Virtual Reality (VR) systems have been increasingly used across several medical fields. A crucial preliminary step for developing optimized VR-based applications for rehabilitation purposes is identifying potential interventions to meet the requirements necessary to satisfy end-users' needs. This study aims to assess the acceptability, usability, and appropriateness of a VR physical therapy program executed with Oculus Quest 2 by expert physiotherapists of shoulder musculoskeletal rehabilitation.Eleven physiotherapists were enrolled to test a VR program for shoulder musculoskeletal rehabilitation. At the end of each session, physiotherapists completed three questionnaires about the acceptability, usability, and appropriateness of the VR system and application, investigating aspects such as wearability, safety, stability, ease of control, comfort, size, utility, playability, and use mode.The acceptability questionnaire revealed that all the physiotherapists found the VR system easy to wear and control, very confident, and safe. The usability questionnaire showed that most physiotherapists (73%) found the VR application entertaining, although only 45% said the system could be used independently by patients without the support of a therapist. Many physiotherapists found the use of the VR application appropriate for patients with rotator cuff tears treated conservatively (63.6%) or surgically (54.5%), for patients with shoulder osteoarthritis treated conservatively (72.7%), for patients with shoulder osteoarthritis after surgical treatment (63.6%). 91% of physiotherapists think it would be best for patients to use the VR system under the supervision of a therapist and not independently in a home setting.The use of VR in orthopaedic rehabilitation is encouraging, although further efforts are needed to increase the independent use of patients without the supervision of a physiotherapist. Moreover, future studies should strive to ensure the clinical effectiveness of VR rehabilitation in reaching therapeutic goal settings.
Few studies investigated the effects of a robotic treatment in hand motor recovery after stroke. Aim of the present study was to evaluate the efficacy of treatment by means of Gloreha Sinfonia® robotic glove in hand motor recovery of a chronic stroke sample of patients with different impairment severity. Thirteen chronic stroke subjects were assigned to either active-assisted robotic treatment or passive robotic treatment according to their ability to actively extend wrist for at least 20 degrees. All subjects underwent 20 sessions of treatment with Gloreha Sinfonia® and were evaluated before (T0), after treatment (T1) and after one month (T2) with clinical scales testing motor performance [Motor Power (MP); Fugl Meyer Upper-Extremity (FMUE)] and spasticity [Modified Ashworth Scale (MAS)]. Both groups showed significant motor recovery and spasticity reduction. Further randomized controlled trials with larger samples are needed to confirm our results.
cervical spinal cord injury leads to loss of upper limb functionality, which causes a decrease in autonomy to perform activities of daily living. The use of robotic technologies in rehabilitation could contribute to improving upper limb functionality and treatment quality. This case report aims to describe the potential of robotic hand treatment with Gloreha Sinfonia, in combination with conventional rehabilitation, in a tetraparetic patient.
Background: Stroke in childhood presents a serious rehabilitation challenge since it leads to physical, cognitive and psychosocial disability. The objective of our study was to describe the effectiveness of robot-mediated therapy (RMT) with Gloreha Sinfonia in addition to a conventional treatment in the recovery of the sensory-motor capabilities of the paretic hand and the quality of life in a ten-year-old child after a stroke. Methods: The girl was enrolled to undergo 10 sessions of RMT with Gloreha Sinfonia. She was evaluated with functional scales and with upper limb kinematic analysis at pre-treatment (T0) and at the end of treatment (T1). Outcome measures were Fugl-Meyer Assessment-Upper Extremity (FMA-UE), Visual Analogic Scale (VAS) and Activities and Participation of Daily Life (ADL). In addition, a Force Assessment System based on Virtual Reality games was used to assess the force control and modulation capability at T0 and T1. Results: At the end of treatment, the patient improved in functional scales and in quality of life for greater involvement in some activity of daily living. Force control and modulation capability significantly increased after the treatment. Conclusions: This clinical case highlights possible positive effects of a combined (conventional plus robotic) rehabilitation treatment for the upper limb in pediatric stroke outcomes from both a sensorimotor and functional point of view, also improving the motivational and affective aspects of the patient and of family members. Further studies are needed to validate these results and to identify the most appropriate modalities and doses.
Background. Rotator cuff tendinopathy (RoCT) is a common pathology among adults. Kinesio-taping (KT) represents a possible rehabilitative treatment. The aim of the present study is to investigate the efficacy of a combination of three different applications of KT combined with a standardized protocol of rehabilitative exercises in reducing pain and in functional recovery in patients affected by RoCT. Materials and methods. 21 patients were enrolled in a real group (RG) and 19 in a sham group (SG). RG received a real KT application and SG received a sham KT application. Both groups received the same rehabilitative protocol. A Numeric Rating Scale (NRS) for shoulder pain, Medical Research Council (MRC) Scales for shoulder strength assessment and Costant Murley Score (CMS) were administered before (T0) and at the end of treatment (T1). Results. Within-group analysis for RG at T1 showed significant improvement in: NRS at-rest (p=0.002), during-movement (p<0.001); CMS (p<0.001); MRC shoulder flexion (p=0.003), extension (p=0.005), abduction (p=0.003), adduction (p=0.007), external rotation (p=0.011), internal rotation (p=0.002), elbow flexion (p=0.008) and extension strength (p=0.011). Within-group analysis for SG at T1 showed significant improvement in: during-movement NRS (p=0.010); CMS (p<0.001). Conclusions. 1. KT application combined with conventional rehabilitative treatment can facilitate immediate pain reduction during rehabilitative treatment. 2. KT application combined with conventional rehabilitative treatment can increase function recovery. 3. KT application combined with conventional rehabilitative treatment can increase strength recovery. 4. Our findings however are not strong enough to recommend the application of KT during rehabilitative treatment for RoCT. 5. These results are the basis for future prospective, randomized controlled trials of larger samples of patients
BACKGROUND: Robotic therapy (RT) has been internationally recognized for the motor rehabilitation of the upper limb. Although it seems that RT can stimulate and promote neuroplasticity, the effectiveness of robotics in restoring cognitive deficits has been considered only in a few recent studies. OBJECTIVE: To verify whether, in the current state of the literature, cognitive measures are used as inclusion or exclusion criteria and/or outcomes measures in robotic upper limb rehabilitation in stroke patients. METHODS: The systematic review was conducted according to PRISMA guidelines. Studies eligible were identified through PubMed/MEDLINE and Web of Science from inception to March 2021. RESULTS: Eighty-one studies were considered in this systematic review. Seventy-three studies have at least a cognitive inclusion or exclusion criteria, while only seven studies assessed cognitive outcomes. CONCLUSION: Despite the high presence of cognitive instruments used for inclusion/exclusion criteria their heterogeneity did not allow the identification of a guideline for the evaluation of patients in different stroke stages. Therefore, although the heterogeneity and the low percentage of studies that included cognitive outcomes, seemed that the latter were positively influenced by RT in post-stroke rehabilitation. Future larger RCTs are needed to outline which cognitive scales are most suitable and their cut-off, as well as what cognitive outcome measures to use in the various stages of post-stroke rehabilitation.
Lower limb orthoses are frequently used in children suffering from cerebral palsy (CP) alongside rehabilitation. The aim of this study was to analyze the effectiveness of ankle–foot orthosis (AFO) and knee–ankle–foot orthosis (KAFO) in walking, balance maintenance, spasticity, and quality of life improvement during rehabilitation in children affected by CP. The hypothesis was that the use of orthoses could improve the parameters compared to non-use. A systematic review was conducted in the main databases, including English language RCTs published about the use of AFO and KAFO in combination or not with rehabilitation methods in children affected by CP and studies mentioning walking, balance, muscle length, and quality of life as outcomes. From an initial number of 1484 results, a final number of 11 RCTs were included, comprising a total number of 442 participants and showing an overall high risk of bias in 10 studies and some concerns in one study. Six studies investigated the domain of walking, four studies investigated the domain of balance, and two studies investigated how KAFO and AFO orthoses could improve and prevent muscle contractures. Using highly heterogeneous study designs, different kinds of orthoses and different assessment tools were used. Further studies conducted with higher methodological quality are needed to establish whether AFO and KAFO are useful or not in combination with rehabilitation in improving the investigated domains.
