Immersive Virtual Reality in Stroke Patients as a New Approach for Reducing Postural Disabilities and Falls Risk: A Case Series

Stroke is a neurologic disorder considered the first cause of disability worldwide due to motor, cognitive, and sensorial sequels. Balance dysfunctions in stroke survivors increase the risk of falls and physiotherapeutic rehabilitation is essential to reduce it. Virtual reality (VR) seems to be an alternative to conventional physiotherapy (CT), providing virtual environments and multisensorial inputs to train balance in stroke patients. The aim of this study was to assess if immersive VR treatment is more effective than CT to improve balance after stroke. This study got the approval from the Ethics Committee of the University of Almeria. Three chronic ischemic stroke patients were selected. One patient who received 25 sessions of immersive VR intervention for two months was compared with another patient who received equivalent CT and a third patient with no intervention. Balance, gait, risk of falling, and vestibular and visual implications in the equilibrium were assessed. After the interventions, the two patients receiving any of the treatments showed an improvement in balance compared to the untreated patient. In comparison to CT, our results suggest a higher effect of immersive VR in the improvement of balance and a reduction of falls risk due to the active upright work during the VR intervention

Virtual Reality-based Therapy Improves Fatigue, Impact and Quality of Life in Patients with Multiple Sclerosis. A Systematic Review with a Meta-Analysis

Patients with multiple sclerosis (PwMS) have a high level of fatigue and a reduced quality of life (QoL) due to the impact of multiple sclerosis (MS). Virtual reality-based therapy (VRBT) is being used to reduce disability in PwMS. The aim of this study was to assess the effect of VRBT on fatigue, the impact of MS, and QoL in PwMS. Methods: A systematic review with meta-analysis was conducted through a bibliographic search on PubMed, Scopus, Web of Science, and PEDro up to April 2021. We included randomized controlled trials (RCTs) with PwMS that received VRBT in comparison to conventional therapy (CT) including physiotherapy, balance and strength exercises, and stretching or physical activity, among others; or in comparison to simple observation; in order to assess fatigue, MS-impact, and QoL. The effect size was calculated using Cohen’s standardized mean difference with a 95% confidence interval (95% CI). Results: Twelve RCTs that provided data from 606 PwMS (42.83 ± 6.86 years old and 70% women) were included. The methodological quality mean, according to the PEDro Scale, was 5.83 ± 0.83 points. Our global findings showed that VRBT is effective at reducing fatigue (SMD −0.33; 95% CI −0.61, −0.06), lowering the impact of MS (SMD −0.3; 95% CI −0.55, −0.04), and increasing overall QoL (0.5; 95% CI 0.23, 0.76). Subgroup analysis showed the following: (1) VRBT is better than CT at reducing fatigue (SMD −0.4; 95% CI −0.7, −0.11), as well as in improving the mental dimension of QoL (SMD 0.51; 95% CI 0.02, 1); (2) VRBT is better than simple observation at reducing the impact of MS (SMD −0.61; 95% CI −0.97, −0.23) and increasing overall QoL (SMD 0.79; 95% CI 0.3, 1.28); and (3) when combined with CT, VRBT is more effective than CT in improving the global (SMD 0.6, 95% CI 0.13, 1.07), physical (SMD 0.87; 95% CI 0.3, 1.43), and mental dimensions (SMD 0.6; 95% CI 0.08, 1.11) of QoL. Conclusion: VRBT is effective at reducing fatigue and MS impact and improving QoL in PwMS

Non-Immersive Virtual Reality to Improve Balance and Reduce Risk of Falls in People Diagnosed with Parkinson’s Disease: A Systematic Review

(1) Objective: To evaluate the effectiveness of non-immersive virtual reality in reducing falls and improving balance in patients diagnosed with Parkinson’s disease. (2) Methods: The following databases were searched: PUBMED, PEDro, Scielo, CINAHL, Web of Science, Dialnet, Scopus and MEDLINE. These databases were searched for randomized controlled trials published using relevant keywords in various combinations. The methodological quality of the articles was evaluated using the PEDro scale. (3) Results: A total of 10 studies with a total of 537 subjects, 58.7% of which (n = 315) were men, have been included in the review. The age of the participants in these studies ranged between 55 and 80 years. Each session lasted between 30 and 75 min, and the interventions lasted between 5 and 12 weeks. These studies showed that non-immersive virtual reality is effective in reducing the number of falls and improving both static and dynamic balance in patients diagnosed with Parkinson’s disease. Results after non-immersive virtual reality intervention showed an improvement in balance and a decrease in the number and the risk of falls. However, no significant differences were found between the intervention groups and the control groups for all the included studies regarding balance. (4) Conclusions: There is evidence that non-immersive virtual reality can improve balance and reduce the risk and number of falls, being therefore beneficial for people diagnosed with Parkinson’s disease

CIBERER : Spanish national network for research on rare diseases: A highly productive collaborative initiative

Altres ajuts: Instituto de Salud Carlos III (ISCIII); Ministerio de Ciencia e Innovación.CIBER (Center for Biomedical Network Research; Centro de Investigación Biomédica En Red) is a public national consortium created in 2006 under the umbrella of the Spanish National Institute of Health Carlos III (ISCIII). This innovative research structure comprises 11 different specific areas dedicated to the main public health priorities in the National Health System. CIBERER, the thematic area of CIBER focused on rare diseases (RDs) currently consists of 75 research groups belonging to universities, research centers, and hospitals of the entire country. CIBERER's mission is to be a center prioritizing and favoring collaboration and cooperation between biomedical and clinical research groups, with special emphasis on the aspects of genetic, molecular, biochemical, and cellular research of RDs. This research is the basis for providing new tools for the diagnosis and therapy of low-prevalence diseases, in line with the International Rare Diseases Research Consortium (IRDiRC) objectives, thus favoring translational research between the scientific environment of the laboratory and the clinical setting of health centers. In this article, we intend to review CIBERER's 15-year journey and summarize the main results obtained in terms of internationalization, scientific production, contributions toward the discovery of new therapies and novel genes associated to diseases, cooperation with patients' associations and many other topics related to RD research

A Proposal of Cognitive Intervention in Patients with Alzheimer’s Disease through an Assembling Game: A Pilot Study

(1) Background: Alzheimer’s disease is an irreversible brain disease, and current treatments are aimed at fighting cognitive decline. We have explored the feasibility of a game-based intervention for people with moderate Alzheimer’s disease; (2) Methods: Six participants, five women and one man, were recruited from a day center to participate in a five-week study, which included a re- and post-evaluation with the Montreal Cognitive Assessment (MoCA) and INECO Frontal Screening (IFS) tests. Three participants were assigned to the control group and three others to the experimental one. Both groups performed a play activity consisting of assembling a pie toy. Participants in the experimental group were asked to make a pie matching a sample after a time interval. Control group participants were asked to freely assemble a pie without the matching component; (3) Results: Patients were shown to be motivated during such an activity during the nine sessions. The experimental group showed a significant increase in IFS scores when comparing the post- and pre-intervention assessments. No significant differences were observed in MoCA scores; (4) The intervention created a social and emotional climate suitable to maintaining participants’ satisfaction and motivation, as well as to developing executive function while promoting positive emotions

Neural coding of reward magnitude in the orbitofrontal cortex of the rat during a five-odor olfactory discrimination task

The orbitofrontal cortex (OBFc) has been suggested to code the motivational value of environmental stimuli and to use this information for the flexible guidance of goal-directed behavior. To examine whether information regarding reward prediction is quantitatively represented in the rat OBFc, neural activity was recorded during an olfactory discrimination “go”/“no-go” task in which five different odor stimuli were predictive for various amounts of reward or an aversive reinforcer. Neural correlates related to both actual and expected reward magnitude were observed. Responses related to reward expectation occurred during the execution of the behavioral response toward the reward site and within a waiting period prior to reinforcement delivery. About one-half of these neurons demonstrated differential firing toward the different reward sizes. These data provide new and strong evidence that reward expectancy, regardless of reward magnitude, is coded by neurons of the rat OBFc, and are indicative for representation of quantitative information concerning expected reward. Moreover, neural correlates of reward expectancy appear to be distributed across both motor and nonmotor phases of the task

Virtual Reality-Based Therapy Reduces the Disabling Impact of Fibromyalgia Syndrome in Women: Systematic Review with Meta-Analysis of Randomized Controlled Trials

Background: Virtual reality-based therapy (VRBT) is a novel therapeutic approach to be used in women with fibromyalgia syndrome (FMS). The aim of our study is to assess the effect of VRBT to reduce the impact of FMS in outcomes such as pain, dynamic balance, aerobic capacity, fatigue, quality of life (QoL), anxiety and depression. Methods: Systematic review with meta-analysis was conducted from a bibliographic search in PubMed, Scopus, PEDro, Web of Science and CINAHL until April 2021 in accordance with PRISMA guidelines. We included randomized controlled trials (RCTs) that compare VRBT versus others to assess the mentioned outcomes in women with FMS. Effect size was calculated with standardized mean difference (SMD) and its 95% confidence interval (95% CI). Results: Eleven RCTs involving 535 women with FMS were included. Using the PEDro scale, the mean methodological quality of the included studies was moderate (6.63 ± 0.51). Our findings showed an effect of VRBT on the impact of FMS (SMD −0.62, 95% CI −0.93 to −0.31); pain (SMD −0.45, 95% CI −0.69 to −0.21); dynamic balance (SMD −0.76, 95% CI −1.12 to −0.39); aerobic capacity (SMD 0.32, 95% CI 0.004 to 0.63); fatigue (SMD −0.58, 95% CI −1.02 to −0.14); QoL (SMD 0.55, 95% CI 0.3 to 0.81); anxiety (SMD −0.47, 95% CI −0.91 to −0.03) and depression (SMD −0.46, 95% CI −0.76 to −0.16). Conclusions: VRBT is an effective therapy that reduces the impact of FMS, pain, fatigue, anxiety and depression and increases dynamic balance, aerobic capacity and quality of life in women with FMS. In addition, VRBT in combination with CTBTE showed a large effect in reducing the impact of FMS and fatigue and increasing QoL in these women