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Background After a stroke, experts recommend regular monitoring and kinematic assessments of patients to objectively measure motor recovery. With the rise of new technologies and increasing needs for neurorehabilitation, an interest in virtual reality has emerged. In this context, we have developed an immersive virtual reality version of the Box and Block Test (BBT-VR). The aim of this study was to assess the concurrent validity of the BBT-VR among patients with stroke and healthy participants. Methods Twenty-three healthy participants and 22 patients with stroke were asked to perform the classical Box and Block Test (BBT) and BBT-VR three times with both hands. Concurrent validity was assessed through correlations between these two tests and reliability of the BBT-VR through correlation on test–retest. Usability of the BBT-VR was also evaluated with the System Usability Scale. Hand kinematic data extracted from controller’s 3D position allowed to compute mean velocity (Vmean), peak velocity (Vpeak) and smoothness (SPARC). Results Results showed strong correlations between the number of blocks displaced with the BBT and the BBT-VR among patients with stroke for affected (r = 0.89; p < 0.001) and less-affected hands (r = 0.76; p < 0.001) and healthy participants for dominant (r = 0.58; p < 0.01) and non-dominant hands (r = 0.68; p < 0.001). Reliability for test–retest was excellent (ICC > 0.8; p < 0.001) and usability almost excellent (System Usability Scale = 79 ± 12.34%). On average participants moved between 30 and 40% less blocks during the BBT-VR than during the BBT. Healthy participants demonstrated significantly higher kinematic measures (Vmean = 0.22 ± 0.086 ms−1; Vpeak = 0.96 ± 0.341 ms−1; SPARC = − 3.31 ± 0.862) than patients with stroke (Vmean = 0.12 ± 0.052 ms−1; Vpeak = 0.60 ± 0.202 ms−1; SPARC = − 5.04[− 7.050 to − 3.682]). Conclusion The BBT-VR is a usable, valid and reliable test to assess manual dexterity, providing kinematic parameters, in a populat

Background: The MyotonPro is a portable device for measuring biomechanical and viscoelastic properties in superficial soft tissues. The aims of this study are firstly to validate the MyotonPro compared to a reliable gold-standard frame and secondly to observe the influence of MyotonPro measurement on the total wrist viscoelasticity. Methods: Three silicone polymers with different elastic properties were assessed with the MyotonPro and with a reference rheometer (Universal Tribometer Mod). Then, a free oscillations method was used to measure the passive elastic and viscous stiffness of the wrist and compared to MyotonPro forearm measurements. Results: A one-way ANOVA demonstrated the validity of the MyotonPro's stiffness (p = 0.001), decrement (p < 0.001), and relaxation (p = 0.008) parameters for measuring the elastic stiffness (k) of the three polymers. The MyotonPro parameters demonstrated excellent reliability on the forearm. Proximal and distal anterior myofascial measurements of the MyotonPro were moderately correlated to the elastic stiffness (p = 0.0027–0.0275, absolute r = from 0.270 to 0.375) of the wrist while the postero-distal myofascial tissues of the forearm demonstrated a moderate correlation with the viscous stiffness of the wrist (p = 0.0096–0.0433, absolute r = from 0.257 to 0.326). Discussion: The MyotonPro is a valid device for measuring elastic stiffness as well as a portable, affordable, and easy-to-use tool for quantifying the biomechanical properties and viscoelasticity of myofascial tissue in healthy subjects.

Revue de l’importance de l’activité physique, son impact sur la santé en parallèle aux effets néfastes de la sédentarité, le grand fléau de notre époque. Dans ce contexte s’insère le plan d’action de l’Organisation Mondiale de la Santé pour promouvoir l’activité physique. La présentation couvrira les principaux éléments de ce plan d’action. Finalement, nous sommes intimement liés à la nature à tout point de vue. La présentation passera en revue les dernières évidences sur l’importance de l’activité physique en pleine nature. Chaque élément sera mis sous le prisme du rôle des professionnels de la santé.

The letter reports an observational study, which our group has undertaken, to evaluate the effect of the Covid-19 lockdown among individuals with a spinal cord injury in Belgium. The primary focus of the study was the impact of the lockdown on physical activity levels, as the literature shows that individuals with a physical disability, such as spinal cord injury, particularly benefit from physical activity. The report was written in accordance to the STROBE guidelines.

Only a few data associated to wearability of facemask during exercise are available in children. The aim of the study was to evaluate the effect of wearing a facemask on perceived exertion (primary aim), dyspnea, physical performance, and cardiorespiratory response during a submaximal exercise test in children aged between 8 and 12 years. This study was performed in 2021 in healthy volunteer children from 8 to 12 years. They performed prospectively two 1-min sit-to-stand tests (STST), with or without a surgical facemask. The perceived exertion (modified Borg scale), dyspnea (Dalhousie scale), heart rate, and pulsed oxygen saturation were recorded before and after STST. The STST measured the submaximal performance. Thirty-eight healthy children were recruited (8-9 years: n = 19 and 10-11 years: n = 19). After the STST, the perceived exertion increased with or without a facemask (8-9 years group: + 1 [0.6; 1.4] and + 1.6 [1.0; 2.1] - 10-11 years group: + 1.3 [0.7; 1.8] and + 1.9 [1.3; 2.6]) and it was higher with the facemask. The difference between the two conditions in perceived exertion was not clinically relevant in any group (mBorgf: 0.56 pts and 0.68 pts, respectively). The different domains of dyspnea assessed with Dalhousie scale were not influenced by the facemask. The submaximal performance measured by the STST was not changed by the mask whatever the age group. The cardio-respiratory demand was not clinically modified.Conclusion: The surgical facemask had no impact on dyspnea, cardiorespiratory parameters, and exercise performance during a short submaximal exercise in healthy children.

INTRODUCTION: Ankle arthropathy is highly prevalent among people with haemophilia (PwH), even with prophylaxis, and leads to pain and disability. Mechanisms and consequences of painful symptoms related to ankle arthropathy have not been extensively studied. METHODS: A consecutive sample of 30 adult PwH was included (60 ankles). Ankle structure was assessed with magnetic resonance imaging (IPSG-MRI) and ultrasound (HEAD-US). The HJHS 2.1 assessed function of ankles and knees. Physical functioning was assessed with the Timed Up and Go test, the 2-Minute Walking Test and activity limitations with the HAL questionnaire. Health-related quality of life was evaluated using the EQ-5D-5L questionnaire. Overall pain severity was examined using the Brief Pain Inventory questionnaire and ankle pain intensity with a visual analogue scale. Pressure pain thresholds with an algometer assessed pain sensitivity. Spearman correlations were used to calculate interrelations between joint structure, function and pain. RESULTS: Twenty-five PwH (83%) reported ≥1 painful joint, with 67% reporting the ankle as most painful joint. MRI-confirmed abnormalities were seen in 76% of talocrural and 55% of subtalar joints. HEAD-US abnormalities were seen in 93% of the ankles. A large variation was seen in pain sensitivity at the ankle. While moderate to high correlations were observed between ankle structure and HJHS, no meaningful correlations were found between MRI-scores and pain intensity or sensitivity. CONCLUSIONS: Structural joint damage is present in many ankles but is not related to pain in PwH. Further studies should consider somatosensory nervous system dysfunction in PwH as contributing factor to painful ankle arthropathy.

Intérêt de la réalité virtuelle dans la rééducation des cérébro-lésés. Quelles évidences ?

Serious Game in Stroke Rehabilitation

The mainstay of hemophilia treatment is to prevent bleeding through regular long-term prophylaxis and to control acute breakthrough bleeds. Various treatment options are currently available for prophylaxis, and treatment decision-making is a challenging and multifaceted process of identifying the most appropriate option for each patient. A multidisciplinary expert panel convened to develop a practical, patient-oriented algorithm to facilitate shared treatment decision-making between clinicians and patients. Key variables were identified, and an algorithm proposed based on five variables: bleeding phenotype, musculoskeletal status, treatment adherence, venous access, and lifestyle. A complementary, patient-focused preference tool was also hypothesized, with the aim of exploring individual patients' priorities, preferences, and goals. It is hoped that the proposed algorithm and the hypothesized patient preference tool will assist in selecting a treatment for each patient that is as efficient as possible in preventing bleeds while also accounting for the patient's expectations and priorities.

Upper limb loss alters individuals’ private and professional life. Prosthetic devices are thus a solution to supply the missing upper limb segments. Nevertheless, commercial prostheses are often unaffordable, or inaccessible, to underprivileged individuals (e.g., no health insurance, low incomes, warzone). Among potential affordable alternatives, additive manufacturing, commonly “3D printing”, has been increasingly employed. This technology offers higher availability and accessibility, and can produce complex geometrical and highly customized products, which are essential features for prostheses manufacturing. Therefore, this study aims to portray an overview of reliable open-source upper limb 3D-printed prostheses currently available. We thus searched the scientific literature and online repositories hosting 3D-printable designs. We extracted data relative to mechanical and kinematic properties, 3D printing process and efficacy for each device. We found six studies implementing open-source 3DP upper limb prostheses and twenty-five open-source designs from online databases meeting selection criteria. Devices’ technical specifications were not systematically reported. In conclusion, though open-source 3D-printed upper limb prostheses can perform some functional tasks and grasps, and are widely employed to supply limb differences, further research is mandatory to validate their usage and to prove their clinical efficacy. More guidelines are required to unify contributions from private makers and non-governmental organizations with scientific groups.

Interest of virtual reality to assess and rehabilitate motor impairments after stroke

Interest of combining robotics and serious game for stroke rehabilitation

Background Recent developments in wearable powered exoskeletons (WPE) allow gait training (GT) for patients after spinal cord injury (SCI). Two recent meta-analyses on GT using WPE showed promising results for paraplegic patients (PP). To this date, there is no review focusing on tetraplegic patients (TP). Objectives ThemainobjectiveofthisreviewwastoassessfeasibilityandsafetyofGTusingWPEinpatientsaftertetraplegia. Method This systematic review was performed according to PRISMA-S guidelines. Two independent reviewers searched several databases for studies on GT using WPE for TP. Primary outcomes concerned the number, type and severity of reported adverse events (AE). Secondary outcomes examined potential additional health benefits (AHB). Results Forty-one studies (6 randomized trials, 24 cohorts and 11 cases series) were selected, including 166 TP, 26 with complete lesions (AIS A) and 71 with level of injury above C6. Minor AE were reported in 17 TP, concerning cutaneous, cardiovascular or musculoskeletal systems. Occurrence of AE is significantly higher in a PP population compared to TP (p value = 0.001). Only one major AE concerned a TP. Studies of low level of evidence suggest that GT using WPE could lead to improvements in walking parameters, cardiovascular efficiency and to a reduction of spasticity. Discussion and conclusion GT using WPE is a feasible and safe intervention for TP. To minimize occurrence of AE, a good patient selection and preparation is proposed. Future clinical trials should be performed to confirm current trends in terms of efficacy and potential AHB.

Background Prevention of chronic pain relies on accurate detection of at-risk patients. Screening tools have been validated mainly in (sub) acute spinal pain and the need of more generic tools is high. We assessed the validity of the French version of the short Örebro Musculoskeletal Pain Screening Questionnaire (ÖMPSQ) in patients with a large range of pain duration and localization. Methods First, we re-analyzed data from a 6-month longitudinal study of 73 patients with (sub) acute spinal pain consulting in secondary line settings. Secondly, we performed a new 12-month longitudinal study of 542 primary care patients with (sub) acute and chronic pain in different localizations (spinal, limbs, “non-musculoskeletal”). The area under the receiver operating characteristic curve and cutoff scores were computed and compared for different subpopulations and ÖMPSQ subscores. Results Data from patients suffering from (sub) acute and chronic spinal pain consulting in both primary and secondary care settings confirmed the validity of the short French ÖMPSQ version and its subsets. In the primary care cohort, the performance of the questionnaire and its psychosocial subscore was variable but at least “fair” in most populations ((sub) acute and chronic, spinal and limb pain). Cutoff scores showed quite large variability depending on the outcome and the subpopulation considered. Conclusions These results confirm the usefulness of the short French ÖMPSQ for prediction of the evolution of (sub) acute and chronic patients with spinal and limb pain, whatever its duration. However, increasing population heterogeneity results in slightly worse predictive performance and largely variable cutoff scores. Consequently, it might be difficult to choose universal cutoff scores and other criteria, such as patients’ values and the available resources for patient management, should be taken into account.

Assessing the functional level of children with severe cerebral palsy (CP) requires sensitive tools. In this study, an 'assessment tool' was developed based on the Test of Infant Motor Performance (TIMP) for this population and the reliability and validity evaluated. Five physical therapists administered the 'assessment tool' to six children (3-6 years old with a diagnosis of CP, GMFCS Level V). Subtest I of the Gross Motor Function Measure (GMFM-88) was also administered. Intra- and inter-rater reliability were assessed, and the concurrent validity between the 'assessment tool' and GMFM-88 calculated. The intra-rater reliability, a comparison of the total scores on the 'assessment tool' (live test) and the videotaped rescoring of the same test one month later showed consistency among four of the five therapists (ICC =0.7545 to 0.979). The inter-rater reliability varied on some of the items but the total score on the 'assessment tool' showed good reliability (ICC 0.816). Scores of children with dyskinesia were less stable. The Spearman's rank correlation coefficient was not significant. Therapists provided recommendations for item revisions. Further development of an 'assessment tool' appears justified; a larger study using a version with revised administration guidelines and items should be undertaken to re-verify the psychometrics properties of the 'assessment tool.'

Stratified approaches to spinal pain that address psychosocial risk factors reduce long-term disability to a moderate extent. Identifying and managing other risk factors might help improve outcomes. This systematic review of longitudinal studies aimed to evaluate possible associations between the onset of chronic spinal pain (including low back, back and neck pain) and putative modifiable lifestyle-related risk or protective factors. This systematic review of longitudinal studies published during the last 2 decades followed PRISMA guidelines. Two reviewers screened Medline, Scopus, Pedro, Cochrane Library, Psycinfo, Science Direct, PTSDpubs and Google Scholar for relevant studies. The QUIPS tool was used to assess the risk of bias. A qualitative meta-synthesis of relevant factors was performed. Of 3716 unique records, 14 studies met the inclusion criteria (10 with low risk of bias and 4 moderate risk of bias). The highest bias observed was attrition. For chronic low back pain, we found moderate evidence for the involvement of high body weight, waist circumference, and hip circumference and conflicting evidence for high body mass index (BMI), smoking, and physical activity. For chronic neck pain, we found strong evidence for high BMI in women, moderate evidence for sleep disorders in women and conflicting evidence for high BMI in men and physical activity. For chronic back pain, we found limited evidence for gardening/yard work in men and more than one adult at home. Effect sizes were small. Several modifiable lifestyle-related factors were identified. Evidence is still sparse and there is a need for more studies. PROSPERO database registration: Ref 172,112 CRD42020172112.

BACKGROUND: Treating hypoxemia while meeting the soaring demands of oxygen can be a challenge during the COVID-19 pandemic. OBJECTIVE: To determine the efficacy of the surgical facemask and the double-trunk mask on top of the low-flow oxygen nasal cannula on arterial partial pressure of oxygen (PaO2) in hypoxemic COVID-19 patients. DESIGN: Randomized controlled trial. PARTICIPANTS: Hospitalized adults with COVID-19 and hypoxemia treated with the low-flow nasal cannula were enrolled between November 13, 2020, and March 05, 2021. INTERVENTIONS: Patients were randomized in a 1:1:1 ratio to receive either the nasal cannula alone (control) or the nasal cannula covered by the surgical facemask or the double-trunk mask. Arterial blood gases were collected at baseline and 30 min after the use of each system. The oxygen output was adapted afterwards to retrieve the baseline pulse oxygen saturation. The final oxygen output value was recorded after another 30-min period. MAIN MEASURES: The primary outcome was the absolute change in PaO2. Secondary outcomes included changes in oxygen output, arterial partial pressure of carbon dioxide (PaCO2), vital parameters, and breathlessness. KEY RESULTS: Arterial blood samples were successfully collected in 24/27 (8 per group) randomized patients. Compared to the nasal cannula alone, PaO2 increased with the surgical facemask (mean change: 20 mmHg, 95% CI: 0.7-38.8; P = .04) and with the double-trunk mask (mean change: 40 mmHg; 95% CI: 21-59; P < .001). Oxygen output was reduced when adding the surgical facemask (median reduction: 1.5 L/min [95% CI: 0.5-4.5], P < .001) or the double-trunk mask (median reduction: 3.3 L/min [95% CI: 2-5], P < .001). The double-trunk mask was associated with a PaCO2 increase of 2.4 mmHg ([95% CI: 0-4.7], P = .049). Neither mask influenced vital parameters or breathlessness. CONCLUSIONS: The addition of the surgical facemask or the double-trunk mask above the nasal cannula improves arterial oxygenation and red

Introduction: To plan treatment and measure post-stroke recovery, frequent and time-bounded functional assessments are recommended. With increasing needs for neurorehabilitation, new technological methods such as virtual reality (VR) have emerged. Here, we developed an immersive VR version of the Action Research Arm Test (ARAT-VR) to complement VR neurorehabilitation. This study aimed to assess the validity, test-retest reliability and usability of the ARAT-VR among individuals with stroke, healthcare professionals and healthy control subjects (HCS). Methods: Eleven healthcare professionals, 30 individuals with stroke, and 25 HCS were recruited. Concurrent validity was measured through correlation between the ARAT-VR and ARAT scores for the individuals with stroke and through scores comparison for the HCS. A third of individuals with stroke and HCS were reseen in a convenient delay to measure testretest reliability. Usability was measured using the System Usability Scale. Results: When assessing paretic hands, the ARAT-VR and classical ARAT were strongly correlated (r=0.84). Test-retest reliability (ICC=0.99; p<0.001) and usability (SUS=82.5[75- 90]) were excellent. Conclusion: The ARAT-VR is a valid, reliable and usable tool to assess hand action among individuals with stroke, providing potential to increase assessment frequency and remote evaluation, particularly for use with VR based neurorehabilitation

BACKGROUND: The perception of dyspnea is a subjective feeling typically self-assessed by the patient. However, the assessment by a caregiver is sometimes required. OBJECTIVES: The primary aim was to compare patient self-assessment and caregiver assessment of dyspnea (interrater reliability) using the modified Borg and visual analog scale (VAS) in hospitalized patients. The secondary aim was to compare dyspnea assessment between the two scales for patients and caregiver (inter-instrument reliability). METHODS: Self-assessment of dyspnea intensity of hospitalized patients with respiratory diseases was compared with caregiver's assessment. Dyspnea intensity was measured using two scales, the modified Borg scale (0-10 scale) and the 10 cm VAS. Mean difference and 95% confidence interval (CI) between assessors (i.e. patient versus caregiver) were calculated for each scale. Inter- and intra-rater reliability was calculated using intraclass correlation coefficients (ICCs). RESULTS: A total of 254 patients were recruited. The mean differences between patient and caregiver ratings were 0.31 (95% CI: 0.09, 0.53) for the modified Borg scale and 0.36 (95% CI: 0.06, 0.65) for the VAS scale. Interrater reliability was good for both scales with ICC of 0.79 (95% CI: 0.73, 0.84) for VAS and 0.82 (95% CI: 0.77, 0.86) for the modified Borg scale. The mean differences in scores between scales were 0.93 (95% CI 0.69, 1.17) for patients' ratings and 0.88 (95% CI 0.72, 1.04) for caregiver's rating. The inter-instrument reliability was moderate to good and similar for both assessors. CONCLUSION: Dyspnea can be accurately estimated by caregivers when patients with lung diseases cannot self-report. Scores on the VAS to rate dyspnea were higher than the scores on the Borg scale.

INTRODUCTION: Despite the fact that joint bleeds (haemarthrosis) frequently occur in people with haemophilia (PwH) with invalidating arthropathies as result, the clinical pain experience has received only limited attention. A sudden increase in pain intensity can be linked to a bleed, but in most cases, no acute bleed is confirmed. Nevertheless, a patient's perception of an acute bleed as cause of the pain might impact the patients' behaviour in response to pain. It is therefore essential to gain more insight into pain coping strategies seen in PwH. AIM: This systematic review aims to identify the range of pain coping behaviour strategies used among PwH and the factors associated with pain coping behaviour. METHODS: This review was reported according to the Preferred Reporting Items for Systematic reviews and Meta-analyses guidelines (PRISMA). PubMed and Web of Science were systematically screened for relevant literature using keyword combinations related to adult PwH, pain and pain coping behaviour strategies. Risk of bias was assessed with the modified Newcastle-Ottowa Scale. RESULTS: Eleven full text articles (nine cross-sectional and two comparative studies) consisting of 1832 PwH met the inclusion criteria. Due to the heterogeneity of the study samples, quality of evaluation instruments and varying risk of bias, it was difficult to draw conclusions regarding the used pain coping behaviour strategies and associated factors. CONCLUSION: Literature on pain coping behaviour strategies and associated factors in PwH is still scarce and describes heterogenous results. Validated haemophilia-specific instruments are warranted to inventory pain coping behaviour in a standardized way.

Stroke results in various interactive cognitive and motor impairments that requires multidisciplinary rehabilitation. For example, preserved cognitive executive functions predict motor recovery success. Despite these links, the evaluation of executive function in hemiparesis patients remains underexplored. Here we developed a virtual reality serious game that measures inhibition based on the visual search paradigm of Treisman (1980). Our objective was to evaluate the serious game feasibility. Twenty individuals with first stroke hemiparesis and twenty age-matched healthy controls were recruited. They were instructed to find a target mole presented amongst distractor moles. The stimulus array consisted of grid of 6 columns and 4 rows of mole hills, from which the target and 11, 17 then 23 distractor moles could randomly appear, in two search conditions (single feature condition and conjunction condition). Responses were made with the ipsilesional hand for individuals with stroke and with the dominant hand for healthy participants, by hitting the target using a virtual hammer. The target appeared in every possible location in the grid (24) for each condition combination (144 trials). Participants were significantly slower in the conjunction compared to single feature condition significantly slower with increased numbers of distractors and significantly slower for individuals with hemiparesis compared to controls. A significant interaction between search condition and distractors showed that reaction time only increased with distractor number for the conjunction condition, with no further interaction between participants. The serious game can successfully evaluate inhibition. However, these preliminary results show no evidence that hemiparesis patients have inhibition impairments.

Background and aims Hemineglect is an attentional disorder characterized by spatial and non-spatial (inhibition) attention deficits. Currently, there is no systematic evaluation of both attention components in clinical tests. Our aim was to create an innovative integrative measure combining the assessment of spatial and non-spatial attention. using a virtual reality serious game based on the visual search paradigm of Treisman (1980) Methods: We tested sixty healthy participants. They were asked to perform a target search task where the spatial target was a mole wearing a red helmet. In a feature search condition, the distractors were moles wearing blue helmets (with and without horns). In a conjunction search condition, the distractors were moles wearing blue helmet or a red helmet with horns. Responses were made with the dominant hand by hitting the target with a virtual hammer. Results: Reaction time results demonstrated a significant effect of search tasks and distractors (F(1,57) = 2175.6, p = 0.000; F (2,114) = 97.3, p = 0.000 respectively). Participants were significantly slower in the conjunction compared to feature search task, and they were slower when the number of distractors increased. A significant interaction between search tasks and distractors (F(2,114) = 106.4, p = 0.000) showed that reaction time only increased with distractor number for the conjunction search task. Conclusion: The innovative virtual reality serious game results replicate the Treisman paradigm, providing reliable measures of spatial and non-spatial attention. Future studies will test hemineglect patients in order to deepen the understanding of spatial and non-spatial components of hemineglect.

Background Robot-assisted therapy (RAT) could address an unmet need to relieve the strain on healthcare providers and intensify treatment in the context of an increasing stroke incidence. A comprehensive meta-analysis could provide firmer data about the topic by considering methodology limitations discovered in previous reviews and providing more rigorous evidence. Objective This meta-analysis study identifies RAT's efficacy for patients with stroke. Methods A systematic search of the 7 databases from January 10 to February 1, 2022, located relevant publications. We used the updated Cochrane risk-of-bias checklist for 52 trials to assess the methodologic quality of the included studies. The efficacy of RAT for patients with stroke was estimated using a pooled random-effects model in the Stata 16 software application. Results The final analysis included 2774 patients with stroke from 52 trials. In those patients, RAT was proven to improve quality of movement (mean difference, 0.15; 95% confidence interval, 0.03–0.28) and to reduce balance disturbances (mean difference, −1.28; 95% confidence interval, −2.48 to −0.09) and pain (standardized mean difference, −0.34; 95% confidence interval, −0.58 to −0.09). Conclusions Robot-assisted therapy seems to improve the quality of mobility and reduce balance disturbances and pain for patients with stroke. These findings will help develop advanced rehabilitation robots and could improve health outcomes by facilitating health services for healthcare providers and patients with stroke.

Background: To plan treatment and measure post-stroke recovery, frequent and time-bounded functional assessments are recommended. With increasing needs for neurorehabilitation, new technological methods such as virtual reality (VR) have emerged. Here, we developed an immersive VR version of the Action Research Arm Test (ARAT-VR) to complement VR neurorehabilitation. Objective: This study aimed to assess the validity, test-retest reliability and usability of the ARAT-VR among individuals with stroke, healthcare professionals and healthy control subjects (HCS). Methods: Eleven healthcare professionals, 30 individuals with stroke, and 25 HCS were recruited. Content validity was assessed by asking healthcare professionals to rate the difficulty of performing each item of the ARAT-VR in comparison to the classical Action Research Arm Test (ARAT). Concurrent validity was measured through correlation between the ARAT-VR and ARAT scores for the individuals with stroke and through scores comparison for the HCS. A third of individuals with stroke and HCS were reseen in a convenient delay to measure test-retest reliability. Usability was measured using the System Usability Scale. Results: On average, healthcare professionals estimated that movement difficulty was comparable in the ARAT-VR to those of the classical ARAT except for the items involving marbles. When assessing paretic hands, the ARAT-VR and classical ARAT were strongly correlated (r=0.84). Test-retest reliability (ICC=0.99; p<0.001) and usability (SUS=82.5[75-90]) were excellent. Conclusion: The ARAT-VR is a valid, reliable and usable tool to assess hand action among individuals with stroke, providing potential to increase assessment frequency and remote evaluation, particularly for use with VR based neurorehabilitation.

Serious gaming in virtual reality to assess and rehabilitate motor or cognitive impairments after stroke; The AUTORREVI Project

Robots in neurorehabilitation

The 6-minute walk test (6MWT) is widely used to assess walking capacity among persons with stroke. Whether a shorter and more convenient test, the 2-minute walk test (2MWT) could replace it, was tested. Two retrospective analyses were conducted. The first one was performed on a sample of 20 persons with stroke who performed both the 2MWT and the 6MWT, and the second one, on a group of 82 persons with stroke who performed the 6MWT while measuring the distance covered each minute. Linear regression models were applied to test the validity of 2MWT with regard to 6MWT. In the first group, distances covered during the 2MWT were highly predictive of the distances covered during the 6MWT (estimated adjusted R² = 0.98; P < 0.001). In the second group, distances covered by participants during the first 2 min of the 6MWT were highly and linearly related to the distances they covered during the whole 6MWT (estimated adjusted R² = 0.98; P < 0.001). Furthermore, the distance covered during the first 2 min of the whole 6MWT allowed us to predict 98% of the variance of the 6MWT. Given its good metric properties and its practical advantages, clinicians and researchers could reasonably use the 2MWT when assessing the walking capacity of persons with stroke, instead of the 6MWT.

Background: To plan treatment and measure post-stroke recovery, frequent and time-bounded functional assess- ments are recommended. With increasing needs for neurorehabilitation advances, new technology based methods, such as virtual reality (VR) have emerged. Here, we developed an immersive VR version of the Action Research Arm Test (ARAT-VR) to complement neurorehabilitation. Objective: This study aimed to assess the validity, usability and test–retest reliability of the ARAT-VR among individu- als with stroke, healthcare professionals and healthy control subjects (HCS). Methods: Among the 19 items of the ARAT, 13 items were selected and developed in immersive VR. 11 healthcare professionals, 30 individuals with stroke, and 25 HCS were recruited. Content validity was assessed by asking health- care professionals to rate the difficulty of performing each item of the ARAT-VR in comparison to the classical Action Research Arm Test (ARAT-19). Concurrent validity was first measured using correlation (Spearman tests) between the ARAT-VR and ARAT-19 scores for the individuals with stroke, and second through correlation and comparison between the scores of the ARAT-VR and the reduced version of the ARAT (ARAT-13) for both individuals with stroke and HCS (Wilcoxon signed rank tests and Bland–Altman plots). Usability was measured using the System Usability Scale. A part of individuals with stroke and HCS were re-tested following a convenient delay to measure test–retest reliability (Intra- class correlation and Wilcoxon tests). Results: Regarding the content validity, median difficulty of the 13 ARAT-VR items (0[0 to − 1] to 0[0–1]) evalu- ated by healthcare professionals was rated as equivalent to the classical ARAT for all tasks except those involving the marbles. For these, the difficulty was rated as superior to the real tasks (1[0–1] when pinching with the thumb-index and thumb-middle fingers, and 1[0–2] when pinching with thumb-ring finger). Regarding the concurrent v

Background and Objective: Several risk factors for the onset of CRPS have been found, but evidence for prognostic factors associated with progression of this condition remains sparse. However, detection and management of these factors are necessary to design secondary prevention strategies. The objective of this systematic review was to identify prognostic factors in adult individuals with early CRPS. Database and Data Treatment: PubMed, Embase, PsycINFO, Cochrane Library, and Scopus, published between Jan 1990 and Nov 2021. Two independent investigators selected cross-sectional and longitudinal studies looking at early (<12 weeks from onset) prognostic factors for pain, CRPS severity score, disability, return to work, or Quality of life. The Quality In Prognostic Studies (QUIPS) tool was used to assess the risk of bias. A qualitative meta-synthesis was performed. Results: Out of 4,652 different articles, six studies met inclusion criteria. We identified 21 early factors associated with poorer prognosis in type I CRPS. We found moderate evidence to support six of them: higher pain intensity, self-rated disability, anxiety, pain-related fear, being a female, and high-energy triggering event. Only two studies had an overall low risk of bias. Conclusions: This study showed an important lack of information on early prognostic factors in CRPS. Only one article investigated the link with psychological characteristics. There is a crucial need of larger studies, with well-defined population using validated measures.

Dexterous manipulation of objects heavily relies on the feedback provided by the tactile afferents innervating the fingertips. Previous studies have suggested that humans might take advantage of partial slip, localized loss of grip between the skin and the object, to gauge the stability of a contact and react appropriately when it is compromised, that is, when slippage is about to happen. To test this hypothesis, we asked participants to perform point-to-point movements using a manipulandum. Through optical imaging, the device monitored partial slip at the contact interface, and at the same time, the forces exerted by the fingers. The level of friction of the contact material was changed every five trials. We found that the level of grip force was systematically adjusted to the level of friction, and thus partial slip was limited to an amount similar across friction conditions. We suggest that partial slip is a key signal for dexterous manipulation and that the grip force is regulated to continuously maintain an upper bound on partial slip across friction conditions.

BACKGROUND: Oropharyngeal myofunctional therapy is a multi-component therapy effective to reduce the severity of obstructive sleep apnoea (OSA). However, existing protocols are difficult to replicate in the clinical setting. There is a need to isolate the specific effectiveness of each component of the therapy. OBJECTIVE: To assess the effects of a 6 weeks tongue elevation training programme in patients with OSA. METHODS: We conducted a multicentre randomised controlled trial. Eligible participants were adults diagnosed with moderate OSA who presented low adherence to continuous positive airway pressure therapy (mean use <4 h per night). The intervention group completed a 6 weeks tongue elevation training protocol that consisted in anterior tongue elevation strength and endurance tasks with the Iowa Oral Performance Instrument. The control group completed a 6 weeks sham training protocol that involved expiratory muscle training at very low intensity. Polygraphy data, tongue force and endurance, and OSA symptoms were evaluated pre- and post-intervention. The primary outcome was apneoa-hypopnea index (AHI). RESULTS: Twenty-seven patients (55 ± 11 years) were recruited. According to modified intention-to-treat analysis (n = 25), changes in AHI and c did not significantly differ between groups. Daytime sleepiness (Epworth Sleepiness Scale) and tongue endurance significantly improved in the intervention group compared to the control group (p = .015 and .022, respectively). In the intervention group, 75% of participants had a decrease in daytime sleepiness that exceeded the minimal clinically important difference. CONCLUSION: Six weeks of tongue elevation muscle training had no effect on OSA severity.

Dear Editor, Hypoxaemia is a typical feature of the coronavirus disease 2019 (COVID-19). The rapid rise in the number of patients requiring oxygen therapy during the pandemic may cause a sharp increase in oxygen demands and potential threats of supply disruption, particularly in developing countries1 or nursing homes. Moreover, the use of elevated oxygen flows via nasal cannula raises concerns about exhaled air dispersion distance and the potential risk of generating aerosols [...]

Physical activity has shown to be a useful tool in rehabilitating motor deficiencies among individuals with a physical disability. However, when patients are discharged from in-patient rehabilitation, their physical activity levels tend to drop. This is partly due to a lack of opportunity to be physically active through adaptive physical activity and sports (APAS) programmes within communities. This study aimed to identify reasons which limit the development or expansions of the APAS offer, in order to emit guiding points as how these could be overcome. An online survey was completed by 330 different sports clubs and centres in Belgium. Several barriers were identified, including lack of demand from potential candidates and lack of funding for these activities. However, despite these barriers, 44% of the sports clubs and centres reported accommodating individuals with a physical disability nonetheless, and 17% reported offering APAS programmes. There is therefore potential to develop APAS sessions in inclusion with individuals without a disability. Communication between different stakeholders within the sports community, and with health professionals, is urgently needed to improve collaborations. Similarly, partnerships with rehabilitation centres and hospitals should be formed in order to enhance visibility of APAS and boost recruitment of participants. Finally, health professionals should recognise the vital role they play in relaying information to their patients concerning leisure-time physical activity’s benefits, safety and opportunity in their community.

BACKGROUND: Early mobilization during critical illness is safe and has beneficial effects on functional outcomes. However, its impact on pulmonary function has not been thoroughly explored. We hypothesized that a sitting position out of bed coupled with exercise could result in an improvement in oxygenation and lung aeration. METHODS: The study was conducted on a cohort of adult subjects within a week of their admission to an ICU. Subjects were transferred to a chair and undertook a 15-min session of exercise, either active or passive. Subjects in the control group were only transferred to a chair. Electrical impedance tomography, a reliable bedside technique monitoring regional lung aeration and the distribution of ventilation, was continuously performed, and blood gases were assessed at baseline and 20 min post-exercise. RESULTS: The cohort included 40 subjects, 17 of whom were mechanically ventilated and 23 spontaneously breathing. The control group for each modality consisted of 5 mechanically ventilated or 5 spontaneously breathing subjects. Mild hypoxemia was present in 45% of the spontaneously breathing cohort, whereas the mechanically ventilated subjects demonstrated moderate (50%) or severe (12%) hypoxemia. Compared with the control group, early mobilization induced a significant increase in lung aeration. In mechanically ventilated subjects, lung aeration increased, especially in the anterior lung regions (mean impedance [95% CI]: T1 (baseline in bed) = 1,265 [691-1,839], T2 (chair sitting) = 2,003 [1,042-2,963], T3 (exercise) = 1,619 [810 2,427], T4 (post exercise in chair) = 2,320 [1,186-3,455]). In spontaneously breathing subjects, lung aeration increased mainly in the posterior lung regions (mean impedance [95% CI]: T1 = 380 [124-637], T2 = 655 [226-1,084], T3 = 621 [335-906], T4 = 600 [340-860]). P aO2 /F IO2 increased, especially in subjects with lower P aO2 /F IO2 at baseline (< 200) (133 ± 31 to 158 ± 48, P = .041). CONCLUSIONS: For critically ill

Dear Editor, Recent scientific literature supports the use of intensive, activity-based, goal-directed interventions, rather than usual care, to encourage significant motor improvements in children with cerebral palsy (CP) [1], [2], [3]. Among these interventions, the Hand-arm Bimanual Intensive Therapy Including Lower Extremities (HABIT-ILE) proposes the practice of voluntary movement control, with many movement repetitions and progressive shaping in a child-friendly context. In addition to bimanual coordination, it includes continuous stimulation of lower extremities (LEs) and trunk [4]. Few intensive interventions have targeted young children with CP, mainly focusing on the upper extremity (UE) of children with unilateral CP [5], [6], [7], [8]. Therefore, we perceived a need for intensive early interventions targeting the whole spectrum of CP. [...]

PURPOSE: The purpose of this study was to examine variations in lower limb surface electromyography (EMG) activity when individuals walked on different outdoor surfaces and to characterize the different potential motor strategies. METHOD: Forty healthy adult participants walked at a self-selected speed over asphalt, grass, and pavement. They then walked on an indoor treadmill at the same gait speed as observed for each outdoor condition. The EMG activity of the vastus lateralis (VL), tibialis anterior (TA), biceps femoris (BF), and gastrocnemius lateralis (GL) muscles was recorded, and the duration and intensity (root mean square) of EMG burst activity was calculated. RESULTS: Walking on grass resulted in a longer TA burst duration than walking on other outdoor surfaces. Walking on pavement was associated with increased intensity of TA and VL activation compared with the indoor treadmill condition. The variability of EMG intensity for all muscle groups tested (TA, GL, BF, VL) was greatest on grass and lowest on asphalt. CONCLUSIONS: The muscle activity patterns of healthy adult participants vary in response to the different qualities of outdoor walking surfaces. Ongoing development of ambulatory EMG methods will be required to support gait retraining programmes that are tailored to the environment.

Objective: In a pragmatic and randomized clinical trial, patients with lateral ankle sprains were assessed, under blinded conditions, for their responsiveness and improvements during Mulligan mobilization-with-movement (MWM) therapy. Methods: Overall, 51 participants with subacute lateral ankle sprains (Grade I–II) were recruited. Following an MWM screening procedure, responders were randomized to either an intervention group (MWM) or a sham group. The MWM group received inferior tibiofibular, talocrural, or cubometatarsal MWM. The treatment or sham was administered upon three sessions, each 4 days apart. Changes from baseline were measured and compared between the sessions for dorsiflexion range of motion, pain, stiffness perception, and the Y-balance test. Results: In total, 43 participants were considered responders to MWM. Using a two-way repeated-measure ANOVA, a statistical and clinically meaningful improvement in dorsiflexion range of motion was revealed in the MWM group (p = 0.004, 1rst = +1.762 cm; 3rd = +2.714 cm), whereas no improvement following the first session occurred in the sham group (p = 0.454, 1rsttrial = +1.091 cm; 3rdtrial = +1.409 cm). Pain and stiffness significantly improved, yet below the clinically meaningful level. The MWM group demonstrated a significant improvement after three sessions for the Y-balance test (p = 0.001, +8.857 cm). Conclusion: More than 80% of participants with subacute lateral ankle sprains responded well to the MWM approach. Three sessions of pragmatically determined MWM provided a significant and clinically meaningful benefit in dorsiflexion range of motion and Y-balance test performance compared to a sham treatment.

La réalité virtuelle après un accident vasculaire cérébral

Background: Substantial postoperative complications occur after tumor resection for esophagogastric cancers. Physical prehabilitation programs aim to prepare patients for surgery by improving their functional status with the aim of reducing postoperative complications. This systematic review aims to summarize the effects of physical prehabilitation programs on exercise capacity, muscle strength, respiratory muscle function, postoperative outcomes, and health-related quality of life and to determine the optimal design of such a program to improve these outcomes in esophagogastric cancer patients undergoing tumor resection. Methods: A systematic literature review was conducted using PubMed, The Cochrane Library, Scopus, and PEDro databases to identify studies evaluating the effects of physical prehabilitation program on exercise capacity, muscle strength, respiratory muscle function, postoperative complications, length of hospital stay, mortality, and health-related quality of life in patients with esophagogastric cancer awaiting surgery. Data from all studies meeting the inclusion criteria were extracted. The quality of each selected study was determined using the Downs and Black checklist. Results: Seven studies with 645 participants were included. The preoperative exercise program consisted of respiratory training alone in three studies, a combination of aerobic and resistance training in two studies, and a combination of respiratory, aerobic, and resistance training in two studies. Training frequency ranged from three times a day to twice a week and each session lasted between 20 and 75 minutes. Four studies were of fair quality and three of good quality. Some studies reported improvements in maximal inspiratory pressure, inspiratory muscle endurance, postoperative (pulmonary) complications, and length of hospital stay in the preoperative exercise group compared to the control group. Conclusion: This systematic review reports the current evidence for physical preh

Background: Due to rises in stroke incidence, a lack of resources to implement effective rehabilitation and a significant proportion of patients with remaining impairments after treatment, there is an increased demand for effective and prolonged rehabilitation. Development of self-rehabilitation programs provides an opportunity to meet these increasing demands. Objective: The primary aim of this meta-analysis was to determine the motor outcome effectiveness of self-rehabilitation in comparison to conventional rehabilitation among patients with stroke. The secondary aim was to assess the influence of trial location (continent), technology, time since stroke (acute/subacute vs chronic), dose (total training duration > vs ≤ 15 hours) and intervention design (self-rehabilitation in addition/substitution to conventional therapy) on effectiveness. Methods: Studies were selected if participants were adults with stroke; the intervention consisted of a self-rehabilitation program defined as a tailored program where for most of the time, the patient performed rehabilitation exercises independently; the control group received conventional therapy; outcomes included motor function and activity; and the study was a randomized controlled trial with a PEDro score ≥ 5. Results: Thirty-five trials were selected (2225 participants) and accumulated motor outcome data analysed. Trials had a median PEDro Score of 7 [6-8]. Self-rehabilitation programs were shown to be as effective as conventional therapy. Trial location, use of technology, stroke stage and intervention design did not appear to have a significant influence on outcomes. Conclusion: This meta-analysis showed low to moderate certainty of evidence that self-rehabilitation and conventional therapy efficacy was equally valuable for post-stroke motor function and activity.

Background: Approximately two thirds of stroke survivors maintain upper limb (UL) impairments and few among them attain complete UL recovery 6 months after stroke. Technological progress and gamification of interventions aim for better outcomes and constitute opportunities in self- and tele-rehabilitation. Objectives: Our objective was to assess the efficacy of serious games, implemented on diverse technological systems, targeting UL recovery after stroke. In addition, we investigated whether adherence to neurorehabilitation principles influenced efficacy of games specifically designed for rehabilitation, regardless of the device used. Method: This systematic review was conducted according to PRISMA guidelines (PROSPERO registration number: 156589). Two independent reviewers searched PubMed, EMBASE, SCOPUS and Cochrane Central Register of Con- trolled Trials for eligible randomized controlled trials (PEDro score ≥ 5). Meta-analysis, using a random effects model, was performed to compare effects of interventions using serious games, to conventional treatment, for UL rehabilita- tion in adult stroke patients. In addition, we conducted subgroup analysis, according to adherence of included studies to a consolidated set of 11 neurorehabilitation principles. Results: Meta-analysis of 42 trials, including 1760 participants, showed better improvements in favor of interventions using serious games when compared to conventional therapies, regarding UL function (SMD = 0.47; 95% CI = 0.24 to 0.70; P < 0.0001), activity (SMD = 0.25; 95% CI = 0.05 to 0.46; P = 0.02) and participation (SMD = 0.66; 95% CI = 0.29 to 1.03; P = 0.0005). Additionally, long term effect retention was observed for UL function (SMD = 0.42; 95% CI = 0.05 to 0.79; P = 0.03). Interventions using serious games that complied with at least 8 neurorehabilitation principles showed better overall effects. Although heterogeneity levels remained moderate, results were little affected by changes in methods or outliers

stroke : Rehabilitation With Games

BACKGROUND: The impact of the COVID-19 pandemic on functional exercise capacity seemed quickly clinically evident. The objective of this study was to assess the functional exercise capacity of patients with severe COVID-19 and to evaluate the effect of a telerehabilitation program in the specific context of the COVID-19 pandemic. METHOD: Patients hospitalized for severe or critical COVID-19 were recruited. The functional exercise capacity (1-min sit-to-stand test (STST)) was prospectively quantified at discharge. A telerehabilitation program was then proposed. A control group was composed with the patients refusing the program. RESULTS: At discharge, none of the 48 recruited patients had a STST higher than the 50th percentile and 77% of them were below the 2.5th percentile. SpO2 was 92.6 ± 3.0% after STST and 15 patients had oxygen desaturation. After 3-months of follow-up, the number of repetitions during STST significantly increased either in telerehabilitation (n = 14) (p < 0.001) or in control groups (n = 13) (p = 0.002) but only one patient had a result higher than the 50th percentile (in Telerehabilitation group) and 37% of them were still under the 2.5th percentile for this result. The improvement was significantly and clinically greater after the telerehabilitation program (p = 0.005). No adverse events were reported by the patients during the program. CONCLUSIONS: Patients hospitalized for COVID-19 have a low functional exercise capacity at discharge and the recovery after three months is poor. The feasibility and the effect of a simple telerehabilitation program were verified, this program being able to substantially improve the functional recovery after three months.