiveness of the combined use of VR and robotics in the treatment of patients with SCI. The literature search was performed between May and July 2021 in the Cochrane Central Register of Controlled Trials, Physiotherapy Evidence Database (PEDro), PubMed, and Web of Science. The methodological quality of each study was assessed using the SCIRE system and the PEDro scale, whereas the risk of bias was analyzed using the Cochrane Collaboration’s tool. A total of six studies, involving 63 participants, were included in this systematic review. Relevant changes were found in the upper limbs, with improvements of shoulder and upper arm mobility, as well as the strengthening of weaker muscles. Combined rehabilitation may be a valuable approach to improve motor function in SCI patients. Nonetheless, further research is necessary, with a larger patient sample and a longer duration

Virtual Reality Systems for Upper Limb Motor Function Recovery in Patients With Spinal Cord Injury: Systematic Review and Meta-Analysis

Background: Patients with spinal cord injury (SCI) usually present with different motor impairments, including a deterioration of upper limb motor function (ULMF), that limit their performance of activities of daily living and reduce their quality of life. Virtual reality (VR) is being used in neurological rehabilitation for the assessment and treatment of the physical impairments of this condition. Objective: A systematic review and meta-analysis was conducted to evaluate the effectiveness of VR on ULMF in patients with SCI compared with conventional physical therapy. Methods: The search was performed from October to December 2019 in Embase, Web of Science, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Scopus, Medline, Physiotherapy Evidence Database (PEDro), PubMed, and Cochrane Central Register of Controlled Trials. The inclusion criteria of selected studies were as follows: (1) comprised adults with SCI, (2) included an intervention with VR, (3) compared VR intervention with conventional physical therapy, (4) reported outcomes related to ULMF, and (5) was a controlled clinical trial. The Cochrane Collaboration's tool was used to evaluate the risk of bias. The RevMan 5.3 statistical software was used to obtain the meta-analysis according to the standardized mean difference (SMD) and 95% CIs. Results: Six articles were included in this systematic review. Four of them contributed information to the meta-analysis. A total of 105 subjects were analyzed. All of the studies used semi-immersive or nonimmersive VR systems. The statistical analysis showed nonsignificant results for the Nine-Hole Peg Test (SMD -0.93, 95% CI -1.95 to 0.09), muscle balance test (SMD -0.27, 95% CI -0.82 to 0.27), Motricity Index (SMD 0.16, 95% CI -0.37 to 0.68), Jebsen-Taylor Hand Function Test (JTHFT) subtests (writing, SMD -0.10, 95% CI -4.01 to 3.82; simulated page turning, SMD -0.99, 95% CI -2.01 to 0.02; simulated feeding, SMD -0.64, 95% CI -1.61 to 0.32; stacking checkers, SMD 0.99, 95% CI -0.02 to 2.00; picking up large light objects, SMD -0.42, 95% CI -1.37 to 0.54; and picking up large heavy objects, SMD 0.52, 95% CI -0.44 to 1.49), range of motion of shoulder abduction/adduction (SMD -0.23, 95% CI -1.48 to 1.03), shoulder flexion/extension (SMD 0.56, 95% CI -1.24 to 2.36), elbow flexion (SMD -0.36, 95% CI -1.14 to 0.42), elbow extension (SMD -0.21, 95% CI -0.99 to 0.57), wrist extension (SMD 1.44, 95% CI -2.19 to 5.06), and elbow supination (SMD -0.18, 95% CI -1.80 to 1.44). Favorable results were found for the JTHFT subtest picking up small common objects (SMD -1.33, 95% CI -2.42 to -0.24). Conclusions: The current evidence for VR interventions to improve ULMF in patients with SCI is limited. Future studies employing immersive systems to identify the key aspects that increase the clinical impact of VR interventions are needed, as well as research to prove the benefits of the use of VR in the rehabilitation of patients with SCI in the clinical setting

Is Virtual Reality Effective for Balance Recovery in Patients with Spinal Cord Injury? A Systematic Review and Meta-Analysis

Virtual reality (VR) is an emerging tool used in the neurological rehabilitation of patients with spinal cord injury (SCI), focused on recovering balance, mobility, and motor function, among other functional outcomes. The main objective of this study was to analyze the effectiveness of VR systems to recover balance in patients with SCI. The literature search was performed between October and December 2019 in the following databases: Embase, Web of Science, CINAHL, Scopus, Medline, Physiotherapy Evidence Database (PEDro), PubMed, and the Cochrane Central Register of Controlled Trials. The methodological quality of each study was assessed using the Spinal Cord Injury Rehabilitation Evidence (SCIRE) system and the PEDro scale, while the risk of bias was analyzed by the Cochrane Collaboration's tool. A total of 12 studies, involving 188 participants, were included in the systematic review, of which two were included in the meta-analysis. Statistical analysis showed favorable results for balance measured by the modified Functional Reach Test (standardized mean difference (SMD) = 3.42; 95% confidence interval: 2.54 to 4.29) and by the t-shirt test (SMD= -2.29; 95% confidence interval: -3.00 to -1.59). The results showed that VR interventions provided potential benefits, in addition to conventional physical therapy, to recover balance in patients with SCI

Quality of Life: Changes in Self-Perception in People with Down Syndrome as a Result of Being Part of a Football/Soccer Team. Self-Reports and External Reports

The hypothesis posed was whether being part of a football/soccer team influenced the quality of life (QL) of the people who participated in it since their perception of themselves is enhanced by factors, such as self-determination, social inclusion, emotional well-being, physical well-being, material well-being, rights, personal development, and internal relationships. The objective was to evaluate the QL of people with Down Syndrome (DS) using their self-perception (n = 39) and the perception of the informants (family members, teachers) (n = 39). The KidsLife-Down Scale, with a few modifications, was used. In general, differences of opinion between the subgroups of participants with DS and informants showed that results were higher in terms of perception for participants in the DS subgroup. Scores for all variables were higher for those participants with DS who said they did engage in practicing competitive football/soccer. Although the perception of informants provides a great deal of information regarding the QL of participants with DS, participants with DS should also be involved in the evaluation process and their self-perceptions taken into account. It is not participating in a football team that causes the conclusions of the study, but training (which includes the friendly matches that are played), the cause correlated with the improvements detected in the athlete’s DS

Asymmetries of the Muscle Mechanical Properties of the Pelvic Floor in Nulliparous and Multiparous Women, and Men: A Cross-Sectional Study

This study aimed to identify if the muscle mechanical properties (MMPs) of both sides of pelvic floor muscles (PFMs) are symmetrical in different populations of both sexes. Between-sides comparisons of MMPs of PFMs, assessed with manual myotonometry, were performed in three groups, with 31 subjects each, composed of healthy nulliparous women (without any type of delivery or pregnancy), multiparous women (with at least two vaginal deliveries), and healthy adult men. Intra-group correlations between MMPs and age, body mass index (BMI), or clinical state of pelvic floor were also obtained. The nulliparous women and the men showed no between-sides differences in any MMP of PFMs. However, the multiparous women showed that the right side displayed less frequency (−0.65 Hz, 95% CI = −1.01, −0.20) and decrement (0.5, 95% CI = 0.11, 0.01), and more relaxation (1.00 ms, 95% CI = 0.47, 1.54) and creep (0.07 De, 95% CI = 0.03, 0.11), than the left side. Further, MMPs were related to age, sex, and BMI, also depending on the population, with the multiparous women being the only group with some between-sides asymmetries, which in this case were positive and of fair intensity for the left side of the PFMs, between BMI, and frequency and stiffness (rho Spearman coefficient: 0.365 and 0.366, respectively). The symmetry of MMPs of the PFMs could depend on the subject’s condition. Multiparous women show a higher tendency to asymmetries than nulliparous women and men, which should be considered in research and clinical settings

Effectiveness of virtual reality and video game interventions in patients with spinal cord injury: systematic review and meta-analysis

Introducción. La lesión de la médula espinal (LM) es una afección neurológica común que genera limitaciones funcionales en los sistemas sensoriales y motores. Aproximadamente el 55% de las personas que viven con una lesión medular (LM) tienen lesiones que afectan solo a una parte de la médula espinal. La recuperación funcional puede tomar años y varía significativamente dependiendo de la zona lesionada. Después de una lesión, la interrupción de los haces de fibras nerviosas puede causar una comunicación neuronal fragmentada o distorsionada dando lugar a complicaciones como debilidad muscular, alteraciones en la calidad del movimiento, dolor y cambios en el tono muscular. Entre los diversos enfoques de tratamiento neurorrehabilitador, el empleo de los sistemas de realidad virtual (RV) y los videojuegos es una apuesta novedosa. En la actualidad, esta tecnología se aplica cada vez más en patologías de origen neurológico (ictus, enfermad de Parkinson, LM, parálisis cerebral infantil, entre otras), ya sea como método de valoración o como intervención, obteniendo mejoras funcionales, debidas principalmente al factor motivador y lúdico de este tratamiento. La necesidad de combinar datos de experiencias científicas similares para obtener conclusiones aplicables a la población ha llevado a utilizar la herramienta del meta-análisis (MA) en diversos campos de la ciencia. Esta metodología se revela como la más útil, generando la mayor evidencia científica, por encima de la revisión sistemática (RS). Objetivos. El objetivo general fue, evaluar la efectividad del uso de la RV y/o videojuegos como terapia para la mejora funcional y motora en sujetos con LM, mediante RS y MA. Como objetivos específicos, valorar dicha efectividad sobre la capacidad funcional, el equilibrio y la función motora de miembros superiores en sujetos con LM. Metodología. La presente revisión ha sido elaborada siguiendo las directrices marcadas por PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) para RS y MA. Se registró en el repositorio de revisiones sistemáticas PROSPERO (CRD 42018093855). La búsqueda se realizó de octubre a diciembre de 2019, incluyendo los artículos publicados desde el inicio de cada base de datos hasta diciembre de 2019 en: CINAHL, Medline, CENTRAL, PEDro, PubMed, Scopus, Web of Science, y Embase, mediante la combinación de los siguientes descriptores y operadores booleanos: (“spinal cord injury” OR “spinal cord injuries” OR “paraplegia” OR “quadriplegia” OR “tetraplegia”) AND (“virtual reality” OR “virtual reality exposure therapy” OR “virtual systems” OR “augmented reality” OR “videogame” OR “video games” OR “exergames” OR “exergaming” OR “play-based therapy” OR “commercial games”). En el caso de PubMed, las búsquedas se realizaron a través de los descriptores MeSH. La calidad metodológica de los estudios se evaluó mediante la escala PEDro, y el riesgo de sesgo con la herramienta de la Colaboración Cochrane. Se utilizó el software estadístico RevMan 5.3 para obtener el MA según la diferencia de medias estandarizada (DME) e Intervalo de confianza del 95% (IC95%). Resultados. Los resultados obtenidos se han informado como tres artículos originales, publicados en revistas de alto impacto científico (1º Cuartil) dentro de su área temática. Al evaluar la efectividad de la terapia basada en RV y/o videojuegos sobre la capacidad funcional en sujetos con LM, se incluyeron siete artículos (150 participantes) para el análisis cualitativo (RS), y cinco de ellos para el cuantitativo (MA). El análisis estadístico mostró resultados favorables para el rendimiento funcional en el grupo de control que realiza la terapia convencional, proporcionado por la medida de independencia funcional (DME) = −0,70; Intervalo de confianza del 95% (IC95%): −1,25 a −0,15). Los resultados no fueron conclusivos para el resto de las variables y la mayoría de los estudios no mostraron efectos beneficiosos de la terapia mediante RV y/o videojuegos frente a la fisioterapia convencional. Al valorar la efectividad de los sistemas de RV y/o videojuegos para recuperar el equilibrio en los pacientes con LM, se incluyeron un total de 12 estudios, con 188 participantes, en la RS, de los cuales, dos se incluyeron en el MA. El análisis estadístico mostró resultados favorables para el equilibrio, medido por la prueba de alcance funcional modificada (DME = 3,42; IC95%: 2,54 a 4,29) y por la prueba de la camiseta (DME = −2,29; IC95%: −3,00 a −1,59). Para verificar la eficacia de las intervenciones de RV y/o videojuegos en la recuperación del miembro superior, Se incluyeron seis artículos en esta RS. Cuatro de ellos contribuyeron con información al MA. Se analizaron un total de 105 sujetos. El análisis estadístico mostró resultados no significativos para la prueba de Nine-Hole Peg (DME: – 0,93; IC95%: –1,95 a 0,09); la prueba de equilibrio muscular (DME: –0,27, IC95%: –0,82 a 0,27); el Índice Motor (DME: 0,16, IC95%: -0,37 a 0,68); subpruebas de la Prueba de Función Manual de Jebsen-Taylor: escritura (DME: -0,10; IC95%: -4,01 a 3,82), paso de páginas (DME: 0,99; IC95%: -2,01 a 0,02), llevar alimentos a la boca (DMS: –0,64, IC95%: –1,61 a 0,32), apilamiento de fichas (DME: 0,99, IC95%: –0,02 a 2,00), levantando objetos grandes y ligeros (DME: –0,42, IC95%: –1,37 a 0,54) y recogiendo objetos grandes y pesados (DME: 0,52, IC95%: –0,44 a 1,49); rango de movimiento del hombro abducción/aducción (DME: –0,23; IC95%: –1,48 a 1,03), flexión/extensión del hombro (DME: 0,56; IC95%: –1,24 a 2,36), flexión del codo (DME: –0,36; IC95%: –1,14 a 0,42), extensión del codo (DME: –0,21; IC95%: –0,99 a 0,57), extensión de la muñeca (DME: 1,44; IC95%: –2,19 a 5,06) y supinación del codo (DME: –0,18; IC95%: –1,80 a 1,44). Se encontraron resultados favorables en la subprueba de recogida de pequeños objetos comunes, de la Prueba de Función Manual de Jebsen-Taylor (DME: –1,33; IC95%: –2,42 a –0,24). Conclusiones. Tras la valoración de los resultados obtenidos, se puede concluir que, la evidencia científica sobre el uso de la RV y/o videojuegos como terapia para la mejora de aspectos motores en sujetos con LM, es limitada. En concreto, tras analizar el uso de la RV y/o videojuegos como intervención para la mejora de la capacidad funcional y de la función motora de miembros superiores en sujetos con LM, la terapia no ha resultado ser más efectiva que la fisioterapia convencional. Por otro lado, sí se han obtenido mejoras sobre el equilibrio de sujetos con LM tras el uso de dicha terapia en adición a la fisioterapia convencional.Introduction. Spinal cord injury (SCI) is a common neurological condition that causes functional limitations in the sensory and motor systems. Approximately 55% of people living with a SCI have injuries that affect only part of the spinal cord. Functional recovery can last for years and it varies significantly depending on the injured area. After an injury, disruption of the nerve fiber bundles can cause fragmented or distorted neural communication resulting in complications such as muscle weakness, altered quality of movement, pain, and changes in muscle tone. Among the different approaches included in the neurorehabilitation treatment, the use of virtual reality (VR) systems and video games is a novel approach. Currently, this technology is increasingly applied in different neurological disorders (stroke, Parkinson's disease, SCI, cerebral palsy, among others), either as an assessment tool or as an intervention, achieving functional improvements, due to the motivational and ludic aspects of this therapy. The need to combine data from similar scientific experiences to obtain conclusions applicable to the population has led to the use of the meta-analysis (MA) tool in various fields of science. This methodology is revealed as the most useful, generating the most scientific evidence, above the systematic review (SR). Objectives. The main aim was to evaluate the effectiveness of the use of VR and/or video games as therapy to improve functional and motor recovery in subjects with SCI through a SR and MA. As specific objectives, we aim to evaluate the effectiveness of VR and video games on functional performance, balance and upper limb motor function in subjects with SCI. Methods. This review was performed following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) for SR and MA. It was also registered in the PROSPERO repository (CRD 42018093855). The search was conducted from October to December 2019, including the articles published from the beginning of each database until December 2019 in the following scientific databases: CINAHL, Medline, CENTRAL, PEDro (Physiotherapy Evidence Database), PubMed, Scopus, Web of Science, and Embase, by combining the different Boolean descriptors and operators: ("spinal cord injury" OR "spinal cord injuries" OR "paraplegia" OR "quadriplegia" OR "tetraplegia") AND ("virtual reality" OR "virtual reality exposure therapy" OR "virtual systems" OR "augmented reality" OR "videogame" OR "video games" OR "exergames" OR "exergaming" OR "play-based therapy" OR "commercial games"). For PubMed database, the search was carried out using the MeSH descriptors. The methodological quality of the studies was evaluated using the PEDro scale, and the risk of bias was assessed by The Cochrane Collaboration tool. The statistical software RevMan 5.3 was used to obtain the MA according to the standardized mean difference (SMD) and 95% confidence interval (95%CI). Results. The results obtained were reported as three original review articles, published in high scientific impact journals (Quartile 1 in Journal Citation Reports) within its thematic area. For the evaluation of the effectiveness of VR and/or video game-based therapy on the functional performance in subjects with SCI, seven articles (150 participants) were included in the qualitative analysis (SR), and five of them in the quantitative analysis (MA). The statistical analysis showed favorable results for functional performance in the control group performing conventional therapy, provided by the measure of functional independence: SMD = -0.70; 95%CI: -1.25 to -0.15. The results were not conclusive for the remaining variables and most of the studies did not show beneficial effects of VR and/or video games interventions versus conventional physiotherapy. When assessing the effectiveness of VR and/or video game systems to recover balance in SCI patients, a total of 12 studies and 188 participants, were included in the SR, of which two were included in the MA. Statistical analysis showed favorable results for balance, as measured by the modified Functional Reach Test (SMD = 3.42; 95%CI: 2.54 to 4.29) and by the T-shirt test (SMD = -2.29; 95%CI: -3.00 to -1.59). To verify the effectiveness of VR and/or video game interventions in upper limb motor function recovery, six articles were included in this SR. Four of them contributed information to the MA. A total of 105 subjects were analyzed. Statistical analysis showed non-significant results for the Nine-Hole Peg test (SMD: -0.93, 95%CI: -1.95 to 0.09); Muscle Balance test (SMD: -0.27, 95%CI: -0.82 to 0.27); Motor Index (SMD: 0.16, 95%CI: -0.37 to 0.68); Jebsen-Taylor Manual Function Test subtests: writing (SMD: -0.10, 95%CI: -4.01 to 3.82), simulated page turning (SMD: 0.99, 95%CI: -2.01 to 0.02), simulated feeding (SMD: -0.64, 95%CI: -1.61 to 0.32), stacking checkers (SMD: 0.99, 95%CI: -0.02 to 2.00), picking up large light objects (SMD: -0.42, 95%CI: -1.37 to 0.54) and picking up large heavy objects (SMD: 0.52, 95%CI: -0.44 to 1.49); shoulder abduction/adduction range of motion (SMD: -0.23, 95%CI: -1.48 to 1.03), shoulder flexion/extension (SMD: 0.56; 95%CI: -1.24 to 2.36), elbow flexion (SMD: -0.36; 95%CI: -1.14 to 0.42), elbow extension (SMD: -0.21; 95%CI: -0.99 to 0.57), wrist extension (SMD: 1.44; 95%CI: -2.19 to 5.06), and elbow supination (SMD: -0.18; 95%CI: -1.80 to 1.44). Favorable results were found in the Jebsen-Taylor Manual Function Test subtest of picking up small common objects (SMD: -1.33; 95%CI: -2.42 to -0.24). Conclusions. After assessing the results obtained, it can be concluded that the scientific evidence on the use of VR and/or video games as therapy for the improvement of motor conditions in subjects with SCI is limited. Specifically, after analyzing the use of VR and/or video games as an intervention for the improvement of functional performance and upper limb motor function in subjects with SCI, the therapy has not proved to be more effective than conventional physiotherapy. Nonetheless, improvements on balance of patients with SCI were obtained through the use of this therapy in addition to conventional physical therapy

Mejora de la conducción en pacientes con lesión medular mediante el uso de la realidad virtual. Revisión sistemática

Introducción. La lesión medular es una patología que provoca afectaciones motoras y sensitivas por debajo de la lesión. Esto da lugar a limitaciones en las actividades de la vida diaria, como en la capacidad de conducción. En los últimos años, la mejora en esta tarea se ha llevado a cabo mediante el tratamiento a través de la realidad virtual (RV) en la rehabilitación de pacientes con lesión medular. El objetivo del presente estudio fue analizar la eficacia del uso de la RV en la capacidad de conducción en pacientes con lesión medular mediante una revisión sistemática. Materiales y métodos. La búsqueda bibliográfica se llevó a cabo en las siguientes bases de datos: PubMed, Web of Science, PEDro, Cochrane Central Register of Controlled Trials, Medline, Scopus y CINAHL, incluyendo los artículos publicados desde enero de 2000 hasta mayo de 2021. Resultados. Tras el proceso de búsqueda, de un total de 51 artículos, se incluyeron siete; dos aplicaron RV inmersiva, y cinco, semiinmersiva. La simulación de conducción en carretera fue abordada por cuatro de ellos, uno de navegación, uno sobre motocicleta y uno en bicicleta. Conclusiones. El uso de la RV en el entrenamiento de la capacidad de conducción ha supuesto mejoras en la calidad de vida, en las habilidades de conducción y en la reducción del miedo a conducir. A pesar de esto, se necesita más investigación, con un mayor número de pacientes, mayor número de sesiones y mejoras en los simuladores de conducción.Introduction. Spinal cord injury is a pathology which causes motor and sensory impairment under the region damaged by the lesion. This results in limitations in daily activities such as driving. In recent years, improvement in this task has been achieved by means of virtual reality treatment in the rehabilitation of patients with spinal cord injury. The aim of the present study was to analyze, through a systematic review, the effectiveness of using virtual reality on driving skills in patients with spinal cord injury. Materials and methods. The literature search was carried out using the following databases: PubMed, Web of Science, PEDro, Cochrane Central Register of Controlled Trials, Medline, Scopus and CINAHL, including articles published from January 2000 to May 2021. Results. After the research process, out of a total of 51 articles, 7 were included: 2 applied immersive VR and 5 semiimmersive VR. Road driving simulation was addressed by 4 of them: 1 on sailing, 1 on motorbike and 1 on bicycle. Conclusions. The use of virtual reality in driving skills training has led to improvements in quality of life, driving skills and reduction of fear of driving. Despite these findings, more research, patients, sessions and improvements are needed for a clearer understanding of this topic and its usefulness

Implementación al modelo didáctico con utilización de herramienta diagnóstica para el uso correcto de las TICs

La investigación presentada en este trabajo se ha llevado a cabo para analizar, en distintos cursos de Grado en Enseñanzas Universitarias, el uso que los estudiantes realizan de las tecnologías digitales y su percepción sobre la utilidad de las mismas, utilizando para ello un cuestionario. Se ha realizado un análisis factorial exploratorio, estableciendo la estructura de factores existente en el conjunto de respuestas a los ítems. Para identificar distintos perfiles en el uso de los distintos instrumentos y estrategias entre los estudiantes, se ha realizado un análisis clúster. El modelo didáctico aplicado en varios cursos, se concreta en la realización de secuencias de actividades de aprendizaje diseñadas con las Tecnologías de la Información y Comunicación (TICs). Con la incorporación de aplicaciones digitales y multimedia, se han puesto en práctica nuevos enfoques de actualización didáctica en la mejora de la enseñanza-aprendizaje. Con la información aportada por esta investigación, se puede realizar una toma de decisiones sobre la incorporación de estos elementos de manera más eficiente, con los planteamientos metodológicos programados. La utilización de las TICs en las actividades puede contribuir a la mejora del rendimiento académico y a la adquisición de competencias profesionales