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Grosse L, Meuche AC, Parzefall B, Börner C, Schnabel JF, Späh MA, Klug P, Sollmann N, Klich L, Hösl M, Heinen F, Berweck S, Schröder SA, Bonfert MV. Functional Repetitive Neuromuscular Magnetic Stimulation (frNMS) Targeting the Tibialis Anterior Muscle in Children with Upper Motor Neuron Syndrome: A Feasibility Study. CHILDREN (BASEL, SWITZERLAND) 2023; 10:1584. [PMID: 37892247 PMCID: PMC10605892 DOI: 10.3390/children10101584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 09/07/2023] [Accepted: 09/11/2023] [Indexed: 10/29/2023]
Abstract
Non-invasive neurostimulation as an adjunctive intervention to task-specific motor training is an approach to foster motor performance in patients affected by upper motor neuron syndrome (UMNS). Here, we present first-line data of repetitive neuromuscular magnetic stimulation (rNMS) in combination with personalized task-specific physical exercises targeting the tibialis anterior muscle to improve ankle dorsiflexion (functional rNMS (frNMS)). The main objective of this pilot study was to assess the feasibility in terms of adherence to frNMS, safety and practicability of frNMS, and satisfaction with frNMS. First, during 10 training sessions, only physical exercises were performed (study period (SP) A). After a 1 week break, frNMS was delivered during 10 sessions (SPC). Twelve children affected by UMNS (mean age 8.9 ± 1.6 years) adhered to 93% (SPA) and 94% (SPC) of the sessions, and omittance was not related to the intervention itself in any case. frNMS was safe (no AEs reported in 88% of sessions, no AE-related discontinuation). The practicability of and satisfaction with frNMS were high. Patient/caregiver-reported outcomes revealed meaningful benefits on the individual level. The strength of the ankle dorsiflexors (MRC score) clinically meaningfully increased in four participants as spasticity of ankle plantar flexors (Tardieu scores) decreased in four participants after SPC. frNMS was experienced as a feasible intervention for children affected by UMNS. Together with the beneficial effects achieved on the individual level in some participants, this first study supports further real-world, large-scale, sham-controlled investigations to investigate the specific effects and distinct mechanisms of action of frNMS.
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Affiliation(s)
- Leonie Grosse
- Division of Pediatric Neurology and Developmental Medicine, Department of Pediatrics—Dr. von Hauner Children’s Hospital, LMU Hospital, Ludwig-Maximilians-Universität München, 80336 Munich, Germany
- LMU Center for Children with Medical Complexity—iSPZ Hauner, Ludwig-Maximilians-Universität München, 80336 Munich, Germany
| | - Anne C. Meuche
- Division of Pediatric Neurology and Developmental Medicine, Department of Pediatrics—Dr. von Hauner Children’s Hospital, LMU Hospital, Ludwig-Maximilians-Universität München, 80336 Munich, Germany
- LMU Center for Children with Medical Complexity—iSPZ Hauner, Ludwig-Maximilians-Universität München, 80336 Munich, Germany
| | - Barbara Parzefall
- Division of Pediatric Neurology and Developmental Medicine, Department of Pediatrics—Dr. von Hauner Children’s Hospital, LMU Hospital, Ludwig-Maximilians-Universität München, 80336 Munich, Germany
- LMU Center for Children with Medical Complexity—iSPZ Hauner, Ludwig-Maximilians-Universität München, 80336 Munich, Germany
| | - Corinna Börner
- Division of Pediatric Neurology and Developmental Medicine, Department of Pediatrics—Dr. von Hauner Children’s Hospital, LMU Hospital, Ludwig-Maximilians-Universität München, 80336 Munich, Germany
- LMU Center for Children with Medical Complexity—iSPZ Hauner, Ludwig-Maximilians-Universität München, 80336 Munich, Germany
- Department of Diagnostic and Interventional Neuroradiology, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, 81675 Munich, Germany
- TUM-Neuroimaging Center, Klinikum rechts der Isar, Technical University of Munich, 81675 Munich, Germany
| | - Julian F. Schnabel
- Division of Pediatric Neurology and Developmental Medicine, Department of Pediatrics—Dr. von Hauner Children’s Hospital, LMU Hospital, Ludwig-Maximilians-Universität München, 80336 Munich, Germany
- LMU Center for Children with Medical Complexity—iSPZ Hauner, Ludwig-Maximilians-Universität München, 80336 Munich, Germany
| | - Malina A. Späh
- Division of Pediatric Neurology and Developmental Medicine, Department of Pediatrics—Dr. von Hauner Children’s Hospital, LMU Hospital, Ludwig-Maximilians-Universität München, 80336 Munich, Germany
- LMU Center for Children with Medical Complexity—iSPZ Hauner, Ludwig-Maximilians-Universität München, 80336 Munich, Germany
| | - Pia Klug
- Division of Pediatric Neurology and Developmental Medicine, Department of Pediatrics—Dr. von Hauner Children’s Hospital, LMU Hospital, Ludwig-Maximilians-Universität München, 80336 Munich, Germany
- LMU Center for Children with Medical Complexity—iSPZ Hauner, Ludwig-Maximilians-Universität München, 80336 Munich, Germany
| | - Nico Sollmann
- Department of Diagnostic and Interventional Neuroradiology, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, 81675 Munich, Germany
- TUM-Neuroimaging Center, Klinikum rechts der Isar, Technical University of Munich, 81675 Munich, Germany
- Department of Diagnostic and Interventional Radiology, University Hospital Ulm, 89081 Ulm, Germany
| | - Luisa Klich
- Specialist Center for Pediatric Neurology, Neurorehabilitation and Epileptology, Schoen Clinic Vogtareuth, 83569 Vogtareuth, Germany
| | - Matthias Hösl
- Gait and Motion Analysis Laboratory, Schoen Clinic Vogtareuth, Krankenhausstr. 20, 83569 Vogtareuth, Germany
| | - Florian Heinen
- Division of Pediatric Neurology and Developmental Medicine, Department of Pediatrics—Dr. von Hauner Children’s Hospital, LMU Hospital, Ludwig-Maximilians-Universität München, 80336 Munich, Germany
- LMU Center for Children with Medical Complexity—iSPZ Hauner, Ludwig-Maximilians-Universität München, 80336 Munich, Germany
| | - Steffen Berweck
- Division of Pediatric Neurology and Developmental Medicine, Department of Pediatrics—Dr. von Hauner Children’s Hospital, LMU Hospital, Ludwig-Maximilians-Universität München, 80336 Munich, Germany
- Specialist Center for Pediatric Neurology, Neurorehabilitation and Epileptology, Schoen Clinic Vogtareuth, 83569 Vogtareuth, Germany
| | - Sebastian A. Schröder
- Division of Pediatric Neurology and Developmental Medicine, Department of Pediatrics—Dr. von Hauner Children’s Hospital, LMU Hospital, Ludwig-Maximilians-Universität München, 80336 Munich, Germany
- LMU Center for Children with Medical Complexity—iSPZ Hauner, Ludwig-Maximilians-Universität München, 80336 Munich, Germany
| | - Michaela V. Bonfert
- Division of Pediatric Neurology and Developmental Medicine, Department of Pediatrics—Dr. von Hauner Children’s Hospital, LMU Hospital, Ludwig-Maximilians-Universität München, 80336 Munich, Germany
- LMU Center for Children with Medical Complexity—iSPZ Hauner, Ludwig-Maximilians-Universität München, 80336 Munich, Germany
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Román-Belmonte JM, Rodríguez-Merchán EC, De la Corte-Rodríguez H. Metaverse applied to musculoskeletal pathology: Orthoverse and Rehabverse. Postgrad Med 2023:1-9. [PMID: 36786393 DOI: 10.1080/00325481.2023.2180953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/15/2023]
Abstract
The Metaverse is 'an integrated network of 3D virtual worlds.' It incorporates digitally created realities into the real world, involves virtual copies of existing places and changes the physical reality by superimposing digital aspects, allowing its users to interact with these elements in an immersive, real-time experience. The applications of the Metaverse are numerous, with an increasing number of experiences in the field of musculoskeletal disease management. In the field of medical training, the Metaverse can help facilitate the learning experience and help develop complex clinical skills. In clinical care, the Metaverse can help clinicians perform orthopedic surgery more accurately and safely and can improve pain management, the performance of rehabilitation techniques and the promotion of healthy lifestyles. Virtualization can also optimize aspects of healthcare information and management, increasing the effectiveness of procedures and the functioning of organizations. This optimization can be especially relevant in departments that are under significant care provider pressure. However, we must not lose sight of the fundamental challenges that still need to be solved, such as ensuring patient privacy and fairness. Several studies are underway to assess the feasibility and safety of the Metaverse.
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Affiliation(s)
- Juan M Román-Belmonte
- Department of Physical Medicine and Rehabilitation, Cruz Roja San José y Santa Adela University Hospital, Madrid, Spain
| | - E Carlos Rodríguez-Merchán
- Department of Orthopedic Surgery, La Paz University Hospital, Madrid, Spain.,Osteoarticular Surgery Research, Hospital La Paz Institute for Health Research - IdiPAZ (La Paz University Hospital - Autonomous University of Madrid), Madrid, Spain
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Tokgöz P, Stampa S, Wähnert D, Vordemvenne T, Dockweiler C. Virtual Reality in the Rehabilitation of Patients with Injuries and Diseases of Upper Extremities. Healthcare (Basel) 2022; 10:healthcare10061124. [PMID: 35742176 PMCID: PMC9222955 DOI: 10.3390/healthcare10061124] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Revised: 06/13/2022] [Accepted: 06/15/2022] [Indexed: 11/30/2022] Open
Abstract
Upper-extremity injuries and diseases rarely have life-threatening consequences, but failure to manage them properly can result in severe dysfunction. This article presents the current state of using virtual reality to support the rehabilitation process of patients with injuries and diseases of the upper extremities and points out their effects on upper-extremity functions. A scoping review was conducted to provide a comprehensive overview of the field of virtual reality for upper-extremity rehabilitation. PubMed, Web of Science, and the Cochrane Library were searched by two independent researchers between April and May 2021 to identify relevant publications and were examined according to inclusion and exclusion criteria. As a result of the literature review, 11 studies of various target groups were identified. Virtual-reality technologies were categorized into multisensory high-end systems and game-based systems. With respect to functional recovery, technologies based on virtual reality were not inferior to traditional rehabilitation. In addition, the users were highly motivated and satisfied. The results emphasize the need for stronger evidence-based virtual-reality technologies for rehabilitation of injuries and diseases of upper extremities.
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Affiliation(s)
- Pinar Tokgöz
- School of Public Health, Bielefeld University, 33615 Bielefeld, Germany
- Department of Digital Health Sciences and Biomedicine, School of Life Sciences, University of Siegen, 57068 Siegen, Germany; (S.S.); (C.D.)
- Correspondence:
| | - Susanne Stampa
- Department of Digital Health Sciences and Biomedicine, School of Life Sciences, University of Siegen, 57068 Siegen, Germany; (S.S.); (C.D.)
| | - Dirk Wähnert
- Department for Trauma Surgery and Orthopedics, Protestant Hospital of Bethel Foundation, 33617 Bielefeld, Germany; (D.W.); (T.V.)
| | - Thomas Vordemvenne
- Department for Trauma Surgery and Orthopedics, Protestant Hospital of Bethel Foundation, 33617 Bielefeld, Germany; (D.W.); (T.V.)
| | - Christoph Dockweiler
- Department of Digital Health Sciences and Biomedicine, School of Life Sciences, University of Siegen, 57068 Siegen, Germany; (S.S.); (C.D.)
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Use of Wearable Technology to Measure Activity in Orthopaedic Trauma Patients: A Systematic Review. Indian J Orthop 2022; 56:1112-1122. [PMID: 35813536 PMCID: PMC9232686 DOI: 10.1007/s43465-022-00629-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Accepted: 03/18/2022] [Indexed: 02/04/2023]
Abstract
BACKGROUND Patient-Reported Outcome Measures (PROMs) are widely used for measurement of functional outcomes after orthopaedic trauma. However, PROMs rely on patient collaboration and suffer from various types of bias. Wearable Activity Monitors (WAMs) are increasingly used to objectify functional assessment. The objectives of this systematic review were to identify and characterise the WAMs technology and metrics currently used for orthopaedic trauma research. METHODS PubMed and Embase biomedical literature search engines were queried. Eligibility criteria included: Human clinical studies published in the English language between 2010 and 2019 involving fracture management and WAMs. Variables collected from each article included: Technology used, vendor/product, WAM body location, metrics measured, measurement time period, year of publication, study geographic location, phase of treatment studied, fractures studied, number of patients studied, sex and age of the study subjects, and study level of evidence. Six investigators reviewed the resulting papers. Descriptive statistics of variables of interest were used to analyse the data. RESULTS One hundred and thirty-six papers were available for analysis, showing an increasing trend of publications per year. Accelerometry followed by plantar pressure insoles were the most commonly employed technologies. The most common location for WAM placement was insoles, followed by the waist. The most commonly studied fracture type was hip fractures followed by fragility fractures in general, ankle, "lower extremity", and tibial fractures. The rehabilitation phase following surgery was the most commonly studied period. Sleep duration, activity time or step counts were the most commonly reported WAM metrics. A preferred, clinically validated WAM metric was not identified. CONCLUSIONS WAMs have an increasing presence in the orthopaedic trauma literature. The optimal implementation of this technology and its use to understand patients' pre-injury and post-injury functions is currently insufficiently explored and represents an area that will benefit from future study. SYSTEMATIC REVIEW REGISTRATION NUMBER PROSPERO ID:210344. SUPPLEMENTARY INFORMATION The online version contains supplementary material available at 10.1007/s43465-022-00629-0.
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Gumaa M, Khaireldin A, Rehan Youssef A. Validity and Reliability of Interactive Virtual Reality in Assessing the Musculoskeletal System: a Systematic Review. Curr Rev Musculoskelet Med 2021; 14:130-144. [PMID: 33512677 PMCID: PMC7844107 DOI: 10.1007/s12178-021-09696-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/08/2021] [Indexed: 12/20/2022]
Abstract
PURPOSE OF REVIEW Assessment of the musculoskeletal system requires consideration of its integrated function with the nervous system. This may be assisted by using valid and reliable methods that simulate real-life situations. Interactive virtual reality (VR) technology may introduce various auditory and visual inputs that mimic real-life scenarios. However, evidence supporting the quality and strength of evidence regarding the adequacy of its psychometric properties in assessing the musculoskeletal function has not been evaluated yet. Therefore, this study reviewed the validity and reliability of VR games and real-time feedback in assessing the musculoskeletal system. RECENT FINDINGS Nine studies were included in quality assessment. Based on outcome measures, studies were categorized into range of motion (ROM), balance, reaction time, and cervical motion velocity and accuracy. The majority of the studies were of moderate quality and provided evidence of VR adequate concurrent and, in some cases, known-groups validity. Also, VR showed high intra-rater reliability for most of the measured outcomes. Based on the included studies, there is a limited promising evidence that interactive VR using games or real-time feedback is highly valid and reliable in assessing ROM in asymptomatic participants and patients with chronic neck pain and radial fracture. For the remaining outcomes, evidence is limited to draw a robust conclusion. Future studies are recommended to test VR psychometric properties in different patients' population using a rigor research methodology.
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Affiliation(s)
- Mohammed Gumaa
- Department of Physical Therapy for Musculoskeletal Disorders and Surgery, Faculty of Physical Therapy, Cairo University, Giza, Egypt
- TRUST Research Center, Cairo, Egypt
| | - Alaaeldin Khaireldin
- Department of Physical Therapy for Musculoskeletal Disorders and Surgery, Faculty of Physical Therapy, Deraya University, Minya, Egypt
- Department of Physical Therapy, Banha University Hospitals, Benha University, Benha, Qalyubia Egypt
| | - Aliaa Rehan Youssef
- Department of Physical Therapy for Musculoskeletal Disorders and Surgery, Faculty of Physical Therapy, Cairo University, Giza, Egypt
- Department of Physical Therapy for Musculoskeletal Disorders and Surgery, Faculty of Physical Therapy, Ahram Canadian University, Giza, Egypt
- Nasr City, Egypt
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Virtual reality hand therapy: A new tool for nonopioid analgesia for acute procedural pain, hand rehabilitation, and VR embodiment therapy for phantom limb pain. J Hand Ther 2020; 33:254-262. [PMID: 32482376 PMCID: PMC7719341 DOI: 10.1016/j.jht.2020.04.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Accepted: 04/09/2020] [Indexed: 02/03/2023]
Abstract
INTRODUCTION Affordable virtual reality (VR) technology is now widely available. Billions of dollars are currently being invested into improving and mass producing VR and augmented reality products. PURPOSE OF THE STUDY The purpose of the present study is to explore the potential of immersive VR to make physical therapy/occupational therapy less painful, more fun, and to help motivate patients to cooperate with their hand therapist. DISCUSSION The following topics are covered: a) psychological influences on pain perception, b) the logic of how VR analgesia works, c) evidence for reduction of acute procedural pain during hand therapy, d) recent major advances in VR technology, and e) future directions-immersive VR embodiment therapy for phantom limb (chronic) pain. CONCLUSION VR hand therapy has potential for a wide range of patient populations needing hand therapy, including acute pain and potentially chronic pain patients. Being in VR helps reduce the patients' pain, making it less painful for patients to move their hand/fingers during hand therapy, and gamified VR can help motivate the patient to perform therapeutic hand exercises, and make hand therapy more fun. In addition, VR camera-based hand tracking technology may be used to help therapists monitor how well patients are doing their hand therapy exercises, and to quantify whether adherence to treatment increases long-term functionality. Additional research and development into using VR as a tool for hand therapist is recommended for both acute pain and persistent pain patient populations.
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Gumaa M, Rehan Youssef A. Is Virtual Reality Effective in Orthopedic Rehabilitation? A Systematic Review and Meta-Analysis. Phys Ther 2019; 99:1304-1325. [PMID: 31343702 DOI: 10.1093/ptj/pzz093] [Citation(s) in RCA: 72] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Revised: 12/04/2018] [Accepted: 03/08/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND Virtual reality (VR) is an interactive technology that allows customized treatment and may help in delivering effective person-centered rehabilitation. PURPOSE The purpose of this review was to systematically review and critically appraise the controlled clinical trials that investigated VR effectiveness in orthopedic rehabilitation. DATA SOURCES Pubmed, CINAHL, Embase, PEDro, REHABDATA, and Sage publications were searched up to September 2018. In addition, manual searching and snowballing using Scopus and Web of Science were done. STUDY SELECTION Two reviewers screened studies for eligibility first by title and abstract and then full text. DATA EXTRACTION Articles were categorized into general or region-specific (upper limbs, lower limbs, and spine) orthopedic disorders. Study quality was assessed using the Evaluation Guidelines for Rating the Quality of an Intervention Study scoring. Meta-analysis quantified VR effectiveness, compared with no treatment, in back pain. DATA SYNTHESIS Nineteen studies were included in the quality assessment. The majority of the studies were of moderate quality. Fourteen studies showed that VR did not differ compared with exercises. Compared with the no-treatment control, 5 studies favored VR and 3 other studies showed no differences. For low back pain, the meta-analysis revealed no significant difference between VR and no-treatment control (n = 116; standardized mean difference = -0.21; 95% confidence interval = -0.58 to 0.15). LIMITATIONS Limitations included heterogeneity in interventions and the outcome measures of reviewed studies. Only articles in English were included. CONCLUSION The evidence of VR effectiveness is promising in chronic neck pain and shoulder impingement syndrome. VR and exercises have similar effects in rheumatoid arthritis, knee arthritis, ankle instability, and post-anterior cruciate reconstruction. For fibromyalgia and back pain, as well as after knee arthroplasty, the evidence of VR effectiveness compared with exercise is absent or inconclusive.
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Affiliation(s)
- Mohammed Gumaa
- Department of Physical Therapy for Musculoskeletal Disorders and Its Surgery, Cairo University, Cairo, Egypt
| | - Aliaa Rehan Youssef
- Department of Physical Therapy for Musculoskeletal Disorders and Its Surgery, Cairo University, 24 Mohammed Korium St, 6th District, Nasr City, Cairo, Egypt
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