A Therapeutic Approach Using the Combined Application of Virtual Reality with Robotics for the Treatment of Patients with Spinal Cord Injury: A Systematic Review
Abstract
:1. Introduction
2. Materials and Methods
2.1. Literature Search
2.2. Selection Criteria
2.3. Data Extraction
2.4. Quality Assessment
2.5. Data Synthesis
3. Results
3.1. Summary of the Main Results
3.2. Asessment of the Risk of Bias and Methodological Quality of the Studies Included in the Review
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Conflicts of Interest
Appendix A
References
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Study Country | Participants (n) | Age (years) Mean ± SD (Range) | Sex F/M | ASIA Grade | Level of Injury | Time after Onset Injury (Months) |
---|---|---|---|---|---|---|
Calabrò et al., 2016 [40] (Messina) Italy | n = 1 | 31 | M | C | Incomplete T10 | 20 |
Casadio et al., 2011 [41] (Chicago) USA | n = 14 CG: 8, IG: 6 | CG: (21–35) IG: 40.17 ± 3.53 | CG: 1F/7M IG: 6M | IG: A (3) C (3) | Complete cervical: C4 (1), C5 (1), C6 (1) Incomplete cervical: C3-C4 (1), C4 (2) | IG: 50.83 |
Dimbwadyo-Terreret al., 2016 [42] (Toledo) Spain | n = 9 CG:3, IG: 6 | CG: 44.17 ± 22.29 IG: 54.3 ± 9.86 | CG: 1F/2M IG: 1F/5M | CG: A (3) IG: A (5) D (1) | CG: complete thoracic: T4 (2), T6 (1) IG: complete thoracic: T4 (5) incomplete cervical: C4 (1) | CG: 5 ± 1 IG: 5.83 ± 2.99 |
Kowalczewski et al., 2011 [43] (Alberta) Canada | n = 13 GC: 7, IG: 6 | 35.92 ± 11.96 | 6F/7M | A-B | Complete cervical: C5 (5)-C6 (4)-C7 (4) | 3.62 ± 2.12 |
Prochazka y Kowalczewski,2015 [44] (Alberta) Canada | n = 13. CG: ND IG: ND | (24–56) | ND | A-B | Complete cervical: C5-C6 | ND |
Tidoni et al., 2016 [45] (Rome) Italy | n = 13 CG: 10, IG: 3 | CG: 29.33 ± 2.87 (24–32) IG: 28 ±5.19 (22–31) | CG: 4F/6M IG: 3M | A-B-D | Complete cervical: C4 (1), C4-C5 (1) Incomplete cervical: C6 (1) | IG: 88.67 |
Study SCIRE-PEDro Scores | Group Interventions | Intensity | Session Duration | Intervention Duration | Outcome | Measuring Instrument | Results |
---|---|---|---|---|---|---|---|
Calabrò et al., 2016 [40] Case report Pre-post test Level 5 | IG: Lokomat Pro with motivating feedback in a virtual environment (non-immersive VR) IG (rTMS): Lokomat Pro (non-immersive VR), + repetitive transcranial magnetic stimulation | 5 times/week | 40 min | 8 weeks | Lower limbs: strength and rigidity in flexion/extension of hip and knee. | ASIA, LEMS RMT, MEP CCT, MUNE rigidity, strength, DGF | IG: slight improvement in kinetic parameters (reduces rigidity in knee and hip). No significant changes in clinical or electrophysiological parameters. IG (rTMS): improvement in ASIA (C to D), LEMS (3 to 9) scores, statistically significant reduction of hip and knee stiffness, device guidance force, BWS (61 ± 6% to 57 ± 3%), increase in hip flexion–extension force, MEP amplitude, MUNE, and speed (1.5 ± 0.3 Km/h to 1.7 ± 0.2 Km/h) |
Casadio et al., 2011 [41] Controlled clinical assay. Pre-post test Level 4 | CG and IG: VR games, consisting of a virtual board (non immersive VR) and simulated conduction (immersive VR), combined with technologies capturing movement (BMI) | 2–3 times/week | 45 min | 3 weeks | Upper limb: ROM of shoulder. Isometric strength of shoulder in 3 directions. | MMT and normal scale with scoring from 0 to 5 for ROM | MMT improves for all individuals: F (1.5) = 10; p = 0.02. Significant correlations between shoulder muscle force in the upper, forward and backward directions and scapular elevation, shoulder protraction and retraction (R = 0.55 p = 0.0073, R = 0.72 p = 0.0012, R = 0.75 p < 0.0001, respectively). Five out of six subjects improved total isometric force. |
Dimbwadyo-Terrer et al., 2016 [42] Clinical assay randomized pilot study. Level 1 | CG: CTP IG: immersive VR system + CyberTouch glove. Two session types: one of reaching and throwing movements, and the other only reaching ones. One type per day was performed. Same CTP as CG. | 2 times/week | 30 min | 2 weeks | Upperlimb: motor (muscle strength and self-management, co-ordination and fine motor control. | Functional state: MB, BI, SCIM. NHPT and JHFT scales. Time taken to complete the items. | No significant differences were found in the outcomes between groups, although MB was higher IG. The SCIM scale improved in both groups: >11 points in IG, and >4 points in SCIM self-care for IG (improved skills, coordination and fine movements of the fingers) IG needed shorter time for NHPT. |
Kowalczewski et al., 2011 [43] Randomized controlled clinical assay. Level 1 | CG: CPT+ 1 month’s rest + ReJoyce with video games (non immersive VR) that mimic the ADL. IG: ReJoyce with videogames that mimic the ADL. + 1 month’s rest. +CPT. | 5 times/week | 60 min | 6 weeks | Upperlimb: functionality for ADL and ROM. | ARAT RAHFT | IG improved more than CG according to ARAT (13.0% ± 9.8% and 4.0% ± 9.6%, respectively=). |
Prochazka y Kowalczewski 2015 [44] Randomized controlled clinical assay Level 1 | CG: telesupervised CPT. IG: FES + sessions telesupervised with ReJoyce (non immersive VR). | 6 times/week | 60 min | 6 weeks | Upperlimb: functionality and ROM. Validity of RAHFT, ARAT and FMA. | RAHFT ARAT FMA | RAHFT is better for studying functionality and FMA for the ROM. Effect sizes of IC group: RAHFT (0.64 ± 3.6) ARAT (1.3 ± 6.3), FMA (1.5 ± 5.2) |
Tidoni et al., 2016 [45] Post-test Level 4 | CG and IG: immersive VR of mathematical game with board and proprioceptive stimulator in the brachial biceps tendon with feedback from a video recorded with a robot. | 12 times/ND | 6 min | ND | Results of questionnaire on user’s experience, optimization calls, and information transfer rate. | UE OC ITR | Patient 1: lesser precision in the task than CG and higher OC and lower ITR (p < 0.022). Patient 2: only VR. UE, OC and ITR did not differ from the CG. Patient 3: did not differ from the CG in the robot scenario, although UE and ITR obtained lower scores in VR. |
Study | 1 | 2 | 3 | 4 | 5 | 6 | 7 | 8 | 9 | 10 | 11 | Total |
---|---|---|---|---|---|---|---|---|---|---|---|---|
Dimbwadyo-Terrer et al., 2016 [42] | - | YES | NO | YES | NO | NO | NO | YES | YES | YES | YES | 6 |
Kowalczewski et al., 2011 [43] | - | YES | NO | YES | NO | YES | NO | YES | YES | YES | YES | 7 |
Prochazka y Kowalczewski, 2015 [44] | - | YES | NO | YES | NO | NO | YES | NO | YES | YES | YES | 6 |
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De Miguel-Rubio, A.; Muñoz-Pérez, L.; Alba-Rueda, A.; Arias-Avila, M.; Rodrigues-de-Souza, D.P. A Therapeutic Approach Using the Combined Application of Virtual Reality with Robotics for the Treatment of Patients with Spinal Cord Injury: A Systematic Review. Int. J. Environ. Res. Public Health 2022, 19, 8772. https://doi.org/10.3390/ijerph19148772
De Miguel-Rubio A, Muñoz-Pérez L, Alba-Rueda A, Arias-Avila M, Rodrigues-de-Souza DP. A Therapeutic Approach Using the Combined Application of Virtual Reality with Robotics for the Treatment of Patients with Spinal Cord Injury: A Systematic Review. International Journal of Environmental Research and Public Health. 2022; 19(14):8772. https://doi.org/10.3390/ijerph19148772
Chicago/Turabian StyleDe Miguel-Rubio, Amaranta, Lorena Muñoz-Pérez, Alvaro Alba-Rueda, Mariana Arias-Avila, and Daiana Priscila Rodrigues-de-Souza. 2022. "A Therapeutic Approach Using the Combined Application of Virtual Reality with Robotics for the Treatment of Patients with Spinal Cord Injury: A Systematic Review" International Journal of Environmental Research and Public Health 19, no. 14: 8772. https://doi.org/10.3390/ijerph19148772