Efficacy of Virtual Reality and Exergaming in Improving Balance in Patients With Multiple Sclerosis: A Systematic Review and Meta-Analysis

Multiple sclerosis (MS) is one of the most common causes of neurological progressive disease and can lead to loss of mobility, walk impairment, and balance disturbance. Among several rehabilitative approaches proposed, exergaming and virtual reality (VR) have been studied in the recent years. Active video game therapy could reduce the boredom of the rehabilitation process, increasing patient motivation, providing direct feedback, and enabling dual-task training. Aim of this systematic review was to assess the efficacy of exergaming and VR for balance recovery in patients with MS. PubMed, Scopus, and Web of Science were systematically searched from the inception until May 14, 2021 to identify randomized controlled trials (RCTs) presenting: patients with MS as participants, exergaming and VR as intervention, conventional rehabilitation as comparator, and balance assessment [Berg Balance Scale (BBS)] as outcome measure. We also performed a meta-analysis of the mean difference in the BBS via the random-effects method. Out of 93 records, this systematic review included and analyzed 7 RCTs, involving a total of 209 patients affected by MS, of which 97 patients performed exergaming or VR and 112 patients underwent conventional rehabilitation. The meta-analysis reported a significant overall ES of 4.25 (p < 0.0001), showing in the subgroup analysis a non-significant ES of 1.85 (p = 0.39) for the VR and a significant ES of 4.49 (p < 0.0001) for the exergames in terms of the BBS improvement. Taken together, these findings suggested that balance rehabilitation using exergames appears to be more effective than conventional rehabilitation in patients affected by MS.

Video game therapy on mobility and dual tasking in multiple sclerosis: study protocol for a randomised controlled trial

IntroductionMultiple sclerosis (MS) is one of the major causes of disability in young adults and affects mobility, compromising daily living activities and participation in social life. Cognitive domain is also frequently impaired in people with MS (PwMS), particularly the capacity to perform dual-task activities. Impaired cognitive processing abilities need to be treated, and motor and cognitive aspects need to be considered together. Recently, video game therapy (VGT) has been used in rehabilitation to improve motor outcomes and cognitive processing speed. The aim of this study is to test the efficacy of commercially available VGT on mobility and dual tasking in PwMS compared with standardised balance platform training (BPT).Methods and analysisThis will be a parallel-assignment, double-blinded, randomised control trial. Forty-eight (24 per arm) PwMS with Expanded Disability Status Scale 4–5.5 will be randomly assigned to receive 1 hour training session over 4 weeks (three sessions/week) of either: (1) VGT on commercial video game console to train balance and mobility-related activities or (2) BPT to perform balance, postural stability and weight-shifting exercises with and without visual feedback. The same assessor will evaluate outcome measures at points: before and after the 12 training sessions and at 3 months of follow-up. The primary outcome will be functional mobility, assessed by the Timed Up and Go test. We will also evaluate gait, risk of fall, fatigue and health-related quality of life as well as cognitive and psychological aspects (depression, anxiety and attentional performance) and stability through posturographic evaluation. Dual-tasking assessment will be performed combining posturographic and neuropsychological tests. Data analysis will be performed to compare the efficacy of the two treatments.Ethics and disseminationEthical approval have been granted from the local Ethics Committee. Study results will be communicated through high-quality journals and national and international conferences.Trial registration numberNCT03353974

Adherence to Kinect Adventure Games in Individuals with Parkinson’s Disease – An Experimental Study from Mysore, India

BACKGROUND Individuals with Parkinson’s disease (PD) experience reduced balance ability and are prone to fall. As the disease advances with age, the traditional forms of physiotherapy are prone to fail in long-term exercise intervention as patients lose interest in performing the exercises. The use of virtual reality game technology consists of tasks in virtual environments that combine physical and cognitive demands in a fun and motivating manner which leads to adherence in a long-term exercise intervention. The objectives of the study were to know the adherence of Kinect adventure games in individuals with PD by attendance percentage of prescribed sessions and analyse the impact of balance after the games in them. METHODS An experimental study with pre-post design in which 11 individuals were selected, with a mean age of 67.8 years. Home-based balance exercises were given three days a week up to 6 weeks (18 sessions). Kinect adventure games were implemented for another six weeks. Adherence was measured by attendance percentage in terms of the frequency of sessions completed. The secondary outcome measure was to assess balance. Participants were evaluated before intervention and post-intervention using BESTest. Descriptive statistics were used to compare the BESTest scores of pre and post-intervention. RESULTS The adherence percentage of Kinect adventure game therapy was 38 %. The adherence percentage of home-based balance exercises was only 9 %. The best scores improved in home-based balance exercise compared to Kinect adventure game therapy. CONCLUSIONS The participants with Parkinson’s disease did not adhere to Kinect adventure game therapy. For the attended sessions the balance improved for home-based balance exercise compared to Kinect game therapy. KEY WORDS Exercise Barrier, Adherence, Balance Training, Virtual Reality, Video Games

The Mastery of Art Therapy in Working with Preschool Children

The study presents some aspects of art therapy in working with preschool children. The purpose of the study is to analyse the features of the creative activity of art therapy: game therapy, visual language, isotherapy, mandalas, collage; to reveal the characteristic features of the intervention of art in work with preschool children. The following general scientific methods were used to achieve this goal: analysis, synthesis, comparison, and modelling. It has been found that therapy helps children process difficult emotions, explore their “self ”, develop greater self-awareness and selfesteem, and learn to manage their emotions and solve problems. It has been studied that the creative process can help to work with memories, events and feelings that are identical to the emotions and activity of the child. It is substantiated that art therapy effectively helps children with anxiety, depression, trauma, and grief, and it can be used to increase the child's self-esteem, communication and problem-solving skills, socialisation. The necessity of using modern methods of art therapy is confirmed. The main aspects of working with preschool children are analysed. The practical side of using art therapy as an art for preschool children, tips and exercises that will help children get into the right way of thinking to create, which are included in any artistic activity to emphasise the therapeutic elements of the process. The current approaches to the art therapy process for preschool children are described: enhances creativity, allows children to express their thoughts and feelings, encourages the integration of psychological, physical and social aspects, improves productive functions, helps children make better decisions, helps children solve their problems, improves motility. The practical significance of the work is that it can be used by students, educators, psychologists, parents for in-depth study of art therapy in working with preschool children

National Priorities in the Education System of the Republic of Kyrgyzstan: Trends in the Introduction of Manas Studies and Innovation

The purpose of the article is to describe the new requirements for teaching the discipline “Manasology”. Objectives of the article: To present changes in the education system of Kyrgyzstan in connection with the adoption in 2011 of the Law “On the epic «Manas»” and to describe new technologies that can be used in the country’s education system with the introduction of the discipline “Manasology”. The object of the research is the current situation in schools and universities of Kyrgyzstan, the subject is the process of forming new teaching technologies and creating educational literature. The educational community of the Republic of Kyrgyzstan takes into account a number of teaching technologies tested in the world, the practical application of which includes the creation of new educational literature. Among them: Technology of integrated learning; Case-technology; Game technology; Technology workshops; Traditional technologies (classroom lesson system). The first technology presupposes a special type of integrated lesson, combining familiarity with the epic “Manas” simultaneously with other subjects while studying one topic. Disciplines of the auxiliary cycle can be “National Literature”, “Kyrgyz Language”, “Oral Folk Art”, etc. The second technology involves the use of educational, research and practical cases, their sources can be epic material: “Manas”, “Semetey”, “Seytek”. The third technology for game therapy, communication games, art therapy, fairy tale or myth therapy, technology of musical influence involves a direct appeal to the heroic epic “Manas”. The fourth technology – a workshop of value orientations – introduces the ideas of tolerance of all ethnic groups and interethnic harmony, covering the history, philosophy, worldview and spiritual culture of the Kyrgyz, glorifying patriotism, friendship, freedom of spirit and who played a creative role in the formation and strengthening of the Kyrgyz statehood, proclaimed in article 1 “Law on the epic «Manas»”.

Impact of virtual reality game therapy and task-specific neurodevelopmental treatment on motor recovery in survivors of stroke

Background/Aims This study aimed to compare the impact of virtual reality game therapy and task-specific neurodevelopmental training on the motor recovery of upper limb and trunk control, as well as physical function, in people who have had a stroke. Methods This randomised, assessor-blinded clinical trial was conducted with 34 patients with post-stroke duration of 135 ± 23 days. Patients with first-onset cortical stroke aged 40–60 years, Mini-Mental State Examination score >20, ability to complete a nine-hole peg test within 120 seconds, ability to lift the affected arm at shoulder level and independent standing were included. Patients were excluded if they had unilateral neglect and musculoskeletal injuries of the affected limb in the past 2 months. Outcome measures used were the Fugl-Meyer Upper Extremity Scale, Action Research Arm Test, Trunk Impairment Scale and Stroke Impact Scale-16. The virtual reality game therapy group performed interactive table tennis, boxing and discus throwing games. The neurodevelopmental treatment group underwent task-specific movements of the upper limb in sitting and standing. All patients performed 45 minutes of treatment, 5 days a week for 4 weeks. Results Both groups showed improvements in all measures after training (P<0.05). There was a between-group difference of 3.47 points in Fugl-Meyer Upper Extremity Scale in favour of the virtual reality game therapy. Conclusions Both treatment regimens resulted in equal improvements in hand dexterity and trunk control after stroke. Virtual reality game therapy improved the upper limb motor recovery of stroke survivors to a greater extent than neurodevelopmental treatment.