Improvements in motor tasks through the use of smartphone technology for individuals with Duchenne muscular dystrophy

Camila Miliani Capelini,1 Talita Dias da Silva,2 James Tonks,3–5 Suzanna Watson,6 Mayra Priscila Boscolo Alvarez,1 Lilian Del Ciello de Menezes,1 Francis Meire Favero,2 Fátima Aparecida Caromano,1 Thais Massetti,1 Carlos Bandeira de Mello Monteiro1 1Graduate Program in Rehabilitation Sciences, Faculty of Medicine, University of São Paulo, 2Department of Medicine, Paulista School of Medicine, Federal University of São Paulo, São Paulo, SP, Brazil; 3University of Exeter Medical School, Exeter, 4University of Lincoln, Lincoln, 5Haven Clinical Psychology Practice, Cornwall, 6The Cambridge Centre for Paediatric Neuropsychologicial Rehabilitation, Cambridge, UK Background: In individuals severely affected with Duchenne muscular dystrophy (DMD), virtual reality has recently been used as a tool to enhance community interaction. Smartphones offer the exciting potential to improve communication, access, and participation, and present the unique opportunity to directly deliver functionality to people with disabilities.Objective: To verify whether individuals with DMD improve their motor performance when undertaking a visual motor task using a smartphone game.Patients and methods: Fifty individuals with DMD and 50 healthy, typically developing (TD) controls, aged 10–34 years participated in the study. The functional characterization of the sample was determined through Vignos, Egen Klassifikation, and the Motor Function Measure scales. To complete the task, individuals moved a virtual ball around a virtual maze and the time in seconds was measured after every attempt in order to analyze improvement of performance after the practice trials. Motor performance (time to finish each maze) was measured in phases of acquisition, short-term retention, and transfer.Results: Use of the smartphone maze game promoted improvement in performance during acquisition in both groups, which remained in the retention phase. At the transfer phases, with alternative maze tasks, the performance in DMD group was similar to the performance of TD group, with the exception of the transfer to the contralateral hand (nondominant). However, the group with DMD demonstrated longer movement time at all stages of learning, compared with the TD group.Conclusion: The practice of a visual motor task delivered via smartphone game promoted an improvement in performance with similar patterns of learning in both groups. Performance can be influenced by task difficulty, and for people with DMD, motor deficits are responsible for the lower speed of execution. This study indicates that individuals with DMD showed improved performance in a short-term motor learning protocol using a smartphone. We advocate that this technology could be used to promote function in this population. Keywords: motor skills, physical therapy, cell phone, virtual reality exposure therapy, transfer of learnin

Comparison of cardiac autonomic modulation of athletes and non-athletes individuals with spinal cord injury at rest and during a non-immersive virtual reality task.

STUDY DESIGN: Cross-sectional study. OBJECTIVES: To compare cardiac autonomic modulation of individuals with spinal cord injury (SCI) that practice different amounts of moderate to vigorous physical activity (PA) and able-bodied controls at rest and during a non-immersive Virtual Reality task. SETTING: Athletes with SCI of wheelchair basketball, wheelchair tennis, wheelchair handball, WCMX (wheelchair motocross), and para-swimming were assessed at the Faca na Cadeira Institute, ICEL and Clube Espéria in São Paulo, Brazil; non-athletes with SCI and able-bodied controls were assessed at the Acreditando Centro de Recuperação Neuromotora, São Paulo, Brazil. METHODS: One-hundred forty-five individuals were assessed: 36 athletes with traumatic SCI (41.1 ± 16.8 years old), 52 non-athletes with traumatic SCI (40.2 ± 14.1 years old), and 57 able-bodied individuals (39.4 ± 12.5 years old). Cardiac autonomic modulation was assessed through heart rate variability (HRV) measured in the sitting position at rest and during a VR game activity. RESULTS: We found significantly more favourable HRV for athletes with SCI when compared to non-athletes with SCI, but no differences between athletes with SCI and able-bodied controls. In addition, athletes and able-bodied controls showed adequate autonomic nervous system (ANS) adaptation (rest versus physical activity in VR), i.e., they experienced parasympathetic withdrawal during VR physical activity, which was not found in non-athletes with SCI. CONCLUSION: The practice of moderate to vigorous physical activity is associated with healthier cardiac autonomic modulation in adults with SCI, which may lead to more favourable health outcomes. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT04618003, retrospectively registered