Wanees M Badawy

: To systematically review the available randomized controlled trials in the literature concerning the application of virtual reality (VR) rehabilitation interventions compared to conventional physical therapy, in regaining the upper limb motor function among patients with chronic stroke. : A systematic electronic database search was conducted for related studies published from inauguration and until June 25, 2020 in nine databases. Another new search was done on February 1, 2021 and no new studies were identified. : Six studies were included in the analysis. Significant improvement was seen following the VR therapy in patients with chronic stroke, compared to their scores prior to it (SMD = 0.28; 95% CI = 0.03-0.53; = .03). There was neither heterogeneity (I = 0% and = .5) nor a risk of bias ( = .8) among the included studies. VR interventions produced a comparable effectiveness to that of the conventional rehabilitation, with no statistically significant difference (SMD = 0.15; 95% CI = -0.14-0.44; = .3). There was neither heterogeneity (I = 40% and = .1) nor a risk of bias ( = .5) among the included studies. : The upper limb motor function of patients with chronic stroke who underwent VR-based rehabilitative intervention showed significant improvement as compared to the pre-treatment state. Our analysis also revealed no superiority of VR interventions over conservative therapies; however, the difference observed did not accomplish statistical significance.

BACKGROUND:
Benign paroxysmal positional vertigo (BPPV) is the most common disorder of the vestibular system of the inner ear, which is a vital part of maintaining balance. Although the efficacy of the Epley maneuver-also known as the canalith repositioning maneuver (CRM)-is well established, data comparing CRM versus a hybrid treatment are lacking.
PURPOSE:
The purpose of this study was to determine the effect of a hybrid treatment, the Gans repositioning maneuver (GRM) either with or without postmaneuver restrictions, compared with CRM on treatment of posterior canal BPPV (PC-BPPV).
RESEARCH DESIGN:
Study design was a randomized controlled trial.
STUDY SAMPLE:
A total of 45 patients (30 males and 15 females) with unilateral PC-BPPV were randomly allocated to one of three equal groups on the basis of the date of the first visit with matched assignment for gender: a GRMR group (GRM with postmaneuver restrictions), a GRM group, and a CRM group.

INTERVENTION:
Patients received weekly administration of the maneuver until resolution of symptoms. The Dix-Hallpike test was performed before treatment at every appointment, and finally after 1 mo from the last maneuver.
DATA COLLECTION AND ANALYSIS:
Nystagmus duration and vertigo intensity were recorded. The supine roll test was performed in case the Dix-Hallpike test was negative to test otoconial migration. Data were analyzed with repeated-measures analysis of variance, paired t-tests with a Bonferroni correction, and the Spearman rank correlation coefficient.
RESULTS:
All patients showed improvement within the groups, and PC-BPPV symptoms were resolved by an average of 2, 1.7, and 1.6 maneuvers for GRMR, GRM, and CRM, respectively, with no statistical differences among the three groups (p > 0.05). Only two patients had recurrence, and one patient had horizontal BPPV at 1 mo follow-up.
CONCLUSION:
We demonstrated that the GRM as a new treatment is effective in treating PC-BPPV with no benefits to postmaneuver restrictions.

Background: Children with spastic diplegic Cerebral Palsy (CP) often show the difficulty to achieve well-balanced sitting posture and display the poor sitting posture such as flexed trunk with kyphotic curvature of the spine and asymmetry of trunk.
Aim of the Study: The present study was designed to determine the effectiveness of kinesio taping over the paraspinal muscles in improving sitting balance in young children with Spastic Diplegic (CP) who displayed poor trunk control.
Material and Methods: Thirty children with Spastic Diplegic (CP) of both sexes with age ranged between 10-16 months were included in this study. Children were randomly assigned to two equal groups (Group I and Group II). The study group (Group I) was treated by kinesio taping which was applied over the paraspinal region for 12 successive weeks in addition to a designed physical therapy program. The control group (Group II) was treated by the designed physical therapy program only. The children were evaluated by sitting score of Gross Motor Function Measure (GMFM) and radiographic studies (Kyphotic and Cobb's angles) were carried out on the whole spine while the children were sitting before and after treatment.
Results: There was a statistically significant improvement in the measured parameters in both groups when comparing their pre and post treatment mean values. However, significant difference was recorded between the two groups after treatment in favor of the study group.
Conclusion: The obtained results suggest that the application of kinesio taping over the trunk become a beneficial therapeutic technique in improving the sitting posture and trunk control in children with Spastic Diplegic (CP) when adjunct to a physical therapy program.

Background: Burn has a causative factor in avoidant behaviors and lack of postural control. Objectives: To guide the rehabilitation team making decision regarding the use of incentive therapy via Wii interactive video games in physical therapy practice for burned patients. Materials and methods: The traditional (control) group received a physical therapy session including positioning, range of motion exercises, stretching exercise for lower limb muscles, and daily walking. The study group (Wii group) received previous physical therapy program followed by 15 minutes of Wii Fit gaming activities. Main outcome measures: Static and dynamic balance assessment using Biodex Balance system, Timed-Up and Go test, Activities-Specific Balance Confidence Scale and Numeric Pain Rating Scale. Results: Statistically significant differences were found between the study and control groups; for the favor of patients practiced the Wii interactive video game. Conclusions: Incentive therapy via active participation of patients using Wii Fit is potentially acceptable as an adjunct to the physical therapy intervention for burned patients aiming to improve postural control.

Background: Multiple sclerosis (MS) is a chronic progressive auto-immune disease that results in demyelination of the central nervous system. The symptoms and complications in addition to impairments and disability in MS patient often reduce the balance outcomes. Purpose: To determine the influence of using the Wii interactive video game as a treatment program to improve the balance outcomes in MS patient. Materials and methods: Thirty MS patients were randomly allocated to two equal groups. The control group received a traditional balance program for 45 minutes and the study group received a virtual reality rehabilitation based on the Nintendo® Wii Balance Board® (WBB) for 30 minutes in addition to the balance exercises given to the control group. The training was three times per week for 4 successive weeks. The outcome measures: Berg Balance Scale (BBS), Timed Up and Go test (TUG), the overall dynamic limits of stability measured by the Biodex Balance System, and the Activities-Specific Balance Confidence Scale (ABC). Results: There was an improvement in all measures in both groups. But the improvement in the balance outcomes was more in the study group. Conclusion: Wii rehabilitation appears to be a useful tool in improving balance outcomes in MS. Further studies have to be carried out to assess the retention of results and generalization.

Background: Trunk performance is directly related to disability. Evaluating the trunk could be helpful in establishing a rational treatment plan in the physical therapy rehabilitation of people with stroke. Objectives: The aims of this study were to assess the strength of trunk flexors and extensors and to measure trunk kinematics in chronic stroke patients as to compare the results with healthy control subjects. Methods: Thirty stroke patients and 20 matched healthy subjects participated in the study. All participants were right handed male and with age ranged between 40 to 56 years. Stroke patients had moderate spasticity, able to walk independently, with a score less than or equal 11 according to the Trunk Impairment Scale (TIS). Biodex Isokinetic dynamometer was used to measure the peak torque of trunk flexor and extensor muscles and Extensor/Flexor ratio. A digital camera and Auto CAD computer software were used to measure trunk ROM in standing and seated postures from three planes (Sagittal, frontal and transverse planes). Results: Stroke patients showed significant decrease in trunk flexors and extensors peak torques with more reduction in the extensors as compared to the healthy subjects (P<0.05). Also stroke patients showed significant decrease in trunk ROM when been measured from the three planes. In addition a strong correlation was observed between trunk muscle torque and flexion–extension ROM. Conclusion: Stroke induced motor impairment of trunk muscle strength that may limit the chronic stroke patients to perform functional activities.

Key Words: Stroke - Trunk - Torque – Isokinetic - Kinematics - Auto CAD