Impact of reflex locomotion and the Bobath concept on clinical and biomolecular parameters in people with multiple sclerosis: study protocol for a randomized controlled trial

IntroductionMultiple sclerosis (MS) is a progressive disease with a fluctuating and unpredictable course that has no curative treatment at present. One of its main characteristics is the variety of signs and symptoms that produce a high percentage of patients who present alterations in balance and gait during the development of the disease, decreased muscle strength, spasticity, or decreased pimax. Rehabilitative therapy, especially physiotherapy, is the main course of the treatment of these alterations using reflex locomotion and the Bobath concept as a form of kinesitherapy that activates the preorganized circuits of the central nervous system.ObjectiveThe objective of this study is to evaluate the reflex locomotion and Bobath concept effects on balance, spasticity, reaction time, respiratory parameters, and lacrimal biomolecular markers.Methods and analysisThis is a randomized controlled trial on the effectiveness of two neurorehabilitation techniques in patients with multiple sclerosis conducted at the University of Salamanca. The research will take place at the Faculty of Nursing and Physiotherapy, University of Salamanca. The study will be conducted from June 2023 to June 2024. The reflex locomotion group will receive individual sessions of therapy (n = 27), and the Bobath concept group (n = 27) will receive the same number of sessions. Both groups will receive two sessions per week for 12 months. The measurement variables will be the Berg Balance Scale, the Tardieu Scale, the Cognitfit Program, Maximum Inspiratory Pressure, and Lacrimal Biomarkers.Ethics and disseminationThis study has been approved by the Ethics Committee of the University of Salamanca on March 2023 (ref: 896).LimitationsThe main limitations of this study are the selection and number of patients, the delay in implementing the therapy within the initially scheduled period, inadequate sample collection, and inadequate sample processing.Trial registration numberClinicalTrials.gov; identifier: NCT05558683

Feasibility and efficacy of a virtual reality game-based upper extremity motor function rehabilitation therapy in patients with chronic stroke: a pilot study

This article belongs to the Special Issue New Technologies in the Evaluation and Treatment of Patients with Neurological Pathologies.Background: The objective of the present study was to develop a virtual reality protocol based on activities of daily living and conventional rehabilitation, using Leap Motion Controller to improve motor function in upper extremity rehabilitation in stroke patients. At the same time, the purpose was to explore its efficacy in the recovery of upper extremity motor function in chronic stroke survivors, and to determine feasibility, satisfaction and attendance rate; Methods: A prospective pilot experimental clinical trial was conducted. The outcome measures used were the grip strength, the Action Research Arm Test (ARAT), the Block and Box Test (BBT), the Short Form Health Survey-36 Questionnaire, a satisfaction questionnaire and attendance rate; Results: Our results showed statistically significant changes in the variables grip strength, BBT and ARAT as well as high levels of satisfaction and attendance; Conclusions: This virtual reality platform represents an effective tool in aspects of upper extremity functionality rehabilitation in patients with chronic stroke, demonstrating feasibility and high levels of attendance and satisfaction

The Use of Functional Electrical Stimulation on the Upper Limb and Interscapular Muscles of Patients with Stroke for the Improvement of Reaching Movements: A Feasibility Study

Introduction: Reaching movements in stroke patients are characterized by decreased amplitudes at the shoulder and elbow joints and greater displacements of the trunk, compared to healthy subjects. The importance of an appropriate and specific contraction of the interscapular and upper limb (UL) muscles is crucial to achieving proper reaching movements. Functional electrical stimulation (FES) is used to activate the paretic muscles using short-duration electrical pulses. Objective: To evaluate whether the application of FES in the UL and interscapular muscles of stroke patients with motor impairments of the UL modifies patients’ reaching patterns, measured using instrumental movement analysis systems. Design: A cross-sectional study was carried out. Setting: The VICON Motion System® was used to conduct motion analysis. Participants: Twenty-one patients with chronic stroke. Intervention: The Compex® electric stimulator was used to provide muscle stimulation during two conditions: a placebo condition and a FES condition. Main outcome measures: We analyzed the joint kinematics (trunk, shoulder, and elbow) from the starting position until the affected hand reached the glass. Results: Participants receiving FES carried out the movement with less trunk flexion, while shoulder flexion elbow extension was increased, compared to placebo conditions. Conclusion: The application of FES to the UL and interscapular muscles of stroke patients with motor impairment of the UL has improved reaching movements.This research has been supported by Spanish Ministry of Science project HYPER PROJECT (CONSOLIDER-INGENIO 2010) Hybrid Neuroprosthetic and Neurorobotic Devices for Functional Compensation and Rehabilitation of Motor Disorders. HYPER-CSD2009-00067

Effects of virtual reality associated with serious games for upper limb rehabilitation inpatients with multiple sclerosis: randomized controlled trial

Background: Dexterity and activities of daily living limitations on the upper limb (UL) represent one of the most common problems in patients with multiple sclerosis (MS). The aim of this study was to evaluate the effectiveness of the specially developed Serious Games that make use of the Leap Motion Controller (LMC) as main user interface for improving UL grip muscle strength, dexterity, fatigue, quality of life, satisfaction and compliance. Methods: A single-blinded randomized controlled trial was conducted. The sample was randomized into two groups: an experimental group who received treatment based on serious games designed by the research team using the developed LMC based Serious Games for the UL plus conventional rehabilitation, and a control group who received the same conventional rehabilitation for the UL. Both groups received two 60 min sessions per week over a ten-week period. Grip muscle strength, coordination, speed of movements, fine and gross UL dexterity, fatigue, quality of life, satisfaction and compliance were assessed in both groups pre-treatment, post-treatment and in a follow-up period of 1 month without receiving any treatment. Results: In the experimental group compared to the control group, significant improvements were observed in the post-treatment assessment for coordination, speed of movements, fine and gross UL dexterity. Also, significant results were found in the follow-up in coordination, speed of movements, fine and gross for the more affected side. Conclusions: An experimental protocol using an LMC based Serious Games designed for UL rehabilitation showed improvements for unilateral gross manual dexterity, fine manual dexterity, and coordination in MS patients with high satisfaction and excellent compliance. Trial registration: This randomized controlled trial has been registered at ClinicalTrials.gov Identifier: NCT04171908, Nov 2019.The research leading to these results has received funding from the ROBOHEALTH-A project (DPI2013-47944-C4-1-R) funded by the Spanish Ministry of Economy and Competitiveness

Validity of a Fully-Immersive VR-Based Version of the Box and Blocks Test for Upper Limb Function Assessment in Parkinson's Disease

In recent decades, gaming technology has been accepted as a feasible method for complementing traditional clinical practice, especially in neurorehabilitation; however, the viability of using 3D Virtual Reality (VR) for the assessment of upper limb motor function has not been fully explored. For that purpose, we developed a VR-based version of the Box and Blocks Test (BBT), a clinical test for the assessment of manual dexterity, as an automated alternative to the classical procedure. Our VR-based BBT (VR-BBT) integrates the traditional BBT mechanics into gameplay using the Leap Motion Controller (LMC) to capture the user’s hand motion and the Oculus Rift headset to provide a fully immersive experience. This paper focuses on evaluating the validity of our VR-BBT to reliably measure the manual dexterity in a sample of patients with Parkinson’s Disease (PD). For this study, a group of twenty individuals in a mild to moderate stage of PD were recruited. Participants were asked to perform the physical BBT (once) and our proposed VR-BBT (twice) system,separately. Correlation analysis of collected data was carried out. Statistical analysis proved that the performance data collected by the VR-BBT significantly correlated with the conventional assessment of the BBT. The VR-BBT scores have shown a significant association with PD severity measured by the Hoehn and Yahr scale. This fact suggests that the VR-BBT could be used as a reliable indicator for health improvements in patients with PD. Finally, the VR-BBT system presented high usability and acceptability rated by clinicians and patients.This work was supported in part by the Spanish Ministry of Economy and Competitiveness via the ROBOESPAS project (DPI2017-87562-C2-1-R), and in part by the RoboCity2030-DIH-CM, Madrid Robotics Digital Innovation Hub (S2018/NMT-4331), which is funded by the Programas de Actividades I+D Comunidad de Madrid and cofunded by the Structural Funds of the EU

El Automatizado Box & Blocks Test. Sistema automático de evaluación de destreza manual gruesa

[Resumen] El cada vez más elevado número de personas que requieren atención médica para rehabilitación física o cognitiva (post-traumática, post-operatoria o por envejecimiento), supone cada vez mayor saturación en los servicios médicos. Esto repercute de forma negativa en la calidad del tratamiento impartido. El proyecto RoboHealth, intenta contribuir a paliar dicha situación, proporcionando asistencia al personal sanitario en procesos de rehabilitación física. RoboHealth abarca dos aspectos durante el proceso de rehabilitación motora: la evaluación y la intervención. En este artículo, se presenta el diseño de un sistema automatizado de evaluación de destreza manual gruesa basado en el test Box and Blocks. A través de cámaras RGB y nube de puntos, se monitoriza la ejecución del test, obteniendo de forma automática el total de cubos desplazados por el usuario, además de datos adicionales como el tiempo empleado en el desplazamiento entre cada cubo y su color. La información se puede visualizar a través de una interfaz gráfica que además, ordena y registra de forma automática los resultados de cada sesión para cada usuario. En primer lugar, se muestra el desarrollo del algoritmo de conteo, la implementación de la interfaz de visualización y registro de datos, así como los resultados de una prueba piloto. Finalmente, se presentan las conclusiones y futuros trabajos.La investigación que lleva a estos resultados ha recibido financiación del proyecto ROBOHEALTH-A (DPI2013-47944-C4-1-R), financiado por el Ministerio de Economía y Competitividad español y del proyecto RoboCity2030-III-CM (S2013 / MIT-2748), financiado por Programas de Actividades de I + D en la Comunidad de Madrid y co-financiado por los Fondos Estructurales de la UEComunidad de Madrid; S2013 / MIT-2748https://doi.org/10.17979/spudc.978849749808

Low Latency Estimation of Motor Intentions to Assist Reaching Movements along Multiple Sessions in Chronic Stroke Patients: A Feasibility Study

A corrigendum on Low Latency Estimation of Motor Intentions to Assist Reaching Movements along Multiple Sessions in Chronic Stroke Patients: A Feasibility Study by Ibáñez, J., Monge-Pereira, E., Molina-Rueda, F., Serrano, J. I., del Castillo, M. D., Cuesta-Gómez, A., et al. (2017). Front. Neurosci. 11:126. doi: 10.3389/fnins.2017.00126. In the recently published article, there were incorrect and missing contents in the Acknowledgments section

Role of VEGF polymorphisms in the susceptibility and severity of interstitial lung disease

The search for biomarkers that can help to establish an early diagnosis and prognosis of interstitial lung disease (ILD) is of potential interest. VEGF polymorphisms have been implicated in the development of several lung disorders. Consequently, we assessed, for the first time, the role of VEGF polymorphisms in the susceptibility and severity of ILD. A total of 436 Caucasian ILD patients (244 with idiopathic interstitial pneumonias (IIPs) and 192 with non-IIP) and 536 ethnically-matched healthy controls were genotyped for VEGF rs833061, rs1570360, rs2010963, rs3025020, and rs3025039 polymorphisms by TaqMan assays. Pulmonary function tests were collected from all the patients. VEGF serum levels were determined by ELISA in a subgroup of patients. No VEGF genotype, allele, carrier, or haplotype differences were found between ILD patients and controls as well as between IIP and non-IIP patients. However, an association of rs1570360 with IIP in women and also with lung function in IIP patients was found. None of the VEGF polymorphisms were associated with VEGF levels. In conclusion, our results suggest that VEGF does not seem to play a relevant role in ILD, although rs1570360 may influence the severity of ILD in women and a worse outcome in IIP patients.Funding: This research was partially supported by a grant from Spanish Society of Pulmonology and Thoracic Surgery (SEPAR 474-2017). S.R.-M. was supported by funds of the RETICS Program (RD16/0012/0009) from the “Instituto de Salud Carlos III” (ISCIII), co-funded by the European Regional Development Fund. V.P.-C. was supported by a pre-doctoral grant from IDIVAL (PREVAL 18/01). B.A.-M. was recipient of a “López Albo” post-residency program funded by Servicio Cántabro de Salud. L.L.-G. was supported by funds from IDIVAL (INNVAL 20/06). O.G. was beneficiary of a grant funded by Xunta de Galicia, Consellería de Educación, Universidade e Formación Profesional and Consellería de Economía, Emprego e Industria (GAIN), GPC IN607B2019/10. R.L.-M. was a recipient of a Miguel Servet type I program fellowship from the ISCIII, co-funded by the ESF, “Investing in your future” (grant CP16/00033)

Pregnancy Outcomes and SARS-CoV-2 Infection: The Spanish Obstetric Emergency Group Study

Pregnant women who are infected with SARS-CoV-2 are at an increased risk of adverse perinatal outcomes. With this study, we aimed to better understand the relationship between maternal infection and perinatal outcomes, especially preterm births, and the underlying medical and interventionist factors. This was a prospective observational study carried out in 78 centers (Spanish Obstetric Emergency Group) with a cohort of 1347 SARS-CoV-2 PCR-positive pregnant women registered consecutively between 26 February and 5 November 2020, and a concurrent sample of PCR-negative mothers. The patients' information was collected from their medical records, and the association of SARS-CoV-2 and perinatal outcomes was evaluated by univariable and multivariate analyses. The data from 1347 SARS-CoV-2-positive pregnancies were compared with those from 1607 SARS-CoV-2-negative pregnancies. Differences were observed between both groups in premature rupture of membranes (15.5% vs. 11.1%, p < 0.001); venous thrombotic events (1.5% vs. 0.2%, p < 0.001); and severe pre-eclampsia incidence (40.6 vs. 15.6%, p = 0.001), which could have been overestimated in the infected cohort due to the shared analytical signs between this hypertensive disorder and COVID-19. In addition, more preterm deliveries were observed in infected patients (11.1% vs. 5.8%, p < 0.001) mainly due to an increase in iatrogenic preterm births. The prematurity in SARS-CoV-2-affected pregnancies results from a predisposition to end the pregnancy because of maternal disease (pneumonia and pre-eclampsia, with or without COVID-19 symptoms)