Search

Background and Objectives: Botulinum toxin injections are commonly used for the treatment of spasticity. However, injection procedures are associated with pain and procedural anxiety. While pharmacological approaches are commonly used to reduce these, innovative technology might be considered as a potential non-pharmacological alternative. Given this context, immersive virtual reality (VR) has shown effectiveness in the management of procedural pain. Our retrospective pilot study aimed to assess the potential added value of virtual reality in the management of pain and anxiety during intramuscular injections of botulinum toxin. Materials and Methods: Seventeen adult patients receiving botulinum toxin injections were included. A numerical rating scale was used to assess pain and anxiety during the injection procedure. The patients reported the pain experienced during previous injections without VR before injection and the pain experienced in the current procedure with VR after the end of the procedure. The level of satisfaction of VR experience, whether or not they agreed to reuse VR for the subsequent toxin botulinum injection, and whether or not they would recommend VR to other patients were assessed. Results: The use of virtual reality led to a decrease of 1.8 pain-related points compared to the procedure without technology. No significant improvement in the level of anxiety was reported. Patients were very satisfied with their VR experiences (7.9 out of 10), and many would agree to reuse VR in their next injection procedure (88%) and to recommend the use of VR in other patients (100%). Conclusion: VR was useful for managing procedural pain related to botulinum toxin injection in adults, with a high level of satisfaction reported by the patients. VR should be considered as a valuable alternative to pharmacological approaches to manage procedural pain during botulinum toxin injection in adults.

Most bread wheat is consumed after processing, which mainly depends on the quantity and quality of protein in the grain. Storage protein content and composition particularly influence the end use quality of milled grain products. Storage proteins are components of the gluten network that confer dough viscoelasticity, an essential property for processing. To explore grain storage protein diversity, 75 bread wheat accessions were grown with two replicates each at two locations. Grains were harvested at maturity and samples were phenotyped for each site and each replicate plant. Grain hardness, thousand-kernel weight and grain nitrogen content were measured. The protein composition of flour from each replicate was characterised by reverse phase-high performance liquid chromatography (RP-HPLC). The molecular distribution of flour polymers was determined by asymmetric flow field-flow fractionation (AF4) and dough technological properties were assessed using a Glutomatic system and a Chopin alveograph. In addition, the 75 accessions were genotyped by the BreedWheat 35k genotyping array (Axiom TaBW35K) containing 34,746 single nucleotide polymorphism markers (SNPs).The dataset produced by this work includes six files with raw data, two files with protocols and figures. Data show the genotypic and phenotypic variabilities of the material used and can be used to explore genetic and environmental effects on traits involved in grain protein quality.This dataset is associated to the research article “Differences in bread protein digestibility traced to wheat cultivar traits” [1].

IntroductionDual-task training may be relevant and efficient in the context of active aging. An issue in training programs lies in enhancing the adherence of participants. This can potentially be improved using games as support. We designed and developed a custom interactive exergame in this way. The objective of this pilot study was to explore the potential use of this exergame and the feasibility of our intervention, including the level of safety and adherence. The result’s trends on cognitive and motor capacities, as well as on the level of motivation for physical activity, fear of falling, and quality of life of participants, were also explored.MethodsOlder adults aged 65 years or older were recruited and realized 30 min of supervised training in groups of 4, 2–3 times a week for 12 weeks. Exercises consisted of incorporated cognitive and motor dual tasks, with an increased difficulty over the weeks. Our program’s safety, engagement, attendance, and completion levels were evaluated. Participants’ postural control in single-task and dual-task conditions, as well as their performances in mental inhibition, flexibility, working memory, mobility, and postural control, and their levels of motivation for physical activity, fear of falling, and quality of life were also assessed. We realized a per protocol statistical analysis with a p-value set at 0.05.ResultsThirty-nine participants (aged 84.6 ± 8.5 years) were recruited. No adverse events, and 89% adherence, 88% attendance, and 87% completion rates were observed. A potentially significant effect of our exergame on working memory in single-task conditions and on the cognitive aspect of dual-task conditions was also observed. We observed no differences in other parameters.DiscussionOur exergame seemed feasible and safe and was enjoyed by participants, mainly due to the gamification of our training program. Moreover, our exergame may be efficient for cognitive training in older adults, as well as for the maintenance of motor functions, motivation for physical activity, fear of falling, and quality of life levels. This constitutes the first step for our solution with interesting results that need to be further studied.

BackgroundThe physical and cognitive loads borne during exergaming may differ from more conventional cognitive-motor dual-task trainings. ObjectiveThe aim of this pilot transversal study was to compare objectively measured and perceived exercise intensity during exergame, cognitive-motor dual-task, and single-task training sessions. MethodsWe recruited apparently healthy young adults who carried out one session of each type of training: exergaming, cognitive-motor dual-tasking, and single-tasking. We used a custom-made exergame as support. The sessions lasted 30 minutes, were spaced at least 24 hours apart, and took place in random order for each group of 4 participants. We used heart rates to assess exercise intensity and the modified Borg scale to assess perception of intensity. In all, 16 apparently healthy young participants carried out all sessions. ResultsThere was no difference between the different types of training in mean heart rates (P=.27), peak heart rates (P=.50), or Borg scale scores (P=.40). Our custom-made exergame’s objectively measured and perceived physical load did not differ between cognitive-motor dual-task and single-task training. ConclusionsAs a result, our exergame can be considered to be as challenging as more traditional physical training. Future studies should be conducted in older adults with or without cognitive impairments and incorporate an assessment of cognitive performance.

Background: Telerehabilitation and follow-up techniques have been developed in recent years to assess the effectiveness of diverse intervention programmes that include exergaming technologies. For patients with upper limb impairment after stroke, motion-gaming technologies can provide effective and amusing training. Beyond efficiency, professionals must analyse patient compliance with the system for self-use at home, because patients may or may not independently perform the exercises prescribed by the therapist. Questions on the sustainable use of this type of home exercise also arise. Objective: This review examines user compliance with exercise programmes, measured according to the training rate (percentage of prescribed sessions and minutes completed) and completion rate (number of drop-outs and discontinued interventions) reported or calculable according to the data collected. Results and discussion: Rates of compliance with training were relatively high. No group effect on compliance was found. Drop-out and discontinued intervention rates were either due to external causes or directly related to the technologies. Some studies have reported the use of supervision, most of them through home visits and remote support. Few studies performed long-term follow-up, which could provide information to help broaden practices. This narrative review considers how this field of research may evolve in the future. LAY ABSTRACT The use of video games in hospitals as a rehabilitation tool in neurology is developing, particularly for stroke victims. For patients with arm problems, it can be effective and fun to use gamified systems. When the patient goes home, they must continue their rehabilitation in order to continue to progress or maintain their skills. However, performing exercises alone at home raises questions about patients’ compliance with the exercises prescribed by their therapists. Do patients complete the prescribed sessions? Are there occasional or permanent interruptions? This narrative review attempts to address these questions. The review also examines the obstacles that might hinder the use of these technologies and the facilitators that may help compliance.

Le vieillissement s’accompagne d’une diminution des capacités cognitives et motrices, représentant une augmentation du risque de chutes. Nous pouvons pallier cette dégradation par le biais d’entraînements spécifiques ; toutefois, les seniors peuvent manquer de motivation à entamer, poursuivre et respecter ces programmes d’entraînements. Une solution possible est le passage par les jeux vidéo. L’objectif du projet INCOME est d’évaluer les effets d’un programme d’entraînement ayant pour support un exergame sur différents paramètres chez des personnes âgées vivant en résidence autonomie municipale de la Ville de Limoges. Pour répondre aux besoins spécifiques des seniors, l’unité de recherche HAVAE et l’école 3iL ont conceptualisé et développé un exergame. Une étude pilote exploratoire teste ce jeu auprès de 40 personnes âgées via un entraînement de 30 minutes, 3 fois par semaines durant 3 mois. Ici, nous décrivons le contexte scientifique, la genèse et le contenu du projet, ainsi que des résultats préliminaires concernant la réception de ce jeu par le public.

Cet article tend à réfléchir sur les facteurs motivationnels liés à l’usage de jeux vidéos dans l’auto-rééducation des membres supérieurs des patients victimes d’un Accident Vasculaire Cérébral à domicile. L’enjeu est notamment de procurer aux utilisateurs un outil utile pour leur rééducation tout en maintenant leur motivation. A partir de la littérature, nous avons recensé divers facteurs se rapportant à la dimension de la motivation. Il ressort de ces lectures que la compréhension explicite des personnes est nécessaire pour augmenter l’intérêt des usagers pour des programmes vidéo ludiques. L’expérience utilisateur est au cœur des stratégies de développement des futurs dispositifs, et il est nécessaire que cette démarche se poursuive dans le domaine de la rééducation neurologique à domicile.

Background and objective: Duration of rehabilitation and active participation are crucial for gait rehabilitation in the early stage after stroke onset. Virtual reality (VR) is an innovative tool providing engaging and playful environments that could promote intrinsic motivation and higher active participation for non-ambulatory stroke patients when combined with robot-assisted gait training (RAGT). We have developed a new, fully immersive VR application for RAGT, which can be used with a head-mounted display and wearable sensors providing real-time gait motion in the virtual environment. The aim of this study was to validate the use of this new device and assess the onset of cybersickness in healthy participants before testing the device in stroke patients. Materials and Methods: Thirty-seven healthy participants were included and performed two sessions of RAGT using a fully immersive VR device. They physically walked with the Gait Trainer for 20 min in a virtual forest environment. The occurrence of cybersickness, sense of presence, and usability of the device were assessed with three questionnaires: the Simulator Sickness Questionnaire (SSQ), the Presence Questionnaire (PQ), and the System Usability Scale (SUS). Results: All of the participants completed both sessions. Most of the participants (78.4%) had no significant adverse effects (SSQ < 5). The sense of presence in the virtual environment was particularly high (106.42 ± 9.46). Participants reported good usability of the device (86.08 ± 7.54). Conclusions: This study demonstrated the usability of our fully immersive VR device for gait rehabilitation and did not lead to cybersickness. Future studies should evaluate the same parameters and the effectiveness of this device with non-ambulatory stroke patients.

Dans un contexte pandémique, la formation des soignants des Établissements d’Hébergement pour Personnes Âgées Dépendantes (EHPAD) à la gestion des mesures de protection est un véritable enjeu de santé publique. En effet, leurs déplacements loin de leurs affectations doivent restés limités (coût, raréfaction du personnel), et la venue de formateurs sur sites augmente les risques de contamination. La délivrance de ces formations en réalité virtuelle permettrait d’assurer une formation de qualité tout en réduisant ces écueils. De plus, elle présente l’intérêt de mieux former les soignants par le vécu de situation proche de la réalité grâce à l’immersion. Malgré ces nombreux avantages, aucune application en réalité virtuelle n’a été développée pour la formation des soignants dans le cadre de la situation pandémique de la COVID-19. Le but de ce projet est d’évaluer la faisabilité de proposer aux personnels des EHPAD une formation en réalité virtuelle à la prévention du risque COVID et à la gestion de patients COVID. Nous avons développé, au sein du Centre de Simulation Virtuelle en Santé (CSVS) de l’Université de Limoges, une application numérique offrant 10 modules de formation (7 modules sur les gestes à adopter en chambre et 3 modules sur la gestion mortuaire). Parallèlement, nous proposons des modules d’entrainement à travers deux chambres des erreurs en réalité virtuelle qui portent sur le contenu des modules de formation. Les résultats préliminaires de cette étude montrent que ce type de formation est considéré comme pertinent par les soignants, mais ils n’ont pas été satisfaits de la thématique du contenu (COVID-19) car elle est jugée trop lassante. Ce travail ouvre également de nombreuses perspectives dont le développement de nouvelles applications en formation continue.

La réalité virtuelle semble offrir de nouvelles perspectives en santé, notamment concernant le retour à domicile de personnes en situation de handicap. Parmi les systèmes virtuels, le Cave Automatic Virtual Environment (CAVE) permettrait de reproduire virtuellement le domicile d’une personne et de faciliter les propositions et les explications d’aménagements de l’ergothérapeute. L’objectif principal de l’étude est de documenter la perception des ergothérapeutes sur l’intérêt du CAVE dans le retour à domicile. L’objectif secondaire est d’identifier et de hiérarchiser les aménagements prioritaires afin de les intégrer au CAVE. Un questionnaire en ligne a été réalisé et transmis via SphinxOnline à des ergothérapeutes participant au projet de retour à domicile de personnes en situation de handicap et réalisant au minimum une visite à domicile par mois. Sur les 50 ergothérapeutes ayant répondu au questionnaire, 82 % pensent que l’utilisation de technologies immersives telles que le CAVE permettrait d’améliorer le projet de retour à domicile de patients. Les réponses des ergothérapeutes ont permis d’identifier 26 produits (évier avec assise évidée, plan de travail, lit médicalisé, chaise percée, barres d’appui, baignoire et douche à siphon de sol, etc.) à intégrer en priorité à la bibliothèque numérique d’un CAVE. Il semble que les ergothérapeutes perçoivent l’intérêt d’utiliser le CAVE dans la préparation du retour à domicile de patients en perte d’autonomie. Néanmoins, il convient de mener de nouvelles enquêtes pour confirmer et compléter cette première liste de produits à intégrer dans la bibliothèque numérique et des études interventionnelles pour valider la faisabilité de l’utilisation du CAVE dans le contexte du retour à domicile. _____________________________________________________________________________________________________________ Occupational therapy and virtual reality for the return home Virtual reality seems to offer new perspectives in health, particularly regarding home discharge after intensive rehabilitation. Virtual systems such as CAVE would make it possible to virtually reproduce a person's home and explore potential solutions for home adaptation before discharge. The primary outcome of this study is to evaluate occupational therapists’ interest for the use of CAVE in decision making regarding patients’ home discharge. The secondary outcome is to identify and prioritize main home adaptations that can be integrated into the CAVE to facilitate the process of returning home for people with disabilities. Data were collected through an online survey using SphinxOnline. Participants were occupational therapists involved in the activities for the return home of people with disabilities with at least one home visit per month. Out of the 50 occupational therapists who responded to the questionnaire, 82 % believed that the use of immersive technology, such as CAVE, would improve home discharge process for people with disabilities. Participants identified 26 products (hollow sink, worktop, medical bed, commode chair, grab bars, bath and floor drain shower, etc.) that should be included as a priority in the digital library for the CAVE. It seems that occupational therapists perceive an interest in using the CAVE to ensure the return home of patients with loss of autonomy. Nevertheless, further studies are needed to establish appropriate list of products to be integrated into the digital library and to evaluate the feasibility of using CAVE in the context of home discharge.

Increasing cerebral oxygenation, more precisely the overactivation of the prefrontal cortex (PFC), reflects cortical control of gait in stroke disease. Studies about the relationship between brain activation and the functional status in stroke patients remain scarce. The aim of this study was to compare brain activation, gait parameters, and cognitive performances in single and dual tasks according to the functional status in subacute stroke patients. Twenty-one subacute stroke patients were divided in two groups according to Barthel Index (“low Barthel” and “high Barthel”) and randomly performed ordered walking, cognitive task (n-back task), and dual tasks (walking + n-back task). We assessed gait performances (speed, variability) using an electronic walkway system and cerebral oxygenation (ΔO2Hb) by functional near-infrared spectroscopy. Patients with better functional status (high Barthel) showed a lower PFC activation (ΔO2Hb) and better gait parameters in single and dual tasks compared to low-Barthel patients, who exhibited decreased gait performances despite a higher PFC activation, especially in the unaffected side (P < 0.001). PFC overactivation in less functional subacute stroke patients may be due to the loss of stepping automaticity. Our results underline the interest of proposing rehabilitation programs focused on walking, especially for patients with low functional capacity.

Background: Walking represents a major component of physical activity (PA), and its restriction could degrade autonomy and quality of life. An important objective for preventive and/or rehabilitative strategies to improve balance and gait in normal and pathological aging conditions is to focus on physical activity. Activity monitors have recently been getting increasingly popular and represent a modern solution to measure—and communicate—PA notably in terms of steps/day. These activity monitors are well-suited for various populations as they can be worn on a variety of locations on the body, including the wrist and the hip (i.e., the two most common locations), in an undifferentiated way according to the manufacturer's instruction. The aim of this study was hence to verify potential differences in step count (SC) by comparing this parameter assessed using wrist- and hip-worn activity trackers over a 24-h period in free-living conditions in young and older adults.Methods: Young adults (n = 22) and older adults (n = 22) voluntarily participated in this study. They were required to wear two commercially-available Actigraph GT3X+ activity monitors simultaneously at two locations recommended by the manufacturer, i.e., one positioned around the wrist and one above the hip, over a 24-h period in free-living conditions. The manufacturer's software was used to obtain estimates of the SC.Results: For both groups, the wrist-worn activity tracker provided significantly higher SC than the hip-worn activity tracker did. For both placements on the body, older adults exhibited significantly lower SC than young adults. Interestingly, for both young and older participants, the difference between both measurements tended to decrease for longer distances.Conclusion: The different estimations of the step count provided by the comparison between two identical Actigraph GT3x on the wrist or the hip during the 24-h observation period in free-living conditions in young and older adults strongly suggests that caution is needed when using total step per day values as an outcome to quantify walking behavior. Probably we can suggest the same caution across implementation of different activity Tracker.

Stroke patients often exhibit difficulties performing a cognitive task while walking, defined as a dual task (DT). Their prefrontal cortex (PFC) activity is higher in DT than in single task (ST). The effects of an increasing load on PFC activity during DT in subacute stroke patients remains unexplored. Our objective was to assess the effects of N-back tasks (low/high load) on cerebral activity, gait parameters, and cognitive performances. Eleven subacute stroke patients (days post-stroke 45.8 ± 31.6) participated in this pilot study (71.4 ± 10 years, BMI 26.7 ± 4.8 kg.m−2, Barthel index 81.8 ± 11.0). Patients completed a STwalk, and 4 conditions with 1-back (low load) and 2-back (high load): STlow, SThigh, DTlow, and DThigh. Overground walking was performed at a comfortable pace and -N-back conditions were carried out verbally. Both gait (speed, stride variability) and cognitive (rate of correct answers) performances were recorded. Changes in PFC oxyhemoglobin (ΔO2Hb) and deoxyhemoglobin (ΔHHb) were measured by functional near infrared spectroscopy (fNIRS). Results showed an increase of ΔO2Hb while walking, which was not augmented by cognitive loads in DT. Walking speed was reduced by low and high cognitive loads in DT compared to STwalk (P < 0.05), but was not different between DTlow and DThigh. Cognitive performances were negatively impacted by both walking (P < 0.05) and cognitive load (between “low” and “high,” P < 0.001). These data highlight a “ceiling” effect in ΔO2Hb levels while walking, leaving no available resources for simultaneous cognitive tasks, during the early recovery period following stroke. In these patients, cognitive, but not motor, performances declined with a higher cognitive load.

People who survive a stroke are often left with long-term neurologic deficits that induce, among other impairments, balance disorders. While virtual reality (VR) is growing in popularity for postural control rehabilitation in post-stroke patients, studies on the effect of challenging virtual environments, simulating common daily situations on postural control in post-stroke patients, are scarce. This study is a first step to document the postural response of stroke patients to different challenging virtual environments. Five subacute stroke patients and fifteen age-matched healthy adults were included. All participants underwent posturographic tests in control conditions (open and closed eyes) and virtual environment without (one static condition) and with avatars (four dynamic conditions) using a head-mounted device for VR. In dynamic environments, we modulated the density of the virtual crowd (dense and light crowd) and the avoidance space with the avatars (near or far). Center of pressure velocity was collected by trial throughout randomized 30-s periods. Results showed that more challenging conditions (dynamic condition) induced greater postural disturbances in stroke patients than in healthy counterparts. Our study suggests that virtual reality environments should be adjusted in light of obtaining more or less challenging conditions.