(1999). "PT lends expertise at games." Physiotherapy Frontline 5(18): 18-18.
	
(2000). "Golf PT tips. What the pros already know -- form, fitness, and flexibility give golfers a better game." Sports Physical Therapy Section: 5-5.
	
(2001). "Reaching their potential: Special Olympics and physical therapy make a winning team at the 2001 Special Olympics World Winter Games." PT: Magazine of Physical Therapy: 6-8.
	
(2009). "Wii-habilitation adds fun to physical and occupational therapy...Reprinted with permission from Weiss Memorial Hospital's LifeSpans." Communique 2009(2): 1-5.
	
(2010). "Wii board helps physios strike a balance." New Scientist 205(2743): 15.
	Game console extra could provide a cheap alternative to physical therapy equipment used to get patients such as stroke victims walking again

(2011). "Feasibility of Wii fit intervention in different age groups of individuals with cerebral palsy: a case series." Pediatric Physical Therapy 23(1): 126-126.
	
(2011). "Nursing team ready for Olympics." Emergency Nurse 19(3): 4-4.
	The article reports that nurses Nicki Bellinger and Claire Birch and physiotherapy instructor Alex Whitfield Jones have selected equipment that will ensure safe handling and recovery of sailors with spinal injuries at the 2012 Olympic Games in London, England.

(2011). "Using technologies for cognitive training in the elderly." Journal of CyberTherapy & Rehabilitation (JCR) 4(2): 155-163.
	
(2011). "Wii gaming system for children with developmental delay: a randomized single-blinded controlled trial." Pediatric Physical Therapy 23(1): 103-103.
	
(2011). "The Wii-augmented balance training in amputees trial: Wii-ABAL-AMPS." Journal of Rehabilitation Medicine (Stiftelsen Rehabiliteringsinformation) 43(8): 750-750.
	
(2011). "Work Wii-Habilitation Into Your Patients' Routines." Physical Medicine & Rehab Coding Alert 12(2): 11-12.
	
(2012). "'Neurogame' therapy for upper extremity function in children with cerebral palsy." Pediatric Physical Therapy 24(1): 105-106.
	
(2012). "Pulmonary Wii-habilitation: exercise intensity achieved by people with chronic obstructive pulmonary disease playing Nintendo Wii...Abstracts from the Physiotherapy New Zealand Conference, held in Wellington on 5th - 6th May 2012." New Zealand Journal of Physiotherapy 40(2): 88-88.
	
(2012). "USE OF NINTENDO WII FIT™ IN THE REHABILITATION OF OUTPATIENTS FOLLOWING TOTAL KNEE REPLACEMENT: A PRELIMINARY RANDOMISED CONTROLLED TRIAL." SportEX Medicine(54): 6-6.
	The article discusses the author's views on a preliminary randomized controlled trial of physiotherapy using Nintendo Wii Fit gaming activities for the rehabilitation of outpatients following total knee replacement (TKR).

(2012). "Validity and reliability of the balance board nintendo Wii for stabilometric assessment. Pilot study." Italian Journal of Physiotherapy 2(3): 113-114.
	
(2013). Surgical Repair and Rehabilitation of a Combined 330° Capsulolabral Lesion and Partial-Thickness Rotator Cuff Tear in a Professional Quarterback: A Case Report, JOSPT, Inc. d/b/a Movement Science Media. 43: 142-153.
	The article presents a case study of a 26-year-old football player who sustained a right iuxatio erecta shoulder dislocation while trying to recover a fumble during a regular-season game. Patient underwent arthroscopic examination, surgical procedures, and postoperative rehabilitation. It was concluded that use of modalities in conjunction with the implementation of immediate motion exercises aided in decreasing pain, postoperative joint effusion, and prevention of scar tissue formation.

(2015). "Want to Achieve APTA’s Vision? Act Like a Race Car Driver...CSM 2015 Highlights." PT in Motion 7(3): 36-36.
	The article reports on the topics discussed by Stephanie Yu at an American Board of Physical Therapy Specialties (ABPTS) event in 2015. She mentioned the traits that physical therapists (PTs) can borrow from the game plan of race car drivers to achieve the vision of the American Physical Therapy Association (APTA) including passion to succeed, courage to take chances, and determination. She also noted the need of good pit crews by both PTs and drivers.

(2016). "Abstracts of Platform Presentations at the 2016 Combined Sections Meeting." Cardiopulmonary Physical Therapy Journal 27(1): 20-28.
	Abstracts of platform presentations during the 2016 combined sections meeting is presented including "Comparison of Arterial Blood Pressures Obtained Following Four Different Rest Intervals" by A. Bolden et al, "Movement Based Video Games As An Alternative Mode of Aerobic Exercise in Cystic Fibrosis: A Systematic Review" by J. Eaton and "Balance Deficits in Pulmonary Rehabilitation" by H. Tymkew et al.

(2016). "Exergame and physiotherapy." Gerontechnology 15: 118s-118s.
	
(2016). "In Memoriam." Physical Therapy 96(3): 419-419.
	The article presents an obituary for members of the American Physical Therapy Association (APTA) who died between January 1, 2015 and December 31, 2015 including Martin Asarnow, Tig R. Baker and Jack Gamet.

(2016). Rehabilitation after a grade III latissimus dorsi tear of a soccer player: A case report, IOS Press. 29: 905-916.
	BACKGROUND: Latissimus dorsi, grade III tendon tears are an uncommon injury. There are very few cases reported in the literature, but most importantly, no cases could be found that relate to soccer. OBJECTIVE: To present a successful, non-operative rehabilitation program for a professional athlete, after a grade III latissimus dorsi tear. CASE DESCRIPTION: A 37 year old healthy, elite professional soccer goalkeeper was injured during a championship game. The athlete fell on his left side with an outstretched and externally rotated upper extremity in order to catch a ball that was going very close to the left pole of his goal-post. After on-field and off-field clinical examinations, the diagnosis was a left latissimus dorsi tendon tear which was later confirmed by MRI as a grade III tear. INTERVENTION: During the first two weeks, intervention consisted of anti-inflammatory treatment and light therapeutic exercises. As the pain was subsiding and the strength was returning, the treatment shifted to purely strengthening and functional training. RESULTS: Four weeks after the injury, the athlete presented with pain 0/10 in all functional activities and full ROM in both active and passive movements. Before discharge, the athlete underwent a sport specific training program, without any complains, that cleared him to participate in normal training with the rest of the team. Three months after the injury the strength of the player's left shoulder was 5/5 in all movements. CONCLUSION: The protocol used yielded an accelerated return to sport (soccer) and function compared with other published research after a grade III latissimus dorsi tendon tear. One year later, the goalkeeper was still playing in the same competitive level without any re-injuries or complains, which means that this treatment protocol withstood the test of time.

(2016). Rotator Cuff Tear Consequent to Glenohumeral Dislocation, JOSPT, Inc. d/b/a Movement Science Media. 46: 708-708.
	The article describes the case of a 21 year old collegiate running back who was tackled during a football game and sustained a posterior glenohumeral disclocation that was reduced with traction performed by the athletic trainer on the field. Magnetic resonance imaging indicated a complete tear of the supraspinatus and infraspinatus. He underwent surgery to repair rotator cuff tears and was referred to physical therapy for passive range of motion for 6 weeks.

(2017). NEW PRODUCTS. Johnstown, Pennsylvania, TCA EP World LLC. 47: 10-12.
	The article offers information about new products for children, including the Balance Wedges cushions from Therapro Inc., TippyTalk application or app from software developer TippyTalk, and Color Changing Light Ball tactile silent fidget toy from Therapy Shoppe Inc.

(2018). PRODUCTS MARKETPLACE. Alexandria, Virginia, American Physical Therapy Association. 10: 58-58.
	The article offers information on a variety of products related to physical therapy including the OPTP catalogue and ATX Full Leg Boot wrap from Game Ready.

(2018). "PTJ: Research on Computer Gaming's Effectiveness in Physical Therapy Needs to Level Up." PT in Motion: 50-50.
	The article discusses a research on the effectiveness of active computer gaming (ACG) in physical therapy which was published in the journal "Physical Therapy." Findings include the moderate effect of ACG on functional exercise capacity and cognition, and the lack of impact on functional mobility or fear of falling.

(2019). "Effects of a Gaming Platform on Balance Training for Children With Cerebral Palsy: Erratum." Pediatr Phys Ther 31(1): 129.
	
(2019). "The Game of Student Life." Frontline (20454910) 25(12): 10-11.
	
(2019). "Introducing the CSP members volunteering at the games." Frontline (20454910) 25(5): 16-17.
	
(2020). "The Rehabilitation Reference Center Is a Game-Changer for Students, Early-Career Members, and Veterans in the Profession." PT in Motion 12(1): 52-52.
	The article offers information on American Physical Therapy Association's Rehabilitation Reference Center.

(2021). Advice P.R.N. Baltimore, Maryland, Lippincott Williams & Wilkins. 51: 10-11.
	The article presents questions and answers related to health and nursing care including the long-term risks to sleep disorders in patients with traumatic brain injury (TBI), effect of virtual reality or motion censor video games on patients with cerebral palsy (CP) during physical therapy, and ways to prevent the spread of airborne illnesses in older adults with cognitive impairments.

(2021). "Fast forward physio." Frontline (20454910) 27(10): 34-35.
	
(2021). Student Focus. Alexandria, Virginia, American Physical Therapy Association. 13: 51-51.
	An excerpt from a post by Lydia Owsley, a physical therapy (PT) student at the University of Saint Mary in Leavenworth, Kansas, on the American PT Association's blog at apta.org about her experience of competing in the Women's 10-meter air pistol event at the 2016 Olympic Games, is presented.

(2021). "Welcome to the April 2021 issue of the Co-Kinetic journal." Co-Kinetic Journal(88): 2-2.
	The issue of the periodical focuses on the April 2021 issue of the Co-Kinetic journal . Topics discussed include Covid 19 has caused many of businesses over the last 12 months and may yet continue to cause, which means that every one of us really needs to be on top of marketing game going forward; and build your business and generate revenue through your CoKinetic subscription, put up some of the subscription prices to better reflect the value of the content.

(2022). "The Patient Wins When You Engage Them in Gamification for Therapeutic Exercise." APTA Magazine 14(4): 41-41.
	The article presents the highlights of the presentation of physical therapists Mitchell Selhorst, Megan Marks, Brittany Selhorst and Kristin Bastian on the use of gamification for therapeutic exercise at the 2022 American Physical Therapy Association (APTA) Combined Sections Meeting in San Antonio, Texas. Other topics include the things to consider when designing games in physical therapy.

A, M. P., et al. (2017). "Randomized controlled trial of a web-based multi-modal therapy program for executive functioning in children and adolescents with unilateral cerebral palsy." Disability & Rehabilitation 39(20): 2021-2028.
	Purpose state: Determine the efficacy of Move-it-to-improve-it (Mitii), a multi-modal web-based program, in improving Executive Function (EF) in children with unilateral cerebral palsy (UCP). METHOD: Participants (n = 102) were matched in pairs then randomized to: intervention (Mitii for 20 weeks; n = 51; 26 males; mean age = 11 years 8 months (SD = 2 years 4 months); Full Scale IQ = 84.65 (SD = 15.19); 28 left UCP; GMFCS-E&R (I = 20, II = 31) or waitlist control (n = 50; 25 males; mean age = 11 years 10 months (SD = 2 years 5 months); Full Scale IQ = 80.75 (SD = 19.81); 20 left UCP; GMFCS-E&R (I = 25, II = 25). Mitii targeted working memory (WM), visual processing (VP), upper limb co-ordination and physical activity. EF capacity was assessed: attentional control (DSB; WISC-IV); cognitive flexibility (inhibition and number-letter sequencing DKEFS); goal setting (D-KEFs Tower Test); and information processing (WISC-IV Symbol Search and Coding). EF performance was assessed via parent report (BRIEF). Groups were compared at 20 weeks using linear regression (SPSS 21). RESULTS: There were no significant between group differences in attentional control (DSB; p = 0.20;CI= -0.40,1.87); cognitive flexibility (Inhibition, p = 0.34; CI= -0.73,2.11; number/letter sequencing, p = 0.17; CI= -0.55,2.94); problem solving (Tower; p = 0.28; CI= -0.61,2.09), information processing (Symbol; p = 0.08; CI= -0.16, 2.75; Coding; p = 0.07; CI= -0.12,2.52) or EF performance (p = 0.13; CI= -10.04,1.38). CONCLUSION: In a large RCT, Mitii(TM) did not lead to significant improvements on measures of EF or parent ratings of EF performance in children with UCP. Implications for rehabilitation A large RCT of the multi-modal web based training; Move It to Improve It (Mitii(TM)) improves motor processing, visual perception, and physical capacity but does demonstrate statistically significant improvements or clinical significance in executive function in children with mild to moderate unilateral cerebral palsy (UCP). Mitii(TM) training completed by an intervention group was highly variable with few children reaching the target dosage of 60 h. Technical issues including server and internet connectively problems lead to disengagement with the program. Web-based training delivered in the home has the potential to increase therapy dose and accessibility, however, Mitii(TM) needs to be tailored to include tasks involving goal-setting, more complex problem solving using multi-dimensional strategies, mental flexibility, switching between two cognitively demanding tasks, and greater novelty in order to increase the cognitive component and challenge required to drive changes in EF.

Aarhus, R., et al. (2011). "Turning training into play: Embodied gaming, seniors, physical training and motivation." Gerontechnology 10(2): 110-120.
	
Abd El-Kafy, E. M., et al. (2022). "The Effect of Robot-Mediated Virtual Reality Gaming on Upper Limb Spasticity Poststroke: A Randomized-Controlled Trial." Games for Health Journal 11(2): 93-103.
	Objective: Stroke is a common reason for motor disability and is often associated with spasticity and poor motor function of the upper limbs involved. Spasticity management is important to accelerate motor recovery. The objective of this study was to investigate the effects of training with robot-mediated virtual reality gaming on upper limb spasticity and motor functions in individuals with chronic stroke. Materials and Methods: A total of 40 Saudi individuals with chronic stroke were involved in this study. Participants were randomly assigned to two groups. The experimental group received conventional physiotherapy and training with robot-mediated virtual reality gaming, and the control group received only conventional physiotherapy. Outcomes were measured by the Action Research Arm Test (ARAT), Wolf Motor Function Test (WMFT), WMFT-Time, Modified Ashworth Scale (MAS), Active Range of Motion (AROM) of multiple joints of the upper limb, and Handgrip Strength (HGS). The scores of all the outcome measures were recorded at baseline and after the completion of the treatment. Results: Individuals with stroke in the experimental group had a better improvement in most measured variables (AROM of shoulder abduction, elbow supination and wrist extension, WMFT-Time, HGS, ARAT, WMFT, and MAS) compared with the control group after the completion of the treatment. Both groups showed significant improvement in all the measured variables after completion of the treatment, except in MAS for wrist flexors in the control group. Conclusion: Training with robot-mediated virtual reality gaming was effective in modulating spasticity and improving the motor functions of the affected upper limbs in individuals with chronic stroke. This study was registered in ClinicalTrial.gov (NCT05069480).

Aberg, A. C., et al. (2017). "A Study Protocol for Applying User Participation and Co-Learning-Lessons Learned from the eBalance Project." International Journal of Environmental Research & Public Health [Electronic Resource] 14(5): 512.
	The eBalance project is based on the idea that serious exergames-i.e., computer gaming systems with an interface that requires physical exertion to play-that are well adapted to users, can become a substantial part of a solution to recognized problems of insufficient engagement in fall-prevention exercise and the high levels of fall-related injuries among older people. This project is carried out as a collaboration between eight older people who have an interest in balance training and met the inclusion criteria of independence in personal activities of daily living, access to and basic knowledge of a computer, four staff working with the rehabilitation of older adults, and an interdisciplinary group of six research coordinators covering the areas of geriatric care and rehabilitation, as well as information technology and computer science. This paper describes the study protocol of the project's initial phase which aims to develop a working partnership with potential users of fall-prevention exergames, including its conceptual underpinnings. The qualitative methodology was inspired by an ethnographical approach implying combining methods that allowed the design to evolve through the study based on the participants' reflections. A participatory and appreciative action and reflection (PAAR) approach, accompanied by inquiries inspired by the Normalization Process Theory (NPT) was used in interactive workshops, including exergame testing, and between workshop activities. Data were collected through audio recordings, photos, and different types of written documentation. The findings provide a description of the methodology thus developed and applied. They display a methodology that can be useful for the design and development of care service and innovations for older persons where user participation is in focus.

Abril-Jimenez, P., et al. (2021). "Co-designing a remote rehabilitation tool for Parkinson's disease: exploratory values and challenges." BMC Neurology 21(1): 491.
	BACKGROUND: Impaired motor function is one of the early symptoms shown in patients with Parkinson Disease (PD). For this reason, rehabilitative interventions have been used for many years to improve motor and non-motor symptoms. Among them, the use of music therapy has shown benefits in helping to overcome some of the most common motor dysfunction. Addressing the challenge of providing access to this type of therapy, this document presents the collaborative design process to develop a remote training support tool for PD based on music therapy. METHODS: A qualitative study with creative co-design methods was used in which different groups of healthcare professionals, patients, and relatives participated in six iterative sessions. Workshops were designed and structured to incrementally discover requirements and needs and validate the proposed prototype ideas. RESULTS: The study provided key aspects that were used for the development and validation of the proposed prototypes for the remote music-based training support tool for PD. Up to 20 factors that had a positive and/or negative influence on patient access to training were detected. These factors were classified into three common themes: daily activities and independence, participation in treatment and barriers to daily treatment, and self-management and personalization of information and telecommunication technologies (ICT). CONCLUSIONS: This paper shows the results of a collaborative design process aimed at identifying the different factors, relevant to patients with PD, to improve their access to remote ICT-based training therapy and their expectations regarding alternative therapies, such as music. The participatory design methods and the iterative model used helped overcome many of the traditionally barriers that this type of technological support solutions usually have, facilitating the future participation.

Acosta, A. M., et al. (2011). "Pilot study to test effectiveness of video game on reaching performance in stroke." Journal of Rehabilitation Research & Development 48(4): 431-444.
	Robotic systems currently used in upper-limb rehabilitation following stroke rely on some form of visual feedback as part of the intervention program. We evaluated the effect of a video game environment (air hockey) on reaching in stroke with various levels of arm support. We used the Arm Coordination Training 3D system to provide variable arm support and to control the hockey stick. We instructed seven subjects to reach to one of three targets covering the workspace of the impaired arm during the reaching task and to reach as far as possible while playing the video game. The results from this study showed that across subjects, support levels, and targets, the reaching distances achieved with the reaching task were greater than those covered with the video game. This held even after further restricting the mapped workspace of the arm to the area most affected by the flexion synergy (effectively forcing subjects to fight the synergy to reach the hockey puck). The results from this study highlight the importance of designing video games that include specific reaching targets in the workspace compromised by the expression of the flexion synergy. Such video games would also adapt the target location online as a subject's success rate increases.

Actrn (2011). "Exercise-based videogames for stroke rehabilitation at home: a single subject randomised trial." https://trialsearch.who.int/Trial2.aspx?TrialID=ACTRN12611000812998.
	INTERVENTION: A crossover study design will be used. There will be 4 two‐week intervention periods. During each intervention period, the participant will use exercise‐based videogames (X‐Box Kinect and Apple I‐pad) independently at home. These videogames will be setup in the participant's home 2 weeks prior to beginning the first intervention period to enable a 2‐week unblinded 'run‐in' period. During each intervention period, either upper limb or lower limb videogame exercise will be undertaken. There will be no 'washout period' between the intervention periods. The participant will be asked to perform as much practice using the videogames as possible within their normal daily routine, and to progress to more physically challenging games as able. The videogames used and their intensity or difficulty will be participant selected, however an experienced clinical physiotherapy neurology specialist will be available via phone to assist the participant with any exercise‐related questions. A technology specialist will also be available to assist with any videogame hardware issues. CONDITION: Stroke PRIMARY OUTCOME: Choice stepping reaction time (Lord and Fitzpatrick 2001) Upper limb reach time. The average time of 3 trials will be used at each timepoint. This test will measure the time it takes the participant to reach with their affected upper limb to click a computer mouse positioned on a table in front of them while seated in response to the illumination of a red light. The test is commenced by the participant clicking a 'start button' with their intact hand. The participant then tries to reach with their affected arm as fast as they can, from a starting position of palm down on their affected thigh, to click the mouse positioned on the table in front of them at a standardised distance, approximating full elbow extension. The mouse is connected to an electronic timer which will display the time elapsed from the illumination of a red light to the pressure of the participant's index finger on the mouse key. The time it takes for the red light to illuminate after the start button is pressed is random. SECONDARY OUTCOME: 3 metre forward tandem (heel‐to‐toe) walk time Action Research Arm Test total and subgroup scores (Yozbatiran et al 2008) Box and Block Test (Mathiowetz et al, 1985). High‐level Mobility Assessment Tool total score (Williams et al, 2010). This tool quantifies high‐level mobility tasks such as walking on toes, running and hopping. Physical Functioning. ; This will be assessed using the Basic Mobility and Daily Activity domains of the Computer Adaptive Testing version of the Boston University Activity Measure for Post Acute Care (AM‐PAC) (Haley et al 2004). The AM‐PAC measures functional outcome by using Item Response Theory. The AM‐PAC Basic Mobility domain includes 101 items that address basic movement and physical functioning activities, such as bending, walking, carrying, and climbing stairs. The AM‐PAC Daily Activity domain includes 70 items that address basic self care and instrumental activities of daily life. Six‐minute walk distance. Step Test (Hill et al 1996). The number of steps in 15 sec of 1)the affected, 2)unaffected, and 3)both legs alternately will be assessed using a 7.5 cm step. Subjective video assessment of walking, and running by an experienced neurological physiotherapist. Summed score of the Motor Assessment Scale upper limb items (6, 7, and 8) (Pickering et al 2010). System Usability Scale (Digital Equipment Corporation, 1986). The System Usability Scale is a 10‐item Likert scale that provides a global view of subjective assessments of usability. It will be used to determine the participant's subjective assessment of usability of 1)lower limb videogames, and 2)upper limb videogames used in this study. Total time spent engaged in upper limb and lower limb exercise‐based videogames. The participant will keep a daily recording log of time spent using each exercise‐based videogame for the lower limb. The upper limb exercise‐based videogame durat on will be captured by the software automatically. INCLUSION CRITERIA: The single participant is a long‐term adult stroke survivor. He has ongoing lower limb and upper limb motor coordination problems on his affected side. He is able to walk independently and use his affected arm for daily tasks. He lives independently within the community.

Actrn (2014). "A Play Activities Program (PAP) for nursing homes residents with chronic pain." https://trialsearch.who.int/Trial2.aspx?TrialID=ACTRN12614001225606.
	INTERVENTION: Participants in the experimental group nursing homes will receive the 8‐week Physical Activities Program (PAP). The PAP is a protocol‐driven intervention which consists of one session per week for a total of 8 weeks. It is conducted in a group format. Participants are encouraged to sit together in small groups of 5 to 6 for group activities in every session so as to create social bonding. Each session lasts for 60 minutes. At the beginning of each session, participants will complete 10 minutes of physical exercises including towel dancing; correct body posture and alignment; stretching of arms, legs, and body muscles performed together under the supervision of the research team. Then, different play activities will be carried out each week. They include drawing, making artwork, throwing a parachute together, and other games playing in group. To ensure the adherence and compliance to protocol, regular meetings will be held among the research team and nursing home staff; also, we shall carefully recruit, thoroughly train, provide ongoing and onsite supervision of research personnel. The nursing home staff training manual, the PAP protocol, the ‘My Play Activities’ portfolio, and materials for play activities of each session has been prepared. CONDITION: chronic pain PRIMARY OUTCOME: Current pain intensity and pain interference as measured by Brief Pain Inventory (BPI) SECONDARY OUTCOME: Happiness as measured by Subjective Happiness Scale Pain self‐efficacy as measured by Pain Self‐Efficacy Questionnaire (PSEQ) Quality of life as measured by SF‐12 INCLUSION CRITERIA: ‐ aged 65 or above ‐ able to speak and understand Cantonese ‐ with an abbreviated mini‐mental state examination (MMSE) score >=7 ‐ willing and able to sign a consent form ‐ have experienced pain during the previous 3 months of intensity score >=3 on the BPI

Actrn (2015). "Does an online psychological intervention improve self-efficacy and disability in people also receiving Multimodal Manual Therapy for chronic low back pain compared to Multimodal Manual Therapy alone? Design of a randomized controlled trial." https://trialsearch.who.int/Trial2.aspx?TrialID=ACTRN12615000269538.
	INTERVENTION: Participants will be randomly allocated to one of two groups. Group 1 Multimodal Manual Therapy (Control): Participants in this group will receive Multimodal Manual Therapy treatment (MMT) only. MMT refers to treatment that is centred around manual therapies but also employs best practice primary care and is supported by therapeutic exercises. The manual therapy component of MMT may involve high‐velocity, low‐amplitude thrust manipulation, non‐thrust joint mobilization, or soft tissue massage. The high‐velocity, low‐amplitude thrust techniques will involve a carefully directed, gentle but quick thrust through the mechanical plane of the spine or pelvic joints that may or may not be accompanied by an audible ‘pop’ or cavitation sound. These techniques may be performed with the therapist’s hands or with the assistance of a device such as a drop‐piece table. The non‐thrust mobilization techniques will involve passive oscillatory movements of the spine or pelvic joints through normal ranges of motion. Soft tissue massage techniques will be directed at the muscles of the back and pelvis and perfomed with the therapist’s hands or a vibrating massage device. All participants will receive components of best practice primary care that involves reassurance, advice about symptom management and encouragement to remain active. MMT may be supported by exercises that may include general physical conditioning, or specific exercise programs that address; symptom management, or mobility, strength or motor control impairments. Other treatment modalities that are used by chiropractors and physiotherapists that are not endorsed by practice guidlines (e.g. therapeutic ultrasound, transcutaneous electrical nerve simulation, heat therapy, etc) will not be included in the definition of MMT. All participants in the MMT group will receive manual therapy. The selection of other supportive treatment modalities will be determined by the chiropractor or physiotherapist according to their clinical judgment. Treatments will either be performed by a registered chiropractor or physiotherapist who has more than 5 years of clinical experience. Participants will receive up to 12 treatments over a period of 8 weeks. The practitioner may elect to use fewer treatments in cases where the participant has experienced significant improvement or has developed adverse effects that warrant stopping care. The definition of an adverse effect (event) is either: 1) a new related complaint which was not present at baseline or previous visit, or 2) a worsening of the presenting complaint. Adverse events will be measured using a similar questionnaire as in the side effects of chiropractic treatment study by Leboeuf‐Yde et al. and will be carried out at the 8 week follow up interval. Group 2 MoodGym combined with Multimodal Manual Therapy (Intervention): Participants in this group will receive the same MMT as Group 1; however, this group will also complete the MoodGYM program. Participants will complete one module of the MoodGYM program per week over a five week period. The content of MoodGYM involves the completion of five modules of 20‐ to 40‐minutes duration. The modules use various tools such as interactive games, mood assessments, and downloadable relaxation audio file. The modules focus on aspects of cognitive behaviour therapy, including cognitive restructuring, the relationship between thoughts and feelings, behavioural activation, relaxation, and problem solving. Participants are encouraged to continue their leanings in their daily life by applying principles taught in the modules. Participants in the MoodGYM group will set up a username and password at the time of enrolment and will be given an instruction manual for their five‐week online MoodGYM program. Participants will also receive a weekly telephone reminder, to enhance adherence with the MoodGYM program and avoid attrition. Attrition has been identified as an issue in similar studies and higher completion rates were achieved with occasional telephone or email contact. No additional counseling or treatment advice will be provided with the reminder telephone calls. Participants who report distress as a result of using MoodGym will be offered referral to a clinical psychologist. Participants in both groups will be given a follow‐up appointment schedule for their 8‐week course of MMT. The MMT will be provided by a chiropractor or a physiotherapist using techniques listed above which are inaccordance with International Clinical Practice Guidelines for chronic LBP. CONDITION: Chronic low back pain PRIMARY OUTCOME: Pain Self Efficacy Questionnaire (PSEQ)(Nicholas, 1989) ; SECONDARY OUTCOME: Depression Anxiety and Stress Scale (DASS21) (Lovibond, 1995) Pain Catastrophizing Scale (PCS) (Sullivan, Bishop, & Pivik, 1995) ; Pain intensity Numerical Rating Scale (Jensen MP, 1992a) Patient Specific Functional Scale (PSFS) (Nicholas MK. 1989) Roland Morris Disability Questionnaire (Roland & Morris, 1983) Work Ability Inventory (WAI) (Tuomi, Oja 1998) INCLUSION CRITERIA: Adults who are present for chiropractic or physiotherapy care with a new episode of non‐specific lower back pain of more than three months duration.

Actrn (2015). "Video-game based exercises for older people with chronic low back pain." https://trialsearch.who.int/Trial2.aspx?TrialID=ACTRN12615000703505.
	INTERVENTION: Video‐game intervention group Participants in the video‐game exercise group will participate in an 8 week home‐based unsupervised exercise program using Nintendo Wii console technology and the Wii Fit Plus software. The video‐game exercise protocol consists of a range of exercises that will be pre‐selected from the Wii Fit Plus software by a research physiotherapist. Exercises will be included under the following categories: warm up, functional muscle strengthening, aerobic, and balance. Each participant will be able to self‐select exercises within each category based on their preference for certain exercises and recommendations by the physiotherapist, thus allowing participants to tailor their exercise program. Exercise sessions will be tailored to last 60 minutes (10 minutes warm up, 20 minutes functional muscle strengthening, 15 minutes aerobic exercises and 15 minutes balance exercises) and are to be completed 3 times per week, with at least one day of rest between exercise sessions. Participants will be asked to maintain exercise intensity at 12‐13 (‘somewhat hard ’) on the Borg rating scale of perceived exertion (RPE) during the functional muscle strengthening and aerobic exercise components. The research physiotherapist will schedule fortnightly phone calls with the participant to monitor for any adverse events , and to encourage the participant to engage in more difficult exercises if appropriate. The participant will also be given an information booklet containing information on how to safely progress their exercises. In addition, if the participant is using the Wii Fit Plus software often enough and improving their scores on certain games, the software will give the participant the option of progressing their exercises through an increase in the amount of repetitions, duration or speed of a task. Participants will be provided with a choice of weekly reminders to complete exercise sessions and to fill in their exercise diary, via emails or telephone calls. The exercise diary will be used to monitor adherence. CONDITION: Chronic low back pain PRIMARY OUTCOME: Self‐Efficacy using the Pain Self‐Efficacy Questionnaire (PSEQ). Mean score out of 60. Use of any care seeking services (doctor, physiotherapist, chiropractor, medication, etc.). Care‐seeking will be assessed by the following 3‐item self‐reported questionnaire (mean score out of 3): ; ; 1) Are you currently receiving any treatment for your low back pain? (e.g. medication use, GP visits, private physiotherapy, private chiropractic, etc.)? ; ; 2) Are you planning to start any treatment for your low back pain in the next months? ; ; 3) Are you currently taking any medication (prescription or over‐the‐counter) for your low back pain? ; ; SECONDARY OUTCOME: Adherence to the exercise program scored as a percentage of the total time suggested to participate in the program. Based on the participant exercise diary. Disability using the Roland Morris Disability Questionnaire. Mean score out of 24. Falls efficacy using the Falls Effiacy Scale‐I (FES‐I). Mean score ranging from 16‐64. Function using the Patient Specific Functional Scale (PSFS). Mean score out of 30. Pain using the Numeric Rating Scale (NRS). Mean score out of 10. Physical activity levels using the Rapid Assessment of Physical Activity (RAPA). Mean score out of 9. Self‐Efficacy using the Pain Self‐Efficacy Questionnaire (PSEQ). Mean score out of 60. Use of any care seeking services (doctor, physiotherapist, chiropractor, medication, etc.). Care‐seeking will be assessed by the following 3‐item self‐reported questionnaire (mean score out of 3): ; ; 1) Are you currently receiving any treatment for your low back pain? (e.g. medication use, GP visits, private physiotherapy, private chiropractic, etc.)? ; ; 2) Are you planning to start any treatment for your low back pain in the next months? ; ; 3) Are you currently taking any medication (prescription or over‐the‐counter) for your low back pain? ; INCLUSION CRITERIA: i) over 55 years old; ii) currently on the waiting list to receive outpatient physiotherapy treatment, which doesn't fall within the next 8 weeks; iii) experienced low back pain for at least the last 3 months; iv) currently has low back pain which is greater than 3/10 on a pain scale; v) sufficient English ability; vi) mobilises independently without the use of any aids (e.g. walking stick, walking frame, etc.); vi) owns a HDMI compatible television at home (this is a requirement to use the video‐game equipment).

Actrn (2016). "LEAP-CP: Learning through Everyday Activities with Parents for infants at high risk of Cerebral Palsy in a low-income country." https://trialsearch.who.int/Trial2.aspx?TrialID=ACTRN12616000653460.
	INTERVENTION: The LEAP‐CP intervention is a multidisciplinary family‐centred intervention comprising of 2 parts; (1) delivered peer to peer in the home during 15 fortnightly 2‐hour visits (over a 7‐10 month period, allowing for missed visits due to illness and family/ religious events); (2) delivered by the caregiver to the infant daily (based on the games/ strategies delivered in the fortnightly peer to peer visit. During the fortnightly visit, the Community Disability Worker (peer trainer) will (i) gather feedback and troubleshoots the previous fortnight’s activities, (ii) deliver the therapeutic modules, (iii) deliver the educational module. The caregiver will be provided with written and pictographic information of the three modules each fortnight to facilitate their use of the strategies each day during the upcoming fortnight. Therapeutic Modules: The therapeutic modules are first modeled with the infant by the CDW, and then the caregiver encouraged to engage with their infant, with CDW coaching. The therapeutic modules consist of: 1. Multidimensional activity based curriculum for infants aged 3‐18 months, based on the Creative Curriculum Learning Games (Sparling & Lewis 2008) as a framework for structure and approach. Culturally modified activity cards are translated into Bengali, and include pictographic prompts for ‘how to make this game easier’ and ‘how to encourage practice in other situations’. The CDW will present four activity cards to the caregiver each fortnight from which the caregiver selects two to learn and deliver with their infant during the fortnight (total of 30 games for the program duration). The four options will be selected based on the infant’s age and developmental stage, with guidance from the Community Coordinator. The literature highlights the importance of collaborative selection of therapeutic activities. When delivering a game, the CDW ensures that the infant can complete at least part of the task actively, to ensure optimal motor learning. 2. Individualised goal‐directed module: Specific goal‐based strategies will be introduced using strategy sheets developed for the study by a multidisciplinary team of clinicians specialised in cerebral palsy (physiotherapy, occupational therapy, speech pathology, psychology and physician). Caregivers will be supported to choose a self‐generated intervention goal in visit number 2, individualised to their infant. Each goal area includes red flags for referral for complex and high risk presentations. As a goal is achieved, caregivers will be encouraged to choose a new goal. If the infant remains on a goal without progress for greater than 4 visits (2 months), caregivers will be encouraged to choose a new goal. Parent Educational Modules (one per fortnight): Module 1. Building rapport and program overview (Novak 2006) ‐ Introduction of CDW, caregiver and infant ‐ Building rapport and general observation of preferred play activity ‐ What does the LEAP/ SC program cover (frequency of visits, content) Module 2. Setting goals and problem solving approach (Novak 2006) ‐ Identify infant and family strengths/ abilities ‐ Discuss caregiver’s needs and priorities for their infant and family (development and care) ‐ Goal setting with the COPM ‐ Introduction of a problem solving approach and caregiver coaching Module 3. Living a meaningful life (Whittingham 2013, 2014) ‐ Dealing with grief ‐ Finding hope to live a meaningful life ‐ Parent self‐care Module 4. Breastfeeding (WHO 1993) ‐ Importance of exclusive breastfeeding ‐ What is optimal breastfeeding ‐ Observation of a feed (with support strategies) Module 5. Parent‐infant bonding and interaction (Care for Child Development modules; Whittingham 2013, 2014) ‐ Increasing caregiver’s awareness of infant movements and behaviours (reading their cues) ‐ Building a warm connection between caregiver and infant ‐ Responding consistently and positively to the infant (praise and advise the caregiver on care practices) Module 6. Encouraging your bab ’s active and independent play (Law 2011) ‐ Importance of infant being active in task engagement. ‐ How to encourage active play: activity selection (just right challenge) and providing appropriate physical support and cues Module 7. Introduction of complementary feeding (WHO 2004) ‐ Importance of complementary feeding ‐ Family beliefs and community practices ‐ Preparing safe and nutritious early foods ‐ Foods for energy and specific nutrients ‐ Observation of a snack (with support strategies) Module 8. Infant health (WHO, 2014) ‐ Reflux: signs, basic management and when to seek help ‐ Epilepsy: signs and when to seek help ‐ Diarrhoeal disease: basic management and when to seek help ‐ Other common health concerns and health seeking behaviour Module 9. Growth monitoring (WHO 2009) ‐ Growth measures ‐ 24 hour recall of dietary intake ‐ Counselling regarding recommended daily intake (food groups) CONDITION: cerebral palsy PRIMARY OUTCOME: Caregiver mental health: change in scores on the Depression, Anxiety, Stress Scale – Short Form (DASS) Infant functional abilities: change in normative scores on the mobility domain of the Pediatric Evaluation of Disability Inventory ‐ Computer Adaptive Test (PEDI‐CAT). This measure was the primary outcome a priori (ie before any recruitment commenced), however the mobility domain was selected as the primary outcome domain. SECONDARY OUTCOME: Canadian Occupational Performance Measure (COPM) Health resource use, recorded on Health Resource Use Form (Boyd 2013) Infant cognitive development: Bayley Scales of Infant Development III (BSID‐III) Infant motor skills: Peabody Developmental Motor Scales ‐ Second edition (PDMS‐2) Infant neurological status: Hammersmith Infant Neurological Examination (HINE) Infant nutritional status: Body Mass Index Z score (WHO guidelines) Infant nutritional status: Head circumference, to nearest completed millimetre Infant nutritional status: Height/ length to nearest completed millimetre (converted into Z scores according to WHO guidelines) Infant nutritional status: Mean upper arm circumference, to nearest completed millimetre Infant nutritional status: Weight, to the nearest 100g (converted into Z scores based on WHO guidelines) Near Vision Detection Scale Quality and extent of stimulation in the home: HOME Inventory INCLUSION CRITERIA: Infants must live in one of the study geographical areas, be aged 12‐40 weeks C.A. and be diagnosed with cerebral palsy (CP) or assessed to be at high risk of cerebral palsy. Eligibility assessments will be videoed by the community coordinator and scored by certified General Movements (GMs) assessors. Infants will be determined at risk if: ‐ Aged 12‐17 weeks corrected age (CA) with absent fidgety movements on the GMs assessment (98% predictive of CP). GMs is a feasible assessment in this context as it can be videoed by the community coordinator and scored by a general movements certified rater. ‐ Aged 18‐40 weeks CA and score as ‘abnormal’ on the Hammersmith Infant Neurological Examination (90% predictive of CP)

Actrn (2016). "Play Activities Program for nursing home residents with chronic pain." https://trialsearch.who.int/Trial2.aspx?TrialID=ACTRN12616000783426.
	INTERVENTION: Participants in the experimental group nursing homes will receive the 8‐week Play Activities Program (PAP). The PAP is a protocol‐driven intervention which consists of one session per week for a total of 8 weeks. It is conducted in a group format with an emphasis on teamwork and learning various pain management techniques via game activities. Participants are encouraged to sit together in small groups of 5 to 6 for group activities in every session so as to create social bonding. The PAP will be carried out in the multi‐function room, preferably with comfortable chairs, adequate lighting, and comfortable ventilation. Each session lasts for 60 minutes. At the beginning of each session, participants will complete 10 minutes of physical exercises including towel dancing; correct body posture and alignment; stretching of arms, legs, and body muscles performed together under the supervision and monitoring of the research team. Then follow by 40 minutes play activities and 10 minutes of portfolio entry. Research assistant with nursing or health‐care background will facilitate in the sessions. Examples of the play activities include: Session One: Participants will will watch a series of photographs of the natural environment displayed by a projector for 10 minutes. They will be asked to choose the photographs that they like the most. Session Two: Each participant will be given a piece of paper and a few balls of cotton wool; the cotton wool balls will be placed on top of the participants’ sheet of paper. The participants need to blow the cotton wool onto the paper of the next person. Session Three: The participants will be asked to hold a piece of cloth (6 feet x 3 feet in size) using both hands and to move a light ball from one side of the cloth to the other side. There will be several holes in the cloth and the participants will have to work together to prevent the ball from falling into these holes. Session Four: The participants will be given colourful paper, and they will make paper flowers and leaves. Session Five: All participants will be seated in a big circle and together they will hold a 6‐metre parachute. They will work together, using both hands to throw the parachute in the air and then release their hands, so that the parachute will stay up for 2‐3 seconds before coming down; Session Six: All participants will sit in a big circle. One person will be invited to stand in front of the group for 30 seconds. The person will then hide in a secret place and modify his/her look. This person will return to the group and the participants will point out the changes that were made. Session Seven: Each participant will be given a small handbag made of plain cloth and will be invited to decorate their handbag with stickers. Session Eight: The final session will be a summary of the previous sessions. The participants will play with the parachute (as in Session Four) and avoid pain traps (as in Session Three). They will be encouraged to bring out their flowers and handbags as a reminder to shine like flowers and lead a pain‐free life (as in Session Seven). To ensure the adherence and compliance to protocol content and process, regular meetings will be held among the research team and nursing home staff; also, we shall carefully recruit, thoroughly train, provide ongoing and onsite supervision of research personnel. The consistency of research personnel training will be provided by the principal investigator. Register of attendance at each session will be done; CONDITION: chronic pain PRIMARY OUTCOME: current pain intensity and pain interferes as measured by Brief Pain Inventory SECONDARY OUTCOME: Acceptability of the PAP as measured by self‐developed open‐ended questionnaire Happiness level as measured by Subjective Happiness Scale (SHS) Health‐related quality of life as measured by the 12‐item Short‐Form Health Survey (SF‐12) Objective assessment of pain as measured by saliva biomarkers including alpha‐amylase, cortisol and beta‐endorphin Pain self‐efficacy as measured by Ch nese version of the Pain Self‐efficacy Questionnaire (PSEQ) INCLUSION CRITERIA: ‐ aged 65 or above ‐ able to speak and understand Cantonese ‐ willing and able to sign a consent form ‐ experienced pain in the last 3 months of intensity score >=3 ‐ with Chinese Mini Mental State Examination (CMMSE) score >=20 and Hong Kong Montreal Cognitive Assessment (HK‐MOCA) >=19

Actrn (2017). "BRAIN Training Trial: balance, Resistance, or INterval Training Trial: a Randomised Controlled Trial of Three Exercise Modalities in Mild Cognitive Impairment."
	Inclusion criteria: 1. Mild Cognitive Impairment (MCI) defined as the presence of all four generally accepted criteria (*) 1.1. Absence of dementia: Clinical Dementia Rating scale (CDR) score below 1. 1.2. No or minimal functional impairment due to cognition: Amsterdam IADL Questionnaire score equal or greater than 40, rated by informant or participant if no informant available. 1.3. Subjective memory/cognitive complaint: a) Cognitive Change Index (CCI) scale: Participant or informant responds to 3 or more statements with a rating of 3, 4 or 5 (‘mild to severe problem’); OR b) Subjective memory complaint questionnaire: Participant or informant responds ‘yes’ to question (1): ‘Have you noticed difficulties with your memory?’ and ‘yes’ to questions 2 OR 3: (2)‘Have you been concerned about your memory?, (3)Have you mentioned any concerns about memory to anyone? respectively, as per recommendations for the assessment of subjective memory complaint. 1.4. Objective cognitive impairment: Score between 19 and 25 on the Montreal Cognitive Assessment (MoCA). 2. Age 60 or above 3. Ambulatory without the assistance of a person 4. If from non‐English speaking background, must have completed some education in English. 5. Residing in the community, including retirement villages and other senior housing or activity sites (independent level of care) 6. Willing to participate in a study which involves attending supervised exercise sessions 3 days per week for 12 months There will be 3‐stage screening, which includes: Telephone screen by research assistant of participant and informant (if available) for willingness to participate, sedentary status, no exclusionary medical history, no current mayor depression (PHQ‐9 score of 9 or below), no planned move, no planned vacation for more than 4 consecutive weeks during the 12 month stuy period. This will be followed by In‐person screen to assess criteria for mild cognitive impairment, and later on by In‐person screen by physician to perform medical screen and stress testing (to ascertain unstable or unsuitable medical conditions). (*) Winblad B, Palmer K, Kivipelto M, et al. Mild cognitive impairment‐beyond controversies, towards a consensus: report of the International Working Group on Mild Cognitive Impairment. J Intern Med 2004;256:240‐6. Exclusion criteria: 1. Diagnosis of dementia 2. High level residential care 3. Non‐ambulatory or requiring person to assist when walking 4. 1 stroke in the past 12 months or 2 or more strokes in a lifetime 5. Cardiovascular event/surgery in the past 6 months 6. Progressive neurological disease 7. Inability to read and identify objects on a computer screen and draw on a piece of paper due to vision impairment 8. Current major depressive episode (PHQ‐9 score of 9 or below) 9. Psychosis 10. Alcohol abuse (Responded ‘Yes’ to questions 3 and 4 of the CAGE, and reported risky drinking behaviour using NHMRC standard criteria) 11. From a non‐English speaking background (NESB) without any education in English 12. Already practicing =150 min moderate intensity exercise, PRT or HIIT regularly 13. Medical contraindications to the planned exercise due to chronic or unstable or terminal diseases 14. Planned move, or planning to be away for 4 or more consecutive weeks during the study period Mild Cognitive Impairment 1. Study Sites: This multi‐site randomised control trial will take place across 3 study sites: University of Sydney (Australia), University of Queensland (Australia), and University of British Columbia (Canada). 2. Intervention Arms and Training Location: Eligible and consenting participants at each study site will be randomly allocated to one of three study arms; progressive‐resistance training (PRT), high‐intensity interval training (HIIT) or a balance, toning & mobility (BTM) sham‐control group. Participants will train supervised 3 days per week, for 52 weeks. Trainers will have a background in exercise and sports science, exercise physiology, kinesiology or physiotherapy. The location of the exercis sessions will vary according to the study site as follows: ‐ University of Sydney and University of British Columbia: PRT and HIIT training sessions will be performed in university‐based gymnasiums; BAT sessions will be performed in separate rooms to the PRT and HIIT training groups. ‐ University of Queensland: PRT training sessions will be performed in a gymnasium based in a retirement village; HIIT and BAT will be performed in separate rooms within the same retirement village. Resident of the retirement village and members of the community will have access to the training areas. 2.1. Intervention Arm 1: Progressive Resistance Training (PRT) The PRT intervention will consist of 7 exercises performed using pneumatic resistance machines for 3 sets of 8 repetitions at 80% of 1 repetition maximum (1RM). Participants will be instructed to contract concentrically ‘as fast as possible’ and then take 3‐4 seconds through the eccentric phase. Rest between repetitions will be 10‐15 seconds, and 1 to 2 minutes between sets. Exercises will be performed in the following order: bilateral leg press, bilateral chest press, unilateral knee extension, bilateral seated row, bilateral knee flexion, bilateral triceps pushdown, unilateral hip abduction. Total session time will be approximately 60 minutes, with a ratio of 1 trainer to 4 participants. Week 1 and 2 of the intervention will include familiarisation (session 1), assessment of 1RM (session 2) and gradual increase in target intensity from 50% (session 3), 60% (session 4), 70% (session 5) until 80% of 1RM is reached in session 6. Thereafter training intensity will be set at 80% 1RM and progressed by a projected gain in strength of 3% 1RM each session, used in conjunction with daily ratings of perceived exertion (15‐18/20 on the Borg Scale). At the start of every 7th session, 1RM will be re‐tested and target weight at 80% 1RM will be recalculated based on the new 1RM. Muscle visualization and mental imagery: Prior to each set, and during the rest intervals, participants will be shown a poster depicting the exercise being performed and the muscles targeted. The instructor will show participants where these muscles are located and encourage participants to feel the area. During the contraction phase of each repetition, participants will be asked to visualise and focus on the contracting muscles as they perform the movement 'as fast as they can'. 2.2. Intervention Arm 2: High Intensity Interval Training (HIIT) The heart rate (HR) target used during the intervention will be set based on the peak HR achieved on the stress test at baseline. The HIIT intervention will be performed on a treadmill, recumbent cross trainer or bike, depending on feasibility, preference, and co‐morbidities such as osteoarthritis or balance impairment. Each session will consist of an 8‐minute warm up at 60% peak HR; one 4‐minute interval with a progressive increase in intensity so as to achieve 85% peak HR by the end of minute 2, and maintain 85% to 95% peak HR during minutes 3 and 4 of the interval; and a 3‐minute cool down at 60% peak HR. Heart rate will be monitored continuously during all sessions using a heart rate monitor to adjust the workload used (speed or slope of treadmill; resistance or revolutions per minute on cross trainer or bike) so as to keep the HR during the last 2 minutes of the interval at 85‐95% of peak, and at 60% during warm‐up and cool‐down. Sessions 1 to 4 of the intervention will include familiarisation and gradual increase of the time spent at 85‐95% peak HR during the interval from 30, 60, 90 to 120 seconds in each successive session. Individuals with atrial fibrillation or on beta‐blockers will be included, but we will use the Borg Scale of Perceived Exertion (rating 16‐17/20) to adjust the workload in addition to HR. Total session time will be 15 minutes, with a ratio of 1 trainer for 4 participants. Change in overall executive domain of cognitive function score (composite measure) calculated based on the scores attained in the following tests: ‐ Neurotrax Stroop Interference Test ‐ Neurotrax Go‐No Go Test ‐ Neurotrax Catch Game ‐ Trails A and B Test (Trails B/Trails A ratio score) ‐ Category Fluency Test ‐ WAIS‐IV Matrix Reasoning Test;Change in individual tests scores for executive domains of cognitive function as assessed by the following tests (not composite measure): ‐ Neurotrax Stroop Interference Test ‐ Neurotrax Go‐No Go Test ‐ Neurotrax Catch Game ‐ Trails A and B Test (Trails B/Trails A ratio score) ‐ Category Fluency Test ‐ WAIS‐IV Matrix Reasoning Test Change in individual tests scores for secondary domains of cognitive function (memory, attention/working memory, visual‐spatial, language, information processing speed, motor skills) as assessed by the following tests: ‐ Neurotrax Verbal (paired associates) and Non‐Verbal (visual‐spatial) Memory tests ‐ Hopkins Verbal Learning Test Revised (HVLT‐R) (Trial 1, total learning and delayed recall) ‐ Benton Visual Retention Test (BVRT) ‐ Neurotrax Information Processing Speed Test ‐ WAIS‐IV Digit Span forwards and backwards tests ‐ Neurotrax Visual Spatial Processing test ‐ Neurotrax Verbal Rhyming test ‐ WAIS‐IV Coding ‐ Trails Making Test form A (TMT‐A) ;Change in individual scores for global cognition as assessed using the following instruments: ‐ Montreal Cognitive Assessment (MoCA) ‐ Clinical Dementia Rating Scale (CDR) ;Change in score of functional impairment due to cognition as assessed using Amsterdam independent activity of daily living (IADL) Questionnaire ;Change in functional mobility as assessed using the Short Physical Performance Battery (SPPB) ;Change in functional mobility as assessed using the 6‐minute walk test.;Change in gait dynamics as assessed using a single and dual task walking test: 1‐minute walking at a) usual speed with no secondary task, b) with a secondary subtraction task, c) with a secondary letter fluency task.;Change in balance as assessed using static and dynamic balance tests: ‐ Static balance: Timed stand feet hip width, feet together, feet near tandem, feet tandem, 1 leg, feet tandem eyes closed, one leg eyes closed. ‐ Dynamic balance: Timed 3mt walk with feet in tandem.;Change in whole body and regional lean and adipose tissue assessed using Dual‐energy X‐ray absorptiometry (DXA);Change in bone density in the lumbar spine and hip assessed using the following techniques: ‐ Dual‐energy X‐ray absorptiometry (DXA) ‐ Peripheral quantitative computed tomography (pQCT)(*) (*)Only at University of Queensland ;Change in individual scores for subjective cognitive complaint as assessed using the following instruments: ‐ Cognitive change Index (CCI) ‐ Set of subjective cognitive complaint questions (non‐validated questionnaire): 1. Have you noticed difficulties with your memory? (YES/NO) 2. Have you been concerned about your memory? (YES/NO) 3. Have you mentioned any concerns about memory to anyone? (YES/NO) 4. Have others commented on your memory? (YES/NO) 5. Have you seen a GP, specialist or other health professional about your memory? (YES/NO) ;Change in structural, metabolic or functional brain changes as assessed using MRI Morphology and Cerebral Perfusion: Structural changes using 3D T1‐weighted, FLAIR, DTI; Metabolic changes using ASL; Functional changes using rs‐fMRI; microbleeds using SWI) Areas of interest: Posterior Cingulate Cortex (PCC) and Hippocampus volumes, perfusion and connectivity; White Matter Hyperintensity volume and distribution, total Grey and White Matter volume, mean Cerebral Blood Flow (rCBF) and Cerebral Blood Volume (rCBV), Hippocampal rCBF and rCBV, structural connectivity in the default mode network (DMN) and frontal‐subcortical network, and functional connectivity in DMN and Fronto‐executive network. ;Waist Circumference using the International Diabetes Federation protocol;Changes in ambulatory blood pressure for 24 hours assessed using Oscar 2 with Sphygmocor Inside.;Changes in blood pressure assessed assessed using the following: ‐ Resting bra hial systolic and diastolic pressures and central aortic systolic blood pressure: SphygmoCor XCEL PWA (pulse wave analysis). ‐ Orthostatic blood pressure: SunTech automatic blood pressure monitor.;Changes in individual measures of arterial stiffness including: Carotid‐femoral pulse wave velocity (PWV), pulse wave analysis (PWA) , central aortic systolic blood pressure, central pulse pressure, augmentation index (AIx): assessed using Sphygmacor Xcel;Changes in Heart Rate Variability (HRV) assessed using SphygmoCor CvMS;Changes in individual vascular measures: ‐ Skin blood flow assessed using Laser Doppler perfusion monitor ‐ Cerebral blood flow assessed using Transcranial Doppler ‐ Flow Mediated Dilation assessed using reactivity of the brachial artery;Changes in biomarkers of brain pathology and cognitive function: BDNF, IGF‐1, IGF‐1 Binding protein 3, HOMA (insulin and glucose), APOE, Serum Cortisol, Epigenetic analysis, GWAS, Nitric Oxide, Vitamin D, Vitamin B12;Change in scores of fear of falling as assessed using the Tinetti Falls‐efficacy scale.;Change in scores of exercise related self‐efficacy assessed using the Ewart's Self‐efficacy scale.;Change in self‐reported attitude to ageing assessed using the Attitudes to Ageing Questionnaire (AAQ);Changes in individual measures of frailty as assessed using: ‐ FRAIL Scale ‐ Fried phenotype index;Change in empathy assessed using the Toronto Empathy Questionnaire;Change in happiness assessed using the Oxford Happiness Questionnaire;Change in self‐reported measure of depression assessed using the Geriatric Depression Scale (GDS‐30 item);Change in self‐reported size and satisfaction of social support assessed using the Duke Social Support Index.;Change in self‐reported quality of liife score as assessed using the Short Form 36 Health Survey Questionnaire (SF‐36);Change in individual measures of functional status as assessed using the following instruments: ‐ KATZ Index of Independence in Activities of Daily Living Assessment (ADL) ‐ Life Space Assessment Scale ‐ Use of assistive devices questionnaire ‐ Use of Community & Health Services questionnaire;Change in objective sleep quality measurement assessed over 7 days using using a Motion Watch 8 actigraphy system (MW8; camntech) together with a 7‐day Consensus Sleep Diary (CSD) ;Change in subjective measure of sleep quality assessed using the Pittsburgh Sleep Quality Index (PSQI) ;Change in objective measure of physical activity participation as assessed over 7‐days using an Axivity MEMS 3‐axis accelerometer and diary. ;Change in individual subjective measures of physical activity participation as assessed using: ‐ Paffenbarger Physical Activity Questionnaire ‐ Physical Activity Scale for the Elderly;Change in individual measures of nutritional status as assessed using: ‐ Mini Nutritional Assessment (MNA) ‐ MediCul Index ;Change in alcohol intake assessed using the CAGE Alcohol questionnaire;Attitudes towards the intervention assessed using semi‐structured interviews with participants allocated to HIIT and PRT intervention groups.;Adherence to the training protocol assessed using daily exercise attendance logs with record of exercise dose and intensity (HIIT: %HRpeak and PRT %1RM) per session. ;All adverse events related and not related to the intervention. Gathered using weekly health status check and reporting of events throughout the study period.;Change in Aerobic Capacity measured by indirect calorimetry during a maximal walking treadmill exercise test to fatigue.;Change in individual measures of muscle strength and power as assessed using: ‐ Maximal dynamic muscle strength assessed using 1 repetition maximum (1RM) on pneumatic resistance machines: Bilateral leg press, unilateral knee extension, bilateral chest press, bilateral triceps extension. ‐ Maximal muscle power assessed using pneumatic resistance machines: bilateral leg press, unilateral knee extension, bilateral chest press, bilateral triceps extension. ‐ Maximal isometric muscle strength assessed using stand‐held dynamometer: unilateral hip abduction, unilateral knee extension, unilateral triceps extension, unilateral ankle dorsiflexion. Maximal grip strength using hand‐held dynamometer.

Actrn (2017). "SPORTS STARS: How well does a sports focused physiotherapy group for children with Cerebral Palsy improve movement and sports participation." https://trialsearch.who.int/Trial2.aspx?TrialID=ACTRN12617000313336.
	INTERVENTION: Sports Stars is a fundamental movement skills therapy using variable practice to prepare children with CP for participation in sports. Therapists will be provided with an online package of intervention documents which detail the intervention. These will be accessed through CPL’s intranet. The session plans detail the intervention provided each week with 3 levels of difficulty. Equipment utilised in these groups included basic sporting equipment such as balls, bats and goals. Sports Stars includes 8 x 1 hour weekly group sessions held after school. Each session includes 50 minutes of active participation in the group and 10 minutes for welcome/subjective review/discussion. Therapy sessions: Each session included the following sections: 1. Warm up (5 minutes) 2. Activity‐ Locomotor Skills (15 minutes) ‐ Running ‐ Agility ‐ Coordination 3. Activity‐ Object Control Skills (15 minutes) ‐ Sending (kicking, batting, throwing, heading) ‐ Receiving (stopping, catching) 4. Participation‐ Modified Sports Game (10 minutes) 5. Cool Down (5 minutes) Each activity includes 3 levels of difficulty that children can progress up when they are achieving the previous level as demonstrated within the group. Activities in Sports Stars should be challenging but achievable. Sports Stars is a face to face group intervention held with 3‐6 participants. The group runs for 8 weeks and includes variable practice of the above categories using four sports: Soccer, Netball, T‐ball and Cricket. Two weeks are allocated to each sport to provide variation in activity whist still developing the same key movement skills described. Reminder calls will be made the day before the group and attendance will be monitored by the physiotherapist running the group with an attendance register to be completed each session. Physiotherapists with at least one year’s experience working with children with Cerebral Palsy in a community setting will provide the Sports Stars intervention. Physiotherapists will undergo a training course on the Sports Stars program in addition to having access to video resources throughout the program. CONDITION: Cerebral Palsy Fundamental motor skills PRIMARY OUTCOME: Canadian Occupational Performance Measure SECONDARY OUTCOME: 10‐meter shuttle run test 10x15m Sprint Test Children’s Assessment of Participation and Enjoyment (CAPE) total and activity types: ; Recreational, Physical activities, Social activities, Skill‐based activities and Self‐improvement activities CP QOL‐Child Functional strength field tests – Standing Broad Jump, Vertical Jump and Seated Throw ; GMFM Challenge Module Muscle Power Sprint Test Preferences of Activities for Children (PAC)‐total and activity types: ; Recreational, Physical activities, Social activities, Skill‐based activities and Self‐improvement activities TGMD‐2 Test of Gross Motor Development Version 2 Timed up and go (TUG) INCLUSION CRITERIA: Children aged 6‐12 years: * With a diagnosis of cerebral palsy. * Who are ambulant without aids (GMFCS I‐II). * Who are able to commit to attending all assessments and all treatment sessions in the 8‐week intervention.

Actrn (2017). "What are the possible benefits of Robotic-Assisted Gait Training and how much training is needed: A pilot randomised clinical trial with children with Cerebral Palsy." https://trialsearch.who.int/Trial2.aspx?TrialID=ACTRN12617001410347.
	INTERVENTION: Pilot 3‐arm randomised controlled trial investigating the effects of Robotic‐Assisted Gait Training (RAGT) in children with cerebral palsy (CP) Arm 1: Six‐week waitlist then random allocation into two or four (30‐40 minute) RAGT sessions per week for six weeks. Arm 2: two (30‐40 minute) sessions of RAGT per week for six weeks Arm 3: four (30‐40 minute) sessions of RAGT per week for six weeks. RAGT sessions: approximately 1 hour, with 30‐40 minutes of this active 1:1 (individual) therapy using the Lokomat Pro in sessions conducted by the Robotics and Innovation Physiotherapist at the Women's and Children's Hospital. These sessions will be carried out at the Little Heroes Foundation Centre for Robotics and Innovation at the Women's and Children's Hospital. All sessions are conducted following the Hocoma Lokomat manual, and directions and session plans are created based on clinical reasoning by paediatric physiotherapists. In the first session of the intervention blocks, pre‐assessment data will be collected and recorded (approximately 1 hour) before an acclimatisation session in the Lokomat®Pro (30‐40 minutes). Each subsequent intervention session will be 60 minutes long which will include around 10‐20 minutes of heart rate and blood pressure measures, set up and fitting time, 30‐40 minutes of active RAGT, and five minutes for completion of final assessments. During the active RAGT period, a range of avatar‐based games and biofeedback information will be used to target different goals as determined by the COPM assessment. The three Lokomat® variables that will be adjusted regularly throughout sessions are treadmill speed, weight support and guidance force. These changes will be made subject to Borgs rating of percieved exertion scores being ideally 13. Treadmill speed would be increased, and weight support decreased if it appears the child requires an increased challenge or is progressing well between sessions. Guidance force is the amount of assistance the Lokomat® is providing the child to walk in the physiological gait pattern. This would be decreased to provide an additional challenge or as a motivational technique using the biofeedback charts. Throughout the RAGT sessions, children will be given feedback on progress as compared to previous sessions and achievements can be logged and shown in real time on the video screen. At the last intervention session, the post‐assessments will be undertaken (approximately 1 hour). The assessments will be repeated six weeks after the intervention period. CONDITION: Cerebral Palsy PRIMARY OUTCOME: Change in Canadian Occupational Performance Measure (COPM) SECONDARY OUTCOME: Australian Spasticity Assessment Scale (ASAS) Borgs Rating of Perceived Exertion Scale (RPE) Cerebral Palsy Quality of Life Questionnaire (CP QOL‐Child) Functional Mobility Scale Gross Motor Function Classification Scale (GMFCS) ; Gross Motor Function Measure sections D and E (GMFM) Preferences for Activities of Children (PAC) Range of motion of lower limbs; Selective motor control in lower limbs ; Knee: ; Position: Sitting ; Ask the participant to extend, flex then extend the knee while keeping the hip flexed. For example: “Straighten your knee as much as you can, then bend it and straighten again. Try to do this without leaning further back or moving your other leg. I will take you ; through the motion first, and then I’ ; d like you to do it yourself.” ; Ankle: ; Position: Sitting. The knee is extended and the examiner supports the calf. Assess passive ankle ; dorsiflexion ROM with the knee extended. The knee may be flexed to approximately 20 degrees if needed to accommodate hamstring and/or ; gastrocnemius tightness. ; Instructions – ; Ask participant to dorsiflex, plantar flex then dorsiflex the ankle while maintaining knee extension. For example: ; “Keeping your knee straight while I support your leg, move your foot up, down then up again. I will take you through the motion first, then ; I’d like you to do it yourself.” Standardised muscle ci cumference of thigh and calf (centimetres) The Children’s Assessment of Participation and Enjoyment (CAPE) Two‐minute walk test (2mwt) INCLUSION CRITERIA: INCLUSION CRITERIA: •Children with a diagnosis of Cerebral Palsy •GMFCS level of II‐IV •Aged 5 to 14 years •Able to follow instructions, and to participate in a minimum of 45 min of active physical therapy •Able to communicate pain, discomfort and report on perceived level of exertion

Actrn (2018). "Staying UpRight in Residential Care: An exercise program for older people living in residential care designed to reduce rates of falls." https://trialsearch.who.int/Trial2.aspx?TrialID=ACTRN12618001827224.
	INTERVENTION: "Staying UpRight" is a strength, power and balance program, delivered in 1 hour sessions, twice weekly over 1 year. It is a group program (approximately 8 residents per group), delivered by one physiotherapist and one assistant. Strength training uses low repetitions, moderate‐high resistance (2 x 10 repetitions at 5‐7/10 effort) in weight‐bearing positions (e.g. lunges, squats, sit to stand, heel raises) progressed by increasing the speed and/or depth of the movement (e.g. deeper lunges). Balance training comprises static and dynamic activities (e.g. tandem and one legged stand, reaching, stepping, walking, and turning) and is progressed by reducing hand support, reducing the base of support, reducing visual input; and adding a cognitive task. For example, walking on the spot on toes and heels is progressed to walking on toes and heels forwards, backwards and sideways; and stepping over obstacles. The program is manualised and includes instruction on exercise delivery and exercise progression. Exercises completed in each session, and exercise progressions for the group are recorded on a spreadsheet, in addition to a participant attendance record. The active control program, led by an activities coordinator, uses only seated activities (no standing component), ‘light’ work (<5/10) with no resistance exercises and no progressions. Activities focus on seated movement and variety e.g. seated upper and lower limb activities; seated boxing, seated marching, heel and toe tapping; seated upper and lower limb stretches using non elastic bands and games e.g. seated scarf catch and throw, pass the parcel. Fidelity of program delivery will be checked during the first 6 months (of physiotherapist delivery) and the second 6 months (of facility staff member delivery) through: a. A site visit from the project manager within the first 2 months of each 6‐month block, which entails observation of a class taking place. Feedback is given as necessary to the physiot CONDITION: Falls ;Dementia; ; Falls; ; Dementia Injuries and Accidents ‐ Fractures Injuries and Accidents ‐ Other injuries and accidents Neurological ‐ Dementias Physical Medicine / Rehabilitation ‐ Physiotherapy PRIMARY OUTCOME: Rate of falling expressed as number of falls per thousand person‐years of follow‐up.[Continuous monitoring of care home accident / incident fall registers for the 6 months prior to study commencement (to provide baseline data) and at 12 months after intervention commencement at the facility ] SECONDARY OUTCOME: Change in cognition, assessed using Montreal Cognitive Assessment scores[Baseline prior to randomization, 6 months and at 12 months after facility intervention commencement. ] Change in gait variability: a composite measure using accelerometer algorithms valid for 14 spatio‐temporal features of gait[Baseline prior to randomization, 6 months and at 12 months after intervention commencement at the facility ] Change in Short Performance Physical Battery (mobility) component scores[Baseline prior to randomization, 6 months and at 12 months after intervention commencement at the facility ] Change in Timed Up and Go (mobility) scores[Baseline prior to randomisation, 6 months and at 12 months after intervention commencement at the facility] Change in total volume (time) and pattern of ambulatory activity (a composite measure of ambulatory bout length, accumulation of bouts, distribution of bouts ) expressed as number of non‐sedentary hours of follow‐up per thousand person‐years of follow‐up, assessed using body‐worn accelerometers[Baseline prior to randomization, 6 months and at 12 months after intervention commencement at the facility ] Cost effectiveness of program expressed as the ratio of estimated total cost of program against estimated total savings in hospitalisation costs. Use of healthcare resources will be obtained using NHIs from national databases (National Minimum Dataset and National Non‐Admitted Patients Collection) and care home records (including intervention details). U it costs will be assigned using Weighted Inlier Equivalent Separations NZ, indicative District Health Board costs for outpatients.[On completion of interventions at all facilities] Fall‐free activity time expressed as falls rate per minutes of ambulatory activity, measured using validated algorithms for body‐worn accelerometers.[Baseline prior to randomization, 6 months and at 12 months after after intervention commencement at the facility ] Rates of hospitalisation for fall‐related injury (fracture, intracranial or extracranial haemorrhage) expressed as number of fall hospitalisations per thousand person years of follow‐up[Continuous monitoring of care home accident / incident fall registers for the 6 months prior to study commencement (to provide baseline data) and at 12 months after intervention commencement at the facility ] Risk of falling expressed as time to first fall. [Continuous monitoring of care home accident / incident fall registers for the 6 months prior to study commencement (to provide baseline data) and at 12 months after intervention commencement at the facility ] INCLUSION CRITERIA: Residents living in participating aged‐care facilities, who are 65 years of age and over, mobile with or without cognitive deficit

Actrn (2019). "The effect of a virtual reality game device on the functioning of children and adolescents with motor disabilities." https://trialsearch.who.int/Trial2.aspx?TrialID=ACTRN12619000781145.
	INTERVENTION: The experimental group will participate in a virtual reality game program with a head mounted display(HMD) device (HTC Vive) while continuing the physiotherapy program of the rehabilitation center in Athens. The duration of the physiotherapy program is 45 minutes,the frequency is twice per week and involves exercises for muscle strengthening,for better balance, functional activities like riding a bicycle, walking on a treadmill and climbing stairs and techniques‐exercises from the neurodevelopmental therapy. A physiotherapist is responsible for the administration of the therapy.He/She uses only simple equipment like pilates balls,layers and rolls. Children receive the physiotherapy program regardless they are involved in this study. The intervention with the HMD will be delivered once a week for 8 weeks.The duration of the intervention will be 45 minutes. Each child will participate alone. The two games, which children will play, will be selected based on children's preferences, through a list of several games, during their familiarization with the HMD device. In the first game,that called "Beat Saber", children hold the 2 controllers (in the game they see them as light sabers) and they have to cut blue and red cubes in the rythm of the music they have chosen, while they are trying to avoid obstacles like walls.In the second game called "Arcade Saga", children hold the 2 controllers (in the game they see them as shields) and they have to punch a ball (small,big,a dozen of balls or a very fast ball.That depends on moving cubes that change the condition of the ball if the ball hits them) and score 7 or 9 goals, depends on the level, to win the computer.They can also slow down the ball with yellow circle rays by targetting the ball and pressing the trigger button. The intervention will be delivered by the researcher, but the assessments with the functional tests at the beginning of the research,at the end 8 weeks later and 8 weeks after the end will CONDITION: cerebral palsy; ; cerebral palsy Neurological ‐ Other neurological disorders Physical Medicine / Rehabilitation ‐ Physiotherapy PRIMARY OUTCOME: Gross motor function assesed by GMFM‐Gross Motor Function Measure[Baseline(before we start the intervention), 8 weeks later after the intervention to the determine the effects of the intervention(in the fisrt week after the intervention has ended‐primary timepoint) and 8 weeks after the end of intervention(int the first week after completing these 8 weeks)] Movement and Changes in body position assesed by Time Up and Go(TUG), 1 Minute Walking Test, 10 Meters Walking Test and by 30 seconds Sit to Stand Test; This a composite primary outcome.[Baseline(before we start the intervention), 8 weeks later after the intervention to the determine the effects of the intervention(in the fisrt week after the intervention has ended‐primary timepoint) and 8 weeks after the end of intervention(int the first week after completing these 8 weeks)] Walking assesed by GMFM‐Gross Motor Function Measure, Time Up and Go(TUG), 1 Minute Walking Test and by 10 Meters Walking Test[Baseline(before we start the intervention), 8 weeks later after the intervention to the determine the effects of the intervention(in the fisrt week after the intervention has ended‐primary timepoint) and 8 weeks after the end of intervention(int the first week after completing these 8 weeks)] SECONDARY OUTCOME: Range Of Motion assessed by a goniometer.This is a composite secondary outcome. ; We will assess the passive range of motion of shoulder abduction, elbow extension, wrist extension, hip abduction,hip flection, knee extension and ankle dorsi flexion.[Baseline(before we start the intervention), 8 weeks later after the intervention(in the fisrt week after the intervention has ended) and 8 weeks after the end of intervention(int the first week after completing these 8 weeks)] Spasticity assesed by Ashworth Scale[Baseline(before we start the intervention), 8 weeks later after the intervention(in the fisrt week after the intervention has e ded) and 8 weeks after the end of intervention(int the first week after completing these 8 weeks)] INCLUSION CRITERIA: Children and adolescents diagnosed with cerebral palsy,ability to understand simple instructions, ability to walk with or without aids (Gross Motor Function Classification System‐GMFCS E & R levels I‐III),not participating in other organized extracurricular activities during the afternoon hours,absence of epilepsy and non‐involvement in therapeutic approaches such as orthopedic surgery or injection of botulinum toxin A (Botox‐A) into hypertonic muscles over the last 6 months.

Actrn (2019). "Effects of exercise in childhood brain cancer survivors." https://trialsearch.who.int/Trial2.aspx?TrialID=ACTRN12619000841178.
	INTERVENTION: Brief name: Goal‐directed therapeutic exercise program Study treatments: Arm 1 = Exercise intervention: participants will receive one weekly 30‐60 minute individualised, goal‐directed therapeutic exercise session for 12 weeks, delivered face‐to‐face by a trained exercise physiologist or physiotherapist at the research facility, and an accompanying parent‐led, home exercise program to be completed for 30 minutes three times per week. The intervention will be based on accepted exercise prescription guidelines for children and adolescents, with the aim of one hour of physical activity most days and three strengthening sessions per week, and comprise of a combination of moderate intensity physical exercise training (aerobic capacity, muscle strength or functional performance) as well as goal‐directed task specific practice. Examples of exercise prescribed in the therapeutic exercise session and in the home exercise program include: bike riding, ball games, skipping and sport‐specific skills such as soccer or netball. The intervention will be tailored according to participant age, e.g. game‐based activities for younger children, and may include peers or siblings to promote adherence to the home‐based component. Adherence to the intervention will be assessed by the physiotherapist or exercise physiologist who will complete a study logbook to record details about the exercises prescribed and the exercises completed. CONDITION: Cancer ‐ Brain Childhood brain cancer (childhood posterior fossa brain tumours); ; Childhood brain cancer (childhood posterior fossa brain tumours) Physical Medicine / Rehabilitation ‐ Other physical medicine / rehabilitation Physical Medicine / Rehabilitation ‐ Physiotherapy PRIMARY OUTCOME: Cardiorespiratory fitness (VO2 peak) as assessed by an electronically‐braked paediatric cycle ergometer [All primary outcomes are assessed at baseline, 12 weeks after intervention commencement (primary time point), 6 months following the 12 week assessment, and at 12‐months following the 12 week intervention] Goal attainment using the Canadian Occupational Performance Measure (COPM)[All primary outcomes are assessed at baseline, 12 weeks after intervention commencement (primary time point), 6 months following the 12 week assessment, and at 12‐months following the 12 week intervention. ] Submaximal endurance using the Modified Shuttle Test (MST)[All primary outcomes are assessed at baseline, 12 weeks after intervention commencement (primary time point), 6 months following the 12 week assessment, and at 12‐months following the 12 week intervention] SECONDARY OUTCOME: Cognitive ability as assessed by the Cognitive Assessment System 2nd Edition[All secondary outcomes are assessed at baseline, 12 weeks after intervention commencement, 6 months following the 12 week assessment, and at 12‐months following the 12 week intervention. ] Fatigue as assessed by the Paediatric Quality of Life Inventory (PedsQL) Multidimensional Fatigue Scale[All secondary outcomes are assessed at baseline, 12 weeks after intervention commencement, 6 months following the 12 week assessment, and at 12‐months following the 12 week intervention. ] Habitual Physical Activity: daily moderate‐to‐vigorous physical activity (MVPA) will be objectively measured using the ActiGraph GT3X+ accelerometer [All secondary outcomes are assessed at baseline, 12 weeks after intervention commencement, 6 months following the 12 week assessment, and at 12‐months following the 12 week intervention.] High‐level mobility skills as assessed by the High‐level Mobility Assessment Tool (HiMAT)[All secondary outcomes are assessed at baseline, 12 weeks after intervention commencement, 6 months following the 12 week assessment, and at 12‐months following the 12 week intervention. ] Muscle strength as assessed by the 30‐second repetition maximum of functional strength exercises (sit‐to‐stand, lateral step‐up and half‐kneel to stand)[All secondary outcomes are assessed at baseline, 12 weeks after interv ntion commencement, 6 months following the 12 week assessment, and at 12‐months following the 12 week intervention] Participation as assessed by the Participation and Environment Measure for children and youth (PEM‐CY)[All secondary outcomes are assessed at baseline, 12 weeks after intervention commencement, 6 months following the 12 week assessment, and at 12‐months following the 12 week intervention. ] Quality of life as assessed by the Paediatric Quality of Life Inventory (PedsQL) Generic Core Scales and Brain Tumor Module[All secondary outcomes are assessed at baseline, 12 weeks after intervention commencement, 6 months following the 12 week assessment, and at 12‐months following the 12 week intervention. ] INCLUSION CRITERIA: Eligibility criteria: (1) Children (5 to 17 years); (2) diagnosis of a PFBT that required surgery at least 12 months earlier, with no maximum time since surgery as long as the participant meets the age eligibility criterion; (3) no chemotherapy or radiation therapy received in the last 6 months; (4) no evidence of progressive disease; and (5) medically able to complete an exercise program.

Actrn (2019). "Integrated physical and cognitive training intervention to reverse cognitive frailty among community dwelling older adults."
	Inclusion criteria: • Malaysian older adults aged 60 years and above. • Community dwelling • Independent ambulation • Currently seeking geriatric health care services at Pusat Aktiviti Warga Emas within Klang Valley • Identified as Pre‐Frail or Frail (1 or more characteristics of frailty present based on Fried et al. 2001) • Identified as mild cognitive impairment or very mild dementia (Score 0.5 on the Clinical Dementia Rating Scale) Exclusion criteria: • Identified as robust (0 for ‘robust’ in terms of characteristic of frailty based on Fried et al. 2001) • Intact cognition or mild to severe dementia (0 for intact, 1‐3 for mild to severe dementia on the Clinical Dementia Rating Scale) • Major depression (Geriatric Depression Score >11) • Diagnosed with progressive degenerative neurologic disease • Diagnosed with terminal illness • Participating in other interventional studies • Unable to commit to participate throughout duration of study cognitive frailty;frailty;cognitive impairment; cognitive frailty frailty cognitive impairment;Physical Medicine / Rehabilitation ‐ Physiotherapy;Neurological ‐ Other neurological disorders BRIEF NAME: WE RISE Project ‐ Warga Emas Robust mInd and muscle Exercise Program. (Warga Emas means older adults in the Malay Language) WHY: The co‐existence of both frailty and cognitive impairment has been termed as ‘Cognitive frailty’ and has been identified as one of the main precursors to dementia. In a recent study in Singapore, older adults with pre‐frailty and frailty coupled with cognitive impairment were found to be at a higher risk of having functional disability, poor quality of life and increased mortality. This study will the first of its kind to provide a modality which could potentially reverse cognitive frailty, as compared to the ‘usual care’ management practice for older adults. There is a need to develop and implement an intervention package which is cost‐ effective, integrated and applies interdisciplinary approaches for successful outcomes. This intervention can be packaged and delivered by interdisciplinary trainers to be implemented in health care service provider centers. Not only will this intervention package optimize the cost of geriatric healthcare, it is also sustainable, and it aims to enrich the lives of the ageing population. WHAT: This is a intervention study which mainly focuses on the domains of physical exercise and cognitive stimulation with the aim of potentially reversing cognitive frailty among community dwelling older adults. Group 1: Intervention Group Intervention group will be receiving 12 weeks of exercise‐based programme in combination with cognitive stimulation training. Materials used during intervention include weight‐cuffs, chairs, basketballs, cognitive stimulating games and stationary. The exercises included in this study were effective evidence based exercises for older adult from systematic reviews. The intervention session comprise of the following: 1. Warm up & Dynamic Stretching – 10 minutes 2. Dance Aerobics – 15 minutes 3. Progressive resistance training – 20 minutes Fried's Frailty Criteria[Baseline, at 12 weeks (at the end of intervention) and at 24 weeks (post intervention)];Clinical Dementia Rating Scale Score[Baseline, at 12 weeks (at the end of intervention) and at 24 weeks (post intervention)] Physical Activiry Scale for the Elderly (PASE)[Baseline, at 12 weeks (at the end of intervention) and at 24 weeks (post intervention)];WHO DIsability Assesment Schedule (WHODAS)[Baseline, at 12 weeks (at the end of intervention) and at 24 weeks (post intervention)];Diet History Questionnaire (DHQ)[Baseline, at 12 weeks (at the end of intervention) and at 24 weeks (post intervention)];Senior Fitness Test[Baseline, at 12 weeks (at the end of intervention) and at 24 weeks (post intervention)];15‐D Quality of LIfe Questionnaire[Baseline, at 12 weeks (at the end of intervention) and at 24 weeks (post intervention)];Digit Span Test[Baseline, at 12 weeks (at the end of interventi n) and at 24 weeks (post intervention)];Rey Auditory Verbal Learning Test[Baseline, at 12 weeks (at the end of intervention) and at 24 weeks (post intervention)];Mini Mental State Examination[Baseline, at 12 weeks (at the end of intervention) and at 24 weeks (post intervention)]

Actrn (2019). "Virtual reality based training for subjects with stroke." https://trialsearch.who.int/Trial2.aspx?TrialID=ACTRN12619001688178.
	INTERVENTION: X‐Box Kinect training for 30 minutes, three times a week for 8 weeks. The participants will play X‐Box Kinect based games under supervision of qualified physiotherapist. X‐Box kinect comes with a body motion sensor and allows the subject to play games and do exercises in virtual environment. The subjects would be reminded to come for their session via text messages. CONDITION: Physical Medicine / Rehabilitation ‐ Physiotherapy Stroke ‐ Haemorrhagic Stroke ‐ Ischaemic Stroke;Balance;Functional independence ;Reduced Mobility ;Risk of fall; ; Stroke ; Balance ; Functional independence ; Reduced Mobility ; Risk of fall PRIMARY OUTCOME: Balance by using Berg Balance Scale[Before receiving intervention and after 8 weeks of commencement of intervention] Fall risk assessment by using Morse fall assessment scale[Before starting intervention and after 8 weeks of commencement of intervention] Functional independence by functional independence measure[Before starting intervention and after 8 weeks of commencement of intervention] SECONDARY OUTCOME: Mobility level by using timed up and go test[Before starting the intervention and after 8 weeks of commencement of intervention] INCLUSION CRITERIA: Vitally stable subjects who suffered stroke at least 3 months ago, with mild to moderately affected upper limb functions, Berg balance score 21‐40 and independent standing for at least 10 seconds.

Actrn (2019). "Virtual reality for chronic pain patients: A pilot study." https://trialsearch.who.int/Trial2.aspx?TrialID=ACTRN12619001170112.
	INTERVENTION: Thirty chronic pain patients that have been assessed by The Auckland Regional Pain Service (TARPS) and waitlisted for physiotherapy treatment will be invited to take part in the study. Those who chose to take part will be randomly assigned to either a 6‐week virtual reality (VR) intervention, or to a control group that will receive standard physiotherapy/treatment as usual. The intervention will consist of twice‐weekly, 30‐minute VR sessions, across 6‐weeks (totalling 12 sessions). Each VR session will be a one‐on‐one, face‐to‐face treatment delivered by a physiotherapist. Participants will wear a VR head mounted display and hand sensors. Participants will be guided by the treating physiotherapist to play games that require moving in a virtual environment. The gamification software for this study have been graded from ‘0 = minimal difficulty’ to ‘6 = very difficult’ based on required range and speed of motion. All participants will start on grade 1, and will progress through the grades at the discretion of the treating physiotherapist. Following the VR intervention, ten participants will be invited to complete semi‐structured interviews. To monitor adherence to the intervention records will be kept regarding the number of VR appointments that each participant completes. Participants in the intervention group will also complete physical capacity evaluations (PCE) and questionnaires assessing pain severity, disability, and fear of movement at baseline, and at the completion of the intervention. Objective measures of physical activity, both during the VR treatment and in daily life, will be collected using activity tracking devices. These will be worn by participants in the VR group for the duration of the first and sixth weeks of the VR trial. CONDITION: Chronic Pain; ; Chronic Pain Musculoskeletal ‐ Other muscular and skeletal disorders Neurological ‐ Other neurological disorders PRIMARY OUTCOME: Change in activity level during the VR treatment sessions as assessed by an activPAL (TM) activity tracking device. Activity levels from the final two VR treatment sessions in week 6 of the intervention will be averaged.; [The final week of the 6 week intervention] Change in objective physical function in the VR group as assessed by participant time to complete a standardised 50m speed‐walk test; [Assessed at the completion of the 6 week intervention] Change in pain scores in the VR group as assessed by the Brief Pain Inventory, Short Form (BPI); (Cleeland, 1989; Cleeland & Ryan, 1994) ; [Assessed at the completion of the 6 week intervention] SECONDARY OUTCOME: Change in fear of movement in the VR group as assessed by the TAMPA scale of kinesiophobia (TAMPA; Miller, Kori, Shashidar & Dennis, 1991). [At the end of the 6 week intervention] Change in general activity levels in the VR participants throughout the week between week 1 and week 6 of the intervention as assessed by an activpal (TM) activity tracking device[At the completion of the 6 week intervention] Change in Objective Function in the VR group assessed by a standardised Dynamic Lift assessment which measures the ability lift objects. ; [At the end of the six week intervention] Difference in pain scores between the intervention group and the treatment as usual group as assessed by the Brief Pain Inventory, Short Form (BPI); (Cleeland, 1989; Cleeland & Ryan, 1994) [Comparisons will be made between the treatment group at the end of the 6 week VR intervention and the control group at two time points; ; 1) at the end of the 6 week waitlist (i.e. VR vs no treatment), and ; 2) at the end of 6 weeks of physiotherapy (i.e. VR vs treatment as usual). ; ] Intervention evaluation by the VR group as assessed by the Patient Global Impression of Change Scale (PGIC; Guy, 1976).[At the end of the six week intervention] Participant retention rates will be assessed by recording the number of VR treatment sessions attended over the 6 week treatment time[A the end of the 6 week intervention] Semi structured interviews: T e first 10 participants to complete 12 VR sessions will undergo semi‐structured interviews with a trained, post‐graduate physiotherapy student. Interviews will be audio‐recorded and transcribed. [At the end of the six week intervention] INCLUSION CRITERIA: (1) experiencing musculoskeletal pain (2) ability to complete a 6‐week active rehabilitation intervention (3) expect to have stable medication for the duration of the trial (4) between the ages of 18 and 70 (5) residing in Auckland (6) ability to communicate in English.

Actrn (2020). "ESPRESSo: Enhancing spontaneous recovery of hand and arm movement with high intensity therapy beginning one week after stroke." https://trialsearch.who.int/Trial2.aspx?TrialID=ACTRN12620000871943.
	INTERVENTION: Participants in the intervention group will complete 90 minutes of upper limb therapy each week day, for three weeks, to complete 15 days of therapy. The therapy can be completed in three 30 minute sessions per day, two 45 minute sessions per day, or one 90 minute session per day, depending on patient preference and the clinical judgement of the treating therapist. Therapy will be initiated within 7 days of stroke and delivered by a trained and registered therapist (physiotherapy and/or occupational therapy). Therapy will involve the patient interacting with video games provided by the MindPod platform. This is a new therapy approach currently available for research, but not more widely available for routine care. While playing the games participants will control the movement of animals on screen by moving their weaker hand and arm. Patients can play the game either seated or standing, depending on their preference and the clinical judgement of the treating therapist. Sessions will be one‐on‐one, with one participant interacting with the games under the guidance and supervision of one therapist. For sessions focused on arm movements, patients will control the movements of a dolphin on screen, to make the dolphin swim, jump, catch fish, and avoid sharks. The movements of the patient's upper limb will be video captured, no markers will be attached to the patient. This video information is used in real‐time by the MindPod platform to transform the patients’ arm movements into movements of the dolphin. This video information also allows the measurement of the amount of movement and amount of time spent moving by each patient in each session, ,for subsequent reporting. Patients with initially moderate to severe upper limb weakness may be fitted with a vest th CONDITION: Physical Medicine / Rehabilitation ‐ Occupational therapy Physical Medicine / Rehabilitation ‐ Physiotherapy Stroke ‐ Haemorrhagic Stroke ‐ Ischaemic Stroke; ; Stroke PRIMARY OUTCOME: Action Research Arm Test score (ARAT, maximum 57) will be used to measure upper limb motor capacity.[12 weeks post‐stroke] SECONDARY OUTCOME: Action Research Arm Test score (ARAT, maximum 57) will be used to measure upper limb motor capacity.[26 weeks post‐stroke] Action Research Arm Test score (ARAT, maximum 57) will be used to measure upper limb motor capacity.[Immediately post‐intervention] Modified Rankin scale score will be used to evaluate disability.[26 weeks post‐stroke] Stroke Impact Scale score will be used to evaluate patient‐reported quality of life.[26 weeks post‐stroke] Upper extremity Fugl‐Meyer scale score (UE‐FM, maximum 66) will be used to measure upper limb motor impairment.[12 weeks post‐stroke] Upper extremity Fugl‐Meyer scale score (UE‐FM, maximum 66) will be used to measure upper limb motor impairment.[26 weeks post‐stroke] Upper extremity Fugl‐Meyer scale score (UE‐FM, maximum 66) will be used to measure upper limb motor impairment.[Immediately post‐intervention] INCLUSION CRITERIA: i. People with monohemispheric ischaemic stroke or intracerebral haemorrhage confirmed by CT or MRI admitted to Auckland City Hospital within the last 7 days ii. First‐ever stroke or previous stroke with no upper limb weakness iii. At least 18 years old iv. Received a “Good” or “Excellent” prediction from the Predict Recovery Potential (PREP2) algorithm v. UE‐FM score < 51 at enrolment vi. Able to give informed consent vii. Patients treated with intravenous thrombolysis and/or intra‐arterial thrombectomy are eligible

Actrn (2021). "Can robotic technology assist children with cerebral palsy after botulinum toxin injection?" https://trialsearch.who.int/Trial2.aspx?TrialID=ACTRN12621000605897.
	INTERVENTION: Robotic enhanced therapy program (starting 1‐2 weeks after lower limb botulinum toxin administration). Participants will undertake individual, face‐to‐face one hour Physiotherapy‐led sessions twice a week for six weeks (twelve sessions total) at the Hospital. One session per week on the Lokomat® Pro Robotic Gait Orthosis (50% of program) and one session per week of land based therapy (50% of program). The participants will be provided with an information sheet which details the nature of the intervention ‐ the specific components and requirements ‐ and consent form. The Lokomat® Pro is a robotic gait orthosis to support a participant on a treadmill. The robotic exoskeleton provides specific guidance of the hip, knee and ankle movements to facilitate a physiological walking pattern. The device is completely programmable and can assist with tactile, visual and auditory feedback for the participant and allow for many repetitions of a typical gait pattern. Games enhance motivation and a visual display allows participants to track their progress. The aim of the Lokomat is to hit targets that are known to be critical elements of functional improvement. A typical Lokomat® session includes set up (10 minutes), facilitated walking for 30‐45 minutes, with standing rest breaks as required. A child’s program will be individualised based on their objective measures, goals and functional level. Lokomat® sessions could include activities that target symmetrical step length, increased step height, reduced body weight support (increased load), movement control or increased pace. A typical land based session includes 45‐60 minutes of activity based rehabilitation and is standard practice at the unit. The land based session is individualised and based on a child’s objective mea CONDITION: Cerebral Palsy;Lower limb hypertonia;Gait abnormalities;Equinus; ; Cerebral Palsy ; Lower limb hypertonia ; Gait abnormalities ; Equinus Musculoskeletal ‐ Other muscular and skeletal disorders Neurological ‐ Other neurological disorders Physical Medicine / Rehabilitation ‐ Physiotherapy PRIMARY OUTCOME: Duration of effect. Time (in days) from botulinum toxin injection to functional deterioration that necessitates re‐injection, assessed using Goal Attainment Scaling (GAS) responses from weekly text messages. A GAS score of ‐1 or below is considered functional deterioration.[Weekly, from week 1 after injection until 'time‐to‐event'. 'Time‐to‐event' will vary for the individual post‐injection.] SECONDARY OUTCOME: An economic evaluation, as assessed by the the Child Health Utility 9‐D (a preference based instrument for estimation of quality adjusted life years for the economic evaluation of health care treatment of young people).[Baseline, and at 6 month and 12 month after botulinum toxin injection . ; ] Gait speed as measured by 10 metre walk test (measured via video).[Baseline, and at 3 month and 6 month after botulinum toxin injection ; ] Gross motor function as measured by the Gross Motor Function Measure GMFM‐66 standing and walking (D&E) sub‐sections . [Baseline, and at 3 month and 6 month after Botulinum toxin injection.] Joint range of motion using a goniometer to measure ankle dorsiflexion (with knee extended), popliteal angle and hip abduction (with hip extended) range. [Baseline, and at 1 month, 3 month, 6 month and at 'time‐to‐event' after Botulinum toxin injection.] Lower limb muscle tone as assessed by Modified Tardieu Scale.[Baseline, and at 1 month, 3 month, 6 month, and at 'time‐to‐event' after Botulinum toxin injection.] Lower limb muscle tone as measured by the Australian Spasticity Assessment Scale (ASAS).[Baseline and at 1 month, 3 month, 6 month and at 'time‐to‐event' after Botulinum toxin injection.] Quality of life as assessed by the Cerebral Palsy Quality Of Life Questionnaire (Child or Teen).[Baseline, and at 6 months after Botulinum toxin injection.] Selective motor control at ankle as assessed by Selective Motor Control measure.[Baseline, and at 1 mo th, 3 month, 6 month and 'time‐to‐event' after Botulinum toxin injection. ; ] Self‐perception of functional performance as measured by Canadian Occupational Performance Measure (COPM).[Baseline, and at 3 month and 6 month after Botulinum toxin injection.] Walking endurance as assessed by 2 minute walk test (measured via video).[Baseline, and at 3 month, 6 month, and at 'time‐to‐event' after Botulinum toxin injection. ; ] INCLUSION CRITERIA: Diagnosed with cerebral palsy (CP). Gross Motor Function Classification System (GMFCS) Level I‐IV. Dynamic hypertonia in lower limb muscles with functional impact not responsive to therapy input alone. Able to follow instructions, participate in 45 minutes of therapy. Able to communicate pain, perceived level of exertion.

Actrn (2021). "CPMovetime: elliptical training in school aged children with cerebral palsy." https://trialsearch.who.int/Trial2.aspx?TrialID=ACTRN12621000506897.
	INTERVENTION: The efficacy of CP‐Movetime will be evaluated using a single case experimental design (SCED) featuring concurrent, randomised, replication multiple‐baseline design across participants with cerebral palsy, aged between 5 and 17 years with severe motor impairments (i.e. Gross Motor Function Classification System (GMFCS) levels IV and V). The phases will include A and B (where A is the baseline and B is the intervention). The study will be conducted and reported as outlined in the Single Case Reporting Guidelines in Behavioural Interventions (SCRIBE) 2016 statement. According to the TIDieR: Why (rationale, theory and goal of elements of the intervention): Non‐ambulant children with cerebral palsy (CP) experience more sedentary behaviour, spending up to 96% of their waking day sitting. With no evidence‐based interventions available, this can have a devastating impact on health and well‐being. With the current recommendations for physical activity being 3 sessions a week for 8 consecutive weeks, CPMovetime aims to develop new interventions based on this dosage to provide opportunities for meaningful and safe physical activity and reduce sedentary behaviour for better health outcomes in children with cerebral palsy. What (is needed for intervention delivery): An ellipitcal trainer, hoist ‐ to enable partial body weight support over the trainer, heart rate monitor and engagement materials such as adapted visual materials and adapted video games. What (procedures and activities used in the intervention): Each session will by 1 hour in duration and consist of 2, 10 minute sessions on an elliptical trainer. The child or participant will be supported with a harness to enable them to be safely upright with partial body weight support. The elliptical trainer will e CONDITION: cerebral palsy; ; cerebral palsy Neurological ‐ Other neurological disorders Physical Medicine / Rehabilitation ‐ Physiotherapy PRIMARY OUTCOME: Goal Attainment Scale (GAS); The Goal Attainment Scale (GAS) is used to enable individualised goal setting to enables goals other than just walking to be evaluated in a meaningful and relevant way. The GAS is a recommended assessment tool for paediatric rehabilitation research particularly as activity and participation outcome measures as it is sensitive to change[The GAS is a target behaviour that will be measured weekly through the A (baseline) and B (intervention) phase of the trial, with 8 weeks post intervention commencement (end of phase B) being the primary endpoint.] Performance and satisfaction ratings on the Canadian Occupational Performance Measure (COPM); The COPM is a widely used outcome measure for children with CP that identifies performance problems in a top down approach in both clinical practice and research. This measure is client/family centered and is therefore the most suitable measure for activity and participation in this population. The COPM is valid, reliable and responsive to changes following intervention from the patient/family’s perspective. [The COPM is a target behaviour that will be measured weekly through the A (baseline) and B (intervention) phase of the trial, with 8 weeks post intervention commencement (end of phase B) being the primary endpoint.] SECONDARY OUTCOME: Blood test evaluation: lipoproteins. ; Prior to and immediately following the intervention a blood sample will be collected at a pathology clinic by a trained phlebotomist. Each blood sample, a 125 ll electrolyte‐balanced heparinized capillary tube (Clinitubes, Reflotron, Copenhagen, Denmark) will filled from a single fingerprick of the subject’s fingertip (Unistik_ 2 Extra; Owen Mumford Ltd, Oxford, UK). The filled capillary tube will be drawn into a GC4+ i‐STAT cartridge and using the i‐STAT Blood Gas Analyzer (i‐ STAT Corporation, East Windsor, NJ, USA), pH, PaCO2, PaO2, lactate, and calculated bicarbonate (HCO3 – ) will be measured. Blood sampling will occur through Pathwest (with written referral for measuring and testing glucose, triglycerides, low and high density ipoproteins and cholesterol).[This is part of the generalisation probe measures which will occur 3 times: (1) Pre baseline, (2) Immediately pre‐intervention which is also immediately post baseline and (3) immediately post intervention.] Blood test evaluation: triglycerides ; ; Prior to and immediately following the intervention a blood sample will be collected at a pathology clinic by a trained phlebotomist. Each blood sample, a 125 ll electrolyte‐balanced heparinized capillary tube (Clinitubes, Reflotron, Copenhagen, Denmark) will filled from a single fingerprick of the subject’s fingertip (Unistik_ 2 Extra; Owen Mumford Ltd, Oxford, UK). The filled capillary tube will be drawn into a GC4+ i‐STAT cartridge and using the i‐STAT Blood Gas Analyzer (i‐ STAT Corporation, East Windsor, NJ, USA), pH, PaCO2, PaO2, lactate, and calculated bicarbonate (HCO3 – ) will be measured. Blood sampling will occur through Pathwest (with written referral for measuring and testing glucose, triglycerides, low and high density lipoproteins and cholesterol).[This is part of the generalisation probe measures which will occur 3 times: (1) Pre baseline, (2) Immediately pre‐intervention which is also immediately post baseline and (3) immediately post intervention.] Blood test evaluation: cholesterol. ; Prior to and immediately following the intervention a blood sample will be collected at a pathology clinic by a trained phlebotomist. Each blood sample, a 125 ll electrolyte‐balanced heparinized capillary tube (Clinitubes, Reflotron, Copenhagen, Denmark) will filled from a single fingerprick of the subject’s fingertip (Unistik_ 2 Extra; Owen Mumford Ltd, Oxford, UK). The filled capillary tube will be drawn into a GC4+ i‐STAT cartridge and using the i‐STAT Blood Gas Analyzer (i‐ STAT Corporation, East Windsor, NJ, USA), pH, PaCO2, PaO2, lactate, and calculated bicarbonate (HCO3 – ) will be measured. Blood sampling will occur through Pathwest (with written referral for measuring and testing glucose, triglycerides, low and high density lipoproteins and cholesterol).[This is part of the generalisation probe measures which will occur 3 times: (1) Pre baseline, (2) Immediately pre‐intervention which is also immediately post baseline and (3) immediately post intervention.] Blood test evaluation: glucose ; ; Prior to and immediately following the intervention a blood sample will be collected at a pathology clinic by a trained phlebotomist. Each blood sample, a 125 ll electrolyte‐balanced heparinized capillary tube (Clinitubes, Reflotron, Copenhagen, Denmark) will filled from a single fingerprick of the subject’s fingertip (Unistik_ 2 Extra; Owen Mumford Ltd, Oxford, UK). The filled capillary tube will be drawn into a GC4+ i‐STAT cartridge and using the i‐STAT Blood Gas Analyzer (i‐ STAT Corporation, East Windsor, NJ, USA), pH, PaCO2, PaO2, lactate, and calculated bicarbonate (HCO3 – ) will be measured. Blood sampling will occur through Pathwest (with written referral for measuring and testing glucose, triglycerides, low and high density lipoproteins and cholesterol).[This is part of the generalisation probe measures which will occur 3 times: (1) Pre baseline, (2) Immediately pre‐intervention which is also immediately post baseline and (3) immediately post intervention.] Body Composition (bone density, lean muscle and body fat percentage). ; ; The Dual‐energy X‐ray Absorptiometry or DXA scanner will be used to determine bone and body composition. The DXA is suitable for use in this population because of the accuracy in determining body composition as well as regional body composition. Ionizing radition is very small (<10 microSieverts) for a whole body scan and this is equivalent to a normal background radiation received over a single day when at sea level. The scan will however, be conducted by a licensed technologist with established competency and reliability in performing the scans. ; ; Each participant will be asked to lie on the table and to stay still for as long as possible. For children in this study, two person transfer will be required (from wheelchair to bed). This will be done with a parent and a therapist on site for the DXA scan positioning. The use of foam blocks and straps will be used to position and support the participant on the table so that they are safe and secure given that this population will not have the postural control to attain and maintain a static position. The scan itself will take up to 5 minutes (dependent on how static the participant is able to remain). Outcomes of interest include bone density (produced by Z scores) as well as fat and lean mass percentages. This is a composite secondary outcome measure. ; [This is part of the generalisation probe measures which will occur 3 times: (1) Pre baseline, (2) Immediately pre‐intervention which is also immediately post baseline and (3) immediately post intervention.] CPCHILD ; The CPCHILD a valid and reliable proxy measure specifically developed for non‐ambulant children with CP to determine changes in functional health status, health related quality of life and caregiver burden. The measure contains 36 items and 7 domains which include (1) personal care/activities of daily living, (2) positioning, transfers and mobility, (3) comfort (includes pain and discomfort) and emotions, (4) communication and social interaction, (5) health, (6) overall quality of life.[This is part of the generalisation probe measures which will occur 3 times: (1) Pre baseline, (2) Immediately pre‐intervention which is also immediately post baseline and (3) immediately post intervention.] Energy Expenditure (Metabolic Cart) ; Expired gases will be measured throughout for the determination of Oxygen consumption (VO2), Carbon dioxide production (VCO2), Minute ventilation (VE), Respiratory Exchange Ratio (RER), tidal volume (Vt) and breathing frequency. Expired will be measured breath‐by‐breath by a TrueOne 2400 metabolic cart (ParvoMedics, Sandy, UT, USA) and averaged every 15 seconds. Expired gasses will be measured throughout the duration of the intervention but averaged over a 2 min period to ensure the participant has reached a physiological steady state. A physiological steady‐state is required to ensure the validity of the calculation, where VO2 is truly representative of the energy expenditure. The physiological steady‐state will be defined as the 2‐min period between 4 and 10 min with an increase of less than 100 mL VO2, RER < 1.0 to assume a negligible anaerobic contribution to energy expenditure. Energy expenditure will be expressed in metabolic equivalents (MET) and kilojoules (kJ). Kilojoules will be calculated based on the KJ equivalent of the VO2 (kJ·L‐1 O2, with a calorie‐to‐kilojoule conversion factor of 4184) determined by the RER using non‐protein respiratory quotient. The gas analyser and ventilometer will be calibrated before each test using gases of known concentrations and a 3‐l syringe (5530 series, Hans Rudolph, Inc., Shawnee, KS, USA). This method of measuring energy expenditure is considered the gold standard non‐invasive method and has been the preferred method documented in the literature. ; ; [This is part of the generalisation probe measures which will occur 3 times: (1) Pre baseline, (2) Immediately pre‐intervention which is also immediately post baseline and (3) immediately post intervention.] Exit interview: feasibility of intervention ; A semi‐structured exit interview will occur after the "B" phase (intervention). This will enable the experience of the intervention and elements of feasibility to be described and explored from the perspective of children (if able to participate) and caregivers[Immediately post intervention after the "B" phase.] Heart rate using a chest strap Polar Heart Rate monitor. ; ; Heart rate will be recorded every 5 seconds throughout the intervention (S610, Polar, Finland). [Heart rate is a target behaviour during the elliptical training. This will be measured at each session during the intervention over the 8 weeks. The primary end point is the heart rate at post intervention (end of phase B).] Rectus Femoris muscle morphology description: Muscle thickness ; ; Real time Ultrasound ; Ultrasonography is a reliable and clinically relevant method of determining and measuring muscle thickness in children with cerebral palsy. It is a safe and non‐invasive technique with no exposure to ionising radiation. Real‐time ultrasound is performed quickly and accurately within the clinic, so there is no need for anesthetics or hospital admissions. ; ; Real time ultrasound imaging (B Mode Ultrasound) will be used to determine bilateral rectus femoris muscle thickness, muscle length and tendon length. A standardised position will be used with the Hip and knee at 90 degrees of flexion. This position will be supported by foam blocks and by a research assistant, using a goniometer and angle finder to maintain this position. ; ; Gel will be applied to the skin with a generous quantity used to ensure no compression or distortion of the muscle which will affect the quality and reliability of the measure. ; ; The distance between the anterior superior iliac spine and the superior border of the patella will be measured and marked with a pen on the skin (as a horizontal line). ; ; The probe will be oriented to this line, running longitudinal to the plane. Images will be taken at this point until there are 5 successive decreases in measurements. This method will be optimised during the pilot testing. ; [This is part of the generalisation probe measures which will occur 3 times: (1) Pre baseline, (2) Immediately pre‐intervention which is also immediately post baseline and (3) immediately post intervention.] Rectus Femoris: Muscle length as measured by 2D muscle ultrasound as describe previously[This is part of the generalisation probe measures which will occur 3 times: (1) Pre baseline, (2) Immediately pre‐intervention which is also immediately post baseline and (3) immediately post intervention.] Sedentary behaviour ; Participants will be asked to wear the watchlike device (Actigraph GTX3) over 7 days and nights. The raw data will then be convertedusing proprietory algorithms on the Actilife software to identify and quantify time spend in sedentary activities (i.e. lying down or sitting). [This is part of the generalisation probe measures which will occur 3 times: (1) in the 7 days leading into Pre baseline, (2)over 7 days Immediately pre‐intervention which is also immediately post baseline and (3) for 7 days immediately post intervention.] Sleep Disturbance Scale ; A screening questionnaire that has been used as a measure of children’s sleep (including domains of sleep onset, respiration, parasomnias such as restlessness and bruxism). It can be used to measure previous 4 weeks of children’s sleep, and has been used before and after sleep related interventions[This is part of the generalisation probe measures which will occur 3 times: (1) Pre baseline, (2) Immediately pre‐intervention which is also immediately post baseline and (3) immediately post intervention.] INCLUSION CRITERIA: Children with cerebral palsy, aged between 5 and 17 years classified within GMFCS levels IV and V.

Actrn (2021). "Early and intensive motor training (versus usual care) to enhance neurological recovery and function in people with spinal cord injury (SCI)." https://trialsearch.who.int/Trial2.aspx?TrialID=ACTRN12621000091808.
	INTERVENTION: A multi‐centre Australia‐wide pragmatic randomised controlled trial will be undertaken to compare 10 weeks of early and intensive motor training in addition to usual care compare to usual care alone for people with recent spinal cord injury. Participants allocated to the intervention group will receive an extra 12 hours of motor training each week for 10 weeks (in additional to usual physiotherapy and usual rehabilitation). This will be provided as 2 hours per day from Monday to Saturday, or in larger blocks of therapy on Saturdays and Sundays, or any combination of both. The therapy will involve active and targeted motor training of all affected muscles below the level of the injury (for example, a typical therapy session for a person with incomplete tetraplegia and some motor function in the lower limbs may include active cycling with electrical stimulation, strengthening exercises for the quadricep muscles and walking on a treadmill with assistance). Training will be supplemented with biofeedback, electrical stimulation, mental imagery, somatosensory stimulation, robotics and computer game‐based therapy where available and appropriate. Treatments will be individualised to the needs of each participant with a focus on training that addresses each person's specific motor problem. The training will be provided on a one‐to‐one basis by a physiotherapist, occupational therapist or suitably qualified healthcare professional. The level of intensity of the exercises will not be directly measured but left to the discretion of the treating therapist. Adherence will be recorded using the International Spinal Cord Injury Physical Therapy‐Occupational Therapy Basic Data Set (Version 1.2). CONDITION: Injuries and Accidents ‐ Other injuries and accidents Neurological ‐ Other neurological disorders Physical Medicine / Rehabilitation ‐ Physiotherapy spinal cord injury; ; spinal cord injury PRIMARY OUTCOME: Total Motor Score (/100 points) according to the International Standards for Neurological Classification of Spinal Cord Injury.[10 weeks after randomisation] SECONDARY OUTCOME: American Spinal Injuries Association Impairment Scale (AIS) according to the International Standards for Neurological Classification of Spinal Cord Injury.[10 weeks after randomisation] EUROQOL ‐ 5D Health Questionnaire (EQ‐ 5D ‐ 5L)[10 weeks and 6 months after randomisation] Lower Extremity Motor Score (/50 points) according to the International Standards for Neurological Classification of Spinal Cord Injury.[10 weeks after randomisation] Participants' impression of therapeutic benefit using a 15‐point scale where zero indicates no change, +7 indicates “a very great deal better” and ‐7 indicates “a very great deal worse”[10 weeks and 6 months after randomisation] Participants' perceptions about ability to perform self‐selected goals using a 11‐point analogue scale where "0 reflects “totally unable to perform” and 10 reflects “totally able to perform”.[10 weeks and 6 months after randomisatioin] Spinal Cord Independence Measure Version III ‐ Self Report (SCIM‐SR)[10 weeks and 6 months after randomisation] Time to discharge as reported by participants or trial staff.(through a study‐specific questionnaire)[6 months after randomisation] Total Sensory Score (/224 points) according to the International Standards for Neurological Classification of Spinal Cord Injury.[10 weeks after randomisation] Upper Extremity Motor Score (/50 points) according to the International Standards for Neurological Classification of Spinal Cord Injury.[10 weeks after randomisation] Walking Index for Spinal Cord Injuries Version II (WISCI)[10 weeks and 6 months after randomisation] World Health Organization Quality of Life ‐ BREF (WHOQOL‐ BREF)[10 weeks and 6 months after randomisation] INCLUSION CRITERIA: People will be eligible to participate if they: ‐ have sustained a traumatic or non‐traumatic SCI below C4 (neurological level) in the preceding 8 weeks ‐ have an AIS A lesion with motor function more than three levels below the motor level, or an AIS C or AIS D lesion (as defined by the International Standards for the Neurological Classification of SCI) ‐ are male or female, over the age of 16 years at the time of signing informed consent (additional consent form a parent or guardian will be attained for those aged under 18 years). ‐ have been cleared by the medical team to commence rehabilitation (as documented in the participant's medical files) ‐ are likely to remain an inpatient for the next 10 weeks ‐ understand and voluntarily sign an informed consent form prior to any study related assessments/procedures being conducted ‐ are willing and able to adhere to the study visit schedule and other protocol requirements

Actrn (2021). "Effectiveness of carer-mediated game-based circuit exercise on functions and quality of life among stroke survivors: A protocol for randomized controlled trial." https://trialsearch.who.int/Trial2.aspx?TrialID=ACTRN12621000727842.
	INTERVENTION: The game‐based circuit exercise perform in the experimental group will be in form of video link web/internet supported which is consisted of; a) resistance exercises including sit to stand, partial squat, step up down, hip raise and heel raise, b) balance exercises including figure of eight walking, tandem walking, backward walking, walking with instruction and walking with sudden change direction and c) aerobic exercises including punching jab, hook, cross straight and combination punching manuovers and squat/kicking. Exercise adherence and performance will be monitored using website analytic in a form of automatic reported activity diary and Borg Scale Rate of Perceived Exertion, respectively. A carer will supervise the participants performing this therapy on a one‐to‐one basis at their home (A carer will undergone 1 hour web/internet supported game‐based circuit exercise hands on training session with researcher at the physiotherapy clinic earlier). All participants in this group will receive 24 x 1 hour sessions, twice/week for 12 weeks. This game‐based circuit exercise program was designed specifically for this study. CONDITION: Stroke ‐ Haemorrhagic Stroke ‐ Ischaemic Stroke; ; Stroke PRIMARY OUTCOME: Aerobic endurance assessed using the S6‐Minute Walk test ; ; [Baseline and at 12 weeks after intervention commencement] Lower limb strength assessed using the 30‐second Chair Rise test; ; [Baseline and at 12 weeks after intervention commencement] Postural stability assessed using the Dynamic Gait Index ; ; [Baseline and at 12 weeks after intervention commencement] SECONDARY OUTCOME: Quality of life assessed using the SF‐36 Quality of Life Questionnaire[Baseline and at 12 weeks after intervention commencement] INCLUSION CRITERIA: Participants who are; 1) diagnosed at least 2 months after stroke either hemorhagic or ischemic by a Neurology physician, 2) able to walk continuously for 10 meters independently with or without walking aid, 3) able to perform basic instrumental activities of daily living such as walking, stepping up and turning with or without walking aid, 4) able to hold a glass full of water with the non‐affected hand and 5) able to follow 3 steps command and 6) physically healthy without disability based on Nagi’s concepts (Pope & Tarlov 1991) will be recruited in this trial.

Actrn (2021). "The iSTOPP Study: Impact of Sensory Training On Persistent Pain." https://trialsearch.who.int/Trial2.aspx?TrialID=ACTRN12621000615886.
	INTERVENTION: Participants allocated to the experimental group will undergo 60‐minutes/day x 5‐days/week x four weeks of in‐home tactile acuity training with the iTAD in addition to their usual physiotherapy care. The iTAD consists of a wearable neoprene collar, containing 12 hemispherical nodes, each enclosing a vibrotactile stimulator. The nodes contact the back of the neck and are wirelessly connected to tablet computer and custom application. The application triggers vibrotactile stimulations, records the user responses, provides feedback and calculates accuracy scores. Training consists of two types of games: The localisation game, where users are asked to indicate the location of a single vibration by, selecting the corresponding location on the tablet; and the orientation game, where users are asked to indicate the direction of a second vibration, relative to a first, by selecting the corresponding arrow. Participants will receive approximately 20‐minutes of training in the correct application of the iTAD, and the operation of the iTAD tablet computer and associated games. Training will be provided by the non‐blinded researcher (physiotherapist). Intensity of the vibrations will be constant, and at a frequency of approximately 220Hz. Application analytics will be used to monitor adherence to the intervention. CONDITION: Musculoskeletal ‐ Other muscular and skeletal disorders Persistent neck pain; ; Persistent neck pain PRIMARY OUTCOME: Feasibility will be considered a composite outcome that will be judged based on data taken from recruitment logs, iTAD digital usage logs, participant completion rates, and questionnaires related to treatment satisfaction (5‐point rating scale, from 1=very satisfied to 5=very disatisfied), blinding (Bang's Blinding Index) and treatment credibility (Perceived Treatment Credibility Scale). In order for the current protocol to be considered feasible for a full‐scale RCT, a minimum threshold for recruitment, adherence, treatment completion, treatment satisfaction, blinding, and treatment credibility will need to be reached.[Recruitment rates, adherence (training duration), dropouts, Bang’s Blinding Index, and Treatment satisfaction scale will be assessed 2‐months after treatment commencement. Credibility of the interventions will be assessed 3‐days after treatment commencement so as to avoid influence by perceived treatment efficacy. ] Locognosia, the ability to localise touch, will be assessed with a manual localisation task. Twelve locations (numbered 1‐12) will be marked on the neck, in three rows of four. Over 36 trials, the researcher will touch a location, and participants will guess which location was stimulated. Score will be given as percentage correct.[Lognognosia will be assessed immediately prior to intervention commencement, 2‐weeks after commencement of the 4‐week intervention, 5‐weeks after commencement of the 4‐week intervention, and 2‐months after commencement of the 4‐week intervention.] Two‐point discrimination threshold (TPDT) assessed using digital sliding two‐point Vernier Calliper.[TPDT will be assessed immediately prior to intervention commencement, 2‐weeks after commencement of the 4‐week intervention, 5‐weeks after commencement of the 4‐week intervention, and 2‐months after commencement of the 4‐week intervention.] SECONDARY OUTCOME: Average pain intensity over the last week will be assessed using a 0‐10 NRS, where 0=no pain, and 10=the worst imaginable pain. [Average pain intensity will be assessed immediately prior to intervention commencement, 2‐weeks after commencement of the 4‐week intervention, 5‐weeks after commencement of the 4‐week intervention, and 2‐months after commencement of the 4‐week intervention.] Pain spread will be assessed by asking participants to colour in a digital body chart in a manner representing their usual pain over the last week. [Pain spread will be assessed immediately prior to intervention commencement, 2‐weeks after commencement of the 4‐week intervent on, 5‐weeks after commencement of the 4‐week intervention, and 2‐months after commencement of the 4‐week intervention.] Tactile acuity as assessed by the iTADs overall composite score. The overall score is an average of two tactile acuity sub scores: the localisation test and orientation test scores. [Tactile acuity will be assessed with the iTAD will be assessed immediately prior to intervention commencement, 2‐weeks after commencement of the 4‐week intervention, 5‐weeks after commencement of the 4‐week intervention, and 2‐months after commencement of the 4‐week intervention.] INCLUSION CRITERIA: Participants will be considered for the study if aged 18 to 75, have had neck pain of at least 6 months duration and report an average neck pain intensity of at least 3 on a 10‐point numeric pain rating scale (NRS) over the past week.

Actrn (2021). "Telerehabilitation with virtual reality in older adults." https://trialsearch.who.int/Trial2.aspx?TrialID=ACTRN12621001380886.
	INTERVENTION: Clinical trial parallel in older adults. Two‐arm, parallel‐groups and randomised. Intervention exposure exercise program version "face to face" (control group) or "remote" (exposure group) both with Nintendo Wii balance board. A virtual reality‐based exercise protocol using Wii therapy (W‐t) with Nintendo Wii balance board an “exposure‐group” performed by older adult properly trained for 6 months in W‐t. An older adult trained in W‐t will be the therapist of his older adult peers which belong to a geriatrics Club, a physical space close to their homes that seeks to provide recreational and sports activities for older adults who attend daily. The elderly therapist will be guided remotely from the telerehabilitation center of the Universidad de Talca. W‐t will be have for 6 weeks of training, which will have at a frequency of three times per week reaching 18 sessions in total and four weeks of follow‐up in the older adults. Each participants will execute three series of exercise with manual guidance and verbal instructions for the first 3 weeks and only verbal instructions by an older adult therapist in the following weeks. The protocol has three series of exercises and activates postural balance in the three planes of motion: sagittal, frontal and transversal. The games –Snowboard, Penguin Slide and Super Hula Hoop‐ will be used for the first two series of exercise, and the yoga game will be used for the third series. In the first series of exercise, the older adults stand with their arms and hands at their sides in the relaxed manner. In the second series of exercises, each game will be repeated in the standing position with their hands on their waists. Between the first and the second series of exercises, there will be a one to two minute break, where the partici CONDITION: Physical Medicine / Rehabilitation ‐ Physiotherapy Postural Instability; Stability deficits; ; Postural Instability ; Stability deficits PRIMARY OUTCOME: Postural balance through CoP sway area (CoPSway), which is defined as the total trajectory that the CoP makes in the medial‐lateral (ML) and anterior–posterior (AP) directions. Posturography (force plate) has been widely used to quantify balance, and is considered the gold standard within the laboratory equipment, as it is able to measure the amount of sway by using the center‐of‐pressure (CoP) displacements.; CoPSway have shown that this is a reliable and valid measure of balance during standing in different clinical and nonclinical populations. Greater values of CoP sway (i.e. sway area) indicate poorer balance control when standing still.; Participants stood on a force plate with their feet at shoulder–width distance and in a comfortable position. Posturography will be assess under eight conditions for 60 seconds each: (i) eyes open (EO), (ii) eyes closed (EC), (iii) then with EO and EC mediolateral displacement of body guided by auditory stimuli (sound) at a frequency of 30Hz (iv), and subsequently 60Hz so much with EO (v) and EC (vi), and finally mediolateral and anteroposterior displacement of body with virtual environment (vii and viii, respectively). Postural balance evaluation will be complete within 30 min.; Data were collected and recorded at 200 Hz using an AMTI OR6‐7 forceplate and AMTI‐NetForce software (AMTI Inc., Boston, MA, USA). A procedure written in Matlab R2012 (Mathworks Inc., Natick, MA, USA) was used for low‐pass filtering data (second‐order Butterworth, 40 Hz cut‐off frequency).; [Baseline, at 2, 4 and 6 weeks (primary timepoint) during the intervention (a Friday or the last day of these weeks), and 8 and 10 weeks (follow up) a Friday or in the last day of these weeks, respectively.] SECONDARY OUTCOME: Standard desviation of CoP in the mediolateral (SDML) and the anterior‐posterior (SDAP) directions, are a composite secondary outcome. Standard deviation measures (SDML and SDAP), both reflect the variability of the CoP displacements, hence, of the motor responses aimed to minimize postural sway. ; Particip nts stood on a force plate with their feet at shoulder–width distance and in a comfortable position. Posturography will be assess under six conditions for 30 seconds each: (i) eyes open (EO), (ii) eyes closed (EC), (iii) mediolateral displacement of body guided by auditory stimuli (sound) at a frequency of 30Hz and (iv) then 60Hz, both with EO and (v) mediolateral and (vi) anteroposterior displacement of body with virtual environment. Postural balance evaluation will be complete within 20 min. ; Data were collected and recorded at 200 Hz using an AMTI OR6‐7 forceplate and AMTI‐NetForce software (AMTI Inc., Boston, MA, USA). A procedure written in Matlab R2012 (Mathworks Inc., Natick, MA, USA) was used for low‐pass filtering data (second‐order Butterworth, 40 Hz cut‐off frequency). ; Clinical measurements: Single‐leg station (seconds); Time Up and Go (meters/seconds); Barthel index (variable in number) and Tinneti scale (variable in number), will be complete within 20 minutes. ; [Baseline, at 2, 4 and 6 weeks during the intervention (a Friday or the last day of these weeks), and 8 and 10 weeks (follow up) a Friday or in the last day of these weeks, respectively.] Velocity of CoP in in the mediolateral (VML) and the anterior‐posterior (VAP) directions, are a composite secondary outcome. Greater values for CoPSway indicates poorer balance control as CoP gets closer to the limit of stability, which demands rapid stabilization responses expressed in greater CoP velocities (VML and VAP). ; Participants stood on a force plate with their feet at shoulder–width distance and in a comfortable position. Posturography will be assess under six conditions for 30 seconds each: (i) eyes open (EO), (ii) eyes closed (EC), (iii) mediolateral displacement of body guided by auditory stimuli (sound) at a frequency of 30Hz and (iv) then 60Hz, both with EO and (v) mediolateral and (vi) anteroposterior displacement of body with virtual environment. Postural balance evaluation will be complete within 20 min. ; Data were collected and recorded at 200 Hz using an AMTI OR6‐7 forceplate and AMTI‐NetForce software (AMTI Inc., Boston, MA, USA). A procedure written in Matlab R2012 (Mathworks Inc., Natick, MA, USA) was used for low‐pass filtering data (second‐order Butterworth, 40 Hz cut‐off frequency). ; [Baseline, at 2, 4 and 6 weeks during the intervention (a Friday or the last day of these weeks), and 8 and 10 weeks (follow up) a Friday or in the last day of these weeks, respectively.] INCLUSION CRITERIA: ‐ Older adults volunteers. ‐ Occasional or permanent corrected lens wear. ‐ Mini Mental State Examination (MMSE) score of over 17 points. ‐ Older adults no falls in the last 12 months.

Actrn (2021). "Telerehabilitation with virtual reality in spastic hemiplegia cerebral palsy." https://trialsearch.who.int/Trial2.aspx?TrialID=ACTRN12621000117819.
	INTERVENTION: Clinical trial parallel in patients with cerebral palsy. Two‐arm, parallel‐groups and randomised. Intervention exposure exercise program version "face to face" (control group) or "remote" (exposure group) both with Nintendo Wii balance board. A virtual reality‐based exercise protocol using Wii therapy (W‐t) with Nintendo Wii balance board an “exposure‐arm” performed by the parents or caregivers from patients' homes, and physiotherapists from the rehabilitation center and from the Special School each one will be guided remotely from the telerehabilitation center of the University of Talca. A total of 18 sessions W‐t will be deliver over a period of 6 weeks with a frequency of 3 times per week (Monday, Wednesday and Friday) for 25 minutes each session and four weeks of follow‐up in participant’s children and adolescent with spastic hemiplegic cerebral palsy. Each participants will execute three series of exercise with manual guidance and verbal instructions for the first 2 weeks and only verbal instructions by a parents or caregivers or physiotherapists in the following weeks. The first two series included Snowboard, Penguin Slide, and Super Hula Hoop; the third series was deep breathing in the Yoga game. The participants will be standing with their arms and hands at their sides, in a relaxed manner, during the first series. Each game will be repeat in a standing position and with their hands on their waist during second series. Finally, the participants will be instruct to maintain their posture and be as relaxed as possible with eyes open (EO) and later eyes closed (EC) during the third series. W‐t will consist of a virtual reality training session using the Nintendo Wii balance board console for 25 min each session. This programme is based on previous studies, tha CONDITION: Cerebral Palsy; ; Cerebral Palsy Neurological ‐ Other neurological disorders Physical Medicine / Rehabilitation ‐ Physiotherapy PRIMARY OUTCOME: Postural balance through CoP sway area (CoPSway), which is defined as the total trajectory that the CoP makes in the medial‐lateral (ML) and anterior–posterior (AP) directions. Posturography (force plate) has been widely used to quantify balance, and is considered the gold standard within the laboratory equipment, as it is able to measure the amount of sway by using the center‐of‐pressure (CoP) displacements.; CoPSway have shown that this is a reliable and valid measure of balance during standing in different clinical and nonclinical populations. Greater values of CoP sway (i.e. sway area) indicate poorer balance control when standing still.; Participants stood on a force plate with their feet at shoulder–width distance and in a comfortable position. Posturography will be assess under six conditions for 30 seconds each: (i) eyes open (EO), (ii) eyes closed (EC), (iii) mediolateral displacement of body guided by auditory stimuli (sound) at a frequency of 30Hz and (iv) then 60Hz, both with EO and (v) mediolateral and (vi) anteroposterior displacement of body with virtual environment. Postural balance evaluation will be complete within 20 min.; ; Data were collected and recorded at 200 Hz using an AMTI OR6‐7 forceplate and AMTI‐NetForce software (AMTI Inc., Boston, MA, USA). A procedure written in Matlab R2012 (Mathworks Inc., Natick, MA, USA) was used for low‐pass filtering data (second‐order Butterworth, 40 Hz cut‐off frequency).; ; [Baseline, at 2, 4 and 6 weeks (primary timepoint) during the intervention (a Friday or the last day of these weeks), and 8 and 10 weeks (follow up) a Friday or in the last day of these weeks, respectively.] SECONDARY OUTCOME: Standard desviation of CoP in the mediolateral (SDML) and the anterior‐posterior (SDAP) directions, are a composite secondary outcome. Standard deviation measures (SDML and SDAP), both reflect the variability of the CoP displacements, hence, of the motor responses aimed to minimize postural sway. ; Participants stood on a force plate with their feet at shoulder–width distance and in a co fortable position. Posturography will be assess under six conditions for 30 seconds each: (i) eyes open (EO), (ii) eyes closed (EC), (iii) mediolateral displacement of body guided by auditory stimuli (sound) at a frequency of 30Hz and (iv) then 60Hz, both with EO and (v) mediolateral and (vi) anteroposterior displacement of body with virtual environment. Postural balance evaluation will be complete within 20 min. ; Data were collected and recorded at 200 Hz using an AMTI OR6‐7 forceplate and AMTI‐NetForce software (AMTI Inc., Boston, MA, USA). A procedure written in Matlab R2012 (Mathworks Inc., Natick, MA, USA) was used for low‐pass filtering data (second‐order Butterworth, 40 Hz cut‐off frequency). ; [Baseline, at 2, 4 and 6 weeks during the intervention (a Friday or the last day of these weeks), and 8 and 10 weeks (follow up) a Friday or in the last day of these weeks, respectively.] Velocity of CoP in in the mediolateral (VML) and the anterior‐posterior (VAP) directions, are a composite secondary outcome. Greater values for CoPSway indicates poorer balance control as CoP gets closer to the limit of stability, which demands rapid stabilization responses expressed in greater CoP velocities (VML and VAP). ; Participants stood on a force plate with their feet at shoulder–width distance and in a comfortable position. Posturography will be assess under six conditions for 30 seconds each: (i) eyes open (EO), (ii) eyes closed (EC), (iii) mediolateral displacement of body guided by auditory stimuli (sound) at a frequency of 30Hz and (iv) then 60Hz, both with EO and (v) mediolateral and (vi) anteroposterior displacement of body with virtual environment. Postural balance evaluation will be complete within 20 min. ; Data were collected and recorded at 200 Hz using an AMTI OR6‐7 forceplate and AMTI‐NetForce software (AMTI Inc., Boston, MA, USA). A procedure written in Matlab R2012 (Mathworks Inc., Natick, MA, USA) was used for low‐pass filtering data (second‐order Butterworth, 40 Hz cut‐off frequency). ; [Baseline, at 2, 4 and 6 weeks during the intervention (a Friday or the last day of these weeks), and 8 and 10 weeks (follow up) a Friday or in the last day of these weeks, respectively.] INCLUSION CRITERIA: ‐ Volunteer participants with Spastic Hemiplegia Cerebral Palsy. ‐ Level I or II of the Gross Motor Function Classification System (GMFCS). ‐ Understand the procedures to be performed (full‐scale intelligence quotient, FSIQ, <80).

Actrn (2022). "Effects of specific closed kinematic chain excercises with biofeedback assissted position control and against forces enhancing positional disorder on lower limb movement pattern." https://trialsearch.who.int/Trial2.aspx?TrialID=ACTRN12622000160730.
	INTERVENTION: Interventions is basically an exercises with resistance of the lower limbs in closed biokinematic chains, performed with modified "Leg‐press" device. This kind of device allows only movement of extension and flexion of lower limbs against resistance ‐ in this specific device (TELKO, manufactured/ distributed byACX/Technomex, Poland) resistance is created from elastic tubing. The only exercise performed will be flexion/ extension of lower limbs in closed kinematic chain made simultaneously for both limbs. The device uses virtual reality visual games to maintain patient focus in training and control parameters like force distribution between left/ right leg. The modification from standard training is due to active correction of the position of the feet and the axis of the lower limbs performed by the strength of the patient's own muscles, against the force disturbing this setting towards the valgus of the knees. The disturbing force will be realized through an elastic band (medium strength). The control of the position of the feet and the axis of the lower limbs will be performed with the use of biofeedback phenomenon and additional controls ( two on upper lowel leg, responsible for lower legs axis, and two on foot, responsible for keeping correct position / pressure of the foot). The exercises will last 15 minutes daily, with resistance and fatigue desribed by the patient as moderate to heavy but pleasant (3 to 5 in ten point Borg Scale). This exercise will be performed individually, as we have only one such device. As every participant will have individual account on the device software, report from every training session will be recorded and used for control of attendance and participation in training session. Speed of excercise ‐ according to patient possi CONDITION: Functional disturbances of Lower limbs axis; ; Functional disturbances of Lower limbs axis Musculoskeletal ‐ Other muscular and skeletal disorders Physical Medicine / Rehabilitation ‐ Physiotherapy PRIMARY OUTCOME: Axis of lower legs during sitting/ standing up ‐ non invasive 3‐d motion analysis (Miomotion, Zebris or Ninox optical camera)[After 5‐days training] Distribution of feet loading during sitting/ standing up ‐ non‐invasive, on baroresistive / stabilometric platform[After 5‐days training] Foot Posture Index in Standing[After 5‐days training] SECONDARY OUTCOME: Axis of lower limb during performance of excercise‐ non invasive 3‐d motion analysis (Miomotion, Zebris or Ninox optical camera)[During excercise] Electric Activity of chosen lower limbs muscles during excercise (fEMG) ‐vastus lateralis and medialis muscles, tibialis anterior and peroneus longus ‐ non‐invasive, with surface EMG device[During excercise] Ground reaction forces during gait on baroresistive platform (non‐invasive)[After 5‐days training] Height of longitudinal arch during exercise ‐ non invasive ‐ picture with scale (mm) visible[During excercise] Maximal Isometric force of hip abductors ‐ Non invasive, hand electrical dynamometer[After 5‐days training] Maximal Isometric force of hip external rotators ‐ Non invasive, hand electrical dynamometer[After 5‐days training] Maximal Isometric force of hip flexors and extensors ‐ Non invasive, hand electrical dynamometer[After 5‐days training] Maximal Isometric force of knee flexors and extensors ‐ Non invasive, hand electrical dynamometer[After 5‐days training] Movement of center of pressure in standing ‐ Non invasive ‐ stabilometric or baroresistive platform[After 5‐days training] range of passive and active movement in the first metatarsophalangeal joint ‐ Non Invasive, goniomety[After 5‐days training] INCLUSION CRITERIA: Occurrence of disturbances in the position of the lower limbs during resistance Closed Kinematic chain exercises ‐ deviation of the knees inwards with equal load on the outer and inner parts of the feet, or loading of external part of the foot while maintaining axis of a lower legs

Afyouni, I., et al. (2020). "Adaptive Rehabilitation Bots in Serious Games." Sensors 20(24): 09.
	In recent years, we have witnessed a growing adoption of serious games in telerehabilitation by taking advantage of advanced multimedia technologies such as motion capture and virtual reality devices. Current serious game solutions for telerehabilitation suffer form lack of personalization and adaptiveness to patients' needs and performance. This paper introduces "RehaBot", a framework for adaptive generation of personalized serious games in the context of remote rehabilitation, using 3D motion tracking and virtual reality environments. A personalized and versatile gaming platform with embedded virtual assistants, called "Rehab bots", is created. Utilizing these rehab bots, all workout session scenes will include a guide with various sets of motions to direct patients towards performing the prescribed exercises correctly. Furthermore, the rehab bots employ a robust technique to adjust the workout difficulty level in real-time to match the patients' performance. This technique correlates and matches the patterns of the precalculated motions with patients' motions to produce a highly engaging gamified workout experience. Moreover, multimodal insights are passed to the users pointing out the joints that did not perform as anticipated along with suggestions to improve the current performance. A clinical study was conducted on patients dealing with chronic neck pain to prove the usability and effectiveness of our adjunctive online physiotherapy solution. Ten participants used the serious gaming platform, while four participants performed the traditional procedure with an active program for neck pain relief, for two weeks (10 min, 10 sessions/2 weeks). Feasibility and user experience measures were collected, and the results of experiments show that patients found our game-based adaptive solution engaging and effective, and most of them could achieve high accuracy in performing the personalized prescribed therapies.

Agmon, M., et al. (2011). "A pilot study of Wii Fit exergames to improve balance in older adults." Journal of Geriatric Physical Therapy 34(4): 161-167.
	PURPOSE: To determine the safety and feasibility of using Nintendo Wii Fit exergames to improve balance in older adults. METHODS: Seven older adults aged 84 (5) years with impaired balance (Berg Balance Scale [BBS] score < 52 points) were recruited from 4 continuing care retirement communities to participate in a single group pre- and postevaluation of Wii Fit exergames. Participants received individualized instructions (at least 5 home visits) on playing 4 exergames (basic step, soccer heading, ski slalom, and table tilt) and were asked to play these games in their homes at least 30 minutes 3 times per week for 3 months and received weekly telephone follow-up. They also completed a paper log of their exergame play and rated their enjoyment immediately after each session. Participants completed the BBS, 4-Meter Timed Walk test, and the Physical Activity Enjoyment Scale at baseline and 3 months. Semistructured interviews were conducted at the 3-month evaluation. RESULTS: Participants safely and independently played a mean of 50 sessions, median session duration of 31 minutes. Two of the games were modified to ensure participants' safety. Participants rated high enjoyment immediately after exergame play and expressed experiencing improved balance with daily activities and desire to play exergames with their grandchildren. Berg Balance Scores increased from 49 (2.1) to 53 (1.8) points (P = .017). Walking speed increased from 1.04 (0.2) to 1.33 (0.84) m/s (P = .018). CONCLUSIONS: Use of Wii Fit for limited supervised balance training in the home was safe and feasible for a selected sample of older adults. Further research is needed to determine clinical efficacy in a larger, diverse sample and ascertain whether Wii Fit exergames can be integrated into physical therapy practice to promote health in older adults.

Aguiar, L. T., et al. (2020). "Efficacy of interventions aimed at improving physical activity in individuals with stroke: a systematic review." Disability & Rehabilitation 42(7): 902-917.
	Purpose: To identify interventions employed to increase post-stroke physical activity, evaluate their efficacy, and identify the gaps in literature.Materials and methods: Randomized controlled trials published until March 2018 were searched in MEDLINE, PEDro, EMBASE, LILACS, and SCIELO databases. The quality of each study and overall quality of evidence were assessed using the PEDro and the GRADE scales.Results: Eighteen studies were included (good PEDro and very low GRADE-scores). In seven, the experimental groups showed significant increases in physical activity (aerobics, resistance, and home-based training; counseling, aerobics, resistance, and home-based training; electrical stimulation during walking; functional-task training; robot-assisted arm therapy; accelerometer-based feedback, and physical activity encouragement). In seven, there were no significant between-group differences (physical activity plan; stretching, use of toe-spreaders, standard treatment; counseling; circuit video-game; functional-task; counseling and cognitive training). The combined experimental and control groups showed significant declines in physical activity in one study (aerobic training or stretching) and increases in three others (aerobic, resistance or sham resistance training; stroke-with advice or only stroke-counseling; aerobic training, educational sessions, standard treatment, and coaching, or mobilization and standard treatment). A meta-analysis could not be performed, due to heterogeneity.Conclusions: Some interventions improved physical activity after stroke. However, the interpretability is limited.Implications for rehabilitationIndividuals with stroke show low physical activity, which may compromise function and health.The use of interventions aimed at improving and maintaining physical activity of individuals with stroke are recommended.Some interventions, such as aerobic, resistance, and combined home-based training, electrical stimulation during walking, functional task training, and arm robot-assisted therapy, could improve the physical activity after stroke.

Ahluwalia, R., et al. (2020). "Pediatric fibrocartilaginous embolism inducing paralysis." Childs Nervous System 36(2): 441-446.
	BACKGROUND: Fibrocartilaginous embolism (FCE) is a rare cause of pediatric ischemic myelopathy. The pathology is thought to result from fragmentation with embolization into the microvasculature of the radicular artery often secondary to high axial force. While most cases arise in the setting of vigorous activity, our case reveals that FCE can also occur during relative physical inactivity. Additionally, while a majority of cases are associated with neck or back pain, our case also reveals that FCE can present without concurrent pain episodes. We describe a rare case of spinal cord infarction (SCI) likely due to FCE in a 14 year old male. Our patient was sitting with his feet elevated, playing a video game, when he developed sudden difficulty moving his arms. Initially presenting with a negative MRI scan and la belle indifference, our patient was suspected to exhibit functional quadraparesis secondary to psychosomatization/adjustment disorder. Repeat MR imaging 7 days later revealed typical findings for FCE with SCI (irregular, pencil-like T2 hyperintensity in the ventral cervical/upper thoracic cord and owl's eye pattern on axial images). Six months later, the diagnosis of FCE remains predominant. Our patient continues to improve with occupational and physical therapy. Ambulatory efforts and bladder function continue to progress. To improve functional gains, the patient is being considered for a chemodenervation procedure. CONCLUSION: Our case reveals that FCE can occur during physical inactivity and present without concurrent pain. Outcome regarding pediatric fibrocartilaginous embolism is highly variant; however, the two largest outcomes reported were either patient death or discharge.

Ahmad, M. A., et al. (2019). "Virtual Reality Games as an Adjunct in Improving Upper Limb Function and General Health among Stroke Survivors." International Journal of Environmental Research & Public Health [Electronic Resource] 16(24): 16.
	Virtual reality (VR) games has the potential to improve patient outcomes in stroke rehabilitation. However, there is limited information on VR games as an adjunct to standard physiotherapy in improving upper limb function. This study involved 36 participants in both experimental (n = 18) and control (n = 18) groups with a mean age (SD) of 57 (8.20) and 63 (10.54) years, respectively. Outcome measures were the Fugl-Meyer assessment for upper extremities (FMA-UE), Wolf motor function test (WMFT), intrinsic motivation inventory (IMI), Lawton of instrumental activities of daily living (IADL), and stroke impact scale (SIS) assessed at pre-post intervention. The experimental group had 0.5 h of upper limb (UL) VR games with 1.5 h of standard physiotherapy, and the control group received 2 h of standard physiotherapy. The intervention for both groups was performed once a week for eight consecutive weeks. The results showed a significant time-group interaction effect for IMI (p = 0.001), Lawton IADL (p = 0.01) and SIS domain of communication (p = 0.03). A significant time effect was found in FMA-UE (p = 0.001), WMFT (p = 0.001), Lawton IADL (p = 0.01), and SIS domains; strength, ADL and stroke recovery (p < 0.05). These results indicated an improvement in UL motor ability, sensory function, instrumental ADL, and quality of life in both groups after eight weeks of intervention. However, no significant (p > 0.05) group effect on all the outcome measures was demonstrated. Thus, replacing a portion of standard physiotherapy time with VR games was equally effective in improving UL function and general health compared to receiving only standard physiotherapy among stroke survivors.

Ahmad, M. A., et al. (2017). "R2: effectiveness virtual reality games in improving upper limb function and general health among stroke survivors." Medical journal of Malaysia Conference: 2017 International Symposium of Health Sciences, i‐SIHAT 2017. Malaysia. 72(pp 19).
	Introduction: The objective of this study was to examine the effectiveness of virtual reality games (VRG) as an adjunct in improving upper limb (UL) function and general health among stroke survivors. Methods: This study involved 36 stroke survivors in both experimental (n=18) and control (n=18) groups with a mean age(SD) of 57(8.20) and 63(10.54) years respectively. Outcome measures were Fugl‐Meyer Assessment for Upper Extremities (FMA‐UE), Wolf Motor Function Test (WMFT), Intrinsic Motivation Inventory (IMI), The Lawton of Instrumental Activities of Daily Living (IADL) and Stroke Impact Scale (SIS) assessed at baseline and 8 weeks postintervention. The experimental group had 0.5 hours of UL VRG with 1.5 hours of standard physiotherapy and the control group received 2 hours of standard physiotherapy. The intervention for both groups was performed once a week for continuous 8 weeks. Results: ANOVA test found a significant time and group interaction effect for IMI (F(1,34)=8.84; p<0.01), IADL (F=7.95; p = 0.01) and SIS domain of communication (F=4.85; p = 0.03). A significant effect of time for both groups was demonstrated in FMA‐UE (F(1,34)=109.01; p<0.01), WMFT (F(1,34)=127.44; p<0.01), IADL (F=7.14; p<0.05) and SIS domains of Strength (F=16.03; p<0.01), domains of ADL (F=10.85; p<0.01) and domains of Stroke Recovery ( F=42.65; p<0.01). However, no significant effect of group on all the outcome measures was found. Overall, the experimental group showed higher percentages of improvement compared to control. Conclusion: VRG as an adjunct to standard physiotherapy is effective in improving motivation, instrumental ADL and communication among stroke survivors.

Akinbola, M., et al. (2015). "Ultimate frisbee injuries in a collegiate setting." International Journal of Sports Physical Therapy 10(1): 75-84.
	PURPOSE/BACKGROUND: Ultimate Frisbee (Ultimate) is a limited-contact team sport growing in popularity, particularly as a collegiate club sport. In 2011, over 947,000 people played Ultimate. Sex, age, skill level, and physical demands of the sport place each player at risk for injury, yet there is limited information on the number of injuries with regard to clinical research. The purpose of this study is to identify injury reporting trends in Ultimate Frisbee against other collegiate club sports and examine correlation with sex, body region, and medical recommendations and to discuss associated risk of injury. METHODS: Athletes who sustained an injury related to participation in their respective club sport attended a physical therapy sports clinic, underwent screening, and were provided direction for injury management. Data was collected on various elements of each case with descriptive statistical analysis performed to catalog injury characteristics. Chi-square analyses were performed to compare proportions between sports, sex, and body region. RESULTS: Ultimate accounted for 143 (31.0%) of the 461 reported injury cases collected from all club sports. Female injuries represented 101 (70.6%) of the 143 Ultimate cases, whereas men totaled 42 (29.4%) (p<0.001). Women had significantly more foot/ankle (26) than men (4) (p<.001) and more lumbar/flank (9) injuries than men (2) (p=.022). CONCLUSIONS: Ultimate accounted for one of the highest number of reported injuries among all club sports. Women reported injuries more than twice as frequently as men. The majority of reported Ultimate injuries involved the lower extremity. Injury trends observed are similar to those previously reported in several NCAA Intercollegiate sports. LEVEL OF EVIDENCE: IV.

Alazba, A., et al. (2018). "RabbitRun: An Immersive Virtual Reality Game for Promoting Physical Activities Among People with Low Back Pain." Technologies 7(1): 2.
	Low back pain (LBP) is one of the most common problems among adults. The usual physiotherapy treatment is to perform physical exercises. However, some LBP patients have false beliefs regarding their pain and they tend to avoid physical movements which might increase their pain and disability. Virtual reality (VR) has proven to be an effective intervention in improving motor functions and reducing pain perception. Existing VR interventions for LBP rehabilitation were based on a non-immersive VR, whereas to effectively reduce the pain intensity, we need an immersive VR. In this paper, we introduce the development and evaluation of a serious game called RabbitRun with an immersive experience to engage the patients in a virtual environment and distract them from the pain while performing LBP exercises. The initial usability evaluation results suggest that RabbitRun game is enjoyable and acceptable. The game is easy to play and learn and most of the participants are willing to play the game at home. This solution will enhance the rehabilitation outcome since the patients who are suffering from LBP can use the system at their home and train more for long period of time using a smartphone and low-cost virtual reality device, such as Google Cardboard.

Algar, L. and K. Valdes (2014). "Using smartphone applications as hand therapy interventions." Journal of Hand Therapy 27(3): 254-256; quiz 257.
	In the hand therapy clinic, smartphones can be used as an educational resource, to view a photo or video of a home exercise program, or as a method of electronically documenting progress related to healing from an injury. Smartphone applications may also serve as appropriate therapy interventions to address deficits often presenting with common hand injuries. For individuals with trapeziometacarpal arthrosis, gaming can encourage radial abduction range of motion and neuromuscular control required for joint stability. People with distal radius fractures may benefit from smartphone applications for range of motion and proprioceptive training. These treatments may assist with addressing client-centered goals and be motivating in the current technology driven times.

Ali, R. R., et al. (2022). "Virtual reality as a pain distractor during physical rehabilitation in pediatric burns." Burns 48(2): 303-308.
	The purpose of this study was to determine the immediate effect of adding Virtual reality (VR) to conventional burn rehabilitation program on pain and range of motion (ROM) in children with burn injuries during rehabilitation sessions after burn. METHODS: Twenty-two pediatric children (13 boys & 9 girls) with burn injuries and inpatient hospitalization participated in this study. Their age ranged from 9 to 16 years old with 2nd degree deep partial thickness burn of TBSA (10%-25%). They were randomly classified into study and control groups of equal numbers; control group receive passive ROM and stretch exercises, and study group receive the same treatment of the control group in addition to VR training. children in the study group wear the Oculus Rift DK2 as a means for VR and they allowed to choose the favorite video they would like to view before starting the study. The children feel like they are actually in a game. The pain was measured using VAS and the maximum range-of-motion of the joints using electronic digital goniometer before and immediately after the rehabilitation session. RESULTS: There was a significant decrease in pain intensity and increase of ROM after application of VR in the study group and a significant difference between groups after treatment for pain and ROM p < 0.05. CONCLUSION: Based on the current findings adding VR to the rehabilitation program of pediatric burn victims had an immediate effect on decreasing pain and increase ROM.

Allegue, D. R., et al. (2021). "A Personalized Home-Based Rehabilitation Program Using Exergames Combined With a Telerehabilitation App in a Chronic Stroke Survivor: Mixed Methods Case Study." JMIR Serious Games 9(3): e26153.
	BACKGROUND: In Canada, only 11% of stroke survivors have access to outpatient and community-based rehabilitation after discharge from inpatient rehabilitation. Hence, innovative community-based strategies are needed to provide adequate postrehabilitation services. The VirTele program, which combines virtual reality exergames and a telerehabilitation app, was developed to provide stroke survivors with residual upper extremity deficits, the opportunity to participate in a personalized home rehabilitation program. OBJECTIVE: This study aims to determine the feasibility of VirTele for remote upper extremity rehabilitation in a chronic stroke survivor; explore the preliminary efficacy of VirTele on upper extremity motor function, the amount and quality of upper extremity use, and impact on quality of life and motivation; and explore the determinants of behavioral intention and use behavior of VirTele along with indicators of empowerment. METHODS: A 63-year-old male stroke survivor (3 years) with moderate upper extremity impairment participated in a 2-month VirTele intervention. He was instructed to use exergames (5 games for upper extremity) for 30 minutes, 5 times per week, and conduct videoconference sessions with a clinician at least once per week. Motivational interviewing was incorporated into VirTele to empower the participant to continue exercising and use his upper extremities in everyday activities. Upper extremity motor function (Fugl-Meyer Assessment-upper extremity), amount and quality of upper extremity use (Motor Activity Log-30), and impact on quality of life (Stroke Impact Scale-16) and motivation (Treatment Self-Regulation Questionnaire-15) were measured before (T1), after (T2) VirTele intervention, and during a 1- (T3) and 2-month (T4) follow-up period. Qualitative data were collected through logs and semistructured interviews. Feasibility data (eg, number and duration of videoconference sessions and adherence) were documented at the end of each week. RESULTS: The participant completed 48 exergame sessions (33 hours) and 8 videoconference sessions. Results suggest that the VirTele intervention and the study protocol could be feasible for stroke survivors. The participant exhibited clinically meaningful improvements at T2 on the Fugl-Meyer and Stroke Impact Scale-16 and maintained these gains at T3 and T4. During the follow-up periods, the amount and quality of upper extremity use showed meaningful changes, suggesting more involvement of the affected upper extremity in daily activities. The participant demonstrated a high level of autonomous motivation, which may explain his adherence. Performance, effort, and social influence have meaningful weights in the behavioral intention of using VirTele. However, the lack of control of technical and organizational infrastructures may influence the long-term use of technology. At the end of the intervention, the participant demonstrated considerable empowerment at both the behavioral and capacity levels. CONCLUSIONS: VirTele was shown to be feasible for use in chronic stroke survivors for remote upper extremity rehabilitation. Meaningful determinants of behavioral intention and use behavior of VirTele were identified, and preliminary efficacy results are promising. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): RR2-10.2196/14629.

Almasi, S., et al. (2022). "Kinect-Based Rehabilitation Systems for Stroke Patients: A Scoping Review." BioMed Research International 2022: 4339054.
	Method: This study was conducted according to Arksey and O'Malley's framework. To investigate the evidence on the effects of Kinect-based rehabilitation, a search was executed in five databases (Web of Science, PubMed, Cochrane Library, Scopus, and IEEE) from 2010 to 2020. Results: Thirty-three articles were finally selected by the inclusion criteria. Most of the studies had been conducted in the US (22%). In terms of the application of Kinect-based rehabilitation for stroke patients, most studies had focused on the rehabilitation of upper extremities (55%), followed by balance (27%). The majority of the studies had developed customized rehabilitation programs (36%) for the rehabilitation of stroke patients. Most of these studies had noted that the simultaneous use of Kinect-based rehabilitation and other physiotherapy methods has a more noticeable effect on performance improvement in patients. Conclusion: The simultaneous application of Kinect-based rehabilitation and other physiotherapy methods has a stronger effect on the performance improvement of stroke patients. Better effects can be achieved by designing Kinect-based rehabilitation programs tailored to the characteristics and abilities of stroke patients.

Almeida, J. and F. Nunes (2020). "The Practical Work of Ensuring Effective Use of Serious Games in a Rehabilitation Clinic: A Qualitative Study." JMIR Rehabilitation And Assistive Technologies 7(1): e15428.
	BACKGROUND: Many rehabilitation clinics adopted serious games to support their physiotherapy sessions. Serious games can monitor and provide feedback on exercises and are expected to improve therapy and help professionals deal with more patients. However, there is little understanding of the impacts of serious games on the actual work of physiotherapists. OBJECTIVE: This study aimed to understand the impact of an electromyography-based serious game on the practical work of physiotherapists. METHODS: This study used observation sessions in an outpatient rehabilitation clinic that recently started using a serious game based on electromyography sensors. In total, 44 observation sessions were performed, involving 3 physiotherapists and 22 patients. Observation sessions were documented by audio recordings or fieldnotes and were analyzed for themes with thematic analysis. RESULTS: The findings of this study showed that physiotherapists played an important role in enabling the serious game to work. Physiotherapists briefed patients, calibrated the system, prescribed exercises, and supported patients while they played the serious game, all of which amounted to relevant labor. CONCLUSIONS: The results of this work challenge the idea that serious games reduce the work of physiotherapists and call for an overall analysis of the different impacts a serious game can have. Adopting a serious game that creates more work can be entirely acceptable, provided the clinical outcomes or other advantages enabled by the serious game are strong; however, those impacts will have to be assessed on a case-by-case basis. Moreover, this work motivates the technology development community to better investigate physiotherapists and their context, offering implications for technology design.

Almeida, J. A., et al. (2014). "No. 73 Development of a Protocol for Treatment of Post-Stroke Patients With Virtual Reality: Preliminary Results." PM&R 6(8): S110.
	The purpose of this study is to analyze the efficacy of a preset protocol developed for the use of virtual environment (VE) as a complementary therapy for patients by stroke and under physical rehabilitation. Six post‐stroke subjects (two women and four men) mean age 56.6 +/‐ 13.8 years were randomly assigned into two groups: a control group (CG) which received only physical rehabilitation therapy and an experimental group (EG) which received physical rehabilitation therapy associated with virtual reality (VR) therapy in accordance with a preset protocol. The VR environment consisted of videogame integrated to a balance board (BB). VR therapy was based on a preset protocol which consisted of six specific games based on posture control strategies and focused on progressive difficulty variability and repetition. A total of 48 sessions (twice per week) 40 minutes each were performed using three diferent games each session, five repetitions of each game with a 2‐3 minute rest interval during the changes from one game to another. In addition to that the player was asked to repeat on the last 10 minutes of the session one of the three games s/he had played. A blind evaluation using Berg balance scale (BBS) was performed before and after the intervention. It was found that two of the subjects in EG showed an improvement in their score of 16% and 14%, respectively; while the third subject showed a decrease of 15%. On the other hand only one subject in the CG achieved a little improvement of 6%, another CG subject presented a decrease of 11%, and the third showed no alteration on his/her BBS scores. We conclude that physical therapy associated with VR based on the preset protocol used for this study was possibly effective since EG presented more expressive results in balance.

Almond, A., et al. (2021). "Navigating diagnostic uncertainty in musculoskeletal practice: The perspectives and experiences of new graduate physiotherapists." Musculoskeletal Science & Practice 52: 102354.
	BACKGROUND: Diagnostic uncertainty in musculoskeletal pain presents as a frequent and challenging dilemma encountered by health professionals. Current literature indicates that diagnostic uncertainty impacts the clinical decision making of experienced physiotherapists. Despite this, the experiences and navigational strategies of new graduate physiotherapists, pertaining to this dilemma, are widely unknown. OBJECTIVES: The aim of this study was to explore how new graduate physiotherapists experience and navigate diagnostic uncertainty when managing individuals with musculoskeletal pain. METHODS: A qualitative study using a thematic analytical research approach was undertaken. A randomized sample of new graduate physiotherapists, working in musculoskeletal settings (n = 17), participated in semi-structured telephone interviews. Interview data was subsequently subject to thematic analysis. RESULTS: Four key themes emerged from the data: 1) diagnostic uncertainty is fraught with challenges; 2) diagnosis is not the end game; 3) intrinsic strategies and extrinsic actions and 4) the imperative role of clinical practice. CONCLUSION: New graduate physiotherapists frequently experience diagnostic uncertainty within musculoskeletal practice and are commonly challenged by this dilemma. Despite this, new graduates utilize several strategies to mitigate challenges including focusing on patient-centered care, maintaining transparency and relying on senior colleagues. Most strategies are directly attributed to clinical experiences. This study further outlines implications for physiotherapy curricula and workplace support.

Alonso, A. C., et al. (2020). "Virtual reality in the rehabilitation of the balance in the elderly." Manual Therapy, Posturology & Rehabilitation Journal 15: 1-5.
	Introduction: Aging is characterized by a series of changes and adaptations that occur in the body progressively and irreversibly over the years. One of the consequences of senescence is the deficit of maintaining balance, this fact is explained by the involvement of the visual, somatosensory and vestibular systems. Given this scenario, the use of tools that can minimize these declines is of paramount importance. In recent times a resource that has been investigated is virtual reality, this technique stands out for presenting cognitive, motor and cardiorespiratory demands beneficial to the elderly. Objective: The present study aimed to perform a narrative review on the influence of virtual reality on the rehabilitation of balance in healthy elderly. Methods: A bibliographic survey was carried out in Portuguese and English, in the electronic databases: Pubmed, Lilacs, Pedro, Scielo, Scopus and Cochrone. A temporal limiter was applied from 2010 to 2015. Results: We selected 84 articles, however only five fit the criteria of the research. Despite the different methodologies and sample used, all articles selected showed significant improvement in postural balance after virtual reality therapy. However, a lack of standardization of the research protocols can be observed, making it difficult to reach a precise conclusion regarding the real effects of this technique for the study population. Conclusion: Virtual reality therapy was shown to be effective for the rehabilitation of postural balance in healthy elderly individuals. However, such evidence needs to be further investigated in future studies.

Alrashidi, M., et al. (2022). "The efficacy of virtual reality interventions compared with conventional physiotherapy in improving the upper limb motor function of children with cerebral palsy: a systematic review of randomised controlled trials." Disability & Rehabilitation: 1-11.
	PURPOSE: Cerebral palsy (CP) is the commonest motor disability affecting children. This study reviewed the evidence for virtual reality (VR) intervention compared with conventional physiotherapy in upper limb function of children with CP. METHODS: Searches were undertaken in MEDLINE, EMBASE, PEDro, CENTRAL, Web of Science, CINAHL, ERIC, ICTRP, EU-CTR, ClinicalTrials.gov and EThOS databases. Only randomised-controlled trials (RCTs) were included. Two reviewers independently screened the search results, assessed full-text articles, extracted data and appraised the methodological quality by using the Cochrane collaboration's risk of bias (RoB2) tool. Albatross plots were used to synthesise the data. RESULTS: Seven RCTs, examining motor function in a total of 202 children with CP, included. Four trials used the Quality of Upper Extremity Skills Test (QUEST) as an outcome measure, and three trials used grip strength. These outcome measures were utilised to develop two Albatross plots. Data from the plots showed contradictory findings of the included studies. CONCLUSIONS: The effect of VR in the upper limb rehabilitation of children with CP remains unclear. All included studies used commercial non-immersive VR games. Future high-quality clinical research is needed to explore the extent to which non-immersive and immersive VR is feasible and effective with children and adolescents.IMPLICATIONS FOR REHABILITATIONThe current evidence supporting the use of VR as a rehabilitative tool is weak and uncertain.The current use of VR relies only on commercial non-immersive VR (off-shelf) games, which are not adjustable to meet the demands and goals of therapy programmes.Future research is needed to study the therapeutic feasibility of immersive VR with children and adolescents.

Al-Rayes, S., et al. (2022). "Gaming elements, applications, and challenges of gamification in healthcare." Informatics in Medicine Unlocked 31: 100974.
	Background & Motivation: Gamification has been identified to be one of the effective approaches in attracting the user's attention and leading behavioural change. However, its application in the field of healthcare has been associated with various challenges. As different conditions need different behavioural therapies, so do the elements and features of the games, targeting the different conditions. Furthermore, games for other purposes such as creating awareness might have different elements and features. Therefore, it is important to understand the concept of gamification in healthcare to support the game developers, decision-makers and future researchers, which motivates the authors to conduct this study. Purpose The objective of this study was to conduct a systematic review of the literature on the concept of gamification, analyse its gaming elements, its applications and its challenges in the field of healthcare. Methods The methodology used in this systematic literature search involved a general database exploration, a focused search and a manual examination. Keywords related to gamification were employed to extract the peer-reviewed articles from the data bases. The articles were obtained from Google Scholar, PubMed, Science Direct, and the Imam Abdulrahman Bin Faisal University's e-Resource databases. Results Findings from the study revealed that points, leader boards, levels, feedback, and challenges were the most commonly used gaming elements in gamified healthcare applications. The assessment also found a growing use of gamified systems in physical fitness, medication and chronic disease management, rehabilitation, and physical therapy for children and adults. Despite its broad application, there are concerns that cheating, privacy violation, and gradual loss of interest among users prevent the success of gamification in healthcare. Conclusion The outcomes from the study support the claim that gamification improves users’ health behaviors. However, further research is needed to identify game designs that will limit cheating, enhance user privacy, and maintain user interest.

Alsalman, D. M., et al. (2021). "Caregiver's Opinions on the Design of the Screens of a Future Gamified Mobile Application for Self-Management of Type 1 Diabetes in Children in Saudi Arabia." International Journal of Telemedicine & Applications 2021: 8822676.
	The objective of this study was to design the screens of a future gamified mobile application for self-management of type 1 diabetes in children based on the opinion of caregivers at the King Fahad Hospital Diabetes Center, Saudi Arabia. To achieve this objective, a questionnaire was designed and distributed among 100 caregivers through face-to-face communication and social media using a Google Forms link. 65% of the participants met the inclusion criteria. The main result of this study was the design of 13 screens of a gamified application for self-management of type 1 diabetes in children from Saudi Arabia. The key features of the screens were caring for a character; using a challenging friend; inclusion of points, level, and leaderboard as rewarding principles; use of reminders and notifications for doctor's appointments, insulin injection times, blood glucose readings; and tips for improving medication adherence, increasing blood glucose readings, supporting physical activities, and adopting healthy eating habits. It can be concluded that the practical implementation of the screens in a future mobile application can motivate children with type 1 diabetes to improve eating habits, physical exercise, and cognitive, emotional, and social behaviors to maintain a stable state of health. Also, the content of the designed screens can help to monitor blood glucose readings and comply with medication treatment. The designed screens are adapted to the Arab culture.

Alshahrany, A. N. and H. Ibrahim (2021). "Motor Skills Performance of Children with Hearing Impairment using Different Modules and Physical Education Setting." Turkish Journal of Computer and Mathematics Education 12(4): 473-487.
	Over recent decades, the common understanding of hearing impairment has improved. People are more concerned with hearing impairment and have come to a consensus that care and positivity must be addressed. Therefore, recent trends in children with hearing disabilities inclusion have started in regular schools. The holistic training program provides opportunities for everyday people to learn about their abilities and special skills. The teacher needs to take care of the locomotive and object control skills of the child through the development of necessarymotor skills to meet life requirements, such as walking, running, throwing, etc. The current study explores the ability of primary school children with hearing loss to incorporate an exergame to improve fundamental motor skills within an inclusive physical education classroom in Saudi Arabia. The study used a Qualitative Method and carried out a content analysis together with a Systematic Literature Review to understand the research carried out in this field. A detailed analysis was carried out of secondary data from articles indexed in Scopus and the websites of the scientific databases and other related documents in the field of study. This study would expand the research awareness related to the success of vital engine skills in elementary school children with hearing impairment through the use of an exergame in comprehensive physical education.

Al-Sharman, A., et al. (2019). "Motor performance improvement through virtual reality task is related to fatigue and cognition in people with multiple sclerosis." Physiotherapy Research International 24(4): e1782.
	BACKGROUND AND PURPOSE: People with multiple sclerosis (MS) who undergo rehabilitation need to perform new motor skills or relearn old motor skills. It is not clear whether people with MS retain the ability to improve motor performance or learning. Furthermore, factors that influence motor performance in people with MS need to be investigated. This study explored motor performance in people with MS using virtual reality (VR). The effect of fatigue and cognitive function on motor performance improvement in people with MS was investigated. METHODS: Twenty MS participants and 20 controls were recruited into the study. To assess motor performance, each participant was asked to perform a VR game for five times (blocks). The main outcome was time to complete the VR game and number of recorded errors. To assess fatigue level and cognitive function, participants were asked to complete the Arabic versions of the Modified Fatigue Impact Scale (MFIS) and the Montreal Cognitive Assessment (MOCA), respectively. RESULTS: MS participants and controls demonstrated a practice-related improvement in performance as shown by the main effect of block for each of the outcome measures (p < .001, time required to complete VR game; p < .001, errors recorded). Strong and significant negative correlations between recorded errors and MOCA (r = .75, p < .001) and between recorded errors and MFIS (r = .55, p = .011) were found in people with MS. CONCLUSIONS: Ability to improve motor performance in people with MS is preserved and related to cognitive function and fatigue impact. Health-care professionals should be made aware of the negative impact of cognitive function and fatigue on motor performance. A multicomponent intervention that targets these factors is advisable. Future research, however, is required to determine the content and potential benefits of such an intervention in the MS population.

Alves, C. C. and A. L. S. Silva (2019). "Pediatric Vestibular Rehabilitation: A Case Study." Pediatr Phys Ther 31(4): E14-E19.
	BACKGROUND: A 9-year-old child with a 9-month history of complaints of dizziness, headache, and motion sensitivity came to physical therapy. The child complained of difficulties playing on a playground, running, riding in a car, watching "action movies," sitting under fluorescent lights, and making quick head movements. METHODS: An initial evaluation included a clinical oculomotor examination, vergence testing, static and dynamic visual acuity testing, head impulse testing, subjective visual vertical, balance testing, the pediatric vestibular symptom questionnaire, the Dizziness Handicap Inventory-child caregivers version (DHI-PC) and a visual vertigo analog scale. Physical therapy included virtual reality with Xbox games plus adaptation, habituation, and balance exercises. She was seen once per week and given a home program of exercises 2 to 3 times a day. RESULTS: After 10 treatment sessions, she reported that playing was easier, headaches had reduced, she could travel as a passenger in a car for long distances without complaints, and that she could watch 3-dimensional action movies without symptoms. Her pediatric vestibular symptom questionnaire scores had reduced from 0.7 to 0.1. The DHI-PC had decreased from 22 to 12 points and her visual vertigo analog scale scores were improved. CONCLUSIONS: Vestibular rehabilitation improved this child's quality of life. She was able to return to her daily living activities with fewer symptoms.

Alves da Cruz, M. M., et al. (2020). "Acute Hemodynamic Effects of Virtual Reality-Based Therapy in Patients of Cardiovascular Rehabilitation: A Cluster Randomized Crossover Trial." Archives of Physical Medicine & Rehabilitation 101(4): 642-649.
	OBJECTIVE: To analyze the acute hemodynamic effects of adding virtual reality-based therapy (VRBT) using exergames for patients undergoing cardiac rehabilitation (CR). DESIGN: Crossover trial. SETTING: Outpatient rehabilitation center. PARTICIPANTS: Patients (N=27) with a diagnosis of cardiovascular disease or cardiovascular risk factors. Mean age (years) +/- SD was 63.4+/-12.7 and mean body mass index (kg/m2) +/- SD was 29.0+/-4.0. INTERVENTIONS: Patients performed 1 VRBT session and 1 CR session on 2 nonconsecutive days. Each session comprised an initial rest, warm-up, conditioning, and recovery. During warm-up, in the VRBT session, games were performed with sensors to reproduce the movements of avatars and, in the CR session, patients were required to reproduce the movements of the physiotherapists. In the conditioning phase for VRBT, games were also played with motion sensors, dumbbells, and shin guards. The CR session consisted of exercises performed on a treadmill. The intensity of training was prescribed by heart rate reserve (HRR; 40%-70%). MAIN OUTCOME MEASURES: The primary outcomes were heart rate, blood pressure, respiratory rate (RR), rating of perceived exertion (RPE), and peripheral oxygen saturation, evaluated before, during, and after the VRBT or CR session on 2 nonconsecutive days. The secondary outcome was to evaluate whether the patients achieved the prescribed HRR and the percentage of time they maintained this level during the VRBT session. RESULTS: VRBT produces a physiological similar pattern of acute hemodynamic effects in CR. However, there was greater magnitude of heart rate, RR, and RPE (P<.01) during the execution of VRBT and until 5 minutes of recovery, observed at the moments of rest, and 1, 3, and 5 minutes of recovery. CONCLUSIONS: Although the VRBT session produces similar physiological acute hemodynamic effects in CR, greater magnitudes of heart rate, RR, and RPE were observed during its execution and up to 5 minutes after the session.

Alves, T., et al. (2022). "Serious Games Strategies With Cable-Driven Robots for Bimanual Rehabilitation: A Randomized Controlled Trial With Post-Stroke Patients." Front Robot AI 9: 739088.
	Cable-driven robots can be an ideal fit for performing post-stroke rehabilitation due to their specific features. For example, they have small and lightweight moving parts and a relatively large workspace. They also allow safe human-robot interactions and can be easily adapted to different patients and training protocols. However, the existing cable-driven robots are mostly unilateral devices that can allow only the rehabilitation of the most affected limb. This leaves unaddressed the rehabilitation of bimanual activities, which are predominant within the common Activities of Daily Living (ADL). Serious games can be integrated with cable-driven robots to further enhance their features by providing an interactive experience and by generating a high level of engagement in patients, while they can turn monotonous and repetitive therapy exercises into entertainment tasks. Additionally, serious game interfaces can collect detailed quantitative treatment information such as exercise time, velocities, and force, which can be very useful to monitor a patient's progress and adjust the treatment protocols. Given the above-mentioned strong advantages of both cable driven robots, bimanual rehabilitation and serious games, this paper proposes and discusses a combination of them, in particular, for performing bilateral/bimanual rehabilitation tasks. The main design characteristics are analyzed for implementing the design of both the hardware and software components. The hardware design consists of a specifically developed cable-driven robot. The software design consists of a specifically developed serious game for performing bimanual rehabilitation exercises. The developed software also includes BiEval. This specific software allows to quantitatively measure and assess the rehabilitation therapy effects. An experimental validation is reported with 15 healthy subjects and a RCT (Randomized Controlled Trial) has been performed with 10 post-stroke patients at the Physiotherapy's Clinic of the Federal University of Uberlandia (Minas Gerais, Brazil). The RCT results demonstrate the engineering feasibility and effectiveness of the proposed cable-driven robot in combination with the proposed BiEval software as a valuable tool to augment the conventional physiotherapy protocols and for providing reliable measurements of the patient's rehabilitation performance and progress. The clinical trial was approved by the Research Ethics Committee of the UFU (Brazil) under the CAAE N degrees 00914818.5.0000.5152 on plataformabrasil@saude.gov.br.

Ambros-Antemate, J. F., et al. (2021). "Software Engineering Frameworks Used for Serious Games Development in Physical Rehabilitation: Systematic Review." JMIR Serious Games 9(4): e25831.
	BACKGROUND: Serious games are a support in the rehabilitation process for treating people with physical disabilities. However, many of these serious games are not adapted to the patient's needs because they are not developed with a software engineering framework with a set of activities, actions, and tasks that must be executed when creating a software product. Better serious games for rehabilitation will be developed if the patient and therapist requirements are identified, the development is planned, and system improvements and feedback are involved. The goal is that the serious game must offer a more attractive environment, while maintaining patient interest in the rehabilitation process. OBJECTIVE: This paper submits the results of a systematic review of serious games in physical rehabilitation identifying the benefits of using a software engineering framework. METHODS: A systematic research was conducted using PubMed, PEDro (Physiotherapy Evidence Database), IEEE Xplore, ScienceDirect, ACM Digital Library, Mary Ann Liebert, Taylor & Francis Online, Wiley Online Library, and Springer databases. The initial search resulted in 701 papers. After assessing the results according to the inclusion criteria, 83 papers were selected for this study. RESULTS: From the 83 papers reviewed, 8 used a software engineering framework for its development. Most of them focused their efforts on 1 or more aspects, such as data acquisition and processing, game levels, motivation, therapist supervision. CONCLUSIONS: This systematic review proves that most of the serious games do not use a software engineering framework for their development. As a result, development systems overlook several aspects and do not have a standardized process, eventually omitting important implementation aspects, which impact the patient's recovery time.

Ambrosino, P., et al. (2020). "Exergaming as an Additional Tool in Rehabilitation of Young Patients with Rheumatoid Arthritis: A Pilot Randomized Controlled Trial." Games for Health Journal 9(5): 368-375.
	Objective: To assess the effectiveness of home videogame-based exercise (exergaming) as an additional rehabilitative tool in young patients with rheumatoid arthritis (RA). Materials and Methods: After a baseline (T0) evaluation, 40 RA inpatients (18-35 years of age) underwent both a 4-week-lasting traditional rehabilitation program and a training by Nintendo((R)) Wii-Fit videogame system. At discharge (T1), subjects were randomly assigned (1:1) to two groups: Group A (experimental group), including subjects who continued Wii-Fit training at home for additional 8 weeks, and Group B (control group), including subjects maintaining their habitual activity during the 8-week follow-up (T2). Measures of disease activity, quality of life, and fatigue were evaluated at each time point. Results: From T0 to T1, a significant improvement in most evaluated outcomes was reported in both study groups. At T2 assessment, only Group A patients experienced a significant improvement of quality of life and fatigue, with a 13.4% reduction in Global Health (GH) values, only a slight increase (4.2%) in Health Assessment Questionnaire (HAQ) score, and a 19.1% Functional Assessment of Chronic Illness Therapy (FACIT) improvement as compared with T1. In contrast, Group B patients reported a 65.8% increase in GH values, a 33% increase in HAQ score, and a 53.4% reduction in FACIT values from T1 to T2. The extended videogame-based home training was an independent predictor of Delta%GH (beta = 0.851; P < 0.001), Delta%HAQ (beta = 0.542; P < 0.001), and Delta%FACIT (beta = -0.505; P < 0.001). Conclusions: Home exergaming may be an effective additional rehabilitative tool in RA, since it allows to maintain the benefits of traditional multidisciplinary rehabilitation.

Amiri, Z., et al. (2022). "StepAR: A personalized exergame for people with multiple sclerosis based on video-mapping." Entertainment Computing 42: 100487.
	As a new tool for rehabilitation, gamified exercises or exergames can motivate and encourage patients to complete their therapy. Appropriate exergames can help people with multiple sclerosis (PwMS) enhance their functional capacity and quality of life. Commercial exergames have the disadvantage of not being able to meet all of the therapy’s requirements, thus designing an exergame with the patients’ characteristics in mind can be an efficient alternative. PwMS have various symptoms and disease progression, and each patient has unique circumstances. As a result, adapting the personalization technique in the exergame can be considered a key aspect of the overall design. The main purpose of this paper is to develop a personalized and gamified exercise for PwMS gait rehabilitation. This game is developed using a video-mapping approach and a dynamic difficulty adjustment (DDA) technique. A pilot study was carried out to gather feedback from patients on the proposed game and the DDA algorithm’s usability. According to the results, the personalized adaptive strategy, which was delivered to each MS patient based on their progress, has been praised and accepted. Overall, the information from this study supports the exergame’s design and will be useful in future clinical trials.

Ana Paula Cunha, L., et al. (2012). "Feasibility of virtual therapy in rehabilitation of Parkinson's disease patients: pilot study." Fisioterapia em Movimento 25(3): 659-666.
	Introduction: Among Parkinson's disease (PD) motor disabilities, postural and balance alterations are important parameters to physical therapists who need to choose speci??ic, targeted therapies for their patients. Among many therapy options, virtual therapy is studied as to whether it can be a viable rehabilitation method. Objective: To verify the applicability of virtual rehabilitation in PD patients for the improvement of their balance and quality of life. Material and methods: Six volunteers, diagnosed to be in Stages II and III of PD (Hoehn and Yahr Scale), were recruited for this study. Patients (65 ± 13 years old) participated in activities involving Wii Fit, for a total of twelve interventions, twice per week. Clinical and qualitative methods were used for the data collection for the initial and ??inal evaluations: Borg's Scale, Berg Functional Balance Scale, Time Up and Go, anterior and lateral functional reach and Nottingham's Scale were performed during the study. Penguin Slide, Ski Slalom, Soccer Heading and Table Tilt were the Wii games selected as a form of virtual therapy. Results: The collected data were analyzed using the Wilcoxon test. Motor skill, functional capacities and quality of life were analyzed as variables of the patients' balance. Statistically signi??icant differences were found in the following tests: Borg's Scale (p = 0.0464), Berg Functional Balance Scale (p = 0.0277), lateral functional reach to the right (p = 0.0431*) and lateral functional reach to the left (p = 0.0277). Conclusion: It is believed that exercises with virtual reality therapy can be a useful tool to improve the balance in PD patients.

Anderson-Hanley, C., et al. (2018). "The Aerobic and Cognitive Exercise Study (ACES) for Community-Dwelling Older Adults With or At-Risk for Mild Cognitive Impairment (MCI): Neuropsychological, Neurobiological and Neuroimaging Outcomes of a Randomized Clinical Trial." Frontiers in aging neuroscience 10(MAY) (no pagination): 76.
	Prior research has found that cognitive benefits of physical exercise and brain health in older adults may be enhanced when mental exercise is interactive simultaneously, as in exergaming. It is unclear whether the cognitive benefit can be maximized by increasing the degree of mental challenge during exercise. This randomized clinical trial (RCT), the Aerobic and Cognitive Exercise Study (ACES) sought to replicate and extend prior findings of added cognitive benefit from exergaming to those with or at risk for mild cognitive impairment (MCI). ACES compares the effects of 6 months of an exer-tour (virtual reality bike rides) with the effects of a more effortful exer-score (pedaling through a videogame to score points). Fourteen community-dwelling older adults meeting screening criteria for MCI (sMCI) were adherent to their assigned exercise for 6 months. The primary outcome was executive function, while secondary outcomes included memory and everyday cognitive function. Exer-tour and exer-score yielded significant moderate effects on executive function (Stroop A/C; d's = 0.51 and 0.47); there was no significant interaction effect. However, after 3 months the exer-tour revealed a significant and moderate effect, while exer-score showed little impact, as did a game-only condition. Both exer-tour and exer-score conditions also resulted in significant improvements in verbal memory. Effects appear to generalize to self-reported everyday cognitive function. Pilot data, including salivary biomarkers and structural MRI, were gathered at baseline and 6 months; exercise dose was associated with increased BDNF as well as increased gray matter volume in the PFC and ACC. Improvement in memory was associated with an increase in the DLPFC. Improved executive function was associated with increased expression of exosomal miRNA-9. Interactive physical and cognitive exercise (both high and low mental challenge) yielded similarly significant cognitive benefit for adherent sMCI exercisers over 6 months. A larger RCT is needed to confirm these findings. Further innovation and clinical trial data are needed to develop accessible, yet engaging and effective interventions to combat cognitive decline for the growing MCI population. ClinicalTrials.gov ID: NCT02237560.

Anderson-Hanley, C., et al. (2017). "Neuropsychological Benefits of Neuro-Exergaming for Older Adults: A Pilot Study of an Interactive Physical and Cognitive Exercise System (iPACES)." J Aging Phys Act 25(1): 73-83.
	Dementia cases are on the rise and researchers seek innovative ways to prevent or ameliorate cognitive impairment in later life. Some research has reported that combining mental and physical exercise may benefit cognition more than either alone. This randomized pilot trial examined the feasibility and cognitive benefit for older adults (n = 30) of a single bout of neuro-exergaming (physical activity with cognitive training) using an interactive physical and cognitive exercise system (iPACES), compared with that of exergaming or neurogaming alone. Intent-to-treat and sensitivity analyses were conducted using repeated-measures ANOVA, controlling for age, sex, and education. A significant interaction effect was found for executive function (Color Trails 2), with a significant improvement in the neuro-exergaming condition. Results demonstrate feasibility for older adults to use a novel and theoretically-derived neuro-exergame, and also provide promising new evidence that neuro-exergaming can yield greater cognitive benefit than either of its component parts.

Anderson-Hanley, C., et al. (2011). "Autism and exergaming: effects on repetitive behaviors and cognition." Psychol Res Behav Manag 4: 129-137.
	Autism is a neurodevelopmental disorder that leads to impairment in social skills and delay in language development, and results in repetitive behaviors and restricted interests that impede academic and social involvement. Physical exercise has been shown to decrease repetitive behaviors in autistic children and improve cognitive function across the life-span. Exergaming combines physical and mental exercise simultaneously by linking physical activity movements to video game control and may yield better compliance with exercise. In this investigation, two pilot studies explored the potential behavioral and cognitive benefits of exergaming. In Pilot I, twelve children with autism spectrum disorders completed a control task and an acute bout of Dance Dance Revolution (DDR); in Pilot II, ten additional youths completed an acute bout of cyber cycling. Repetitive behaviors and executive function were measured before and after each activity. Repetitive behaviors significantly decreased, while performance on Digits Backwards improved following the exergaming conditions compared with the control condition. Additional research is needed to replicate these findings, and to explore the application of exergaming for the management of behavioral disturbance and to increase cognitive control in children on the autism spectrum.

Andrade, A., et al. (2020). "Effect of practice exergames on the mood states and self-esteem of elementary school boys and girls during physical education classes: A cluster-randomized controlled natural experiment." PLoS ONE [Electronic Resource] 15(6): e0232392.
	Reduced physical exercise can impact children's mental health. Use of active electronic games can help promote psychological health. Physical education (PE class) uses different resources, methods, and contents to promote student health. We investigated the effect of exergames on the mood and self-esteem of children and compare it that of with traditional PE classes. From a sample of 213 children (7-11 years old), 140 from 10 classes of the fourth and fifth grades of elementary school (59 boys, 81 girls; mean age 9.41+/-0.48 years), allocated to an experimental group (EG; n = 68; five clusters) and a PE group (PE; n = 72; five clusters), participated in this experimental controlled study. The EG practiced exergames during three 40-minute classes, and the PE group held three routine curricular PE classes. Brunel's Mood Scale and Rosenberg's Self-Esteem Scale were applied. Repeated measures ANOVA identified differences between sexes and groups. The main results of the EG demonstrated reduced tension in girls (p <0.05; ES: 0.62; 95% CI: 0.17-1.05). Regarding sex comparisons, anger was lower in girls (F: 4.57; p <0.05; ES: 0.61; 95% CI: 0.11-1.11) in the EG. Vigor was higher in girls in the EG than in those in the PE group (F: 5.46; p <0.05; ES: 0.56; 95% CI: 0.12-1.01). The main results of the PE group indicated increased self-esteem in boys (p <0.05; ES: 0.58; 95% CI: 0.08-1.07) and reduction of girls' mental confusion (p <0.05; ES 0.58; 95% CI 0.15-1.06). Thus, exergames impact boys' and girls' self-esteem and mood, as well as traditional physical education classes. Further study on exergames in schools is essential, with long-term effects on physical and mental health. Exergames bring interesting, varied content, technology, and innovation that can increase the attractiveness of physical education.

André, F. and M. Galaup (2020). "Serious game : une expérimentation en formation initiale." Kinésithérapie, la Revue 20(219): 10-17.
	Nous souhaitons savoir si l'utilisation des serious game (SG) en formation initiale de kinésithérapie amène une acquisition des savoirs théoriques, et interroger le ressenti des apprenants afin d'évaluer l'impact de cette modalité d'apprentissage sur la motivation des étudiants. Trente-six étudiants ont utilisé un SG dans le cadre de la rééducation d'un patient BPCO. Une évaluation des savoirs théoriques était réalisée par un QCM en pré et post modalité pédagogique. L'évaluation du ressenti des apprenants se faisait via un questionnaire en ligne suite à la séquence de SG avec 10 questions fermées et 3 questions ouvertes. Nous avons observé une amélioration significative des savoirs théoriques suite au SG (p < 0,001). Le ressenti des apprenants a permis d'objectiver de l'attractivité, de l'utilité, du réalisme, de la facilité dans des situations d'apprentissage et de la satisfaction suite à cet usage numérique. Ces résultats laissent à penser que l'utilisation de SG en formation initiale permettrait de faciliter la mobilisation des savoirs théoriques spécifiques à une situation donnée. Ces derniers permettraient également de favoriser l'apprentissage par le ressenti positif des apprenants. 5. We want to know if the use of serious games (SG) in initial physiotherapy training leads to the acquisition of theoretical knowledge and to question the learners' feelings in order to evaluate the impact of this modality on students' motivation. A total of thirty-six students used an SG for COPD rehabilitation. An assessment of theoretical knowledge was realised by a pre- and post-assessment MCQ. The evaluation of learners' feelings was established via an online questionnaire following the SG sequence with 10 closed questions and 3 open questions. We observed a significant improvement in theoretical knowledge following the SG (P < 0.0001) The learners' feelings made it possible to objectify the attractiveness, usefulness, realism, ease in learning situations and satisfaction following this digital use. These results suggest that the use of SG in initial training could allow the acquisition of theoretical knowledge. SG could also make it possible to promote learning through the positive feelings of learners. 5.

Anloague, P. A. and D. S. Strack (2018). "Considerations in the Diagnosis and Accelerated Return to Sport of a Professional Basketball Player With a Triceps Surae Injury: A Case Report." Journal of Orthopaedic & Sports Physical Therapy 48(5): 388-397.
	Study Design Case report. Background Acute injuries of the triceps surae and Achilles tendon are common in sports. Rupture of the plantaris tendon can be challenging to diagnose. There is limited evidence detailing the diagnosis, rehabilitation, and accelerated return to sport of elite professional basketball players who have sustained calf injuries. Case Description A 25-year-old male professional basketball player sustained an injury to his calf during a professional basketball game. This case report details the presumptive diagnosis, graduated progression of intervention, and return to play of a professional athlete with a likely isolated plantaris tendon tear. Outcomes The patient returned to postseason competition 10 days post injury. Objective measures were tracked throughout rehabilitation and compared to baseline assessments. Before returning to play, the athlete showed improvements beyond the minimal clinically important difference for calf girth (2 cm) and numeric pain-rating scale score (4 points, 0-10 scale). Functional testing was conducted that included the Y Balance Test lower quarter and the Functional Movement Screen, with results that exceeded or returned the athlete to preseason levels. Discussion This report details the case of a professional basketball player who returned to competitive play in an accelerated time frame following injury to his calf. Diagnosing a plantaris tendon rupture can be challenging, and anatomical variations of this muscle should be considered. It was demonstrated in this case that physical therapy rehabilitation was helpful in making a treatment-based clinical diagnosis when imaging was unclear. Level of Evidence Therapy, level 5. J Orthop Sports Phys Ther 2018;48(5):388-397. Epub 6 Apr 2018. doi:10.2519/jospt.2018.7192.

Anonymous (2012). "Using Health Games for Physical Therapy: An Interview with Ernie Medina, DrPH." Games for Health Journal 1(4): 246-247.
	Dictionary.com defines catalyst as "a person or thing that precipitates an event or change." That certainly defines Ernie Medina, PhD, the subject of this month's Games for Health Journal interview. Dr. Medina is a blithe force in the use of health games, and his enthusiasm, creativity, commitment, and good nature are exciting and engaging. And, the catalytic role he is developing provides the much-needed link between patients who can benefit from health games and doctors looking for effective, high-compliance means for rehabilitation.

Anonymous (2016). "Erratum." Multiple Sclerosis 22(12): NP9-NP11.
	In the article The use of gaming technology for rehabilitation in people with multiple sclerosis, DOI: 10.1177/1352458514563593, published in Multiple Sclerosis Volume 21 Issue 4, Table 1 was printed incorrectly. The corrected Table 1 is below:spmsj;22/12/NP9/TABLE11352458515585718T1table1-1352458515585718Table 1.Exergaming studies.Ref.PlatformParticipants and interventionOutcomesPlow and Finlayson(31)WiiPre-test vs. post-test repeated measures home-based Wii training. PARTICIPANTS: N=30, age 43.2 +/- 9.3 years, 9 +/- 6.8 years since diagnosis. INTERVENTION: 3 x per week programme consisting of yoga, balance, strength, and aerobic training in each session. Wii playing minutes ranged from 10-30 minutes based on participants' RPE when playing the "Basic Run" game. No therapist monitored training in the home. Participants were telephoned every other week (a total of four times) for the first seven weeks after receiving Wii-Fit to monitor adverse events and to encourage increases in the duration or frequency of using Wii-Fit. By the end of the seven weeks, all participants were encouraged to play Wii-Fit three to five times a week for 20 to 30 mins.TUG/TUG dual task; Maximum number of push-ups; timed number of sit-ups in 60s; Maximum number of steps in three mins onto a six-inch platform; Single/double leg balance with eyes open/closed on a soft/firm surface; Physical Activity and Disability Survey; SF-36; MFIS; The barrier self-efficacy scale.Improvements pre- vs. post-test: Number of steps and push-ups; Eyes/open closed, single leg balance on firm surface.Post-test vs. follow-up (14 weeks): measures returned to baseline.Kalron et al.(29)WiiPilot intervention. No control group. PARTICIPANTS: N=32, age 43.6 +/- 1.9 years, 6.9 +/- 0.8 years since diagnosis, EDSS 3.1 +/- 0.2. INTERVENTION: Wii Tennis played for one session of 30 mins (3x10 mins).FRT and FSST taken pre- and post-intervention. FRT and FSST both significantly improved by 9.1% and 17.5% respectively.Prosperini et al.(28)WiiRandomized Crossover Trial - Home-Based. PARTICIPANTS: N=36, age 36.2 +/- 8.6 years, 10.7 +/- 5.8 years since diagnosis, and median EDSS of 3.5 (1.5-5.0). Wii group - 12-week duration, daily sessions (with the exception of the weekend) of home-based training with the Wii Balance Board, each lasting 30 mins. No intervention group - 12 weeks of no intervention. They then swapped to the Wii group after 12 weeks and the Wii group had no intervention for 12 weeks. Contact with physiotherapists every four weeks and phone contact once per week.CoP path, Four Square Step, 25-FWT, MSIS-29. Significant improvements for time x treatment interaction for all measures.Plow and Finlayson(35)WiiA repeated measures longitudinal design with a baseline control period. PARTICIPANTS: See Plow and Finlayson(31) Intervention: All participants were prescribed a three-times-a-week exercise programme - see Plow and Finalyson.(31)Semi-structured interviews conducted over the phone before and after the 14-week Wii-Fit programme. Examined the usability of Nintendo Wii-Fit and identified reasons for using or not using Wii-Fit on; a regular basis.Nilsagard et al.(25)WiiA multicentre RCT with random (1:1) allocation to exercise group or non-exercise group. Wii group: participants N=42, age 50.0 +/- 11.5 years, 12.5 +/- 8.0 years since. Individual physiotherapist-supervised sessions of 30 mins of balance exercise using Wii-Fit Plus twice a week for six to seven weeks, a total of 12 sessions. Non-exercise group: participants N=42, age 49.4 +/- 11.1 years, 12.2 +/- 9.2 years since diagnosis. This group was invited to start exercising using Wii-Fit Plus after the second data collection.TUG; TUG dual task; Four Square Step; Timed Chair Stands; 25-FWT; Dynamic Gait Index; ABC; MSWS-12. Improvements in Wii Group pre- vs. post-test: TUG dual task, Four Square Step, Timed Chair Stands, Dynamic Gait Index.Improvements in Non-exercise group pre- vs. post-test: Dynamic Gait Index.Wii vs. non-exercise at follow-up: No significant difference.Guidi et al.(27)WiiSingle-blind, RCT. PARTICIPANTS: Aged between 25-65 years, at least three years since diagnosis, EDSS score 0-3.5. Wii group (N=9) played Physiofun Balance Training - Physio Mode. Sessions 10x45-mins, twice a week for five weeks. Non-exercise group (N=8) received advice about strategies for behaviour and environment aimed at reducing falls.BBS significantly improved for Wii Group vs. Non-exercise group.Brichetto et al.(26)WiiRCT: Wii vs. traditional rehabilitation strategies. Twelve sessions (three 60-minute sessions/week) of intervention. Wii group: participants N=18, age 40.7 +/- 11.5 years, years since diagnosis 11.2 +/- 6.4 years, mean EDSS 3.9 +/- 1.6. One hour of supervised Wii Balance Board sessions. CONTROL GROUP: participants N=18, age 43.2 +/- 10.6 years, years since diagnosis 12.3 +/- 7.2 years, mean EDSS 4.3 +/- 1.6. Exercises consisted of static and dynamic exercises in both single leg and double leg stance, with or without an equilibrium board and half-kneeling exercises of increasing difficulty.BBS and MFIS. Postural assessment was quantified with a stabilometric platform (quiet standing, barefoot with open/closed eyes). No significant differences between the groups at baseline. Significant improvements in outcomes for both modes at post-test. A significant group x time interaction, revealing a more marked improvement for BBS score, open/closed-eye stabilometry in the Wii group compared to the control group.Ortiz-Gutierrez, et al.(32)KinectXbox-group: participants N=24, age 39.7 +/- 8.1 years, years since diagnosis 9.7 +/- 6.8. 40 sessions - four sessions per week (20 mins per session) for 10 weeks. Individual Tele-Rehabilitation treatments using commercial games. Sessions were monitored via videoconference. CONTROL GROUP: participants N=23, age 42.8 +/- 7.4 years, years since diagnosis 10.9 +/- 5.4. Physiotherapy treatment twice a week (40 mins per session) at a clinic for 10 weeks. Low-load strength exercises, proprioception exercises on unstable surfaces, gait facilitation exercises, and muscle-tendon stretching.Computerized dynamic posturography and SOT. Improvement of general balance in both groups. Visual preference and the contribution of vestibular information, via SOT, yielded significant differences in the exercise group.Kramer et al.(34)WiiMatched controlled trial (3 groups). Three weeks, nine supervised training sessions lasting 30 mins each. PARTICIPANTS: N=23, age 42.8 +/- 7.4 years, years since diagnosis 10.9 +/- 5.4. Conventional balance training (control) group: Consisted of various exercises on the floor. Exergame training (playing exergames on an unstable platform) group: Wii Sports/Sports Resort/Fit games that require arm movements (tennis, table tennis, boxing, archery, and sword fight) or displacements of the whole body to control the game avatar (ski slalom, balance bubble, penguin picnic, soccer heading, tilt city, and perfect ten). Table tennis, tennis, and tilt city were the preferred games. Single task (ST) exercises on the unstable platform group.Pre- and post-testing. Combination of single and dual tasks. Six static balance tests: four balance tests on an unstable surface, and two gait analyses (normal and dual task). All groups significantly improved balance and gait measures. The exergame training group showed significantly higher improvements in the gait dual task condition compared to the single task condition. Adherence to home-based balance training was highest in the exergame group.Goble et al.(24)WiiCase study. N=1, 28 year old Male. Relapsing-remitting MS since age 11. EDSS 5.0. INTERVENTION: Six-week balance training, 3x30 mins per week. Wii-Fit games (yoga, table-tilt, penguin slide, ski jump and bubble balance).20s double leg standing. CoP path length (body sway). Participant relapsed after five weeks training. Follow-up measure taken post-relapse (two months). Over first two weeks 12% decrease in body sway from baseline. 22% increase in body sway over the next two weeks despite training. Relapse occurred week five. Balance impairment remained upon remittance (follow-up) when compared to week two.Forsberg et al.(33)WiiParticipants: N=15, median age 55 years, median time since diagnosis 13 years. INTERVENTION: See Nilsagard et al.(25)Qualitative research approach. Interviewed (15-45 mins) within two weeks after the end of the intervention period. Interview covered reflections on using Wii-Fit for exercising. Patients considered Wii-Fit exercises to be fun, challenging, and self-motivating.*Thomas et al.(24)WiiPublished trial methodology multicentre definitive RCT to assess the clinical and cost-effectiveness of a home-based physiotherapist-supported Wii intervention. Immediate arm (N=15): Wii training for 12 months. Delayed arm (N=15): Wii training after six months. Comparison between first six months of immediate arm vs. six months of no training in delayed group, and then 12 months of Wii training in immediate group vs. six months Wii training in delayed group.Balance, gait and mobility: Two-minute walk test, Step test, Steady stance test, Instrumented TUG, Gait stride-time rhythmicity, Static posturography.Physical activity: GLTEQ, ActivPAL.Hand dexterity/coordination: Nine-hole peg test.Self-efficacy: SCI-ESES, MSSE.Psychological well-being and QoL: HADS, EQ-5D-5L, MSIS-29, FSI, SF-36v2. Adherence to training.*published trial methodology25-FWT: 25 Foot Walk Time; ABC: Activities-specific Balance Confidence; AI: Ambulation Index; BBS: Berg Balance Score; CoP: Centre of Pressure; EDSS: Expanded Disability Status Scale; EQ-5D-5L: EuroQual 5 Dimensions-5 Levels; FRT: Functional Reach Test; FSI: Fatigue Symptom Inventory; FSST: Four Square Step Test; GLTEQ: Godin Leisure-Time Exercise Questionnaire; HADS: Hospital Anxiety and Depression Scale; MFIS: Modified Fatigue Impact Scale; MMSE: Mini-Mental State Examination; MS: Multiple Sclerosis; MSIS-29: Multiple Sclerosis Impact Scale; MSSE: Multiple Sclerosis Self-Efficacy Scale; MSWS-12: MS Walking Scale; QoL: Quality of Life; RCT: Randomized Control Trial; RPE: Ratings of Perceived Exertion; SCI-ESES: Spinal Cord Injury Exercise Self-Efficacy Scale; SF-36: Short-Form Health Survey; SOT: Sensory Organization Test; TUG: Timed-Up-and-Go.

Antunes, A. and R. N. Madeira (2022). "PLAY - Model-based Platform to Support Therapeutic Serious Games Design." Procedia Computer Science 198: 211-218.
	One of the reasons why patients lose focus and interest in physiotherapy exercises is their repetitive nature. Frequently used techniques when trying to promote user engagement and motivation are the gamification of tasks and use of serious games. This paper conceptualizes a framework model to support the design of serious games for children with special needs and a computational platform that implements this concept. The model includes the definition of games based on levels and sequences of actions. The actions model therapeutic exercises. The platform allows the creation of game actions applicable for specific therapies. The setting of the game action scope, in relation to the intended therapies, allows the system to suggest specific actions, based on the patient profile and current needs. The platform allows for later viewing and analysis of recorded results and a comparative analysis of patients’ usage data and results is possible. Moreover, data and results can be shared and compared between clinics that use the platform.

Anwar, N., et al. (2022). "Virtual Reality Training Using Nintendo Wii Games for Patients With Stroke: Randomized Controlled Trial." JMIR Serious Games 10(2): e29830.
	BACKGROUND: Stroke is a leading cause of disability. It is difficult to devise an optimal rehabilitation plan once stroke survivors are back home. Conventional rehabilitative therapies are extensively used in patients with stroke to recover motor functioning and disability, but these are arduous and expensive. Virtual reality (VR) video games inspire patients to get involved in their therapeutic exercise routine in a fun way. VR in the form of games provides a fruitful, secure, and challenging learning environment for motor control and neural plasticity development in rehabilitation. The effects of upper limb sensorimotor functioning and balance are the main focus of this trial. OBJECTIVE: The aim of this study is to compare the effects of VR training and routine physical therapy on balance and upper extremity sensorimotor function in patients with stroke. METHODS: It was a single assessor-blinded randomized clinical trial. A total of 74 participants with their first chronic stroke were included and rehabilitated in a clinical setting. The lottery method was used to randomly assign patients to either the VR group (n=37) or the routine physical therapy group (n=37). The VR group received a 1-hour session of VR training for 3 weekdays over 6 weeks, and the routine physical therapy group received different stretching and strengthening exercises. The outcome measuring tools were the Berg Balance Scale for balance and the Fugl-Meyer Assessment (upper extremity) scale for sensorimotor, joint pain, and range assessment. The assessment was done at the start of treatment and after the 6 weeks of intervention. Data analysis was done using SPSS 22. RESULTS: The trial was completed by 68 patients. A significant difference between the two groups was found in the Berg Balance Scale score (P<.001), Fugl-Meyer Assessment for motor function (P=.03), and Fugl-Meyer Assessment for joint pain and joint range (P<.001); however, no significant difference (P=.19) in the Fugl-Meyer Assessment for upper extremity sensation was noted. CONCLUSIONS: VR training is helpful for improving balance and function of the upper extremities in the routine life of patients with stroke; although, it was not found to be better than conventional training in improving upper limb sensation. VR training can be a better option in a rehabilitation plan designed to increase functional capability. TRIAL REGISTRATION: Iranian Registry of Clinical Trials RCT20190715044216N1; https://www.irct.ir/user/trial/40898/view.

Apolo-Arenas, M. D., et al. (2021). "Standardized Outcomes Measures in Physical Therapy Practice for Treatment and Rehabilitation of Cerebral PALSY: A Systematic Review." J Pers Med 11(7): 26.
	Cerebral palsy (CP) treatment includes physical therapy and various complementary therapies to the standard clinical treatment. However, there are not many reviews that focus on the methods used and evaluation procedures. This study aims to analyze which tools are most suitable for the evaluation and methodology of patients with CP treated with physical therapy. Following the PRISMA statement, through a PICOS strategy, PubMed/MEDLINE, Web of Science (WOS), Scopus, Science Direct, and Scielo were searched with the following terms: cerebral palsy AND (physical therapy modalities OR therapeutics) AND outcome assessment. The methodological quality of the RCTs was assessed with the Evidence Project risk of bias tool. Thirty-seven RCTs and six RCT protocols, comprising 1359 participants with different types of CP: spastic hemiplegia/paresis, spastic diplegia/paresis, and spastic CP, met the inclusion criteria, uncovering 21 variables measured through 77 different instruments and several interventions. The therapies most widely used in CP are gaming or technology-assisted therapies, aerobic training, hippotherapy, music therapy, gait training, and aquatic exercises. This study provides an overview of what the authors used in the neurorehabilitation field through procedure evaluation and checking the technological advance that began to be used.

Aquino, A., et al. (2006). "Efficacy of physical exercise playing a video game for mucus clearance in patients with Cystic Fibrosis." Journal of cystic fibrosis 5 Suppl: S83.
	29th European Cystic Fibrosis Conference; 2006 June 15‐18; Copenhagen, Denmark.

Aquino, A., et al. (2006). "374 Efficacy of physical exercise playing a video game for mucus clearance in patients with Cystic Fibrosis." Journal of cystic fibrosis 5: S83.
	
Aragón, S., et al. (2016). "An Example of the Informative Potential of Polar Coordinate Analysis: Sprint Tactics in Elite 1,500-m Track Events." Measurement in Physical Education and Exercise Science 21(1): 26-33.
	Polar coordinate analysis is a powerful data reduction technique based on the Zsumstatistic, which is calculated from adjusted residuals obtained by lag sequential analysis. Its use has been greatly simplified since the addition of a module in the free software program HOISAN for performing the necessary computations and producing easy-to-interpret results in the form of polar coordinate maps. In this study, we provide a simple and practical example of how this technique can be used to analyze tactical behaviors in sport and physical exercise. We studied 158 performances by 82 male runners in thirteen 1,500-m finals held at the Olympic Games, the World Championships in Athletics, and the European Athletics Championships between 2000 and 2012 to investigate associations between the initiation of sprints by race winners and other runners (focal behaviors) and the lap and zone of the track in which the sprints were initiated (conditional behaviors). The significant prospective/retrospective activating/inhibitory relationships shown in the polar coordinate maps confirm the decision to start a sprint is a tactical one and are consistent with a winning strategy consisting of avoiding giving rivals the benefit of the slipstream while conserving sufficient energy for a final winning burst. Polar coordinate analysis is a powerful technique for studying tactical behaviors in the field of sport.

Arnoni, J. L. B., et al. (2019). "Effects of virtual reality in body oscillation and motor performance of children with cerebral palsy: A preliminary randomized controlled clinical trial." Complementary Therapies in Clinical Practice 35: 189-194.
	BACKGROUND AND PURPOSE: Virtual reality is an adjuvant technique to rehabilitation of children with cerebral palsy (CP). It has been gaining prominence in this field because of its accessibility and great levels of motivation it promotes in treatment. However, there is a lack of studies addressing the effects of virtual reality-based therapy on activity levels regarding postural stability, especially considering the level of evidence presented by studies addressing this issue. Therefore, we aim to evaluate the effects of intervention in body sway and gross motor function of children with CP using an active video game. MATERIALS AND METHODS: In this blind randomized controlled trial, fifteen children with CP, Gross Motor Function Classification System (GMFCS) I-II, regularly attending conventional physical therapy programs, were randomly assigned to an intervention (IG:n=7) or to a control group (CG:n=8). In both groups, children remained attending conventional therapy. In addition, IG underwent intervention using an active video game twice a week for 45min and eight weeks. Standing body sway was assessed using a force plate, and Gross Motor Function Measure (GMFM) dimensions D (Standing) and E (Walking, Running and Jumping) were tested. RESULTS: Following the virtual reality-based intervention, the IG only showed significant improvements in the GMFM dimensions D (p=0.021) and E (p=0.008). Improvements were clinically significant (D=10.8%; E=14.0%). For the CG, no variable analyzed showed differences after eight weeks. CONCLUSIONS: Intervention using an active video game is a promising tool that can improve the gross motor function of children with CP, GMFCS I-II.

Aro, A. R., et al. (2016). "Integrating research evidence and physical activity policy making-REPOPA project." Health Promot Int 31(2): 430-439.
	Evidence shows that regular physical activity is enhanced by supporting environment. Studies are needed to integrate research evidence into health enhancing, cross-sector physical activity (HEPA) policy making. This article presents the rationale, study design, measurement procedures and the initial results of the first phase of six European countries in a five-year research project (2011-2016), REsearch into POlicy to enhance Physical Activity (REPOPA). REPOPA is programmatic research; it consists of linked studies; the first phase studied the use of evidence in 21 policies in implementation to learn more in depth from the policy making process and carried out 86 qualitative stakeholder interviews. The second, ongoing phase builds on the central findings of the first phase in each country; it consists of two sets of interventions: game simulations to study cross-sector collaboration and organizational change processes in the use of evidence and locally tailored interventions to increase knowledge integration. The results of the first two study phases will be tested and validated among policy makers and other stakeholders in the third phase using a Delphi process. Initial results from the first project phase showed the lack of explicit evidence use in HEPA policy making. Facilitators and barriers of the evidence use were the availability of institutional resources and support but also networking between researchers and policy makers. REPOPA will increase understanding use of research evidence in different contexts; develop guidance and tools and establish sustainable structures such as networks and platforms between academics and policy makers across relevant sectors.

Arora, M. and C. Quel De Oliveira (2022). Telephysical Therapy. Telerehabilitation. M. Alexander. New Delhi, Elsevier: 281-295.
	This chapter covers the use of telehealth in physiotherapy practice. TelePT is described as the provision of physiotherapy services (assessment and intervention) at a distance using telecommunications technology as the service delivery medium. It includes the use of voice and data between two or more units via telecommunication channels (phone, computer, mobile applications). TelePT is a growing area of physiotherapy as it offers solutions to many barriers associated with the delivery of physiotherapy services, such as transportation cost and time from the perspective of both the healthcare system and the client; it also facilitates continuity of care after discharge from hospital and allows for rehabilitation in the client’s own social and vocational environments. The role of health monitoring devices, such as fitness trackers, pedometers and accelerometers in the physiotherapy assessment and the use of game-based software and smartphone applications to deliver treatment strategies are also covered in this chapter. Physiotherapy goals that could be achieved via telehealth and the evidence behind its application in numerous populations are discussed. Lastly, this chapter provides the reader with a practical framework on the eligibility of clients for telePT, assessments and treatment strategies.

Arrebola, L. S., et al. (2019). "The use of video games combined with conventional physical therapy in children with upper limb fractures: An exploratory study." Journal of Pediatric Rehabilitation Medicine 12(1): 65-70.
	PURPOSE: To determine the effect of rehabilitation using video games combined with conventional therapy in children with loss of range of motion (ROM) after conservative or surgical treatment of upper limb fractures. METHODS: This retrospective observational study included 12 children (9 boys, 3 girls; mean age: 6.75 +/- 2.83 y) treated with combined video game and conventional physical therapy following upper limb fracture. Children completed 60 minutes of combined therapy (20 minutes of game therapy and 40 minutes of physical therapy) two times per week until therapy was no longer warranted. The flexion and extension ROM of the elbow and wrist, pronation and supination of the forearm, and pain during rest and effort were measured at the beginning and end of treatment. RESULTS: Children experienced significantly increased extension (p< 0.001) and flexion (p< 0.01) ROM of the elbow, increased flexion ROM of the wrist (p< 0.05), and reduced pain during effort (p< 0.05) after an average of 6 weeks of combined treatment. CONCLUSION: The use of video games with conventional therapy was effective in reducing pain and recovering ROM in children with upper limb fractures.

Arvinen-Barrow, M., et al. (2014). "The potential psychological benefits of active video games in the rehabilitation of musculoskeletal injuries and deficiencies." Physical Therapy Reviews 19(6): 410-439.
	
Ashkenazi, T., et al. (2013). "Low-cost virtual reality intervention program for children with developmental coordination disorder: a pilot feasibility study." Pediatr Phys Ther 25(4): 467-473.
	PURPOSE: To explore the feasibility of using a low-cost, off-the-shelf virtual reality (VR) game to treat young children with developmental coordination disorder (DCD) and to determine the effect of this intervention on motor function. METHODS: Nine children, aged 4 to 6 years, referred to physical therapy because of suspected DCD participated in 10 game-based intervention sessions. OUTCOME MEASURES: Outcome measures included Movement Assessment Battery for Children-2 (M-ABC-2), the DCD Questionnaire (DCD-Q), the 6-minute walk test, and 10-m walk test. RESULTS: Statistically significant changes were observed in the total standard score (P = .024) and the balance subscore (P = .012) of the M-ABC-2 and in the DCD-Q (P < .05). The children seemed to be motivated and to enjoy the interaction with the VR environment. CONCLUSION: VR games seemed to be beneficial in improving the children's motor function.

Ashwini, K., et al. (2021). Fine motor skills and cognitive development using virtual reality-based games in children. Handbook of Decision Support Systems for Neurological Disorders. H. D. Jude, Academic Press: 187-201.
	Fine motor skills are an integral part of everyday activities. Children with neurological disorders, such as cerebral palsy and autism spectrum disorder, have problems with fine motor skills, social interaction, and communication. Such children need to repeat a skill to acquire it. Therapy is needed so that children can develop important life skills and be involved in academic activities. However, children need to undergo long sessions of therapy, which will be tedious for them. Physical therapy can therefore be made interactive and motivating by the use of virtual reality-based games. In this chapter, a virtual reality-based serious gaming platform is proposed for fine motor skills and cognitive development of children with special needs. The Unity3D-based virtual reality environment together with a Leap Motion Controller is used to design the rehabilitation games. The Leap Motion Controller with its gesture recognition ability can provide a cohesive platform to improve the life skills of special needs children. The proposed games are developed in such a way that they improve the pincer grasp, intellectual reasoning, and hand–eye coordination of children. More colorful and fun virtual reality games are developed to keep the children engaged for longer. The developed platform is cost effective, remotely accessible, personalized, and physically less painful. The proposed virtual reality game can also be used as an auxiliary tool along with traditional rehabilitation methods.

Askin, A., et al. (2018). "Effects of Kinect-based virtual reality game training on upper extremity motor recovery in chronic stroke." Somatosensory & Motor Research 35(1): 25-32.
	BACKGROUND: Therapeutic benefits of Kinect-based virtual reality (VR) game training in rehabilitation encourage its use to improve motor function. OBJECTIVE: To assess the effects of Kinect-based VR training on motor recovery of the upper extremity and functional outcomes in patients with chronic stroke. METHODS: In this randomized controlled trial, group A received 20 sessions of physical therapy (PT) + 20 sessions of Kinect-based VR training and group B received only 20 sessions of PT. Clinical outcome measures were assessed at baseline and at the end of the treatments. Primary outcome measures that assess stroke patients' motor function included upper extremity (UE) Fugl-Meyer Assessment (FMA). Secondary outcome measures were Brunnstrom Recovery Stages (BRS), Modified Ashworth Scale (MAS), Box and Block test (BBT), Motricity index (MI), and active range of motion (AROM) measurement. RESULTS: Statistically significant improvements in game scores (p < 0.05) were observed in group A. In within-group analysis, there were statistically significant improvements in all clinical outcome measures except for the BRS-hand, MAS-distal, and MAS-hand in group A; MAS-(proximal, distal, hand) and BRS-(UE, hand) in group B compared with baseline values. Differences from baseline of FMA, MI, and AROM (except adduction of shoulder and extension of elbow) were greater in group A (p < 0.05). CONCLUSIONS: To conclude, our results suggest that the adjunct use of Kinect-based VR training may contribute to the improvement of UE motor function and AROM in chronic stroke patients. Further studies with a larger number of subjects with longer follow-up periods are needed to establish its effectiveness in neurorehabilitation.

Aslan, H. and B. Turhan (2021). "Subakromiyal Sıkışma Sendromunda Video Oyunları Tabanlı Egzersiz Eğitiminin Etkilerinin İncelenmesi." Harran Üniversitesi Tıp Fakültesi Dergisi 18(2): 262-268.
	
Ata, M. (2020). "Effect of Virtual Reality on Balance in Children with Hemiplegic Cerebral Palsy." Archives of physical medicine and rehabilitation 101(12): e137‐.
	Research Objectives: To investigate the effect of the Xbox Kinect as virtual reality gaming system on balance in hemiplegic cerebral palsied Children. Design: Randomized controlled trial. Duration: 3 months. Setting: Institutional rehabilitation practice. Participants: Thirty school aged children of both sexes with spastic hemiplegic cerebral palsy were randomly assigned into two groups: a control group and an experimental group. Both groups received standard physical therapy program for three months, while children in the experimental group received an additional training using the plus X‐Box one Kinect training program 3 times per week for 30 minute each for three months. Interventions: Children in both groups received standard physical therapy program for three months, while children in the experimental group received an additional training using the plus X‐Box one Kinect training program 3 times per week for 30 minute each for three months. Main Outcome Measures: Each child in both groups was evaluated before and after three months of treatment using the Pediatric Balance Scale. Results: Thirty children with spastic hemiplegic cerebral palsy participated and competed the study (19 male and 11 female, age rage 6 to 12 years old). The results showed that percentage of improvements in the control group is 4.54%, while in the experimental group is 7.32%, statistical analysis indicated that the Pediatric Balance Scale has been improved significantly in the experimental group as compared to the control group (p < 0.001). Conclusions: The results of the current study indicated that the VR training using Xbox Kinect has improved the balance in spastic hemiplegic cerebral palsied children. Author(s) Disclosures: There is no conflict of interest or any financial or personal relationship with other people or organizations that could have influenced the presented work inappropriately. This research received no specific grant from any funding agency in the public, commercial, or not for‐profit sectors. Keywords: Hemiplegic Cerebral Palsied Children, Balance, Virtual Reality

Athanasopoulos, S., et al. (2007). "The 2004 Olympic Games: physiotherapy services in the Olympic Village polyclinic." Br J Sports Med 41(9): 603-609; discussion 609.
	OBJECTIVE: First, to document the injuries sustained during the 2004 Olympic Games in a sample of patients visiting the physiotherapy department of the Olympic Village polyclinic. Second, to provide information and data about the physiotherapy services for planning future Olympics and other mass gatherings. DESIGN: Observational study. SETTING: Olympic Village polyclinic. PARTICIPANTS: 457 patients aged 15-72 years visited the physiotherapy department from 30 July through 30 August. RESULTS: The department's workload was at a peak during the last 15 days of the Olympic Games (periods B and C). The most common injuries were overuse injuries (47.3%). The most common pathology for physiotherapy attendance was myofascial pain/muscle spasm (32.5%), followed by tendinopathy (19.2%) and ligament sprain (18.7%). The most prevalent site of injury was the thigh (21%), followed by the knee (14.1%) and the lumbar spine (13.5%). Most injuries had symptoms of <7 days' duration. The geographical region with the greatest demand for physiotherapy services was Africa (40.6%). Most patients were athletes (74.8%), although team officials accounted for a considerable number (14%). CONCLUSIONS: The smallest national teams--especially those from developing countries--were more likely to take advantage of services, probably because the larger teams had their own medical and physiotherapy staff. The characteristics of patients, their sustained injuries and the subsequent treatment varied by the accreditation status of the patients. The physiotherapy department's workload was dependent on the Olympic Games schedule.

Auccahuasi, W., et al. (2021). Low-cost system in the analysis of the recovery of mobility through inertial navigation techniques and virtual reality. Healthcare Paradigms in the Internet of Things Ecosystem. V. E. Balas and S. Pal, Academic Press: 271-292.
	Abstract People can develop fully, when they can make use of all their faculties and abilities, the ability to mobilize is one of the most important factors; when this capacity fails to develop or is limited generates a deficit in mental and personal development, and when this problematic situation is taken to children, it becomes more critical because children are in a stage of physical and emotional growth and development, present some deficiency that makes their mobilization impossible to have harmful effects; these deficiencies in most cases are caused by diseases and accidents. Their recovery depends in most cases on surgical interventions and their subsequent treatment to recover mobility, based on physiotherapy and rehabilitation exercises. Rehabilitation treatments in adults are carried out with minimal problems due to the degree of awareness and the needs of the patient; the problem grows considerably when dealing with children, who in the development of rehabilitation exercises are required without considering the environment, which in most cases are not conditioned for them, so that its realization is in some traumatic cases and generates a negative reaction to these exercises; the proposed system manages to improve the environment for children to make their exercises and in particular at the moment of being able to evaluate the progress, with the use of recreational environments, the proposal is based on the use of video game technologies with a virtual reality approach based on the video game “Minecraft,” as mechanism of registration of the displacement at the moment of the march; an inertial navigation circuit is used to register the direction, displacement, deviation at the time the child walks interacting with the game, giving the feeling that the child is inside the video game; interaction and control is done wirelessly using a Bluetooth connection or a Wi-Fi connection depending on the distance between the child and the workstation. The results in the tests show that the child has better acceptance at the time he performs the rehabilitation exercises and at the time he moves to analyze the progress because it is part of the video game, as well as you can record the movements made and can graph it to assess its center of gravity and linearity in the displacement.

Ayhualem, S., et al. (2021). "Burden of neck pain and associated factors among smart phone user students in University of Gondar, Ethiopia." PLoS ONE [Electronic Resource] 16(9): e0256794.
	BACKGROUND: Mobile technology has spread rapidly around the globe. In 2018 the numbers of mobile subscribers in Ethiopia hit 66.2 million. Musculoskeletal complaints related to smartphone use in different body parts have been reported ranging from 8.2% to 89.9%. Neck pain has the highest prevalence rate, which ranges from 17.3% to 67.8%. However, there is limited evidence on the burden of neck pain related to Smartphone usage and no research is done in Ethiopia. Therefore, this study was conducted to determine the burden of neck pain and factors associated with smartphone use in Ethiopia. PURPOSE: The objective of this study was to identify the prevalence and factors associated with neck pain among smartphone users at University of Gondar. METHODS: Institutional based cross-sectional study was conducted from November to December 2019 to determine the prevalence and associated factors of neck pain, with a sample of 845 university student smartphone users at University of Gondar, Ethiopia. A self-administered questionnaire adapted from the Nordic musculoskeletal questionnaire was used to collect data. Independent variables which had a significant association were identified using logistic regression models. Results were reported by using texts and frequency distribution tables. RESULTS: Out of 845 questionnaires distributed, 808 students responded; hence, the response rate was 95.6%. The overall prevalence of neck pain among smart phone users in the past 12 months was 47.4% (95% CI, 44.1-50.9%). Attending 5th year (AOR: 3.907, 95% CI: 1. 952-7.82) and 6th year (AOR: 2.93,95% CI: 1,304-6.59), regular physical exercise (AOR: 2.405, 95% CI: 1.549-3.734), cigarette smoking (AOR: 5.415, 95% CI: 2.685-10.919), residency (AOR: 1.681, 95% CI: 1.181-2.391), break while using smartphone (AOR: 3.253 95% CI: 2.252-4.699), used smartphone > 6 hour per day (AOR: 2.782 (1.528 95% CI: 1.528-5.063), used other devises (AOR: 3.158 95% CI: 2.128-4.689), number of social media used daily (AOR: 2.007 95% CI: 1.228-3.2788), used devise for playing game (AOR: 1.484 95% CI: 1.024-2.15) were factors significantly associated with neck pain. CONCLUSION: The current study depicted that nearly half of the study participants reported neck pain in the past 12 months. Attending last year of university, personal characteristics, use of smart phone for longer period, playing game, not taking break, other electronic device use, increased number of social media use were associated with neck pain among smartphone users.

Azuma, N. and F. Someya (2020). "Injury prevention effects of stretching exercise intervention by physical therapists in male high school soccer players." Scandinavian Journal of Medicine & Science in Sports 30(11): 2178-2192.
	We aimed to examine the prevalence of injury after physical therapy intervention for muscle tightness and injury prevention in male high school soccer players. A randomized controlled trial was conducted. Participants comprised 124 players from two high schools who competed in national tournament soccer games held from April 2018 to March 2019. Players were randomly divided into intervention (with a 12-week stretching intervention by physical therapists) and control groups (without the intervention). Players and coaches provided written information regarding injuries and daily training and match times; physical therapists visited each team weekly to collect data and review documentation. Muscle tightness and injury incidence, number, type, location, circumstances, situations, severity, and contents during the 12-week intervention period and a subsequent 40-week observation period were compared between groups. Injuries were significantly lower with intervention during the 40-week observation period (P < .01) but not during the 12-week intervention period (P = .44). Injury types mainly included disorder, non-contact, lower-limb/trunk, and muscle/tendon injuries. Significant interactions were observed for all tightness-test measurement items. The intervention group showed significant improvements in heel-buttock distance, and straight leg-raise and hip rotation angles (pre-intervention < 12 weeks < 52 weeks), as well as significant improvements in ankle dorsiflexion angles at 12 and 52 weeks (relative to pre-intervention values). Instructed stretching exercises, personally designed by physical therapists to address muscle tightness, improved the range of motion and trunk flexibility, with a positive effect on the injury rate in male high school soccer players, especially for non-contact disorder injuries during training.

b6wnsy, R. B. R. (2021). "Comparison of physiotherapy: Conventional and using game, in patients with dialysis chronic kidney disease." https://trialsearch.who.int/Trial2.aspx?TrialID=RBR-6b6wnsy.
	INTERVENTION: Control Group (15 individuals): Conventional Physiotherapy will be performed. The protocol for conventional physiotherapy will be based on the considerations obtained in the evaluations, including cervical mobilization and stretching (stretching, flexion, extension, lateral inclination and rotation), upper limb exercises (shoulder, elbow and wrist flexion and extension) and lower limb exercises (flexion, extension, abduction and adduction) for 30 seconds for each set. The following variables will be assessed: Quality of Life, peripheral muscle strength, respiratory muscle strength, muscle strength rating, peak respiratory flow, functional capacity of the upper limbs, plasma levels and assessment of the level of physical activity. Intervention Group (15 individuals): Physiotherapy will be performed using Non‐Immersive Virtual Reality. The protocol related to RVNI will be made using games chosen according to the characteristics and limitations of each patient, taking into account the results obtained in the evaluations. The console used will be the Nintendo Wii and all games will be similar in structure and guidelines, aimed at active movement of the upper limb. Patients to be submitted to this treatment group will not receive treatment with conventional physiotherapy from those involved in the project, thus evaluating the exclusive effects of RVNI. The following variables will be evaluated: Quality of Life, peripheral muscle strength, respiratory muscle strength , graduation of muscular strength, peak of respiratory flow, functional capacity of the upper limbs, plasma levels and evaluation of the level of physical activity. H02.010.625 L01.224.160.875 CONDITION: E00‐E90 Renal Insufficiency, Chronic PRIMARY OUTCOME: Increase in functional capacity, verified through the ring test (Pegboard and Ring Test), from the significance finding, given by p value less than or equal to 0.05 in Levene's test, both intragroups and intergroups in the pre measurements , 4th session and post intervention. Increase in global muscle strength, verified through the Medical Research Council (MRC) strength rating, based on the finding of significance, given by a p‐value less than or equal to 0.05 in the Levene test, both within and between groups in measurements pre, 4th session and post intervention. Increase in handgrip strength, verified by means of dynamometry, based on the finding of significance, given by a p value less than or equal to 0.05 in the Levene test, both within and between groups in the pre‐, 4th session and post‐intervention measurements . Increased expiratory flow, verified by means of Peak Flow, based on the finding of significance, given by a p‐value less than or equal to 0.05 in the Levene test, both intragroups and intergroups in the pre‐, 4th session and post‐intervention measurements. Increased respiratory muscle strength, verified by means of manovacuometry, based on the finding of significance, given by a p value less than or equal to 0.05 in the Levene test, both within and between groups in the pre‐, 4th session and post‐intervention measurements. SECONDARY OUTCOME: Improvement in the quality of life levels, verified through the specific questionnaire for patients with chronic kidney disease (KDQOL‐SF), based on the finding of significance, given by a p value less than or equal to 0.05 in the Levene test, both intragroups and intergroups in pre and post intervention measurements. Improvement of plasma levels, verified through laboratory tests, from the finding of significance, given by a p value less than or equal to 0.05 in the Levene test, both within and between groups in the pre and post intervention measurements. INCLUSION CRITERIA: Both sexes, aged 18 years or over, patients from the hemodialysis session of Hospital Santa Casa de Caridade Alfenas Nossa Senhora do Perpétuo Socorro, who undergo hemodialysis session three times a week, using bicipital fistula for access.

B, S., et al. (2020). "Identification of the most relevant intervertebral effort indicators during gait of adolescents with idiopathic scoliosis." Computer Methods in Biomechanics & Biomedical Engineering 23(10): 664-674.
	The intervertebral efforts, i.e., forces and torques, during gait have been recognized as influencing the progression of scoliosis, due to the mechanical modulations according to the Hueter-Volkmann Law. Therefore, these efforts are key variables for posture correction and to control the progression of scoliosis. Using the intervertebral efforts during gait for the clinical follow-ups has never been performed. For this, it would be necessary to identify amongst all these efforts the most relevant ones, which is the objective of this study. A previously developed dynamical model of the human body was used to compute the 3 D intervertebral efforts during the gait of 15 participants with adolescent idiopathic scoliosis (AIS) and 12 typically developed adolescents (TDA). Kolmogorov-Smirnov and Two-sample t-test were applied on the calculated intervertebral efforts and the graphs of intervertebral efforts were studied. Antero-posterior (AP) forces and torques and medio-lateral (ML) forces are the most relevant intervertebral efforts amongst the other efforts in adolescents with AIS during gait. Discussion: Gait analysis in adolescents with AIS based on the relevant intervertebral efforts could be an effective means to follow-up and evaluate the progression of scoliosis during their treatment period. This study highlights the most relevant intervertebral efforts of individuals with AIS during gait. As future work, the identified intervertebral efforts could be implemented in a quantified and visual feedback tool for therapeutic and performance evaluation or interactive sessions in physiotherapy, e.g., via video games for dynamic posture self-correction.

Babaiasl, M., et al. (2016). "A review of technological and clinical aspects of robot-aided rehabilitation of upper-extremity after stroke." Disabil Rehabil Assist Technol 11(4): 263-280.
	Cerebrovascular accident (CVA) or stroke is one of the leading causes of disability and loss of motor function. Millions of people around the world are effected by it each year. Stroke results in disabled arm function. Restoration of arm function is essential to regaining activities of daily living (ADL). Along with traditional rehabilitation methods, robot-aided therapy has emerged in recent years. Robot-aided rehabilitation is more intensive, of longer duration and more repetitive. Using robots, repetitive dull exercises can turn into a more challenging and motivating tasks such as games. Besides, robots can provide a quantitative measure of the rehabilitation progress. This article overviews the terms used in robot-aided upper-limb rehabilitation. It continues by investigating the requirements for rehabilitation robots. Then the most outstanding works in robot-aided upper-limb rehabilitation and their control schemes have been investigated. The clinical outcomes of the built robots are also given that demonstrates the usability of these robots in real-life applications and their acceptance. This article summarizes a review done along with a research on the design, simulation and control of a robot for use in upper-limb rehabilitation after stroke. Implications for Rehabilitation Reviewing common terms in rehabilitation of upper limb using robots Reviewing rehabilitation robots built up to date Reviewing clinical outcomes of the mentioned rehabilitation robots.

Bacha, J. M. R., et al. (2018). "Effects of Kinect Adventures Games Versus Conventional Physical Therapy on Postural Control in Elderly People: A Randomized Controlled Trial." Games for Health Journal 7(1): 24-36.
	OBJECTIVE: To compare the effectiveness of Kinect Adventures games versus conventional physiotherapy to improve postural control (PC), gait, cardiorespiratory fitness, and cognition of the elderly. In addition, we evaluated the safety, acceptability, and adherence to the interventions. MATERIALS AND METHODS: The study was a randomized clinical trial in which 46 elderly individuals were selected, mean age 69.3 (5.34) years. Participants were allocated to the Kinect Adventures Training Group (KATG) or the Conventional Physical Therapy Group (CPTG), 23 individuals in each group. Participants of both groups participated in 14 training sessions lasting 1 hour each, twice a week. The KATG practiced four Kinect Adventures games. The CPTG participated in conventional physiotherapy. The primary outcome was PC: Mini-Balance Evaluation Systems Test (Mini-BESTest), and secondary outcomes were gait: Functional Gait Assessment (FGA), cardiorespiratory fitness: Six-minute step test (6MST), and cognition: Montreal Cognitive Assessment (MoCA). Acceptability was assessed through a questionnaire created by the researchers themselves. Adherence was assessed by the "frequency of the number of elderly individuals who completed the interventions and safety through the presence of adverse effects." Participants were assessed immediately pre- and posttreatment and fourth week after the end of the treatment. Statistical analysis was done through repeated-measures analysis of variance and Tukey post hoc test. RESULTS: Both groups presented a significant improvement in the PC (Mini-BEST), gait (FGA), and cognition (MoCA) posttreatment that was maintained at fourth week after treatment (post hoc Tukey test; P < 0.05). Regarding cardiorespiratory fitness (6MST), the KATG presented improvement posttreatment and maintenance of the results in the fourth week after treatment. CPTG showed improvement only in fourth week after treatment (post hoc Tukey tests; P < 0.05). Regarding the acceptability, the questionnaire showed that both groups were satisfied with regard to the proposed interventions. There was 91% adherence in both training sessions. Regarding the safety, 34% and 26% of the individuals of the KATG and CPTG, respectively, presented adverse effects of delayed muscle pain in the lower limbs after the first session only. CONCLUSION: There were no significant differences between the KATG and CPTG; both interventions provided positive effects on PC, gait, cardiorespiratory fitness, and cognition of the elderly.

Bačić, B. (2018). Towards the next generation of exergames: Flexible and personalised assessment-based identification of tennis swings. Ithaca, Cornell University Library, arXiv.org.
	Current exergaming sensors and inertial systems attached to sports equipment or the human body can provide quantitative information about the movement or impact e.g. with the ball. However, the scope of these technologies is not to qualitatively assess sports technique at a personalised level, similar to a coach during training or replay analysis. The aim of this paper is to demonstrate a novel approach to automate identification of tennis swings executed with erroneous technique without recorded ball impact. The presented spatiotemporal transformations relying on motion gradient vector flow and polynomial regression with RBF classifier, can identify previously unseen erroneous swings (84.5-94.6%). The presented solution is able to learn from a small dataset and capture two subjective swing-technique assessment criteria from a coach. Personalised and flexible assessment criteria required for players of diverse skill levels and various coaching scenarios were demonstrated by assigning different labelling criteria for identifying similar spatiotemporal patterns of tennis swings.

Bačić, B. and P. Hume (2018). Computational intelligence for qualitative coaching diagnostics: Automated assessment of tennis swings to improve performance and safety. Ithaca, Cornell University Library, arXiv.org.
	Coaching technology, wearables and exergames can provide quantitative feedback based on measured activity, but there is little evidence of qualitative feedback to aid technique improvement. To achieve personalised qualitative feedback, we demonstrated a proof-of-concept prototype combining kinesiology and computational intelligence that could help improving tennis swing technique utilising three-dimensional tennis motion data acquired from multi-camera video. Expert data labelling relied on virtual 3D stick figure replay. Diverse assessment criteria for novice to intermediate skill levels and configurable coaching scenarios matched with a variety of tennis swings (22 backhands and 21 forehands), included good technique and common errors. A set of selected coaching rules was transferred to adaptive assessment modules able to learn from data, evolve their internal structures and produce autonomous personalised feedback including verbal cues over virtual camera 3D replay and an end-of-session progress report. The prototype demonstrated autonomous assessment on future data based on learning from prior examples, aligned with skill level, flexible coaching scenarios and coaching rules. The generated intuitive diagnostic feedback consisted of elements of safety and performance for tennis swing technique, where each swing sample was compared with the expert. For safety aspects of the relative swing width, the prototype showed improved assessment ...

Badau, D., et al. (2022). "The Impact of Implementing an Exergame Program on the Level of Reaction Time Optimization in Handball, Volleyball, and Basketball Players." International Journal of Environmental Research & Public Health [Electronic Resource] 19(9): 5598.
	The main aim of the present study was to implement an exergame program that uses Fitlight technology to identify the impact on motor, recognition, and cognitive reaction times in junior athletes practicing team sports: basketball, handball, and volleyball. The second aim was to identifying differences in progress of the three types of reaction time between female and male players through computerized tests. The study included 360 subjects for basketball, 130 athletes of which were 68 male subjects and 62 female subjects; for handball, 124 athletes of which 64 were male subjects and 60 female athletes; for volleyball, 106 athletes of which 48 male were subjects and 48 female athletes. Characteristics of the experimental players: average age +/- SD 13.60 +/- 1.07; average sports experience +/- SD 6.24 +/- 0.92. The research included an initial and a final test between which a program of exergames was implemented over a period of 3 months focused on optimizing human reaction times. The evaluation of the reaction times was carried out through three computer games, the results being processed in SPSS 22. The relevant results of the research: for the simple motor reaction time (MSRT), the greatest progress between tests was the volleyball group, and for women, it was the basketball group; for the recognition reaction time (RRT), the male handball group and the female basketball group recorded the greatest progress; for the cognitive reactive time (CRT), the greatest progress was achieved by the male and female volleyball players. In all tests, the progress of the female basketball, handball, and volleyball players showed superior progress to similar male players. The results of the research highlighted the effectiveness of the experimental exergame program by using Fitlight technology in optimizing human reaction times in junior team-game athletes. Using computer games to evaluate reaction times allowed us to differentiate the evaluation on the types of human reactions under both standardized conditions but also under conditions of efficiency and attractiveness.

Bailey, M. J., et al. (2002). "Treatment of Visual Neglect in Elderly Patients With Stroke: A Single-Subject Series Using Either a Scanning and Cueing Strategy or a Left-Limb Activation Strategy." Physical Therapy 82(8): 782-797.
	BACKGROUND AND PURPOSE: The presence of unilateral visual neglect (UVN) may adversely affect functional recovery, and rehabilitation strategies that are practical for use in clinical settings are needed. The purpose of this study was to evaluate the use of 2 approaches to reduce UVN in people who have had strokes. SUBJECTS: Seven elderly patients with stroke and severe left UVN, aged 60 to 85 years, were recruited from a stroke rehabilitation unit. METHODS: A nonconcurrent, multiple-baselines-across-subjects approach, with an A-B-A treatment-withdrawal single-subject experimental design, was used. Five subjects received a scanning and cueing approach, and 2 subjects received a contralesional limb activation approach, for 10 one-hour sessions. In the former approach, active scanning to the left was encouraged by the therapist, using visual and verbal cues and a mental imagery technique, during reading and copying tasks and simple board games. In the latter approach, functional and goal-oriented left upper-limb activities in neglected hemispace were encouraged. Unilateral visual neglect was examined by a masked (blinded) examiner throughout all phases using the Star Cancellation Test, the Line Bisection Test, and the Baking Tray Task. Data were analyzed using visual and inferential statistical techniques. RESULTS: Both subjects who received limb activation and 3 of the 5 subjects who received scanning and cueing showed a reduction in UVN in one or more tests. This improvement was maintained during the withdrawal phase. DISCUSSION AND CONCLUSION: Both approaches had a positive effect of reducing aspects of UVN in some subjects relative to no-treatment baselines. However, causality cannot be assured in the absence of controls. The approaches are practical for use in rehabilitation settings. These procedures warrant further replication across subjects, settings, and therapists.

Ballantyne, R. and P. M. Rea (2019). "A Game Changer: 'The Use of Digital Technologies in the Management of Upper Limb Rehabilitation'." Advances in Experimental Medicine & Biology 1205: 117-147.
	Hemiparesis is a symptom of residual weakness in half of the body, including the upper extremity, which affects the majority of post stroke survivors. Upper limb function is essential for daily life and reduction in movements can lead to tremendous decline in quality of life and independence. Current treatments, such as physiotherapy, aim to improve motor functions, however due to increasing NHS pressure, growing recognition on mental health, and close scrutiny on disease spending there is an urgent need for new approaches to be developed rapidly and sufficient resources devoted to stroke disease. Fortunately, a range of digital technologies has led to revived rehabilitation techniques in captivating and stimulating environments. To gain further insight, a meta-analysis literature search was carried out using the Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) method. Articles were categorized and pooled into the following groups; pro/anti/neutral for the use of digital technology. Additionally, most literature is rationalised by quantitative and qualitative findings. Findings displayed, the majority of the inclusive literature is supportive of the use of digital technologies in the rehabilitation of upper extremity following stroke. Overall, the review highlights a wide understanding and promise directed into introducing devices into a clinical setting. Analysis of all four categories; (1) Digital Technology, (2) Virtual Reality, (3) Robotics and (4) Leap Motion displayed varying qualities both-pro and negative across each device. Prevailing developments on use of these technologies highlights an evolutionary and revolutionary step into utilizing digital technologies for rehabilitation purposes due to the vast functional gains and engagement levels experienced by patients. The influx of more commercialised and accessible devices could alter stroke recovery further with initial recommendations for combination therapy utilizing conventional and digital resources.

Ballesteros, S. (2022). "Cognitive plasticity induced in older adults by cognitive training, physical exercise, and combined interventions." Multiple pathways of cognitive aging: motivational and contextual influences: 340‐367.
	Aging in the 21st century is a fact, and governments must invest in research into the most effective ways to reduce and/ or attenuate cognitive decline and dementia in older people. However, one should not be too pessimistic, as aging does not have only negative effects‐there are cognitive functions that do not deteriorate as people age. There are also many individual differences among elders, and some of them deal efficiently with their professional careers and perform their jobs competently until a very old age. This chapter examines in detail results showing that not all are bad news as some cognitive functions do not decline with age and there are ways to maintain functionality in the plastic older brain. It discusses results showing that combined multidomain interventions may induce larger cognitive gains than single‐domain interventions. The chapter describes an ongoing four‐arm randomized controlled trial conducted to investigate the possible synergetic effects of a group‐based multidomain training program that combines physical exercise with video game training, in comparison to those produced by cognitive training combined with physical control activity, physical training with cognitive control activity, or a combination of both control activities. (PsycInfo Database Record (c) 2022 APA, all rights reserved)

Ballesteros, S., et al. (2015). "Maintaining older brain functionality: A targeted review." Neurosci Biobehav Rev 55: 453-477.
	The unprecedented growth in the number of older adults in our society is accompanied by the exponential increase in the number of elderly people who will suffer cognitive decline and dementia in the next decades. This will create an enormous cost for governments, families and individuals. Brain plasticity and its role in brain adaptation to the process of aging is influenced by other changes as a result of co-morbidities, environmental factors, personality traits (psychosocial variables) and genetic and epigenetic factors. This review summarizes recent findings obtained mostly from interventional studies that aim to prevent and/or delay age-related cognitive decline in healthy adults. There are a multitude of such studies. In this paper, we focused our review on physical activity, computerized cognitive training and social enhancement interventions on improving cognition, physical health, independent living and wellbeing of older adults. The methodological limitations of some of these studies, and the need for new multi-domain synergistic interventions, based on current advances in neuroscience and social-brain theories, are discussed.

Ballesteros, S., et al. (2020). "Effects of multidomain versus single-domain training on executive control and memory in older adults: study protocol for a randomized controlled trial." Trials [Electronic Resource] 21(1): 404.
	BACKGROUND: Previous research suggests that both cognitive training and physical exercise help to maintain brain health and cognitive functions that decline with age. Some studies indicate that combined interventions may produce larger effects than each intervention alone. The aim of this study is to investigate the effects of combined cognitive and physical training compared to cognitive training and physical training alone on executive control and memory functions in healthy older adults. OBJECTIVES: The main objectives of this four-arm randomized controlled trial (RCT) are: to investigate the synergetic effects of a simultaneous, group-based multidomain training program that combines cognitive video-game training with physical exercise, in comparison to those produced by cognitive training combined with physical control activity, physical training combined with cognitive control activity, or a combination of both control activities; to investigate whether event-related potential latencies of the P2 component are shorter and N2 and P3b components assessed in a memory-based task switching task are enhanced after training; and to find out whether possible enhancements persist after a 3-month period without training. METHODS: In this randomized, single-blind, controlled trial, 144 participants will be randomly assigned to one of the four combinations of cognitive training and physical exercise. The cognitive component will be either video-game training (cognitive intervention, CI) or video games not specifically designed to train cognition (cognitive control, CC). The physical exercise component will either emphasize endurance, strength, and music-movement coordination (exercise intervention, EI) or stretching, toning, and relaxation (exercise control, EC). DISCUSSION: This RCT will investigate the short and long-term effects of multidomain training, compared to cognitive training and physical training alone, on executive control and memory functions in healthy older adults, in comparison with the performance of an active control group. TRIAL REGISTRATION: ClinicalTrials.gov, NCT03823183. Registered on 21 January 2019.

Ballesteros, S., et al. (2018). "Editorial: Cognitive and Brain Plasticity Induced by Physical Exercise, Cognitive Training, Video Games, and Combined Interventions." Frontiers in Human Neuroscience 12: 169.
	
Balli, F. (2018). "Developing Digital Games to Address Airway Clearance Therapy in Children With Cystic Fibrosis: Participatory Design Process." JMIR Serious Games 6(4): e18.
	BACKGROUND: Children affected with cystic fibrosis do respiratory exercises to release the mucus stuck in their lungs. OBJECTIVE: The objective of our study was to develop prototypes of digital games that use breath pressure to make this daily physiotherapy more fun. METHODS: We used a participatory design approach and organized short events to invite contributors from different disciplines to develop game prototypes. From the 6 prototypes, 3 were tested by 10 children during a prestudy. The source code of the games, of which 2 continue to be developed, has been released on the internet under fair use licenses. RESULTS: We discuss 7 themes of importance in designing games for health, combining our experience with a review a posteriori of literature. CONCLUSIONS: This study provides examples of games and their pitfalls as well as recommendations to create games for health in a participatory approach that enables everyone to improve and adapt the work done.

Balli, F. (2018). "Game Jams to Co-Create Respiratory Health Games Prototypes as Participatory Research Methodology." Forum : Qualitative Social Research 19(3).
	In diesem Beitrag zeige ich, wie partizipative Handlungsforschung und Game Jams zusammen zur Bereicherung von sozialtransformatorischen Aktivitäten beitragen können. Partizipative Handlungsforschung ist ein kollaborativer Ansatz, bei dem Forschende und Forschungsteilnehmer/innen einen Reflexions- und Handlungszyklus durchlaufen, um eine geteilte Herausforderung gemeinsam zu verstehen und zu meistern. Bei Game Jams handelt es sich um spielerische Events, bei denen Personen mit unterschiedlicher disziplinärer Zugehörigkeit auf der Grundlage eines gemeinsamen Wissensfundus neue Spielprototypen kreieren.Die Darstellung relevanter Literatur wird durch Beispiele aus elf Game Jams illustriert, die in der Schweiz und in Kanada veranstaltet wurden, um Spiele für eine respiratorische Mukoviszidose-Physiotherapie zu entwickeln bzw. das Selbstmanagement im Falle von Asthma-Erkrankungen zu verbessern. In Ihrem Zusammenspiel eröffnen partizipative Handlungsforschung und Game Jams attraktive und inklusive Kontexte, die die Aneignung interdisziplinären Wissens erleichtern, zur Ausbildung von Leitungs- und sozialen Skills beitragen sowie zivilgesellschaftliches Engagement befördern.Alternate abstract:In this article I discuss how participatory action research (PAR) and game jams can be mutually enriching activities to achieve social transformation. PAR is a collaborative method where researchers and participants go through a cycle of reflection and action to understand and solve a collective challenge. Game jams are playful events where people from different disciplines build on collective knowledge to create game prototypes. The literature review is illustrated with eleven game jams held in Switzerland and Canada to create games for respiratory physiotherapy in cystic fibrosis, and to foster self-management in asthma. Together, game jams and PAR offer attractive and inclusive contexts to ease the appropriation of interdisciplinary knowledge, develop leadership and social skills, and foster civic engagement.

Baltaci, G., et al. (2013). "Comparison between Nintendo Wii Fit and conventional rehabilitation on functional performance outcomes after hamstring anterior cruciate ligament reconstruction: prospective, randomized, controlled, double-blind clinical trial." Knee Surgery, Sports Traumatology, Arthroscopy 21(4): 880-887.
	PURPOSE: The aim of this prospective, randomized, controlled, double-blind clinical trial was to compare the outcomes, including knee strength, balance, coordination, proprioception and response time, of Nintendo Wii Fit with those of conventional rehabilitation on the subjects with anterior cruciate ligament reconstruction. METHODS: Thirty volunteer subjects were enrolled in either Wii Fit (n = 15; mean age, 29 +/- 7 years) or conventional rehabilitation (n = 15; mean age, 29 +/- 6 years) programmes from the first week up to 12th weeks of the operation. Endoscopic reconstruction of a completely ruptured ACL was performed by using graft harvested from hamstrings. Each subject underwent an individual therapeutic programme. Functional examinations included the measurements of the balance using modified star excursion balance test, coordination, proprioception and response time using functional squat system and strength of flexor and extensor muscles of the involved and uninvolved leg using an isokinetic machine. RESULTS: There was no significant difference between Wii Fit and conventional group in terms of isokinetic knee strength at 12th week, and dynamic balance, and functional squat tests including coordination, proprioception and response time at first, 8th and 12th weeks of the rehabilitation. CONCLUSION: Two different 12-week-physiotherapy programmes following ACL reconstruction have the same affect on muscle strength, dynamic balance and functional performance values in both groups. We considered that the practice of Wii Fit activities like conventional rehabilitation could also address physical therapy goals, which included improving visual-perceptual processing, coordination, proprioception and functional mobility.

Banerjee-Guenette, P., et al. (2020). "Facilitating the Implementation of Virtual Reality-Based Therapies in Pediatric Rehabilitation." Physical & Occupational Therapy in Pediatrics 40(2): 201-216.
	Aims: Evaluate the impact of a multifaceted knowledge translation (KT) strategy for the implementation of virtual reality (VR) intervention by rehabilitation clinicians in a pediatric hospital setting.Methods: Eleven therapists were recruited and completed a questionnaire on perceptions on VR usage. A multifaceted KT strategy was implemented over five months. VR usage was tracked and clinician perceptions were reassessed. Baseline characteristics were summarized using descriptive statistics and a Wilcoxon signed rank sum test evaluated changes pre- and post-KT.Results: Perceived ease of use, behavioral control, self-efficacy, and barriers to use improved significantly post-KT; however, intention to use did not. Usage was higher pre-KT than the last two months of KT. Pre-KT, barriers included system setup and use, knowledge of games, and lack of resources, whereas post-KT, they were the lack of appropriate patients and patient-specific experience. KT supports and patient engagement were reasons for continued use.Conclusions: This study highlights the importance of supporting clinicians when implementing VR in clinical rehabilitation. Clinicians benefit from experiential and individualized learning opportunities, peer-led coaching, and hands-on training. Whether these strategies translate to increased usage and how usage is influenced by environmental factors (i.e. lack of appropriate clients) warrants additional research.

Barak Ventura, R., et al. (2020). "A 3D printing approach toward targeted intervention in telerehabilitation." Sci Rep 10(1): 3694.
	Neuromuscular impairment requires adherence to a rehabilitation regimen for maximum recovery of motor function. Consumer-grade game controllers have emerged as a viable means to relay supervised physical therapy to patients' homes, thereby increasing their accessibility to healthcare. These controllers allow patients to perform exercise frequently and improve their rehabilitation outcomes. However, the non-universal design of game controllers targets healthy people and does not always accommodate people with disability. Consequently, many patients experience considerable difficulty assuming certain hand postures and performing the prescribed exercise correctly. Here, we explore the feasibility of improving rehabilitation outcomes through a 3D printing approach that enhances off-the-shelf game controllers in home therapy. Specifically, a custom attachment was 3D printed for a commercial haptic device that mediates fine motor rehabilitation. In an experimental study, 25 healthy subjects performed a navigation task, with the retrofit attachment and without it, while simulating disability of the upper limb. When using the attachment, subjects extended their wrist range of motion, yet maintained their level of compensation. The subjects also showed higher motivation to repeat the exercise with the enhanced device. The results bring forward evidence for the potential of this approach in transforming game controllers toward targeted interventions in home therapy.

Baranauskas, M., et al. (2020). "Dietary Acid-Base Balance in High-Performance Athletes." International Journal of Environmental Research & Public Health [Electronic Resource] 17(15): 5332.
	Physical exercise leads to metabolic changes that affect the acid-base balance in skeletal muscles and other tissues. Nutrition is one of the factors that may influence the acid-base balance in the body. Keeping alkaline circumstances in the body is important not only for health and athletic performance in training but also during competition in many sport events. This is especially significant for athletes who practice in sport at the highest level of competition. The aim of the study was to determine the dietary acid-base balance in competitive Lithuanian high-performance athletes, and to evaluate the effect of actual diets of athletes on NEAP (net endogenous acid production), muscle mass and body mineral content during a four-year Olympic cycle. The research participants were 18.1 +/- 3.3-year-old Lithuanian high performance athletes (n = 323). The actual diet was investigated using the 24 h recall dietary survey method. The measurements of body composition were performed using BIA (bioelectrical impedance analysis). The potential renal acid load of the diets of athletes (dietary PRAL) and NEAP were calculated. In 10.2% of athletes, NEAP exceeds 100 mEq . day(-1) and is on average 126.1 +/- 32.7 mEq . day(-1). Higher NEAP in athletes is associated with lower muscle mass (beta -1.2% of body weight, p < 0.001) but has no effect on the amount of minerals in the body (beta 0.01% of body weight, p = 0.073). Overall, 25-30% of Lithuanian high-performance athletes use high-protein diets (2.0-4.8 g . kg(-1) . day(-1)) leading to a dietary acid-base imbalance as well as an excessive production of endogenous acids in the body. Athletes are recommended to consume higher amounts of potassium and magnesium. An increase in calcium intake up to 1500 mg per day is recommended. In exceptional cases, periodised nutrition for athletes may involve diets complemented with bicarbonate and/or beta-alanine supplements.

Barbosa, A. R. and A. V. Guimaraes (2015). "Paper Abstract." Journal of the American Geriatrics Society 63: S1-S320.
	Background: Participating in regular physical exercise is important for the motor and cognitive performance.There has been a rapid growth in popularity, among older adults, of "exergames"‐ video gaming with remote controls and motion sensors that incorporates physical activity into game play. The aim of this study was assess the effects of exergames training program on cognitive performance and functional fitness in older adults without cognitive impairment. Methods: In this pilot study (pretest‐training‐posttest design) sixteen active subjects (69.4 +/‐ 6.1 years) were divided into two groups: intervention group (IG; n=8) and control group (CG; n=8). The Xbox 360 Kinect was used for intervention: sportive games, two 1‐hr sessions per week over a period of 8 weeks. Participants completed 4 functional fitness tests and a brief computerized battery of cognitive tests (Cogstate Battery) at baseline and after intervention. The cognitive battery evaluated the velocity and accuracy in the following domains: psychomotor function, attention, learning and working memory. Results: The Student "t" test showed: a) the trainees improved (p=0.043) the accuracy (number of correct answers) in the domain of attention, between pre and post intervention; b) significant improvement for the IG in the time‐up‐and‐go (seconds) and 6‐min walk (meters) tests. There were a significantly (p <0.05) improvement ("Wilcoxon" test) in arm curl test (no. of reps.) and 30‐s chair stand (no. of reps.) tests for the IG, comparing pre and post intervention. Conclusion: "Exergames" that simulate sports games may benefit cognitive performance and functional fitness in older adults. The short period of intervention may not be sufficient to cause significant changes in all cognitive domains assessed.

Barcelos, N., et al. (2015). "Aerobic and cognitive exercise (ACE) pilot study for older adults: executive function improves with cognitive challenge while exergaming." Journal of the International Neuropsychological Society 21(10): 768‐779.
	Dementia cases are increasing worldwide; thus, investigators seek to identify interventions that might prevent or ameliorate cognitive decline in later life. Extensive research confirms the benefits of physical exercise for brain health, yet only a fraction of older adults exercise regularly. Interactive mental and physical exercise, as in aerobic exergaming, not only motivates, but has also been found to yield cognitive benefit above and beyond traditional exercise. This pilot study sought to investigate whether greater cognitive challenge while exergaming would yield differential outcomes in executive function and generalize to everyday functioning. Sixty‐four community based older adults (mean age=82) were randomly assigned to pedal a stationary bike, while interactively engaging on‐screen with: (1) a low cognitive demand task (bike tour), or (2) a high cognitive demand task (video game). Executive function (indices from Trails, Stroop and Digit Span) was assessed before and after a single‐bout and 3‐month exercise intervention. Significant group x time interactions were found after a single‐bout (Color Trails) and after 3 months of exergaming (Stroop; among 20 adherents). Those in the high cognitive demand group performed better than those in the low cognitive dose condition. Everyday function improved across both exercise conditions. Pilot data indicate that for older adults, cognitive benefit while exergaming increased concomitantly with higher doses of interactive mental challenge.

Barros, M., et al. (2012). "Exergames: the role of ergonomics and design in helping to control childhood obesity through physical and functional exercise program." Work 41 Suppl 1: 1208-1211.
	In the area of the design and physiotherapy, the using of virtual technologies for immersion of users are spreading. And this affirmation extends to several areas of knowledge. In games, the quote is, resources are being used to work cognitive skills, attention, memory, among other factors beside the children. Currently, at the expense of usability, low cost, virtual technologies of perception and interaction, as Nintendo Wii, X-Box 360, among others, arises therefore a new class of games called Exergames, which is the union of physical activity the game. This fact gives users the development of sensory and motor skills through virtual reality mechanisms suitable for certain needs. This literature review aimed to provide an overview of the current context of Exergames, especially in use for controlling childhood obesity, which is growing alarmingly, with some features, applications and possibilities for use at the design and other areas such as physiotherapy.

Basha, M. A., et al. (2022). "Effects of Wii Fit Rehabilitation on Lower Extremity Functional Status in Adults With Severe Burns: A Randomized Controlled Trial." Archives of Physical Medicine & Rehabilitation 103(2): 289-296.
	OBJECTIVES: To investigate the effects of the Wii Fit rehabilitation program in addition to a standard physical therapy program (SPTP) on lower extremity functional status and functional mobility in adults with severe burns after hospital discharge. DESIGN: A single-blinded, parallel groups, randomized controlled trial. SETTINGS: Outpatient rehabilitation center. PARTICIPANTS: Thirty-four patients (N=34), aged 31.3+/-7.3 years old, with lower extremity deep partial-thickness and full-thickness burn and total body surface area of more than 40% were allocated randomly into 2 equal groups. INTERVENTIONS: The Wii Fit group received the Wii Fit program for 30 minutes in addition to SPTP for 60 minutes, whereas the SPTP group received SPTP only. The intervention was 3 sessions a week for 12 weeks. MAIN OUTCOME MEASURES: The primary outcome measurements were the functional status and functional mobility, which were assessed by the high mobility assessment tool, Lower Limb Functional Index, and timed Up and Go test. The secondary outcomes included exercise capacity, muscle strength, and balance measured by the 6-minute walk test, isokinetic muscle strength assessment, and stability index. All the outcome measures were collected at the baseline and after 12 weeks of intervention. RESULTS: After 12 weeks of intervention, there were statistically significant differences between groups in all outcome measures in favor of the Wii Fit group (P<.001). Also, statistically significant differences were found in all the measured outcomes after 12 weeks of intervention in each group (P<.05). CONCLUSIONS: Patients with lower extremity burns who received the Wii Fit program in addition to the SPTP had better improvements in lower limb functional status, functional mobility, exercise capacity, muscle strength, and balance than patients who received SPTP alone. The Wii Fit program was a useful adjunctive therapy in rehabilitating adults with lower extremity burn injury.

Basha, M. A., et al. (2022). "Effect of exercise mode on physical function and quality of life in breast cancer-related lymphedema: a randomized trial." Supportive Care in Cancer 30(3): 2101-2110.
	PURPOSE: This study aimed to compare the effects of virtual reality (VR) training and resistance exercises training on lymphedema symptom severity as well as physical functioning and QoL in women with breast cancer-related lymphedema (BCRL). METHODS: In a single blinded randomized trial, women diagnosed with unilateral BCRL were randomly divided into two groups: the Xbox Kinect group received VR Kinect-based games (n = 30) and resistance exercise group received resistance training (n = 30). In addition, both groups received complex decongestive physiotherapy (manual lymphatic drainage, compression bandages, skin care, and exercises). The intervention was conducted five sessions per week for 8 weeks. The outcome measures included excessive limb volume, visual analogue scale (VAS), the Disability of the Arm, Shoulder, and Hand (DASH) questionnaire, shoulder range of motion (ROM), shoulder muscles strength, hand grip strength, and Study Short-Form (SF-36). The outcomes were evaluated pre and post intervention (week 8). RESULTS: Statistical significant differences were recorded in VAS (pain intensity), DASH, shoulder ROM (p < 0.001), bodily pain (p = 0.002), general health (p < 0.001), and vitality (p = 0.006) in favor of the Xbox Kinect group. However, there were statistically significant differences in shoulder flexion strength (p = 0.002), external rotation strength (p = 0.004), and abduction strength and handgrip strength (p < 0.001) in favor of the resistance exercise group. CONCLUSIONS: The VR training was superior to resistance exercises training in BCRL management. The empirical findings support the VR as a new effective and encouraging intervention modality which can assist in improving physical functioning and quality of life in women with BCRL. TRIAL REGISTRATION: This study is retrospectively registered at ClinicalTrials.gov (ID: NCT04724356).

Bassett, J. (2011). "Game changers." Advance for Physical Therapy & Rehab Medicine 22(22): 12-14.
	
Bassett, J. (2012). "Game change." Advance for Physical Therapy & Rehab Medicine 23(9): 14-17.
	
Bateni, H. (2012). "Changes in balance in older adults based on use of physical therapy vs the Wii Fit gaming system: a preliminary study." Physiotherapy 98(3): 211-216.
	OBJECTIVES: To determine the effectiveness of Wii Fit training on balance control in older adults compared with physical therapy training. DESIGN: Quasi-experimental design. PARTICIPANTS: Eight males and nine females aged 53 to 91 years. MATERIALS AND METHODS: Participants were divided into three groups: one group received both physical therapy training and Wii Fit training (PW group), one group received Wii Fit training alone (WI group), and one group received physical therapy training alone (PT group). Training consisted of three sessions per week for 4 weeks. MAIN OUTCOME: Berg Balance Scale (all groups) and Bubble Test (PW and WI groups) scores. STATISTICAL ANALYSIS: Descriptive statistics, medians, interquartile ranges and 95% confidence intervals are reported to identify trends in balance control as a result of different types of training. RESULTS: All subjects showed improvement in the Berg Balance Scale and Bubble Test scores. The PT and PW groups tended to perform better than the WI group on the Berg Balance Scale following treatment. Although the differences in the Bubble Test score were not substantial between the PW and WI groups, the PW group performed slightly better than the WI group on the Berg Balance Scale. CONCLUSIONS: Wii Fit training appears to improve balance. However, physical therapy training on its own or in addition to Wii Fit training appears to improve balance to a greater extent than Wii Fit training alone.

Baumann, E., et al. (2018). "Rehabilitation Considerations for an Uncommon Injury of the Knee: A Case Report." International Journal of Sports Physical Therapy 13(3): 511-519.
	BACKGROUND AND PURPOSE: Chronic instability of the proximal tibiofibular joint (PTFJ) is an uncommon condition that accounts for <1% of knee injuries. The mechanism of injury is a high-velocity twisting motion on a flexed knee. Surgical management is controversial due to complications; however, surgeons are now utilizing ligament reconstruction to restore stability. There is a paucity of information in the literature regarding postoperative care and rehabilitation after PTFJ reconstruction. The purpose of this case report is to describe the post-surgical rehabilitation for an adolescent athlete following PTFJ ligament reconstruction using a modified anterior cruciate ligament reconstruction (ACL) post-operative rehabilitation protocol. CASE DESCRIPTION: A 15-year-old female soccer player reported left ankle and knee pain for one year after a contact injury and landing on a hyperflexed knee during a soccer game. The surgeon diagnosed the subject with chronic PTFJ instability and performed reconstruction using an allograft ligament and calcium phosphate bone graft. The subject presented to physical therapy three weeks post-operatively with complete resolution of ankle pain and mild knee pain. The subject's goal was to return to golf as she reported apprehension with a potential return to soccer. After consulting with the surgeon and because the subject was only allowed to advance weight bearing status by 20 pounds each week (to protect the graft site), the treating therapists progressed the subject using a modified ACL protocol as there is no documented post-operative rehabilitation protocol to treat patients after a PTFJ reconstruction. OUTCOMES: Outcome measures for this subject included the patient specific functional scale (PSFS), verbal numeric pain rating scale and ability to participate in golf. The initial PSFS score was 4/30 (activities included walking, jogging and golf) and the subject's reported pain level was 3/10. Three months after surgery the subject demonstrated significant improvement to 30/30 on the PSFS, 0/10 pain, and had progressed to participation in both golf and jogging. DISCUSSION: The modified ACL protocol was effective in safely rehabilitating this adolescent athlete following a PTFJ reconstruction. This subject demonstrated some yellow flags which may have slowed her rehabilitation progression. Use of a modified ACL reconstruction protocol served as a guideline for the rehabilitation of this rare condition. Additional research is necessary to establish evidence-based guidelines for treatment of PTFJ reconstruction. LEVEL OF EVIDENCE: Level 4.

Baur, K., et al. (2018). "Music meets robotics: a prospective randomized study on motivation during robot aided therapy." J Neuroeng Rehabil 15(1): 79.
	BACKGROUND: Robots have been successfully applied in motor training during neurorehabilitation. As music is known to improve motor function and motivation in neurorehabilitation training, we aimed at integrating music creation into robotic-assisted motor therapy. We developed a virtual game-like environment with music for the arm therapy robot ARMin, containing four different motion training conditions: a condition promoting creativity (C+) and one not promoting creativity (C-), each in a condition with (V+) and without (V-) a visual display (i.e., a monitor). The visual display was presenting the game workspace but not contributing to the creative process itself. In all four conditions the therapy robot haptically displayed the game workspace. Our aim was to asses the effects of creativity and visual display on motivation. METHODS: In a prospective randomized single-center study, healthy participants were randomly assigned to play two of the four training conditions, either with (V+) or without visual display (V-). In the third round, the participants played a repetition of the preferred condition of the two first rounds, this time with a new V condition (i.e., with or without visual display). For each of the three rounds, motivation was measured with the Intrinsic Motivation Inventory (IMI) in the subscales interest/enjoyment, perceived choice, value/usefulness, and man-machine-relation. We recorded the actual training time, the time of free movement, and the velocity profile and administered a questionnaire to measure perceived training time and perceived effort. All measures were analysed using linear mixed models. Furthermore, we asked if the participants would like to receive the created music piece. RESULTS: Sixteen healthy subjects (ten males, six females, mean age: 27.2 years, standard deviation: 4.1 years) with no known motor or cognitive deficit participated. Promotion of creativity (i.e., C+ instead of C-) significantly increased the IMI-item interest/enjoyment (p=0.001) and the IMI-item perceived choice (p=0.010). We found no significant effects in the IMI-items man-machine relation and value/usefulness. Conditions promoting creativity (with or without visual display) were preferred compared to the ones not promoting creativity. An interaction effect of promotion of creativity and omission of visual display was present for training time (p=0.013) and training intensity (p<0.001). No differences in relative perceived training time, perceived effort, and perceived value among the four training conditions were found. CONCLUSIONS: Promoting creativity in a visuo-audio-haptic or audio-haptic environment increases motivation in robot-assisted therapy. We demonstrated the feasibility of performing an audio-haptic music creation task and recommend to try the system on patients with neuromuscular disorders. TRIAL REGISTRATION: ClinicalTrials.gov, NCT02720341. Registered 25 March 2016, https://clinicaltrials.gov/ct2/show/NCT02720341.

Baxter, C., et al. (2021). "Seeking Inspiration: Examining the Validity and Reliability of a New Smartphone Respiratory Therapy Exergame App." Sensors 21(19): 6472.
	BACKGROUND: Clinically valid and reliable simulated inspiratory sounds were required for the development and evaluation of a new therapeutic respiratory exergame application (i.e., QUT Inspire). This smartphone application virtualises incentive spirometry, a longstanding respiratory therapy technique. OBJECTIVES: Inspiratory flows were simulated using a 3 litre calibration syringe and validated using clinical reference devices. Syringe flow nozzles of decreasing diameter were applied to model the influence of mouth shape on audible sound levels generated. METHODS: A library of calibrated audio inspiratory sounds was created to determine the reliability and range of inspiratory sound detection at increasing distances separating the sound source and smartphones running the app. RESULTS: Simulated inspiratory sounds were reliably detected by the new application at higher air inflows (high, medium), using smaller mouth diameters (<25 mm) and where smartphones were held proximal (</=5 cm) to the mouth (or at distances up to 50 cm for higher airflows). Performance was comparable for popular smartphone types and using different phone orientations (i.e., held horizontally, at 45 degrees or 90 degrees ). CONCLUSIONS: These observations inform future application refinements, including prompts to reduce mouth diameter, increase inspiratory flow and maintain proximity to the phone to optimise sound detection. This library of calibrated inspiratory sounds offers reproducible non-human reference data suitable for development, evaluation and regression testing of a therapeutic respiratory exergame application for smartphones.

Bayraktar, B., et al. (2011). "Injury evaluation of the Turkish national football team over six consecutive seasons." Ulusal Travma ve Acil Cerrahi Dergisi = Turkish Journal of Trauma & Emergency Surgery: TJTES 17(4): 313-317.
	BACKGROUND: The aim of our study was to evaluate the incidence, mechanisms and anatomic sites of injuries of the Turkish National Men's Football Team over six years. METHODS: The affected anatomic site, incidence rate, type of injury, and applied treatment procedures were recorded by the medical staff. Official and friendly games and training sessions over the period January 2000 - December 2005 were documented daily. Cross- tabulation, frequency analysis, descriptive statistics, and chi-square test methods were used in statistical evaluations. RESULTS: In total, 52 official and friendly games were played and 208 training sessions were conducted. The total number of injuries recorded in this period was 108, and the averages per match and training were 1.0 and 0.27, respectively. The most commonly affected anatomic site was the thigh (25%), the most common injury type was contusion (32%) and the most common applied treatment procedure was physical therapy and rehabilitation (89.8%). CONCLUSION: Our results provide valuable information about the incidence, affected anatomical site, and type and severity of injuries in football. This study can serve as reference data for future scientific studies in the field, and also provides information regarding the prevention of injuries.

Bayramoglu, M. and N. Unluturk (2017). "Nonhealing, progressive stress fractures of the foot in a 13-year-old basketball player: is vitamin K deficiency a risk factor?" Journal of Physical Therapy Science 29(4): 763-766.
	[Purpose] To report an adolescent male basketball player with nonhealing stress fractures of the foot and discuss the probable factors. [Subject and Methods] A 13-year-old basketball player presented with right foot pain. He had been playing basketball for three years and practicing 5 days/week. He denied any increase in daily training intensity. Magnetic resonance imaging confirmed stress fractures of the cuboid and cuneiform, with mild edema of the soft tissues between the tarsal bones and tenosynovitis of the flexor hallucis and flexor digitorum longi. The foot was immobilized for 4 weeks, with progressive weight bearing introduced at the fifth week. At the 6th week, while still restricted to partial weight bearing, he reported diffuse severe pain. The entire foot was painful with palpation, and new imaging showed stress fractures of the talus, cuboid, cuneiform, and proximal first metatarsal bones, and tenosynovitis of the flexor hallucis longus and flexor digitorum longus tendons with progression of the soft tissue edema around the tarsal bones. Acute phase reactants were elevated; vitamin K level was low. [Results] He started participating in games again at the 6th month post-injury. [Conclusion] Management of patients with stress fractures includes immobilization, physical therapy, and biomechanical arrangements. If the expected healing does not occur, a deficiency of vitamin K might be considered as a factor. Questioning on dietary habits of the patient and encouraging adequate intake of the deficient nutrient might assist in the healing process.

Beato, M. C., et al. (2020). "Can the Wii Fit Balance Board be Used as a Fall Risk Assessment Tool among Poststroke Patients?" Journal of Stroke & Cerebrovascular Diseases 29(2): 104500.
	BACKGROUND: The prevalence of falls can be as high as 73% in the stroke population. Falls occur as a result of multiple factors. Factors such as balance impairments can be improved through physical therapy intervention. However, insurance payers limit the number of visits per patient. It is crucial to find other ways to assess balance after discharge from rehabilitation. PURPOSE: The purpose of this study is to determine if the Nintendo Wii Fit can be used as a fall risk assessment tool among the poststroke population. METHODOLOGY: A sample of 11 stroke survivors were recruited (mean age 63.36 years). Each participant completed a balance and fall risk assessment using the Berg Balance Scale, Timed Up & Go, Four Square Step Test, Five Times Sit-to-Stand and 8-Foot Walk Test. Bivariate correlation will examine the validity of the Nintendo Wii Fit as a fall risk assessment tool in this population. RESULTS: The Nintendo Wii Fit Balance Test was found to be correlated with gait speed measured by the 8-Foot Walk Test. There is no correlation between the Wii Fit Balance Tests and most common standardized fall risk measures. Standardized fall risk outcome measures also significantly correlate with each other. CONCLUSIONS: The study suggests that while there is a potential utility of the game system to be used at home by patient and caregivers, the Wii Fit Balance Test may not be an appropriate substitute to the standardized fall risk assessment tool for stroke patients in the clinical setting.

Becker, H., et al. (2020). "Predicting functional performance via classification of lower extremity strength in older adults with exergame-collected data." J Neuroeng Rehabil 17(1): 164.
	OBJECTIVE: The goal of this article is to present and to evaluate a sensor-based functional performance monitoring system. The system consists of an array of Wii Balance Boards (WBB) and an exergame that estimates whether the player can maintain physical independence, comparing the results with the 30 s Chair-Stand Test (30CST). METHODS: Sixteen participants recruited at a nursing home performed the 30CST and then played the exergame described here as often as desired during a period of 2 weeks. For each session, features related to walking and standing on the WBBs while playing the exergame were collected. Different classifier algorithms were used to predict the result of the 30CST on a binary basis as able or unable to maintain physical independence. RESULTS: By using a Logistic Model Tree, we achieved a maximum accuracy of 91% when estimating whether player's 30CST scores were over or under a threshold of 12 points, our findings suggest that predicting age- and sex-adjusted cutoff scores is feasible. CONCLUSION: An array of WBBs seems to be a viable solution to estimate lower extremity strength and thereby functional performance in a non-invasive and continuous manner. This study provides proof of concept supporting the use of exergames to identify and monitor elderly subjects at risk of losing physical independence.

Bedair, R., et al. (2016). "Impact of virtual reality games as an adjunct treatment tool on upper extremity function of spastic hemiplegic children." International journal of pharmtech research 9(6): 1‐8.
	Aim: This study was conducted to investigate effect ofvirtual reality games (VRG) as an adjunct treatment tool on upper extremity function in management of spastic hemiplegic children. Methods and subjects: the study was conducted on forty spastic hemiplegic cerebral palsied children; ranged in age from 5 to 10 years old. They were divided into two equal groups; the control group that received selected physical therapy program and the study group that received the same program in addition to VRG. Both groups were evaluated with Peabody Developmental motor scale PDMS‐2 and Abilhand Kids questionnaire. Results Object manipulation and visual‐motor skills of PDMS‐2 and upper limb functions were measured before and four months post treatment. Significant results in both groups were noted in all measuring variables. Object manipulation, visual‐motor skills and upper limb functions were significantly improved in study group post treatment compared to control one. Discussion and Conclusion significant improvement of object manipulation, visual motor skills and upper limb functions in study group post treatment are related to active participation of children in simulating environment, driven their active motivation and enhance their participation through self‐competition activities. VRG can enhance active participation of children with motor deficits in majority of upper limb activities through consideration of child personality and changing of environmental factors.

Behrendt, T., et al. (2021). "Comparison of the effects of open vs. closed skill exercise on the acute and chronic BDNF, IGF-1 and IL-6 response in older healthy adults." BMC Neuroscience 22(1): 71.
	BACKGROUND: Accumulating evidence shows that physical exercise has a positive effect on the release of neurotrophic factors and myokines. However, evidence regarding the optimal type of physical exercise for these release is still lacking. The aim of this study was to assess the acute and chronic effects of open-skill exercise (OSE) compared to closed-skill exercise (CSE) on serum and plasma levels of brain derived neurotrophic factor (BDNFS, BDNFP), and serum levels of insulin like growth factor 1 (IGF-1), and interleukin 6 (IL-6) in healthy older adults. METHODS: To investigate acute effects, thirty-eight participants were randomly assigned to either an intervention (badminton (aOSE) and bicycling (aCSE), n = 24, 65.83 +/- 5.98 years) or control group (reading (CG), n = 14, 67.07 +/- 2.37 years). Blood samples were taken immediately before and 5 min after each condition. During each condition, heart rate was monitored. The mean heart rate of aOSE and aCSE were equivalent (65 +/- 5% of heart rate reserve). In a subsequent 12-week training-intervention, twenty-two participants were randomly assigned to either a sport-games (cOSE, n = 6, 64.50 +/- 6.32) or a strength-endurance training (cCSE, n = 9, 64.89 +/- 3.51) group to assess for chronic effects. Training intensity for both groups was adjusted to a subjective perceived exertion using the CR-10 scale (value 7). Blood samples were taken within one day after the training-intervention. RESULTS: BDNFS, BDNFP, IGF-1, and IL-6 levels increased after a single exercise session of 30 min. After 12 weeks of training BDNFS and IL-6 levels were elevated, whereas IGF-1 levels were reduced in both groups. However, only in the cOSE group these changes were significant. We could not find any significant differences between the exercise types. CONCLUSION: Our results indicate that both exercise types are efficient to acutely increase BDNFS, BDNFP, IGF-1 and IL-6 serum levels in healthy older adults. Additionally, our results tend to support that OSE is more effective for improving basal BDNFS levels after 12 weeks of training.

Belghali, M., et al. (2021). "Improving Serious Games to Tackle Childhood Obesity." Frontiers in Psychology 12: 657289.
	Childhood obesity has become a global public health issue. Today, there are opportunities to promote health through technological devices such as serious games. Despite the major advancement of this field of research, the use of serious games as a validated intervention in clinical practice requires further clarifications on some methodological aspects. In this perspective article, we report the pros and cons of existing serious games. Besides, we attempt to propose a new methodology of design of a serious game that could help to cope with childhood obesity. The proposed idea consists of a serious game in virtual reality based on enjoyment, movement, education, and executive functioning (EF) training. Longitudinal studies and solid research protocol would certainly ensure consistency and aid interpretation.

Beltran-Alacreu, H., et al. (2022). "A Serious Game for Performing Task-Oriented Cervical Exercises Among Older Adult Patients With Chronic Neck Pain: Development, Suitability, and Crossover Pilot Study." JMIR Serious Games 10(1): e31404.
	BACKGROUND: There is sparse research on the effectiveness of therapeutic exercise for the treatment of neck pain in older adult populations. Moreover, there is a lack of research on the use of serious games or virtual reality for the treatment of neck pain in this population. OBJECTIVE: The primary aim of this study was to develop and assess the suitability of a serious game for performing task-oriented cervical exercises in patients with neck pain. METHODS: A serious game was designed based on the key features identified by previous studies that designed serious video games for physical and cognitive rehabilitation or exercise. The game in this study was designed to provide an interactive scenario, with the main functionality of the software solution to control a virtual airplane to reach targets using head motions. At the end of the exercise, the application stores the targets reached and missed and the airplane's trajectory. A crossover pilot study was carried out for preliminary evaluation of the suitability of the technology in the older adult population. Men and women over 65 years of age with chronic neck pain were included. Subjects were randomly assigned to two study arms; each arm consisted of a sequence of two 4-week treatments with an intermediate washout period of 4 weeks. The total study duration was 16 weeks due to a final follow-up measure 4 weeks after the end of all treatments. Treatment A consisted of the use of the serious game developed in this study, and treatment B consisted of conventional exercises. Subjects allocated to the A-B study arm received treatment A first, followed by treatment B, and vice versa in the B-A arm. The following variables were assessed: Suitability Evaluation Questionnaire (SEQ) scores, Visual Analog Scale scores, and the number of targets reached in the serious game. RESULTS: A total of 18 subjects were assessed for eligibility. A total of 13 subjects, aged between 71 and 92 years (mean 81.85, SD 6.82), were finally included and completed the study protocol. The global mean SEQ score was 50.38 (SD 5.35) out of 65 points, showing good suitability of the serious game. Most patients considered the experience very enjoyable and "real" in terms of the virtual environment and found the information provided to be clear. Also, they believed that the game could be very helpful for their rehabilitation. None of the patients felt any neck pain or discomfort when playing the game, and only 2 patients out of 13 (15%) reported some degree of dizziness, eye discomfort, or disorientation, which did not limit their capacity to finish the session. CONCLUSIONS: The serious game developed in this study showed good suitability for use in adults over 70 years of age with chronic neck pain. The game was a safe method for performing task-oriented cervical exercises, and patients reported very high levels of satisfaction and acceptance after the use of this technology.

Bender, D. and K. E. Randall (2005). "Description and evaluation of an interactive jeopardy game designed to foster self-assessment." Internet Journal of Allied Health Sciences & Practice 3(4): 11p-11p.
	Basic clinical skill courses require students to progress from early information acquisition toward the ability to synthesize and modify the information for various clinical scenarios. In our program, graduate physical and occupational therapy students obtain practice with this clinical reasoning process during a classroom version of the Jeopardy! game. This interactive game show format offers a low-risk environment that encourages student participation. The students divide into two interdisciplinary teams, and each team elects four persons to formally answer the questions. These spokespersons take turns selecting a category of questions. Since all students are assigned to a team, even those not actively answering questions are still involved in the problem solving process. Category topics include areas such as physiologic changes, exercise prescription, abuse, discharge planning, community services, patient education, safety, and caregiver preparation. Each team selects a topic area and chooses a monetary value for the question. The instructor reads a clinical scenario and students work together to quickly provide an answer. The complexity of each scenario increases as the dollar value increases. If a student team answers incorrectly, incompletely, or exceeds thirty seconds to answer, the other team may answer the question. The team interaction creates opportunities to provide feedback to peers on the accuracy, appropriateness, and timeliness of their clinical recommendations. The level of friendly competition, combined with the rapid pace of the game, encourages students to learn from each other as they practice the clinical decision-making process.

Bentlage, E., et al. (2020). "Practical Recommendations for Maintaining Active Lifestyle during the COVID-19 Pandemic: A Systematic Literature Review." International Journal of Environmental Research & Public Health [Electronic Resource] 17(17): 6265.
	Diminished volumes of habitual physical activity and increased sedentary levels have been observed as a result of COVID-19 home-confinement. Consequences of inactivity, including a higher mortality rate and poorer general health and fitness, have been reported. This systematic review aimed to provide practical recommendations for maintaining active lifestyles during pandemics. In May 2020, two electronic databases (PubMed; Web of Science) were used to search for relevant studies. A total of 1206 records were screened by two researchers. Thirty-one relevant studies were included in this systematic review, in which the methodological quality was assessed. With regard to six studies, which explicitly dealt with physical activity during COVID-19, the evidence level is classified by three articles to level II, and in the other three to level VI. Regarding the physical activity recommendations in these papers, three of them were classified to a medium, and the same number to a weak evidence base. Of the 25 papers which refer to other pandemics and/or isolation situations, one was classified to evidence level I, four were ranged to level II, three to level III, one to level V, and the others to level VI. This systematic review revealed that reduced physical activity levels are of serious concern during home confinement in pandemic times. The recommendations provided by many international organizations to maintain active lifestyles during these times mainly target the general population, with less consideration for vulnerable populations (e.g., older adults, people with health issues). Therefore, personalized and supervised physical activity programs are urgently needed, with the option to group-play physical activity programs (e.g., exergames). These can be assisted, delivered, and disseminated worldwide through information and communication technology solutions. If it is permitted and safe, being active outside in daylight is advised, with an effort level of mild to moderate using the rating of perceived exertion scale. Relaxation techniques should be integrated into the daily routine to reduce stress levels. On the evidence base and levels of the included articles in this review, the results need to be interpreted with caution. Given that policies are different across regions and countries, further research is needed to categorize recommendations according to different social-distancing scenarios.

Benzing, V., et al. (2021). "Staying Active under Restrictions: Changes in Type of Physical Exercise during the Initial COVID-19 Lockdown." International Journal of Environmental Research & Public Health [Electronic Resource] 18(22): 16.
	The COVID-19 pandemic and the associated governmental restrictions suddenly changed everyday life and potentially affected exercise behavior. The aim of this study was to explore whether individuals changed their preference for certain types of physical exercise during the pandemic and to identify risk factors for inactivity. An international online survey with 13,881 adult participants from 18 countries/regions was conducted during the initial COVID-19 related lockdown (between April and May 2020). Data on types of exercise performed during and before the initial COVID-19 lockdown were collected, translated, and categorized (free-text input). Sankey charts were used to investigate these changes, and a mixed-effects logistic regression model was used to analyze risks for inactivity. Many participants managed to continue exercising but switched from playing games (e.g., football, tennis) to running, for example. In our sample, the most popular exercise types during the initial COVID-19 lockdown included endurance, muscular strength, and multimodal exercise. Regarding risk factors, higher education, living in rural areas, and physical activity before the COVID-19 lockdown reduced the risk for inactivity during the lockdown. In this relatively active multinational sample of adults, most participants were able to continue their preferred type of exercise despite restrictions, or changed to endurance type activities. Very few became physically inactive. It seems people can adapt quickly and that the constraints imposed by social distancing may even turn into an opportunity to start exercising for some. These findings may be helpful to identify individuals at risk and optimize interventions following a major context change that can disrupt the exercise routine.

Benzing, V. and M. Schmidt (2017). "Cognitively and physically demanding exergaming to improve executive functions of children with attention deficit hyperactivity disorder: a randomised clinical trial." BMC Pediatrics 17(1): 8.
	BACKGROUND: Attention deficit hyperactivity disorder (ADHD) is one of the most common mental disorders observed in childhood and adolescence. Its key symptoms - reduced attention, poor control of impulses as well as increased motor activity - are associated with decreased executive functions performance, finally affecting academic achievement. Although drug treatments usually show some effect, alternative treatments are continually being sought, due to lack of commitment and possible side effects. Cognitive trainings are frequently used with the objectives of increasing executive function performance. However, since transfer effects are limited and novelty and diversity are frequently ignored, interventions combining physical and cognitive demands targeting a broader range of cognitive processes are demanded. METHODS: The aim of the study is to examine the effects of a cognitively and physically demanding exergame on executive functions of children with ADHD. In a randomised clinical trial, 66 girls and boys diagnosed with ADHD (age 8-12) will be assigned either to an 8-week exergame intervention group (three training sessions per week a 30 min) or a waiting-list control group. Before and afterwards, the executive function performance (computer-based tests), the sport motor performance and ADHD symptoms will be assessed. DISCUSSION: The current study will offer insights into the effectiveness of a combination of cognitive and physical training using exergaming. Positive effects on the executive functions, sport motor performance and ADHD symptoms are hypothesized. Beneficial effects would mean a large degree of scalability (simple and cost-effective) and high utility for patients with ADHD. TRIAL REGISTRATION: KEK BE 393/15 (March 8, 2016); DRKS00010171 (March 14, 2016).

Benzing, V. and M. Schmidt (2018). "Exergaming for Children and Adolescents: Strengths, Weaknesses, Opportunities and Threats." J Clin Med 7(11): 08.
	Exergaming, or active video gaming, has become an emerging trend in fitness, education and health sectors. It is defined as digital games that require bodily movements to play, stimulating an active gaming experience to function as a form of physical activity (PA). Since exergaming is becoming more popular, claims have been made on the usefulness of exergaming. It has, for example, been entitled as being "the future of fitness" by the American College of Sports Medicine, promoting PA and health in children and adolescents. However, research also suggests that long-term engagement in exergaming is difficult to achieve, and there is a noticeable reservation towards exergaming by parents, teachers and caregivers. To provide an overview and to outline the future directions of exergaming, the aim of this review was to critically illustrate the strengths, weaknesses, opportunities and threats of exergaming to promote PA and health in children and youth. The available evidence indicates that exergaming has the potential to improve health via an increase in PA. However, it seems that this potential is frequently underexploited, and further developments such as customized exergames are needed.

Bermejo-Martins, E., et al. (2018). "An exploratory trial of a health education programme to promote healthy lifestyles through social and emotional competence in young children: Study protocol." Journal of Advanced Nursing 74(1): 211-222.
	AIM: To implement and evaluate a health education programme based on the development of social and emotional competence in young children. BACKGROUND: Children's social and emotional skills play a key role in the adoption and maintenance of their lifestyles. Currently, a more comprehensive perspective dealing with these aspects is needed to promote healthy habits in children and develop effective health education programmes. DESIGN: An exploratory randomized controlled trial. METHODS: A convenience sample of 30 children (5 and 6 years old) will be recruited from a public school in Spain, with 15 participants in the experimental group and 15 in the control group. Participants in the experimental group will receive the first unit of the programme, consisting of developing emotional knowledge skills around daily health habits (eating, hygiene, sleep and physical exercise) using different game-based dynamics and an emotional diary, while those in the control group will continue with their usual school routine. Outcome measures include emotional knowledge ability, basic social skills and children's health profile. The perceived impact of the intervention by parents, acceptability (by parents and children) and feasibility of the programme will be also assessed. Data will be collected at baseline, postintervention and at 7-month follow-up. DISCUSSION: This study offers an innovative intervention aimed at improving children's healthy lifestyles from a holistic perspective by addressing social and emotional competence as one of the most influential aspects of children's development. This exploratory trial is an essential step to explore crucial aspects of the full-scale clinical trial.

Berrios Aguayo, B., et al. (2019). "Acute effect of two different physical education classes on memory in children school-age." Cognitive Development 50: 98-104.
	The purpose of this study was to evaluate the effectiveness of an aerobic game vs. team game class on memory in children. A total of 236 children aged 8–12 years participated in this study. The students were randomly assigned to two experimental groups (EGs): team game group (EG1), n = 79; aerobic exercise group (EG2), n = 79; and control group (CG) n = 78 (CG did not perform any kind of physical education). The Rey Auditory Verbal Learning test was employed to analyse memory. In the pre-test condition, there were no significant differences in any memory variables. In post-test conditions (20 min after of the physical exercise), the EGs displayed higher scores than the CG in deferred memory and recognition, moreover, the EG1 displayed higher scores than the CG in Trial 5 (p = .002), trials summation (p = .003), and learning curve (p = .043). There were no significant differences between EGs in both pretest and posttest conditions. For the group x time interaction (within-group), the EGs showed significant improvements in all memory variables except in the learning curve. In the EGs, the effect size (group x time) in the most of the memory variables was medium and in the CG it was low.

Berton, A., et al. (2020). "Virtual Reality, Augmented Reality, Gamification, and Telerehabilitation: Psychological Impact on Orthopedic Patients' Rehabilitation." J Clin Med 9(8): 07.
	BACKGROUND: Remote virtual rehabilitation aroused growing interest in the last decades, and its role has gained importance following the recent spread of COVID19 pandemic. The advantages of virtual reality (VR), augmented reality (AR), gamification, and telerehabilitation have been demonstrated in several medical fields. In this review, we searched the literature for studies using these technologies for orthopedic rehabilitation and analyzed studies' quality, type and field of rehabilitation, patients' characteristics, and outcomes to describe the state of the art of VR, AR, gamification, and telerehabilitation for orthopedic rehabilitation. METHODS: A comprehensive search on PubMed, Medline, Cochrane, CINAHL, and Embase databases was conducted. This review was performed according to PRISMA guidelines. Studies published between 2015 and 2020 about remote virtual rehabilitations for orthopedic patients were selected. The Methodological Index for Non-Randomized Studies (MINORS) and Cochrane Risk-of-Bias assessment tool were used for quality assessment. RESULTS: 24 studies (9 randomized controlled trials (RCTs) and 15 non-randomized studies) and 2472 patients were included. Studies mainly concern telerehabilitation (56%), and to a lesser extent VR (28%), AR (28%), and gamification (16%). Remote virtual technologies were used following knee and hip arthroplasty. The majority of included patients were between 40 and 60 years old and had a university degree. Remote virtual rehabilitation was not inferior to face-to-face therapy, and physical improvements were demonstrated by increased clinical scores. Orthopedic virtual remote rehabilitation decreased costs related to transports, hospitalizations, and readmissions. CONCLUSION: The heterogeneity of included studies prevented a meta-analysis of their results. Age and social context influence adaptability to technology, and this can modify compliance to treatment and outcomes. A good relationship between patient and physiotherapist is essential for treatment compliance and new technologies are useful to maintain clinical interactions remotely. Remote virtual technologies allow the delivery of high-quality care at reduced costs. This is a necessity given the growing demand for orthopedic rehabilitation and increasing costs related to it. Future studies need to develop specific and objective methods to evaluate the clinical quality of new technologies and definitively demonstrate advantages of VR, AR, gamification, and telerehabilitation compared to face-to face orthopedic rehabilitation.

Betser, J. (2010). "Countdown to London 2012: Olympic and Paralympic Games: volunteering." Osteopath 13(1): 22-23.
	
Bevan, A., et al. (2022). "POSA288 Virtual Reality and Gaming Technology in Clinical Research: Past Trends and Future Prospects." Value in health 25(1): S191‐.
	Objectives: Digital therapeutics (DTx) is a category of regulated software designed to improve health outcomes via the delivery of evidence‐based behavioral or physical therapy to treat or prevent disease. Virtual reality (VR) and video games (VG) represent new modalities with the potential to increase patient engagement for the delivery of DTx. This research aims to characterize how these technologies have been studied. Methods: Clinicaltrials.gov was searched for studies containing “(video game OR gaming OR game OR virtual reality AND NOT board OR ball)” registered up to and including 03‐Jun‐2021. Technology type (VR or VG) was determined based on study title, intervention and outcome. 3,041 studies were returned, of which 1,398 studies were excluded primarily due to inability to determine technology type. Results: 1,643 studies were analyzed (VR=1,000 [60.1%], VG=643 [30.9%]) of which 67.3% were registered in the last 5 years. 82.3% of studies were non‐industry and non‐government funded. In terms of study design, 94.1% of studies were interventional and the most common interventional model was the randomized, parallel groups design (60.1% [VR 61.1%, VG 59.7%]). Most studies investigated the treatment effects (47.3% [VR 52.9%, VG 38.7%]), followed by 11% of the overall sample investigating preventative effects (VR 5.3%, VG 19.9%). The median sample size across all studies was n=57 (IQR=30‐100). CONCLUSION: Most (>70%) of the clinical research on VR and VG has been small interventional (<100 subjects) studies investigating treatment effects of these technologies. These findings point to a paucity of large studies (≥1000 subjects) on these technologies (<2.3%). DTx could be considered well suited to decentralized (DcT) study approaches, which could enable larger, more robust trials. The ability to apply such approaches to study VR and VG presents an exciting opportunity to advance the development these technologies in real‐world settings.

Bezdenezhnykh, A. F., et al. (2015). "Mechanisms, Clinical Strategies, and Promising Treatments of Neurodegenerative Diseases. 12th International Conference AD/PD Nice, France, March 18-22, 2015: Abstracts." Neurodegener Dis 15 Suppl 1: 1-1969.
	Objectives: Comparing an effectiveness of using neuropsychological computer programs for cognitive correction with effects of using entertaining computer games for rehabilitation of patients with post stroke cognitive impairments. Methods: Patients after hemispheric stroke in recovery period (up to 1 year) with cognitive impairments (N=47, age 40‐65) were randomized into three groups. All patients received physiotherapy. Patients in the intervention group had 10 everyday training sessions with neuropsychological computer programs of 40 min duration. Participants in the active control group played entertaining games keeping the identical regimen. The passive control group patients received standard treatment. Results: In the intervention group after training course we observed significant improvements on every cognitive and functional scales. In the active control group changes on FAB, Moca, Shulte's test, MMSE were also statistically significant. We found no significant changes on cognitive scales in the Passive control group after treatment. Significant improvements were observed in the intervention group comparing with the passive control group (MoCA, CDT, FAB, Shulte's test). Differences between groups where patients played neuropsychological and entertaining games were statistically insignificant. At the same time there were no significant differences between the active control and the passive control groups. Conclusions: Additional using of the complex of neuropsychological computer programs is an effective and simple method of the correction cognitive impairments in post stroke patients comparing with the standard rehabilitation without special cognitive training. It is still necessary to clarify whether there is a difference between effectiveness of neuropsychological computer training and entertaining computer games.

Biesek, S., et al. (2021). "Effects of Exergames and Protein Supplementation on Body Composition and Musculoskeletal Function of Prefrail Community-Dwelling Older Women: A Randomized, Controlled Clinical Trial." International Journal of Environmental Research & Public Health [Electronic Resource] 18(17): 9324.
	This study aimed to investigate the effects of exergames and protein supplementation on the body composition and musculoskeletal function of pre-frail older women. Methods: A randomized controlled clinical trial was conducted with 90 pre-frail older women (71.2 +/- 4.5 years old) divided into five groups: control (CG); exergames training (ETG); protein supplementation (PSG); exergames combined with protein supplementation (ETPSG); exergames combined with isoenergetic supplementation (ETISG). The primary outcomes were pre-frailty status, body composition (appendicular muscle mass (ASM); appendicular muscle mass index (ASMI)) assessed by dual energy X-ray absorptiometry and gastrocnemius muscle architecture via ultrasound. Secondary outcomes were protein intake, plasma levels of interleukin (IL)-6, plantar and dorsiflexion isokinetic peak torque, and handgrip strength (HS). Data were analyzed using an ANOVA mixed model test and Bonferroni post hoc test (p < 0.05). The ETG showed a reduction of ASM (16.7 +/- 3.4 vs. 16.1 +/- 3.3 kg; Delta = -0.5; p = 0.02; d = 0.26) and ASMI (6.8 +/- 0.9 vs. 6.5 +/- 0.9 kg; Delta = -0.2; p = 0.03; d = 0.35), without changing ASM in other groups. The average protein intake in the supplemented groups (PSG and ETPSG) was 1.1 +/- 0.2 g/kg/day. The dorsiflexion peak torque increased 11.4% in ETPSG (16.3 +/- 2.5 vs. 18.4 +/- 4.2 Nm; p = 0.021; d = -0.58). The HS increased by 13.7% in ETG (20.1 +/- 7.2 vs. 23.3 +/- 6.2 kg, Delta = 3.2 +/- 4.9, p = 0.004, d = -0.48). The fatigue/exhaustion reduced by 100% in ETG, 75% in PSG, and 100% in ETPSG. Physical training with exergames associated with protein supplementation reversed pre-frailty status, improved the ankle dorsiflexors torque, and ameliorated fatigue/exhaustion in pre-frail older women.

Biggs, A. and K. D. Shelbourne (2006). "Use of Knee Extension Device During Rehabilitation of a Patient with Type 3 Arthrofibrosis after ACL Reconstruction." North American Journal of Sports Physical Therapy 1(3): 124-131.
	BACKGROUND: Arthrofibrosis is a frequent complication following rehabilitation of a patient with anterior cruciate ligament (ACL) reconstruction. Although prevention is the best treatment, little information exists within the literature regarding the management and rehabilitation intervention for arthrofibrosis. In this case report a rehabilitation program in the treatment of a patient with arthrofibrosis is described. OBJECTIVES: To identify the importance of discrete measures of knee range of motion in the knee of a patient following ACL reconstruction in order to help prevent postoperative complications. CASE DESCRIPTION: The patient was an 18-year-old female who sustained an ACL and medial collateral ligament (MCL) injury in a basketball game and underwent an ACL reconstruction with an ipsilateral patellar tendon graft. The patient developed arthrofibrosis and, despite traditional physical therapy of therapeutic exercise and manual therapy, the patient continued to complain of pain, stiffness, limited activities of daily living, and the inability to participate in competitive sports. This patient used a knee extension device as part of her rehabilitation program. OUTCOMES: The patient was able to obtain knee extension and flexion equal to her opposite normal knee. Upon completion of the rehabilitation program, the patient returned to full activities of daily living and competitive sports. DISCUSSION: Increasing and maintaining knee extension that is equal to the opposite normal knee is an important component in the successful outcome for the patient after ACL reconstruction. The use of a knee extension device may provide an effective rehabilitation intervention in the treatment of arthrofibrosis.

Billis, A., et al. (2020). "Development of Cognitive and Physical Exercise Systems, Clinical Recordings, Large-Scale Data Analytics, and Virtual Coaching for Heart Failure Patients: Protocol for the BioTechCOACH-ForALL Project." JMIR Research Protocols 9(5): e17714.
	BACKGROUND: Heart failure is a chronic disease affecting patient morbidity and mortality. Current guidelines for heart failure patient treatment are focused on improving their clinical status, functional capacity, and quality of life. However, these guidelines implement numerous instructions including medical treatment adherence, physical activity, and self-care management. The complexity of the therapeutic instructions makes them difficult to follow especially by older adults. OBJECTIVE: The challenge of this project is to (1) measure real-life adherence to a regular physical exercise program and (2) attempt to influence older adult patients with heart failure toward embracing a more physically active self-care lifestyle. METHODS: This research consists of two studies, including a lab experiment and a pragmatic evaluation of technology at patients' homes. The lab experiment aims at exploring in an objective way (measuring neurophysiological responses to stimuli) patient engagement with different characteristics of virtual agents, while the home study is a 3-phase prospective study where the developed technology platform is tested by heart failure patients in their own home environments. Patients undergo evaluation of their physical activity and cognitive status using standard evaluation methods (6-minute walk test, questionnaires) and receive wearable devices to accurately measure everyday life activity levels (home study phases 1-3). During home study phases 2 and 3, exergames (serious games for physical exercise) to provide a physical exercise plan as a joyful activity are delivered to patients' private households and e-coaching techniques are implemented in the final phase (home study phase 3) of the protocol, to influence patient attitudes toward a more healthy and recommended lifestyle. RESULTS: The trial is still ongoing. Recruitment is ongoing, and the project has progressed for some participants through phase 2 of the home study. The sample size for both studies is 28 participants; 10 have already been included in the study, and both baseline clinical and patient-reported outcome data are retrieved. Phases 2 and 3 of the home pilot study are expected to be completed within 6 months. CONCLUSIONS: The main challenge of the project is the change of attitude of older age heart failure patients through an e-coaching system. Given the adoption of a cocreation and living lab approach and the main objective for real-life evaluation, the project is ready to react to any collected feedback, even during the implementation of the research plan. Clinical assessment and objective evaluation are expected to provide all required information for reliable findings. TRIAL REGISTRATION: ClinicalTrials.gov NCT03877328; https://clinicaltrials.gov/ct2/show/NCT03877328. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/17714.

Bindoff, I., et al. (2016). "Quittr: The Design of a Video Game to Support Smoking Cessation." JMIR Serious Games 4(2): e19.
	BACKGROUND: Smoking is recognized as the largest, single, preventable cause of death and disease in the developed world. While the majority of smokers report wanting to quit, and many try each year, smokers find it difficult to maintain long-term abstinence. Behavioral support, such as education, advice, goal-setting, and encouragement, is known to be beneficial in improving the likelihood of succeeding in a quit attempt, but it remains difficult to effectively deliver this behavioral support and keep the patient engaged with the process for a sufficient duration. In an attempt to solve this, there have been numerous mobile apps developed, yet engagement and retention have remained key challenges that limit the potential effectiveness of these interventions. Video games have been clearly linked with the effective delivery of health interventions, due to their capacity to increase motivation and engagement of players. OBJECTIVE: The objective of this study is to describe the design and development of a smartphone app that is theory-driven, and which incorporates gaming characteristics in order to promote engagement with content, and thereby help smokers to quit. METHODS: Game design and development was informed by a taxonomy of motivational affordances for meaningful gamified and persuasive technologies. This taxonomy describes a set of design components that is grounded in well-established psychological theories on motivation. RESULTS: This paper reports on the design and development process of Quittr, a mobile app, describing how game design principles, game mechanics, and game elements can be used to embed education and support content, such that the app actually requires the user to access and engage with relevant educational content. The next stage of this research is to conduct a randomized controlled trial to determine whether the additional incentivization game features offer any value in terms of the key metrics of engagement-how much content users are consuming, how many days users are persisting with using the app, and what proportion of users successfully abstain from smoking for 28 days, based on user-reported data and verified against a biochemical baseline using cotinine tests. CONCLUSIONS: We describe a novel, and theoretically-informed mobile app design approach that has a broad range of potential applications. By using the virtual currency approach, we remove the need for the game to comprehensively integrate the healthy activity as part of its actual play mechanics. This opens up the potential for a wide variety of health problems to be tackled through games where no obvious play mechanic presents itself. The implications of this app are that similar approaches may be of benefit in areas such as managing chronic conditions (diabetes, heart disease, etc), treating substance abuse (alcohol, illicit drugs, etc), diet and exercise, eating disorders (anorexia, bulimia, and binge eating), and various phobias.

Blanc, P., et al. (2011). "264 Effect of the Wii sport boxing video game on the heart rate in cardiac rehabilitation patients." Archives of Cardiovascular Diseases Supplements 3(1): 87.
	Physical exercise is an important part of the rehabilitation program in cardiac patients. The new generations of active video games allow performing various recreational sport activities at home. However, the cardiac impact of virtual sport activities has been poorly investigated. The purpose of this prospective study was to analyze the heart rate (HR) response of cardiac patients while playing a commercially available gaming system: Wii sports boxing game software. Twenty seven voluntary patients (5 women, 22 men, mean age 50.6 +−13.3 years old) were included in the study after completion of a 6 week cardiac rehabilitation (CR) program. Causes of admission in CR were: percutaneous transluminal angioplasty (33%), coronary artery bypass grafting (19%), valve replacement (15%), dilated cardiomyopathy (11%), other (22%). Patients performed an exercise testing (ET) with gas exchanges measurement at the end of the CR program and before playing video game. The exercise testing allowed the determination of the ventilatory threshold HR and the maximum HR. Participants played competitive boxing matches for 15 minutes, as recommended by Nintendo, with a five minute warm up. HR was recorded using a polar system (S610i) whilst playing Wii sports boxing and compared to ET measures. All participants had not previously used Wii and consented to the study. During virtual sport activity, mean HR was 106+/−25 bpm and maximum heart rate was 190 bpm. Throughout the HR recordings, 49 +− 35% of the game (8.24 min +− 6.22) was performed with a HR above the ventilatory threshold HR (107.0 +/−17.6 bpm). Finally, HR was higher than the ET maximum HR during 9% +− 16% of the game (1.52 min +−3.22). Conclusions In this preliminary study, the main part of the Wii sports boxing game lead to an HR above the anaerobic threshold, implying an important demand on anaerobic metabolism. Consequently, caution should be recommended to cardiac patients before playing virtual sport activities on video game.

Blank, C., et al. (2012). "Medical services at the first Winter Youth Olympic Games 2012 in Innsbruck/Austria." Br J Sports Med 46(15): 1048-1054.
	BACKGROUND: The Youth Olympic Games (YOG) are a new format designed by the International Olympic Committee. So far no reference data are available regarding the organisation or implementation of the medical services that were needed for the Winter Youth Olympic Games that took place for the first time in Innsbruck 9-24 January 2012. OBJECTIVES: (1) To provide insight into what is needed to prepare for such a complex high level sporting event from a medical perspective, (2) to provide data on medical services for future organising committees and (3) to provide information on different National Olympic Committee (NOC) delegation structures and the consequences of registering a National Olympic Committee Team Physician. METHODS: A medical information system in the form of a patient data-management system was developed with all involved parties to standardise data collection. All medical encounters occurring at any IYOGOC medical service centre (including physiotherapy and psychology facilities) were tracked and collected in daily reports. Data evaluation was prepared based on different interest groups (Athletes, National Olympic Committees, Workforce, International Olympic Committee and Media) and analysed. RESULTS: 327 medical encounters (42.8% athletes; out of these, 57.9% were accounted to athletes with own NOC team physician) were seen during the YOG 2012. The total number of hospital transports was 27.3%, of which 8.9% were hospitalised with an average length of 1.9 nights. Physiotherapy usage was low with only 19 medical encounters resulting in a referral to physiotherapy accounting for 67 treatments during the entire YOG. Psychological care service was not used at all. The main reason for illnesses was disorders of the respiratory system (28.8%), injuries mostly affected upper extremities (49.6%) and were mostly diagnosed with lacerations and contusions (26.2%). Injury (70.7%) and illness (29.3%) incidences in athletes were slightly lower than previous studies showed. 40.0% of NOC delegations registered their own team physicians, which led to a significant difference in usage frequency of medical service (-3%, p=0.012). CONCLUSIONS: Medical service coverage at the first Winter Youth Olympic Games seemed to be appropriate. No disaster or epidemic disease challenged the medical service plan. Future organising committees could use the provided data as a reference for their planning efforts.

Blasco-Peris, C., et al. (2022). "Effects of Exergaming in Patients with Cardiovascular Disease Compared to Conventional Cardiac Rehabilitation: A Systematic Review and Meta-Analysis." International Journal of Environmental Research & Public Health [Electronic Resource] 19(6): 3492.
	Background: Exercise-based cardiac rehabilitation (CR) programs are used for improving prognosis and quality of life in patients with cardiovascular disease (CVD). Nonetheless, adherence to these programs is low, and exercise-based CR programs based on virtual reality (i.e., exergaming) have been proposed as an alternative to conventional CR programs. However, whether exergaming programs are superior to conventional CR programs in patients with CVD is not known. Objective: This systematic review with meta-analysis was conducted to explore whether exergaming enhances exercise capacity, quality of life, mental health, motivation, and exercise adherence to a greater extent than conventional CR programs in patients with CVD. Method: Electronic searches were carried out in PubMed, Embase, Web of Science, and Cumulative Index to Nursing and Allied Health Literature databases up to June 2021. Meta-analyses were performed using robust variance estimation with small-sample corrections. The effect sizes were calculated as the mean differences (MD) or standardized mean differences (SMD) as appropriate. The SMD magnitude was classified as trivial (&lt;0.20), small (0.20-0.49), medium (0.50-0.79), or large (>/=0.80). Heterogeneity was interpreted based on the I(2) statistics as low (25%), moderate (50%), or high (75%). Results: Pooled analyses showed no differences between exergaming and conventional CR programs for enhancing exercise capacity (i.e., distance covered in the six-minute walk test) (MD+ = 14.07 m (95% confidence interval (CI) -38.18 to 66.32 m); p = 0.426) and mental health (SMD+ = 0.17 (95% CI -0.36 to 0.70); p = 0.358). The results showed a small, statistically nonsignificant improvement in quality of life in favor of exergaming (SMD+ = 0.22 (95% CI = -0.37 to 0.81); p = 0.294). Moderate heterogeneity was found for exercise capacity (I(2) = 53.7%), while no heterogeneity was found for quality of life (I(2) = 3.3%) and mental health (I(2) = 0.0%). Conclusions: Exergaming seems not to be superior to conventional CR programs for improving exercise capacity, quality of life, or mental health in patients with CVD.

Block, M. E. (2012). "EDITOR'S CORNER. Going Global." Palaestra 26(2): 4-4.
	The author informs that the next issue of the journal will be devoted to the 2012 Paralympic Games to be held in London. He also informs that the current issue of the journal features a story on Pető Institute highlighting conductive education and a unique program using WI active gaming console. He gives an account of programs from around the world that will be featured in the journal including the North American Federation of Adapted Physical Activity (NAFAPA) symposium.

Bond, S., et al. (2021). "Exergaming and Virtual Reality for Health: Implications for Cardiac Rehabilitation." Current Problems in Cardiology 46(3): 100472.
	Cardiac Rehabilitation (CR) programs, focused on improving the health trajectory of patients with cardiovascular disease, strive to increase physical activity (PA) and cardiorespiratory fitness. However, historically low compliance with recommended PA has prompted exploration of alternatives to traditional courses of exercise therapy. One alternative, exergaming, or the requirement of physical exercise inherent to a video game's activities, has shown to have a promising impact in improving patient self-efficacy for exercise training using digital hardware (eg, the Wii or the Xbox Kinect). Furthermore, novel technologies in virtual reality can provide an engaging, immersive environment for exergaming techniques, maximizing goal-oriented training and building self-efficacy for patients during CR. Many groundbreaking institutions are already calculating energy expenditure of commercially successful virtual reality games and finding promise in the cardiometabolic responses to a number of virtual reality games. Research is still limited in establishing the efficacy of these games, but virtual reality and exergaming are quickly proving to be appropriate and equivalent alternatives to traditional exercise programs. Though studies have examined the impact of prescriptive exergaming on PA, they have yet to examine the potential for genuine integration of game-based motivational techniques and immersive environments into clinical interaction. The purpose of this review is to describe the current body of evidence and the impact and future potential of virtual reality and exergaming. Further, we will introduce the concept of a "Clinical Arcade" as a new approach to integration of these techniques in CR care.

Bonnechere, B., et al. (2014). "Can serious games be incorporated with conventional treatment of children with cerebral palsy? A review." Research in Developmental Disabilities 35(8): 1899-1913.
	The use of video games in rehabilitation is becoming more popular to clinicians. These games are embedded in off-the-shelf commercial entertainment applications or especially-developed for clinical purposes. Treatment of cerebral palsy (CP) children is a challenging task for clinicians. Lack of motivation and progress monitoring are two important factors clinicians need to deal with. The use of serious games (SG), sometimes referred to as Virtual Rehabilitation (VR), could therefore be an interesting adjuvant to conventional treatment for these patients. This is however a new discipline and many scientific issues remain to be solved. The aim of this paper is to describe available conventional treatment for CP children together with the level of evidence of each approach. A systematic review of the use of SG in rehabilitation is then conducted. 31 papers (7 randomized clinical trials, 16 cohort studies and 8 single-cases studies) were selected and analyzed, and their level of evidence compared to the conventional treatment. These studies reported outcomes for 352 patients. In summary, this review shows that it is difficult to compare those studies despite the large amount of patients. This is due to the lack of standardization in patient rehabilitation strategy and to the use of various clinical scales and scores. This non-standardization in patient follow-up between previously-published works make evidence-based conclusions difficult to obtain in order to support these techniques objectively. The use of SG for rehabilitation purposes currently meets similar issues. This paper proposes standardization strategies in order to improve treatment comparison and SG use in rehabilitation.

Bonnechere, B., et al. (2017). "Balance improvement after physical therapy training using specially developed serious games for cerebral palsy children: preliminary results." Disability & Rehabilitation 39(4): 403-406.
	PURPOSE: Cerebral palsy (CP) leads to various clinical signs mainly induced by muscle spasticity and muscle weakness. Among these ones impaired balance and posture are very common. Traditional physical therapy exercise programs are focusing on this aspect, but it is difficult to motivate patients to regularly perform these exercises, especially at home without therapist supervision. Specially developed serious games (SG) could therefore be an interesting option to motivate children to perform specific exercise for balance improvement. METHOD: Ten CP children participated in this study. Patients received four sessions of SG included into conventional therapy (1 session of 30 min a week during 4 weeks). Trunk control and balance were assessed using Trunk Control Motor Scale (TCMS) before and after interventions. RESULTS: Children presented a significant improvement in TCMS global score after interventions [37.6 (8.7) and 39.6 (9.5) before and after interventions, respectively, p = 0.04]. CONCLUSION: SG could therefore be an interesting option to integrate in the conventional treatment of CP children. Implication for Rehabilitation Cerebral palsy (CP) leads to balance issues. Rehabilitation exercises are not performed (enough) at home. Serious games (SG) could increase patients' motivation. SG increase balance control of CP children.

Boot, W. R., et al. (2020). "Older adults and video gaming for leisure: Lessons from the Center for Research and Education on Aging and Technology Enhancement (CREATE)." Gerontechnology 19(2): 138-146.
	Background Video games are often designed by younger adults for younger adults. When older adults are considered targets of game design, the focus is often not on leisure, but rehabilitation (e.g., cognitive training, stroke recovery, physical therapy). Commercial video games, if they are aimed toward older adult consumers at all, are typically marketed based on older adults' concerns about cognitive decline. Although there have been extensive investigations into the potential of video games to improve cognition and health, a comparatively smaller number of studies have been devoted to the development and design of games for older adults primarily for fun and recreation. In the Center for Research and Education on Aging and Technology Enhancement (CREATE), we believe this is an important oversight. Methods This paper first provides a review of the demographics of aging gamers, what has been learned about older gamers in terms of preferences and barriers to adoption and then reviews research published over the past decade conducted by CREATE researchers on video gaming, and what has been learned relevant to the design of games for leisure for older adults. Results Research has found consistent preferences among older adults regarding preferred video games and game features, but also striking individual differences. Just as not all younger adults prefer the same types of games, older adults are not a homogenous group in terms of preferences. Data suggest that contrary to stereotypes, given the opportunity (access) and support (design, training), many older adults can become active gamers and reap the benefits of gaming for leisure. Conclusions Video games can support the leisure activities of individuals of all ages. However, to achieve success, game designers must conform to principles of good design for older adults and engage them directly in the design process

Booth, L. (2010). "Countdown to the London 2012 Olympic and Paralympic games: volunteering." SportEX Medicine(44): 7-8.
	
Booth, L. (2010). "LONDON 2012 GAMES VOLUNTEERING UPDATE." SportEX Medicine(45): 32-33.
	The article announces that the London Organising Committee of the Olympic Games and Paralympic Games (LOCOG) seeks volunteers for the London 2012 Games. It mentions two kinds of volunteer needed in the event, namely the specialist volunteers and the generalists volunteers. It mentions several qualifications of the volunteers including the volunteers availability for a minimum of 10 days of the Games, hold a basic first aid in sport qualification, and have a license to practice acupuncture.

Booth, L. and N. Mooney (2015). "DEVELOPING AN INTERDISCIPLINARY APPROACH TO THE PHYSICAL THERAPY SERVICES AT THE LONDON 2012 OLYMPIC AND PARALYMPIC GAMES." SportEX Dynamics(45): 23-29.
	The article focuses on the interdisciplinary Physical Therapy Service provided by chiropractors, osteopaths, physiotherapists and sports massage practitioners at the 2012 London Olympics in England. It mentions a brief history into the creation of the service by representatives from all four disciplines in 2009, policies imposed by the London Organising Committee for the Olympic Games and Paralympic Games (LOCOG) on the Physical Therapy Service providers and staffing logistics for the service.

Booth, V., et al. (2014). "The effectiveness of virtual reality interventions in improving balance in adults with impaired balance compared with standard or no treatment: a systematic review and meta-analysis." Clinical Rehabilitation 28(5): 419-431.
	OBJECTIVE: To evaluate whether virtual reality interventions, including interactive gaming systems, are effective at improving balance in adults with impaired balance. DESIGN: Systematic review and meta-analysis of randomized control trials. METHODS: Studies were identified from electronic databases (CENTRAL, MEDLINE, EMBASE, AMED, CINAHL, PyschINFO, PyschBITE, OTseeker, Ei Compendex, and Inspec) searched to November 2011, and repeated in November 2012. Two reviewers selected studies meeting inclusion criteria and quality of included studies assessed using a Joanna Briggs Institute appraisal tool. Data was pooled and a meta-analysis completed. The systematic review was reported following guidance of the PRISMA statement. RESULTS: A total of 251 articles were screened. Eight randomized control trials were included. These studies presented the results of 239 participants, with various aetiologies, and used a variety of virtual reality systems. The number of falls was documented in only one included study. Meta-analysis was completed on data from the Berg Balance Scale, walking speed, 30 second sit-to-stand test, and Timed Up and Go Test, and favoured standard therapy when compared with standard plus virtual reality interventions. CONCLUSIONS: There was a notable inconsistency in the outcome measures, experimental, and control interventions used within the included studies. The pooled results of the studies showed no significant difference. Therefore this review cannot support nor refute the use of virtual reality interventions, rather than conventional physiotherapy, to improve balance in adults with impaired balance.

Bostancı, Ö., et al. (2019). "The differential impact of several types of sports on pulmonary functions and respiratory muscle strength in boys aged 8–12." Isokinetics and Exercise Science 27(4): 307-312.
	BACKGROUND: An enthusiasm for physical exercise is often developed in the paediatric age group through collective game-based sporting activities. Regular exercise via sports can create positive effects on the respiratory systems of boys as well as on their overall growth and development. To help identify deviations from positive trends in these areas, respiratory function tests have become an essential part of the diagnosis and assessment of pulmonary disease. OBJECTIVE: To investigate the effect of different types of sports on pulmonary functions and respiratory muscle strength and to help establish baseline reference values in healthy Turkish boys aged 8–12 years. METHODS: A total of 624 healthy boys, who train at least twice a week for football (128), basketball (105), archery (60), swimming (111) and wrestling (74), as well as 146 boys who do not perform regular physical activities voluntarily, participated in the study. To evaluate and potentially differentiate amongst the merits of these several sports, we obtained a variety of baseline measurements from our subjects, including forced vital capacity (FVC), forced expiratory volume in one second (FEV1), FEV1/FVC, maximal peak expiratory flow (PEF max), maximal voluntary ventilation (MVV), maximal inspiratory pressure (MIP) and maximal expiratory pressure (MEP). RESULTS: There were statistically significant differences amongst the types of sports regarding the various metrics we examined: FVC, FEV1, FEV1/FVC, PEF max, MVV, MIP and MEP (p < 0.05). The active boys showed higher mean values for pulmonary functions and respiratory muscle strength than the passive ones. Also, the wrestlers generally had better respiratory parameters than those of athletes in the other four sports we investigated. CONCLUSIONS: It was clear that exercise, especially regarding pulmonary function and respiratory muscle strength, produced better outcomes in the active boys compared with our control group of relatively passive boys. The mechanisms responsible for this difference are likely due to the resistance effect of exercise.

Bourque, M., et al. (2019). Combining physical therapy and cognitive behavioral therapy techniques to improve balance confidence and community participation in people with unilateral transtibial amputation who use lower limb prostheses: a study protocol for a randomized sham-control clinical trial. Durham, Research Square.
	Background : Low balance confidence is a prevalent yet overlooked issue among people who use lower limb prostheses (LLP) that can diminish community integration and quality of life. There is a critical need to develop rehabilitation programs that specifically target balance confidence in people who use LLP. Previous research has shown that multicomponent interventions including cognitive-behavioral therapy (CBT) techniques and exercise are feasible and effective for improving balance confidence in older adults. Therefore, a cognitive behavioral-physical therapy (CBPT) intervention was developed to target balance confidence and increase community integration in people who use LLP. Methods : This randomized control trial will recruit sixty people who use LLP with low balance confidence. Participants will be randomized to the CBPT intervention condition or control condition. Discussion : The trial is designed to test the effects of the CBPT intervention on balance confidence and functional mobility in lower limb prosthesis users by examining self-reported and objective measures of community integration and quality of life. The trial will also examine the relationship between changes in balance confidence and changes in community integration following participation in CBPT intervention. Additionally, through participant feedback, researchers will identify opportunities to improve intervention efficacy.

Bourrelier, J., et al. (2021). "Enhancement of Anticipatory Postural Adjustments by Virtual Reality in Older Adults with Cognitive and Motor Deficits: A Randomised Trial." Geriatrics (Basel) 6(3): 72.
	BACKGROUND: Postural activities involved in balance control integrate the anticipatory postural adjustments (APA) that stabilize balance and posture, facilitating arm movements and walking initiation and allowing an optimal coordination between posture and movement. Several studies reported the significant benefits of virtual reality (VR) exercises in frail older adults to decrease the anxiety of falling and to induce improvements in behavioural and cognitive abilities in rehabilitation processes. The aim of this study was thus to test the efficiency of a VR system on the enhancement of the APA period, compared to the use of a Nintendo Wii system. METHODS: Frail older adults (n = 37) were included in this study who were randomized and divided into a VR exercises group (VR group) or a control group using the Nintendo Wii system (CTRL group). Finally, 22 patients were included in the data treatment. APA were studied through muscular activation timings measured with electromyographic activities. The functional reach test, the gait speed, and the time up and go were also evaluated before and after a 3-week training phase. RESULTS AND DISCUSSION: As the main results, the training phase with VR improved the APA and the functional reach test score along the antero-posterior axis. Together, these results highlight the ability of a VR training phase to induce neuromuscular adaptations during the APA period in frail older adults. Then, it underlines the effective transfer from learning carried out during the VR training movements to control balance abilities in a more daily life context.

Bovim, L. P. V., et al. (2021). "Theoretical Rationale for Design of Tasks in a Virtual Reality-Based Exergame for Rehabilitation Purposes." Frontiers in aging neuroscience 13: 734223.
	Virtual reality games are playing a greater role in rehabilitation settings. Previously, commercial games have dominated, but increasingly, bespoke games for specific rehabilitation contexts are emerging. Choice and design of tasks for VR-games are still not always clear, however; some games are designed to motivate and engage players, not necessarily with the facilitation of specific movements as a goal. Other games are designed specifically for the facilitation of specific movements. A theoretical background for the choice of tasks seems warranted. As an example, we use a game that was designed in our lab: VR Walk. Here, the player walks on a treadmill while wearing a head-mounted display showing a custom-made virtual environment. Tasks include walking on a glass bridge across a drop, obstacle avoidance, narrowing path, walking in virtual footsteps, memory, and selection tasks, and throwing and catching objects. Each task is designed according to research and theory from movement science, exercise science, and cognitive science. In this article, we discuss how for example walking across a glass bridge gives perceptual challenges that may be suitable for certain medical conditions, such as hearing loss, when perceptual abilities are strained to compensate for the hearing loss. In another example, walking in virtual footsteps may be seen as a motor and biomechanical constraint, where the double support phase and base of support can be manipulated, making the task beneficial for falls prevention. In a third example, memory and selection tasks may challenge individuals that have cognitive impairments. We posit that these theoretical considerations may be helpful for the choice of tasks and for the design of virtual reality games.

Bowes, A., et al. (2012). "'Keeping your brain active': the activities of people aged 50-65 years." Int J Geriatr Psychiatry 27(3): 253-261.
	OBJECTIVE: The paper aims to construct a baseline of knowledge about current activities, attitudes and motivations of a sample of people aged 50-65 years in relation to 'keeping one's brain active', with a particular focus on activities suggested in the literature and in popular parlance to have positive effects. METHODS: An online survey of people aged 50-65 years concerning their activities and motivations in relation to 'keeping one's brain active' was conducted with a sample of people employed in Scotland and in two online discussion forums. The survey ascertained respondents' background demographic data, data on health and lifestyle factors, activities they engaged in and reasons for engagement, including any concerns about dementia and experience of dementia. The achieved sample of 402 responses was representative of the general population on most counts, although the sample included more better-educated people and more smokers. RESULTS: Dementia prevention was a motivating factor for 21% of the respondents. More women and more of those living alone reported this motivation. It was linked with experience of dementia and future fears of developing the condition. New 'brain-training' technologies were used by younger people in higher socio-economic groups, and dementia prevention was cited as a motivation. CONCLUSION: The findings indicate that dementia prevention motivates activities perceived to keep the brain active, despite there being a virtual absence of scientific evidence showing that the desired effects will follow. Given the existence of evidence suggesting that other activities, particularly physical exercise, may be more important and the possibility that stress itself may promote the development of dementia, further research is urgently needed.

bq4rg, R. B. R. (2019). "Effects of gametherapy on dementia and cognitive decline in functional and cognitive capacity and biomarkers." https://trialsearch.who.int/Trial2.aspx?TrialID=RBR-3bq4rg.
	INTERVENTION: Exercise Movement Techniques Exercise Therapy Other The physical exercises will be performed twice a week, totaling 16 sessions. The elderly will be divided into two groups, balanced by gender, age and schooling: 1) physical exercise with video game (EVG) (25 subjects); 2) physical exercises without video game (EX)(25 subjects). Both groups will perform 2 sessions for familiarization of the exercises. The EVG will perform exercises of the Nintendo Wii video game System®, use with Balance Board devices (Force platform that captures pressure center oscillations), Wii Motion and Nunchuck (hand controls that via BlueTooth captures the Movements that the participant makes). To design the images of the games we will use an image project (projected screen with dimensions of 85 x 100 cm). The selected games are aimed at stimulating the control of balance, muscular strength, gait and cognitive stimuli of inhibitory control, decision making, reaction speed, attention, judgment and flexibility of thought. Each session will take around 30 to 45 minutes in total, where the following games will be held in the Wii Fit Plus, Wii Sports and Wii EA Active package:Pinguim (Penguim Slide) (Wii Fit Plus); Agachamento (Rowing squat) (Wii Fit Plus); Corrida (Free Run) (Wii Fit Plus); Step (Free Step) (Wii Fit Plus); Boxe (Wii Sports); Dança (dance) (Wii EA Active). The EX will perform exercises exactly the same as the EVG. The movements are the same, even in their frequency of realization, but the EX will not have the visualization and interaction with the video game. All training and familiarization sessions will be accompanied by trained health professionals (physiotherapists and physical educators) in order to avoid eventual falls or events that may occur with the elderly during the practice of the exercises Physical. There will always be a chair so that the elderly can rest, when necessary, and the professional will always be at the side to guarantee the safe practice of physical exercises. Video Games CONDITION: F00‐F99 Mental Disorders Neurocognitive Disorders Unspecified dementia Unspecified dementia; Mental Disorders; Neurocognitive Disorders ; Neurocognitive Disorders ; Mental Disorders ; Unspecified dementia PRIMARY OUTCOME: Difference between BDNF, Irisine, Cortisol, Inflammatory Cytokines levels dosed in blood and saliva. Difference between cognitive ability through mental mini‐exam (MMSE), digit spam, floor maze test, stroop test, clock test, verbal fluency test and MoCA. Difference between functional capacity through senior fitness test, stabilometry, double‐task stabilometry, dual‐task get‐up and go test, Berg scale and gait. SECONDARY OUTCOME: Difference in depressive symptoms analyzed by geriatric depression scale (GDS). Differences between fear of falls analyzed by the Falls Efficacy Scale (FES‐I). INCLUSION CRITERIA: Inclusion criterion, having CDR 0.5; 1 and 2, with a minimum of three years of formal study.

Brach, M., et al. (2009). "Implementation of preventive strength training in residential geriatric care: a multi-centre study protocol with one year of interventions on multiple levels." BMC Geriatrics 9: 51.
	BACKGROUND: There is scientific evidence that preventive physical exercise is effective even in high age. In contrast, there are few opportunities of preventive exercise for highly aged people endangered by or actually in need of care. For example, they would not be able to easily go to training facilities; standard exercises may be too intensive and therefore be harmful to them; orientation disorders like dementia would exacerbate individuals and groups in following instructions and keeping exercises going. In order to develop appropriate interventions, these and other issues were assigned to different levels: the individual-social level (ISL), the organisational-institutional level (OIL) and the political-cultural level (PCL). Consequently, this conceptional framework was utilised for development, implementation and evaluation of a new strength and balance exercise programme for old people endangered by or actually in need of daily care. The present paper contains the development of this programme labeled "fit for 100", and a study protocol of an interventional single-arm multi-centre trial. METHODS: The intervention consisted of (a) two group training sessions every week over one year, mainly resistance exercises, accompanied by sensorimotor and communicative group exercises and games (ISL), (b) a sustainable implementation concept, starting new groups by instructors belonging to the project, followed by training and supervision of local staff, who stepwise take over the group (OIL), (c) informing and convincing activities in professional, administrative and governmental contexts, public relation activities, and establishing an advisory council with renowned experts and public figures (PCL). Participating institutions of geriatric care were selected through several steps of quality criteria assessment. Primary outcome measures were continuous documentation of individual participation (ISL), number of groups continued without external financial support (at the end of the project, and after one year) (OIL). Secondary outcome was measured by sensorimotor tests and care-related assessments in the beginning and every 16 weeks (ISL), by qualitative outcome descriptions 12 months after group implementation (OIL) and by analysis of media response and structured interviews with stakeholders, also after 12 months (PCL). CONCLUSION: Exemplarily, preventive exercise has been established for a neglected target population. The multi-level approach used here seems to be helpful to overcome institutional and individual (attitude) barriers. TRIAL REGISTRATION: Current Controlled Trials ISRCTN55213782.

Brachman, A., et al. (2021). "The Effects of Exergaming Training on Balance in Healthy Elderly Women-A Pilot Study." International Journal of Environmental Research & Public Health [Electronic Resource] 18(4): 1412.
	Our aim was to observe, through objective testing using an assessment module incorporated in a new exergaming system, whether elderly people's static and functional balance is improved by a balance exergaming training program based on movements performed in everyday life. Thirteen healthy elderly women participated in 12 sessions of balance-based exergaming training (three times a week, 30 min per session). All objective outcomes, the quiet standing test, functional balance test (FBT), and limit of stability (LOS) test, were measured on three occasions: before intervention, after six training sessions, and after the completion of the four-week program. The results showed a significant improvement in LOS performance after the intervention. In FBT, participants exhibited a significant decrease (p < 0.01; Kendall's W = 0.5) in the average time to target hit after six trainings. The average center of pressure velocity increased after six and 12 sessions, however did not reach significance (p = 0.053); nevertheless the size of the effect was large (etap2 = 0.22). The parameters of the quiet standing test were not significantly affected by the training. The results support the need for more definite and objective studies assessing exergaming for balance in elderly.

Brandao, M. B., et al. (2019). "Family-Centered Early Intervention Program for Brazilian Infants with Congenital Zika Virus Syndrome: A Pilot Study." Physical & Occupational Therapy in Pediatrics 39(6): 642-654.
	Aims: To evaluate the effects of a 16-week program based on Goals-Activity-Motor Enrichment (GAME) principles on infants with congenital Zika virus syndrome (CZS)'s mother report of functional goal achievement, motor and cognitive abilities, home enrichment, and parents' perceptions regarding the service provided. Methods: Quasi-experimental study with infants (n = 32) with CZS and their mothers. Twenty-two infants composed the GAME-based group and 10 were included in the control group. The primary outcome measure was the Canadian Occupational Performance Measure. Secondary outcome measures were the Bayley Scales of Infant and Toddler Development, the Affordances in the Home Environment for Motor Development-Infant Scale, and the Measure of Processes of Care. All measures were performed by blinded assessors. Results: Mothers of infants in the GAME-based group reported significant improvements in their infants' performance on functional priorities (p = 0.0001) and satisfaction with their infants' performance (p = 0.0001), the extent in which services promoted enabling and partnership (p = 0.021), provided general information (p = 0.039), specific information (p = 0.0001), and an enriched home environment (p = 0.0001). Infants in both groups did not improve in motor or cognitive abilities. Conclusions: A family-centered early intervention program based on GAME principles improved mothers' individualized outcomes and enriched infants with CZS's environment. Future studies should elucidate long-term benefits of interventions for this population.

Bray, N., et al. (2020). "Powered mobility interventions for very young children with mobility limitations to aid participation and positive development: the EMPoWER evidence synthesis." Health Technology Assessment (Winchester, England) 24(50): 1-194.
	BACKGROUND: One-fifth of all disabled children have mobility limitations. Early provision of powered mobility for very young children (aged < 5 years) is hypothesised to trigger positive developmental changes. However, the optimum age at which to introduce powered mobility is unknown. OBJECTIVE: The aim of this project was to synthesise existing evidence regarding the effectiveness and cost-effectiveness of powered mobility for very young children, compared with the more common practice of powered mobility provision from the age of 5 years. REVIEW METHODS: The study was planned as a mixed-methods evidence synthesis and economic modelling study. First, evidence relating to the effectiveness, cost-effectiveness, acceptability, feasibility and anticipated outcomes of paediatric powered mobility interventions was reviewed. A convergent mixed-methods evidence synthesis was undertaken using framework synthesis, and a separate qualitative evidence synthesis was undertaken using thematic synthesis. The two syntheses were subsequently compared and contrasted to develop a logic model for evaluating the outcomes of powered mobility interventions for children. Because there were insufficient published data, it was not possible to develop a robust economic model. Instead, a budget impact analysis was conducted to estimate the cost of increased powered mobility provision for very young children, using cost data from publicly available sources. DATA SOURCES: A range of bibliographic databases [Cumulative Index to Nursing and Allied Health Literature (CINHAL), MEDLINE, EMBASE (Elsevier, Amsterdam, the Netherlands), Physiotherapy Evidence Database (PEDro), Occupational Therapy Systematic Evaluation of Evidence (OTseeker), Applied Social Sciences Index and Abstracts (ASSIA), PsycINFO, Science Citation Index (SCI; Clarivate Analytics, Philadelphia, PA, USA), Social Sciences Citation Index (SSCI; Clarivate Analytics), Conference Proceedings Citation Index - Science (CPCI-S; Clarivate Analytics), Conference Proceedings Citation Index - Social Science & Humanities (CPCI-SSH; Clarivate Analytics), Cochrane Central Register of Controlled Trials (CENTRAL), Cochrane Database of Systematic Reviews, Database of Abstracts of Reviews of Effects (DARE), NHS Economic Evaluation Database (NHS EED), Health Technology Assessment (HTA) Database and OpenGrey] was systematically searched and the included studies were quality appraised. Searches were carried out in June 2018 and updated in October 2019. The date ranges searched covered from 1946 to September 2019. RESULTS: In total, 89 studies were included in the review. Only two randomised controlled trials were identified. The overall quality of the evidence was low. No conclusive evidence was found about the effectiveness or cost-effectiveness of powered mobility in children aged either < 5 or >/= 5 years. However, strong support was found that powered mobility interventions have a positive impact on children's movement and mobility, and moderate support was found for the impact on children's participation, play and social interactions and on the safety outcome of accidents and pain. 'Fit' between the child, the equipment and the environment was found to be important, as were the outcomes related to a child's independence, freedom and self-expression. The evidence supported two distinct conceptualisations of the primary powered mobility outcome, movement and mobility: the former is 'movement for movement's sake' and the latter destination-focused mobility. Powered mobility should be focused on 'movement for movement's sake' in the first instance. From the budget impact analysis, it was estimated that, annually, the NHS spends pound1.89M on the provision of powered mobility for very young children, which is < 2% of total wheelchair service expenditure. LIMITATIONS: The original research question could not be answered because there was a lack of appropriately powered published research. CONCLUSIONS: Early powered mobility is likely to have multiple benefits for very young children, despite the lack of robust evidence to demonstrate this. Age is not the key factor; instead, the focus should be on providing developmentally appropriate interventions and focusing on 'movement for movement's sake'. FUTURE WORK: Future research should focus on developing, implementing, evaluating and comparing different approaches to early powered mobility. STUDY REGISTRATION: This study is registered as PROSPERO CRD42018096449. FUNDING: This project was funded by the National Institute for Health Research (NIHR) Health Technology programme and will be published in full in Health Technology Assessment; Vol. 24, No. 50. See the NIHR Journals Library website for further project information.
The aim of this study was to find out the benefits and costs of providing very young children, aged < 5 years, with powered mobility devices. Examples of powered mobility devices are electrically powered wheelchairs and modified ride-on toys. We looked at many research papers about children and powered mobility. We found many benefits of powered mobility. We then combined all of the information to see if using powered mobility before the age of 5 years had any specific benefits for children. The evidence tells us that powered mobility has a positive effect on children's movement, and it can boost children's social interactions with other people, and their independence. Children using powered mobility were able to go to their friends by themselves, move around a play space as they wanted and take part in physical activities and games. We found that the fit between the child, the powered mobility device and the child's everyday environment was important. When the fit was not good, children experienced a lot of problems. Some children and families felt that powered mobility did not suit their needs, leading to children using a manual wheelchair instead and thereby missing out on education, social opportunities and play. Barriers to powered mobility were found in the physical environment (e.g. inaccessible buildings) and the social environment (e.g. adults supervising children too closely) and often affected children's independence. We found that the advantages and disadvantages of powered mobility were similar in younger and older children, even though the activities they took part in were different. We also found that each year the NHS spends < 2% of its wheelchair service budget on powered mobility for very young children. In conclusion, powered mobility can benefit very young children, but it requires a good fit with the child's environment.
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Braz, N. F. T., et al. (2018). "Eficácia do Nintendo Wii em desfechos funcionais e de saúde de indivíduos com doença de Parkinson: uma revisão sistemática." Fisioterapia e Pesquisa 25(1): 100-106.
	The objective of this study was to conduct a systematic review of the literature on the effectiveness of Nintendo Wii in the improvement of functional and health outcomes of individuals with Parkinson's disease. A systematic review of the literature was developed following the PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses), with research in MEDLINE, SciELO, LILACS, PEDro through a search strategy that combined the terms Wii, Parkinson's Disease, rehabilitation, and physical therapy, followed by manual search. Inclusion criteria were: experimental studies or quasi-experiments related to interventions involving the use of Nintendo Wii to improve functional outcomes in individuals with Parkinson's disease, published until February 2016, without language restriction. The methodological quality of the studies was assessed with the PEDro scale. Of the 701 studies found, we included seven that met the inclusion criteria - most of the articles (57.14%) had bad methodological quality and were quasi-experiments. The results suggest that the use of Wii seems effective to improve functional outcomes (balance, mobility, motor performance and independence) and health (reducing the risk of falls), being more consistent the results for the improvement of balance. Studies with better methodological quality are needed for the establishment of evidence. Standardization on the types of games, intensity and frequency suitable for each type of patient with PD are still required.
El objetivo de este estudio ha sido el de revisar sistemáticamente la literatura sobre la eficacia del Nintendo Wii en la mejora de resultados funcionales y de salud de individuos con enfermedad de Parkinson. La revisión sistemática de la literatura ha sido desarrollada siguiendo el PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses), con búsquedas en las bases de datos MEDLINE, SciELO, LILACS y PEDro de acuerdo con la estrategia de búsqueda compuesta por la combinación de los términos "Wii", "Enfermedad de Parkinson", "rehabilitación" y "fisioterapia", seguida de búsqueda manual. Los criterios de inclusión han sido: los estudios experimentales o casi-experimentales relacionados a las intervenciones involucrando el uso del Nintendo Wii para la mejora de resultados funcionales en los individuos con enfermedad de Parkinson, publicados hasta febrero de 2016, sin restricción de idioma. La cualidad metodológica de los estudios ha sido evaluada por la escala PEDro. De los 701 estudios encontrados, han sido incluidos siete que atendieron a los criterios de inclusión, la gran parte (el 57,14%) con cualidad metodológica mala y del tipo casi-experimental. Los resultados sugieren que el uso del Wii parece eficaz para la mejora de resultados funcionales (el equilibrio, la movilidad, el desempeño motor y la independencia) y de salud (disminución del riesgo de caídas), siendo más consistentes los resultados para la mejora del equilibrio. Son necesarios estudios con mejor cualidad metodológica para el establecimiento de las evidencias. Todavía son necesarias estandarizaciones sobre los tipos de juegos, intensidad y frecuencia adecuados para cada tipo de paciente con EP.
O objetivo deste estudo foi revisar sistematicamente a literatura sobre a eficácia do Nintendo Wii na melhora de desfechos funcionais e de saúde de indivíduos com doença de Parkinson. A revisão foi desenvolvida seguindo o PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses), com buscas nas bases de dados MEDLINE, SciELO, LILACS e PEDro mediante estratégia de busca composta pela combinação dos termos "Wii", "Doença de Parkinson", "reabilitação" e "fisioterapia", seguida de busca manual. Os critérios de inclusão foram: estudos experimentais ou quase-experimentais relacionados a intervenções envolvendo o uso do Nintendo Wii para melhora de desfechos funcionais em indivíduos com doença de Parkinson, publicados até fevereiro de 2016, sem restrição de idioma. A qualidade metodológica dos estudos foi avaliada pela escala PEDro. Dos 701 estudos encontrados, foram selecionados sete que atenderam aos critérios de inclusão, a maioria (57,14%) apresentava qualidade metodológica ruim e era do tipo quase-experimental. Os resultados sugerem que o uso do Wii parece eficaz para melhora de desfechos funcionais (equilíbrio, mobilidade, desempenho motor e independência) e de saúde (diminuição do risco de quedas), sendo mais consistentes os resultados para melhora do equilíbrio. São necessários estudos com melhor qualidade metodológica para o estabelecimento das evidências e, ainda, padronizações sobre os tipos de jogos, intensidade e frequência adequados para cada tipo de paciente com DP.

Brochu, A., et al. (2015). "WS05.4 Video games for positive expiratory pressure (PEP) therapy in children with cystic fibrosis: A pilot study." Journal of cystic fibrosis 14: S9.
	Background Adherence to respiratory physiotherapy is a major challenge in children with cystic fibrosis (CF). Video games have shown promising results in improving adherence to treatment in chronic diseases. However, the feasibility of adapting video games to positive expiratory pressure (PEP) therapy in CF has not been explored. Hypothesis Therapeutic games can be adapted to PEP therapy. Methods In collaboration with students in the game design program of University of Montreal, we developed and adapted 3 video games to the parameters of PEP therapy (6 series of 15 respirations). The PARI's PEP S™ device was connected to a computer by a pressure sensor. Ten children (5 girls, 5 boys) between the age of 8 and 10 tested the video games on one occasion during PEP therapy under the supervision of the physical therapist of the CHU Sainte-Justine CF clinic. Questionnaires were completed before and after the trial by all participants which consisted of their overall evaluation of the games, their interest in pursuing the video games at home and whether they believe the games may improve adherence to PEP therapy. Results The PARI's PEP S™ device was successfully connected to a computer and all PEP parameters were monitored adequately. Nine children (9/10) were very interested in pursuing the video games while doing their PEP therapy at home. All of them thought that the games were well adapted to the PEP therapy and that it may improve their adherence to the treatment. Conclusion Video games can be adapted to PEP therapy. A second study is currently being planned to investigate whether video games may improve adherence to respiratory physiotherapy in children with CF.

Broderick, M., et al. (2021). "Self-Directed Exergaming for Stroke Upper Limb Impairment Increases Exercise Dose Compared to Standard Care." Neurorehabilitation & Neural Repair 35(11): 974-985.
	Background. One of the strongest modifiable determinants of rehabilitation outcome is exercise dose. Technologies enabling self-directed exercise offer a pragmatic means to increase dose, but the extent to which they achieve this in unselected cohorts, under real-world constraints, is poorly understood. Objective. Here we quantify the exercise dose achieved by inpatient stroke survivors using an adapted upper limb (UL) exercise gaming (exergaming) device and compare this with conventional (supervised) therapy. Methods. Over 4 months, patients presenting with acute stroke and associated UL impairment were screened at a single stroke centre. Participants were trained in a single session and provided with the device for unsupervised use during their inpatient admission. Results. From 75 patients referred for inpatient UL therapy, we recruited 30 (40%), of whom 26 (35%) were able to use the device meaningfully with their affected UL. Over a median enrolment time of 8 days (IQR: 5-14), self-directed UL exercise duration using the device was 26 minutes per day (median; IQR: 16-31), in addition to 25 minutes daily conventional UL therapy (IQR: 12-34; same cohort plus standard care audit; joint n = 50); thereby doubling total exercise duration (51 minutes; IQR: 32-64) relative to standard care (Z = 4.0, P <.001). The device enabled 104 UL repetitions per day (IQR: 38-393), whereas conventional therapy achieved 15 UL repetitions per day (IQR: 11-23; Z = 4.3, P <.001). Conclusion. Self-directed adapted exergaming enabled participants in our stroke inpatient cohort to increase exercise duration 2-fold, and repetitions 8-fold, compared to standard care, without requiring additional professional supervision.

Broeren, J., et al. (2008). "eHealth beyond the horizon -- get IT there. Virtual rehabilitation after stroke...Proceedings of MIE2008: the XXIst International Congress of the European Federation for Medical Informatics...information technology." Studies in Health Technology & Informatics 136: 77-82.
	
Broeren, J., et al. (2007). "Assessment and training in a 3-dimensional virtual environment with haptics: a report on 5 cases of motor rehabilitation in the chronic stage after stroke." Neurorehabilitation & Neural Repair 21(2): 180-189.
	OBJECTIVE: This exploratory study assessed the possible effectiveness of hemiparetic upper extremity training in subjects with chronic stroke with computer instrumentation (haptic force feedback) and 3-dimensional visualization applied to computer games, as well as to evaluate concurrent computer-assisted assessment of the kinematics of movements and test whether any improvement detected in the computer environment was reflected in activities of daily living (ADLs). METHODS: A single-subject repeated-measures experimental design (AB) was used. After baseline testing, 5 patients were assigned to the therapy 3 times a week for 45 min for 5 weeks. Velocity, time needed to reach, and hand path ratio (reflecting superfluous movements) were the outcome measures, along with the Assessment of Motor and Process Skills and the Box and Block test. The follow-up phase (C) occurred 12 weeks later. RESULTS: Improvements were noted in velocity, time, and hand path ratio. One patient showed improvement in occupational performance in ADLs. CONCLUSIONS: The application of this strategy of using virtual reality (VR) technologies may be useful in assessing and training stroke patients. The results of this study must be reproduced in further studies. The VR systems can be placed in homes or other nonclinical settings.

Brooke, T., et al. (2020). "Stress and burnout: exploring postgraduate physiotherapy students' experiences and coping strategies." BMC Medical Education 20(1): 433.
	BACKGROUND AND PURPOSE: The impact of stress and burnout in students is an emerging topic. When students perceive that they are unable to cope with stressors, there is increased potential for burnout. To maximise students' higher educational institution outcomes, students must be able to effectively cope with stressful demands. Research suggests physiotherapy students, in particular, suffer from a high risk of stress and burnout, however limited research exists on postgraduate, pre-registration, physiotherapy students. The purpose of this study was to determine perceived stress, burnout and associated coping strategies across three timepoints in the first year of a postgraduate, pre-registration physiotherapy program. METHODS: A qualitative and quantitative survey design was utilised at one Australian Higher Education Institution. The 51-item self-administered questionnaire consisted of demographics, the Coping Self Efficacy (CSE) Scale and Maslach Burnout Inventory - General Survey for Students (MBI-GS (S)), and open-ended questions. The questionnaire was administered at three timepoints (T) in the program: T1 at the start of semester 1, T2 before the first placement in semester 2 and T3 after 10-weeks of placement. Data were analysed using descriptive, statistical and thematical analysis. SUBJECTS: All first year Doctor of Physiotherapy students. RESULTS: A response rate of 62% (n = 38) was achieved. There were no differences in stress and burnout scores between sexes, nor differences in stress and burnout over time. Highest median CSE scores were seen at T1, with highest median MBI-GS (S) cynicism scores at T2, exhaustion (EX) at T1 and T2, and professional efficacy at T1 and T2. The greatest mean CSE changes were seen from T1-T2 and T1-3, and PE greatest changes from T2-T3 and T1-T3. No strong correlation was found between stress and burnout. Curriculum coursework was a frequently reported stressor, along with clinical placement and transition periods. Coping strategies utilized by students were both positive and maladaptive. Positive strategies included sporting activities, baking, listening to music, and social connections, whereas maladaptive strategies included alcohol consumption, excessive eating, and gaming. CONCLUSION: Student consistently identified periods of stress and burnout, with curriculum coursework in particular being a trigger. Findings acknowledge the need for further investigation on sources of perceived stress, burnout, and coping mechanisms to optimise student welfare and enhance Higher Education Institution outcomes.

Brookes, J., et al. (2017). "Robots testing robots: ALAN-Arm, a humanoid arm for the testing of robotic rehabilitation systems." IEEE Int Conf Rehabil Robot 2017: 676-681.
	Robotics is increasing in popularity as a method of providing rich, personalized and cost-effective physiotherapy to individuals with some degree of upper limb paralysis, such as those who have suffered a stroke. These robotic rehabilitation systems are often high powered, and exoskeletal systems can attach to the person in a restrictive manner. Therefore, ensuring the mechanical safety of these devices before they come in contact with individuals is a priority. Additionally, rehabilitation systems may use novel sensor systems to measure current arm position. Used to capture and assess patient movements, these first need to be verified for accuracy by an external system. We present the ALAN-Arm, a humanoid robotic arm designed to be used for both accuracy benchmarking and safety testing of robotic rehabilitation systems. The system can be attached to a rehabilitation device and then replay generated or human movement trajectories, as well as autonomously play rehabilitation games or activities. Tests of the ALAN-Arm indicated it could recreate the path of a generated slow movement path with a maximum error of 14.2mm (mean = 5.8mm) and perform cyclic movements up to 0.6Hz with low gain (<1.5dB). Replaying human data trajectories showed the ability to largely preserve human movement characteristics with slightly higher path length and lower normalised jerk.

Brown, R., et al. (2011). "Use of the Wii Fit system for the treatment of balance problems in the elderly: a feasibility study." Journal of the Israeli Physical Therapy Society (JIPTS) 13(1): 32-32.
	Background: The rate of falls among patients following a stroke is twice the rate seen in an age and gender matched population. In recent years, the use of virtual reality (VR) for the treatment of balance problems in the elderly has become increasingly widespread. This paper is a report of the feasibility and outcome of using a low-cost, commercially available gaming system - Wii Fit - for balance training after stroke. Methods: The patient was an 86 year-old woman five weeks after stroke, who was unable to walk without close supervision, even with a walker, due to poor balance and a tendency to fall. In addition to standard physical therapy, the patient participated in four training sessions with the Wii Fit system; each training session included four different games. The outcome measures were the Berg Balance Scale (BBS), the Functional Reach and Lateral Reach tests, Timed Up & Go test (TUG), computerized posturography, and the Short Feedback Questionnaire (SFQ). The tests were done before the intervention and on the last day of training. The SFQ was done during the third training session. Results: The patient greatly enjoyed the training sessions and felt that she was receiving very 'up-to-date' treatment. She did not experience any discomfort such as nausea or dizziness while using the system. Following combined Wii and standard treatment, the patient demonstrated improved antero-posterior symmetry of stance, and there was a 10 second improvement in her TUG score. When released from hospital, she was able to walk with a walker with minimal supervision. Conclusions: This initial pilot study indicates that the Wii Fit gaming system has the potential to be used in clinical settings in order to improve balance. A full clinical trial is necessary in order to examine this premise.

Brown, S. R., et al. (2014). "Knee mechanics during planned and unplanned sidestepping: a systematic review and meta-analysis." Sports Medicine 44(11): 1573-1588.
	BACKGROUND: Knee joint mechanics during sidestepping are associated with anterior cruciate ligament injury. Unplanned sidestepping more closely emulates game scenarios when compared with planned sidestepping by limiting decision time, increasing knee loading and challenging the integrity of soft-tissue structures in the knee. It is important to quantify the loads that may challenge the integrity of the knee during planned and unplanned sidestepping. OBJECTIVE: Our objective was to review literature on knee mechanics during planned and unplanned phases of sidestepping. DATA SOURCES: PubMed, CINAHL, MEDLINE (EBSCO), SPORTDiscus and Web of Science were searched using the terms knee mechanics OR knee kine*, AND plan*, unplan*, anticipat*, unanticipat*, side*, cut* or chang*. STUDY SELECTION: A systematic approach was used to evaluate 4,629 records. Records were excluded when not available in English, only available in abstract of conference proceedings, not involving a change-of-direction sidestep, not comparing planned and unplanned or maintaining a running velocity greater than 2 m s(-1). DATA EXTRACTION: Included studies were evaluated independently by two authors using a custom-designed methodological quality assessment derived from the Physiotherapy Evidence Database (PEDro) scale and then confirmed by a third author. DATA SYNTHESIS: Only six studies met the inclusion criteria and were retained for meta-analysis. Magnitude-based inferences were used to assess the standardised effect of the differences between planned and unplanned sidestepping. Knee angles and knee moments were extracted and reported for flexion/extension, abduction/adduction and internal/external rotation for initial contact, weight acceptance, peak push-off and final push-off phases of sidestepping. RESULTS: For kinematic variables, unplanned sidestepping produced a wide range of small to large increases in knee extension angles, small and moderate increases in knee abduction angles and a small increase in internal rotation angle relative to planned sidestepping during the sidestepping manoeuvre. For kinetic variables, unplanned sidestepping produced mostly small (small to large) increases in knee flexor moments, small to moderate increases in knee abductor moments and mostly moderate (small to large) increases in internal rotator moments relative to planned sidestepping. LIMITATIONS: Approach velocity constraints during the sidestepping manoeuvre were lifted due to the low number of eligible studies. The varying approach velocities included (ranging from 3.0 to 5.5 m s(-1)) may impact the kinematic and kinetic variables examined in this review. CONCLUSIONS: Differences in knee mechanics between planned and unplanned sidestepping exist. The most substantial effects occurred during the weight acceptance phase of sidestepping. It seems that biomechanical factors commonly associated with anterior cruciate ligament injury risk are affected the most during the loading phase compared with peak push-off; made evident in the coronal (abductor) and transverse (internal rotator) knee kinetic data presented in this review. The authors of this review propose a rationale for the incorporation of unplanned sport tasks in the development of anterior cruciate ligament injury screening and in prophylactic training programmes.

Brox, E., et al. (2011). "Healthy Gaming - Video Game Design to promote Health." Applied Clinical Informatics 2(2): 128-142.
	BACKGROUND: There is an increasing interest in health games including simulation tools, games for specific conditions, persuasive games to promote a healthy life style or exergames where physical exercise is used to control the game. OBJECTIVE: The objective of the article is to review current literature about available health games and the impact related to game design principles as well as some educational theory aspects. METHODS: Literature from the big databases and known sites with games for health has been searched to find articles about games for health purposes. The focus has been on educational games, persuasive games and exergames as well as articles describing game design principles. RESULTS: The medical objectives can either be a part of the game theme (intrinsic) or be totally dispatched (extrinsic), and particularly persuasive games seem to use extrinsic game design. Peer support is important, but there is only limited research on multiplayer health games. Evaluation of health games can be both medical and technical, and the focus will depend on the game purpose. CONCLUSION: There is still not enough evidence to conclude which design principles work for what purposes since most of the literature in health serious games does not specify design methodologies, but it seems that extrinsic methods work in persuasion. However, when designing health care games it is important to define both the target group and main objective, and then design a game accordingly using sound game design principles, but also utilizing design elements to enhance learning and persuasion. A collaboration with health professionals from an early design stage is necessary both to ensure that the content is valid and to have the game validated from a clinical viewpoint. Patients need to be involved, especially to improve usability. More research should be done on social aspects in health games, both related to learning and persuasion.

Bruggers, C. S., et al. (2012). "Patient-empowerment interactive technologies." Science Translational Medicine 4(152): 152ps116.
	Video games capture the rapt attention of an individual player's mind and body, providing new opportunities for personalized health care. An example of therapeutic interactive technologies is an incentive-based video game that translates physical exercise into mental empowerment via motivational metaphoric visualization in order to help patients psychologically overcome cancer. Such nonpharmacological interventions may enhance patients' resilience toward various chronic disorders via neuronal mechanisms that activate positive emotions and the reward system.

Bruggers, C. S., et al. (2018). "A Prototype Exercise-Empowerment Mobile Video Game for Children With Cancer, and Its Usability Assessment: Developing Digital Empowerment Interventions for Pediatric Diseases." Front Pediatr 6: 69.
	BACKGROUND: Medical advances continue to improve morbidity and mortality of serious pediatric diseases, including cancer, driving research addressing diminished physical and psychological quality of life in children with these chronic conditions. Empowerment enhances resilience and positively influences health, disease, and therapy understanding. We describe the development and usability assessment of a prototype Empower Stars! mobile video game grounded in behavioral and exercise theories with the purpose of coupling physical exercise with empowerment over disease in children with cancer. METHODS: Academic faculty, health-care providers, and community video game developers collaborated in this project. The iPadAir was selected as a delivery platform for its accelerometer and gyroscope features facilitating exercise design. Unity multiplatform technology provided animation and audiovisual features for immediate player feedback. Javascript, C#, Photoshop, Flash, and SketchUp were used for coding, creating graphical assets, Sprite sheets, and printing files, respectively. 3D-printed handles and case backing were used to adapt the iPad for physical exercise. Game usability, engagement, and enjoyment were assessed via a multilevel study of children undergoing cancer chemotherapy, their parents, and pediatric cancer health-care providers. Feedback crucial for ongoing game development was analyzed. RESULTS: A prototype Empower Stars! mobile video game was developed for children 7-14 years old with cancer. Active, sedentary, educational, and empowerment-centered elements intermix for 20 min of exercise within a 30 min "one-day treatment" gameplay session involving superheroes, space exploration, metaphorical cancer challenges, life restoration on a barren planet, and innumerable star rewards. No player "dies." Usability assessment data analyses showed widespread enthusiasm for integrating exercise with empowerment over cancer and the game itself. Favorite elements included collecting star rewards and planet terraforming. Traveling in space and the Healthy Food Choice game were least liked. The need for improved gameplay instructions was expressed by all groups. The usability study provided essential feedback for converting the prototype into alpha version of Empower Stars! CONCLUSION: Adapting exercise empowerment-promoting video game technology to mobile platforms facilitates usability and widespread dissemination for children with cancer. We discuss broader therapeutic applicability in diverse chronic pediatric diseases, including obesity, asthma, cystic fibrosis, diabetes, and juvenile idiopathic arthritis.

Brummeler, L. t. and C. van Dijkum (1989). Physiotherapist's dilemma. Simulation-Gaming. J. H. G. Klabbers, W. J. Scheper, C. A. T. Takkenberg and D. Crookall. Amsterdam, Pergamon: 332-339.
	ABSTRACT In this paper a simulation game “Therapist's Dilemma” is described which have been developed for physiotherapists, family doctors, patients and representatives of health insurance companies. The game has to produce insight into the quality of treatment and related cost of physiotherapy. The game is interactive: (1) the participants are making joint decisions; (2) the consequences of these decisions are calculated with a computer program; (3) results are returned to the participants and are evaluated by them; (4) new decisions are made for the next cycle. The game is played in three or four cycles and is completed with a debriefing. Special interest is given to the introduction of the game with the help of a hypercard tutorial.

Brunner, I., et al. (2016). "Is upper limb virtual reality training more intensive than conventional training for patients in the subacute phase after stroke? An analysis of treatment intensity and content." BMC Neurology 16(1): 219.
	BACKGROUND: Virtual reality (VR) training is thought to improve upper limb (UL) motor function after stroke when utilizing intensive training with many repetitions. The purpose of this study was to compare intensity and content of a VR training intervention to a conventional task-oriented intervention (CT). METHODS: A random sample of 50 video recordings was analyzed of patients with a broad range of UL motor impairments (mean age 61y, 22 women). Patients took part in the VIRTUES trial and were randomized to either VR or CT and stratified according to severity of paresis. A standardized scoring form was used to analyze intensity, i.e. active use of the affected UL expressed in % of total time, total active time and total duration of a training session in minutes, content of training and feedback. Two raters collected data independently. Linear regression models as well as descriptive and graphical methods were used. RESULTS: Patients in the VR group spent significantly more time actively practicing with an activity rate of 77.6 (8.9) % than patients in the CT 67.3 (13.9) %, (p = .003). This difference was attributed to the subgroup of patients with initially severe paresis (n = 22). While in VR severely impaired patients spent 80.7 % (4.4 %) of the session time actively; they reached 60.6 (12.1) % in CT. VR and CT also differed in terms of tasks and feedback provided. CONCLUSION: Our results indicate that patients with severely impaired UL motor function spent more time actively in VR training, which may influence recovery. The upcoming results of the VIRTUES trial will show whether this is correlated with an increased effect of VR compared to CT. TRIAL REGISTRATION: ClinicalTrials.gov NCT02079103 , February 27, 2014.

Bruzga, B. (2001). "Knee osteoarthritis -- keeping senior athletes in the game." Sports Physical Therapy Section: 12-15.
	
Buck, M. and M. Fink (2012). "Nintendo Wii fall reduction effectiveness in the elderly and its ability to assess balance using center of pressure: a literature review." Orthopaedic Physical Therapy Practice 24(3): 148-153.
	Background and Purpose: One or more falls are experienced by about 30% ofpeople over 65 years old each year. The purpose of this literature review was to determine if the Nintendo Wii is effective to decrease fall risk in the elderly and to determine if it is comparable to other mechanical devices in assessing balance deficits. Methods: A literature search of Cochrane, PubMed, CINAHL, Medline, and Google Scholar was completed to identifY potential studies (published through October 2011). Findings: Eight studies were located that used the Nintendo Wii: two were single patient case studies, 4 used elderly patients, and 3 used the Timed Up and Go outcome measure. Clinical Relevance: Since increased falls and decreased balance correlate to lower levels ofphysical activity in the elderly population, strategies to address balance deficits should be incorporated into the rehabilitation session ofevery elderly patient.

Bujalance-Moreno, P., et al. (2019). "A systematic review on small-sided games in football players: Acute and chronic adaptations." Journal of Sports Sciences 37(8): 921-949.
	Small-sided games (SSG) are played on a small pitch, often using modified rules and involving a smaller number of players. This article aimed to critically analyse the literature to determine how small-sided games affect the performance of football players in the short- and long term. Electronic databases were searched for literature dating from January 2000 to July 2018. The methodological quality of the studies was evaluated using the modified Downs and Black Quality Index (cross-sectional studies) and the Physiotherapy Evidence Database (PEDro) scale (intervention studies). Fifty-three studies, 44 cross-sectional and 9 intervention studies, met the inclusionary criteria for review. Most of the cross-sectional studies focused on describing the differences between SSG protocols, whereas 4 studies focused on making a comparison between "interval" and "continuous" SSG training regimes. On the other hand, intervention studies focused on making a comparison between SSG-based protocols and high-intensity intermittent training (HIIT)-based running protocols, in addition to determine the effect of a SSG-based training programme alone. SSG-based football plans (2 to 4 SSG sessions per week) show athletic performance improvements in football players by improving sprint, repeated sprint ability (RSA) and change of direction (COD) along with muscular and physiological adaptation.

Bunch, D. (2019). "A MAN FOR ALL SEASONS...Tim Myers." AARC Times 43(10): 18-23.
	The article informs that Tim Myers has made an impact on everything from evidence-based medicine to patient education to Association management in the profession. Topics discussed include Myers and his friends created competitions involving board games they could play at each other's homes; volunteered at a community hospital in physical therapy, as many of these programs required community service upon applying; and the profession of respiratory therapy.

Burges Watson, D., et al. (2016). "Promoting physical activity with a school-based dance mat exergaming intervention: qualitative findings from a natural experiment." BMC Public Health 16: 609.
	BACKGROUND: Physical activity is critical to improving health and well-being in children. Quantitative studies have found a decline in activity in the transition from primary to secondary education. Exergames (active video games) might increase physical activity in adolescents. In January 2011 exergame dance mat systems were introduced in to all secondary schools across two local authority districts in the UK. We performed a quasi-experimental evaluation of a natural experiment using a mixed methods design. The quantitative findings from this work have been previously published. The aim of this linked qualitative study was to explore the implementation of the dance mat scheme and offer insights into its uptake as a physical activity intervention. METHODS: Embedded qualitative interviews at baseline and 12 month follow-up with purposively selected physical education teachers (n = 20) and 25 focus groups with a convenience sample of pupils (n = 120) from five intervention schools were conducted. Analysis was informed by sociology of translation approach. RESULTS: At baseline, participants (both teachers and pupils) reported different expectations about the dance mats and how they could be employed. Variation in use was seen at follow-up. In some settings they were frequently used to engage hard to reach groups of pupils. Overall, the dance mats were not used routinely to increase physical activity. However there were other unanticipated benefits to pupils such as improved reaction time, co-ordination and mathematic skills. The use of dance mats was limited in routine physical education classes because of contextual issues (school/government policy) technological failures (batteries/updates) and because of expectations about how and where they could be used. CONCLUSIONS: Our linked quantitative study (previously published) suggested that the dance mats were not particularly effective in increasing physical activity, but the qualitative results (reported here) show that the dance mats were not used routinely enough to show a significant effect on physical activity of the intervention. This research demonstrates the benefit of using mixed methods to evaluate complex physical activity interventions. Those planning any intervention for promoting physical activity in schools need to understand the distinction between physical activity and physical education.

Burr, S. (2002). "Contract gives physios a sporting chance." Physiotherapy Frontline 8(15): 9-9.
	The closing ceremony of Manchester's Commonwealth Games is still fresh in the minds of physios who tended to the needs of competitors from 72 nations. But it hasn't always been such a harmonious relationship for physios wanting to get a foot in the changing room door, writes Sarah Burr.

Burstin, A. and R. Brown (2010). "Virtual environments for real treatments." Polish Annals of Medicine 17(1): 101-111.
	Introduction In the era of evidence-based practice, more evidence of the beneficial impact of physical therapy and rehabilitation interventions have emerged. Kwakkel and Wagenaar's meta-analysis, Carr and Shepherd's work relating to the motor learning concept, and Fiatarone's research of strength training, emphasize the influence of rehabilitation in outcome gains by demonstrating that in conjunction with the therapist's expertise, the most influencing factors are therapy frequency and intensity. Aim To show the problem which is the gap between this knowledge and reality. Discusion Recently published observational studies revealed that patients in rehabilitation facilities receive a very small amount of therapy time during rehabilitation. Virtual reality (VR) technology offers assistance, as it enables patients who have difficulties coping in the “real world” to gradually deal with their problems via the “virtual world”. It provides the user with a real time interactive experience, through visual, audible, tactile or any other kind of feedback. Individuals find themselves in a pleasant, challenging, motivating and “inviting” functional environment, thus tending to forget their limitations or disability. In addition, VR encourages them to reach their goals which are difficult to achieve in any other treatment setting. Conclusions

Button, B. M., et al. (2000). "The five year follow-up of two groups of newly diagnosed infants with CF randomized to receive standard or modified physiotherapy during infancy." Pediatric Pulmonology Suppl 20: 301‐302.
	We previously investigated the acute effects of manual techniques applied in different positions, including standard physiotherapy (SPT) [supine horizontal; prone, left and right sides with 30° head down tilt] and modified physiotherapy (MPT) [supine 30° head up tilt, prone, left and right sides horizontal] on gastro‐oesophageal reflux (GOR), at the time of diagnosis of CF in 20 infants using newborn screening. The SPT regimen was associated with a significant increase in episodes of GOR compared with MPT. Thereafter, the infants were randomised to receive daily treatment with either SPT or MPT over the following 12 months. Parents kept a daily diary of respiratory symptoms and antibiotic use. The results of this 12 month study showed that infants in the SPT group had significantly more annual days with upper respiratory symptoms p=0.03. Overall, the trend was for the MPT group to have fewer days with lower respiratory tract symptoms and fewer days on antibiotics. Aims: to study (1) the radiological status; and (2) the pulmonary function of the two groups of infants over five years. Method: Infants received either SPT or MPT until they were mature enough to include "bubble PEP", blowing games and physical activities in their daily treatment. A radiologist blinded to the randomisation process determined each infant's Brasfield score at diagnosis, 12 months after diagnosis, at 2‐3 years, and at 5‐6years. A normal Brasfield score is 25/25 (points are subtracted for radiological changes). Pulmonary function tests (PFT) were commenced at the age of 5 years and the best PFT achieved between 5 and 6 years measured in an accredited laboratory was recorded for each subject. Results: On reviewing the patient records, indications are that overall treatment and adherence in the two groups was equal. The mean Brasfield scores for the SPT versus MPT groups respectively were: at diagnosis 24.57 versus 24.50; at 12 months after diagnosis 24.28 vs 24.71; at two to three years of age 23.71 vs 24.86; and at five to six years of age 22.4 vs 24.25. Mean best pulmonary function tests recorded between five to six years for SPT versus MPT groups were FEV1: 101.02±11.07 vs 116.27 ±11.75 with p=0.0432; FVC: 96.17��14.40 vs. 109.8±5.91 with p=0.0575. Discussion: Postural drainage with head down tilt has been the traditional method of airway clearance at many centres. Since newborn screening, infants commence daily airway clearance within the first months of life. Extrapolation has occurred from studies in older patients with chronic sputum to very young asymptomatic infants. The regimen of MPT, "bubble PEP" and physical activity appear to be an effective method of airway clearance in the first 6 years of life without the potential side effects of increased episodes of GOR associated with SPT? Conclusion: MPT should be considered as the most appropriate regimen for infants with CF.

Buttress, S., et al. (2019). "The use of gamified virtual physiotherapy as an effective treatment for patients with shoulder problems." Physiotherapy 105: e162-e163.
	
Byagowi, A., et al. (2014). "Design and Application of a Novel Virtual Reality Navigational Technology (VRNChair)." J Exp Neurosci 8: 7-14.
	This paper presents a novel virtual reality navigation (VRN) input device, called the VRNChair, offering an intuitive and natural way to interact with virtual reality (VR) environments. Traditionally, VR navigation tests are performed using stationary input devices such as keyboards or joysticks. However, in case of immersive VR environment experiments, such as our recent VRN assessment, the user may feel kinetosis (motion sickness) as a result of the disagreement between vestibular response and the optical flow. In addition, experience in using a joystick or any of the existing computer input devices may cause a bias in the accuracy of participant performance in VR environment experiments. Therefore, we have designed a VR navigational environment that is operated using a wheelchair (VRNChair). The VRNChair translates the movement of a manual wheelchair to feed any VR environment. We evaluated the VRNChair by testing on 34 young individuals in two groups performing the same navigational task with either the VRNChair or a joystick; also one older individual (55 years) performed the same experiment with both a joystick and the VRNChair. The results indicate that the VRNChair does not change the accuracy of the performance; thus removing the plausible bias of having experience using a joystick. More importantly, it significantly reduces the effect of kinetosis. While we developed VRNChair for our spatial cognition study, its application can be in many other studies involving neuroscience, neurorehabilitation, physiotherapy, and/or simply the gaming industry.

bygmz, R. B. R. (2022). "Effect of Virtual Reality on Abdominal Contraction of sedentary young adults: randomized clinical trial." https://trialsearch.who.int/Trial2.aspx?TrialID=RBR-6bygmz9.
	INTERVENTION: Control group: 15 young adults will participate in an abdominal muscle strength training program. The exercises that will be used to compose the protocol are: isometric abdominal contraction exercises, such as the left and right side plank with extended lower limbs, with the elbow resting on a mat, and the other arm serving as support with the hand at the waist (two repetitions of one minute each, with an interval of one minute and thirty seconds between them, totaling 10 minutes); conventional board in the prone position, with the elbows resting on the mat, in 90° of flexion, and with the lower limbs extended, touching the fingertips on the mat to better stabilize the movement (three repetitions, one minute each, with a three‐minute break and thirty seconds between them, totaling 10 minutes). Experimental group: 15 young adults will participate in an abdominal contraction training program using a video game in non‐immersive virtual reality mode. The chosen game excelled in the basic principles that guide the abdominal contraction training. In this way, the game will provide visual and proprioceptive stimuli in a static and dynamic way. Within the game, the individual will aim to reach the end of the route following the path of the snow track and the flow of curves, considering that, as the better your abdominal contraction, the faster the avatar will slide over the ice. The game has a scoring system and encourages overcoming. The sooner you reach the end of the route, the higher the user's score. A total of three circuits will be carried out per day of intervention (each circuit will last an average of two minutes), where the user will have to rest for four minutes every time he finishes the circuit. For both groups, in the first contact with the evaluators, the parti E01.370.600.425 G11.427.410.698.277 CONDITION: E02.831.535 Sedentary behavior, muscle strength, young adult, virtual reality exposure therapy, physical therapy modalities PRIMARY OUTCOME: It is expected to find a significant strength gain in the abdominal muscles of the participating young adults, assessed using a digital dynamometer, at the end of 16 weeks. Considering an improvement from positive changes in the indicators and predicted values ??in the first evaluation. SECONDARY OUTCOME: It is expected to find an improvement in quality of life markers as a qualifier of a better performance in activities of daily living, evaluated by the WHOQOL‐OLD questionnaire, at the end of 16 weeks. Considering a significant improvement in the results to be more positive about what is evaluated in the questionnaire. INCLUSION CRITERIA: Age between 18 and 29 years old; male and female individuals; sedentary academics; academics with preserved mental faculties.

Byra, J. and K. Czernicki (2020). "The Effectiveness of Virtual Reality Rehabilitation in Patients with Knee and Hip Osteoarthritis." J Clin Med 9(8): 14.
	Osteoarthritis (OA) is a common health problem leading to pain, limitation in physical function, a decrease in the quality of life and disability. OA affects 60-70% of the population above 65 years of age all over the world, and is associated with a high cost of healthcare. The main method of treatment of OA, apart from pharmacotherapy and surgery, is comprehensive rehabilitation. Advances in medical technology have resulted in the possibility of using computer-assisted interventions in rehabilitation. The present narrative review is aimed at investigating the effectiveness of virtual reality (VR) in the rehabilitation of elderly patients with knee or hip osteoarthritis, including patients after arthroplasty. This literature review based on Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines was carried out in five databases: PubMed, Medline, Web of Science, Scopus and PEDro. It includes ten randomized controlled trials focused on the application of games and biofeedback in the rehabilitation of patients with knee and hip osteoarthritis. There are no conclusive reports that interventions based on VR are more effective than standard physical therapy. Moreover, evidence regarding patients after total hip arthroplasty (THA) is very scarce. The effectiveness of VR-based rehabilitation is unclear, although interventions based on VR are promising in view of pain management, postural and proprioception training. However, this evidence is not sufficient to create clinical guidelines and further high-quality studies are needed.

Byrne, H., et al. (2017). "Effects of Self-directed Exercise Programmes on Individuals with Type 2 Diabetes Mellitus: A Systematic Review Evaluating Their Effect on HbA1c and Other Metabolic Outcomes, Physical Characteristics, Cardiorespiratory Fitness and Functional Outcomes." Sports Medicine 47(4): 717-733.
	BACKGROUND: Type two diabetes mellitus (T2DM) is caused and progressed by an individual's lifestyle and, therefore, its optimal day-to-day management may involve the patient taking responsibility for this, including fulfilling a planned and prescribed exercise regime used as part of the treatment. A prescription of exercise designed to meet a patient's individual needs with minimal supervision from healthcare practitioners would facilitate this. However, the optimal prescription of exercise in the population remains unclear. OBJECTIVE: This review examines the effects planned self-directed exercise has on glycosylated haemoglobin and other outcomes in individuals with T2DM and aims to identify the most suitable forms of planned self-directed exercise for individuals with T2DM that can be carried out independently. METHODS: A search of the electronic databases PubMed, SPORTDiscus, CINAHL, EMBASE, Cochrane (Trials) and ClinicalTrials.gov was conducted along with reference lists of previous reviews. Randomised controlled trials published in English between January 1990 and February 2015 examining participants diagnosed with T2DM only were included. Studies were critically appraised using the PEDro (Physiotherapy Evidence Database) scale and data were presented on standardised tables. RESULTS: Twenty-eight articles that used five element gymnastics, a games console exercise intervention (Wii fit plus) or aerobic, resistance or combined training were included. CONCLUSION: This review comprehensively summarised the effects planned self-directed exercise interventions had on individuals with T2DM. The review found that self-directed exercise was found to be beneficial for individuals with T2DM for improving glycosylated haemoglobin, physical characteristics, cardiorespiratory fitness, functional measures and other metabolic outcomes.

Byrne, P. A., et al. (2017). "Knotless Repair of Achilles Tendon Rupture in an Elite Athlete: Return to Competition in 18 Weeks." Journal of Foot & Ankle Surgery 56(1): 121-124.
	Rupture of the Achilles tendon is an increasingly common injury, particularly in physically active males, and current evidence favors minimally invasive surgical repair. We describe the case of a 36-year-old male elite bobsled athlete with complete rupture of the Achilles tendon. He was treated with surgical repair of the ruptured tendon using an innovative, minimally invasive procedure based on an internal bracing concept and was able to undergo early mobilization and aggressive physiotherapy rehabilitation. His recovery was such that he returned to training at 13 weeks postoperatively and participated in an international competition at 18 weeks, winning a World Cup silver medal. He subsequently raced at the 2014 Winter Olympic Games at 29 weeks after surgery. At >2 years since his injury, he has experienced no complications or reinjury. This represents an exceptional recovery that far exceeds the standard expected for such injuries. The use of this technique for athletes could enable accelerated return to sporting activity and attainment of their preinjury activity levels.

Cacopardo, T., et al. (2010). "The Effects of the Nintendo WiiTM on Dynamic Balance and Functional Gait in an Individual with Guillain-Barre Syndrome." Journal of Acute Care Physical Therapy 1(2): 79-79.
	
Calvaresi, D., et al. (2019). "Real-time multi-agent systems for telerehabilitation scenarios." Artificial Intelligence in Medicine 96: 217-231.
	Telerehabilitation in older adults is most needed in the patient environments, rather than in formal ambulatories or hospitals. Supporting such practices brings significant advantages to patients, their family, formal and informal caregivers, clinicians, and researchers. This paper presents a focus group with experts in physiotherapy and telerehabilitation, debating on the requirements, current techniques and technologies developed to facilitate and enhance the effectiveness of telerehabilitation, and the still open challenges. Particular emphasis is given to (i) the body-parts requiring the most rehabilitation, (ii) the typical environments, initial causes, and general conditions, (iii) the values and parameters to be observed, (iv) common errors and limitations of current practices and technological solutions, and (v) the envisioned and desired technological support. Consequently, it has been performed a systematic review of the state of the art, investigating what types of systems and support currently cope with telerehabilitation practices and possible matches with the outcomes of the focus group. Technological solutions based on video analysis, wearable devices, robotic support, distributed sensing, and gamified telerehabilitation are examined. Particular emphasis is given to solutions implementing agent-based approaches, analyzing and discussing strength, limitations, and future challenges. By doing so, it has been possible to relate functional requirements expressed by professional physiotherapists and researchers, with the need for extending multi-agent systems (MAS) peculiarities at the sensing level in wearable solutions establishing new research challenges. In particular, to be employed in safety-critical cyber-physical scenarios with user-sensor and sensor-sensor interactions, MAS are requested to handle timing constraints, scarcity of resources and new communication means, crucial to providing real-time feedback and coaching. Therefore, MAS pillars such as the negotiation protocol and the agent's internal scheduler have been investigated, proposing solutions to achieve the aforementioned real-time compliance.

Cameirao, M. S., et al. (2010). "Neurorehabilitation using the virtual reality based Rehabilitation Gaming System: methodology, design, psychometrics, usability and validation." J Neuroeng Rehabil 7: 48.
	BACKGROUND: Stroke is a frequent cause of adult disability that can lead to enduring impairments. However, given the life-long plasticity of the brain one could assume that recovery could be facilitated by the harnessing of mechanisms underlying neuronal reorganization. Currently it is not clear how this reorganization can be mobilized. Novel technology based neurorehabilitation techniques hold promise to address this issue. Here we describe a Virtual Reality (VR) based system, the Rehabilitation Gaming System (RGS) that is based on a number of hypotheses on the neuronal mechanisms underlying recovery, the structure of training and the role of individualization. We investigate the psychometrics of the RGS in stroke patients and healthy controls. METHODS: We describe the key components of the RGS and the psychometrics of one rehabilitation scenario called Spheroids. We performed trials with 21 acute/subacute stroke patients and 20 healthy controls to study the effect of the training parameters on task performance. This allowed us to develop a Personalized Training Module (PTM) for online adjustment of task difficulty. In addition, we studied task transfer between physical and virtual environments. Finally, we assessed the usability and acceptance of the RGS as a rehabilitation tool. RESULTS: We show that the PTM implemented in RGS allows us to effectively adjust the difficulty and the parameters of the task to the user by capturing specific features of the movements of the arms. The results reported here also show a consistent transfer of movement kinematics between physical and virtual tasks. Moreover, our usability assessment shows that the RGS is highly accepted by stroke patients as a rehabilitation tool. CONCLUSIONS: We introduce a novel VR based paradigm for neurorehabilitation, RGS, which combines specific rehabilitative principles with a psychometric evaluation to provide a personalized and automated training. Our results show that the RGS effectively adjusts to the individual features of the user, allowing for an unsupervised deployment of individualized rehabilitation protocols.

Cameron, R. A., et al. (2018). "Multimodal Community-Based Exercise for Children with Cerebral Palsy: Dosing Interventions for Effectiveness." Critical Reviews in Physical and Rehabilitation Medicine 30(1): 15-43.
	Dosing is an important component of effectiveness of treatment programs for children with cerebral palsy. Interventions that provide more time for practice have the potential for driving sustainable changes in both plasticity and participation. Regardless of type, the time per session, effort, and frequency of performance of an activity appear to be key factors when dosing for optimal treatment effectiveness. One way to increase engagement and frequency per week of a particular activity is by partnering with community centers, specialized and non-specialized fitness centers, or local physical therapy education programs. We need more information about effective doses of interventions that can be utilized in a multimodal community-based exercise program. In this paper, we review effective doses of whole body vibration, bicycling, active video gaming, body weight support treadmill training, and aquatics for children with cerebral palsy.

Campelo, A. M. and L. Katz (2020). "Older Adults' Perceptions of the Usefulness of Technologies for Engaging in Physical Activity: Using Focus Groups to Explore Physical Literacy." International Journal of Environmental Research & Public Health [Electronic Resource] 17(4).
	Insufficient physical activity (PA) levels observed among older adults remain extremely high and pose a danger to developing and maintaining their physical literacy (PL). Each person's level of PL partly depends on their physical and cognitive skills, confidence level, and degree of motivation to practice PA daily. New technologies, such as exergames and wearable fitness trackers, may enable older adults to increase their PL, stimulating uptake and ongoing PA participation. Objective: This focus group study aims to describe older adults' perceptions of the use of technologies to engage in physical exercise programs. Methods: Fifteen participants were randomly selected from a sample of 40 older adults who completed a randomized controlled trial that investigated the benefits of using technology in the context of group-based exercise programs. Separate post-intervention focus groups were performed with an exergaming group, a conventional physical training group, and a no training group (control). Data were mapped onto constructs from the four domains of PL: affective, physical, cognitive, and behavioral. Results: Generally, participants expressed positive perceptions about the benefits of using technology to engage in PA. These positive feelings outweighed the costs and the lack of familiarization with technology. Common themes for the three groups emerged from the discussions and included familiarization with technology, using fitness tracker to monitor PA, previous exposure to technology, and interaction with peers, staff members, and relatives. In particular, participants from the exergaming group explored the ideas of training their cognitive skills while using the exergame accessories, exercising in an alternative way, competitive versus cooperative play, changes in sense of humor, skill transferability from game to real environment, progressions of the exercise intensities, and the potential use of exergames for rehabilitation. Conclusions: Participants in this study reported positive perceptions about implementing technology into exercise. Emphasizing the benefits of using technology in group-based exercise programs may increase older adults' PL levels and their future technology adoption. The potential implementation of technology into conventional exercise programs should focus on older adults' lifelong values, biopsychosocial conditions, and the possibility of reducing age-related risk of injuries and chronic diseases.

Campo-Prieto, P., et al. (2022). "Wearable Immersive Virtual Reality Device for Promoting Physical Activity in Parkinson's Disease Patients." Sensors 22(9): 26.
	Parkinson's disease (PD) is a neurological disorder that usually appears in the 6th decade of life and affects up to 2% of older people (65 years and older). Its therapeutic management is complex and includes not only pharmacological therapies but also physiotherapy. Exercise therapies have shown good results in disease management in terms of rehabilitation and/or maintenance of physical and functional capacities, which is important in PD. Virtual reality (VR) could promote physical activity in this population. We explore whether a commercial wearable head-mounted display (HMD) and the selected VR exergame could be suitable for people with mild-moderate PD. In all, 32 patients (78.1% men; 71.50 +/- 11.80 years) were a part of the study. Outcomes were evaluated using the Simulator Sickness Questionnaire (SSQ), the System Usability Scale (SUS), the Game Experience Questionnaire (GEQ post-game module), an ad hoc satisfaction questionnaire, and perceived effort. A total of 60 sessions were completed safely (without adverse effects (no SSQ symptoms) and with low scores in the negative experiences of the GEQ (0.01-0.09/4)), satisfaction opinions were positive (88% considered the training "good" or "very good"), and the average usability of the wearable HMD was good (75.16/100). Our outcomes support the feasibility of a boxing exergame combined with a wearable commercial HMD as a suitable physical activity for PD and its applicability in different environments due to its safety, usability, low cost, and small size. Future research is needed focusing on postural instability, because it seems to be a symptom that could have an impact on the success of exergaming programs aimed at PD.

Campo-Prieto, P., et al. (2021). "Immersive Virtual Reality Exergame Promotes the Practice of Physical Activity in Older People: An Opportunity during COVID-19." Multimodal Technologies and Interaction 5(9): 52.
	Life expectancy has increased in recent years. Physical activity has been postulated as a key element in active aging strategies. However, adherence to physical exercise programs has traditionally been low among the elderly, and the current situation of the COVID-19 pandemic has added extra impediments. Immersive virtual reality (IVR) devices could motivate this population to practice exercise. This study aimed to analyse the use of IVR exergames as a tool to facilitate physical exercise in older people. Four healthy older adults (males, 65–77 years) participated in the study. They carried out two exergaming sessions with HTC Vive ProTM. Outcomes were evaluated using the Simulator Sickness Questionnaire (SSQ), System Usability Scale (SUS), Game Experience Questionnaire (GEQ post-game module), an ad hoc satisfaction questionnaire, and perceived effort. All participants completed the sessions without adverse effects, with no SSQ symptoms reported. SUS scores were high in both sessions (SUS > 85/100). Post-game GEQ scores were 3.08–3.41/4 (positive experiences) and 0.08–0.16/4 (negative experiences). Opinions showed high levels of satisfaction with the experience. Exergaming programs, based on commercial head-mounted displays, are a feasible alternative to traditional senior exercise, and could be a solution to the current situation that has arisen from the impact of the COVID-19 pandemic.

Cano-Manas, M. J., et al. (2017). "[Commercial video games in the rehabilitation of patients with sub-acute stroke: a pilot study]." Rev Neurol 65(8): 337-347.
	INTRODUCTION: Stroke generates dependence on the patients due to the various impairments associated. The use of low-cost technologies for neurological rehabilitation may be beneficial for the treatment of these patients. AIM: To determine whether combined treatment using a semi-immersive virtual reality protocol to an interdisciplinary rehabilitation approach, improve balance and postural control, functional independence, quality of life, motivation, self-esteem and adherence to intervention in stroke patients in subacute stage. PATIENTS AND METHODS: A longitudinal prospective study with pre and post-intervention evaluation was carried out. Fourteen were recruited at La Fuenfria Hospital (Spain) and completed the intervention. Experimental intervention was performed during eight weeks in combination with conventional treatment of physiotherapy and occupational therapy. Each session was increased in time and intensity, using commercial video games linked to Xbox 360 degrees videoconsole and Kinect sensor. RESULTS: There were statistical significant improvements in modified Rankin scale (p = 0.04), baropodometry (load distribution, p = 0.03; support surface, p = 0.01), Barthel Index (p = 0.01), EQ-5D Questionnaire (p = 0.01), motivation (p = 0.02), self-esteem (p = 0.01) and adherence to the intervention (p = 0.02). CONCLUSIONS: An interdisciplinary rehabilitation approach supplemented with semi-immersive virtual reality seems to be useful for improving balance and postural control, functional independence in basic activities of daily living, quality of life, as well as motivation and self-esteem, with excellent adherence. This intervention modality could be adopted as a therapeutic tool in neurological rehabilitation of stroke patients in subacute stage.

Capelini, C. M., et al. (2017). "Improvements in motor tasks through the use of smartphone technology for individuals with Duchenne muscular dystrophy." Neuropsychiatr Dis Treat 13: 2209-2217.
	BACKGROUND: In individuals severely affected with Duchenne muscular dystrophy (DMD), virtual reality has recently been used as a tool to enhance community interaction. Smartphones offer the exciting potential to improve communication, access, and participation, and present the unique opportunity to directly deliver functionality to people with disabilities. OBJECTIVE: To verify whether individuals with DMD improve their motor performance when undertaking a visual motor task using a smartphone game. PATIENTS AND METHODS: Fifty individuals with DMD and 50 healthy, typically developing (TD) controls, aged 10-34 years participated in the study. The functional characterization of the sample was determined through Vignos, Egen Klassifikation, and the Motor Function Measure scales. To complete the task, individuals moved a virtual ball around a virtual maze and the time in seconds was measured after every attempt in order to analyze improvement of performance after the practice trials. Motor performance (time to finish each maze) was measured in phases of acquisition, short-term retention, and transfer. RESULTS: Use of the smartphone maze game promoted improvement in performance during acquisition in both groups, which remained in the retention phase. At the transfer phases, with alternative maze tasks, the performance in DMD group was similar to the performance of TD group, with the exception of the transfer to the contralateral hand (nondominant). However, the group with DMD demonstrated longer movement time at all stages of learning, compared with the TD group. CONCLUSION: The practice of a visual motor task delivered via smartphone game promoted an improvement in performance with similar patterns of learning in both groups. Performance can be influenced by task difficulty, and for people with DMD, motor deficits are responsible for the lower speed of execution. This study indicates that individuals with DMD showed improved performance in a short-term motor learning protocol using a smartphone. We advocate that this technology could be used to promote function in this population.

Capin, J. J., et al. (2017). "On-Ice Return-to-Hockey Progression After Anterior Cruciate Ligament Reconstruction." Journal of Orthopaedic & Sports Physical Therapy 47(5): 324-333.
	Synopsis The literature pertaining to the rehabilitation of ice hockey players seeking to return to sport after anterior cruciate ligament reconstruction (ACLR) is currently limited. The purpose of this clinical commentary was to present a criterion-based progression for return to ice hockey for athletes after ACLR. First, we review pertinent literature and provide previously published guidelines on general rehabilitation after ACLR. Then, we present a 4-phase, on-ice skating progression with objective criteria to initiate each phase. During the early on-ice phase, the athlete is reintroduced to specific demands, including graded exposure to forward, backward, and crossover skating. In the intermediate on-ice phase, the emphasis shifts to developing power and introducing anticipated changes of direction within a controlled environment. During the late on-ice phase, the focus progresses to developing anaerobic endurance and introducing unanticipated changes of direction, but still without other players or contact. Finally, once objective return-to-sport criteria are met, noncontact team drills, outnumbered and even-numbered drills, practices, scrimmages, and games are progressively reintroduced during the return-to-sport phase. Recommendations for off-ice strength and conditioning exercises complement the on-ice progression. Additionally, we apply the return-to-hockey progression framework to a case report of a female collegiate defensive ice hockey player who returned to sport successfully after ACLR. This criterion-based return-to-hockey progression may guide rehabilitation specialists managing athletes returning to ice hockey after ACLR. J Orthop Sports Phys Ther 2017;47(5):324-333. Epub 29 Mar 2017. doi:10.2519/jospt.2017.7245.

Carballo-Fazanes, A., et al. (2020). "Physical Activity Habits and Determinants, Sedentary Behaviour and Lifestyle in University Students." International Journal of Environmental Research & Public Health [Electronic Resource] 17(9): 3272.
	University students, as a result of their lifestyles, represent a section of the population that is most likely to adopt sedentary behaviours. The aim of the present study was to analyse the determining factors dictating the performance of physical activity as well as sedentary behaviour among university students. A total of 608 students (64.6% women) from the University of Santiago de Compostela (Spain) were selected by stratified random sampling to take part in the study, which involved completing a questionnaire on lifestyle and physical activity. Of the participating students, 69.6% indicated that they performed physical activity; the main reasons given were to maintain fitness and for health, while a lack of time and laziness were the principal reasons given for abandoning or not taking up physical exercise. Significant associations were established between not doing physical activity and the time exposed to screens, time studying, feeling low and smoking; on the other hand, associations could be seen between doing physical activity and the participation of relatives (parents, mothers, partners, older siblings and friends) in physical activity, as well as a positive sense of satisfaction relating to physical education taught in schools. In conclusion, most of the university students did some physical activity, which was associated with less sedentary behaviour, while the influence of school physical education and of the habits of relatives played an important role.

Carbonera, R. P., et al. (2016). "Physiological responses during exercise with video games in patients with cystic fibrosis: A systematic review." Respiratory Medicine 119: 63-69.
	BACKGROUND: Interactive video games are recently being used as an exercise tool in cystic fibrosis (CF). This study aimed to assess the literature describing whether video games generate a physiological response similar to the exercise intensity needed for training in CF. METHODS: An online search in PubMed, Embase, Cochrane, SciELO, LILACS and PEDro databases was conducted and original studies describing physiological responses of the use of video games as exercise in CF were included. RESULTS: In four, out of five studies, the heart rate achieved during video games was within the standards recommended for training (60-80%). Two studies assessed VO2 and showed higher levels compared to the six-minute walk test. No desaturation was reported. Most games were classified as moderate intensity. Only one study used a maximum exercise test as comparator. CONCLUSION: Interactive video games generate a heart rate response similar to the intensity required for training in CF patients.

Cardinali, D. P., et al. (2002). "A multifactorial approach employing melatonin to accelerate resynchronization of sleep-wake cycle after a 12 time-zone westerly transmeridian flight in elite soccer athletes." Journal of Pineal Research 32(1): 41-46.
	Rapid transmeridian translocation through multiple time zones has a negative impact on athletic performance. The aim of the present study was to test the timely use of three factors (melatonin treatment, exposure to light, physical exercise) to hasten the resynchronization of a group of elite sports competitors and their coaches to a westerly transmeridian flight comprising of 12 time-zones. Twenty-two male subjects were included in the study. They were professional soccer players and their coaches who travelled to Tokyo to play the final game of the Intercontinental Coup. The day prior to departure, urine was collected from each subject from 18:00 to 06:00 hrs to measure the melatonin metabolite 6-sulphatoxymelatonin. Participants were asked to complete sleep log diaries from day 0 (preflight) to the day before returning to Buenos Aires (day 8). All subjects received 3 mg of melatonin p.o. daily at expected bedtime at Tokyo immediately after leaving Buenos Aires. Upon arrival at Tokyo the subjects performed a daily physical exercise routine outdoors at two restricted times of the day (from 08:00 to 11:00 hrs in the morning and from 13:00 to 16:00 hrs in the afternoon). Exposure to sunlight or physical exercise at other times of the day was avoided. Except for the number of awakenings (which increased on days 1 and 3) and sleep latency (which decreased on days 2, 6 and 8), there was an absence of significant changes in subjective sleep parameters as compared with preflight assessment. Sleep quality and morning alertness at Tokyo correlated significantly with preflight 6-sulphatoxymelatonin excretion. Mean resynchronization rate of sleep-wake cycle to the 12 hr-time shift was 2.13 +/- 0.88 days, significantly different from the minimal resynchronization rate of 6 days expected after a 12-time-zones flight. The results indicate that the combination of melatonin treatment, an appropriate environmental light schedule and timely applied physical exercise can be useful to help elite athletes to overcome the consequences of jet lag.

Carlisle, D. (2012). "Your business. Extraordinary measures...in a second article on making physiotherapy more business like, Daloni Carlisle talks to a physio who's ahead of the game in terms of measuring levels of patient satisfaction." Frontline (20454910) 18(7): 30-31.
	
Carmeli, E., et al. (2009). "Physical exercises can reduce anxiety and improve quality of life among adults with intellectual disability." International sportmed journal 10(2): 77‐85.
	
Carneiro, M. I. S., et al. (2016). "Applicability of a motor rehabilitation system in stroke victims." Fisioterapia em Movimento 29(4): 723-730.
	Introduction: The recovery of stroke patients is long and boring due to the repetitive nature of the exercises used and the length of treatment. Thus, we started using virtual reality as an alternative and, because of its advantages, health professionals are adapting video games for physical therapy. However, there are some limitations, such as the fact that games are designed for entertainment and not for therapeutic purposes. Objective: In order to mitigate gaps in assistive devices for physical therapy, this study describes the development and applicability of a computer support system for motor rehabilitation - Ikapp - in stroke victims. Methods: Twenty-seven stroke patients filled out a socioeconomic questionnaire, tested Ikapp during five minutes and answered a usability and satisfaction questionnaire about handling the tool. The chi-square test was used to analyze any association between sociodemographic factors and the features of the system. Results: The Ikapp system can be an excellent device to assist neurological rehabilitation of stroke patients, as participants questionnaires showed that 85.2% were satisfied in regard to motivation and inclusion of Ikapp in physiotherapy and 77.8% relative to ease of interaction with the tool. Conclusion: The Ikapp system proved to be an easy-to-use and accessible computer support system for patients with functional limitations.
Introdução: A recuperação de indivíduos pós-Acidente Vascular Encefálico (AVE) tem se mostrado longa e monótona devido ao caráter repetitivo dos exercícios utilizados na clínica e aos anos de tratamento. Logo, temse utilizado a Realidade Virtual (RV) como uma alternativa e diante de suas vantagens, profissionais de saúde vêm adaptando vídeo games à fisioterapia. No entanto, existem algumas limitações, como a do fato de estes vídeo games terem sido desenvolvidos para diversão e não serem apropriados para uso terapêutico. Objetivo: Em busca de atenuar lacunas existentes em dispositivos adaptados à fisioterapia, este estudo descreve o desenvolvimento e a aplicabilidade de um sistema computacional de suporte a reabilitação motora -- Ikapp -- em pacientes pós-AVE. Métodos: 27 pacientes pós-AVE preencheram um questionário socioeconômico, testaram o Ikapp durante 5 min e responderam a um questionário de usabilidade e satisfação sobre o manuseio da ferramenta. Para analisar a associação de fatores sociodemográficos com funcionalidades do sistema, o teste qui quadrado (Exato de Fisher) foi utilizado. Resultados: O Ikapp pode ser uma excelente ferramenta de auxílio à reabilitação neurológica de pacientes pós-AVE, visto que seus testes evidenciaram 85,2% de satisfação no que diz respeito à motivação e inclusão no processo fisioterápico e 77,8% em relação à facilidade de interação com a ferramenta. Conclusão: O Ikapp mostrou ser um sistema computacional de fácil aplicação e acessível a pacientes com diferentes limitações funcionais.

Caro, K., et al. (2017). "Using the FroggyBobby exergame to support eye-body coordination development of children with severe autism." International Journal of Human-Computer Studies 105: 12-27.
	Children with severe autism lack of the eye-body coordination skills which are needed to conduct aimed limb movements. Physical therapy relies on the repetition of limb movements that demands children with severe autism to aim for a visual target. But their movements during physical therapies are most of the time aimless, and they found the visual stimuli confusing and not engaging. Exergames could support motor therapies as they combine game technology with exercise activity. This technology can offer a natural interaction and use multisensory stimuli appropriate to keep children with autism focused during motor therapeutic interventions. In this paper, we hypothesize that exergames supporting motor therapeutic interventions and alleviating such attention and motor challenges could help children with severe autism to develop the necessary coordination skills needed to follow up visual targets. We present a 7-weeks evaluation study of the deployment of an exergame supporting the practice of eye-body coordination exercises. Seven children with severe autism and three psychotherapists participated in the study. Our results indicate children with severe autism maintained their attention for the total duration of the therapy, reduced their aimless limb movements and developed aimed limb movements, as a result of weeks of usage of the exergame. We close discussing challenges for existing clinical practice from a design and clinical point of view.

Carpinella, I., et al. (2017). "Wearable Sensor-Based Biofeedback Training for Balance and Gait in Parkinson Disease: A Pilot Randomized Controlled Trial." Archives of Physical Medicine & Rehabilitation 98(4): 622-630 e623.
	OBJECTIVES: To analyze the feasibility and efficacy of a novel system (Gamepad [GAMing Experience in PArkinson's Disease]) for biofeedback rehabilitation of balance and gait in Parkinson disease (PD). DESIGN: Randomized controlled trial. SETTING: Clinical rehabilitation gym. PARTICIPANTS: Subjects with PD (N=42) were randomized into experimental and physiotherapy without biofeedback groups. INTERVENTIONS: Both groups underwent 20 sessions of training for balance and gait. The experimental group performed tailored functional tasks using Gamepad. The system, based on wearable inertial sensors, provided users with real-time visual and acoustic feedback about their movement during the exercises. The physiotherapy group underwent individually structured physiotherapy without feedback. MAIN OUTCOME MEASURES: Assessments were performed by a blinded examiner preintervention, postintervention, and at 1-month follow-up. Primary outcomes were the Berg Balance Scale (BBS) and 10-m walk test (10MWT). Secondary outcomes included instrumental stabilometric indexes and the Tele-healthcare Satisfaction Questionnaire. RESULTS: Gamepad was well accepted by participants. Statistically significant between-group differences in BBS scores suggested better balance performances of the experimental group compared with the physiotherapy without biofeedback group both posttraining (experimental group-physiotherapy without biofeedback group: mean, 2.3+/-3.4 points; P=.047) and at follow-up (experimental group-physiotherapy without biofeedback group: mean, 2.7+/-3.3 points; P=.018). Posttraining stabilometric indexes showed that mediolateral body sway during upright stance was significantly reduced in the experimental group compared with the physiotherapy without biofeedback group (experimental group-physiotherapy without biofeedback group: -1.6+/-1.5mm; P=.003). No significant between-group differences were found in the other outcomes. CONCLUSIONS: Gamepad-based training was feasible and superior to physiotherapy without feedback in improving BBS performance and retaining it for 1 month. After training, 10MWT data were comparable between groups. Further development of the system is warranted to allow the autonomous use of Gamepad outside clinical settings, to enhance gait improvements, and to increase transfer of training effects to real-life contexts.

Carregosa, A. A., et al. (2018). "Virtual Rehabilitation through Nintendo Wii in Poststroke Patients: Follow-Up." Journal of Stroke & Cerebrovascular Diseases 27(2): 494-498.
	OBJECTIVE: To evaluate in the follow-up the sensory-motor recovery and quality of life patients 2 months after completion of the Nintendo Wii console intervention and determine whether learning retention was obtained through the technique. METHODS: Five hemiplegics patients participated in the study, of whom 3 were male with an average age of 54.8 years (SD = 4.6). Everyone practiced Nintendo Wii therapy for 2 months (50 minutes/day, 2 times/week, during 16 sessions). Each session lasting 60 minutes, under a protocol in which only the games played were changed, plus 10 minutes of stretching. In the first session, tennis and hula hoop games were used; in the second session, football (soccer) and boxing were used. For the evaluation, the Fulg-Meyer and Short Form Health Survey 36 (SF-36) scales were utilized. The patients were immediately evaluated upon the conclusion of the intervention and 2 months after the second evaluation (follow-up). RESULTS: Values for the upper limb motor function sub-items and total score in the Fugl-Meyer scale evaluation and functional capacity in the SF-36 questionnaire were sustained, indicating a possible maintenance of the therapeutic effects. CONCLUSION: The results suggest that after Nintendo Wii therapy, patients had motor learning retention, achieving a sustained benefit through the technique.

Carro, R. M., et al. (2022). "Serious Games for Training Myoelectric Prostheses through Multi-Contact Devices." Children 9(3): 423.
	In the medical context, designing and developing myoelectric prostheses has made it possible for patients to regain mobility lost due to amputations; however, their use requires intensive training. Serious games through multi-touch devices can serve as a complement to the activities carried out during face-to-face sessions with occupational therapists and physiotherapists, as a useful resource to engage patients, especially children, and make them enjoy training. In this paper, we describe our work to support the training of myoelectric prostheses through digital serious games. Firstly, we studied the needs of children with myoelectric prostheses and the way they perform rehabilitation. Secondly, we designed specific games to support training accordingly. Thirdly, we developed a system able to generate variations of these games dynamically, adapting the elements at each round to the needs and progress of each child. The interfaces are simple, friendly, and based on tablets to favor autonomy. Finally, we assessed the potential of the use of these games for rehabilitation. Specialists in Physiotherapy, Occupational Therapy, Medicine and Special Education collaborated as experts; they agreed that SilverTouch is good for myoelectric prosthetic training and confirmed its potential to be widely used in this context.

Carroll, K. E. and D. J. Galles (2018). "Case study using virtual rehabilitation for a patient with fear of falling due to diabetic peripheral neuropathy." International Journal of Child Health & Human Development 11(2): 257-261.
	The purpose of this retrospective case study is to report on the effects of using virtual rehabilitation (VR) to facilitate improvement of gait stability and endurance in a patient recovering from diabetic neuropathy who also experienced fear of falling. In addition to traditional physical therapy, the patient also participated in six sessions of VR, using custom built games with notable objective and subjective improvements. Timed Up and Go (TUG) testing revealed objective improvements and subjectively the subject's gait appeared more stable and fluid. She reported increased confidence in walking and endorsed increased confidence on the Activity-specific Balance Confidence Scale (ABC). These results support that VR can be an important adjunct to more traditional therapies, add a sense of competition and enjoyment, and increase the engagement of the subject while providing numerous repetitious therapeutic exercises. This study also establishes how VR games can be inexpensively made and tailored to specific therapy needs as these games were made by undergraduate Computer Science students for class credit.

Carvalho, G. F., et al. (2016). "Augmenting back pain exercise therapy using an interactive gaming-based intervention in the home setting." Archives of physical medicine and rehabilitation 97(10): e133‐.
	Research Objectives: To compare the outcomes of a conventional, exercise‐ based rehabilitation intervention for chronic low back pain (cLBP) with the outcomes achieved by combining a conventional intervention with adjunct therapy delivered using an interactive gaming system for homebased therapy. Design: Randomised controlled trial. Setting: Rehabilitation hospital (outpatient). Participants: Six adults 31.8 ± 3.9 years old diagnosed with non‐specific cLBP and pain intensity > 3 (on a visual analog scale ‐ VAS). Interventions: Conventional physical therapy for both groups for 8 weeks. The Usual Care group (UCG, n=3) received prescription of additional regular home‐based exercises. The Game Therapy group (GTG, n=3) performed instead home exercises using the Valedo interactive gaming system. Main Outcome Measure(s): Pain intensity (Visual Numeric Scale ‐ VNS 0‐10), number of days with pain and severity of bothersome pain (VAS 0‐10) over the last week; Owestry questionnaire; and exercise adherence. Results: Both groups showed general improvements in response to treatment. The GTG showed greater improvement in pain intensity (‐1.7 points) than the UCG (+0.3 points). It also showed a greater change in the Oswestry score (4.3 points) than the UCG (0.6 points). However, the UCG showed a greater change in number of days with pain over the last week (‐3.3 days) than the GTG (+0.3 days). It also showed a greater change in the severity of bothersome pain over the last week (‐1.3 on a VAS 0‐10) than the GTG (+0.33). Exercise adherence was higher in the UCG (57%) than in the GTG (49%). Conclusions: The study has so far shown the feasibility of utilizing an interactive gaming system in the treatment of patients with cLBP. Future results of this clinical trial (as we continue to recruit subjects) will contribute to determine the effectiveness of this treatment option.

Cary, F., et al. (2014). "Kinect Based System and Serious Game Motivating Approach for Physiotherapy Assessment and Remote Session Monitoring." International Journal on Smart Sensing and Intelligent Systems 7(5): 1-6.
	This paper describes a framework focused on being a health monitoring platform as well as a source of entertainment for physiotherapy patients, particularly stroke survivors. Using the Microsoft Kinect sensor a serious game captures 3D data during the patient’s session and sends it to a server. Through a web application these data can be further visualized by the physiotherapists on their assessments. Moreover, this framework intends to be a useful and effective tool for remote physiotherapy sessions allowing for a considerable cost reduction. Experimental results related to arms and shoulders rehabilitation are included in this paper.

Casserly, D. M. and G. D. Baer (2013). "Effectiveness of commercially available gaming devices in upper limb stroke rehabilitation." Physical Therapy Reviews 19(1): 15-23.
	Background: Hemiparesis of the upper extremity is estimated to affect 50-75% of individuals who experience a stroke. Recently the use of commercially available off-the-shelf (COTS) gaming technology has shown promise for providing interactive rehabilitation. The existing evidence however, has not yet been reviewed systematically to determine the effectiveness of such gaming devices in upper limb (UL) rehabilitation post-stroke. Objectives: To determine the effectiveness of COTS gaming technology for UL rehabilitation in post-stroke patients and to assess the feasibility, and effect on quality of life (QoL). Methods: A systematic search of the databases CINAHL, MEDLINE, PsycINFO, Pubmed, SPORTDiscus, and SCOPUS was conducted. Quality scoring of the included articles was based on the Effective Public Health Practice Project (EPHPP) quality assessment tool for quantitative studies. Results: In total, eight studies were included for review. The commercial gaming devices were found to be feasible for use among post-stroke individuals. The devices were found to be effective as an adjunct to conventional stroke rehabilitation, and were feasible in relation to time taken, cost-effectiveness, safety, and the positive effect on the QoL of the stroke population. Conclusions: As the findings of the current review are primarily based on lower levels of research, it is not possible to make recommendations regarding the use of these devices in clinical practice. However, findings of the included studies did indicate that rehabilitation including gaming technology had a positive effect on the UL rehabilitation of stroke patients.

Castañer, M., et al. (2016). "Quality of physical activity of children in exergames: Sequential body movement analysis and its implications for interaction design." International Journal of Human-Computer Studies 96: 67-78.
	Exergames are videogames based on full-body interaction that foster physical exercise during gameplay. Much research has focused on whether exergames foster sufficient physical activity and with which intensity they do so. This is usually measured through energy expenditure and compared to traditional physical activities such as sports or physical education exercises. However, little research has been undertaken on the quality of the physical activity, understood not as how well the movement is done, but as the richness and diversity of physical activity defined by experts, such as diverse types of motor skills (jumps, turns, pivots, manipulative actions, etc) and diverse types of conditioning capabilities (endurance, stretch, general strength, coordination, etc.). Hence, exergames typically address only aerobic (cardiovascular) activity and other types tend to be ignored. In this paper we propose a method for analyzing the types of physical activity (quality) that an exertion interface elicits. We propose this method as an analytical tool which can provide key information to categorize exergames, aid to their design and help designers make sure they achieve game mechanics that elicit the desired types of physical activity. We describe the method through the analysis of two exergames that we developed in the past for our exertion interface for children, called the Interactive Slide. We present the results of a systematic observational method, until now used mainly in sports analysis, which is based on applying sequential body movement analysis to obtain the play characteristics of 48 children. These results -action events and time-based patterns- typify the movement found in the two aforementioned exergames for this platform. We have found significant movement differences between the two, as well as some differences associated to age. Moreover, we show that sequential body movement analysis, which has already been successfully used in the past to analyze sports, can also be effective in analyzing exergames and hence allow grounded discussion on health issues related to their use.

Cavalcanti, V. C., et al. (2019). "Usability and effects of text, image and audio feedback on exercise correction during augmented reality based motor rehabilitation." Computers & Graphics 85: 100-110.
	This paper aims to evaluate text, image and audio feedback regarding usability, exercise correction and user preferences when using Augmented Reality (AR) to guide movements execution in rehabilitation applications. For that, this study used an AR rehabilitation tool, named ARkanoidAR, which attempts to correct the wrong movement performed by a user through text, image and audio feedback, while he/she is playing a game controlled based on the therapy protocol defined by a physiotherapist for that particular user. The ARkanoidAR uses a Kinect sensor to track the human body and its movements, and it is completely configurable according to patient therapy needs. To evaluate feedback effects individually, this study collected quantitative data to measure success rate, which represents the amount of time that the user executed the movements correctly when using the application with each feedback individually activated. Experiments were composed of five phases: control, text, image, audio and control. The feedback sequence was randomized before the tests in order to avoid bias. Quantitative results show that users understood the instructions for performing the movements correctly since the success rate along time increased. Tests also included observation and qualitative analysis through questionnaires and a semi-structured interview to evaluate the usability perception of users. The qualitative data helped to detect different types of problems for each feedback based on users’ answers. This study was carried out with healthy people, and did not predict the particularities and limitations of physiotherapy patients.

Ceranoglu, T. A. (2010). "Star Wars in psychotherapy: video games in the office." Academic Psychiatry 34(3): 233-236.
	OBJECTIVE: Video games are used in medical practice during psycho-education in chronic disease management, physical therapy, rehabilitation following traumatic brain injury, and as an adjunct in pain management during medical procedures or cancer chemotherapy. In psychiatric practice, video games aid in social skills training of children with developmental delays and in cognitive behavioral therapy (CBT). This most popular children's toy may prove a useful tool in dynamic psychotherapy of youth. METHODS: The author provides a framework for using video games in psychotherapy by considering the characteristics of video games and describes the ways their use has facilitated various stages of therapeutic process. RESULTS: Just as other play techniques build a relationship and encourage sharing of emotional themes, sitting together in front of a console and screen facilitates a relationship and allows a safe path for the patient's conflict to emerge. CONCLUSION: During video game play, the therapist may observe thought processes, impulsivity, temperament, decision-making, and sharing, among other aspects of a child's clinical presentation. Several features inherent to video games require a thoughtful approach as resistance and transference in therapy may be elaborated differently in comparison to more traditional toys. Familiarity with the video game content and its dynamics benefits child mental health clinicians in their efforts to help children and their families.

Chadda, D. (2008). "Game plan." Physiotherapy Frontline 14(13): 4-4.
	
Chan, G., et al. (2019). "Motivational strategies and approaches for single and multi-player exergames: a social perspective." PeerJ Comput Sci 5: e230.
	BACKGROUND: Exergames have attracted the interest of academics, practitioners, and designers, in domains as diverse as health, human-computer interaction, psychology, and information technology. This is primarily because exergames can make the exercise experience more enjoyable and entertaining, and in turn, can increase exercise levels. Despite the many benefits of exergames, they suffer from retention problems. Thus, the objective of this article was to review theories and game elements that have been empirically examined or employed in an attempt to make exergames more motivating so people engage in sustained physical activity (duration of physical activity) in a repeating pattern over time (frequency of physical activity). METHODOLOGY: A literature search and narrative review were conducted. RESULTS: Five major theories and elements were prevalent in the exergaming literature: (1) self-determination theory, (2) gamification, (3) competition and cooperation, (4) situational interest, and (5) social interaction. These theories and elements are important for encouraging long-term play and show promise for designing exergames to promote sustained engagement and motivate physical activity. We discuss their strengths and weaknesses throughout the paper. CONCLUSIONS: The long-term effectiveness of exergame interventions is unclear mainly because of the limited amount of long-term studies. Better metrics are also needed to evaluate this effectiveness. We also identified particular attention to social factors and group dynamics, such as multi-player exergames and more effective player matchmaking strategies for increasing social connectedness, as a key area of future research.

Chan, T. C., et al. (2012). "Interactive virtual reality Wii in geriatric day hospital: a study to assess its feasibility, acceptability and efficacy." Geriatrics & gerontology international 12(4): 714-721.
	AIM: Rehabilitation using interactive virtual reality Wii (Wii-IVR) was shown to be feasible in patients with different medical problems, but there was no study examining its use in a geriatric day hospital (GDH). The aim of the present study was to test the feasibility, acceptability and efficacy of Wii-IVR in GDH. METHODS: It was a clinical trial with matched historic controls. Patients of a GDH were recruited to participate in Wii-IVR by playing "Wii Fit". Participants used a Wii controller to carry out movements involved in an arm ergometer. Each participant received eight sessions of Wii-IVR in addition to conventional GDH rehabilitation. Feasibility was assessed by the total time receiving Wii-IVR, the percentage of maximal heart rate reserve (%MHR) and Borg perceived exertion scale (BS) after participating in Wii-IVR. %MHR and BS were compared with those after carrying out an arm ergometer for the same duration. Acceptability was assessed by an interviewer-administered questionnaire. Efficacy was assessed by comparing improvements in Functional Independence Measure (FIM) between participants and matched historic controls, who received conventional GDH rehabilitations only. RESULTS: A total of 30 patients completed the study. Participants completed a total of 1941 min of event-free Wii-IVR. The mean %MHR was 15.9% +/- 9.9% and the mean BS was 7.9 +/- 2.3. There was no significant difference in %MHR and BS between participating in Wii-IVR and arm ergometer. Most participants found Wii-IVR similar to the arm ergometer, and would like to continue Wii-IVR if they had Wii at home. Improvements in FIM of participants were significantly more than that of historic controls. CONCLUSIONS: Wii-IVR in GDH was feasible and most participants accepted it. Participants had more improvements in FIM.

Chang, J. Y., et al. (2021). "Review of physiotherapy service for athletes of 2018 Olympic Winter games: Consideration of preparation for two polyclinics." Physical Therapy in Sport 49: 106-111.
	OBJECTIVE: This study will provide to better understand the needs for physiotherapy services during the 2018 PyeongChang Olympic Winter Games (POG) from two polyclinics. It is necessary to understand the needs and what physiotherapists do during the Olympic Winter games for first time. DESIGN: An observational study. SETTING: 2018 PyeongChang Olympic Winter Games. PARTICIPANTS: Athletes who visited the physiotherapy department of polyclinics. RESULTS: During 25 the days of the POG, a total of 125 athletes (n = 125, 83 males, 42 females) visited the two polyclinics. Of all visits, 69.6% were from the mountain polyclinic and 30.4% from the city. There were three reasons for visit, most of the reason for visit was injury and injury with recovery or injury prevention. Overall, the injury rate (per 1000 athletes) was 42.8 across 13 sports visited the physiotherapy department during the POG. Total numbers of treatments sessions were 823 provided and electrophysical modalities (36.2%) was the most utilized service in POG. And also there were significant differences in the physiotherapy services provided at the two polyclinics. CONCLUSION: As each polyclinic differed in location, they addressed different populations of athletes; hence, the study provides insights into the injury trends and different physiotherapy treatments.

Chang, Y. J., et al. (2013). "A Kinect-based upper limb rehabilitation system to assist people with cerebral palsy." Research in Developmental Disabilities 34(11): 3654-3659.
	This study assessed the possibility of rehabilitating two adolescents with cerebral palsy (CP) using a Kinect-based system in a public school setting. The system provided 3 degrees of freedom for prescribing a rehabilitation program to achieve customized treatment. This study was carried out according to an ABAB reversal replication design in which A represented the baseline and B represented intervention phases. Data showed that the two participants significantly increased their motivation for upper limb rehabilitation, thus improving exercise performance during the intervention phases. Practical and developmental implications of the findings are discussed.

Chanpimol, S., et al. (2020). "Acceptability and outcomes of an individualized exergaming telePT program for veterans with multiple sclerosis: a pilot study." Arch Physiother 10: 18.
	BACKGROUND: Physical rehabilitation services are an important component of treatment for persons with multiple sclerosis (PwMS) to improve and maintain physical mobility. However, PwMS often have significant barriers to outpatient physical therapy (PT) services including mobility deficits and lack of transportation. The integration of exercise gaming (exergaming) and telehealth into clinical PT practices may overcome these barriers. The overarching purpose of this pilot study was to evaluate the acceptability and effects of an individualized telePT intervention using exergaming. METHODS: Ten individuals with multiple sclerosis (MS) completed a 12-week exergaming (Jintronix(R)) telerehabilitation intervention. In order to measure the acceptability of the telerehabilitation intervention, adherence was measured through the tablet-based rehabilitation software and each participant completed a satisfaction questionnaire. Clinical outcome measures were assessed at baseline and post-intervention. To evaluate the efficacy of this intervention, the following measures of physical function and fatigue were included; the Short Physical Performance Battery (SPPB), 25-Foot Walk (25FW), Modified Fatigue Impact Scale (MFIS), Multiple Sclerosis Walking Scale-12 (MSWS), and the 2-Minute Walk Test (2MWT). Clinical outcomes were analyzed using the Sign test and Wilcoxon signed rank test. All other data were evaluated using descriptive statistics. RESULTS: After the intervention, participants demonstrated significant improvements in ambulation speed during the 25FW (p = 0.04) and ambulation distance during the 2MWT (p = 0.002). Statistically significant increases of SPPB total score (p = .04) and sub-scores were also found. Participants did not demonstrate significant changes in the MFIS (p = 0.31) or MSWS-12 (p = 0.06) after the intervention. Participants had a 58.3% adherence rate during the intervention and performed their exercise program an average of 2.5 times per week. All participants reported that they were either 'satisfied or 'very satisfied' with their telerehabilitation experience, would use telerehabilitation again, and would recommend telerehabilitation to others. CONCLUSION: This individualized telerehabilitation intervention which integrates exergaming and clinical video teleconferencing is acceptable to patients and may offer a viable alternative to traditional PT for PwMS. TRIAL REGISTRATION: NCT03655431, retrospectively registered on August 31st, 2018.

Chanpimol, S., et al. (2017). "Using Xbox kinect motion capture technology to improve clinical rehabilitation outcomes for balance and cardiovascular health in an individual with chronic TBI." Arch Physiother 7.
	BACKGROUND: Motion capture virtual reality-based rehabilitation has become more common. However, therapists face challenges to the implementation of virtual reality (VR) in clinical settings. Use of motion capture technology such as the Xbox Kinect may provide a useful rehabilitation tool for the treatment of postural instability and cardiovascular deconditioning in individuals with chronic severe traumatic brain injury (TBI). The primary purpose of this study was to evaluate the effects of a Kinect-based VR intervention using commercially available motion capture games on balance outcomes for an individual with chronic TBI. The secondary purpose was to assess the feasibility of this intervention for eliciting cardiovascular adaptations. METHODS: A single system experimental design (n = 1) was utilized, which included baseline, intervention, and retention phases. Repeated measures were used to evaluate the effects of an 8-week supervised exercise intervention using two Xbox One Kinect games. Balance was characterized using the dynamic gait index (DGI), functional reach test (FRT), and Limits of Stability (LOS) test on the NeuroCom Balance Master. The LOS assesses end-point excursion (EPE), maximal excursion (MXE), and directional control (DCL) during weight-shifting tasks. Cardiovascular and activity measures were characterized by heart rate at the end of exercise (HRe), total gameplay time (TAT), and time spent in a therapeutic heart rate (TTR) during the Kinect intervention. Chi-square and ANOVA testing were used to analyze the data. RESULTS: Dynamic balance, characterized by the DGI, increased during the intervention phase chi(2) (1, N = 12) = 12, p = .001. Static balance, characterized by the FRT showed no significant changes. The EPE increased during the intervention phase in the backward direction chi(2) (1, N = 12) = 5.6, p = .02, and notable improvements of DCL were demonstrated in all directions. HRe (F (2,174) = 29.65, p = < .001) and time in a TTR (F (2, 12) = 4.19, p = .04) decreased over the course of the intervention phase. CONCLUSIONS: Use of a supervised Kinect-based program that incorporated commercial games improved dynamic balance for an individual post severe TBI. Additionally, moderate cardiovascular activity was achieved through motion capture gaming. Further studies appear warranted to determine the potential therapeutic utility of commercial VR games in this patient population. TRIAL REGISTRATION: Clinicaltrial.gov ID - NCT02889289.

Chanthaphun, S., et al. (2019). "Development of a training paradigm for voluntary control of the peri-auricular muscles: a feasibility study." J Neuroeng Rehabil 16(1): 75.
	BACKGROUND: Spinal cord injury (SCI) can lead to severe and permanent functional deficits. In humans, peri-auricular muscles (PAMs) do not serve any physiological function, though their innervation is preserved in even high level SCI. Auricular control systems provide a good example of leveraging contemporary technologies (e.g., sEMG controlled computer games) to enable those with disabilities. Our primary objective is to develop and test the effectiveness of an auricular muscle training protocol to facilitate isolated and coordinated, bilateral voluntary control that could be used in individuals without volitional control of the vestigial PAMs. METHODS: Seventeen non-disabled persons were screened; 13 were eligible and 10 completed the entire protocol. The facilitation phase, included one session of sub-motor threshold, sensory electrical stimulation followed by neuromuscular electrical stimulation paired with ear movement feedback for up to 8 additional sessions. Participants progressed to the skill acquisition phase where they dawned an auricular control device that used sEMG signals to control movements of a cursor through three levels of computer games, each requiring increasingly more complex PAM coordination. RESULTS: The 10 who completed the protocol, finished the facilitation phase in 3 to 9 sessions and achieved some level of voluntary auricle movement that ranged between 1 and 5 mm. Qualitative analysis of longitudinal post-session auricular movement, revealed two subgroups of learners. Six successfully completed all 3 games-the "Learners". Two were partially successful in game completion and two were unable to complete a single game--"Poor/Non-Learners". Quantitative analysis revealed a significant group difference in auricular amplitude for both facilitation and skill phases (p < .05), and a significant relationship between performance in the two phases (R(2) = 0.84, p = 0.004). CONCLUSION: Sixty percent of those who completed the facilitation phase were able to learn and demonstrate functional voluntary control of the vestigial PAMs. Those who progressed the fastest through facilitation were also those who were most proficient in skill acquisition with the device. There was considerable variability in progression through the two-phase protocol, with 20% deemed Poor/Non-Learners and unable to complete even the most basic game following training. There were no serious adverse events. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT02358915 , first posted February 9, 2015.

Chen, C. C. (2016). "Improvement in the physiological function and standing stability based on kinect multimedia for older people." Journal of Physical Therapy Science 28(4): 1343-1348.
	[Purpose] The increase in the Taiwanese older population is associated with age-related inconveniences. Finding adequate and simple physical activities to help the older people maintaining their physiological function and preventing them from falls has become an urgent social issue. [Subjects and Methods] This study aimed to design a virtual exercise training game suitable for Taiwanese older people. This system will allow for the maintenance of the physiological function and standing stability through physical exercise, while using a virtual reality game. The participants can easily exercise in a carefree, interactive environment. This study will use Kinect for Windows for physical movement detection and Unity software for virtual world development. [Results] Group A and B subjects were involved in the exercise training method of Kinect interactive multimedia for 12 weeks. The results showed that the functional reach test and the unipedal stance test improved significantly. [Conclusion] The physiological function and standing stability of the group A subjects were examined at six weeks post training. The results showed that these parameters remained constant. This proved that the proposed system provide substantial support toward the preservation of the Taiwanese older people' physiological function and standing stability.

Chen, C. K., et al. (2018). "Acceptance of different design exergames in elders." PLoS ONE [Electronic Resource] 13(7): e0200185.
	For promoting the successful aging of elderly residents of Chang Gung Silver Village in Taiwan, five interactive exergames were developed to promote the well-being of the elderly. The exergames included both physical games and cognitive games, and were implemented using various computer-based technologies in the Chang Gung Silver Village. The exergames were trialed by 39 elderly residents (15 male, 24 female; mean age 79.5 +/- 17.5 years) of Chang Gung Silver Village. Following the trials, the participants were requested to complete a Technology Acceptance Model 2 (TAM2) questionnaire. The results showed that the perceived playfulness and perceived usefulness of the exergames were significantly related to the users' usage behavior and intention to use for both the physical games and the cognitive games. However, a relationship between the output quality of the game and the usage behavior was apparent only in the case of the cognitive exergames. Finally, the impact of social influence on the intention to use and the usage behavior was more pronounced for the physical exergames. Overall, the results revealed that the acceptance of exergames by the elderly depends not so much on the awareness of fun in using the game, but the perceived usefulness of the related physical and cognitive abilities.

Chen, K., et al. (2016). "Home-Based Versus Laboratory-Based Robotic Ankle Training for Children With Cerebral Palsy: A Pilot Randomized Comparative Trial." Archives of Physical Medicine & Rehabilitation 97(8): 1237-1243.
	OBJECTIVE: To examine the outcomes of home-based robot-guided therapy and compare it to laboratory-based robot-guided therapy for the treatment of impaired ankles in children with cerebral palsy. DESIGN: A randomized comparative trial design comparing a home-based training group and a laboratory-based training group. SETTING: Home versus laboratory within a research hospital. PARTICIPANTS: Children (N=41) with cerebral palsy who were at Gross Motor Function Classification System level I, II, or III were randomly assigned to 2 groups. Children in home-based and laboratory-based groups were 8.7+/-2.8 (n=23) and 10.7+/-6.0 (n=18) years old, respectively. INTERVENTIONS: Six-week combined passive stretching and active movement intervention of impaired ankle in a laboratory or home environment using a portable rehabilitation robot. MAIN OUTCOME MEASURES: Active dorsiflexion range of motion (as the primary outcome), mobility (6-minute walk test and timed Up and Go test), balance (Pediatric Balance Scale), Selective Motor Control Assessment of the Lower Extremity, Modified Ashworth Scale (MAS) for spasticity, passive range of motion (PROM), strength, and joint stiffness. RESULTS: Significant improvements were found for the home-based group in all biomechanical outcome measures except for PROM and all clinical outcome measures except the MAS. The laboratory-based group also showed significant improvements in all the biomechanical outcome measures and all clinical outcome measures except the MAS. There were no significant differences in the outcome measures between the 2 groups. CONCLUSIONS: These findings suggest that the translation of repetitive, goal-directed, biofeedback training through motivating games from the laboratory to the home environment is feasible. The benefits of home-based robot-guided therapy were similar to those of laboratory-based robot-guided therapy.

Chen, M., et al. (2020). "Design and Evaluation of an Augmented Reality-Based Exergame System to Reduce Fall Risk in the Elderly." International Journal of Environmental Research & Public Health [Electronic Resource] 17(19): 7208.
	Falls are a major public health concern in today's aging society. Virtual reality (VR) technology is a promising method for reducing fall risk. However, the absence of representations of the user's body in a VR environment lessens the spatial sense of presence. In terms of user experience, augmented reality (AR) can provide a higher degree of presence and embodiment than VR. We developed an AR-based exergame system that is specifically designed for the elderly to reduce fall risk. Kinect2.0 was used to capture and generate 3D models of the elderly and immerse them in an interactive virtual environment. The software included three functional modules: fall risk assessment, cognitive-motor intervention (CMI) training, and training feedback. The User Experience Questionnaire (UEQ-S) was used to evaluate user experience. Twenty-five elders were enrolled in the study. It was shown that the average scores for each aspect were: pragmatic quality score (1.652 +/- 0.868); hedonic quality score (1.880 +/- 0.962); and overall score was 1.776 +/- 0.819. The overall score was higher than 0.8, which means that the system exhibited a positive user experience. After comparing the average score in a dataset product of UEQ-S Data Analysis Tool, it was found that the pragmatic quality aspect was categorized as good, while the hedonic quality aspect was categorized as excellent. It revealed a positive evaluation from users.

Chen, S. C., et al. (2021). "Feasibility and effect of interactive telerehabilitation on balance in individuals with chronic stroke: a pilot study." J Neuroeng Rehabil 18(1): 71.
	BACKGROUND: Stroke survivors need continuing exercise intervention to maintain functional status. This study assessed the feasibility and efficacy of an interactive telerehabilitation exergaming system to improve balance in individuals with chronic stroke, compared to conventional one-on-one rehabilitation. METHODS: In this prospective case-control pilot study, 30 Taiwanese individuals with chronic stroke were enrolled and randomly allocated to an experimental group and a control group. All participants received intervention 3 times per week for 4 weeks in the study hospital. The experiment group underwent telerehabilitation using a Kinect camera-based interactive telerehabilitation system in an independent room to simulate home environment. In contrast, the control group received conventional one-on-one physiotherapy in a dedicated rehabilitation area. The effectiveness of interactive telerehabilitation in improving balance in stroke survivors was evaluated by comparing outcomes between the two groups. The primary outcome was Berg Balance Scale (BBS) scores. Secondary outcomes were performance of the Timed Up and Go (TUG) test, Modified Falls Efficacy Scale, Motricity Index, and Functional Ambulation Category. RESULTS: Comparison of outcomes between experimental and control groups revealed no significant differences between groups at baseline and post-intervention for all outcome measures. However, BBS scores improved significantly in both groups (control group: p = 0.01, effect size = 0.49; experimental group: p = 0.01, effect size = 0.70). Completion times of TUG tests also improved significantly in the experimental group (p = 0.005, effect size = 0.70). CONCLUSION: The Kinect camera-based interactive telerehabilitation system demonstrates superior or equal efficacy compared to conventional one-on-one physiotherapy for improving balance in individuals with chronic stroke. Trial registration ClinicalTrials.gov. NCT03698357. Registered October 4, 2018, retrospectively registered.

Chen, T. Y., et al. (2015). "Effects of transcranial direct current stimulation on balance in healthy adults." Physiotherapy 101: eS229.
	Background: tDCS (transcranial direct current stimulation) is a safe, non‐invasive brain stimulation modality. Through applying weak direct current on the target brain region, it can induce cortical excitability changes in humans. Disorders like Parkinson's, cerebral palsy, and strokes who usually present balance deficit are commonly seen in the clinics. Purpose: The aim of this study was to evaluate the effects of tDCS on balance in healthy adults. We hypothesized that the balance in healthy adults can be improved after practicing a balance motor task combined with tDCS. Methods: Fourteen healthy adults (mean age: 23.3 y/o, mean height: 163.3 cm, mean weight: 56.7 kg) involved in the study. Participants were randomly distributed into (1) sham (n = 7), (2) tDCS (n = 7) group. The stimulation parameters were (1) intensity: 1 mA, (2) ramp up/down: 10 seconds, (3) stimulation session: 20 minutes (sham group: 30 seconds). Anode was placed over primary motor cortex (Cz) and cathode was placed over inion. Balance motor task was a computer game that participants had to control a moveable plate as match as possible with target plate by performing ankle dorsiflexion and plantarflexion on the seesaw. Parameters of center of pressure (COP) were recorded by Nintendo Wii Balance Board and seesaw's angle was recorded by inclinometer. Training session contained eight trials, each trial lasted 2 minutes with an inter‐trial (1 minute) for rest to avoid muscle fatigue. Participants received tDCS during training session. Learning effect was calculated by the coefficient between target plate and control plate. Independent t test was used to compare theCOPand seesaw's angle between groups. The significance level was p < 0.05. Results: There were no significant difference in COP of bilateral foot standing (static condition, p = 0.80), bilateral foot standing on the air pillow (dynamic condition, p = 0.24), static standing on the seesaw (p = 0.40) in two groups. However, compared to sham group, learning effect was larger in tDCS group but without statistical significance (0.64 vs. 0.47, p = 0.489). Conclusion(s): There was no significant finding in this study. However, there was one trend that the learning effect of practicing a balance motor task was larger with tDCS. So, we had to recruit more participants in this study to confirm this effect. Implications: Disorders with balance deficit were commonly seen in the clinics. In the future, researchers could focus on the patients whom were post‐stroke or Parkinson's, even elderly.

Chen, Y., et al. (2018). "Effectiveness of Virtual Reality in Children With Cerebral Palsy: A Systematic Review and Meta-Analysis of Randomized Controlled Trials." Physical Therapy 98(1): 63-77.
	Background. Researchers recently investigated the effectiveness of virtual reality (VR) in helping children with cerebral palsy (CP) to improve motor function. A systematic review of randomized controlled trials (RCTs) using a meta-analytic method to examine the effectiveness of VR in children with CP was thus needed. Purpose. The purpose of this study was to update the current evidence about VR by systematically examining the research literature. Data Sources. A systematic literature search of PubMed, CINAHL, Cochrane Central Register of Controlled Trials, ERIC, PsycINFO, and Web of Science up to December 2016 was conducted. Study Selection. Studies with an RCT design, children with CP, comparisons of VR with other interventions, and movement-related outcomes were included. Data Extraction. A template was created to systematically code the demographic, methodological, and miscellaneous variables of each RCT. The Physiotherapy Evidence Database (PEDro) scale was used to evaluate the study quality. Effect size was computed and combined using meta-analysis software. Moderator analyses were also used to explain the heterogeneity of the effect sizes in all RCTs. Data Synthesis. The literature search yielded 19 RCT studies with fair to good methodological quality. Overall, VR provided a large effect size (d = 0.861) when compared with other interventions. A large effect of VR on arm function (d = 0.835) and postural control (d = 1.003) and a medium effect on ambulation (d = 0.755) were also found. Only the VR type affected the overall VR effect: an engineer-built system was more effective than a commercial system. Limitations. The RCTs included in this study were of fair to good quality, had a high level of heterogeneity and small sample sizes, and used various intervention protocols. Conclusions. When compared with other interventions, VR seems to be an effective intervention for improving motor function in children with CP.

Chen, Y., et al. (2021). "Comparison between the effects of exergame intervention and traditional physical training on improving balance and fall prevention in healthy older adults: a systematic review and meta-analysis." J Neuroeng Rehabil 18(1): 164.
	OBJECTIVE: Physical training (PT, e.g., Tai Chi and strength training) has been demonstrated to improve balance control and prevent falls. Recently, exergame intervention (EI) has emerged to prevent falls by enhancing both physical and cognitive functions in older adults. Therefore, we aim to quantitatively assess and compare the effects of PT and EI on the performance of balance control and fall prevention in healthy older adults via meta-analysis. METHODS: A search strategy based on the PICOS principle was used to find the publication in the databases of PubMed, EMBASE, Web of Science, Cochrane Library, and MEDLINE. The quality and risk of bias in the studies were independently assessed by two researchers. RESULTS: Twenty studies consisting of 845 participants were included. Results suggested that as compared to PT, EI induced greater improvement in postural control (sway path length, SMD = - 0.66, 95% CI - 0.91 to - 0.41, P < 0.001, I(2) = 0%; sway speed, SMD = - 0.49, 95% CI - 0.71 to - 0.27, P < 0.001, I(2) = 42%) and dynamic balance (SMD = - 0.19, 95% CI - 0.35 to - 0.03, P = 0.02, I(2) = 0%) in healthy older adults. The EI with 90-119 min/week for more than 8-week significantly reduced falls. Subgroup analyses revealed that exergames, which were designed by the two principles of repeatedly performing diversified tasks and gradually increase the difficulty of the task, induced significant effects in improving balance control and falls prevention respectively (P = 0.03, P = 0.009). In addition, intervention that combines EI and PT induced significant improvement in postural control (P = 0.003). CONCLUSION: The exergame intervention, especially the combination of EI and PT, is a promising strategy to improve balance control and reduce falls in healthy older adults. Future studies with rigorous design, larger sample size, and follow-up assessments are needed to further assess the effectiveness of diverse exergame interventions in fall prevention and to quantify the "dose-effect" relationship, as well as the carry-over effect of such intervention, which will ultimately help optimize the rehabilitative strategies to improve balance control and prevent falls.

Cheshire, W. P. (2013). "Highlights in clinical autonomic neuroscience: Autonomic correlates of social cognition." Auton Neurosci 174(1-2): 5-7.
	Human beings by nature are relational and in relating to others modulate their autonomic responses. Interpersonal relationships may be stressful or calming depending on social contexts, individual temperaments and personality traits. Not only human relationships, but also interactions with affectionate pets and virtual relationships via social networking technology can elicit autonomic responses. These responses range from sympathetic arousal to vagal modulation of cardiovascular activity, and from changes in energy intake and expenditure to modification of physical exercise habits, all of which have potential implications for health and well-being.

Cheung, J., et al. (2013). "Virtual reality as balance rehabilitation for children with brain injury: A case study." Technology and Disability 25(3): 207-219.
	BACKGROUND: Balance impairments are common in children with acquired brain injury (ABI) and a need exists to explore motivating interventions with this population. Xbox Kinect is a gaming system that might assist therapists in providing meaningful rehabilitation. OBJECTIVE: To explore the effect of Kinect on improving balance and motivation in one child with ABI. METHODS: Using an A-B design, the participant received traditional balance therapy for five days, followed by 15 days of Kinect rehabilitation. Balance and motivation were measured daily; function measured weekly. Baseline and intervention trend lines were visually analyzed to assess changes in balance and motivation. RESULTS: Participant was unable to follow protocol; intervention was modified to use Nintendo Wii at day 14. While Kinect data showed greater improvement in balance when compared to traditional and Wii rehabilitation, Wii showed greater improvement in dynamic balance involving the body's affected side. Motivation remained high between baseline and intervention. CONCLUSIONS: Kinect may be challenging to use therapeutically early in rehabilitation for improving balance in children with ABI. However, Kinect might improve balance more than traditional or Wii rehabilitation when used with the appropriate child at the right stage of rehabilitation. Motivation results remain inconclusive. Further research is warranted.

Cheung, N.-y., et al. (2020). "Virtual reality–based cognitive-motor training on cognitive functions in older people: a systematic review." Asian Journal of Gerontology and Geriatrics 15(1): 46.
	
Chia, J. K., et al. (2011). "Medical care delivery at the Inaugural Youth Olympic Games Singapore 2010." British Journal of Sports Medicine 45(16): 1283-1288.
	Context Mass gatherings such as the Youth Olympic Games require medical services for large populations with special needs specific to elite competitive youth athletes. The location of the Games in a heavily populated city with dispersed competition venues provides unique challenges. Objective To describe the planning and delivery of medical services and to provide data for future planning. Setting Singapore. One large multipurpose clinic was set up in the Games Village as well as medical posts at competitive venues for 26 sports for onsite coverage. Period of coverage: 10 August 2010 to 28 August 2010. Participants A total of 1,337 medical encounters ranging from athletes to officials and volunteers who received medical care from a spectrum of medical professionals. Major outcome measures Number of cases attended to at the Games Village medical centres and the medical posts at the competition venues, utilisation of medical services, and the pattern of these injuries and referral patterns to hospitals. Results Medical encounters for non-athletes represented 40.9% of the total medical encounters. The rate of heat illnesses was low for athletes at 1.7% (N = 13). The total hospitalisation rate was low at 1.7% (n = 23). Utilisation of onsite pharmacy and physiotherapy services were high at 45.2% (n = 887) and 37.8% (n = 743), respectively, of the encounters for all support services. Conclusion The dispersed nature of the Games venues provided challenges to the organisation of medical cover for the participants. Organisers in future Games can make use of the data to plan for future Games of a similar nature.

Chiu, H. C., et al. (2018). "Balance and mobility training at home using Wii Fit in children with cerebral palsy: a feasibility study." BMJ Open 8(5): e019624.
	OBJECTIVES: To investigate whether balance and mobility training at home using Wii Fit is feasible and can provide clinical benefits. DESIGN: Single-group, pre-post intervention study. SETTING: Participants' home. PARTICIPANTS: 20 children with cerebral palsy (6-12 years). INTERVENTION: Participants undertook 8 weeks of home-based Wii Fit training in addition to usual care. MAIN MEASURES: Feasibility was determined by adherence, performance, acceptability and safety. Clinical outcomes were strength, balance, mobility and participation measured at baseline (preintervention) and 8 weeks (postintervention). RESULTS: The training was feasible with 99% of training completed; performance on all games improved; parents understood the training (4/5), it did not interfere in life (3.8/5), was challenging (3.9/5) and would recommend it (3.9/5); and there were no injurious falls. Strength increased in dorsiflexors (Mean Difference (MD) 2.2 N m, 95% CI 1.1 to 3.2, p<0.001), plantarflexors (MD 2.2 N m, 95% CI 1.3 to 3.1, p<0.001) and quadriceps (MD 7.8 N m, 95% CI 5.2 to 10.5, p<0.001). Preferred walking speed increased (MD 0.25 m/s, 95% CI 0.09 to 0.41, p<0.01), fast speed increased (MD 0.24 m/s, 95% CI 0.13 to 0.35, p<0.001) and distance over 6 min increased (MD 28 m, 95% CI 10 to 45, p<0.01). Independence in participation increased (MD 1.4 out of 40, 95% CI 0.0 to 2.8, p=0.04). CONCLUSIONS: Balance and mobility training at home using Wii Fit was feasible and safe and has the potential to improve strength and mobility, suggesting that a randomised trial is warranted. TRIAL REGISTRATION NUMBER: ACTRN12616001362482.

Cho, Y., et al. (2022). "The role of goal adjustment during rehabilitation from stroke." Applied Psychology. Health and Well-being 14(1): 26-43.
	We investigated motivational regulation involving adjustment of recovery goals in post-stroke rehabilitation via standard in-clinic physiotherapy and in-home telerehabilitation (TR). We used a secondary dataset collected at 11 US sites as part of a clinical trial using video games and game control pads designed to induce certain arm movements required for recovery (n = 124; Mage = 61.44, SD = 13.30). Participants were randomly assigned to either the TR or in-clinic condition and underwent 36 therapy sessions, reporting on their activity-inherent enjoyment for 6-8 weeks. Compared with the in-clinic patients and TR patients with high game performance, TR patients with lower game performance reported lower activity-inherent enjoyment, which is an important motivational resource for successful recovery. The results suggest that these differences occur because TR patients become discouraged by low game score feedback, which may have signaled a poor prospect for recovery. However, the results also suggest that low game performers who successfully adjusted their recovery goals were resilient to the impact of low game score feedback on their motivational resources and satisfaction with therapy. The findings suggest that goal adjustment may be particularly beneficial when patients are discouraged by feedback indicating suboptimal recovery prospects.

Cho, Y. and K. S. Park (2020). "The Chongchong Step Master Game for Gait and Balance Training." Multimodal Technologies and Interaction 4(3): 56.
	Exercise can help to improve health, strengthen vitality and prevent brain disease, especially for the elderly. Exercise games, or exergames, which combine both exercise and video gaming, train people in a fun and competitive manner to lead a healthy lifestyle. Exergames promote more physical effort and have the potential to contribute to physical education. This research presents a full-body virtual reality exercise game called the Chongchong Step Master, which is designed to improve gait and balance function and prevent dementia in the elderly. This system used Kinect sensors to accurately recognize the user’s body movements and the stepping board mat to recognize and guide the user’s walking motion. It aims to help the elderly exercise more easily and independently with the virtual physical trainer.

Choi, J., et al. (2019). "31.1 Combining Exercise Physiology, Recreational Therapy, Virtual Reality Gaming Technology, and Psychosocial Rehabilitation to Promote Physical Exercise in Serious Mental Illness." Schizophrenia Bulletin 45(Supplement_2): S139-S140.
	Background Physical exercise (PE) is a safe, non-stigmatizing, and side-effect free intervention that has the potential to mitigate neurocognitive dysfunction in psychosis, as well as reduce anxiety and paranoia. Developing and promoting PE programs for people with SMI in the community where participants cannot be paid to participate requires an interdisciplinary approach to activate motivation for exercise. We report the initial development and pilot results of a PE community program developed to enhance motivation and engagement in adults with schizophrenia, merging expertise from the fields of exercise physiology, recreational therapy, virtual reality (VR) gaming technology, and neuropsychiatric rehabilitation. Methods Adult outpatients diagnosed with schizophrenia (N=29) were enrolled in 18 hours (40 min session, 3x/week for 3 months) of exergaming. Exergaming uses interactive exercise equipment connected to a computer and monitor so the patient is engaged in a virtual game while exercising. For example, while pedaling on an exergaming stationary bike, the can have the experience of racing or biking through the countryside, either using a virtual reality headset or simply looking at the monitor. The PE regimen was tailored for each participant based on input from a (1) exercise physiologist about optimal methods to achieve volitional exhaustion and reduce the risk for injury, (b) recreational therapist who set up the overall exercise milieu to promote enjoyment, (c) expert in VR technology who calibrated and tailored the virtual experience to each participant (d) psychiatrist who monitored medical risk for strenuous exercise, and (d) psychologist who collected outcome data. Cognition and symptoms were assessed at baseline and post (3 mo.) while motivation and treatment engagement were recorded biweekly. Results Large effects were seen in working memory from baseline to post (WASI WMI; ES=.53), with medium effects in overall symptoms (PANSS; ES=.30). Importantly, participants reported a high degree of motivation for PE throughout the treatment period (Intrinsic Motivation Inventory total score>35), and 27 out of 29 completed the entire PE regimen of 18 hours although they were not paid to attend. Conclusions This study highlights the potential benefits of a PE program developed by an interdisciplinary team combing expertise in exercise, technology, recreation, and neuropsychiatry. Drawing from experience in other fields may help develop new treatments in psychiatric rehabilitation to maximize overall outcome. Funded by a Hartford Hospital Auxiliary Special Projects Grant to JC

Choi, S. D., et al. (2017). "Exergame technology and interactive interventions for elderly fall prevention: A systematic literature review." Appl Ergon 65: 570-581.
	Training balance and promoting physical activities in the elderly can contribute to fall-prevention. Due to the low adherence of conventional physical therapy, fall interventions through exergame technologies are emerging. The purpose of this review study is to synthesize the available research reported on exergame technology and interactive interventions for fall prevention in the older population. Twenty-five relevant papers retrieved from five major databases were critically reviewed and analyzed. Results showed that the most common exergaming device for fall intervention was Nintendo Wii, followed by Xbox Kinect. Even though the exergame intervention protocols and outcome measures for assessing intervention effectiveness varied, the accumulated evidences revealed that exergame interventions improved physical or cognitive functions in the elderly. However, it remains inconclusive whether or not the exergame-based intervention for the elderly fall prevention is superior to conventional physical therapy and the effect mechanism of the exergaming on elderly's balance ability is still unclear.

Chong, D. Y. K. (2019). "Benefits and challenges with gamified multi-media physiotherapy case studies: a mixed method study." Arch Physiother 9: 7.
	BACKGROUND: The use of gamification in higher education context has become popular in recent years with one aim of enhancing learning motivation, yet, it is unknown how physiotherapy students perceive gamified education experience. Using gamification together with multi-media patient case studies, this study explored whether and how gamified education motivated physiotherapy students' learning. It also investigated how other factors such as class design and mechanics affected gamified experience. METHOD: Six case studies in the subject Neurological Physiotherapy were transformed from paper-based cases to multi-media cases built by iSpring suite 8.1. Simulated, real or animated clients were used. Gamification mechanics such as leaderboards, scoring and prioritisation were embedded in the case studies. These gamified case studies were used in classes with Year-3 students enrolled in this subject. After taking these classes, 10 students participated in two focus groups and 32 students responded to a survey to share their experiences and perceptions on this pedagogy. RESULTS: Results showed that students perceived gamified education as motivating since this satisfied their competence and social needs and enhanced their self-efficacy. In addition, authentic patient videos, class activities that allowed conflict resolution and reflection, and the use of leaderboards were enablers in this gamified experience. CONCLUSION: Future gamified education in physiotherapy can provide authentic experience through class designs and gamification mechanics to foster learning motivation. A suggested mapping of gamified lessons for physiotherapy education is provided based on the results of this study.

Chong, Y., et al. (2018). "Going Forward with Pokemon Go." J Emerg Trauma Shock 11(4): 243-246.
	Pokemon Go is an augmented reality (AR) game which combines the use of smart mobile technology with physical exploration in the real world. It was a global phenomenon that rocked the world since 2016. Across boundaries and nations, the young and seniors were actively downloading and playing, joining the intrend gaming community. Was it a fleeting fad or a more sustainable activity? This paper discusses the literature currently available on this interesting phenomenon: its effect on physical and mental health as well as some documented hazards and distractions. From the review, Pokemon Go demonstrates that cleverly implemented AR games can reach millions of people and trigger substantial behavioral changes. AR games can help increase physical activities and exercise provided people's interest can be sustained.

Choong, K., et al. (2015). "In-Bed Mobilization in Critically Ill Children: A Safety and Feasibility Trial." J Pediatr Intensive Care 4(4): 225-234.
	The objective of this study was to evaluate the feasibility and safety of implementing two methods of in-bed mobilization in critically ill children. This prospective cohort trial was conducted at McMaster Children's Hospital, Pediatric Critical Care Unit (PCCU). Hemodynamically stable patients aged 3 to 17 years with a longer than 24-hour PCCU stay were eligible to participate in the study. Children with cardiorespiratory instability, already mobilizing well or at their baseline mobility, anticipated death during this PCCU admission, and those with contraindications to mobilization were excluded. Two methods of mobilization were applied for a maximum of 2 days, respectively, depending on the level of consciousness and cognitive ability of the participant. In-bed cycling was used for passive mobilization and interactive video games (VG) were used for active mobilization. The primary outcomes were safety and feasibility. Secondary outcomes were physical activity during the study period, as reflected by accelerometer measurements. A total of 406 patients were screened over 1 year, 35 of who were eligible and 31 (89%) consented to participate. Median age of participants was 11 years (quartile 1 is 6 years and quartile 3 is 14 years), and 15 (48%) were male. Twenty-five (81%) participants received the study intervention, 22 (88%) of who received the intervention within 24 hours of consent. Twenty-one (84%) participants received in-bed cycling, five (20%) received VG, and only one received both. Fifteen (60%) completed the prescribed 2-day intervention, while in 11 (44%) the intervention was interrupted or not applied, most commonly because the patient was transferred out of the PCCU. Physical activity was greater during the intervention compared with nonintervention times with in-bed cycling, but not with VG. There were no adverse events attributable to the intervention. This pilot reveals that in-bed cycling can enhance physical activity, and appears to be safe and feasible in this group of critically ill children. VG was feasible only in a minority of patients who were cooperative and age appropriate. Further research is necessary to evaluate the efficacy and most appropriate methods of enhancing mobility and rehabilitation in this population.

Choudhary, N. (2018). "European Stroke Organisation Conference: Abstracts." European Stroke Journal 3(1_suppl): 3-204.
	Background and Aims: Eye‐hand coordination is essential for humans, as many activities in daily life require precise eye and hand functions. The stroke survivors have poorer eye‐hand coordination when using their hemiparetic hand. A significant correlation exists between eye‐hand coordination performance and hand function test scores. The aim of this study was to develop a low cost system for testing and training eye and hand coordination using gamification as a tool for improving hand function in chronic stroke patients. Method: 6 subjects (mean age 63.2±4.3 years) with chronic stroke were screened and randomized into experimental and control groups with n=3 each. Both groups received 1 hour of standard upper limb physical therapy, 6 days a week for total 4 weeks. Experimental group also played a customized eye hand coordination game called ?HandEye? using Tobii Eye XVR and Leap MotionVR for 3 sessions of 2 minutes each. Primary outcome measure was BBT (Box and Block Test). Results: A significant improvement in scores of BBT was found in both experimental (F5234.244, p< 0.001) and control (F585.099, p< 0.001) group from pre to post intervention but the change in BBT scores were higher in experimental group. The difference between change in BBT scores from pre to post intervention were significant (F552.071, p< 0.001). Pearson's correlation analysis revealed a highly positive relationship (r2=0.604; p<0.01) between scores of Handeye and Box and Block Test of the hemiparetic extremity in the experimental group. Conclusion: Natural user interface technology and gamification techniques can be useful for hand rehabilitation in stroke survivors.

Choudhary, N. (2018). "WCNR 2018 Poster Abstracts." Neurorehabilitation and neural repair 32(4-5): 363-538.
	Objectives: Eye‐hand coordination is essential for humans, as many activities in daily life require precise eye and hand functions. Eye gaze supports hand movement planning by marking key positions to which the fingertips or grasped object are subsequently directed. The stroke survivors have poorer eye‐hand coordination, in terms of slower movement and reduced accuracy when using their affected hand. The present study examined a novel way to train eye hand coordination in stroke patients by gamification using emerging natural user interface technologies. Methods: A total of 6 subjects (mean age 59.6 years) with chronic stroke were screened and randomized into experimental and control groups with n=3 each. Control group received 1 hour of standard upper limb physical therapy interventions like strengthening exercises, grasp and release activities, reaching and dexterity tasks once daily, 6 days a week for total 4 weeks. Along with the above interventions experimental group also played a customized eye and hand coordination computer game using Tobii eye x and Leap motion controller for 3 sessions of 2 minutes each. The primary outcome measure was Box and Block test. Results: There was a significant improvement in hand function scores of the affected hand in the experimental group (F= 4.471, p= 0.025) compared to the control group. Total scores of the hand function test also correlated significantly with hand eye coordination performance scores (r= 0.643) Conclusions: By using emerging natural user interface technology and gamification techniques eye hand coordination performance and hand function scores can be improved in stroke survivors.

Choudhary, N. (2018). "World Stroke Congress Abstracts, 2018." International journal of stroke 13(2_suppl): 3-217.
	Introduction/Background: The stroke survivors have poorer eye‐hand coordination when using their affected hand. A significant correlation exists between eye‐hand coordination performance and hand function test scores. The aim of this study was to develop a low‐cost system for training eye and hand coordination for improving hand function in chronic stroke patients. Material(s) and Method(s): 6 subjects (mean age 63.2+/‐4.3 years) with chronic stroke were screened and randomized into experimental and control groups with n=3 each. Both groups received 1 hour of standard upper limb physical therapy, 6 days a week for total 4 weeks. Experimental group also played a customized eye hand coordination game called "HandEye" using Tobii Eye X and Leap Motion for 3 sessions of 2 minutes each. Primary outcome measure was BBT (Box and Block Test). Result(s): A significant improvement in scores of BBT was found in both experimental (F=234.244, p< 0.001) and control (F=85.099, p < 0.001) group from pre to post intervention but the change in BBT scores were higher in experimental group. The difference between change in BBT scores from pre to post intervention were significant (F=52.071, p <0.001). Conclusion(s): Natural user interface technology and gamification techniques can be useful for hand rehabilitation in stroke survivors. (Figure Presented).

Choudhary, N. (2019). "Effect of training eye hand coordination using emerging natural user interface technologies for improving hand function in stroke survivors-a randomized controlled study." Neurology 92(15).
	Objective: The objective of this study was to develop a low cost system for training eye and hand coordination using gamification as a tool for improving hand function in chronic stroke patients. Background: Eye‐hand coordination is essential for humans, as many activities in daily life require precise eye and hand functions. The stroke survivors have poorer eye‐hand coordination when using their hemiparetic hand. A significant correlation exists between eye‐hand coordination performance and hand function test scores. Design/Methods: 6 subjects (mean age 63.2± 4.3 years) with chronic stroke were screened and randomized into experimental and control groups with n=3 each. Both groups received 1 hour of standard upper limb physical therapy, 6 days a week for 4 weeks. Experimental group also played a customized eye hand coordination game called “HandEyeâ€� using Tobii Eye X® and Leap Motion® for 3 sessions of 2 minutes each. Primary outcome measure was BBT (Box and Block Test). Results: A significant improvement in scores of BBT was found in both experimental (F=234.244, p<0.001) and control (F=85.099, p<0.001) group from pre to post intervention but the change in BBT scores were higher in experimental group. The difference between the change in BBT scores from pre to post intervention were significant (F= 52.071, p<0.001). Pearson's correlation analysis revealed a highly positive relationship (r = 0.604; p <0.01) between scores of HandEye and Box and Block Test of the hemiparetic extremity in the experimental group. Conclusions: Natural user interface technologies can be useful for hand rehabilitation in stroke survivors.

Chu, C. H., et al. (2022). "Effects of Exergaming on Physical and Cognitive Outcomes of Older Adults Living in Long-Term Care Homes: A Systematic Review." Gerontology: 1-17.
	BACKGROUND: Aging is often associated with increasing functional decline as measured by deterioration in mobility and activities of daily living. Older adults (OAs) living in residential long-term care (LTC) homes in particular may not engage in regular physical exercise, significantly increasing their risk of further cognitive and functional decline. Exergaming may hold promise for OAs by combining exercise and technology-based gaming systems, but evidence for its use in LTC is unknown. METHODS: A systematic review was conducted to summarize the effects of exergaming interventions on physical, cognitive, and quality of life (QoL) outcomes for OAs (>65 years of age) living in LTC. RESULTS: Twenty-one studies involving 657 OAs living in LTC met the inclusion criteria. Most studies were associated with a high risk of bias and many used uncontrolled designs and small samples. Across studies, exergame interventions were associated with preliminary benefits relative to control conditions on standardized measures of physical outcomes (e.g., Timed Up &amp; Go, 5-meter gait speed). No consistent effects were found for cognitive and QoL outcomes. CONCLUSIONS: Exergames might be a promising intervention to benefit the physical health of OAs (>65 years) living in LTC, but more research is required to determine the effects of exergaming on physical health, as well as cognitive and QoL outcomes. More specifically, larger and more methodologically robust evaluations are needed.

Chua, L. K., et al. (2021). "Gamified Dual-Task Training for Individuals with Parkinson Disease: An Exploratory Study on Feasibility, Safety, and Efficacy." International Journal of Environmental Research & Public Health [Electronic Resource] 18(23).
	OBJECTIVES: The feasibility and safety of the use of neurorehabilitation technology (SMARTfit((R)) Trainer system) by physical therapists in implementing a gamified physical-cognitive dual-task training (DTT) paradigm for individuals with Parkinson disease (IWPD) was examined. Additionally, the efficacy of this gamified DTT was compared to physical single-task training (STT), both of which were optimized using physio-motivational factors, on changes in motor and cognitive outcomes, and self-assessed disability in activities of daily living. METHODS: Using a cross-over study design, eight participants with mild-to-moderate idiopathic PD (including one with mild cognitive impairment) completed both training conditions (i.e., gamified DTT and STT). For each training condition, the participants attended 2-3 sessions per week over 8.8 weeks on average, with the total amount of training being equivalent to 24 1 h sessions. A washout period averaging 11.5 weeks was inserted between training conditions. STT consisted of task-oriented training involving the practice of functional tasks, whereas for gamified DTT, the same task-oriented training was implemented simultaneously with varied cognitive games using an interactive training system (SMARTfit((R))). Both training conditions were optimized through continual adaptation to ensure the use of challenging tasks and to provide autonomy support. Training hours, heart rate, and adverse events were measured to assess the feasibility and safety of the gamified DTT protocol. Motor and cognitive function as well as perceived disability were assessed before and after each training condition. RESULTS: Gamified DTT was feasible and safe for this cohort. Across participants, significant improvements were achieved in more outcome measures after gamified DTT than they were after STT. Individually, participants with specific demographic and clinical characteristics responded differently to the two training conditions. CONCLUSION: Physical therapists' utilization of technology with versatile hardware configurations and customizable software application selections was feasible and safe for implementing a tailor-made intervention and for adapting it in real-time to meet the individualized, evolving training needs of IWPD. Specifically in comparison to optimized STT, there was a preliminary signal of efficacy for gamified DTT in improving motor and cognitive function as well as perceived disability in IWPD.

Chudecka, M. and A. Lubkowska (2010). "Temperature changes of selected body’s surfaces of handball players in the course of training estimated by thermovision, and the study of the impact of physiological and morphological factors on the skin temperature." Journal of Thermal Biology 35(8): 379-385.
	
Chung, A. M., et al. (2016). "Do people with intellectual disability use Nintendo Wii when placed in their home as part of a physiotherapy program? An observational study." Disabil Rehabil Assist Technol 11(4): 310-315.
	PURPOSE: To examine how much, and in what way, Nintendo Wii (Wii) is used when prescribed as part of a home-physiotherapy program for people with intellectual disability. METHODS: Twenty people with intellectual disability were recruited. The following parameters were recorded about play patterns over a 12-week period: frequency, duration, perceived exertion, play position, play mode, initiation of play and games from Wii Sports and Wii Fit Plus. RESULTS: Participants used the Wii for a median of 101 min per week (interquartile range [IQR]: 50-172) in weeks one and two across a median of three days per week (IQR: 3-4), decreasing down to a median of 35 min per week (IQR: 0-141) in weeks 11 and 12 across a median of one day per week (IQR: 0-3). CONCLUSIONS: Usage of the Wii drops off rapidly when it is placed in the homes of people with intellectual disability as part of a physiotherapy program. Implications for Rehabilitation Usage of the Nintendo Wii drops off rapidly when it is placed in the homes of people with intellectual disability and they are instructed to use it as part of a home physiotherapy program. Games commonly played include bowling and boxing in Wii Sport, and penguin slide, ski jump and tight rope walk in Wii Fit Plus. Physiotherapists should use person and family centred practice to ensure that Nintendo Wii is a suitable intervention for the person with an intellectual disability and provide support to encourage ongoing usage.

Cichy, I., et al. (2020). "Participating in Physical Classes Using Eduball Stimulates Acquisition of Mathematical Knowledge and Skills by Primary School Students." Frontiers in Psychology 11: 2194.
	An increasing number of studies are evidencing relationships between physical activity (PA) and the mathematical performance of early school students. This is not surprising due to the fact that children grow in all areas simultaneously and their motor and intellectual developments determine each other. Nevertheless, such an approach of combining mathematics education with physical exercises, in addition through play, which is the basis of children's activity and the preferred way of spending time, is still rare at schools. In response to this problem, "Eduball" has been created, which is an educational ball with printed letters, numbers, and other signs used for team mini-games. Surprisingly, despite the studies on general usefulness of Eduball in preschool and early-school education and the effects of physical exercise classes carried out using these balls, still little is known about their impact on mathematical development. Here, we investigate the relationships between the use of Eduball and the acquisition of mathematical knowledge and skills by children. We used a quantitative approach in the form of an experiment in natural settings in which 7-year-old students (first grade) took part (N = 25). For the purposes of this experiment, we created scenarios of physical exercise classes integrated with mathematical contents that used Eduball. Mathematical knowledge and skills were assessed by one of the commonly used tests. The results were compared with the data from the control group of traditional physical education classes (N = 22). As assumed, after a 1-year experiment, students from both groups improved their results, but we found a greater progress in terms of mathematical knowledge and skills in the experimental class compared to the control one. Eduball particularly affected competences related to such mathematical categories as: sets and their elements, multiplication and division, geometric shapes and measuring length, and measuring volume and mass. In sum, our results show that physical exercise classes that used Eduball stimulate the acquisition of mathematical competences by students and, consequently, confirm that there is a strong relation of physical and mathematical development. Therefore, there is a need to review children's educational models, as well as primary school curricula, to combine physical and cognitive activities.

Cikajlo, I., et al. (2018). "Can telerehabilitation games lead to functional improvement of upper extremities in individuals with Parkinson's disease?" International Journal of Rehabilitation Research 41(3): 230-238.
	Parkinson's disease (PD) is treated by medication, less with deep brain stimulation and physiotherapy. Different opinions on the clinical meaningfulness of the physiotherapy or recommended intensive physiotherapy were found. Our objectives were to design intensive target-based physiotherapy for upper extremities suitable for telerehabilitation services and examine the clinical meaningfulness of the exergaming at an unchanged medication plan. A telerehabilitation exergaming system using the Kinect sensor was developed; 28 patients with PD participated in the study. The system followed the participants' movements and adapted the difficulty level of the game in real time. The outcomes of the study showed that seven out of 26 participants could set up the equipment at home alone. Clinical outcomes of Box and Blocks Test (mean: 47 vs. 52, P=0.002, Cohen's d=0.40), UPDRS III (mean: 27 vs. 29, P=0.001, d=0.22), and daily activity Jebsen's test; writing a letter (mean: 24.0 vs. 20.6, P=0.003, d=0.23); and moving light objects (mean: 4.4 vs. 3.9, P=0.006, d=0.46) were statistically significant (P<0.05) and considered clinically meaningful. The Nine-Hole Peg Test showed a statistically nonsignificant improvement (mean: 28.0 vs. 26.5, P=0.089, d=0.22). The participants claimed problems with mobility but less with activities of daily living and emotional well-being (PDQ-39). The findings lead to preliminary conclusions that exergaming is feasible, but may require technical assistance, whereas clinically meaningful results could be achieved according to validated instruments and an unchanged medication plan in individuals with PD.

Cikajlo, I. and K. Peterlin Potisk (2019). "Advantages of using 3D virtual reality based training in persons with Parkinson's disease: a parallel study." J Neuroeng Rehabil 16(1): 119.
	BACKGROUND: Parkinson's disease (PD) is a slowly progressive neurodegenerative disease. There are mixed reports on success of physiotherapy in patients with PD. Our objective was to investigate the functional improvements, motivation aspects and clinical effectiveness when using immersive 3D virtual reality versus non-immersive 2D exergaming. METHODS: We designed a randomized parallel study with 97 patients, but only 20 eligible participants were randomized in 2 groups; the one using 3D Oculus Rift CV1 and the other using a laptop. Both groups participated in the 10-session 3 weeks training with a pick and place task in the virtual world requiring precise hand movement to manipulate the virtual cubes. The kinematics of the hand was traced with Leap motion controller, motivation effect was assessed with modified Intrinsic Motivation Inventory and clinical effectiveness was evaluated with Box & Blocks Test (BBT) and shortened Unified Parkinson's disease rating scale (UPDRS) before and after the training. Mack-Skilling non-parametrical statistical test was used to identify statistically significant differences (p < 0.05) and Cohen's U3 test to find the effect sizes. RESULTS: Participants in the 3D group demonstrated statistically significant and substantially better performance in average time of manipulation (group x time, p = 0.009), number of successfully placed cubes (group x time, p = 0.028), average tremor (group x time, p = 0.002) and UPDRS for upper limb (U3 = 0.35). The LCD and 3D groups substantially improved their BBT score with training (U3 = 0.7, U3 = 0.6, respectively). However, there were no statistically significant differences in clinical tests between the groups (group x time, p = 0.2189, p = 0.2850, respectively). In addition the LCD group significantly decreased the pressure/tension (U3 = 0.3), the 3D did not show changes (U3 = 0.5) and the differences between the groups were statistically different (p = 0.037). The 3D group demonstrated important increase in effort (U3 = 0.75) and perceived competences (U3 = 0.9). CONCLUSIONS: The outcomes of the study demonstrated that the immersive 3D technology may bring increased interests/enjoyment score resulting in faster and more efficient functional performance. But the 2D technology demonstrated lower pressure/tension score providing similar clinical progress. A study with much larger sample size may also confirm the clinical effectiveness of the approaches. TRIAL REGISTRATION: The small scale randomized pilot study has been registered at ClinicalTrials.gov Identifier: NCT03515746 , 4 May 2018.

Cikajlo, I., et al. (2020). "Multi-Exergames to Set Targets and Supplement the Intensified Conventional Balance Training in Patients With Stroke: A Randomized Pilot Trial." Frontiers in Psychology 11: 572.
	People who survive a stroke usually suffer movement disorders resulting in involuntary abnormal movements. Intensive and repetitive physiotherapy is often a key to functional restoration of movements. Rehabilitation centers have recently offered balance training supported by exergames in addition to conventional therapy. The primary objective was to investigate different types of balance training (multi-exergaming and conventional) in addition to a conventional 6-week physiotherapy program. Furthermore, we examined the choice of an appropriate exergame to target balance training. We designed a randomized pilot trial. Hospital inpatients with stroke aged 33-65 were recruited and randomized into 2 groups by drawing lots; a control group receiving 1 week of conventional balance training and an exergaming group 1 week of multiple-game exergaming, comprising single leg exercises, weight shifting, balancing and standing up. Center of pressure was monitored for the exergaming group and clinical data were collected (non-blinded assessment) using Four Square Step Test, Timed Up and Go, 10 m Walk Test, Romberg, Sharpened Romberg, Clinical Test for Sensory Interaction in Balance in both groups. Statistical tests were used to find significant (p < 0.05) differences and Cohen's U3 for effect sizes. Recruited participants (20/30) met the inclusion criteria and were randomized; 10 per group. 1 participant of the exergaming group was excluded from center of pressure analysis. Both groups demonstrated substantively and statistically significant improvements of functional balance, in particular the exergaming group (FSST p = 0.009, U3 = 0.9 and 10 MWT p = 0.008, U3 = 0.9). However, significant differences between the groups were found in tests with eyes closed, Sharpened Romberg test (p = 0.05) and standing on the right leg (p = 0.035). The center of pressure area decreased up to 20% for the exergaming group. Both types of additional balance training demonstrated comparable outcomes, however, the multi-exergaming could target specific motor control disorders by the selection of exergames according to Gentile's taxonomy. We may not prioritize exergaming due to the low statistical power of clinical outcomes. However, exergaming enables independent balance training, which is feasible without strenuous physiotherapy and may thus be crucial for future home or telerehabilitation services. Clinical Trial Registration: www.clinicaltrials.gov/, identifier NCT03282968.

Ciolcă, C. and C. Mogâldea (2014). "Types of Communication in Kinetotherapy Classes Involving Students with Hearing Impairments." Procedia - Social and Behavioral Sciences 117: 610-615.
	A significant role in kinesiology classes involving students suffering from hearing impairments is played by communication with these students. The aim is to improve their communication skills, encouraging them to use the best mode of communication, creating the opportunities for socialization and for the integration process (games, physical therapy lesson, and others). The role of the teacher is to transmit knowledge to pupils in a specific language. Due to the particularities of the pupils, the verbal communication in class may be accompanied by nonverbal communication, visual and symbols. Expressive didactic communication involves such elements as the teacher's attitude, way of dressing and motor behavior, facial expression, use of certain gestures, symbols or video, as well as use of permanent eye contact with students throughout classes. This research aims at highlighting the types of communication (verbal, nonverbal, visual and symbols) that may significance contribute to an effective communication in kinesiology classes.

Ciortea, V. M., et al. (2021). "Telerehabilitation—A Viable Option for the Recovery of Post-Stroke Patients." Applied Sciences 11(21): 10116.
	As the number of stroke survivors is continuously growing, with an important number suffering from consequent functional deficits, the rehabilitation field is facing more complex demands. Technological progress gives us the opportunity to remotely assist patients while they exercise at home through telerehabilitation (TR), addressing the problems of limited medical resources and staff, difficult transportation, or living a long distance from rehabilitation centers. In addition, TR is a way to provide continuity in long-term post-stroke recovery during the COVID-19 pandemic, which limits traveling and human interaction. While the implementation of TR is increasing, the biggest challenges are to raise patients’ acceptability of the new method and their motivation and engagement during the program. In this review, we aimed to find methods to address these challenges by identifying the patients who benefit the most from this therapy and efficiently organizing the space and technology used for telerehabilitation. User-friendly technologies and devices along with therapists’ constant support and feedback are some of the most important aspects that make TR an efficient intervention and an alternative to conventional therapy.

Clark, R. and T. Kraemer (2009). "Clinical use of Nintendo Wii bowling simulation to decrease fall risk in an elderly resident of a nursing home: a case report." Journal of Geriatric Physical Therapy 32(4): 174-180.
	Purpose: Of the estimated 1.7 million residents of nursing homes in the United States, approximately half fall annually; and 11% of these sustain injury. This is twice the rate for persons dwelling in the community. By addressing fall risk, physical therapists have an opportunity to reduce falls which are the leading cause of injury deaths, as well as the most common cause of nonfatal injuries for older adults in the United States. This case report examines the effect of a novel interactive video game intervention to address balance dysfunction in an elderly resident of a nursing home who was at risk for falls. Case Description: The patient is an 89-year-old resident diagnosed with an unspecified balance disorder and a history of multiple falls. Self reports of gait abnormalities, scores on several clinical measures, and her fall history classified her as having substantial risk for future falls. Intervention: A nontraditional approach to balance training, employing the Nintendo Wii bowling simulation, was used as intervention for this patient's balance disorder. Outcomes: After 6 one-hour treatment sessions, the patient's Berg Balance Score improved from 48 to 53. On the Dynamic Gait Index, the patient improved her score from 19 to 21. The patient's Timed Up and Go Test improved from 14.9 to 10.5 seconds, all suggesting a reduced risk of falling. The patient's ABC Score improved from 88 to 90%.

Clark, S. (2001). "In the game. Weight of injury: injuries often plague many inexperienced weight lifters." Advance for Directors in Rehabilitation 10(1): 27-28.
	
Close, C. and F. Gibbs (1999). "Contractures of the hand in a boy with Duchenne muscular dystrophy associated with use of a computer game console." Physiotherapy 85(11): 595-596.
	A boy with Duchenne muscular dystrophy played finger-operated computer games for up to six hours daily. He experienced fatigue, stiffness and occasional pins and needles which might have led to contractures in his hands. His condition led him to adopt a sedentary game but also predisposed him to stiff joints. Physiotherapists need to be aware of this propensity. A joy-stick operated game might carry less risk of repetitive strain injury --for all children.

Cole, A. (2007). "The waiting game." Physiotherapy Frontline 13(8): 26-30.
	
Colombo, R., et al. (2007). "Design strategies to improve patient motivation during robot-aided rehabilitation." J Neuroeng Rehabil 4: 3.
	BACKGROUND: Motivation is an important factor in rehabilitation and frequently used as a determinant of rehabilitation outcome. Several factors can influence patient motivation and so improve exercise adherence. This paper presents the design of two robot devices for use in the rehabilitation of upper limb movements, that can motivate patients during the execution of the assigned motor tasks by enhancing the gaming aspects of rehabilitation. In addition, a regular review of the obtained performance can reinforce in patients' minds the importance of exercising and encourage them to continue, so improving their motivation and consequently adherence to the program. In view of this, we also developed an evaluation metric that could characterize the rate of improvement and quantify the changes in the obtained performance. METHODS: Two groups (G1, n = 8 and G2, n = 12) of patients with chronic stroke were enrolled in a 3-week rehabilitation program including standard physical therapy (45 min. daily) plus treatment by means of robot devices (40 min., twice daily) respectively for wrist (G1) and elbow-shoulder movements (G2). Both groups were evaluated by means of standard clinical assessment scales and the new robot measured evaluation metric. Patients' motivation was assessed in 9/12 G2 patients by means of the Intrinsic Motivation Inventory (IMI) questionnaire. RESULTS: Both groups reduced their motor deficit and showed a significant improvement in clinical scales and the robot measured parameters. The IMI assessed in G2 patients showed high scores for interest, usefulness and importance subscales and low values for tension and pain subscales. CONCLUSION: Thanks to the design features of the two robot devices the therapist could easily adapt training to the individual by selecting different difficulty levels of the motor task tailored to each patient's disability. The gaming aspects incorporated in the two rehabilitation robots helped maintain patients' interest high during execution of the assigned tasks by providing feedback on performance. The evaluation metric gave a precise measure of patients' performance and thus provides a tool to help therapists promote patient motivation and hence adherence to the training program.

Colomer, C., et al. (2016). "Effect of a mixed reality-based intervention on arm, hand, and finger function on chronic stroke." J Neuroeng Rehabil 13(1): 45.
	BACKGROUND: Virtual and mixed reality systems have been suggested to promote motor recovery after stroke. Basing on the existing evidence on motor learning, we have developed a portable and low-cost mixed reality tabletop system that transforms a conventional table in a virtual environment for upper limb rehabilitation. The system allows intensive and customized training of a wide range of arm, hand, and finger movements and enables interaction with tangible objects, while providing audiovisual feedback of the participants' performance in gamified tasks. This study evaluates the clinical effectiveness and the acceptance of an experimental intervention with the system in chronic stroke survivors. METHODS: Thirty individuals with stroke were included in a reversal (A-B-A) study. Phase A consisted of 30 sessions of conventional physical therapy. Phase B consisted of 30 training sessions with the experimental system. Both interventions involved flexion and extension of the elbow, wrist, and fingers, and grasping of different objects. Sessions were 45-min long and were administered three to five days a week. The body structures (Modified Ashworth Scale), functions (Motricity Index, Fugl-Meyer Assessment Scale), activities (Manual Function Test, Wolf Motor Function Test, Box and Blocks Test, Nine Hole Peg Test), and participation (Motor Activity Log) were assessed before and after each phase. Acceptance of the system was also assessed after phase B (System Usability Scale, Intrinsic Motivation Inventory). RESULTS: Significant improvement was detected after the intervention with the system in the activity, both in arm function measured by the Wolf Motor Function Test (p < 0.01) and finger dexterity measured by the Box and Blocks Test (p < 0.01) and the Nine Hole Peg Test (p < 0.01); and participation (p < 0.01), which was maintained to the end of the study. The experimental system was reported as highly usable, enjoyable, and motivating. CONCLUSIONS: Our results support the clinical effectiveness of mixed reality interventions that satisfy the motor learning principles for upper limb rehabilitation in chronic stroke survivors. This characteristic, together with the low cost of the system, its portability, and its acceptance could promote the integration of these systems in the clinical practice as an alternative to more expensive systems, such as robotic instruments.

Combs, S. A., et al. (2012). "Effects of a repetitive gaming intervention on upper extremity impairments and function in persons with chronic stroke: a preliminary study." Disability & Rehabilitation 34(15): 1291-1298.
	PURPOSE: The purpose of this study was to examine the feasibility and effects of an upper extremity gaming system on impairments, activity and participation restrictions in persons with chronic stroke. METHOD: Nine participants with chronic (5.4 SD 3 years after stroke) upper extremity impairment due to stroke completed 18 sessions over 6 weeks with the Hand Dance Pro gaming system that included trunk restraint. Measures collected at pretest and posttest included three-dimensional motion analysis of paretic upper extremity reaching, Wolf Motor Function Test (WMFT) and Stroke Impact Scale (SIS). Data were analyzed across time, with effect sizes (Cohen's d), and by categorizing participants with Fugl-Meyer Upper Extremity Motor Assessment scores (mild >50/66, moderate 26-50/66 and severe <26/66). RESULTS: Statistically, significant improvements and medium-to-large effect sizes from pretest to posttest were found with ipsilateral reaching kinematic outcomes of movement duration, mean velocity and elbow excursion (p < 0.05). Participants with mild impairment demonstrated the greatest change in elbow excursion. No significant differences and small effect sizes were found for the WMFT and SIS. CONCLUSION: The gaming intervention with high repetitions of reaching to targets and trunk restraint was feasible and led to improvements in upper extremity movement kinematics in this group of participants with chronic stroke.

Condon, C., et al. (2020). "A systematic review and meta-analysis of the effectiveness of virtual reality as an exercise intervention for individuals with a respiratory condition." Adv Simul (Lond) 5(1): 33.
	BACKGROUND: Respiratory diseases impose an immense health burden worldwide and affect millions of people on a global scale. Reduction of exercise tolerance poses a huge health issue affecting patients with a respiratory condition, which is caused by skeletal muscle dysfunction and weakness and by lung function impairment. Virtual reality systems are emerging technologies that have drawn scientists' attention to its potential benefit for rehabilitation. METHODS: A systematic review and meta-analysis following the PRISMA guidelines was performed to explore the effectiveness of virtual reality gaming and exergaming-based interventions on individuals with respiratory conditions. RESULTS: Differences between the virtual reality intervention and traditional exercise rehabilitation revealed weak to insignificant effect size for mean heart rate (standardized mean difference, SMD = 0.17; p = 0.002), peak heart rate (SMD = 0.36; p = 0.27), dyspnea (SMD = 0.32; p = 0.13), and oxygen saturation SpO2 (SMD = 0.26; p = 0.096). In addition, other measures were collected, however, to the heterogeneity of reporting, could not be included in the meta-analysis. These included adherence, enjoyment, and drop-out rates. CONCLUSIONS: The use of VRS as an intervention can provide options for rehabilitation, given their moderate effect for dyspnea and equivalent to weak effect for mean and maximum peak HR and SpO2. However, the use of virtual reality systems, as an intervention, needs further study since the literature lacks standardized methods to accurately analyze the effects of virtual reality for individuals with respiratory conditions, especially for duration, virtual reality system type, adherence, adverse effects, feasibility, enjoyment, and quality of life.

Cong, Z., et al. (2012). "Sedentary behaviors among Hispanic children: influences of parental support in a school intervention program." American Journal of Health Promotion 26(5): 270-280.
	PURPOSE: To examine the effect of parental support on sedentary behaviors among Hispanic children. DESIGN AND SETTING: A longitudinal quasi-experimental design with five waves of data collection was used to examine the effect of parental support on children's sedentary behaviors in a school-based intervention program in west Texas. SUBJECTS: Hispanic low-income parents and their children of 5 to 9 years (N = 416 child-parent dyads) over a 22-month period (1217 observations). INTERVENTION: Transformacion Para Salud was a multicomponent intervention program aimed at prevention and control of childhood overweight and obesity. It used a community-based participatory research approach, including nutrition education, physical exercise, gardening, and family involvement. MEASURES: Sedentary behaviors were measured by parents' report of their children's daily screen time per week, including TV/DVD, computer, Internet, and video games. Parental support was measured with parents' reported support for active living. ANALYSIS: Growth curve analysis was used to examine trajectories of sedentary behaviors of children. RESULTS: Response rate was over 70%. Parental support reduced children's sedentary behaviors. Girls were less sedentary than boys, but girls were less affected by parental support. The intervention was effective in reducing children's sedentary behaviors over time. CONCLUSION: It is important for school intervention programs to mobilize parents to provide more support to reduce sedentary behaviors.

Constantinou, M. and A. Wilson (2004). "Traumatic tear of tibialis anterior during a Gaelic football game: a case report." Br J Sports Med 38(6): e30.
	Reports of traumatic injury to the anterior lower leg muscles are scarce, with only a handful of reports of traumatic injury to the tibialis anterior. A database search of Medline, Cinhal, and Sports Discus only revealed three such cases, and they did not result from a direct sporting injury. This report documents the case of a traumatic rupture of tibialis anterior muscle in a young female Gaelic football player. It details the surgical repair and management of tibialis anterior muscle and the physiotherapy rehabilitation to full function.

Cooper, T. and J. M. Williams (2017). "Does an exercise programme integrating the Nintendo Wii-Fit Balance Board improve balance in ambulatory children with cerebral palsy?" Physical Therapy Reviews 22(5-6): 229-237.
	Background: Cerebral palsy is a common childhood movement disorder with balance impairment a common complaint. Active video games such as the Nintendo Wii-Fit have been found to be a valuable therapeutic tool, enjoyed by a variety of populations including children with CP, but a synthesis of the research investigating its specific use for balance in children with CP has yet to be conducted. Objectives: To determine the effectiveness of a Nintendo Wii-Fit Balance board programme in improving balance in ambulatory children with CP. Methods: A systematic search of the literature was conducted. A total of six studies matching inclusion and exclusion criteria were found and critically appraised by a modified version of Downs and Black's Checklist. Results: All studies used the Nintendo Wii-Fit software, with variable programme length and frequency of sessions. All but one study demonstrated a significant improvement in at least one balance outcome post-intervention, with dynamic balance appearing to be greater influenced. Discussion: The impact of age on the results was inconclusive. Children with cognitive, visual or vestibular impairments may show less of an improvement. A 6-week programme appears sufficient, provided training frequency remains high. Overall, there is moderate evidence to suggest that a Nintendo Wii-Fit Balance Board programme can improve balance in children with CP. Conclusions: Balance training with a Nintendo Wii-Fit Balance Board can enhance balance in individuals with ambulatory CP. Due to limited evidence investigating ataxic or dyskinetic CP, results from this study should be generalised with caution to these subtypes. Future research should aim to investigate the long-term effects of the intervention.

Cordeiro d'Ornellas, M., et al. (2015). "Evaluating the Impact of Player Experience in the Design of a Serious Game for Upper Extremity Stroke Rehabilitation." Studies in Health Technology & Informatics 216: 363-367.
	Video games have become a major entertainment industry and one of the most popular leisure forms, ranging from laboratory experiments to a mainstream cultural medium. Indeed, current games are multimodal and multidimensional products, relying on sophisticated features including not only a narrative-driven story but also impressive graphics and detailed settings. All of these elements helped to create a seamless and appealing product that have resulted in a growing number of players and in the number of game genres. Although video games have been used in education, simulation, and training, another application that exploits serious gaming is the exploration of player experience in the context of game research. Recent advances in the natural user interfaces and player experience have brought new perspectives on the in-game assessment of serious games. This paper evaluates the impact of player experience in the design of a serious game for upper extremity stroke rehabilitation. The game combines biofeedback and mirror neurons both in single and multiplayer mode. Results have shown that the game is a feasible solution to integrate serious games into the physical therapy routine.

Corregidor-Sánchez, A., et al. (2021). "Exergames to Prevent the Secondary Functional Deterioration of Older Adults during Hospitalization and Isolation Periods during the COVID-19 Pandemic." Sustainability 13(14): 7932.
	The COVID-19 pandemic is having an intense impact on the functional capacity of older adults, making them more vulnerable to frailty and dependency. The development of preventive and rehabilitative measures which counteract the consequences of confinement or hospitalization is an urgent need. Exergaming can promote physical activity, prevent falls, and maintain functional and cognitive capacity. However, although the use of exergames in health programs for the elderly is promising, their widespread use should not be considered without the supervision of a social health professional. Therefore, the objective of this work was to evaluate and analyze three video game consoles (Nintendo Wii®, Xbox-Kinect® and Play Station 4®) and 26 commercial exergames with the aim of identifying their usefulness for the prevention of functional deterioration. Three occupational therapists analyzed the data independently, and subsequently agreed on the results. The examination of the commercial consoles met three criteria: components, interaction channels and the type of the exergame. Each exergame was analyzed taking into account its ability to train postural control, balance, upper limb functionality and cognitive function. The results of the evaluation showed that exergames contain game activities that can be part of the rehabilitative treatment aimed at the prevention of the functional impairment of older people affected by COVID.

Corti, C., et al. (2018). "Feasibility of a home-based computerized cognitive training for pediatric patients with congenital or acquired brain damage: An explorative study." PLoS ONE [Electronic Resource] 13(6): e0199001.
	OBJECTIVES: Pediatric brain damage is associated with various cognitive deficits. Cognitive rehabilitation may prevent and reduce cognitive impairment. In recent years, home-based computerized cognitive training (CCT) has been introduced in clinical practice to increase treatment opportunities for patients (telerehabilitation). However, limited research has been conducted thus far on investigating the effects of remote CCT for the juvenile population in contexts other than English-speaking countries. The aim of the present study was to investigate the feasibility of a home-based CCT in a group of Italian adolescents with brain damage. A commercially available CCT (Lumosity) developed in the English language was used due to the lack of telerehabilitation programs in the Italian language that allow stimulation of multiple cognitive domains and, at the same time, remote automatic collection of data. Thus, this investigation provides information on the possibility of introducing CCT programs available in foreign languages in countries with limited investment in the telerehabilitation field. METHODS: 32 adolescents aged 11-16 with a diagnosis of congenital or acquired (either traumatic or non-traumatic) brain damage participated in the study. They received 40 training sessions (5 days/week for 8 weeks). Before starting the training program, they received face-to-face demonstration of training exercises and written instructions in their mother tongue. The feasibility of both training and study design and procedures was assessed through 9 criteria taken from extant literature. RESULTS: All 9 feasibility criteria were met. 31 out of the 32 participants demonstrated adherence to the training program. 94.2% of training sessions were completed in the recommended timeframe. No significant technical issue was found. CONCLUSIONS: Telerehabilitation seems to be a feasible practice for adolescents with brain damage. A training program developed in a foreign language can be used to counter the unavailability of programs in patients' mother tongue. TRIAL REGISTRATION: The trial is registered with the ISRCTN registry with study ID ISRCTN59250807.

Costa, D., et al. (2015). "Active video game exercise training improves the clinical control of asthma in children." Physiotherapy 101: e272-e273.
	Background: Asthma is a chronic inflammatory disorder characterized by airway obstruction associated with recurrent episodes of wheezing, shortness of breath, chest tightness and coughing. Symptoms experienced during daily physical activities or the fear of triggering these symptoms often keep asthmatic children from engaging in physical exercise which leads to a reduction in physical fitness. Nevertheless, there is evidence that physical exercise is an important nonpharmacological component of the clinical control of asthma in both children and adults. The treatment of a chronic disease that involves continual physical training can be discouraging for children so active video game system can be as effective as a treadmill training to improve clinical control and aerobic training in children with asthma. Purpose: The aim of the present study was to determine whether aerobic exercise involving an active video game system improves asthma control, airway inflammation and functional capacity in children with moderate to severe asthma. Methods: A randomized, controlled, single‐blinded clinical trial was conducted. Both groups completed an eight‐week supervised program with two weekly 40‐minute sessions. Pre‐training and post‐training evaluations involved the Asthma Control Questionnaire (ACQ6), exhaled nitric oxide levels (FeNO), maximum exercise testing (Bruce protocol) and lung function. Thirty‐six children with moderate to severe asthma randomly were allocated to either a video game group (VGG; N = 20) or a treadmill group (TG; n = 16). Results: The Kolmogorov‐Smirnov was employed to determine data distribution. Parametric variables were expressed as mean+/‐standard deviation. Non‐parametric variables were expressed as median interquartile intervals (95% CI). Two‐way ANOVA with Tukey's post hoc test was used for the comparisons between the pre‐training and posttraining evaluations. The unpaired t‐test was used for the analysis of energy expenditure. The effect size was calculated using Cohen's d and the results were interpreted based on Cohen (2008), as follows: small (0.21 to 0.49), medium (0.50 to 0.79) or large (>0.80). No differences between the VGG and TG were found at baseline. Improvements occurred in both groups with regard to asthma control and functional capacity. Moreover, a significant reduction in FeNO was found in the VGG (p < 0.05). Although mean energy expenditure at rest and during exercise training was similar in both groups, maximum energy expenditure was higher in the VGG. The maximum predicted HR achieved during the training session was significantly higher in the VGG when compared to the TG (90.5% vs. 65.2%, respectively; p < 0.01). Conclusion(s): Aerobic training using an active video game system improves asthma control and functional capacity as well as reduces pulmonary inflammation. In addition, children expend greater energy during video game training. Implications: Active video game when performed in an outpatient setting in a supervised, individualized fashion, active video game systems promote aerobic training in children with asthma and have a positive impact on both the control of the disease and pulmonary inflammation. It's an alternative to conventional treadmill exercise training for asthmatic children.

Coyne, C. (2008). "Video 'games' in the clinic: PTs report early results." PT: Magazine of Physical Therapy 16(5): 22-28.
	Physical therapists across the nation are introducing the Wii to patients--and seeing dramatic increases in program compliance, some encouraging out-comes, and a generally more upbeat mood in the clinic.

Criminger, C., et al. (2018). "Transcranial direct current stimulation plus concurrent activity may influence task prioritization during walking in people with Parkinson&rsquo;s disease &ndash; initial findings." Journal of Parkinsonism and Restless Legs Syndrome Volume 8: 25-32.
	Introduction: Walking for people with Parkinson’s disease (PD) degrades during motor–cognitive interplay (ie, dual-task conditions). Current management of PD improves motor symptoms but inadequately addresses cognitive function, indicating a necessity for novel interventions. In this pilot study, we examined bi-hemisphere transcranial direct current stimulation (tDCS) with concurrent activity and dual-task walking in people with PD. Methods: Participants received 3 sessions (tDCSsitting, tDCSbike, tDCSWii) of bilateral tDCS (dorsolateral prefrontal cortex; left = anode, right = cathode) at 2 mA and 1 sham session (tDCSsham). Sessions were randomized, single-blinded, and performed during medication “ON” times separated by 7±2 days. Following each session, participants performed Timed Up and Go (TUG) single, dual-task conditions (TUGalone, TUGmotor, TUGcognitive). Results: Sixteen participants with PD completed this study (mean age=68.13±9.76 years, ­Unified Parkinson’s Disease Rating Scale mean=40.31±18.27, Repeatable Battery for the Assessment of Neuropsychological Status mean=84.13 [13th percentile]). No differences were observed for TUG conditions between tDCS sessions. Dual task cost for TUGmotor, 14.73% (tDCSSitting), 17.78% (tDCSBike), 15.97% (tDCSWii)), 19.02% (tDCSSham); for TUGcognitive (walking), 20.01% (tDCSSitting), 18.7% (tDCSBike), 31.18% (tDCSWii), 20.01% (tDCSSham); for TUGcognitive (cognitive), 33.72% (tDCSSitting), 14.99% (tDCSBike), 4.42% (tDCSWii), 19.11% (tDCSsham). Conclusion: Our bi-hemisphere tDCS paired with concurrent activities did not lessen dual-task cost in participants with PD but appeared to influence task prioritization. Further investigation with a larger sample size is warranted.

Crisco, J. J., et al. (2015). "Design and Kinematic Evaluation of a Novel Joint-Specific Play Controller: Application for Wrist and Forearm Therapy." Physical Therapy 95(7): 1061-1066.
	BACKGROUND: The wrist extensors and flexors are profoundly affected in most children with hemiparetic cerebral palsy (CP) and are the major target of physical therapists' and occupational therapists' efforts to restore useful hand functions. A limitation of any therapeutic or exercise program can be the level of the child's engagement or adherence. The proposed approach capitalizes on the primary learning avenue for children: toy play. OBJECTIVE: This study aimed to develop and evaluate the measurement accuracy of innovative, motion-specific play controllers that are engaging rehabilitative devices for enhancing therapy and promoting neural plasticity and functional recovery in children with CP. DESIGN: Design objectives of the play controller included a cost-effective, home-based supplement to physical therapy, the ability to calibrate the controller so that play can be accomplished with any active range of motion, and the capability of logging play activity and wrist motion over week-long periods. METHODS: Accuracy of the play controller in measuring wrist flexion-extension was evaluated in 6 children who were developing in a typical manner, using optical motion capture of the wrist and forearm as the gold standard. RESULTS: The error of the play controller was estimated at approximately 5 degrees in both maximum wrist flexion and extension. LIMITATIONS: Measurements were taken during a laboratory session, with children without CP, and no toy or computer game was interfaced with the play controller. Therefore, the potential engagement of the proposed approach for therapy remains to be evaluated. CONCLUSIONS: This study presented the concept, development, and wrist tracking accuracy of an inexpensive approach to extremity therapy that may have a health benefit for children with hemiparesis, and potentially for patients of any age with a wide range of extremity neuromotor impairments.

Cross, P. S., et al. (2011). "Management of acute sports injuries and medical conditions by physical therapists: assessment via case scenarios." International Journal of Sports Physical Therapy 6(3): 158-172.
	PURPOSE/BACKGROUND: Some physical therapists (PTs) provide services at sporting events, but there are limited studies investigating whether PTs are properly prepared to provide such services. The purpose of this study was to assess acute sports injury and medical condition management decision-making skills of PTs. METHODS: A Web-based survey presented 17 case scenarios related to acute medical conditions and sport injuries. PTs from the Sports Physical Therapy Section of The American Physical Therapy Association were e-mailed a cover letter/Web link to the survey and invited to participate over a 30-day period. Data were analyzed using SPSS 18.0. RESULTS: A total of 411 of 5158 PTs who were members of the Sports Physical Therapy Association in 2009 and had valid e-mail addresses completed the survey, of which 389 (7.5%) were appropriate for analysis. Over 75.0% of respondents felt "prepared" or "somewhat prepared" to provide immediate care for 13 out of 16 medical conditions, with seizures, spinal cord injuries, and internal organ injuries having the lowest percentages. Over 75.0% of the respondents made "appropriate" or "overly cautious" decisions for 11 of the 17 acute injury or medical condition cases. CONCLUSIONS: Results of the current study indicate that PTs felt more "prepared" and tended to make "appropriate" return to play decisions on the acute sports injury and medical condition case studies more often than coaches who participated in a similar study, regardless of level of importance of the game or whether the athlete was a starter vs. non-starter. However, for PTs who plan on assisting at sporting events, additional preparation/education may be recommended, such as what is taught in an emergency responder course.

crpzc, R. B. R. (2015). "Effects of active computer gaming and aerobic exercise on memory, attention and physical performance in older adults." https://trialsearch.who.int/Trial2.aspx?TrialID=RBR-9crpzc.
	INTERVENTION: F01.145.632 F04.754.137.506.662 Subjects (n = 27) were randomized into 2 groups of intervention: exergames and aerobic exercise. In the exergames training 13 healthy subjects (aged 55 and+), both sexes, will participate in an exercise program using active videogames that simulate sports activities. The sessions will include the games of bowling, boxing, ski, soccer, tennis, table tennis and athletics. The program duration is 12 weeks, being held 3 times / week, on alternate days, with each session lasting 60 minutes. Each participant will use the heart rate monitor to check their average heart rate in each session. The temperature in the intervention room will be maintained between 22 and 25 degrees Celsius. In the aerobic training (active control) 14 healthy subjects (55 and +), both sexes, will be submitted to exercises in cycle ergometer and/or treadmills.The intervention protocol consists of 60 minutes (continuous ) at an intensity of 40% to 59% of heart rate reserve. Program duration is 12 weeks being performed 3 times / week on alternate days. To maintain the training intensity, each participant will use a heart rate monitor in every session.The temperature in the intervention room will be maintained between 22 and 25 degrees Celsius. Individuals will be assessed before and after 12 weeks of intervention. CONDITION: Cognitive ability, motor ability, cardiovascular responses. ; F02.463.188 ; G11.427.685 ; E01.370.600.875.500 E01.370.600.875.500 F02.463.188 G11.427.685 Z00‐Z99 PRIMARY OUTCOME: Expected outcome: Improvement in executive function, verified by test computer, after verification of change of at least 5% in the number of errors and execution speed (milliseconds), in the pre and post‐intervention measurements.; Expected outcome: Improvement in psychomotor processing speed, verified by test computer, after verification of change of at least 5% in the number of errors and execution speed (milliseconds), in the pre and post‐intervention measurements.; Expected outcome: Improvement in attention, verified by test computer, after verification of change of at least 5% in the number of hits (accuracy) and reaction time for correct answers (milliseconds), in the pre and post‐intervention measurements.; Expected outcome: Improvement in short‐term memory and visual learning, verified by test computer, after verification of change of at least 5% in the number of hits (accuracy) and reaction time for correct answers (milliseconds), in the pre and post‐intervention measurements.; Expected outcome: Improvement in working memory, verified by test computer, after verification of change of at least 5% in the number of hits (accuracy) and execution speed (milliseconds,) in the pre and post‐intervention measurements.; Expected outcome: Improvement in delayed recall assessment, verified by test computer, after verification of change of at least 5% in the number of hits (accuracy) and execution speed (milliseconds) in the pre and post‐intervention measurements.; Expected outcome: The improvement in global cognitive function, verified by the Mini‐Mental State Examination test, after verification of change of at least 5% in the number of correct answers in the pre and post intervention measurements.; Expected outcome: Improvement in functional mobility, verified by “timed up and go” test, after verification of change of at least 5% in the execution time (seconds), in the pre and post‐intervention measurements.; Expected outcome: Improvement in lower‐extremity muscle strength, verified by “chair stand” test, after verification of change of at least 5% in the number of execution, in 30 seconds, in the pre and post‐intervention measurements.; Expected outcome: Improvement in upper limb muscle strength, verified by “arm curl” test, after verification of change of at least 5% in the number of execution, in 30 seconds, in the pre and post‐intervention measurements.; Expected outcome: Improvement in aerobic endurance, verified by “2 minute step” test, after verification of ch nge of at least 5% in the number of times right knee reaches the required height, in the pre and post‐intervention measurements.; Expected outcome: Improvement in cardiovascular responses, verified by heart rate, from the verification of at least 5% in heart rate variability, in the measurements pre and post intervention.; Observed outcome: Improvement in executive function, verified by test computer, after verification of change of at least 5% in the number of errors and execution speed (milliseconds), in the pre and post‐intervention measurements.; Observed outcome: Improvement in short‐term memory and visual learning, verified by test computer, after verification of change of at least 5% in the reaction time for correct answers (milliseconds), in the pre and post‐intervention measurements.; Expected outcome: Improvement in delayed recall assessment, verified by test computer, after verification of change of at least 5% in the execution speed (milliseconds) in the pre and post‐intervention measurements.; Observed outcome: The improvement in global cognitive function, verified by the Mini‐Mental State Examination test, after verification of change of at least 5% in the number of correct answers in the pre and post intervention measurements.; Observed outcome: Improvement in functional mobility, verified by “timed up and go” test, after verification of change of at least 5% in the execution time (seconds), in the pre and post‐intervention measurements.; Observed outcome: Improvement in lower‐extremity muscle strength, verified by “chair stand” test, after verification of change of at least 5% in the number of execution, in 30 seconds, in the pre and post‐intervention measurements.; Observed outcome: Improvement in upper limb muscle strength, verified by “arm curl” test, after verification of change of at least 5% in the number of execution, in 30 seconds, in the pre and post‐intervention measurements.; Observed outcome: Improvement in aerobic endurance, verified by “2 minute step” test, after verification of change of at least 5% in the number of times right knee reaches the required height, in the pre and post‐intervention measurements.; Observed outcome: Improvement in cardiovascular responses, verified by heart rate, from the verification of at least 5% in heart rate variability, in the measurements pre and post intervention.; SECONDARY OUTCOME: Secondary outcomes are not expected INCLUSION CRITERIA: Individuals of both sexes (target sample = 27 subjects); aged 55 years or older; not participating in regular exercise programs in the last three months; who provide a medical certificate that indicates the consent to participate in physical exercise; subjects without contact videogames of games and exergames; people without visual and hearing impairment, which may hinder the identification of colors, images and sounds.

Csondor, E., et al. (2022). "Adrenal, Gonadal and Peripherally Steroid Changes in Response to Extreme Physical Stress for Characterizing Load Capacity in Athletes." Metabolites 12(2): 91.
	Athletes are often exposed to extreme physical stress during training or competitions. The consequent activation of the hypothalamus-hypophysis-adrenal (HPA) axis results in intensified steroid hormone production in the adrenal cortex. We determined the impact of an acute extreme physical stress on adrenal and gonadal steroidogenesis in healthy male professional athletes (n = 40). The subjects underwent an extreme physical load test until total voluntary fatigue between 14:00 and 18:00 when the hormone levels are relatively stable. Blood was taken before the start (baseline), at the peak load (peak), and 30 min following completion of the exercise (recovery). The vital parameters, lactate levels, and blood levels of the 14 steroid hormones were recorded. The multivariate statistical analysis of the results revealed that all monitored hormone levels increased upon stress. Significant changes in steroid concentrations were detected at peak versus baseline, peak versus recovery, and at baseline versus recovery. The mineralocorticoid (including aldosterone and corticosterone), glucocorticoid (11-deoxycortisol and cortisol), and androgen (androstenedione, dehydroepiandrosterone, and dehydroepiandrosterone sulfate) pathways, as well as gonadal testosterone synthesis are activated simultaneously under extreme physical load. The profiling of adrenal and gonadal steroid biosynthesis in athletes may help the characterization of their loading capacity.

Ctri (2011). "Use of Nintendo Wiiâ?¢, a commercially available gaming console, in the treatment of children with cerebral palsy rehabilitation." https://trialsearch.who.int/Trial2.aspx?TrialID=CTRI/2011/11/002137.
	INTERVENTION: Intervention1: Virtual reality gaming with Nintendo Wii gaming console: Virtual reality gaming using the Nintendo Wiiâ?¢ gaming console. Duration: 45‐60 minutes per day, 6 days a week, for 3 weeks (18 sessions). Type of games: Boxing (in standing posture) and tennis (in standing posture). The intervention will be a supplement to routine physiotherapy and occupational therapy. Routine therapy will be in accordance with patient‐specific needs as prescribed by the attending physician. Control Intervention1: Routine physiotherapy and occupational therapy.: Routine therapy will be in accordance with patient‐specific needs as prescribed by the attending physician. CONDITION: Cerebral palsy PRIMARY OUTCOME: Posture control (as assessed by static posturography and the Bergâ??s Balance Scale (BBS))‐‐‐‐‐‐Timepoint: 3 weeks SECONDARY OUTCOME: Assessment of hand‐skills by â??box and blockâ?? test of gross manual dexterity and upper limb function by Quality of Upper Extremity Skills Test (QUEST)‐‐‐‐‐‐Timepoint: 3 weeks Functional ambulation, as assessed by walking distance and speed measurement.‐‐‐‐‐‐Timepoint: 3 weeks Visual perceptual skills, as assessed by the Test for Visual‐Perceptual Skills, 3rd edition (TVPS‐3).‐‐‐‐‐‐Timepoint: 3 weeks INCLUSION CRITERIA: 1. Adequate functional hand skills to be able to hold the Wii remotes [as assessed by clinical examination]. 2. Adequate gross motor skills to play in standing/ sitting position for at least 25 minutes at a stretch with or without support and be able to stand for 1 minute with or without aids (but no external support) [as assessed by clinical examination]. 3. Sufficient cognitive skills to follow directions, stay on task, and understand the games [as assessed by the Paediatric Occupational Therapy (OT) test].

Ctri (2013). "To compare the effect of structured intensive physical exercise on cognitive, autonomic and anthropometric parameters in adolescents." https://trialsearch.who.int/Trial2.aspx?TrialID=CTRI/2013/08/003897.
	INTERVENTION: Intervention1: Supervised structured physical activity: Structured physical exercise will be given by the trained Physical health education instructors at least six times per week for two hours each day for six months. one hour in the morning and 1 hour in the evening. Structured physical activity is designed to meet the goal that students will be having at least 30 minutes per day three times a week of vigorous physical intensity activity, muscle strengthening & stretching and bone strengthening exercises by following choices of exercises: â?¢ Stretching exercises for warm‐up and cooling down â?¢ Moderate aerobic exercises: Jogging, brisk walk, skipping â?¢ High intensity aerobic exercises: Football/ basketball/ handball /kho kho/badminton, running â?¢ Muscle strengthening & Bone strengthening exercises: Hatha yoga, playing games: tug of war, resistance exercise using body weight ‐ Sit ups, curl ups, pull ups & gymnasium exercises Control Intervention1: unsupervised physical activity: students will be allowed to play whichever games they chose for two hours each day, one hour in morning and one hour in the evening without any supervision for 6 months. CONDITION: Decreased cardiorespiratory fitness, decreased cognition, stress PRIMARY OUTCOME: To compare the effect of supervised structured physical activity and unsupervised physical activity on cognitive, autonomic and anthropometric parameters in adolescents‐‐‐‐‐‐Timepoint: 6 months SECONDARY OUTCOME: To assess fitness level, cognitive, autonomic and anthropometric parameters in adolescents‐‐‐‐‐‐Timepoint: 6 months INCLUSION CRITERIA: Willing for six times per week of physical activity for at least 2 hours duration Healthy volunteers

Ctri (2015). "A clinical trial to study the effect of training on response time and response force in children with intellectual developmental disorders." https://trialsearch.who.int/Trial2.aspx?TrialID=CTRI/2015/04/005724.
	INTERVENTION: Intervention1: Computer based video games: 4 weeks of training with video games Intervention2: Exercise training: Four weeks of supervised exercise training. In addition they will continue to receive their regular Physiotherapy sessions. Intervention3: Video game training: Four weeks of supervised training with computer based video games. In addition they will continue to receive their regular Physiotherapy sessions. Control Intervention1: Control group: The control group will continue to receive their regular Physiotherapy sessions. CONDITION: Intellectual developmental disorders PRIMARY OUTCOME: Response time in milliseconds ; Response force in Newtons ; Number of errors‐‐‐‐‐‐Timepoint: 0,4,8weeks SECONDARY OUTCOME: Response Speed subset & ; Upper‐limb Speed and Dexterity subtest of Bruininks‐Oseretsky Test of Motor Proficiency‐‐‐‐‐‐Timepoint: 0,4,8weeks INCLUSION CRITERIA: Participants with intellectual developmental disorder having functional corrected vision and hearing, and functional grip

Ctri (2017). "EFFECTS OF MICROSOFT KINETIC X BOX GAME ALONG WITH STANDARD PHYSIOTHERAPY ON MOTOR FUNCTION,DYNAMIC BALANCE,ACTIVITIES OF DAILY LIVING AND QUALITY OF LIFE AMONG SPECIAL CHILDREN -RANDOMIZED CONTROLLED TRIAL." https://trialsearch.who.int/Trial2.aspx?TrialID=CTRI/2017/12/011045.
	INTERVENTION: Intervention1: VIRTUAL REALITY GAME THERAPY ALONG WITH STANDARD PHYSIOTHERAPY: KINETIC X BOX 360 WITH INFRARED CAMERA SENSOR AND SPEAKER, PROJECTOR AND USE OF CHAIR,BALL,STAIRS,RAMPS. Control Intervention1: STANDARD PHYSIOTHERAPY: USE OF CHAIR,BALL,RAMPS,STAIRS,MARKERFOR PERFORMING TASK SPECIFIC ACTIVITIES. CONDITION: SPASTIC DIPLEGIC CEREBRAL PALSY CHILDREN PRIMARY OUTCOME: â?¢Gross motor function ; â?¢Dynamic balance ; â?¢Activities of daily living ; â?¢Quality of life ; ‐‐‐‐‐‐Timepoint: 0 WEEK,END OF 6TH WEEK,END OF 10TH WEEK ; SECONDARY OUTCOME: functional motor performance and capacity‐‐‐‐‐‐Timepoint: o week,6th week,10th week(follow up) INCLUSION CRITERIA: 1. Spastic diplegic Cerebral palsy children 2. Age ‐ 6‐12 years 3. Children with GMFCS‐E&R as levels II or III 4. Children with MACS‐ Levels‐I, II, 5. Range of motion of lower and upper extremity permitting to perform the activity 6. Able to understand, communicate and follow the studyâ??s instructions

Ctri (2018). "Benefits of using computer games for hand function in people with stroke." https://trialsearch.who.int/Trial2.aspx?TrialID=CTRI/2018/04/013211.
	INTERVENTION: Intervention1: Computer based training on hand‐function: Computer based game training involves manipulating small objects using software system. Exercise session lasts for 45 minutes a day,3 days a week over 6 weeks duration. Control Intervention1: Conventional Physiotherapy: Physical therapy exercise involves stretches, active functional movements of hand. Exercise session lasts 45 minutes a day,3 days a week over 6 weeks duration. CONDITION: Stroke PRIMARY OUTCOME: Wolf Motor Function Test‐‐‐‐‐‐Timepoint: Two time points: ; Baseline ; 6 weeks post intervention SECONDARY OUTCOME: Motor Activity Log‐‐‐‐‐‐Timepoint: Two time points ; Baseline ; 6 weeks post intervention INCLUSION CRITERIA: 1) Subjects who are able to understand simple verbal command and respond to it 2) Vision by their ability to identify game objects on monitor from 5 feet away 3) Patients scoring 0 to 2 on Modified Ashworth Scale of spasticity

Ctri (2018). "Benefits of using games in computer for the recovery of hand movements and memory in people with Parkinsons disease." https://trialsearch.who.int/Trial2.aspx?TrialID=CTRI/2018/03/012604.
	INTERVENTION: Intervention1: Virtual reality and app based games: Virtual reality and app based games addresses on motor and cognitive function. The exercise session lasts for 45 minutes a day, 2 days a week over 6 weeks. Control Intervention1: Conventional Physiotherapy: Physical therapy includes warm up, stretches, strengthening and balance exercises. The exercise session lasts for 45 minutes a day, 2 days a week over 6 weeks. CONDITION: Parkinsons Disease PRIMARY OUTCOME: Unified Parkinson Disease Rating Scale.‐‐‐‐‐‐Timepoint: Two time points: ; Baseline and 6 weeks post intervention. SECONDARY OUTCOME: 1)Balance Evaluation System Test ; 2)Addenbrooke cognitive examination (ACE‐R) ; 3)The Montreal Cognitive Assessment ; 4)Parkinsons Disease Questionnaire (PDQ‐39)‐‐‐‐‐‐Timepoint: Two time points: ; Baseline and 6 weeks post intervention. INCLUSION CRITERIA: 1) Hoehn and Yahr scale 1‐3 2) Good vision and hearing 3) No prior experience of virtual reality

Ctri (2018). "A computer game based exercise protocol for patients with arm and hand problems after stroke." https://trialsearch.who.int/Trial2.aspx?TrialID=CTRI/2018/06/014577.
	INTERVENTION: Intervention1: Game based Rehabilitation Platform (GRP): Off the shelf computer games to be played with the wireless Airmouse and GRP secured on objects of different sizes and shapes which patients will need to manipulate to get desired movements of targets on the computer screen. Dosage is one session lasting for 45 to 60 minutes thrice a week for a period of 12 weeks Control Intervention1: Routine Physiotherapist care: Regular routine Physiotherapy care provided in the hospital CONDITION: Post first ever stroke PRIMARY OUTCOME: Wolf Motor Function Test and Stroke Specific quality of Life‐‐‐‐‐‐Timepoint: 12th week and 16th week post recruitment SECONDARY OUTCOME: GRP assessment game‐‐‐‐‐‐Timepoint: baseline 12th and 16th weeks INCLUSION CRITERIA: (a) Between 18 to 70 years of age (b) Patients with first ever stroke (c) Time of stroke onset between 1 to 3 months (d) Level of spasticity in upper extremity between grades 1 and 1+ based on Modified Ashworth scale (e) Brunnstrom hand recovery stages of 4 5 6 shoulder and elbow recovery stages of 3 4 5

Ctri (2018). "Impact of Virtual Reality exercises on simple reaction time and fall risk among Parkinsons patients : a comparative study." https://trialsearch.who.int/Trial2.aspx?TrialID=CTRI/2018/10/016071.
	INTERVENTION: Intervention1: Group A: Virtual Reality Exercises with Conventional Physical Therapy Group B: Conventional Physical Therapy: Virtual reality exercises: patients will be exposed any two software through XBOX 360 Kinect for 30 min per session; Kinect sports games like bowling, boxing (15 minutes) & Kinect adventure games like 20,000 leaks, river rush, tight rope (15 minutes). Conventional physical therapy for 30 minutes includes static posture maintaining exercises like stance with wide base of support, narrow base of support, partial tendom standing, tendom standing, one leg standing (15 minutes); Dynamic weight shifting exercises like choice stepping, rope crossing forward, backward, rightward and leftward(15 minutes). Control Intervention1: Simple Reaction Time test, Mini‐BESTest scale: Simple reaction time test is the minimal time needed to respond to a stimulus and a basic measure of processing speed. The patient will be made to sit with their dominant side elbow flexed at 90 with mid‐pronated forearm resting on a flat horizontal table surface, with the open hand at the edge of the surface. Ruler will be suspended vertically by the examiner. Patient will be asked to catch the ruler as quickly as possible, once it is released from the examiners hand. Distance the ruler traveled from starting will be recorded. Then distance will be converted into time by using formula. Three trials will be taken and then mean of this three will be used for the analysis. Mini‐BESTest scale is a balance scale to assess postural control and predict fall risk in people with Parkinsons Disease. This test has 14 items that focuses on dynamic balance. Each items is scored from 0‐2; a score of 0 indicates that a person is unable to perform the task while a score 2 is normal. The best score is the maximum amount of points, being 28. CONDITION: Other specified degenerative disorders of nervous system in diseases classified elsewhere PRIMARY OUTCOME: Simple reaction time test (SRT), ; Mini‐Balance Evaluation System Test (Mini‐BESTest)ScaleTimepoint: Pre and Post after 6 weeks SECONDARY OUTCOME: NILTimepoint: NIL INCLUSION CRITERIA: 1. Mini‐Mental state examination score >24 2. Modified Hoehn‐yahr stages II to III 3. No untreated medical conditions that might be affect balance and walking function 4. Not engaged in any balance or gait training 5. No untreated medical conditions that might affect balance and walking function 6. Able to walk unassisted for at least 5 minutes

Ctri (2020). "Effect of video game based treatment on eye and hand movements among stroke patients." https://trialsearch.who.int/Trial2.aspx?TrialID=CTRI/2020/07/026461.
	INTERVENTION: Intervention1: Head Mounted Virtual Reality display: A head mounted display is a display device, worn on the head or as part of a helmet, that has a small display optic in front of one or each eye. This Video games training consists of games that involves the movement of body parts such as hand, head, and eye. Each game will run for 15 minutes with 5 minutes breaks. ‐ Based on Visual acuity of the patients, size of the target can be changed. ‐ Depending upon the Visual field defects, the target can be shifted to the viewing side. ‐ Speed of the game can be adjusted depending upon the patientâ??s performance. ‐ In case of diplopia, occlusion of one eye can be done. ‐ The therapy will be given with best corrected visual acuity. Control Intervention1: Conventional Physical Therapy: It is the treatment of movement disorders caused by impairments of joints and the muscles that move the joints. Here physical therapy will be given for improvement of Upper limb function. CONDITION: Health Condition 1: I638‐ Other cerebral infarction PRIMARY OUTCOME: 1. Horizontal and Vertical time taken in seconds, H/V Ratio using Developmental eye movement test. ; 2. Reading Speed using MN Read chart (time in second) ; Timepoint: Twice during study period SECONDARY OUTCOME: 1. Fugyl Meyer Upper Limb Score ; 2. Reach Performance Scale Score ; 3. Score of Action Research Arm testTimepoint: Twice during study period INCLUSION CRITERIA: 1. Chronic Stroke of â?Â¥6 months 2. Arm paresis (Chedoke‐McMaster Arm Scale of 2‐6 /7) with voluntary elbow flexion/extension of at least 20° per direction 3. Visual Acuity: Ability to see the largest targets in the game binocularly

Ctri (2021). "Compare the effect of whole body vibration and virtual reality on balance, pain and quality of function in patients with diabetic neuropathy - A Randomized controlled trial." https://trialsearch.who.int/Trial2.aspx?TrialID=CTRI/2021/04/032840.
	INTERVENTION: Intervention1: Whole body vibration duration 3 session per week for 3 weeks: Whole body vibration will be given for 20 mins with break after 10mins in each followed by conventional Physiotherapy treatment for 25mins Control Intervention1: 1st group will be given whole body vibration along with conventional therapy : Group A‐ whole body vibration will be given in 2sets of 10mins each of 50Hz, 3 sessions per week will be given for 3weeks along with conventional Physiotherapy after each session for 25mins Group B‐ Virtual reality for 20mins with break between each game followed by conventional Physiotherapy for 25mins. Group C‐ will be given only Physiotherapy treatment which includes TENS for 20 mins. Neural mobilization of affected nerve with 1min after each repetition will be given for 3 weeks, 3 times per week. Control Intervention2: Group B‐ will be given virtual reality along with conventional Physiotherapy Group C‐ will be given only Physiotherapy treatment: Group B‐ will be given virtual reality for 20mins with break between each game followed by conventional Physiotherapy treatment Group C‐ will be given only Physiotherapy treatment for 45mins Control Intervention3: Virtual reality duration 3 session per week for 3 weeks: Virtual reality will be given for 20mins with break after each game followed by conventional Physiotherapy treatment for 25mins CONDITION: Health Condition 1: E114‐ Type 2 diabetes mellitus with neurological complications PRIMARY OUTCOME: 1.Michigan neuropathy screening instrument ; 2.toronto clinical scoring system ; 3. Random glucose level ; 4. Balance master ; 5. Verbal analogue scale ; 6. Time up and go testTimepoint: 1.time points is 15 Michigan neuropathy screening instrument ; 2.time points 19 toronto clinical scoring system ; 3. time points 200 Random glucose level ; 4. time points graph Balance master ; 5. time points 10 Verbal analogue scale ; 6. time points 20 sec Time up and go test SECONDARY OUTCOME: no secondary outcome measures in this studyTimepoint: no time points INCLUSION CRITERIA: Subjects diagnosed with diabetic neuropathy Subjects with type 2 Diabetes mellitus Subjects fall under mild to moderate category of diabetic neuropathy

Ctri (2021). "COVID-19 Pandemic- Impact of online yoga on mental health and quality of life in adolescents." https://trialsearch.who.int/Trial2.aspx?TrialID=CTRI/2021/02/031543.
	INTERVENTION: Intervention1: Tele Yoga: Online yoga would be taught to school children in the intervention group that would consist of practices like loosening practices, Surya Namaskara, Asanas, Pranayama and relaxation. Control Intervention1: Online Physical Exercises: Standard physical exercises will be provided to the control group comprising of routine exercises and games that can be done at home. CONDITION: PRIMARY OUTCOME: 1.To conduct a survey to assess the mental health and Health related Quality Of Life (HRQOL) in school children and its implications on parents in Kerala due to the current COVID‐19 home confinement ; 2.To assess the efficacy of tele yoga for mental health and Health Related Quality Of Life (HRQOL) in school children during home confinementTimepoint: Strengths and Difficulties Questionnaire Time‐point: 8 and 12 weeks ; WHOQOL‐BREF Time‐point: 8 and 12 weeks SECONDARY OUTCOME: 1.To assess the efficacy of self‐practice of tele yoga for mental health and Health related Quality Of Life (HRQOL) in school children during home confinement ; 2.To assess the efficacy of self‐practice of tele yoga for mental health and Health related Quality Of Life (HRQOL) in school children soon after joining school ; 3.To assess parental response of implication of tele yoga on school childrenTimepoint: Well‐being of Children in Lockdown Scale (WCLS) Time Point: 8 weeks and 12 weeks INCLUSION CRITERIA: 1. School children between the age group of 12‐18 years 2. Children fluent in English or Malayalam languages 3. Both males and females 4. Children & parents consenting to participate in the study 5. Children having access to a smartphone or electronic device with internet connectivity

Ctri (2021). "Developmental coordination Disorder Motor abilities." https://trialsearch.who.int/Trial2.aspx?TrialID=CTRI/2021/09/036196.
	INTERVENTION: Intervention1: VIRTUAL REALITY: virtual reality programme for 60 minutes game session per day 3 times a week for 24 weeks Control Intervention1: conventional Physiotherapy: conventional training for a period of 24 weeks of Gross motor training for core stability, Strengthening exercises, Balance and Coordination Exercises CONDITION: PRIMARY OUTCOME: Developmental Cordination disorder questionnaire ; ; Movement assessment battery for children ; Timepoint: 4 weeeks and 8 weeks ; SECONDARY OUTCOME: Timed up and go test ; Timepoint: 4 weeks ; INCLUSION CRITERIA: Age 6‐10 years Both Male and Female Developmental Coordination disorder questionnaire â??score 15‐55 Children obtained total scores on the Movement ABC below the 15th Percentile No prior Physiotherapy

Ctri (2021). "Effect of Computer game-based exercises on weak hand functions in patients with stroke." https://trialsearch.who.int/Trial2.aspx?TrialID=CTRI/2021/01/030170.
	INTERVENTION: Intervention1: Computer Game based Exercises: Computer game based interface will be utilized to assess the hemiparetic upper extremity functions as well as will be used to train the dexterity functions based on game activities which will be played by the patient using manipulation of various sensory enriched real time objects of different dimensions. These objects will be secured with a inertial‐ based motion mouse which will influence the movement of the game paddle on the computer screen thus allowing various movements to be practiced with respect to the game scenario on screen Control Intervention1: Conventional Physiotherapy: The Conventional therapy will consist of exercises which will be selected autonomously by the researcher as appropriate to the patientsâ?? physical impairments and efficiency. Patients will receive specific exercises of the upper extremity including (1) Neuromuscular interventions‐ NDT about 70% of the therapy content, (2) Structural interventions about 20% of the therapy content, (3) Individual task‐oriented exercises about 10% of the therapy content. CONDITION: Health Condition 1: I699‐ Sequelae of unspecified cerebrovascular diseases PRIMARY OUTCOME: Computer game‐based upper extremity function assessment tool (CG‐UE) ; Wolf Motor Function Test (WMFT) ; Timepoint: Patients will be assessed at baseline(pre intervention), then at 4‐ weeks, 8‐ weeks, post intervention at the end of 12‐ weeks and a repeat follow up assessment will be performed at 16‐ weeks on the outcome measures. SECONDARY OUTCOME: Stroke Impact scale ; Train Making Test A and B ; Qualitative OutcomeTimepoint: Patients will be assessed at baseline(pre intervention), then at 4‐ weeks, 8‐ weeks, post intervention at the end of 12‐ weeks and a repeat follow up assessment will be performed at 16‐ weeks on the outcome measures. ; Upon completion of the therapy program the patients will be invited to take part in an interview where a set of open‐ended questions will be asked and the responses will be recorded and qualitatively analysed. INCLUSION CRITERIA: 1.First time stroke survivors 2.Patients between the age‐ group of 40‐70 years 3.Both genders will be included 4.Patients with intact sensory function on the affected upper extremity 5.Upper extremity spasticity less than or equal to 1+ on Modified Ashworth scale 6.Brunnstrom hand recovery stages of 4, 5 for shoulder and elbow recovery stages of 4, 5 7.Patients who demonstrate cognitive function on MoCA scale (defined as score >19/30) 8.Patients who demonstrate an ability to independently maintain sitting posture. 9.Able to perform/ initiate little finger extension and/or shoulder abduction 10.Minimum Score of 7 or more as evaluated on the Trunk Impairment Scale

Ctri (2021). "Effect of Leap Motion Tracking Device on Pain, Range of Motion, Muscle Strength And Functional Parameters in patients with Distal Radial Fracture." https://trialsearch.who.int/Trial2.aspx?TrialID=CTRI/2021/05/033498.
	INTERVENTION: Intervention1: Leap Motion Controller Device: 5 games, each game concentrating on the specific wrist movement, for 5 minutes each, for 30 minutes of the treatment session. Control Intervention1: Conventional Physiotherapy Treatment: Whirlpool bath, Maitland Mobilization grade I and II for pain management, Stretching, Strengthening with Theraband for 60 minutes. CONDITION: Health Condition 1: S62‐ Fracture at wrist and hand level PRIMARY OUTCOME: 1. Disabilities of the Arm, Shoulder and Hand Outcome Questionnaire (DASH) ; 2. Universal GoniometerTimepoint: 1. Disabilities of the Arm, Shoulder and Hand Outcome Questionnaire (DASH) ; 2. Universal Goniometer SECONDARY OUTCOME: 1. Visual Analogue Scale (VAS) ; 2. Grip Strength using Hand DynamometerTimepoint: Pre Treatment day 1 ; Post Treatment 6 weeks INCLUSION CRITERIA: 1. Patients must be diagnosed with an A3 extraarticular multi‐fragmentary distal radial fracture type and treated conservatively with plaster cast immobilization and closed reduction. 2. Participants must accept and sign the Informed consent. 3. No previous history of wrist/ hand fracture, history of inflammatory arthritis, or any possible upper limb fracture. 4. Patients who are able to comprehend

Ctri (2021). "Effectiveness of Rehabilitation Manipulandam Device for improving hand functioning in children with neurodevelopmental disorder." https://trialsearch.who.int/Trial2.aspx?TrialID=CTRI/2021/07/034903.
	INTERVENTION: Intervention1: Group B: Group B‐ Will receive only Physiotherapy treatment. Intervention2: Group A: Group A‐ will receive therapy using Rehabilitation Manipulandam Device. therapy session will be for 45min, 3 days a week, for 8 weeks. CONDITION: Health Condition 1: F82‐ Specific developmental disorder ofmotor function PRIMARY OUTCOME: 1) PDMS‐2 ; 2) QUEST scale ; 3) CUE scale( computer game assisted assessment tool) ; 4) ; GAS scale(Goal Attainment Scaling)Timepoint: Before receiving treatment. ; After 1 week, to check reliability of device. ; Once in every month till the follow up that is till 3 months SECONDARY OUTCOME: Not applicableTimepoint: Not applicable INCLUSION CRITERIA: (1) Children with confirmed medical diagnosis of Neurodevelopment disorder by the Medical practitioner or pediatrician. (2) Age group â?? 4‐10 years of children with either gender. (3) Modified Ashworth scale was used to determine the level of spasticity in biceps Brachialis, pronators and finger flexors from grade 1 to 1+ (4) Mini Mental Scale Examination‐ >10 (5) Parents willing to participate

Ctri (2021). "Treatment of the weakness of Upper Extremity due to Stroke by virtual gaming." https://trialsearch.who.int/Trial2.aspx?TrialID=CTRI/2021/11/038339.
	INTERVENTION: Intervention1: Virtual Gaming: Virtual gaming will be given minimum of 3 sessions/week for 3 months Control Intervention1: Physiotherapy: Routine Physiotherapy for 3 months (Standard of care) CONDITION: Health Condition 1: I63‐ Cerebral infarction PRIMARY OUTCOME: Fugl Meyer score and Wolf motor function testTimepoint: Baseline and 3 months SECONDARY OUTCOME: Quality of life scale (SF‐36)Timepoint: Baseline and 3 months INCLUSION CRITERIA: (a) Age between 18‐70 years of age (b) Patients with first‐ever stroke with impairment of upper limb extremity function (c) Time of stroke onset between 1‐6 months (d) Level of spasticity in upper extremity between grades 1 and 1+ based on Modified Ashworth scale (e) Brunnstrom hand recovery stages of 4,5,6, shoulder and elbow recovery stages of 3,4,5

Cuesta-Vargas, A. and M. Gine-Garriga (2014). "Development of a new index of balance in adults with intellectual and developmental disabilities." PLoS ONE [Electronic Resource] 9(5): e96529.
	PURPOSES: The first objective was to propose a new model representing the balance level of adults with intellectual and developmental disabilities (IDD) using Principal Components Analysis (PCA); and the second objective was to use the results from the PCA recorded by regression method to construct and validate summative scales of the standardized values of the index, which may be useful to facilitate a balance assessment in adults with IDD. METHODS: A total of 801 individuals with IDD (509 males) mean 33.1 +/- 8.5 years old, were recruited from Special Olympic Games in Spain 2009 to 2012. The participants performed the following tests: the timed-stand test, the single leg stance test with open and closed eyes, the Functional Reach Test, the Expanded Timed-Get-up-and-Go Test. Data was analyzed using principal components analysis (PCA) with Oblimin rotation and Kaiser normalization. We examined the construct validity of our proposed two-factor model underlying balance for adults with IDD. The scores from PCA were recorded by regression method and were standardized. RESULTS: The Component Plot and Rotated Space indicated that a two-factor solution (Dynamic and Static Balance components) was optimal. The PCA with direct Oblimin rotation revealed a satisfactory percentage of total variance explained by the two factors: 51.6 and 21.4%, respectively. The median score standardized for component dynamic and static of the balance index for adults with IDD is shown how references values. CONCLUSIONS: Our study may lead to improvements in the understanding and assessment of balance in adults with IDD. First, it confirms that a two-factor model may underlie the balance construct, and second, it provides an index that may be useful for identifying the balance level for adults with IDD.

Cuthbert, J. P., et al. (2014). "Virtual reality-based therapy for the treatment of balance deficits in patients receiving inpatient rehabilitation for traumatic brain injury." Brain Injury 28(2): 181-188.
	OBJECTIVE: To evaluate the feasibility and safety of utilizing a commercially available virtual reality gaming system as a treatment intervention for balance training. DESIGN: A randomized controlled trial in which assessment and analysis were blinded. SETTING: An inpatient rehabilitation facility. INTERVENTION: Interventions included balance-based physical therapy using a Nintendo Wii, as monitored by a physical therapist, and receipt of one-on-one balance-based physical therapy using standard physical therapy modalities available for use in the therapy gym. RESULTS: Participants in the standard physical therapy group were found to have slightly higher enjoyment at mid-intervention, while those receiving the virtual reality-based balance intervention were found to have higher enjoyment at study completion. Both groups demonstrated improved static and dynamic balance over the course of the study, with no significant differences between groups. Correlational analyses suggest a relationship exists between Wii balance board game scores and BBS scores for measures taken beyond the baseline assessment. CONCLUSIONS: This study provides a modest level of evidence to support using commercially available VR gaming systems for the treatment of balance deficits in patients with a primary diagnosis of TBI receiving inpatient rehabilitation. Additional research of these types of interventions for the treatment of balance deficits is warranted.

Cyrillo, F., et al. (2011). "Research Report Abstracts." Physiotherapy 97: eS18-eS1415.
	Purpose: The Effect of a video game system on balance and gait after stroke. Relevance: Contribute for scientific basis of clinical practice and evidence based practice. Participants: There were selected 10 subjects aged 20‐60 years, males, righties, which showed hemiparesis post‐stroke, single episode, supratentorial, occurring for at least six months from the time of the study. Methods: The patients were randomized into two groups the control group (CG) who received a sixty minutes conventional physical therapy treatment in group, once a week and the experimental group (EG) witch received in addition to the group treatment ten sessions with the video game Wii twice a week per 20 minutes. The training using Wii Balance software included yoga, balance and aerobic practice. Patients were assessed by the Orpington Severity Scale, the Berg Balance Scale, the Dynamic Gait Index, the Functional Reach Test and the Time Up and Go Test. Analysis: The analysis was performed with SPSS software for intragroup and intergroup. The variables were analyzed for their normality. To evalue the comparisons was applied analysis of variance. The significance level was 0.05. Results: The results showed a significantly improvement in the Berg Balance Scale (p = 0.02) and in the Dynamic Gait Index (p = 0.04) for both groups after the treatment. No significant differences were found between the experimental and the control group (p = 0.62). Conclusions: The use of a video game system as a complement of the conventional physiotherapy treatment for stroke patients demonstrated the same effects of the therapy alone but can be considered as a motivational instrument that can contribute for the patients' adhesion in therapy. Implications: Implications clinical care in physiotherapy.

Cyrillo, F. and J. Greve (2018). "The effects of virtual reality on the rehabilitation of patients with knee OA: A randomized controlled clinical trial." Annals of physical and rehabilitation medicine 61: e129-e130.
	Introduction/Background Knee OA is one of the most prevalent orthopedic diseases in the elderly population, with a degenerative and progressive character that affects the articular cartilage, limiting the articular range of motion (ROM) due to rigidity and causing important functional restrictions. Virtual reality (VR) is one of the instruments that can help in the rehabilitation process of patients, motivating them and enabling more assertive movements and exercises. Material and method Ninety patients (65 women and 25 men) between 50 and 70 years old, with a medical diagnosis of OA in at least one knee participated in the study. After completing the WOMAC and Lequesne questionnaires, they were evaluated for pain and muscular strength. The volunteers signed the consent term and were then randomly divided, using opaque, sealed envelopes, into 3 groups: control group - performed a conventional physiotherapy program with aerobic and muscle strengthening exercises; experimental group 1 (Wii) - in addition to the conventional program used Nintendo's Wii Fit games; experimental group 2 (Kinect) - complemented the conventional treatment with the Xbox Kinect video game system. Results It was observed that, in general, the three study groups demonstrated statistically significant improvement (P<0.05) in relation to pain and muscular strength. The groups with inclusion of the VR resources only presented better results than the control group in the function dimension of the WOMAC questionnaire. Conclusion The methodological conditions used in the study suggest that virtual reality as an additional instrument in rehabilitation programs for patients with knee OA was better than the control group only in the function dimension of the WOMAC questionnaire.

da Rocha, J. K., et al. (2021). "Elderly Individuals Were Believed To Do Light-moderate Walking, Aquatics, And Resistance Or Stretching Exercises." Medicine & Science in Sports & Exercise 53(8S): 264-264.
	PURPOSE: The aim of this study was to analyze students' and practitioners' indications regarding the frequency, intensity, time, and type of exercises for elderly individuals. METHODS: This retrospective analysis covered the period between 1999 and 2009 when undergraduate students and practitioners (N: 2250) reported their beliefs on exercise prescription for elderly individuals. Participants were from majors in kinesiology, medicine, nursing, nutrition, physical therapy, and psychology from different Brazilian states. They were asked to indicate in order of priority the three most appropriate types of exercise for healthy (HEI) and unhealthy elderly individuals (UEI) with their frequency (days/wk), time (min/day), and intensity (light, moderate, or vigorous). RESULTS: Participants were mostly women (N: 1424, 63%) aged 14-65 (25.03 ± 6.88 years) who were undergraduate students (N: 1351, 60%) majoring in kinesiology (N: 708, 32%). A few participants neither knew how to indicate exercise for elderly individuals (N: 68, 3%) nor were willing to answer the questionnaire (N: 124, 6%). Participants indicated 56 types of activities (e.g., fishing), exercises (e.g., flexibility), martial arts (e.g., Tai Chi), popular games (e.g., bocce), or sports (e.g., volleyball). Walking (WK, N: 1207, 56%), aquatics (AQ, N: 542, 24%), and resistance exercises (RE, N: 280, 12%) were the most prevalent indications in order of priority for HEI. Such an order was similar for UEI, except for the fact that stretching (ST, N: 210, 9%) followed WK (N: 844, 38%) and AQ (N: 329, 15%). UEI tended to be indicated with a fewer frequency (2.72 ± 1.83 vs 3.65 ± 1.56 days/wk), shorter time (36.54 ± 19.42 vs 44.65 ± 21.11 min/day), and lower intensity; UEI were only indicated with light intensity (WK, N: 1192, 53%; AQ, N: 1121, 50%; ST, N: 1016, 45%), while moderate (WK, N: 1157, 51%; AQ, N: 1072, 48%) and light intensities (RE, N: 998, 44%) were suggested for HEI. CONCLUSION: Light-moderate walking, aquatics, and resistance or stretching exercises were believed to be the order of priority for elderly individuals regardless of clinical status. Future studies could focus on determining current beliefs on exercise prescription for elderly individuals since our findings provide evidence that supports secular trend analyses.

Da Silva Junior, J. L. A., et al. (2021). "A Bowling Exergame to Improve Functional Capacity in Older Adults: Co-Design, Development, and Testing to Compare the Progress of Playing Alone Versus Playing With Peers." JMIR Serious Games 9(1): e23423.
	BACKGROUND: Older people often do not meet the recommended levels of exercise required to reduce functional decline. Social interaction is mentioned by this cohort as a reason for joining group-based exercises, which does not occur when exercising alone. This perspective shows that exergames can be used as motivational resources. However, most available exergames are generic, obtained from commercial sources, and usually not specifically designed or adapted for older people. OBJECTIVE: In this study, we aim to co-design and develop a new exergame alongside older participants to (1) tailor the game mechanics and optimize participants' adherence to and enjoyment of exercise; (2) test the participants' functional capacity, motivation, and adherence to the exergaming program; and (3) compare these scores between those who played alone and those who played with peers. METHODS: We conducted a co-design process to develop a new exergame adapted to older people. For user testing, 23 participants were divided into 2 groups to play individually (alone group) or to compete in pairs (with peers group). They played the game twice a week, resulting in 21 exergaming sessions. We assessed the participants' General Physical Fitness Index (GPFI) before and after the user testing. We also administered questionnaires about the gaming experience and exercise adherence with its motivators and barriers. RESULTS: We introduced a new bowling exergame for Xbox with a Kinect motion sensor that can be played in single or multiplayer mode. For the GPFI measurements, the sample was homogeneous in the pretest (with peers group: mean 40.5 [SD 9.6], alone group: mean 33.9 [SD 7.8]; P=.11). After the exergame testing sessions, both groups had significant gains (with peers group: mean 57.5 [SD 8.7], P=.005; alone group: mean 44.7 [SD 10.6]; P=.02). Comparing the posttest between groups, it was found that the group in which participants played with peers had better outcomes than the group in which participants played alone (P=.02). Regarding the gaming experience and exercise adherence, both groups recognized the benefits and expressed enthusiasm toward the exergame. CONCLUSIONS: The findings suggest that the developed exergame helps in improving the functional capacity and adherence to physical exercise among older people, with even better results for those who played with peers. In addition to leading to more appropriate products, a co-design approach may positively influence the motivation and adherence of participants.

da Silva Ribeiro, N. M., et al. (2015). "Virtual rehabilitation via Nintendo Wii(R) and conventional physical therapy effectively treat post-stroke hemiparetic patients." Top Stroke Rehabil 22(4): 299-305.
	BACKGROUND: The Nintendo(R) Wii is a simple and affordable virtual therapy alternative. It may be used at home, and it is a motivating recreational activity that provides continuous feedback. However, studies comparing the use of the Nintendo(R) Wii to conventional physical therapy are needed. OBJECTIVE: To compare the effect of a rehabilitation treatment using the Nintendo(R) Wii (NW) with conventional physical therapy (CPT) to improve the sensorimotor function and quality of life for post-stroke hemiparetic patients. METHODS: The present study applied a randomized, blind, and controlled clinical trial. In total, 30 patients with post-stroke hemiparesis were evaluated. A total of 15 patients were randomly assigned to each group. The SF-36 quality of life and Fugl-Meyer scales were used to evaluate the patients. RESULTS: After treatment, the only variable that differed between the groups was the physical functioning domain of the SF-36 in the group that received conventional physical therapy. A significant difference was observed between both groups before and after treatment in terms of the following Fugl-Meyer scale items: passive movement and pain, motor function of the upper limbs (ULs), and balance. The CPT group also showed a significant difference with regard to their UL and lower limb (LL) coordination. The SF-36 scale analysis revealed a significant difference within both groups with regard to the following domains: physical functioning, role limitation due to physical aspects, vitality, and role limitation due to emotional aspects. The NW group also exhibited a significant difference in the mental health domain. The results indicate that both approaches improved the patients' performance in a similar manner. CONCLUSION: Virtual rehabilitation using the Nintendo Wii(R) and CPT both effectively treat post-stroke hemiparetic patients by improving passive movement and pain scores, motor function of the upper limb, balance, physical functioning, vitality, and the physical and emotional aspects of role functioning.

Dahl-Popolizio, S., et al. (2014). "Comparing Outcomes of Kinect Videogame-Based Occupational/Physical Therapy Versus Usual Care." Games for Health Journal 3(3): 157-161.
	OBJECTIVE: The purpose of this study was to assess the effectiveness of a game-like exercise tool as a component of occupational and physical therapy treatment for patients with shoulder pain and impairment in an outpatient physical therapy clinic. MATERIALS AND METHODS: The product evaluated is a hands-free therapy (HFT) prototype, using Microsoft((R)) (Redmond, WA) Kinect technology. HFT was designed as a home exercise program (HEP), or adjunct to a clinic-based exercise program, with the goal to improve patient compliance and outcomes by providing patients with continuous immediate feedback and engaging them in a game-like experience. Eight patients with shoulder injuries were randomly assigned to study groups. Outcomes in pain, range of motion, and function were assessed. The experimental group received six sessions using HFT; the control group received six sessions of treatment as usual. RESULTS: The research demonstrated that patient outcomes were as good in the group using HFT as outcomes achieved with usual care. HFT was found to be a useful adjunct in an outpatient therapy clinic, allowing patients to complete exercises with real-time feedback and minimal therapist oversight. CONCLUSIONS: These preliminary findings support the potential use of technology to provide an effective therapy and HEP system. Additional research utilizing a larger sample size is warranted to determine if this product can be an effective tool to improve HEP compliance and to determine the effectiveness of HFT as an adjunctive treatment in the clinic.

Dalmazane, M., et al. (2021). "Effects on gait and balance of home-based active video game interventions in persons with multiple sclerosis: A systematic review." Multiple Sclerosis and Related Disorders 51: 102928.
	BACKGROUND: The current coronavirus disease (COVID-19) pandemic makes it difficult to obtain physical therapy in rehabilitation centres, particularly for persons with multiple sclerosis (pwMS), who are a population at high risk, since viral infections may contribute to MS exacerbations and relapses. Active video games could be a way to maintain physical therapy at home as part of the rehabilitation. The aim of this review is to summarise the current best evidence for the effectiveness of home-based active video games on gait and balance, user compliance, feasibility and safety for pwMS. METHODS: We searched for studies in five databases (PubMed, Scopus, Cochrane, CINAHL and Science direct) up to October 2020. Selection of studies, extraction of data and methodological quality assessment through the PEDro scale were made independently by two authors and discussed with a third author. RESULTS: Nine studies were included in this systematic review. We found significant improvements in balance; results were mixed concerning mobility, physical activity and gait. Home-based active video games are feasible and safe, with good compliance and adherence. The methodological quality of the studies was moderate (PEDro scale: 5.3 +/- 2). CONCLUSION: Overall, home-based active video games were found safe and effective improving static and dynamic balance in pwMS. Compliance was good, probably because it is a motivating and enjoyable training. Active video games can be a relevant alternative for physical rehabilitation at home in pwMS. Future studies should follow more rigorous methodological standards (larger sample sizes, more randomised controlled trials) to improve the quality of evidence and include cost-effectiveness in the analysis.

Danish, D. (2012). "Chronic Pain Vignettes." Rehab Management: The Interdisciplinary Journal of Rehabilitation 25(8): 14-19.
	The article provides different perspectives for both the clinicians and patients for chronic pain management. Millions are affected by chronic pain every year which puts a tremendous burden on health care costs, rehabilitation, and lost worker productivity. Chronic pain can vary in intensity, therefore, applying analogies like The Game of Straw or The Roller Coaster Ride can help patients connect better with their condition, accept it and make them go for a therapy that will provide comfort.

Dao, T. T., et al. (2016). "Interactive and Connected Rehabilitation Systems for E-Health." IRBM 37(5-6): 289-296.
	Functional rehabilitation aims at recovering the locomotion dysfunction of the human body by the physical therapy. The objective of this paper was to develop interactive and connected rehabilitation systems as a system of systems for monitoring the bio-feedbacks of the human musculoskeletal system during the rehabilitation exercises. Video-based non-contact system as Kinect sensor was used to get kinematics data of the human body. Generic and subject-specific avatar representations were integrated. Rehabilitation exercises will be designed as serious games to motivate the end users. Our first prototype was focused on the rehabilitation exercises of the lower limb. Software development and experimental aspects of our proposed solution were presented and discussed. Our system would be of great interest in the supervision of physical therapy exercises in clinical as well as in non-clinical environments (e.g. rehabilitation at home). As perspectives, multi-sensor fusion between Kinect sensor and other kinematics-based sensors like Shimmer ones will be investigated to get an accurate 3D joint motion. Electromyography (EMG) signals will be also used to monitor the muscle functions. Moreover, specific device will also be developed to facilitate the sensors set up and motion monitoring.

Das, J., et al. (2022). "Technological visuo-cognitive training in Parkinson's disease: Protocol for a randomised cross-over trial." Physiotherapy 114: e107-e108.
	Keywords: Parkinson's; Visuo‐cognition; Stroboscopic Purpose: Visual and cognitive impairments are common non‐motor symptoms (NMS) in people with Parkinson's (PwP). These NMS impact on balance and gait impairments, leading to reduced quality of life and increased risk of falls, hospitalisation, and mortality. There is limited evidence for rehabilitation of visual or cognitive impairment in PwP, with the added complexity that these systems are interrelated (termed visuo‐cognition). Non‐pharmacological interventions for visuo‐cognitive deficits in PwP are achievable with modern technology. Novel devices such as combined mobile applications and stroboscopic glasses have been shown to improve visuo‐cognitive outcomes in healthy individuals, but their effectiveness in people with neurological conditions has yet to be examined. This study aims to investigate the use of technology for visuo‐cognitive training in PwP. The feasibility and potential effectiveness of a technological visuo‐cognitive training (TVT) package will be compared to conventional visual training in PwP. Participants will undergo a 4‐week TVT period and a 4‐week standard care period, with baseline and post‐intervention assessments of vision, cognition, balance, gait and clinical outcomes. Methods: This is a two‐armed cross‐over design, assessor‐blinded, single‐centre randomised trial. Forty adults with mild‐to‐moderate PD will be randomly assigned to either Group A (n = 20) or Group B (n = 20). Group A will receive 8 sessions of TVT over a 4‐week period. Each session will include a series of visuo‐cognitive training drills using a mobile device and hand‐eye co‐ordination activities whilst wearing stroboscopic glasses (Senaptec Inc., USA). Group B will receive 8 sessions of active control intervention involving standard visuo‐cognitive training drills and games. After a 2‐week wash out period, the groups will cross‐over and Group A will receive 8 sessions of active control intervention and Group B will receive 8 sessions of TVT. Assessments will be recorded at baseline, after the first 4‐week intervention and at the end of the second 4‐week intervention. The primary clinical outcome will be change in visuo‐cognition from baseline to follow‐up measured using the Trail Making Test. Secondary outcomes will include change in balance, gait, quality of life, fear of falling and activity levels. Feasibility will be examined in relation to safety and acceptability of the TVT intervention; user experiences of TVT will be explored through qualitative semi‐structured interview. Results: The protocol, data collection and analysis methods will be presented at the Physiotherapy UK 2021 conference. Conclusion(s): We hypothesise that TVT will improve aspects of visuo‐cognitive function in PwP, which in turn may influence balance and walking capability. TVT may reduce risk factors associated with balance impairment and ultimately falls. Falls are one of the leading causes of hospitalisation and mortality in PwP and therefore new rehabilitation techniques are urgently needed. Understanding the effects of TVT in PwP will help physiotherapists to develop tailored interventions using digital technologies for NMS that have received limited attention. Impact: If TVT is feasible and effective in PwP it could be used within clinical practice to primarily improve visuo‐cognition, but secondly enhance balance and gait, and ultimately reduce falls risk. This study will provide preliminary data to support a larger, multi‐centre randomised controlled trial. Funding acknowledgements: This work forms part of a collaborative PhD study funded by Northumbria University, Faculty of Health & Life Sciences with support from biotechnology company, Senaptec (Beaverton, Oregan USA).

Davidson, D. M. (2008). "Surgery for the athlete: these new advances help get competitors back in the game." Podiatry Management 27(5): 85-92.
	
Davidson, K. L. (2002). "Airway clearance strategies for the pediatric patient." Respiratory Care 47(7): 823-828.
	Clinicians who care for cystic fibrosis (CF) patients have many techniques to choose from to facilitate mucus clearance. Little has been published about when to introduce the various techniques and in what order to teach them. Debates have occurred over these issues in the CF community, and there is now consensus on some topics. It is very important to teach adherence to therapy at an early age. Adherence to an airway clearing regimen assists in maintaining good pulmonary function in CF patients. Knowing when and how to introduce airway clearance techniques beyond chest physiotherapy (CPT) is clinically relevant and useful. A 5-position modified CPT routine can be used with infants and children, and it takes less time and may improve adherence. Infants and toddlers can be taught breathing games that eventually lead them to perform diaphragmatic breathing and huffing. Once they have mastered diaphragmatic breathing and huffing, children can be taught the active cycle of breathing technique. Modified CPT can be phased out at that point. Positive expiratory pressure therapy can usually be introduced around 6-7 years of age. High-frequency chest wall oscillation, oscillating positive expiratory pressure, and autogenic drainage all follow. CF patients should be given every opportunity to learn and master various techniques to promote mucus clearance.

Davies, T. (2012). "Welcome." SportEX Medicine(54): 3-3.
	An introduction is presented in which the editor praises the brilliantly organized and coordinated Olympic and Paralympic Games in London, England, commends the physical therapies of Lynn Booth and her team, and dedicates the editorial to the sporting endeavors of the Games Makers.

de Bruin, E. D., et al. (2019). "Playing Exergames Facilitates Central Drive to the Ankle Dorsiflexors During Gait in Older Adults; a Quasi-Experimental Investigation." Frontiers in aging neuroscience 11: 263.
	PURPOSE: Gait training might be of particular importance to reduce fall risk in older adults. In the present study we explore the hypothesis that video game-based training will increase tibialis anterior (TA) muscle EMG-EMG coherence and relates to functional measures of lower limb control. METHODS: We focus on video game-based training performed in standing position, where the subjects have to lift their toes to place their feet on different target zones in order to successfully play the game. This type of training is hypothesized leading to progressive changes in the central motor drive to TA motor neurons and, consequently, improved control of ankle dorsiflexion during gait. RESULTS: Twenty older adults, 79 +/- 8 years old, 13 females/7 males, participated. Results showed a significant difference against 0 in the experimental DeltaPOST condition in dual-task walking and beta Frequency Of Interest (p = 0.002). Walking under dual task condition showed significant change over time in minimal Toe Clearance for both the left [chi(2)(2) = 7.46, p = 0.024, n = 20] and right [chi(2)(2) = 8.87, p = 0.012, n = 20] leg. No change in lower extremity function was detectable. CONCLUSION: Overall we conclude that the initiation of an exergame-based training in upright standing position improves neural drive to the lower extremities in older adults, effects on minimal Toe Clearance and seems an acceptable form of physical exercise for this group.

de Carvalho, I. F., et al. (2018). "The Influence of Video Game Training with and without Subpatelar Bandage in Mobility and Gait Speed on Elderly Female Fallers." Journal of Aging Research 2018: 9415093.
	OBJECTIVES: The aim of the study was to investigate the effect of balance training with Nintendo Wii technology, with and without the use of additional sensory information (subpatellar bandage), in the functional mobility and gait speed of elderly female fallers. METHODS: Twenty elderly women were divided into two groups: group I: trained with the use of the Nintendo Wii; group II: trained using the Nintendo Wii and the addition of sensory information (subpatellar bandage). The functional mobility was assessed with the Timed up and Go test (TUG) and gait speed with the 10 m test. The tests were carried out with and without the use of the subpatellar bandage. The training was carried out within sessions of 30 minutes, twice a week, using three different games (Penguin Slide, Table Tilt, and Tightrope). RESULTS: There was an increase in the gait speed and a decrease in the TUG time in both groups, independently of the sensory condition used (p < 0.05). In the short term, the subpatellar bandage improved the TUG time (p < 0.05) and the gait speed (p < 0.01). CONCLUSION: The training for postural balance with virtual reality was effective for improving functional mobility and gait speed of elderly female fallers. The subpatellar bandage did not maximize the effect of training.

de Castro, M. R., et al. (2016). "Jogos recreativos para a terceira idade: uma análise a partir da percepção dos idosos." Revista Brasileira de Ciências do Esporte 38(3): 283-289.
	Resumo Objetivou‐se analisar as percepções dos idosos sobre a sua participação nos Jogos Recreativos da Terceira Idade. Foram entrevistados 15 homens e 11 mulheres, (69,62 ± 6,54 anos) por meio de entrevista semiestruturada analisada à luz da análise de conteúdo. Os resultados são expressos nas categorias: interação social; cuidados com a saúde; combate ao sedentarismo, adesão e permanência em programas de exercícios físicos. Essas denotam que tais intervenções são vistas pelos idosos como oportunidade de melhoria da saúde e socialização. A participação ativa enquanto coautor na elaboração contribuiu para adesão e permanência. Assim, eventos esportivos e recreativos são percebidos como direito materializado e ferramenta importante no processo de educação para saúde de pessoas idosas. This paper aimed to analyze the perception of the elderly about their participation in Recreational Games to Elderly. We interviewed 15 men and 11 women (69.62 ± 6.54 years) through a semi‐structured interview later analyzed in the light of Content Analysis. Results are expressed in categories: social interaction, health care, combating sedentary lifestyle, adherence and retention in physical exercise programs. These denote that such interventions are perceived by elderly as an opportunity to improve health and socialization. Active participation as a coauthor in formulation contributed to adherence and retention. Thus, recreational and sporting events are perceived as an important tool in the process of health education for the elderly. Resumen El objetivo fue analizar la percepción de los ancianos sobre su participación en juegos recreativos. Se entrevistó a 15 hombres y a 11 mujeres (69,62 ± 6,54 años) mediante entrevistas semiestructuradas analizadas a la luz del análisis de contenido. Los resultados se expresan en categorías: interacción social, asistencia sanitaria, lucha contra el sedentarismo, adhesión y permanencia en programas de actividad física. Estos indican que los ancianos ven este tipo de intervenciones como una oportunidad para mejorar la salud y la socialización. La participación activa como coautor en la redacción contribuyó a la adhesión y permanencia. Así, eventos recreativos y deportivos se perciben como una herramienta adecuada e importante en el proceso de educación para la salud en los ancianos.

De Marchis, M., et al. (2017). "Effectiveness of a psychomotor intervention in a group of paediatric patients with cystic fibrosis hospitalized for pulmonary exacerbation: a randomized controlled study." Journal of cystic fibrosis 16: S28‐S29.
	Objectives: Patients with cystic fibrosis (CF) are encouraged to practice physical activity, however adherence is generally poor, specially for children, and the hospitalization for a pulmonary exacerbation can represent a time of inactivity for these patients, who often accept to receive only chest physiotherapy and antibiotic therapy. The purpose of our study was to evaluate the effects of a psychomotor intervention (PI) on exercise capacity (Six Minutes Walk Test), lung function (FEV1) and Quality of Life (CFQ‐R), performed during hospitalization for pulmonary exacerbation lasting 14 days, in a group of paediatric CF patients. We also compared patients' preference between PI and usually prescribed physical activity (Likert scale). Methods: 30 paediatric patients with CF, randomly assigned to a PI (study group) or to a physical exercise programme (control group). Inclusion criteria: CF diagnosis confirmed using sweat test, hospitalization for pulmonary exacerbation, age 6‐18 years. Exclusion criteria: fever at admission. All measurements were performed at admission and at discharge. The PI intervention consisted in "animal games" (jumping like a rabbit, then like a kangaroo.), circuit routes with different materials, traditional games (cherry picking, cops and robbers.). Results: We found statistically significant increases in patients' preference for PI versus usual physical activity (Likert+ 23,20/100; p = 0.001). The other outcomes increased but not statistically significant. Conclusion: Psychomotor intervention could be a good therapeutic option for CF paediatric patients, especially to improve adherence to phisical activity.

de Menezes, L. D. C., et al. (2020). "Can individuals with down syndrome improve their performance after practicing a game on a mobile phone?—A new insight study." Learning and Motivation 72: 101685.
	Introduction Down syndrome (DS) is a genetic disorder characterized by the presence of an extra chromosome, which is typically associated with motor and cognitive changes that interfere with the ability to perform daily activities. To enable gains in motor skills in individuals with DS, one option is to use new technologies such as mobile phone tasks in a virtual reality environment. Objective To explore whether a mobile phone game is a feasible tool to improve motor performance of upper limbs in individuals with DS. Method The game Marble Maze Classic® was used, in which the participants moved the mobile phone to guide a virtual marble through a maze design. We evaluated 100 individuals, 50 with DS and 50 individuals with typical development matched by gender and age. The participants were divided into two conditions: a ‘condition with an original maze’, with 25 individuals in the comparison group (typical development) and 25 in the experimental group (DS) and a ‘reverse condition’ with the same number of participants that used a maze design with an opposite path to the original as a counter-balance measure. The dependent variable used was time in seconds to finish the maze path. ANOVA was used in analysis of group differences. Post-hoc comparisons were performed using Tukey’s Honest Significant Difference test (p < 0.05). Results The comparison group improved during practice and maintained performance in the retention phase; they were able to transfer learning to different mazes. The DS group improved and retained motor performance, but transferred motor performance only in the original maze, not in the reverse condition. That is, the DS group failed to transfer learning as effectively as the comparison group. Conclusion People with DS managed to adapt to the task but underperformed compared to people with TD. Difficulty in maintaining performance with increased task difficulty was observed in the DS participants, highlighting the need to differentiate such tasks in improving performance.

De Miguel-Rubio, A., et al. (2020). "Virtual Reality Systems for Upper Limb Motor Function Recovery in Patients With Spinal Cord Injury: Systematic Review and Meta-Analysis." JMIR MHealth and UHealth 8(12): e22537.
	BACKGROUND: Patients with spinal cord injury (SCI) usually present with different motor impairments, including a deterioration of upper limb motor function (ULMF), that limit their performance of activities of daily living and reduce their quality of life. Virtual reality (VR) is being used in neurological rehabilitation for the assessment and treatment of the physical impairments of this condition. OBJECTIVE: A systematic review and meta-analysis was conducted to evaluate the effectiveness of VR on ULMF in patients with SCI compared with conventional physical therapy. METHODS: The search was performed from October to December 2019 in Embase, Web of Science, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Scopus, Medline, Physiotherapy Evidence Database (PEDro), PubMed, and Cochrane Central Register of Controlled Trials. The inclusion criteria of selected studies were as follows: (1) comprised adults with SCI, (2) included an intervention with VR, (3) compared VR intervention with conventional physical therapy, (4) reported outcomes related to ULMF, and (5) was a controlled clinical trial. The Cochrane Collaboration's tool was used to evaluate the risk of bias. The RevMan 5.3 statistical software was used to obtain the meta-analysis according to the standardized mean difference (SMD) and 95% CIs. RESULTS: Six articles were included in this systematic review. Four of them contributed information to the meta-analysis. A total of 105 subjects were analyzed. All of the studies used semi-immersive or nonimmersive VR systems. The statistical analysis showed nonsignificant results for the Nine-Hole Peg Test (SMD -0.93, 95% CI -1.95 to 0.09), muscle balance test (SMD -0.27, 95% CI -0.82 to 0.27), Motricity Index (SMD 0.16, 95% CI -0.37 to 0.68), Jebsen-Taylor Hand Function Test (JTHFT) subtests (writing, SMD -0.10, 95% CI -4.01 to 3.82; simulated page turning, SMD -0.99, 95% CI -2.01 to 0.02; simulated feeding, SMD -0.64, 95% CI -1.61 to 0.32; stacking checkers, SMD 0.99, 95% CI -0.02 to 2.00; picking up large light objects, SMD -0.42, 95% CI -1.37 to 0.54; and picking up large heavy objects, SMD 0.52, 95% CI -0.44 to 1.49), range of motion of shoulder abduction/adduction (SMD -0.23, 95% CI -1.48 to 1.03), shoulder flexion/extension (SMD 0.56, 95% CI -1.24 to 2.36), elbow flexion (SMD -0.36, 95% CI -1.14 to 0.42), elbow extension (SMD -0.21, 95% CI -0.99 to 0.57), wrist extension (SMD 1.44, 95% CI -2.19 to 5.06), and elbow supination (SMD -0.18, 95% CI -1.80 to 1.44). Favorable results were found for the JTHFT subtest picking up small common objects (SMD -1.33, 95% CI -2.42 to -0.24). CONCLUSIONS: The current evidence for VR interventions to improve ULMF in patients with SCI is limited. Future studies employing immersive systems to identify the key aspects that increase the clinical impact of VR interventions are needed, as well as research to prove the benefits of the use of VR in the rehabilitation of patients with SCI in the clinical setting.

De Miguel-Rubio, A., et al. (2020). "Effectiveness of Virtual Reality on Functional Performance after Spinal Cord Injury: A Systematic Review and Meta-Analysis of Randomized Controlled Trials." J Clin Med 9(7): 2065.
	A spinal cord injury (SCI) usually results in a significant limitation in the functional outcomes, implying a challenge to the performance of activities of daily living. The main aim of this study is to analyze the effectiveness of virtual reality to improve functional performance in patients with SCI. The search was performed between October and December 2019 in Cumulative Index to Nursing and Allied Health Literature (CINAHL), Medline, Cochrane Central Register of Controlled Trials, Physiotherapy Evidence Database (PEDro), PubMed, Scopus, Web of Science, and Embase. The methodological quality of the studies was evaluated through the PEDro scale, and the risk of bias was evaluated with the Cochrane collaboration's tool. Seven articles were included in this systematic review, and five of them in the meta-analysis. Statistical analysis showed favorable results for functional performance in control group performing conventional therapy, measured by the functional independence measure (standardized mean difference (SMD)= -0.70; 95% confidence interval: -1.25 to -0.15). Results were inconclusive for other outcomes. Most studies have not shown beneficial effects on functional performance compared with conventional physical therapy. The results obtained showed that virtual reality may not be more effective than conventional physical therapy in improving functional performance in patients with SCI.

de Oliveira, V., et al. (2021). "State Anxiety after Exergame Beach Volleyball Did Not Differ between the Single and Multiplayer Modes in Adult Men." International Journal of Environmental Research & Public Health [Electronic Resource] 18(20): 10957.
	This study compared the exergame beach volleyball's acute effects on state anxiety level in single vs. multiplayer mode in adult men. Sixty adult men (age: 21.98 [4.58] years, body mass: 75.40 [15.70] kg, height: 1.77 [0.09] m, and body mass index: 24.19 [5.44] kg/m(2); data are expressed as median [interquartile range]) were assigned to play exergame of beach volleyball in single- or multiplayer mode for approximately 30 min using the Xbox 360 Kinect((R)). The state anxiety level was evaluated before and after the intervention. There was no significant difference in the state anxiety levels after an exergame session between the single and multiplayer modes (p-value = 0.407, effect size (rB) = -0.12, defined as small). Furthermore, there was no significant difference in the state anxiety levels before and after an exergame session in single-player mode (p-value = 0.516, effect size (d) = 0.14, defined as trivial) and multiplayer mode (p-value = 0.053, rB = 0.43, defined as medium). In conclusion, state anxiety level after exergame beach volleyball did not differ between the single and multiplayer modes in adult men.

De Paula Oliveira, T., et al. (2016). "Extensive training in virtual reality promotes an increase in the body function and activity, but not in participation domain according to 1CF: a randomized controlled trial." Cerebrovascular diseases (Basel, Switzerland) 41: 309‐.
	Background: Stroke causes sensory‐motor impairments, leading to balance problems, falls, and functional limitation. Despite the advances in rehabilitation field, a large number of patients are unable to recovery the full independence in activities in daily living (ADL), which decreases their quality of life. Thus, the search for more efficient strategies for balance and gait recovery has been a constant goal for physiotherapy. Virtual Reality (VR) has been proposed as a novel therapeutic tool for motor rehabilitation in patients with Stroke, however the evidences from controlled studies remains limited. Objectives: To compare the effect of balance training performed in VR using Nintendo Wii Fit™(NWF) games with conventional balance training on Body Functions, Activity and Participation level according to the International Classification of Functioning, Disability and Health (ICF) framework in patients with chronic sequels of Stroke. Methods: A parallel, prospective, single‐blind, randomized clinical trial was conducted with a total of 23 participants 14 female, mean age of 50.2 years (SD=11), mean post‐stroke duration 6 years (SD=5.6), 18 left paretic side. Patients were randomly allocated into an experimental group (EG), which performed a balance training based on 8 NWF games and a control group (CG), which performed conventional balance training in real environment. The 14 individual intervention sessions were similar apart from the use of NWF games for EG. The (1) Lower limb subscale of Fulg‐Meyer Assessment (FMA‐LE), (2) Limits of Stability (LOS) and (3) Rhythmic Weight Shift (RWS) obtained on force plate were used to assess lower limb motor and balance functions, as measures of Body Function domain; the scores in (4) MiniBESTest and (5) Six Minute Walk Test (6MWT) were used to assess the balance and gait performance, as measures of Activity domain; and finally (6) Stroke‐Specific Quality of Life Scale (SS‐QOL), was used as a measure of Participation domain. Both groups were assessed before (BT), 7 days (7dAT), and 60 days after the end of training (60dAT). Results: Six 2X3 RM‐ANOVA using as factor Groups (EG; CG), and evaluations (BT, 7dAT; 60dAT) as repeated measures were performed for each outcome score. The results showed a significant interaction between the factors for FMA‐LE (p=.003, ES=. 88) and significant assessment effect for LOS, RWS, 6MWT and MiniBESTest (p=.0004, ES=. 98; p= 02, ES=. 83; p= 002, ES= 91; p=. 002, ES=. 91). Tukey pos‐hoc test for these measures showed a significant increase in the score for EG only, which remained at end of the study. There was not statistical significant improvement in SS‐QOL scores for both groups. Conclusion: The extensive balance training performed in VR using NWF games was more efficient than conventional balance training to improve the Body Functions and Activity level but not Participation level in patients with chronic sequels of stroke.

Deacon, M., et al. (2018). "Can Wii Balance? Evaluating a Stepping Game for Older Adults." IEEE Transactions on Neural Systems & Rehabilitation Engineering 26(9): 1783-1793.
	Decline in balance control is an issue for older adults as it leads to an increased risk of falling which may result in serious injury. Mitigating this risk may be achieved through balance training and exercise, but lack of adherence to an exercise program often occurs. Improvement in balance control may be difficult to quantify in an unbiased manner given the therapist providing the treatment also assesses the patient. We developed a gamified system using an off-the-shelf technology through an iterative feedback with therapists and clients to evaluate a response time during stepping as a measure of balance control. The game was designed using serious game strategies to increase participant engagement. This game included two Nintendo Wii balance boards between which the individual was required to step while the times were recorded. To provide evidence that the system could be used in a clinical environment, we conducted a cross-sectional study collecting data for five minutes at the beginning of a physiotherapy assessment. One hundred and four individuals older than 50 years of age were recruited who were able to step forward with or without an aid. The response time for a step using the system was negatively correlated to the Berg balance score.

Debska, M., et al. (2019). "Enjoyment and Intensity of Physical Activity in Immersive Virtual Reality Performed on Innovative Training Devices in Compliance with Recommendations for Health." International Journal of Environmental Research & Public Health [Electronic Resource] 16(19): 30.
	The aim of the study is to assess the enjoyment and intensity of physical exercise while practicing physical activity (PA) in immersive virtual reality (IVR) using innovative training devices (omni-directional Omni treadmill and Icaros Pro flight simulator). The study also contains the results of subjective research on the usefulness of such a form of PA in the opinion of users. In total, 61 adults (10 women and 51 men) took part in the study. To assess the enjoyment level (EL) Interest/Enjoyment subscale of Intrinsic Motivation Inventory (IMI) was used. Exercise intensity was assessed during 10-min sessions of active video games (AVGs) in IVR based on heart rate (HR). The average enjoyment level during physical exercise in IVR on the tested training devices was high (Omni 5.74 points, Icaros 5.60 points on a 1-7 Likert scale) and differed significantly in favor of PA on Omni. In the opinion of the majority of participants, AVGs in IVR on the tested devices constitute a sufficiently useful form of PA to meet the needs of leisure time activities, and they can even replace some forms of physical effort performed in a classic way. The intensity of PA during games on training devices was at the level recommended for health benefits for 80.55% (Omni) and 50.77% (Icaros Pro) of its duration. Based on the conducted research, it can be assumed that AVGs in IVR using a multi-directional treadmill and a flight simulator can be an effective tool for increasing participation in health-oriented PA.

Decavele, S., et al. (2019). "Abstracts of the 31st Annual Meeting of the European Academy of Childhood Disability (EACD), Paris, France, 23-25 May 2019." Dev Med Child Neurol 61 Suppl 2: 4-82.
	Introduction: Cerebral palsy (CP) is the most common cause of permanent neurological disabilities in children. Many children require long‐term daily physiotherapy (PT) and video‐gaming is a promising tool to increase motivation in rehabilitation. The effects of an intervention with rehabilitation specific video‐games were evaluated on individually defined therapy goals, gross motor function, and motivation. Additionally, we evaluated the effects after three months. Patients and Methods: Thirty‐two children (bilateral spastic CP, Gross Motor Function Classification level III‐IV, 6‐15y) were randomized using a cross‐over design into an intervention group (regular PT and gaming) or a control group (regular PT). The effects of both training periods (each 12wks) were compared using the Goal Attainment Scale (GAS), Trunk Control Measurement Scale (TCMS), Pediatric Balance Scale (PBS), Gross Motor Function Measure‐88 (GMFM‐88), and Dimensions of Mastery Motivation Questionnaire (DMQ). Results: The GAS estimated marginal mean change scores (EMC) were significantly higher after the intervention compared to the control period (8.5 and 2.4, p=0.00). The EMC for standing exercises (3.85% and 0.22%, p=0.04) and dynamic sitting balance (5.9% and ‐1.7%, p=0.00) were also significantly higher. After three months follow‐up the results were not maintained for the total GMFM scores (‐1.1%) and for static sitting balance (‐3.2%) (p=0.04). Conclusion: A combined approach of 'regular' PT and rehabilitation specific gaming showed significant results on individually defined therapy goals, dynamic sitting balance, and standing exercises. However, follow‐up results show that continuous physiotherapy is needed.

Decavele, S., et al. (2020). "The Effect of a Rehabilitation Specific Gaming Software Platform to Achieve Individual Physiotherapy Goals in Children with Severe Spastic Cerebral Palsy: A Randomized Crossover Trial." Games for Health Journal.
	Cerebral palsy (CP) is the most common cause of permanent neurological disabilities in children. Many children require long-term daily physiotherapy (PT), and videogaming is a promising tool to increase motivation in rehabilitation. The short- and medium-term effects of an intervention with rehabilitation specific videogames were evaluated on individually defined therapy goals, gross motor function, and motivation. Thirty-two children with bilateral spastic CP, Gross Motor Function Classification level III-IV, and 6-15 years were randomized into an intervention group (regular PT and gaming) or a control group (regular PT), followed by a crossover. The effects of both training periods (each 12 weeks) were compared using the Goal Attainment Scale (GAS), Trunk Control Measurement Scale (TCMS), Pediatric Balance Scale (PBS), Gross Motor Function Measure-88 (GMFM-88), and Dimensions of Mastery Motivation Questionnaire (DMQ). After 3 months follow-up, children were retested using the GMFM, TCMS, and PBS. The GAS change scores were significantly higher after the intervention compared to the control period (8.5 and 2.4, P < 0.001). The change scores for standing exercises (3.85 and 0.22, P = 0.04) and dynamic sitting balance (5.9 and -1.7, P < 0.001) were also significantly higher. After 3 months follow-up the results did not persist. A combined approach of regular PT and rehabilitation specific gaming showed significant effects on individually defined therapy goals, dynamic sitting balance, and standing exercises. However, the lack of persistent effect indicates that continuous individual goal-oriented PT with the addition of gaming is needed.

DeFroda, S. F., et al. (2018). "Physical Therapy Protocols for Arthroscopic Bankart Repair." Sports & Health 10(3): 250-258.
	BACKGROUND: Outcomes after arthroscopic Bankart repair can be highly dependent on compliance and participation in physical therapy. Additionally, there are many variations in physician-recommended physical therapy protocols. HYPOTHESIS: The rehabilitation protocols of academic orthopaedic surgery departments vary widely despite the presence of consensus protocols. STUDY DESIGN: Descriptive epidemiology study. LEVEL OF EVIDENCE: Level 3. METHODS: Web-based arthroscopic Bankart rehabilitation protocols available online from Accreditation Council for Graduate Medical Education (ACGME)-accredited orthopaedic surgery programs were included for review. Individual protocols were reviewed to evaluate for the presence or absence of recommended therapies, goals for completion of ranges of motion, functional milestones, exercise start times, and recommended time to return to sport. RESULTS: Thirty protocols from 27 (16.4%) total institutions were identified out of 164 eligible for review. Overall, 9 (30%) protocols recommended an initial period of strict immobilization. Variability existed between the recommended time periods for sling immobilization (mean, 4.8 +/- 1.8 weeks). The types of exercises and their start dates were also inconsistent. Goals to full passive range of motion (mean, 9.2 +/- 2.8 weeks) and full active range of motion (mean, 12.2 +/- 2.8 weeks) were consistent with other published protocols; however, wide ranges existed within the reviewed protocols as a whole. Only 10 protocols (33.3%) included a timeline for return to sport, and only 3 (10%) gave an estimate for return to game competition. Variation also existed when compared with the American Society of Shoulder and Elbow Therapists' (ASSET) consensus protocol. CONCLUSION: Rehabilitation protocols after arthroscopic Bankart repair were found to be highly variable. They also varied with regard to published consensus protocols. This discrepancy may lead to confusion among therapists and patients. CLINICAL RELEVANCE: This study highlights the importance of attending surgeons being very clear and specific with regard to their physical therapy instructions to patients and therapists.

Dennett, A. M. and N. F. Taylor (2015). "Machines that go "ping" may improve balance but may not improve mobility or reduce risk of falls: a systematic review." Journal of Rehabilitation Medicine 47(1): 18-30.
	OBJECTIVE: To determine the effectiveness of computer-based electronic devices that provide feedback in improving mobility and balance and reducing falls. DATA SOURCES: Randomized controlled trials were searched from the earliest available date to August 2013. DATA EXTRACTION: Standardized mean differences were used to complete meta-analyses, with statistical heterogeneity being described with the I-squared statistic. The GRADE approach was used to summarize the level of evidence for each completed meta-analysis. Risk of bias for individual trials was assessed with the (Physiotherapy Evidence Database) PEDro scale. DATA SYNTHESIS: Thirty trials were included. There was high-quality evidence that computerized devices can improve dynamic balance in people with a neurological condition compared with no therapy. There was low-to-moderate-quality evidence that computerized devices have no significant effect on mobility, falls efficacy and falls risk in community-dwelling older adults, and people with a neurological condition compared with physiotherapy. CONCLUSION: There is high-quality evidence that computerized devices that provide feedback may be useful in improving balance in people with neurological conditions compared with no therapy, but there is a lack of evidence supporting more meaningful changes in mobility and falls risk.

Dennis-Jones, C. (2005). "Computer games can reduce child pain, research reveals." Therapy Weekly 31(30): 2-2.
	
Desai, N., et al. (2012). "ARE SELF SNAGS EFFECTIVE FOR CHRONIC NECK PAIN?" Romanian Journal of Physical Therapy / Revista Romana de Kinetoterapie 18(29): 9-15.
	Objective The purpose of the study was to investigate the effectiveness of self Sustained Natural Apophyseal Glides (SNAGs) on pain, active cervical Range of Motion and functional disability in chronic nonspecific neck pain. Design Randomized Controlled Trial. Setting Department of Musculoskeletal Physiotherapy, Pravara Rural Hospital (tertiary hospital), Loni, Tal- Rahata, Dist-Ahmednagar, Maharashtra State, India- 413 736. Participants One hundred and three participants between 25-53 years of age with clinical diagnosis of chronic nonspecific neck pain. Interventions Self SNAGs, therapist administered SNAGs and conventional physiotherapy for six weeks. Main outcome measures The outcome measures used in the study were Numerical Pain Rating Scale (NPRS), Active Cervical Range of Motion (ACROM), and Neck Disability Index (NDI). Results There was no significant difference in self administered SNAGS and therapist administered SNAGS in the treatment of chronic nonspecific neck pain over the period of six weeks. Conclusions Patients with chronic nonspecific neck pain can be advised to perform Self Sustained Natural Apophyseal Glides (SNAGs) instead of therapist administered SNAGS.
Obiective Scopul acestui studiu a fost investigarea eficienţei Alunecărilor Apofiziale Naturale auto Susţinute (AANS) asupra durerii, a gamei de mişcări cervicale active şi a dizabilităţii funcţionale în cazul durerii cervicale cronice nespecifice. Design Probă Controlată Aleatorie. Locaţie Secţia de Kinetoterapie Musculoscheletală, Spitalul Rural Pravara (spital de gradul trei), Loni, Tal- Rahata, Dist-Ahmednagar, Statul Maharashtra, India- 413 736 Participanţi O sută trei participanţi cu vârste cuprinse între 25-53 de ani, cu diagnostic clinic de durere cervicală cronică nespecifică. Intervenţii Auto AANS-uri, AANS-uri administrate de către terapeut şi kinetoterapie convenţională timp de şase săptămâni. Principalele măsurători Principalele măsurători utilizate în studiu au fost Scala Numerică a Durerii (SND), Gama de Mişcări Cervicale Active (GMCA) şi Indexul de Dizabilitate a Gâtului (IDG). Rezultate Nu au fost diferenţe semnificative între AANS auto administrate şi cele administrate de către terapeut în tratamentul durerii cervicale cronice nespecifice timp de şase săptămâni. Concluzii Pacienţii cu durere cervicală cronică nespecifică pot fi sfătuiţi să-şi administreze singuri AANS.

Desalew, A., et al. (2017). "Childhood overweight, obesity and associated factors among primary school children in dire dawa, eastern Ethiopia; a cross-sectional study." BMC Obesity 4: 20.
	BACKGROUND: Obesity in children is increasing worldwide. Malnutrition has become a double burden challenge of public health concern in developing countries. Childhood obesity increases the risk of chronic disease in childhood as well as adulthood. However, information is very scarce about childhood obesity in developing countries specifically in Ethiopia. Therefore, we aimed to assess childhood overweight, obesity and associated factors among primary school children at Dire Dawa, Eastern Ethiopia. METHODS: A school based cross-sectional study was conducted in Dire Dawa from 1(st) to 30(th) March, 2016. Study participants were selected using multistage sampling method. Pre-tested self-administered questionnaire, face to face interview technique and anthropometric measurements were used to collect data by eight well trained data collectors. Data were coded, cleaned and entered into EpiData software version 3.5.1, and exported into SPSS (version 21.0) statistical software, for data analysis. Bivariate and multivariate logistic regression were carried out to identify associated factors with childhood overweight and obesity. Statistical significance was declared using Adjusted Odds Ratio (AOR) at 95% CI and p-value less than 0.05. RESULTS: The prevalence of overweight and obesity were 14.7% (95% CI: 11.7, 18.0) and 5.8% (95% CI: 3.6, 8.0), respectively. Children who were from private school (AOR = 3.4, 95% CI: 1.4, 8.5), from families belonged to high socioeconomic class (AOR = 16.9, 95% CI: 6.5, 23.9), preferred sweetened foods (AOR = 2.3, 95% CI: 1.1, 5.1), had not engaged in regular physical exercise (AOR = 3.8, 95% CI: 1.5, 9.8), had experienced sedentary life style like spent their free time watching TV (AOR = 3.6, 95% CI: 1.6, 7.9), play computer game (AOR = 4.6, 95% CI:1.4,15.4), and were not having close friends (AOR = 2.9, 95% CI: 1.4, 6.2) were significantly associated with overweight/obesity risk. CONCLUSION: Overweight/obesity in children is on alarming stage in the study area. Therefore, more attention should be given to creating awareness about healthy diet and improving life style through school and public media in collaboration with concerned bodies.

Deutsch, J., et al. (2011). "Research Report Abstracts." Physiotherapy 97: eS18-eS1415.
	Purpose: To determine if balance and selected mobility outcomes improve more when administering a Wii‐based compared to an optimal standard of care intervention for individuals in the chronic phase post‐stroke. Relevance: Interest and enthusiasm for the interactive video gaming is pervasive in clinical practice. Determining whether this type of therapy is superior to optimal standard of care is relevant for its adoption. Participants: Ten individuals in the chronic phase poststroke (>10 months) ranging in age from 34 to 68 years of both genders (M = 8; F = 2) participated. Individuals were included if they reported difficulty with balance and mobility, were able to walk 50 meters without physical assistance and were able to follow instructions. Subjects were recruited from the community through announcements and solicitation at stroke support groups. Methods: Individuals were randomly assigned to either a Wii‐based or optimal standard of care group. They received 12 hours of training in a period of 4 weeks by attending therapy either 2 or 3 times a week. Treatment was administered in three areas: sitting, standing and choice balance and mobility activities. Wii‐based activities were selected from the Wii Sports and Fit programs. In the standard of care group individuals did repeated stepping timed to a metronome as a warm up, visual feedback on a low‐cost force platform, navigation of an obstacle with varied surfaces and elevations and a choice of balance and mobility activities they selected such as basketball drills and frisbee. In the Wii group the Wii‐Fit walking activities were used awarm up (on either hard, soft or irregular surfaces), Sitting balance activities included boxing drills and games, standing balance activities were selected from the Wii Fit balance tasks, as well as the strength and yoga menus, choice activities were selected from the Wii games such as bowling, golf and baseball. Each individual participated in activities designed to address global deficits with balance and mobility while customized to their impairments and goals. Individuals were pre‐post (in the week after treatment) tested by a blinded assessor on balance, mobility, visual‐spatial and participation measures. Only the balance measures are reported here. Analysis: Data were analyzed using a 2x2 RMANOVA for between and within group comparisons for three dependent variables dynamic gait index (DGI), timed up and go (TUG (c) with and without a cognitive task TUG), and the Activities Balance Confidence Questionnaire (ABC). Results: There were no significant differences in balance measures between groups. However within group differences were found for all variables in the optimal standard of care group DGI (F = 9.35, p = 0.012), TUG (F = 18.33, p = 0.002), TUG(c) (F = 15, p = 0.004). Clinically meaningful differences were found for both groups on the DGI and TUG. Conclusions: Optimal standard of care was significantly better at improving balance outcomes for individuals in the chronic phase post‐stroke than a comparable Wii‐based balance program. However, clinically meaningful changes were measured in both groups. Implications: While Wii‐based balance activities may be used to complement optimal standard of care, based on these data, their exclusive administration is not recommended.

Deutsch, J. E., et al. (2008). "Use of a low-cost, commercially available gaming console (Wii) for rehabilitation of an adolescent with cerebral palsy." Physical Therapy 88(10): 1196-1207.
	BACKGROUND AND PURPOSE: The purpose of this retrospective and prospective case report is to describe the feasibility and outcomes of using a low-cost, commercially available gaming system (Wii) to augment the rehabilitation of an adolescent with cerebral palsy. PATIENT AND SETTING: The patient was an adolescent with spastic diplegic cerebral palsy classified as GMFCS level III who was treated during a summer session in a school-based setting. INTERVENTION: The patient participated in 11 training sessions, 2 of which included other players. Sessions were between 60 and 90 minutes in duration. Training was performed using the Wii sports games software, including boxing, tennis, bowling, and golf. He trained in both standing and sitting positions. OUTCOMES: Three main outcome measures were used: (1) visual-perceptual processing, using a motor-free perceptual test (Test of Visual Perceptual Skills, third edition); (2) postural control, using weight distribution and sway measures; and (3) functional mobility, using gait distance. Improvements in visual-perceptual processing, postural control, and functional mobility were measured after training. DISCUSSION AND CONCLUSION: The feasibility of using the system in the school-based setting during the summer session was supported. For this patient whose rehabilitation was augmented with the Wii, there were positive outcomes at the impairment and functional levels. Multiple hypotheses were proposed for the findings that may be the springboard for additional research. To the authors' knowledge, this is the first published report on using this particular low-cost, commercially available gaming technology for rehabilitation of a person with cerebral palsy.

Deutsch, J. E., et al. (2011). "Nintendo wii sports and wii fit game analysis, validation, and application to stroke rehabilitation." Top Stroke Rehabil 18(6): 701-719.
	BACKGROUND: Interactive video gaming has become ubiquitous in the practice of rehabilitation. The Nintendo Wii is one such system. Interactive gaming can promote intensive task-based therapy in a manner that is motivating for the user. Widespread enthusiasm for consoles and their games prompted us to analyze the games for their rehabilitation elements related to improving balance and mobility for individuals poststroke. PURPOSE: The purpose of this article is to provide a game analysis for clinical application and evaluation of the game elements for research on interactive video gaming. METHODS: Using a team of game players and raters, 5 tables (1 for the Wii Sports and 4 for the Wii Fit) were developed and validated. The tables consist of 3 categories: game description, impairments targeted (strength, endurance, balance, and coordination), and feedback provided (knowledge of performance [KP] and knowledge of results [KR]). Two domain content experts established face validity. Construct validity was performed by 2 therapist-raters who had more than 15 years' clinical experience and postgraduate training in motor learning. Observations about the games including the fidelity of the interfaces, the nature of the feedback, and some of the challenges to adapting the games for rehabilitation are presented. RESULTS: An 80% agreement between raters set as the criterion for establishing the construct validity was met for feedback evaluation. There was 100% agreement on impairment ratings. Games provide a greater amount of KR compared with KP. CONCLUSION: Given the preponderance of KR, therapists will need to monitor motor performance. Adaptation of interactive video consoles for rehabilitation requires careful evaluation of the games' attributes using relevant rehabilitation construits.

Devos, H., et al. (2011). "Research Report Abstracts." Physiotherapy 97: eS18-eS1415.
	Purpose:Very fewrehabilitation programmes exist to retrain driving skills commonly affected after stroke. The purpose of this randomised controlled trial (RCT) was to investigate the short and long term effects of two driving retraining programmes on fitness‐to‐drive after stroke. Relevance: This RCT helps us to gain insight into the carryover effect of two distinct rehabilitation concepts on fitness‐to‐drive. The simulator programme focuses on the contextual training of driving skills, while the cognitive rehabilitation programme addresses the training of cognitive components of driving in a non‐contextual setting. Participants: Throughout a 20‐month recruitment period, 83 participants (65 men, 18 women) consented to partake. Participants presented with mild to moderate functional impairments and were all independently ambulant. They were 6 to 9 weeks after stroke and on average 54±12 years old, had 33±11 years of driving experience, and had a Barthel score of 74±26. Methods: Participants were randomly allocated into either a simulator group or a cognitive group. Both groups received 15 hours of driving therapy. Participants in the simulator group were trained on lane tracking, speed control, anticipation, road sign recognition, hazard perception, and overtaking maneuvers. The driving simulator was a Ford Fiesta 1.8 with automatic gear transmission. STISIM Drive software was used to develop tailor‐made scenarios. Participants in the cognitive group were trained on visuospatial skills, problemsolving skills, road sign recognition, and route finding using off‐the‐shelf games. Fitness‐to‐drive decisions were derived from medical, visual, neuropsychological, and on‐road tests before training, immediately after training, at 6 months and at 60 months post‐stroke. The assessors were blind to the allocation of the participants in the two treatment groups. Analysis: A Generalized Estimating Equation model was fitted with main effects of Group (simulator versus cognitive) and of Time (before training, after training, 6 month followup, 60 month follow‐up), and the interaction effect of Group by Time. The fitness‐to‐drive decision (pass‐fail) was the main outcome measure. Results: Both groups significantly improved in a visual and many perceptual tests and in the on‐road test immediately after training. At 6 months follow‐up, significantly more participants in the simulator (73%) compared to the cognitive group (42%) passed the driving evaluation and were safe to resume driving (p = 0.03). The advantage of the simulator training over the cognitive program had however faded at the 60 months evaluation. Conclusions: Contextual training in a driving simulator speeds up the restoration of driving skills after stroke, with apparent effects observed at 6 months post‐stroke. However, the beneficial effect disappears after 5 years. Implications: The results of this RCT favour the implementation of simulator therapy in the conventional rehabilitation programme of stroke survivors with mild deficits. Future studies should investigate whether driving simulator therapy can partly replace on‐road training in terms of fitness‐to‐drive success rates, cost‐ and time effectiveness.

Dey, P., et al. (2021). "Study of the interactions of sneezing droplets with particulate matter in a polluted environment." Phys Fluids (1994) 33(11): 113310.
	We have performed a three-dimensional numerical simulation to determine the effect of local atmospheric pollution level on the spreading characteristics of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus through ejected droplets during sneezing and coughing in an open space. Utilizing a finite volume-based numerical method, we have performed computations for various ranges of droplet diameters and sneezing speeds. The interactions between the droplets and the suspended particles are considered by taking both hydrophobic and hydrophilic wettability characteristics into account. Our computational results show that the virus-containing droplets partially affect aerosols during the path of their transmission. With the progression of time, the droplet distribution shows an asymmetric pattern. The maximum dispersion of these droplets is found for higher sneezing velocities. The droplets with a diameter of 50 mum travel a larger distance than the larger diameter droplets. We have found that an aerosol with hydrophilic wettability undergoes complete wetting by the disease-containing droplets and therefore is conducive to disease propagation. The droplet engagement duration with aerosol decreases with increase in the sneezing velocity. Our study recommends against using physical exercise centers in a closed environment such as gymnasium and indoor games during the COVID pandemic, especially in a polluted environment. The results from our work will help in deciding proper social distancing guidelines based on the local atmospheric pollution level. They may act as a precursor in controlling further spread of diseases during this unprecedented situation of the COVID pandemic.

Di Lodovico, L., et al. (2019). "Which sports are more at risk of physical exercise addiction: A systematic review." Addictive Behaviors 93: 257-262.
	INTRODUCTION: Excessive physical exercise may evolve into physical exercise addiction, a recently identified entity with many yet unclear aspects, such as global prevalence and variability according to different types of physical exercise. METHODS: We systematically reviewed the current literature up to June 2018 to collect all studies screening exercise addiction with two of the most frequently used screening scales: the Exercise Addiction Inventory (EAI) and the Exercise Dependence Scale (EDS). RESULTS: We detected forty-eight studies (20 using the EAI, 26 the EDS, and 2 both scales) reporting variable point prevalence of exercise addiction risk, depending on the target population and the investigated sport. The EAI identifies a higher proportion of people at risk for physical exercise addiction among endurance athletes (14,2%) followed by ball games (10,4%), fitness centre attendees (8,2%) and power disciplines (6,4%), while a frequency of 3,0% was reported in the general population. Studies using the EDS found discrepant results. DISCUSSION: This systematic review suggests that sport disciplines are associated with different vulnerability for physical exercise addiction. Besides the different addictive potential of each sport, the heterogeneity of results may be also due to socio-demographic and cultural characteristics of the target populations. The EAI and the EDS identify different proportions of individuals at risk for exercise addiction both in general population and in specific sport categories. As the EAI screens a higher proportion of subjects at risk, especially in endurance disciplines, it could be more appropriate for early detection of at-risk subjects and/or disciplines. CONCLUSION: Tailored prevention strategies for each discipline could help better preserving benefits of sports. More precision in research methods and the use of the most appropriate scale are required to allow a better comparability of prevalence among physical exercise disciplines and in general population.

Dias, J. D., et al. (2018). "Serious games as an educational strategy to control childhood obesity: a systematic literature review1." Revista Latino-Americana de Enfermagem 26: e3036.
	OBJECTIVES: to identify in the literature the efficacy of serious games to improve knowledge for and/or behavioral changes among overweight or obese children. METHOD: Systematic Literature Review. The Cochrane Systematic Reviews Handbook was used. The studies were collected from the following databases: Public Medline; Web Of Science; Science Direct; Latin American and Caribbean Health Sciences Literature; and the Health Game Research and Cumulative Index to Nursing & Allied Health Literature. The descriptors were video games and obesity, while the key word was serious games. Inclusion criteria were: studies classified as Randomized Clinical Trials written in English, Spanish or Portuguese and in which children were the subjects of the study. RESULTS: 2,722 studies were identified in the initial search and six studies remained in the final sample. The papers focused on encouraging behavioral changes in players, including physical exercise and improved eating habits. The studies report that serious games are a potential strategy to encourage positive coping with childhood obesity. CONCLUSION: research in this field is an expanding and promising strategy and serious games represent an alternative means to provide health education to children.

Dicianno, B. E., et al. (2015). "Perspectives on the evolution of mobile (mHealth) technologies and application to rehabilitation." Physical Therapy 95(3): 397-405.
	Individuals with chronic conditions and disabilities who are vulnerable to secondary complications often require complex habilitative and rehabilitative services to prevent and treat these complications. This perspective article reviews the evolution of mHealth technologies and presents insights as to how this evolution informed our development of a novel mHealth system, iMHere (interactive mobile health and rehabilitation), and other technologies, including those used by the Veterans Administration. This article will explain the novel applications of mHealth for rehabilitation and specifically physical therapy. Perspectives on the roles of rehabilitation professionals in the delivery of health care using mHealth systems are included. Challenges to mHealth, including regulatory and funding issues, are discussed. This article also describes how mHealth can be used to improve patient satisfaction and delivery of care and to promote health and wellness.

Diez Alegre, M. I. and R. Cano de la Cuerda (2012). "Empleo de un video juego como herramienta terapéutica en adultos con parálisis cerebral tipo tetraparesia espástica. Estudio piloto." Fisioterapia 34(1): 23-30.
	Resumen Objetivo Determinar si el entrenamiento con un videojuego mejora la función motriz, la coordinación, la ejecución de las actividades básicas de la vida diaria (ABVD), la calidad de vida relacionada con la salud (CVRS), así como el grado de autoestima en adultos con parálisis cerebral (PC). Material y métodos Estudio piloto prospectivo con valoración pre y post-intervención. Se reclutó a 10 pacientes con tetraparesia espástica procedentes del Centro de Referencia Estatal de León, con diagnóstico de PC tipo moderado. Se recogieron datos sobre rango de movilidad activa, actividad muscular, motricidad fina y coordinación, ejecución de las ABVD, CVRS y grado de autoestima, evaluados con el Biometrics E-Link® electrogoniométrico y electromiográfico, el Nine Hole Peg Test, el índice de Barthel, el test EQ-5D y la escala de Rosenberg, respectivamente. La intervención con el videojuego Boccia-wii® se llevó a cabo durante un periodo 2,5 meses, con 1 h y media de entrenamiento semanal, distribuido en 3 días a la semana, con 30 min de duración cada día. Resultados Se obtuvieron mejorías estadísticamente significativas en la coordinación y motricidad fina de la mano (p=0,013), en el nivel de CVRS (p=0,00059), el rango de movilidad activa en la flexión de codo (p=0,049), la extensión de muñeca (p=0,017), la desviación radial (p=0,017) y en la actividad muscular del bíceps braquial (p=0,047). Conclusiones Nuestros resultados parecen determinar que el entrenamiento con Boccia-wii® es útil en pacientes adultos con PC tetraparesia espástica, por lo que podría ser implantado como medida terapéutica coadyuvante en el tratamiento fisioterápico convencional. Objective To determine if the training with a video game improves motor function, coordination, performance of basic activities of daily living (ADL), health-related quality of life (HRQoL) parameters and self-esteem in adults with cerebral palsy (CP). Material and methods A prospective evaluation pre-and post-intervention pilot study was performed. Ten patients with spastic tetraparesis from the State Reference Center in Leon, diagnosed of moderate CP, were recruited. Data were collected on active range of motion, muscle activity, and fine motor coordination, performance of ADL, level of HRQL and grade of self-esteem, assessed with the Biometrics E-Link® electrogoniometer and electromyographic, Nine Hole Peg Test, the Index Barthel, the EQ-5D test and the Rosenberg scale, respectively. Treatment with the video game Boccia-wii® was conducted over a period of 2.5 months, with one and a half hours of weekly training, spread over 3 days a week, 30minutes each day. Results We obtained statistically significant improvements in coordination and fine motor skills of the hand (P=.013), on the level of HRQL (P=.00059), active range of motion in the elbow flexion (P=.049), extension wrist (P=.017), radial deviation (P=.017) and the biceps muscle activity (P=.047). Conclusions Our results seem to determine that the training with Boccia-wii® is useful in adult patients with spastic tetraparesis PC, so it could be established as a therapeutic adjunct in conventional physiotherapy.

DiFrancisco-Donoghue, J., et al. (2019). "Managing the health of the eSport athlete: an integrated health management model." BMJ Open Sport & Exercise Medicine 5(1): e000467.
	OBJECTIVES: eSport is a form of electronic gaming, also known as professional or competitive video gaming, and is growing at a rapid pace worldwide. Over 50 US colleges have established varsity gaming teams over the past three years; some colleges offer eSport scholarships as they do for traditional sports. There is little objective research on the health habits of these players who are often placed under the direction of the athletics department on college campuses, and there is currently no health management model on how to treat these new athletes. METHODS: Anonymous electronic surveys were sent to 65 collegiate eSport players from nine universities across the USA and Canada inquiring about gaming and lifestyle habits, and musculoskeletal complaints due to eSport competition. RESULTS: Players practiced between 3 and 10 hours per day. The most frequently reported complaint was eye fatigue (56%), followed by neck and back pain (42%). eSport athletes reported wrist pain (36%) and hand pain (32%). Forty per cent of participants do not participate in any form of physical exercise. Among the players surveyed, only 2% had sought medical attention. CONCLUSION: eSport players, just like athletes in traditional sports, are susceptible to overuse injuries. The most common complaint was eye fatigue, followed by neck and back pain. This study shows eSport athletes are also prone to wrist and hand pain. This paper proposes a health management model that offers a comprehensive medical team approach to prevent and treat eSport athletes.

Dixon, C. L., et al. (2018). "Distraction for pain management during labor induction: a randomized clinical trial." American journal of obstetrics and gynecology 218(1): S228‐S229.
	OBJECTIVE: Non‐pharmacologic intervention using music or video games has been applied for pain management in pediatrics, palliative care, physical therapy, and surgery. Previous studies pertaining to music in labor are limited. Our objective was to assess whether distraction using music and/or video games improves pain outcomes and assists in analgesia management in women undergoing labor induction. STUDY DESIGN: Pregnant women with singleton gestation undergoing labor induction with a Foley bulb (FB) at term were randomized to an iPod with music and video game apps or no iPod. Exclusion criteria included receipt of pain medication at time of FB placement, chronic narcotic use and visual or auditory impairment. The primary outcome was the time from FB placement to request for pain medication. Secondary outcomes included number of patients requesting pain medication within 6 and 12 hours, type of pain medication received, pain visual analog scale scores and patient satisfaction. We estimated that 200 women would be needed for 90% power to show a 35% reduction in our primary outcome. Mann‐Whitney, Chi‐square, Kaplan‐Meier curves, and Pearson product moment correlation were used for statistical analysis (significance: p < 0.05). RESULTS: 219 patients were randomized. Baseline characteristics were similar between the two groups. There was no difference in the time from FB placement until pain medication request between groups (Table 1, Figure 1). Patients in the iPod group were less likely to request an epidural as their first type of analgesia than those in the no iPod group (RR 0.72; 95% CI 0.61‐0.98; p = 0.04). There were no significant differences in other secondary outcomes. Per protocol analysis of those in the iPod group who used the device ≤80% of the time (n=29) and those in the no iPod group who used music and/or video games ≤20% (n=89) showed no differences in the primary or secondary outcomes. Increased percent time of iPod use as assessed by nurse was correlated with a longer time until pain medication request (R2 0.22, p=0.025). CONCLUSION: While there were some differences between the groups, we were not able to show that music and video games improve pain outcomes or management in pregnant women undergoing mechanical labor induction at term. Larger trials are needed to determine if this approach or other non‐pharmacologic interventions may assist in intrapartum pain management.

Dmitrasinovic, G., et al. (2016). "ACTH, Cortisol and IL-6 Levels in Athletes following Magnesium Supplementation." J Med Biochem 35(4): 375-384.
	BACKGROUND: Physical exercise activates the hypothalamo-pituitary-adrenal (HPA) axis and induces the body's inflammatory response. Due to contemporary dietary habits and increased energy expenditure, athletes are susceptible to depletion of magnesium ions. The aim of our study was to investigate, through assessment of plasma ACTH, serum IL-6, and salivary/serum cortisol levels, if chronic magnesium supplementation might reduce damaging stress effects in amateur rugby players. METHODS: Rugby players (N=23) were randomly assigned to intervention and control group. Basal samples were collected before intervention group started a 4-week-long supplementation with magnesium (500 mg Mg/d). Blood and saliva sampling were done a day before the match (Day-1), on the morning of competition (Game), and during a six-day-long recovery period (Day1, Day3 and Day6). ACTH, serum/salivary cortisol, IL-6 and total/differential leukocytes counts were determined at each time point. RESULTS: There was a statistically significant increase in ACTH concentration in intervention group compared to control group, while reductions in cortisol concentrations between the two groups were the greatest at Day-1 (p < 0.01) and at the day of competition (Game) (p < 0.01). Our results revealed that magnesium completely abolished the increase in IL-6 level noted in control group on Day1 and Day3 vs. Day-1 (p < 0.01) and also diminished the rise in neutrophil/lymphocyte ratio in intervention group vs. control group (p < 0.01). CONCLUSIONS: These results suggest the possibly important influence magnesium supplementation might have on the change of parameters of HPA axis activity and reduction of immune response activation following strenuous physical exercise such as a rugby game.

Do Amaral Santos, P. L., et al. (2014). "No. 72 Retaining the Effects of Virtual Reality Therapy on Posture Control of Patients With Stroke: Preliminary Results." PM&R 6(8): S110.
	It is known that therapy in virtual environment (VE) using a videogame (VG) and a balance board (BB) has been widely used to achieve gains in body posture control (PC) and balance for stroke patients. However the retention and durability of these gains are not reported in literature. This study intends to analyze the retention of PC in patients with stroke 3 months after termination of rehabilitation protocol with VR using videogame as an interface. Four subjects (either male or female) diagnosed with stroke mean age 62.25 (+/‐6.23) participated in this study and were randomized into two groups: a control group (CG) and an experimental group (EG). Both groups received conventional physical therapy but the EG received VR therapy as well. Twenty‐four sessions of VG were performed using games designed to develop balance control. Subjects were evaluated initially using Berg balance scale and two AMTI force platforms with an acquisition frequency (AF) of 1.000 Hz; then reevaluated at the end of the protocol and three months after concluding the therapeutic program. A Nintendo Wii Fit Plus videogame integrated to a balance board was used for VR. Data were processed using Matlab Software. The following stabilometric variables of posture in nearly quiet standing position were analyzed: total oscillation displacement of the COP (TOD) area (AR) maximum and minimum speeds of TOD (TODVMAX TODVMIN) as well as Berg BS score. A decrease of TOD in 20% was found on EG for both subjects when compared to CG. We found a 30% decrease of AR for EG and a decrease of 40% in both TODVMAX and TODVMIN for EG. Therefore EG showed more significant gains when compared to CG proving the efficacy of VG in improving PC and balance.

Do, J. H., et al. (2016). "The effects of virtual reality-based bilateral arm training on hemiplegic children's upper limb motor skills." Neurorehabilitation 38(2): 115-127.
	BACKGROUND: Hemiplegic cerebral palsy is a neurological symptom appearing on the unilateral arm and leg of the body that causes affected upper/lower limb muscle weakening and dysesthesia and accompanies tetany and difficulties in postural control due to abnormal muscle tone, and difficulties in body coordination. OBJECTIVES: The purpose of this study was to examine the impact of virtual reality-based bilateral arm training on the motor skills of children with hemiplegic cerebral palsy, in terms of their upper limb motor skills on the affected side, as well as their bilateral coordination ability. METHODS: The research subjects were three children who were diagnosed with hemiplegic cerebral palsy. The research followed an ABA design, which was a single-subject experimental design. The procedure consisted of a total of 20 sessions, including four during the baseline period (A1), 12 during the intervention period (B), and four during the baseline regression period (A2), For the independent variable bilateral arm training based on virtual reality, Nintendo Wii game was played for 30 minutes in each of the 12 sessions. For the dependent variables of upper limb motor skills on the affected side and bilateral coordination ability, a Wolf Motor Function Test (WMFT) was carried out for each session and the Pediatric Motor Activity Log (PMAL) was measured before and after the intervention, as well as after the baseline regression period. To test bilateral coordination ability, shooting baskets in basketball with both hands and moving large light boxes were carried out under operational definitions, with the number of shots and time needed to move boxes measured. The results were presented using visual graphs and bar graphs. RESULTS: The study's results indicated that after virtual reality-based bilateral arm training, improvement occurred in upper limb motor skills on the affected sides, and in bilateral coordination ability, for all of the research subjects. Measurements of the effects of sustained therapy after completion of the intervention, during the baseline regression period, revealed that upper limb motor skills on the affected side and bilateral coordination ability were better than in the baseline period for all subjects. CONCLUSION: This study confirmed that for children with hemiplegic with cerebral palsy, bilateral arm training based on virtual reality can be an effective intervention method for enhancing the upper limb motor skills on the affected side, as well as bilateral coordination ability.

Dobkin, B. H. (2017). "A Rehabilitation-Internet-of-Things in the Home to Augment Motor Skills and Exercise Training." Neurorehabilitation & Neural Repair 31(3): 217-227.
	Although motor learning theory has led to evidence-based practices, few trials have revealed the superiority of one theory-based therapy over another after stroke. Nor have improvements in skills been as clinically robust as one might hope. We review some possible explanations, then potential technology-enabled solutions. Over the Internet, the type, quantity, and quality of practice and exercise in the home and community can be monitored remotely and feedback provided to optimize training frequency, intensity, and progression at home. A theory-driven foundation of synergistic interventions for walking, reaching and grasping, strengthening, and fitness could be provided by a bundle of home-based Rehabilitation Internet-of-Things (RIoT) devices. A RIoT might include wearable, activity-recognition sensors and instrumented rehabilitation devices with radio transmission to a smartphone or tablet to continuously measure repetitions, speed, accuracy, forces, and temporal spatial features of movement. Using telerehabilitation resources, a therapist would interpret the data and provide behavioral training for self-management via goal setting and instruction to increase compliance and long-term carryover. On top of this user-friendly, safe, and conceptually sound foundation to support more opportunity for practice, experimental interventions could be tested or additions and replacements made, perhaps drawing from virtual reality and gaming programs or robots. RIoT devices continuously measure the actual amount of quality practice; improvements and plateaus over time in strength, fitness, and skills; and activity and participation in home and community settings. Investigators may gain more control over some of the confounders of their trials and patients will have access to inexpensive therapies.

Dockx, K., et al. (2016). "Virtual reality for rehabilitation in Parkinson's disease." Cochrane Database of Systematic Reviews 12(12): CD010760.
	BACKGROUND: Parkinson's disease (PD) is a neurodegenerative disorder that is best managed by a combination of medication and regular physiotherapy. In this context, virtual reality (VR) technology is proposed as a new rehabilitation tool with a possible added value over traditional physiotherapy approaches. It potentially optimises motor learning in a safe environment, and by replicating real-life scenarios could help improve functional activities of daily living. OBJECTIVES: The objective of this review was to summarise the current best evidence for the effectiveness of VR interventions for the rehabilitation of people with PD in comparison with 1) active interventions, and 2) passive interventions. Our primary goal was to determine the effect of VR training on gait and balance. Secondary goals included examining the effects of VR on global motor function, activities of daily living, quality of life, cognitive function, exercise adherence, and the occurrence of adverse events. SEARCH METHODS: We identified relevant articles through electronic searches of the Cochrane Movement Disorders Group Trials Register, the Cochrane Central Register of Controlled Trials (CENTRAL) (the Cochrane Library), MEDLINE, Embase, CINAHL, the Physiotherapy Evidence Database (PEDro), online trials registers, and by handsearching reference lists. We carried out all searches up until 26 November 2016. SELECTION CRITERIA: We searched for randomised and quasi-randomised controlled trials of VR exercise interventions in people with PD. We included only trials where motor rehabilitation was the primary goal. DATA COLLECTION AND ANALYSIS: Two review authors independently searched for trials that corresponded to the predefined inclusion criteria. We independently extracted and assessed all data for methodological quality. A third review author was responsible for conflict resolution when required. MAIN RESULTS: We included 8 trials involving 263 people with PD in the review. Risk of bias was unclear or high for all but one of the included studies. Study sample sizes were small, and there was a large amount of heterogeneity between trials with regard to study design and the outcome measures used. As a result, we graded the quality of the evidence as low or very low. Most of the studies intended to improve motor function using commercially available devices, which were compared with physiotherapy. The interventions lasted for between 4 and 12 weeks.In comparison to physiotherapy, VR may lead to a moderate improvement in step and stride length (standardised mean difference (SMD) 0.69, 95% confidence interval (CI) 0.30 to 1.08; 3 studies; 106 participants; low-quality evidence). VR and physiotherapy interventions may have similar effects on gait (SMD 0.20, 95% CI -0.14 to 0.55; 4 studies; 129 participants; low-quality evidence), balance (SMD 0.34, 95% CI -0.04 to 0.71; 5 studies; 155 participants; low-quality evidence), and quality of life (mean difference 3.73 units, 95% CI -2.16 to 9.61; 4 studies; 106 participants). VR interventions did not lead to any reported adverse events, and exercise adherence did not differ between VR and other intervention arms.The evidence available comparing VR exercise with a passive control was more limited. The evidence for the main outcomes of interest was of very low quality due to the very small sample sizes of the two studies available for this comparison. AUTHORS' CONCLUSIONS: We found low-quality evidence of a positive effect of short-term VR exercise on step and stride length. VR and physiotherapy may have similar effects on gait, balance, and quality of life. The evidence available comparing VR with passive control interventions was more limited. Additional high-quality, large-scale studies are needed to confirm these findings.

Dominguez-Tellez, P., et al. (2020). "Game-Based Virtual Reality Interventions to Improve Upper Limb Motor Function and Quality of Life After Stroke: Systematic Review and Meta-analysis." Games for Health Journal 9(1): 1-10.
	Stroke is the main cause of disability in adulthood. Recent advances in virtual reality (VR) technologies have led to its increased use in the rehabilitation of stroke patients. A systematic review and meta-analysis of randomized controlled trials (RCTs) was conducted to determine the effectiveness of game-based reality on upper limb (UL) motor function and quality of life after stroke. In March 2018, a search of the following databases was performed: PubMed, PEDro, Web of Science, Scopus, The Cochrane Library, and Medline at EBSCO. The selection criteria were all RCTs published in English or Spanish during the past 10 years. The PEDro scale was used to evaluate the methodological quality of the studies. A total of 20 clinical trials were included in the systemic review, of which 15 contributed information to the meta-analysis. Favorable results were found for VR interventions on UL motor function (Fugl-Meyer Assessment for upper extremity, standardized mean difference [SMD] = 1.53, 95% CI [0.51-2.54]) and quality of life (functional independence measure, SMD = 0.77, 95% CI [0.05-1.49]). The results demonstrate the potential benefits of VR interventions on the recovery of UL motor function and on quality of life after stroke.

dos Santos Mendes, F. A., et al. (2012). "Motor learning, retention and transfer after virtual-reality-based training in Parkinson's disease--effect of motor and cognitive demands of games: a longitudinal, controlled clinical study." Physiotherapy 98(3): 217-223.
	OBJECTIVES: To evaluate the learning, retention and transfer of performance improvements after Nintendo Wii Fit training in patients with Parkinson's disease and healthy elderly people. DESIGN: Longitudinal, controlled clinical study. PARTICIPANTS: Sixteen patients with early-stage Parkinson's disease and 11 healthy elderly people. INTERVENTIONS: Warm-up exercises and Wii Fit training that involved training motor (shifts centre of gravity and step alternation) and cognitive skills. A follow-up evaluative Wii Fit session was held 60 days after the end of training. Participants performed a functional reach test before and after training as a measure of learning transfer. MAIN OUTCOME MEASURES: Learning and retention were determined based on the scores of 10 Wii Fit games over eight sessions. Transfer of learning was assessed after training using the functional reach test. RESULTS: Patients with Parkinson's disease showed no deficit in learning or retention on seven of the 10 games, despite showing poorer performance on five games compared with the healthy elderly group. Patients with Parkinson's disease showed marked learning deficits on three other games, independent of poorer initial performance. This deficit appears to be associated with cognitive demands of the games which require decision-making, response inhibition, divided attention and working memory. Finally, patients with Parkinson's disease were able to transfer motor ability trained on the games to a similar untrained task. CONCLUSIONS: The ability of patients with Parkinson's disease to learn, retain and transfer performance improvements after training on the Nintendo Wii Fit depends largely on the demands, particularly cognitive demands, of the games involved, reiterating the importance of game selection for rehabilitation purposes.

Douris, P. C., et al. (2018). "The Effects of Aerobic Exercise and Gaming on Cognitive Performance." J Hum Kinet 61: 73-83.
	The purpose of our study was to investigate the effects of video gaming, aerobic exercise (biking), and the combination of these two activities on the domains of cognitive performance: selective attention, processing speed, and executive functioning. The study was a randomized clinical trial with 40 subjects (mean age 23.7 +/- 1.8 years) randomized to one of four thirty-minute conditions: video gaming, biking, simultaneous gaming and biking, and a control condition. Cognitive performance was measured pre and post condition using the Stroop test and Trails B test. A mixed design was utilized. While video gaming, biking, simultaneous gaming and biking conditions improved selective attention and processing speed (p < 0.05), only the bike condition improved the highest order of cognitive performance, executive function (p < 0.01). There were no changes in cognitive performance for the control condition. Previous studies have shown that if tasks approach the limits of attentional capacity there is an increase in the overall chance for errors, known as the dual-task deficit. Simultaneous biking and gaming may have surpassed attentional capacity limits, ultimately increasing errors during the executive function tests of our cognitive performance battery. The results suggest that the fatiguing effects of a combined physically and mentally challenging task that extends after the exercise cessation may overcome the eventual beneficial cognitive effects derived from the physical exercise.

Douthitt, L., et al. Patients Offer Advice to Physical Therapists...Highlights from CMS 2016, Alexandria, Virginia, American Physical Therapy Association.
	The article discusses the highlights of the Section on Women's Health session "The Customer Experience in Health Care: The Game Changer." Highlights mentioned include talks by patients Erin Jackson and Lisa Maczura on their experiences in the health care system and their suggestions to make physical therapy more effective and achieve improved patient outcomes.

Douthitt, L., et al. (2016). "Military PTs Describe Virtual Reality Applications For Injured Service Members...Highlights from CMS 2016." PT in Motion 8(3): 39-39.
	The article reports that a panel of physical therapists (PTs) discussed the use of virtual reality (VR) and serious game-based technology (SG) for the diagnosis and rehabilitation of injured service members at the Federal Physical Therapy Section's session.

Dreyer, C., et al. (1999). "Pre-hospital care at the VII Island Games, Jersey 1997." Pre-hospital Immediate Care 3(4): 211-214.
	Objective: To describe the incidence of injuries and other health problems presenting to the host medical team during the VII Island Games. The athletes were participating in 14 different sports over a six day period. Methods: A cohort study was undertaken involving the games participants. Demographic details, history, and diagnosis of injury/health problem and resultant treatment were recorded for each patient. Results: Of 1834 participants 64 (3.5%) athletes presented to the medical team. Athletes from visiting teams without an attendant doctor accounted for 71.9% of those seen. Among the presenting athletes, volleyball was the most frequently represented sport providing 23.4% of the patients. Athletics was second with 20.3%. Soft tissue injuries accounted for 86.8% of presentations with 33.9% being chronic or acute on chronic. The lower limb was the commonest site of injury (59%). Referral for physiotherapy was the most frequent 'disposal' with 27.3% receiving this treatment. Of the athletes seen, eight (12.5%) were referred to hospital and two athletes (1.5%) were admitted. Conclusions: High attendance by athletes without a team doctor and the impact of acute on chronic/chronic injuries are factors which must be closely considered when planning a host community medical service. The attendance of team doctors is one way in which visiting teams may reduce the workload of the host community medical service that has limited resources. It may also be argued that in order to manage the acute on chronic/chronic sporting injuries, a host medical team should include doctors with an interest in sports medicine.

Drks (2011). "Controlled clinical trial investigating the efficacy of physiotherapy compared to treatment with the Nintendo Wii game console for the improvement of balance in patients with stroke." https://trialsearch.who.int/Trial2.aspx?TrialID=DRKS00003168.
	INTERVENTION: Intervention 1: 15 patients with balance disorder after stroke. Treatment period 4 weeks with 4 sessions group therapy per week . Status survey using questionnaires and balance tests before and after treatment phase, 4 weeks after end of therapy, alternative to discharge. The therapy is done with the Nintendo Wii game console. In this game console you can control the game character by shifting the weight of your body. In the treatment, the balance is trained on a "playful" way . Results about the success / failure of the exercise are displayed directly on the screen. Intervention 2: 15 patients with balance disorder after stroke. Treatment period 4 weeks with 4 sessions group therapy per week . Status survey using questionnaires and balance tests before and after treatment phase, 4 weeks after end of therapy, alternative to discharge. Application of classical physiotherapeutical balance therapy. The balance disorder will be treated by using different therapeutical material. These exercises have been adapted to the playful style of the Wii treatment. CONDITION: I64 ‐ Stroke, not specified as haemorrhage or infarction I69.3 ‐ Sequelae of cerebral infarction R42 ‐ Dizziness and giddiness PRIMARY OUTCOME: The primary outcome is measured with the BBS: Berg Balance Scale.; This is a test battery consisting of motor tests to determine balance and risk of falling.; Primary endpoint is either 4 weeks after end of treatment, or ‐ if earlier ‐ at discharge from hospital.; The primary parameter is the change in the value of the Berg Balance Scale before, immediately after and 4 weeks after end of therapy. SECONDARY OUTCOME: COP measurement: Measurement of body pressure point in the upright position, change of ability to regulate posture before/after therapy; ; TUG: Timed Up and Go test. Test checks the understanding of a simple everyday task, the ability to stand up alone, to walk 3 meters, turn around and sit down (time tracking); ; MFAS: Motor Function Assessment Scale. Capture of patients' motor function in 44 sub‐items (sitting, standing up and standing, walking and function of the upper extremities); ; FIM: Functional Independence Measure. Test for the assessment of needs and autonomy of patients in everyday life; ; Questions about the fall/therapy frequency; Standardized questions about the frequency of falls, the incidence of self‐induced additional therapy and satisfaction with the therapy.; ; Secondary endpoint is either 4 weeks after end of treatment, or ‐ if earlier ‐ at discharge from hospital. INCLUSION CRITERIA: • cerebral infarction within the last 6 months, previously ambulatory • aged between 18 and 90 years • able to stand with assistance/therapeutic appliances

Drks (2014). "Ballschule - leicht gemacht (Ball School - easy): Physical exercise and diet counselling for overweight children." https://trialsearch.who.int/Trial2.aspx?TrialID=DRKS00005275.
	INTERVENTION: Intervention 1: Arm 1: The movement therapy procedures are based on the concept of the Heidelberg ball school (Roth & Kröger, 2005, 2011) and aimed for mediating having fun while being physically active and sport specific skills. Methods of behavior therapy have been implemented in movement therapies to change particular behavior, such as daily activities. The 1,5 hour exercise program was offered twice per week for half a year. Intervention 2: Arm 2: In dietetic treatment the concept of optimised mixed diet was implemented. Methods of behavior therapy were implemented in dietetic treatment to change particular behavior, e.g. eating behavior. Over a period of six month tere were eight 1,5 units of nutrition counselling partially together with their parents. Intervention 3: Arm 3: In the combined group the children took part in the ball school program as well as the nutrition counselling together with their parents. The contents were equivalent to the ones of the ball school – and nutrition group (see Arm 1 and Arm 2). Intervention 4: The control group did not participate at a special programm during the intervention period of six month. CONDITION: E66.09 ‐ [generalization E66.0: Obesity due to excess calories] PRIMARY OUTCOME: The goals can be explained by the following hypotheses: ; Effectivity hypothesis I:; There is an expected correlation between weight reduction and an improvement of the functional (flow‐mediated vasodilatation), morphologic (intima media thickness) and biochemical parameters (lipid profile, insulin resistance, hs‐CRP).; Effectivity hypothesis II:; There is an expected correlation between the improved function of the endothelium and the increased amount of physical activity or change in nutrition.; Determination of the flow‐mediated vasodilatation (FMD) und intima media thickness (IMT):; Measurements were taken with high resolution ultrasonic sound with an integrated ECG (Kretz Voluson 730). A 12 MHz receiving transducer with a 0,1 mm resolution and a penetration depth of maximum 7,5 cm was used to take measurements from the brachial artery and carotids. The calculation of the lumen diameter results from the method of Wendelhag, information for the breadboard model is provided by Celemayer.; FMD: The subjects were measured fasting between 8 and 10 o’clock with at least 10 min of rest prior to the examination, first measurement after the rest, then a hyper systolic compression of 5 min, post ischemic scan 45, 90, 120 sec. after releasing the blood pressure cuff measured three times to determine the mean value.; IMT: Measuring the distance between the intima lumen and the media adventitia. The measurement took place on both sides at four different locations: carotid artery communis, Bifukation, carotid artery interna. IMT: mean value out of 8 measurements. In addition BMI, blood pressure and different blood values were measured. ; The analyses were made at baseline and half a year later after the intervention. SECONDARY OUTCOME: The sports scientific primary outcome criteria are differentiated in assumptions of overall motor skills and sport specific skills. The overall motor skills are expected to improve, e.g. the fine motor skills and general motor abilities and endurance, as well as psychosocial features such as the ability to concentrate or the self‐concept. Advance in sport specific abilities like ball coordination, technical and tactical skills are expected as well.; In order to identify cardiopulmonary endurance performance capacity, the subjects had to perform a 6 minute run (Bös et al., 2001), to identify overall body coordination the subjects had to perform the body coordination test for children (BCC) (“Körperkoordinationstest für Kinder KTK”) by Schilling (1974). The motor test for four to six year old children (MOT 4‐6) was applied to determine fine motor skills, this is a method to diagnose the stage of development of motor skills of kindergarten aged children (Zimmer & Volkamer, 1987). The MOT 4‐6 consists of 18 tasks, 5 were selected in o der to test the fine motor skills and ability to respond. Three exercises were selected from the diagnostic inventory of basic motor skills (DMB), to determine eye‐hand‐coordination, respectively visual motor skills combined with fine motor skills (Eggert, 2008). A total score of the fine motor skills was put together each out of the three exercises from the MOT 4‐6 and DMB for statistical analysis. To determine the subjects’ performance in game sports, the children were put into small groups and took part in three games with different demands (hand, racket, foot), each game lasted for ten minutes. In order to analyze the game performance, the modified rating scale by Scholl (1986) was applied. The peer acceptance, the cognitive competence and the competence in sports was determined with the pictorial scale of perceived competence and social acceptance in the German version (PSCA‐D)(Asendorf & Aken,1993).; In this present study, body awareness (self‐assessment, ideal self‐image, body contentment) was measured with the modified charts of body shapes / outlines (Radtke 2004) according to Collins (1991) with seven increments each for girls and boys (Radtke, 2004; Collins,1991).; Two aspects of the cognitive performance were determined. The differential performance test – KG (DL – KG) (Kleber et al., 1999) was used to measure performance during focused activity, the culture fair intelligence test (CFT) (Weiß & Jürgen, 1997; Weiß, 1998)was applied to measure overall intelligence. The performance diagnostics of sports medicine was done on a bicycle ergometer. The gradual increase of physical exercise up until maximum individual performance, heart rate and oxygen uptake were parameters they looked at to determine the physical performance capacity.; Simultaneously an ECG was recorded in order to measure the heart rate. Prior to the exercise, every three minutes during the exercise, at the end of the exercise during the time frame after the exercise blood pressure was taken. Any contraindication and dropout criteria for ergometries were maintained. ; The additional secondary endpoint has got expectations as follows: the combined group (Arm 3) shows a higher weight reduction (SDS – BMI) compared to the ball school – and nutrition counselling group (Arm 1 and Arm 2) itself. The control group is expected to have the lowest weight reduction (SDS – BMI).; The analyses were made at baseline and half a year later after the intervention. INCLUSION CRITERIA: Age‐appropriate body weight above the 90th percentile; age between 6 and 10 years old, respectively attending primary school; exclusion from general diseases after being examined in the clinic for child – and youth medical care; sufficient motivation also alongside with their parents; adequate understanding of the German language; letter of agreement by a legal guardian for taking part in the study

Drks (2014). "Comparison Of An Individualized Outpatient Exercise Training Versus A Standardized Outpatient Exercise Training In Patients With Mild To Very Severe Chronic Obstructive Pulmonary Disease." https://trialsearch.who.int/Trial2.aspx?TrialID=DRKS00006043.
	INTERVENTION: Intervention 1: Individualized Training (IT): Patients in this group take part in an individualized outpatient exercise training. The program consists of all aspects of exercise training which have been recommended by the joint American College of Chest Physicians and the American Association of Cardiovascular and Pulmonary Rehabilitation (ACCP/AACVPR) clinical practice guidelines. Training once a week for 60 minutes over a time period of three months. Intervention 2: Non‐individualized Training (NT): Patients participate as part of a group in different exercises including various playful approaches like ball games. Training once a week for 60 minutes over a time period of three months. CONDITION: J44.8 ‐ Other specified chronic obstructive pulmonary disease PRIMARY OUTCOME: Health‐related Quality of Life (COPD‐Assessment‐Test) before/after 3‐months training period SECONDARY OUTCOME: 1. Lung function (spirometry); 2. Physical exercise capability (6‐minute walking test (6‐MWT)); 3. Quality of Live (St. Georges Respiratory Questionnaire (SGRQ)); 4. Muscle mass (ultrasound measurement of rectus femoris cross‐sectional area); 5. Systemic inflammation (serum level measurements of inflammatory markers); ; All parameter are measured before and after a three months training period. INCLUSION CRITERIA: COPD GOLD I ‐ IV Capable to come to the facilities on a weekly basis

Drks (2021). "Immersive virtual reality fitness games for enhancement of recovery after colorectal surgery." https://trialsearch.who.int/Trial2.aspx?TrialID=DRKS00024888.
	INTERVENTION: Intervention 1: On weekdays, each participant in the VR Fitness Group is offered one 30‐minute session of activity‐promoting VR fitness game per day from the first post‐operative day until discharge. The sessions are in addition to the in‐house physiotherapy standard that all patients receive after surgery. Intervention 2: Patients in the control group do not receive additional sessions with an activity‐promoting VR fitness game. CONDITION: C18 ‐ Malignant neoplasm of colon C19 ‐ Malignant neoplasm of rectosigmoid junction C20 ‐ Malignant neoplasm of rectum PRIMARY OUTCOME: Because this study is a pilot study, it is not designed to test a specific hypothesis.; Therefore, a distinction was made between feasibility endpoints and clinical endpoints.; Feasibility endpoints:; ‐ Participation, recruitment, and retention rates. Participation rate is the proportion of participants who meet inclusion criteria and agree to participate in the study. Recruitment rate is the number of participants recruited per month. Retention rate is the number of participants who completed the total number of planned interventions.; ‐ Proportion of interventions actually completed relative to planned interventions for each participant.; ‐ Rate of discontinued interventions and reasons for discontinuation.; ‐ Compliance regarding the patient's response to the questionnaires. Compliance with regard to completion of questionnaires is the proportion of; Completed questionnaires at the specified dates.; ‐ Deviations from the study protocol. Number of deviations from the; study protocol (e.g., interventions not performed or performed differently than described in the study protocol, questionnaires not distributed or not completed) and reason for deviation from the study protocol (patient‐related, personnel‐related, organizational). SECONDARY OUTCOME: Because this study is a pilot study, it is not designed to test a specific hypothesis.; Therefore, a distinction was made between feasibility endpoints and clinical endpoints.; Clinical endpoints:; ‐ Difference in health status surveyed with the EQ‐5D‐5L health questionnaire preoperatively, 7 days after surgery, and 30 days after surgery.; ‐ Difference in number and severity of postoperative complications between study groups; ‐ Difference in length of hospital stay between the two; Study groups; ‐ Difference in psychosocial distress preoperatively, at 7 days, and at 30 days, assessed with the NCCN Distress Thermometer; ‐ Difference in patient satisfaction at discharge INCLUSION CRITERIA: Patients who are between 18 and 75 years of age, are capable of informed consent and are not under legal guardianship, are undergoing abdominal surgery for colorectal carcinoma or liver metastases of colorectal carcinoma, and provide written informed consent.

Duff, A., et al. (2006). "Betterland: an interactive cd-rom guide for children with cystic fibrosis." Paediatric Nursing 18(7): 30-33.
	Effective management of cystic fibrosis (CF) depends on adherence to a daily multi-component regimen. Segregation policies have been reported to lead to a dramatic fall in the incidence of cross infection rates in specialist CF centres. Previously, peers provided a valuable source of information and support; segregation means that there is virtually no contact with other people with CF. In this context the Betterland CD-ROM was developed with the aim of improving knowledge and understanding and helping children and young people cope with time-consuming CF treatments (inhalation therapies and physiotherapy) and painful procedures by using filmed-model approaches. Betterland is an interactive computer game, designed in the style of a theme park. Patient and carer feedback has been positive and the CD-ROM has been incorporated into a nurse-led Moving to High School (MotHS) programme, as well as the patient education work of the CF multidisciplinary team, particularly clinical nurse specialists.

Dundar, P. and M. Kilinc (2018). "The effect of technology-assisted exergame treatment on upper extremity functions in children with cerebral palsy: pilot study." Fizyoterapi rehabilitasyon 29(2): S24‐.
	Purpose: Inability to function in upper extremities is an important symptom restricts activities of daily living, in children with hemiparetic cerebral palsy(CP). Many physiotherapy methods are used to reduce inability. Purpose of this study was to investigate effect of touch‐based gaming therapy on children's trunk control, quality of upper extremity movements, muscle tone, hand skills inaddition to physiotherapy program in children with hemiparesis CP. Methods: We included five hemiparetic children, ages 6 to 12 years, Gross Motor Function Classification System levels I‐II, Manual Ability Classification System levels I‐III. Modified Ashworth Scale, Trunk Control Measurement Scale, Quality of Upper Extremity Skills Test, Abilhand‐Kids Scale are used to assess the children. In addition, upper extremity functional performances of children were evaluated before and after the treatment with the computer‐based "restriction map" method. The children were given a exergame treatment of 30 minutes, inaddition to traditional 30‐minute physiotherapy program for 3 days for 8 weeks. Game treatments consisted of six games and sublevels in the USE‐IT smart activity table. Results: Participants' QUEST grasp and total score, tones of wrist flexor muscles improved significantly after treatment (p<0.05). No significant change was found in other parameters (p>0.05). Conclusion: Technology‐supported game treatments are of particular interest in treatment of children with neurological disorder. It is thought result of this study is that the improvement in the quality of upper extremity movements is promising finding, that more comprehensive and randomized controlled studies in this area will provide more general information about the location of the technologists in physiotherapy.

Dunn, A., et al. (2019). "A Novel Clinician-Orchestrated Virtual Reality Platform for Distraction During Pediatric Intravenous Procedures in Children With Hemophilia: Randomized Controlled Trial." JMIR Serious Games 7(1): e10902.
	BACKGROUND: Needles are frequently required for routine medical procedures. Children with severe hemophilia require intensive intravenous (IV) therapy to treat and prevent life-threatening bleeding and undergo hundreds of IV procedures. Fear of needle-related procedures may lead to avoidance of future health care and poor clinical outcomes. Virtual reality (VR) is a promising distraction technique during procedures, but barriers to commercially available VR platforms for pediatric health care purposes have prevented widespread use. OBJECTIVE: We hypothesized that we could create a VR platform that would be used for pediatric hemophilia care, allow clinician orchestration, and be safe and feasible to use for distraction during IV procedures performed as part of complex health care. METHODS: We created a VR platform comprising wireless, adjustable, disposable headsets and a suite of remotely orchestrated VR games. The platform was customized for a pediatric hemophilia population that required hands-free navigation to allow access to a child's hands or arms for procedures. A hemophilia nurse observing the procedure performed orchestration. The primary endpoint of the trial was safety. Preliminary feasibility and usability of the platform were assessed in a single-center, randomized clinical trial from June to December 2016. Participants were children with hemophilia aged 6-18 years. After obtaining informed consent, 25 patients were enrolled and randomized. Each subject, 1 caregiver, and 1 hemophilia nurse orchestrator assessed the degree of preprocedural nervousness or anxiety with an anchored, combined modified visual analog (VAS)/FACES scale. Each participant then underwent a timed IV procedure with either VR or standard of care (SOC) distraction. Each rater assessed the distraction methods using the VAS/FACES scale at the completion of the IV procedure, with questions targeting usability, engagement, impact on procedural anxiety, impact on procedural pain, and likability of the distraction technique. Participants, caregivers, and nurses also rated how much they would like to use VR for future procedures. To compare the length of procedure time between the groups, Mann-Whitney test was used. RESULTS: Of the 25 enrolled children, 24 were included in the primary analysis. No safety concerns or VR sickness occurred. The median procedure time was 10 (range 1-31) minutes in the VR group and was comparable to 9 (range 3-20) minutes in the SOC group (P=.76). Patients in both the groups reported a positive influence of distraction on procedural anxiety and pain. Overall, in 80% (34/45) of the VR evaluations, children, caregivers, and nurses reported that they would like to use VR for future procedures. CONCLUSIONS: We demonstrated that an orchestrated, VR environment could be developed and safely used during pediatric hemophilia care for distraction during IV interventions. This platform has the potential to improve patient experience during medical procedures. TRIAL REGISTRATION: Clinical Trials.gov NCT03507582; https://clinicaltrials.gov/ct2/show/NCT03507582 (Archived by WebCite at http://www.webcitation.org/73G75upA3).

Dunn, M. K. and S. Z. George (2009). "Comparison of preoperative and postoperative functional and psychosocial outcome measures in a patient with acute noncontact knee dislocation: a case report." Orthopaedic Physical Therapy Practice 21(3): 78-86.
	Introduction: Many athletes experience psychological and emotional challenges related to stress associated with serious injuries. Traditionally, impairment based measures have been used to determine an athlete's readiness to return to sport. The purpose of this case report was to describe the use of physical impairment in conjunction with patient reported functional and psychosocial outcomes measures preoperatively and postoperatively in the treatment of an athlete with multiple ligament disruption following acute noncontact knee dislocation. Case Description: Patient was a 17-year-old male referred to physical therapy following acute noncontact knee dislocation sustained during a football game, resulting in ruptured anterior cruciate ligament (ACL), torn medial collateral ligament (MCL), and medial meniscal tear. Patient underwent ACL reconstruction with meniscal repair 6 weeks following injury. Patient reported functional and psychosocial outcome measure forms including the International Knee Documentation Subjective Knee Form (IKDC), the Tampa Scale for Kinesiophobia-11 (TSK-11), the Pain Catastrophizing Scale (PCS), the Modified Self-Efficacy for Rehabilitation Out-comes Scale (MSER), and the Knee Activity Self-Efficacy Scale (KA-SES) were administered at set intervals throughout rehabilitation. Physical impairments including pain, circumferential girth, range of motion (ROM), and strength were measured throughout rehabilitation. Prior to beginning rehabilitation, the patient possessed moderate amount of fear associated with moving the involved extremity and decreased self efficacy in relation to activities specific to rehabilitation. The patient also had extreme limitation performing any activity due to knee pain, swelling, and instability. Outcomes: Likely meaningful improvements in IKDC and TSK-11 and improvements believed to be meaningful in PCS, MSER, and KA-SES scores preoperatively and postoperatively. Improvements in patient reported functional and psychosocial outcomes measures were congruent with improvements in ROM, strength, and pain. Discussion: Improvements in patient reported functional and psychosocial outcome measures potentially increase the likelihood of returning to preinjury level of physical activity, including sports. Future research should address which factors alone and in combination predict return to preinjury activity level, including sports.

Durakovic, Z., et al. (2011). "Hypertrophic cardiomyopathy and sudden cardiac death due to physical exercise in Croatia in a 27-year period." Collegium Antropologicum 35(4): 1051-1054.
	The paper deals with the sudden cardiac death during physical exercise in males in Croatia. The data are a part of a retrospective study dealing with 69 sudden death due to physical activity in men in Croatia during 27 years: from January 1, 1984 to December 31, 2010. Three of them suddenly died during training and two of them died during recreational physical exercise, probably because of malignant ventricular arrhythmia due to hyperthrophic cardiomyopathy. One had an obstructive form of hypertrophic cardiomyopathy with i.v. septum of 40 mm and four had a non-obstructive forms of hyperthrophic cardiomyopathy with left ventricular wall of 18-20-22-25 mm. First athlete was a short trails runner, aged 24, with no any previous physical discomforts, who suddenly collapsed and died during training. The second athlete was a soccer player aged 18, with no any previous physical discomfort, who suddenly collapsed and died during training. The third aged 15, was a school boy, basketball player, with no any previous physical discomfort, who collapsed and died during training. Two aged 25 and 34, were with no physical discomfort during exercise and died suddenly during recreational soccer games. A sudden cardiac death due to physical exercise in young athletes in Croatia suffered of hyperthropic cardiomyopathy reached 0.06/100 000 yearly (p = 0.00000) in 27 years, in teenagers 0.26/100 000 (p = 0.00226), in teenagers suffered of hypertrophic cardiomyopathy reached 0.10/100 000 (p = 0.00000), in all young athletes suffered of other heart diseases reached 0.19/100 000 (p = 0.00005), and in the total male population aged 15 or more, engaged in sports and recreational physical exercise: 0.71/100.0000 (p = 0.00001).

Duvauchelle, J. (2021). "ACTIVE AGING for a STRONGER FUTURE." Alive: Canada's Natural Health & Wellness Magazine(468): 29-33.
	The article offers insights on active aging to be able to live better and healthier. Topics discussed include the 7 specific areas of life - the emotional, intellectual, physical, professional, social, spiritual, and environmental that is covered by active aging, the importance of regular physical exercise on living with quality, and the game-changing benefits of active aging. Also noted is the ready implementation of physical activity once a worthwhile incentive is chosen.

Eaton, C. and K. George (2006). "Position specific rehabilitation for rugby union players. Part II: Evidence-based examples." Physical Therapy in Sport 7(1): 30-35.
	It has been stated that a rehabilitation programme should incorporate sport-specific exercises and subject a player to at least as hard demands as they will encounter on return to competition. Research has empirically demonstrated the quantities, times spent, and work to rest ratios for the demands of rugby and report that they do vary between positions. Utilising this information, this article has provided evidence-based examples of how sport-specific exercises can be progressed. The aim of these exercises is to provide the physiotherapist or conditioner with a means to ensure the safe return to optimum competition. The examples have concentrated on the high-intensity (HI) activities of rugby such as running, tackling and scrummaging as these have been shown to vary most between positions. The article also provides an example of how the HI activities can be combined with the low-intensity (LI) activities of the game, e.g. walking or standing, to reflect the work to rest ratios experienced by each playing position. In conclusion, this article recognises that data are not currently available for all the demands of rugby union and that this needs to be addressed before a fully evidence-based programme can be achieved.

Eckert, M., et al. (2018). "The Blexer system – Adaptive full play therapeutic exergames with web-based supervision for people with motor dysfunctionalities." EAI Endorsed Transactions on Game-Based Learning 5(16).
	This work presents the “Blexer” (Blender Exergames) system for therapeutic exergames designed for people with physical dysfunctionalities. The users control the games with corporal movements, captured by the Kinect® sensor. Games incorporate an amplifying functionality that enhances the immersive feeling. Via the medical platform “Blexer-med”, clinicians configure the games individually for each patient. On the user’s PC, the middleware “Chiro” is used to transmit configuration data and results between the games and the web platform. Opposed to similar approaches found in literature, our system does not rely on pathology specific mini-games but focus on the design of generic “Full-Play” games, with a complete and compelling gaming environment. The principles of eight Core Drives defined in the Octalysis framework have been applied in the design of the first prototype game “Phiby’s Adventure” presented here. It contains four generic exercises useful for daily training.

Eckert, M., et al. (2017). "New Approaches to Exciting Exergame-Experiences for People with Motor Function Impairments." Sensors 17(2): 354.
	The work presented here suggests new ways to tackle exergames for physical rehabilitation and to improve the players' immersion and involvement. The primary (but not exclusive) purpose is to increase the motivation of children and adolescents with severe physical impairments, for doing their required exercises while playing. The proposed gaming environment is based on the Kinect sensor and the Blender Game Engine. A middleware has been implemented that efficiently transmits the data from the sensor to the game. Inside the game, different newly proposed mechanisms have been developed to distinguish pure exercise-gestures from other movements used to control the game (e.g., opening a menu). The main contribution is the amplification of weak movements, which allows the physically impaired to have similar gaming experiences as the average population. To test the feasibility of the proposed methods, four mini-games were implemented and tested by a group of 11 volunteers with different disabilities, most of them bound to a wheelchair. Their performance has also been compared to that of a healthy control group. Results are generally positive and motivating, although there is much to do to improve the functionalities. There is a major demand for applications that help to include disabled people in society and to improve their life conditions. This work will contribute towards providing them with more fun during exercise.

Eggenberger, P., et al. (2015). "Does multicomponent physical exercise with simultaneous cognitive training boost cognitive performance in older adults? A 6-month randomized controlled trial with a 1-year follow-up." Clinical Interventions In Aging 10: 1335-1349.
	BACKGROUND: Cognitive impairment is a health problem that concerns almost every second elderly person. Physical and cognitive training have differential positive effects on cognition, but have been rarely applied in combination. This study evaluates synergistic effects of multicomponent physical exercise complemented with novel simultaneous cognitive training on cognition in older adults. We hypothesized that simultaneous cognitive-physical components would add training specific cognitive benefits compared to exclusively physical training. METHODS: Seniors, older than 70 years, without cognitive impairment, were randomly assigned to either: 1) virtual reality video game dancing (DANCE), 2) treadmill walking with simultaneous verbal memory training (MEMORY), or 3) treadmill walking (PHYS). Each program was complemented with strength and balance exercises. Two 1-hour training sessions per week over 6 months were applied. Cognitive performance was assessed at baseline, after 3 and 6 months, and at 1-year follow-up. Multiple regression analyses with planned comparisons were calculated. RESULTS: Eighty-nine participants were randomized to the three groups initially, 71 completed the training, while 47 were available at 1-year follow-up. Advantages of the simultaneous cognitive-physical programs were found in two dimensions of executive function. "Shifting attention" showed a timexintervention interaction in favor of DANCE/MEMORY versus PHYS (F[2, 68] =1.95, trend P=0.075, r=0.17); and "working memory" showed a timexintervention interaction in favor of DANCE versus MEMORY (F[1, 136] =2.71, trend P=0.051, R (2)=0.006). Performance improvements in executive functions, long-term visual memory (episodic memory), and processing speed were maintained at follow-up in all groups. CONCLUSION: Particular executive functions benefit from simultaneous cognitive-physical training compared to exclusively physical multicomponent training. Cognitive-physical training programs may counteract widespread cognitive impairments in the elderly.

Eggenberger, P., et al. (2015). "Multicomponent physical exercise with simultaneous cognitive training to enhance dual-task walking of older adults: a secondary analysis of a 6-month randomized controlled trial with 1-year follow-up." Clinical Interventions In Aging 10: 1711-1732.
	BACKGROUND: About one-third of people older than 65 years fall at least once a year. Physical exercise has been previously demonstrated to improve gait, enhance physical fitness, and prevent falls. Nonetheless, the addition of cognitive training components may potentially increase these effects, since cognitive impairment is related to gait irregularities and fall risk. We hypothesized that simultaneous cognitive-physical training would lead to greater improvements in dual-task (DT) gait compared to exclusive physical training. METHODS: Elderly persons older than 70 years and without cognitive impairment were randomly assigned to the following groups: 1) virtual reality video game dancing (DANCE), 2) treadmill walking with simultaneous verbal memory training (MEMORY), or 3) treadmill walking (PHYS). Each program was complemented with strength and balance exercises. Two 1-hour training sessions per week over 6 months were applied. Gait variables, functional fitness (Short Physical Performance Battery, 6-minute walk), and fall frequencies were assessed at baseline, after 3 months and 6 months, and at 1-year follow-up. Multiple regression analyses with planned comparisons were carried out. RESULTS: Eighty-nine participants were randomized to three groups initially; 71 completed the training and 47 were available at 1-year follow-up. DANCE/MEMORY showed a significant advantage compared to PHYS in DT costs of step time variability at fast walking (P=0.044). Training-specific gait adaptations were found on comparing DANCE and MEMORY: DANCE reduced step time at fast walking (P=0.007) and MEMORY reduced gait variability in DT and DT costs at preferred walking speed (both trend P=0.062). Global linear time effects showed improved gait (P<0.05), functional fitness (P<0.05), and reduced fall frequency (-77%, P<0.001). Only single-task fast walking, gait variability at preferred walking speed, and Short Physical Performance Battery were reduced at follow-up (all P<0.05 or trend). CONCLUSION: Long-term multicomponent cognitive-physical and exclusive physical training programs demonstrated similar potential to counteract age-related decline in physical functioning.

Eggers, J. and S. Hecht (2014). "A CASE OF BENIGN PAROXYSMAL POSITIONAL VERTIGO MASQUERADING AS TRAUMATIC BRAIN INJURY SYMPTOMS IN A FOOTBALL PLAYER." American Journal of Physical Medicine & Rehabilitation: a51-a52.
	Case Diagnosis: Benign paroxysmal positional vertigo occurring in a football player after head trauma. Case Description: A 22 year old male playing defensive end on a division I collegiate football team reported initial complaints of vertigo and impaired balance following a helmet to helmet collision during a football game. No other symptoms of TBI were present. He had no prior history of TBI. He reported a prior history of vertigo symptoms with spontaneous resolution approximately 5 years previously which had been attributed to a presumed diagnosis of viral labyrinthitis. On re-evaluation the following day, his only complaint was intermittent vertigo with associated nausea, with episodes lasting 15-20 seconds and related to head movements. His symptoms were reproduced with the Dix- Hallpike maneuver, and his neurologic examination including balance and cognition testing was otherwise normal. He was referred to physical therapy with vestibular evaluation revealing evidence of bilateral posterior canal BPPV. He was treated with Epley's maneuver for the left side and the following day with Epley's maneuver for the right side with complete resolution of his symptoms. He returned to football activities five days after the initial development of his complaints and remained asymptomatic. Discussions: Vertigo is a potential symptom of traumatic brain injury. There has been increased emphasis on identification of traumatic brain injury symptoms and the current standard of care prohibits returning to play with any residual symptoms of TBI. However, other etiologies of vertigo following head trauma should be considered, especially in the absence of any other symptoms. Symptoms of vertigo or dizziness may be secondary to otolith dysfunction resulting in BPPV rather than representing symptoms of traumatic brain injury. Otolith dysfunction and symptoms of BPPV following head trauma have previously been described in the literature. Recognition of this diagnosis can lead to prompt and appropriate treatment with resolution of symptoms and avoidance of an unnecessary delay in return to athletic activities. Conclusions: Isolated symptoms of vertigo, especially if positional in nature, following head trauma should not reflexively be attributed to TBI resulting in unnecessary participation restrictions. These symptoms may be secondary to BPPV which can be successfully treated with use of the Epley's maneuver.

Egwu, M. O. (1996). "The musculoskeletal effect of intense physical training of non-athletic youth corps conscripts." Br J Sports Med 30(2): 112-115.
	OBJECTIVE: To determine the musculoskeletal problems associated with high intensity physical exercise among non-athletic youth subjects. METHODS: 484 fresh Nigerian graduates participating in the mandatory National Youth Service Corps (NYSC) programme were studied. At the start of the four week intensive physical training which formed part of the orientation course for the programme, the subjects completed a questionnaire designed to determine their previous exercise habit. The physical training consisted of jogging, physical drills, games (soccer and volleyball), and man o'war activities. During the period of physical training, the subjects were instructed to report all ailments to the camp clinic. RESULTS: Muscular pain/soreness and injuries were major problems associated with the exercise. The lower limbs were most affected and the ankle joint was found to be more injury-prone than other joints. CONCLUSIONS: Most of these graduates were physically unfit and the intense fitness programme produced adverse effects on their physical health. Precamp physical preparation would be desirable.

Eichinger, F. L. F., et al. (2018). "Serious game for rehabilitation of the lower limb of hemiparetics patients after stroke." Annals of physical and rehabilitation medicine 61: e486-e487.
	Introduction/Background Hemiparesis is the classic clinical condition of stroke and is related to important locomotor limitations. The treatment strategies traditionally chosen are limited by the monotony, boredom and repetitiveness of the exercises. Serious games (SG) combine specific physical training with a higher attentional and motivational level, increasing adherence to treatment. The aim of this study was to verify the therapeutic effects of exercise program using a SG developed for evaluation and rehabilitation of hemiparetic patients after stroke. Material and method Non-Randomized Controlled Clinical Trial involving 24 patients (12 men) was conducted. Patients were divided into 2 groups. One group consisted in realize exercises with a SG mim-Pong (experimental, Fig. 1) and the other group a conventional physical therapy (control). Both groups completed the 20-session treatment protocol. The following variables evaluated were: muscle strength, motor control, motor impairment, spasticity, functional mobility and gait speed. Data were analyzed with descriptive statistics, paired Student's t-test and effect size calculation. Results Patients did not differ in terms of sociodemographic characteristics at baseline. In the experimental group, significant improvements were observed for all variables (Table 1). Large effect sizes were found for muscle strength of hamstrings, quadriceps femoris and hamstrings scores, Fugl-Meyer Assessment Scale and Modified Ashworth Scale. In the control group the improvements were lower than experimental group with small to moderate effect sizes. Significant differences were found only for game scores (QFS and HS) probably due to learning during the training phase conducted before assessment with the SG. Conclusion These results suggest that SG promote superior improvements to those obtained with conventional treatment of hemiparetic patients after stroke. This superiority is probably due to increased attention demand and motivation during interventions with SG.

Elena, P., et al. (2021). "Differences Between Exergaming Rehabilitation and Conventional Physiotherapy on Quality of Life in Parkinson's Disease: A Systematic Review and Meta-Analysis." Frontiers in neurology [electronic resource]. 12: 683385.
	Parkinson's disease (PD) is a neurodegenerative condition with both motor and non-motor symptoms affecting the quality of life (QoL) of older adults. Exergaming rehabilitation allows the interaction of the subject with digital games through the implementation of repetitive functional activities. Conventional physiotherapy uses patient-centered programs that include a variety of active exercises. The aim of this review was to look into the effectiveness of exergaming rehabilitation on the QoL of people with PD and compare it with conventional physiotherapy. Five electronic databases were searched for eligible studies until February 2021. For the statistical analysis, the mean, standard deviation, and 95% confidence interval were used to calculate effect sizes between groups. To determine heterogeneity, statistical index I (2) was used. A total of 548 participants were included in 14 studies. Exergaming rehabilitation related with improved QoL (p = 0.687, 95% CI: -1.682 to -0.734), balance (p = 0.039, 95% CI: 0.364-13.689), (p = 0.018, 95% CI: 0.446-4.830), and gait (p = 0.005, 95% CI: 0.351-1.924). No significant difference was found between groups regarding the Unified Parkinson's Disease Rating Scale (p = 0.196, 95% CI: -5.970 to 1.225) and for the Timed Up and Go Test (p = 0.12, 95% CI: 0.446-4.830). Exergames as a rehabilitation method can be used to provide alternative interactive intervention with positive results for QoL in people with PD. Further investigation is needed to assess the effect on mental health in this population group.

Eliasson, A.-C., et al. (2009). "Control of Reaching Movements in 6-year-old Prematurely Born Children with Motor Problems - An Intervention Study." Advances in Physiotherapy 5(1): 33-48.
	The aim was to improve the control of reaching movements in prematurely born children with impaired coordination. Fifteen 6-year-old prematurely born children (birth weight < 1500 g) practised mouse-controlled computer games daily for 4 weeks. In addition, as a control condition, each child practised trampoline jumping for an equally long period. The outcome was measured in terms of: (1) computer game skill, (2) kinematic analysis of planar reaching movements on a digitizing tablet, and (3) motor performance measured with the Movement ABC. After intervention, all the assessments used showed an improvement although only the skill in performing the computer game was clearly related to the type of intervention. Lack of tight correlation between computer game practice and performance on the digitizing tablet might be due to minor but crucial differences in control aspects between the tasks. The present results indicate that the expectation of transfer even to very similar tasks should be low. The findings thus support a task-specific approach to practice, while corroborating the positive impact of non-specific intervention.

Ellerman, S. (1998). "The match game: patients' coping styles." Healthweek (Texas) 3(20): 8-36.
	
Elliott, J. (2004). "Government affairs. Scoring points in the statehouse." PT: Magazine of Physical Therapy 12(9): 30-33.
	Physical therapy has had its share of victories this year in state legislatures. Now is the time to build on successes, learn from disappointments, and develop strong game plans for 2005.

Elrefaei, L. A., et al. (2019). Jcave: A 3D Interactive Game to Assist Home Physiotherapy Rehabilitation. Ithaca, Cornell University Library, arXiv.org.
	The purpose of this paper is to investigate the applicability of applying gamification approach on the physiotherapy rehabilitation. A new developing game called JCave was designed and developed for the prove of concept. The propose game target the children from six to twelve years of age who need physical therapy in their upper limbs. JCave is a finite and multilevel single-player 3D video game. The player's role is to collect jewels from a cave and increase his/her score by performing physical therapy exercises. The game uses Xbox360 Kinect as a motion capture camera to observe gestures and track the child. Automatic gesture recognition algorithms are implemented for elbow flexion-extension exercises and shoulder flexion, which are the active range of motion (AROM) exercises for both the right and left arms. The JCave game is implemented using Unity3D and Blender to design 3D model objects.

Emanuelson, I., et al. (2014). "Abstracts 2014. [corrected]." Brain Injury 28(5-6): 517-878.
	Objectives: Childhood brain tumour treatment carries a substantial risk of impaired intellectual development. Physical activity appears to have a positive effect on cognitive function in humans and on neurogenesis in animal models. The aim was to investigate if homebased exercise‐gaming could achieve improved motor and process function if supported by a web‐based coach. Methods: Children of 7‐17 years of age who underwent treatment including radiotherapy for a malignant brain tumour 1‐5 years earlier were randomized to either an intervention or a waiting‐list group. After 10 weeks the groups shifted in a cross‐over fashion. A motion controlled video console (Nintendo Wii) was used for physical exercise, for a minimum of 30 minutes a day, 5 days a week, for 10 weeks. In order to sustain compliance a coach had weekly web‐sessions over the Internet with the child. All children were tested with cognitive and motor tests (BOT2) as well as execution of daily activities, using the Assessment of Motor and process Skills (AMPS), before and after each period. Test scores before and after the intervention period were compared for the whole group and a parallel group comparison was also performed. Results: All children (six boys and seven girls) who were involved in the study (n=13) completed the programme. Their mean age was 12.5 years (range=7.2‐16.4). After the intervention period there was a significant improvement compared to base‐line, in body coordination in BOT2 (p=0.02) and in the motor (p=0.012) and process (p=0.002) parts of AMPS. In the parallel group analysis there was an improvement in the intervention group compared to controls, in the process part of AMPS (p=0.029), but not to a statistically significant change in the motor part of AMPS (p=0.058) or BOT2 body co‐ordination (p=0.27). Conclusion: Exercise‐gaming used as an enjoyable home‐based intervention for childhood brain tumour survivors improved body co‐ordination and motor and process skills in daily activities after 10 weeks.

Emuk, Y., et al. (2018). "European Stroke Organisation Conference: Late Breaking Abstracts." European Stroke Journal 3(1_suppl): 587-620.
	Background and Aims: Difficulty in balance maintenance is a particularly common problem for patients with stroke and recovery of balance is an essential component of independence in daily life activities following stroke. Several studies have researched the effectiveness of different physiotherapy interventions previously; however, research with good methodological quality is still needed. This study aimed to investigate the effects of traditional physiotherapy methods and virtual reality interventions on balance in patients with chronic stroke and compare the effectiveness of three different approaches. Method: After the application of inclusion and exclusion criteria participants divided into three groups randomly. The first group receives a standard rehabilitation programme which include trunk stabilization and weight transfer exercises. Participants in video game group receive a 30‐minute standard rehabilitation plus 30 minutes of balance training with Wii Fit. Third group receives 30 minutes of standard rehabilitation plus a 30‐minute of balance therapy with Biodex balance system (Biodex, Inc, Shirley, NY, USA). All participants receive a total of 16 sessions, 2 times in a week for 8 weeks. We record Berg Balance Scale (BBS), Timed Up and Go Test (TUG), NeuroCom Balance Master System, Stroke Impact Scale Short Form (SIS‐16), Fall Efficacy Scale (FES‐I), and Physical Activity Enjoyment Scale (PACES) results of patients before and after the rehabilitation programmes. Differences within the groups will be shown using Wilcoxon test and differences between the groups will be indicated by use of Kruskal‐Wallis Test. Results: N/A Conclusion: N/A.

Esfahlani, S. S., et al. (2018). "ReHabgame: A non-immersive virtual reality rehabilitation system with applications in neuroscience." Heliyon 4(2): e00526.
	This paper proposes the use of a non-immersive virtual reality rehabilitation system "ReHabgame" developed using Microsoft Kinect and the Thalmic Labs Myo gesture control armband. The ReHabgame was developed based on two third-person video games that provide a feasible possibility of assessing postural control and functional reach tests. It accurately quantifies specific postural control mechanisms including timed standing balance, functional reach tests using real-time anatomical landmark orientation, joint velocity, and acceleration while end trajectories were calculated using an inverse kinematics algorithm. The game was designed to help patients with neurological impairment to be subjected to physiotherapy activity and practice postures of daily activities. The subjective experience of the ReHabgame was studied through the development of an Engagement Questionnaire (EQ) for qualitative, quantitative and Rasch model. The Monte-Carlo Tree Search (MCTS) and Random object (ROG) generator algorithms were used to adapt the physical and gameplay intensity in the ReHabgame based on the Motor Assessment Scale (MAS) and Hierarchical Scoring System (HSS). Rasch analysis was conducted to assess the psychometric characteristics of the ReHabgame and to identify if these are any misfitting items in the game. Rasch rating scale model (RSM) was used to assess the engagement of players in the ReHabgame and evaluate the effectiveness and attractiveness of the game. The results showed that the scales assessing the rehabilitation process met Rasch expectations of reliability, and unidimensionality. Infit and outfit mean squares values are in the range of (0.68-1.52) for all considered 16 items. The Root Mean Square Residual (RMSR) and the person separation reliability were acceptable. The item/person map showed that the persons and items were clustered symmetrically.

Estepa, A., et al. (2016). "Development of a Kinect-based exergaming system for motor rehabilitation in neurological disorders." Journal of Physics: Conference Series 705(1).
	The development of videogames for physical therapy, known as exergames, has gained much interest in the last years. In this work, a sytem for rehabilitation and clinical evaluation of neurological patients is presented. The Microsoft Kinect device is used to track the full body of patients, and three games were developed to exercise and assess different aspects of balance and gait rehabilitation. The system provides visual feedback by means of an avatar that follows the movements of the patients, and sound and visual stimuli for giving orders during the experience. Also, the system includes a database and management tools for further analysis and monitoring of therapies. The results obtained show, on the one side, a great reception and interest of patients to use the system. On the other side, the specialists considered very useful the data collected and the quantitative analysis provided by the system, which was then adopted for the clinical routine.

Eusterwiemann, E., et al. (2019). "2019 ACR/ARP Annual Meeting Abstract Supplement." Arthritis Rheumatol 71 Suppl 10: 1-5362.
	For a searchable version of these abstracts, please visit www.acrabstracts.org.

Ewart, C. K. and K. B. Kolodner (1992). "Diminished pulse pressure response to psychological stress: early precursor of essential hypertension?" Psychosomatic Medicine 54(4): 436-446.
	An excessive blood pressure response to mental stress is a widely reported characteristic of young normotensive offspring of hypertensive parents. At odds with these reports are data from a large biracial study showing that high risk adolescent offspring had diminished pulse pressure under mental stress and no evidence of greater blood pressure reactivity. We examined this apparent contradiction in a similar but larger sample of 213 normotensive adolescents, comparing blood pressure and heart rate responses to video game, mirror drawing, mental arithmetic, interview, and physical exercise in high- and low-risk offspring. Results replicated the diminished pulse pressure finding, suggesting it is characteristic of African Americans and is evoked by behavioral tasks that entail skeletal-motor inhibition. Submaximal physical exercise failed to discriminate between offspring groups. Possible biologic correlates of diminished pulse pressure in black adolescents with "high normal" blood pressure warrant further investigation.

f3sm, R. B. R. (2015). "Balance among patients with Parkinson's disease after physical therapy intervention using Nintendo wii®." https://trialsearch.who.int/Trial2.aspx?TrialID=RBR-9f3sm9.
	INTERVENTION: E02.779.483 I03.450.642.693.930 The sample will consist of 26 individuals with Parkinson's disease, in which they will be randomly divided into two groups: experimental group (13) and control group (13). The control group will perform conventional physical therapy twice a week, one hour each session for 4 weeks, they will be considered: stretching exercises, strengthening, flexibility, agility, coordination and balance. The experimental group will carry conventional therapy once a week, one hour each session, for 4 weeks (the same items in the control group will be contemplated). In addition to conventional therapy, this group will participate once a week for an hour, for 4 weeks of therapy involving video games (Nintendo Wii®), contemplating balance, coordination, strength, conditioning and agility. The sample will be evaluated by the following tests: Romberg balance test (static equilibrium, in which the subject will be in bipedal position, eyes open, then closed, both in stable ground and in unstable ground), Berg Balance Scale (dynamic balance in which the subject must perform 14 different activities involving dinamic balance) and Timed up and Go test (this test it will take note the time the subject takes to get up from a chair, walk for about 3 meters up to a ground markings, return to the starting point and sit). Both groups will be compared by statistical analysis (t test). The variables are static balance, dynamic balance and prone to falls. Participants will be evaluated after four weeks of intervention. CONDITION: G00‐G99 Parkinson's disease ; G20 PRIMARY OUTCOME: Result expected at the beginning of the research: the experimental group (group participate in games with Nintendo Wii associated with conventional physical therapy) will present better results when compared to the control group, which will only conventional physiotherapy. Compared variables are: static balance, dynamic balance and propensity to falls. For the variable static balance test to be used will be the Romberg test, in which the individual must be in support bipedal for at least 30 seconds without support, with open and closed eyes, and on a stable and then unstable surface. The higher the time the best static balance. For variable dynamic balance the subject will be assessed by the Berg Balance Scale and must perform 14 different activities, such as getting up, sit, turn, walk up and down stairs without need any aid or device. The score ranges from 0‐4 each item, generating a maximum total score of 56 points, and the higher the score the better the dynamic balance. For the variable propensity to falls the subject will participate in the test "Timed up and go", which consists of getting up from a chair, walk three meters, come back and sit). Hold the course in 10 seconds or less means no risk of falling, from 11 to 20 seconds means slight risk of falling between 21 to 30 seconds means moderate risk of falling and finally elapsed time above 30 seconds means high risk for queda.Os participants will be evaluated after four weeks of intervention. SECONDARY OUTCOME: It is expected that as a result the variables static balance, dynamic balance and prone to falls are better in the experimental group compared to the control group. Thus, it is expected that the individual in the experimental group can: 1) keep longer static balance in the Romberg test, in which the individual must be in support bipede for at least 30 seconds without support, with open eyes and then closed, and over a stable and then unstable surface. The higher the the best time the static equilibrium; 2) carry out 14 different activities proposed in the Berg Balance Scale without the need for any aid or device, such as stand up, sit down, turn, up and down stairs. The score ranges from 0‐4, generating a maximum score of 56 points, and the higher the score the better the dynamic balance; 3) who can perform the test "Timed up and go" faster than the control group (this test consists of getting up from a chair, walk three meters, come back and sit). Hold the course in 10 seconds or less means no risk of falling, from 11 to 20 seconds means slight risk of falling between 21 to 30 seconds means moderate risk of falling and finally elapsed time above 30 seconds means high risk for falling. Participants will be evaluated after four weeks of intervention. INCLUSION CRITERIA: to present a confirmed diagnosis of Parkinson's Disease; degree of involvement of Parkinson's Disease between 2.5 to 3.0 on the Hoehn and Yahr scale ; Being currently in service in Brazil Parkinson Association (BPA); have availability to perform physiotherapy on BPA 2 times a week for 01 months, with duration of 1 hour; make use of medicament for Parkinson's Disease.

f6wr, R. B. R. (2013). "Knowledge about healthy habits and risk factors for cardiovascular diseases a group of students." https://trialsearch.who.int/Trial2.aspx?TrialID=RBR-8f6wr7.
	INTERVENTION: Behavioural N02.421.143.130.320 N04.590.374 The sample consisted of 79 children aged 7 to 11 years were randomized into two groups. For randomization generates a table with random numbers by a researcher who did not belong to the study, these figures were placed in envelopes and sealed brown color and then these envelopes were opened by an investigator who was not in the study by defining what would be the control group and intervention group. Intervention group: 40 children participated in eight weekly workshops playful with time between 30 and 60 minutes for two months. The first two interventions were based on collage of pictures of food and activities directed to health was considered good for heart health and bad. The third workshop was based on the painting of healthy foods and the fourth of unhealthy foods. The fifth and sixth workshop was aimed at creating a memory game consisting of pictures of healthy and unhealthy and figures of children performing physical exercise. The seventh workshop was conducted with the use of music where it stimulated the exercises and dances. In the eighth workshop is set up a table with healthy and unhealthy child and each won two hearts one smiling and one sad and it was requested that the food presented as they showed the heart happy and sad to healthy foods for unhealthy ones. After the end of each workshop took place guidelines on the importance of healthy practices for heart health. Control group: 39 children placed received no intervention during this period. CONDITION: C18.654.726.500 Obesity child ; C18.654.726.500 PRIMARY OUTCOME: Increase in the number of correct answers to 12 questions of specifically prepared by staff. It can be observed that there was no significant difference in knowledge before intervention between groups, the groups showed an average nine hits in an instrument of 12 questões.Após interventions was no significant difference in the intervention group with p <0.005. SECONDARY OUTCOME: There was an increase in physical activity in both groups but not being statistically significant p = 0.006. ; ; Decreased percentile in the Intervention group but not statistically significant with p = 0.158. With average standard deviation of 70.9 ± 27.3 before and after 69.9 ± 26.3 ; ; The control group showed increased percentile when measured after intervenção.Com mean and standard deviation before and after 62.0 ± 32.3 63.9 ± 30.2 ; ; . INCLUSION CRITERIA: Children aged 7 to 11 years old. Authorization from parents.

Fang, R., et al. (2017). "Music therapy is a potential intervention for cognition of Alzheimer's Disease: a mini-review." Translational Neurodegeneration 6: 2.
	Alzheimer's Disease (AD) is a global health issue given the increasing prevalence rate and the limitations of drug effects. As a consequent, non-pharmacological interventions are of importance. Music therapy (MT) is a non-pharmacological way with a long history of use and a fine usability for dementia patients. In this review, we will summarize different techniques, diverse clinical trials, and the mechanisms of MT as it is helpful to the cognition in AD, providing reference for future research. Many articles have demonstrated that MT can reduce cognitive decline especially in autobiographical and episodic memories, psychomotor speed, executive function domains, and global cognition. MT is a promising intervention for strategy of dementia especially of AD and it must be started as early as possible. However, more evidences with prospective, randomized, blinded, uniform and rigorous methodological investigations are needed. And we should consider to combine MT with other cognitive stimulations such as dance, physical exercise, video game, art and so on.

Fares, M. Y., et al. (2022). "Lower limb injuries in an english professional football club: injury analysis and recommendations for prevention." Physician & Sportsmedicine: 1-9.
	BACKGROUND: Lower limb injuries constitute a problem in the sport of football. Our aim is to explore patterns and trends of lower limb injuries in an English professional football club. METHODS: This is a descriptive epidemiological study. Reports provided by the club's physical therapy team were screened for injuries among professional football players sustained over four seasons, from 2015/2016 to 2018/2019. Data included setting of injury (in-match or training), anatomical location of injury, type of injury, number of days off and month of injury. RESULTS: A total of 296 lower limb injuries were recorded in our study, with a rate of 11.14 per 1000 football hours. Injury rate during games was 51.38 per 1000 football hours, significantly greater than that during training at 3.81 per 1000 football hours (p = 0.021). The thigh was significantly the most commonly injured location at 4.67 per 1000 football hours (p < 0.001). Grade I tears were the most common injury type at 1.73 per 1000 football hours, significantly greater than grade III tears (p = 0.027), contusions (p = 0.043), fractures (p = 0.02), and lacerations (p = 0.019). Injury rates were found to be greatest during preseason and declined as season progressed. On average, an injury sidelined the affected footballer for a total of 20 days. CONCLUSION: Lower limb injuries were more common during matches than training. The thigh is the most common injury location, and grade I muscle tear was the most common type of injury. Injury rates were higher early on in the season. Potential prevention strategies include spacing out competition, adopting training and exercise regimens that cater for recovery, and increasing research regarding injury mechanisms.

Farjadian Bejestan, A. B. (2015). Mechanical design and control system development of novel 2 degree-of-freedom ankle and balance rehabilitation robotic system, Northeastern University: 219 p-219 p.
	Stroke is a leading cause of serious long-term disability in the United States. Ankle and balance disabilities are caused by neurological impairments such as traumatic brain injury, cerebral palsy and stroke. Due to increased survival rates after stroke, significant growth in stroke population is projected by 2030, which will make rehabilitation procedures even more important. Common rehabilitation techniques require intensive cooperation and effort of therapists and patients over prolonged sessions. Conventional ankle and balance rehabilitation systems are built from a simple set of mechanical elements which lack sensory systems or networks. Current more advanced technologies do not combine ankle strength, mobility, motor control and coordinated balance training in one device that can retrain the patients in multiple positions from sitting to standing.In this work, we present the Virtually-Interfaced Robotic Ankle and Balance Trainer (vi-RABT), a low-cost platform-based robotic system that is designed to improve overall ankle/balance strength, mobility and control. The system is equipped with two degrees-of-freedom (DOF) controlled actuation along with complete means of accurate force and angular measurements. Effective control techniques and virtual reality games were developed and interfaced into the system hardware. Under IRB approved protocol, the system was used to assess ankle force, mobility and motor control in a pool of healthy human subjects, while playing interactive virtual reality games on a large screen. In the next phase, an anisotropic assistive/resistive control paradigm has been implemented into practice, with realistic functionality consistent with the expectations of a Physical Therapy expert. A pilot experiment was conducted to investigate the feasibility of assistive control using vi-RABT.The inspiring results on the pool of human subjects suggest that, in contrast to the upper extremity, subjects have better control over ankle's position than the force they can regulate. The early results on the assistive control showed that, in the presence of objective force feedback, subjects finished the game in a shorter time and with fewer errors. The ankle rehabilitation aspect of the system is ready to be utilized in physical therapy. Further research is required to develop the balance rehabilitation paradigm. Vi-RABT has the potential to be used for variety of ankle and lower extremity neuromuscular impairments.

Farr, W. J., et al. (2021). "Feasibility of a randomised controlled trial to evaluate home-based virtual reality therapy in children with cerebral palsy." Disability & Rehabilitation 43(1): 85-97.
	PURPOSE: Evidence is increasing for effective virtual reality therapy for motor rehabilitation for children with Cerebral Palsy. We assessed the feasibility of a virtual reality therapy mode of intervention, appropriateness of measures, and potential cost-effectiveness. METHODS: A 12-week, 2-group, parallel-feasibility trial (ISRCT 17624388) using Nintendo Wii Fit(TM) at home. Children aged 5-16, with ambulatory Cerebral Palsy, who were able to follow simple instructions were randomised to two groups; one supported by physiotherapists (individualised activity programme), the other unsupported with children having free choice (control). Children were assessed in clinic at baseline, week 6, and week 12 by blinded assessors. Feasibility of the intervention was assessed via recruitment, adherence, and usefulness of measurement tools. RESULTS: Forty-four children were eligible (out of 48 approached): 31 consented, 30 were randomised, 21 completed the study; 10 in the supported group and 11 in the unsupported group. Nine children discontinued from tiredness, after-school activities, homework, surgery, technical difficulties or negative system feedback. The supported group completed 19 of 36 (IQR 5-35) possible sessions; the unsupported group 24 of 36 sessions (IQR 8-36). Gross Motor Function Measure scores varied by Cerebral Palsy severity after the intervention. There were no adverse events. CONCLUSION: Virtual reality therapy offers potential as a therapeutic adjunct for children with Cerebral Palsy, warranting substantive confirmatory study. Gross Motor Function Measure, with modifications to improve sensitivity, appeared appropriate as a primary measure, with Timed up and Go test secondary. The intervention was inexpensive costing pound20 per child. An explanatory trial to evaluate the clinical/cost-effectiveness of commercial system virtual reality therapy is feasible with minor methodological adaptation. Implications for rehabilitation Home-based interactive computer gaming was feasible, safe and cost effective as a therapy adjunct. Discontinue if additional pressures are present: imminent surgery, family resilience to technical difficulties, negative system feedback, after-school activities. Change in Gross Motor Function Measurement scores varied by severity of Cerebral Palsy.

Fatoye, F., et al. (2020). "Pms20 Cost Effectiveness of Virtual Reality Game Versus Clinic Based Mckenzie Extension Therapy for Chronic Non Specific Low Back Pain." Value in health 23: S218‐.
	Background: Low‐back pain (LBP) is a major public health problem globally and its direct and indirect healthcare costs are growing rapidly. Therefore, it is necessary to provide treatments that are cost‐effective. Virtual reality involving the use of video games or non‐game applications are alternatives to conventional face‐to‐face physical therapy for patients with LBP. The aim of this study was to assess the cost‐effectiveness of Virtual Reality Game (VRG) compared to Clinic‐based McKenzie therapy (CBMT) for chronic non‐specific LBP. Methods: Patients with chronic non‐specific LBP were randomised into either VRG (game version of the traditional McKenzie programme) or CBMT group. Patients’ level of disability was assessed using Oswestry Disability Index (ODI) at week 4 and week 8. ODI was mapped to SF‐6D to generate quality adjusted life years (QALYs) used for cost‐effectiveness analysis. Resource use and costs were assessed based on rehabilitation services in Nigeria in 2018 from a healthcare perspective. Cost‐effectiveness analysis which including the direct healthcare costs was conducted. Incremental cost per QALY was also calculated. Result: Forty six patients (VRG, n = 22; CBMT, n = 24) with the mean (± SD) age of 32.6 ± (11.5) years for VRG and 48.8± (10.2) years for CBMT intervention completed in this study. The mean direct health costs per patient were USD106.0 and USD133.59 for VRG and CBMT, respectively. The mean quality adjusted life years at week 4 and week 8 were (VRG, 0.0574 ± (0.002); CBMT, 0.0548 ± (0.002)); and (VRG; 0.116 ± (0.002); CBMT; 0.114 ± (0.004)), respectively. ICER showed that VRG arm was less costly and more effective than CBMT. Conclusion: The findings of this study suggests that VRG was cost saving for chronic non‐specific LBP compared to CBMT. This evidence could guide policy makers, payers, and clinicians in evaluating VRG as a treatment option for people with chronic non‐specific LBP.

Feistritzer-Gröbl, P., et al. (2013). "Game based physiotherapy for evidence based practice in children with juvenile idiopathic scoliosis." Scoliosis 8(S1): O16-O16.
	
Feletti, F., et al. (2021). "Injuries and illnesses related to dinghy-sailing on hydrofoiling boats." BMC Sports Sci Med Rehabil 13(1): 118.
	BACKGROUND: Hydrofoil technology has changed sailing, significantly increasing its speed and resulting in spectacularity and mass media interest. Although high speed can expose participants to a risk of high-energy trauma, there are no scientific studies related to trauma in dinghies that exploit this technology. Therefore, this study aims primarily to measure the injury rate, and identify the kind and anatomical distribution of most common injuries and secondarily identify the traumatic dynamics most often involved and the main risk factors. METHODS: This descriptive epidemiology study examined data relative to injuries and illnesses suffered by 77 sailors (91% males) from 13 nationalities during three international, gathered through a specifically designed questionnaire. RESULTS: The prevalence of illnesses and overuse injuries during the regatta week were 6.5% and 18.2%, respectively, while the incidence of acute injuries was 16/1000 sailor-hours. Upper limbs, lower limbs and lumbar spine were involved in 34.6%, 26.9% and 15.4% of cases of musculoskeletal injuries, respectively. None of the acute injuries reached the maximal score of severity, while the higher score value was 63/100. Most of the reported illnesses (80%; n = 4) were upper respiratory tract infections with a prevalence in the week of the regatta of 5.2% and an incidence of 0.51/1000 sailor-hours. Environmental factors played a role in 77% of the incidents resulting in acute injuries. CONCLUSIONS: This study provides valuable information for regatta organizers, boat builders, athletes, coaches, and doctors. In addition, it fosters the importance of ergonomics of boats, adequate clothing and specific physical training for injuries and illnesses prevention.

Felipe, F. A., et al. (2020). "Evaluation instruments for physical therapy using virtual reality in stroke patients: a systematic review." Physiotherapy 106: 194-210.
	BACKGROUND: Physiotherapeutic rehabilitation is essential to improve functional mobility, muscular strength, balance and quality of life of stroke patients, but conventional techniques using repeated physical activities can soon become monotonous. The use of virtual reality (VR) in rehabilitation offers a possible alternative to the traditional methods of promoting improvements in muscle strength and balance. However, there is not yet consensus about which instruments should be used to assess the effectiveness of VR in stroke rehabilitation. OBJECTIVE: To conduct a systematic review to identify the types of evaluation tools used for different VR interventions to rehabilitate stroke patients, considering balance, strength, function, quality of life, cognition and motivation. DATA SOURCES: A comprehensive literature search using MEDLINE-PubMed, Web of Science, Scopus, Lilacs and IEEE Xplore was undertaken. STUDY SELECTION: Studies on stroke patients who had undergone VR therapy and an assessment of its effectiveness using evaluative instruments. STUDY APPRAISAL AND SYNTHESIS METHODS: Data were extracted by a single reviewer using standardised forms, and were checked by a second reviewer. The extracted information included study design, number of participants, type of stroke, items that were evaluated (balance, muscle strength, functional evaluation), console used, number of rehabilitation sessions, results and conclusions. RESULTS: In total, 1836 articles were identified; of these, 29 were included in this review after consideration of the inclusion and exclusion criteria. The selected articles rated one or more of the following factors: balance (n=12), grip strength (with or without devices for direct measurement) (n=8), functionality (n=12) and quality of life (n=12). LIMITATIONS: The full text of one article was not available, despite a request to the authors to send it via email. CONCLUSION AND IMPLICATIONS OF KEY FINDINGS: The Berg Balance Scale, the Fugl-Meyer Assessment and the Stroke Impact Scale were the instruments used most frequently to assess balance, function and quality of life, respectively, in stroke patients who underwent rehabilitation using VR. Systematic review registration PROSPERO number: 87546.

Feodoroff, B., et al. (2019). "Effects of Full Body Exergaming in Virtual Reality on Cardiovascular and Muscular Parameters: Cross-Sectional Experiment." JMIR Serious Games 7(3): e12324.
	BACKGROUND: In recent years, many studies have associated sedentary behavior in front of screens with health problems in infants, children, and adolescents. Yet options for exergaming-playing video games that require rigorous physical exercise-seem to fall short of the physical activity levels recommended by the World Health Organization. OBJECTIVE: The purpose of this study was to investigate the effect of a fully immersive virtual reality (VR)-based training system on cardiovascular and muscular parameters of young adults. METHODS: A cross-sectional experiment design was used to analyze muscle activity (surface electromyography), heart rate, perceived exertion (RPE), cybersickness symptoms, perceived workload, and physical activity enjoyment (PACES) in 33 participants performing two 5-minute flights on a new training device. RESULTS: Participants' performance of the planking position required to play the game resulted in moderate aerobic intensity (108 [SD 18.69] bpm). Due to the mainly isometric contraction of the dorsal muscle chain (with a mean activation between 20.6% [SD 10.57] and 26.7% [SD 17.39] maximum voluntary isometric contraction), participants described the exercise as a moderate to vigorous activity (RPE 14.6 [SD 1.82]). The majority reported that they enjoyed the exercise (PACES 3.74 [SD 0.16]). However, six participants had to drop out because of cybersickness symptoms and two because of muscle pain due to prior injuries. CONCLUSIONS: Our findings suggest that fully immersive VR training systems can contribute to muscle-strengthening activities for healthy users. However, the dropout rate highlights the need for technological improvements in both software and hardware. In prevention and therapy, movement quality is a fundamental part of providing effective resistance training that benefits health. Exergaming on a regular basis has the potential to develop strong muscles and a healthy back. It is essential that future VR-based training systems take into account the recommendations of sport and exercise science.

Ferguson, G. D., et al. (2013). "The efficacy of two task-orientated interventions for children with Developmental Coordination Disorder: Neuromotor Task Training and Nintendo Wii Fit Training." Research in Developmental Disabilities 34(9): 2449-2461.
	Neuromotor Task Training (NTT) and Nintendo Wii Fit Training (Wii training) are both task-based interventions used to improve performance in children with motor coordination problems. The aim of this study was to compare the efficacy of these two interventions on the motor performance, isometric strength and cardiorespiratory fitness (aerobic and anaerobic capacity) of children with Developmental Coordination Disorder (DCD) attending mainstream schools in a low-income setting. A pragmatic, quasi-experimental study design was utilized. Children between the ages of 6-10 years, who scored at or below the 16th percentile on the Movement Assessment Battery for Children-2 (MABC-2) and whose teacher reported a functional motor problem, were allocated to either NTT (n=37) or Wii training (n=19) groups depending on school of attendance. The MABC-2, a hand-held dynamometer, the Functional Strength Measure, the Muscle Power Sprint Test and the 20m Shuttle Run Test were used to assess performance at baseline and after the intervention. The main findings show that the mean motor performance scores of both groups improved over the study period. However, significant differences in improvement were detected between groups, with the NTT group showing greater improvement in motor performance, functional strength and cardiorespiratory fitness. No improvements in isometric strength were seen in either group. The Wii training group showed significant improvement in anaerobic performance. This study provides evidence to support the use of both the Wii Training and NTT for children with DCD. However, in comparison to Wii training, the NTT approach yields superior results across measures of motor proficiency, cardiorespiratory fitness and functional strength. The decision to use either approach may be influenced by resources and time constraints.

Fernandes, C. S., et al. (2022). "Exergames to improve Rehabilitation after Anterior Cruciate Ligament Injury: Systematic review and GRADE evidence synthesis." International Journal of Orthopaedic and Trauma Nursing 44: 100917.
	INTRODUCTION: Exergames are a fun, engaging, and interactive form of exercise that has been used in rehabilitation. This systematic review aimed to evaluate the effectiveness of exergames compared to usual rehabilitation after anterior cruciate ligament reconstruction. METHOD: We performed a Systematic Review and GRADE evidence synthesis. The PRISMA guidelines for systematic reviews were followed. MEDLINE(R) (Medical Literature Analysis and Retrieval System Online), CINAHL(R) (Cumulative Index to Nursing and Allied Health Literature), SPORTDiscus, SCOPUS, SciELO (Scientific Electronic Library Online), Cochrane Central Register of Controlled Trials, and PEDro (Physiotherapy Evidence Database) were searched from their first record to May 2021. Randomised controlled trials using exergames as an intervention were included. RESULTS: Initial literature searches yielded 794 non-duplicated records. After exclusion based on title, abstract, and full text review, five articles were included for analysis. Compared with the control group, the participants in the exergames group showed differences in proprioception and flexion angle difference. CONCLUSION: Although there is no conclusive evidence that favours exergames over traditional rehabilitation, they did not aggravate the effects of rehabilitation. Nonetheless, exergames can be safe and motivating.

Fernandes, C. S., et al. (2021). "The Use of Gamification in Patients Undergoing Hip Arthroplasty: Scoping Review." Games for Health Journal 10(3): 147-157.
	Objective: The use of gamification can promote health-related behavior. This article is the first attempt to provide a historical overview of the use of games in patients undergoing hip arthroplasty. Materials and Methods: We conducted a scoping review to map and characterize the games used for the person undergoing hip arthroplasty. To perform this review, the respective descriptors were identified using search syntax appropriate to each of the databases: MEDLINE_ (Medical Literature Analysis and Retrieval System Online), CINAHL_ (Cumulative Index to Nursing and Allied Health Literature), SPORTDiscus, in the Psychology and Behavioral Sciences Collection, SCOPUS, SciELO (Scientific Electronic Library Online), and PEDRo (Physiotherapy Evidence Database). Results: An initial 968 articles were identified, of which 7 articles were included. The domains of the games under analysis essentially focus on aspects of rehabilitation (n = 5), or related (n = 2), and mostly exergames (n = 6). However, the instruments, characteristics, and procedures used to evaluate the games in the included studies have little depth and large variability. Conclusion: Few games exist that support people who have undergone hip arthroplasty. Most of the games under review were exergames to support rehabilitation. Consequently, we recommend developing another type of game with a focus on monitoring, counseling, and/or social support for selfmanagement training in persons undergoing hip arthroplasty.

Fernandes, F. G., et al. (2019). "Mapping Study on the Use of Digital Games for Persons with Disabilities in Upper Members." Anais Da Academia Brasileira de Ciencias 91(2): e20180936.
	Digital games are no longer seen as a form of entertainment detrimental to health. They have become an important tool to improve the treatment of patients, ranging from those who are experiencing a serious illness, such as cancer, to those requiring milder procedures such as physiotherapy. However, there are people who are physically disabled and have difficulty playing digital games. In this line of reasoning, this work presents a systematic review on the use of digital games for people with physical disabilities in the upper limbs. The sources of research were the following indexed databases: IEEE Xplore, Portal of Periodicals of the Coordination of Improvement of Personnel of Higher Level (CAPES), PubMed, Scielo, Science Direct, Scopus and Web of Science. It should be noted that the application of Systematic Mapping in the elaboration of a bibliographical review allowed to identify the main gaps for the development of new research, and to redirect to the main publications related to the study. Finally, the results shows that it is an area that is constantly expanding.

Ferraz, D., et al. (2017). "Abstracts of the 1st Pan American Parkinson's Disease and Movement Disorders Congress." Mov Disord 32 Suppl 1: S1-S90.
	Objective: To compare the effects of three exercise programs as functional training, stationary bicycle and Xbox games on physical endurance, body composition and muscle strength of elderly with Parkinson's disease (PD). Background: Non‐communicable chronic diseases are the main health problem in the world. PD is the second most prevalent neurodegenerative disease in elderly population. Its symptoms improve physical inactivity and reduce mobility, promoting physical disability. Methods: A randomized controlled trial with blind assessment was conducted in the State Reference Health Care Center for Elderly (CREASI) in Salvador, Bahia, Brazil. Senior aged 60 and older with primary PD participated in the study. The participants were randomized into three intervention groups. Group 1 (G1) was submitted to functional training, the Group 2 (G2) did a stationary bicycle training and Group 3 (G3) was trained with Xbox Kinect Adventures games. The 6‐minute walk test, the 10‐meters walk test, the sitting‐rising test and the body mass index were used to evaluate the physical fitness by the same blind researcher. To compare independent and paired variables was used nonparametric tests. The significance level used was 5 % (p<0,05). Results: 36 elderly with PD participated in the study (G1 n=12; G2 n=10; G3 n=14). All groups showed statistically significant improvements in 6‐minute walk test (G1 p=0,023; G2 p=0,007; G3=0,048) and in sitting‐rising test (G1 p=0,002; G2 p=0,028; G3 p=0,041). Only the G3 improved significantly the gait speed in the 10‐meters walk test (p=0,041) and the G2 reduced body mass index (p=0,038). Conclusions: Eight‐week exercise programs are able to improve the physical fitness of elderly people with PD. Functional training, bike stationary and Xbox games proved effective as a physical exercise modalities to increase the cardiorespiratory fitness of the participants. Aerobic workout on stationary bicycle was the only one able to improve all components of physical fitness, including cardiorespiratory fitness, muscular strength and endurance and body composition. (Figure presented).

Ferraz, D. D., et al. (2017). "Nintendo Wii training on postural balance and mobility rehabilitation of adults with Parkinson's disease: a systematic review." Fisioterapia em Movimento 30(suppl 1): 383-393.
	Introduction: Postural instability affects balance control in Parkinson disease (PD) patients and increases the particular risk of falling compared with healthy older adults. Video games with not immersive virtual reality have been used in neurological disorders rehabilitation process. Objective: To evaluate the effectiveness of the video game console Nintendo Wii (NW) on postural balance and mobility treatment of adults with PD in Hoehn and Yahr stages I to III. Methods: The following databases were searched electronically on MEDLINE, Cochrane Library, PEDro, CAPES Periodic, BIREME, and LILACS databases. The search period for this review was January 2010 to June 2016. The assessment of methodological quality was performed using the PEDro Scale as reference. Results: 12 original studies were selected, but only 3 were randomized controlled trials (RCTs). Conclusion: Some of the studies analysed suggest that NW can provide improvement in balance and mobility of adults with PD. These benefits should be interpreted with caution because of the low methodological quality of the included trials, and the lack of common assessment of treatment effects. There is little evidence to ensure the effectiveness and support the inclusion of the treatment with NW of patients with PD.
Introdução: A instabilidade Postural altera o controle do equilíbrio em pacientes com Doença de Parkinson (DP) e diminui o risco de quedas quando comparado a idosos saudáveis. Vídeo games com realidade virtual não imersiva tem sido utilizados no processo de reabilitação de desordens neurológicas. Objetivo: Avaliar a eficácia do videogame Nintendo Wii (NW) no tratamento do equilíbrio postural e mobilidade de pacientes adultos com DP em estágios I a III da escala de Hoehn & Yahr. Métodos: As seguintes bases de dados foram pesquisadas eletronicamente no período de março e junho 2016: MEDLINE, Biblioteca Cochrane, PEDro, Periódico CAPES, BIREME e bases de dados Lilacs, publicados até 03 de julho de 2016. A avaliação da qualidade metodológica foi realizada utilizando a Escala PEDro como referência. Resultados: 12 estudos originais foram selecionados, mas apenas 3 eram ensaios clínicos randomizados (ECRs). Conclusão: Alguns dos estudos analisados sugerem que o NW pode proporcionar melhora no equilíbrio e na mobilidade de adultos com DP. Estes benefícios devem ser interpretados com cautela por causa da baixa qualidade metodológica dos estudos incluídos e da falta de avaliação comum dos efeitos do tratamento. Há pouca evidência para garantir a eficácia e apoiar a inclusão do tratamento com NW em pacientes com DP.

Ferraz, D. D., et al. (2018). "The Effects of Functional Training, Bicycle Exercise, and Exergaming on Walking Capacity of Elderly Patients With Parkinson Disease: A Pilot Randomized Controlled Single-blinded Trial." Archives of Physical Medicine & Rehabilitation 99(5): 826-833.
	OBJECTIVES: To compare the effects of functional training, bicycle exercise, and exergaming on walking capacity of elderly with Parkinson disease (PD). DESIGN: A pilot randomized, controlled, single-blinded trial. SETTING: A state reference health care center for elderly, a public reference outpatient clinic for the elderly. PARTICIPANTS: Elderly individuals (>/=60 years of age; N=62) with idiopathic PD (stage 2 to 3 of modified Hoehn and Yahr staging scale) according to the London Brain Bank. INTERVENTION: The participants were randomly assigned to three groups. Group 1 (G1) participated in functional training (n=22); group 2 (G2) performed bicycle exercise (n=20), and group 3 (G3) trained with Kinect Adventures (Microsoft, Redmond, WA) exergames (n=20). MAIN OUTCOME MEASURES: The primary outcome measure was the 6-minute walk test (6MWT); secondary outcome measures were the 10-m walk test (10MWT), sitting-rising test (SRT), body mass index, Parkinson Disease Questionnaire-39, World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0), and 15-item Geriatric Depression Scale. RESULTS: All groups showed significant improvements in 6MWT (G1 P=.008; G2 P=.001; G3 P=.005), SRT (G1 P<.001; G2 P=.001; G3 P=.003), and WHODAS 2.0 (G1 P=.018; G2 P=.019; G3 P=.041). Only G3 improved gait speed in 10MWT (P=.11). G1 (P=.014) and G3 (P=.004) improved quality of life. No difference was found between groups. CONCLUSIONS: Eight weeks of exergaming can improve the walking capacity of elderly patients with PD. Exergame training had similar outcomes compared with functional training and bicycle exercise. The three physical exercise modalities presented significant improvements on walking capacity, ability to stand up and sit, and functionality of the participants.

Ferreira, V., et al. (2020). "Interactive Video Gaming Improves Functional Balance in Poststroke Individuals: Meta-Analysis of Randomized Controlled Trials." Evaluation & the Health Professions 43(1): 23-32.
	The main objective of this study was to evaluate the effects of interactive video games on functional balance and mobility in poststroke individuals. The Health Science databases accessed included Medline via PubMed, LILACS, SciELO, and PEDro. The inclusion criteria were as follows: clinical studies evaluating the use of interactive video games as a treatment to improve functional balance and mobility in individuals poststroke and studies published in the Brazilian Portuguese, English, or Spanish language between 2005 and April 2016. PEDro Scale was used to analyze the methodological quality of the studies. The Berg Balance Scale and Timed Up and Go Test (TUGT) data were evaluated using a meta-analysis, the publication bias was assessed by funnel plots, and the heterogeneity of the studies by I (2) statistic. Eleven studies were included in the final analysis. Functional balance improved in individuals treated using interactive video games (mean difference = 2.24, 95% confidence interval [0.45, 4.04], p = .01), but no improvement was observed in mobility as measured by TUGT. The studies presented low heterogeneity (24%). The mean score on the PEDro Scale was 6.2 +/- 1.9. Interactive video games were effective in improving functional balance but did not influence the mobility of individuals poststroke.

Ferrer-Sargues, F. J., et al. (2021). "Escape-cardio: Gamification in cardiovascular physiotherapy. An observational study." Nurse Education Today 106: 105062.
	INTRODUCTION: In recent years, innovative educational strategies of learning have appeared, to generate greater motivation in the students. Gamification has become popular in the educational area, including Escape Rooms. The primary aim of the study was to evaluate if this gamification activity led to better knowledge acquisition by the students, improving performance in their final exam. As a secondary objective, we surveyed the satisfaction of the students participating in the Educational Escape Room. MATERIAL AND METHODS: An observational study of cases and controls was carried out. We designed an escape room based on the cardiovascular area of physiotherapy, titled Escape-Cardio. We provided scaffolded learning activities through the activity. Primary outcomes corresponded to the students' qualifications and the number of correct answers in the final exam. Qualitative questionnaire results of students of both courses were collected using a self-created survey, which was completed after the activity. RESULTS: 58 students participated in the Escape-Cardio. We observed better performance in the intervention group, improving their average mark and number of correct answers in the exam, with a statistically significant difference compared to the control group (p-value<0.05). In the qualitative assessment, students answered the survey, and all of them scored unanimously each item with the maximum score, aiming for 100% satisfaction. CONCLUSION: Escape-Cardio students improved their professional knowledge application in the cardiovascular physiotherapy area in a statistically significant way. An excellent qualitative evaluation was achieved by them.

Fetters, L. (2021). "A New Year!" Pediatr Phys Ther 33(1): 1.
	
feyzioğlu, ö. (2021). "Acute Effects of Video Game-based Exercises in Patients Receiving Chemotherapy After Breast Cancer Surgery - A Pilot Study." Turkish Journal of Oncology 37(1).
	OBJECTIVE Virtual reality programs, which have developed rapidly with the advancement of technology, have led to the development of alternative treatment methods preferred in rehabilitation. This study aimed to investigate the acute effects of a video game-based exercise program applied after breast cancer surgery on the upper extremity functionality, pain severity, and the level of fatigue. METHODS Fifteen female patients aged between 30 and 60 years (50.13±8.79) who completed their 12th week after breast cancer surgery and were received adjuvant chemotherapy treatment were randomly included in this pre-test and post-test study. The patients were performed a 30-min video game-based exercise program. The muscle strength, range of motion (ROM), pain and fatigue level assessments were performed before and after the video game-based exercises. The level of exercise pleasure was determined with the modified visual analog scale. RESULTS Shoulder flexion, abduction, and external rotation ROM significantly increased after video game-based exercise program. No difference was detected for shoulder abduction muscle strength (p>0.05) and pain level significantly increased (p<0.05). The average exercise pleasure level is 4.5/5 and the average fatigue level was 11.13/20. CONCLUSION Video game-based exercises provided improvement in ROM of the shoulder joint without causing fatigue. Studies with different treatment durations are needed to minimize the increase in pain level.

Feyzioglu, O., et al. (2020). "Is Xbox 360 Kinect-based virtual reality training as effective as standard physiotherapy in patients undergoing breast cancer surgery?" Supportive Care in Cancer 28(9): 4295-4303.
	PURPOSE: Breast cancer surgery may be associated with pain and physical symptoms in the upper limbs. Functional impairment and pain-related avoidance of movement may further increase disability level. This study aimed to investigate the potential effects of early postoperative virtual reality (VR) therapy on pain, range of motion (ROM), muscle strength, functionality, and fear of movement. METHODS: Forty women with breast cancer who had undergone unilateral mastectomy with axillary lymph node dissection and who were receiving adjuvant therapy were included in the study and randomly assigned to two groups: the Kinect-based rehabilitation group (KBRG) and the standardized physical therapy group (SPTG). The KBRG (n = 20) received VR therapy using Xbox Kinect-based games and the SPTG (n = 20) received standard physiotherapy. Study subjects were assessed at baseline and after the 6-week treatment. Outcome measures were pain (visual analogue scale), grip strength (dynamometer), functionality (disabilities of the arm shoulder and hand questionnaire), muscle strength (handheld dynamometer), ROM (digital goniometer), and fear of movement (Tampa kinesiophobia scale (TKS)). RESULTS: Both groups detected significant changes in pain, ROM, muscle strength, grip strength, functionality, and TKS scores after the treatment (p < 0.01). Fear of movement was significantly improved in the KBRG and the SPTG displayed more improvement in functionality (p < 0.05). There were no differences in ROM, muscle strength, grip strength, and pain between the groups after the treatment (p > 0.05). CONCLUSION: Kinect-based VR therapy resulted in significant outcomes that were comparable to those obtained under standard physiotherapy in the early postoperative phase in patients who had undergone breast cancer surgery. TRIAL REGISTRATION: This study is registered at ClinicalTrials.gov ( ClinicalTrials.gov identifier: NCT03618433).

Ficklscherer, A., et al. (2016). "Testing the feasibility and safety of the Nintendo Wii gaming console in orthopedic rehabilitation: a pilot randomized controlled study." Arch Med Sci 12(6): 1273-1278.
	INTRODUCTION: The Nintendo Wii game console is already used as an additional training device for e.g. neurological wards. Still there are limited data available regarding orthopedic rehabilitation. The authors' objective was to examine whether the Nintendo Wii is an appropriate and safe tool in rehabilitation after orthopedic knee surgery. MATERIAL AND METHODS: A prospective, randomized, controlled study comparing standard physiotherapy vs. standard physiotherapy plus game console training (Wii group) in patients having anterior cruciate ligament (ACL) repair or knee arthroplasty was conducted. The subjects of the Wii group (n = 17; mean age: 54 +/-19 years) performed simple knee exercises daily under the supervision of a physiotherapist in addition to the normal rehabilitation program. The patients of the control group (n = 13; 52 +/-18 years) were treated with physiotherapy only. The participants of both groups completed a questionnaire including the International Knee Documentation Committee (IKDC) score, the Modified Cincinnati Rating System and the Tegner Lysholm Knee Score prior to the operation, before discharge from hospital and four weeks after treatment. RESULTS: There was no significant difference in the score results between the Wii and the control group (p > 0.05). CONCLUSIONS: We demonstrated that physiotherapy using the Nintendo Wii gaming console after ACL reconstruction and knee arthroplasty does not negatively influence outcome. Because training with the Wii device was highly accepted by patients, we see an opportunity whereby additional training with a gaming console for a longer period of time could lead to even better results, regarding the training motivation and the outcome after orthopedic surgery.

Figueiredo, J. P. and S. M. Cardoso (2014). "Perceived health in the Portuguese population aged >/= 35." Revista de Saude Publica 48(3): 406-427.
	OBJECTIVE: To evaluate the exploratory relationship between determinants of health, life satisfaction, locus of control, attitudes and behaviors and health related quality of life in an adult population. METHODS: Observational study (analytical and cross-sectional) with a quantitative methodological basis. The sample was composed oy 1,214 inhabitants aged >/= 35 in 31 civil parishes in the County of Coimbra, Portugal, 2011-2012. An anonymous and voluntary health survey was conducted, which collected the following information: demographic, clinical record, health and lifestyle behaviors; health related quality of life (Medical Outcomes Study, Short Form-36); health locus of control; survey of health attitudes and behavior, and quality of life index. Pearson's Linear Correlation, t-Student, Wilcoxon-Mann-Whitney; One-way ANOVA; Brown-Forsythe's F; Kruskal-Wallis; Multiple Comparisons: Tukey (HSD), Games-Howell and Conover were used in the statistical analysis. RESULTS: Health related quality of life was shown to be lower in females, in older age groups, in obese/overweight individuals, widows, unassisted, those living alone, living in rural/suburban areas, those who did not work and with a medium-low socioeconomic level. Respondents with poor/very poor self-perceived health (p < 0.0001), with chronic disease (p < 0.0001), who consumed < 3 meals per day (p </= 0.01), who were sedentary, who slept </= 6 h/day and had smoked for several years revealed the worst health results. Health related quality of life was positively related with a bigger internal locus, with better health attitudes and behaviors (physical exercise, health and nutritional care, length of dependence) and with different areas of life satisfaction. CONCLUSIONS: Better health related quality of life was associated with certain social, psychological, family and health characteristics, a satisfactory lifestyle, better socioeconomic conditions and a good internal locus of control over health attitudes and behaviors.

Finch, C. F., et al. (2013). "Priorities for investment in injury prevention in community Australian football." Clin J Sport Med 23(6): 430-438.
	OBJECTIVE: High-quality sport-specific information about the nature, type, cause, and frequency of injuries is needed to set injury prevention priorities. This article describes the type, nature, and mechanism of injuries in community Australian Football (community AF) players, as collected through field-based monitoring of injury in teams of players. DATA SOURCES: Compilation of published prospectively collected injury data from 3 studies in junior community AF (1202 injuries in 1950+ players) and 3 studies in adult community AF (1765 injuries in 2265 players). This was supplemented with previously unpublished data from the most recent adult community AF injury cohort study conducted in 2007 to 2008. Injuries were ranked according to most common body regions, nature of injury, and mechanism. MAIN RESULTS: In all players, lower limb injuries were the most frequent injury in community AF and were generally muscle strains, joint sprains, and superficial injuries. These injuries most commonly resulted from incidental contact with other players, or from "overexertion." Upper limb injuries were less common but included fractures, strains, and sprains that were generally caused by incidental contact between players and the result of players falling to the ground. CONCLUSIONS: Lower limb injuries are common in community AF and could have an adverse impact on sustained participation in the game. Based on what is known about their mechanisms, it is likely that a high proportion of lower limb injuries could be prevented and they should therefore be a priority for injury prevention in community AF.

Fincher, K. N. and K. Burroughs (2021). "Popping Elbow In A Collegiate Lacrosse Player." Medicine & Science in Sports & Exercise 53(8S): 435-435.
	HISTORY: A 20 yo female collegiate lacrosse goalie presented to the clinic for right elbow pain and popping. Her pain began about 18 months ago when she fell on an outstretched hand during a game, causing a valgus stress at her right elbow. She was treated initially as a UCL sprain with decreased activity, then return to normal participation. She reported intermittent pain since. Her pain was at her right medial elbow (severity of 6/10), worse first thing in the morning. She described popping with flexion and extension and reported dysesthesias in the right 4th and 5th digits with this maneuver. Denied swelling. EXAM: MSK: R Shoulder: Full AROM symmetric with contralateral. R Elbow: Full AROM, pain in deep flexion. No joint effusion. Clicking noted over cubital tunnel. Pain and laxity on valgus stress at 30 and 70 degrees of flexion. Pain with Milking maneuver. No pain at the tricep or with resisted extension. Focal tenderness to palpation at the medial joint line and at the inferior and posterior medial epicondyle. Positive Tinel's. R Wrist: Full AROM symmetric with contralateral. Skin: No ecchymosis or erythema. Neuro: Sensation grossly intact, strength 5/5 symmetric in upper extremities. DIFFERENTIAL: Valgus extension overload syndrome, ulnar neuropathy, ulnar nerve subluxation, UCL sprain/tear, loose body RESULTS: R elbow: X ray 3 view: No fracture or dislocation. MSKUS: Hypoechoic area within the UCL consistent with partial tear. Laxity demonstrated on stress testing. Subluxation of the ulnar nerve demonstrated from within the cubital tunnel riding over the medial epicondyle during flexion. MR arthrogram: Partial-thickness tear (grade 2 sprain) of the UCL at its insertion. A few intact insertional fibers remain. FINAL DIAGNOSIS: Right UCL partial tear and ulnar nerve subluxation TREATMENTS/OUTCOME: We discussed treatment options with patient, with concomitant issues surgical intervention was chosen. Patient underwent a right UCL repair and ulnar nerve subcutaneous transposition without complication. At 5 weeks post op she had full AROM and resolved ulnar dysesthesias. She then underwent a guided physical therapy program and at 3 months after surgery she had full painless ROM and no instability. She was cleared to increased activity as tolerated and allowed to participate in her season starting 4 months post-operative.

Fine, J. (2000). "The Effect of Leisure Activity on Depression in the Elderly: Implications for the Field of Occupational Therapy." Occupational Therapy in Health Care 13(1): 45-59.
	The purpose of this annotated review of literature was to examine the effect of leisure activity on depression in the elderly. Despite some limitations, the literature, in general, suggests an inverse correlation between leisure activity and depression in the elderly. Individuals who engaged in leisure activity, whether it was physical exercise or more sedentary activity such as card games, were less depressed than individuals who did not engage in leisure activity. More scientific research is needed, however, to confirm this effect. Further studies could serve to define leisure activity as a tool for treatment in the field of occupational therapy.

Fink Barnes, L. A., et al. (2021). "Athletes With Anterior Shoulder Instability: A Prospective Study on Player Perceptions of Injury and Treatment." Orthop J Sports Med 9(9): 23259671211032239.
	BACKGROUND: Many in-season athletes choose to delay or avoid surgery in order to continue playing and avoid downtime such as missed games or seasons. PURPOSE: To learn about the attitudes toward the injury and treatment of in-season shoulder instability in competitive athletes who have suffered a shoulder dislocation. STUDY DESIGN: Cross-sectional study; Level of evidence, 3. METHODS: A study-specific questionnaire about athletes' perceptions of injury and treatment was administered to injured players. Secondary outcomes included the American Shoulder and Elbow Surgeons (ASES) score and the Western Ontario Shoulder Instability Index (WOSI). Mean scores and standard deviations were calculated, and between-group analyses with t tests were performed to compare the ASES and WOSI scores. The Mann-Whitney U test was used for analyses performed on the following groups: early operative versus nonoperative management; age <18 versus >/=18 years; first-time dislocators versus recurrent dislocators; self-reducing subluxations versus dislocations requiring assistance; and dominant arm affected versus nondominant arm. RESULTS: There were 45 patients included in this study (33 male, 12 female) with a mean age of 18 +/- 2.8 years. Several sports were represented, with the most common being football, baseball, soccer, and rugby. In this study of in-season athletes with shoulder instability, 13 (28.9%) chose early surgery, 4 (8.9%) chose surgery at season's end, while 28 (62.2%) chose physical therapy followed by a wait-and-see approach, with 13 (46.4%) of these patients ultimately requiring surgery. Athletes who chose nonoperative treatment were statistically more likely to believe that their shoulder would heal on its own (P < .001) or with physical therapy (P < .025); they were also more likely to agree that they would rather stop sports than undergo surgery (P < .04). Athletes with worse ASES and WOSI scores at injury were more likely to choose surgery (P < .03 and P < .05, respectively). Athletes with >1 dislocation were less likely to believe that the shoulder would heal without surgery (P < .025). Most athletes agreed that seasonal timing and recruitment prospects were an important factor in their decision in favor of surgery (P < .038), and most agreed that their doctor influenced their ultimate treatment decision (P < .006). Most athletes also agreed that a repeat dislocation would cause further injury to the shoulder. CONCLUSION: Treatment decisions were most strongly related to the athletes' perceptions of injury severity and the influence of the treating surgeon.

Fitter, N. T., et al. (2020). "Exercising with Baxter: preliminary support for assistive social-physical human-robot interaction." J Neuroeng Rehabil 17(1): 19.
	BACKGROUND: The worldwide population of older adults will soon exceed the capacity of assisted living facilities. Accordingly, we aim to understand whether appropriately designed robots could help older adults stay active at home. METHODS: Building on related literature as well as guidance from experts in game design, rehabilitation, and physical and occupational therapy, we developed eight human-robot exercise games for the Baxter Research Robot, six of which involve physical human-robot contact. After extensive iteration, these games were tested in an exploratory user study including 20 younger adult and 20 older adult users. RESULTS: Only socially and physically interactive games fell in the highest ranges for pleasantness, enjoyment, engagement, cognitive challenge, and energy level. Our games successfully spanned three different physical, cognitive, and temporal challenge levels. User trust and confidence in Baxter increased significantly between pre- and post-study assessments. Older adults experienced higher exercise, energy, and engagement levels than younger adults, and women rated the robot more highly than men on several survey questions. CONCLUSIONS: The results indicate that social-physical exercise with a robot is more pleasant, enjoyable, engaging, cognitively challenging, and energetic than similar interactions that lack physical touch. In addition to this main finding, researchers working in similar areas can build on our design practices, our open-source resources, and the age-group and gender differences that we found.

Fitzgerald, D., et al. (2008). "Report on research in progress." Physiotherapy Ireland 29(1): 67-68.
	The purpose of this research is to develop and investigate the benefits of using motion tracking sensors to interact with on-screen computer games designed specifically to instruct, motivate and monitor a patient during an exercise programme. In separate collaborative projects we have developed two virtual reality-based systems that can guide a user through therapeutic exercises. User evaluation studies designed to assess users' satisfaction with using the systems were conducted aimed at identifying areas were system modifications were required to improve usability levels. Future work will involve conducting a 4-week balance training study to compare virtual reality-based exercise to conventional methods of a wobble board balance training programme.

Fitzgerald, D., et al. (2010). "Effects of a wobble board-based therapeutic exergaming system for balance training on dynamic postural stability and intrinsic motivation levels." Journal of Orthopaedic & Sports Physical Therapy 40(1): 11-19.
	STUDY DESIGN: Randomized controlled trial. OBJECTIVES: To compare the effects of wobble board exercises with and without feedback provided through integrating the wobble board movement into a computer game system, by comparing changes in postural stability and motivation. BACKGROUND: Therapeutic exergaming systems may offer a solution to poor adherence to postural control exercise regimes by improving motivation levels during exercise performance. METHODS: Twenty-two healthy adults, randomly assigned to an exergaming group (n = 11) and a control group (n = 11), completed 12 exercise sessions. Dynamic postural stability was quantified at baseline and follow-up using the star excursion balance test and the dynamic postural stability index during a jump-landing task. Intrinsic motivation was measured at baseline using the Self-Motivation Inventory and at follow-up using the Intrinsic Motivation Inventory. RESULTS: Star excursion balance test scores showed a statistically significant (P<.008) improvement in the posteromedial and posterolateral direction for both groups. No within-group change for the dynamic postural stability index or between-group difference for star excursion balance test or dynamic postural stability index scores were observed. The "interest and enjoyment" category of the Intrinsic Motivation Inventory showed significantly higher scores (P<.001) in the exergaming group at follow-up, which was 1 of the 5 Intrinsic Motivation Inventory categories evaluated. CONCLUSIONS: The findings suggest that exercising with the therapeutic exergaming system showed similar improvements in dynamic postural stability and showed a greater level of interest and enjoyment when compared to a group doing similar balance training without the game system. LEVEL OF EVIDENCE: Therapy, level 2b.

Flynn, S., et al. (2012). "Poster 120 Implementing Agile, User-Centered Design in Video Games for Cognitive Rehabilitation." Archives of physical medicine and rehabilitation 93(10): e49.
	
Flynn, S., et al. (2007). "Feasibility of using the Sony PlayStation 2 gaming platform for an individual poststroke: a case report." Journal of Neurologic Physical Therapy 31(4): 180-189.
	RATIONALE: Many Americans live with physical functional limitations stemming from stroke. These functional limitations can be reduced by task-specific training that is repetitive, motivating, and augmented with feedback. Virtual reality (VR) is reported to offer an engaging environment that is repetitive, safe, motivating, and gives task-specific feedback. The purpose of this case report was to explore the use of a low-cost VR device [Sony PlayStation 2 (PS2) EyeToy] for an individual in the chronic phase of stroke recovery. CASE: An individual two years poststroke with residual sensorimotor deficits completed 20 one-hour sessions using the PS2 EyeToy. The game's task requirements included target-based motion, dynamic balance, and motor planning. The feasibility of using the gaming platform was explored and a broad selection of outcomes was used to assess change in performance. OUTCOMES: Device use was feasible. Clinically relevant improvements were found on the Dynamic Gait Index and trends toward improvement on the Fugl-Meyer Assessment, Berg Balance Scale, UE Functional Index, Motor Activity Log, and Beck Depression Inventory. CONCLUSION: A low-cost VR system was easily used in the home. In the future it may be used to improve sensory/motor recovery following stroke as an adjunct to standard care physical therapy.

Foletto, A. A., et al. (2017). "Serious Games for Parkinson's Disease Fine Motor Skills Rehabilitation Using Natural Interfaces." Studies in Health Technology & Informatics 245: 74-78.
	Parkinson's Disease rehabilitation can be long and boring being difficult to maintain patient engagement on therapy programs. Novel technologies are allowing computer games to be played throught natural interfaces. This paper presents the development and assessment of a system of serious games for fine motor skills rehabilitation using natural interfaces. The games were assessed throught a questionnaire that evaluated the game experience through seven components: immersion, flow, competence, tension, challenge and positive and negative affect. In addition, a conceptual framework for development of serious games for fine motor skills rehabilitation was proposed. The results from the quantitative questionnaire suggested that the player experience was positive on all components assessed. Also, player experience between the three games was statistically the same, implying that the games can be used with consistency in a physical therapy rehabilitation program.

Foo, J., et al. (2013). "Low-cost evaluation and real-time feedback of static and dynamic weight bearing asymmetry in patients undergoing in-patient physiotherapy rehabilitation for neurological conditions." J Neuroeng Rehabil 10: 74.
	BACKGROUND: Weight bearing asymmetry is common in patients with neurological conditions, and recent advances in gaming technology have produced force platforms that are suitable for use in a clinical setting. The aim of this research is to determine whether commercially-available Wii Balance Boards with customized software providing real-time feedback could be used in a clinical setting to evaluate and improve weight-bearing asymmetry in people with various neurological conditions. METHODS: Twenty participants (age = 43.25 +/- 19.37 years) receiving physiotherapy as a result of a neurological condition performed three trials each of two tasks (static standing and sit-to-stand) with and without visual feedback. Vertical forces were measured using available Wii Balance Boards coupled with customized software that displayed visual feedback in real-time. Primary outcome measures included weight-bearing asymmetry as a percentage of body mass, peak force symmetry index, and a visual analogue scale score rating self-perceived level of asymmetry. RESULTS: Weight-bearing asymmetry during the static balance task was significantly reduced (Z = -2.912, p = 0.004, ES = 0.65) with visual feedback. There was no significant difference (Z = -0.336, p = 0.737) with visual feedback for the dynamic task, however subgroup analysis indicated that those with higher weight-bearing asymmetry responded the most to feedback. Correlation analysis revealed little or no relationship between participant perception of weight-bearing asymmetry and the results for the static or dynamic balance task (Spearman's rho: rho = 0.138, p = 0.561 and rho = 0.018, rho =0.940 respectively). CONCLUSIONS: These findings suggest that weight-bearing asymmetry can be reduced during static tasks in patients with neurological conditions using inexpensive commercially-available Wii Balance Boards coupled with customized visual feedback software. Further research is needed to determine whether real-time visual feedback is appropriate for reducing dynamic weight-bearing asymmetry, whether improvements result in improved physical function, and how cognitive and physical impairments influence the patient's ability to respond to treatment.

Foody, J., et al. (2006). "A prototype sourceless kinematic-feedback based video game for movement based exercise." Conference Proceedings: ... Annual International Conference of the IEEE Engineering in Medicine & Biology Society 2006: 5366-5369.
	This paper presents a prototype kinematic and audio feedback based video game, availing of a scalable motion capture acquisition system, based around a number of orientation sensors. The orientation sensors used are USB based tri-axis magnetic and gravitational field transducers. The novel video-game is capable of incorporating the real time data from these sensors to control an on screen avatar, which in turn can be programmed to give appropriate instructions to the user i.e. play a sound file, once the user obtains a certain posture. The video game is designed to promote physical exercise and movement based relaxation, in particular; yoga. In addition, design considerations; implementation and performance of the system are analyzed, discussed and the accuracy qualitatively analyzed by comparing movement data obtained from it to that of a validated motion analysis technique, the CODA motion analysis system.

Fornasini, S., et al. (2020). "Using Geocaching to Promote Active Aging: Qualitative Study." Journal of Medical Internet Research 22(6): e15339.
	BACKGROUND: Over the past few years, the development of technologies supporting active aging has been increasing. Among the activities that promote physical exercise by using technologies is geocaching-a treasure hunt of sorts in which participants use a receiver GPS to hide or find real or virtual objects. Although this activity is particularly suited to the promotion of healthy lifestyles in older people, geocaching remains to be unexplored in this area. OBJECTIVE: This study aimed to investigate the effectiveness of activities combining geocaching and self-tracking technologies to promote active aging, evaluate the usability of technologies, and explore the ways in which technologies have been integrated in the organizational context under examination to determine the user experience of participants. METHODS: A group of individuals aged 65 years and older (N=14) attending a senior center managed by a social cooperative was involved in the study. Some of them created the geocaching contents, and others, split into 2 teams, participated in the game. Each participant was given a pedometer bracelet and the geocaching app. The steps taken by individual participants along with the number of caches found by each group translated into team scores. RESULTS: The main results of the study were as follows: (1) activities in favor of active aging that involve the use of new technologies can foster the participation of elderly people; in particular, adding gamification to self-tracking can be a valid strategy to promote physical exercise among the elderly; (2) for this to happen, involvement of older people firsthand is crucial, and there must be a focus on their active involvement and empowerment in every phase of the project; and (3) the mediation of conflicts and competition that arise from the gamification could only take place because of the strong support of the organization in the form of social workers. CONCLUSIONS: The results show that promoting active aging through technologies requires more effort than simply using these tools; it requires a wider process that involves an articulated organizational network with heterogeneous actors, technologies, and relations.

Forsberg, A., et al. (2015). "Perceptions of using videogames in rehabilitation: a dual perspective of people with multiple sclerosis and physiotherapists." Disability & Rehabilitation 37(4): 338-344.
	PURPOSE: Our aim was to describe experiences of using Nintendo Wii Fit for balance exercise, from the perspectives of patients with multiple sclerosis (MS) and their physiotherapists (PT). METHODS: Individual interviews with 15 patients with MS were conducted, recruited from a multi-centre study investigating the effects of balance exercising using Wii Fit. We also conducted a single focus group interview with nine PT involved in the study. The interviews were audio-recorded, transcribed, and analysed using content analysis. RESULTS: Both patients and PT said that exercising with Wii Fit games was fun, and that it challenged the patients' physical and cognitive capacities. The competitive content in the games provided motivation to continue playing. Patients and PT reported improved body control and, more importantly, positive effects on balance and walking in daily life. The PT regarded Wii training as an effective alternative to other balance training, but some felt unsure in how to manage the video game. The patients regarded Wii training as a possible home training solution. CONCLUSIONS: Patients with MS and their PT considered Wii Fit exercises to be fun, challenging, and self-motivating. Exercising with Wii games can address balance impairments in MS, and can be performed at home as well as in rehabilitation settings. Implications for Rehabilitation Nintendo Wii Fit can be used as a fun and challenging way to perform balance exercises. The competitive content embedded in the games triggers continued playing and exercising. The positive effect on balance control can improve standing and walking in everyday activities.

Fort, K. M. and K. J. Overton (2015). Nintendo Wii Fit(TM) intervention for balance improvement in a child with developmental coordination disorder, Florida Gulf Coast University: 37 p-37 p.
	Objective: This research study aimed to determine if the Nintendo Wii Fit(TM) video gaming program and its balance games could improve balance in child, age eight, with Developmental Coordination Disorder (DCD) or hypotonia when used as a primary intervention tool. Recent studies have been completed recently as to the effectiveness of the Nintendo Wii Fit(TM) system as an intervention tool, concluding with positive results. However, there are limited studies focusing on the pediatric population and even less ones concentrating on children with disorders that directly affect their balance capabilities, such as DCD. Method: This single-subject case study involved the participation of a child that has been diagnosed with DCD or related movement deficits to perform selected Nintendo Wii Fit(TM) balance exercises in a controlled clinical environment three times a week over the course of six weeks. The study consisted of one participant, aged eight, who was diagnosed with hypotonia and was not currently receiving physical therapy. The participant completed six different balance exercises for a total of 18 minutes during each visit. Before starting the intervention, the participant was shown proper use the Nintendo Wii Fit(TM) gaming system and given a trial run, to assist with alleviating any learning curves. At all times during the study, the participant was in a safe, controlled environment completing tasks that required no more challenge to a child's balance than is experienced during normal daily activities. A pre- and post-intervention assessment utilizing the Pediatric Balance Scale (PBS) measured the participant's balance improvement. Results: At the conclusion of the study, the child was shown to have improved his PBS score by 4 points, advancing from the medium fall risk category to the low fall risk category. Conclusion: While more extensive studies need to be completed, the results found support the Nintendo Wii Fit(TM) system as a valuable intervention tool for pediatric populations with balance deficits.

Foulds, R., et al. (2010). "Augmenting pediatric constraint-induced movement therapy and bimanual training with video gaming technology." Technology & Disability 22(4): 179-191.
	Cerebral palsy (CP) is the most common cause of physical disability in childhood. Hemiplegia is among the most common forms of CP and the resulting impaired hand function is one of the most disabling symptoms, affecting self-care activities such as feeding, dressing, and grooming. To date, evidence-based treatments are limited. Recent approaches, however, have capitalized on findings that show children with hemiplegia have residual motor capabilities and neuroplastic changes in nervous system function that emerge and improve with practice. Here the etiology and neural basis of hemiplegic CP is first briefly reviewed, followed by a description of the residual motor capabilities in the involved upper extremity and the potential role of intensive practice. Two promising approaches that target residual motor function, constraint-induced movement therapy (CIMT) and bimanual training, are then described. Recent evidence suggests that such task-oriented training approaches to rehabilitation are enhanced when the tasks are meaningful to the performer. Increasingly, this means use of current technology, specifically video gaming, to maintain salience and motivation and target specific motor impairments. Thus a method for using commercially available video gaming, including the Nintendo Wii to augment such intensive treatment approaches is described. It is suggested that with such intensive treatment programs, gaming can be an important compliment to, but not a replacement for, salient task-oriented activities in the real world and that video gaming and virtual reality training will be an important part of future rehabilitation efforts.

Fowler, N. and V. Lancey (2004). "Tackling the risk of injury in rugby." SportEX Medicine(19): 11-13.
	The publicity surrounding the recent Rugby Union World Cup and the all round good showing of teams from the Home Nations will no doubt Lead to an increased interest in the game. Equally certain is that with an increase in participation will come an increase in the number of players becoming injured. This article Looks at the biomechanics and areas of greatest injury risk and is followed by a section on the physiotherapist's role as part of the medical team.

Fox, D., et al. (2014). "Normative data for the Functional Movement Screen in male Gaelic field sports." Physical Therapy in Sport 15(3): 194-199.
	OBJECTIVE: To determine normative values for the Functional Movement Screen (FMS) in Elite and Sub-Elite male Gaelic Football and Hurling players. DESIGN: A cross sectional study of functional movement in Gaelic games at Elite and Sub-Elite level. Players were video recorded completing the Functional Movement Screen Tool and scored post-test. Comparisons were analysed using Mann-Whitney U tests. SETTING: Field testing in team gym facility and university biomechanics laboratory. PARTICIPANTS: A total of 62 players were tested. This consisted of 41 Hurling, and 21 Gaelic Football players. 30 of these participants were deemed Elite and 32 were deemed Sub-Elite. The mean age of the sample was 22.15 +/- 3.02 years. MAIN OUTCOME MEASURES: Functional Movement Screen (FMS). RESULTS: The FMS mean score for the sample was 15.56 +/- 1.46. The Elite group (15.8 +/- 1.58) scored higher than the Sub-Elite group (15.34 +/- 1.31) but there was no significant difference between groups. CONCLUSIONS: This study provides normative reference values for Gaelic Players. Elite Gaelic Players perform no better than a young, active population in the FMS indicating a potential problem with the FMS as a measure.

fqv, R. B. R. (2018). "Effects of Video Game Games on Breathing and Balance of Parkinson's patients." https://trialsearch.who.int/Trial2.aspx?TrialID=RBR-277fqv.
	INTERVENTION: Device F04.754.137.506.662 G11.427.410.698.277 I03.450.642.693.930 Procedure/surgery Thirty‐four subjects with Parkinson's disease, with a mean age of 64.4 ± 9.7 years, were divided into three groups: 12 subjects in the exergame group used the Nintendo Wii (R) as a tool to promote physical training, 12 individuals in the functional training group underwent functional training simulating the movements of the exergame group and 10 subjects in the control group who remained 4 weeks without performing physical exercises. Individuals in the exergame group and functional training group performed 12 physical training sessions, 3 times per week for 60 minutes. Intervention protocol: Group exergame (EX): The games were selected to optimize an aerobic physical training and its sequence in increasing order of difficulty. They were performed in the following order described: For heating a five‐minute walk on the Nintendo Wii itself was performed. After the warm‐up, soccer was performed, in which the subject performed laterolateral movements to head the largest amount of balls, having to divert the boots and the teddy bears. The next game was the hula hoop, it is a simple and efficient game in which the subjects must perform circulatory movements with the hip and move the trunk in different directions to get as many hula hoops. Another game was Penguin Slide, in which the main character is a penguin standing on an iceberg trying to balance, moving from one end to another and catching the largest number of fish without falling into the water. In step activity the individual climbed and descended from the Nintendo Wii platform, performing anteroposterior and laterolateral movements. The game snowboard was the penultimate one realized by the participants, in that game the avatar of the subject is projected in a track of ski in the snow, made a good score if it passed between the flags, had to make laterolateral and anteroposterior movements. Boxing was the last game, this simulates the event of hitting, defending and avoiding opponent's punches. CONDITION: C10.228.140.079.862.500 F03.608 G00‐G99 Parkinson disease; Respiratory disorders in diseases classified elsewhere; Motor Disorders ; C10.228.140.079.862.500 ; J99 ; F03.608 PRIMARY OUTCOME: Expected outcome: Exercise training with exergame and functional training are believed to improve balance in individuals with Parkinson's.; Evaluation method: Baropodometry, berg scale, Time Up Go.; Conclusion: Individuals who underwent exergame physical training improved the balance [F (2,31) = 3.52, p, 0.05], fear of falling [(2,31) = 29,94 , p <0.001] and lower limb mobility [(2,31) = 4,12, p <0,05], different from subjects submitted to functional training and individuals who remained without physical exercise. Expected outcome: Exergen training is more effective than functional training to improve respiratory capacity in individuals with Parkinson's disease. And the failure to perform physical exercises can worsen the respiratory condition of these individuals.; Evaluative method: the spirometer, manovacuometer and the 6‐minute walk test.; Conclusion: Individuals in the exergame group and the functional training group increased the strength of the respiratory muscles [Pimáx: F (1,31) = 22,18; p <0.001; r = 0.41]; Pmax [F (1.31) = 31.53; p <0.001; r = 0.50] and the distance walked in the 6‐minute walk test [F (1,31) = 13,22; p <0.01; r = 0.29] after the intervention. However, when compared to the control group, only the inspiratory muscle strength in the individuals who performed exercises with exergame was different [F (2,31) = 9,34; p <0.01; r = 0.37]. It was also found that the control group decreased mean forced expiratory flow after the intervention [F (1,31) = 6,93; p <0.05; r = 0.18]. SECONDARY OUTCOME: Expected outcome: It is believed that subjects with Parkinson's disease present reductions in respiratory capacity variables. ; Evaluative method: Spirometer, Manovacuometer and 6‐minute walk test (values obtained by the participants compared to the val es predicted before the intervention protocol) ; Conclusion: It was observed that the participants presented values below the predicted in the variables that consider the respiratory capacity [TC6 min: T (24) = ‐13,341, p <0.001]; [Pmax: T (24) = ‐3.771, p <0.01]; [Pmax: T (24) = ‐11.062, p <0.001]; [FVC: T (24) = ‐8.329, p <0.001]; [PFE: T (24) = ‐11.077, p <0.001]; [FEV1: T (24) = ‐4.739, p <0.001]; [FEV1 / FVC: T (24) = 3.660, p <0.01]; [FEF25‐75%: T (24) = 2,582, p <0.05]. Indicating that these subjects present respiratory compromises that can lead to morbidity and death. Expected outcome: That exercise training with exergame be more effective than functional training to improve quality of life and the perceived state of depression in individuals with Parkinson's disease. And that the individuals in the control group do not happen the same. ; Evaluation method: Parkinson's Disease Quality of Life Assessment Scale and the Beck Depression Inventory. ; Results: Exergame and functional training increased perception of quality of life [F (1,31) = 39,89; p <0.001; r = 0.56] and decreased the perception of depression [F (1,31) = 21,59; p <0.001; r = 0.41] in subjects with Parkinson's disease. The perception of quality of life decreased in the control group after 1 month of not performing physical exercises. INCLUSION CRITERIA: Subjects with moderate stages of Parkinson's disease; both genders; autonomy to perform the exercises; identified through the Mini Mental Status Examination

Francis, S. L., et al. (2021). "Gamifying accelerometer use increases physical activity levels of individuals pre-disposed to type II diabetes." Preventive Medicine Reports 23: 101426.
	Physical activity is important for preventing obesity and diabetes, but most obese and pre-diabetic patients are not physically active. We developed a Fitbit-based game called MapTrek that promotes walking. We recruited obese and pre-diabetic patients. Half were randomly assigned to the control group and given a Fitbit alone. The others were given a Fitbit plus MapTrek. The MapTrek group participated in 6 months of weekly virtual races. Each week, participants were placed in a race with 9 others who achieved a similar number of steps in the previous week's race. Participants moved along the virtual route by the steps recorded on their Fitbit and received daily walking challenges via text message. Text messages also had links to the race map and leaderboard. We used a Bayesian mixed effects model to analyze the number of steps taken during the intervention. A total of 192 (89%) participants in the control group and 196 (91%) in the MapTrek group were included in the analyses. MapTrek significantly increased step counts when it began: MapTrek participants walked almost 1,700 steps more than the control group on the first day of the intervention. We estimate that there is a 97% probability that the effect of MapTrek is at least 1,000 additional steps per day throughout the course of the 6-month intervention and that MapTrek participants would have walked an additional 81 miles, on average, before the effect ended. Our MapTrek intervention led to significant extra walking by the MapTrek participants.

Frankel, H. L. (2012). "The Sir Ludwig Guttmann lecture 2012: the contribution of Stoke Mandeville Hospital to spinal cord injuries." Spinal Cord 50(11): 790-796.
	This Ludwig Guttmann Lecture was presented at the 2012 meeting of the International Spinal Cord Society in London. It describes the contribution of Stoke Mandeville Hospital to the field of spinal cord injuries. Dr Ludwig Guttmann started the Spinal Unit at Stoke Mandeville Hospital in 1944 and introduced a novel, comprehensive method of care, which included early admission, prevention and treatment of spinal cord injury related complications, active rehabilitation and social reintegration. Soon a dedicated specialist team was assembled and training of visitors was encouraged, some of whom went on to start their own spinal units. Research went hand in hand with clinical work, and over the years more than 500 scientific contributions from Stoke Mandeville have been published in peer reviewed journals and books. Guttmann introduced sport as a means of physical therapy, which soon lead to organised Stoke Mandeville Games, first national in 1948, then international in 1952 and finally the Paralympic Games in 1960. Stoke Mandeville is regarded as the birthplace of the Paralympic movement, and Guttmann was knighted in 1966. Stoke Mandeville is also the birthplace of the International Medical Society of Paraplegia, later International Spinal Cord Society, which was formed during the International Stoke Mandeville Games in 1961, and of the Society's medical journal Paraplegia, later Spinal Cord, first published in 1963. Guttmann's followers have continued his philosophy and, with some new developments and advances, the present day National Spinal Injuries Centre at Stoke Mandeville Hospital provides comprehensive, multidisciplinary acute care, rehabilitation and life-long follow-up for patient with spinal cord injuries of all ages.

Freitas, A., et al. (2021). "Benefits of a virtual environment program at the level of functional physical fitness in non-institutionalized elderly." Annals of medicine 53(sup1): S138-S139.
	Introduction: Balance is one of the main concerns in the elderly population since there is a decline in the somatosensory system functions which may lead to a high probability of falling [1]. The risk of falling is one of the main problems among the elderly population due to its multifactorial causes [2]. One strategy to promote greater adherence and motivation to intervention in Physical Therapy is the use of virtual environment programs. This associated with a balance exercise program is an effective method for preventing falls, because it improves balance levels [3]. The purpose of this study is to analyse the benefit of a virtual environment exercise program in non‐institutionalized elderly at the end of six weeks. Materials and methods: In this randomised controlled trial 68 non‐institutionalized elderly from a day care institution in Corroios, were included. Thirty two subjects, age 80.6 ± 7.0 yrs constituted the experimental group (EG); and 36, age, 81.7 ± 7.1 yrs constituted the control group (CG). The EG was submitted to 6 weeks of a virtual environment exercise program performed on a Nintendo Wii, and to a set of recreational activities. The CG only performed the activities. The instruments used in the present study to evaluate performance were Tinettis index which evaluates the static balance and the gait to quantify the risk of fall, and the Fullertons functional fitness tests to assess physical parameters such as strength, aerobic endurance, flexibility and agility/balance [4]. All subjects sign an informed consent. This study follows all the principles of the Declaration of Helsinki. Results: At the end of the 6 weeks of intervention in a virtual environment, significant improvements in upper limb strength, agility and static balance were observed. In the intragroup comparison, it was possible to verify improvements in all tests of the battery of physical fitness. The values of the functional fitness test were significantly different (p<.05) between EG and CG groups for the following variables: 30‐second chair stand 14.4 ± 2.5 vs. 10.0 ± 3.4 times (p=.037); arm curl 16.1 ± 3.9 vs. 13.5 ± 5.9 times (p=.041); 8‐foot up‐and‐go 9.2 ± 2.1 vs. 15.3 ± 6.6 sec (p=.021); two min. step 120.0 ± 35.8 vs. 75.3 ± 38.4 steps (p=.016), respectively; as well as for the Tinetti index. Discussion and conclusions: Performing an exercise program through a virtual environment with biofeedback can provide several benefits in the elderly population due to the provision of instant feedback. Studies suggest that an exercise program with virtual environment may be an effective tool to improve balance levels and specific components of physical fitness, such as aerobic capacity, speed, agility, muscle strength and flexibility [5], which was verified in this study.

French, S. (1989). "Teaching Methods: 4. Adding Interest to your Teaching." Physiotherapy 75(12): 741-743.
	Summary Physiotherapists are frequently called upon to teach their colleagues and other groups. This article is the last in a monthly series of four on different methods of doing this. It explores various teaching methods and discusses the uses, advantages and disadvantages of each.

Friedrich, R., et al. (2015). "Serious Games for Home-based Stroke Rehabilitation." Studies in Health Technology & Informatics 213: 157-160.
	On average, two thousand residents in the United States experience a stroke every day. These circumstances account for $28 billion direct costs annually and given the latest predictions, these costs will more than triple by 2030. In our research, we propose a portfolio of serious games for home-based stroke rehabilitation. The objective of the game approach is to enrich the training experience and establish a higher level of compliance to prescribed exercises, while maintaining a supportive training environment as found in common therapy sessions. Our system provides a collection of mini games based on rehabilitation exercises used in conventional physical therapy, monitors the patient's performance while exercising and provides clinicians with an interface to personalize the training. The clinician can set the current state of rehabilitation and change the playable games over time to drive diversification. While the system still has to be evaluated, an early stage case study with one patient offered positive indications towards this concept.

Friend, B. and K. Beirne (1996). "The British Olympic heroes who aren't going for gold." Physiotherapy Frontline 2(14): 8-8.
	As the 100th Olympic Games draw near, it is not only the competitors who are gearing up for the ultimate challenge. The British physios looking after the UK's finest athletes also need to rise to the occasion. Bernadette Friend and Katherine Beirne report.

Fritz, S. L., et al. (2013). "Active video-gaming effects on balance and mobility in individuals with chronic stroke: a randomized controlled trial." Top Stroke Rehabil 20(3): 218-225.
	BACKGROUND: Treatments that provide feedback, increase practice with multiple repetitions, and motivate patients are essential to rehabilitation post stroke. OBJECTIVE: To determine whether playing active video games results in improved balance and mobility post stroke. METHODS: Thirty participants with chronic (time since stroke = 3.0 [2.9] years) hemiparesis post stroke were randomly assigned to a gaming group or normal activity control group. Gaming systems provided participants with an interactive interface of real-time movement of either themselves or an avatar on the screen. Participants played games 50-60 minutes/day, 4 days/week, for 5 weeks. The intervention was strictly game-play, in standing position, without physical therapy. The control group received no special intervention and continued with normal activity. Both groups were tested prior to, following the 5 weeks (post test), and 3 months following the completion of the study. Outcome measures included the Fugl-Meyer Assessment, Berg Balance Scale, Dynamic Gait Index, Timed Up & Go, 6-minute walk test, 3-meter walk (self-selected and fast), and perception of recovery. RESULTS: No statistically significant differences between or within groups were found through analysis of covariance (covaried for side of hemiparesis) at post test or follow-up. Although the within-group effect sizes were primarily indexed as "small" (< .36), the gaming group exhibited higher within-group effect sizes before and after testing than did the control group on all 7 dependent variables analyzed. CONCLUSIONS: Even though the only intervention was game-play, there were small positive effects. Therapist assistance in making more optimum movement choices may be needed before significant improvements are seen with commercially available, general purpose games.

Fu, C. (2018). "Terapia intensiva: avanços e atualizações na atuação do fisioterapeuta." Fisioterapia e Pesquisa 25(3): 240-240.
	
Fuertes Munoz, G., et al. (2019). "A RGBD-Based Interactive System for Gaming-Driven Rehabilitation of Upper Limbs." Sensors 19(16): 09.
	Current physiotherapy services may not be effective or suitable for certain patients due to lack of motivation, poor adherence to exercises, insufficient supervision and feedback or, in the worst case, refusal to continue with the rehabilitation plan. This paper introduces a novel approach for rehabilitation of upper limbs through KineActiv, a platform based on Microsoft Kinect v2 and developed in Unity Engine. KineActiv proposes exergames to encourage patients to perform rehabilitation exercises prescribed by a specialist, controls the patient's performance, and corrects execution errors on the fly. KineActiv comprises a web platform where the physiotherapist can review session results, monitor patient health, and adjust rehabilitation routines. We recruited 10 patients for assessing the system usability as well as the system performance. Results show that KineActiv is a usable, enjoyable and reliable system, that does not cause any negative feelings.

Fujikura, J., et al. (2008). "The Sakado school-based 'Shokuiku' food and nutrition education project." Asia-Pacific Journal of Public Health 20: 57-63.
	The purpose of this study was to obtain baseline data for a school-based food nutrition education on 'how snacks should be eaten'. The subjects were 704 fifth-graders (371 boys, 333 girls) from all the primary schools in Sakado City who participated in the study in November 2006. They completed a 'Life Habit Questionnaire' and a 'Food Frequency Questionnaire (BDHQ)'. Based on their answers the subjects were classified into three groups. Statistical methods including chi-square test, and one-way layout ANOVA were used to analyze the relations between Rohrer index by gender, lifestyle groups of above each question, and intake of snacks. There was the significant relation between the Rohrer index by sex and 'helping with domestic chores', 'communication with the families' and 'physical exercise'. The variables 'soft beverage drinking', 'physical exercise' 'time spent on TV and video games' and 'less frequent breakfast intake' consume significantly higher amounts of snacks than others groups. 'Helping with domestic chores' was significant associated with 'communication with the families' and 'physical exercise'. The results suggest that guidance should be given on eating breakfast every day, developing exercise patterns and appropriate eating of snacks.

Fujikura, J., et al. (2008). "The Sakado school-based "shokuiku" food and nutriti education project." Asia-Pacific Journal of Public Health 20 Suppl: 57-63.
	The purpose of this study was to obtain baseline data for a school-based food nutrition education on "how snacks should be eaten". The subjects were 704 fifth-graders (371 boys, 333 girls) from all the primary schools in Sakado City who participated in the study in November 2006. They completed a 'Life Habit Questionnaire' and a 'Food Frequency Questionnaire (BDHQ)'. Based on their answers the subjects were classified into three groups. Statistical methods including chi-square test, and one-way layout ANOVA were used to analyze the relations between Rohrer index by gender, lifestyle groups of above each question, and intake of snacks. There was the significant relation between the Rohrer index by sex and 'helping with domestic chores', 'communication with the families' and 'physical exercise'. The variables 'soft beverage drinking', 'physical exercise' 'time spent on TV and video games' and 'less frequent breakfast intake' consume significantly higher amounts of snacks than others groups. 'Helping with domestic chores' was significant associated with 'communication with the families' and 'physical exercise'. The results suggest that guidance should be given on eating breakfast every day, developing exercise patterns and appropriate eating of snacks.

Fung, V., et al. (2012). "Use of Nintendo Wii Fit in the rehabilitation of outpatients following total knee replacement: a preliminary randomised controlled trial." Physiotherapy 98(3): 183-188.
	OBJECTIVES: To determine whether Nintendo Wii Fit is an acceptable adjunct to physiotherapy treatment in the rehabilitation of balance, lower extremity movement, strength and function in outpatients following total knee replacement. DESIGN: Preliminary randomised controlled trial. SETTING: Outpatient department of a rehabilitation hospital. PARTICIPANTS: Adult outpatients following total knee replacement. INTERVENTIONS: The study group received a physiotherapy session followed by 15minutes of Wii Fit gaming activities. The games encouraged lateral and multidirectional weight shifting, and provided visual feedback regarding postural balance. The control group received a physiotherapy session followed by 15minutes of lower extremity strengthening and balance training exercises. MAIN OUTCOME MEASURES: Length of outpatient rehabilitation, 2-minute walk test, knee range of motion, timed standing, Activity-specific Balance Confidence Scale, Lower Extremity Functional Scale and Numeric Pain Rating Scale, all measured on admission and every 2 weeks until discharge. A patient satisfaction survey was completed at discharge. RESULTS: Seventeen males (34%) and 33 females (66%) with a mean age of 68 (standard deviation 11) years participated in the study. No significant differences in age, gender, days since surgery or length of outpatient rehabilitation were found between the groups. In addition, there were no significant differences in pain (P=0.220), knee flexion (P=0.951), knee extension (P=0.492), walking speed (P=0.855), timed standing tasks (P=0.289), Lower Extremity Functional Scale (P=0.079), Activity-specific Balance Confidence Scale (P=0.523) or patient satisfaction with therapy services (P=0.201) between the groups. CONCLUSIONS: Wii Fit is potentially acceptable as an adjunct to physiotherapy intervention for outpatients following total knee replacement, provided the games chosen challenge balance and postural control, and use the lower extremities. Further research is needed to establish whether video games as a therapy adjunct increase patient motivation and compliance with rehabilitation goals. ClinicalTrials.gov ID: NCT01548664.

Fung, V., et al. (2010). "The utilization of nintendo wii fit in the rehabilitation of outpatients following total knee replacements: preliminary results of a randomized controlled trial." Archives of physical medicine and rehabilitation 91(10): e37‐.
	Objective: To determine if the Nintendo Wii Fit is an acceptable adjunct to the rehabilitation therapy of outpatients following total knee replacement. Design: Randomized controlled trial. Setting: Outpatient clinic in a rehabilitation hospital. Participants: 30 outpatients following total knee replacements were randomly assigned to either a video game (VG) group (n=18) or an additional exercise (AE) group (n=12) for 15 minutes following their scheduled physiotherapy (PT) session, twice weekly. Interventions: VG group used the Wii Fit balance board to play games which encouraged lateral and multidirectional weight shifting, and provided visual feedback regarding postural balance. AE group performed lower‐extremity strengthening and balance training exercises. Main Outcome Measures: Numerical Pain Rating Scale (NPRS), range of motion (ROM), 2‐minute walk test (2MWT), timed standing (TS), Lower Extremity Functional Scale (LEFS), Activity‐ specific Balance Confidence scale (ABC), and patient satisfaction. Conclusions: There were 11 men (36.7%) and 19 women (63.3%) with a mean age of 70.7 ± 8.9 years. There was no significant difference between age, sex, number of days since surgery on admission, or overall length of outpatient rehabilitation stay between VG or AE groups. There was also no significant difference between VG or AE groups for changes from admission to discharge in NPRS (P=.708), knee flexion ROM (P=.846), knee extension ROM (P=.648), 2MWT (P=.422), timed standing tasks (P=.262), LEFS (P=.223), ABC (P=.831), or patient satisfaction with therapy services (P=.201). These results showed no significant outcome differences between the VG and AE groups, suggesting that Nintendo Wii Fit is an acceptable adjunct to physiotherapy interventions for the outpatient total knee replacement population. These results are preliminary, and suggest that statistically significant differences might be detected with a larger sample size.

Fung, V., et al. (2011). "Research Report Abstracts." Physiotherapy 97: eS18-eS1415.
	Purpose: To determine whether the Nintendo Wii FitTM is an acceptable adjunct to the rehabilitation of outpatients following total knee replacement (TKR). Relevance: Trends in physical rehabilitation favor the use of commercially available video games as therapeutic modalities. Clinical reports suggest that video games can increase patient motivation and enjoyment during therapy, but there is limited research investigating whether specific patient populations receive measurable benefit from its use. The Nintendo Wii FitTM encourages multidirectional weight shifting and provides visual feedback for postural balance. We hypothesized that Nintendo Wii FitTM can potentially benefit the rehabilitation of the lower extremities following TKR. Participants: Fifty outpatients following TKR surgery, receiving physiotherapy (PT) treatment twice weekly, were randomly assigned to either a study group (n = 27) or a control group (n = 23). The study group received an additional 15 minutes of Nintendo Wii FitTM activity, and the control group received an additional 15 minutes of lower extremity exercise, following each PT session. Methods: This was a randomized controlled trial. Knee range of motion (ROM), balance, lower extremity function, walking speed, and pain were measured on admission and every two weeks until discharge from PT services. Assessors were blinded to participant randomization. Length of outpatient stay and patient satisfaction with hospital services was also collected. Analysis: SPSS statistical software was used to perform t‐test and Chi‐square analyses to compare the magnitude of change from initial assessment to discharge, between the study and control groups. A p < 0.05 was considered significant. Results: There were 17 males (34%) and 33 females (66%) with a mean age of 68.0 (SD = 11.1 years). There was no significant difference between study and control groups for age, gender, number of days between surgery and admission, or overall length of outpatient rehab stay. There was also no significant difference between groups for pain (p = 0.220), knee flexion (p = 0.951), knee extension (p = 0.492), walking speed (p = 0.855), timed standing tasks (p = 0.289), the Lower Extremity Functional Scale (LEFS) (p = 0.079), the Activities‐specific Balance Confidence (ABC) scale (p = 0.523) or patient satisfaction with therapy services (p = 0.200). Conclusions: The Nintendo Wii FitTM is an acceptable adjunct to PT intervention for the outpatient TKR population, provided the applications chosen challenge balance, postural control, and utilize the lower extremities. Implications: Investigating the effect of Nintendo Wii FitTM on PT treatment might provide knowledge to assist clinical decision making related to its use in rehabilitation. Using video games as a therapy adjunct might increase patient motivation, compliance with rehabilitation goals, and provide an innovative method to deliver PT intervention.

Fung, V., et al. (2010). "The utility of a video game system in rehabilitation of burn and nonburn patients: a survey among occupational therapy and physiotherapy practitioners." Journal of Burn Care & Research 31(5): 768-775.
	The objective of this study was to investigate perceptions of occupational therapists and physiotherapists on the use of Nintendo Wii (Nintendo of America Inc., Redmond, WA) in rehabilitation. Occupational therapists and physiotherapists in a rehabilitation hospital trialed four Wii games that addressed physical movement, balance, coordination, and cognitive performance. Then, they completed an opinion survey on the utility of Wii in rehabilitation. The results were compared between burn care therapists (BTs) and nonburn care therapists, using chi(2) with a P < .05 considered significant. The participation rate was 79% (63/80), and they agreed that Wii was easy to set up (71%), operate (68%), and safe to use (76%). Participants agreed that Wii would be beneficial in outpatient (76%) and inpatient (65%) settings and that it could improve treatment compliance (73%). Participants recommended 15 to 30-minute Wii intervention (59%) daily (81%) and twice per week (43%). Participants believed that neurologic (71%), trauma (68%), burn (59%), and musculoskeletal (49%) patients would benefit from Wii intervention but not cardiac (43%) or organ transplant patients (18%). Participants believed that outcomes using Wii could be measured reliably (49%), and skills learned while playing could be transferable to daily function (60%). The significant differences between BTs and nonburn care therapists' perceptions are that BT-treated younger patients (21-40 years vs >60 years, P < .05) and BT favored the therapeutic benefit of Wii in rehabilitation (93% vs 58%, P = .02), specifically in burn rehabilitation (85% vs 39%, P = .001). Occupational therapists and physiotherapists favored the use of Wii in rehabilitation as an adjunct to traditional therapy because it is therapeutic, engaging, and may increase patient participation in rehabilitation.

g9f6w, R. B. R. (2020). "Rehabilitation of Children and Adolescents with Cystic Fibrosis." https://trialsearch.who.int/Trial2.aspx?TrialID=RBR-5g9f6w.
	INTERVENTION: /rehabilitation In this study, 20 participants Will be submitted to treatment with exergame and 20 participants with conventional treatment. The two proposed treatments will follow the protocol with a frequency of 3 times a week and a duration of 8 weeks. Both the IG (Intervention Group) and the CG (Control Group) will initially perform a 5‐minute warm‐up, followed by 10 minutes of respiratory physiotherapy, i.e., exercises performed with buccal‐type Expiratory Positive Airway Pressure (EPAP). This training should be performed with the patient inhaling the mean lung volume and then actively exhaling with an inspiratory / expiration index (R I: E) 1: 3. After 15 expirations, the patient performs a series of huff's (forced expiratory technique), keeping the glottis open to displace and expectorate the secretions mobilized. After respiratory physiotherapy, the IG will perform exercises with the games of the Xbox One exergame with Kinect sensor for 30 minutes and an intensity of 70‐85% of maximal heart rate (HR max). The games used will be Love Me Again, Summer and Happy. The CG, after respiratory physiotherapy, will perform an aerobic training on treadmill for 30 minutes and an intensity of 70‐85% HRmax. Both groups will perform after the training a cooling, lasting of 5 minutes, composed by exercises of relaxation of Yoga and Meditation. Procedure/surgery CONDITION: Cystic fibrosis Cystic Fibrosis ; Cystic fibrosis J00‐J99 PRIMARY OUTCOME: Increased cardiorespiratory fitness in children and adolescents with cystic fibrosis, verified by the six‐minute walk test (6MWT), based on the finding of a variation of at least 5% in pre and post‐intervention measurements. SECONDARY OUTCOME: Increased muscle strength of the lower and upper limbs, verified by the isokinetic evaluation and handgrip, from the finding of a variation of at least 20% in the pre and post‐intervention measurements. It is expected to find an increase in FEV1, verified by spirometry, from a variation of at least 5% in pre‐ and post‐intervention measurements. ; ; INCLUSION CRITERIA: Children and adolescents; both gender; age between 6 and 18 years with a clinical diagnostic of cystic fibrosis

Galan-Martin, M. A., et al. (2019). "Pain neuroscience education and physical exercise for patients with chronic spinal pain in primary healthcare: a randomised trial protocol." BMC Musculoskeletal Disorders 20(1): 505.
	BACKGROUND: Chronic musculoskeletal pain affects more than 20% of the population, and the prevalence is increasing, causing suffering, loss of quality of life, disability, and an enormous expenditure on healthcare resources. The most common location for chronic pain is the spine. Many of the treatments used are mainly passive (pharmacological and invasive) and poor outcomes. The treatments currently applied in the public health system do not comply with the recommendations of the main clinical practice guidelines, which suggest the use of educational measures and physical exercise as the first-line treatment. A protocol based on active coping strategies is described, which will be evaluated through a clinical trial and which could facilitate the transfer of the recommendations of the clinical practice guidelines to a primary care setting. METHODS: Randomised and multicentre clinical trials, which will be carried out in 10 Primary Care centres. The trial will compare the effect of a Pain Neuroscience Education program (six sessions, 10 h) and group physical exercise (18 sessions program carried out in six weeks, 18 h), with usual care physiotherapy treatment. Group physical exercise incorporates dual tasks, gaming, and reinforcement of contents of the educational program. The aim is to assess the effect of the intervention on quality of life, as well as on pain, disability, catastrophism, kinesiophobia, central sensitisation, and drug use. The outcome variables will be measured at the beginning of the intervention, after the intervention (week 11), at six months, and a year. DISCUSSION: Therapeutic interventions based on active coping strategies are essential for the treatment of chronic pain and the sustainability of the Public Health System. Demonstrating whether group interventions have an effect size is essential for optimising resources in such a prevalent problem. TRIAL REGISTRATION: NCT03654235 "Retrospectively registered" 31 August 2018.

Galen, S. S., et al. (2015). "Validity of an Interactive Functional Reach Test." Games for Health Journal 4(4): 278-284.
	INTRODUCTION: Videogaming platforms such as the Microsoft (Redmond, WA) Kinect((R)) are increasingly being used in rehabilitation to improve balance performance and mobility. These gaming platforms do not have built-in clinical measures that offer clinically meaningful data. We have now developed software that will enable the Kinect sensor to assess a patient's balance using an interactive functional reach test (I-FRT). The aim of the study was to test the concurrent validity of the I-FRT and to establish the feasibility of implementing the I-FRT in a clinical setting. SUBJECTS AND METHODS: The concurrent validity of the I-FRT was tested among 20 healthy adults (mean age, 25.8+/-3.4 years; 14 women). The Functional Reach Test (FRT) was measured simultaneously by both the Kinect sensor using the I-FRT software and the Optotrak Certus((R)) 3D motion-capture system (Northern Digital Inc., Waterloo, ON, Canada). The feasibility of implementing the I-FRT in a clinical setting was assessed by performing the I-FRT in 10 participants with mild balance impairments recruited from the outpatient physical therapy clinic (mean age, 55.8+/-13.5 years; four women) and obtaining their feedback using a NASA Task Load Index (NASA-TLX) questionnaire. RESULTS: There was moderate to good agreement between FRT measures made by the two measurement systems. The greatest agreement between the two measurement system was found with the Kinect sensor placed at a distance of 2.5 m [intraclass correlation coefficient (2,k)=0.786; P<0.001] from the participant. Participants with mild balance impairments whose balance was assessed using the I-FRT software scored their experience favorably by assigning lower scores for the Frustration, Mental Demand, and Temporal Demand subscales on the NASA/TLX questionnaire. CONCLUSIONS: FRT measures made using the Kinect sensor I-FRT software provides a valid clinical measure that can be used with the gaming platforms.

Galna, B., et al. (2014). "Retraining function in people with Parkinson's disease using the Microsoft kinect: game design and pilot testing." J Neuroeng Rehabil 11(1): 60.
	BACKGROUND: Computer based gaming systems, such as the Microsoft Kinect (Kinect), can facilitate complex task practice, enhance sensory feedback and action observation in novel, relevant and motivating modes of exercise which can be difficult to achieve with standard physiotherapy for people with Parkinson's disease (PD). However, there is a current need for safe, feasible and effective exercise games that are appropriate for PD rehabilitation. The aims of this study were to i) develop a computer game to rehabilitate dynamic postural control for people with PD using the Kinect; and ii) pilot test the game's safety and feasibility in a group of people with PD. METHODS: A rehabilitation game aimed at training dynamic postural control was developed through an iterative process with input from a design workshop of people with PD. The game trains dynamic postural control through multi-directional reaching and stepping tasks, with increasing complexity across 12 levels of difficulty. Nine people with PD pilot tested the game for one session. Participant feedback to identify issues relating to safety and feasibility were collected using semi-structured interviews. RESULTS: Participants reported that they felt safe whilst playing the game. In addition, there were no adverse events whilst playing. In general, the participants stated that they enjoyed the game and seven of the nine participants said they could imagine themselves using the game at home, especially if they felt it would improve their balance. The Flow State Scale indicated participants were immersed in the gameplay and enjoyed the experience. However, some participants reported that they found it difficult to discriminate between different types and orientations of visual objects in the game and some also had difficulty with the stepping tasks, especially when performed at the same time as the reaching tasks. CONCLUSION: Computer-based rehabilitation games using the Kinect are safe and feasible for people with PD although intervention trials are needed to test their safety, feasibility and efficacy in the home.

Gamboa, E., et al. (2018). "Improving Patient Motivation Towards Physical Rehabilitation Treatments with PlayTherapy Exergame." Studies in Health Technology & Informatics 249: 140-147.
	A key problem in physical rehabilitation treatments is patient motivation since those treatments involve slow, repetitive, and often painful movements. Consequently, little progress may be achieved after a session, leading to longer or even uncompleted treatments. In this paper, PlayTherapy a platform to assist physical rehabilitation treatments is described. PlayTherapy is composed of two main components: (i) a rehabilitation digital exergame, consisting of a set of movement based and interactive mini-games; (ii) an information management system that keeps patient personal progress. Both components were developed in collaboration with a group of physiotherapists. Additionally, a User Experience (UX) evaluation, involving a group of physiotherapists and patients, is presented. This evaluation showed that the inclusion of PlayTherapy in physical rehabilitation treatments may increase patient motivation.

Gandhi, D. B., et al. (2021). "A computer-game-based rehabilitation platform for individuals with fine and gross motor upper extremity deficits post-stroke (CARE fOR U) - Protocol for a randomized controlled trial." Eur Stroke J 6(3): 291-301.
	BACKGROUND & PURPOSE: Activity-based neuroplasticity and re-organization leads to motor learning via replicating real-life movements. Increased repetition of such movements has growing evidence over last few decades. In particular, computer-game-based rehabilitation is found to be effective, feasible and acceptable for post-stroke upper limb deficits. Our study aims to evaluate the feasibility and effectiveness of 12 weeks of computer-game-based rehabilitation platform (GRP) on fine and gross motor skills post-stroke in India. METHODS: Through this trial we will study the effect of adjunctive in-hospital GRP (using a motion-sensing airmouse with off-the-shelf computer games) in 80 persons with subacute stroke, for reduction of post-stroke upper limb deficits in a single-centre prospective Randomized Open, Blinded End- point trial when compared to conventional therapy alone. RESULTS: We intend to evaluate between-group differences using Wolf Motor Function test, Stroke Specific Quality of Life, and GRP assessment tool. Feasibility will be assessed via recruitment rates, adherence to intervention periods, drop-out rate and qualitative findings of patient experience with the intervention. CONCLUSION: The CARE FOR U trial is designed to test the feasibility and effectiveness of a computer-game based rehabilitation platform in treating upper limb deficits after stroke. In case of positive findings GRP can be widely applicable for stroke populations needing intensive and regular therapy with supervision.

Gandhi, G., et al. (2019). "Traditional Indian sports - A case-control study on Kho Kho players investigating genomic instability and oxidative stress as a function of metabolic genotypes." Heliyon 5(6): e01928.
	The beneficial effects of physical exercise regularly for overall well being, or for recreational or professional purposes are widely accepted in clinical practice and have from time immemorial been the reasons for performing traditional sports. On the contrary, there is also evidence implying increased oxidative stress and genetic damage from intensive exercising. Depending on the intensity, time, frequency and characteristics of exercises, there can be differential induction of oxidative stress and provocation of oxidation of cellular macromolecules (including DNA) and cellular dysfunction which can likely accumulate with age, physical attributes and increase the susceptibility to disease on one hand, while stimulating cell signalling pathways leading to cell adaptation and improved resistance to stress, on the other. In order to observe if continuous sports activities as in Kho Kho increase oxidation capacity, which can also provoke oxidation of cellular macromolecules, the effects on oxidative/antioxidant changes and DNA damage in professional Kho Kho players modulated by individual genetic differences were assessed. Kho Kho, a traditional Indian game of 'Tag', is an all-time favourite which requires endurance, agility and strength. Healthy Kho Kho players (20.27 +/- 0.28 y; sports age 6.78 +/- 0.52 y) and controls (20.90 +/- 0.45 y) were matched for age, gender, BMI, VO2 max (maximal oxygen uptake), frequency of GSTT1 (present/null), M1 (present/null), SOD2 (C199T) polymorphisms but differed for variant allele frequencies of GSTP1 (A313G) and SOD2 (C47T). Players compared to controls had significantly increased levels of DNA damage (1.8x, 44.66 +/- 1.68 vs. 23.85 +/- 1.79 mum, p = 0.000), lipid (MDA) peroxidation (2x, 1.72 +/- 0.06 vs. 0.83 +/- 0.16 mumol/l, p = 0.000) and total antioxidant capacity (1.09x, 1.69 +/- 0.06 vs. 1.11 +/- 0.03 mmol Trolox equivalent/l, p = 0.000) but with no differences for SOD activity (94.99 +/- 2.42 vs. 93.36 +/- 2.54 U/ml, p = 0.935). These results suggest that the players have increased genetic damage and oxidative stress probably from the intense physical activity in the absence of other exposure(s) as other attributes were comparable in the study group. The players may therefore be at increased risk for susceptibility to cancer, various diseases and precocious age-related changes and should be sensitized to health risks related to regular intensive physical exercise.

Gandolfi, M., et al. (2017). "Virtual Reality Telerehabilitation for Postural Instability in Parkinson's Disease: A Multicenter, Single-Blind, Randomized, Controlled Trial." BioMed Research International 2017: 7962826.
	INTRODUCTION: Telerehabilitation enables patients to access remote rehabilitation services for patient-physiotherapist videoconferencing in their own homes. Home-based virtual reality (VR) balance training has been shown to reduce postural instability in patients with Parkinson's disease (PD). The primary aim was to compare improvements in postural stability after remotely supervised in-home VR balance training and in-clinic sensory integration balance training (SIBT). METHODS: In this multicenter study, 76 PD patients (modified Hoehn and Yahr stages 2.5-3) were randomly assigned to receive either in-home VR telerehabilitation (n = 38) or in-clinic SIBT (n = 38) in 21 sessions of 50 minutes each, 3 days/week for 7 consecutive weeks. VR telerehabilitation consisted of graded exergames using the Nintendo Wii Fit system; SIBT included exercises to improve postural stability. Patients were evaluated before treatment, after treatment, and at 1-month follow-up. RESULTS: Analysis revealed significant between-group differences in improvement on the Berg Balance Scale for the VR telerehabilitation group (p = 0.04) and significant Time x Group interactions in the Dynamic Gait Index (p = 0.04) for the in-clinic group. Both groups showed differences in all outcome measures over time, except for fall frequency. Cost comparison yielded between-group differences in treatment and equipment costs. CONCLUSIONS: VR is a feasible alternative to in-clinic SIBT for reducing postural instability in PD patients having a caregiver.

Gandy, J. and G. Jensen (1992). "Group work and reflective practicums in physical therapy education: models for professional behavior development." Journal of Physical Therapy Education (American Physical Therapy Association, Education Section) 6(1): 6-10.
	As the professional role of the physical therapist continues to evolve, physical therapy educators are faced with the task of preparing professionals who can solve problems and make decisions in an often ambiguous, complex health care setting. They also, however, are faced with curriculums that are already content rich and that leave little room for new additions. The authors suggest alternative teaching methods that focus on active learning strategies applied in small group process and reflective activities. Small group process can facilitate development of professional behaviors through the use of collaboration, collegiality, goal setting, decision making, divergent thinking, peer evaluation and self-evaluation, and creative problem solving. Reflective activities can be used to help bridge theory with practice. Reflection allows time for analyzing, synthesizing, and integrating complex information and examining alternative strategies and their consequences. Examples of specific classroom activities of these two teaching methods include group expert techniques, game activities, provocative issues, student-designed evaluations, and reflective practicums.

Garcia-Agundez, A., et al. (2019). "Recent advances in rehabilitation for Parkinson's Disease with Exergames: A Systematic Review." J Neuroeng Rehabil 16(1): 17.
	OBJECTIVE: The goal of this contribution is to gather and to critically analyze recent evidence regarding the potential of exergaming for Parkinson's disease (PD) rehabilitation and to provide an up-to-date analysis of the current state of studies on exergame-based therapy in PD patients. METHODS: We performed our search based on the conclusions of a previous systematic review published in 2014. Inclusion criteria were articles published in the indexed databases Pubmed, Scopus, Sciencedirect, IEEE and Cochrane published since January 1, 2014. Exclusion criteria were papers with a target group other than PD patients exclusively, or contributions not based on exergames. Sixty-four publications out of 525 matches were selected. RESULTS: The analysis of the 64 selected publications confirmed the putative improvement in motor skills suggested by the results of the previous review. The reliability and safety of both Microsoft Kinect and Wii Balance Board in the proposed scenarios was further confirmed by several recent studies. Clinical trials present better (n = 5) or similar (n = 3) results than control groups (traditional rehabilitation or regular exercise) in motor (TUG, BBS) and cognitive (attention, alertness, working memory, executive function), thus emphasizing the potential of exergames in PD. Pilot studies (n = 11) stated the safety and feasibility of both Microsoft Kinect and Wii Balance Board, potentially in home scenarios as well. Technical papers (n = 30) stated the reliability of balance and gait data captured by both devices. Related meta-analyses and systematic reviews (n = 15) further support these statements, generally citing the need for adaptation to patient's skills and new input devices and sensors as identified gaps. CONCLUSION: Recent evidence indicates exergame-based therapy has been widely proven to be feasible, safe, and at least as effective as traditional PD rehabilitation. Further insight into new sensors, best practices and different cognitive stadiums of PD (such as PD with Mild Cognitive Impairment), as well as task specificity, are required. Also, studies linking game parameters and results with traditional assessment methods, such as UPDRS scores, are required. Outcomes for randomized controlled trials (RCTs) should be standardized, and follow-up studies are required, particularly for motor outcomes.

Garcia-Bravo, S., et al. (2020). "Effects of Virtual Reality on Cardiac Rehabilitation Programs for Ischemic Heart Disease: A Randomized Pilot Clinical Trial." International Journal of Environmental Research & Public Health [Electronic Resource] 17(22): 16.
	(1) Background: The aim of the present study was to determine the effects of a virtual reality (VR) program, as a complementary tool to a conventional cardiac rehabilitation (CR) program in phase II of patients with ischemic heart disease compared to a conventional treatment group. (2) Methods: A single blinded randomized clinical trial was conducted. The patients were randomized to a control group (CG) or an experimental group (EG). The EG carried out a training based on VR of aerobic exercise using the XBOX ONE console and Kinect sensor. Ergometry, metabolic equivalents (METS), Functional Independence Measure, 6-min walk test (6MWT), the Short Form Health Survey-36 Questionnaire (SF-36), the Beck Depression Inventory-II, and the degree of satisfaction and adherence to treatment were used as outcome measures. (3) Results: Our results showed no statistically significant differences between the two groups. Statistical analysis within group for the EG showed statistically significant changes in the variables HR final ergometry, ergometry minutes, % ergometry, METS, final HR 6MWT, 6MWT distance, 6MWT number of laps, and for the SF-36 and Beck Depression Inventory-II. (4) Conclusion: A VR-based video game program, as an adjunct tool to a CR program, showed improvements in ergometry, METS, resistance to fatigue and health-related quality of life with excellent adherence and satisfaction perceived by patients with ischemic heart disease in phase II.

Garcia-Bravo, S., et al. (2021). "Virtual reality and video games in cardiac rehabilitation programs. A systematic review." Disability & Rehabilitation 43(4): 448-457.
	PURPOSE: To carry out a systematic review about the information about the application of of virtual reality and videogames in cardiac rehabilitation. METHODS: A systematic review was conducted. Jadad scale was applied to evaluate the methodological quality of the articles included and the degree of evidence and the level of recommendation were determined through the Oxford Center for Evidence-Based Medicine. PRISMA guidelines statement for systematic reviews were followed. RESULTS: The total number of articles included in the present review was 10, with heterogeneity in the study populations, cardiac rehabilitation phases, technology used and protocols. Most of the studies showed an increase in heart rate, less pain, a greater ability to walk, higher energy levels, an increase in physical activity and improvements of motivation and adherence. The methodological quality of the studies was between acceptable and poor. CONCLUSIONS: The use of virtual reality and videogames could be considered as complementary tools of physical training in patients with cardiovascular diseases in the different phases of cardiac rehabilitation. However, it is also necessary to carry out studies with adequate methodological quality to determine the ideal technological systems, target populations and clearly protocols to study their effects in the short, medium and long-term assessments.Implications for rehabilitationThe use of virtual reality and videogames could be considered as complementary tools for physical training in patients with cardiovascular diseases.Interactive virtual reality using exergames may promote heart rate, fatigue perception, physical activity and reduce pain in patients with cardiovascular diseases.Virtual reality and videogames enhance motivation and adherence in cardiac rehabilitation programs.

García-Bravo, S., et al. (2020). "Training With Wii Balance Board for Dynamic Balance in Older Adults." Topics in Geriatric Rehabilitation 36(2): 79-85.
	Background and Purpose: Age-related muscle strength deterioration and decreased ability to react appropriately and regain balance after unexpected sudden disturbances and deficit they have in the use of responsible mechanisms to control the dynamic stability in response to a disturbance are important intrinsic risk factors for the fall. The main objective of this study is to verify the impact on the dynamic balance, through the Limits of Stability test, of a physical exercise program in older adults using the Nintendo Wii console. Methods: The sample consisted of a total of 12 patients. Pre and posttreatment measurements and assessments were carried out at the Laboratory of Motion Analysis, Biomechanics, Ergonomics and Motor Control (LAMBECOM) in the Faculty of Health Sciences of the Rey Juan Carlos University. Results and Conclusions: The results of this study show improvements in the scores of all the variables analyzed by Limits of Stability: RT, MVL, EPE, MXE and DCL. The results obtained seem to determine that the protocol used through training with the Nintendo Wii and its Wii Fit video game produced clinical improvements in postural control and dynamic balance and a positive impact on quality of life.

Garcia-Hermoso, A., et al. (2020). "Exercise program and blood pressure in children: The moderating role of sedentary time." Journal of Science & Medicine in Sport 23(9): 854-859.
	OBJECTIVES: The aim of the present study was to test a before-school physical activity intervention (Active-Start intervention) on blood pressure in children and examine whether sedentary time moderates the effect of the intervention on blood pressure. DESIGN: Randomized controlled trial. METHODS: The Active-Start intervention comprising 170 children (8-10 years old) from three public schools with low socioeconomic status in Santiago (Chile). The exercise intervention was delivered daily, before starting the first school-class (8:00-8:30 a.m.), for 8 weeks. The intervention was mainly a program of cooperative physical games at moderate-vigorous intensity. Resting systolic and diastolic blood pressure was determined from the average of two measurements at baseline and at the end of intervention. Moderate-to-vigorous physical activity and sedentary time was assessed using a GENEActiv tri-axial accelerometer prior to the program intervention. RESULTS: The Active-Start intervention decreased blood pressure levels in children (p<0.01) but did not change relative to the control group. Johnson-Neyman analysis revealed a significant relationship between the effect of intervention on systolic blood pressure and mean arterial pressure when sedentary time was below, but not at or above, 657 and 659min per day (i.e., the effect of physical exercise disappears), respectively. CONCLUSIONS: The effect of physical activity on blood pressure could disappear in children with excessive sedentary time, which highlights the need to reduce total levels of sedentary time in the day-to-day life of young people in and out of schools.

Garcia-Hermoso, A., et al. (2020). "Bullying victimization, physical inactivity and sedentary behavior among children and adolescents: a meta-analysis." Int J Behav Nutr Phys Act 17(1): 114.
	BACKGROUND: Physical activity and sedentary behavior are related with psycho-social variables among youth, however its relationship with bullying victimization is unclear. The aim of the study was to clarify the associations between physical activity and sedentary behaviors with bullying victimization among children and adolescents. METHODS: Two independent authors searched in four databases. The studies were selected/included only if participants were children and/or adolescents and the relationship between physical activity and/or sedentary behavior with bullying victimization was reported. Random-effects meta-analyses were used. RESULTS: A total of 18 cross-sectional studies (including 386,740 children and adolescents, 51.8% females) were reviewed. Our study found that not meeting the physical activity guidelines (Odds Ratio [OR] = 1.14, 95% confidence interval [CI], 1.04 to 1.23) and excessive sedentary behavior (i.e., 2 h per day or more of screen time) (OR = 1.21, 95% CI, 1.14 to 1.28) were associated with 14 and 21% higher bullying victimization, respectively. Consistent associations were also found when we analyzed specific forms of bullying for sedentary behavior, including traditional and cyberbullying. CONCLUSIONS: The present study establishes the first quantitative framework for understanding the influence of physical activity and sedentary behavior on bullying victimization, and lays the groundwork for future studies and interventions aimed to its promotion. TRIAL REGISTRATION: CRD42018099388 .

Gatica-Rojas, V., et al. (2017). "Does Nintendo Wii Balance Board improve standing balance? A randomized controlled trial in children with cerebral palsy." European journal of physical & rehabilitation medicine. 53(4): 535-544.
	BACKGROUND: Evidence on the effect of systemic exercise programs to improve the standing balance with the Nintendo Wii system is very limited and its post-treatment effectiveness is unknown in cerebral palsy (CP) patients. AIM: Primary aim was to compare the effect of Nintendo Wii balance board (Wii-therapy) and standard physiotherapy (SPT), on the performance of standing balance in children and adolescents with CP. Secondary aim was to determine the post-treatment effectiveness of Wii-therapy and SPT. DESIGN: Two-arm, matched-pairs, parallel-groups, randomized, controlled clinical trial. SETTING: Outpatient Rehabilitation Centre in the city of Talca. POPULATION: Patients with CP type spastic hemiplegia (SHE) and spastic diplegia (SDI), aged 7 to 14 years, and level I or II of GMFCS or GMFCS-ER. Were excluded patients with FSIQ<80, epilepsy, previous surgeries and application of Botulinum Toxin-A in the lower limb, uncorrected vision and hearing disorders. METHODS: Thirty-two CP patients (10.7+/-3.2 years old) were randomly assigned to either Wii-therapy (SDI=7; SHE=9) or SPT intervention (SDI=7; SHE=9). In each group, patients received three sessions per week over a period of 6 weeks. Standing balance was assessed at baseline and every 2 weeks. Additionally, two follow-up assessments (4 additional weeks) were performed to determine post-treatment effectiveness. Standing balance was quantified on force platform obtaining the outcomes area of center-of-pressure (CoP) sway (CoPSway), standard deviation in the medial-lateral (SDML) and the anterior-posterior (SDAP) directions, and velocity in both directions (VML and VAP). RESULTS: Compared to SPT, Wii-therapy significantly reduced the CoPSway (P=0.02) and SDAP in the eyes-open condition (P=0.01). However, the effects wane after 2-4 weeks. Post-hoc analysis revealed that only SHE children benefited from Wii-therapy. CONCLUSIONS: Wii-therapy was better than SPT in improving standing balance in patients with CP, but improves the balance only in SHE patients. Also, Wii-therapy effectiveness waned 2-4 weeks after the end the intervention. CLINICAL REHABILITATION IMPACT: A systematic exercise program like Wii-therapy using the Nintendo Wii Balance Board device can be considered to improves the standing balance in patients with CP, specifically in the SHE type. This program is easy to transfer to physiotherapists and rehabilitation centers.

Gava, V., et al. (2022). "Effects of Gaming on Pain-Related Fear, Pain Catastrophizing, Anxiety, and Depression in Patients with Chronic Musculoskeletal Pain: A Systematic Review and Meta-Analysis." Games for Health Journal 24: 24.
	The aim was to systematically review the effects of gaming on pain-related fear, pain catastrophizing, anxiety, and depression in patients with chronic musculoskeletal pain. Databases (Medline, EMBASE, PsycInfo, CINAHL, Cochrane Central Register for Controlled Trials [CENTRAL], Web of Science, and SCOPUS) were searched from inception up to October 2021. Two reviewers independently selected randomized controlled trials that compared the effects of any gaming modality with other interventions or no treatment on pain-related fear, pain catastrophizing, anxiety, and depression. For data synthesis, Standardized Mean Differences (SMDs) and 95% confidence interval (CI) were calculated using a random-effects inverse variance model for meta-analysis according to the outcome of interest, comparison group, and follow-up period. The level of evidence was synthesized using Grading of Recommendations, Assessment, Development, and Evaluations (GRADE). Thirteen studies were included with a total sample of 680 patients. Gaming was superior to other treatments and no treatment on reducing pain-related fear (SMD: -1.23; 95% CI: -2.02 to -0.44) and anxiety (SMD: -0.55; 95% CI: -1.01 to -0.09), respectively. Gaming was not superior to other treatments on reducing pain catastrophizing, anxiety, and depression, and it was not superior to no treatment on reducing pain-related fear, pain catastrophizing, and depression. Those findings were based on very low or low-quality evidence. In a conclusion, gaming modalities may have positive effects on some mental health outcomes. However, there were conflicting results with low-quality evidence, which indicates that more high-quality randomized controlled trials are needed.

Gay, V. C., et al. (2019). "Using Asynchronous Exergames to Encourage an Active Ageing Lifestyle: Solitaire Fitness Study Protocol." Studies in Health Technology & Informatics 266: 70-75.
	A healthy and active lifestyle can significantly improve the well-being and quality of life; however, some elderly people struggle to stay motivated and engaged with any form of exercise. The project Elaine (Elderly, AI and New Experiences) addresses this problem by seeking to improve the quality of life of the elderly through exergames. Currently, the project explores a novel approach in the field of health informatics called asynchronous exergaming. This approach, a new trend in games in the health domain, allows the elderly to workout at their own pace, and in their own time, with their physical activity linked asynchronously to a game. This paper presents the study protocol for Solitaire Fitness, a new asynchronous exergame developed by the team. The game aims at increasing the motivation of the elderly to engage in physical exercise whilst helping to maintain their cognitive abilities. It also describes the protocol for the trial. The result of this research has the potential to benefit elderly that need nudging to be motivated to exercise, health care providers treating people with sedentary lifestyles and researchers investigating ways to encourage the elderly to exercise.

Geldenhuys, G., et al. (2014). "Sensory profiling of Egyptian goose (Alopochen aegyptiacus) meat." Food Res Int 64: 25-33.
	No sensory profile information is available for Egyptian goose (Alopochen aegyptiacus) meat. The aim of this study was to conduct descriptive analysis in order to establish the sensory attributes of the breast portion of this species. Meat from guineafowl, Pekin duck, ostrich and broiler chicken were used as reference species. Egyptian goose meat had a very intense game aroma, game flavour and metallic aftertaste, mainly attributable to the muscle's high percentage of polyunsaturated fatty acids and Fe. Egyptian goose meat was also low in tenderness and high residue; this may be due to the high level of physical exercise endured by the breast muscle. Egyptian goose meat proved to be similar to ostrich meat regarding appearance (dark, red colour) and low tenderness, but differed from guineafowl and broiler chicken, the latter two meat types illustrated a higher degree of juiciness and tenderness. These results of Egyptian goose meat can now be used for further sensory studies as it is important to also establish the influence of extrinsic factors such as season and gender on the meat quality of this waterfowl species.

Gerling, K. and R. Mandryk (2014). "Custom-designed motion-based games for older adults: A review of literature in human-computer interaction." Gerontechnology 12(2): 68-80.
	
Gescheit, D. T., et al. (2017). "Injury epidemiology of tennis players at the 2011-2016 Australian Open Grand Slam." Br J Sports Med 51(17): 1289-1294.
	AIM: To examine the epidemiology and in-event treatment frequency of injury at the 2011-2016 Australian Open tournaments. METHODS: Injury incidence was defined as a medical consultation by a tournament physician and in-event treatment frequency as the mean total number of follow-up medical/physiotherapy consultations (2013-2016 tournaments only). Data were collated by sex, injury region and type and reported as frequencies per 10 000 game exposures. Incidence rate s+/- 95% CI and rate ratios were used to test effects for injury, sex and year. RESULTS: Female players experienced more injuries than male players (201.7 vs 148.6). The shoulder (5.1+/-1.1 injuries per year), foot (3.2+/-1.1), wrist (3.1+/-1.5) and knee (3.1+/-1.1) were the most commonly injured regions among females. Knee (3.5+/-1.6), ankle (2.3+/-1.3) and thigh (2.3+/-1.5) were the most prevalent male injuries. Upper arm injuries and in-event treatment frequency increased by >/=2.4 times in both sexes over the 5-year period. Muscle injuries were most frequent. There was a greater than twofold increase in men and women with stress fractures over the 5-year period. The torso region, including the neck, thoracic spine, trunk and abdominal, lumbar spine, hip and groin, pelvis/buttock, attracted high in-event treatment frequencies in both sexes. CONCLUSION: Investigation of injury at the Australian Open suggests that females are more commonly injured than males. Upper and lower extremity injuries affected females while lower limb injuries were more prominent in males. There was an increasing rate of in-event treatments of upper limb and torso injuries as well as stress fractures during the observation period.

Ghisio, S., et al. (2015). "An Open Platform for Full Body Interactive Sonification Exergames." EAI Endorsed Transactions on Serious Games 2(5).
	This paper addresses the use of a remote interactive platform to support home-based rehabilitation for children with motor and cognitive impairment. The interaction between user and platform is achieved on customizable full-body interactive serious games (exergames). These exergames perform real-time analysis of multimodal signals to quantify movement qualities and postural attitudes. Interactive sonification of movement is then applied for providing a real-time feedback based on “aesthetic resonance” and engagement of the children. The games also provide log file recordings therapists can use to assess the performance of the children and the effectiveness of the games. The platform allows the customization of the games to address the children’s needs. The platform is based on the EyesWeb XMI software, and the games are designed for home usage, based on Kinect for Xbox One and simple sensors including 3-axis accelerometers available in low-cost Android smartphones.

Giansanti, D. and G. Maccioni (2019). "Toward the Integration of Devices for Pulmonary Respiratory Rehabilitation in Telemedicine and e-Health." Telemedicine Journal & E-Health 25(3): 257-259.
	Respiratory rehabilitation is a therapeutic path based on performing regular physical exercise. It aims to modify the impact that the respiratory disease has on the patients' quality of life, reducing the severity of the symptoms, and improving their ability to adhere to the activities of daily life. After an initial assessment, they are prescribed (1) different forms and modes of physical exercise and (2) exercise of pulmonary musculature to improve individual performance and the consequences of the symptoms of the emotional sphere related to the pathological condition. At the moment, the devices for pulmonary exercitation/incentivization, even if gamified, give out qualitative information and are not provided with electronics and/or are not connected to the network. The objective of this opinion article is to introduce new models of rehabilitation in this field of Telemedicine and e-Health at a first stage of research. In particular, a new environment for home rehabilitation is proposed, which is based to gamified devices for pulmonary incentivization integrated to the e-Healthcare system integratable also with automatic systems for the 6-min walk tests proposed by the same authors. A first device has been designed and tested. The next steps will be dedicated to the widening of the environment with the design of other devices and to complete the integration with the healthcare system.

Giibbons, J. (2014). "KINESIOLOGY TAPING: THE BRIGHTLY COLOURED TAPE THAT’S MAKING A BIG STATEMENT." SportEX Dynamics(41): 8-12.
	The article focuses on the origins, use, and application of kinesiology taping method (KTM), which has gained popularity in sporting events such as the Olympics and Commonwealth Games. Topics include doctor Kenzo Kase who developed the taping system in the 1970s, the support provided by kinesiology to injured muscles and joints, and the four benefits of KTM.

Gil-Gamez, J., et al. (2016). "Validation and cultural adaptation of "Kujala Score" in Spanish." Knee Surgery, Sports Traumatology, Arthroscopy 24(9): 2845-2853.
	PURPOSE: To translate the patellofemoral disorder questionnaire "Kujala Score" into Spanish and to adapt it for Spanish culture . METHODS: International recommendations were followed to translate the "Kujala Score" into Spanish together with a cultural adaptation and validation. We analysed the following parameters: internal consistency, agreement construct validity, test-retest reliability, ceiling and floor effects, and responsiveness. The reproducibility and responsiveness were tested in 72 patients with patellofemoral pain syndrome in a test-retest design with follow-up testing at 7 days. The "Kujala Score" and the VISA-P were administered to 98 patients and 30 patients, respectively, who completed the "Kujala Score" and VISA-P after physiotherapy treatment, which consisted of rest, ice, proprioceptive exercise and manual therapy. RESULTS: The Spanish "Kujala Score" had high internal consistency (Cronbach alpha = 0.8; if an item was deleted, Cronbach alpha = 0.77-0.80), excellent reliability and agreement (interclass correlation coefficient = 0.99), and good construct validity that was significantly correlated with the outcome of the Spanish VISA-P (Spearman rho = 0.7; P < 0.001). No ceiling or floor effects was detected for the Spanish "Kujala Score" or the responsiveness of the participants based on 40 patients receiving physical therapy, rest, ice and proprioceptive exercises for 1 month, demonstrating that it is a good determinant of changes in the symptomatology of patients with knee pain. CONCLUSIONS: The Spanish adaptation of the patellofemoral disorder questionnaire "Kujala Score" proved to be valid and sensitive to clinical changes and to be a reliable instrument to assess the severity of pain and disability in patients with patellofemoral disorders. This questionnaire will be useful in clinical practice and research as an appropriate tool to evaluate and record the symptomatology of patients with patellofemoral pain syndrome among Spanish population. LEVEL OF EVIDENCE: Diagnostic study, Level I.

Gil-Lacruz, A. I. and M. Gil-Lacruz (2012). "[The role of risk propensity in smokers and overweight people]." Rev Psiquiatr Salud Ment 5(3): 139-149.
	INTRODUCTION: The aim of this study is to investigate the nature of the link associating the risk propensity of smoking and overweight. For example, a person who is a smoker and obese does not have to be more prone to risk than another person who is obese and a non-smoker. MATERIAL AND METHODS: The data was taken from the German Questionnaire on Personality and Daily (Cross section for the period 2005). This questionnaire was selected because it collects individual data on the sociodemographic characteristic, behaviours, risk attitudes, lottery games, and health status. Our main contribution is to analyse the role of risk propensity taking into account smoking and overweight. RESULTS: Risk propensity encourages smoking, and to smoke and be overweight are positively associated. When the role of the unobserved characteristics are greater, the lower is the correlation between smoking and overweight. Although the risk propensity is an important determining factor of individual behaviour (smoking and overweight), its inclusion does not decrease the influence of personal circumstances and conditions. The need to define other measurements to be able to analyse the risk propensity of risk specific to risk behaviour is also highlighted. DISCUSSION: To reduce the number of smokers would require interventions in life styles. Given that overweight is an important determining factor in the decision to smoke, to encourage healthy behaviours, such as physical exercise or balanced diets, could improve the health status of the population on reducing obesity rates, and consequently the number of smokers.

Gitterman, G. (2003). "In the game. Shouldering pain: diagnosing and treating patients with shoulder impingement." Advance for Directors in Rehabilitation 12(7): 25-28.
	
Givon Schaham, N., et al. (2018). "Game analysis and clinical use of the Xbox-Kinect for stroke rehabilitation." International Journal of Rehabilitation Research 41(4): 323-330.
	Whole-body movement is required to interact (play) with Microsoft Xbox with the 3D Kinect sensor (Xbox-Kinect) and, therefore, may be suitable for encouraging and practicing movements as part of stroke rehabilitation. We aimed to describe (i) game analysis, (ii) clinical use, and (iii) to characterize the Xbox-Kinect game experience with individuals with chronic stroke. Four therapists played the Xbox-Kinect games and then carried out a games analysis on the basis of the categories suggested by Deutsch. Eleven participants (age 29-69 years) with chronic stroke and varying motor deficits played Xbox-Kinect games for 4-22 sessions as part of a video-game group intervention and the clinical use was documented. The game experience of 'Bowling' (Kinect-Sport) and '20 000 leaks' (Kinect Adventures) was characterized by self-report questionnaires. Detailed tables of game analysis are provided. The clinical use of the console with the participants is presented. Participants reported high enjoyment and 'somewhat-high' perceived exertion after playing the two games and stated that overall the console suited their therapeutic goals. This information can assist clinicians with their clinical reasoning and decision-making for incorporating the Xbox-Kinect into stroke rehabilitation. Potentially, the Xbox-Kinect could be used as an on-going tool to facilitate whole-body movement and physical activity of individuals with chronic stroke.

gjdkr, R. B. R. (2019). "The use of videogame as a resource for the recovery of post-stroke patients." https://trialsearch.who.int/Trial2.aspx?TrialID=RBR-3gjdkr.
	INTERVENTION: Device Participants will be divided into two groups in a random manner, in which one group will be directed to the physiotherapeutic treatment through Kinesiotherapy, while the other group will be submitted to the physiotherapeutic treatment through the use of Virtual Reality. Both groups will do 12 sessions, these being twice a week for 50 minutes. • CINESIOTHERAPY GROUP: It will be formed by 15 participants. Physiotherapeutic intervention for the control group will be performed by means of passive stretching, assisted and active assets of upper limbs and lower limbs, passive mobilizations, postural shift training, proprioception exercises, gait training, muscular womb manipulation, tactile sensory stimulation , active assisted exercise and isometric exercises. • VIRTUAL REALITY GROUP: It will be formed by 15 participants. Physiotherapeutic intervention will be done through Virtual Reality using adventure games that require limbs and trunk movements, stimulating static and dynamic balance and motor coordination to accomplish the proposed task. Physical Therapy Modalities Procedure/surgery Virtual Reality CONDITION: Stroke Stroke ; Stroke PRIMARY OUTCOME: To evaluate motor control regarding body balance in an objective (baropodometry) and qualitative way (Time Testing up and go), use of the paretic limb (Fugl‐Meyer Scale and Motor Assessment Scale), and motivation of group participants virtual reality. SECONDARY OUTCOME: To evaluate the improvement of the motor control considering a variation of at least 5% in the pre‐ and post‐intervention measurements, as well as the intervention and control groups. ; INCLUSION CRITERIA: 30 individuals from UEAFTO will be recruited or by spontaneous demand. that obey the following criteria: patients of both sexes, aged 35 years and over, with diagnosis of Hemiparesis after ischemic stroke, with a predominant upper limb involvement, with the ability to ambulate, and who does not perform, at the time of the study, physiotherapeutic treatment

Gkikopoulos, G., et al. (2020). "Examining re-injury worry, confidence and attention after a sport musculoskeletal injury." Journal of Sports Medicine & Physical Fitness 60(3): 428-434.
	BACKGROUND: Sport injury is an unfortunate event which can have a major impact on the injured athletes' psychology. Athletes may experience re-injury worry and low levels of attention and confidence getting back to competition following a sport injury. The aim of the study was to examine re-injury worry, confidence and attention of previously injured athletes, before they returned to competition. METHODS: Cross-sectional research design. A total of 52 athletes volunteered for this study, aged 23.1+/-4.8 years old with a previous musculoskeletal injury during the last year. Participants completed the Causes of Re-Injury Worry Questionnaire, the Sport Confidence Questionnaire of Rehabilitated Athletes Returning to Competition and the Attention Questionnaire of Rehabilitated Athletes Returning to Competition, on their first competitive game after rehabilitation program. RESULTS: The athletes experienced average levels of re-injury worry and distraction attention and high levels of confidence and functional attention. The duration of injury, the medical and physiotherapy treatment and the absence from sport were significantly correlated with the questionnaire factors "Re-injury worry due to opponent's ability", "Functional attention" and "Distraction attention". CONCLUSIONS: Psychological characteristics of previously injured athletes may be influenced from the duration of: 1) medical treatment; 2) injury; 3) physiotherapy treatment; and 4) absence from sport, when they return to competition. More research needs to be conducted to confirm the present results.

Glen, K., et al. (2017). "Exergaming: Feels good despite working harder." PLoS ONE [Electronic Resource] 12(10): e0186526.
	Strategies to encourage exercise have led to research on cycle ergometer 'exergaming', as a means of enhancing exercise enjoyment. This research has typically prescribed the exercise intensity and used one exercise mode. The aim of this study was to compare self-selected exercise intensity on a cycle ergometer with and without exergaming modes activated. A total of 20 participants aged between 18-40 years (M = 24.2 +/- 5.9) completed a sub-maximal exercise test. Participants returned two days later to complete one 45 minute session of self-selected exercise with 15 minutes in each of 'control' (standard ergometer), 'track', and 'game' modes, with order randomized. Heart rate, work rate, perceived exertion, and affective valence were recorded during exercise. Dissociation and enjoyment were recorded in the rest interval between each mode. Participants exercised above ventilatory threshold (VT) in all three modes (track, M = 9.5 +/- 12%; game, M = 6.2 +/- 12%; and control, M = 4.4 +/- 14% above VT) and at higher work rates (P < 0.05) exergaming (track, M = 94.5 +/- 27.9; game, M = 96.2 +/- 32.8 watts) than control (M = 86.6 +/- 26.5 watts). Despite exercising at a higher intensity, participants perceived exercise during the exergaming modes to be most pleasant (P < 0.01), with greater enjoyment (P < 0.01) and dissociation (P < 0.01) in the game than track mode, and both modes higher on these variables than the control mode. Findings support the use of exergaming as a strategy to encourage individuals to exercise, with participants choosing to work harder physiologically, but reporting more positive psychological responses during and following the exercise.

Goggins, L., et al. (2020). "Injury and Player Availability in Women's International Pathway Cricket from 2015 to 2019." International Journal of Sports Medicine 41(13): 944-950.
	This prospective cohort study aimed to describe injury and illness epidemiology within women's international pathway cricket, understanding what influences player availability in this unique context where players are contracted part-time. Approximately 8.4% of players were impacted by injury or illness during the year, with an average 2.3% of players completely unavailable on any given day. Most medical complaints occurred during training (111.2 injuries/100 players per year). Of all complaints, medical illness had the highest overall incidence (45.0 complaints/100 players), followed by hand injuries (24.7 injuries/100 players). Gradual onset injuries were most common. Overall average match time-loss complaint prevalence rate was 4.1% and average match time-loss injury incidence rate was 7.0 injuries/1000 days of play. Fielding (56.4 injuries/100 players per year) was the activity resulting in the highest average overall and time-loss injury incidence rates, though 'other' activities (e. g. those occurring outside of cricket participation) collectively accounted for 78.3 injuries/100 players per year. The high incidence of medical illness relative to other complaints may be a distinct feature of the women's cricket international pathway compared to other cricket samples. The high occurrence of injuries arising from 'other' activities, likely due to part-time participation, presents an opportunity for targeted injury prevention strategies.* The first study on an international women's cricket pathway, contributes to the empirical base for specific injury risks associated with the women's cricket game, which is an emerging research area for a developing sport.* Some of the findings may be a distinct feature of the women's cricket international pathway, highlighting potential opportunities for targeted prevention strategies.* With the upcoming development of an elite domestic structure these preliminary findings will provide a good starting point for physiotherapy and medical staff working in these contexts.

Gomes, G. C. V., et al. (2018). "Feasibility, safety, acceptability, and functional outcomes of playing Nintendo Wii Fit Plus(TM) for frail older adults: A randomized feasibility clinical trial." Maturitas 118: 20-28.
	BACKGROUND: Recently, interactive video games (IVGs) have been used as a health-care intervention that provides both exercise and cognitive stimulation. Several studies have shown that IVGs can improve postural control, gait, cognition, and functional independence in elderly people and patients with neurological disease. However, there is a lack of evidence about the effects of IVGs on frail and pre-frail elderly people. The aim of this study was to evaluate the feasibility, safety, and acceptability of playing Nintendo Wii Fit Plus() (NWFP) interactive video games, and the functional outcomes (postural control, gait, cognition, mood, and fear of falling) in frail and pre-frail older adults. METHODS: This study is a randomized controlled, parallel-group, feasibility trial. Participants were frail and pre-frail older adults randomly assigned to the experimental group (EG, n = 15) or control group (CG, n = 15). Participants in the EG performed 14 training sessions, lasting 50 min each, twice a week. In each training session, participants played five of 10 selected games, with two attempts at each game. Participants in the CG received general advice regarding the importance of physical activity. All participants were assessed on three occasions by a blinded physical therapist: before and after intervention, and 30 days after the end of the intervention (follow-up). We assessed the feasibility (score of participants in the games), acceptability (game satisfaction questionnaire), safety (adverse events during training sessions), and functional outcomes: (1) postural control (Mini-BESTest); (2) gait (Functional Gait Assessment); (3) cognition (Montreal Cognitive Assessment); (4) mood (GDS-15); and (5) fear of falling (FES-I). RESULTS: Participants in the EG improved their scores in all 10 games, reported that they understood and enjoyed the tasks of the games, and presented few adverse events during the practice. There was a significant improvement in the Mini-BESTest and Functional Gait Assessment in the EG when compared with the CG (p < 0.05). CONCLUSION: The use of NWFP was feasible, acceptable, and safe for frail older adults and improved their postural control and gait. There were no effects on cognition, mood, or fear of falling. This trial was registered in the Brazilian Registry of Clinical Trials (RBR-823rst) on 11 June 2016.

Gomes, T. T., et al. (2019). "Rehabilitation through virtual reality: physical activity of patients admitted to the intensive care unit." Rev Bras Ter Intensiva 31(4): 456-463.
	OBJECTIVE: To evaluate the level of activity that Nintendo WiiTM can elicit in intensive care unit patients and its associated safety and patient satisfaction. METHODS: Experimental, single-center study performed at a tertiary care hospital. Patients >/= 18 years old who were admitted to the intensive care unit, participated in videogames as part of their physical therapy sessions and did not have mobility restrictions were included. Th exclusion criteria were the inability to comprehend instructions and the inability to follow simple commands. We included n = 60 patients and performed 100 sessions. We used the Nintendo WiiTM gaming system in the sessions. An accelerometer measured the level of physical activity of patients while they played videogames. We evaluated the level of activity, the modified Borg scale scores, the adverse events and the responses to a questionnaire on satisfaction with the activity. RESULTS: One hundred physical therapy sessions were analyzed. When the patients played the videogame, they reached a light level of activity for 59% of the session duration and a moderate level of activity for 38% of the session duration. No adverse events occurred. A total of 86% of the patients reported that they would like to play the videogame in their future physical therapy sessions. CONCLUSION: Virtual rehabilitation elicited light to moderate levels of activity in intensive care unit patients. This therapy is a safe tool and is likely to be chosen by the patient during physical therapy.

Gómez-Portes, C., et al. (2021). "A Platform Based on Personalized Exergames and Natural User Interfaces to Promote Remote Physical Activity and Improve Healthy Aging in Elderly People." Sustainability 13(14): 7578.
	In recent years, there has been a significant growth in the number of research works focused on improving the lifestyle and health of elderly people by means of technology. Telerehabilitation and the promotion of physical activity at home have been two of the fields that have attracted more attention, especially currently due to the COVID-19 pandemic. However, elderly people are sometimes reluctant to use technology at home, mainly due to fear of technology and lack of familiarity. In this context, this article presents a low-cost platform that relies on exergames and natural user interfaces to promote physical activity at home and improve the quality of life in elderly people. The underlying system is easy to use and accessible, offering a number of interaction mechanisms that guide users through the execution of routines and exercises. A relevant feature of the proposal is the ability to customize the exergames, making it possible for the therapist to adapt them according to the user’s needs. Motivation is also addressed within the developed platform to maintain the user’s engagement level as time passes by. An empirical experiment is conducted to measure the usability and motivational aspects of the proposal, which was evaluated by 17 users between 62 and 89 years of age. The obtained results showed that the proposal was well received, considering that most of the users were not experienced at all with exergame-based systems.

Gonzalez-Franco, M., et al. (2014). "Empowering patients to perform physical therapy at home." Annual International Conference Of The IEEE Engineering In Medicine And Biology Society 2014: 6308-6311.
	In this paper we address the problem of patient adherence to physical therapy using a sensor-enabled virtual reality gaming interface that motivates users to complete their exercises while collecting quantitative data. The system also allows the therapist to monitor and interact with patients remotely providing reinforcing feedback and support with the CollaboRhythm care delivery platform. The data collected with this system enables the therapist and the patient to make informed decisions about patient treatment and exercise regimens based on the patient progress. The system is capable of supporting a wide array of rehabilitation scenarios with remote collaboration. A knee replacement scenario was tested with an experimental protocol involving 16 healthy participants. The results show both quantitatively and qualitatively that patients can learn intuitively to perform their physical therapy exercises on a remote environment without further human intervention.

Gonzalo-Bellot, A. and S. Rodríguez-Seoane (2022). "Efectividad de la realidad virtual y los videojuegos sobre el control postural y equilibrio en población infantil con parálisis cerebral en el ámbito de la Atención Temprana. Revisión sistemática." Fisioterapia 44(4): 240-253.
	Las alteraciones motoras de la parálisis cerebral generan alteraciones del control postural y equilibrio. Los videojuegos y la realidad virtual trabajan sobre esos aspectos lúdicamente. El objetivo fue evaluar su efectividad en el control postural y equilibrio en población infantil con parálisis cerebral en Atención Temprana. Entre enero y febrero del 2021 se realizó la búsqueda de ensayos clínicos aleatorizados y sin grupo control en Epistemonikos, Pubmed, Cochrane Library, Web of Science, Scopus, Science Direct, PEDro y Dialnet. Se revisó la bibliografía de guías clínicas, revisiones sistemáticas y metaanálisis. Se complementó con las revistas Fisioterapia , Cuestiones de Fisioterapia y Pediatric Physical Therapy. Tras la elección de artículos utilizándose la Declaración PRISMA, se analizó su calidad con las escalas CONSORT, TREND y SIGN. Se incluyeron 16 estudios que evaluaban el control postural, equilibrio y función motora gruesa en población infantil entre 3 y 13 años con parálisis cerebral. La realidad virtual utilizada fue: Wii, XBOX, PlayStation2, TYROMOTION y ordenador. Los estudios obtuvieron mejoras significativas en variables que median el control postural, equilibrio y función motora gruesa al finalizar y se mantuvieron 4-8 semanas. No indicaron efectos adversos reseñables. La calidad fue variable incluyéndose estudios 1+ y 1− de la escala SIGN. Los estudios reportan cierto grado de efectividad en la mejora del control postural y equilibrio en población infantil con parálisis cerebral en diferentes rangos de edad. Son necesarios estudios con mayor muestra, calidad y población centrada en Atención Temprana para generalizar estos resultados. Motor disorders in cerebral palsy cause alterations in postural control and balance. Video games and virtual reality work on these aspects in a playful way. The objective was to evaluate their effectiveness on postural control and balance in children with cerebral palsy in Early Intervention. Between January and February 2021 we searched in Epistemonikos, Pubmed, Cochrane Library, Web of Science, Scopus, Science Direct, PEDro and Dialnet for randomised clinical trials and trials without a control group. Bibliographies of clinical guidelines, systematic reviews and meta-analyses were reviewed. It was complemented with the journals Fisioterapia, Cuestiones de Fisioterapia and Pediatric Physical Therapy. We use PRISMA Statement. After selecting articles, their quality was analysed using CONSORT, TREND and SIGN scales. Sixteen studies were included that assessed postural control, balance and gross motor function in children aged 3–13 years with cerebral palsy. The virtual reality used was Wii, XBOX, PlayStation2, TYROMOTION and computer. The studies showed significant improvements in variables that evaluate postural control, balance and gross motor function at the end and maintained for 4–8 weeks. Motivation and participation levels increased. No notable adverse effects were reported. Quality was variable, including 1+ and 1− on the SIGN scale. Studies report a certain degree of effectiveness in improving postural control and balance in children with cerebral palsy in different age ranges. Studies with a larger sample, quality and a study population focused on Early Intervention are needed to generalise these results.

Gordon, C., et al. (2012). "Potential of the Nintendo Wii as a rehabilitation tool for children with cerebral palsy in a developing country: a pilot study." Physiotherapy 98(3): 238-242.
	OBJECTIVES: To explore the possibility of using the Nintendo Wii as a rehabilitation tool for children with cerebral palsy (CP) in a developing country, and determine whether there is potential for an impact on their gross motor function. DESIGN: Pilot study with a pre-post-test design. SETTING: Sir John Golding Rehabilitation Center, Jamaica, West Indies. PARTICIPANTS: Seven children, aged 6 to 12 years, with dyskinetic CP were recruited for the study. One child dropped out at week 4. INTERVENTION: Training with the Nintendo Wii was conducted twice weekly for 6 weeks. The games used were Wii Sports Boxing, Baseball and Tennis. MAIN OUTCOME MEASURES: Percentage attendance over the 6-week period, percentage of sessions for which the full duration of training was completed, and changes in gross motor function using the Gross Motor Function Measure (GMFM). RESULTS: All six participants who completed the study had 100% attendance, and all were able to complete the full 45 minutes of training at every session. Those who were wheelchair bound participated in two games, whilst those who were ambulant played three games. The mean GMFM score increased from 62.83 [standard deviation (SD) 24.86] to 70.17 (SD 23.67). CONCLUSION: The Nintendo Wii has the potential for use as a rehabilitation tool in the management of children with CP. Clinical trials should be conducted in this area to determine whether this could be an effective tool for improving gross motor function.

Gouveia, E. S. E. C., et al. (2020). "Effects of the Interactive Videogame Nintendo Wii Sports on Upper Limb Motor Function of Individuals with Post-Polio Syndrome: A Randomized Clinical Trial." Games for Health Journal 9(6): 461-471.
	Objective: To compare the effects of an upper limb videogame-based training with a training based on similar motor demands on upper limb function, dexterity, functionality, balance, fatigue, and pain in post-polio syndrome (PPS) and to assess the acceptability, feasibility, and safety of the intervention. Materials and Methods: This is a randomized, parallel, single-blind clinical trial. Thirty-nine individuals were randomized into Interactive Videogames Group (IVG, n = 19) and Active Exercises Group (AEG, n = 20). Participants performed two weekly sessions (50 minutes each), totaling 14 sessions with the aim of providing mild to moderate intensity. IVG practiced four Nintendo Wii Sport games (tennis, golf, boxing, and bowling). The AEG performed similar movements required for IVG. Primary outcome: upper limb motor function-Motor Function Measure-32. Secondary outcomes: dexterity-Box and Block test; functionality-Functional Independence Measure; balance-Functional Reach Test, muscle fatigue-Fatigue Severity Scale, upper limb pain-Visual Analogue Scale for pain, acceptability, applicability, and safety. Analysis of group, time, interaction between groups, and time effects was performed through repeated-measures analysis of variance (2 x 3) and Bonferroni post hoc test with alpha of 0.05. Results: Interactive videogames were safe, feasible, and acceptable. Both groups showed similar postintervention improvement on motor function, functionality, balance, pain, and fatigue, with maintenance over the follow-up period. There was an interaction effect between the groups on dexterity and the IVG demonstrated better performance compared with the AEG. Final Considerations: The similar positive clinical effects of the interactive video games on PPS upper limb function and its superior effects on dexterity support its use as a safe and feasible intervention. Particularly when it comes to chronic patients, who require long-term physical therapy, new and stimulating interventions may contribute to the rehabilitation process and improve their engagement in the treatment. Registered on the Brazilian Clinical Trials platform under number RBR-8S2NBF.

Goyal, C., et al. (2022). "Virtual Reality-Based Intervention for Enhancing Upper Extremity Function in Children With Hemiplegic Cerebral Palsy: A Literature Review." Cureus 14(1): e21693.
	Cerebral palsy (CP) is the most common cause of motor disability in the pediatric population, with hemiplegia as one of the most widely seen subtypes of spastic CP. Although most of the children with hemiplegic CP are independent ambulators, deficits in hand function of the affected side remain a major concern of caregivers and children themselves. Children use the unaffected upper extremity to compensate for the weakness in the affected one, which consequently leads to the disuse of the hemiparetic upper extremity. Interactive virtual environments can enhance the activation of brain areas during training by providing feedback that can catalyze neuroplastic changes for improved function. Although numerous studies have been conducted on the impact of virtual reality (VR)-based rehabilitation in adults with stroke, studies on its use in the pediatric population are scarce. The three broad categories of VR systems based on the type of human-computer interactions are feedback-focused, gesture-based, and haptic-based. Preliminary studies have shown promising results of VR intervention in improving motor function, including upper extremity function, in children with hemiplegic CP. It is an engaging and entertaining intervention that adds an advantage of high compliance due to motivation. The current literature consists of studies with highly heterogeneous groups of participants and small sample sizes. Further investigation on children with a specific type of CP with advanced VR systems technology is warranted.

Goyal, C., et al. (2022). "Haptic Feedback-Based Virtual Reality Intervention for a Child With Infantile Hemiplegia: A Case Report." Cureus 14(3): e23489.
	Virtual reality (VR) refers to an advanced technology that provides real life-like experience in a virtual environment. Numerous commercially available systems provide gaming opportunities with VR, while a few also provide haptic feedback along with VR. In the recent past, VR has been explored as a viable intervention in the field of neurorehabilitation. Although there are promising results for adults with hemiplegia, the research involving children with infantile hemiplegia is in the nascent stage. Infantile hemiplegia is manifested by sensory and motor deficits predominantly on one side of the body resulting in adverse effects on the functionality of the affected side since early life. VR gaming has an intense, motivational component that encourages children to put sustained voluntary effort to use both upper extremities. A six-year-old male with infantile hemiplegia presented with difficulty in using the left upper extremity. Pre-intervention scores of the nine-hole peg test (9HPT) and box and block test (BBT) were used to evaluate the manual dexterity, while those of ABILHAND-kids and functional independence measure for children (WeeFIM self-care section) assessed the functional independence. The child underwent treatment for six weeks (five days/week), with each session lasting for 60 minutes/day that included VR gaming with haptic feedback for 30 minutes and conventional physiotherapy for 30 minutes. Post-intervention scores were recorded and were compared with pre-intervention scores. Marked improvement in left upper extremity function was noted not only objectively by the outcome measures but also subjectively by the parents as well as by the child. Moreover, the child remarked that he enjoyed the therapy sessions. The findings of this report would facilitate the design of further research in this area in the form of larger trials.

Grampurohit, N., et al. (2021). "Highlighting gaps in spinal cord injury research in activity-based interventions for the upper extremity: A scoping review." Neurorehabilitation 49(1): 23-38.
	BACKGROUND: Upper extremity activity-based therapy for neurologic disorders employs high-intensity, high repetition functional training to exploit neuroplasticity and improve function. Research focused on high-intensity upper extremity activity-based therapy for persons with spinal cord injury (SCI) is limited. OBJECTIVE: To summarize high-intensity activity-based interventions used in neurological disorders for their current or potential application to SCI. METHODS: The scoping review included articles from MEDLINE, CINAHL, Cochrane CENTRAL, and OTSeeker with the criteria: non-invasive activity-based interventions delivered at least three times/week for two weeks, upper extremity functional outcomes, age 13 years or older, English language, and neurological disorders three months post onset/injury. RESULTS: The search yielded 172 studies. There were seven studies with SCI, all in adults. Activity-based interventions in SCI included task-specific training and gaming, with and without electrical stimulation, and a robotic exoskeleton. The other populations found in the review included studies in stroke, cerebral palsy, and multiple sclerosis. Thirty-four different interventions were reported in other populations. In comparison to the extensive stroke research, work in SCI was not found for high-intensity interventions using virtual reality, brain stimulation, rehabilitation devices, and applications to the home and telerehab settings. CONCLUSION: The results highlight critical gaps within upper extremity high-intensity activity-based research in SCI.

Grant, M. E., et al. (2014). "The role of sports physiotherapy at the London 2012 Olympic Games." Br J Sports Med 48(1): 63-70.
	BACKGROUND: There is a lack of information on the utilisation of physiotherapy services at the Olympic Games. AIM: To better understand the athlete and non-athlete requirements of the physiotherapy services at the Olympic Village Polyclinic during the London 2012 Olympic Games. METHODS: From 16 July to 14 August 2012, physiotherapy encounters for athletes and non-athletes (National Olympic Committee (NOC) team officials, coaches, team managers, workforce, Olympic family, technical officials and press) were recorded on the ATOS electronic medical records system at the polyclinic in the main Athletes' Village in Stratford. RESULTS: Of the 1778 encounters, 1219 (69%) were administered to athletes and 559 (31%) to non-athletes. The anatomical areas most frequently recorded at the first visits for athletes were knee (15.4%), lumbar spine/lower back (15.2%) and upper leg (12.6%) and that for non-athletes were lumbar spine/lower back (19.8%), knee (15.8%) and neck/cervical spine. Muscle (33.3%) and joint injuries (24.8%) were the most common diagnoses in athletes and non-athletes (24.4% and 30.1%). The five most frequently used treatment modalities were therapeutic soft tissue techniques (23.3%), mobilisation techniques (21.8%), taping (8.9%), cryotherapy (6.9%) and exercise prescription (6.4%). The most common cause of athletes' injuries was overuse (43.6%). CONCLUSIONS: This study of the London 2012 Olympic Games workload highlights the physiotherapy needs of athletes as well as non-athletes and identifies the high numbers of pre-existing and overuse injuries in this setting, providing an insight into the reasons why the athletes seek physiotherapy support during the Olympic Games.

Grant, M. E., et al. (2021). "The usage of multidisciplinary physical therapies at the Rio de Janeiro 2016 Olympic Summer Games: an observational study." Brazilian Journal of Physical Therapy 25(3): 262-270.
	BACKGROUND: This observational research study analyses the uptake of physical therapies treatments in the Polyclinic during the Rio 2016 Olympic Games. OBJECTIVE: To describe the usage of physical therapies services - physical therapy, osteopath, chiropractic, and sports massage - by athletes and non-athletes and across different sports. METHODS: The multidisciplinary team of physical therapies recorded treatment modalities, information on provider discipline and reason for attendance, in an Electronic Medical Record system throughout the 32 days of operation of the Olympic Polyclinic. Cold-therapy total immersion ice baths (TIIB) were provided as part of the services, but were reported and analysed separately. RESULTS: There were 4993 encounters (4038 athletes, 955 non-athlete encounters). 1395 athletes (12.4% of all athletes) and 393 non-athletes sought treatment. For all four provider disciplines, in addition to TIIB, the primary reason for athlete attendance was for recovery (52% of all encounters), followed by injury treatment (30%), and maintenance (16%). Athletes reported "injury" as the main reason for physical therapy (92% of all encounters, 2.8 encounters per athlete), chiropractic (94%, 1.9) and osteopathy (91%, 1.8) visits. Almost all TIIB visits were used for recovery (98% of all TIIB encounters; 2.1 encounters per athlete). Athletes from handball (37% of all handball athletes), followed by judo (22%), and athletics (21%), presented the largest user groups. CONCLUSION: This Olympic Polyclinic study evaluates the physical therapies' activity, and athlete's reason for use of the multidisciplinary physical therapies team, including total immersion ice bath provision. These results emphasise the importance of a multidisciplinary approach.

Grasso, M. C., et al. (1998). "Music: meeting the challenge of adherence to chest physiotherapy for infants and toddlers with cystic fibrosis." Pediatric Pulmonolgy 26 Suppl 17: 397.
	Daily chest physiotherapy (CPT) plays an integral role in the management of children with CF. CF newborn screening results in the introduction of CPT in infants at approximately 2 months of age. At this time, the parent‐infant routine is often not yet established and the introduction of CPT is potentially overwhelming. In order to facilitate optimal adherence to CPT for both parents and children, parents are encouraged to use adjunctive techniques with CPT such as singing games, stories, television, toys and recorded music. the aim of this study was to assess the effect of specifically composed and compiled music such as an adjunct to CPT. The goals of the music were to provide a distraction for children, encourage positive parent‐infant interaction and facilitate a relaxed environment. Outcomes measures were child and parent enjoyment of the routine and parent perception of time taken to complete the routine. The study utilised an independent and repeated measures experimental design. Twenty parents of children with CF under 2 years of age were randomly allocated to treatment and control groups. Parents in the treatment group used the treatment tape for 12 weeks (TT). Parents in the control group did not receive a music tape for the initial 6 weeks (NT), but used a familiar music tape for the next 6 weeks (FT). All participants were asked to chart the frequency of tape use. Parents were interviewed prior to commencement of the study and twice thereafter at 6 weekly intervals, at which time they were asked to rank their child's enjoyment of CPT, their own enjoyment of CPT and their perception of time taken to complete the routine on a 7‐point Likert scale. The mean unit changes (¦ SD) in enjoyment of and perception of time taken to complete CPT with TT for 6 weeks versus CPT with NT were: child's enjoyment: 1.35 units (¦ 1.9) vs. ‐ 0.70 units (¦ 1.6), p = 0.02; parent's enjoyment: 1.30 units (¦ 1.3) vs. ‐ 0.10 units (¦ 0.9), p = 0.02; and perception of time: ‐4.5 minutes (¦ 16.9) vs. 0.2 minutes (¦ 10.2), p = 0.46. The mean unit change changes (¦ SD) in enjoyment of and perception of time taken to complete CPT after use of the FT for 6 weeks in comparison to NT were: child's enjoyment 0.5 (¦ 1.8), p = 0.4; parent's enjoyment: 1.1 units (¦ 2.4), p = 0.2; and perception of time: + 3.3 minutes (¦ 8.5), p = 0.3. In summary, use of the TT was associated with a significant improvement in child and parental enjoyment of CPT after 6 weeks when compared to no music, while use of the FT did not affect enjoyment of CPT. Perception of time taken to complete the CPT routine did not change significantly, regardless of the use of music. The use of specifically composed music is an effective tool to increase CPT enjoyment for children and parents. This may facilitate a positive experience of CPT and result in improved adherence with CPT in this age group.

Gray, R. C., et al. (2021). Regression Oracles and Exploration Strategies for Short-Horizon Multi-Armed Bandits. Ithaca, Cornell University Library, arXiv.org.
	This paper explores multi-armed bandit (MAB) strategies in very short horizon scenarios, i.e., when the bandit strategy is only allowed very few interactions with the environment. This is an understudied setting in the MAB literature with many applications in the context of games, such as player modeling. Specifically, we pursue three different ideas. First, we explore the use of regression oracles, which replace the simple average used in strategies such as epsilon-greedy with linear regression models. Second, we examine different exploration patterns such as forced exploration phases. Finally, we introduce a new variant of the UCB1 strategy called UCBT that has interesting properties and no tunable parameters. We present experimental results in a domain motivated by exergames, where the goal is to maximize a player's daily steps. Our results show that the combination of epsilon-greedy or epsilon-decreasing with regression oracles outperforms all other tested strategies in the short horizon setting.

Grecco, L. A., et al. (2013). "Effect of transcranial direct current stimulation combined with gait and mobility training on functionality in children with cerebral palsy: study protocol for a double-blind randomized controlled clinical trial." BMC Pediatrics 13(1): 168.
	BACKGROUND: The project proposes three innovative intervention techniques (treadmill training, mobility training with virtual reality and transcranial direct current stimulation that can be safely administered to children with cerebral palsy. The combination of transcranial stimulation and physical therapy resources will provide the training of a specific task with multiple rhythmic repetitions of the phases of the gait cycle, providing rich sensory stimuli with a modified excitability threshold of the primary motor cortex to enhance local synaptic efficacy and potentiate motor learning. METHODS/DESIGN: A prospective, double-blind, randomized, controlled, analytical, clinical trial will be carried out.Eligible participants will be children with cerebral palsy classified on levels I, II and III of the Gross Motor Function Classification System between four and ten years of age. The participants will be randomly allocated to four groups: 1) gait training on a treadmill with placebo transcranial stimulation; 2) gait training on a treadmill with active transcranial stimulation; 3) mobility training with virtual reality and placebo transcranial stimulation; 4) mobility training with virtual reality and active transcranial stimulation. Transcranial direct current stimulation will be applied with the anodal electrode positioned in the region of the dominant hemisphere over C3, corresponding to the primary motor cortex, and the cathode positioned in the supraorbital region contralateral to the anode. A 1 mA current will be applied for 20 minutes. Treadmill training and mobility training with virtual reality will be performed in 30-minute sessions five times a week for two weeks (total of 10 sessions). Evaluations will be performed on four occasions: one week prior to the intervention; one week following the intervention; one month after the end of the intervention;and 3 months after the end of the intervention. The evaluations will involve three-dimensional gait analysis, analysis of cortex excitability (motor threshold and motor evoked potential), Six-Minute Walk Test, Timed Up-and-Go Test, Pediatric Evaluation Disability Inventory, Gross Motor Function Measure, Berg Balance Scale, stabilometry, maximum respiratory pressure and an effort test. DISCUSSION: This paper offers a detailed description of a prospective, double-blind, randomized, controlled, analytical, clinical trial aimed at demonstrating the effect combining transcranial stimulation with treadmill and mobility training on functionality and primary cortex excitability in children with Cerebral Palsy classified on Gross Motor Function Classification System levels I, II and III. The results will be published and will contribute to evidence regarding the use of treadmill training on this population. TRIAL REGISTRATION: ReBEC RBR-9B5DH7.

Greenstein, J., et al. (2021). "Effect of a Mobile Health App on Adherence to Physical Health Treatment: Retrospective Analysis." JMIR Rehabilitation And Assistive Technologies 8(4): e31213.
	BACKGROUND: Adherence to prescribed medical interventions can predict the efficacy of the treatment. In physical health clinics, not adhering to prescribed therapy can take the form of not attending a scheduled clinic visit (no-show appointment) or prematurely terminating treatment against the advice of the provider (self-discharge). A variety of interventions, including mobile phone apps, have been introduced for patients to increase their adherence to attending scheduled clinic visits. Limited research has examined the impact of a mobile phone app among patients attending chiropractic and rehabilitation clinic visits. OBJECTIVE: This study aims to compare adherence to prescribed physical health treatment among patients attending a chiropractic and rehabilitation clinic who did and did not choose to adopt a phone-based app to complement their treatment. METHODS: The medical records of new patients who presented for care during 2019 and 2020 at 5 community-based chiropractic and rehabilitation clinics were reviewed for the number of kept and no-show appointments and to determine whether the patient was provider-discharged or self-discharged. During this 24-month study, 36.28% (1497/4126) of patients seen in the targeted clinics had downloaded the Kanvas app on their mobile phone, whereas the remaining patients chose not to download the app (usual care group). The gamification component of the Kanvas app provided the patient with a point every time they attended their visits, which could be redeemed as an incentive. RESULTS: During both 2019 and 2020, the Kanvas app group was provider-discharged at a greater rate than the usual care group. The Kanvas app group kept a similar number of appointments compared with the usual care group in 2019 but kept significantly more appointments than the usual care group in 2020. During 2019, both groups exhibited a similar number of no-show appointments; however, in 2020, the Kanvas app group demonstrated more no-show appointments than the usual care group. When collapsed across years and self-discharged, the Kanvas app group had a greater number of kept appointments compared with the usual care group. When provider-discharged, both groups exhibited a similar number of kept appointments. The Kanvas app group and the usual care group were similar in the number of no-show appointments when provider-discharged, and when self-discharged, the Kanvas app group had more no-show appointments compared with the usual care group. CONCLUSIONS: Patients who did or did not have access to the Kanvas app and were provider-discharged exhibited a similar number of kept appointments and no-show appointments. When patients were self-discharged and received the Kanvas app, they exhibited 3.2 more kept appointments and 0.94 more no-show appointments than the self-discharged usual care group.

Gregori, D., et al. (2012). "Familial environment in high- and middle-low-income municipalities: a survey in Italy to understand the distribution of potentially obesogenic factors." Public Health 126(9): 731-739.
	OBJECTIVES: To explore the familial and social environment in high- and middle-low-income municipalities in Italy to evaluate the distribution of potentially obesogenic factors. A hybrid methodological approach was chosen. A survey of 1215 Italian children was performed to collect information regarding child, family and peer characteristics; additionally, income data were derived from national estimates based on zip codes. STUDY DESIGN: A cross-sectional study conducted via computer-assisted telephone interviews (CATI). METHODS: A CATI facility was used to interview 1215 Italian children aged 6-10 years. Information regarding family composition; body mass index (BMI) of the child, father and mother; mother's perception of the child's weight; levels of physical activity of the child, father and mother; time spent watching television or playing video games; use of social networks; leisure-time habits; and dietary habits of peers was collected. Income per year per person was obtained from the Italian National Institute of Statistics estimates. Municipalities were divided into two groups: one representing the highest ranking income from the total Italian income distribution, and one representing middle-low incomes. Differences between middle-low-income and high-income groups for child and parent BMIs, social networks, and dietary and leisure-time habits were compared using Wilcoxon and McNemar tests, as appropriate. Multivariate analysis was conducted using logistic regression. RESULTS: In total, 604 high-income children and 611 middle-low-income children were identified. A significant difference in father's BMI was found between middle-low- and high-income groups: 10.5% of fathers in middle-low-income municipalities were obese, compared with 3.8% in high-income areas (P < 0.001). On the contrary, this analysis found no association between income group and the mother's BMI. In this sample, middle-low-income children participated in less physical activity than high-income children (22.7% vs 34.8% participated in sporting activities for more than 3 h per week, P < 0.001), and spent more time in sedentary activities, such as watching television. However, middle-low-income children were not isolated and were surrounded by a wider social network than high-income children (80.4% vs 69% had more than three friends, P < 0.001). CONCLUSIONS: Significant differences were found in the distribution of obesogenic behaviours between middle-low- and high-income municipalities, suggesting that social factors as well as the physical environment should be considered in the development of health policies and interventions to reduce childhood obesity.

Greinacher, R., et al. (2020). Impact of Tactile and Visual Feedback on Breathing Rhythm and User Experience in VR Exergaming. Ithaca, Cornell University Library, arXiv.org.
	Combining interconnected wearables provides fascinating opportunities like augmenting exergaming with virtual coaches, feedback on the execution of sports activities, or how to improve on them. Breathing rhythm is a particularly interesting physiological dimension since it is easy and unobtrusive to measure and gained data provide valuable insights regarding the correct execution of movements, especially when analyzed together with additional movement data in real-time. In this work, we focus on indoor rowing since it is a popular sport that's often done alone without extensive instructions. We compare a visual breathing indication with haptic guidance in order for athletes to maintain a correct, efficient, and healthy breathing-movement-synchronicity (BMS) while working out. Also, user experience and acceptance of the different modalities were measured. The results show a positive and statistically significant impact of purely verbal instructions and purely tactile feedback on BMS and no significant impact of visual feedback. Interestingly, the subjective ratings indicate a strong preference for the visual modality and even an aversion for the haptic feedback, although objectively the performance benefited most from using the latter.

Gremaud, A. L., et al. (2018). "Gamifying Accelerometer Use Increases Physical Activity Levels of Sedentary Office Workers." Journal of the American Heart Association 7(13): 02.
	BACKGROUND: Sedentary work is hazardous. Over 80% of all US jobs are predominantly sedentary, placing full-time office workers at increased risk for cardiovascular and metabolic morbidity and mortality. Thus, there is a critical need for effective workplace physical activity interventions. MapTrek is a mobile health platform that gamifies Fitbit use for the purpose of promoting physical activity. The purpose of this study was to test the efficacy of MapTrek for increasing daily steps and moderate-intensity steps over 10 weeks in a sample of sedentary office workers. METHODS AND RESULTS: Participants included 146 full-time sedentary office workers aged 21 to 65 who reported sitting at least 75% of their workday. Each participant received a Fitbit Zip to wear daily throughout the intervention. Participants were randomized to either a: (1) Fitbit-only group or 2) Fitbit + MapTrek group. Physical activity outcomes and intervention compliance were measured with the Fitbit activity monitor. The Fitbit + MapTrek group significantly increased daily steps (+2092 steps per day) and active minutes (+11.2 min/day) compared to the Fitbit-only arm, but, on average, participants' steps declined during the study period. CONCLUSIONS: MapTrek is an effective approach for increasing physical activity at a clinically meaningful level in sedentary office workers, but as with accelerometer use alone, the effect decreases over time. CLINICAL TRIAL REGISTRATION: URL: https://www.clinicaltrials.gov. Unique identifier: NCT03109535.

Greulich, T., et al. (2013). "A randomized clinical trial comparing the influence of two different training modalities (individualized Vs. Non-Individualized) in patients with moderate to very severe COPD." American journal of respiratory and critical care medicine 187.
	Rationale: Current understanding suggests that physical exercise improves exercise capacity, quality of life (QoL), and exacerbation rate in patients with chronic obstructive pulmonary disease (COPD). Randomized clinical trials comparing different training modalities are scarce. Preliminary results of this trial have already been reported before (Greulich T, et al. Am J Respir Crit Care Med 183;2011:A5046). Methods: We randomized 48 patients with moderate to very severe COPD in an ambulatory training program. Patients were randomized in a 1:1 ratio to one of the following two groups: ‐ 25 Patients randomized to group IT participated in an individualized outpatient exercise training. This training program included all components of exercise training that have been postulated by the joint ACCP/AACVPR clinical practice guidelines. ‐ 23 Patients randomized to non‐individualized training (NT) participated as part of a group together in different exercises which included ball games and other playful aspects. ‐ 8 patients not willing to undergo physical exercise served as a control group (CG). The following assessments have been performed before and after having attended at least 12 training sets in not more than 18 weeks: 6‐minute walking test (6‐MWT), ultrasound measurement of rectus femoris cross‐sectional area (US), and measurement of QoL (COPD‐Assessment‐Test (CAT)). Results: Dropout rates were as follows: 52% percent did not complete NT, 28% percent did not complete IT. The comparison between baseline and final assessment of the CG showed no differences. For the IT group the 6MWT increased from 395 m +/‐ 104.39 m to 429.12 m +/‐ 126.1 m (p=0.02) while the improvement in US demonstrated a trend towards improvement (6.38cm2 +/‐ 2.49cm2 to 6.89cm2 +/‐ 1.94cm2; p=0.098). In the NT group, only minor improvements of the 6MWT (399.55m +/‐ 59.94m to 408.89m +/‐ 54.3m; p=0.085) and the US (6.33cm2 +/‐ 3.24cm2 to 6.73 cm2 +/‐ 1.7cm2; p=0.77) could be detected. Comparing individual improvements between both training modalities, no difference was detected. However, the comparison between improvements in CG and IT yielded a significant difference in the US measurement in favor of individualized training (p=0.038; figure 1). No significant results were seen regarding QoL. (Figure presented) Conclusion: Training performed only once weekly does not result in clinically meaningful improvements. Comparing IT with NT, individualized training seems to confer modest advantages.

Grießmeir, M. and B. Hanne-Behke (2012). "Nintendo Wii in patients with Parkinson's disease: the use in the outpatient physiotherapy effectively?" Zeitschrift fur physiotherapeuten 64(7): 6‐18.
	
Griffin, M., et al. (2012). "Using the Nintendo Wii as an intervention in a falls prevention group." Journal of the American Geriatrics Society 60(2): 385-387.
	
Griffin, M., et al. (2013). "Comparing the Energy Expenditure of Wii Fit()-Based Therapy Versus Traditional Physiotherapy." Games for Health Journal 2(4): 229-234.
	OBJECTIVE: Activity-promoting computer gaming systems, which encourage the use of the body to control game play, are commonly used in rehabilitation. However, the mechanisms by which improvements in clinical outcomes occur after using activity-promoting gaming systems are unknown. Therefore the aims of this study were to compare the physiological cost and enjoyment of Nintendo((R)) (Kyoto, Japan) Wii Fit-based therapy compared with traditional-based physiotherapy training. SUBJECTS AND METHODS: Young adults (n=35), 20.7+/-1.6 years old, carried out a traditional physiotherapy training program and a Wii Fit-based training program. Energy expenditure was assessed using indirect calorimetry while at rest and during training modes, and enjoyment was measured using a modified Physical Activity Enjoyment Scale. RESULTS: For the traditional physiotherapy-based program, all physiological measures (oxygen consumption [VO2], energy expenditure, and metabolic equivalents [METs]) were significantly greater (VO2, 0.64 versus 0.51 L/minute; energy expenditure, 186.0 versus 146.5 J/kg/minute; METs, 2.6 versus 2.1) than for the Wii Fit-based program. Enjoyment was rated statistically significantly higher for the Wii Fit-based program (76.0+/-13.7 percent) compared with the traditional program (67.5+/-14.8 percent). CONCLUSIONS: The lower physiological cost associated with the Wii Fit suggests that it is less demanding than the traditional therapy, even though this modality of training has been shown to elicit improvements in rehabilitative outcomes. This suggests that frailer individuals, whose energy levels are impaired, may benefit from using the Wii Fit as a rehabilitative tool because of the lower demand on energy.

Griffiths, M. (2005). "Video games and health." BMJ 331(7509): 122-123.
	
Gröbl, P. and V. Saraph (2013). "Long-term results with Game-Based Physiotherapy (GBPT) according to Schroth in children with Juvenile Idiopathic Scoliosis (JIS)." Scoliosis 8(S2): O46-O46.
	
Grunert, R., et al. (2019). "A technical concept of a computer game for patients with Parkinson's disease - a new form of PC-based physiotherapy." International Journal of Neuroscience 129(8): 770-775.
	Background: At present, there are no meaningful and sophisticated computer games that simultaneously allow the treatment of movement disorders such as Parkinson's syndrome. In particular, there are no systems to consider the severity of the disease and the physical skills of the patient. Methods: A computer game using the Microsoft Kinect as markerless sensor for the 3 D recognition of the patient's movement was developed to support the rehabilitation. The scenario of a basketball game was created after determining that the movement like throwing a ball and the correct posture of the body are important. A study based on system usability was performed with 15 patients to evaluate the system. Results: The technical feasibility of a computer-assisted training system for supporting patients with Parkinson's disease has been demonstrated. No markers on the patient are required for movement detection and allow a user-friendly handling. Regarding the usability study, the patients were accepting of such a system and its at-home use and symptoms like 'freezing' and the Pisa syndrome can be treated. Conclusions: The physiotherapist can be assisted by the developed rehabilitation system. An objective measurement of the patient's training progress delivers valuable information to adjust the training sessions for every patient individually. Due to its modular character, the system can also be applied to other diseases or sports injuries and offers the basis for further development.

Guggenberger, B., et al. (2021). "Instrumental Validity of the Motion Detection Accuracy of a Smartphone-Based Training Game." International Journal of Environmental Research & Public Health [Electronic Resource] 18(16): 09.
	Demographic changes associated with an expanding and aging population will lead to an increasing number of orthopedic surgeries, such as joint replacements. To support patients' home exercise programs after total hip replacement and completing subsequent inpatient rehabilitation, a low-cost, smartphone-based augmented reality training game (TG) was developed. To evaluate its motion detection accuracy, data from 30 healthy participants were recorded while using the TG. A 3D motion analysis system served as reference. The TG showed differences of 18.03 mm to 24.98 mm along the anatomical axes. Surveying the main movement direction of the implemented exercises (squats, step-ups, side-steps), differences between 10.13 mm to 24.59 mm were measured. In summary, the accuracy of the TG's motion detection is sufficient for use in exergames and to quantify progress in patients' performance. Considering the findings of this study, the presented exer-game approach has potential as a low-cost, easily accessible support for patients in their home exercise program.

Guimarães, V., et al. (2021). "An Exergame Solution for Personalized Multicomponent Training in Older Adults." Applied Sciences 11(17): 7986.
	In addition to contributing to increased training motivation, exergames are a promising approach to counteract age-related impairments. Mobility limitations, cognitive impairment, and urinary incontinence are very common in older adults. To optimally address these conditions, exergames should include interventions for strength, balance, cognition, and pelvic floor muscle training. In this study, we develop a personalized multicomponent exergame solution for the geriatric rehabilitation of age-related impairments. The exergame can provide interventions for balance, strength, cognition, and urinary incontinence in one single session, accommodating the needs of older adults with multiple disabilities. For its development, we involved a multidisciplinary team that helped us to specify the structure and contents of the exergame considering training requirements, game design principles, and end-user characteristics. In addition to allowing the customization of the training components, the exergame includes automatic adaptation of difficulty/load, in line with player progress over time. The game mechanics ensures the fulfilment of training needs as defined by the therapist. The exergame is cross-platform compatible (web-based) and includes novel means of interaction with wearable sensors.

Gummesson, C. and L. J. Remedios (2018). "Searching our mindset – looking at places and spaces in education." Physical Therapy Reviews 23(1): 1-3.
	An introduction to articles in the issue is presented on topics including whether assessment can be counter-productive and reinforce a problematic mindset among students, tips on the practicalities of designing assessment tasks, and the use of augmented reality and gaming technology to devise ways of helping students to learn functional anatomy.

Guo, D. and Z. Yang (2022). "Sports Facilities Investment Based on Multi-objective Optimization and Attribute Decision-Making." Mathematical Problems in Engineering 2022: 1-12.
	With the development of the social spiritual civilization, people pay more and more attention to physical health. The construction of sports facilities is an important way to improve the national physical quality, which helps to promote the national exercise. So, the demands of sports facilities around the world are in the climax. The blind and crazy expansion of sports facilities can alleviate people’s demand for physical exercise to a certain extent, but there are also risks of environmental damage and economic waste. At present, there is still a lack of scientific guiding theory for the investment decision-making of sports design. In order to improve the quality and efficiency of the sports facility’s construction, its investment decision-making research was combed. According to the requirements, construction goal, and the restriction of the sports facility’s construction, the method of multi-objective optimization and attribute decision was studied and adopted to provide guidance for sports facilities investment decisions-making in this article. And sports facilities construction plan in a given area was taken as a study example to verify the effectiveness of the results studied in this paper. The results showed that the application of multi-objective optimization and attribute decision-making methods to guide the investment and construction of sports facilities can improve its economy and reduce environmental pollution.

Guo, W., et al. (2021). "Effects of Open-Skill Exercises on Cognition on Community Dwelling Older Adults: Protocol of a Randomized Controlled Trial." Brain Sciences 11(5).
	(1) Cognitive function may benefit from physical exercise in older adults. However, controversy remains over which mode of exercise is more beneficial. (2) The aim of the proposed study is to investigate the effect of open-skill exercise training on cognitive function in community dwelling older adults compared with closed-skill exercise, cognitive training, and active control. (3) One hundred and sixty participants, aged between 60 and 80 years old, will be recruited from community senior centers in Yangzhou, China and randomly assigned to one of four groups: open-skill exercise group, closed-skill exercise group, mobile game playing group, and active control group. All participants will join a 24-week program involving 50 min sessions three times a week. The primary outcome measure is visuospatial working memory. Secondary measures include subjective memory complaint, attention network, nonverbal reasoning ability, and physical activities. All participants will be measured before, mid-way, and immediately after intervention, and three months later. (4) If successful, this study is expected to provide evidence-based recommendations for older adults to select the most efficient and effective mode of exercise to improve cognitive function. Importantly, the three intervention groups provide an opportunity to separate the cognitive activity component from the physical activity component. Comparison of these components is expected to help elucidate possible mechanisms contributing to the additional cognitive benefit of open-skill exercises.

Gutierrez, R. O., et al. (2013). "A telerehabilitation program by virtual reality-video games improves balance and postural control in multiple sclerosis patients." Neurorehabilitation 33(4): 545-554.
	BACKGROUND: Balance and postural control (PC) disorders are frequent motor disorder symptoms associated with multiple sclerosis (MS). OBJECTIVE: To demonstrate the potential improvements in balance and PC among patients with MS who complete a virtual reality telerehabilitation program that represents a feasible alternative to physical therapy for situations in which conventional treatment is not available. METHODS: 50 patients was recruited. Control group (n = 25) received physiotherapy treatment twice a week (40 min per session). Experimental group (n = 25) received telerehabilitation treatment using the Xbox 360(R) console monitored via videoconference. Experimental group attended 40 sessions, four sessions per week (20 min per session). The treatment schedule lasted 10 weeks for both groups. A computerised dynamic posturography and clinical outcomes (Berg Balance and Tinettti scales) were used at baseline and at the end of the treatment. RESULTS: Results showed an improvement over general balance in both groups. Visual preference, the contribution of vestibular information, mean response time and Tinetti test yielded significant differences in the experimental group. An ANOVA revealed significant between-group post-treatment differences in the composite equilibrium score, Berg and Tinetti scales in the experimental group. CONCLUSION: We suggest that our virtual reality program enables anticipatory PC and response mechanisms and might serve as a successful therapeutic alternative in situations in which conventional therapy is not readily available.

gwjgj, R. B. R. (2018). "Use of Virtual Immersion Therapy to improve the Posture, Balance and Walking of children with Hearing Loss." https://trialsearch.who.int/Trial2.aspx?TrialID=RBR-2gwjgj.
	INTERVENTION: Children in both groups will receive treatment for eight weeks (2 months). There will be two sessions per week, lasting 50 minutes in each session. Children from both groups will receive information on the first day of each treatment (Physiotherapy or Virtual Reality). In order to provide the child with an understanding of what their participation in the study will be and how the exercises and games will be, in this case, the experimental group. This training will not be counted as one of the intervention sessions. It will last 30 minutes and will serve as a child to understand and live with the exercises and games proposed by the study. The intervention group will make use of two Xbox360 virtual games, they are: rapids and summit reflexes, for 50 minutes. Reflexes: A game in which the child is on a platform in movement, which transports it, having to overcome obstacles that will appear through jumps, squats and medio‐lateral displacements of the body. Rapids: The child is on a boat that descends a turbulent river until arriving at the end in a safe place, not forgetting to collect items that guarantee more points in the way. For this, the child should perform jumping movements, squats, mid‐lateral displacement with the body, to change the direction of the boat. At certain times she needs to jump to reach hard‐to‐reach areas. Each game will be used for 25 minutes. The control group will do training with static and dynamic balancing exercises for vestibular rehabilitation. The proposed exercises will be kept balanced in the following Physiotherapy devices: Balancing standing on the ground with eyes open and closed for two minutes in each position. Keep balanced on the balance boards with lateral and antero‐posterior displacement, for five minutes each board, perform free jumps on a trampoline in front of a mirror for five minutes, walk in a straight line demarcated in the ground (with open eyes and closed) and on a line demarcated in a block o E02.779 CONDITION: Child, Posture, Postural Balance, Gait, Virtual Reality Exposure Therapy ; M01.060.406 ; G11.427.695 ; G11.427.690 ; E01.370.600.250 ; F04.754.137.506.662 E01.370.600.250 F04.754.137.506.662 G11.427.690 G11.427.695 M01.060.406 PRIMARY OUTCOME: Postural control: continuous quantitative variable, expressed by centimeter squared, obtained through the velocity of oscillation of the child's center of pressure (COP), in the anteroposterior and medial‐lateral directions, during the tests performed on the force platform, the greater the body oscillation of the child, the worse its postural control Body balance: obtained through the circular displacement area of the child, during the tests performed on the force platform, the greater the area of oscillation of the child's balance, the worse your balance; ; ; ; Falls: a quantitative variable, expressed through the frequency of falls in the last week and in the last month, perceived by both the child and his caregivers, the higher the frequency of falls, the worse the result of therapy Functionality: quantitative variable, expressed through scoring, obtained through the child's self‐assessment and the evaluation of the mother or caregiver, the lower the child's score on this scale, the worse your functionality Gait: quantitative variable, expressed by scoring, obtained by performing gait‐related functional tasks which the researcher observes and scores using the Dynamic Gait Index (DGI) scale and by the final score of the timed up and go test , provided in seconds, the lower the child's score on the scale, the worse the gait performance, and the slower the child is to perform the test the worse his performance, respectively Quality of life: quantitative variable, expressed through scoring, obtained through the self‐evaluation of the child in both scales,the lower the child's score on this scale, the worse your quality of life ; Vertical jump: quantitative variable, expressed in milliseconds, square centimeters and meters per second, the higher the jump, the better the balance stability nd the better the therapy efficacy SECONDARY OUTCOME: Conventional Physical Therapy Exercises: (vestibular rehabilitation): the exercises will be divided into four categories: coordination, agility, eye‐hand and balance, will be performed repetitive physical exercises, with the use of a trampoline, some cones, ropes, ball, rocker, balance boards and orthopedic foams, mirror for the child to try to balance these instruments by means of the therapeutic exercises Virtual Immersion Therapy: exergame, game of Xbox 360, kinect adventure, released on november 4, 2010, we will use the games: ridge of reflexes and chutes INCLUSION CRITERIA: The children must be enrolled or in attendance in the collaborating institutions of this study; to be in the age group between 7‐11 years of age; to present, through a medical report, diagnosis of sensorineural hearing loss; to have degrees of hearing loss (severe to profound) (values higher than 70 dB); dominate the Brazilian sign language, this last criterion will be used to ensure that all the commands referring to the demands of the methodology will be understood by all children, we also point out that, all children have access to learning the Brazilian language of signs in your institution of education and the child must undergo exams of auditory and vestibular function

Gyan, T. (2012). "MY OLYMPIC EXPERIENCE." SportEX Medicine(54): 34-34.
	A personal narrative is presented which explores the author's experience volunteering as first responder physiotherapist in the medical team at the International Broadcasting Centre (IBC) and at the Olympic Park at the Paralympic Games during the Olympic Games 2012 in London, England.

h2pr, R. B. R. (2018). "Effect of video games on rehabilitation in patients in the burn therapy unit in sergipe." https://trialsearch.who.int/Trial2.aspx?TrialID=RBR-77h2pr.
	INTERVENTION: F04.754.137.506.662 The intervention is in patients with burns in the thorax and upper limbs inside an intensive burn unit, submitted to two physiotherapeutic interventions. The test group (n=10) will undergo rehabilitation through virtual reality with the Nintendo Wii sport console (tennis, golf and boxing) and the control group (n= 10) will undergo rehabilitation with conventional physiotherapy (active exercises that contemplates the same objective of the test group). Both interventions lasted 30 min, one session per day for 10 days. CONDITION: Burned ; N02.278.388.493.160 N02.278.388.493.160 PRIMARY OUTCOME: The presentation of the expected outcome is that game therapy may be a viable tool in rehabilitation in burn patients in the acute phase compared to conventional physiotherapeutic treatment. There was no significant difference in the intergroup variables, demonstrating that the therapeutic responses between the protocols were similar. The results of this study emphasize the importance of physiotherapy in burn patients to obtain functional and emotional gains, and game therapy is a resource with great therapeutic potential in the recovery of this patient profile. SECONDARY OUTCOME: In the intra‐group analysis of the studied variables, we observed in the group treated with Nintendo Wii sport (Gwii) a significant increase in MEP (p = 0.0226), right upper limb dynamometry (DMSD) (p = 0.0203), dynamometry (p = 0.0367), Functional Independence Measure ‐ MIF (p = 0.0003) and (P = 0.0019), as well as a significant reduction in the level of anxiety and pain (p = 0.0323), whereas in the group treated with conventional physiotherapy (GFt) all variables studied had a significant improvement. However, in the assessments between the groups (intergroups), there was no significant difference in any of the studied variables. The secondary outcome is to observe the effect of game therapy (Nintendo Wii sport) through instruments that assess maximum respiratory pressures, palmar pre‐healing strength, functionality, cardiorespiratory fitness and anxiety / pain. INCLUSION CRITERIA: Patients with burns 2nd and 3rd grades in the thorax and upper limbs, which are hemodynamically stable, suitable for rehabilitation in terms of cognitive ability to follow simple commands, have normal or corrected vision and hearing with the use of orthoses.

Hadab, Z. A., et al. (2019). "The Effect of Compound Exercises in the Lactic Ability in the Futsal for Female Players." Indian Journal of Public Health Research & Development 10(8): 1151‐1155.
	The importance of the research lies in the importance of the physiological side and the role it plays in assessing the training and functional status of the five penthouse football players and what the trainer can do to train the training to develop the athletic ability of five‐legged football players to continue the skillful performance for the longest period without feeling tired. The problem of research in the low level of physical performance and weakness of the ability to maintain the same level as they started in the competition and this decline in the level of physical reflected clearly on the performance of the team in the skill and weakness in the speed of the implementation of the various skills required by the nature of the game during the game, the case drew the attention of the researchers and its interest to know the hidden reasons behind it in order to diagnose and try to develop solutions and appropriate treatments through a training curriculum to develop the athletic ability of the players of the five‐footed football halls. The aim of the study was to identify the effect of the use of compound exercises in the athletic ability of five‐legged football players. The researchers used the experimental method in the controlled control method, experimental group, pre‐test and control group for its suitability and the nature of solving the research problem. The entire community of Basrah,Al‐Basrah players was selected by five football lounges as a sample and randomly divided into two groups (experimental group and control group), with five players in each group. And then make them homogeneity and equivalence for the purpose of starting from the point looked one. The researchers prepared five physical exercises in futsal, within the period of special preparation of the team to compete with 36 training units over a period of three months with (12) weeks and exercise time 30 minutes from the main section of (60) minutes. The results were statistically significant. The researchers concluded that the Compound physical and functional exercises at (30) second and over three months resulted in an improvement in the lactic ability of the functional organs better than the traditional exercises. Therefore, the researcher recommends the need to apply and implement the Compound exercises and its time is relatively long to develop the physiological indicators of lactic ability.

Haghighi Osgouei, R., et al. (2020). "Rehabilitation Exergames: Use of Motion Sensing and Machine Learning to Quantify Exercise Performance in Healthy Volunteers." JMIR Rehabilitation And Assistive Technologies 7(2): e17289.
	BACKGROUND: Performing physiotherapy exercises in front of a physiotherapist yields qualitative assessment notes and immediate feedback. However, practicing the exercises at home lacks feedback on how well patients are performing the prescribed tasks. The absence of proper feedback might result in patients performing the exercises incorrectly, which could worsen their condition. We present an approach to generate performance scores to enable tracking the progress by both the patient at home and the physiotherapist in the clinic. OBJECTIVE: This study aims to propose the use of 2 machine learning algorithms, dynamic time warping (DTW) and hidden Markov model (HMM), to quantitatively assess the patient's performance with respect to a reference. METHODS: Movement data were recorded using a motion sensor (Kinect V2), capable of detecting 25 joints in the human skeleton model, and were compared with those of a reference. A total of 16 participants were recruited to perform 4 different exercises: shoulder abduction, hip abduction, lunge, and sit-to-stand exercises. Their performance was compared with that of a physiotherapist as a reference. RESULTS: Both algorithms showed a similar trend in assessing participant performance. However, their sensitivity levels were different. Although DTW was more sensitive to small changes, HMM captured a general view of the performance, being less sensitive to the details. CONCLUSIONS: The chosen algorithms demonstrated their capacity to objectively assess the performance of physical therapy. HMM may be more suitable in the early stages of a physiotherapy program to capture and report general performance, whereas DTW could be used later to focus on the details. The scores enable the patient to monitor their daily performance. They can also be reported back to the physiotherapist to track and assess patient progress, provide feedback, and adjust the exercise program if needed.

Haik, J., et al. (2006). "The use of video capture virtual reality in burn rehabilitation: the possibilities." Journal of Burn Care & Research 27(2): 195-197.
	We independently explored the use of the Sony PlayStation II EyeToy (Sony Corporation, Foster City, CA) as a tool for use in the rehabilitation of patients with severe burns. Intensive occupational and physical therapy is crucial in minimizing and preventing long-term disability for the burn patient; however, the therapist faces a difficult challenge combating the agonizing pain experienced by the patient during therapy. The Sony PlayStation II EyeToy is a projected, video-capture system that, although initially developed as a gaming environment for children, may be a useful application in a rehabilitative context. As compared with other virtual reality systems the EyeToy is an efficient rehabilitation tool that is sold commercially at a relatively low cost. This report presents the potential advantages for use of the EyeToy as an innovative rehabilitative tool with mitigating effects on pain in burn rehabilitation. This new technology represents a challenging and motivating way for the patient to immerse himself or herself in an alternate reality while undergoing treatment, thereby reducing the pain and discomfort he or she experiences. This simple, affordable technique may prove to heighten the level of patient cooperation and therefore speed the process of rehabilitation and return of functional ability.

HaitaoHao, et al. (2021). "Physical education and its role in improving the health of college students by active participation and optimization by deep learning." Aggression and Violent Behavior: 101628.
	Lack of physical exercise leads to many complicated diseases such as obesity, diabetes, and cardiovascular diseases, or even death in certain cases. College students are at an age where their physical activity levels decline. Physical education may be beneficial in preserving the student's life and improve their health condition. This paper aims to provide support and optimization using a deep learning approach for the students in their college environment. Deep Learning (DL) allows the students to create their areas of interest and set their own rules, leading to active participation. DL increases the students' level of participation by providing effective communication, collaboration, creativity, technological advancement, critical thinking, personalized and real-time learning. The participation of the students can be initiated by allowing them to select a game and exercise routine in their area of interest. If one team does exercise, then another team will participate in the game of their choice. With the help of DL, they can change a rule or adapt a constant. With a lot of training, they will figure out how to excel in their physical activity. This program aims to involve everyone in this task, and nobody should be left out. The critical aspects such as the low performance of a student in physical activity are considered significantly critical and should be maximized to improve the accuracy of the student's performance. Students should take their failure as an opportunity to discover an alternate approach to succeed in it. Optimization is provided by selecting the best approach for each student from the set of available approaches by reducing the student's perception level and increase motivation to engage in each activity. Physical training has a positive impact on the student's health with a 94% increase in energy expenditure and 82% in the fitness rate of the students. The deep learning approach used maximized efficiency in increasing the students' participation and performance level up to 92%.

Halfon, S. T., et al. (1990). "Physical activity program during working hours among industrial workers in Israel." Harefuah 118(9): 511‐513.
	During 1984‐1985, 540 employees of 2 pharmaceutical factories of the Teva concern participated in a physical activity program. To evaluate its effects on employees' health, the participants were randomly divided into 2 groups of equal size. The test group participated in regular physical exercise before lunch for 15 minutes, 5 days a week. The controls played social games for the same time periods while seated. The physical activity program included stretching, relaxing, and aerobic exercises. The program was carried out by employees who had been trained to be instructors by the researchers and were supervised by a professional teacher. During the 7 months of the study, adherence was about 90%. The results in test and control groups were determined by questionnaires. After 7 months, the test group clearly showed increased interest in sports activities, increased job satisfaction and work efficiency, and decreased fatigue during work.

Hamilton, C., et al. (2021). "Usability of affordable feedback-based technologies to improve mobility and physical activity in rehabilitation: a mixed methods study." Disability & Rehabilitation: 1-10.
	PURPOSE: To explore physiotherapists' views on the usability of feedback-based technologies used in physical rehabilitation. MATERIALS AND METHODS: A mixed methods study which was nested within a randomised controlled trial to investigate the effectiveness of affordable feedback-based technologies to improve mobility and physical activity within aged care and neurological rehabilitation. Technologies included virtual reality systems, handheld device apps and wearable devices. Physiotherapists (n = 11) who were involved in prescribing technologies during the trial rated the usability of 11 different devices using the System Usability Scale (SUS), then attended a focus group. Descriptive statistics and framework analysis were used for analysis. RESULTS: Fitbit devices (mean 89.8, SD 9.3), Fysiogaming (mean 75.6, SD 15.3) and Xbox Kinect (mean 75.5, SD 11.2) rated in the acceptable range (>70) on the SUS. Three key factors on usability emerged from the focus groups: (1) Key device features relating to practicalities (ease of set up and use, reliability, safety) and therapeutic benefit (customisation, high active practice time, useful feedback) are important for usability; (2) Usability depends on the context of use; and (3) Usability can be enhanced with technical, clinical, environmental and financial support. CONCLUSIONS: Health service managers and clinicians should consider key device features identified, contextual factors of their service, and supports available when selecting technologies for use in clinical practice. Further collaboration between clinicians, researchers and technology developers would benefit future technology development, particularly taking into consideration the identified key device features from this study.IMPLICATIONS FOR REHABILITATIONTechnology selection should be based on key device features relating to both practicalities and therapeutic benefit.Contextual factors and available supports should also be considered when selecting technologies.Key usability features identified in this study such as ease of set up, reliability and customisability should be considered in the design of future feedback-based technologies to optimise usability in physical rehabilitation.

Hammond, J., et al. (2014). "An investigation of the impact of regular use of the Wii Fit to improve motor and psychosocial outcomes in children with movement difficulties: a pilot study." Child Care Health Dev 40(2): 165-175.
	BACKGROUND: Children with Developmental Co-ordination Disorder (DCD) experience poor motor and psychosocial outcomes. Interventions are often limited within the healthcare system, and little is known about how technology might be used within schools or homes to promote the motor skills and/or psychosocial development of these children. This study aimed to evaluate whether short, regular school-based sessions of movement experience using a commercially available home video game console (Nintendo's Wii Fit) would lead to benefits in both motor and psychosocial domains in children with DCD. METHODS: A randomized crossover controlled trial of children with movement difficulties/DCD was conducted. Children were randomly assigned to an intervention (n = 10) or comparison (n = 8) group. The intervention group spent 10 min thrice weekly for 1 month using Wii Fit during the lunch break, while the comparison group took part in their regular Jump Ahead programme. Pre- and post-intervention assessments considered motor proficiency, self-perceived ability and satisfaction and parental assessment of emotional and behavioural problems. RESULTS: Significant gains were seen in motor proficiency, the child's perception of his/her motor ability and reported emotional well-being for many, but not all children. CONCLUSIONS: This study provides preliminary evidence to support the use of the Wii Fit within therapeutic programmes for children with movement difficulties. This simple, popular intervention represents a plausible method to support children's motor and psychosocial development. It is not possible from our data to say which children are most likely to benefit from such a programme and particularly what the dose and duration should be. Further research is required to inform across these and other questions regarding the implementation of virtual reality technologies in therapeutic services for children with movement difficulties.

Han, Z. and C.-H. Chen (2021). "Research on Sports Balanced Development Evaluation System Based on Edge Computing and Balanced Game." Security and Communication Networks 2021: 1-8.
	Sports can promote physical and mental health and the development of personality. How to build a balanced development evaluation system for sports and find a quality education suitable for the school are particularly important. In this article, we use edge computing technology to design a balanced development framework for sports. The framework will guide students to actively participate in physical exercise and develop sports to a higher, more comprehensive level. Then, the equilibrium game model is used to analyse the evaluation system of the balanced development of college sports. The research results show that the university sports balanced development evaluation system has good application prospects. The empirical analysis results verify its accuracy and reliability.

Hannay, D. R., et al. (1993). "The provision and use of medical services during the 1991 World Student Games in Sheffield." Journal of Public Health Medicine 15(3): 229-234.
	This paper describes the provision and use of medical services organized by Sheffield during the World Student Games in 1991. A descriptive study of medical and physio-therapy records, together with minor incident logs and hospital referrals, was carried out. It was found that 571 medical records and 357 physiotherapy records were completed, of which 83 per cent were generated at the Games Village. The majority of patients were competitors, although team officials accounted for a disproportionate number. Most physiotherapy requests were for sports injuries, whereas this was not so for medical cases. Twenty-five per cent of medical records and 40 per cent of physiotherapy records were for recurrent conditions which had started before arrival. Athletics and football accounted for the greatest number of records per competitor. During the Games, 82 patients were referred to hospital, of whom only 12 were admitted. The largest group of hospital referrals was for dental treatment, and the next largest was for minor trauma. A total of 1089 minor incidents were recorded, mainly at the competition venues and in the Physiotherapy Room at the Games Village. In addition, the Red Cross and the St John Ambulance Association attended to 330 people during the Games. The smallest national teams tended to make most demands on services, probably because the larger teams were accompanied by their own medical and physiotherapy staff. It is concluded that the main demands for medical services at the World Student Games were for general practice and physiotherapy at the Games Village, and for first aid at competition venues.(ABSTRACT TRUNCATED AT 250 WORDS)

Harms, M. (2012). "Advancing technology in rehabilitation." Physiotherapy 98(3): 181-182.
	
Harms, M. (2014). "Physio findings...Michele Harms, Editor of Physiotherapy Journal marks avery special birthday with a focus on non-communicable diseases." Frontline (20454910) 20(13): 18-19.
	
Harreby, M., et al. (1997). "Low back pain and physical exercise in leisure time in 38-year-old men and women: a 25-year prospective cohort study of 640 school children." European Spine Journal 6(3): 181-186.
	A cohort of 38-year-old men and women were studied for leisure time physical exercise in relation to low back pain (LBP), education, work, social class and smoking by a self-administered questionnaire. At the age of 14 years, the subjects had been interviewed by their school doctor regarding history of LBP and radiographs of the thoracic and lumbar spine were taken. The results show no positive correlation between radiographic changes and LBP in the adolescent period and decreased physical activity in adulthood. Physical activity for at least 3 h/week reduces the risk of LBP measured as lifetime, 1-year and point prevalence. Eighty-five percent of the subjects who reported taking physical exercise for at least 3 h/week had participated in sports activity almost constantly since their school days and these reported being in better condition than the rest of the cohort. Otherwise they did not have a healthier mode of life. No physical exercise during leisure time was associated with a short school education, unskilled work, unemployment and sickness, low social class, divorce, living in an apartment and smoking. Sixty percent had never or not for many years been interested in participating in sports. Badminton and tennis were the most common sports practised (36%), followed by gymnastics (32%), ball games-soccer and team handball-(25%), running (20%) and swimming (18%). Gymnastics and swimming seem to reduce LBP significantly. Our results show a falling interest in participating in sports activities over time, with 68% of the subjects being members of an athletic association previously, but only 29% currently. Women were more physically inactive during leisure time, probably because of their dual role. Logistic regression analysis indicates that physical activity is related to a long school education, high social class and regular sports activity over time.

Harriger, A. R., et al. (2016). Recruiting via Creation of STEM Solutions to Societal Problems. Atlanta, American Society for Engineering Education-ASEE.
	The literature is replete with studies that share many reasons why students, particularly women and minorities, choose specific fields of study. At or near the top of these reasons is a desire to help people/society…to make a (positive) difference in the world. The Teaching Engineering Concepts to Harness Future Innovators and Technologists (TECHFIT) project uses this approach to teach teams of middle school teachers how a combination of STEM skills can enable them to envision, design, and implement technology-supported fitness games with the goal of increasing physical activity. The teachers, in turn, manage and deliver an afterschool program at their schools to teach their students how to combine STEM skills and use supplied technology to innovate exergames. The paper and presentation will share details about the content of the TECHFIT program as well as share a sampling of the exergames created by teacher teams and student teams. Anecdotal feedback that describes TECHFIT’s impact on both groups will be shared as well.

Hart, P., et al. (2014). "The design and evaluation of an activity monitoring user interface for people with stroke." Annual International Conference Of The IEEE Engineering In Medicine And Biology Society 2014: 5908-5911.
	Usability is an important topic in the field of telerehabilitation research. Older users with disabilities in particular, present age-related and disability-related challenges that should be accommodated for in the design of a user interface for a telerehabilitation system. This paper describes the design, implementation, and assessment of a telerehabilitation system user interface that tries to maximize usability for an elderly user who has experienced a stroke. An Internet-connected Nintendo((R)) Wii gaming system is selected as a hardware platform, and a server and website are implemented to process and display the feedback information. The usability of the interface is assessed with a trial consisting of 18 subjects: 10 healthy Doctor of Physical Therapy students and 8 people with a stroke. Results show similar levels of usability and high satisfaction with the gaming system interface from both groups of subjects.

Harvey, L. A., et al. (2011). "Early intensive hand rehabilitation after spinal cord injury ("Hands On"): a protocol for a randomised controlled trial." Trials [Electronic Resource] 12(1): 14.
	BACKGROUND: Loss of hand function is one of the most devastating consequences of spinal cord injury. Intensive hand training provided on an instrumented exercise workstation in conjunction with functional electrical stimulation may enhance neural recovery and hand function. The aim of this trial is to compare usual care with an 8-week program of intensive hand training and functional electrical stimulation. METHODS/DESIGN: A multicentre randomised controlled trial will be undertaken. Seventy-eight participants with recent tetraplegia (C2 to T1 motor complete or incomplete) undergoing inpatient rehabilitation will be recruited from seven spinal cord injury units in Australia and New Zealand and will be randomised to a control or experimental group. Control participants will receive usual care. Experimental participants will receive usual care and an 8-week program of intensive unilateral hand training using an instrumented exercise workstation and functional electrical stimulation. Participants will drive the functional electrical stimulation of their target hands via a behind-the-ear bluetooth device, which is sensitive to tooth clicks. The bluetooth device will enable the use of various manipulanda to practice functional activities embedded within computer-based games and activities. Training will be provided for one hour, 5 days per week, during the 8-week intervention period. The primary outcome is the Action Research Arm Test. Secondary outcomes include measurements of strength, sensation, function, quality of life and cost effectiveness. All outcomes will be taken at baseline, 8 weeks, 6 months and 12 months by assessors blinded to group allocation. Recruitment commenced in December 2009. DISCUSSION: The results of this trial will determine the effectiveness of an 8-week program of intensive hand training with functional electrical stimulation. TRIAL REGISTRATION: NCT01086930 (12th March 2010)ACTRN12609000695202 (12th August 2009).

Harvey, N. and L. Ada (2013). "Suitability of Nintendo Wii Balance Board for rehabilitation of standing after stroke." Physical Therapy Reviews 17(5): 311-321.
	Background: Normal standing requires ongoing postural adjustments while performing a variety of everyday tasks. Reduced muscle strength and dexterity affect the ability to stand after stroke. Biofeedback has been shown to be effective in training lower limb activities in people with stroke. Nintendo Wii, Nintendo Wii Balance Board, and Nintendo Wii Fit Plus are potentially useful devices for providing feedback to train standing after stroke. Objectives: What specific Nintendo Wii Fit Plus games are suitable for rehabilitation of standing in patients with stroke? Method: A criteria-based review of the Nintendo Wii Fit Plus was carried out to determine the movements required, feedback provided, demands upon the patient, difficulty of and instruction provided by the Nintendo Wii Fit Plus games in the context of stroke rehabilitation. Seventy-five Nintendo Wii Fit Plus games were reviewed and 20 were included for in-depth review. Major findings: The games require movements of the centre of mass in different directions, provide feedback in different ways and place additional physical and cognitive demands upon the patient. Only five games are suitable for people who have severely impaired ability to stand. Six games are suitable for people with moderately impaired standing and nine games are suitable only for people with mildly impaired standing ability. Game goals and the position of the patient can be modified to make the games target physiotherapy goals. Conclusions: Enough suitable games exist to make the Nintendo Wii and Nintendo Wii Fit Plus an appropriate biofeedback device for rehabilitation of standing after stroke.

Hashim, H. L., et al. (2021). "User Personas: Discovering Factors That Influence Genz's Sedentary Lifestyle for the Development of a Mobile Exergame Design Model." Turkish Journal of Computer and Mathematics Education 12(3): 2088-2093.
	The use of mobile devices for youths in tertiary education is found to be linked to sedentary behaviour. This paper attempts to create user personas on these youths and finding the factors that affect their sedentary lifestyles, which could assist the development of a mobile exergame design model. An online survey consisting of sociodemographic and IPAQ questionnaires was used to collect data on students in a public university. Three user personas were derived, which are based on their weekly physical activity levels: Low, Moderate, and High. It was found that income status, time management, daily smartphone usage, and fitness self-rating has a direct relationship with physical activity levels. The user personas share a common factor in that smartphone usage is essential to manage the youths' daily activities regardless of their physical activities. The derived user personas would assist future mobile exergame design model development by concentrating on the influencing factors from the Low and Moderate physical activity level groups._

Hashim, S. S. R., et al. (2021). "Medical Interactive Recovery Assistant: a useful clinical tool in paediatric shoulder rehabilitation?" International Journal of Therapy and Rehabilitation 28(9): 1-15.
	Background/aims: Outpatient physical therapy is the mainstay of treatment in shoulder instability, but lack of motivation and intermittent monitoring of progress is associated with poor compliance. 'Exergames' (a combination of videogames and physical exercise) may provide an additional or alternative motivational factor. The aim of this study was to determine the applicability of the Medical Interactive Recovery Assistant Xbox Kinect gaming software in the management of adolescent atraumatic shoulder instability. Methods: Patients completed six 30-minute sessions playing games using the Medical Interactive Recovery Assistant while participating in a therapy programme. Pain and fatigue questionnaires, functional assessments and a framework analysis of free-text comments were used. Results: A total of 20 female patients (15 unilateral, five bilateral pathology, mean age 14.1 years) completed the sessions. An average session length was 10.8 mins (range 0–24 mins). After each session using the Medical Interactive Recovery Assistant, 80% were neither in pain, nor overly tired. At 2 weeks, the Stanmore Percentage of Normal Shoulder Assessment scores had improved by a mean 17.9% and 10 (50%) patients showed improvements in Oxford Shoulder Instability Scores. Overall, 15 participants (75%) liked the technology; however six (32%) preferred standard physiotherapy, because of software limitations and lack of personal interaction. Conclusions: Medical Interactive Recovery Assistant gamification is applicable for this patient cohort and could be integrated into adolescent atraumatic shoulder instability rehabilitation programmes; however, results emphasise the importance of personal contact.

Hassan, M. M., et al. (2022). "Diet and physical exercises for preschoolers with ADHD and their mothers: An intervention study." Complementary Therapies in Medicine 67: 102826.
	BACKGROUND: Attention deficit hyperactivity disorder (ADHD) is a serious public health problem. Diet-focused approaches and physical exercise can be used to complement other ADHD management techniques. OBJECTIVE: To determine the prevalence of ADHD symptoms among preschoolers in nursery schools and to evaluate the educational interventions toward nutrition and physical exercise in mothers and their preschoolers with ADHD symptoms. RESEARCH METHODOLOGY: A two-phase sampling method was employed. First, a cross-sectional survey was conducted to determine the prevalence of ADHD symptoms in four nursery schools (400 preschoolers aged between 3 and 6 years). Second, an intervention study (a quasi-experimental research design with one group completing the pre-test and the post-test) was performed on 36 preschoolers having ADHD symptoms and their mothers by using the educational intervention for mothers and photos and games about nutrition and physical exercise for the preschoolers with ADHD; mothers of four children out of the 40 refused to participate in the study. Data were analyzed using SPSS version 20. The paired t-test was used to determine significant differences between the groups. Differences were considered significant at P < 0.05. RESULTS: Of the 400 preschoolers, 10% had high ADHD symptoms. The mean score of mothers' knowledge of nutrition and physical exercise improved after the implementation of the program (p = 0.01). In addition, preschoolers with ADHD enjoyed the session with photos and games (p = 0.01). CONCLUSIONS AND IMPLICATIONS: Educational intervention significantly improved the knowledge of the mothers. Moreover, preschoolers with ADHD symptoms enjoyed the session with photos and games. This intervention appears to be feasible and promising for further investigation of its effects.

Hassett, L., et al. (2020). "Digitally enabled aged care and neurological rehabilitation to enhance outcomes with Activity and MObility UsiNg Technology (AMOUNT) in Australia: A randomised controlled trial." PLoS Medicine / Public Library of Science 17(2): e1003029.
	BACKGROUND: Digitally enabled rehabilitation may lead to better outcomes but has not been tested in large pragmatic trials. We aimed to evaluate a tailored prescription of affordable digital devices in addition to usual care for people with mobility limitations admitted to aged care and neurological rehabilitation. METHODS AND FINDINGS: We conducted a pragmatic, outcome-assessor-blinded, parallel-group randomised trial in 3 Australian hospitals in Sydney and Adelaide recruiting adults 18 to 101 years old with mobility limitations undertaking aged care and neurological inpatient rehabilitation. Both the intervention and control groups received usual multidisciplinary inpatient and post-hospital rehabilitation care as determined by the treating rehabilitation clinicians. In addition to usual care, the intervention group used devices to target mobility and physical activity problems, individually prescribed by a physiotherapist according to an intervention protocol, including virtual reality video games, activity monitors, and handheld computer devices for 6 months in hospital and at home. Co-primary outcomes were mobility (performance-based Short Physical Performance Battery [SPPB]; continuous version; range 0 to 3; higher score indicates better mobility) and upright time as a proxy measure of physical activity (proportion of the day upright measured with activPAL) at 6 months. The dataset was analysed using intention-to-treat principles. The trial was prospectively registered with the Australian New Zealand Clinical Trials Registry (ACTRN12614000936628). Between 22 September 2014 and 10 November 2016, 300 patients (mean age 74 years, SD 14; 50% female; 54% neurological condition causing activity limitation) were randomly assigned to intervention (n = 149) or control (n = 151) using a secure online database (REDCap) to achieve allocation concealment. Six-month assessments were completed by 258 participants (129 intervention, 129 control). Intervention participants received on average 12 (SD 11) supervised inpatient sessions using 4 (SD 1) different devices and 15 (SD 5) physiotherapy contacts supporting device use after hospital discharge. Changes in mobility scores were higher in the intervention group compared to the control group from baseline (SPPB [continuous, 0-3] mean [SD]: intervention group, 1.5 [0.7]; control group, 1.5 [0.8]) to 6 months (SPPB [continuous, 0-3] mean [SD]: intervention group, 2.3 [0.6]; control group, 2.1 [0.8]; mean between-group difference 0.2 points, 95% CI 0.1 to 0.3; p = 0.006). However, there was no evidence of a difference between groups for upright time at 6 months (mean [SD] proportion of the day spent upright at 6 months: intervention group, 18.2 [9.8]; control group, 18.4 [10.2]; mean between-group difference -0.2, 95% CI -2.7 to 2.3; p = 0.87). Scores were higher in the intervention group compared to the control group across most secondary mobility outcomes, but there was no evidence of a difference between groups for most other secondary outcomes including self-reported balance confidence and quality of life. No adverse events were reported in the intervention group. Thirteen participants died while in the trial (intervention group: 9; control group: 4) due to unrelated causes, and there was no evidence of a difference between groups in fall rates (unadjusted incidence rate ratio 1.19, 95% CI 0.78 to 1.83; p = 0.43). Study limitations include 15%-19% loss to follow-up at 6 months on the co-primary outcomes, as anticipated; the number of secondary outcome measures in our trial, which may increase the risk of a type I error; and potential low statistical power to demonstrate significant between-group differences on important secondary patient-reported outcomes. CONCLUSIONS: In this study, we observed improved mobility in people with a wide range of health conditions making use of digitally enabled rehabilitation, whereas time spent upright was not impacted. TRIAL REGISTRATION: The trial was prospectively registered with the Australian New Zealand Clinical Trials Register; ACTRN12614000936628.

Hassett, L., et al. (2018). "Activity and mobility using technology (amount) rehabilitation trial: Support and health coaching during the community program." Annals of physical and rehabilitation medicine 61: e514-e515.
	Introduction/Background The need for rehabilitation is growing although there are limited resources to meet this demand. Use of affordable technologies to enable health professionals to prescribe and monitor rehabilitation remotely may be one strategy to meet this demand. Aim: to describe physiotherapy support provided to participants using technology to improve mobility and physical activity in the post-hospital phase of the AMOUNT rehabilitation trial (n=300). Material and method Process evaluation including participants (mean age 70 (SD 18); 52% male; 54% with neurological conditions limiting mobility) randomised to the intervention group (n=149). Intervention was additional to standard rehabilitation, prescribed using a protocol which matched games/exercises from eight technologies to the participant's mobility limitations. Technologies included video and computer games/exercises, tablet applications and activity monitors. Participants were taught to use the technologies during inpatient rehabilitation and were then discharged home to use the technologies≥5 days a week for the remainder of the 6-month trial. Trial protocol required the physiotherapist to provide support every 1–2 weeks using a health coaching approach. Intervention datasheets were audited to determine frequency, duration, mode and type of support provided. Results Participants used on average 2 (SD 1) technologies in the post-hospital phase, with 95% of participants using an activity monitor. Physiotherapists had contact with participants on average 15 (SD 5) times (approximately every 11 days), of which eight were phone calls (11min duration), six home-visits (46min duration) and one other. Contact primarily incorporated health coaching (68%) with 8% of contact specifically for technology support. Topics discussed during health coaching included discussing data from prescribed technologies (79%), physical activity and mobility status (70%), adherence (64%) and goal setting (47%). Conclusion A health coaching model to support technology-based rehabilitation post-hospitalisation is feasible. Some support can be provided remotely limiting the need for frequent home visits.

Hauer, K., et al. (2000). "Myocardial ischemia during physical exercise in patients with stable coronary artery disease: predictability and prevention." International Journal of Cardiology 75(2-3): 179-186.
	AIMS: We assessed whether exercise-induced myocardial ischemia during intensive group exercise sessions can be predicted in patients with coronary artery disease and stable angina pectoris. METHODS AND RESULTS: Twenty-three patients underwent cardiac catheterization, 201-thallium scintigraphy, and exercise testing prior to participation in group training sessions. Heart rates and myocardial ischemia were documented by Holter monitoring. The individual training heart rate was calculated as a percentage of the maximal heart rate achieved during symptom-limited exercise testing. Myocardial ischemia occurred significantly more often during group exercise sessions (15 of 23 patients) than during treadmill testing (4 of 23 patients, P<0.001). Maximal heart rate (145+/-23 vs. 134+/-21 beats/min, P<0.004) and maximal plasma lactate concentrations (6.0+/-2.9 vs. 4.3+/-2.0 mmol/l, P<0.05) were significantly higher than during symptom-limited exercise testing. Ischemic episodes occurred significantly more often during jogging than during competitive ball games or interval training. Myocardial ischemia occurred in patients who exceeded their individual target training heart rates (43 of 44 episodes; P<0.001). Duration of ischemic episodes did not correlate with any marker obtained at the beginning of the study. CONCLUSION: These data demonstrate that routine diagnostic procedures do not sufficiently identify patients at risk for exercise-induced myocardial ischemia. Ischemic events are only effectively prevented by choosing adequate types of exercise and, above all, by the strict adherence to individual target heart rates.

Häuplik-Meusburger, S., et al. (2010). "A game for space." Acta Astronautica 66(3-4): 605-609.
	As countermeasure to heavy workloads or monotony, astronauts have drawn on leisure activities imported from Earth or invented in situ. Aside from consumption of media, physical exercise, Earth observation, communication with ground or crew and the practising of instruments, also games play an important role. With a few exceptions, the emphasis, however, lies on virtual games and software applications. A review of play activities in orbit and their benefits to date suggests a need for additional recreational opportunities. In response, an interactive strategy game for use in microgravity is presented that relies on interlocking sphere-shaped game pieces in order to make the most of the kinetic and sensory potential of reduced gravity conditions. Aside from the play value and aesthetics of this reconfigurable modular game structure, the activity may help maintain and enhance manual dexterity, mental alertness and sociability amongst the crew. The design solution and prototype are presented and needs for further research and development are outlined.

Hause, C. J. (2017). "Scapulothoracic muscle strengthening for the management of medial epicondylitis." Scapulothoracic muscle strengthening for the management of Medial epicondylitis: 1-1.
	Background: Medial epicondylitis has become increasingly more prevalent in adolescent baseball pitchers due to the repetitive forces placed on the elbow joint during overhead throwing motions and the growing intensity of youth sports (M.C. Ciccotti et al., 2004). Dysfunction in the wrist, elbow, shoulder, or scapula can disrupt the transmission of force, putting greater stress on the remaining links of the kinetic chain (Lucado et al., 2010). Regional interdependence is a model that suggests examining areas remote from the patient's primary problem area to identify seemingly unrelated contributing factors (Sueki et al., 2013). Strengthening of the scapulothoracic muscles is proposed as an innovative approach for treating individuals with medial epicondylitis. Limited research is available that connects regional interdependence to the management of medial epicondylitis. Purpose: The purpose of this case report and literature review was to document the effectiveness of scapular muscle strengthening in the management of pain and function in an adolescent baseball pitcher with medial epicondylitis as compared to a traditional treatment protocol. Methods: For the case report, a rehabilitation program to target middle trapezius (MT), lower trapezius (LT), and serratus anterior (SA) muscle imbalances was implemented. The patient was seen for treatment once a week for a total of six visits over the course of six weeks. For the literature review, a search was performed using the following databases: PubMed, PEDro, Cochrane Library, and Google Scholar. Articles were screened based on exclusion criteria and reviewed for relevance to the search terms. Outcomes: The patient was able to complete 20 pitches with an Numeric Pain Rating Scale score of 0/10 to be able to play in a game. His scapular muscle strength increased from 4-/5 for the MT, LT, and SA, to 4/5 for the LT and SA and 4+/5 for the MT. Analysis of overhead throwing motion revealed decreased upper trapezius compensation and decreased scapular winging throughout the motion. His elbow extension range of motion was restored to normal by sixth (final) treatment session. Eleven articles were eligible for appraisal and were included in the review. Discussion: The intervention used in this case study offers an advanced approach to the management of medial epicondylitis. Scapular muscle strengthening may assist in optimizing the entire kinetic chain during overhead throwing motions, therefore decreasing repetitive stress and subsequent pain in the elbow joint. This systematic review provides updated evidence regarding the effectiveness of scapular strengthening for the management of medial epicondylitis. Further research is necessary to directly link the benefits of a strengthening protocol targeting the scapular muscles to improve pain and function in medial epicondylitis.

Hedayati, M., et al. (2019). "Investigating the effect of physical games on the memory and attention of the elderly in adult day-care centers in Babol and Amol." Clinical Interventions In Aging 14: 859-869.
	Background: Physical activity is a behavioral strategy that increases general (public) health, including the mental performance of individuals. The goal of this study was to investigate the effect of group physical games on cognitive performance (memory, attention) of old people in adult day-care centers. Methods: In this quasi-experimental study, 50 elderly people (aged >60 years) were selected from two adult day-care centers using available sampling and divided into two groups: control and intervention. As approval was received from the Babol Hamrah Salamat adult day-care center to modify the design of the center's yard, this center was selected to conduct an intervention program. The intervention group received a physical activity program twice a week for 6 weeks. Questionnaires that were used for collecting data included demographic questions, a standard questionnaire for daily activities of living, and a short-term test, the Abbreviated Mental Test Score. Cognitive function was assessed with the Wechsler Memory Scale (WMS) (Form A), before and after the intervention. Statistical analysis of normal variables was performed using independent and paired t-tests and in non-standard cases with Mann-Whitney and Wilcoxon non-parametric tests at a significance level of P<0.05, using SPSS software (version 22). Results: Statistical analysis showed that the scores of the subjects in the intervention group, compared to the control group, had significantly improved. The calculated mean differences in the intervention groupwere, for memory function d=8.4+/-3.3 (P=0.001), and for attention and concentration d=4.18+/-2.38 (P<0.001) (WMS). This level of change in the intervention group was significant. Conclusion: The results of this study showed that a physical exercise program can improve the memory and attention/concentration of the elderly. Therefore, it seems that such activities are a useful method for maintaining cognitive function.

Hee-Tae, J., et al. (2017). "Feasibility of using the RAPAEL Smart Glove in upper limb physical therapy for patients after stroke: A randomized controlled trial." Annual International Conference Of The IEEE Engineering In Medicine And Biology Society 2017: 3856-3859.
	We aim to assess the feasibility of using the RAPAEL Smart Glove as an assistive tool for therapists in clinical rehabilitation therapy settings and to investigate if it can be used to improve the motor recovery rate of stroke survivors. Our randomized controlled study involved 13 post-stroke inpatients. An experimental treatment consisted of one 30-minute game-assisted therapy and one 30-minute conventional therapy per day while the control treatment consisted of two 30-minute conventional therapies. Each therapy block consisted of 15 days over a period of 3 weeks. The measured outcomes were the scores on the Wolf Motor Function Test and the active range of motion for the forearm and the wrist. The mean Wolf Motor Function Test score for the group that received game therapies as well as conventional therapies was significantly higher than that for the group who received only conventional therapies. The results suggest that the motor recovery rate of the clinical rehabilitation therapies can be improved when wearable sensors and therapeutic games are used by therapists in their routine therapy practice.

Henrique, P. P. B., et al. (2019). "Effects of Exergame on Patients' Balance and Upper Limb Motor Function after Stroke: A Randomized Controlled Trial." Journal of Stroke & Cerebrovascular Diseases 28(8): 2351-2357.
	BACKGROUND: Stroke is a major cause of motor incapacity in adults and the elderly population, requiring effective interventions capable of contributing to rehabilitation. Different interventions such as use of exergames are being adopted in the motor rehabilitation and balance area, as they act as motivating instruments, making therapies more pleasurable. OBJECTIVE: The aim of this study was to investigate the effects of exergame on patients' balance and upper limb motor function after stroke. METHODS: This study is a randomized controlled trial. Thirty-one participants of both genders, mean age of 76 years, were assigned to the experimental or control groups; the experimental group (n=16) underwent exergame rehabilitation using Motion Rehab AVE 3D, and the control group (n=15) underwent conventional physiotherapy. Both EG and GC sessions happened twice a week, for 30 minutes each, over a 12 weeks period, resulting in 24 sessions. All sessions were composed of similar exercises, with same purpose and elapsed time (5 minutes). Instruments applied to verify inclusion criteria were a sociodemographic questionnaire and clinical aspects and a Mini-Mental State Examination. At baseline and after 12 weeks of intervention, the Modified Ashworth Scale, the Fugl-Meyer Assessment, and the Berg Balance Scale were used. RESULTS: In both groups, patients obtained significant improvement from baseline values in all analyzed variables (shoulder, elbow, and forearm; wrist; hand; and balance) (P < .001). In the intergroup comparison, there were significant differences between the 2 groups for changes in values from preintervention to postintervention of shoulder, elbow and forearm (P=.001), and total (P=.002). CONCLUSION: Exergame rehabilitation in poststroke patients can be an efficient alternative for restoring balance and upper limb motor function and might even reduce treatment time.

Henrique, P. P. B., et al. (2021). "Kinesiotherapy With Exergaming as a Potential Modulator of Epigenetic Marks and Clinical Functional Variables of Older Women: Protocol for a Mixed Methods Study." JMIR Research Protocols 10(10): e32729.
	BACKGROUND: Kinesiotherapy is an option to mitigate worsening neuropsychomotor function due to human aging. Moreover, exergames are beneficial for the practice of physical therapy by older patients. Physical exercise interventions are known to alter the epigenome, but little is known about their association with exergames. OBJECTIVE: We aim to evaluate the effects of kinesiotherapy with exergaming on older women's epigenetic marks and cognitive ability, as well as on their clinical functional variables. Our hypothesis states that this kind of therapy can elicit equal or even better outcomes than conventional therapy. METHODS: We will develop a virtual clinic exergame with 8 types of kinesiotherapy exercises. Afterward, we will conduct a 1:1 randomized clinical trial to compare the practice of kinesiotherapy with exergames (intervention group) against conventional kinesiotherapy (control group). A total of 24 older women will be enrolled for 1-hour sessions performed twice a week, for 6 weeks, totaling 12 sessions. We will assess outcomes using epigenetic blood tests, the Montreal Cognitive Assessment test, the Timed Up and Go test, muscle strength grading in a hydraulic dynamometer, and the Game Experience Questionnaire at various stages. RESULTS: The project was funded in October 2019. Game development took place in 2020. Patient recruitment and a clinical trial are planned for 2021. CONCLUSIONS: Research on this topic is likely to significantly expand the understanding of kinesiotherapy and the impact of exergames. To the best of our knowledge, this may be one of the first studies exploring epigenetic outcomes of exergaming interventions. TRIAL REGISTRATION: Brazilian Clinical Trials Registry/Registro Brasileiro de Ensaios Clinicos (ReBEC) RBR-9tdrmw; https://ensaiosclinicos.gov.br/rg/RBR-9tdrmw. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/32729.

Henry, B. W., et al. (2007). "Effects of participation in an aging game simulation activity on the attitudes of allied health students toward older adults." Internet Journal of Allied Health Sciences & Practice 5(4): 9p-9p.
	The Aging Game simulation activity was designed to improve medical students' attitudes toward older adults. This study was conducted to determine if the Aging Game, adapted for use with allied health students, could yield positive results in the students' levels of anxiety about aging and attitudes toward aging. The modified Aging Game was implemented at a large Midwestern university with 156 students from three allied health areas DS nutrition and dietetics, physical therapy, and long-term care administration. All students actively engaged in the simulation activity and completed pre- and posttest questionnaires containing the Anxiety about Aging Scale (AAS) and the Aging Semantic Differential (ASD) measures. Results indicated most students had low anxiety about aging and positive attitudes toward older adults both before and after the Aging Game activity. Changes in the students' pre- and posttest scores on AAS and/or ASD measures were mixed, with small differences in average scores. The demographics of the sample group for this study may partially explain the effects the simulation experience had on these allied health students. That some students took on a more negative attitude toward older adults after the simulation could be attributed to a more realistic view of the difficulties and challenges of aging. Also, the shortened timeframe of the Aging Game simulation may have affected the students' reactions to the activity. Future activities to complement the simulation, such as reflective writing and interaction with older adults, may improve the impact of the Aging Game on the attitudes of allied health students.

Hill, T. (2014). "Understanding the Effect of Athletic Taping." Rehab Management: The Interdisciplinary Journal of Rehabilitation 27(9): 22-22.
	The article discusses significance of using athletic taping by physical therapists for healing patients. It states that the taping can provide relief and help in targeting pain at its source and mentions that the taping has been used for providing stability to the body parts stressed by improper body posture. It cites use of athletic taping by athletes at Olympic games and highlights findings inferring inability of the taping to increase strength in uninjured athletes.

Hilton, L. (2012). "In the game." Today in PT 6(6): 18-20.
	Creative games help kids get into shape without realizing they're working out.

Himmelmeier, R. M., et al. (2019). "Study Protocol: Does an Acute Intervention of High-Intensity Physical Exercise Followed by a Brain Training Video Game Have Immediate Effects on Brain Activity of Older People During Stroop Task in fMRI?-A Randomized Controlled Trial With Crossover Design." Frontiers in aging neuroscience 11: 260.
	Background: Elderly people are affected by processes leading to decline in various aspects of daily living that impair their quality of life. Regarding neurological aspects, executive functions have been shown to be valuable for daily life and to slow decline during aging. Most intervention studies intended to improve cognitive functions during aging specifically address long-term destructive processes and countermeasures. However, to an increasing degree, studies also investigate the acute benefits that prove to be useful for daily life, such as physical exercise or video games in the form of exercise video gaming ("exergaming"). Because little is known about the change in cognitive ability following acute intervention of a combination of physical exercise and video gaming, especially for older people, this work is designed as an attempt to address this matter. Methods: This study is a randomized crossover controlled trial to test the response to an acute bout of high-intensity physical exercise followed by a short session with a brain training (Brain Age) video game in physically active and cognitively healthy older adults (60-70 years). The response is measured using Stroop task performance (cognitive task for executive function) and related brain activity assessed with functional magnetic resonance imaging (fMRI). The control conditions are low-intensity physical exercise and Tetris for video gaming. Discussion: This study is intended to provide insight into the alteration of executive function and its related brain activity from an acute intervention with a combination of physical exercise and video gaming in older people. The protocol might not be implementable in daily life to improve cognitive abilities. However, the results can support future studies that investigate cognition and the combination of physical exercise and video gaming. Moreover, it can provide real-life implications. Trial registration: This trial was registered in The University Hospital Medical Information Network Clinical Trials Registry (UMIN000033054). Registered 19 July 2018, https://upload.umin.ac.jp/cgi-open-bin/ctr/ctr_view.cgi?recptno=R000037687.

Hobden, J. (2007). "Raising the game." Physiotherapy Frontline 13(4): 20-23.
	Whether you're a world-class athlete or a weekend enthusiast, you can boost performance with the help of physiotherapy. Jane Hobden talks to the experts.

Hodgins, D. and J. Miles (2012). "GAITSMART--NEW TECHNOLOGY TO KEEP ATHLETES AVAILABLE FOR COMPETITION." SportEX Medicine(53): 26-30.
	This article describes a new sensor-based gait monitoring system that can be used by sports physiotherapists to monitor injured players during training. It provides a brief background to the technology and then goes on to describe how it has been used by the head physiotherapist at the London Broncos. The results from a 5-minute test every week support the adaptation of training sessions where necessary, with the result that players are available for match games

Hodgson, C. L., et al. (2013). "Clinical review: early patient mobilization in the ICU." Crit Care 17(1): 207.
	Early mobilization (EM) of ICU patients is a physiologically logical intervention to attenuate critical illness-associated muscle weakness. However, its long-term value remains controversial. We performed a detailed analytical review of the literature using multiple relevant key terms in order to provide a comprehensive assessment of current knowledge on EM in critically ill patients. We found that the term EM remains undefined and encompasses a range of heterogeneous interventions that have been used alone or in combination. Nonetheless, several studies suggest that different forms of EM may be both safe and feasible in ICU patients, including those receiving mechanical ventilation. Unfortunately, these studies of EM are mostly single center in design, have limited external validity and have highly variable control treatments. In addition, new technology to facilitate EM such as cycle ergometry, transcutaneous electrical muscle stimulation and video therapy are increasingly being used to achieve such EM despite limited evidence of efficacy. We conclude that although preliminary low-level evidence suggests that EM in the ICU is safe, feasible and may yield clinical benefits, EM is also labor-intensive and requires appropriate staffing models and equipment. More research is thus required to identify current standard practice, optimal EM techniques and appropriate outcome measures before EM can be introduced into the routine care of critically ill patients.

Hoffman, H. G., et al. (2020). "Virtual reality hand therapy: A new tool for nonopioid analgesia for acute procedural pain, hand rehabilitation, and VR embodiment therapy for phantom limb pain." Journal of Hand Therapy 33(2): 254-262.
	INTRODUCTION: Affordable virtual reality (VR) technology is now widely available. Billions of dollars are currently being invested into improving and mass producing VR and augmented reality products. PURPOSE OF THE STUDY: The purpose of the present study is to explore the potential of immersive VR to make physical therapy/occupational therapy less painful, more fun, and to help motivate patients to cooperate with their hand therapist. DISCUSSION: The following topics are covered: a) psychological influences on pain perception, b) the logic of how VR analgesia works, c) evidence for reduction of acute procedural pain during hand therapy, d) recent major advances in VR technology, and e) future directions-immersive VR embodiment therapy for phantom limb (chronic) pain. CONCLUSION: VR hand therapy has potential for a wide range of patient populations needing hand therapy, including acute pain and potentially chronic pain patients. Being in VR helps reduce the patients' pain, making it less painful for patients to move their hand/fingers during hand therapy, and gamified VR can help motivate the patient to perform therapeutic hand exercises, and make hand therapy more fun. In addition, VR camera-based hand tracking technology may be used to help therapists monitor how well patients are doing their hand therapy exercises, and to quantify whether adherence to treatment increases long-term functionality. Additional research and development into using VR as a tool for hand therapist is recommended for both acute pain and persistent pain patient populations.

Hoffmann, K. and J. Wiemeyer (2022). "Physical and motivational effects of Exergames in healthy adults-Protocol for a systematic review and meta-analysis." PLoS ONE [Electronic Resource] 17(4): e0266913.
	Exergames have the potential to be used as motivating physical training tools. Numerous studies are currently available that investigate the effects of physical training with Exergames. However, most studies focus on specific training effects or specific target groups. A comprehensive summary of conditioning, coordinative and sports skill related training effects with Exergames in healthy adults is still missing. This contribution presents the protocol for a systematic review that aims to: a) summarize absolute and relative effects of training with Exergames on physical indicators and motivation compared to no or conventional training; b) identify possible mediators and moderators for varying training responses; c) identify gaps in the current evidence related to Exergame-based training.

Holmefur, M., et al. (2009). "Test-retest and alternate forms reliability of the assisting hand assessment." Journal of Rehabilitation Medicine 41(11): 886-891.
	OBJECTIVE: The Assisting Hand Assessment (AHA) has earlier demonstrated excellent validity and rater reliability. This study aimed to evaluate test-retest reliability of the AHA and alternate forms reliability between Small kids vs School kids AHA and the 2 board games in School kids AHA. DESIGN: Test-retest and alternate forms reliability was evaluated by repeated testing with 2 weeks interval. SUBJECTS: Fifty-five children with unilateral cerebral palsy, age range 2 years and 3 months to 11 years and 2 months. METHODS: Intraclass correlation coefficients and smallest detectable difference were calculated. Common item and common person linking plots using Rasch analysis and Bland-Altman plots were created. RESULTS: Intraclass correlation coefficients for test-retest was 0.99. Alternate forms intraclass correlation coefficients were 0.99 between Small kids and School kids AHA and 0.98 between board games. Smallest detectable difference was 3.89 points (sum scores). Items in common item linking plots and persons in common person linking plots were within 95% confidence intervals, indicating equivalence across test forms. CONCLUSION: The AHA has excellent test-retest and alternate forms reliability. A change of 4 points or more between test occasions represents a significant change. Different forms of the AHA give equivalent results.

Hong, J. S., et al. (2020). "Effect of physical exercise intervention on mood and frontal alpha asymmetry in internet gaming disorder." Mental health and physical activity 18.
	Purpose: We aimed to evaluate the effect and neurophysiological mechanism of physical exercise intervention combined with cognitive behavioral therapy on mood and frontal alpha asymmetry in the treatment of Internet gaming disorder. Methods: Fifty male adolescents with Internet gaming disorder were randomly assigned to one of two groups. In the cognitive behavioral therapy + physical exercise group (CBT + PE group, n = 25), participants underwent eight sessions of cognitive behavioral therapy and six sessions of exercise intervention; in the cognitive behavioral therapy‐only group (CBT‐only group, n = 25), participants underwent eight sessions of cognitive behavioral therapy and six sessions of supportive counseling. A resting quantitative electroencephalogram, Young Internet Addiction Scale, the Korean Attention Deficit Hyperactivity Disorder Rating Scale, Beck Depression Inventory, and Beck Anxiety Inventory were evaluated before and after the intervention. Results: Although both the CBT + PE and CBT‐only groups showed a significant reduction in Beck Depression Inventory and Young Internet Addiction Scale scores, indexing a decrease in depression, this effect was more pronounced in the CBT + PE group than in the CBT‐only group. An increase in the F4–F3 and F8–F7 frontal alpha asymmetry values was more pronounced in the CBT + PE group than in the CBT‐only group. Conclusion: Physical exercise intervention in combination with cognitive behavioral therapy for individuals with Internet gaming disorder seems to improve the severity of internet use and depressive mood and enhance left prefrontal activation.

Houghton, V. (2005). "Chiropractic crossroads. Chiropractic triumphs at 2005 World Games." ACA News (American Chiropractic Association) 1(9): 7-7.
	
Howes, S., et al. (2017). "Older adults’ experience of falls prevention exercise delivered using active gaming and virtual reality." Physiotherapy 103: e4-e5.
	
hqwmx, R. B. R. (2018). "Effect of memory training allied to physical exercise in adult and elderly health parameters: association with genetic variables." https://trialsearch.who.int/Trial2.aspx?TrialID=RBR-8hqwmx.
	INTERVENTION: Behavioural C10.597.606.525 Cognitive training (25 participants ‐ 12 weeks of training, one session per week lasting 90 minutes. The training will be divided into 3 parts: 4 weeks for attention training, 4 weeks for memory training and 4 weeks for executive function training. All the functions were learned by the participants, with the aim of greater understanding and use of the training; for that homework will also be develop weekly). Physical exercise (25 people. Multicomponent training ‐ 12 weeks of training, two sessions per week lasting 180 minutes, with the intensity of the Borg scale. In all series of training caused by changes in strength, flexibility, agility and coordination through free weights, medicine balls, elastic bands and agility ladder). Cognitive training and physical exercise (25 participants ‐ 12 weeks of training, one session per week lasting 90 minutes The game will be divided into 3 parts: 4 weeks for attention training, 4 weeks for memory training and 4 Physical Exercises: 20 participants, 12 weeks of training, two sessions, to train the functions performed by the participants, with the purpose of greater training and utilization for the exercise, per week with duration of 180 minutes, with the determination of brightness in the scale scale of Borg In all the series of exercises suffered as capacity of strength, flexibility, agility and coordination through free weights, medicinal balls, elastic bands and ladder of agility). The training sessions will be held every other day for this group. Control intervention (25 participants, without treatment). This set contains an adequate routine during the 3 months of intervention. G11.427.410.698.277 CONDITION: C10.228.140.380 Dementia; cognitive dysfunction; functional capacity. ; F03.615.250.700 ; C10.228.140.380 ; E01.370.386.700.485.750.275 E01.370.386.700.485.750.275 F00‐F99 F03.615.250.700 PRIMARY OUTCOME: Expected outcome 1: More expressive improvement in the cognitive performance of the participants of the group that performed cognitive training and physical exercise; verified by means of the scores of the cognitive evaluation instruments (Montreal Cognitive Assessment, Mattis Dementia Rating Scale, Five Digit Testing, Trail Making Test, Rey Auditory Verbal Learning Test and King Complex Figures); the scores of each evaluation will be compared through the cut‐off scores before and after the training Expected outcome 2: A better result is expected in the scores of the cognitive evaluation instruments in participants who did not carry polymorphic alleles of BDNF (rs6265) and APOE (E4) Expected outcome 3: Increase in the score of instruments that measure the psychosocial dimensions of aging in all groups submitted to training; (SF‐36), social support (Social Support Questionnaire), anxiety level (Beck Anxiety Inventory) and level of physical activity (Modified Baecke Questionnaire for the Elderly); the scores of each evaluation will be compared through the cut‐off scores before and after the training SECONDARY OUTCOME: Secondary outcomes are not expected INCLUSION CRITERIA: Healthy volunteers; both genders; 50 years or older and less than 80 years old.

Hsieh, C. C., et al. (2015). "Tai chi-based exergaming program for older adults at risk of cognitive impairment." Physiotherapy 101: eS592.
	Background: Tai Chi chuan is a popular Chinese mindbody exercise. Many studies have shown beneficial effects of physical and cognitive function in older adults without cognitive impairment, but evidence in who with cognitive impairment is limited. Physical demands combined with cognitive challenges may reduce exercise adherence. Recently an interactive vediogame technology, "exergaming" program has applied to health promotion and rehabilitation to enhance motivation and participation. Therefore, a modified Tai chi exercise via embodied interactive games maybe adapted for the elderly. Purpose: The purpose of the study is to develop, investigate and evaluate the feasibility and effectiveness of Tai chi‐based exergaming program for older adults at risk of cognitive impairment. Methods: TheTai chi‐based exergaming program is"Your Shape Fitness Evolved 2012" Zen energy classes in Xbox 360 Kinect console. A Kinect sensor device will capture the player motion and provide it as feedback. There are 8 activities total within easy to hard, 2 different classes and 4 activities per class. Some activities require player to pass them in order to unlock the more advanced/difficult activities. A standby assistance will be required to assure safety. A cross‐sectional pilot study will be conducted first from healthy elderly volunteers. Oxygen consumption (VO2), metabolic equivalents (METs), percentage maximal heart rate (%HRmax), Heart Rate Variability (HRV), and Ratings of Perceived Exertion Scale (RPEs) will be assessed during rest and playing game. Additionally, a technology acceptance model (TAM) questionnaire will be used to assess the usefulness, attitude toward use and satisfactory of the program. Second, experimental study of repeated measurement will be executed in twice per week of six months intervention. Older adults at risk of cognitive impairment will be randomly assigned to either a Tai chi‐based exergaming program or an education control. Data will be collected at baseline, 3 (middle‐point), 6 (end‐point) and 12 months (follow‐up). Primary outcome is cognitive function, including Mini Mental State Examination (MMSE), digit span tests, visual span tests, verbal fluency test, and trail making tests. Secondary outcomes include physical performance, emotion, well‐being, and social participation. The adherence of movement, attendance, completion and adverse reports during exercise will also be recorded. Two‐way (groupxtime) repeated measures analysis of variance (ANOVA) will be used for statistical calculations. Results: We expect the Tai chi‐based exergaming program is a safe, light‐intensity exercise. Older adults may accept the novel exercise mode, and have higher adherence. There may be some benefits in physical, cognitive or social function for both individuals with or without cognitive decline. Conclusion(s): There is growing body of evidence to suggest that early physical activity intervention may prevent or delay the decline of physical and cognitive function for the elderly, including at risk of cognitive impairment. The Tai chi‐based exergaming program is feasible and accessible that should be experimentally validated. Implications: Keeping a healthy lifestyle is a way to successful aging. For rehabilitation and health promotion, the Tai chi‐based exergaming program can offer an alternative option, and have potentially broad application at home or in the community.

Hsieh, W. M., et al. (2016). "Application of the Blobo bluetooth ball in wrist rehabilitation training." Journal of Physical Therapy Science 28(1): 27-32.
	[Purpose] The introduction of emerging technologies such as the wireless Blobo bluetooth ball with multimedia features can enhance wrist physical therapy training, making it more fun and enhancing its effects. [Methods] Wrist injuries caused by fatigue at work, improper exercise, and other conditions are very common. Therefore, the reconstruction of wrist joint function is an important issue. The efficacy of a newly developed integrated wrist joint rehabilitation game using a Blobo bluetooth ball with C# software installed was tested in wrist rehabilitation (Flexion, Extension, Ulnar Deviation, Radial Deviation). [Results] Eight subjects with normal wrist function participated in a test of the system's stability and repeatability. After performing the Blobo bluetooth ball wrist physical therapy training, eight patients with wrist dysfunction experienced approximately 10 degrees improvements in range of motion (ROM) of flexion extension, and ulnar deviation and about 6 degrees ROM improvement in radial deviation. The subjects showed progress in important indicators of wrist function. [Conclusion] This study used the Blobo bluetooth ball in wrist physical therapy training and the preliminary results were encouraging. In the future, more diverse wrist or limb rehabilitation games should be developed to meet the needs of physical therapy training.

Huang, J., et al. (2022). "Are Sports Champions Also Anti-Epidemic Heroes? Quantitative Research on the Influence of Sports Champions' Demonstration Effect on the COVID-19 Epidemic in China." International Journal of Environmental Research & Public Health [Electronic Resource] 19(4): 2438.
	What kind of role do sports champions play in the COVID-19 epidemic? Do they contribute to the mitigation of the epidemic by some pathway? In this paper, we empirically explore the influence and mechanism of the demonstration effect of sports champions upon the COVID-19 epidemic using COVID-19-related dataset of prefecture-level cities in China from 1 January 2020 to 17 March 2020. The two-way fixed effect model of econometrics is applied to estimate the result, the instrumental variable approach is adopted to address potential endogeneity issues, and socio-economic factors including public health measures, residents' self-protection awareness, effective distance from Wuhan are also taken into consideration. The results show that the demonstration effect of champions in major sporting events increases the participation in physical exercise, which in turn reduces the possibility of being infected with the epidemic. An increase of one gold medal results in a 0.93% increase in the sports population, then leads to a 3.58% decrease in the cumulative case growth rate (p < 0.01). Further, we find that the effect is greater in regions with developed economies and abundant sports resources. Interestingly, it is greater in regions with less attention to sports, which again confirms the role of the demonstration effect.

Hubbard, T. J. and T. W. Kaminski (2002). "In the game. Courting injury: basketball is fast becoming a high-risk contact sport." Advance for Directors in Rehabilitation 11(3): 29-31.
	
Huber, T., et al. (2021). Dynamic Difficulty Adjustment in Virtual Reality Exergames through Experience-driven Procedural Content Generation. Ithaca, Cornell University Library, arXiv.org.
	Virtual Reality (VR) games that feature physical activities have been shown to increase players' motivation to do physical exercise. However, for such exercises to have a positive healthcare effect, they have to be repeated several times a week. To maintain player motivation over longer periods of time, games often employ Dynamic Difficulty Adjustment (DDA) to adapt the game's challenge according to the player's capabilities. For exercise games, this is mostly done by tuning specific in-game parameters like the speed of objects. In this work, we propose to use experience-driven Procedural Content Generation for DDA in VR exercise games by procedurally generating levels that match the player's current capabilities. Not only finetuning specific parameters but creating completely new levels has the potential to decrease repetition over longer time periods and allows for the simultaneous adaptation of the cognitive and physical challenge of the exergame. As a proof-of-concept, we implement an initial prototype in which the player must traverse a maze that includes several exercise rooms, whereby the generation of the maze is realized by a neural network. Passing those exercise rooms requires the player to perform physical activities. To match the player's capabilities, we use Deep Reinforcement Learning to adjust the structure of the maze and to decide which exercise rooms to include in the maze. We evaluate our prototype in an exploratory user study utilizing both biodata and subjective questionnaires.

Hudelle, R., et al. (2018). "Traitements kinésithérapiques du tremblement cérébelleux : revue de littérature." Kinésithérapie, la Revue 18(204): 21-29.
	Résumé Le tremblement cérébelleux est l'un des symptômes de l'ataxie cinétique. Il est présent lors des mouvements volontaires et lors du maintien d'une position. Il engendre un déficit fonctionnel et peut avoir un impact sur le plan psycho-social. Nous avons tenté d'identifier les moyens masso-kinésithérapiques existant pour traiter ces tremblements. La recherche a été effectuée sur les bases de données francophones et anglophones sur la période allant de janvier 2005 à décembre 2015. La recherche a identifié 36 références. Parmi les moyens de traitement identifiés, certains montrent une efficacité à court terme, comme le lestage du membre. D'autres ne sont applicables qu'en présence du thérapeute comme le biofeedback musculaire ou la modification du feedback visuel. Les techniques que le patient peut utiliser seul n'ont pas fait l'objet d'études approfondies, il s'agit entre autres de la relaxation ou de l'occlusion des yeux lors de certaines tâches. Il est également possible de traiter l'ataxie dans son ensemble par l'amélioration globale de la coordination et de la précision des gestes. Les bénéfices obtenus sont cependant minimes. Il en va de même pour la thérapie utilisant les jeux vidéo. Dans ses grandes lignes, la « rééducation fonctionnelle, ludique et sportive » préconisée par Sultana et Mesure est très ancienne et toujours utilisée. De ce fait, ce type de rééducation a fait l'objet de plusieurs études indépendantes. Le principe de résistance mentale n'a pas encore fait l'objet d'études approfondies. Cette revue de littérature est cependant altérée par un biais relatif aux sources primaires. Niveau de preuve 2. Summary Cerebellar tremors are one of the symptoms of kinetic ataxia. They occur during voluntary movements as well as when keeping a position. They lead to a functional deficit and can have a psycho-social impact. We have tried to identify already-existing treatments in physiotherapy to cure such tremors. French and English databases have been examined, spanning a decade from January 2005 to December 2015. The study focuses on 36 references. Thus, among the well-identified treatments, some show a short-term efficiency such limb-ballasting. Others are practicable exclusively with the therapist, like muscular biofeedback or visual feedback modification. Self-relying techniques for patients have not been investigated yet, like among other things closing eyes or relaxing. Ataxia can also be treated globally by improving global coordination and gesture precision. The benefits gained are minor, though. So is it for video-games-based therapy too. In broad outline, the "functional rehabilitation, playful and sporting" advocated by Sultana and Measure is very old and still used. As a result, this type of rehabilitation has been the subject of several independent studies. The principle of mental resistance has not been studied. This literature review is, however, altered by a bias towards primary sources. Level of evidence 2.

Hudon, A., et al. (2016). "Ethics teaching in rehabilitation: results of a pan-Canadian workshop with occupational and physical therapy educators." Disability & Rehabilitation 38(22): 2244-2254.
	PURPOSE: Ethical practice is an essential competency for occupational and physical therapists. However, rehabilitation educators have few points of reference for choosing appropriate pedagogical and evaluation methods related to ethics. The objectives of this study were to: (1) identify priority content to cover in ethics teaching in occupational therapy (OT) and physical therapy (PT) programmes and (2) explore useful and innovative teaching and evaluation methods. METHOD: Data for this qualitative descriptive study were collected during a 1-d knowledge exchange workshop focused on ethics teaching in rehabilitation. RESULTS: Twenty-three educators from 11 OT and 11 PT Canadian programmes participated in the workshop. They highlighted the importance of teaching foundational theoretical/philosophical approaches and grounding this teaching in concrete examples drawn from rehabilitation practice. A wide range of teaching methods was identified, such as videos, blogs, game-based simulations and role-play. For evaluation, participants used written assignments, exams, objective structured clinical examinations and reflective journals. The inclusion of opportunities for student self-evaluation was viewed as important. CONCLUSION: The CREW Day provided ethics educators the opportunity to share knowledge and begin creating a community of practice. This space for dialogue could be expanded to international rehabilitation ethics educators, to facilitate a broader network for sharing of tacit and experiential knowledge. Implications for Rehabilitation According to the study participants, rehabilitation ethics education should include learning about foundational knowledge related to ethical theory; be grounded in examples and cases drawn from clinical rehabilitation practice; and contribute to building professional competencies such as self-knowledge and critical thinking in students. Regardless of the methods used by occupational therapy (OT) and physical therapy (PT) educators for teaching and evaluation, the value of creating spaces that support open discussion for students (e.g. protected discussion time in class, peer-discussions with the help of a facilitator, use of a web discussion forum) was consistently identified as an important facet. Educators from OT and PT programmes should work with various professionals involved in OT and PT student training across the curricula (e.g. clinical preceptors, other educators) to extend discussions of how ethics can be better integrated into the curriculum outside of sessions specifically focused on ethics. The CREW Day workshop was the first opportunity for Canadian rehabilitation ethics educators to meet and discuss their approaches to teaching and evaluating ethics for OT and PT students. Including international rehabilitation ethics educators in this dialogue could positively expand on this initial dialogue by facilitating the sharing of tacit and experiential knowledge amongst a larger and more diverse group of ethics educators.

Hudson, Z. and L. Daley (2002). "Manchester 2002 -- games to remember." Physical Therapy in Sport 3(4): 163-164.
	
Hughes, A. M., et al. (2014). "Translation of evidence-based Assistive Technologies into stroke rehabilitation: users' perceptions of the barriers and opportunities." BMC Health Serv Res 14: 124.
	BACKGROUND: Assistive Technologies (ATs), defined as "electrical or mechanical devices designed to help people recover movement", demonstrate clinical benefits in upper limb stroke rehabilitation; however translation into clinical practice is poor. Uptake is dependent on a complex relationship between all stakeholders. Our aim was to understand patients', carers' (P&Cs) and healthcare professionals' (HCPs) experience and views of upper limb rehabilitation and ATs, to identify barriers and opportunities critical to the effective translation of ATs into clinical practice. This work was conducted in the UK, which has a state funded healthcare system, but the findings have relevance to all healthcare systems. METHODS: Two structurally comparable questionnaires, one for P&Cs and one for HCPs, were designed, piloted and completed anonymously. Wide distribution of the questionnaires provided data from HCPs with experience of stroke rehabilitation and P&Cs who had experience of stroke. Questionnaires were designed based on themes identified from four focus groups held with HCPs and P&Cs and piloted with a sample of HCPs (N = 24) and P&Cs (N = 8). Eight of whom (four HCPs and four P&Cs) had been involved in the development. RESULTS: 292 HCPs and 123 P&Cs questionnaires were analysed. 120 (41%) of HCP and 79 (64%) of P&C respondents had never used ATs. Most views were common to both groups, citing lack of information and access to ATs as the main reasons for not using them. Both HCPs (N = 53 [34%]) and P&C (N = 21 [47%]) cited Functional Electrical Stimulation (FES) as the most frequently used AT. Research evidence was rated by HCPs as the most important factor in the design of an ideal technology, yet ATs they used or prescribed were not supported by research evidence. P&Cs rated ease of set-up and comfort more highly. CONCLUSION: Key barriers to translation of ATs into clinical practice are lack of knowledge, education, awareness and access. Perceptions about arm rehabilitation post-stroke are similar between HCPs and P&Cs. Based on our findings, improvements in AT design, pragmatic clinical evaluation, better knowledge and awareness and improvement in provision of services will contribute to better and cost-effective upper limb stroke rehabilitation.

Hughes, C. J. (1995). "On your mark, get set -- buy!" PT: Magazine of Physical Therapy 3(8): 20-24.
	In the race to save time and money, buying equipment may seem like running an obstacle course. Be ahead of the game: Prepare!

Hugli, A. S., et al. (2015). "Adherence to home exercises in non-specific low back pain. A randomised controlled pilot trial." J Bodyw Mov Ther 19(1): 177-185.
	Specific exercises for the improvement of movement control of the lumbopelvic region are well-established for patients with non-specific low back pain (NSLBP) and movement control impairment (MCI). However, a lack of adherence to home exercise regimens is often observed. The aim of the study was to explore the differences in home exercise (HE) adherence between patients who perform conventional exercises and those who exercise with Augmented Feedback (AF). Twenty patients with NSLBP and MCI were randomly allocated into two groups. The physiotherapy group (PT group) completed conventional exercises, and the AF group exercised with an AF system that was designed for use in therapy settings. The main outcome measure was self-reported adherence to the home exercise regimen. There was no significant difference in HE duration between the groups (W = 64, p = 0.315). The AF group exercised for a median of 9 min and 4 s (IQR = 3'59"), and the PT group exercised for 4 min and 19 s (IQR = 8'30"). Exercising with AF led to HE times that were similar to those of conventional exercise, and AF might be used as an alternative therapy method for home exercise.

Hung, E. S., et al. (2019). "Effects of Interactive Video Game-Based Exercise on Balance in Diabetic Patients with Peripheral Neuropathy: An Open-Level, Crossover Pilot Study." Evid Based Complement Alternat Med 2019: 4540709.
	Purpose. This study evaluated the effects of interactive video game-based (IVGB) exercise on balance in diabetic patients with peripheral neuropathy. Materials and Methods. Twenty-four patients were randomly assigned to two groups (12 participants per group). Group A received IVGB training for the first 6 weeks, with no exercise in the subsequent 6 weeks. Group B had no exercise for the first 6 weeks and then underwent IVGB training in the subsequent 6 weeks. For all participants, the Modified Falls Efficacy Scale (MFES), Time Up and Go (TUG) test, Berg Balance Scale (BBS), and Unipedal Stance Test (UST) were employed at weeks 0, 6, and 12 of the experiment. Results. BBS, right-leg UST, and TUG test scores significantly improved after IVGB intervention, whereas MFES and left-leg UST tended to improve after IVGB intervention. Conclusions. This study revealed that 6-week balance-based exercise training using the IVGB system exerted positive effects on functional balance in patients with diabetic peripheral neuropathy (DPN).

Hung, J. W., et al. (2014). "Randomized comparison trial of balance training by using exergaming and conventional weight-shift therapy in patients with chronic stroke." Archives of Physical Medicine & Rehabilitation 95(9): 1629-1637.
	OBJECTIVE: To compare the effects of exergaming with conventional weight-shift training on balance function in patients with chronic stroke. DESIGN: Single-blind randomized controlled trial. SETTING: Medical center. PARTICIPANTS: Patients (N=30) with chronic stroke and balance deficits. INTERVENTIONS: Twelve weeks of Wii Fit training or conventional weight-shift training. MAIN OUTCOME MEASURES: Static balance was assessed using posturography. We recorded the stability index and percentage of weight bearing on the affected leg in 8 positions. We also used the timed Up and Go and forward reach tests for dynamic balance evaluation, Falls Efficacy Scale-International for fear of falling assessment, and Physical Activity Enjoyment Scale for estimating the enjoyment of training. RESULTS: The exergaming group showed more improvement in stability index than the control group in head straight with eyes open while standing on a foam surface, eyes closed while standing on a solid surface with head turned 30 degrees to the left, and eyes closed while standing on a solid surface with head turned up positions (time-group interaction P=.02, .04, and .03, respectively); however, the effects were not maintained. At 3-month follow-up, the control group showed more improvement in weight-bearing symmetry in the head straight with eyes open while standing on a solid surface position than the exergaming group (time-group interaction P=.03). Both groups showed improvement in the timed Up and Go test, forward reach test, and fear of falling. The improvement in fear of falling was not maintained. The exergaming group enjoyed training more than the control group (P=.03). CONCLUSIONS: Exergaming is enjoyable and effective for patients with chronic stroke.

Hunt, L. (2008). "Console game is well fit." Physiotherapy Frontline 14(8): 9-9.
	
Hunt, L. (2008). "Game plan." Physiotherapy Frontline 14(18): 14-15.
	As the CSP turns its attention to the challenges of the coming year, Louise Hunt looks at the ongoing work in delivering improved services to members.

Hunt, L. (2008). "Rehab goes to the wall." Physiotherapy Frontline 14(21): 11-11.
	
Hunt, L. (2008). "Wii proves a winner once again." Physiotherapy Frontline 14(14): 9-9.
	
Hunt, L. (2009). "Wiihabilitation website set up." Physiotherapy Frontline 15(10): 8-8.
	
Hurkmans, H. L., et al. (2010). "Energy expenditure in adults with cerebral palsy playing Wii Sports." Archives of Physical Medicine & Rehabilitation 91(10): 1577-1581.
	OBJECTIVE: To determine energy expenditure of adults with bilateral spastic cerebral palsy while playing Wii Sports tennis and boxing. DESIGN: Cross-sectional study. SETTING: University medical center. PARTICIPANTS: Five men and 3 women with bilateral spastic cerebral palsy and ambulatory ability (Gross Motor Function Classification System level I or II) participated. The mean participant age +/- SD was 36+/-7 years. Exclusion criteria were comorbidities that affected daily physical activity and fitness, contraindications to exercise, or inability to understand study instructions owing to cognitive disorders or language barriers. INTERVENTION: Participants played Wii Sports tennis and boxing, each for 15 minutes in random order. MAIN OUTCOME MEASURE: By using a portable gas analyzer, we assessed energy expenditure by oxygen uptake (Vo(2)) while sitting and during Wii Sports game play. Energy expenditure is expressed in metabolic equivalents (METs), which were calculated as Vo(2) during Wii Sports play divided by Vo(2) during sitting. RESULTS: Mean +/- SD energy expenditure during Wii Sports game play was 4.5+/-1.1METs for tennis and 5.0+/-1.1METs for boxing (P=.024). All participants attained energy expenditures greater than 3METs, and 2 participants attained energy expenditures greater than 6METs while playing Wii Sports tennis or boxing. CONCLUSIONS: Both Wii Sports tennis and boxing seem to provide at least moderate-intensity exercise in adults with bilateral spastic cerebral palsy (GMFCS level I or II). These games, therefore, may be useful as treatment to promote more active and healthful lifestyles in these patients. Further research is needed to determine the energy expenditures of other physically disabled patient groups while playing active video games, and to determine the effectiveness of these games in improving health and daily activity levels.

Hutterer, I. and Z. Denes (1975). "Psychosomatic rehabilitation of elderly persons." Journal of the American Geriatrics Society 23(3): 137-139.
	The psychosomatic rehabilitation of the elderly is an important task from both social and economic viewpoints. For psychic rehabilitation, moderate activity and the playing of games (such as chess, dominoes or cards) are recommended. Based on experiences with a group of 50 persons of the 70-90 age group., bridge playing is an especially desirable form of recreation. For somatic rehabilitation, physical exercise is a valuable aid, based on experiences with 338 partially disabled patients of the 51-81plus age group

Ilg, W., et al. (2012). "Video game-based coordinative training improves ataxia in children with degenerative ataxia." Neurology 79(20): 2056-2060.
	OBJECTIVE: Degenerative ataxias in children present a rare condition where effective treatments are lacking. Intensive coordinative training based on physiotherapeutic exercises improves degenerative ataxia in adults, but such exercises have drawbacks for children, often including a lack of motivation for high-frequent physiotherapy. Recently developed whole-body controlled video game technology might present a novel treatment strategy for highly interactive and motivational coordinative training for children with degenerative ataxias. METHODS: We examined the effectiveness of an 8-week coordinative training for 10 children with progressive spinocerebellar ataxia. Training was based on 3 Microsoft Xbox Kinect video games particularly suitable to exercise whole-body coordination and dynamic balance. Training was started with a laboratory-based 2-week training phase and followed by 6 weeks training in children's home environment. Rater-blinded assessments were performed 2 weeks before laboratory-based training, immediately prior to and after the laboratory-based training period, as well as after home training. These assessments allowed for an intraindividual control design, where performance changes with and without training were compared. RESULTS: Ataxia symptoms were significantly reduced (decrease in Scale for the Assessment and Rating of Ataxia score, p = 0.0078) and balance capacities improved (dynamic gait index, p = 0.04) after intervention. Quantitative movement analysis revealed improvements in gait (lateral sway: p = 0.01; step length variability: p = 0.01) and in goal-directed leg placement (p = 0.03). CONCLUSIONS: Despite progressive cerebellar degeneration, children are able to improve motor performance by intensive coordination training. Directed training of whole-body controlled video games might present a highly motivational, cost-efficient, and home-based rehabilitation strategy to train dynamic balance and interaction with dynamic environments in a large variety of young-onset neurologic conditions. CLASSIFICATION OF EVIDENCE: This study provides Class III evidence that directed training with Xbox Kinect video games can improve several signs of ataxia in adolescents with progressive ataxia as measured by SARA score, Dynamic Gait Index, and Activity-specific Balance Confidence Scale at 8 weeks of training.

Imam, B., et al. (2018). "A clinical survey about commercial games in lower limb prosthetic rehabilitation." Prosthet Orthot Int 42(3): 311-317.
	BACKGROUND: Despite the popularity of commercial games in lower limb prosthetic rehabilitation, data about their prevalence of use as well as therapists' perspectives about these games are still lacking. OBJECTIVES: To learn about the prevalence of use of commercial games in lower limb prosthetic rehabilitation and therapists' perspectives about these games. STUDY DESIGN: Cross-sectional. METHODS: An online survey was sent to physical and occupational therapists across prosthetic rehabilitation facilities in Canada. The survey had questions about the use of commercial games and therapists' perspectives. RESULTS: Data were collected from 82 therapists. Overall, 46.3% (38/82) reported that they use commercial games; of those, 94.7% (36/38) used the Nintendo Wii Fit. The most reported perceived benefits were the Wii Fit helping to improve weight shifting ( n = 76/82, 92.7%) and balance ( n = 75/82, 91.5%), and being motivating and complementing traditional therapy ( n = 75/82, 91.5%). The most reported perceived barriers/challenges were lack of time and familiarity with the games ( n = 58/82, 70.7%). CONCLUSION: Commercial games, particularly the Wii Fit, are commonly used in lower prosthetic rehabilitation in Canada. Most of the queried therapists view the Wii Fit positively. Knowledge translation activities and developing standard treatment protocols would be helpful in minimizing the barriers identified in this study. Clinical relevance The Wii Fit is prevalent in lower limb prosthetic rehabilitation in Canada and it is viewed positively by therapists as having the potential to improve balance and weight bearing, making rehabilitation more motivating, and complementing traditional therapy. Future studies should investigate the efficacy of the Wii Fit in prosthetic rehabilitation.

Irct2014040817177N (2014). "A comparative study of the effects of virtual reality based exercises versus conventional exercises in the neck region on sensorimotor function and postural control of patients with nonspecific chronic neck pain." https://trialsearch.who.int/Trial2.aspx?TrialID=IRCT2014040817177N1.
	INTERVENTION: Control group (conventional training): The combination of joint position sense and movement sense training (by using laser beam fixed on the head), gaze stability training, eye and head coordination training will be performed in each session and they will be progressed in the next sessions. Eight exercise sessions each lasted 20 minutes is programed. 5 minutes warm up exercises will be performed at the beginning of each session. Intervention 1: Control group (conventional training): The combination of joint position sense and movement sense training (by using laser beam fixed on the head), gaze stability training, eye and head coordination training will be performed in each session and they will be progressed in the next sessions. Eight exercise sessions each lasted 20 minutes is programed. 5 minutes warm up exercises will be performed at the beginning of each session. Intervention 2: Intervention group: (virtual reality training) the computer game is designed to improve cervicocephalic kinesthesia, eye‐head coordination, reflexes related to head and neck, eye and vestibular system. The stages of the game are designed easy to difficult sequentially. The duration of each training session and the number of training sessions are the same as conventional group. Intervention group: (virtual reality training) the computer game is designed to improve cervicocephalic kinesthesia, eye‐head coordination, reflexes related to head and neck, eye and vestibular system. The stages of the game are designed easy to difficult sequentially. The duration of each training session and the number of training sessions are the same as conventional group. Treatment ‐ Other CONDITION: Cervicalgia Nonspecific chronic neck pain. ; Cervicalgia PRIMARY OUTCOME: Functional disability. Timepoint: Before and after training. Method of measurement: Neck disability index questionnaire. Head and neck proprioception (position sense). Timepoint: Before and after training. Method of measurement: Head repositioning error. Maximum range of motion of the head and neck. Timepoint: Before and after training. Method of measurement: Kinematic assessment. Neuromuscular control of the head and neck movements. Timepoint: Before and after trainig. Method of measurement: Movement time of fitt's task. Pain intensity. Timepoint: Before and after training. Method of measurement: Visual analoge scale. Postural control. Timepoint: Before and after training. Method of measurement: Systematic balance assessment. INCLUSION CRITERIA: INCLUSION CRITERIA: non‐traumatic neck pain with a duration between 3 months and 12 months; age between 20 to 55 years. Exclusion criteria: History of cervical and upper thoracic trauma in the 6 months before examination; neurological signs and symptoms in upper extremities; nerve injury, spinal cord compression; cervical spine pathology or surgery; cancer; cervical instability; forward head posture; sever osteoporosis; cervical or thoracic spine or upper extremities fracture; pregnancy; history of brain or vestibular system injury; congenital anomaly of the cervical spine; cervical spine physiotherapy intervention in the preceding 6 months; scored more than 15 (out of possible 50) on the neck disability index; any disorders in which exercise therapy is contraindicated; otolaryngeal disorders that affect postural control; hearing problem; inability to clearly see any number with size 14 of Calibri font on monitor screen with or without glasses; the participant

Irct20150210021034N (2020). "Effects of therapeutic game for neck pain." https://trialsearch.who.int/Trial2.aspx?TrialID=IRCT20150210021034N6.
	INTERVENTION: Intervention 1: Intervention group: The conventional physiotherapy modalities were delivered with isometric exercise through the computerized game (exergame). The conventional physiotherapy included heating through a towel at 74 degrees of Celsius, transcutaneous electrical stimulation (pulse duration:100‐110 ms; frequency: 70‐80 Hz), ultrasound modality (pulse wave with intensity of 1.25‐1.5 W/cm2; duration: 5 min), and stretching of the upper trapezius muscle (10‐30 seconds; 3‐5 repeats). The exergame included software and a glove as a controller of the game. The isometric neck exercises are carried out while the patient was playing the game. The hand pressure against the head was applied in four directions. This pressure was holding 10 seconds to control the motion of the game character in the game's path. Intervention 2: Control group: The conventional physiotherapy protocols for neck pain followed with hand‐resisted isometric exercise. The conventional physiotherapy was the same as explained for the exergame group. The participants were instructed to apply pressure by their hand against the head and hold it for 10 s in four directions. Each pressure repeated five times, and two minutes rest was given after each exercise set. People carried out the exercise three times a day and repeated it every other day. CONDITION: M43.02 People with grade 2 (mild) and grade 3 (moderate) cervical spondylosis. ; Spondylolysis, cervical region PRIMARY OUTCOME: Isometric strength of neck muscles. Timepoint: The outcome was measured in three time intervals: before starting the exercise, after the last session of the exercise, and one month after finishing the exercise sessions. Method of measurement: The isometric strength of neck muscles were measured using a digital force dynamometer. Neck function. Timepoint: The outcome was measured in three time intervals: before starting the exercise, after the last session of the exercise, and one month after finishing the exercise sessions. Method of measurement: Neck was assessed using the "Neck disability index". Pain intensity. Timepoint: The outcome was measured in three time intervals: before starting the exercise, after the last session of the exercise, and one month after finishing the exercise sessions. Method of measurement: Pain intensity was measured using "visual analogue scale". INCLUSION CRITERIA: People with clinical symptoms of mild and moderate neck osteoarthritis Neck pain (if pain is scored at least 3 on visual analouge scale) Muscle spasm Sensory loss in the arm Shoulder or scapular muscles pain

Irct20190131042571N (2020). "The effect of physical and mental training on mental indicators, irisin and BDNF." https://trialsearch.who.int/Trial2.aspx?TrialID=IRCT20190131042571N1.
	INTERVENTION: Intervention 1: Intervention group 1: Group One (MSROM Physical Exercise): These exercises are special for the elderly, and the equipment used includes a chair, a light ball, 2 to 3 pounds, and a resistance tank for each subject. The movements include strength training, stretching in the range of motion, and heart strengthening exercises based on the score of the perceived stress scale, the adjustment range from 11 to 15. The duration of this part of the training is 25 minutes in the first week, which adds 5 minutes to the time each week to 60 minutes in the eighth week. Exercise is done in two groups of men and women. Intervention 2: Intervention group 2: (Smart Thinker Mental Exercise): This mental game suitable for the elderly is launched by the Android operating system on the tablet and the phone, and includes four games of easy, moderate and hard difficulty. These four games are: Up and Down, Color Games, Rock Paper Scissors, and Find Me. Mental exercises begin at the beginning of the first week with 30 minutes, and during the training period, with the addition of 5 minutes each week, the seventh week reaches 60 minutes. This time is also repeated in the eighth week. The degree of difficulty of the training is considered by the computer game settings and is gradually applied within eight weeks. Exercise is done in two groups of men and women. Intervention 3: Control group: During the protocol's implementation period, there are no regular training programs and they pay to their normal lives. CONDITION: Condition 1: Depression. Condition 2: Insomnia. ; Moderate depressive episode ; Nonorganic insomnia F32.1 F51.0 PRIMARY OUTCOME: Brain derived neurotrophic factor (BDNF). Timepoint: The beginning of the study (before the intervention) and the end of the study (after 8 weeks). Method of measurement: BDNF Laboratory Kit. Irisin. Timepoint: The beginning of the study (before the intervention) and the end of the study (after 8 weeks). Method of measurement: irisin Laboratory Kit. Score 15 to 21 in the Insomnia Severity Index (ISI). Timepoint: The beginning of the study (before the intervention) and the end of the study (after 8 weeks). Method of measurement: Insomnia Severity Index (ISI) Questionnaire. Score 5 to 10 in the Geriatric Depression Scale Short Form (GDS‐SF). Timepoint: The beginning of the study (before the intervention) and the end of the study (after 8 weeks). Method of measurement: Geriatric Depression Scale Short Form (GDS‐SF) Questionnaire. INCLUSION CRITERIA: A score of 5 to 10 in the GDS‐SF questionnaire A score of 15 to 21 in the Insomnia Intensity Index (ISI) Normal or nearly normal visual and hearing abilities Ability to read and write.

Irct20190715044216N (2019). "EFFECT OF VIRTUAL REALITY TRAINING AND ROUTINE PHYSICAL THERAPY ON BALANCE AND FUNCTIONAL INDEPENDENCE IN STROKE PATIENTS." https://trialsearch.who.int/Trial2.aspx?TrialID=IRCT20190715044216N1.
	INTERVENTION: Intervention 1: Virtual Reality group: The Wii is a home video game console released by Nintendo on November 19, 2006. As a seventh‐generation console, the Wii competed with Microsoft's Xbox 360 and Sony's PlayStation 3. Nintendo states that its console targets a broader demographic than that of the two others. This device is the most suitable one to be utilized in this trial due to its control on three dimensional measurement. Patients in this group will get daily 60 minutes session, 3 days a week for 12 weeks. Intervention 2: Routine physical therapy group: These include proven methods such as sustained stretching program for hypo flexibility, strengthening program for extensiblity and balance training and coordination exercise to improve motor control and deficit. Also include motivational sessions over the time. Patient in this group will get 60 minutes session, 3 days a week for 12 weeks. CONDITION: Cerebrovascular Accident (CVA) (Stroke). ; Cerebellar stroke syndrome G46.4 PRIMARY OUTCOME: Balance. Timepoint: before intervention, 12 week after intervention, 24 week post intervention. Method of measurement: Balance measurement through balance board and through Berg balance scale. Functional independence. Timepoint: before intervention, 12 week after intervention, 24 week post intervention. Method of measurement: Strength testing on 0‐5 scale and through Stroke impact scale questionnaire. Hand function. Timepoint: before intervention, 12 week after intervention, 24 week post intervention. Method of measurement: wolf motor hand function test. INCLUSION CRITERIA: Patients of both genders i.e. male and female Age between 41‐60 years Unilateral involvement of extremity First exposure of stoke episode either hemorrhagic or ischemic in origin and stroke evident by reports of CT Scan or MRI At least a score of 2 on medical research council scale Stable alert patient and able to follow the instructions of physical therapist

Irct20191013045090N (2020). "Developing a machine-based training program in rehabilitation after reconstruction of the anterior cruciate ligament." https://trialsearch.who.int/Trial2.aspx?TrialID=IRCT20191013045090N1.
	INTERVENTION: Intervention 1: Intervention group: ]It is a game‐based rehabilitation program based on expert opinions and with the Wii Fit system to improve the balance for patients after reconstruction of the anterior cruciate ligament and Includes seven Ski Slalom, Ski Jump, Table Tilt, Balance Bubble, Perfect 10, Penguin Slide, Skateboard Adena on Wii system. Intervention 2: Control group: The common rehabilitation program treatments used in physiotherapy clinics for patients after reconstruction of the anterior cruciate ligament.Patients' exercise therapy programs in the control group will include:• Static exercises for quadriceps, hamstring, gluteal muscles and SLR. .•Closed chain exercises to increase knee mobility.• Proprioseptive exercises on the balance board.• Functional exercises such as using a stationary bike or treadmill.• Stretching exercises for the lower extremities .• Lower extremity muscle strengthening exercises. CONDITION: Anterior cruciate ligament tear. ; Sprain of anterior cruciate ligament of knee PRIMARY OUTCOME: Dynamic Balance. Timepoint: Pre and Post Intervention. Method of measurement: Modified Star Excursion Balance Test. Physical Function. Timepoint: Pre and Post Intervention. Method of measurement: Single leg hop for time & One leg hop for distance. Static Balance. Timepoint: Pre and Post Intervention. Method of measurement: Balance Error Scoring System ?Test. SECONDARY OUTCOME: Knee range of motion. Timepoint: Pre and Post Intervention. Method of measurement: Goniometery. Pain Intensity. Timepoint: Pre and Post Intervention. Method of measurement: Visual Analogue Scale. Thigh Atrophy. Timepoint: Pre and Post Intervention. Method of measurement: Measurement of thigh circumference with Cm tape measure. INCLUSION CRITERIA: Unilateral ACL injury with specialist physician diagnosis and MRI approval At least 3 months after ACL reconstruction surgery (With Bone‐Patellar‐Tendon‐Bone Surgery Type) Male Full consent to participate in the research Having a referral from an orthopedic specialist Complete cardiovascular health of patients with physician approval Balanced state of mind

Irct20200330046895N (2020). "EFFECTS OF VIRTUAL REALITY EXERCISES ON CLINICAL OUTCOMES IN PATIENTS WITH CHRONIC LOW BACK PAIN: A RANDOMIZED CONTROLLED TRIAL." https://trialsearch.who.int/Trial2.aspx?TrialID=IRCT20200330046895N1.
	INTERVENTION: Intervention 1: Intervention group: Group A will get Virtual reality exercises. The Kinect device will be used for Virtual Reality (VR) Exercises in which patient will perform exercises through reflex ridge VR game which includes trunk slide flexion, jumping, sitting to avoid hitting the obstacles and combine movement of legs and arms 5 minutes as displayed on wall mounted LCD, then after 30 seconds rest patient will perform exercises through Body Ball VR game which includes moving arm, pushing head and kicking the ball for 5 minutes. Prior to VR exercise thermotherapy through hot pack for 10 minutes will be applied on Lumbar region. In addition to VR exercise patients will get routine physical therapy which includes patient education ,posture care and exercises as three sets of 10 repetition of bridging, prone leg raises, trunk extension in prone with arms behind the back, trunk rotation exercises, knee to chest and prone position with diagonal elevation of the arm and leg exercise. This will be done on alterante days and total twelve sessions will be given. Intervention 2: Intervention group: Group B Routine physical Therapy exercise, patients will get thermotherapy through hot pack for 10 minutes will be applied on Lumbar region before exercises then routine physical therapy which includes patient education ,posture care and exercises as three sets of 10 repetition of bridging, prone leg raises, trunk extension in prone with arms behind the back, trunk rotation exercises, knee to chest and prone position with diagonal elevation of the arm and leg exercise. This will be done on alterante days and total twelve sessions will be given. CONDITION: Chronic Low back Pain. ; Low back pain M54.5 PRIMARY OUTCOME: Functional disability. Timepoint: before intervention and then on 4th, 8th and 12th week. Method of measurement: Modified Oswestry low back Disability Questionnaire. Lumbar Range of motion. Timepoint: before intervention and then on 4th, 8th and 12th week. Method of measurement: Inclinometer. Pain Intensity. Timepoint: before intervention and then on 4th, 8th and 12th week. Method of measurement: Visual analogue scale. SECONDARY OUTCOME: Muscle Endurance. Timepoint: before intervention then on 4th, 8th and 12th session. Method of measurement: Biering–Sorensen test. Quality of Life. Timepoint: before intervention and then After 12th session. Method of measurement: SF‐36. INCLUSION CRITERIA: Low back pain that persists for more than 12 weeks Non radiating low back pain Localized pain in lumbar spine Both males and females Age between 25 to 50 years

Irct20210106049948N (2021). "Effect of video game-based therapy plus physiotherapy in treatment of muscle strength in post-stroke patients." https://trialsearch.who.int/Trial2.aspx?TrialID=IRCT20210106049948N2.
	INTERVENTION: Intervention 1: Intervention group: The intervention group will receive 3 sessions per week for 8 weeks of physiotherapy based on Brunnstrom approach which last 45 minutes plus will play with video game of PlayStation 4 Pro immediately after the end of each session for 20 minutes. Intervention 2: Control group: The control group will receive 3 sessions per week for 8 weeks of physiotherapy based on Brunnstrom approach which last 45 minutes. CONDITION: G46.4 Stroke. ; Cerebellar stroke syndrome PRIMARY OUTCOME: The rate of depression. Timepoint: Before and after intervention. Method of measurement: Based on Beck Anxiety Inventory. The rate of muscle strength. Timepoint: Before and after intervention. Method of measurement: Based on Brunnstrom approach. INCLUSION CRITERIA: Patients with post‐stroke depression based on Beck Depression Inventory Muscle strength stage 2 to 5 based on Brunnstrom criteria No having cerebral hemorrhage No history of disabilities before the stroke Age of 17‐18 years

Irct20210507051203N (2021). "EFFECTS OF VIRTUAL REHABILITATION ON UPPER EXTREMITY MOTOR RECOVERY IN PATIENTS WITH SUBACUTE STROKE." https://trialsearch.who.int/Trial2.aspx?TrialID=IRCT20210507051203N1.
	INTERVENTION: Intervention 1: Intervention Group 1: In this group patients will be treated with routine physiotherapy combined with virtual rehabilitation. The exercise program consists of stretching, strengthening and isometric exercises. Virtual rehabilitation consists of 30 minutes session 5 days per week for 4 weeks. Intervention 2: Intervention Group 2 In this group patients will be treated with routine physiotherapy program. Routine physiotherapy will be performed 30 minutes 10 repetitions, twice a day 5 days per week for 4 weeks. CONDITION: I63.9 Subacute Stroke. ; Cerebral infarction, unspecified PRIMARY OUTCOME: Fugl Meyer Assessment. Timepoint: Before Intervention, 2 Weeks and 4 Weeks. Method of measurement: 226 points multi‐item questionnaire used for the evaluation of recovery from stroke. SECONDARY OUTCOME: • Brunnstrom Recovery Stages. Timepoint: Baseline, 2 Weeks and after 4 Weeks. Method of measurement: Brunnstrom recovery stages or BRS is 6‐stage evaluation tool indicating the recovery after stroke. Modified Ashworth Scale. Timepoint: Baseline, 2 Weeks and after 4 Weeks. Method of measurement: It is 6 points scale ranging from 0‐4 and lower reading indicates the normal tone of muscle and higher score means more resistance to passive movement or spasticity. INCLUSION CRITERIA: • Ischemic or hemorrhagic stroke • Stroke onset with less than 2 weeks and more than 6 months • First‐ever ischemic or hemorrhagic stroke confirmed by MRI or CT • Patients with more than 25 years and less than 65 years Old • Unilateral upper extremity weakness, • Patients who could perform the reaching activity with their hemiparetic arm. • Both genders will be included • Voluntary shoulder, elbow and wrist movement which is able to perform In‐game commands. • Subjects willing to participate in the study.

Irct20210614051570N (2021). "Investigating the Effect of rehabilitation along with virtual games on Motor learning functional development to improve motor impairments using EEG." https://trialsearch.who.int/Trial2.aspx?TrialID=IRCT20210614051570N1.
	INTERVENTION: Intervention 1: Intervention group:this group received conventional upper extremity rehabilitation for stroke patients who need a shoulder and elbow rehabilitation. Conventional rehabilitation means hybrid upper limb functional patterns, scapular, elbow, forearm, wrist, and finger mobility, and slow muscle stretching. The purpose of these exercises is to strengthen weak muscles of the shoulder and elbow in balanced or unbalanced weights to increase joint mobility, relieving muscle power imbalance, gaining control of a transverse limb, reducing muscle stiffness, and gaining a complete range of motion. Shoulder exercises with SWS without VR were performed for maximally 60 minutes by these patients in that way. Intervention 2: Control group: the stroke patients that receives traditional rehabilitation. this group received conventional upper extremity rehabilitation for stroke patients who need a shoulder and elbow rehabilitation. Conventional rehabilitation means hybrid upper limb functional patterns, scapular, elbow, forearm, wrist, and finger mobility, and slow muscle stretching. The purpose of these exercises is to strengthen weak muscles of the shoulder and elbow in balanced or unbalanced weights to increase joint mobility, relieving muscle power imbalance, gaining control of a transverse limb, reducing muscle stiffness, and gaining a complete range of motion. The patients practiced SWS therapy without using an HMD for maximally 60 minutes, three times a week, and 12 appointments and functional physiotherapy was performed. CONDITION: G46.4 Patients with limited mobility on the right side of the body due to stroke. ; Cerebellar stroke syndrome PRIMARY OUTCOME: Eeg signal changes due to rehabilitation. Timepoint: 45 days. Method of measurement: By recording brain signals. INCLUSION CRITERIA: Rad has limited mobility due to stroke A maximum of three months have passed since their stroke.

Islam, M. S., et al. (2020). "Problematic internet use among young and adult population in Bangladesh: Correlates with lifestyle and online activities during the COVID-19 pandemic." Addictive Behaviors Reports 12: 100311.
	BACKGROUND: Although internet use can boost individuals' quality of life in various aspects, activities on the internet (e.g., gambling, video gaming, social media use, pornography use, etc.) can be used as coping strategy to deal with psychological stressors and mood states (e.g., fear, anxiety, depression) particularly during the global COVID-19 pandemic. OBJECTIVES: The present study assessed problematic internet use (PIU) among Bangladeshi youth and adults in Bangladesh and examined its correlation with lifestyle and online activities during the COVID-19 pandemic. METHODS: An online cross-sectional survey was utilized between May and June 2020 comprising 13,525 Bangladeshi individuals (61.3% male; age range 18-50 years; mean age 23.7 years) recruited from various online platforms. The self-report survey included questions concerning socio-demographics, lifestyle, and online activities during the COVID-19 pandemic, as well as psychometric scales such as the nine-item Internet Disorder Scale-Short Form (IDS9-SF). RESULTS: Utilizing hierarchical regression analysis, problematic internet use was significantly and positively associated with those who were younger, having a higher level of education, living with a nuclear family, engaging in less physical exercise, avoiding household chores, playing online videogames, social media use, and engaging in recreational online activities. CONCLUSIONS: Excessive internet use appears to have been commonplace during the COVID-19 pandemic period and young adults were most vulnerable to problematic internet use.

Ismail, W., et al. (2021). "Improving patient rehabilitation performance in exercise games using collaborative filtering approach." PeerJ Comput Sci 7: e599.
	BACKGROUND: Virtual reality is utilised in exergames to help patients with disabilities improve on the movement of their limbs. Exergame settings, such as the game difficulty, play important roles in the rehabilitation outcome. Similarly, suboptimal exergames' settings may adversely affect the accuracy of the results obtained. As such, the improvement in patients' movement performances falls below the desired expectations. In this paper, a recommender system is incorporated to suggest the most preferred movement setting for each patient, based on the movement history of the patient. METHOD: The proposed recommender system (ResComS) suggests the most suitable setting necessary to optimally improve patients' rehabilitation performances. In the course of developing the recommender system, three methods are proposed and compared: ReComS (K-nearest neighbours and collaborative filtering algorithms), ReComS+ (k-means, K-nearest neighbours, and collaborative filtering algorithms) and ReComS++ (bacterial foraging optimisation, k-means, K-nearest neighbours, and collaborative filtering algorithms). The experimental datasets are collected using the Medical Interactive Recovery Assistant (MIRA) software platform. RESULT: Experimental results, validated by the patients' exergame performances, reveal that the ReComS++ approach predicts the best exergame settings for patients with 85.76% accuracy.

Isrctn (2008). "Effect of botulinum toxin A injections and specific intensive rehabilitation therapy in children with hemiparetic cerebral palsy on upper limb functions and skills." https://trialsearch.who.int/Trial2.aspx?TrialID=ISRCTN69541857.
	INTERVENTION: This study will take place in three hospitals in the Netherlands: University Hospital Maastricht (Franciscusoord Valkenburg), Maartenskliniek Nijmegen Hospital and Free University Medical Centre (Vrije Universiteit Medisch Centrum [VUMC]) Amsterdam. Interventions: Group A: BtA injections (Dysport®) prior to therapy programme and intensive physical and occupational therapy programme Group B: BtA injections only Group C: Intensive physical and occupational therapy programme Group D: Usual care BtA injections: The most spastic muscles hampering function will be injected. Dysport® dilution: 25 U/0.1 ml, dose 6 ‐ 9 U/kg body weight muscles above elbow, 3 ‐ 6 U/kg body weight muscles in forearm, limited to no more than 150 units (0.6 ml) at any one injection site. In the intrinsic thumb muscles the maximum dose will be 25 U per muscle. A maximum Dysport® dose of 1,000 U per child in total per session will be used. Intensive physical and occupational therapy programme: Participants will receive one hour of ocupational therapy and 30 minutes of physical therapy, twice a week for 12 weeks. CONDITION: Cerebral palsy ; Nervous System Diseases ; Cerebral palsy PRIMARY OUTCOME: 1. Assisted Hand Assessment (AHA): original test kit for children 2.5 ‐ 6 years and board game for children 7 ‐ 12 years (T2, T4, T6); 2. A measure of manual ability for children with upper limb impairments (ABILHAND)‐Kids questionnaire (T1 ‐ T6); 3. Canadian Occupational Performance Measure (COPM): establishing treatment goals; Goal Attainment Scaling (GAS) of the most important bimanual treatment goal (T1, T4, T6); 4. Video recording of two fine motor tasks (children 7 ‐ 12 years: buttering and cutting bread, screw construction task; children 2.5 ‐ 6 years: building with 'poppons', threading beads) and one gross motor task (children 2.5 ‐ 6 years: building blocks; children 7 ‐ 12 years: stacking cylinders). These videos will be scored with newly developed and reliability tested Video Observation (VO) criteria (T2, T6).; ; T1 and T2: Baseline; T3: 6 weeks after btA and start of the therapy program ; T4: 12 weeks, end of therapy program ; T5: 18 weeks ; T6: 24 weeks SECONDARY OUTCOME: 1. Wrist and elbow tone and Tardieu Scale or Spasticity Test (SPAT): supine and sitting (T1 ‐ T6); 2. Active and passive range of motion (ROM) of wrist (with fisted hand and with extended fingers), and of elbow and thumb (T1 ‐ T6); 3. Grip strength: E‐link (biometrics®) and functional grip strength (T1 ‐ T6); ; T1 and T2: Baseline ; T3: 6 weeks after btA and start of the therapy program ; T4: 12 weeks, end of therapy program ; T5: 18 weeks ; T6: 24 weeks INCLUSION CRITERIA: 1. Aged 2.5 ‐ 12 years, either sex 2. Cerebral palsy 3. Hagberg diagnosis: spastic hemiparesis or extreme asymmetric diplegia 4. Hand function impairment Zancolli grade I with evident problems in thumb extension and supination, Zancolli grade IIA and IIB 5. Mentally able to comprehend and perform tasks 6. Children and their parents should be able to cope with the intensive rehabilitation therapy programme and the measurement sessions 7. Children and the parents/caregivers should comprehend and speak Dutch 8. Children and their parents indicate the necessity for improvement of the children's abilities

Isrctn (2013). "The efficacy of an on-line coaching program focusing on the promotion of an active lifestyle in children after medical cancer treatment." https://trialsearch.who.int/Trial2.aspx?TrialID=ISRCTN85913225.
	INTERVENTION: In the ?COME ON, move on!? program all children are coached individually for the period of one year to stimulate the start of a normal age‐related lifestyle and to participate in daily activities, games and sports. The pediatric physical therapist in the UMC St Radboud will design a program with concrete goals and assignments, which fit with 1) the child?s needs and ambitions, 2) the child?s actual level and 3) the child?s daily life and environment. The program will be performed at home in the child?s own surroundings with or without additional pediatric physical therapy or other intervention. The exercise training will be adapted into normal daily activities of the child and the parents. During the program (duration one year) the pediatric physical therapist from the UMC St Radboud will regularly contact the child and the parents by means of an Internet website specially designed for the ?COME ON, move on! program. During the one‐year coaching program there will be a switch from intensive coaching (weekly contact) to more and more autonomy and independence of the child towards resuming and maintaining a normal age‐related lifestyle and participation in daily activities, games and sports. The control group will be referred to a pediatric physical therapist if indicated. At the moment referral to pediatric physical therapy for an assessment is not standard and functional problems are mostly detected after a few months. Therefore, both groups (the experimental and control group) profit from the study program. CONDITION: Children aged 4‐12 years who had finished their treatment for Acute Lymphoblastic Leukemia (ALL) or other types of cancer. ; Cancer ; Leukemia PRIMARY OUTCOME: The primary outcome variables are the degree of physical activity as measured with the actometer (the Techtrail) and the registered activities in the diary, converted to Metabolic Equivalents (MET?s) at T0,T1,T2 and T3. The difference in intra‐individual changes will be compared between groups: a significant difference from 10% between T2 and T3 will be judged as clinically relevant. SECONDARY OUTCOME: The secondary outcome variables are the change in motor performance level (MABC), endurance level (BRUCE protocol), quality of life level (TAQOL child and parents), and the extent of participation in sports (sport questionnaire). The difference in intra‐individual changes will be compared between the two groups. A significant difference of 10% between T2 and T3 will be judged as clinically relevant. The influence of background variables (disease, age, SES etc.) will be analyzed. Moreover, the presence of age‐related reference‐norms in the MABC, the BRUCE, and the TAPQOL allow comparison with the typical population. INCLUSION CRITERIA: Children aged 4‐12 years, who completed the cancer therapy in the UMC St Radboud after informed consent from the parents. For this explorative study we expected to include 30 children (25 eligible each year, 30% informed consent).

Isrctn (2015). "The effect of exercise and nutrition on structural and functional systems in the elderly brain." https://trialsearch.who.int/Trial2.aspx?TrialID=ISRCTN12084831.
	INTERVENTION: Participants are randomized into two groups with different nutritional supplementation: 1. Intervention group: This group will take 13.5 ml of omega‐3 fatty acid supplementation daily for 26 weeks at home 2. Control group: This group will take 13.5 ml of olive oil supplementation daily for 26 weeks at home After 16 weeks, all participants follow 10 weeks of guided video‐game‐based physical exercise. Training sessions take place three times per week for 30 minutes. For the video‐game training, the participant follows the step instructions presented on a computer screen. Participants are standing on a pressure‐sensitive platform, which records right and wrong movements. Participants are accustomed slowly to the exercise and are continuously monitored by the instructors. CONDITION: People over 65 years, healthy (self‐report), and living independently or in a community residence ; Not Applicable PRIMARY OUTCOME: Current primary outcome measures as of 24/02/2016:; 1. Structural level:; 1.1. Transcranial magnetic stimulation: Motor evoked potential in M.tibialis anterior ; 2. Functional level:; 2.1. Electroencephalography: Event related potential and frequency band distribution ; 2.2. Cognitive test: Test for Attentional Performance (TAP); All measures are assessed pre‐intervention and after intervention.; ; Previous primary outcome measures:; 1. Structural level:; 1.1. Transcranial magnetic stimulation: Motor evoked potential in M.tibialis anterior ; 2. Functional level:; 2.1. Electroencephalography: Event related potential and frequency band distribution ; 2.2. Cognitive tests: Test for Attentional Performance (TAP) and Attention Network Test (ANT); All measures are assessed pre‐intervention and after intervention. SECONDARY OUTCOME: 1. Gait parameters:; 1.1. Temporal and spatial gait parameters are assessed with the Physilog®; 2. Prevention of falls:; 2.1. Icon Falls Efficacy Scale International (Icon‐FES‐I) questionnaire is used as a measure of 'concern' about falling, to determine the transfer effects of training to activities of daily living; 3. Mental state and depression:; 3.1. Mini Mental State Examination (MMSE); 3.2. Geriatric Depression Scale (GDS): symptoms of depression are recorded. The German version of the GDS has a good validity and reliability; 4. Blood samples measuring fatty acid; ; All measures are assessed pre‐intervention and after intervention. In addition, blood samples are measured after 16 weeks. INCLUSION CRITERIA: 1. Age above 65 years 2. Live independently or in a residency dwelling 3. Non‐smoker 4. Healthy (self‐reported)

Isrctn (2015). "Gymnasium for Robotic Rehabilitation (Gimnasio de Rehabilitación Robótica)." https://trialsearch.who.int/Trial2.aspx?TrialID=ISRCTN98578807.
	INTERVENTION: Patients were randomly allocated to receive either traditional or Robot Gym rehabilitation therapy. The robot Gym therapy consist of six stations of computer and motor‐assisted devices which aid in the cognitive enhancement and motor rehabilitation of upper and lower extremities. The first station is formed by a low cost system for arm rehabilitation called Theradrive; this device allows patients to realize therapy while playing commercial videogames with a Logitech wheel. Second and third stations house the Bioness devices (NESS H200 and L300), which provides functional electrical stimulation to hand and foot, respectively. The MOTOMed devices are on the fourth and fifth stations to help motor rehabilitation on the upper and lower limbs through a series of games played by doing movements similar to bicycling. The last station is formed by the Capitains Log Brain‐Trainer, which is a commercial cognitive rehabilitation therapy system to improve neuroplasticity. The traditional therapy is formed by the standard physical therapy, which includes physical and occupational therapy, personalized for each patient. This type of therapy seeks to improve the range of motion and muscle strength, as well as improve the performance of activities of daily living. CONDITION: Stroke ; Circulatory System ; Stroke, not specified as haemorrhage or infarction PRIMARY OUTCOME: All selected patients will receive the following tests to measure our primary outcomes one week before the start of the 24 therapy sessions and one week after the end of the 24 sessions:; 1. Kinetic and kinematic of lower and upper extremity data using the motion analysis lab; 2. Motivational survey ; 3. Fugl Meyer for upper and lower extremities; 4. Functional Test ; 5. Box and blocks; 6. Timed Get up and Go; 7. Six Minutes Walk; 8. Ten Meters Walk SECONDARY OUTCOME: 1. Minimental Test at the initial consult with the physiatrist, approximately 2 weeks before the 24 sessions of therapy and during the final consult 2 weeks after the end of the intervention.; 3. Geriatric Depression Scale at the initial consult with the physiatrist, approximately 2 weeks before the 24 sessions of therapy and during the final consult 2 weeks after the end of the intervention.; 3. Pain and exercise survey (using visual analogue scale) are performed every third session starting from session one through the end of the sessions; 4. Motor Activity Log applied one week before the beginning of therapy and one week after the end of the 24th session; 5. Visual Neglect Test (Albert's test) at the initial consult with the physiatrist, approximately 2 weeks before the 24 sessions of therapy and during the final consult 2 weeks after the end of the intervention. INCLUSION CRITERIA: 1. Patients who were clinically diagnosed with hemiplegia from stroke occurred no less than 6 months prior to the study 2. Medically stable 3. Between 21 and 75 years old 4. The subject must have the left side affected 5. The subject must have the ability to sit for 60 minutes and to stand assisted or unassisted for 30‐40 minutes 6. They must not be more than mildly depressed and moderately cognitively disabled 7. Must have residual motion in shoulder and elbow, and residual movement in leg flexion, extension and hip adduction (Brunnstrom scale ranging from 2 to 5, Ashworth scale over 4 and Manual Muscular Test >1 and <3)

Isrctn (2015). "Wii Fit and cerebral palsy feasibility study." https://trialsearch.who.int/Trial2.aspx?TrialID=ISRCTN17624388.
	INTERVENTION: 1. Control Group: Control participants will use the Nintendo Wii Fit for 30‐minute sessions, 3 times a week, over a 12‐week period. They will have free choice over which games they choose and duration each game is played within the session. Scheduled phone contact will be made every two weeks but only to oversee progress or if they need physiotherapy advice 2. Supported Group: Supported participants will follow a therapist prescribed schedule over a 12‐week period, utilising specified Nintendo Wii Fit games for designated amounts of time per session. Sessions will last 30 minutes, undertaken three times a week with games selected for specific physiotherapy purposes, such as core stability or balance. During this 12‐week period, fortnightly telephone contact to families will oversee the child’s progress, update game selection and respond to any queries. CONDITION: Cerebral Palsy ; Nervous System Diseases PRIMARY OUTCOME: 1. Gross Motor Function Measurement (GMFM); 2. Bruininks‐Oseretsky test of motor proficiency (BOT‐2); 3. Timed up and go test (TUG); 4. Goal Attainment Scale (GAS); 5. Strengths and Difficulties Questionnaire; ; Measurements will be taken at baseline (week 1), midway (week 6), and exit of trial period (week 12). Measurements will be taken by blinded members of the trial team. INCLUSION CRITERIA: 1. Inclusion criteria for questionnaire (phase one of study): 1.1. Parents of children with cerebral palsy of any level (ie GMFCS 1‐5) 1.2. Child aged 5 to 16 years old 1.3. Under management of Sussex Community NHS Trust identified from local clinical database 2. Inclusion criteria for randomised, single blind, controlled study (phase two of study): 2.1. Ambulatory Bilateral and Unilateral CP 2.2. GMFCS types I and II e.g. able to walk without a walking aid 2.3. Ability to follow simple task instruction 2.4. All school ages ‐from 5 up to the age of 16; primary ‐5 to 11 years and secondary >11 – 16 years, (Upper limit of 16 to avoid timetabling variations at 6th form programmes) 2.5. Under management of Sussex Community NHS Trust, identified from local clinical database

Isrctn (2017). "Effectivity of virtual reality physical exercise program in brain and motor aging in fibromyalgia." https://trialsearch.who.int/Trial2.aspx?TrialID=ISRCTN65034180.
	INTERVENTION: Participants are randomly allocated to one of two groups. Those in the first group are the control group. Those in the second group perform physical activity within the VirtualEx‐FM program. The program consists of two weekly 1‐hour sessions for 24 weeks. It will be based on a Motion‐Controlled Video Game on Microsoft Xbox Kinect and it will be carried out indoors in a room of the local fibromyalgia association's building. Participants are evaluated before and after the program in a non‐invasive way: 1. Sociodemography, quality of life, life habits and impact of fibromyalgia 2. Brain aspects ‐ magnetic resonance without contrast, cognitive, mental and cardiac (heart rate variability) 3. Electroencephalographic pattern and motor in daily activities by means of standardized tests of physical condition CONDITION: Fibromyalgia ; Musculoskeletal Diseases ; Fibromyalgia PRIMARY OUTCOME: 1. Health related quality of life is measured using EQ‐5D‐5L and Whoqol – Brief questionnaires at baseline and 24 weeks; 2. Impact of fibromyalgia is measured using Fibromyalgia Impact Questionnaire (FIQ) and its revised version, the FIQ‐R at baseline and 24 weeks; 3. Cost‐effectiveness is measured using EQ‐5D‐5L and Whoqol – Brief questionnaires at baseline and 24 weeks; 4. Activities of daily living and physical fitness (with and without dual‐task) are measured at baseline and 24 weeks by:; 4.1. Lower limb strength using 30s chair stand test and the 10‐step stair climbing test with and without carrying a load; 4.2. Hand‐grip strength using a grip‐strength dynamometer (TKK 5401 Model); 4.3. Aerobic endurance using the Canadian Aerobic Fitness Test and 6 min walking; 4.4. Upper body strength using the “Arm Curl Test”; 4.5. Balance using Biodex Balance System. This device measures, in degrees, the tilt about each axis during static and dynamic conditions and calculates a mediolateral stability index, an anteroposterior stability index, and an overall stability index; 4.6. Chair sit‐and‐reach and Back scratch to evaluate upper and lower body flexibility; 4.7. Cognitive tasks tested using a wireless motion capture device "Functional Assessment of Biomechanics (FAB)" and a wireless electroencephalography (EEG) system (Enobio, Neuroelectrics) in order to assess the motor and brain pattern of the activities of daily living; 5. Electrical activity and volumes of important structures of the brain measured at baseline and 24 weeks by:; 5.1. Electrical activity at rest using Enobio (Neuroelectrics, Cambridge, MA, USA); 5.2. Volumes of structures such as hippocampus or pineal gland using Magnetic Resonance Imaging (MRI) SECONDARY OUTCOME: 1. Cognitive impairment is measured using the Mini‐Mental State Examination (MMSE) and executive function with the Stroop test at baseline and 24 weeks; 2. Psychophysiological response to daily life activities is measured using EEG register while they are watching a video where people are doing different daily activities with and without pain at baseline and 24 weeks; 3. Pain‐related fear measured using the Tampa Scale for Kinesiophobia (TSK‐ 11SV) at baseline and 24 weeks; 4. Cortisol and melatonin levels are measured using saliva samples at baseline and 24 weeks; 5. Pain is measured using the Visual Analog Scale (VAS) and with an algometer on the fibromyalgia‐specific tender points at baseline and 24 weeks; 6. Depression is assessed using the Geriatric Depression Scale (GDS) at baseline and 24 weeks; 7. Body composition is measured using a bioelectrical impedance analysis (Tanita BC‐415) and waist to hip ratio at baseline and 24 weeks; 8. Perceived effort using a Borg Scale is measured at each session (after finishing each session); 9. Drug treatment is measured using questionnaires at baseline and 24 weeks; 10. Cost‐effectiveness analysis is measured using the number of visits to the health care system in the last six months at baseline and 24 weeks; 11. Self‐reported work absence is assessed by a single question asking the number of days tha participants had to miss work in the last 6 months at baseline and 24 weeks; 12. Fear of falling will be assessed with a VAS from 0 (no fear) to 100 (extreme fear) and using the FES‐I questionnaire at baseline and 24 weeks; 13. Number of falls are recorded as the self‐reported number of falls in the last year and in the last six months at baseline and 24 weeks; 14. Volume of physical activity in their free time is measured using the international physical activity questionnaire (IPAQ) at baseline and 24 weeks; 15. Covariables are measured at baseline and 24 weeks using:; 15.1. Sociodemographic variables: gender, age, education level, profession, income level, religiosity, postal code and familiar situation.; 15.2. Other diseases; 15.3. Current treatment and therapies, years since diagnosis of FM and years since the first symptoms; 15.4. Current pain “at today”; 16. Sleep quality, latency, duration, efficiency, disturbances, use of sleep medication is measured using the Pittsburgh Sleep Quality Index at baseline and 24 weeks; 17. Health habits are assessed using the EUROPALIQ questionnaire at baseline and 24 weeks INCLUSION CRITERIA: 1. Women 2. Aged between 30 and 75 years 3. Diagnosed with fibromyalgia by a rheumatologist 4. Able to communicate effectively with the study staff 5. Read and signed the written informed consent

Isrctn (2017). "REVERE Breathe." https://trialsearch.who.int/Trial2.aspx?TrialID=ISRCTN14521547.
	INTERVENTION: The intervention under investigation is an interactive technology‐enhanced incentive spirometry, via a device named InspireVR. This novel device will consist of a mouthpiece, though which the patient inhales (Vitalograph Pneumotrac). This mouthpiece contains a pneumotachograph measuring maximum inspiratory capacity (MIC); the signal from which will be converted a novel, bespoke game via purpose built “midware”. The game will be presented on a touch‐screen display device (Windows Notebook), which will be incorporated into a stand to allow comfortable interaction Those recruited into the study will be advised to attempt incentive spirometry sessions hourly from the morning after their operation (day 1), aiming for 10 sessions per day. Each incentive spirometry session will consist of 10 MIC breaths, with short intervals between to allow recovery if required. The patients will be offered the Spiroball and InspireVR device on an alternating basis for each session of incentive spirometry. If the patient is unable to use the InspireVR device, they will be advised to use the alternative Spiroball device instead. The order of which device is offered first each day will be randomised between patients, and alternate each day. The participants will take part in the trial for their first three post operative days following elective oesophagectomy or total gastrectomy. Data will be collected daily during the patients’ ICU stay, and will consist of: 1. Demographic and Patient technology acceptance at pre‐admission clinic 2. Daily record of InspireVR and Spirometry use, reasons for refusal of device usage, significant events, pain during incentive spirometry, evidence of PPC. Usage is recorded automatically by the InspireVR system and manually for the Spiroball by the patient and nursing staff. 3. Modified System Usability Scale (Patients and Staff Users) 4. Video capture and link analysis of activity during one daytime shift 5. Performance during InspireVR game. MIC achieved, l CONDITION: Specialty: Critical care, Primary sub‐specialty: Critical Care; UKCRC code/ Disease: Cancer/ Malignant neoplasms of digestive organs ; Respiratory ; Lung infections after surgery PRIMARY OUTCOME: Successful patient usage of the InspireVR. Usage will be defined as the total number of successful attempts (patient able to record a MIC breath) using InspireVR compared with number of successful attempts when using Spiroball (as reported by the patient). Feasibility of the device will be established if the number of successful attempts at incentive spirometry during InspireVR use is equal to or higher than the number of patient‐reported successful uses of the Spiroball device. InpsireVR usage will be collected via the device software. Use of Spiroball will be reported by the patient and bedside staff using a paper log. SECONDARY OUTCOME: 1. User (patients) acceptance and experience of the InspireVR device is assessed using a 10 item likert scale, based on the validated System Usability Scale on day 3‐4 of trial, following completion of intervention; 2. User (physiotherapists and nurses) acceptance and experience of the InspireVR device is assessed using a 10 item likert scale, based on the validated System Usability Scale (Focus group during trial period); 3. Compliance with incentive spirometry. Each session will be recorded by embedded software within the InspireVR device. Use of the Spiroball will recorded by the patient and on the patient nursing records (current standard practice) daily during intervention. ; 4. Patient achievement of prespecified targets for MIC on the InspireVR is assessed via InspireVR software daily during intervention; 5. Side effects and adverse events whilst using the InspireVR device are collected daily during intervention; 6. Pain and discomfort experience during use of InspireVR and Spiroball is assessed using a 0‐3 Verbal rating scale at each IS session; 7. Therapist/clinical staff (doctor/nurse/physiotherapist) user acceptance and experience is assessed through semi structured inter iews and free text comments during the trial period; 8. Post‐operative pulmonary complications (PPCs) as defined by the PROVE network investigators is collected routinely; 9. All cause 30 day morbidity (Clavien‐Dindo classification) ; 10. Critical Care Unit length of stay ; 11. Hospital length of stay ; 12. In hospital mortality ; 13. All cause 30 day mortality INCLUSION CRITERIA: Patient INCLUSION CRITERIA: 1. All consecutive patients undergoing elective oesophagectomy and total gastrectomy for cancer treatment on their first post‐operative admission to the critical care units (intensive care or high dependency units) at QEHB or BHH 2. Age 18 years and over 3. All genders Staff Inclusion criteria All clinical, nursing and physiotherapy staff who have had direct care responsibilities for patients participating in the trial will be invited to participate in the focus groups during the study. Physiotherapists, nursing staff and doctors allocated to care for participants will be identified during the intervention days of the study and approached by the research team.

Isrctn (2018). "Wii balance training in stroke patients." https://trialsearch.who.int/Trial2.aspx?TrialID=ISRCTN14335555.
	INTERVENTION: Randomization was performed by using ‘random permutated blocks’ using blocks of 2 patients for each of the 2 treatments (Pocock, 1994). Using this method and a randomization table, the 2 treatments were put in random order and placed in dense , numbered envelopes. One person who was not involved in any of the other study procedures conducted the randomization. Blinding was applied to the researcher who performed the measurements and who analyzed the data. It was not possible to blind the patient or the therapist, because both knew which balance therapy was given. According to group allocation, patients were provided twice a week 30 minutes of conventional balance therapy or Wii Fit balance training under supervision of a physical therapist. For the residual days of the week, the patients were instructed to exercise, in conformity with the allocated group, for at least 30 minutes a day at home (more was allowed). The intervention lasted for eight weeks. Nintendo Wii Fit With Wii Fit balance training, the Wii Balance board was used, which consists of 4 transducers to assess force distribution and the resulting movements in the Center of Pressure (CoP). Eleven games to exercise balance (Table Tilt (plus), Ski Slalom, Balance Bubble (plus), Penguin Slide, Heading, Tilt City, Segway Circuit, Perfect 10, Snowball Fight, Muscle Workouts and Step Basics) were selected in accordance with the physical therapist. At the sessions under supervision, the physical therapist selected, in consultation with the patients, one or more games for the patients to exercise in that session. This selection was based on two conditions: whether the patients enjoyed the game and if the game was feasible for the patients. At home the patients were allowed to select one or more games for their balance exercises. For safety reasons, the patients were allowed to use a walker during the exercise when he/ she needed it. Conventional balance therapy The conventional balance therapy consisted of d CONDITION: Subacute stroke patients in an outpatient setting ; Circulatory System ; Stroke, not specified as haemorrhage or infarction PRIMARY OUTCOME: 1. Balance measured using the Berg Balance Scale (BBS) prior to and directly after the eight‐week intervention; 2. Gait instability measured using the Dynamic Gait Index (DGI) prior to and directly after the eight‐week intervention SECONDARY OUTCOME: 1. Walking speed measured using the 5 Meter Walk Test (5MWT) prior to and directly after the eight‐week intervention; 2. Fatigue measured using the Fatigue Severity Scale (FSS) prior to and directly after the eight‐week intervention; 3. Fatigue measured using the VAS‐Fatigue Severity Scale (VAS‐f) prior to and directly after the eight‐week intervention; 4. Independence of Activities of Daily Living measured using the Barthel Index (BI) prior to and directly after the eight‐week intervention; 5. Physical activity measured using the actigraph (GT1M‐1 and GT1M‐2) prior to and directly after the eight‐week intervention; 6. Physical activity measured using the Physical Activity Scale for Individuals with Physical Disabilities (PASIPD) prior to and directly after the eight‐week intervention; 7. Individuals perceived functioning in daily activities and social participation measured using the Life Habits prior to and directly after the eight‐week intervention; 8. Individual perceived general health (quality of life) measured using the Short‐Form 36 (SF‐36) prior to and directly after the eight‐week intervention INCLUSION CRITERIA: 1. Patients with subacute stroke (>6 weeks and <6 months) 2. Discharged from the rehabilitation center 3. Ischemic, hemorrhagic or recurrent stroke (diagnosed by a neurologist) 4. Aged >18 years 5. Continued outpatient physical therapy 6. Functional Ambulation Category (FAC) independence level of =4 7. Berg Balance Scale (BBS) score <56 or a BBS score of 56 and a score of 0 or 1 at item 5 of the Dynamic Gait Index (DGI) 8. Understanding of simple exercises 9. None of the included patients used he Wii for at least the last four weeks before the trial started 10. All participants provided written informed consent before the start of the study

Isrctn (2021). "Does a 10-week physiotherapy programme, using interactive exercise equipment, improve balance and walking in children with cerebral palsy aged 4-18 years when compared to usual care?" https://trialsearch.who.int/Trial2.aspx?TrialID=ISRCTN80878394.
	INTERVENTION: The objective of the trial is to assess the feasibility of conducting an RCT evaluating the effect of interactive exercise equipment on balance and walking for children with cerebral palsy, the feasibility of the intervention and investigate participant views of taking part in the trial. Participants will be randomised on a 1:1 using a minimisation criteria based on age and gross motor function classification to either the intervention or usual physiotherapy care. The intervention is 20 minutes training using a Happy Rehab interactive training device for 20 minutes, 3 times per week for 10 weeks. The device will be used in the home and set up by the usual treating physiotherapist. CONDITION: Ambulant children with cerebral palsy GMFCS I‐III ; Nervous System Diseases ; Cerebral palsy PRIMARY OUTCOME: ; Balance measured by two potential primary outcome measures at 0, 10 and 20 weeks:; 1. Next step test of dynamic balance, specifically the medio‐lateral and antero‐posteriori movement of the centre of mass and stepping error; 2. Pediatric Balance Scale; SECONDARY OUTCOME: ; 1. Walking kinematics measured using CODAmotion gait analysis at 0, 10 and 20 weeks; 2. Muscle strength of quadriceps, hamstrings, and gastrocnemius and hip abductors measured using a handheld dynamometer (three measurements) at 0, 10 and 20 weeks; 3. Passive range of movement and spasticity measured using the modified Tardieu scale of quadriceps, hamstrings, gastrocnemius and hip adductors using a goniometer (three measurements) at 0, 10 and 20 weeks; 4. Participation measured using the Canadian Occupational Performance Measure (COPM) at 0, 10 and 20 weeks; 5. Quality of life measured using CHU‐9D at 0, 10 and 20 weeks; INCLUSION CRITERIA: 1. Diagnosis of cerebral palsy Gross Motor Function Classification Scale (GMFCS) I‐III 2. Aged 4‐18 years 3. Leg weakness (=4/5 on the MRC muscle strength rating scale) in at least one muscle group 4. Leg hypertonia (=1 on the Tardieu scale fast stretch) in at least one muscle group 5. Ability to interact with a computer game using a mouse or joystick

Iwamoto, J., et al. (2004). "Conservative treatment of isolated posterior cruciate ligament injury in professional baseball players: a report of two cases." Knee 11(1): 41-44.
	Conservative treatment is currently recommended for most isolated posterior cruciate ligament (PCL) injuries in athletes. However, it is not known whether conservative treatment is applicable even in high performance athletes with isolated PCL injury. The results in two extremely high performance athletes, professional baseball players with isolated acute PCL injury treated conservatively are reported. A catcher and an out fielder, who were regular players, hurt their knees in baseball games. Magnetic resonance images of the knee detected complete PCL rupture. Following a carefully guided physical therapy program, a 3-week period of immobilization of the knee in full extension was achieved with a knee brace, while performing hard quadriceps muscle strengthening exercise, and then running exercise was started. Six to eight weeks after injury, they were able to return fully to their original sporting activity despite tibial posterior translation on posterior drawer test, and to sustain this activity over 2 years. Switching of weight-bearing to non-weight-bearing in a deep knee flexion is considered to contribute to subjective instability in athletes with PCL-deficiency. Probably because our cases, even though extremely high performance athletes were infrequently subjected to such a situation while playing baseball, they were able to return to their pre-injury level of athletic performance without severe subjective instability through conservative treatment.

Jacob Rodrigues, M., et al. (2020). "Physiological and Behavior Monitoring Systems for Smart Healthcare Environments: A Review." Sensors 20(8): 2186.
	Healthcare optimization has become increasingly important in the current era, where numerous challenges are posed by population ageing phenomena and the demand for higher quality of the healthcare services. The implementation of Internet of Things (IoT) in the healthcare ecosystem has been one of the best solutions to address these challenges and therefore to prevent and diagnose possible health impairments in people. The remote monitoring of environmental parameters and how they can cause or mediate any disease, and the monitoring of human daily activities and physiological parameters are among the vast applications of IoT in healthcare, which has brought extensive attention of academia and industry. Assisted and smart tailored environments are possible with the implementation of such technologies that bring personal healthcare to any individual, while living in their preferred environments. In this paper we address several requirements for the development of such environments, namely the deployment of physiological signs monitoring systems, daily activity recognition techniques, as well as indoor air quality monitoring solutions. The machine learning methods that are most used in the literature for activity recognition and body motion analysis are also referred. Furthermore, the importance of physical and cognitive training of the elderly population through the implementation of exergames and immersive environments is also addressed.

Jahn, P., et al. (2012). "InterACTIV: An Exploratory Study of the Use of a Game Console to Promote Physical Activation of Hospitalized Adult Patients With Cancer." Oncology Nursing Forum 39(2): E84-90.
	Purpose/Objectives: To explore the application of the Nintendo Wii™ game console to motivate hospitalized adult patients with cancer to be physically active during treatment periods.Design: An exploratory study with a mixed-method approach, including descriptive statistics and Mayring's qualitative data evaluation method.Setting: The Department of Radiation Oncology at the University Hospital in Halle (Saale) in Germany.Sample: Convenience sample of 7 adult inpatients.Methods: All patients received physical training for five days for 30 minutes per day with Nintendo Wii. After the last training session, patients were interviewed using a semistructured guideline.Main Research Variables: Applicability of a motion-activated game console during inpatient treatment periods, patients' distraction from the hospital environment.Findings: In general, the use of a motion-activated game console in a hospital environment was evaluated positively. Participants showed a high degree of acceptance using this kind of physical activity. Because of the Nintendo Wii, the majority of individuals felt stimulated to become physically active during hospitalization. In addition, all patients lost time awareness and felt distracted from the daily hospital routine. A majority of the patients reported an improved mood state from the game sessions.Conclusions: The results indicate that a motion-activated game console could be useful to motivate adult patients with cancer to be physically active during hospitalization.Implications for Nursing: Nurses can recommend the use of game consoles such as the Nintendo Wii for physical exercise; in addition, the motivational effects of playing motion-activated game consoles might be particularly helpful for patients with cancer-related fatigue to overcome barriers and begin exercise.

Janhunen, M., et al. (2021). "Effectiveness of Exergame Intervention on Walking in Older Adults: A Systematic Review and Meta-Analysis of Randomized Controlled Trials." Physical Therapy 101(9): 1-11.
	OBJECTIVE: The objective of this review was to systematically evaluate the effectiveness of exergaming on walking in older adults. In addition, the aim was to investigate the relationship between the exergaming effect and age, baseline walking performance, exercise traits, technology used, and the risk of bias. METHODS: A literature search was carried out in the databases MEDLINE, CINAHL, CENTRAL, EMBASE, WoS, PsycInfo, and PEDro up to January 10, 2020. Studies with a randomized controlled trial design, people >/=60 years of age without neurological disorders, comparison group with other exercise or no exercise, and walking-related outcomes were included. Cochrane RoB2, meta-analysis, meta-regression, and Grading of Recommendations, Assessment, Development and Evaluation were used to estimate quality, treatment effect, covariates' effect, and the certainty of evidence, respectively. RESULTS: In the studies included (n = 66), the overall risk of bias was low (n = 2), unclear (n = 48), or high (n = 16). Compared with comparison groups, exergaming interventions were more effective for walking improvements (standardized mean difference = -0.21; 95% CI = -0.36 to -0.06; 3102 participants, 58 studies; moderate-quality evidence) and more or equally effective (standardized mean difference = -0.32; 95% CI = -0.64 to 0.00; 1028 participants, 13 studies; low-quality evidence) after nonexergaming follow-up. The strongest effect for covariates was observed with the type of comparison group, explaining 18.6% of the variance. CONCLUSION: For older adults without neurological disorders, exergame-based training improved walking, and improvements were maintained at follow-up. Greater benefits were observed when exergaming groups were compared with inactive comparison groups. To strengthen the evidence, further randomized controlled trials on the effectiveness of gamified exercise intervention are needed. IMPACT: Exergaming has an effect equivalent to other types of exercising on improving walking in older adults. Physical therapists and other rehabilitation professionals may consider exergaming as a promising form of exercise in this age group.

Jansen, C. P., et al. (2014). "Assessing the effect of a physical activity intervention in a nursing home ecology: a natural lab approach." BMC Geriatrics 14(1): 117.
	BACKGROUND: Physical activity (PA) is not only an important marker of physical impairment, but also a pathway to improve quality of life and enhance cognitive and social functioning of old individuals. Yet, making interventional use of PA training as a means for prevention and enhancement of quality of life of nursing home residents has found very limited attention worldwide so far. That said, the project 'Long-term Care in Motion' (LTCMo) as a part of the INNOVAGE consortium (funded by the European Commission) has the following aims: Overall: Install and assess a socially innovative intervention in the nursing home ecology. Concrete: (a) Conceptualization of a multidimensional intervention program (resident and staff oriented) with the potential to promote PA in nursing home residents; (b) Mixed-methods assessment of the program based on automated recording as well as questionnaire data. METHODS/DESIGN: LTCMo's PA-related intervention has several components which are applied in parallel manner: (1) Residents are engaged in a physical exercise program that is based on multiple approaches: supervised group sessions, a serious games approach, and specific training in severely impaired persons; (2) Staff members will receive a competence training with a focus on PA motivation and facilitation of residents' PA engagement. Primary outcome assessment (movement-related behavior of residents) is completely conducted by means of automated data collection strategies (accelerometer-based activity recording, sensor-based life space recording). This is enriched by a broad range of secondary outcomes (e.g., cognitive performance, depression of residents; behavioral and attitudinal components of staff). Pre-, post- and 3-month follow-up assessment will take place in the target intervention setting as well as in a waiting control condition in which we will also replicate the training and its assessment in a later step. DISCUSSION: Although we are faced with methodological challenges (e.g., rather small sample size; no randomized control trial), we believe that our approach has something to offer and indeed has some unique characteristics that may have the potential to contribute to the enhancement of nursing home residents' quality of life and at the same time further PA-related research with vulnerable populations at large. TRIAL REGISTRATION: Current Controlled Trials ISRCTN96090441. Registered 31 July 2014.

Jansen-Kosterink, S. M., et al. (2013). "A Serious Exergame for Patients Suffering from Chronic Musculoskeletal Back and Neck Pain: A Pilot Study." Games for Health Journal 2(5): 299-307.
	INTRODUCTION: Over recent years, the popularity of videogames has gone beyond youth and gamers and is slowly entering the field of professional healthcare. Exergames are an attractive alternative to physical therapy. The primary aim of this pilot study was to explore the user experience (usability, satisfaction, level of motivation, and game experience) of the patient with the "PlayMancer" exergame. The secondary aim was to explore the progression of the performed motor skills (walking velocity, overhead reach ability, and cervical range of motion) and the clinical changes (to physical condition, disability, and pain intensity) in a group of patients with chronic musculoskeletal pain using an exergame for 4 weeks. MATERIALS AND METHODS: In the European PlayMancer project, an exergame for physical rehabilitation of chronic pain patients was developed. This exergame is controlled by relevant motions of the patient's body captured by a motion suit and several infrared cameras. In three different integrated minigames, the patient can train the following motor skills: Walking velocity, overhead reaching, and neck mobility. RESULTS: Ten patients participated in this study and completed the 4 weeks of gaming. Patients rated the usability of the exergames as good (score of 78.5 [standard deviation 9.7; range, 60.0-97.5]) on the System Usability Scale, and the game motivated all patients to perform their exercises. Patients enjoyed playing and were pleased with both the game environment and the game play. Overall, the patients made a progression in the examined motor skills during the minigames over the 4 weeks of gaming. CONCLUSIONS: The "PlayMancer" exergame is a potential tool for achieving physical rehabilitation because it motivates patients to perform their exercises and as a result increases their motor skills and physical condition.

Janssen, J., et al. (2017). "Gamification in Physical Therapy: More Than Using Games." Pediatr Phys Ther 29(1): 95-99.
	The implementation of computer games in physical therapy is motivated by characteristics such as attractiveness, motivation, and engagement, but these do not guarantee the intended therapeutic effect of the interventions. Yet, these characteristics are important variables in physical therapy interventions because they involve reward-related dopaminergic systems in the brain that are known to facilitate learning through long-term potentiation of neural connections. In this perspective we propose a way to apply game design approaches to therapy development by "designing" therapy sessions in such a way as to trigger physical and cognitive behavioral patterns required for treatment and neurological recovery. We also advocate that improving game knowledge among therapists and improving communication between therapists and game designers may lead to a novel avenue in designing applied games with specific therapeutic input, thereby making gamification in therapy a realistic and promising future that may optimize clinical practice.

Jaume-i-Capo, A., et al. (2014). "Interactive rehabilitation system for improvement of balance therapies in people with cerebral palsy." IEEE Transactions on Neural Systems & Rehabilitation Engineering 22(2): 419-427.
	The present study covers a new experimental system, designed to improve the balance and postural control of adults with cerebral palsy. This system is based on a serious game for balance rehabilitation therapy, designed using the prototype development paradigm and features for rehabilitation with serious games: feedback, adaptability, motivational elements, and monitoring. In addition, the employed interaction technology is based on computer vision because motor rehabilitation consists of body movements that can be recorded, and because vision capture technology is noninvasive and can be used for clients who have difficulties in holding physical devices. Previous research has indicated that serious games help to motivate clients in therapy sessions; however, there remains a paucity of clinical evidence involving functionality. We rigorously evaluated the effects of physiotherapy treatment on balance and gait function of adult subjects with cerebral palsy undergoing our experimental system. A 24-week physiotherapy intervention program was conducted with nine adults from a cerebral palsy center who exercised weekly in 20-min sessions. Findings demonstrated a significant increase in balance and gait function scores resulting in indicators of greater independence for our participating adults. Scores improved from 16 to 21 points in a scale of 28, according to the Tinetti Scale for risk of falls, moving from high fall risk to moderate fall risk. Our promising results indicate that our experimental system is feasible for balance rehabilitation therapy.

jdbrm, R. B. R. (2019). "The Neurological and Clinical Effects of Game Therapy in Fibromyalgia Patients." https://trialsearch.who.int/Trial2.aspx?TrialID=RBR-8jdbrm.
	INTERVENTION: Exercise Intervention Procedures The 20 participants in the game therapy group will use the Nintendo Wii (R) as a therapeutic tool, which in turn will be composed of control devices (Wii Remote) and the Wii Balance Board platform coupled with a 32‐inch television. You will use the games of walking, soccer, hula hoop, yoga, skateboarding, tennis, basketball, penguin slide, step, snowboard and boxing. With a score that corresponds to the performance of each participant, increasing the difficulty of the exercise once it is changing level. The intervention protocol of the gametherapy group aims at aerobic activities and the sequence will be performed in increasing order of difficulty according to the weeks. Throughout the protocol, participants will walk on the Nintendo Wii itself, in the initial ten minutes as warm‐up. Next, five minutes of active stretching of the quadriceps, triceps, sciatic, ischiatibial, flexor and extensor muscles of the wrist and elbow, extensors, flexors, and rotators of the neck will be performed. The training period of the gametherapy group will be sixty minutes, divided into 10 minutes of warm‐up with a walk using the Nintendo Wii, 5 minutes of stretching, 14 minutes for each game interspersed with a rest period of no more than 1 minute, or when requested by the participant. Performed three times a week for a total of 36 sessions. As for the 20 participants in the group, conventional exercises will perform conventional exercises simulating the movements of the gametherapy group, in the same sequence of weeks. Throughout the protocol, participants will begin sessions with a free walk for 10 minutes. Then 5 minutes of active stretching of the quadriceps, triceps, sciatic, ischiatibial, flexor and extensor muscles of the wrist and elbow, extensors, flexors and rotators of the neck. Participants in the conventional exercises group will perform exercise protocol for 36 sessions, 60 minutes a day and three times a week. The 20 particip Other Video Games Virtual Reality CONDITION: Anxiety Chronic Pain Depression Fatigue Fibromyalgia Fibromyalgia; Chronic Pain; Fatigue; Paresthesia; Irritable Bowel Syndrome; Anxiety; Depression. ; Fibromyalgia ; Chronic Pain ; Fatigue ; Paresthesia ; Irritable Bowel Syndrome ; Anxiety ; Depression G00‐G99 Irritable Bowel Syndrome Paresthesia PRIMARY OUTCOME: Expected outcome 1: That the game therapy is more effective than conventional physical exercises to reduce pain intensity, as well as increase the threshold of pressure pain and cutaneous sensory threshold. It is believed that not performing any type of physical exercise can worsen or stagnate the pain of these patients.; Evaluation method: Intensity of pain at rest and in movement (Numerical Scale of 11 points), pressure pain threshold (digital algometry), cutaneous sensory threshold (Von Frey filaments), temporal summation (Temporal Summation Test), conditioned modulation of pain (Conditional Modulation of Pain Test).; Expected outcome 2: It is believed that game therapy is more effective than conventional physical exercises to improve electrical, neurobiological, concentration and attention aspects. And, fibromyalgia that do not perform physical exercise can worsen or stagnate your pain.; Evaluation method: encephalic electrical activity (EEG), concentration and attention (P300 evoked endogenous potential) SECONDARY OUTCOME: Expected outcome 1: That game therapy is more effective than conventional physical exercises to improve functional capacity and trunk muscle strength. ; Evaluation method: Rikli Jones battery and trunk dynamometer. Expected outcome 2: Increase motivation, compliance, quality of life and sleep, as well as decrease depression and physical disability of patients with fibromyalgia. ; Evaluation Method: The Motivation Inventory for Exercise (IME‐2), the quality of life evaluation will be performed using the Short Form Health Survey 36 (SF‐36), the Pittsburgh Sleep Quality Index (PSQI), Roland Morris Physical Impairment Questionnaire (QIRM) and Beck Depression Invento y. Expected outcome 3: That the game therapy may promote the increase of the concentration of anti‐inflammatory cytokines and decrease the pro‐inflammatory ones. As well as it can promote decrease of the hormone cortisol. ; Evaluation method: ELISA enzymatic tests, using commercial kit (eBioscience). INCLUSION CRITERIA: The inclusion criteria for the study will consist of clinical diagnosis of Fibromyalgia; female gender; autonomy to perform the exercises; preserved cognitive aspect evaluated through the Mini Mental Status Examination.

Jecan, S., et al. (2018). "Elder Monitoring Workflow System for Independent Living." International Journal of Computers Communications & Control 13(1): 62-70.
	This paper presents an automatic workflow framed in a gerontechnology solution, as part of the Active and Assisted Living (AAL) platform in Mobile@Old project. Our solution aims to increase or preserve cognitive functions, to track medication and coordinate physical activity through an exercising game (exergame). The exergame is customized according to each elderly person’s reactions and specificities. The workflow involves doctors, physiotherapists, the elderly person and their caregivers, in an ecosystem designed to ensure well-being and independence.

Jelsma, D., et al. (2014). "The impact of Wii Fit intervention on dynamic balance control in children with probable Developmental Coordination Disorder and balance problems." Hum Mov Sci 33: 404-418.
	The aim of this study was to examine differences in the performance of children with probable Developmental Coordination Disorder (p-DCD) and balance problems (BP) and typical developing children (TD) on a Wii Fit task and to measure the effect on balance skills after a Wii Fit intervention. Twenty-eight children with BP and 20 TD-children participated in the study. Motor performance was assessed with the Movement Assessment Battery for Children (MABC2), three subtests of the Bruininks Oseretsky Test (BOT2): Bilateral Coordination, Balance and Running Speed & Agility, and a Wii Fit ski slalom test. The TD children and half of the children in the BP group were tested before and after a 6weeks non-intervention period. All children with BP received 6weeks of Wii Fit intervention (with games other than the ski game) and were tested before and afterwards. Children with BP were less proficient than TD children in playing the Wii Fit ski slalom game. Training with the Wii Fit improved their motor performance. The improvement was significantly larger after intervention than after a period of non-intervention. Therefore the change cannot solely be attributed to spontaneous development or test-retest effect. Nearly all children enjoyed participation during the 6weeks of intervention. Our study shows that Wii Fit intervention is effective and is potentially a method to support treatment of (dynamic) balance control problems in children.

Jelsma, J., et al. (1997). "Sports injuries sustained at the Sixth All Africa Games: the physiotherapy perspective." South African Journal of Physiotherapy 53(3): 17-21.
	The Sixth All Africa Games were held in Zimbabwe in September 1995. A voluntary physiotherapy service was provided to guest athletes. Data was gathered relating to onset, mechanism, region and management of injuries. During the 10-day period of the games, 541 treatments were performed on 258 guest athletes. The onset of injury in 35.3% of cases was prior to the start of the games. Overuse was the most common mechanism of injury and 24% of injuries were in the chronic stage. The lower limb was the site of 49.5% of injuries with strains and sprains contributing 75% of the injuries in this study. All together 16 treatment modalities were used, the most frequently used being ice combined with compression. Sixty-two per cent of athletes attended for a single treatment. The mechanisms, distribution and types of injuries were similar to those described by other authors. Of relevance is the number of athletes who were carrying the injury at the commencement of the games and that the main mechanism of injury was overuse. This has implications for training and treatment. The need to provide a comprehensive first treatment with advice regarding ongoing self management was essential as the majority attended only once.

Jelsma, J., et al. (1997). "Provision of physiotherapy services at the sixth All Africa Games." Br J Sports Med 31(3): 246-248.
	The provision of physiotherapy services to guest nations by the host nation, Zimbabwe, at the sixth All Africa Games is examined. There was a high rate of pre-existing injury. Ice, the Cryocuff, and ultrasound were the most frequently used tools, and should be made available to physiotherapists at all multisport events. It is recommended that collection of epidemiological data be standardised to allow comparison between events.

Jelsma, J., et al. (2013). "The effect of the Nintendo Wii Fit on balance control and gross motor function of children with spastic hemiplegic cerebral palsy." Developmental neurorehabilitation 16(1): 27-37.
	OBJECTIVE: To study the impact of training using the Nintendo Wii Fit in 14 children with spastic hemiplegic cerebral palsy. METHODS: A single-subject single blinded design with multiple subjects and baselines was utilised. Interactive video gaming (IVG) in lieu of regular physiotherapy was given for 3 weeks. Outcome measures included modified balance and running speed and agility (RSA) scales of the Bruininks-Oserestky test of Motor Performance 2 and the timed up and down stairs (TUDS). RESULTS: Balances score improved significantly (F(2, 26) = 9.8286, p = 0.001). Changes over time in the RSA (F(2, 26) = 0.86198, p = 0.434) and the TUDS (F(2, 26) = 1.3862, p = 0.268) were not significant. Ten children preferred the intervention to conventional physiotherapy. CONCLUSION: Most children preferred the IVG but as the effect did not carry over into function, IVG should not be used in place of conventional therapy and further research is needed into its use as an adjunct to therapy.

Jena, R. (2019). Out of the Box: A combined approach for handling occlusion in Human Pose Estimation. Ithaca, Cornell University Library, arXiv.org.
	Human Pose estimation is a challenging problem, especially in the case of 3D pose estimation from 2D images due to many different factors like occlusion, depth ambiguities, intertwining of people, and in general crowds. 2D multi-person human pose estimation in the wild also suffers from the same problems - occlusion, ambiguities, and disentanglement of people's body parts. Being a fundamental problem with loads of applications, including but not limited to surveillance, economical motion capture for video games and movies, and physiotherapy, this is an interesting problem to be solved both from a practical perspective and from an intellectual perspective as well. Although there are cases where no pose estimation can ever predict with 100% accuracy (cases where even humans would fail), there are several algorithms that have brought new state-of-the-art performance in human pose estimation in the wild. We look at a few algorithms with different approaches and also formulate our own approach to tackle a consistently bugging problem, i.e. occlusions.

Jeng, K. and R. E. Rothman (2011). "Update on emerging infections: news from the Centers for Disease Control and Prevention. Expanded HIV testing and trends in diagnoses of HIV infection-District of Columbia, 2004-2008." Ann Emerg Med 57(3): 296-298.
	
Jha, K. K., et al. (2021). "Randomised trial of virtual reality gaming and physiotherapy on balance, gross motor performance and daily functions among children with bilateral spastic cerebral palsy." Somatosensory & Motor Research 38(2): 117-126.
	BACKGROUND: Balance issues and poor gross motor function affect the daily needs of children with cerebral palsy. PURPOSE: The study objective was to examine the effects of virtual reality gaming and physiotherapy on balance, gross motor performance and daily functioning among children with bilateral spastic cerebral palsy. METHOD: Thirty-eight children with bilateral spastic cerebral palsy aged 6-12 years with GMFCS- level II-III, Manual Ability Classification System level I-III participated in this randomized controlled trial. The experimental group performed virtual reality games and physiotherapy, while the control group underwent physiotherapy alone. The exercise intensity was 60 minutes session a day, 4-days a week for 6-weeks. Paediatric Balance Scale (PBS), Kids-Mini-Balance Evaluation System Test (Kids-Mini-BESTest), Gross Motor Function Measure-88 (GMFM-88), and Wee-Functional Independence Measure (WeeFIM) were the outcome measures collected at baseline, 6-week post-training and 2-months follow-up. RESULTS: The time by group interaction of repeated measures ANOVA revealed no statistical significance for all the outcome measures except Kids-Mini-BESTest (p < 0.05). The PBS and, Kids-Mini-BESTest improved by a mean (standard deviation) score of 5.1(1.7) and 8.7(2.8) points, respectively in the experimental group as compared to control group [3.4(1.6) and 5.8(2.5) points]. These gains remained at follow-up (p < 0.001). CONCLUSION: Combined virtual reality gaming and physiotherapy is not superior over physiotherapy alone in improving the gross motor performance and daily functioning among children with bilateral spastic cerebral palsy. Virtual gaming, along with physiotherapy, appears to be beneficial in their balance capacity, warranting further trials to investigate the same in children with GMFCS level-III.

Ji, C. and J. Yang (2021). "Effects of Physical Exercise and Virtual Training on Visual Attention Levels in Children with Autism Spectrum Disorders." Brain Sciences 12(1).
	This study compared the effects of physical exercise (PE) and virtual training (VT) on the improvement of the visual attention mechanism in children with autism spectrum disorders (ASD). One hundred eighty-nine children with ASD were recruited from Orphan School in Liaoning Province, China. After screening, 100 children ultimately participated in the experiment. Children with ASD were randomly assigned to VT (VT, n = 34), PE (PE, n = 33) and control group (CG, n = 33). The VT group experiment was performed in a virtual environment through the game FIFA21 three times per week for 6 weeks. The PE group played physical football matches three times per week for 6 weeks. Children with ASD in the CG group did not receive VT or PE but only received psychological counseling. Visual attention of children with ASD is evaluated by using the multiple object tracking paradigm (MOT). After 6 weeks of observation, although none of the three groups saw improvements in the correct rate of ring tracking, the observations of the VT and PE groups were significant (p < 0.05) compared to the CG group in finding detection rate of probe stimulus. Through MOT tests, VT and PE improved the detection rate of probe stimulus in children with ASD. Therefore, this paper indicates that VT and PE can improve the visual attention ability of children with ASD.

jm, R. B. R. (2017). "Risk factors for falls in the elderly: effects of different programs on Perception, Cognition, Clinical and Physical Status." https://trialsearch.who.int/Trial2.aspx?TrialID=RBR-97jm74.
	INTERVENTION: G11.427.410.698.277 I03.450.642.693.465 The elderly participants of the study will carry out programs corresponding to the group drawn with weekly progression of the activities performed. The experimental program will be standardized for all groups, so each session will last 60 minutes, will be held 3 times a week for 12 weeks. The options for activities available will be: 1) Group Without Exercises: 24 women will receive information about falls and their risks, both inside and outside the home. Lectures will be held and informational folders distributed; 2) Group A (Virtual Games Moderate Intensity): 24 women will perform a program of muscular strength, balance and muscular endurance exercises through videogame games available in the market for this purpose. This group will have teacher help during classes, however, the main focus of the activities will be directed by the videogame; 3) Group B (High intensity virtual games): 24 women will perform the same activity proposed for Group A, however, will perform all the exercises proposed by the videogame with a vest (with adjustable load) to increase the intensity (difficulty) of the activities that will be carried out; 4) Group C (Virtual games moderate intensity + Gym): 24 women will perform the same program of exercises of Group A (Virtual games), with additional muscular strengthening exercises (bodybuilding). The bodybuilding will be indicated by the teacher and will consist of exercises mainly for the lower limbs (legs); 5) Group D (High intensity virtual games + Gym): 24 women will perform the same group B exercise program, with additional muscular strengthening exercises (bodybuilding). The bodybuilding will be indicated by the teacher and will consist of exercises mainly for the lower limbs (legs); 6) Group E (Multicomponent): 24 women will perform a program of muscular strength, balance and muscular endurance without video game and with teacher indicating the activities that will be performed by the elderly. In this group the exercises will be dire CONDITION: M01.975 SP2.006.047 Women; Health of the Elderly ; M01.975 ; SP2.006.047 PRIMARY OUTCOME: Reduction of the risk of falls in the elderly from the observation of a variation of at least fifteen percent in the measurements before and after experimental programs (Educational without exercises, exercises with video games and multi‐component exercises) of the strength and muscular power through the test of sit and (time in seconds that it takes to sit and lift five times, the lower the time the better the strength and muscle power), functional mobility through the Timed up and Go test (time in seconds that it takes to get up from a chair, walk 3 meter, turn around in the cone, return and sit again, the lower the time the better the mobility) and balance through the Mini‐best test (battery of tests that evaluates the elderly in different conditions and positions of the body and its response to postural instability, the higher the score the greater the balance) after a period of three months of physical exercise SECONDARY OUTCOME: Secondary outcomes are not expected INCLUSION CRITERIA: Elderly; 60 years or older; women; pre‐fragile

Johansen, T., et al. (2019). "Effectiveness of training with motion-controlled commercial video games on hand and arm function in young people with cerebral palsy: A systematic review and meta-analysis." Journal of Rehabilitation Medicine 52(1): jrm00012.
	OBJECTIVE: To examine the effect of motion-controlled commercial video games compared with traditional occupational and physiotherapy methods for hand and arm function in persons of all ages with cerebral palsy. DATA SOURCES: A systematic literature search was conducted in Medline, EMBASE, CINAHL, Cochrane Central Register of Controlled Trials, OTseeker and PEDro for randomized controlled trials involving persons with cerebral palsy using motion-controlled commercial video games as a training method for hand and arm function, compared with traditional therapy. STUDY SELECTION AND DATA EXTRACTION: Screening, data-extraction, risk of bias and quality assessment was carried out independently by 2 of the authors. The risk of bias of each study was assessed using the Cochrane Collaborations Risk of Bias Tool. The quality of evidence was assessed using Grading of Recommendations Assessment, Development and Evaluation (GRADE). DATA SYNTHESIS: Eight randomized controlled trials, with a total of 262 participants, were included. A random effects meta-analysis showed a statistically significant difference between the groups in favour of motion-controlled commercial video games. The quality of the evidence was, however, rated as very low. CONCLUSION: Despite a significantly greater improvement in hand and arm function in favour of motion-controlled commercial video games, the results of this review should be interpreted with caution with regards to high risk of bias and the low strength of evidence. There is a need for high-powered studies on the effectiveness of training with motion-controlled commercial video games for persons with cerebral palsy, especially in adults.

Johnson, S. D. and K. Kulig (2009). "Patellar tendon rupture in a basketball player." Journal of Orthopaedic & Sports Physical Therapy 39(11): 825.
	The patient was a 21-year-old male who was referred to physical therapy with a 1-week history of right knee pain and stiffness following an injury of traumatic onset. While attempting to jump off of both legs to dunk a basketball during a game, the patient heard and felt a pop in his right knee that was associated with an immediate onset of pain and swelling. He was unable to bear weight following the injury and, therefore, immediately went to the emergency department, where radiographs were completed and interpreted as negative for a fracture. However, the patella for the right knee was superiorly displaced. The patient was issued crutches and referred to physical therapy. At the time of the initial physical therapy examination, the patient was still not able to bear full weight on the right lower extremity or actively fully extend his right knee. Due to concern over possible meniscal, medial collateral ligament, or patellar tendon involvement, the patient's physician was contacted and magnetic resonance imaging was ordered. Five days later, the patient presented with decreased knee effusion and the special tests for the medial collateral ligament and meniscus were negative. However, the patient was still not able to actively extend his knee, suggesting a possible rupture of the patellar tendon, which was later confirmed on magnetic resonance imaging. Surgical repair of the patellar tendon was performed 2 weeks later.

Joo, S., et al. (2018). "A Comparative Study of Smartphone Game with Spirometry for Pulmonary Function Assessment in Stroke Patients." BioMed Research International 2018: 2439312.
	BACKGROUND: The monitoring and rehabilitation of pulmonary function can be immensely important for long-term performance of daily life activities in stroke patients. In recent times, smartphone game-based assessment (SGA) has been gaining in popularity as an alternative to laboratory assessments. Hence, the aims of this study were (1) to quantify the reliability and validity of SGA for pulmonary function and (2) to assess the validity of SGA in comparison to spirometry. MATERIALS/METHODS: Thirty-four stroke subjects (age = 49.24 +/- 8.25 years) performed spirometry and the smartphone game on different days. Spirometric values were obtained using a spirometer (SP-1, Schiller, USA). A breathing game application (Breathing+ package, Breathing Labs, Slovenia) was used to obtain the values for the SGA of pulmonary function. The concurrent validity was determined by comparing data collected from the 2 systems, and the reliability was determined by comparing data collected from 3 sessions of using the breathing game on a smartphone. RESULTS: All parameters demonstrated excellent agreement with intraclass correlation coefficients (ICC (2.1)) values for reliability and concurrent validity. CONCLUSION: We compared the relationship between the SGA and the spirometry as certified pulmonary function test. The SGA data were statistically significant and reliable for pulmonary function assessment in stroke patients. It will therefore be useful during rehabilitation to improve pulmonary function and clinical monitoring in stroke patients.

Joreitz, R. (2010). "Getting back in the game. Rehabbing lower extremity injuries and helping to stave off recurrence." Rehab Manag 23(7): 18, 20-11.
	Rehabbing lower extremity injuries and helping to stave off recurrence.

Jovancevic, J., et al. (2012). "A protocol for a randomized clinical trial of interactive video dance: potential for effects on cognitive function." BMC Geriatrics 12(1): 23.
	BACKGROUND: Physical exercise has the potential to affect cognitive function, but most evidence to date focuses on cognitive effects of fitness training. Cognitive exercise also may influence cognitive function, but many cognitive training paradigms have failed to provide carry-over to daily cognitive function. Video games provide a broader, more contextual approach to cognitive training that may induce cognitive gains and have carry over to daily function. Most video games do not involve physical exercise, but some novel forms of interactive video games combine physical activity and cognitive challenge. METHODS/DESIGN: This paper describes a randomized clinical trial in 168 postmenopausal sedentary overweight women that compares an interactive video dance game with brisk walking and delayed entry controls. The primary endpoint is adherence to activity at six months. Additional endpoints include aspects of physical and mental health. We focus this report primarily on the rationale and plans for assessment of multiple cognitive functions. DISCUSSION: This randomized clinical trial may provide new information about the cognitive effects of interactive videodance. It is also the first trial to examine physical and cognitive effects in older women. Interactive video games may offer novel strategies to promote physical activity and health across the life span.The study is IRB approved and the number is: PRO08080012ClinicalTrials.gov Identifier: NCT01443455.

Jprn, U. (2016). "Usefulness of cancer rehabilitation of multidisciplinary cooperation in the hematological malignancy." https://trialsearch.who.int/Trial2.aspx?TrialID=JPRN-UMIN000021590.
	INTERVENTION: The control group estimates physical function and psychological status as the physiotherapy starting date,one week later,two week later. In addition, physical therapist(Aerobic exercise, muscle strength training and balance practice, 40 minutes every day) do physiotherapy for one week.After that,Physical therapy in combination the game equipment(Aerobic exercise, muscle strength training and balance practice, 40 minutes every day) do physiotherapy for one week. The intervention group estimates physical function and psychological status as the physiotherapy starting date,one week later,two week later.In addition, Physical therapy in combination the game equipment do physiotherapy(Aerobic exercise, muscle strength training and balance practice, 20 minutes every day and Wii Fit U, 20 minutes every day) for one week.After that,physical therapist(Aerobic exercise, muscle strength training and balance practice, 40 minutes every day) do physiotherapy for one week. CONDITION: Malignancy PRIMARY OUTCOME: Amount of activity,Knee extension strength,Grip strength,Timed Up and Go test,Functional Reach test,30 seconds chair stand test,Profile of Mood States Brief Form.; Evaluation time is performed before intervention starting for more than 30 minutes in the physiotherapy starting date, 1 week later and 2 weeks later. INCLUSION CRITERIA: The hematological malignancy who enforces physiotherapy

Jull, G. A. and R. L. Cupit (1984). "Physiotherapy at the XII Commonwealth Games Part I: Organization and Utilization of Services." Australian Journal of Physiotherapy 30(1): 3-9.
	During the XII Commonwealth Games held in Brisbane in 1982, Australian physiotherapists provided a host service which treated nearly one thousand competitors and officials. This service, which was offered at both the Games Villages and Sporting Venues, required extensive planning over a two and a half year period. Appropriate staffing, equipment and space allocation was needed to cater for the wide variety of expected injuries. The services were well utilized which justified the efforts of the organizers and physiotherapists involved in the host team.

Jull, G. A. and R. L. Cupit (1984). "Physiotherapy at the XII Commonwealth Games Part II: Injuries and Management." Australian Journal of Physiotherapy 30(1): 10-14.
	At the XII Commonwealth Games held in Brisbane in 1982, Australian physiotherapists as members of the host nation's medical division, treated the injuries of competitors from the ten sports contested. The nature and incidence of the injuries treated by the host physiotherapists is tabulated and comment is made regarding several significant features. Implications for the management skills of physiotherapists required either to travel with teams or work as host physiotherapists are made. Furthermore, the utilization of equipment is indicated. Overall the paper provides a resource to assist in future planning for such events in respect to physiotherapy manpower, expertise and equipment needs.

Junge, A., et al. (2000). "Psychological and sport-specific characteristics of football players." American Journal of Sports Medicine 28(5 Suppl): S22-28.
	It is hypothesized that players of different levels of play might differ not only in their football skills but also in their way of playing football and with respect to psychological factors such as concentration, reaction time, or competitive anxiety. The psychological characteristics of a player might influence his way of playing football (in particular with respect to fair play) and also his risk of injury. A group of 588 football players were studied by questionnaire; additionally, reaction time tests were performed. Psychological characteristics were assessed by three established self-evaluation questionnaires: the Athletic Coping Skills Inventory, the State Competitive Anxiety Test, and the State-Trait-Anger-Expression-Inventory. Football-specific characteristics that were investigated included playing experience and positions played, style of play, number of training hours and games, as well as aspects of fair play. Reaction time was tested twice: without the influence of physical exercise and immediately after a 12-minute run. A significant reduction in reaction time was observed after physical exercise. In high-level players, the reaction time immediately after the 12-minute run was significantly shorter than it was in low-level players. The questionnaire answers given regarding fair play clearly indicated that fair play is not paid sufficient respect. The relationship between psychological characteristics and attitudes toward fair play was analyzed and discussed.

Junior, V., et al. (2019). "Combining Proprioceptive Neuromuscular Facilitation and Virtual Reality for Improving Sensorimotor Function in Stroke Survivors: A Randomized Clinical Trial." J Cent Nerv Syst Dis 11: 1179573519863826.
	AIM: To assess a program combining virtual reality (VR) games and proprioceptive neuromuscular facilitation (PNF) and to compare it with the standalone techniques in stroke survivors. METHODS: A randomized controlled clinical trial. A total of 48 participants were recruited in the outpatient clinic of a University Hospital in Salvador, Brazil. They were randomly assigned to 3 groups (n = 16 each): PNF, VR, and PNF/VR. Participants attended twice-weekly 50-minute sessions over a 2-month period. The PNF/VR group performed both PNF and VR exercises employing Nintendo Wii electronic games. Motor performance was assessed before and immediately after the treatment using the Fugl-Meyer Assessment scale. RESULTS: An improvement in the mean scores was observed after treatment independent of the allocation group with significant intragroup changes: 14.5, 10.5, and 10.4 for PNF, VR, and PNF/VR, respectively. Score changes were also observed in the analyses of specific sections as follows: (1) a significant improvement in the passive movement and pain score was observed in the PNF and PNF/VR groups; (2) the same was observed for the motor function of the upper limb in all groups, for the motor function of the lower limb in the VR group and for balance in the PNF and PNF/VR groups. CONCLUSIONS: The use of a program combining virtual rehabilitation and PNF presented results that were comparable with those obtained with the isolated techniques.

Juras, G., et al. (2019). "Standards of Virtual Reality Application in Balance Training Programs in Clinical Practice: A Systematic Review." Games for Health Journal 8(2): 101-111.
	OBJECTIVE: To determine the effect of virtual reality (VR) games on improving balance in different groups of neurological patients with a particular focus on the study quality and to determine the gold standard in VR training in these groups. MATERIALS AND METHODS: A systematic review of controlled trials published between January 2009 and December 2017 was conducted. The PubMed, SCOPUS, SPORTDiscus, and Medline databases were searched. Studies involved patients with stroke or Parkinson's disease or children with cerebral palsy. The Physiotherapy Evidence Database (PEDro) scale was used to assess the methodological quality of the included studies. RESULTS: A total of 20 studies met the inclusion criteria. The PEDro scores ranged from 4 to 8 points. Analysis of the rehabilitation programs revealed a very large discrepancy in the planned volume of exercises in different subgroups of patients. CONCLUSIONS: Overall, the comparison of VR interventions between conventional rehabilitation and no intervention exhibited significantly better results. However, these results should be interpreted with great caution due to the large diversity of the systems, games, and training volume used in the VR therapy. In all included studies, only several articles included objective methods to assess the effect of VR. In addition, most of the articles showed a high risk of bias, such as a lack of randomization and blinding or a small sample size. That is why further well-designed randomized control trials are required to evaluate the influence of VR on balance in different groups of neurological patients.

k94c, R. B. R. (2020). "Effectiveness of Active Video Games in adherence to ambulatory Cardiac Rehabilitation: randomized clinical trial." https://trialsearch.who.int/Trial2.aspx?TrialID=RBR-22k94c.
	INTERVENTION: Cardiac Rehabilitation Intervention Group It will consist of 30 participants. As an intervention, the group will use the exergaming of the Nintendo Wii where the patient will manipulate items on the screen through the recognition of their movements, with the use of a console. Boxing, bicycle and tennis games will be used during the sessions. A session will be held to adapt to the use of the Nintendo Wii console. The aerobic exercise of this group will consist of a warm‐up phase, lasting 5 minutes at low intensity, followed by 20 minutes at moderate intensity (Borg scale modified between 3‐4), ending with 5 minutes at low intensity, totaling 30 minutes of intervention. The sessions will take place three times a week, for 12 weeks (excluding the adaptation session). Group control It will consist of 30 participants. Perform aerobic exercise on a treadmill. A session to adapt to the use of the treadmill will be held. The exercise will consist of a warm‐up phase, lasting 5 minutes (at low intensity), followed by 20 minutes at moderate intensity (Borg between 3‐4), ending with 5 minutes at low intensity (totaling 30 minutes of intervention) . The sessions will take place three times a week, for 12 weeks (excluding the adaptation session). Other Virtual Reality CONDITION: Coronary Artery Disease Heart Diseases Heart Failure Heart Failure; Heart Diseases; Coronary Artery Disease ; Heart Failure ; Heart Diseases ; Coronary Artery Disease PRIMARY OUTCOME: Adherence to CR phase II, identified by the percentage of attendance at CR sessions, during the stipulated period of intervention. Adherence will be stratified as total (100% attendance), partial (50% to 99%) or low (less than 50%). SECONDARY OUTCOME: Distance covered in the 6MWT (performed according to the criteria of the American Thoracic Society ‐ ATS). Gait speed. Lung function. Patients' affective component and the pleasure associated with the practice of physical exercise through, respectively, the “sensation scale” / Feeling scale (FS) and the “fun scale” / Physical activity enjoyment scale (PACES). Perceived disability (World Health Organization Disability Assessment Schedule‐ WHODAS). Quality of life (using the SF‐36 questionnaire). Readmission and deaths due to cardiovascular causes. Respiratory muscle strength (using manovacuometry). Symptoms of anxiety and depression (by Hospital Anxietyand Depression Scale ‐ HAD) INCLUSION CRITERIA: Heart disease patients, of both sexes, over 18 years old, with medical clearance to perform CR.

Kachmar, O., et al. (2021). "Personalized balance games for children with cerebral palsy: A pilot study." Journal of Pediatric Rehabilitation Medicine 14(2): 237-245.
	PURPOSE: To assess the changes in balance function in children with cerebral palsy (CP) after two weeks of daily training with personalized balance games. METHODS: Twenty-five children with CP, aged 5 to 18 years were randomly selected for experimental or control groups. Over a period of two weeks, all participants received 8-9 game sessions for 15-20 minutes, totaling 150-160 minutes. The experimental group used personalized balance games available from the GAmification for Better LifE (GABLE) online serious gaming platform. Children from the control group played Nintendo Wii games using a handheld Wii Remote. Both groups received the same background treatment. Recorded outcome measures were from a Trunk Control Measurement Scale (TCMS), Timed Up & Go Test (TUG), Center of Pressure Path Length (COP-PL), and Dynamic Balance Test (DBT). RESULTS: After two weeks of training in the experimental group TCMS scores increased by 4.5 points (SD = 3.5, p< 0.05) and DBT results increased by 0.88 points (IQR = 1.03, p< 0.05) while these scores did not change significantly in the control group. Overall, TUG and COP-PL scores were not affected in either group. CONCLUSION: This study demonstrates improvement of balancing function in children with CP after a two-week course of training with personalized rehabilitation computer games.

Kachmar, O., et al. (2016). "Changes in Muscle Spasticity in Patients With Cerebral Palsy After Spinal Manipulation: Case Series." J Chiropr Med 15(4): 299-304.
	OBJECTIVE: The purpose of this case series was to report quantitative changes in wrist muscle spasticity in children with cerebral palsy after 1 spinal manipulation (SM) and a 2-week course of treatment. METHODS: Twenty-nine patients, aged 7 to 18 years, with spastic forms of cerebral palsy and without fixed contracture of the wrist, were evaluated before initiation of treatment, after 1 SM, and at the end of a 2-week course of treatment. Along with daily SM, the program included physical therapy, massage, reflexotherapy, extremity joint mobilization, mechanotherapy, and rehabilitation computer games for 3 to 4 hours' duration. Spasticity of the wrist flexor was measured quantitatively using a Neuroflexor device, which calculates the neural component (NC) of muscle tone, representing true spasticity, and excluding nonneural components, caused by altered muscle properties: elasticity and viscosity. RESULTS: Substantial decrease in spasticity was noted in all patient groups after SM. The average NC values decreased by 1.65 newtons (from 7.6 +/- 6.2 to 5.9 +/- 6.5) after 1 SM. Another slight decrease of 0.5 newtons was noted after a 2-week course of treatment. In the group of patients with minimal spasticity, the decrease in NC after the first SM was almost twofold-from 3.93 +/- 2.9 to 2.01 +/- 1.0. In cases of moderate spasticity, NC reduction was noted only after the 2-week course of intensive treatment. CONCLUSIONS: In this sample of patients with cerebral palsy, a decrease in wrist muscle spasticity was noted after SM. Spasticity reduction was potentiated during the 2-week course of treatment.

Kahol, K. (2011). "Integrative gaming: a framework for sustainable game-based diabetes management." Journal of Diabetes Science & Technology 5(2): 293-300.
	Obesity and diabetes have reached epidemic proportions in both developing and developed nations. While doctors and caregivers stress the importance of physical exercise in maintaining a healthy lifestyle, many people have difficulty subscribing to a healthy lifestyle. Virtual reality games offer a potentially exciting aid in accelerating and sustaining behavior change. However, care needs to be taken to develop sustainable models of employing games for the management of diabetes and obesity. In this article, we propose an integrative gaming paradigm designed to combine multiple activities involving physical exercises and cognitive skills through a game-based storyline. The persuasive story acts as a motivational binder that enables a user to perform multiple activities such as running, cycling, and problem solving. These activities guide a virtual character through different stages of the game. While performing the activities in the games, users wear sensors that can measure movement (accelerometers, gyrometers, magnetometers) and sense physiological measures (heart rate, pulse oximeter oxygen saturation). These measures drive the game and are stored and analyzed on a cloud computing platform. A prototype integrative gaming system is described and design considerations are discussed. The system is highly configurable and allows researchers to build games for the system with ease and drive the games with different types of activities. The capabilities of the system allow for engaging and motivating the user in the long term. Clinicians can employ the system to collect clinically relevant data in a seamless manner.

Kamel, F. A. H. and M. A. Basha (2021). "Effects of Virtual Reality and Task-Oriented Training on Hand Function and Activity Performance in Pediatric Hand Burns: A Randomized Controlled Trial." Archives of Physical Medicine & Rehabilitation 102(6): 1059-1066.
	OBJECTIVE: To assess the efficacy of a motion-sensing, hands-free gaming device and task-oriented training (TOT) programs on improving hand function, activity performance, and satisfaction in pediatric hand burns. DESIGN: A randomized controlled trial. SETTING: Outpatient rehabilitation center. PARTICIPANTS: Fifty children with deep partial-thickness or full-thickness hand burns. (N=50; mean age, 10.70+/-1.64y; range, 7-14y) INTERVENTIONS: Children were randomized into 1 of the following 3 groups: the motion-sensing, hands-free gaming device group that used interactive video games plus traditional rehabilitation (TR); the TOT group that used real materials plus TR; and the control group that only received TR, all groups received the interventions 3 days per week for 8 weeks. MAIN OUTCOME MEASURES: We assessed the children at the baseline and after 8 weeks of intervention. The primary outcome measures were the Jebsen-Taylor Hand Function Test, Duruoz Hand Index (DHI), and Canadian Occupational Performance Measure (COPM). The secondary outcome measures were range of motion (ROM) of the digits, grip strength, and pinch strengths (tip, palmer, and lateral pinch). RESULTS: There was a significant increase in all measurements of the motion-sensing, hands-free gaming device and TOT groups compared with that of the control group postintervention (P<.05). There was no significant change in Jebsen-Taylor Hand Function Test, COPM performance, ROM, grip strength, and tip and lateral pinch strengths between the motion-sensing, hands-free gaming device group and TOT group (P>.05), whereas there was a significant increase in DHI, COPM satisfaction, and palmer pinch strength (P<.05) in the motion-sensing, hands-free gaming device group compared with the TOT group postintervention. CONCLUSIONS: The motion-sensing, hands-free gaming device and TOT programs resulted in significant improvement in hand function, activity performance and satisfaction, ROM of the digits, grip strength, and pinch strengths in pediatric hand burns compared with the traditional hand rehabilitation.

Kane, A. M., et al. (2011). "The use of the Nintendo WII Fit in the post-surgical rehabilitation of a youth with cerebral palsy: a case report." Pediatric Physical Therapy 23(3): 316-316.
	
Kanitkar, A., et al. (2017). "The Effectiveness of a Computer Game-Based Rehabilitation Platform for Children With Cerebral Palsy: Protocol for a Randomized Clinical Trial." JMIR Research Protocols 6(5): e93.
	BACKGROUND: It is difficult to engage young children with cerebral palsy (CP) in repetitive, tedious therapy. As such, there is a need for innovative approaches and tools to motivate these children. We developed the low-cost, computer game-based rehabilitation platform CGR that combines fine manipulation and gross movement exercises with attention and planning game activities appropriate for young children with CP. OBJECTIVE: The objective of this study is to provide evidence of the therapeutic value of CGR to improve upper extremity (UE) motor function for children with CP. METHODS: This randomized controlled, single-blind, clinical trial with an active control arm will be conducted at 4 sites. Children diagnosed with CP between the ages of 4 and 10 years old with moderate UE impairments and fine motor control abnormalities will be recruited. RESULTS: We will test the difference between experimental and control groups using the Quality of Upper Extremity Skills Test (QUEST) and Peabody Developmental Motor Scales, Second Edition (PDMS-2) outcome measures. The parents of the children and the therapist experiences with the interventions and tools will be explored using semi-structured interviews using the qualitative description approach. CONCLUSIONS: This research protocol, if effective, will provide evidence for the therapeutic value and feasibility of CGR in the pediatric rehabilitation of UE function. TRIAL REGISTRATION: Clinicaltrials.gov NCT02728375; http:https://clinicaltrials.gov/ct2/show/NCT02728375 (Archived by WebCite at http://www.webcitation.org/6qDjvszvh).

Kapitany-Foveny, M., et al. (2018). "Potential of an Interactive Drug Prevention Mobile Phone App (Once Upon a High): Questionnaire Study Among Students." JMIR Serious Games 6(4): e19.
	BACKGROUND: In recent years, drug prevention networks and drug education programs have started using Web-based or mobile phone apps as novel prevention tools, testing their efficacy compared with face-to-face prevention. OBJECTIVE: The aim of this study was to assess the potential of an interactive app called Once Upon a High (VoltEgySzer). METHODS: The app approaches drug prevention from 6 different aspects, and it addresses youngsters with 6 different modules: (1) interactive comics/cartoons, telling stories of recovery; (2) quiz game; (3) roleplay game; (4) introduction of psychoactive drugs; (5) information on the somatic and psychological effects of psychoactive substances; (6) list of available treatment units, rehabs, and self-support groups in Hungary. Students of 2 vocational schools and 2 high schools filled out a questionnaire at a baseline (T0) and a 2-month follow-up (T1) data collection session. Students of 1 vocational school and 1 high school downloaded the Once Upon a High app (app group), whereas students from the other vocational school and high school did not (nonapp group). The time points of T0 and T1 questionnaires contained demographic variables, items with regard to substance use characteristics for both legal and illegal substances, including novel psychoactive substance, exercise habits, knowledge about psychoactive substances, attitudes toward substance users and validated instruments measuring the severity of tobacco (Fagerstrom Test for Nicotine Dependence), alcohol (Alcohol Use Disorder Identification Test), cannabis (Cannabis Abuse Screening Test), and synthetic cannabinoid consumption. Beliefs about substance use (Beliefs About Substance Abuse) and perceived self-efficacy (General Perceived Self-Efficacy) were also measured. At T1, members of the app group provided additional evaluation of the app. RESULTS: There were 386 students who participated in the T0 session. After dropout, 246 students took part in T1 data collection procedure. Alcohol was the most frequently consumed psychoactive substance (334/364, 91.8% lifetime use), followed by tobacco (252/386, 65.3%, lifetime use) and cannabis (43/323, 13.3% lifetime use). Decreased self-efficacy (beta=-.29, P=.04) and increased daily physical exercise frequencies (beta=.04, P<.001) predicted higher frequencies of past month energy drink consumption, whereas elevated past month alcohol consumption was mainly predicted by a decrease in negative attitudes toward substance users (beta=-.13, P=.04) in the regression models. Once Upon a High was found to be effective only in reducing energy drink consumption (beta=-1.13, P=.04) after controlling for design effect, whereas perceived utility of the app showed correlation with a decreasing alcohol use (rS(44)=.32, P=.03). The roleplay module of the app was found to be the most preferred aspect of the app by the respondents. CONCLUSIONS: The Once Upon a High app can be a useful tool to assist preventive intervention programs by increasing knowledge and self-efficacy; however, its efficacy in reducing or preventing substance use needs to be improved and further studied. Additional potential impacts of the app need further testing.

Kaplan, O., et al. (2018). "Exergame Experience of Young and Old Individuals Under Different Difficulty Adjustment Methods." Computers 7(4): 59.
	In this work, we compare the exergaming experience of young and old individuals under four difficulty adjustment methods. Physical inactivity is a leading cause of numerous health conditions including heart diseases, diabetes, cancer, and reduced life expectancy. Committing to regular physical exercise is a simple non-pharmaceutical preventive measure for maintaining good health and sustaining quality of life. Incorporating exercise into games, studies frequently used exergames as an intervention tool over the last decades to improve physical functions and to increase adherence to exercise. While task difficulty optimization is crucial to exergame design, researchers consistently overlooked age as an element which can significantly influence the nature of end results. We use the Flow State Scale to analyze the mental state of young and old individuals to compare constant difficulty with ramping, performance-based, and biofeedback-based difficulty adjustments. Our results indicate that old individuals are less likely to experience flow compared to young under the same difficulty adjustment methods. Further investigation revealed that old individuals are likely to experience flow under ramping and biofeedback-based difficulty adjustments whereas performance-based adjustments were only feasible for young.

Kapsigay, B., et al. (2017). "HPR effects of virtual rehabilitation on shoulder periarthritis." Annals of the rheumatic diseases Conference: Annual European Congress of Rheumatology, EULAR 2017. Spain. 76(Supplement 2): 1496.
	Background: The virtual rehabilitation (Nintendo Wii) program works with a 3‐dimensional, computer‐assisted, virtual reality creation system. The system creates a mirror effect and provides the smoothness of the movement of the adult. It keeps visual and sensory feedback during exercise. The avatar that appears on the screen detects motion and displays the result thanks to the control commander. The use of virtual reality practice in the exercise program is a new way of improving participation and motivation of participants. Objectives: The aim our study is to investigate the effect of virtual rehabilitation on kinesophobia and clinical fragility in patients with shoulder periathritis. Methods: Fifteen cases diagnosed with shoulder periarthritis were included in the study. In our study, we used Tampa Kinesophobia Scale for kinesophobia, VAS for pain severity, manual muscle test for muscle strength and goniometer for ROM. In addition to Clinical fragility Scale for fragility and 4‐item Quality of Life Questionnaire were used to assess quality of life. Finally, Shoulder Pain and Disability Index (SPADI) was used for shoulder disability. Eight of 15 patients were included in the control group (CG) and 7 in the virtual rehabilitation group (VRG). Both groups were treated with Therapeutic US, TENS and Cold Pack. In addition to these, the control group consisted of 15 sessions of active stretching and strengthening exercises for 20 minutes each session; the VRG was given a total of 15 sessions of the virtual rehabilitation program for 45 minutes each session, with 3 sessions per week. Intra‐group pretreatment and post‐treatment differences were analyzed by Wilcoxon test, and inter‐group comparisons were analyzed by Mann‐Whitney U test. Results: Statistically significant reductions in Frajilite, Kinesophobia, SPADI and VAS values were observed in the VRG analyzes; A statistically significant increase in the 4‐item quality of life questionnaire, range of motion and muscle strength values was assessed (p<0.05). In the CG, there was a statistically significant decrease in kinesophobia, VAS and SPADI values; There was a statistically significant increase in joint range of motion and muscle strength evaluations (p<0,05). There was no statistically significant difference in the fragility evaluation of the CG (p>0,05). Fragility and kinesophobia decreased in both groups after treatment compared to before treatment, but this decrease was found to be higher in VRG (p<0.05). Conclusions: As a result of our study, virtual rehabilitation in the treatment of kinesophobia and fragility in shoulder periarthritis patients was game‐focused and it was found to be an effective method for increasing participation and biofeedback. Virtual rehabilitation was considered as an alternative to conventional physiotherapy and rehabilitation programs.

Karakoc, Z. B., et al. (2016). "The results of adding virtual rehabilitation to standard rehabilitation program on balance and lower extremity functionality after ACL reconstruction: pilot study." Physiotherapy 102: e247‐.
	Relevance: Research report. Purpose: It was aimed to investigate the effect of adding virtual rehabilitation to standard rehabilitation on pain, balance, range of motion, lower extremity muscle strength and lower extremity functionality in cases undergoing anterior cruciate ligament reconstruction. Methods/analysis: The study included patients who had undergone anterior cruciate ligament (ACL) reconstruction in Dr. Lutfi Kirdar Training and Research Hospital, Department of Orthopaedics and Traumatology. Demographic data were recorded on a patient assessment form prepared by the researchers. The exclusion criteria were posterior cruciate ligament and meniscus injury, an injury affecting the spine/lower extremity in the last 6 weeks, a history of lower extremity surgery, congenital orthopaedic disease or a medical contraindication for exercises. The primary outcome measures were evaluations of pain intensity with a Visual Analog Scale (VAS), range of motion with a universal goniometer, strength of quadriceps and hamstrings muscles with a portable muscle tester, functionality of the lower extremity with the Lower Extremity Functionality Scale and balance with the Nintendo Wii U Balance Board (Basic balance test of Nintendo Wii U game console). Patients were assessed before starting rehabilitation, three weeks after starting rehabilitation and at the end of the rehabilitation program. The physiotherapy program, which included electrical stimulation, muscle strengthening, stretching and closed kinetic chain exercises, was applied three times a week for 6 weeks. After 3 weeks of rehabilitation, Nintendo Wii U Balance Games were added at 40 minutes per session for 3 weeks. The balance games consisted of four games; heading a soccer ball, penguin slide, table tilt and skiing slalom. The Friedman non‐parametric test in the SPSS statistics program was used for statistical analysis in this study. Results: All the patients were male with a mean age of 30±8.23 years. ACL reconstruction was applied to the left knee in five cases and the right knee in four. No statistically significant differences were determined between the 1st, 2nd and 3rd evaluations of balance, center of pressure, pain, and muscle strength values (P > 0.05). The 3rd assessment showed a significant increase in lower extremity functionality compared to the 2nd assessment. The range of motion values were increased significantly between weeks 3 and 6. Discussion and conclusions: The application of the assessment tests shortly after the rehabilitation and game sessions could be considered to be the reason that no differences were determined between assessments. Patients reported the Wii game to be enjoyable and safe, which was supported by their engagement in the training. Future randomized controlled studies with larger sample sizes are required to confirm this result. Impact and implications: For physiotherapy practice.

Karamians, R., et al. (2020). "Effectiveness of Virtual Reality- and Gaming-Based Interventions for Upper Extremity Rehabilitation Poststroke: A Meta-analysis." Archives of Physical Medicine & Rehabilitation 101(5): 885-896.
	OBJECTIVE: To investigate the efficacy of virtual reality (VR)- and gaming-based interventions for improving upper extremity function poststroke, and to examine demographic and treatment-related factors that may moderate treatment response. DATA SOURCES: A comprehensive search was conducted within the PubMed, CINAHL/EBSCO, SCOPUS, Ovid MEDLINE, and EMBASE databases for articles published between 2005 and 2019. STUDY SELECTION: Articles investigating gaming and VR methods of treatment for upper extremity weakness were collected with the following study inclusion criteria: (1) participants aged 18 years or older with upper extremity deficits; (2) randomized controlled trials or prospective study design; (3) Downs-Black rating score of >/=18; and (4) outcome measure was the Wolf Motor Functioning Test, the Fugl-Meyer, or the Action Research Arm Test. DATA EXTRACTION: Thirty-eight articles met inclusion criteria. The primary outcome was proportional improvement on the Wolf Motor Functioning Test, Fugl-Meyer, or Action Research Arm Test. The following individual or treatment factors were extracted: VR or gaming dose, total treatment dose, chronicity (> or <6mo), severity of motor impairment, and presence of a gaming component. DATA ANALYSIS: Random effects meta-analysis models were utilized to quantify (1) the proportional recovery that occurs after VR or gaming; (2) the comparative treatment effect of VR or gaming vs conventional physiotherapy; and (3) whether the benefit of virtual reality differed based on participant characteristics or elements of the treatment. RESULTS: On average, VR or gaming interventions produced an improvement of 28.5% of the maximal possible improvement. Dose and severity of motor impairment did not significantly influence rehabilitation outcomes. Treatment gains were significantly larger overall (10.8%) when the computerized training involved a gaming component vs just visual feedback. VR or gaming interventions showed a significant treatment advantage (10.4%) over active control treatments. CONCLUSIONS: Overall, VR- or gaming-based upper extremity rehabilitation poststroke appears to be more effective than conventional methods. Further in-depth study of variables affecting improvement, such as individual motor presentation, treatment dose, and the relationship between them, are needed.

Karas, H. E., et al. (2021). "The Effects of Virtual Reality on Upper Extremity in Patients with Obstetric Brachial Plexus Injury." Journal of Pediatric Neurology 20(01): 028-036.
	The present study aimed to examine the effects of playing Nintendo Wii games on upper extremity functions compared with conventional physiotherapy, in children with obstetric brachial plexus injury (OBPI). Twenty-two patients with brachial plexus injuries were enrolled. The patients were divided into two groups by simple randomization. The control group (conventional physiotherapy group [CTG]: n  = 11) received conventional physiotherapy for 6 weeks (40 minutes per day, for 4 days per week). The study group, called Nintendo Wii group (NWG; n  = 11), received conventional physiotherapy as well as tennis, baseball, and boxing games with Nintendo Wii on days when there was no physical therapy. The upper extremity range of motion (ROM) was evaluated using a digital goniometer, motor function was assessed using the Active Movement Scale (AMS), and shoulder functions were assessed with the Mallet Scoring System (MSS). Virtual reality treatment had a positive effect on shoulder flexion, forearm pronation, wrist flexion, ROM, and functionality ( p  < 0.05). There was a significant improvement in shoulder abduction and shoulder external rotation in the CTG ( p  < 0.05). There was no significant difference in the MSS values of either groups ( p  > 0.05). As per the AMS, in the NWG, the shoulder internal rotation increased significantly ( p  < 0.05). Nintendo Wii treatment used in addition to conventional physiotherapy may be effective in increasing upper extremity functions in children with OBPI.

Karasu, A. U., et al. (2018). "Effectiveness of Wii-based rehabilitation in stroke: A randomized controlled study." Journal of Rehabilitation Medicine 50(5): 406-412.
	OBJECTIVE: To investigate the efficacy of Nintendo Wii Fit(R)-based balance rehabilitation as an adjunc-tive therapy to conventional rehabilitation in stroke patients. METHODS: During the study period, 70 stroke patients were evaluated. Of these, 23 who met the study criteria were randomly assigned to either the experimental group (n = 12) or the control group (n = 11) by block randomization. Primary outcome measures were Berg Balance Scale, Functional Reach Test, Postural Assessment Scale for Stroke Patients, Timed Up and Go Test and Static Balance Index. Secondary outcome measures were postural sway, as assessed with Emed-X, Functional Independence Measure Transfer and Ambulation Scores. An evaluator who was blinded to the groups made assessments immediately before (baseline), immediately after (post-treatment), and 4 weeks after completion of the study (follow-up). RESULTS: Group-time interaction was significant in the Berg Balance Scale, Functional Reach Test, anteroposterior and mediolateral centre of pressure displacement with eyes open, anteroposterior centre of pressure displacement with eyes closed, centre of pressure displacement during weight shifting to affected side, to unaffected side and total centre of pressure displacement during weight shifting. Demonstrating significant group-time interaction in those parameters suggests that, while both groups exhibited significant improvement, the experimental group showed greater improvement than the control group. CONCLUSION: Virtual reality exercises with the Nintendo Wii system could represent a useful adjunctive therapy to traditional treatment to improve static and dynamic balance in stroke patients.

Karila, L. and A. Benyamina (2021). "Addictions en temps de pandémie." La Presse Médicale Formation 2(3): 273-281.
	Résumé L’Organisation mondiale de la santé a déclaré la maladie causée par le coronavirus 2 comme pandémie en mars 2020. Via les différentes mesures prises, un phénomène stressant psychosocial induit par cette épidémie a, dès lors, émergé en raison des difficultés financières, de l’isolement social et du caractère incertain du futur. L’ensemble des études nationales et internationales a mis en évidence une augmentation des usages de tabac, d’alcool et de substances illicites. Outre les comportements de consommation excessive, voire les décompensations addictives liées aux substances, il faut également prendre en considération l’usage excessif de la pornographie, des jeux de hasard et d’argent, des jeux vidéo essentiellement via Internet et l’exercice physique. La COVID-19 peut être à l’origine d’un certain nombre de conséquences et de complications chez les personnes souffrant de troubles liés à l’usage de substances licites ou illicites, population particulièrement vulnérable. Dans cette revue de la littérature narrative, nous analyserons les données concernant les comportements de consommation excessive et les addictions aux substances psychoactives licites et illicites et à certains types de comportements de la vie quotidienne. Nous avons, pour ce faire, utilisé les combinaisons de mots-clés pour sélectionner les articles scientifiques de langue anglaise et française publiés entre 2019 et 2021 en consultant les bases de données Medline, Embase, PsycInfo, Google Scholar. Summary The World Health Organization declared the disease caused by coronavirus 2 as a pandemic in March 2020. Through the various measures taken, a psychosocial stressful phenomenon induced by this epidemic has therefore emerged due to financial difficulties, social isolation and the uncertain nature of the future. All national and international studies have shown an increase in the use of tobacco, alcohol and illicit substances. In addition to excessive consumption behavior and even addictive decompensations linked to substances, excessive use of pornography, gambling, gambling, video games mainly via the Internet and physical exercise must also be taken into account. COVID-19 can cause a number of consequences and complications for people with legal and illegal substance use disorders, a particularly vulnerable population. In this review of the literature, we will analyze the data concerning the behaviors of excessive consumption and addiction to licit and illicit psychoactive substances and to certain types of behaviors of daily life. To do this, we used the keyword combinations to select the scientific articles in English and French published between 2018 and 2021 by consulting the Medline, Embase, PsychInfo, Google Scholar databases.

Karimy, M., et al. (2019). "A Study on the Knowledge, Attitude, and Practices of Iranian Mothers towards Childhood Obesity." Obesity Facts 12(6): 669-677.
	OBJECTIVES: In the recent decades, a dramatic increase in childhood obesity is one of the main public health problems. The aim of the study was to assess the knowledge, attitude, and practices (KAP) of Iranian mothers towards childhood obesity. METHODS: This cross-sectional descriptive research was conducted on KAP of 432 mothers and their children aged 6-7 years (214 boys and 218 girls) who were referred to the Zarandieh health centers, Iran, in 2017. The participants were selected via multistage random sampling. Demographic and KAP data were obtained by self-report using standard questionnaires. The weight and height of the subjects were measured according to standard methods and body mass index was calculated. Data were analyzed by inferential statistics using SPSS18 software. RESULTS: The prevalence of obesity (OB) was 11.5% in boys and 7% in girls. The mean score for attitude for mothers with normal-weight children was higher than for mothers with obese children. Food habits like consumption of breakfast, having fast food at least twice a week, and eating in front of TV were associated with OB. Physical activity habits like duration of TV watching/computer games/sleep and regular physical exercise were associated with OB. CONCLUSIONS: This study identified the importance of educating Iranian mothers to change of lifestyle (eating and physical activity habits) and attitudes towards weight control in their children. Therefore, it seems that these results may be valuable in the development of educational programs and strategies for the prevention of childhood obesity.

Karssemeijer, E. G. A., et al. (2019). "The quest for synergy between physical exercise and cognitive stimulation via exergaming in people with dementia: a randomized controlled trial." Alzheimers Res Ther 11(1): 3.
	BACKGROUND: Exercise is often proposed as a non-pharmacological intervention to delay cognitive decline in people with dementia, but evidence remains inconclusive. Previous studies suggest that combining physical exercise with cognitive stimulation may be more successful in this respect. Exergaming is a promising intervention in which physical exercise is combined with cognitively challenging tasks in a single session. The aim of this study was to investigate the effect of exergame training and aerobic training on cognitive functioning in older adults with dementia. METHODS: A three-armed randomized controlled trial (RCT) compared exergame training, aerobic training and an active control intervention consisting of relaxation and flexibility exercises. Individuals with dementia were randomized and individually trained three times a week during 12 weeks. Cognitive functioning was measured at baseline, after the 12-week intervention period and at 24-week follow-up by neuropsychological assessment. The domains of executive function, episodic memory, working memory and psychomotor speed were evaluated. Test scores were converted into standardized z-scores that were averaged per domain. Between-group differences were analysed with analysis of covariance. RESULTS: Data from 115 people with dementia (mean (SD) age = 79.2 (6.9) years; mean (SD) MMSE score = 22.9 (3.4)) were analysed. There was a significant improvement in psychomotor speed in the aerobic and exergame groups compared to the active control group (mean difference domain score (95% CI) aerobic versus control 0.370 (0.103-0.637), p = 0.007; exergame versus control 0.326 (0.081-0.571), p = 0.009). The effect size was moderate (partial eta(2) = 0.102). No significant differences between the intervention and control groups were found for executive functioning, episodic memory and working memory. CONCLUSIONS: To our knowledge, this is the first RCT evaluating the effects of exergame training and aerobic training on cognitive functioning in people with dementia. We found that both exergame training and aerobic training improve psychomotor speed, compared to an active control group. This finding may be clinically relevant as psychomotor speed is an important predictor for functional decline. No effects were found on executive function, episodic memory and working memory. TRIAL REGISTRATION: Netherlands Trial Register, NTR5581 . Registered on 7 October 2015.

Karssemeijer, E. G. A., et al. (2019). "Exergaming as a Physical Exercise Strategy Reduces Frailty in People With Dementia: A Randomized Controlled Trial." Journal of the American Medical Directors Association 20(12): 1502-1508 e1501.
	OBJECTIVES: People with dementia are known to be physically frailer, more sedentary, and participate less in regular physical exercise compared to their healthy peers. Physical activity interventions have the potential to reduce the level of frailty in community-dwelling older adults. Exergaming combines physical exercise with cognitive stimulation in a virtual environment. It is an innovative and fun way of exercising, which may aid people with dementia to be more physically active. The primary aim of this study was to investigate the efficacy of a 12-week exergame training and equally long aerobic training, both compared to an active control group, on frailty in people with dementia. DESIGN: A 3-armed randomized controlled trial compared exergame training, aerobic training, and an active control intervention. PARTICIPANTS: 115 people with dementia [mean (standard deviation [SD]) age = 79.2 (6.9) years; mean (SD) Mini-Mental State Examination score = 22.9 (3.4)]. METHODS: Participants were randomized and individually trained 3 times a week during 12 weeks. The Evaluative Frailty Index for Physical activity (EFIP) was used to assess the level of frailty at baseline and after the 12-week intervention period. Between-group differences were analyzed with analysis of covariance. RESULTS: The exergame group showed a trend toward higher adherence compared to the aerobic group (87.3% vs 81.1%, P = .05). A significant reduction on the EFIP was found in the exergame group (EG) compared to the active control group (CG) [mean difference (95% confidence interval) between EG and CG: -0.034 [-0.062, -0.007], P = .012], with a small-to-moderate effect size (partial eta(2) = 0.055). CONCLUSIONS AND IMPLICATIONS: This is the first study to show that a 12-week exergame intervention reduces the level of frailty in people with dementia. This is an important and promising result, because frailty is a powerful predictor for adverse health outcomes, and its reduction may have positive effects on health status. Moreover, exergaming resulted in high adherence rates of physical exercise, which makes it an effective strategy to engage people with dementia in physical activity.

Kastelein, A., et al. (2020). "IUGA 45th Virtual Annual Meeting." Int Urogynecol J 31(Suppl 1): 1-244.
	Introduction: Urinary incontinence is a common condition in women, with a reported prevalence ranging from 25 to 51% [1]. Of these women, an estimated 38% suffer from stress urinary incontinence (SUI) [2]. Supervised pelvic floor muscle training (PFMT) is an efficacious treatment forwomen withmild to moderate SUI [3], butmay not be accessible to all patients and adherence to training recommendations is often poor. A European consortium has developed an innovative self‐management system that may be an alternative for conventional PFMT. Objectives: To compare the self‐management intervention to usual care PFMT supervised by a therapist in a clinical setting, in terms of efficacy, quality of life and satisfaction. Methods: We performed a multicenter, non‐blinded randomized controlled trial to prove non‐inferiority of the self‐management treatment. Both groups performed 12 weeks of weekly supervised PFMT, either by the selfmanagement system (remote supervision) or supervised by a healthcare professional in a clinical setting (face‐to‐face supervision). The self‐management system consisted of a wireless vaginal and abdominal biofeedback device, connected via Bluetooth to a smartphone with access to serious games and a web‐platform, allowing remote supervision by a healthcare professional. The primary outcome was patient reported improvement of SUI symptoms, measured by the International Consultation on Incontinence Questionnaire‐ Urinary Incontinence Short Form (ICIQ‐UI SF) at 12 months. Secondary outcomes included Patient Global Impression of Improvement (PGI‐I), quality of life (Incontinence Impact Questionnaire and EuroQol‐5Dquestionnaire) and satisfaction (self‐developed questionnaire). Results:A total of 263 women withmild tomoderate SUI were randomly assigned to the self‐management group (n=133) or the usual care PFMT group (n=130). There were no significant differences between groups at baseline. At 12 months, the median change in ICIQ score in the selfmanagement group (‐4) was non‐inferior to the usual care group (‐4) (p=0.59, 95% CI ‐0.7 ‐ 1.3). Subjective improvement according to the PGI questionnaire was reported by 80.6% of women in the selfmanagement group, compared to 79.2%of women in the usual care group (p=0.32). There were also no significant differences in improvement of quality of life and satisfaction between groups. Conclusions: Our study showed that PFMT for mild to moderate SUI with an innovative, remotely‐supervised self‐management intervention is non‐inferior to conventional PFMT supervised by a therapist in a clinical setting, which implicates that more women with bothersome SUI have access to an efficacious intervention.

Kct (2015). "Canoe game-based virtual reality training after stroke." https://trialsearch.who.int/Trial2.aspx?TrialID=KCT0001505.
	INTERVENTION: Others(Therapeutic exercise program) : All subjects participated in a conventional rehabilitation program, consists of physical therapy and occupational therapy. But only the experimental group participated in canoe game‐based VR training program for additionally 30 minutes a day, 3 days a week, over 5 weeks. Assessors were blinded to minimize bias in research. CONDITION: Diseases of the nervous system PRIMARY OUTCOME: Dynamic balance ability: (1) Berg balance scale, (2) Timed up and go test Postural stability of trunk: (1) Trunk impairment scale (2) Modified functional reach test Static balance ability: (1) Wii‐Fit Balance Board‐based system (Balancia v 2.0) SECONDARY OUTCOME: Upper limb motor function: (1) Fugl‐Meyer assessment, (2) Manual function test INCLUSION CRITERIA: INCLUSION CRITERIA: (1) non‐cerebellar stroke within the previous 6 months; (2) ability to understand and follow simple verbal instructions; (3) Mini‐Mental State Examination score of = 21; (4) minimum score of 15 on the Berg Balance Scale (the minimum level deemed safe for balance intervention participation); and (5) ability to walk 10 meters independently, with or without an assistance device.

Keci, A., et al. (2019). "Role of Rehabilitation in Neural Plasticity." Open Access Macedonian Journal of Medical Sciences 7(9): 1540-1547.
	AIM: Verifying if physical therapy, neurostimulation techniques, aerobic fitness and video games can induce neural plasticity making it possible for cortical reorganisation, motor recovery in patients, improvement of cognitive functions and transfer of spatial knowledge in the everyday living environment. METHODS: There have been revised scientific articles respectively focused on the role of pain, the role of physical therapy, neurostimulation techniques and video games in cortical reorganisation. Articles related to the role of pain have taken in the study subjects with pain, to observe its role in cortical reorganisation. Studies related to physical therapy and neurostimulation techniques after cerebrovascular accident consisted of the involvement of these subjects which exposed to different neurostimulations. Also, related to cognition and video games subjects exposed to these interventions for cognitive benefits. RESULTS: From all articles reviewed there have been effective results of neurostimulation techniques, aerobic fitness and video games in cortical reorganisation inducing neural plasticity (p < 0.05) toward motor recovery, improvement of executive functions and transfer of spatial knowledge. CONCLUSION: Rehabilitation through locomotor training and neurostimulation techniques, improves mobility in subjects after a cerebrovascular accident due to cortical reorganisation. Also, through aerobic fitness and video games, there have been improvements in cognitive functions. This way, rehabilitation dedicated to the promotion of well-being and health urges beneficial neuroplastic changes in brain corresponding in functional improvement.

Kefaliakos, A., et al. (2016). "Virtual Reality in the Rehabilitation of Patients with Neurological Disorders...International Conference on Informatics, Management, and Technology in Healthcare, July 2016, Athens, Greece." Studies in Health Technology & Informatics 226: 45-47.
	Neurological disorders affect the lifestyle and the living conditions of a patient. Virtual Reality is a technology that may be used to simulate various types of tasks in a computerized environment guiding the patient and help on rehabilitation. This review try to answer how Virtual Reality technologies can effect on the patients rehabilitation’s results. Treatments which involves Virtual Reality applications offer new ways to make the patients more committed to their program and keeps them motivated. Another characteristic of a Virtual Reality treatment is that both patients and therapists can observe the mistakes made during a physiotherapy session. The insert of VR sessions in traditional rehabilitation therapy of patients with neurological disorders have produced positive results.

Keisari, S., et al. (2022). "Synchrony in Old Age: Playing the Mirror Game Improves Cognitive Performance." Clinical Gerontologist 45(2): 312-326.
	OBJECTIVES: Studies have shown that synchronized motion between people positively affects a range of emotional and social functions. The mirror-game is a synchrony-based paradigm, common to theater, performance arts, and therapy, which includes dyadic synchronized motion, playfulness, and spontaneity. The goal of the current study is to examine the effects of the mirror-game on subjective and cognitive indices in late life. METHODS: Thirty-four older adults (aged 71-98) participated in a within-group study design. Participants conducted two sessions of 9-minute movement activities: the mirror-game and the control condition - a physical exercise class. Several measures were taken before and after experimental sessions to assess socio-emotional and attentional functions. RESULTS: The mirror-game enhanced performance on the attention sub-scale and led to faster detections of spoken words in noise. Further, it enhanced perceived partner responsiveness and led to an increase in positive reported experience. CONCLUSIONS: Our preliminary findings suggest that the mirror-game, rather than the exercise class, may have an immediate impact on mood and some attentional functions. CLINICAL IMPLICATIONS: The mirror-game is a novel intervention, with potential benefits of social-emotional and cognitive functioning, which can be easily implemented into the daily routine care of older adults. Future studies should explore the effect of the mirror-game on additional cognitive and socio-emotional aspects.

Kenyon, L. K., et al. (2021). "Outcomes of a child-based manual wheelchair skills peer training program: an exploratory case report." Disabil Rehabil Assist Technol: 1-5.
	PURPOSE: The purpose of this exploratory case series was to describe the outcomes for both a child-learner and a child-peer after a single manual wheelchair (MWC) skills training session involving child-based peer training techniques, followed by related home-based skills practice. MATERIALS AND METHODS: Participants were a 9-year-old with L4-L5 spina bifida (pseudonym: Amari) and a 3-year-old with T10 spina bifida (pseudonym: Mary). Pre-intervention examination included administration of the Wheelchair Skills Test Questionnaire (WST-Q), the MWC short scale within the Mobility domain of the Paediatric Evaluation of Disability - Computer Adapted Test (MWC PEDI-CAT), and the Canadian Occupational Performance Measure (COPM). The peer training session, facilitated by a physical therapy team, involved games and activities involving MWC use. When appropriate, Amari was asked to talk aloud and verbally describe the components of the skills she was performing. Each child and her mother were instructed in specific MWC skills to practice at home over a 3-week period. RESULTS: Both participants' post-intervention WST-Q capacity, confidence, and performance scores increased. Increases in parent-proxy COPM scores indicated clinically meaningful change in all identified occupational performance problems. Mary's total MWC PEDI-CAT post-intervention score increased by 11 points. Both mothers reported that the participation in the activities helped also to improve their child's self-esteem and self-image. CONCLUSIONS: Both the participants in this exploratory case appeared to demonstrate improvements in MWC skills, self-esteem, and self-image following a single child-based MWC skills peer training session and related home-based skills practice. Future research involving such peer training methods is warranted.

Kenyon, L. K., et al. (2018). "Power Mobility Training Methods for Children: A Systematic Review." Pediatr Phys Ther 30(1): 2-8.
	PURPOSE: To summarize and critically appraise the existing evidence related to power mobility training methods used in research studies conducted with children 21 years or younger. METHODS: A systematic review was conducted using 16 electronic databases to identify primary source quantitative studies published in peer-reviewed journals. Data extraction, determination of level of evidence, evaluation of methodological rigor, and assessment of the risk of bias were completed. The Evidence Alert Traffic Light Grading System (EATLS) was used. RESULTS: Twenty-seven studies were included in the review. Levels of evidence were II to V; scientific rigor scores were 2 to 7. CONCLUSIONS: An overall Yellow EATLS level of evidence was found indicating that therapists should use caution when providing power mobility training interventions and measure outcomes related to established goals in areas such as development, functional skills, or use of a power mobility device.

Keskinen, T., et al. (2014). "Schoolchildren’s user experiences on a physical exercise game utilizing lighting and audio." Entertainment Computing 5(4): 475-484.
	Motivated by the troubling news on decreased exercise amount and increased obesity among children and adolescents, we investigated the possibilities of interactive lighting technology in encouraging children to participate in physical exercise in schools. We have created a story-driven physical exercise game based on light and sound utilizing a reasonably priced technological setup. The game has been evaluated with several groups of schoolchildren during physical education classes. The results show that a physical exercise game enhanced with lighting and audio keeps schoolchildren motivated both mentally and physically even after several playtimes. In subjective evaluations, participants still found the story of the game interesting after three playtimes, and were eager to exercise this way again.

Ketelhut, S., et al. (2022). "The New Way to Exercise? Evaluating an Innovative Heart-rate-controlled Exergame." International Journal of Sports Medicine 43(1): 77-82.
	Exergames may offer novel opportunities to expand physical activity. Most games, however, only result in low to moderate-intensity activities that are too low to allow relevant physical adjustments. In the present study, the exercise intensity of a new, heart rate controlled, functional fitness game was assessed. 28 subjects (aged 24.8+/-3.8 yrs; 46% female; BMI 23.2+/-2.3 kg/m2) were enrolled in this study. VO2max and maximal heart rate (HRmax) were assessed during a maximal graded exercise test on a treadmill and compared with the oxygen consumption (VO2) and heart rate (HR) during a game in the ExerCube.In the ExerCube, the subjects reached a peak HR of 187.43+/-9.22 bpm, which corresponds to 96.57+/-3.64% of their HRmax. The mean HR throughout the game was 167.11+/-10.94 bpm, corresponding to 86.07+/-4.33% of HRmax. VO2peak reached 41.57+/-5.09 ml/kg/min during the game in the ExerCube, which corresponds to 84.75+/-7.52% of VO2max. The mean VO2 consumption during the game reached 32.39+/-4.04 ml/kg/min, which corresponds to 66.01+/-5.09% of VO2max. The ExerCube provides a form of vigorous physical exercise. Due to its playful, immersive, and motivating nature, the ExerCube seems to be a promising tool to facilitate physical activity.

Khan, M. J., et al. (2015). "Risk Factors of Tendo-Achilles Injury in Football, Cricket and Badminton Players at Dhaka, Bangladesh." Bangladesh Medical Research Council Bulletin 41(1): 19-23.
	Achilles tendon is the tendon connecting the heel with the calf muscles. Tendo-achilles injury (TAI) in players is common in games. The frequency of TAI is unknown and aetiology is controversial: The present descriptive cross-sectional study was done to determine the prevalence of TAI and associated factors contributing to it in football, cricket and badminton. From January to June 2012, male players (n = 131), age -17-35 years, were selected by purposive sampling technique from renowned sporting clubs at Dhaka, Bangladesh. TAI was diagnosed through structured questionnaire and interviewing the respondents. The analysis by Statistical Package for Social Sciences (SPSS) programme revealed that 11.5% players suffered from TAI, i.e. prevalence was 115 per 1000 respondents. Most injuries (70/131; 53.4%) occurred in the playground and (59/131; 45.3%) happened in practice field. Injuries among the players of third division were higher, i.e. about 36% (p = 0.000). TAI was significantly dependent on occupation (p = 0.046), BMI (p = 0.008), divisional status (p = 0.023), game type (p = 0.043), ground condition (p = 0.05) and injury severity (p = 0.000). The injured players referred for treatment to the physiotherapist was highest (9/15, i.e. 60%) followed by the physicians (5/15, i.e. 33%) (p = 0.000). The associations of TAI with various factors were discussed suggesting effective measures be taken and treatment, particularly physiotherapy, be given to injured players. However, there is a need of team work with sports medicine specialist also to enable the injured players to continue their professional games.

Kho, M. E., et al. (2012). "Feasibility and observed safety of interactive video games for physical rehabilitation in the intensive care unit: a case series." Journal of Critical Care 27(2): 219 e211-216.
	BACKGROUND: Early rehabilitation in the intensive care unit (ICU) improves patients' physical function. Despite reports of using commercially available interactive video game systems for rehabilitation, there are few data evaluating feasibility and safety as part of routine in-patient rehabilitation, particularly in the ICU. METHODS: We conducted an observational study from September 1, 2009, to August 31, 2010, of adults admitted to a 16-bed medical ICU receiving video games as part of routine physical therapy (PT), evaluating use and indications and occurrence of 14 prospectively monitored safety events. RESULTS: Of 410 patients receiving PT in the medical ICU, 22 (5% of all patients; male, 64%; median age, 52 years) had 42 PT treatments with video games (median [interquartile range] per patient, 1.0 [1.0-2.0]). Main indications for video game therapy included balance (52%) and endurance (45%), and the most common activities included boxing (38%), bowling (24%), and balance board (21%). Of 42 treatments, 69% occurred while standing and 45% while mechanically ventilated. During 35 hours of PT treatment, 0 safety events occurred (95% upper confidence limit for safety event rate, 8.4%). CONCLUSIONS: Novel use of interactive video games as part of routine PT in critically ill patients is feasible and appears safe in our case series. Video game therapy may complement existing rehabilitation techniques for ICU patients.

Khundam, C., et al. (2021). "A Study of Physical Fitness and Enjoyment on Virtual Running for Exergames." International Journal of Computer Games Technology 2021: 1-16.
	Virtual Reality (VR) technology has advanced forward in everyday life where virtual fitness is possible through physically moving around in the real world. Exergame is a video game for exercise aimed at making exercise more fun. VR exergame applies these trends together for virtual fitness with immersive game play. The VR locomotion is traveling in VR, which is commonly used in adventure role-playing games (RPG). Virtual running can be applied as a locomotion technique for VR exergames. The design of virtual running in VR exergames should be considered as an exercise for fitness and also for enjoyment. This paper proposed two motion-based locomotion techniques: ArmSwing and Squat for virtual running, which are considered as aerobic and strength exercise. These two postures were used to study how physical exertion affected players while interacting in the test scene. Usability, motion sickness, and enjoyment were assessed to analyze the differences of each posture. The results showed that motion sickness and enjoyment of ArmSwing and Squat were not different, while usability was different where ArmSwing was rated higher than Squat. The results from the interviews suggest that most players preferred aerobic exercise (ArmSwing) more than strength exercise (Squat) for a long period of exercise. However, for a short period of exercise, players preferred strength exercise more than aerobic exercise. The adventure-based RPG for exercise needs a solution design appropriate for virtual running in VR, and our results can be a guideline for developers in order to handle motion-based locomotion for VR exergames.

Kilbride, C., et al. (2019). "GameBall: the development of a novel platform to provide enjoyable and affordable hand and arm rehabilitation following stroke." Physiotherapy 105: e192-e193.
	
Kilbride, C., et al. (2020). "Rehabilitation via home based gaming exercise for the upper-limb post stroke (RHOMBUS): results of an intervention feasibility trial." Physiotherapy 107: e25-e25.
	
Kilbride, C., et al. (2018). "Rehabilitation via HOMe Based gaming exercise for the Upper-limb post Stroke (RHOMBUS): protocol of an intervention feasibility trial." BMJ Open 8(11): e026620.
	INTRODUCTION: Effective interventions to promote upper-limb recovery poststroke are characterised by intensive and repetitive movements. However, the repetitive nature of practice may adversely impact on adherence. Therefore, the development of rehabilitation devices that can be used safely and easily at home, and are motivating, enjoyable and affordable is essential to the health and well-being of stroke survivors.The Neurofenix platform is a non-immersive virtual reality device for poststroke upper-limb rehabilitation. The platform uses a hand controller (a NeuroBall) or arm bands (NeuroBands) that facilitate upper-limb exercise via games displayed on a tablet. The Rehabilitation via HOMe Based gaming exercise for the Upper-limb post Stroke trial aims to determine the safety, feasibility and acceptability of the Neurofenix platform for home-based rehabilitation of the upper-limb poststroke. METHODS AND ANALYSIS: Thirty people poststroke will be provided with a Neurofenix platform, consisting of a NeuroBall or NeuroBands (dependent on impairment level), seven specially designed games, a tablet and handbook to independently exercise their upper limb for 7 weeks. Training commences with a home visit from a research therapist to teach the participant how to safely use the device. Outcomes assessed at baseline and 8 weeks and 12 weeks are gross level of disability, pain, objectively measured arm function and impairment, self-reported arm function, passive range of movement, spasticity, fatigue, participation, quality of life (QOL) and health service use. A parallel process evaluation will assess feasibility, acceptability and safety of the intervention through assessment of fidelity to the intervention measured objectively through the Neurofenix platform, a postintervention questionnaire and semistructured interviews exploring participants' experiences of the intervention. The feasibility of conducting an economic evaluation will be determined by collecting data on QOL and resource use. ETHICS AND DISSEMINATION: Ethics approval granted from Brunel University London (10249-MHR-Mar/2018-12322-2). Trial results will be submitted for publication in journals, presented at national and international conferences and distributed to people with stroke. TRIAL REGISTRATION NUMBER: ISRCTN60291412; Pre-results.

Kim, D. S., et al. (2019). "PyeongChang 2018 Winter Olympic Games and athletes' usage of 'polyclinic' medical services." BMJ Open Sport & Exercise Medicine 5(1): e000548.
	OBJECTIVE: This paper aims to describe the medical service of two polyclinics of the PyeongChang Winter Olympic Games and to analyse the injury and illness of athletes who visited the polyclinics during the oilympic period in order to provide some insight with respect to the future construction and operation of polyclinics in mass gathering events such as the Olympic Games. METHODS: The PyeongChang Olympic Village was located near the Olympic Stadium for snow sports athletes and the Gangneung Olympic Village was located near the ice venues for ice sports athletes. During the Olympic Games, polyclinics were consisted of emergency service and outpatient clinics. We retrospectively analysed the electronic medical record data of athletes who visiting polyclinics between 9 February 2018 and 25 February 2018. RESULTS: During the Olympics, there were 1639 athlete encounters in both polyclinics. Among those, injuries of athletes were 237 (14% of all athlete encounters) in total, and the most common injured site was knee joint. Upper respiratory infection was the most frequent case in diseases of athlete encounters. Total 223 cases of image study were done, MRI was 44 cases. CONCLUSION: The PyeongChang Winter Olympic Games had the highest number of participants in the history of Winter Olympic Games. Overall 48% of athletes encountered polyclinics due to disease during the Games period. Upper respiratory infection and other seasonal diseases were more frequent this Olympic Games than before. Polyclinics were managed healthcare of athletes as well as injury and illness of athletes. In winter sports, a polyclinic and similar medical facilities should be prepare for diseases considering geography, weather as well as injuries and endemic diseases when planning future mass gathering events.

Kim, K. J. and M. Heo (2019). "Comparison of virtual reality exercise versus conventional exercise on balance in patients with functional ankle instability: A randomized controlled trial." J Back Musculoskelet Rehabil 32(6): 905-911.
	BACKGROUND: Recently, a variety of virtual reality (VR)-based interventions have been studied. However, they were only partially applied to physical therapy. OBJECTIVE: The present study investigated the effects of a VR exercise program by comparing the results of VR and conventional exercise on balance in patients with functional ankle instability (FAI). METHODS: Twenty-one participants with symptoms of FAI participated in this study. In the VR training program, the strength and balance exercises were done for 10 minutes each using a program included in the Nintendo Wii Fit Plus for VR intervention. In the conventional program, four ankle strength exercises using the TheraBand and the balance exercises were performed for 10 minutes each. Static and dynamic balance were measured in the overall, anterior-posterior, and medial-lateral directions. RESULTS: Static balance in the VR exercise was significantly lower in the overall direction than in the conventional exercise. Dynamic balance in the virtual reality exercise was significantly lower than in the conventional exercise at level 2, level 4, and level 8 balance in the medial-lateral direction. CONCLUSIONS: This study has shown that VR exercise is more effective in the overall direction (static) and medial-lateral direction (dynamic) of balance than conventional method in patients with FAI.

Kim, S. Y., et al. (2014). "Body in the interactive game: How interface embodiment affects physical activity and health behavior change." Computers in Human Behavior 36: 376-384.
	Does the delivery platform for a health behavior game contribute to its effectiveness? With the growing popularity of interactive video games that combine physical exercise with gameplay, known as “exergames,” there has been a burgeoning interest in their impact on users’ exercise attitudes and behavioral outcomes. This study examines how the level of user interface embodiment, the degree to which the user’s body interacts with the game, affects the user’s experience, game behavior, and intention for behavior change. We conducted a between-participants experiment in which participants (N=119) played an exergame under one of the three levels of user interface embodiment (low, medium, and high). Our results revealed a significant positive main effect of user interface embodiment on user experience (i.e., the sense of being in the game, “presence,” and enjoyment); level of energy expenditure (change in heart rate); and intention to further engage in exergame-play exercise but not necessarily to increase exercise in the physical world. A further analysis revealed the mediating roles of user experience in the association between user interface embodiment and intention to repeat exergaming and a potential link between heart rate change and level of presence in the game. We conclude that type of interface is a key variable in this health communication environment, affecting user experience, behavior, and some intention for behavior change.

King, E., et al. (2021). "A service evaluation exploring perceptions of relatives of ICU patients and multidisciplinary team on patients’ experience of games based therapy." Physiotherapy 113: e49-e49.
	
Kircher, E., et al. (2022). "A Game-Based Approach to Lower Blood Pressure? Comparing Acute Hemodynamic Responses to Endurance Exercise and Exergaming: A Randomized Crossover Trial." International Journal of Environmental Research & Public Health [Electronic Resource] 19(3): 1349.
	The present randomized crossover study aimed to determine whether an exergaming session in an innovative, functional fitness game could be an effective exercise approach that elicits favorable blood pressure (BP) responses, such as a typical moderate endurance exercise (ET). Therefore, acute hemodynamic responses after a training session in the ExerCube and an ET on a treadmill were assessed and compared. Twenty-eight healthy recreational active participants (13 women; aged 24.8 +/- 3.9 years) completed an exergaming session (EX) and an ET in a randomized and counterbalanced order. Before and throughout the 45 min after the training, the peripheral and central BP were measured. After the ET, there was a moderate decrease in both peripheral systolic (-1.8 mmHg; p = 0.14) and diastolic (-0.8 mmHg; p = 0.003), as well as central diastolic (-1.5 mmHg; p = 0.006) pressure compared to the resting value before the exercise. After the EX, there was a significant decrease in peripheral systolic (-6.3 mmHg; p < 0.001) and diastolic (-4.8 mmHg; p < 0.001), as well as central systolic (-5.8 mmHg; p < 0.001) and diastolic (-5.3 mmHg; p < 0.001) pressure compared to baseline. The interaction effects showed significant differences in peripheral and central systolic BP as well as in peripheral diastolic BP (p = 0.05). The EX seems to be an effective training approach that triggers relevant peripheral and central BP-responses, which are more pronounced than after a typical ET. Therefore, the ExerCube can be a time-efficient training tool to improve cardiovascular health.

Kirsch, N. R. (2017). "Name Game: Can a PT simply drop the title, without consequences?" PT in Motion 9(11): 12-15.
	The author discusses whether physical therapists (PT) can ethically stop practicing under the title in 2017. She cites a PT with a solo, cash-based practice focused on fitness and wellness services who can take down her PT license due to its documentation requirements and her desire for minimal paperwork, and raises ethical questions on clients' rights on background and training information and the PT's need to be honest with them. The author also invites reader feedback on the issues.

Klompstra, L., et al. (2014). "Exergaming to increase the exercise capacity and daily physical activity in heart failure patients: a pilot study." BMC Geriatrics 14(1): 119.
	BACKGROUND: Regular daily physical activity is recognised as important in heart failure (HF) patients, but adherence to physical activity is low (<50%). To improve adherence to exercise in HF patients, alternative approaches to motivate and increase self-efficacy to exercise are needed. Therefore, we have studied a new phenomenon: exergames (games to improve physical exercise). The aims of the study were to assess the influence of the exergame platform Nintendo Wii on exercise capacity and daily physical activity in heart failure patients, to study factors related to exercise capacity and daily physical activity, and to assess patients' adherence to exergaming. METHODS: A 12-week pilot study with a pretest-posttest design was conducted. The intervention consisted of an instruction on how to use the Wii and 12 weeks' access to Wii at home. The main variables tested were exercise capacity (measured with a six-minute walking test), daily physical activity (measured with an activity monitor), and time exergaming (daily self-report with a diary). Bivariate correlations were used to assess associations between symptom experience, self-efficacy, motivation, anxiety, and depression. RESULTS: In total, 32 heart failure patients were included. More than half of the patients (53%) significantly increased their exercise capacity after 12 weeks. No significant difference was found in daily physical activity between baseline and 12 weeks. Lower NYHA class and shorter time since diagnosis were factors significantly related to the increase in exercise capacity. The daily mean time spent exergaming was 28 minutes, and having grandchildren and being male were related to more time spent exergaming. CONCLUSION: Exergaming has the potential to increase exercise capacity in elderly, chronically ill cardiac patients. Although the daily physical activity did not change over time, exergaming was feasible for heart failure patients and might be a rehabilitation option for patients with heart failure.

Kobayashi, D., et al. (2020). "Efficacy of physical exercise using the balance board game on physical and psychological function in patients with hematological malignancies confined to a bioclean room." Phys Ther Res 23(2): 172-179.
	OBJECTIVE: This study aimed to define the efficacy and features of physical therapy (PT) using the Nintendo Wii Fit U (Nintendo Inc., Kyoto, Japan) in patients with hematological malignancies confined to a bioclean room. METHOD: A total of 33 patients with hematological malignancies confined to a bioclean room were enrolled in this study. This study was designed as a randomized crossover test between two weeklong interventions: PT program (Therapist PT) and Wii Fit U program (Wii PT). We compared the efficacy of Wii PT and Therapist PT with regard to physical and psychological function test scores. RESULTS: Of the 33 patients, 22 were analyzed. The validity of the crossover design was demonstrated, as there were no significant differences in period and carryover effects between the two groups. Therapist PT resulted in significantly better improvements in fatigue scores and total mood disturbance (TMD) scores in the Profile of Mood States short-form Japanese version compared to Wii PT (fatigue score, -5.2+/-8.3 vs 2.7+/-8.2; TMD score, -22.5+/-32.8 vs -2.6+/-20.5; p<0.05). Physical function improved post-Wii PT and post-Therapist PT interventions (p<0.05), and there was no difference in treatment effect. CONCLUSION: Improvements in physical function were clearly observed following the use of Wii PT in patients confined to a bioclean room. However, compared to Therapist PT, Wii PT was less effective in improving the psychological function of patients.

Kocabas, R., et al. (2018). "The acute effects of interval exercise on oxidative stress and antioxidant status in volleyball players." Journal of Sports Medicine & Physical Fitness 58(4): 421-427.
	BACKGROUND: Volleyball is briefly described as an "interval" sport with both aerobic and anaerobic components. Exercise may influence antioxidant/prooxidant balance, which leads to differences in oxidative stress status between athletes in different sport disciplines, but the results of the previous studies are inconsistent. In this study, we aimed to determine the acute effects of exercise on oxidative stress parameters such as serum total oxidant status (TOS) and total antioxidant status (TAS) levels in volleyball players. METHODS: Thirteen male volleyball players from the same team participated in this study. The volleyball game lasted approximately 95 minutes including warm-up and cool-down periods. Blood samples were taken before the warm-up and after the cool down. Serum TOS and TAS levels were measured. Oxidative stress index (OSI), a predictor of antioxidant/prooxidant balance (TOS/TAS), was also calculated. RESULTS: The following data were revealed as median: TOS 6.84 mumol H2O2 Eq/L (95% CI: 5.80-8.13) and 5.15 (95% CI: 4.20-6.02); TAS 1.96 mmol Trolox Eq/L (95% CI: 1.91-2.08) and 1.95 (95% CI: 1.86-2.00); and OSI indexes, 3.31 (arbitrary unit) (95% CI: 2.84-4.00) and 2.64 (95% CI: 2.26-3.18) before and after the match with respectively. Serum TOS and OSI levels were significantly lower after volleyball match when compared to before (P<0.05). There was no significant difference in serum TAS levels (P>0.05). CONCLUSIONS: In individuals who exercise active sports, TOS level has been found to be decreased while TAS level has not been affected significantly after volleyball match. Our results suggested that volleyball training may not cause oxidative stress in these players. Regular physical exercise especially, volleyball training may provide adequate protection against exercise-induced oxidative stress.

Kolt, G. S. (2008). "Olympic Games and participation in sport." Physical Therapy in Sport 9(3): 107-108.
	
Konstantinidis, E. I., et al. (2021). "Physical Training In-Game Metrics for Cognitive Assessment: Evidence from Extended Trials with the Fitforall Exergaming Platform." Sensors 21(17): 5756.
	Conventional clinical cognitive assessment has its limitations, as evidenced by the environmental shortcomings of various neuropsychological tests conducted away from an older person's everyday environment. Recent research activities have focused on transferring screening tests to computerized forms, as well as on developing short screening tests for screening large populations for cognitive impairment. The purpose of this study was to present an exergaming platform, which was widely trialed (116 participants) to collect in-game metrics (built-in game performance measures). The potential correlation between in-game metrics and cognition was investigated in-depth by scrutinizing different in-game metrics. The predictive value of high-resolution monitoring games was assessed by correlating it with classical neuropsychological tests; the area under the curve (AUC) in the receiver operating characteristic (ROC) analysis was calculated to determine the sensitivity and specificity of the method for detecting mild cognitive impairment (MCI). Classification accuracy was calculated to be 73.53% when distinguishing between MCI and normal subjects, and 70.69% when subjects with mild dementia were also involved. The results revealed evidence that careful design of serious games, with respect to in-game metrics, could potentially contribute to the early and unobtrusive detection of cognitive decline.

Konstantinidis, E. I., et al. (2016). "Design, Implementation, and Wide Pilot Deployment of FitForAll: An Easy to use Exergaming Platform Improving Physical Fitness and Life Quality of Senior Citizens." IEEE J Biomed Health Inform 20(1): 189-200.
	Many platforms have emerged as response to the call for technology supporting active and healthy aging. Key requirements for any such e-health systems and any subsequent business exploitation are tailor-made design and proper evaluation. This paper presents the design, implementation, wide deployment, and evaluation of the low cost, physical exercise, and gaming (exergaming) FitForAll (FFA) platform system usability, user adherence to exercise, and efficacy are explored. The design of FFA is tailored to elderly populations, distilling literature guidelines and recommendations. The FFA architecture introduces standard physical exercise protocols in exergaming software engineering, as well as, standard physical assessment tests for augmented adaptability through adjustable exercise intensity. This opens up the way to next generation exergaming software, which may be more automatically/smartly adaptive. 116 elderly users piloted FFA five times/week, during an eight-week controlled intervention. Usability evaluation was formally conducted (SUS, SUMI questionnaires). Control group consisted of a size-matched elderly group following cognitive training. Efficacy was assessed objectively through the senior fitness (Fullerton) test, and subjectively, through WHOQoL-BREF comparisons of pre-postintervention between groups. Adherence to schedule was measured by attendance logs. The global SUMI score was 68.33+/-5.85%, while SUS was 77.7. Good usability perception is reflected in relatively high adherence of 82% for a daily two months pilot schedule. Compared to control group, elderly using FFA improved significantly strength, flexibility, endurance, and balance while presenting a significant trend in quality of life improvements. This is the first elderly focused exergaming platform intensively evaluated with more than 100 participants. The use of formal tools makes the findings comparable to other studies and forms an elderly exergaming corpus.

Korneck, K. and J. Rambur (2009). "Diamonds are forever." PT: Magazine of Physical Therapy 17(4): 64-64.
	In North Dakota, much more than just a game.

Kosse, N. M., et al. (2011). "EXERGAMING: INTERACTIVE BALANCE TRAINING IN HEALTHY COMMUNITYDWELLING OLDER ADULTS." Journal of CyberTherapy & Rehabilitation (JCR) 4(3): 399-407.
	Exergaming is a term used for videogame exercise. The aim of this study was to examine the training effect of an exergame that relies on the movements of a dynamic balance board. Nine healthy elderly subjects participated in a six-week intervention in which they played balance games three times a week. before, after and during the intervention phase balance was assessed with the figure-of-eight test, the berg balance scale (bbs), and the tandem and one-leg stance, both performed with eyes open and closed. Intervention effects were examined using multilevel modeling statistics. predominantly, the dynamic balance performance, measured by the figure-of-eight and the bbs, improved (p <0.05). balance improvement was dependent on level of performance at the start of training, participants with initially low balance scores improved more across time than the highest scoring participants.

Kotwani, P., et al. (2021). "A holistic care approach to combat the COVID-19 disease." J Family Med Prim Care 10(2): 844-849.
	BACKGROUND: Coronavirus disease-2019 (COVID-1) 9 pandemic is spreading like a wildfire across the globe. For its containment, measures such as isolation and quarantine are followed. The patients tested positive for COVID-19 disease are kept in isolation with no interaction with the family members leading to negative mental health consequences. To address this, Parul Sevashram Hospital adapted to a more holistic approach to treatment. METHODOLOGY: A process documentation of the best practices was undertaken. Key Informant Interviews (KIIs) were used to gather responses of the project implementers (n = 2), physiotherapists (n = 2), dietician (n = 1), Ayurveda practitioners (n = 2), and staff nurses (n = 2) who were mainly involved in tailoring the package of services to be offered as well as their implementation. In addition, KIIs were also conducted with the patients (n = 10) their views on the additional package of services offered to them and the overall level of satisfaction with the care. FINDINGS: The holistic care services involved diet therapy, physiotherapy and yoga, AYUSH medicines for boosting immunity, music therapy and books and indoor games. Few implementation challenges include convincing healthcare workers for providing care to COVID patients, availing raw materials for preparing AYUSH medicines during lockdown. Trainings were also provided to HCW on infection control practices, provided monetary incentive and mobilised the existing resources for addressing the challenges. CONCLUSION: The holistic care has potential influence on patient's mental health, recovery rate, and satisfaction of COVID-19 patients. These approaches can be up-scaled with a minimum investment and has a potential to benefit patients both in public and private hospitals.

Koulouri, C. (2010). "From antiquity to Olympic revival: sports and Greek national historiography (nineteenth-twentieth centuries)." International Journal of the History of Sport 27(12): 2014-2052.
	This study investigates the evolution of the historiography of Greek sport from the foundation of the Greek state (1830) until 1982 and its links with Greek national history, which also took shape primarily during the nineteenth century. The gradual 'nationalisation' of sport as an element of Greek national character since antiquity corresponded to changes in perceptions of the national past reflected in historiography. The ancient Olympic Games, Byzantine contests and exercises, the competitions of the klephts and armatoloi (militia soldiers) during the Ottoman rule and the modern revival of the Olympic Games were all successively integrated in a national history of sport confirming national continuity and unity. However this particular genre of national historiography did not gain academic recognition until recently. The authors of histories of physical exercise and sport were amateurs or physical education instructors and could not ensure to their work the authority of a separate discipline.

Koulouris, D., et al. (2022). "An IoT-Enabled Platform for the Assessment of Physical and Mental Activities Utilizing Augmented Reality Exergaming." Sensors 22(9): 3181.
	Augmented reality (AR) and Internet of Things (IoT) are among the core technological elements of modern information systems and applications in which advanced features for user interactivity and monitoring are required. These technologies are continuously improving and are available nowadays in all popular programming environments and platforms, allowing for their wide adoption in many different business and research applications. In the fields of healthcare and assisted living, AR is extensively applied in the development of exergames, facilitating the implementation of innovative gamification techniques, while IoT can effectively support the users' health monitoring aspects. In this work, we present a prototype platform for exergames that combines AR and IoT on commodity mobile devices for the development of serious games in the healthcare domain. The main objective of the solution was to promote the utilization of gamification techniques to boost the users' physical activities and to assist the regular assessment of their health and cognitive statuses through challenges and quests in the virtual and real world. With the integration of sensors and wearable devices by design, the platform has the capability of real-time monitoring the users' biosignals and activities during the game, collecting data for each session, which can be analyzed afterwards by healthcare professionals. The solution was validated in real world scenarios and the results were analyzed in order to further improve the performance and usability of the prototype.

Kozin, S., et al. (2022). "Use of closed chain exercises, eccentric exercises, and proprioceptive muscle facilitation to prevent elbow injuries in climbers: a randomized control trial." Physiotherapy Quarterly 30(2): 90-99.
	Introduction To determine the influence of exercises in a closed kinematic chain, exercises in eccentric mode in combination with proprioceptive muscle facilitation on the level of injuries and technical skill of amateur climbers. Methods The participants in this study were 84 male amateur rock climbers, aged 18–19; 40 athletes were in the Intervention Group and 44 athletes were in the Control Group. In the Intervention Group, a developed injury prevention program was used. The program included the use of neuromuscular training. Exercises for proprioceptive muscle facilitation were also used. We determined the Incidence rate ratio and confidence intervals and the reliability of the influence of the level of mastery of the technique on the number of injuries by the Cochran’s and Mantel-Haenszel methods. Results The use of our program reduces the Incidence rate ratio in climbers for mild, moderate and severe elbow injuries; a significant decrease was found for moderate and severe injuries. There was also a significant improvement in the results of biomechanical analysis of climbing technique in athletes in the Intervention Group (p < 0.001). There was a high reliability of the influence of the level of mastery of the technique on the number of injuries (p < 0,001). Conclusions The use of exercises in a closed kinematic chain, exercises in eccentric mode in combination with proprioceptive muscle facilitation reduces the Incidence rate ratio of the shoulders and increases technical skill among amateur climbers.

Kozyavkin, V., et al. (2020). "Oral presentations." Developmental Medicine & Child Neurology 62(S4): 4-51.
	Introduction: The latest evidence shows benefits of intensive multimodal treatments for improvement of hand function. This pilot study aimed to assess effect of one of such approaches, intensive neurophysiological rehabilitation system (INRS), on different components of hand function in children with cerebral palsy (CP). Patients and Methods: A pilot pre‐post study was conducted on 32 participants with bilateral spastic CP (mean age 10.2y, SD 2.9). All children underwent a two‐week course of INRS with up to 5 hours of daily treatment. The program was adjusted according to the patient's goals and included the following components: physical therapy, occupational therapy, spinal manipulative therapy, joint mobilization, computer game therapy, gait correction, and suit therapy. Participants were assessed before and after the two‐week course. The primary outcome measure was the Jebsen‐Taylor Hand Function Test (JTHFT) score that is used to assess the unimanual functions required for activities of daily living. The secondary outcome measures included ABILHAND‐Kids questionnaire, Box and Blocks test (BBT), and hand‐grip dynamometry. Results: For the dominant hand, JTHFT score decreased in 14.9 sec in the whole group (SD 38, p<0.05). Also, we noted the meaningful change in 2 points for BBT (SD 3.7, p<0.05). For non‐dominant hand, change in 1.8 points for BBT was observed (SD 2.8, p<0.001). Other findings were not statistically significant. Conclusion: Improvement in hand function, particularly changes in JTHFT and BBT scores, was observed in children with CP after the two‐week course of INRS. Further research, especially randomized controlled trials, is needed.

kqvnz, R. B. R. (2018). "Short-term motor control adaptations after a Single Robotic therapy associated with the Video game." https://trialsearch.who.int/Trial2.aspx?TrialID=RBR-9kqvnz.
	INTERVENTION: Device E02.760.169.063.500.387 E02.760.169.063.500.477 The study will include 28 subjects, divided into two groups called hemiparetic group and control group. The hemiparetic group will have 14 subjects with chronic hemiparesis due to unilateral stroke, of ischemic origin, of any hemispheres, being able to be of both genders. 14 healthy subjects according to the description of (BOOTH and LEES, 2006), who present age and gender paired with the hemiparetic group, will be included in the control group. The sample size was calculated by the mean values ??and standard deviation of the previous study (ROY et al., 2011), using the impedance variation variable. The size will be recalculated in a pilot study. The educational group will be offered educational material to encourage changes in lifestyle, promoting stroke prevention. As for the hemiparetic group, the individuals will be invited to participate in a therapeutic group with the proposal to encourage regular exercises and awareness about the responsibility of the active process of rehabilitation. This group will include functional exercises, circuits with varied motor challenges associated with submaximal aerobic exercises for a period of two months. Patients will be accompanied by experienced physiotherapist. They will also receive guidance for home exercises. When the patient is accompanied by a caregiver, this will be included in the therapeutic environment and will receive information about self‐care (prevention of injuries and the importance of regular physical exercise) and about patient care. Evaluation protocol details Individuals should attend the Physiotherapy department in three days. On the first day, the subject will return to the next day to familiarize himself with the neuromuscular performance assessment protocol, the Anklebot and computational game (line of tests) to verify the inclusion, exclusion and functional tests. base). After one week the evaluation protocol will be performed again. The order of concentric and eccentric isokinetic co CONDITION: C10.228.140.300.775 C10.597.636 C23.550.291.500 G00‐G99 Stroke paresis Chronic diseases ; C10.597.636 ; C23.550.291.500 ; C10.228.140.300.775 PRIMARY OUTCOME: Conclusion 1: Differences in submaximal (Nm) sensorimotor control during dorsiflexion and plantarflexion; conclusion 2 : Differences in Torque (Nm) maximum, work (J) and power muscular (W) Conclusion 2 found: Significative differences between groups, were found for torque, work and power, but not as pre and post treatment. conclusion 3 : Differences in Muscle activation (RMS , median frequence) conclusion 3 found: There were no significant differences related to the means of muscle activation (RMS and median frequency) when considering the analyzes between groups and between the evaluations. Conclusion 4 found: There were no significant differences related to the average game metric (game score, time to start the movement) when considering the analyzes between groups and between evaluations. conclusion 4: Differences in metrics data of game (game score, trajectory error, time to initiation). Outcome 1 found: Considering the steadiness test initial values, the hemiparesis group had a low performance during dorsiflexion and plantarflexion when compared to the control group. However, the hemiparesis group showed greater dexterity during dorsiflexion post‐robotic assistance therapy. SECONDARY OUTCOME: Secondary outcomes are not expected INCLUSION CRITERIA: The individuals with hemiparesis were not linked to any rehabilitation programs and this experience was the first contact with robotic therapy. The following inclusion criteria were considered 6 or more months post‐stroke; men or women aged between 50 and 75 years; low spasticity: less than level 3 on the modified Ashworth scale so that the individual would be able to perform the isokinetic test; and independent overground walking levels 2 and 5 according to the Functional Ambulation Categories. The control group participants had to score greater than 8 on the Physical Activi y Questionnaire Basal, which indicates they were not sedentary. This is important because sedentary people have deleterious modifications in the neuromuscular system; individuals from the control group performed physical activity, mainly aerobic activities, at least 3 times a week. No further criteria regarding the physical activity level were used.

Krasnikova, V. V., et al. (2022). "[Comparative effectiveness of various methods of physical rehabilitation in the complex treatment of patients with dyscirculatory encephalopathy with vestibulo-atactic syndrome]." Vopr Kurortol Fizioter Lech Fiz Kult 99(2): 23-31.
	Dyscirculatory encephalopathy is a complex of functional and structural changes in the brain that occur against the background of chronic insufficiency of cerebral blood flow. The high prevalence of this pathology, as well as a pronounced impact on the quality of life and working capacity of patients, determines the importance of optimizing rehabilitation measures and developing the most promising strategies for physical rehabilitation. OBJECTIVE: To compare the effectiveness of a special complex of therapeutic (vestibular) gymnastics and training with biofeedback (BFB) on a stabiloplatform in the rehabilitation of patients with dyscirculatory encephalopathy with vestibulo-atactic syndrome. MATERIAL AND METHODS: A cohort prospective single-center randomized comparative study of the clinical effectiveness of the author's complex of therapeutic exercises and stabilometric training with BFB in the complex treatment of patients with dyscirculatory encephalopathy with vestibulo-atactic syndrome was carried out. The study involved 40 patients aged 65-89 years who were randomized into 2 equal groups. Patients of the 1st group, against the background of drug therapy and physiotherapy, were trained on a stabiloplatform with BFB (a training game according to the manufacturer's instructions). Patients of the 2nd group performed a complex of therapeutic (vestibular) gymnastics specially designed for this study. The effectiveness of physical rehabilitation was assessed by the dynamics of (1) subjective symptoms (complaints of patients), (2) indicators of stabilometry (symmetry index, the sum of the coordination indices for the right and left legs, fluctuation) and (3) the results of functional testing using the Get up and go test, the Berg balance scale and the Tinetti mobility scale. RESULTS: In the group of patients who performed vestibular gymnastics, in contrast to patients who participated in training using a multifunctional stabiloplatform with BFB, a statistically significant improvement was revealed when assessed by the Get up and go test and the Berg balance scale. In none of the groups, a distinct dynamics of stabilometry indicators was registered. No correlation was found between the main indicators of stabilometry and the data of functional tests. CONCLUSION: Thus, vestibular gymnastics has demonstrated greater effectiveness in the rehabilitation of patients with dyscirculatory encephalopathy and vestibulo-atactic syndrome in comparison with stabilometric training with biofeedback. The discrepancy between stabilometry indicators and the results of functional testing in patients requires a targeted study.

Krebs, H. I., et al. (1999). "Overview of clinical trials with MIT-MANUS: a robot-aided neuro-rehabilitation facility." Technol Health Care 7(6): 419-423.
	We are applying robotics and information technology to assist, enhance, and quantify neuro-rehabilitation. Our goal is a new class of interactive, user-affectionate clinical devices designed not only for evaluating patients, but also-for delivering meaningful therapy via engaging "video games". Notably, the novel robot MIT-MANUS has been designed and programmed for clinical neurological applications, and has undergone extensive clinical trials for more than four years at Burke Rehabilitation Hospital - White Plains, NY. This paper will review results of the first clinical trial of 20 patients, which showed that: - Stroke patients treated daily with additional robot-aided therapy during acute rehabilitation had improved outcome in motor activity at hospital discharge, when compared to a control group that received only standard acute rehabilitation treatment. - This improved outcome was sustained after three years. - The neuro-recovery process continued far beyond the commonly accepted 3 months post-stroke interval.

Krichevets, A. N., et al. (1995). "Computer games as a means of movement rehabilitation." Disability & Rehabilitation 17(2): 100-105.
	In order to improve arm control in a child with Erb's palsy, a computer game was used in which participation required the movement of a lever, controlled by the child's arm. Counter-balancing weights were used to facilitate movement but counteract pathological compensatory movements. The use of this system (with appropriate modifications at successive stages of therapy) produced a substantial improvement in arm control. It was concluded that the use of such techniques capitalizes on the child's motivation to succeed, and has advantages over traditional physiotherapy that relies on passive, repetitive movements and sometimes painful limb manipulation. In this situation the child made spontaneous, voluntary movements, concentrating on the outcome of movements rather than the actions per se.

Krneta, Z., et al. (2014). "Effects of kinesiological activity on preschool children's motor abilities." Science & Sports 29: S48.
	Introduction Physical activity and motor skills acquisition play a key role in childhood development especially during the preschool period [1]. Previous studies have confirmed the effect of kinesiological activity on the children's motor abilities [2], [3]. The purpose of this study was to evaluate the effects of additional kinesiological treatment on motor abilities in preschool children. Methods An experimental treatment was carried out on a sample of 70 preschool boys (6.10±1.24years) by applying kinesiological activities. The 60-minute treatment was applied over a period of one school year (9months), twice a week. The experimental treatment was saturated with many skills, balance and agility-based drills. Means of exercising to develop and improve co-ordination, timing, agility, balance, speed, flexibility, strength, endurance, cardiovascular recovery, speed of solving complex motor problems, etc.: perceptual-motor activities, creative movements, rhythms and dances, stunts, tumbling, and apparatus activities, running, jumping, throwing, games and basic elements of team sports. This variety of movement raises interest in preschool children for kinesiological activity. A control group of 41 boys (5.60±0.54years) were trained according to the regular program for preschool institutions. Treatment effects were assessed by 10 motor ability tests: Obstacle course backwards, Arm plate tapping, Seated straddle stretch, One-leg test, Crossed-arm sit-ups, Bent-arm hang, Standing broad jump, Speed of simple movements, Darts and 20-meter run. Results The significant differences between the groups were observed, demonstrating positive impact of kinesiological treatment on motor development. The most significant effect of experimental treatment was the improvement in explosive strength (Standing broad jump) and flexibility (Seated straddle stretch) of preschool boys. Conclusion These findings, obtained only in one school year, point to the importance of physical exercise and the application of additional kinesiological activities with various modalities, to improve motor development. The effects of the perennial application of kinesiology activities could be beneficial and could form the basis for a better biological and motor development in old age.

Kruse, L., et al. (2021). "Enabling Immersive Exercise Activities for Older Adults: A Comparison of Virtual Reality Exergames and Traditional Video Exercises." Societies 11(4): 134.
	Participating in cognitive and physical activities can help older adults to live a healthy and independent life. However, with the ongoing pandemic, face-to-face training options became unavailable or limited, yielding a need for alternatives. In this paper, we conducted a user study with older adults (N = 25) to compare a traditional, recorded 2D gymnastics video with an immersive virtual reality (VR) exergame. We evaluated the movement and heart rate of the participants, as well as their enjoyment, attention to the task, and perceived workload. In the VR condition, we additionally assessed their feeling of cybersickness. Finally, qualitative feedback about their preferences was collected. The results indicate that our immersive VR exergame can be a suitable alternative, but not a replacement for traditional 2D video-based exercise activities. Furthermore, the cognitive aspect of exergames can lead to the feeling of physical workload, even if easy movements are performed. Finally, we discuss the implications of our results for future VR exergames and point out advantages and disadvantages of the systems.

Kulkarni, T. N., et al. (2018). "WCNR 2018 Poster Abstracts." Neurorehabilitation and neural repair 32(4-5): 363-538.
	Objectives: BACKGROUND AND PURPOSE Virtual reality (VR) using commercial gaming devices has been recognized a promising tool to induce functional recovery after lesions followed by stroke.Therefore the purpose of the study was to explore the effect of X Box 360 kinect on trunk, postural control and quality of life in stroke rehabilitation. OBJECTIVE was to compare the effect of VR using X Box 360 Kinect and conventional therapy (CT) on trunk and postural control in terms of sitting limit of stability, maintaining and changing posture and quality of life (QOL). Methods: The experimental study on chronic patients was conducted at neurophysiotherapy department. 28 participants fulfilling inclusion criteria, allotted in VR group (Group A, n=15) and CT group (Group B, n=13). VR group was trained using X BOX 360 kinect for 6 weeks (30mins/day, 3 days/week). CT group underwent mobility, balance and trunk specific exercises for same period. Pre and post intervention Trunk impairment scale (TOS) for trunk control, sitting limit of stability (LOS), Postural assessment scale (PASS) for postural control and stroke specific QOL (SSQOL) for QOL analyzed for both groups. Results: Both the groups showed significant (P<0.05) improvement in TIS, PASS, SSQOL. But VR group showed significantly more improvement compared to CT Group (P<0.05) in dynamic component of TIS, maintaining and changing posture components (P<0.05) of PASS, reaction time and movement velocity (P<0.05) components of LOS. There was no significant difference in end point excursion, maximum end point excursion and directional control between the groups. Conclusions: CONCLUSION VR training using X box 360 is significantly more effective on trunk, postural control and QOL in chronic stroke patients compared to conventional physiotherapy. Therefore this costeffective, Kinect friendly technique can be used in rehabilitation.

Kuys, S. S., et al. (2011). "Gaming console exercise and cycle or treadmill exercise provide similar cardiovascular demand in adults with cystic fibrosis: a randomised cross-over trial." J Physiother 57(1): 35-40.
	QUESTION: Does exercise using a gaming console result in similar cardiovascular demand and energy expenditure as formally prescribed exercise in adults with cystic fibrosis? How do these patients perceive gaming console exercise? DESIGN: Randomised cross-over trial with concealed allocation and intention-to-treat analysis. PARTICIPANTS: 19 adults with cystic fibrosis admitted to hospital for treatment of a pulmonary exacerbation. INTERVENTION: Participants underwent two 15-minute exercise interventions on separate days; one involving a gaming console and one a treadmill or cycle ergometer. OUTCOME MEASURES: Cardiovascular demand was measured using heart rate and rating of perceived exertion (RPE). Energy expenditure was estimated using a portable activity monitor. Perception (enjoyment, fatigue, workload, effectiveness, feasibility) was rated using a horizontal 10-cm visual analogue scale. RESULTS: There was no significant difference in average heart rate (mean difference 3 beats/min, 95% CI -3 to 9) or energy expenditure (0.1 MET, 95% CI -0.3 to 0.5) between the two interventions. Both interventions provided a 'hard' workout (RPE approximately 15). Gaming console exercise was rated as more enjoyable (mean difference 2.6 cm, 95% CI 1.6 to 3.6) than formal exercise but they didn't differ significantly in fatigue (-1.0 cm, 95% CI -2.4 to 0.3), perceived effectiveness (-0.4 cm, 95% CI -1.2 to 0.3), or perceived feasibility for inclusion in routine management (0.2 cm, 95% CI -0.7 to 1.1). CONCLUSION: Gaming console exercise provides a similar cardiovascular demand as traditional exercise modalities. It is feasible that adults with cystic fibrosis could include gaming console exercise in their exercise program. TRIAL REGISTRATION: ACTRN12610000861055.

Lagerberg, D. (2005). "Physical activity and mental health in schoolchildren: a complicated relationship." Acta Paediatrica 94(12): 1699-1701.
	UNLABELLED: According to a study by Parfitt and Eston, physical activity was positively associated with child mental health and self-esteem. In this commentary, gender differences, causal links and implications for prevention are discussed. CONCLUSION: The relationship between physical activity and mental health is not as simple as to say that activity will invariably lead to improved mental health. For youngsters to be engaged in physical exercise, it is important that the needs of the particular child be taken into account. Forced and frightening activities should be avoided. The context should be one of enjoyment rather than of harsh discipline and skill-dependent games where many children are apt to fail.

Lai, C. H., et al. (2013). "Effects of interactive video-game based system exercise on the balance of the elderly." Gait & Posture 37(4): 511-515.
	This study evaluated the effects of interactive video-game based (IVGB) training on the balance of older adults. The participants of the study included 30 community-living persons over the age of 65. The participants were divided into 2 groups. Group A underwent IVGB training for 6 weeks and received no intervention in the following 6 weeks. Group B received no intervention during the first 6 weeks and then participated in training in the following 6 weeks. After IVGB intervention, both groups showed improved balance based on the results from the following tests: the Berg Balance Scale (BBS), Modified Falls Efficacy Scale (MFES), Timed Up and Go (TUG) test, and the Sway Velocity (SV) test (assessing bipedal stance center pressure with eyes open and closed). Results from the Sway Area (SA) test (assessing bipedal stance center pressure with eyes open and closed) revealed a significant improvement in Group B after IVGB training. Group A retained some training effects after 6 weeks without IVGB intervention. Additionally, a moderate association emerged between the Xavix measured step system stepping tests and BBS, MFES, Unipedal Stance test, and TUG test measurements. In conclusion, IVGB training improves balance after 6 weeks of implementation, and the beneficial effects partially remain after training is complete. Further investigation is required to determine if this training is superior to traditional physical therapy.

Laine, T. H. and S. Carolina Islas (2015). "Distributed Pervasive Worlds: The Case of Exergames." Journal of Educational Technology & Society 18(1): 50-66.
	Pervasive worlds are computing environments where a virtual world converges with the physical world through context-aware technologies such as sensors. In pervasive worlds, technology is distributed among entities that may be distributed geographically. We explore the concept, possibilities, and challenges of distributed pervasive worlds in a case study—an exergame entitled Running Othello. Combining a board game with sensor-enhanced physical activity, Running Othello aims at motivating young players to be physically active. Based on the analyzed literature and mixed-method evaluations of Running Othello, the following contributions emerged: (i) a total of 13 design principles for distributed pervasive exergames, (ii) the players’ perceptions with distributed gameplay, (iii) an analysis of development challenges, and (iv) four dimensions of distribution in Running Othello. Player evaluations were conducted on university students and on children and young adults participating at a science festival. These results are useful scholars and developers interested in the concept of pervasive worlds. With this exploratory paper, we have taken the first steps toward comprehending the conceptualization, design, implementation, and evaluation of distributed pervasive worlds.

Lamboglia, C. M., et al. (2013). "Exergaming as a strategic tool in the fight against childhood obesity: a systematic review." Journal of Obesity 2013: 438364.
	Improper use of electronic media is considered a major contributing factor to childhood obesity. However, exergames, a new generation of active games, have made it possible to combine electronic entertainment with physical exercise. The purpose of this systematic review was to analyze the use of exergaming as a strategic tool in the fight against childhood obesity. Information was retrieved from the databases SciELO, LILACS, Pubmed, Ebsco, and Science Direct, using the search words "egames," "exergames," "exergaming," "new generation of video games," "active video games," "energy expenditure," "body composition," and "physical activity" in English and Portuguese, covering the period January 2008 to April 2012. Nine articles met the inclusion criteria. Exergaming was found to increase physical activity levels, energy expenditure, maximal oxygen uptake, heart rate, and percentage of physical activity engaged in and to reduce waist circumference and sedentary screen time. Thus, exergaming may be considered a highly relevant strategic tool for the adoption of an active and healthy lifestyle and may be useful in the fight against childhood obesity.

Lamoth, C. J., et al. (2012). "Exergaming for elderly: effects of different types of game feedback on performance of a balance task." Studies in Health Technology & Informatics 181: 103-107.
	Balance training to improve postural control in elderly can contribute to the prevention of falls. Video games that require body movements have the potential to improve balance. However, research about the effects of type of visual feedback (i.e. the exergame) on the quality of movement and experienced workout intensity is scarce. In this study twelve healthy older and younger subjects performed anterior-posterior or mediolateral oscillations on a wobble board, in three conditions: no feedback, real-time visual feedback, and real-time visual feedback with a competitive game element. The Elderly moved slower, less accurately and more irregularly than younger people. Both feedback conditions ensured a more controlled movement technique on the wobble-board and increased experienced workout intensity. The participants enjoyed the attention demanding competitive game element, but this game did not improve balance performance more than interacting with a game that incorporated visual feedback. These results show the potential of exergames with visual feedback to enhance postural control.

Landau, S. M., et al. (2012). "Association of lifetime cognitive engagement and low beta-amyloid deposition." Archives of Neurology 69(5): 623-629.
	OBJECTIVE: To assess the association between lifestyle practices (cognitive and physical activity) and beta-amyloid deposition, measured with positron emission tomography using carbon 11-labeled Pittsburgh Compound B ([(11)C]PiB), in healthy older individuals. DESIGN: Cross-sectional clinical study. SETTING: Berkeley, California. PARTICIPANTS: Volunteer sample of 65 healthy older individuals (mean age, 76.1 years), 10 patients with Alzheimer disease (AD) (mean age, 74.8 years), and 11 young controls (mean age, 24.5 years) were studied from October 31, 2005, to February 22, 2011. MAIN OUTCOME MEASURES: Cortical [(11)C]PiB average (frontal, parietal, lateral temporal, and cingulate regions) and retrospective, self-report scales assessing participation in cognitive activities (eg, reading, writing, and playing games) and physical exercise. RESULTS: Greater participation in cognitively stimulating activities across the lifespan, but particularly in early and middle life, was associated with reduced [(11)C]PiB uptake (P<.001, accounting for age, sex, and years of education). Older participants in the highest cognitive activity tertile had [(11)C]PiB uptake comparable to young controls, whereas those in the lowest cognitive activity tertile had [(11)C]PiB uptake comparable to patients with AD. Although greater cognitive activity was associated with greater physical exercise, exercise was not associated with [(11)C]PiB uptake. CONCLUSIONS: Individuals with greater early- and middle-life cognitive activity had lower [(11)C]PiB uptake. The tendency to participate in cognitively stimulating activities is likely related to engagement in a variety of lifestyle practices that have been implicated in other studies showing reduced risk of AD-related pathology. We report a direct association between cognitive activity and [(11)C]PiB uptake, suggesting that lifestyle factors found in individuals with high cognitive engagement may prevent or slow deposition of beta-amyloid, perhaps influencing the onset and progression of AD.

Landis, C., et al. (2019). "Calculating Heart Rate Variability from ECG Data from Youth with Cerebral Palsy During Active Video Game Sessions." J Vis Exp 148(148): 05.
	The aim of this study was to generate a method for calculating heart rate variability (HRV) from electrocardiogram (ECG) waveforms. The waveforms were recorded by a HR monitor that participants (youth with cerebral palsy (CP)) wore during active video game (AVG) sessions. The AVG sessions were designed to promote physical activity and fitness (aerobic performance) in participants. The goal was to evaluate the feasibility of AVGs as a physical therapy (PT) intervention strategy. The maximum HR (mHR) was determined for each participant and the Target Heart Rate Zone (THRZ) was calculated for each of three exercise phases in the 20 min AVG session: (warm-up at 40-60% mHR, conditioning at 60-80% mHR, and cool down at 40-60% mHR). Each participant played three 20 min games during the AVG session. All games were played while sitting on a bench because many youth with CP cannot stand for extended periods of time. Each game condition differed with participants using hand icons only, hand and feet icons together or feet icons only to collect objects. The objective of the game (called KOLLECT) is to collect objects to gain points and avoid hazards to not lose points. Hazards were used in the warm-up and cool down phases only to promote slower, controlled movement to maintain HR in the target heart rate zone (THRZ). There were no hazards in the conditioning phase to promote higher levels and more intense physical activity. Analytic methods were used to generate HRV (selected time-domain and frequency-domain measures) from ECG data to examine aerobic workload. Recent applications of HRV indicate that short-term measurements (5 min bouts) are appropriate and that HRV biofeedback may help improve symptoms and the quality of life in a variety of health conditions. Although HR is a well-accepted clinical measure to examine aerobic performance and intensity in PT interventions, HRV may provide information of the autonomic system functions, recovery and adaptation during AVG sessions.

Langan, J., et al. (2018). "Reported use of technology in stroke rehabilitation by physical and occupational therapists." Disabil Rehabil Assist Technol 13(7): 641-647.
	PURPOSE: With the patient care experience being a healthcare priority, it is concerning that patients with stroke reported boredom and a desire for greater fostering of autonomy, when evaluating their rehabilitation experience. Technology has the potential to reduce these shortcomings by engaging patients through entertainment and objective feedback. Providing objective feedback has resulted in improved outcomes and may assist the patient in learning how to self-manage rehabilitation. Our goal was to examine the extent to which physical and occupational therapists use technology in clinical stroke rehabilitation home exercise programs. MATERIALS AND METHODS: Surveys were sent via mail, email and online postings to over 500 therapists, 107 responded. RESULTS: Conventional equipment such as stopwatches are more frequently used compared to newer technology like Wii and Kinect games. Still, less than 25% of therapists' report using a stopwatch five or more times per week. Notably, feedback to patients is based upon objective data less than 50% of the time by most therapists. At the end of clinical rehabilitation, patients typically receive a written home exercise program and non-technological equipment, like theraband and/or theraputty to continue rehabilitation efforts independently. CONCLUSIONS: The use of technology is not pervasive in the continuum of stroke rehabilitation. Implications for Rehabilitation The patient care experience is a priority in healthcare, so when patients report feeling bored and desiring greater fostering of autonomy in stroke rehabilitation, it is troubling. Research examining the use of technology has shown positive results for improving motor performance and engaging patients through entertainment and use of objective feedback. Physical and occupational therapists do not widely use technology in stroke rehabilitation. Therapists should consider using technology in stroke rehabilitation to better meet the needs of the patient.

Lange, B., et al. (2011). "Development and evaluation of low cost game-based balance rehabilitation tool using the Microsoft Kinect sensor." Annual International Conference Of The IEEE Engineering In Medicine And Biology Society 2011: 1831-1834.
	The use of the commercial video games as rehabilitation tools, such as the Nintendo WiiFit, has recently gained much interest in the physical therapy arena. Motion tracking controllers such as the Nintendo Wiimote are not sensitive enough to accurately measure performance in all components of balance. Additionally, users can figure out how to "cheat" inaccurate trackers by performing minimal movement (e.g. wrist twisting a Wiimote instead of a full arm swing). Physical rehabilitation requires accurate and appropriate tracking and feedback of performance. To this end, we are developing applications that leverage recent advances in commercial video game technology to provide full-body control of animated virtual characters. A key component of our approach is the use of newly available low cost depth sensing camera technology that provides markerless full-body tracking on a conventional PC. The aim of this research was to develop and assess an interactive game-based rehabilitation tool for balance training of adults with neurological injury.

Lange, B., et al. (2011). "Breathe: A Game to Motivate the Adherence of Breathing Exercises." Journal of Physical Therapy Education 25(1): 30-35.
	
Lange, B., et al. (2010). "Development of an interactive game-based rehabilitation tool for dynamic balance training." Top Stroke Rehabil 17(5): 345-352.
	Conventional physical therapy techniques have been shown to improve balance, mobility, and gait following neurological injury. Treatment involves training patients to transfer weight onto the impaired limb to improve weight shift while standing and walking. Visual biofeedback and force plate systems are often used for treatment of balance and mobility disorders. Researchers have also been exploring the use of video game consoles such as the Nintendo Wii Fit as rehabilitation tools. Case studies have demonstrated that the use of video games may have promise for balance rehabilitation. However, initial usability studies and anecdotal evidence suggest that the current commercial games are not compatible with controlled, specific exercise required to meet therapy goals. Based on focus group data and observations with patients, a game has been developed to specifically target weight shift training using an open source game engine and the Nintendo Wii Fit Balance Board. The prototype underwent initial usability testing with a sample of clinicians and with persons with neurological injury. Overall, feedback was positive, and areas for improvement were identified. This preliminary research provides support for the development of a game that caters specifically to the key requirements of balance rehabilitation.

Lange, B., et al. (2013). "Initial usability assessment of off-the-shelf video game consoles for clinical game-based motor rehabilitation." Physical Therapy Reviews 14(5): 355-363.
	
Lange, B. S., et al. (2010). "The potential of virtual reality and gaming to assist successful aging with disability." Phys Med Rehabil Clin N Am 21(2): 339-356.
	Using the advances in computing power, software and hardware technologies, virtual reality (VR), and gaming applications have the potential to address clinical challenges for a range of disabilities. VR-based games can potentially provide the ability to assess and augment cognitive and motor rehabilitation under a range of stimulus conditions that are not easily controllable and quantifiable in the real world. This article discusses an approach for maximizing function and participation for those aging with and into a disability by combining task-specific training with advances in VR and gaming technologies to enable positive behavioral modifications for independence in the home and community. There is potential for the use of VR and game applications for rehabilitating, maintaining, and enhancing those processes that are affected by aging with and into disability, particularly the need to attain a balance in the interplay between sensorimotor function and cognitive demands and to reap the benefits of task-specific training and regular physical activity and exercise.

Larsen, M. N., et al. (2018). "Cardiovascular adaptations after 10 months of intense school-based physical training for 8- to 10-year-old children." Scandinavian Journal of Medicine & Science in Sports 28 Suppl 1: 33-41.
	This study examined cardiovascular adaptations in 8- to 10-year-old schoolchildren after 10 months (a full school year) of 3 x 40 minute per week of small-sided ball games (SSG, including football, basketball, and/or floorball) or circuit strength training (CST). The study involved 291 Danish schoolchildren, 8-10 years old, cluster-randomized to SSG (n = 93, 4 schools, 5 classes), CST (n = 83, 4 schools, 4 classes), or a control group (CON, n = 115, 2 schools, 5 classes). Before and after the 10-month intervention, resting heart rate and blood pressure measurements were performed as well as comprehensive transthoracic echocardiography and peripheral arterial tonometry (PAT). Analysis of baseline-to-10-months changes showed between-group differences (P < 0.05) after both training interventions in diastolic blood pressure (delta scores: SSG -2.1 +/- 6.0 mm Hg; CST -3.0 +/- 7.1 mm Hg; CON 0.2 +/- 5.3 mm Hg). Moreover, there were between-group differences in delta scores (P < 0.05) in interventricular septum thickness (SSG 0.17 +/- 0.87 mm; CST 0.30 +/- 0.94 mm; CON -0.15 +/- 0.68 mm), left-atrial volume index (SSG 0.32 +/- 5.13 mL/m(2) ; CON 2.60 +/- 5.94 mL/m(2) ), and tricuspid annular plane systolic excursion (SSG -0.4 +/- 3.3 mm; CON: 0.1 +/- 3.6 mm). No significant between-group differences were observed for the PAT-derived reactive hyperemia index. In conclusion, 10 months of 3 x 40 minutes per week of SSG and CST in 8- to 10-year-old children decreased diastolic blood pressure and elicited discrete cardiac adaptations, suggesting that intense physical exercise in school classes can have effects on cardiovascular health in children.

Larsson, E., et al. (2020). "An evidence map of digital tools to support social engagement in older adults living with mental illness or those who are at risk for mental health decline." Gerontechnology 19(3): 1-29.
	Background: The use of digital technology might contribute to social engagement and mental health in an ageing population. Objective: To systematically map and describe the scientific knowledge and knowledge gaps on the effects of different types of digital tools for outcomes related to social engagement in older adults at risk for mental health decline. Methods: Thirteen groups of outcomes (domains) were defined, related to social engagement, by the use of digital tools. Thereafter, a systematic literature search was conducted in April 2017 to identify systematic reviews in line with the objective, an additional search for systematic reviews published since April 2017 was done in September 2019. In addition, reference lists as well as protocols from the Cochrane Collaboration and Campbell were searched. The final sample includes nine systematic reviews, published between 2012 and 2019, with both qualitative and quantitative results. Results: This evidence map shows that education in and use of digital tools, including computers and the internet, might decrease loneliness. Research is still limited, but the existing research points towards positive effects from the use of digital tools on outcomes related to social engagement, such as loneliness, social isolation, social interaction and/or social support, participation, depression, physical health/activities, as well as security, self-esteem or empowerment. Scientific knowledge gaps are present for the domains of quality of life, activities in daily living (ADL), cognition, autonomy, and usability. Conclusion: The evidence map shows inconclusive evidence about the effects on outcomes related to social engagement from the use of digital tools for older adults at risk of mental health decline or mental illness. More research is needed, and future research should include studies with a strong design, larger populations, and various subgroups of older adults in different contexts to further evaluate the effects of the digital tools related to social engagement for older adults at risk of mental health decline or mental illness.

Lau, J., et al. (2022). "Immersive Technology for Cognitive-Motor Training in Parkinson's Disease." Frontiers in Human Neuroscience 16: 863930.
	Background: Parkinson's disease (PD) is a neurodegenerative disease in which the progressive loss of dopaminergic neurons (DA) leads to initially sporadic and eventually widespread damage of the nervous system resulting in significant musculoskeletal and cognitive deterioration. Loss of motor function alongside increasing cognitive impairment is part of the natural disease progression. Gait is often considered an automatic activity; however, walking is the result of a delicate balance of multiple systems which maintain the body's center of mass over an ever-changing base of support. It is a complex motor behavior that requires components of attention and memory to prevent falls and injury. In addition, evidence points to the critical role of salient visual information to gait adaptability. There is a growing understanding that treatment for PD needs to address movement as it occurs naturally and walking needs to be practiced in more complex environments than traditional therapy has provided. Methods: In this single-blinded randomized-controlled pilot study, an immersive treadmill training was piloted to determine feasibility and preliminary efficacy on gait and cognition in people with PD. Eighteen participants with Hoehn and Yahr stages I-III PD were randomized to either an intervention or a waitlist control group. Following baseline data collection, the intervention group trained for 30 min, three times/week for 4 weeks on a split belt treadmill combined with a first-person immersive video game targeting visuospatial skills and working memory. Assessment was repeated after 4 weeks of training for the experimental group and 1-month after baseline for the control group. Primary motor outcomes were captured with the APDM Opal sensors during 6 MWT, TUG, and TUG Cognitive. Secondary outcomes of cognition were measured with the Montreal Cognitive Assessment (MoCA), Verbal Fluency (Fruit, Vegetable, and Animal) and the Symbol Digit Modality Test (SDMT). Within subject differences were calculated using the Wilcoxon Signed Ranked Test and between subject comparisons were analyzed using the Mann Whitney U-test. Results: This novel treadmill training program was well-tolerated with all participants in the intervention group completing 4 weeks of training three times a week without any adverse effects. After immersive cognitive motor training, the experimental group made clinically relevant improvements in gait speed and walking distance during the 6 MWT while members of the control group showed no change or decreased gait speed and walking distance over the 1-month trial. In addition, the experimental group demonstrated significant improvement for the TUG Cognitive (p = 0.05) and those changes were greater than the control group (between group p = 0.040). The experimental group also improved scores on MoCA (p = 0.007) and SDMT (p = 0.01) cognitive outcome measures while the control group did not. Conclusion: The use of immersive gaming technology to engage specific areas of cognition related to gait is feasible in PD. The treadmill training program paired with a customized interactive video game improved walking velocity in addition to non-significant but consistent improvements in other gait measures and cognitive performance in participants with early to mid-stage PD.

Laufer, Y. and P. L. Weiss (2011). "Virtual Reality in the Assessment and Treatment of Children With Motor Impairment: A Systematic Review." Journal of Physical Therapy Education 25(1): 59-71.
	
Laut, J., et al. (2015). "Increasing patient engagement in rehabilitation exercises using computer-based citizen science." PLoS ONE [Electronic Resource] 10(3): e0117013.
	Patient motivation is an important factor to consider when developing rehabilitation programs. Here, we explore the effectiveness of active participation in web-based citizen science activities as a means of increasing participant engagement in rehabilitation exercises, through the use of a low-cost haptic joystick interfaced with a laptop computer. Using the joystick, patients navigate a virtual environment representing the site of a citizen science project situated in a polluted canal. Participants are tasked with following a path on a laptop screen representing the canal. The experiment consists of two conditions: in one condition, a citizen science component where participants classify images from the canal is included; and in the other, the citizen science component is absent. Both conditions are tested on a group of young patients undergoing rehabilitation treatments and a group of healthy subjects. A survey administered at the end of both tasks reveals that participants prefer performing the scientific task, and are more likely to choose to repeat it, even at the cost of increasing the time of their rehabilitation exercise. Furthermore, performance indices based on data collected from the joystick indicate significant differences in the trajectories created by patients and healthy subjects, suggesting that the low-cost device can be used in a rehabilitation setting for gauging patient recovery.

Laver, K. (2013). "Gaming consoles are widely used in clinical rehabilitation settings however evidence to support their use is lacking." Physical Therapy Reviews 19(1): 41-42.
	
Laver, K., et al. (2012). "Use of an interactive video gaming program compared with conventional physiotherapy for hospitalised older adults: a feasibility trial." Disability & Rehabilitation 34(21): 1802-1808.
	PURPOSE: To assess the feasibility of a physiotherapy intervention using an interactive gaming program compared with conventional physiotherapy for hospitalised older people. METHODS: Randomised controlled pilot study in a geriatric rehabilitation unit within an acute public hospital. Participants were randomly allocated to physiotherapy using an interactive gaming program (n = 22) or conventional physiotherapy in a ward-based gym (n = 22). Feasibility was assessed by comparing the effects of the intervention on clinical outcome measures (primary outcome: mobility as assessed by the Timed Up and Go test, secondary outcomes: safety, adherence levels, eligibility and consent rates). RESULTS: Participants (n = 44) had a mean age of 85 years (SD 4.5) and the majority (80%) were women. Univariable analyses showed no significant difference between groups following intervention. However, multivariable analyses suggested that participants using the interactive gaming program improved more on the Timed Up and Go test (p = 0.048) than participants receiving conventional physiotherapy. There were no serious adverse events and high levels of adherence to therapy were evident in both groups. Only a small proportion of patients screened were recruited to the study. CONCLUSIONS: In this feasibility study, the use of a commercially available interactive gaming program by physiotherapists with older people in a hospital setting was safe and adherence levels were comparable with conventional therapy. Preliminary results suggest that further exploration of approaches using games as therapy for older people could include commonly used measures of balance and function.

Laver, K., et al. (2011). "Is the Nintendo Wii Fit really acceptable to older people? A discrete choice experiment." BMC Geriatrics 11(1): 64.
	BACKGROUND: Interactive video games such as the Nintendo Wii Fit are increasingly used as a therapeutic tool in health and aged care settings however, their acceptability to older people is unclear. The aim of this study was to determine the acceptability of the Nintendo Wii Fit as a therapy tool for hospitalised older people using a discrete choice experiment (DCE) before and after exposure to the intervention. METHODS: A DCE was administered to 21 participants in an interview style format prior to, and following several sessions of using the Wii Fit in physiotherapy. The physiotherapist prescribed the Wii Fit activities, supervised and supported the patient during the therapy sessions. Attributes included in the DCE were: mode of therapy (traditional or using the Wii Fit), amount of therapy, cost of therapy program and percentage of recovery made. Data was analysed using conditional (fixed-effects) logistic regression. RESULTS: Prior to commencing the therapy program participants were most concerned about therapy time (avoiding programs that were too intensive), and the amount of recovery they would make. Following the therapy program, participants were more concerned with the mode of therapy and preferred traditional therapy programs over programs using the Wii Fit. CONCLUSIONS: The usefulness of the Wii Fit as a therapy tool with hospitalised older people is limited not only by the small proportion of older people who are able to use it, but by older people's preferences for traditional approaches to therapy. Mainstream media portrayals of the popularity of the Wii Fit with older people may not reflect the true acceptability in the older hospitalised population.

Laver, K. E., et al. (2018). "Virtual Reality for Stroke Rehabilitation." Stroke 49(4): e160-e616.
	The use of virtual reality programs specifically designed for stroke rehabilitation is increasing as is the use of commercial video game devices in clinical settings. This review is an update of our review published first in 2011 and then in 2015. Objectives The primary objective of this review was to examine the efficacy of virtual reality compared with an alternative intervention or no intervention on upper limb function and activity. Our secondary objective was to examine the efficacy on gait and balance, global motor function, cognitive function, activity limitation, participation restriction, quality of life, and adverse events. Methods We searched the Cochrane Stroke Group Trials Register (April 2017), CENTRAL, MEDLINE, Embase, and 7 additional databases as well as trials registries. We included randomized and quasi-randomized trials of virtual reality in adults after stroke. The primary outcome of interest was upper limb function and activity. Two review authors independently selected trials, extracted data, and assessed risk of bias with input from a third author to moderate disagreements when required. Main Results A total of 72 trials (with 2470 participants) were included in the review. This review includes 35 new studies in addition to the studies included in the previous version of this review (published in 2015). Most studies involved small sample sizes and interventions varied in terms of both the goals of treatment and the virtual reality program or device used. Although there are a relatively large number of randomized controlled trials, the evidence remains mostly low quality when rated using the GRADE system because of the risk of bias in the studies and inconsistent findings between studies. Control groups in the included studies usually received either no therapy or conventional therapy which was provided by an occupational therapist or physiotherapist. Primary outcome: when virtual reality was compared with the same dose of conventional therapy the results were not statistically significant for upper limb function (standardized mean difference, 0.07; 95% confidence interval, -0.05-0.20; 22 studies, 1038 participants, low-quality evidence). However, when virtual reality was used to supplement usual care (thereby providing participants in the intervention group with a higher dose of therapy), there was a statistically significant difference between groups (standardized mean difference, 0.49; 95% confidence interval, 0.21-0.77, 10 studies, 210 participants, low-quality evidence). Secondary outcomes: when compared with conventional therapy approaches there were no statistically significant effects for gait speed or balance. Results were statistically significant for the activities of daily living outcome (standardized mean difference, 0.25; 95% confidence interval, 0.06-0.43; 10 studies, 466 participants, moderate-quality evidence); however, we were unable to pool results for cognitive function, participation restriction, or quality of life. There were few adverse events experienced in the 23 studies which reported on this and adverse events were relatively mild. There was a trend suggesting that customized virtual reality programs were preferable to commercial game products, however, these findings were not statistically significant (Figure).

Laxmaiah, A., et al. (2007). "Factors affecting prevalence of overweight among 12- to 17-year-old urban adolescents in Hyderabad, India." Obesity 15(6): 1384-1390.
	OBJECTIVE: The problem of overweight and obesity is not confined only to developed countries but is also widely prevalent in developing countries. The objective of this study was to assess the prevalence of overweight and obesity as defined by the International Obesity Task Force (IOTF) among school-age children in Hyderabad, India, and identify its associated factors. RESEARCH METHODS AND PROCEDURES: A cross-sectional and institutional study, adopting a multistage stratified cluster sampling procedure, was carried out during 2003 on adolescents 12 to 17 years of age of both sexes from Hyderabad, India. RESULTS: The overall prevalence of overweight was 6.1% [95% confidence interval (CI): 4.2, 8.0] among boys and 8.2% among girls (CI: 6.0, 10.4); 1.6% and 1.0% were obese, respectively. The prevalence was significantly higher (p < 0.05) among adolescents who watched television > or =3 h/d (10.4%) or belonged to a high socioeconomic background (14.9%, p < 0.001), whereas it was significantly lower among those participating regularly in outdoor games > or =6 h/wk (3.1%, p < 0.004) and household activities > or =3 h/d (4.7%, p < 0.001). The logistic regression analysis revealed that the prevalence of overweight was 4 times higher among the adolescents of high socioeconomic status [odds ratio (OR): 4.1; CI: 2.25, 7.52], 3 times higher in those not participating in outdoor games (OR: 2.75; CI: 1.56, 4.72), and 1.92 times higher in those watching television > or =3 h/d (OR: 1.92; CI: 1.16, 3.18). DISCUSSION: This study confirmed the findings of earlier studies carried out in Western countries and emphasizes that regular physical exercise, doing household activities, regulated television viewing, and healthy eating behaviors could contribute to controlling overweight and obesity.

Leahy, T. M., et al. (2020). "Injury surveillance and prevention practices across Rugby schools in Ireland." Physical Therapy in Sport 43: 134-142.
	OBJECTIVES: To ascertain the extent of injury surveillance and prevention practices currently in operation and the availability of qualified personnel across Rugby playing schools in the Republic of Ireland. DESIGN: Cross-sectional survey design. SETTING: Rugby playing schools across Ireland. PARTICIPANTS: The Rugby games master, head Rugby coach or teacher/coach with knowledge of all Rugby activities in the school. RESULTS: Ninety-three Rugby playing schools responded and reported 356 (97% male, 3% female) school Rugby teams. Rugby injuries were formally monitored in 86% of schools. Injury recorders were primarily coaches (61%). Physiotherapy provision was available in 28% of schools, 14% of schools provided access to a medical doctor and 44% of schools provided access to an S&C coach. Structured warm-ups were undertaken in 66% of schools, weekly gym sessions in 49% of schools and 31% of schools did not implement any formal injury prevention measures. CONCLUSIONS: Injury monitoring practices, medical personnel accessibility and the frequency of injury prevention practices varies considerably across Rugby playing schools in Ireland. Future injury surveillance and prevention systems should be suitable for use by non-medical personnel and reflect the structural organisation of the school Rugby game so that data are not solely representative of the elite, well-resourced schools.

Lebrun, C. M., et al. (1986). "Organizing Sports Medicine Coverage at the Canada Summer Games." Physician & Sportsmedicine 14(11): 118-127.
	In brief: This article documents the experience with medical coverage for the 1985 Canada Summer Games to help determine the demands of caring for athletes at this level of competition. A total of 599 medical and physiotherapy treatments were given to the 339 members of the British Columbian team (including 20 mission staff) during the two weeks of the games. Most treatments were carried out in the clinic by physiotherapists, suggesting that athletes were seen more frequently for chronic musculoskeletal complaints than for acute medical emergencies. However, physicians responsible for on-site care must be equipped to treat conditions ranging from corneal abrasions to acute head or neck injuries.

Lee, A. T. C., et al. (2018). "Association of Daily Intellectual Activities With Lower Risk of Incident Dementia Among Older Chinese Adults." JAMA Psychiatry 75(7): 697-703.
	Importance: Associations between late-life participation in intellectual activities and decreased odds of developing dementia have been reported. However, reverse causality and confounding effects due to other health behaviors or problems have not been adequately addressed. Objective: To examine whether late-life participation in intellectual activities is associated with a lower risk of incident dementia years later, independent of other lifestyle and health-related factors. Design, Setting, and Participants: A longitudinal observational study was conducted at all Elderly Health Centres of the Department of Health of the Government of Hong Kong among 15582 community-living Chinese individuals age 65 years or older at baseline who were free of dementia, with baseline evaluations performed January 1 to June 30, 2005, and follow-up assessments performed from January 1, 2006, to December 31, 2012. Statistical analysis was performed from January 1, 2015, to December 31, 2016. Main Outcomes and Measures: The main outcome was incident dementia as diagnosed by geriatric psychiatrists in accordance with the International Statistical Classification of Diseases and Related Health Problems, Tenth Revision, or a Clinical Dementia Rating of 1 to 3. At baseline and follow-up interviews, self-reported information on participation in intellectual activities within 1 month before assessment was collected. Examples of intellectual activities, which were described by a local validated classification system, were reading books, newspapers, or magazines; playing board games, Mahjong, or card games; and betting on horse racing. Other important variables including demographics (age, sex, and educational level), physical and psychiatric comorbidities (cardiovascular risks, depression, visual and hearing impairments, and poor mobility), and lifestyle factors (physical exercise, adequate fruit and vegetable intake, smoking, and recreational and social activities) were also assessed. Results: Of the 15582 individuals in the study, 9950 (63.9%) were women, and the median age at baseline was 74 years (interquartile range, 71-77 years). A total of 1349 individuals (8.7%) developed dementia during a median follow-up period of 5.0 years. Multivariable logistic regression analysis showed that the estimated odds ratio for incident dementia was 0.71 (95% CI, 0.60-0.84; P < .001) for those with intellectual activities at baseline, after excluding those who developed dementia within 3 years after baseline and adjusting for health behaviors, physical and psychiatric comorbidities, and sociodemographic factors. Conclusions and Relevance: Active participation in intellectual activities, even in late life, might help delay or prevent dementia in older adults.

Lee, G. H. (2019). "Effects of virtual reality exercise program using the sony playstation 2 gaming platform on balance, emotion and quality of life in patients with Parkinson's disease." Movement disorder 34: S56‐.
	Objective: This study was to investigate the effectiveness of a 12‐week virtual reality(VR) exercise program designed around low‐cost VR device, the Sony PlayStation 2 (PS2) gaming platform, in improving balance, emotion and quality of life among patients with Parkinson's disease (PD). Background: Many old patients live with physical functional limitations stemming from PD. These functional limitations can be reduced by task‐specific training that is repetitive, motivating, and augmented with feedback. Virtual reality exercise treatments that provide feedback, increase practice with multiple repetitions, and motivate patients are reported to be effective in exercise therapy on these handicapped patients. Methods: Thirty participants with idiopathic PD were randomly assigned to a gaming group or normal activity control group. PS2 gaming systems provided participants with an interactive interface of real‐time movement of either themselves or an avatar on the screen. Participants played games 50‐60 minutes/day, 3 days/week, for 12 weeks. The intervention was strictly game‐play, in standing position, without physical therapy. The control group received no special intervention and continued with normal activity. Both groups were tested prior to, and following the completion of the study. The Berg Balance Scale(BBS) were used to assess balance abilities. Quantification of improvement was conducted utilizing static posturography and Sensory Organization Test (SOT) of Computerized Dynamic Posturography (CDP). Statistical significance was tested in between the patients before and after treatment by t‐test, Wilcoxon signed rank test and Wilcoxon rank sum test. Results: After 36 training sessions, there were significant beneficial effects of the virtual reality game exercise on balance(BBS). The trained patients showed a significant improvement in the follow‐up CDP (p < .05). On the other hand, no significant difference was observed within the control groups. Conclusions: These findings demonstrated that the PS2 gaming program could improve the outcomes in terms of balance, depression and quality of life in patients with PD. A low‐cost PS2 VR gaming system was easily used in the home. In the future it may be used to improve motion, balance and quality of life as an adjunct to standard care physical therapy.

Lee, H. Y., et al. (2015). "The Effects of Nursing Interventions Utilizing Serious Games That Promote Health Activities on the Health Behaviors of Seniors." Games for Health Journal 4(3): 175-182.
	OBJECTIVES: Seniors, during their senescence, experience difficulties when engaging in physical, social, and leisure activities. Meanwhile, increased access to information technology in recent years among seniors has led to the increased applicability of games aiding senior activities that incorporate information technology. In this study, we constructed and assessed a nursing intervention incorporating an actual walking exercise game developed for the use of seniors in order to identify the cognitive, social, and physical impact it has on their health behaviors. SUBJECTS AND METHOD: This quasi-experimental study used a one-group pre-/post-test design in which 15 people 65 years of age or older were selected to participate through a serious health game conducted at the senior welfare center twice a week, for 12 weeks. Besides having their basic physical measurements taken, seniors participated in physical exercise sessions that included educational content. The measured variables were health beliefs and concerns, subjective knowledge, subjective norms, perceived reliability, perceived ease of use and usefulness, perceived behavioral control, attitudes about health behaviors, intentions to perform health behaviors, health behaviors, blood pressure, pulse rate, endurance, agility and balance, and flexibility. RESULTS: Significant increases in health beliefs and concerns, perceived reliability, perceived behavioral control, perceived ease of use, attitudes about health behaviors, and intentions to perform health behaviors were observed at post-test, compared with pre-test data points. These increases were also recorded for physical domains. Significant increases in systolic blood pressure and pulse rates were noted immediately after the intervention, along with increased endurance levels, indicating that the exercise had an effect on participants' health. CONCLUSIONS: Ongoing research is required regarding the development and impact of distinctive nursing interventions, conducted through various forms of serious health games relatively easy to use, by integrating various motivating factors for engaging in health behaviors and the entertainment value of such games.

Lee, M., et al. (2016). "A Further Step to Develop Patient-Friendly Implementation Strategies for Virtual Reality-Based Rehabilitation in Patients With Acute Stroke." Physical Therapy 96(10): 1554-1564.
	BACKGROUND: Virtual reality (VR)-based rehabilitation is gaining attention as a way to promote early mobilization in patients with acute stroke. However, given the motor weakness and cognitive impairment associated with acute stroke, implementation strategies for overcoming patient-perceived difficulty need to be developed to enhance their motivation for training. OBJECTIVE: The purpose of this study was to explore patient-perceived difficulty and enjoyment during VR-based rehabilitation and the factors affecting those experiences. DESIGN: An exploratory mixed-method design was used in this study. METHODS: Eight individuals with acute stroke participated in 2 training modes of VR-based rehabilitation (ie, workout and game modes) 20 to 30 minutes per day for 5 to 8 sessions. A visual analog scale was used to assess patient-perceived difficulty and enjoyment at every session. Then semistructured interviews were conducted to explore the factors affecting those experiences. RESULTS: Levels of difficulty and enjoyment varied depending on the training mode and participants' phases of recovery. Five major factors were identified as affecting those varied experiences: (1) ease of following the directions, (2) experience of pain, (3) scores achieved, (4) novelty and immediate feedback, and (5) self-perceived effectiveness. CONCLUSIONS: Levels of difficulty and enjoyment during VR-based rehabilitation differed depending on the phases of recovery and training mode. Therefore, graded implementation strategies for VR-based rehabilitation are necessary for overcoming patient-perceived difficulty and enhancing enjoyment. Ease of following the directions might be best considered in the very early stage, whereas multisensory feedback may be more necessary in the later stage. Health professionals also should find a way for patients to avoid pain during training. Feedback, such as knowledge of results and performance, should be used appropriately.

Lee, M., et al. (2016). "Patient perspectives on virtual reality-based rehabilitation after knee surgery: Importance of level of difficulty." Journal of Rehabilitation Research & Development 53(2): 239-252.
	This article explored the perspectives of 25 patients regarding virtual reality (VR)-based rehabilitation following knee surgery and identified the important factors that allowed patients to immerse themselves in rehabilitation. Qualitative analysis of data collected via open-ended questionnaire and quantitative analysis of data from physical assessments and surveys were conducted. In the open-ended questionnaire, the majority of participants mentioned level of difficulty as the most common reason for selecting both the most and the least immersive exercise programs. Quantitative analysis showed that participants experienced a high level of flow (3.9 +/- 0.3 out of 5.0) and a high rate of expectation of therapeutic effect (96%) and intention of exercise adherence (96%). Further, participants with more severe pain or physical dysfunction tended to have more positive experiences (e.g., Difficulty-Skill Balance, Clear Goals, and Transformation of Time), leading to high levels of flow during VR-based rehabilitation. In conclusion, VR-based games are potentially acceptable as a motivational rehabilitation tool for patients following knee surgery. However, to best meet patients' needs, it might be useful to equip a VR program with varied levels of difficulty, taking into account the severity of the individual's knee injury. Additionally, severe pain or physical dysfunction might act as an indication rather than a contraindication for VR-based rehabilitation.

Lee, M. M., et al. (2018). "Game-Based Virtual Reality Canoe Paddling Training to Improve Postural Balance and Upper Extremity Function: A Preliminary Randomized Controlled Study of 30 Patients with Subacute Stroke." Med Sci Monit 24: 2590-2598.
	BACKGROUND Virtual reality (VR) training with motion-controlled console games can be incorporated into stroke rehabilitation programs. The use of a variety of gaming software can provide the patient with an opportunity to perform activities that are exciting, entertaining, and that may not be feasible in clinical environments. The aim of this preliminary randomized controlled study was to investigate the effects of game-based VR canoe paddling training, when combined with conventional physical rehabilitation programs, on postural balance and upper extremity function in 30 patients with subacute stroke. MATERIAL AND METHODS Thirty patients, who were within six months following the diagnosis of stroke, were randomly allocated to either the experimental group (n=15) or the control group (n=15). All participants participated in a conventional rehabilitation program. Also, the experimental group (n=15) performed the VR canoe paddling training for 30 minutes each day, three times per week, for five weeks. After five weeks, outcomes of changes in postural balance and upper extremity function were evaluated and compared between the two groups. RESULTS At five weeks, postural balance and upper extremity function showed significant improvements in both patients groups when compared with the baseline measurements (p<0.05). However, postural balance and upper extremity function were significantly improved in the experimental group when compared with the control group (p<0.05). CONCLUSIONS Game-based VR canoe paddling training is an effective rehabilitation therapy that enhances postural balance and upper extremity function in patients with subacute stroke when combined with conventional physical rehabilitation programs.

Lee, S. (2015). "Game-Based Virtual Reality Training Improves Sitting Balance after Spinal Cord Injury: A Single-Blinded, Randomized Controlled Trial." Medical Science and Technology 56: 53-59.
	Background: Virtual reality (VR) is a useful device for rehabilitation methods. It is a motivational device to stimulate physical activity and function. The aim of this study was to investigate the effect of game‐based VR training using Nintendo Wii on sitting balance ability in participants with spinal cord injury (SCI). Material/Methods: SCI survivors (N=26, American Spinal Injury Association Impairment Scale category A or B) were randomly allocated into the following 2 groups: the virtual reality group (n=13) and the control group (n=13). Both groups received conventional rehabilitation for 5 sessions 60~90 minutes per week for 6 weeks. The VR group completed an additional 6 weeks (30 minutes ×3 sessions/week) of Nintendo Wii‐based VR balance training to improve static balance ability (postural sway distance, postural sway velocity) and dynamic balance ability (modified functional reach test [mFRT], T‐shirt test). Results: Both groups showed significant improvement in static and dynamic balance ability (p<.05). When comparing among groups, there was significant improvement in static and dynamic balance ability with respect to; anterior‐ posterior (AP) and total postural sway distance (p<.05); AP and total postural sway velocity (p<.05); left, front and right mFRT (p<.05); and the T‐shirt test (p<.05). There was no significant change in mediolateral (ML) postural sway distance and velocity. Conclusions: VR training improved static and dynamic balance ability in SCI survivors, and its application may be useful as a balance improvement program in home and inpatient rehabilitation for SCI.

Lee, S. and S. Shin (2013). "Effectiveness of virtual reality using video gaming technology in elderly adults with diabetes mellitus." Diabetes Technol Ther 15(6): 489-496.
	BACKGROUND: Diabetes in elderly adults is associated with an increased risk of fall. The aim of study was to determine whether a virtual reality exercise (VRE) program would improve balance, strength, gait, and falls efficacy in elderly adults with diabetes. SUBJECTS AND METHODS: Fifty-five subjects with diabetes mellitus over 65 years of age were randomly assigned to a VRE group (VREG) (n=27) and a control group (CG) (n=28). The VREG received the VRE program and diabetes education, whereas the CG received only the diabetes education. The VRE program used video gaming (PlayStation((R)) 2; Sony, Tokyo, Japan) and was conducted for 50 min twice a week for 10 weeks. Balance, muscle strength, gait, and falls efficacy were measured at baseline and after intervention. Measurements were taken using a clinical tests (the one-leg-standing test, the Berg Balance Scale, the functional reach test, the timed up-and-go test, and the sit-to-stand test), and gait analysis. A self-administered questionnaire was used to measure falls efficacy. RESULTS: After training, the VREG showed significantly improved balance, decreased sit-to-stand times, and increased gait speed, cadence, and falls efficacy. CONCLUSIONS: The VRE program was to maximize the effects of exercise by triggering players was to be fully immersed into the games and enhanced major influential factors on the falls of subject. This study suggests VRE programs are feasible and effective for reduced the risk of falls in elderly adults with type 2 diabetes.

Leemrijse, C. (2003). "Developmental coordination disorder: evaluation and treatment." Nederlands Tijdschrift Voor Fysiotherapie: 24-27.
	A child's popularity is often related to his or her proficiency in sports and games, and children value physical competence highly. The movement difficulties of children with developmental coordination disorder (DCD) often invite ridicule from their peers. Children with DCD have a poor motor performance for their age which is not explainable by mental retardation or any known physical disorder, and which interferes with academic achievement and activities of daily living. Most striking are problems in the general coordination of posture and movements and in the execution of fine movements, such as writing and fastening buttons.

LeGear, T., et al. (2016). "Does a Nintendo Wii exercise program provide similar exercise demands as a traditional pulmonary rehabilitation program in adults with COPD?" The clinical respiratory journal 10(3): 303-310.
	BACKGROUND AND AIMS: The chronic obstructive pulmonary disease (COPD) population can experience lower activity and fitness levels than the non-COPD population. The Nintendo Wii may be an appropriate at-home training device for the COPD population, which could be used as a supplement for a pulmonary rehabilitation program. This study was a randomized, within-subject, cross-over study involving 10 adults with COPD previously enrolled in St Paul's Hospital's pulmonary rehabilitation program. This study attempted to determine if specific Wii activities resulted in similar energy expenditures to that of a more traditional pulmonary rehabilitation activity. METHODS: Participants completed two 15-min exercise interventions in a single session, with a washout period of 30 min in-between. The interventions were an experimental Wii intervention and a traditional treadmill intervention. RESULTS: There was no significant difference in total energy expenditure between the two 15-min exercise interventions [mean difference 36.3 joules; 95% confidence interval (CI): 31.4, 104]. There was no significant difference in heart rate (mean difference -0.167 beats per minute; 95% CI: -4.83, 4.50), rating of perceived exertion (mean difference 0.100; 95% CI: -0.416, 0.616) and Borg dyspnea scale (mean difference 0.267; 95% CI: -0.004, 0.537) between the two 15-min exercise interventions. There was a significant difference in SpO2 between the two 15-min exercise interventions (Wii intervention mean difference 2.33% > treadmill intervention; 95% CI: 1.52, 3.15). CONCLUSION: Gaming technology can provide an exercise program that has similar cardiovascular demands to traditional pulmonary rehabilitation programs for patients with COPD. Further research is necessary to address feasibility and long-term adherence.

Lehmann, I., et al. (2020). "Experience of an upper limb training program with a non-immersive virtual reality system in patients after stroke: a qualitative study." Physiotherapy 107: 317-326.
	OBJECTIVES: The YouGrabber (YG) is a new virtual reality training system that focuses on unilateral and bimanual activities. This nested study was part of a larger multicenter randomized controlled trial and explored experiences of people with chronic stroke during a 4 weeks intensive upper limb training with YG. DESIGN: A qualitative design using semi-structured, face-to-face interviews. A phenomenological descriptive approach was used, with data coded, categorized and summarized using a thematic analysis. Topics investigated included: the experience of YG training, perceived impact of YG training on arm function, and the role of the treating therapist. RESULTS: Five people were interviewed (one female, age range 55 to 75 years, 1 to 6 years poststroke). Seven main themes were identified: (1) general experience, (2) expectations, (3) feedback, (4) arm function, (5) physiotherapist's role, (6) fatigue, (7) motivation. Key experiences reported included feelings of motivation and satisfaction, with positive factors identified as challenge, competition, fun and effort. The YG training appeared to trigger greater effort, however fatigue was experienced at the end of the training. Overall, patients described positive changes in upper limb motor function and activity level, e.g. automatic arm use. While the opportunity for self-practice was appreciated, input from the therapist at the start of the intervention was deemed important for safety and confidence. CONCLUSIONS: Reported experiences were mostly positive and the participants were motivated to practice intensively. They enjoyed the challenging component of the games.

Leite, M. M. A. G., et al. (2019). "Financial costs of musculoskeletal injuries in elite female volleyball players...Third World Congress of Sports Physical Therapy, October 4-5, 2019, Vancouver, British Columbia." International Journal of Sports Physical Therapy 14(6): S11-S12.
	Objective: To analyze direct and indirect costs of musculoskeletal injuries in Brazilian elite female volleyball players. Methods: A retrospective cohort study was performed over two seasons, analyzing one elite female volleyball team database. The direct costs are related to the injury rehabilitation (number of physiotherapy visits per injury) and indirect costs are related to the low productivity or work absence and were calculated by time loss (number of time loss per injury x athlete's salary per day) and matches lost (the number of official matches lost x athlete's salary per match). Descriptive data were organized in Microsoft Office® Excel® 2016-2017. Results: A total of 24 elite female volleyball players who participated in 2015-2016 and 2016-2017 seasons were considered in the analysis. Both seasons had the same coach and physiotherapist. The direct cost was 27,994.40 USD and the average cost per injury was 243.43 USD. Considering injuries without time loss the total cost was 2,849.50 USD and 25,144.96 USD for time-loss injuries. Indirect cost was 12,320.29 USD, which was a result of 249 days lost because of injuries. Fifteen official matches were lost as a result of musculoskeletal injuries, and the club spent 27,518.01 USD because of athlete absence. Analyzing the physiotherapy department budget to female volleyball, 45% represented the direct costs to injuries rehabilitation. Conclusion: The results of the present study showed the financial impact of musculoskeletal injuries in one elite female volleyball team with a high infrastructure. Future research should be done with all the Super League Teams to represent the Brazilian Volleyball costs. Clinical implication: The direct costs were higher than the indirect costs, showing the importance of the sports physiotherapist in the team monitoring, since most of the injuries did not lead to time loss from training and games.

Levac, D. (2016). How Can Therapists Enhance Children's Engagement in Home-Based Rehabilitation Interventions? Philadelphia, Pennsylvania, Taylor & Francis Ltd. 36: 359-362.
	The author looks at the role of therapists in improving the engagement of children in home-based rehabilitation interventions. She references the study "Understanding Engagement in Home-Based Interactive Computer Play," by S. James et al., published in the journal "Physical & Occupational Therapy in Pediatrics" in 2015. She cites the increasing popularity of interactive computer play (ICP) systems as rehabilitation interventions. She explains how therapists should measure client motivation.

Levac, D., et al. (2015). ""Kinect-ing" with clinicians: a knowledge translation resource to support decision making about video game use in rehabilitation." Physical Therapy 95(3): 426-440.
	Microsoft's Kinect for Xbox 360 virtual reality (VR) video games are promising rehabilitation options because they involve motivating, full-body movement practice. However, these games were designed for recreational use, which creates challenges for clinical implementation. Busy clinicians require decision-making support to inform game selection and implementation that address individual therapeutic goals. This article describes the development and preliminary evaluation of a knowledge translation (KT) resource to support clinical decision making about selection and use of Kinect games in physical therapy. The knowledge-to-action framework guided the development of the Kinecting With Clinicians (KWiC) resource. Five physical therapists with VR and video game expertise analyzed the Kinect Adventure games. A consensus-building method was used to arrive at categories to organize clinically relevant attributes guiding game selection and game play. The process and results of an exploratory usability evaluation of the KWiC resource by clinicians through interviews and focus groups at 4 clinical sites is described. Subsequent steps in the evaluation and KT process are proposed, including making the KWiC resource Web-based and evaluating the utility of the online resource in clinical practice.

Levac, D., et al. (2012). "Usual and virtual reality video game-based physiotherapy for children and youth with acquired brain injuries." Physical & Occupational Therapy in Pediatrics 32(2): 180-195.
	Little is known about how therapists promote learning of functional motor skills for children with acquired brain injuries. This study explores physiotherapists' description of these interventions in comparison to virtual reality (VR) video game-based therapy. Six physiotherapists employed at a children's rehabilitation center participated in semi-structured interviews, which were transcribed and analyzed using thematic analysis. Physiotherapists describe using interventions that motivate children to challenge performance quality and optimize real-life functioning. Intervention strategies are influenced by characteristics of the child, parent availability to practice skills outside therapy, and therapist experience. VR use motivates children to participate, but can influence therapist use of verbal strategies and complicate interventions. Physiotherapists consider unique characteristics of this population when providing interventions that promote learning of motor skills. The VR technology has advantageous features but its use with this population can be challenging; further research is recommended.

Levac, D., et al. (2016). "Development and Reliability Evaluation of the Movement Rating Instrument for Virtual Reality Video Game Play." JMIR Serious Games 4(1): e9.
	BACKGROUND: Virtual reality active video games are increasingly popular physical therapy interventions for children with cerebral palsy. However, physical therapists require educational resources to support decision making about game selection to match individual patient goals. Quantifying the movements elicited during virtual reality active video game play can inform individualized game selection in pediatric rehabilitation. OBJECTIVE: The objectives of this study were to develop and evaluate the feasibility and reliability of the Movement Rating Instrument for Virtual Reality Game Play (MRI-VRGP). METHODS: Item generation occurred through an iterative process of literature review and sample videotape viewing. The MRI-VRGP includes 25 items quantifying upper extremity, lower extremity, and total body movements. A total of 176 videotaped 90-second game play sessions involving 7 typically developing children and 4 children with cerebral palsy were rated by 3 raters trained in MRI-VRGP use. Children played 8 games on 2 virtual reality and active video game systems. Intraclass correlation coefficients (ICCs) determined intra-rater and interrater reliability. RESULTS: Excellent intrarater reliability was evidenced by ICCs of >0.75 for 17 of the 25 items across the 3 raters. Interrater reliability estimates were less precise. Excellent interrater reliability was achieved for far reach upper extremity movements (ICC=0.92 [for right and ICC=0.90 for left) and for squat (ICC=0.80) and jump items (ICC=0.99), with 9 items achieving ICCs of >0.70, 12 items achieving ICCs of between 0.40 and 0.70, and 4 items achieving poor reliability (close-reach upper extremity-ICC=0.14 for right and ICC=0.07 for left) and single-leg stance (ICC=0.55 for right and ICC=0.27 for left). CONCLUSIONS: Poor video quality, differing item interpretations between raters, and difficulty quantifying the high-speed movements involved in game play affected reliability. With item definition clarification and further psychometric property evaluation, the MRI-VRGP could inform the content of educational resources for therapists by ranking games according to frequency and type of elicited body movements.

Levac, D. E. and P. A. Miller (2013). "Integrating virtual reality video games into practice: clinicians' experiences." Physiother Theory Pract 29(7): 504-512.
	The Nintendo Wii is a popular virtual reality (VR) video gaming system in rehabilitation practice and research. As evidence emerges related to its effectiveness as a physical therapy training method, clinicians require information about the pragmatics of its use in practice. The purpose of this descriptive qualitative study is to explore observations and insights from a sample of physical therapists (PTs) working with children with acquired brain injury regarding practical implications of using the Wii as a physical therapy intervention. Six PTs employed at a children's rehabilitation center participated in semi-structured interviews, which were transcribed and analyzed using content analysis. Two themes summarize the practical implications of Wii use: 1) technology meets clinical practice; and 2) onus is on the therapist. Therapists described both beneficial and challenging implications arising from the intersection of technology and practice, and reported the personal commitment required to orient oneself to the gaming system and capably implement this intervention. Findings include issues that may be relevant to professional development in a broader rehabilitation context, including suggestions for the content of educational initiatives and the need for institutional support from managers in the form of physical resources for VR implementation.

Levesque, B., et al. (1990). "Carbon monoxide in indoor ice skating rinks: evaluation of absorption by adult hockey players." American Journal of Public Health 80(5): 594-598.
	We evaluated alveolar carbon monoxide (CO) levels of 122 male, adult hockey players active in recreational leagues of the Quebec City region (Canada), before and after 10 weekly 90-minute games in 10 different rinks. We also determined exposure by quantifying the average CO level in the rink during the games. Other variables documented included age, pulmonary function, aerobic capacity, and smoking status. Environmental concentrations varied from 1.6 to 131.5 parts per million (ppm). We examined the absorption/exposure relationship using a simple linear regression model. In low CO exposure levels, physical exercise lowered the alveolar CO concentration. However, we noted that for each 10 ppm of CO in the ambient air, the players had adsorbed enough CO to raise their carboxyhemoglobin (COHb) levels by 1 percent. This relationship was true both for smokers and non-smokers. We suggest that an average environmental concentration of 20 ppm of CO for the duration of a hockey game (90 minutes) should be reference limit not to be exceeded in indoor skating rinks.

Lewis, D. (2013). "An innovative approach to therapy." Physiotherapy 99(3): 266.
	
Lewis, M., et al. (2020). "ESTABLISHMENT OF A HOSPITAL-BASED PEDIATRIC OSTOMY SUPPORT GROUP...WOCNext 2020 Reimagined: Online Event, June 5-7, 2020." Journal of Wound, Ostomy & Continence Nursing 47: S26-S26.
	BACKGROUND: The benefits of ostomy support groups are well documented as providing lifelong learning and increased quality of life through social interaction. While adult support groups are abundant, pediatric ostomy support groups are limited. The United Ostomy Associations of America (UOAA) lists 315 affiliated adult support groups versus 2 supporting the pediatric population. Parents of children with ostomies, and teens themselves, often struggle to find ostomy resources for proper supplies, education, and emotional support. METHODOLOGY: In an effort to create a place for direct interaction and WOC nurse support, a pediatric ostomy support group was formed. A large quaternary pediatric hospital provided administrative support and meeting space as well as an affiliation agreement with the UOAA. The group is led by 2 WOC nurses, 2 adult ostomates, and a volunteer with an elementary school education background. Additional support is provided by hospital WOC nurse leadership, pediatric general surgery, child life specialists, hospital chaplains, social services, clinical nutrition, and physical therapy. Members come together the second Sunday of each month to share challenges and successes with peers who have common diagnoses. Meeting topics include mental, physical, financial, and social issues impacting children and adolescents managing ostomy care. Younger children are provided a craft to make or a game to play during the discussion. Teen members share their social and school experiences and coping mechanisms. OUTCOME: Providing a forum that provides solutions to pouching problems and coping strategies for the challenges of managing the unique needs of the pediatric ostomate has resulted in increased confidence and improved quality of life. Most of all, those in attendance now realize that they are not alone.

Li, J., et al. (2021). "Wii or Kinect? A Pilot Study of the Exergame Effects on Older Adults' Physical Fitness and Psychological Perception." International Journal of Environmental Research & Public Health [Electronic Resource] 18(24): 12939.
	Exergames are now often implemented among older adults for health purposes. This study aimed to investigate whether playing Kinect and Wii exergames has effects on older adults' physical fitness and psychological perceptions towards exergames. A total of 23 older participants aged above 60 years were recruited and randomly assigned into two groups, in which they played either Kinect or Wii Bowling exergames for three sessions in one week. Physiological and psychological measures were collected including heart rate, blood pressure, shoulder flexibility, as well as perceived benefits and intentions for future use. Findings indicated that exergames are equivalent to light-intensity exercises, and hence pose no or minimal risk to older adults. Older adults had a positive attitude towards exergames and have a strong willingness to engage in exergaming on a regular basis. Although no significant platform difference was identified, observation and qualitative findings suggested that Wii might provide a more intense physical activity than Kinect, while Kinect might obtain a higher perception among older adults than Wii. The study has several practical implications for both health professionals and exergame designers targeting the ageing population.

Li, R., et al. (2021). "Rehabilitation training based on virtual reality for patients with Parkinson's disease in improving balance, quality of life, activities of daily living, and depressive symptoms: A systematic review and meta-regression analysis." Clinical Rehabilitation 35(8): 1089-1102.
	OBJECTIVE: To examine the effectiveness of rehabilitation training based on virtual reality in improving balance, quality of life, activities of daily living, and depressive symptoms of patients with Parkinson's disease. DATA SOURCES: PubMed, EMBASE, CINAHL, Scopus, Cochrane Library, PsycINFO, ProQuest, Physiotherapy Evidence Database, IEEE Xplore, China National Knowledge Infrastructure, Wanfang, and VIP Information databases were searched from their inception to October 15, 2020. Trial registries, gray literature, and target journals were also searched. METHODS: Eligible randomized controlled trials included studies with patients with Parkinson's disease in rehabilitation training based on virtual reality. Comprehensive Meta-Analysis 3.0 software was used. Physiotherapy Evidence Database Scale and the Grading of Recommendation, Assessment, Development, and Evaluation system were used to assess the methodological quality of individual trials and the overall quality of the evidence, respectively. RESULTS: A total of 22 randomized controlled trials with 836 patients were included. Meta-analysis revealed that training significantly improved balance (g = 0.66, P < 0.001), quality of life (g = 0.28, P = 0.015), activities of daily living (g = 0.62, P < 0.001), and depressive symptoms (g = 0.67, P = 0.021) compared to the control group. Subgroup analysis indicated that training should utilize video game consoles. Meta-regression analyses showed that age, sessions, and frequency of training had statistically significant impacts on balance scores. Quality of individual trials was high and overall evidence ranged from very low to low. CONCLUSION: Virtual rehabilitation training could be adopted in healthcare institutions as supplementary training for patients with Parkinson's disease.

Li, W., et al. (2009). "The development of a home-based virtual reality therapy system to promote upper extremity movement for children with hemiplegic cerebral palsy." Technology and Disability 21(3): 107-113.
	Children with hemiplegic cerebral palsy (hemiplegia) have difficulty performing motor tasks with their hemiplegic upper extremity (UE). A virtual reality therapy home-based system (VRT-Home) using a Sony PlayStation 2 equipped with an 'EyeToy' video camera was adapted for children to practise hemiplegic hand and arm movements and the system's preliminary usability was evaluated. To use the VRT-Home, participants sit in a chair, hold down a button that occupies their non-hemiplegic side and keeps the system on, and perform movements with their hemiplegic UE to play fun, immersive, games in virtual environments. Supervised test sessions with five child participants found that the system successfully elicited targeted hand/arm movements of the hemiplegic UE, particularly reaching activities that involve the shoulder and elbow. A further home usability study with five participants showed, through usage logging and caregiver and child satisfaction surveys, that the intervention with the VRT-Home was an enjoyable way to practise hemiplegic arm movements at home.

Liao, W.-w., et al. (2018). "Kinect-based individualized upper extremity rehabilitation is effective and feasible for individuals with stroke using a transition from clinic to home protocol." Cogent Medicine 5(1).
	Purpose: To investigate the effectiveness and feasibility of Kinect-based upper extremity rehabilitation on functional performance in chronic stroke survivors. Methods: This was a single cohort pre-post test study. Participants (N = 10; mean age = 62.5 ± 9.06) engaged in Kinect-based training three times a week for four to five weeks in a university laboratory. To simulate a clinic to home transfer condition, individualized guidance was given to participants at the initial three sessions followed by independent usage. Outcomes included Fugl-Meyer assessment of upper extremity, Wolf Motor Function Test, Stroke Impact Scale, Confidence of Arm and Hand Movement and Active Range of Motion. Participant experience was assessed using a structured questionnaire and a semi-structured interview. Results. Improvement was found in Fugl-Meyer assessment scores (p = 0.001), Wolf Motor Function Test, (p = 0.008), Active Range of Motion (p < 0.05) and Stroke Impact Scale-Hand function (p = 0.016). Clinically important differences were found in Fugl-Meyer assessment scores (Δ = 5.70 ± 3.47) and Wolf Motor Function Test (Δ Time = −4.45 ± 6.02; ∆ Functional Ability Scores = 0.29 ± 0.31). All participants could use the system independently and recognized the importance of exercise individualization by the therapist. Conclusions. The Kinect-based UE rehabilitation provided clinically important functional improvements to our study participants.

Lima, J. L., et al. (2020). "Exergames for Children and Adolescents with Autism Spectrum Disorder: An Overview." Clin Pract Epidemiol Ment Health 16: 1-6.
	Autistic Spectrum Disorder (ASD) is a complex neurodevelopmental disorder associated with various etiologies and characterized by deficits in social interaction, emotional reciprocity, communication, motor skills and cognitive functions. Studies have proposed that limited levels of physical activity and late motor skills and fitness, particularly in children and adolescents with ASD, may accentuate social and emotional deficits. In view of this, exergames, which are active video-games, can be considered a low-cost and safe type of exercise for children and adolescents with ASD, since they are more enjoyable than ordinary physical activities, influencing on treatment adherence. Thus, our study aims to evidence the effects of exergames on physical fitness, cognitive functions, and repetitive behaviors in children and adolescents with ASD. Despite the small number of studies investigating the effects of exergames as new strategy in children and adolescents with ASD, results suggest exergames as potential tool for the treatment of children and adolescents with ASD for improvement in physical fitness, cognitive functions and repetitive behavior. Our review pointed towards the importance of exergames for children and adolescents with ASD. Despite few studies conducted about this issue, we can consider exergames a potential tool to increase physical fitness, cognitive functions and to decrease repetitive behavior in children and adolescents with ASD. Moreover, health professionals should be careful when attempting to help this population, because the current literature is unclear yet about the improvement of ASD features through exergames.

Limb, M. (2004). "All part of the game." Physiotherapy Frontline 10(4): 21-23.
	Leeds United's footballers are benefiting from a specialist physiotherapy team committed to putting the science into sport, writes Matthew Limb.

Limb, M. (2010). "Up and running, cycling and swimming." Frontline (20454910) 16(14): 18-19.
	A tailored physio programme has helped Britain's world triathlon champion back to the top of his game following injury.

Lin, C. Y., et al. (2015). "Development of a novel haptic glove for improving finger dexterity in poststroke rehabilitation." Technol Health Care 24 Suppl 1: S97-103.
	Almost all stroke patients experience a certain degree of fine motor impairment, and impeded finger movement may limit activities in daily life. Thus, to improve the quality of life of stroke patients, designing an efficient training device for fine motor rehabilitation is crucial. This study aimed to develop a novel fine motor training glove that integrates a virtual-reality based interactive environment with vibrotactile feedback for more effective post stroke hand rehabilitation. The proposed haptic rehabilitation device is equipped with small DC vibration motors for vibrotactile feedback stimulation and piezoresistive thin-film force sensors for motor function evaluation. Two virtual-reality based games ``gopher hitting'' and ``musical note hitting'' were developed as a haptic interface. According to the designed rehabilitation program, patients intuitively push and practice their fingers to improve the finger isolation function. Preliminary tests were conducted to assess the feasibility of the developed haptic rehabilitation system and to identify design concerns regarding the practical use in future clinical testing.

Lin, H. T., et al. (2022). "Benefits of applying virtual reality in pelvic movement training through a Wii Fit: a randomized controlled trial." BMC Medical Education 22(1): 47.
	BACKGROUND: Pelvic movement training has become compulsory for part of medical students. An increasing amount of research has focused on the influence of virtual reality (VR) on learning effectiveness. However, its application to pelvic floor muscles or pelvic movement training is still in its infancy. We compared the effectiveness of conventional pelvic movement training with or without VR-assisted pelvic movement training for student learning. METHODS: We recruited 44 university students (16 male and 28 female participants; average age = 19.7 +/- 0.31 years) who had not previously received pelvic movement education or training. The participants were randomly assigned into traditional and experimental groups to acquire pelvic movements and relevant knowledge. The traditional group received conventional classes (about 15 min), whereas the experimental group received both conventional classes and VR-assisted teaching (additional VR session took approximately 25-45 min depending on the speed of movement of each participant). The participants were asked to control the trajectory of the centre of pressure on the Wii Fit balance board and build-in games to learn pelvic movements. We conducted evaluations before, immediately after, and 2 weeks after the experiment, based on the scores of written and practical examinations. The experimental group was also asked to complete a questionnaire during the posttest. RESULTS: We carried out two-way repeated measures ANOVA and discovered that the written examination scores indicated a significant Time x Group interaction (p=0.015). In each group, the written and practical examinations in the posttest and follow-up test exhibited significantly improved results compared with the baseline value (p <0.001, except for traditional group of written exam in follow up test vs. baseline p=0.001). The written examination in the follow-up test did not decline significantly compared with those in the posttest, but the practical examination in the follow-up test was decline significantly compared with those in the posttest (p=0.033). The experimental group had superior overall performance in the practical examinations than the traditional group (experimental group: mean = 76.27, 95% confidence level [CI] = 70.84-81.71; traditional group: mean = 64.21, 95% CI = 58.78-69.65). No significant difference in the written examination between two groups. The percentage for agreement ratio on the usefulness, ease of use, users' intention to continue using the VR-assisted teaching is high (95.5-100%). CONCLUSIONS: The results of this study suggested that conventional and conventional + VR teaching were both effective. However, the incorporation of VR stimulated learning motivation and facilitated precise performance of pelvic movements. It is recommended that pelvic floor muscles training could be supplemented with VR or games to increase students' motivation and understanding how to perform pelvic movements.

Lindop, F. (2011). "Helping a person with Parkinson's to move." Nursing & Residential Care 13(10): 484-486.
	Parkinson's can cause difficulties with walking, transferring, balance and posture, all of which can be frustrating and potentially cause falls. Fiona Lindop explains some strategies you can implement to help.

Lindsay, A., et al. (2015). "Changes in acute biochemical markers of inflammatory and structural stress in rugby union." Journal of Sports Sciences 33(9): 882-891.
	Rugby union is a sport governed by the impacts of high force and high frequency. Analysis of physiological markers following a game can provide an understanding of the physiological response of an individual and the time course changes in response to recovery. Urine and saliva were collected from 11 elite amateur rugby players 24 h before, immediately after, and at 17, 25, 38, 62 and 86 h post-game. Myoglobin, salivary immunoglobulin A and cortisol were analysed by ELISA, whereas neopterin and total neopterin were analysed by high-performance liquid chromatography. There was a significant post-game increase of all four markers. The increases were cortisol 4-fold, myoglobin 2.85-fold, neopterin 1.75-fold and total neopterin 2.3-fold when corrected with specific gravity. All significant changes occurred post-game only, with markers returning to and remaining at baseline within 17 h. The intensity of the game caused significant changes in key physiological markers of stress. They provide an understanding of the stress experienced during a single game of rugby and the time course changes associated with player recovery. Neopterin provides a new marker of detecting an acute inflammatory response in physical exercise, while specific gravity should be considered for urine volume correction post-exercise.

Ling, Y., et al. (2017). "Usability Test of Exercise Games Designed for Rehabilitation of Elderly Patients After Hip Replacement Surgery: Pilot Study." JMIR Serious Games 5(4): e19.
	BACKGROUND: Patients who receive rehabilitation after hip replacement surgery are shown to have increased muscle strength and better functional performance. However, traditional physiotherapy is often tedious and leads to poor adherence. Exercise games, provide ways for increasing the engagement of elderly patients and increase the uptake of rehabilitation exercises. OBJECTIVE: The objective of this study was to evaluate Fietsgame (Dutch for cycling game), which translates existing rehabilitation exercises into fun exercise games. The system connects exercise games with a patient's personal record and a therapist interface by an Internet of Things server. Thus, both the patient and physiotherapist can monitor the patient's medical status. METHODS: This paper describes a pilot study that evaluates the usability of the Fietsgame. The study was conducted in a rehabilitation center with 9 participants, including 2 physiotherapists and 7 patients. The patients were asked to play 6 exercise games, each lasting about 5 min, under the guidance of a physiotherapist. The mean age of the patients was 74.57 years (standard deviation [SD] 8.28); all the patients were in the recovery process after hip surgery. Surveys were developed to quantitatively measure the usability factors, including presence, enjoyment, pain, exertion, and technology acceptance. Comments on advantages and suggested improvements of our game system provided by the physiotherapists and patients were summarized and their implications were discussed. RESULTS: The results showed that after successfully playing the games, 75% to 100% of the patients experienced high levels of enjoyment in all the games except the squats game. Patients reported the highest level of exertion in squats when compared with other exercise games. Lunges resulted in the highest dropout rate (43%) due to interference with the Kinect v2 from support chairs. All the patients (100%) found the game system useful and easy to use, felt that it would be a useful tool in their further rehabilitation, and expressed that they would like to use the game in the future. The therapists indicated that the exercise games highly meet the criteria of motor rehabilitation, and they intend to continue using the game as part of their rehabilitation treatment of patients. Comments from the patients and physiotherapists suggest that real-time corrective feedback when patients perform the exercises wrongly and a more personalized user interface with options for increasing or decreasing cognitive load are needed. CONCLUSIONS: The results suggest that Fietsgame can be used as an alternative tool to traditional motor rehabilitation for patients with hip surgery. Lunges and squats are found to be more beneficial for patients who have relatively better balance skills. A follow-up randomized controlled study will be conducted to test the effectiveness of the Fietsgame to investigate how motivating it is over a longer period of time.

Lipert, A., et al. (2021). "Frequency and Characteristics of Injuries and Rehabilitation Procedures in Rugby Players in Poland and France." International Journal of Environmental Research & Public Health [Electronic Resource] 18(9): 30.
	Objectives: Rugby is sport with a high risk of injury. Repeated changes in exercise intensity and the high training intensity may cause to overuse injuries and long-term disability. The aim of the study was to analyze the prevalence of injuries during trainings and forms of rehabilitation procedures performed after their occurrence among elite and sub-elite rugby players. Methods: The data was obtained from 60 professional rugby males from France and Poland. Data were collected using paper-based recording form. It was a specially designed questionnaire which concerned specific details of the injury, including body location, type of injury, treatment and number of days off lost from playing rugby and on forms of rehabilitation procedures performed after their occurrence among elite and sub-elite rugby players. Results: During the study period, the overall incidence rate for injury suggested a 1.04 times more often injury occurrence (IRR = 1.04, 95% CI: 0.08; 2.00) among Polish players compared with French players; however, the distribution of injuries varied by country. The training injury incidence (TII) and incidence proportion (IP) were also higher in Poland than in France (p < 0.05) with the sprain as the most frequent type of injury in all rugby players. France was 7.8 times (IRR = 7.88, 95% CI: 1.29; 3.21) more likely to sustain a fracture than Poland, which much often experienced less serious injuries (bruise, rapture of muscle and ligament) (IRR = 3.02, 95% CI: 2.06; 3.98). Polish players were provided with various forms of physiotherapy while Franch players often worked with a physiotherapist with a therapeutic method (p < 0.005). Poland and France reported experiencing side effects after an injury and the most frequent was pain. In their opinions, the reasons influencing the effectiveness of rehabilitation are too quick return to the game and too short time of rehabilitation. Conclusions: The competitive level of the rugby player influences not only the frequency and type of injury occurrence, but also access to the different forms of rehabilitation. Nonetheless, the side effects occurring after injury and the causes of ineffective rehabilitation are still similar. Further studies are needed to gather significant data to accurately formulate future injury prevention protocols or recommend modifications to game laws or competition formats, aiming at players' welfare.

Litterini, A. (2003). "In the game. Fighting back: prescribing exercise programs for athletes with cancer." Advance for Directors in Rehabilitation 12(3): 27-29.
	
Liu, H., et al. (2022). "Effect of Wii Fit Exercise With Balance and Lower Limb Muscle Strength in Older Adults: A Meta-Analysis." Frontiers in Medicine 9: 812570.
	Background: Falls and fall-related injuries are not uncommon among older adults and may lead to serious health deterioration and decreased quality of life. Numerous types of physical activity have been proposed to improve balance and strength in older adults with varying degrees of success. Nintendo's Wii Fit video exergame uses body movement as a game controller and provides real-time feedback for games designed to enhance balance and muscle strength. However, whether Wii Fit exercise improves the balance and lower limb muscle strength of older adults remains uncertain. Objective: To evaluate the current literature by using meta-analyses to assess whether Wii Fit exercise is associated with improved balance and lower limb muscle strength in older adults. Methods: We searched PubMed, EMBASE, Web of Science, China National Knowledge Infrastructure, and Wanfang Data from inception to February 16, 2022, for relevant studies and conducted a manual search of the literature. Data extraction of the included studies were independently performed by two authors. The methodologic quality of each included study was assessed using the Physical Therapy Evidence Database (PEDro) scale. Meta-analyses were conducted using Review Manager 5.3. Results: Of 991 articles initially identified, 10 articles (379 participants; aged >/=65 years, range 65-92 years; 188 participants in Wii Fit exercise groups, and 191 participants in control groups), including 8 randomized controlled trials, were assessed in this meta-analysis. The methodologic quality of the included studies evaluated with the PEDro average score was 6.4 and ranged from 5 to 8 points, indicating moderate quality. Compared with no exercise, Wii Fit exercise was associated with significant improved scores on the Berg Balance Scale, which evaluates functional balance (mean difference, 1.38; 95% CI, 0.61-2.16; I (2) = 31%; P = 0.0005) and on the Timed Up and Go test, which evaluates static and dynamic balance (standardized mean difference, -0.51; 95% CI,-0.88 to -0.14; I (2) = 52%; P = 0.007). However, for the three studies assessed, Wii Fit exercise did not significantly improve scores on the 30-s chair stand test, which evaluates the functional strength and endurance of the lower limb muscles (mean difference, 0.82; 95% CI, -0.14 to 1.77; z = 1.68; P = 0.09). Conclusions: Our findings indicated that Wii Fit exercise is an effective approach to improve functional, static, and dynamic balance among older adults. Additional meta-analyzes with higher numbers of randomized controlled trials are suggested to confirm the benefits of Wii Fit exercise on balance in older adults, to establish whether functional strength and endurance of lower limb muscles are improved, and to explore the relationship between improved balance and fall prevention in this population.

Liu, Z. M., et al. (2022). "Usability and Effects of a Combined Physical and Cognitive Intervention Based on Active Video Games for Preschool Children." International Journal of Environmental Research & Public Health [Electronic Resource] 19(12): 7420.
	Executive functions (EFs) are essential for early childhood development, and effective programs to improve EFs in preschool education are becoming increasingly crucial. There is rising evidence that combined physical-cognitive intervention training utilizing active video games (exergames) could be a viable strategy to improve EFs. However, there is a shortage of empirical evidence on the application of this approach in preschool education. The effectiveness of exergame intervention training in preschools must be evaluated. This study conducted a randomized controlled trial to assess the effects of exergames intervention training on preschool children's EFs. A total of 48 participants aged 4-5 years were enrolled; 24 were randomly allocated to receive exergames physical activity training, and the remaining 24 received conventional physical activity training. After a four-week intervention, the children who received the exergames intervention training exhibited considerably greater gains in all three EFs tasks than children who received the conventional physical activity program. Follow-up interviews revealed that the children accepted the exergames well. The results demonstrate the viability of incorporating exergames into preschool education to improve children's EFs, supporting prior findings and offering more empirical evidence from early childhood research.

LJ, D. S., et al. (2022). "Use of Stakeholder Feedback to Develop an App for Vestibular Rehabilitation-Input From Clinicians and Healthy Older Adults." Frontiers in neurology [electronic resource]. 13: 836571.
	Close to half people over 60 years of age experience vestibular dysfunction. Although vestibular rehabilitation has been proven effective in reducing dizziness and falls in older adults, adherence to exercise programs is a major issue and reported to be below 50%. Therefore, this research aimed to develop an app with gaming elements to improve adherence to exercises that are part of vestibular rehabilitation, and to provide feedback to increase the accuracy during exercise performance. A clinician-informed design was used where five physical therapists were asked identical questions about the exercises they would like to see in the app, including their duration and frequency. Games were developed to train the vestibulo-ocular (VOR) reflex using VOR and gaze shifting exercises; and to train the vestibulo-spinal system using weight shifting and balance exercises. The games were designed to progress from simple to more complex visuals. The games were controlled by an Inertial Measurement Unit placed on the head or anterior waist. The app was tested on ten healthy females (69.1 +/- 5.1 years) with no prior history of vestibular dysfunction or complaints of dizziness. Participants completed gaze stabilization and balance exercises using the app and provided feedback on the user interface, ease of use, usefulness and enjoyment using standardized questionnaires and changes they would like to see in the form of open-ended questions. In general, participants reported that they found the app easy to use, the user interface was friendly, and they enjoyed playing the games due to the graphics and colors. They reported that the feedback provided during the exercise session helped them recognize their mistakes and motivated them to do better. However, some elements of the app were frustrating due to incomplete instructions and inability to distinguish game objects due to insufficient contrast. Feedback received will be implemented in a revised version which will be trialed in older adults with dizziness due to vestibular hypofunction. We have demonstrated that the "Vestibular App(TM)" created for rehabilitation with gaming elements was found to be enjoyable, useful, and easy to use by healthy older adults. In the long term, the app may increase adherence to vestibular rehabilitation.

Lohse, K., et al. (2013). "Video games and rehabilitation: using design principles to enhance engagement in physical therapy." Journal of Neurologic Physical Therapy 37(4): 166-175.
	Patient nonadherence with therapy is a major barrier to rehabilitation. Recovery is often limited and requires prolonged, intensive rehabilitation that is time-consuming, expensive, and difficult. We review evidence for the potential use of video games in rehabilitation with respect to the behavioral, physiological, and motivational effects of gameplay. In this Special Interest article, we offer a method to evaluate effects of video game play on motor learning and their potential to increase patient engagement with therapy, particularly commercial games that can be interfaced with adapted control systems. We take the novel approach of integrating research across game design, motor learning, neurophysiology changes, and rehabilitation science to provide criteria by which therapists can assist patients in choosing games appropriate for rehabilitation. Research suggests that video games are beneficial for cognitive and motor skill learning in both rehabilitation science and experimental studies with healthy subjects. Physiological data suggest that gameplay can induce neuroplastic reorganization that leads to long-term retention and transfer of skill; however, more clinical research in this area is needed. There is interdisciplinary evidence suggesting that key factors in game design, including choice, reward, and goals, lead to increased motivation and engagement. We maintain that video game play could be an effective supplement to traditional therapy. Motion controllers can be used to practice rehabilitation-relevant movements, and well-designed game mechanics can augment patient engagement and motivation in rehabilitation. We recommend future research and development exploring rehabilitation-relevant motions to control games and increase time in therapy through gameplay.Video Abstract available (see Video, Supplemental Digital Content 1, http://links.lww.com/JNPT/A61) for more insights from the authors.

Lohse, K. R., et al. (2014). "Virtual reality therapy for adults post-stroke: a systematic review and meta-analysis exploring virtual environments and commercial games in therapy." PLoS ONE [Electronic Resource] 9(3): e93318.
	BACKGROUND: The objective of this analysis was to systematically review the evidence for virtual reality (VR) therapy in an adult post-stroke population in both custom built virtual environments (VE) and commercially available gaming systems (CG). METHODS: MEDLINE, CINAHL, EMBASE, ERIC, PSYCInfo, DARE, PEDro, Cochrane Central Register of Controlled Trials, and Cochrane Database of Systematic Reviews were systematically searched from the earliest available date until April 4, 2013. Controlled trials that compared VR to conventional therapy were included. Population criteria included adults (>18) post-stroke, excluding children, cerebral palsy, and other neurological disorders. Included studies were reported in English. Quality of studies was assessed with the Physiotherapy Evidence Database Scale (PEDro). RESULTS: Twenty-six studies met the inclusion criteria. For body function outcomes, there was a significant benefit of VR therapy compared to conventional therapy controls, G = 0.48, 95% CI = [0.27, 0.70], and no significant difference between VE and CG interventions (P = 0.38). For activity outcomes, there was a significant benefit of VR therapy, G = 0.58, 95% CI = [0.32, 0.85], and no significant difference between VE and CG interventions (P = 0.66). For participation outcomes, the overall effect size was G = 0.56, 95% CI = [0.02, 1.10]. All participation outcomes came from VE studies. DISCUSSION: VR rehabilitation moderately improves outcomes compared to conventional therapy in adults post-stroke. Current CG interventions have been too few and too small to assess potential benefits of CG. Future research in this area should aim to clearly define conventional therapy, report on participation measures, consider motivational components of therapy, and investigate commercially available systems in larger RCTs. TRIAL REGISTRATION: Prospero CRD42013004338.

Lopes, A., et al. (2008). "Brazilian physiotherapy services in the 2007 Pan-American Games." British Journal of Sports Medicine 42(6): 531-531.
	
Lopes, A. D., et al. (2009). "Brazilian physiotherapy services in the 2007 Pan-American Games: Injuries, their anatomical location and physiotherapeutic procedures." Physical Therapy in Sport 10(2): 67‐70.
	
Lopes, J. B. P., et al. (2020). "Effect of Transcranial Direct Current Stimulation Combined With Xbox-Kinect Game Experience on Upper Limb Movement in Down Syndrome: A Case Report." Front Bioeng Biotechnol 8: 514.
	Transcranial direct current stimulation (tDCS) is a non-invasive brain stimulation technique used to enhance local synaptic efficacy and modulate the electrical activity of the cortex in neurological disorders. Researchers have sought to combine this type of stimulation with well-established therapeutic modalities, such as motor training involving Xbox Kinect games, which has demonstrated promising results. Thus, this study aimed to determine whether tDCS can enhance upper limb motor training in an eight-year-old child with Down Syndrome (DS) (cognitive age: five years, based on the Wechsler Intelligence Scale for Children). The evaluations consisted of three-dimensional analysis of upper limb kinematics during a reaching task performed before, after10 session, and one month after the intervention. The intervention protocol involved 1 20-min sessions of tDCS over the primary motor cortex at an intensity of 1 mA during Xbox Kinect game training involving an upper limb motor task. The analysis of the kinematic data revealed that in the pre-intervention evaluation, the dominant limb executed the task slowly and over a long path. These aspects improved at the post-intervention and follow-up evaluations, as demonstrated by the shorter total movement duration (3.05 vs. 1.58 vs. 1.52 s, respectively). Similar changes occurred with the non-dominant upper limb; a significant increase in movement velocity at the post-intervention and follow-up evaluations was observed (0.53 vs. 0.54 vs. 0.85 m/s, respectively). The present case report offers preliminary data from a protocol study, and the results confirm the notion that anodal tDCS combined with upper limb motor training leads to improvements in different kinematic variables.

Lopez, S. A. (2016). "Restoring function in children with Steven-Johnson Syndrome/ Toxic Epidermal Necrolysis Overlap Syndrome: Traditional therapeutic exercise versus traditional therapeutic exercise and video game therapy." Restoring Function in Children with Steven-Johnson Syndrome/ Toxic Epidermal Necrolysis Overlap Syndrome: Traditional Therapeutic Exercise Versus Traditional Therapeutic Exercise & Video Game Therapy: 1-1.
	A literature search was performed to determine if traditional therapeutic exercise alone was more effective than traditional therapeutic exercise and video game therapy (VGT) for restoring function in children with Steven-Johnson Syndrome/Toxic Epidermal Necrolysis (SJS/TEN) Overlap Syndrome. The searches began March 2016 using the databases: PubMed, Goggle Scholar, Physiotherapy Evidence Database (PEDro) and the Cumulative Index of Nursing and Allied Health Literature (CINAHL). From the articles retrieved, five were considered for further review. Two articles favored standard physical therapy, while three benefited from both interventions together. Overall, it was concluded that therapeutic exercises alone or with VGT were equally effective interventions. The most useful information collected provided implication that VGT aids to reduce pain experience and anxiety. This is helpful because physical therapists can incorporate VGT into their practice to increase patient compliance and motivation, while providing a holistic approach to address pain. Further research, is needed to examine how frequency, intensity, mode and duration of conventional physical therapy and VGT treatment influence the rate of recovery of patients with SJS/TEN (Toma & Brown, 2012).

Lopez-Liria, R., et al. (2022). "Effectiveness of Video Games as Physical Treatment in Patients with Cystic Fibrosis: Systematic Review." Sensors 22(5): 28.
	Physical training at home by making individuals play active video games is a new therapeutic strategy to improve the condition of patients with cystic fibrosis (CF). We reviewed studies on the use of video games and their benefits in the treatment of CF. We conducted a systematic review with data from six databases (PubMed, Medline, Scopus, Web of Science, PEDro, and Cochrane library plus) since 2010, according to PRISMA standards. The descriptors were: "Cystic Fibrosis", "Video Game", "Gaming Console", "Pulmonary Rehabilitation", "Physiotherapy", and "Physical Therapy". Nine articles with 320 participants met the inclusion criteria and the study objective. Patients who played active video games showed a high intensity of exercise and higher ventilatory and aerobic capacity compared to the values of these parameters in tests such as the cardiopulmonary stress test or the six-minute walk test. Adequate values of metabolic demand in these patients were recorded after playing certain video games. A high level of treatment adherence and satisfaction was observed in both children and adults. Although the quality of the included studies was moderate, the evidence to confirm these results was insufficient. More robust studies are needed, including those on evaluation and health economics, to determine the effectiveness of the treatment.

Lopez-Sosa, C., et al. (2019). "Female sexual dysfunction associated with idiopathic cerebellar ataxia: A case report." BMC Womens Health 19(1): 133.
	BACKGROUND: Cerebellar ataxia affects individuals in reproductive age. To date, few clinical cases of cerebellar ataxia and involvement of the cerebellum in sexual response were reported. We report a case of a woman that need to restore skills related for execution of sexual activity and coordination of movements during sexual intercourse. CASE PRESENTATION: We present a case of idiopathic cerebellar ataxia in a 25-year-old woman who was referred for sexual health consultation. The patient complained of sexual problems as follows: "I forgot the behaviors that I should adopt in a sexual encounter, and I know what to do only after paying attention to my movements." The history of sexual behavior indicated that this patient presented a "romantic love" model. The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) reports that this condition involves anorgasmia disorder and female sexual arousal disorder. In addition, there was a loss of automatism and coordination of movements in the pelvis and lower extremities. The patient's condition improved with occupational and physical therapy combined with rehabilitation therapy based on cognitive behavioral criteria for sexual therapy. CONCLUSIONS: The case evolved from the romantic-affective model to a realistic model. The patient reported being comfortable during sexual intercourse and could explain her sexual needs to her partner. She managed to coordinate lower limb and pelvic movements, but did not reach an orgasm. Moreover, vaginal lubrication occurred with a time lag of 15-30 min after the end of sexual intercourse or masturbation.

Loria, K. (2010). "Net gains. Physical therapists help soccer players--both amateur and professional--stay at the top of their game." PT in Motion 2(5): 30-39.
	
Loria, K. (2014). "Game On." PT in Motion 6(7): 16-21.
	The article focuses on the benefits of using the video game "Kinect Adventures!" for the Xbox 360 patients rehabilitation. Topics discussed include the game permits the patient to compete against an opponent, gamification means using elements and design concepts from games to other circumstances or applications, and a study of physical therapy (PT) Sheryll Flynn on the use of gaming platforms for stroke victims.

Loria, K. (2014). "Net Gains." PT in Motion 6(3): 22-27.
	The article focuses on experiences of physical therapists (PTs) with contracts with National Basketball Association teams. Topics discussed include arrangements of PTs with the team's athletic trainer and physician, rehabilitation trainings to get injured players back to the game, and performance trainings, citing PTs including Megan Rowlands of Keystone Physical Therapy, Chris Powers of Movement Performance Institute and Jeff Stone at Athletico Physical Therapy. INSETS: Double-Teaming Injuries;Similarities and Differences.

Loria, K. (2020). "Aiding the Olympic Dream." APTA Magazine 12(6): 42-51.
	The article discusses the key role played by physical therapists (PT) in preparing U.S. athletes for the 2021 Olympic Games. Also cited are the experience of saber fencer Daryl Homer in recovering from his ankle injury with the help of physical therapist (PT) Scott A. Weiss of Arista Physical Therapy & Wellness, as well as several PTs who help train athletes like Blake Butler, Arnold Bell, and Theodore "Ted" Corbitt.

Loria, K. (2022). "Serving Up Physical Therapy for Pickleball Players." APTA Magazine 14(6): 38-49.
	The article discusses the role of physical therapy in helping pickleball players maintain and regain their physical strength during the game. Topics mentioned include some misconceptions about pickleball, the risk that amateur players can get while playing the game, the common injuries of pickleball players, the importance of integrating strength and power training, and some safety precautions for seniors.

Loureiro, A. P. C., et al. (2018). "European Stroke Conference. 27th Conference, Athens, Greece, April 11-13, 2018." Cerebrovasc Dis 45 Suppl 1(Supplement 1): I-II.
	Click here for the free "http://misc.karger.com/websites/CED_2018_045_S1/index.html" Abstract E-Book

Loureiro, R. C., et al. (2011). "Advances in upper limb stroke rehabilitation: a technology push." Med Biol Eng Comput 49(10): 1103-1118.
	Strokes affect thousands of people worldwide leaving sufferers with severe disabilities affecting their daily activities. In recent years, new rehabilitation techniques have emerged such as constraint-induced therapy, biofeedback therapy and robot-aided therapy. In particular, robotic techniques allow precise recording of movements and application of forces to the affected limb, making it a valuable tool for motor rehabilitation. In addition, robot-aided therapy can utilise visual cues conveyed on a computer screen to convert repetitive movement practice into an engaging task such as a game. Visual cues can also be used to control the information sent to the patient about exercise performance and to potentially address psychosomatic variables influencing therapy. This paper overviews the current state-of-the-art on upper limb robot-mediated therapy with a focal point on the technical requirements of robotic therapy devices leading to the development of upper limb rehabilitation techniques that facilitate reach-to-touch, fine motor control, whole-arm movements and promote rehabilitation beyond hospital stay. The reviewed literature suggest that while there is evidence supporting the use of this technology to reduce functional impairment, besides the technological push, the challenge ahead lies on provision of effective assessment of outcome and modalities that have a stronger impact transferring functional gains into functional independence.

Lowman, J. D., et al. (2020). "Gaming Console Home-Based Exercise for Adults with Cystic Fibrosis: Study Protocol." Int J Caring Sci 13(2): 1530-1540.
	BACKGROUND: Despite evidence of exercise benefits to lung function, adherence to routine exercise in adults with cystic fibrosis (CF) is low. The incorporation of interactive virtual reality video exergame activities in home-based programs as an incentive may help improve motivation and adherence to exercise. This proposed study will attempt to improve the physical fitness and respiratory function of sedentary adults with CF by engaging them in a Nintendo Wii Fit Plus home-based exercise program. METHODS: A single group pretest-posttest design will be used to examine the immediate (12-weeks) and long-term effect (24-weeks) of a home-based exergame program on improving pulmonary-related function (physical fitness and respiratory function) in sedentary adults with CF. Participants will receive a one-time orientation to the Wii Fit Plus, and will be requested to use it to exercise according to the recommended guidelines 3 times a week for 30 min in the following 24 weeks. Monthly phone monitoring will be conducted during the first 12 weeks. Besides evaluating the efficacy of a home-based exergame program on improving aerobic capacity, physical activity, and respiratory-related symptoms, we will examine the impact of the exergame on airway ion transport as measured by nasal potential difference, which will be collected at baseline and at the end of 12-weeks only. DISCUSSION: This is the first study to evaluate the feasibility, acceptability and potential effectiveness of a low-cost exercise avenue (i.e., exergames) for adults with CF to improve their pulmonary-related function, which is important for CF disease management and prevention of complications. In addition, the proposed study will be the first to investigate the therapeutic efficacy of home-based exergames on airway ion transport among adults with CF. Through an increase in physical activity, it is expected that participants will improve their physical fitness and respiratory function at the end of the study. TRIAL REGISTRATION: ClinicalTrials.gov ID: NCT02277860.

Lozano, E. I. and J. L. Potterton (2018). "The use of Xbox Kinect in a Paediatric Burns Unit." S Afr J Physiother 74(1): 429.
	BACKGROUND: The popularity of video game use in burns rehabilitation has grown because, in addition to facilitating maintenance of range of motion (ROM), the virtual imaging characteristics of these games provide distraction from pain. OBJECTIVES: The effect of using Xbox Kinect as an adjunct to physiotherapy in a Paediatric Burns Unit (PBU) has not been established. This study aimed to investigate the effect of using the Xbox Kinect on outcomes of children in the PBU at Chris Hani Baragwanath Academic Hospital. METHODS: This non-equivalent, post-test only control group study took place over a period of 14 months. The control group received standard physiotherapy management and the experimental group received standard physiotherapy management and additional Xbox Kinect. Outcome measures were ROM, Activities Scale for Kids (ASK(c)p) and a modified Wong-Baker FACES((R)) enjoyment rating scale. Outcomes were assessed at discharge and then 1 week post-discharge at the usual follow-up appointment. RESULTS: Sixty-six children participated in this study. More than 50% of the burns were because of hot water, followed by flame burns (30%) and electrical burns (12%). The addition of Xbox Kinect was effective in achieving higher active ROM (AROM) between discharge and follow-up (p < 0.01). Fun and enjoyment (p < 0.01) was found to be significantly higher in the children who participated in Xbox Kinect. Total body surface area (TBSA%) (p = 0.03), age (p = 0.05) and AROM (p = 0.04) were significantly associated with ASK(c)p scores. CONCLUSION: The use of the Xbox Kinect has been shown to be a beneficial and useful adjunct to burns rehabilitation in this paediatric burns population. CLINICAL IMPLICATIONS: Currently, there is limited information and research on interventions for children with burns in South Africa. The addition of Xbox Kinect to standard physiotherapy in-patient care was both enjoyable and effective and should be considered where funding is available.

Luna-Oliva, L., et al. (2013). "Kinect Xbox 360 as a therapeutic modality for children with cerebral palsy in a school environment: a preliminary study." Neurorehabilitation 33(4): 513-521.
	BACKGROUND: Limited evidence is available about the effectiveness of virtual reality using low cost commercial consoles for children with developmental delay. OBJECTIVE: The aim of this preliminary study is to evaluate the usefulness of a videogame system based on non-immersive virtual reality technology (Xbox 360 KinectTM) to support conventional rehabilitation treatment of children with cerebral palsy. Secondarily, to objectify changes in psychomotor status of children with cerebral palsy after receiving rehabilitation treatment in addition with this last generation game console. METHODS: 11 children with cerebral palsy were included the study. A baseline, a post-treatment and a follow-up assessment were performed related to motor and the process skills, balance, gait speed, running and jumping and fine and manual finger dexterity. All the participants completed 8 weeks of videogame treatment, added to their conventional physiotherapy treatment, with Xbox 360 Kinect (Microsoft) game console. RESULTS: The Friedman test showed significant differences among the three assessments for each variable: GMFM (p = 0.001), AMPS motor (p = 0.001), AMPS process (p = 0.010), PRT (p = 0.005) and 10 MW (p = 0.029). Wilcoxon test showed significant statistically differences pre and post-treatment, in all the values. Similarly, results revealed significant differences between basal and follow-up assessment. There were not statistical differences between post-treatment and follow-up evaluation, indicating a long-term maintenance of the improvements achieved after treatment. CONCLUSIONS: Low cost video games based on motion capture are potential tools in the rehabilitation context in children with CP. Our Kinect Xbox 360 protocol has showed improvements in balance and ADL in CP participants in a school environment, but further studies are need to validate the potential benefits of these video game systems as a supplement for rehabilitation of children with CP.

m5yhw, R. B. R. (2014). "The effect of video games and conventional physiotherapy in the physical fitness of elderly." https://trialsearch.who.int/Trial2.aspx?TrialID=RBR-4m5yhw.
	INTERVENTION: F04.754.137.506.662 The sample was intentionally composed of 30 elderly women aged 60 to 74 years , attending the active community centers in Teresina . Two groups , in which 15 volunteers underwent therapy with the Xbox 360 ( Kinect )( G1 ) , and 15 underwent functional training circuit(G2), were randomized both groups underwent 8 sessions , 2 times per week for 40 minutes. data collection consisted of interviews and the application of the Time Up and Go Test Stationary Marching 2 min and Berg Balance Scale tests, conducted at the beginning and after one month of intervention CONDITION: G11.427.685 G11.427.690 Physical Fitness. Balance Postural ; G11.427.685 ; G11.427.690 U00‐U99 PRIMARY OUTCOME: Improved static balance verified by the Berg Balance Scale , improved dynamic balance by Time Up And Go Test , and improvement in functional mobility by minute step test 2 minutes , from the observation of a variation of at least 95% confidence in the statistical significance test. SECONDARY OUTCOME: Improved physical fitness of elderly involved in the work , assessed with the Berg Scale and the Time Up and Go Test , and Gait stationary 2 minutes , with a statistical significance of p < 0.05 in post intervention. INCLUSION CRITERIA: Of age or over 60 years , a medical certificate with authorization for physical activity , participating constantly in the center of coexistence and accept volunteer study .

Ma, M., et al. (2018). "Validation of a Kinect V2 based rehabilitation game." PLoS ONE [Electronic Resource] 13(8): e0202338.
	Interactive technologies are beneficial to stroke recovery as rehabilitation interventions; however, they lack evidence for use as assessment tools. Mystic Isle is a multi-planar full-body rehabilitation game developed using the Microsoft Kinect(R) V2. It aims to help stroke patients improve their motor function and daily activity performance and to assess the motions of the players. It is important that the assessment results generated from Mystic Isle are accurate. The Kinect V2 has been validated for tracking lower limbs and calculating gait-specific parameters. However, few studies have validated the accuracy of the Kinect(R) V2 skeleton model in upper-body movements. In this paper, we evaluated the spatial accuracy and measurement validity of a Kinect-based game Mystic Isle in comparison to a gold-standard optical motion capture system, the Vicon system. Thirty participants completed six trials in sitting and standing. Game data from the Kinect sensor and the Vicon system were recorded simultaneously, then filtered and sample rate synchronized. The spatial accuracy was evaluated using Pearson's r correlation coefficient, signal to noise ratio (SNR) and 3D distance difference. Each arm-joint signal had an average correlation coefficient above 0.9 and a SNR above 5. The hip joints data had less stability and a large variation in SNR. Also, the mean 3D distance difference of joints were less than 10 centimeters. For measurement validity, the accuracy was evaluated using mean and standard error of the difference, percentage error, Pearson's r correlation coefficient and intra-class correlation (ICC). Average errors of maximum hand extent of reach were less than 5% and the average errors of mean and maximum velocities were about 10% and less than 5%, respectively. We have demonstrated that Mystic Isle provides accurate measurement and assessment of movement relative to the Vicon system.

MacDonald, J. A. and L. Gauthier (2015). "Treatment of Post-Stroke Hemispatial Neglect with 3D Gaming Therapy." Archives of physical medicine and rehabilitation 96(12): e6-e7.
	
Mace, M., et al. (2017). "Balancing the playing field: collaborative gaming for physical training." J Neuroeng Rehabil 14(1): 116.
	BACKGROUND: Multiplayer video games promoting exercise-based rehabilitation may facilitate motor learning, by increasing motivation through social interaction. However, a major design challenge is to enable meaningful inter-subject interaction, whilst allowing for significant skill differences between players. We present a novel motor-training paradigm that allows real-time collaboration and performance enhancement, across a wide range of inter-subject skill mismatches, including disabled vs. able-bodied partnerships. METHODS: A virtual task consisting of a dynamic ball on a beam, is controlled at each end using independent digital force-sensing handgrips. Interaction is mediated through simulated physical coupling and locally-redundant control. Game performance was measured in 16 healthy-healthy and 16 patient-expert dyads, where patients were hemiparetic stroke survivors using their impaired arm. Dual-player was compared to single-player performance, in terms of score, target tracking, stability, effort and smoothness; and questionnaires probing user-experience and engagement. RESULTS: Performance of less-able subjects (as ranked from single-player ability) was enhanced by dual-player mode, by an amount proportionate to the partnership's mismatch. The more abled partners' performances decreased by a similar amount. Such zero-sum interactions were observed for both healthy-healthy and patient-expert interactions. Dual-player was preferred by the majority of players independent of baseline ability and subject group; healthy subjects also felt more challenged, and patients more skilled. CONCLUSION: This is the first demonstration of implicit skill balancing in a truly collaborative virtual training task leading to heightened engagement, across both healthy subjects and stroke patients.

Macedo, C. S. G., et al. (2019). "Physical Therapy Service delivered in the Polyclinic During the Rio 2016 Paralympic Games." Physical Therapy in Sport 36: 62-67.
	OBJECTIVE: To characterize the Physical Therapy Services delivered at the Polyclinic during the Rio 2016 Paralympic Games. DESIGN: Retrospective Cohort Study. SETTING: Physical Therapy Services (PTS) of the Polyclinic. PARTICIPANTS: Athletes attended for Physical Therapy treatment at the Polyclinic during Rio 2016 Paralympic Games. MAIN OUTCOME MEASURES: The number of athletes treated, their nationalities, their sports modality, the most frequently treated regions and the interventions applied. RESULTS: A total of 4504 interventions were delivered and 399 athletes were treated in the PTS. Athletes representing athletics and sitting volleyball were the most frequently attended for treatment. The main diagnoses were muscle tension and tendinopathy. Analgesia was the main purpose of treatment and myofascial release and electrotherapy was the most frequent interventions. Recovery service had a total of 1579 encounters and male athletes used cryo-immersion 3 times more when compared to female. CONCLUSION: Athletes representing athletics and sitting volleyball were the most frequently attended for treatment and the thoracic/lumbar spine and pelvis/hip were the most commonly affected regions. Muscle strain and tendinopathy were the most frequent diagnoses and myofascial release and electrotherapy were the most frequent therapies used to achieve analgesia.

Maeder, A. J., et al. (2012). "Exergames for the elderly: Towards an embedded Kinect-based clinical test of falls risk." Studies in Health Technology & Informatics 178: 51-57.
	
Maixnerová, E., et al. (2017). "The effect of balance therapy on postural stability in a group of seniors using active video games (Nintendo wii)." Journal of Physical Education and Sport 17(02): 735-739.
	Impaired postural stability increases the risk of falls. Therefore, the aim of this study was to analyse the lasting effects of a training intervention using a Nintendo Wii system on impaired postural stability in an elderly population. Thirty-two elderly subjects (24 females and 4 males) from two independent living communities were divided into Wii Fit (n = 15, 9 therapy sessions using Wii Fit balance board) and control (n = 13) groups. All participants performed three different stances on force plates, which are considered the gold standard for measuring balance performance. Each stance was measured three times in the following sequence: a natural bipedal stance with eyes open, a bipedal stance with a narrow base, and a natural bipedal stance with eyes closed. One-way analysis of variance (ANOVA) and LSD Fisher's post hoc tests were used with the level of significance set at 5%. Effect size was determined using η2. The results showed a significant difference in the centre of pressure velocity in the anterior-posterior direction between the baseline and post-treatment measurements (post-intervention and follow up) for all measured conditions in Wii Fit Group. The control group did not show any significant differences between measurements. The results of this study suggest that using the Nintendo Wii is an effective physical activity for improving balance in the elderly and that the effects of balance therapy on postural stability persist for several weeks after intervention.

Maly, M. R. and S. M. Robbins (2014). "Osteoarthritis year in review 2014: rehabilitation and outcomes." Osteoarthritis Cartilage 22(12): 1958-1988.
	OBJECTIVE: To highlight research studies examining rehabilitation for hip and knee osteoarthritis (OA), as well as the outcome measures used to assess treatment efficacy, published in 2013. DESIGN: A systematic search was performed in Medline, CIHAHL and Embase databases from January to December 2013. The search was limited to 2013, human studies, and English. Rehabilitation intervention studies included were prospective controlled designs. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) system was used to evaluate the quality of evidence. First, individual articles were rated for quality. Second, articles were grouped based on outcome: OA disease markers, pain, physical function (self-reported, performance), and health. RESULTS: Of 503 titles reviewed, 36 studies were included. The outcome measures related to OA disease markers were organized into subthemes of anthropometrics, biomechanics and physiology. The quality of evidence was of moderate, high, and low quality for anthropometric, biomechanical and physiological measures respectively. These studies supported the use of diet for weight loss combined with exercise. Bodies of evidence that showed the efficacy of exercise and passive strategies (thermal/electrical modalities, traction, manual therapy) for reducing pain were of low and moderate quality respectively. The evidence supporting diet and exercise, physiotherapy, and passive strategies to improve physical function was of moderate quality. Evidence supporting exercise to improve psychological factors was of moderate quality. CONCLUSIONS: Exercise combined with diet for weight loss should be the mainstays of rehabilitation for people with knee and hip OA to provide benefit to OA disease markers, pain, physical function, and health.

Mamede, A., et al. (2021). "Combining Web-Based Gamification and Physical Nudges With an App (MoveMore) to Promote Walking Breaks and Reduce Sedentary Behavior of Office Workers: Field Study." Journal of Medical Internet Research 23(4): e19875.
	BACKGROUND: Sedentary behavior (SB) and lack of physical activity (PA) have been associated with poorer health outcomes and are increasingly prevalent in individuals working in sedentary occupations such as office jobs. Gamification and nudges have attracted attention as promising strategies to promote changes in health behavior. However, most effectiveness studies thus far lacked active controls, and few studies have tested interventions combining these strategies. OBJECTIVE: This study investigates the effectiveness of combining a gamified digital app with physical nudges to increase PA and reduce SB in Dutch office workers. METHODS: Employees in the municipality of Rotterdam (N=298) from two office locations were randomized at the location level to either a 10-week intervention, combining a 5-week gamification phase encompassing a gamified digital app with social support features and a 5-week physical nudges phase, or to an active control (ie, basic digital app with self-monitoring and goal setting). The primary outcome was the daily step count, objectively measured via accelerometers. Secondary outcomes were self-reported PA and SB measured at baseline and at 5, 10, and 14 weeks. Mixed effects models were used to analyze the effects of the intervention on the outcome measures. RESULTS: A total of 78.5% (234/298) of participants completed the study and provided accelerometer data, whereas 36.9% (110/298) participants completed the self-report measures at 14 weeks. In the gamification phase, step count data were missing for 13.5% (473/3492) of observations in the control and 11.4% (445/3888) in the intervention condition; however, these percentages increased to 39.6% (1154/2910) and 59.6% (1932/3492) at follow-up, respectively. During the gamification phase, intervention participants increased their number of daily steps by 634 (95% CI 154.2-1113.8; P=.01) more than participants in the control group, after controlling for relevant factors. Improvements were not sustained during the physical nudges phase (P=.76) or follow-up (P=.88). CONCLUSIONS: A digital intervention with gamification and social support features significantly increased the step count of office workers compared with an active control. Physical nudges in the workplace were insufficient to promote the maintenance of behavioral changes achieved in the gamification phase. Future research should explore the long-term effectiveness of similar gamified digital interventions. TRIAL REGISTRATION: International Standard Randomized Controlled Trial Number (ISRCTN) 49129401; https://www.isrctn.com/ISRCTN14881571.

Manlapaz, D., et al. (2011). "Research Report Abstracts." Physiotherapy 97: eS18-eS1415.
	Purpose: The objective of the study is to determine the effectiveness of Nintendo Wii in upper extremity recovery of patients with chronic stroke. Relevance: The use of Nintendo Wii seems to be evolving into a therapeutic tool as widespread reports claim that it is now being used benefiting patients in rehabilitation centers. However, lack of evidences and standard parameters as to its effectiveness. Participants: Sixteen adults with chronic stroke participated in the study. Participants were recruited through distribution of letters to hospitals and rehabilitation centers. Methods: Participants were divided into two groups; experimental and control group through random allocation sampling using the fishbowl method. Participants assigned in the experimental group underwent their prescribed PT programs and Nintendo Wii after the treatment twice a week for 6 weeks. Fugl Meyer (FMS), Motor Assessment Scale (MAS) and Fast Fourier Transform (FFT) analysis of Wii mote acceleration data were used as an outcome measure. Analysis: Homogeneity of the participants included in the study was considered to ascertain the same population. Descriptive data such as the mean of participants' age, months post stroke and laterality of the affected upper extremity were computed. Both interval/ratio‐scale demographic variables (age and months post‐stroke) were tested for normality using the Jarque‐Bera (JB) test which compares the kurtosis and skewness of the sample with that of a normal distribution. Mann‐Whitney U test for independent samples were conducted to determine if there is a significant difference between control and experimental group for both pre‐test and post‐test. Wilcoxon Signed Rank test was implemented to determine if there is a significant difference on pre‐test and post‐test for each group. Results: FMS scores showed significant difference between the control AND experimental groups with the latter yielding higher scores particularly in the flexor synergy component of FMS. MAS scores of UE function (pre‐tests of both groups = p‐value of 0.4295; post‐tests of both groups = p value of 0.1031; alpha = 0.05) of both groups did not reach the significant level, however, the experimental group showed relative improvement as compared to the control group. Preliminary results of FFT analysis showed pronounced magnitude of the dominant frequency and lesser number of residual frequencies in the experimental group compared to control group. Conclusions: The use of Nintendo Wii as a novel approach provided marked improvement in the UE function of chronic stroke patients demonstrated within a short timeframe (6 weeks). The gain in the motor function is highly attributed to the notion that repetitive used of affected limb along thereby enhancing cortical reorganization. Further studies should be conducted to attain a significant level. Implications: Preliminary findings provided a new ground for further investigations regarding the use of game console device as a form of VR intervention. Likewise, there is also a need to venture on its effectiveness not only in gross motor function but also in terms of its carry over in functional task activities.

Manlapaz, D. G., et al. (2021). "Ergonomic considerations in exergaming delivery in orthopedic and neurologic rehabilitation: a systematic review protocol." Physical Therapy Reviews 26(5): 386-390.
	The increasing popularity of exergaming (exercise and gaming) has already emerged in the rehabilitation setting to help individuals develop, maintain, and restore maximum body movement and physical function. However, there is a lack of attention to the risk of sustaining injuries associated with exergaming. While there are reports of potential harm or injuries for patients using this intervention, ergonomics has still not been given attention or consideration in the deliverance of exergaming during rehabilitation. The primary aim of this review is to identify the ergonomic considerations in the delivery of exergaming in rehabilitation. The secondary aim is to review the outcome measures used in the results of exergaming to patients with neurologic and orthopedic conditions from the literature gathered and appraised. The study will use a systematic review design to identify the ergonomic considerations and outcome measures in the delivery of exergaming and rehabilitation of neurologic and orthopedic patients by using only randomized controlled trial studies. Centre for Evidence-based Medicine of Oxford University will be used to appraise the reliability and validity of the chosen article and the Mendeley software, Rayyan QCRI application, and a spreadsheet software will be used in the inclusion, critical appraisal, and data gathering process to ensure objectivity. Preferred Reporting Items for Systematic Reviews (PRISMA) will be provided for visualization of the study acquisition and selection process. The extracted data will undergo analysis and will then determine the ergonomic considerations and outcome measures utilized in the studies reviewed.

Maraz, A., et al. (2015). "Why do you dance? Development of the Dance Motivation Inventory (DMI)." PLoS ONE [Electronic Resource] 10(3): e0122866.
	Dancing is a popular form of physical exercise and studies have show that dancing can decrease anxiety, increase self-esteem, and improve psychological wellbeing. The aim of the current study was to explore the motivational basis of recreational social dancing and develop a new psychometric instrument to assess dancing motivation. The sample comprised 447 salsa and/or ballroom dancers (68% female; mean age 32.8 years) who completed an online survey. Eight motivational factors were identified via exploratory factor analysis and comprise a new Dance Motivation Inventory: Fitness, Mood Enhancement, Intimacy, Socialising, Trance, Mastery, Self-confidence and Escapism. Mood Enhancement was the strongest motivational factor for both males and females, although motives differed according to gender. Dancing intensity was predicted by three motivational factors: Mood Enhancement, Socialising, and Escapism. The eight dimensions identified cover possible motives for social recreational dancing, and the DMI proved to be a suitable measurement tool to assess these motives. The explored motives such as Mood Enhancement, Socialising and Escapism appear to be similar to those identified in other forms of behaviour such as drinking alcohol, exercise, gambling, and gaming.

Marchese, V., et al. (2021). "Shoulder Pain - Football, A Traumatic Diagnosis." Medicine & Science in Sports & Exercise 53(8S): 430-430.
	HISTORY: A 17-year-old senior high school football running back sustained a left shoulder injury while being tackled. While carrying the football, he was driven into the ground with the weight of the opposing player landing on him and onto his left shoulder. He completed the remainder of the game and did not bring this injury to the attention of the medical staff until three days later. He endorsed moderate to severe pain over the center of his chest radiating laterally across the course of the pectoralis. He complained of shoulder stiffness and significant limitation in range of motion. He denied numbness, tingling, or loss of sensation. PHYSICAL EXAMINATION: Examination of the left shoulder revealed no obvious deformity of the shoulder or chest. There was significant tenderness to palpation of the SC joint, distal clavicle, and pectoralis musculature. The patient had limited active range of motion in all directions, however there was full passive motion. Strength testing was 5/5 in all directions. There were no signs of instability. The upper extremity was neurovascularly intact. DIFFERENTIAL DIAGNOSIS: 1. Sternoclavicular Separation 2. Medial Clavicle Fracture 3. Sternal Fracture 4. Pectoralis Strain TEST AND RESULTS: AP and oblique radiographs of the sternoclavicular joints - No evidence of fracture. Medial clavicles symmetric and in position with no findings to suggest dislocation. MRI of left sternoclavicular joint without intravenous contrast - Vertical nondisplaced fracture through the far left lateral sternal manubrium with associated marrow edema, Intact left sternoclavicular joint with surrounding soft tissue and capsular edema, Mild strain injury of the medial left pectoralis musculature. FINAL WORKING DIAGNOSIS: Nondisplaced Fracture of the Sternal Manubrium, SC sprain, Pectoralis strain TREATMENT AND OUTCOMES: 1. Complete rest from athletic activity for 2 weeks 2. Five pound lifting restriction 3. Physical therapy started at 4 weeks post injury 4. Anticipated return to sport 10 weeks post injury when there is full painless ROM, normal strength and athlete is able to meet the demands of his sport.

Marin-Pardo, O., et al. (2020). "A Virtual Reality Muscle-Computer Interface for Neurorehabilitation in Chronic Stroke: A Pilot Study." Sensors 20(13): 04.
	Severe impairment of limb movement after stroke can be challenging to address in the chronic stage of stroke (e.g., greater than 6 months post stroke). Recent evidence suggests that physical therapy can still promote meaningful recovery after this stage, but the required high amount of therapy is difficult to deliver within the scope of standard clinical practice. Digital gaming technologies are now being combined with brain-computer interfaces to motivate engaging and frequent exercise and promote neural recovery. However, the complexity and expense of acquiring brain signals has held back widespread utilization of these rehabilitation systems. Furthermore, for people that have residual muscle activity, electromyography (EMG) might be a simpler and equally effective alternative. In this pilot study, we evaluate the feasibility and efficacy of an EMG-based variant of our REINVENT virtual reality (VR) neurofeedback rehabilitation system to increase volitional muscle activity while reducing unintended co-contractions. We recruited four participants in the chronic stage of stroke recovery, all with severely restricted active wrist movement. They completed seven 1-hour training sessions during which our head-mounted VR system reinforced activation of the wrist extensor muscles without flexor activation. Before and after training, participants underwent a battery of clinical and neuromuscular assessments. We found that training improved scores on standardized clinical assessments, equivalent to those previously reported for brain-computer interfaces. Additionally, training may have induced changes in corticospinal communication, as indexed by an increase in 12-30 Hz corticomuscular coherence and by an improved ability to maintain a constant level of wrist muscle activity. Our data support the feasibility of using muscle-computer interfaces in severe chronic stroke, as well as their potential to promote functional recovery and trigger neural plasticity.

Marin-Pena, O., et al. (2021). "Non-surgical treatment as the first step to manage peritrochanteric space disorders." Knee Surgery, Sports Traumatology, Arthroscopy 29(8): 2417-2423.
	PURPOSE: Greater trochanter pain syndrome (GTPS) or lateral hip pain terms include external snapping hip, trochanteric bursitis and gluteus medius or minimus pathology. The aim of this review is to update the most recent knowledge about non-surgical management of peritrochanteric disorders. METHODS: A literature review was performed including articles most relevant in the last years that were focused in non-surgical treatment of peritrochanteric disorders. RESULTS: Conservative treatment still has a place and includes activity modification, NSAIDs, analgesics, physiotherapy, home training, local corticosteroid injection (CSI) and shock wave therapy (SWT). These non-surgical alternatives have demonstrated good clinical results with low rate of complications. CONCLUSION: Most patients tend to resolve GTPS or lateral hip pain with non-surgical management in the mid-term but when everything failed, surgical options should be evaluated. The next frontier that will be a game changer is to determine an individualized treatment plan based on the exact pathology. LEVEL OF EVIDENCE: V.

Marley, W. D., et al. (2022). "A multicenter randomized controlled trial comparing gamification with remote monitoring against standard rehabilitation for patients after arthroscopic shoulder surgery." Journal of Shoulder & Elbow Surgery 31(1): 8-16.
	BACKGROUND: Gamification has become increasingly popular in rehabilitation and is viewed as a tool to improve patient activation, motivation, and engagement. The aim of this study was to compare the efficacy of validated exergames played through a system using "depth sensor" and bespoke software against standard physiotherapy in patients treated with arthroscopic shoulder surgery. This included the following common conditions: subacromial impingement syndrome, calcific tendinopathy, and rotator cuff tear. METHODS: Following arthroscopic shoulder surgery, patients were randomized into 1 of 2 groups: In the standard rehabilitation group, patients were followed up for 12 weeks after surgery with standard postoperative physiotherapy and underwent electronic measurements of their active range of movement (ROM). In the exergame group, patients followed a postoperative regimen of exergames using the principles of gamification with physiotherapy support. Patients were given an exergame schedule prescribed by their therapist on Medical Interactive Recovery Assistant (MIRA) software (MIRA Rehab, London, UK) paired with a Microsoft Kinect sensor (Microsoft, Redmond, WA, USA). The primary outcome was active ROM objectively measured by MIRA and Kinect. Secondary outcome measures included the Oxford Shoulder Score, the Disabilities of the Arm, Shoulder and Hand score, and the EQ-VAS score at 12 weeks after surgery. RESULTS: A total of 71 patients were recruited to the study. We excluded 7 patients based on intraoperative findings. Thirty-three patients were treated with exergames, and 31 patients underwent conventional physiotherapy. There was no significant difference between the 2 groups in baseline ROM. Postoperatively, there was no significant difference in any of the cardinal planes of movement (forward flexion, P = .64; abduction, P = .33; and external rotation, P = .75). The mean Oxford Shoulder Score improved from 29.25 to 38.2 in the control group (P = .001) and from 27.1 to 35.1 in the trial group (P = .01); there was no significant difference between the groups at 12 weeks (P = .246). The mean Disabilities of the Arm, Shoulder and Hand score improved from 38.13 to 16.98 in the control group (P = .001) and from 42.3 to 22.54 in the trial group (P = .007); there was no significant difference between the 2 groups (P = .328). There was no significant difference in the EQ-VAS score in either group at any time point (P = .5866). CONCLUSION: This randomized controlled trial demonstrates that exergames can be used effectively in the rehabilitation of patients following arthroscopic shoulder surgery. Outcomes, judged by ROM and patient-reported outcome measures, are equivalent to conventional physiotherapy rehabilitation protocols. This health care innovation has the potential to relieve some of the heavy burden placed on physiotherapy departments for "routine" postoperative care in shoulder surgery.

Marques-Sule, E., et al. (2021). "Effectiveness of Nintendo Wii and Physical Therapy in Functionality, Balance, and Daily Activities in Chronic Stroke Patients." Journal of the American Medical Directors Association 22(5): 1073-1080.
	OBJECTIVES: The aim of this study was to assess whether a virtual rehabilitation program using Nintendo Wii added to conventional physical therapy improved functionality, balance, and daily activities in chronic stroke survivors, when compared with conventional physical therapy. DESIGN: We undertook a randomized controlled clinical trial. The participants of this study were randomized to 2 groups: (1) conventional physical therapy (CPTG), which included exercises related to functionality, balance, and activities of daily living; and (2) virtual reality with Nintendo Wii (VRWiiG), which included balance training with the Wii Balance Board and upper limb exercises with the Wii Sports package, added to conventional physical therapy. SETTING AND PARTICIPANTS: This study was conducted in a university rehabilitation clinic and 29 stroke survivors were admitted. METHODS: Both interventions lasted 4 weeks, 2 sessions per week. Assessments were performed at baseline and at the end of the study, including functionality [Timed up and go (TUG)], balance [Tinetti Performance-Oriented Mobility Assessment (POMA)], Berg Balance Scale (BBS), and activities of daily living [Fugl-Meyer Upper Limb Motor Assessment, Barthel Index, Frenchay Activity Index (FAI)]. RESULTS: Regarding TUG, POMA, and BBS, the analysis of variance showed significant differences for time and group *time interaction. Post hoc analysis showed between-group differences (P = .044, d = -0.78; P = .012, d = 1.00; P = .042, d = 0.79, respectively) and within-group differences only in the VRWiiG (P < .001, d = 0.75; P < .001, d = -0.76; P < .001, d = -0.57, respectively). Regarding activities of daily living, post hoc analysis showed within-group differences only in VRWiiG. CONCLUSIONS AND IMPLICATIONS: Our study showed promising results in functionality, balance, and activities of daily living when adding virtual reality with Nintendo Wii to conventional physical therapy in chronic stroke survivors. All procedures were approved by the Human Research Ethics Committee of the University of Valencia (H1518177391901). ClinicalTrials.gov database (NLM identifier NCT04144556).

Martinez-Millana, A., et al. (2022). "Motivating Physical Activity for Individuals with Intellectual Disability through Indoor Bike Cycling and Exergaming." International Journal of Environmental Research & Public Health [Electronic Resource] 19(5): 2914.
	People with intellectual disabilities have more sedentary lifestyles than the general population. Regular physical activity is of both medical and social importance, reducing the risk of cardiovascular disease and promoting functioning in everyday life. Exergames have been envisioned for promoting physical activity; however, most of them are not user-friendly for individuals with intellectual disabilities. In this paper, we report the design, development, and user acceptance of a mobile health solution connected to sensors to motivate physical activity. The system is mounted on an indoor stationary bicycle and an ergometer bike tailored for people with intellectual disabilities. The development process involved the application of user-centered design principles to customize the system for this group. The system was pilot-tested in an institutional house involving six end-users (intervention group) and demonstrated/self-tested to relatives of persons with ID and staff (supervision group). A System Usability Scale and open-ended interview in the supervision group were used to assess the user acceptance and perceived usefulness. Results indicate that the users with an intellectual disability enjoyed using the system, and that respondents believed it was a useful tool to promote physical activity for the users at the institution. The results of this study provide valuable information on beneficial technological interventions to promote regular physical activity for individuals with intellectual disabilities.

Martins, P. C., et al. (2020). "Cell integrity indicators assessed by bioelectrical impedance: A systematic review of studies involving athletes." J Bodyw Mov Ther 24(1): 154-164.
	INTRODUCTION: Bioelectrical impedance analysis (BIA) has been used to evaluate cellular health and integrity through bioelectrical indicators. In the sporting context, monitoring these indicators can be useful to assess the quality and vitality of cells and body tissues. OBJECTIVE: The aim of this systematic review was to investigate indicators of cellular health and integrity evaluated by BIA in athletes. METHODS: Searches were performed in December 2017 in the Lilacs, Medline, PubMed, Science Direct, Scielo, Scopus, SPORTDiscus, and Web of Science databases, following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. RESULTS: The searches retrieved 31 articles (30 involving professional athletes and one involving university athletes). In longitudinal studies (n=15), the bioelectrical parameters directly associated with cellular health and integrity were extracellular water (ECW), phase angle (PA), BIA vector analysis (BIVA), crude reactance data (Xc), resistance (R), and ECW/BCM ratio. Regarding the findings of cross-sectional studies (n=16), the investigated parameters (ECW, PA, BIVA, Z, BCM, and ECW/BCM) were directly associated with gender, age, sports performance level, modality, and game position. CONCLUSIONS: In the included studies, the cellular health and integrity indicators were: Z, Xc, R, total water, intracellular water, ECW, PA, BIVA, BCM, and ECW/BCM.

Martins, T., et al. (2015). "Web Platform for Serious Games’ Management." Procedia Computer Science 64: 1115-1123.
	An expected increase in the number of older people with mobility problems will bring more concerns to the health professionals. One way to help both, professionals and patients, can be found in the development of serious games oriented to motor rehabilitation in physical therapy sessions. Optimization of game management, collection and processing of information, which are the health professional responsibility, can be achieved with the integration of a Back Office system in the game. Therefore, this article aims to present a modular system of Back Office, for centralized management of one or more games targeted for physical therapy.

Martins, T., et al. (2020). "Physioland – A serious game for physical rehabilitation of patients with neurological diseases." Entertainment Computing 34: 100356.
	Objective Being aware that serious games can be an interesting and appealing tool, the objective of this paper is to present the Physioland, a serious game based on image processing techniques, developed to monitor the physical therapy practice of patients with reduced mobility as a consequence of neurological disease. Materials and Methods Several tests were performed in a clinical environment. The system stores every second the data relative to alignment, compensation and speed of the patient while he/she performs each exercise. The sample consisted of eleven elements aged from 17 years to 83 years, with neurological diseases in a mild or moderate state, with sequelae such as hemiparesis, paraparesis, hemidystonia, cerebellar syndrome and hemihyposthesia. Each patient used the game in twice a week in sessions of physical therapy, with the duration of about thirty minutes, for twelve to fifteen sessions. In each session, the patient performed several challenges, for two and a half minutes or five minutes each, according to his/her physiotherapeutic plan. Results All the patients suffered oscillations in their behavior, but with better or worse performances, higher or lower scores, they were able to successfully complete the different exercises provided by Physioland, which are part of their physiotherapeutic plans. Conclusion Based on the results obtained it can be said that it was possible to adapt specific exercises of traditional physical therapy to situations of electronic game, reason why Physioland fulfills the objective of monitoring the practice of physical therapy of patients with reduced mobility as a consequence of neurological disease.

Mason, B., et al. (2020). "The Use of Acute Exercise Interventions as Game Day Priming Strategies to Improve Physical Performance and Athlete Readiness in Team-Sport Athletes: A Systematic Review." Sports Medicine 50(11): 1943-1962.
	BACKGROUND: The use of exercise as a priming strategy to enhance sport performance is becoming increasingly popular in professional sports and as an area of research interest. Early research suggests that the acute physiological responses to exercise can positively influence performance for up to 48 h. There is yet to be a comprehensive review of exercise strategies which could be implemented specifically on the day of competition. OBJECTIVES: The aim of this systematic review was to provide a synthesis of research investigating acute exercise interventions as game day priming strategies for team-sport athletes to improve physical performance and athlete readiness when implemented in the 1-12 h prior to competition. METHODS: A literature search of SPORTDiscus, PubMed and Cochrane Central Register for Controlled Trials was conducted. A total of 6428 studies were retrieved and assessed against the following inclusion criteria: (1) randomised controlled trials and non-randomised comparative studies with reported pre-post intervention outcomes; (2) exercise interventions were applied 1-12 h prior to the assessment of outcome measures. Studies were excluded if they used nutrition, supplementation, pre-heating, pre-cooling, stretching, massage or vibration training as the priming strategies, or if interventions were performed at altitude or in hypoxic environments. Studies were assessed for methodological quality at the study level using the Physiotherapy Evidence Database (PEDro) scale. RESULTS: Twenty-nine studies satisfied the eligibility criteria and were included in this review. Studies were categorised as resistance training; cycling; running; and other strategies. Resistance training using heavy loads at low volumes increased strength and power measures following a 4-6 h recovery, with limited improvements observed following shorter (1-3 h) and longer (6-12 h) recovery periods. Running-based sprint priming led to improvements in subsequent sprint and repeat sprint performance following a 5-6 h recovery, whereas cycling improved counter-movement jump height in a single study only. No significant differences were reported in any performance measures following endurance-based running or cycling strategies. Physiological markers, such a hormone and blood lactate responses, showed mixed results between studies. CONCLUSIONS: High-intensity low-volume resistance training leads to a greater physiological and performance response than high-volume resistance training. Maximal running sprints may be more effective than maximal cycling sprints due to an increased physiological demand; however, loading protocols must also be considered in conjunction with exercise volume and movement specificity to achieve a beneficial response for subsequent performance. There is limited evidence to suggest endurance cycling or running exercise is beneficial as a priming strategy.

Mat Rosly, M., et al. (2017). "Exergaming boxing versus heavy-bag boxing: are these equipotent for individuals with spinal cord injury?" European journal of physical & rehabilitation medicine. 53(4): 527-534.
	BACKGROUND: Current strategies for increased physical activity and exercise in individuals with spinal cord injury (SCI) face many challenges with regards to maintaining their continuity of participation. Barriers cited often include problems with accessing facilities, mundane, monotonous or boring exercises and expensive equipment that is often not adapted for wheelchair users. AIM: To compare the physiological responses and user preferences between conventional heavy-bag boxing against a novel form of video game boxing, known as exergaming boxing. DESIGN: Cross-sectional study. SETTING: Exercise laboratory setting in a university medical center. POPULATION: Seventeen participants with SCI were recruited, of which sixteen were male and only one female. Their mean age was 35.6+/-10.2 years. METHODS: All of them performed a 15-minute physical exercise session of exergaming and heavy-bag boxing in a sitting position. The study assessed physiological responses in terms of oxygen consumption, metabolic equivalent (MET) and energy expenditure between exergaming and heavy-bag boxing derived from open-circuit spirometry. Participants also rated their perceived exertion using Borg's category-ratio ratings of perceived exertion. RESULTS: Both exergaming (MET: 4.3+/-1.0) and heavy-bag boxing (MET: 4.4+/-1.0) achieved moderate exercise intensities in these participants with SCI. Paired t-test revealed no significant differences (P>0.05, Cohen's d: 0.02-0.49) in the physiological or perceived exertional responses between the two modalities of boxing. Post session user survey reported all the participants found exergaming boxing more enjoyable. CONCLUSIONS: Exergaming boxing, was able to produce equipotent physiological responses as conventional heavy-bag boxing. The intensity of both exercise modalities achieved recommended intensities for health and fitness benefits. CLINICAL REHABILITATION IMPACT: Exergaming boxing have the potential to provide an enjoyable, self-competitive environment for moderate-vigorous exercise even at the comfort of their homes.

Mayer, R. (2012). "London calling: clincians shine at the olympic games." Advance for Physical Therapy & Rehab Medicine 23(12): 14-17.
	
Maynard, L. G., et al. (2019). "Effects of Exercise Training Combined with Virtual Reality in Functionality and Health-Related Quality of Life of Patients on Hemodialysis." Games for Health Journal 8(5): 339-348.
	Objective: The progression of chronic kidney disease can directly affect patient's health-related quality of life (HRQoL). Exercise training is a good option to reverse the impacts caused by the disease. To escape from the monotonous routine and stimulate further practice, the therapist should consider making physical activity more playful. Using videogames during exercise training is possible to rehabilitate the patient aiming for fun beyond the organic condition. The present study aimed to evaluate the effects of exercise training combined with Virtual Reality (VR) in functionality and HRQoL of patients on hemodialysis. Materials and Methods: A randomized controlled study in which control group (n = 20) maintained only hemodialysis without any physical effort or intervention from the researchers and intervention group (n = 20) who performed endurance and strength physical exercises in combination with VR during hemodialysis for 12 weeks. All eligible patients underwent a familiarization of games and were evaluated by an investigator-blind for functional capacity, quality of life, and depressive symptoms. Functional capacity tests included walking speed, timed up and go (TUG), and Duke Activity Status Index (DASI). To evaluate a HRQoL, Kidney Disease and Quality-of-Life Short-Form (KDQOL-SF, v. 1.3) was used and to investigate depressive symptoms, the Center for Epidemiological Scale-Depression. Paired sample t-tests were conducted to determine differences within each group. Repeated-measures analysis of variance (group vs. time) was used to assess group differences in our major outcomes. The level of significance was 5%. Results: The exercise improved functional capacity (TUG: P = 0.002, DASI: P < 0.001) and HRQoL in physical and specific domains: physical functioning (P = 0.047), role physical (P = 0.021), as well as in physical composite summary (P < 0.001) and effects of kidney disease (P = 0.013). There was no influence on depressive symptoms (P = 0.154). Conclusion: Physical training combined with VR improved functional capacity and some quality-of-life domains of hemodialysis patients.

Mazer, B., et al. (2010). "Clinical management of musculoskeletal injuries in active children and youth." Clin J Sport Med 20(4): 249-255.
	OBJECTIVE: To describe how different health care specialists manage musculoskeletal injury in children and examine factors influencing return to play decisions. DESIGN: National survey. SETTING: Secure Web site hosting online questionnaire. PARTICIPANTS: Medical doctors, physical therapists, and athletic therapists who were members of their respective sport medicine specialty organizations. INDEPENDENT VARIABLES: Professional affiliation and the effect of the following factors were examined: pushy parent, cautious parent, protective equipment, previous injury, musculoskeletal maturity, game importance, position played, team versus individual sport, and time since injury. MAIN OUTCOME MEASURES: Recommendation of return to activity after common injuries seen in children and adolescents as described in 5 vignettes; consistency of responses across vignettes. RESULTS: The survey was completed by 464 respondents (34%). There were several differences between the professional groups in their recommendations to return to activity. Most factors studied did not tend to influence the decision to return to activity, although protective equipment often increased the response to return sooner. The number of participants who would return a child to activity sooner or later for each factor varied greatly across the 5 vignettes, except for pushy parent or cautious parent. CONCLUSIONS: Management practices of sport medicine clinicians vary according to profession, child, clinical factors, and sport-related factors. Decisions regarding return to play vary according to 5 specific characteristics of each clinical case. These findings help establish areas of consensus and disagreement in the management of children with injuries and safe return to physical activity.

McCague, A. Special Olympics: World Summer Games 2011, Society of Chiropodists & Podiatrists.
	The article offers information on the Special Olympics World Summer Games 2011 which were held June 25 to July 4, 2011 in Athens, Greece. It mentions that several Fit Feet volunteers worked as a team to screen over 2000 athletes, and captured data for static and dynamic analysis to be used for answering questions about athletes with Intellectual Disabilities (ID). The volunteers included international podiatry volunteers, local physiotherapy students, and postgraduates.

McDonough, D. J., et al. (2020). "Effects of Physical Activity on Children's Motor Skill Development: A Systematic Review of Randomized Controlled Trials." BioMed Research International 2020: 8160756.
	OBJECTIVE: This systematic review synthesized current randomized controlled trials (RCTs) examining casual evidence regarding the effects of traditional and exergaming-based physical activity (PA) interventions on motor skill development in typically developed children (i.e., those aged 6-12 years). METHODS: We adhered to the PRISMA-P statement and searched electronic databases (Medline, PsycInfo, Web of Science, PubMed, ERIC, Scopus, and SportDiscus) from inception through July 2020. We screened for peer reviewed RCTs published in English between 2000 and 2020 examining the effect of PA on motor skill development in healthy children. RESULTS: A total of 25 RCTs were included, 20 (80%) of which reported significant improvements in children's motor skill performance. Specifically, 18 studies examined traditional PA interventions and 7 studies examined exergaming-based PA interventions, 83% and 71% of which observed statistically significant improvements in children's motor skill development, respectively. CONCLUSIONS: Findings support the causal evidence regarding the effects of PA on motor skill development in children. Notable limitations of this review included heterogeneity of measurement protocols and assessment tools used to test children's motor skills across studies, a wide range of PA intervention dose across studies, and the lack of power analyses and long-term follow-up assessments in individual studies to discern appropriate sample sizes and long-term effectiveness, respectively. To further strengthen the evidence in this emerging field, we advocate for future RCTs to employ a priori power analyses, long-term follow-up measurements, and more exergaming-based interventions to allow for comparisons with traditional PA interventions, to explore the dose response and moderating relationships between PA and motor skill development in childhood, and to utilize homogenous assessment instruments to allow for more rigorous, quantitative syntheses.

McGee, C., et al. (2021). "More Than a Game: Musculoskeletal Injuries and a Key Role for the Physical Therapist in Esports." Journal of Orthopaedic & Sports Physical Therapy 51(9): 415-417.
	SYNOPSIS: The esports industry is growing exponentially: more viewers, more support, more money, and more players. Esports competitors require high-level cognitive function and dexterity. There is an increasing demand for physical therapists to manage esports-related musculoskeletal injuries across all levels of play (amateur, semi-professional, professional). Clinicians have relied on general musculoskeletal principles and extrapolating research findings from other populations, including athletes, office workers, air traffic controllers, and musicians, to inform an evidence-based practice approach to assessing and managing injury in esports competitors. The physical demands of esports competitors are triple those of office workers, varying across esports games, platforms (computer, console, mobile), and levels of performance. We highlight the role of physical therapy in esports, the need for best-practice guidelines for musculoskeletal health care, the current research evidence, and the large research gaps in the field. J Orthop Sports Phys Ther 2021;51(9):415-417. doi:10.2519/jospt.2021.0109.

McGuire, J., et al. (2011). "Assessing the Applicability of the Nintendo Wii as a Device for Advancing Clinical Practice and Functional Independence." Critical Reviews in Physical & Rehabilitation Medicine 23(1-4): 109-123.
	The purpose of this review was to assess the potential of the Nintendo Wii to collect clinical data such as center of pressure and weight. The use of this system as an assistive device for individuals with disability was also reviewed. Keywords including 'Wii,' 'Nintendo Wii,' 'rehabilitation,' and 'instrumentation' were entered into the search engines Pubmed, CINAHL, and Google Scholar. Articles in English, and focusing on the use of the Nintendo Wii were reviewed. Articles focusing on the use of this system in a rehabilitation setting were excluded. In total, 260 articles were identified. After reviewing the abstracts, 13 were considered suitable for the current review (12 from Pubmed and CINAHL, 1 from Google Scholar). The Nintendo Wii, when paired with customized software, is able to collect data regarding center of pressure, weight-bearing asymmetry, and posture similar in quality to data collected by laboratory equipment. The literature is equivocal regarding the validity and reliability of data that the device can collect its own, suggesting the need for further research. When paired with custom software, the Nintendo Wii may act as an assistive device allowing individuals with disability to interact with, and respond to, environmental stimuli.

McIntyre, V., et al. (2019). "Anterior Cruciate Ligament Repair in a Professional Soccer Player Using Internal Brace Ligament Augmentation: A Case Report Focusing on Rehabilitation." Surgical Technology International 35: 341-348.
	BACKGROUND: Anterior cruciate ligament (ACL) reconstruction with hamstring or patellar tendon autograft has been the gold standard for the operative treatment of an ACL rupture for many years. Repair with Internal Brace Ligament Augmentation (IBLA) is a new technique that uses ultra-high strength tape (FiberTape, Arthrex, Naples, FL, USA) to bridge the ligament. This technique reinforces the ligament as a secondary stabiliser, encouraging natural healing of the ligament by protecting it during the healing phase and supporting early mobilisation. CASE DESCRIPTION: This retrospective case report focuses on the rehabilitation of a 21-year-old male professional soccer player who ruptured his ACL in a contact injury whilst playing a competitive game. He underwent ACL repair with IBLA two weeks following injury. The six-month rehabilitation programme consisted of gradual progressions for mobility, proprioception, strengthening, cardiovascular maintenance and running in conjunction with physiotherapy to assist with the maintenance of soft tissue quality, pain management and control of oedema. RESULTS: After completing the rehabilitation programme, the patient returned to unrestricted sporting activity within six months. At 18-month follow-up, the patient continues to play at the same competitive level without any issues. CONCLUSION: This rehabilitation programme after ACL repair with IBLA successfully enabled a professional soccer player to return to his pre-injury playing level.

McKenna, J., et al. (2002). "Physiotherapists' lived experience of rehabilitating elite athletes." Physical Therapy in Sport 3(2): 66-78.
	Aim: To examine the 'lived experiences' of physiotherapists while treating elite athletes. Participants: Ten practising staff in south-west England, UK. Methods: After giving informed consent, in-depth interviews were conducted and member-checked. Adopting a hermeneutical approach, data reduction was undertaken by individuals, and then rebuilt by the research team in a consensus-building process. Findings: The essence of the lived experience of treating elite athletes was one of 'working-ness'. In describing experiences of how well rehabilitation was working, physiotherapists expressed a wide range of 'knowing' about rehabilitation and about elite athletes. However, the quality of the physiotherapists experience was often a product of local politics, short time frames and interpersonal relationships. Accounts resonated with Merleau-Ponty's concepts of 'in-the-body', and Husserl's 'Being in the world'. Elite athletes were seen in terms of their: (1) 100%-ness, (2) individualized injury experience, (3) ignorant knowing, and of how (4) soccer is different. To describe their own part in the rehabilitation process, physiotherapists spoke about 'I-who' and this involved: (5) trying to keep everyone happy, (6) getting into the sport, but staying outside the game, (7) offering 'real' and 'service' treatments, and (8) Using 'goaling' to retrieve athleticism. Physiotherapists were concerned with the 'working-ness' of their practices and relationships. They used many ways of 'knowing' about their effectiveness to do what they feel is an important, but often stressful, job. These issues provide an important addition to existing templates of professional preparation of, and support for, sports specialists. Copyright 2002 Published by Elsevier Science Ltd.

McPhail, S. M., et al. (2016). "Nintendo Wii Fit as an adjunct to physiotherapy following lower limb fractures: preliminary feasibility, safety and sample size considerations." Physiotherapy 102(2): 217-220.
	OBJECTIVE: The Nintendo Wii Fit integrates virtual gaming with body movement, and may be suitable as an adjunct to conventional physiotherapy following lower limb fractures. This study examined the feasibility and safety of using the Wii Fit as an adjunct to outpatient physiotherapy following lower limb fractures, and reports sample size considerations for an appropriately powered randomised trial. METHODOLOGY: Ambulatory patients receiving physiotherapy following a lower limb fracture participated in this study (n=18). All participants received usual care (individual physiotherapy). The first nine participants also used the Wii Fit under the supervision of their treating clinician as an adjunct to usual care. Adverse events, fracture malunion or exacerbation of symptoms were recorded. Pain, balance and patient-reported function were assessed at baseline and discharge from physiotherapy. RESULTS: No adverse events were attributed to either the usual care physiotherapy or Wii Fit intervention for any patient. Overall, 15 (83%) participants completed both assessments and interventions as scheduled. For 80% power in a clinical trial, the number of complete datasets required in each group to detect a small, medium or large effect of the Wii Fit at a post-intervention assessment was calculated at 175, 63 and 25, respectively. CONCLUSIONS: The Nintendo Wii Fit was safe and feasible as an adjunct to ambulatory physiotherapy in this sample. When considering a likely small effect size and the 17% dropout rate observed in this study, 211 participants would be required in each clinical trial group. A larger effect size or multiple repeated measures design would require fewer participants.

McQueen, P. D., et al. (2018). "Comparative Analysis of the Nonoperative Treatment of Elbow Ulnar Collateral Ligament Injuries in Professional Baseball Players with and without Platelet-Rich Plasma." Orthopaedic Journal of Sports Medicine 6(7_suppl4): 1-2.
	Objectives: In the setting of ulnar collateral ligament (UCL) injury, surgical reconstruction of the UCL is not always selected, as it leads to a prolonged recovery time and return to play rates between 67-95%. To date, there is limited data on outcomes following nonoperative treatment in this population. Orthobiologics, such as platelet-rich plasma (PRP), have recently been used as an adjunct therapy for standard nonoperative treatment including rest and physical therapy for UCL injuries. The objective of this study was to determine if the addition of PRP injections in professional baseball players with UCL injuries reduces recovery time, lowers the likelihood of surgery, and increases the return to play rate compared to traditional nonoperative treatment. Methods: The Health and Injury Tracking System (HITS) database was searched from 2011-2015 for Major and Minor league baseball players with Grade I, II or III UCL injuries. Standard demographic, injury, and return to play data was obtained for all players. MRI's for 353 athletes were reviewed by a musculoskeletal radiologist and graded accordingly. Outcomes were compared between players who received PRP injections in addition to traditional nonoperative treatment (PRP group) and players who received traditional nonoperative treatment alone (No PRP group). Statistical analysis was performed using Student's T-test and Chi-square for parametric data. Kaplan Meier's analysis was used for estimating longevity of the treatment. Results: A total of 544 Major and Minor League Baseball players with UCL tears underwent an initial course of nonoperative treatment (active rest & rehabilitation) for their injury between 2011-2015. Of these, 133 underwent PRP injections plus rehab and 411 underwent rehab alone. There was a significantly higher proportion of Major League Baseball players in the PRP group compared to the No PRP group (25.6% vs 9.0%, P<0.001). There was no difference between the two cohorts in regard to the grade of UCL tear (Figure 1). The players in the PRP group had a significantly longer time before returning to a throwing program compared to the No PRP group (64 days vs 51 days, P<0.001). The mean time from injury date to PRP injection was 14.5 days, which may explain the difference in time to return to throwing. The return to play rate in a live game without surgery was significantly lower in the PRP group compared to the No PRP group (46% vs 57%, P=0.03). There was no difference in the proportion of athletes requiring UCL reconstruction (58% vs 51%) or the time to surgery (154 days vs 178 days) between the two groups. Kaplan Meier survivor analysis showed no difference between the PRP and No PRP groups with regard to longevity of the native UCL (Figure 2). Conclusion: Among Major and Minor League Baseball players who were treated nonoperatively for a UCL injury between 2011-2015, 24% underwent PRP injections prior to rehab. Compared to traditional nonoperative rehab alone program, players who received PRP injections experienced a significantly longer time before returning to throwing, which may be in part due to the delay between the injury date and PRP injection. PRP injections did not appear to have a significant effect on the likelihood of surgical intervention.

Mehnert, A., et al. (2011). "Effects of a physical exercise rehabilitation group program on anxiety, depression, body image, and health-related quality of life among breast cancer patients." Onkologie 34(5): 248-253.
	BACKGROUND: Since physical exercise programs have the potential to help cancer patients regain physical fitness and may exert a range of positive consequences for recovery and psychological well-being, the impact of a physical exercise program was investigated in this prospective study. PATIENTS AND METHODS: Women with primary nonmetastatic breast cancer after a minimum 4-week period post chemotherapy and/or radiotherapy completion were randomly assigned to one of 2 groups: intervention group (IG) (n = 30) and waiting group (WG) (n = 28). The 10-week twice weekly exercise group program consisted of gymnastics, movement games, relaxation, walking, and jogging. Anxiety, depression, body image, and quality of life were measured using standardized questionnaires. Maximal oxygen uptake (VO(2)max/kg) was assessed as a measure of physical fitness. RESULTS: Patients in the IG improved significantly over time with regard to anxiety (p = 0.03, d = 0.45), depression (p = 0.05, d = 0.43), individual body image (p = 0.006, d = 0.44), and VO(2)max/kg (p < 0.001, d = 0.50), whereas no improvements were observed in the WG. However, this randomized controlled trial failed to demonstrate significant intervention effects in quality of life and social body image. CONCLUSIONS: This prospective study provided evidence for the effectiveness of a 10-week physical exercise intervention to significantly improve psychosocial wellbeing, individual body image, and physical fitness.

Meijer, H. A., et al. (2018). "Systematic Review on the Effects of Serious Games and Wearable Technology Used in Rehabilitation of Patients With Traumatic Bone and Soft Tissue Injuries." Archives of Physical Medicine & Rehabilitation 99(9): 1890-1899.
	OBJECTIVE: To assess the effects on functional outcomes and treatment adherence of wearable technology and serious games (ie, interactive computer applications with specific purposes useful in the "real world") currently used in physical rehabilitation of patients after traumatic bone and soft tissue injuries. DATA SOURCES: PubMed, EMBASE, Cochrane Library, and Current Index to Nursing and Allied Health Literature were searched without publication date restrictions for the terms wearable, serious game, videogame or mobile application, and rehabilitation, exercise therapy, and physiotherapy. STUDY SELECTION: The search yielded 2704 eligible articles, which were screened by 2 independent reviewers. Studies comparing serious games to standard therapy were included. DATA EXTRACTION: Methodology and results of the studies were critically appraised in conformity with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. DATA SYNTHESIS: Twelve articles were included, all of which tested "off-the-shelf" games. No studies on "wearable-controlled" games or games specifically developed for rehabilitation could be included. Medical conditions included postoperative rehabilitation and acute traumatic injuries. All studies were of low to moderate quality. Only 2 studies found beneficial effects of serious games compared to conventional therapy. One of 3 studies reporting pain scores found beneficial effects of serious games compared to physiotherapy. One of 5 trials reporting treatment adherence found a statistically significant advantage in the game group compared to conventional physiotherapy. Because of heterogeneity in study design and outcome measures, pooling of data was not possible. CONCLUSIONS: Serious games seem a safe alternative or addition to conventional physiotherapy after traumatic bone and soft tissue injuries. Future research should determine their validity and effectiveness in rehabilitation therapy, next to their cost-effectiveness and effect on treatment adherence.

Meijer, H. A. W., et al. (2019). "Face Validity and Content Validity of a Game for Distal Radius Fracture Rehabilitation." Journal of Wrist Surgery 8(5): 388-394.
	Background Patients recovering from a variety of wrist injuries are frequently advised to exercise to regain lost wrist and hand function. Treatment regimens to regain motion in the wrist are highly variable, and adherence to exercise protocols is known to be low. A serious game ReValidate! incorporating standardized exercise regimens was developed to motivate patients. In this study, the game is evaluated regarding its face validity and content validity. Methods In this cross-sectional study, a mixed group of "users" ( n = 53) including patients currently recovering from wrist injury, and a mixed group of "experts" ( n = 46) including professionals advising patients on therapy regimen after wrist injury played at least one complete level of the serious game. Players evaluated the game by means of a structured questionnaire regarding its content, clinical applicability, and user experience. Questions were answered on a Likert scale ranging from 1 (strongly disagree) to 5 (strongly agree). Results All groups valued the game as being able to support wrist rehabilitation and being of use to patients recovering from a distal radius fracture (users: median 4, P25-P75 3-4 vs. experts: median 4, P25-P75 3.50-5; p = not significant). The types of exercises performed during the game were considered to be both realistic and complete compared with regular physiotherapy exercises (users: median 4, P25-P75 3-4 vs. experts: median 4, P25-P75 3-5, p = not significant). Conclusions The ReValidate! serious game can be regarded as a valid tool for patients to regain their wrist function after injury. Level of evidence This is a Level II study.

Meijer, H. A. W., et al. (2021). "Serious game versus standard care for rehabilitation after distal radius fractures: a protocol for a multicentre randomised controlled trial." BMJ Open 11(3): e042629.
	INTRODUCTION: Distal radius fractures are among the most prevalent traumatic injuries worldwide. These injuries are associated with high healthcare-related and socioeconomic costs, mainly resulting from loss of productivity. To optimise recovery and return to work, wrist exercises are recommended. However, adherence to standard exercise regimens is low. Serious games provide a treatment platform for standardised postoperative care, uniting meaningful recovery with entertainment. Also, mobile serious games, for example, smartphone or tablet applications, are able to send practice reminders believed to improve self-efficacy. METHODS AND ANALYSIS: To test the effectiveness of a mobile serious game for distal radius fracture rehabilitation compared with standard care, a multicentre, randomised controlled clinical trial was designed. Primary outcome will be the Patient-Rated Wrist Evaluation (PRWE) score after 6 weeks of treatment. Secondary outcomes are range of motion, grip strength, pain scores, and self-reported treatment adherence after 2, 6 and 12 weeks of treatment.Adult patients with any type of closed distal radius fracture are included directly after non-operative or operative fracture treatment. Patients are recruited in the outpatient clinics of four teaching hospitals. The intended sample size is 92 patients, based on the minimal clinically important difference of the PRWE score at 6 weeks, using a superiority model.Patients are randomised between using the wearable-controlled mobile serious game ReValidate! (intervention group) and standard care consisting of unsupervised exercises and a referral for physiotherapy or exercise therapy upon request or recommendation by the treating clinician (control group). ETHICS AND DISSEMINATION: The protocol has been approved by the Medical Ethical Review Board of the Amsterdam University Medical Centres, location Academic Medical Centre in Amsterdam, the Netherlands. Results will be made available to involved healthcare providers, funders, and to the general public including patients via peer-reviewed academic journals and international conferences. TRIAL REGISTRATION NUMBER: Dutch Trial Registry (NTR), NL6140, protocol V.2.

Meinke, A., et al. (2021). "Exergaming Using Postural Feedback From Wearable Sensors and Exercise Therapy to Improve Postural Balance in People With Nonspecific Low Back Pain: Protocol for a Factorial Pilot Randomized Controlled Trial." JMIR Research Protocols 10(8): e26982.
	BACKGROUND: Physical exercise is a common treatment for people with low back pain (LBP). Wearable sensors that provide feedback on body movements and posture during exercise may enhance postural balance and motor control in people with LBP. OBJECTIVE: This study aims to investigate whether physical exercising with postural feedback (EPF) improves postural balance, motor control, and patient-reported outcomes in people with LBP. METHODS: The study was an assessor-blinded 2x2 factorial trial. We planned to recruit 80 participants with nonspecific LBP who did not receive treatment for LBP. In addition, we aimed to recruit 40 patients with chronic, nonspecific LBP who were receiving exercise therapy (ET) at the University Hospital Zurich. Both ET patients and participants without treatment were randomized to receive either an additional EPF intervention or no additional intervention. This resulted in four different combinations of interventions: ET+EPF, ET, EPF, and no intervention. The participants underwent outcome assessments at inclusion (T1); 3 weeks later, at randomization (T2); after an intervention period of 3 weeks with a predefined exercise schedule for participants receiving EPF (T3); and after an additional 6 weeks, during which participants assigned to the EPF groups could exercise as much as they wished (T4). Patients receiving ET completed their regularly prescribed therapies during the study period. Balance was assessed during quiet standing on a force platform, and motor control was assessed during a lifting task and a waiter's bow task. Physical activity was recorded using an activity tracker and the participants' mobile phones during the study. The predefined EPF schedule consisted of nine sessions of 20 minutes of exercise with a tablet and inertial measurement unit sensors at home. Participants performed a series of trunk and hip movements and received feedback on their movements in a gamified environment displayed on the tablet. RESULTS: The first participant was recruited in May 2019. Data collection was completed in October 2020, with 3 patients and 32 eligible people without therapy who passed the eligibility check. CONCLUSIONS: Although it will not be possible to investigate differences in patients and people without other therapies, we expect this pilot study to provide insights into the potential of EPF to improve balance in people with LBP and adherence to such interventions. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/26982.

Meldrum, D., et al. (2012). "Virtual reality rehabilitation of balance: assessment of the usability of the Nintendo Wii((R)) Fit Plus." Disabil Rehabil Assist Technol 7(3): 205-210.
	PURPOSE: The aim of this study was to investigate the usability of the Nintendo Wii Fit Plus((R)) (NWFP) in the treatment of balance impairment in vestibular and other neurological disease. METHODS: This was a cross-sectional, quasi-experimental study. Participants (n = 26; mean age 43 +/- 14, M13:F13) with quantified balance impairment took part in a 30-minute session on the NWFP using exercises and games that challenge balance. Outcomes included the System Usability Scale (SUS), a numerical rating scale of enjoyment and a post treatment questionnaire. RESULTS: The mean SUS score was high (mean 82 +/- 18%) with only two participants rating below 50%. There was a negative correlation of age with SUS scores (r = -0.54; p = 0.004). Mean numerical rating scale score (/10) for enjoyment of the NWFP session was 8.4 +/- 3. Of the participants, 88.5% said that they would like to use the NWFP in future treatment. Seventy-three percent reported more enjoyment and motivation than usual physiotherapy. No falls occurred during testing. CONCLUSIONS: This study has quantified the usability of the NWFP as a treatment for balance impairment showing high levels of usability and enjoyment with no serious adverse effects. The results of this study may assist physiotherapists in devising novel balance rehabilitation programmes. [Box: see text].

Mendes, F., et al. (2011). "Research Report Abstracts." Physiotherapy 97: eS18-eS1415.
	Purpose: The aim of the present study was to compare the improvement in performance of PD patients and healthy elderly on visuo‐motor tasks involving balance and gait, who were trained using Nintendo Wii Fit Plus. Relevance: The reduction in dopamine levels in striate cortical circuits caused by PD compromises the motor learning process, particularly in late phases of the disease when motor performance is no longer controlled automatically. This deficiency in automatic motor control increases PD patients' dependency on attention for controlling balance and gait. This compromises their functional performance by progressively limiting their ability to manage multi‐tasks, rendering them more prone to falls. Although some studies have shown evidence that at least partial recuperation of automatic motor ability in PD patients may be possible, few studies have explored this possibility in the sphere of rehabilitation. Virtual environments, in which motor responses are triggered by visual stimuli simulating complex situations, stimulate automatic motor control while attention is dedicated to the visual task. We used the Nintendo Wii Fit Plus to provide PD patients with training in a virtual environment in a bid to verify the potential to improve performance in this condition. Participants: 10 idiopathic PD patients, with a mean age of 66.4 years, at stages 1 and 2 according to the Hoehn and Yahr Classification, and 10 healthy elderly with mean age of 65.3 years, took part in the study. All participants signed the HCFMUSP informed consent term. Methods: A blinded, randomized, controlled, longitudinal clinical trial was conducted. The control group (CG) comprised healthy elderly whereas the experimental group comprised individuals with PD (PD). A total of 10 games were selected on the Nintendo Wii Fit Plus which elicited movements from the center of gravity, associated or otherwise with upper limb movement, and step alternation. The training was split into 14 sessions with two sessions given per week. Each session entailed 2 tries at 5 of the 10 games. Analysis: Performance on each of the games during the 14 sessions was analyzed using 2x7 repeated measures ANOVA, with group (CG and PD) as a factor, and sessions (S1, S2, S3, S4, S5, S6 and S7) as repeated independent variables. Tukey's post hoc test was applied for all interactions reaching a level of significance. Results: The results evidenced a significant interaction between group and sessions (p < 0.01), in 7 of the 10 games analyzed. The post‐test showed that although PD patients presented poorer performance than elderly subjects (p < 0.001), the former were able to significantly improve their performance between S1 and S5 (p < 0.001), whereas the healthy elderly achieved a significant improvement between S1 and S3 (p < 0.0001). Conclusions: PD patients were able to improve their performance on balance and step alternation tasks, trained in a virtual environment, requiring automatic motor control while directing attention to the visual stimuli guiding the tasks. This finding suggests that, given suitable training, impairment to automatic motor control in PD patients can be minimized. Implications: Training in virtual environments can stimulate automate motor control, representing an effective therapeutic strategy for improving control of balance and gait in PD patients.

Mendes Xavier, A. C., et al. (2012). "A Atuação da Fisioterapia como Meio de Melhorar a Performance em Atletas de Bocha Paraolímpica da Associação dos Deficientes Físicos do Paraná." Revista Inspirar Movimento & Saude 4(2): 24-34.
	The major focus of this work is the evaluation of Physiotherapy as a way to improve athletes' performance in Paralympics boccia game from Associação dos DeficientesFísicos do Paraná. BobathNeuroevolutive Treatment was applied as a therapeutic resource for enhancement of strength and precision abilities. It has been chosen a qualitative, critical, and reflexive methodology in a participative study. Therefore a bibliographic research has been undertaken, searching for documents that could answer the questions raised from the aim subject of this study. Video recording and photography, as well as specific tests for performance analysis were employed as evaluation procedure. At the end of the treatment, a significant improvement of strength, precision, posture, and daily life activities was achieved. We suggest that future studies involving Paralympics athletes harboring cerebral paralysis include kinesis therapeutic evaluation of volunteers, application of goniometry, electromyography, and muscular length measuring, for a more precise biomechanical analysis. It is recommended a treatment with a Physical Educator after each Physiotherapeutic Session. An increase in number of physiotherapeutic sessions would lead to better results in daily life activities and physical performance for athletes.
O estudo focaliza a atuação da Fisioterapia como meio de melhorar a performance em atletas de bocha paraolímpica da Associação dos Deficientes Físicos do Paraná. Verifica a aplicação do tratamento NeuroevolutivoBobath como recurso terapêutico para a melhora da força e precisão. Como metodologia optou-se por uma abordagem qualitativa, crítica e reflexiva em uma pesquisa participante. Desta forma, realizou-se a princípio uma pesquisa bibliográfica, buscando na literatura pertinente documentos que ajudassem a responder às questões levantadas na problemática do tema em estudo. Como procedimento de análise empregou-se os recursos de filmagem, fotografias e testes específicos para análise da performance. Ao final do tratamento, resultou em uma melhora significativa da força, precisão, postura e atividades da vida diária. Sugere-se que os próximos estudos envolvendo atletas paraolímpicos, portadores de PC, incluam avaliações cinesioterapêuticas dos voluntários, realizando-se goniometria, eletromiografia e teste de comprimento muscular para uma melhor análise da biomecánica. É interessante também, que o treinamento com o Educador Físico fosse mantido e realizado logo após as sessões de Fisioterapia. Acredita-se que o aumento do número de sessões fisioterapêuticas aplicadas possibilitariam melhores resultados para os atletas.

Mendonca, L. D., et al. (2017). "Preparation and organization of Brazilian physical therapy for the Rio 2016 Olympic and Paralympic Games." Physical Therapy in Sport 25: 62-64.
	
Mentiplay, B. F., et al. (2019). "Do video game interventions improve motor outcomes in children with developmental coordination disorder? A systematic review using the ICF framework." BMC Pediatrics 19(1): 22.
	BACKGROUND: Children with developmental coordination disorder (DCD) experience a range of difficulties that can potentially limit their academic, social and physical ability. Recent research has developed interventions that aim to improve motor outcomes in a variety of paediatric cohorts using video gaming equipment. Therefore, we aimed to systematically review the literature on virtual reality or video game interventions that aim to improve motor outcomes in children with DCD. METHODS: Seven databases were searched for studies using the following criteria: a) virtual reality or video game based intervention; b) children with DCD; and c) motor outcomes relating to body structure and function, activity or participation. Data were extracted relating to study design, participant characteristics, details of the intervention, outcome measures, results, and feasibility/adherence. RESULTS: Fifteen articles were included for review, including eight randomised controlled trials. No studies used virtual reality equipment, with all interventions using video games (Nintendo Wii in 12/15 articles). Mixed effects of video game intervention on outcome were found, with conflicting evidence across studies. Studies that reported on feasibility found most children enjoyed and adhered to the video game interventions. CONCLUSIONS: This review found limited evidence for the effectiveness of video game interventions for children with DCD to improve motor outcomes due to limitations in the research including low sample sizes and low to moderate methodological quality. Further research is needed to determine the effect of video game or virtual reality interventions on motor outcomes in children with DCD. PROTOCOL REGISTRATION: The protocol for this systematic review can be found on PROSPERO ( CRD42017064427 ).

Mentzoni, R. A., et al. (2011). "Problematic video game use: estimated prevalence and associations with mental and physical health." Cyberpsychology, behavior and social networking 14(10): 591-596.
	A nationwide survey was conducted to investigate the prevalence of video game addiction and problematic video game use and their association with physical and mental health. An initial sample comprising 2,500 individuals was randomly selected from the Norwegian National Registry. A total of 816 (34.0 percent) individuals completed and returned the questionnaire. The majority (56.3 percent) of respondents used video games on a regular basis. The prevalence of video game addiction was estimated to be 0.6 percent, with problematic use of video games reported by 4.1 percent of the sample. Gender (male) and age group (young) were strong predictors for problematic use of video games. A higher proportion of high frequency compared with low frequency players preferred massively multiplayer online role-playing games, although the majority of high frequency players preferred other game types. Problematic use of video games was associated with lower scores on life satisfaction and with elevated levels of anxiety and depression. Video game use was not associated with reported amount of physical exercise.

Merino-Campos, C. and H. Del Castillo Fernández (2016). "Los beneficios de los videojuegos interactivos: una aproximación educativa y una revisión sistemática de la actividad física." Journal of New Approaches in Educational Research 5(2): 115-122.
	This article sets out to conduct a systematic review of the current literature on active video games as potential educational tools for physical education or physical activity. To begin with, research on active video games for educational and physical purposes has been examined with the purpose of verifying improvement of attitudes, intellectual skills, knowledge, motor skills and physical properties associated with physical activity and physical education. A second aim will be to determine the effectiveness of active video games compared with traditional approaches to physical activity. From this perspective, a systematic literature search from relevant international databases was conducted from January to July 2015 in order to find papers published in journals or conference proceedings from January 2010 onwards. Then, 2648 references were identified in database searches and 100 of these papers met the inclusion criteria. Two main conclusions are to be drawn from this research. Firstly, controlled studies demonstrate that active video games increase capacities in relation to physical activity and education. Secondly, Research also shows that physical activity interventions designed and measured using behavioural theories are more likely to be successful in comparison with traditional exercise activities.

Meyns, P., et al. (2017). "The Effect of Additional Virtual Reality Training on Balance in Children with Cerebral Palsy after Lower Limb Surgery: A Feasibility Study." Games for Health Journal 6(1): 39-48.
	OBJECTIVE: Impaired balance is disabling for children with cerebral palsy (CPc), especially for CPc who recently underwent lower limb surgery. Positive results of using virtual reality (VR) in balance rehabilitation have been published in several outpatient populations. We investigated the feasibility of applying additional VR training focused on sitting balance in CP inpatients of a rehabilitation center after lower limb surgery. Additionally, we investigated the rate of enjoyment of VR training compared with conventional physiotherapy. MATERIALS AND METHODS: Eleven spastic CPc (4/7 males/females) following rehabilitation after lower limb orthopedic surgery were included (5-18 years). The control group received conventional physiotherapy. The intervention group received additional VR training. Balance was measured using the Trunk Control Measurement Scale every 3 weeks of the rehabilitation period. Enjoyment was analyzed using a 10-point Visual Analog Scale. RESULTS: Providing additional VR training was feasible in terms of recruitment, treatment adherence, and assessment adherence. Both groups improved sitting balance after therapy. The current games were not perceived as more enjoyable than conventional physiotherapy. CONCLUSION: Including additional VR training to conventional physiotherapy is feasible and might be promising to train sitting balance in CPc after lower limb surgery. Future research should take equal patient allocation and training duration between groups into consideration.

Miguel-Rubio, A., et al. (2020). "Is Virtual Reality Effective for Balance Recovery in Patients with Spinal Cord Injury? A Systematic Review and Meta-Analysis." J Clin Med 9(9): 2861.
	Virtual reality (VR) is an emerging tool used in the neurological rehabilitation of patients with spinal cord injury (SCI), focused on recovering balance, mobility, and motor function, among other functional outcomes. The main objective of this study was to analyze the effectiveness of VR systems to recover balance in patients with SCI. The literature search was performed between October and December 2019 in the following databases: Embase, Web of Science, CINAHL, Scopus, Medline, Physiotherapy Evidence Database (PEDro), PubMed, and the Cochrane Central Register of Controlled Trials. The methodological quality of each study was assessed using the Spinal Cord Injury Rehabilitation Evidence (SCIRE) system and the PEDro scale, while the risk of bias was analyzed by the Cochrane Collaboration's tool. A total of 12 studies, involving 188 participants, were included in the systematic review, of which two were included in the meta-analysis. Statistical analysis showed favorable results for balance measured by the modified Functional Reach Test (standardized mean difference (SMD) = 3.42; 95% confidence interval: 2.54 to 4.29) and by the t-shirt test (SMD= -2.29; 95% confidence interval: -3.00 to -1.59). The results showed that VR interventions provided potential benefits, in addition to conventional physical therapy, to recover balance in patients with SCI.

Milankov, M., et al. (2013). "Dislocation of the proximal tibiofibular joint." Medicinski Pregled 66(9-10): 387-391.
	INTRODUCTION: Dislocation of the proximal tibiofibular joint is a rare injury. It occurs during a sports activity that includes rough twisting movements of the bent knee. The role of the proximal tibiofibular joint is to reduce torsional loads to the ankle, to distribute the bending moment of the outer side of tibia, and transfer the vertical load while standing. In the literature there is no larger series; only several cases of the proximal tibiofibular joint dislocation treated by different methods have been published so far. CASE REPORT: A 23-year-old male soccer player sustained an injury after he had joined the game without previous warming-up. He fell on his right side because of a sudden change of direction while his foot was fixed to the base. He felt a severe pain and had a sensation as if something had snapped in his right knee. Pain and swelling at the head of fibula were found by physical examination, which, however, did not reveal any pain, swelling and instability of the ankle or peroneal nerve palsy. The x-ray showed anterolateral dislocation of the proximal tibiofibular joint, Ogden type II. Since manual reposition in general anesthesia failed, open reduction internal fixation was performed and proximal tibiofibular joint was transfixed with a screw After the wound closure, the above-the-knee plaster cast was applied. The screw was extracted six weeks later, full weight bearing was allowed and he started with physical therapy. Four months after the injury he returned to sports activities. On the follow-up one year after the injury he had the full range of motion of the knee, no complains, and continued with active soccer playing. X-ray showed no signs of arthrosis of the proximal tibiofibular joint. CONCLUSION: The proximal tibiofibular joint dislocation may be the cause of the chronic pain of the knee so it has to be taken into account when making differential diagnosis in case of the pain at the lateral side of the knee. The key for making the accurate diagnosis is the technically correct X-ray of the injured knee compared with the opposite one, showing the displacement of fibular head. If manual reposition fails, open reduction internal fixation and screw transfixation of the proximal tibiofibular joint allow good results and fast return to sport activities.

Milioni, V. L., et al. (2020). "WITHDRAWN: There are differences between cryotherapy techniques applied to the ankle in skin superficial temperature, agility, and equilibrium: Analysis between ice pack, immersion in cold water, and game ready®." Physical Therapy in Sport 45: e2.
	The Publisher regrets that this article is an accidental duplication of articles which have already been published in Physical Therapy in Sport (2018) e1-e7 http://dx.doi.org/10.1016/j.ptsp.2020.04.010. The duplicate articles have therefore been withdrawn. The full Elsevier Policy on Article Withdrawal can be found at https://www.elsevier.com/about/our-business/policies/article-withdrawal.

Miller, C. A., et al. (2012). "Using the Nintendo Wii Fit and body weight support to improve aerobic capacity, balance, gait ability, and fear of falling: two case reports." Journal of Geriatric Physical Therapy 35(2): 95-104.
	BACKGROUND & PURPOSE: Lower limb amputation in older adults has a significant impact on balance, gait, and cardiovascular fitness, resulting in diminished community participation. The purpose of this case study was to describe the effects of a balance training program utilizing the Nintendo Wii Fit (Nintendo of America, Inc, Redmond, Washington) balance board and body-weight supported gait training on aerobic capacity, balance, gait, and fear of falling in two persons with transfemoral amputation. CASE DESCRIPTIONS: Participant A, a 62 year-old male 32 months post traumatic transfemoral amputation, reported fear of falling and restrictions in community activity. Participant B, a 58 year-old male 9 years post transfemoral amputation, reported limited energy and balance deficits during advanced gait activities. INTERVENTION: 6-weeks, 2 supervised sessions per week included 20 minutes of Nintendo Wii Fit Balance gaming and 20 minutes of gait training using Body Weight Support. OUTCOMES: Measures included oxygen uptake efficiency slope (OUES), economy of movement, dynamic balance (Biodex platform system), Activities-Specific Balance Confidence (ABC) Scale, and spatial-temporal parameters of gait (GAITRite). Both participants demonstrated improvement in dynamic balance, balance confidence, economy of movement, and spatial-temporal parameters of gait. Participant A reduced the need for an assistive device during community ambulation. Participant B improved his aerobic capacity, indicated by an increase in OUES. DISCUSSION: This case study illustrated that the use of Nintendo Wii Fit training and Body Weight Support were effective interventions to achieve functional goals for improving balance confidence, reducing use of assistive devices, and increasing energy efficiency when ambulating with a transfemoral prosthesis.

Millett, C. J., et al. (1999). "Seizures during video-game play and other common leisure pursuits in known epilepsy patients without visual sensitivity." Epilepsia 40 Suppl 4: 59-64.
	PURPOSE: Some individuals who are negative to flash/pattern sensitivity have been reported to experience seizures while exposed to video games. This study seeks to examine systematically whether exposure to video-game material is a risk factor for seizures in patients with chronic epilepsy without visual sensitivity. METHODS: Two hundred and twelve chronic epilepsy patients participated in the study. All were negative to rigorous flash and pattern sensitivity testing. They were randomly allocated to a video game-playing session or to a period of leisure (involving reading, physical exercise, puzzles, etc.) and then alternated between these activities for a fixed total of eight 45-min periods while undergoing video-EEG monitoring. The study ceased if the participant experienced a clinical seizure. RESULTS: Twenty-five of 212 subjects experienced a seizure while participating in the study. Thirteen seizures occurred during periods of video-game play, and 12 during alternative leisure. CONCLUSIONS: We have not identified a greater risk of seizures in patients with (not visually sensitive) epilepsy during video-game play compared with other common leisure pursuits. Furthermore, we exposed a large population (212 patients) mostly with severe epilepsy, mainly drug reduced and some sleep deprived, to prolonged video game-playing without observing a significant excess number of seizures. This finding provides strong support for the hypothesis that seizures during video game play in the >95% of the epilepsy population without visual sensitivity are most likely to represent a chance occurrence, although, as always, each individual should be carefully assessed.

Millett, C. J., et al. (2001). "A study of the relationship between participation in common leisure activities and seizure occurrence." Acta Neurologica Scandinavica 103(5): 300-303.
	OBJECTIVE: To investigate whether participation in a structured programme of fairly intensive leisure activities increased seizure occurrence. MATERIAL AND METHODS: 212 adults with medically-intractable epilepsy were closely monitored for seizure occurrence during an "activities day", i.e. a day consisting of various structured sessions of leisure pursuits (video game play, reading, word puzzles, television, physical exercise), and during other days of relative rest, whilst undergoing prolonged video EEG monitoring. RESULTS: The relative risk of seizures did not differ significantly during activities days [0.71 (95% CL: 0.38 to 1.33)] compared with days of relative rest. CONCLUSIONS: These findings fail to provide empirical support for the hypothesis that cognitive exertion has an adverse effect on seizure control.

Minkoff, J., et al. (2003). "Juxta-articular myxoma: a rare cause of painful restricted motion of the knee." Arthroscopy 19(10): E6-13.
	A 68-year-old athletic woman presented to our institution in January 2002 with a several-month history of progressing complaints of pain, swelling, and loss of motion in the right knee. These manifestations had begun the previous July during a game of tennis. She experienced persisting pain and recurring effusions. Because the patient had been residing in another state between July and January, rheumatologic and orthopaedic evaluations of the knee, including a magnetic resonance imaging (MRI), had been performed at a geographically distant (but affiliated) institution. The resulting presumptive diagnosis was a "wear and tear" degenerative articular disorder of the knee. A program of anti-inflammatory medication and physical therapy was begun for several months but produced no therapeutic benefit by the time the patient presented at our institution. After examination confirmed marked losses of both flexion and extension of the knee, effusion, and exquisite medial joint tenderness, an MRI was repeated, using intra-articular gadolinium as a contrast agent. It revealed an intra-articular mass encircling the medial and posterior extents of the medial femoral condyle. An arthroscopic multiportal excisional biopsy was performed. It revealed the existence of a juxta-articular myxoma. The patient recovered most of the range of motion during the next several months, and the effusion and severe pain gradually dissipated. The patient was subsequently followed by sequential physical examinations and MRIs, performed at increasing intervals of time, without recurrence of a mass or of her flagrant symptoms in the first year post surgery. Though the patient's diagnosis was established and treatment outcome was satisfactory, many issues were brought up in this case regarding most appropriate selection of diagnostic tests and treatment approaches.

Mirich, R., et al. (2021). "The Effects of Virtual Reality Based Rehabilitation on Upper Extremity Function in a Child with Cerebral Palsy: A Case Report." Physical & Occupational Therapy in Pediatrics 41(6): 620-636.
	AIM: This case report was designed to assess the efficacy of virtual reality (VR) rehabilitation on improving upper extremity function for a child with spastic hemiplegic cerebral palsy. METHODS: In addition to conventional therapies completed three times per week, the participant engaged in virtual reality rehabilitation with the Neofect Smart Kids five to seven days per week for six weeks totaling just over twelve hours of intervention time. Outcome measures were administered pre-intervention, post-intervention, and 6-weeks post-intervention. RESULTS: Varying levels of improvement in motor function, quality of movement, and functional use were observed during intervention evidenced by improved scores on the following standardized assessments: Peabody Developmental Motor Scales, Second Edition; the Quality of Upper Extremity Skills Test; and the Pediatric Evaluation and Disability Inventory-Computer Adaptive Test. The participant maintained improvements in motor skills at 6-weeks post intervention, however, the quality of his movements and overall frequency of use with his affected upper extremity decreased in the 6-weeks following termination of intervention. CONCLUSIONS: Even though the results are not generalizable, the VR intervention for this child allowed for greater movement repetition and improved functional upper extremity use.

Mobini, A., et al. (2014). "Accuracy of Kinect's skeleton tracking for upper body rehabilitation applications." Disabil Rehabil Assist Technol 9(4): 344-352.
	UNLABELLED: Games and their use in rehabilitation have formed a new and rapidly growing area of research. A critical hardware component of rehabilitation programs is the input device that measures the patients' movements. After Microsoft released Kinect, extensive research has been initiated on its applications as an input device for rehabilitation. However, since most of the works in this area rely on a qualitative determination of the joints' movements rather than an accurate quantitative one, detailed analysis of patients' movements is hindered. The aim of this article is to determine the accuracy of the Kinect's joint tracking. To fulfill this task, a model of upper body was fabricated. The displacements of the joint centers were estimated by Kinect at different positions and were then compared with the actual ones from measurement. Moreover, the dependency of Kinect's error on distance and joint type was measured and analyzed. IMPLICATIONS FOR REHABILITATION: It measures and reports the accuracy of a sensor that can be directly used for monitoring physical therapy exercises. Using this sensor facilitates remote rehabilitation.

Mocan, M., et al. (2021). "Cardiac Rehabilitation Early after Sternotomy Using New Assistive VR-Enhanced Robotic Exoskeleton-Study Protocol for a Randomised Controlled Trial." International Journal of Environmental Research & Public Health [Electronic Resource] 18(22): 11922.
	(1) Background and objective: Cardiac rehabilitation (CR) means delivering health education by structured exercises with the means of risk reduction, in a cost-effective manner. Well-conducted CR improves functional capacity, decreases re-hospitalization, and reduces mortality up to 25%. We bring to attention the protocol of a randomised control trial with the aim of validating the prototype of an assistive upper-body robotic exoskeleton system enhanced with a non-immersive virtual reality exergame (CardioVR-ReTone) in patients who undergone cardiac surgery. (2) Methods: Description of the CardioVR-ReTone system and the technical specification, followed by the group selection, randomization and evaluated variables. (3) Expected results: The primary outcome measurement is the modification of life quality at the end of the CR exercise training program. Secondary outcomes will encompass measurements of sternal stability, muscular activity, cardiac response to exercise, pain level and compliance/adherence to CR. (4) Conclusions: Implementing these novel features of the CardioVR-ReTone system, addressability, and efficacy of CR, so problematic in certain situations and especially in cardiac surgery, will be greatly facilitated, being independent of the skills and availability of the rehabilitation therapist.

Molina, K. I., et al. (2014). "Virtual reality using games for improving physical functioning in older adults: a systematic review." J Neuroeng Rehabil 11: 156.
	The use of virtual reality through exergames or active video game, i.e. a new form of interactive gaming, as a complementary tool in rehabilitation has been a frequent focus in research and clinical practice in the last few years. However, evidence of their effectiveness is scarce in the older population. This review aim to provide a summary of the effects of exergames in improving physical functioning in older adults. A search for randomized controlled trials was performed in the databases EMBASE, MEDLINE, PsyInfo, Cochrane data base, PEDro and ISI Web of Knowledge. Results from the included studies were analyzed through a critical review and methodological quality by the PEDro scale. Thirteen studies were included in the review. The most common apparatus for exergames intervention was the Nintendo Wii gaming console (8 studies), followed by computers games, Dance video game with pad (two studies each) and only one study with the Balance Rehabilitation Unit. The Timed Up and Go was the most frequently used instrument to assess physical functioning (7 studies). According to the PEDro scale, most of the studies presented methodological problems, with a high proportion of scores below 5 points (8 studies). The exergames protocols and their duration varied widely, and the benefits for physical function in older people remain inconclusive. However, a consensus between studies is the positive motivational aspect that the use of exergames provides. Further studies are needed in order to achieve better methodological quality, external validity and provide stronger scientific evidence.

Molina-Cantero, A. J., et al. (2021). "A Study on Physical Exercise and General Mobility in People with Cerebral Palsy: Health through Costless Routines." International Journal of Environmental Research & Public Health [Electronic Resource] 18(17): 31.
	Sedentary behavior (SB) is a common problem that may produce health issues in people with cerebral palsy (CP). When added to a progressive reduction in motor functions over time, SB can lead to higher percentages of body fat, muscle stiffness and associated health issues in this population. Regular physical activity (RPA) may prevent the loss of motor skills and reduce health risks. In this work, we analyzed data collected from 40 people (20 children and teenagers, and 20 adults) who attend two specialist centers in Seville to obtain an up-to-date picture regarding the practice of RPA in people with CP. Roughly 60% of the participants showed mostly mid/severe mobility difficulties, while 38% also had communicative issues. Most of the participants performed light-intensity physical activity (PA) at least once or twice a week and, in the majority of cases, had a neutral or positive attitude to exercising. In the Asociacion Sevillana de Paralisis Cerebral (ASPACE) sample test, the higher the International Classification of Functioning, Disability and Health (ICF), the higher the percentage of negative responses to doing exercise. Conversely, in the Centro Especifico de Educacion Especial Mercedes Sanroma (CEEEMS), people likes PA but slightly higher ratios of positive responses were found at Gross Motor Function Classification System (GMFCS) levels V and II, agreeing with the higher personal engagement of people at those levels. We have also performed a literature review regarding RPA in CP and the use of low-cost equipment. As a conclusion, we found that RPA produces enormous benefits for health and motor functions, whatever its intensity and duration. Costless activities such as walking, running or playing sports; exercises requiring low-cost equipment such as elastic bands, certain smartwatches or video-games; or therapies with animals, among many others, have all demonstrated their suitability for such a purpose.

Molina-Torres, G., et al. (2021). "Game-Based Learning Outcomes Among Physiotherapy Students: Comparative Study." JMIR Serious Games 9(1): e26007.
	BACKGROUND: University teaching methods are changing, and in response to a classical teacher-centered approach, new methods continue to strengthen knowledge acquisition by involving students more actively in their learning, thus achieving greater motivation and commitment. OBJECTIVE: This study aimed to analyze the degree of satisfaction of physiotherapy students who used a board game-based approach, as well as to compare the difference between traditional and gamification teaching methods and their influence on the final evaluation of these students. METHODS: A comparative study was conducted. Participants were physiotherapy students who were enrolled in the subject of "physiotherapy in geriatric and adult psychomotricity" (n=59). They were divided into two groups (experimental [n=29] and control [n=30] groups) through convenience sampling. The experimental group received gamification lessons, where the students performed different tests adapted from Party&Co, and the control group received traditional lessons. A total of 16 theoretical lessons were received in both groups. RESULTS: The scores in the final examination of the subject were higher in the experimental group (mean 7.53, SD 0.95) than in the control group (mean 6.24, SD 1.34), showing a statistically significant difference between the two groups (P=.001). CONCLUSIONS: Overall, the "Physiotherapy Party" game not only stimulated learning and motivated students, but also improved learning outcomes among participants, and the improvements were greater than those among students who received traditional teaching.

Molina-Torres, G., et al. (2021). "Escape Room vs. Traditional Assessment in Physiotherapy Students' Anxiety, Stress and Gaming Experience: A Comparative Study." International Journal of Environmental Research & Public Health [Electronic Resource] 18(23): 03.
	Escape Rooms can serve multiple academic and educational purposes and can be used as part of the evaluation of a learning program. The aim of this study was to analyze the levels of anxiety and stress perceived in the evaluation using the Escape Room compared to the traditional evaluation, as well as to analyze the gaming experience. METHODS: A comparative study was carried out in students of the Degree in Physiotherapy, with a total of 56 participants who underwent 2 evaluation processes. The variables analyzed were the State-Trait Anxiety Inventory, the Perceived Stress Questionnaire, and the Gaming Experience Scale. A comparative analysis was performed between the groups using the Mann Whitney U test and Student's T test. RESULTS: The levels of state-anxiety and trait-anxiety were higher in the traditional assessment group. Although no differences were found in the qualification obtained by the students, statistically significant differences were found between the two evaluation systems in terms of the overload factor, the energy factor, and the fear-anxiety factor of the perceived stress questionnaire. CONCLUSIONS: The Escape Room can be considered as an alternative to the traditional evaluation in Physiotherapy Degree students due to its lower levels of anxiety and perceived stress.

Money, A. G., et al. (2019). "Falls Sensei: a serious 3D exploration game to enable the detection of extrinsic home fall hazards for older adults." BMC Med Inform Decis Mak 19(1): 85.
	BACKGROUND: Falls are the main cause of death and injury for older adults in the UK. Many of these falls occur within the home as a result of extrinsic falls risk factors such as poor lighting, loose/uneven flooring, and clutter. Falls education plays an important role in self-management education about extrinsic hazards and is typically delivered via information leaflets, falls apps, and educational booklets. Serious games have the potential of delivering an engaging and informative alternative to traditional methods but almost exclusively, these are currently delivered as exergaming applications that focus solely on intrinsic falls risk factors. This study presents 'Falls Sensei' a first-person 3D exploration game that aims to educate older adults about extrinsic falls risk factors within the home environment. After presenting Falls Sensei, game usability and older adults' perceptions and attitudes towards using the game in practice are explored. METHODS: This study involved 15 community dwelling older adults. After playing the Falls Sensei game, participants completed a Systems Usability Scale (SUS) questionnaire and post task interview, and follow-up interviews three weeks later. Inductive and deductive thematic template analysis, informed by the Unified Theory of Acceptance and Use of Technology model, was used to analyse the think-aloud, post-task and follow-up interview transcripts. Descriptive statistical analysis and one-sampled t-tests were used to analyse log-file data and SUS responses. RESULTS: Three high-level themes emerged from the analysis of transcriptions: Performance Expectancy; Effort Expectancy; Social Influence. The SUS score was 77.5/100 which indicates 'Good' levels of usability. Interestingly, reported usability of the game increased with participant age. Participants were positive about the usability of the game (p < = 0.05 for 9/10 items). The most memorable fall hazards were those most commonly encountered in the game or those most challenging to participants. CONCLUSIONS: The results support the use of serious games as an engaging tool for educating older adults about extrinsic falls risk factors. Awareness of home hazard detection was raised by the game, and some older adults became more aware for the need to adapt their own homes after gameplay. Further research would be needed to draw comparisons with established interventions.

Monteiro-Junior, R. S., et al. (2015). "Wii-Workouts on Chronic Pain, Physical Capabilities and Mood of Older Women: A Randomized Controlled Double Blind Trial." CNS Neurol Disord Drug Targets 14(9): 1157-1164.
	Chronic Low Back Pain (CLBP) is a public health problem and older women have higher incidence of this symptom, which affect body balance, functional capacity and behavior. The purpose of this study was to verifying the effect of exercises with Nintendo Wii on CLBP, functional capacity and mood of elderly. Thirty older women (68 +/- 4 years; 68 +/- 12 kg; 154 +/- 5 cm) with CLBP participated in this study. Elderly individuals were divided into a Control Exercise Group (n = 14) and an Experimental Wii Group (n = 16). Control Exercise Group did strength exercises and core training, while Experimental Wii Group did ones additionally to exercises with Wii. CLBP, balance, functional capacity and mood were assessed pre and post training by the numeric pain scale, Wii Balance Board, sit to stand test and Profile of Mood States, respectively. Training lasted eight weeks and sessions were performed three times weekly. MANOVA 2 x 2 showed no interaction on pain, siting, stand-up and mood (P = 0.53). However, there was significant difference within groups (P = 0.0001). ANOVA 2 x 2 showed no interaction for each variable (P > 0.05). However, there were significant differences within groups in these variables (P < 0.05). Tukey's post-hoc test showed significant difference in pain on both groups (P = 0.0001). Wilcoxon and Mann-Whitney tests identified no significant differences on balance (P > 0.01). Capacity to Sit improved only in Experimental Wii Group (P = 0.04). In conclusion, physical exercises with Nintendo Wii Fit Plus additional to strength and core training were effective only for sitting capacity, but effect size was small.

Monteiro-Junior, R. S., et al. (2014). "Hemodynamic responses of unfit healthy women at a training session with nintendo wii: a possible impact on the general well-being." Clin Pract Epidemiol Ment Health 10: 172-175.
	AIMS: The purpose of this study was assess the effect of a training session with Nintendo Wii(R) on the hemodynamic responses of healthy women not involved in regular physical exercise. METHOD: Twenty-five healthy unfit women aged 28 +/- 6 years played for 10 minutes the game Free Run (Wii Fit Plus). The resting heart rate (RHR), systolic and diastolic blood pressures (SBP and DBP), and double (rate-pressure) product (DP) were measured before and after activity. The HR during the activity (exercise heart rate, EHR) was measured every minute. RESULTS: A statistically significant difference was observed between the RHR (75 +/- 9 bpm) and the mean EHR (176 +/- 15 bpm) (P < 0.001). The EHR remained in the target zone for aerobic exercise until the fifth minute of activity, which coincided with the upper limit of the aerobic zone (80% heart rate reserve (HRR) + RHR) from the sixth to tenth minute. The initial (110 +/- 8 mmHg) and final (145 +/- 17 mmHg) SBP (P < 0.01) were significantly different, as were the initial (71 +/- 8 mmHg) and final (79 +/- 9 mmHg) DBP (P < 0.01). A statistically significant difference was observed between the pre- (8.233 +/- 1.141 bpm-mmHg) and post-activity (25.590 +/- 4.117 bpm-mmHg) DP (P < 0.01). CONCLUSION: Physical exercise while playing Free Run sufficed to trigger acute hemodynamic changes in healthy women who were not engaged in regular physical exercise.

Monteiro-Junior, R. S., et al. (2016). "Exergames: neuroplastic hypothesis about cognitive improvement and biological effects on physical function of institutionalized older persons." Neural Regen Res 11(2): 201-204.
	Exergames can be considered a dual task because the games are performed by a man-videogame interface, requiring cognitive and motor functions simultaneously. Although the literature has shown improvements of cognitive and physical functions due to exergames, the intrinsic mechanisms involved in these functional changes have still not been elucidated. The aims of the present study were (1) to demonstrate the known biological mechanisms of physical exercise regarding muscle adaptation and establish a relationship with exergames; and (2) to present a neurobiological hypothesis about the neuroplastic effects of exergames on the cognitive function of institutionalized older persons. These hypotheses are discussed.

Montoya, D., et al. (2022). "Biomechanical Assessment of Post-Stroke Patients' Upper Limb before and after Rehabilitation Therapy Based on FES and VR." Sensors 22(7): 2693.
	Stroke is a medical condition characterized by the rapid loss of focal brain function. Post-stroke patients attend rehabilitation training to prevent the degeneration of physical function and improve upper limb movements and functional status after stroke. Promising rehabilitation therapies include functional electrical stimulation (FES), exergaming, and virtual reality (VR). This work presents a biomechanical assessment of 13 post-stroke patients with hemiparesis before and after rehabilitation therapy for two months with these three methods. Patients performed two tests (Maximum Forward Reach and Apley Scratching) where maximum angles, range of motion, angular velocities, and execution times were measured. A Wilcoxon test was performed (p = 0.05) to compare the variables before and after the therapy for paretic and non-paretic limbs. Significant differences were found in range of motion in flexion-extension, adduction-abduction, and internal-external rotation of the shoulder. Increases were found in flexion-extension, 17.98%, and internal-external rotation, 18.12%, after therapy in the Maximum Forward Reach Test. For shoulder adduction-abduction, the increase found was 20.23% in the Apley Scratching Test, supporting the benefits of rehabilitation therapy that combines FES, exergaming, and VR in the literature.

Moran, C. A., et al. (2019). "Heart rate agreement between the 20-meter shuttle run test and virtual system in healthy children: a cross-sectional study." BMC Pediatrics 19(1): 491.
	BACKGROUND: Earlier studies evaluated the physiological responses to video games in children with different clinical conditions; however, no study has compared active video games with an incremental field test in healthy children. The purpose of this study was to verify the agreement between the 20-m shuttle run test (20 m-SRT) and virtual system (VS). METHODS: This is a cross-sectional study of 235 children (9.0 +/- 0.8 years, 109 boys). The two tests were performed one week apart and the children were instructed not to engage in any physical exercise or sports in the 24 h preceding each test. Their resting heart rate was monitored for one minute and then throughout the tests. To evaluate the influence of motivation on the 20 m SRT and (VS), at the end of the tests the children were asked to rate their motivation on a scale of zero to 10, zero being "not cool" and 10 "awesome". Perceived exertion at the end of the tests was assessed using the modified Borg scale. RESULTS: Maximum heart rate (HRmax) did not differ between the 20 m-SRT and VS (194.4 +/- 10.2 bpm vs. 193.2 +/- 13.8 bpm, respectively). Both tests were similar for intensity > and < 96% HRmax. The children showed greater exertion on the Borg scale and motivation during the VS. The multiple logistic regression model showed that motivation (p = 0.98), sex (p = 0.53), age (p = 0.61), nutritional status (p = 0.65), and speed (p = 0.18) were not predictive factors of the child's reaching HRmax. CONCLUSION: VS can be used as a tool to evaluate the intensity of maximal exercise tests, given that the percentage of children who achieved HRmax did not differ between the VS and 20 m SRT. The perceived exertion scales were correlated, but only the modified Borg scale correlated with HRmax in the 20 m SRT. The tests are motivational, and most children obtained the maximum VS score.

Moreau, D., et al. (2017). "High-intensity training enhances executive function in children in a randomized, placebo-controlled trial." eLife 6(08): 22.
	Background: Exercise-induced cognitive improvements have traditionally been observed following aerobic exercise interventions; that is, sustained sessions of moderate intensity. Here, we tested the effect of a 6 week high-intensity training (HIT) regimen on measures of cognitive control and working memory in a multicenter, randomized (1:1 allocation), placebo-controlled trial. Methods: 318 children aged 7-13 years were randomly assigned to a HIT or an active control group matched for enjoyment and motivation. In the primary analysis, we compared improvements on six cognitive tasks representing two cognitive constructs (N = 305). Secondary outcomes included genetic data and physiological measurements. Results: The 6-week HIT regimen resulted in improvements on measures of cognitive control [BFM = 3.38, g = 0.31 (0.09, 0.54)] and working memory [BFM = 5233.68, g = 0.54 (0.31, 0.77)], moderated by BDNF genotype, with met(66) carriers showing larger gains post-exercise than val(66) homozygotes. Conclusions: This study suggests a promising alternative to enhance cognition, via short and potent exercise regimens. Funding: Funded by Centre for Brain Research. Clinical trial number: NCT03255499.
Exercise has beneficial effects on the body and brain. People who perform well on tests of cardiovascular fitness also do well on tests of learning, memory and other cognitive skills. So far, studies have suggested that moderate intensity aerobic exercise that lasts for 30 to 40 minutes produces the greatest improvements in these brain abilities. Recently, short high-intensity workouts that combine cardiovascular exercise and strength training have become popular. Studies have shown that these brief bouts of strenuous exercise improve physical health, but do these benefits extend to the brain? It would also be helpful to know if the effect that exercise has on the brain depends on an individual's genetic makeup or physical health. This might help to match people to the type of exercise that will work best for them. Now, Moreau et al. show that just 10 minutes of high-intensity exercise a day over six weeks can boost the cognitive abilities of children. In the experiments, over 300 children between 7 and 13 years of age were randomly assigned to one of two groups: one that performed the high-intensity exercises, or a 'control' group that took part in less active activities - such as quizzes and playing computer games - over the same time period. The children who took part in the high-intensity training showed greater improvements in cognitive skills than the children in the control group. Specifically, the high-intensity exercise boosted working memory and left the children better able to focus on specific tasks, two skills that are important for academic success. Moreau et al. further found that the high-intensity exercises had the most benefit for the children who needed it most - those with poor cardiovascular health and those with gene variants that are linked to poorer cognitive skills. This suggests that genetic differences do alter the effects of exercise on the brain, but also shows that targeted exercise programs can offer everyone a chance to thrive. Moreau et al. suggest that exercise need not be time consuming to boost brain health; the key is to pack more intense exercise in shorter time periods. Further work could build on these findings to produce effective exercise routines that could ultimately form part of school curriculums, as well as proving useful to anyone who wishes to improve their cognitive skills.
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Moreira, G. M., et al. (2021). "Estabilidade dinâmica de pessoas com AVE durante o movimento de cabeceio simulado em um jogo digital." Fisioterapia e Pesquisa 28(4): 369-375.
	Postural stability is a goal of physical therapy treatment which can be achieved by bilateral weight transfer exercises. Digital games come as an alternative to performing these exercises, and their evaluation still needs improvement. We proposed using biomechanical variables to assess postural stability behavior. We aimed to investigate dynamic postural stability during soccer headers simulated by a digital game with different speed requirements. For this, 16 post-stroke volunteers (12 men and 4 women with a mean age of 56 years) and 16 healthy volunteers, paired by sex and age, participated in the experimental collection, in which they were subjected to the digital game "Cabeceio" (Soccer Heading), which has five speed levels, from slowest to the fastest, lasting 30 seconds each. From the kinematic signals, we could estimate our indicators of interest: the area of the base of support and the margin of stability, the latter defined as the smallest distance between the edges of the base of support and the vertical projection of the extrapolated CM, considering CM speed. The values of the base of support failed to differ between game speed levels, but did so between groups. The margin of stability failed to differ between levels and groups. The speed levels of the game possibly failed to encourage volunteers to pursue different strategies to maintain dynamic stability, such as taking a step. Although they maintained different support bases, post-stroke individuals adopted a smaller base of support than healthy ones.
La estabilidad postural es el objetivo del tratamiento en fisioterapia que puede lograrse mediante ejercicios de traslado de peso bilateral. Los juegos digitales son una alternativa para realizar estos ejercicios, pero aún necesita mejorar su evaluación. Se propone el uso de variables biomecánicas para verificar el comportamiento de estabilidad postural dinámica durante el movimiento de cabeceo, simulado por un juego digital con diferentes requerimientos de velocidad. Para ello, 16 voluntarios pos-accidente cerebrovascular (ACV) -12 hombres y 4 mujeres, con edad media de 56 años- y 16 individuos sanos pareados por sexo y edad participaron de la recolección experimental, en la que fueron sometidos al juego digital "cabeceo", que cuenta con cinco niveles de velocidad, del más lento al más rápido, con una duración de 30 segundos cada uno. A partir de las señales cinemáticas fue posible calcular los indicadores de interés, el área de base de apoyo y el margen de estabilidad, definido como la menor distancia entre los bordes de la base de apoyo y la proyección vertical del centro de masa (CM) extrapolado, que considera la velocidad del CM. Los valores de la base de apoyo no mostraron diferencias entre niveles de velocidad de juego, pero sí entre grupos. El margen de estabilidad no difirió entre niveles y grupos. Los niveles de velocidad de juego posiblemente no animaron a los voluntarios a buscar diferentes estrategias para mantener la estabilidad, como dar un paso, pero les hicieron adoptar diferentes bases de apoyo, llevando a los individuos con ACV a emplear una base de apoyo menor que la de los individuos sanos.
A estabilidade postural é um objetivo de tratamento na fisioterapia que pode ser alcançado por meio de exercícios de transferência de peso bilateral. Os jogos digitais surgem como alternativa para execução desses exercícios, mas sua avaliação ainda necessita de aprimoramento. Propõe-se aqui o uso de variáveis biomecânicas para verificar o comportamento da estabilidade postural dinâmica durante um movimento de cabeceio, simulado por um jogo digital com diferentes exigências de velocidades. Para isso, 16 voluntários pós-acidente vascular encefálico (AVE) - 12 homens e 4 mulheres, com idade média de 56 anos - e 16 hígidos pareados por sexo e idade participaram da coleta experimental, na qual eles foram submetidos ao jogo digital "cabeceio", que tem cinco níveis de velocidade, do mais lento ao mais rápido, com duração de 30 segundos cada. A partir dos sinais cinemáticos foi possível calcular os indicadores de interesse, a área da base de suporte e a margem de estabilidade, definida como a menor distância entre as bordas da base de suporte e a projeção vertical do centro de massa (CM) extrapolado, que considera a velocidade do CM. Os valores da base de suporte não apresentaram diferenças entre os níveis de velocidade do jogo, mas sim entre grupos. A margem de estabilidade não diferiu entre níveis e grupos. Os níveis de velocidade do jogo, possivelmente, não estimularam os voluntários a buscar estratégias diferentes para manter a estabilidade, como dar um passo, mas os fizeram adotar bases de suporte diferentes, sendo que indivíduos com AVE adotaram uma base de suporte menor do que a dos hígidos.

Moret, B., et al. (2021). "Cognitive exergame training and transcranial random noise stimulation effects on executive control in healthy young adults." Neuropsychology 35(5): 568-580.
	Objective: In the present study, we investigated the efficacy of transcranial random noise stimulation (tRNS) combined with an exergame training (physical exercise combined with a videogame) chosen as potential techniques to boost brain functioning and to promote plastic effects in healthy young adults. The aim was to improve the motor response speed and the response time when inhibition was required. Method: Forty-nine participants were randomly assigned to four conditions. The protocol consisted of eight sessions of exergame cognitive training (or no training) associated with the active or sham stimulation of the left dorsolateral prefrontal cortex (left-DLPFC). Results: The results indicated faster simple reaction times following the exergame training, and faster reaction times in Go trials (while the ratio of NoGo trials remained unaltered) following tRNS. No interactions were present between the two procedures. Conclusions: These findings reveal better performance in both tasks with independent effects of the two techniques. Using noninvasive brain stimulation and exergame training may be a viable strategy to increase motor response speed and improve executive control. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Morone, G., et al. (2014). "The efficacy of balance training with video game-based therapy in subacute stroke patients: a randomized controlled trial." BioMed Research International 2014: 580861.
	The video game-based therapy emerged as a potential valid tool in improving balance in several neurological conditions with controversial results, whereas little information is available regarding the use of this therapy in subacute stroke patients. The aim of this study was to investigate the efficacy of balance training using video game-based intervention on functional balance and disability in individuals with hemiparesis due to stroke in subacute phase. Fifty adult stroke patients participated to the study: 25 subjects were randomly assigned to balance training with Wii Fit, and the other 25 subjects were assigned to usual balance therapy. Both groups were also treated with conventional physical therapy (40 min 2 times/day). The main outcome was functional balance (Berg Balance Scale-BBS), and secondary outcomes were disability (Barthel Index-BI), walking ability (Functional Ambulation Category), and walking speed (10-meters walking test). Wii Fit training was more effective than usual balance therapy in improving balance (BBS: 53 versus 48, P = 0.004) and independency in activity of daily living (BI: 98 versus 93, P = 0.021). A balance training performed with a Wii Fit as an add on to the conventional therapy was found to be more effective than conventional therapy alone in improving balance and reducing disability in patients with subacute stroke.

Morri, M., et al. (2019). "Effect of Game Based Balance Exercises on Rehabilitation After Knee Surgery: A Controlled Observational Study." Journal of Medical Systems 43(5): 141.
	Does a rehabilitation protocol based on balance exercises using Serious Game improve walk performance in patients undergoing knee resection and reconstruction for bone primary tumor?. 30 patients undergoing modular prosthetic replacement, following a primary bone tumor, were consecutively enrolled. During each hospitalization a physiotherapy treatment was activated, included 25 min training phase aimed postural and proprioceptive control. In order to better evaluate the walking speed at one-year post surgery in the study group, data were compared with a group of 22 patients treated in a previous period, called the control group, collected retrospectively. The control group differed only for the type of physiotherapy treatment offered. No statistically significant differences emerged from the two groups, regarding baseline characteristics. Walking speed in the study group was improved compared to the control group with a median difference of 0.22 m/s (p = 0.022). A difference was also measured in the speed of centre mass, with a median reduction of 4.5 mm/s (p = 0.005) in the study group, showing an improvement in postural control in stand-up position. Exercises aimed at recovering balance and Serious Game should be proposed in order to improve motor performance and postural control in the medium and long term.

Morris, M., et al. (2018). "Home based exercises to reduce falls in people with Parkinson's disease: a randomized trial." Movement disorders 33: S130‐.
	Objective: To measure the outcomes of a six week, twice weekly, home physiotherapy exercise and falls education program on falls, mobility and quality of life in people with Parkinson's disease (PD). Background: Worldwide, there is a shift away from hospitalisation, towards home based therapy for people with chronic diseases. The dosage of home based physiotherapy to achieve positive outcomes in PD is untested. Methods: We conducted a randomized trial of 133 people living in their own homes with idiopathic Parkinson's. Participants were randomly allocated to a 6‐week exercise group receiving strategy training, strength training and falls education, or a 6‐week control group. The control participants received a non‐specific program of games and general information. Each group had weekly sessions led by a physiotherapist or trained clinician plus a self‐guided home program once per week. Falls over 12 months were the main outcome. Mobility and quality of life were secondary outcomes. Results: We recorded over 2200 falls over the year following therapy. No statistically significant differences in slips, trips or falls occurred for the two groups (IRR 1.6, 95% CI 0.7‐3.4) (Morris et al., 2017). The survival analysis for the time to first fall was also comparable (log‐rank test Χ2 = 0.79, p =.37) (Morris et al., 2017). Betweengroup differences were negligible for disability and quality of life. Conclusions: Providing people with PD with 6 weeks of homebased physiotherapy did not change falls rates or mobility outcomes compared to a control group. The dosage was arguably not enough to provide people with PD with sufficient practice for motor learning or falls prevention.

Morrison, C. W. (1970). "Physiotherapy at the IXth British Commonwealth Games." Physiotherapy 56(11): 507-508.
	
Moscon, A. C., et al. (2018). "Proximal tibiofibular joint dislocation treated using flexible and permanent syndesmosis fixation." BMJ Case Reports 2018: 1-4.
	We present the case of a 40-year-old man who suffered an isolated proximal tibiofibular dislocation of the left knee after a trauma during a soccer game. Physical examination and radiographic imaging revealed an anterolateral dislocation of the proximal fibula. The diagnosis was confirmed by MRI. The treatment choice was open reduction and internal fixation under direct visualisation using flexible and permanent internal fixation. Postoperative treatment includes knee immobilisation during the first week, and partial weight was allowed for 2 weeks progressing to full weight bearing over 4 weeks. The patient started a gradual and progressive physical therapy programme with range of motion exercises, muscle strengthening and gait training. Full knee range of motion was achieved after 4 weeks. No complaint of pain or hardware discomfort was reported, and the patient is back to daily life and sports activities after 6 months of surgical treatment.

Mosesson, J. (1998). "World view. A Gaijin PT at the 1998 Winter Olympic Games." PT: Magazine of Physical Therapy 6(7): 12-14.
	
Mugisha, S., et al. (2022). "Improving Haptic Response for Contextual Human Robot Interaction." Sensors 22(5): 2040.
	For haptic interaction, a user in a virtual environment needs to interact with proxies attached to a robot. The device must be at the exact location defined in the virtual environment in time. However, due to device limitations, delays are always unavoidable. One of the solutions to improve the device response is to infer human intended motion and move the robot at the earliest time possible to the desired goal. This paper presents an experimental study to improve the prediction time and reduce the robot time taken to reach the desired position. We developed motion strategies based on the hand motion and eye-gaze direction to determine the point of user interaction in a virtual environment. To assess the performance of the strategies, we conducted a subject-based experiment using an exergame for reach and grab tasks designed for upper limb rehabilitation training. The experimental results in this study revealed that eye-gaze-based prediction significantly improved the detection time by 37% and the robot time taken to reach the target by 27%. Further analysis provided more insight on the effect of the eye-gaze window and the hand threshold on the device response for the experimental task.

Mugueta-Aguinaga, I. and B. Garcia-Zapirain (2017). "Is Technology Present in Frailty? Technology a Back-up Tool for Dealing with Frailty in the Elderly: A Systematic Review." Aging & Disease 8(2): 176-195.
	This study analyzes the technologies used in dealing with frailty within the following areas: prevention, care, diagnosis and treatment. The aim of this paper is, on the one hand, to analyze the extent to which technology is present in terms of its relationship with frailty and what technological resources are used to treat it. Its other purpose is to define new challenges and contributions made by physiotherapy using technology. Eighty documents related to research, validation and/or the ascertaining of different types of hardware, software or both were reviewed in prominent areas. The authors used the following scales: in the area of diagnosis, Fried's phenotype model of frailty and a model based on trials for the design of devices. The technologies developed that are based on these models accounted for 55% and 45% of cases respectively. In the area of prevention, the results proved similar regarding the use of wireless sensors with cameras (35.71%), and Kinect sensors (28.57%) to analyze movements and postures that indicate a risk of falling. In the area of care, results were found referring to the use of different motion, physiological and environmental wireless sensors (46,15%), i.e. so-called smart homes. In the area of treatment, the results show with a percentage of 37.5% that the Nintendo((R)) Wii console is the most used tool for treating frailty in elderly persons. Further work needs to be carried out to reduce the gap existing between technology, frail elderly persons, healthcare professionals and carers to bring together the different views about technology. This need raises the challenge of developing and implementing technology in physiotherapy via serious games that may via play and connectivity help to improve the functional capacity, general health and quality of life of frail individuals.

Muhammad, F., et al. (2016). "Risk Factors of Childhood Obesity and Overweight in Young Children and Adolescents Aged Between 5 to 15 Years in Urban Bangladesh: A Scoping Review." Malaysian Journal of Nutrition 22(3): 455-459.
	Introduction: Childhood obesity is one of the most serious public health challenges of the 21st century. The problem is global and is steadily affecting many low- and middle-income countries, particularly in urban settings. Risk factors for obesity in this context have not been explored. The objective of this study was to identify the risk factors associated with childhood obesity/overweight among young children and adolescents 5-15 years of age in urban Bangladesh. Methods: A scoping review based on York methodology was performed. This methodology involves a comprehensive search of published academic articles, conference proceedings and grey literature through PubMed, Bangla JOL, Google and Google scholar, limited to English-written papers. Results: Findings revealed that having at least one overweight parent and engaging in sedentary activities for more than 4 h a day were independent risk factors for childhood overweight and/or obesity.Children who spent ≥ 30 min each day in outdoor games at home that involved physical exercise had decreased odds (OR = 0.38, 95% CI: 0.1–0.8) of being overweight or obese compared to children who did not exercise at home. Conclusion: Spending much time seated or somewhat inactive were key risk factors for childhood obesity and overweight. More research, prevention and management of childhood obesity/overweight in young children and adolescents in urban Bangladesh should be a policy priority.

Mulligan, N. F., et al. (2014). "Balance Retraining in Community-Dwelling Older Adults." Topics in Geriatric Rehabilitation 30(2): 117-126.
	Objectives: To review the literature that describes effective intervention strategies to improve balance in older community-dwelling adults. Data Sources: CINAHL, PubMed, Cochrane, and Cochrane Center Register for Controlled Trial Databases. Review Methods: A search of the terms 'balance and exercise,' 'fall risk and exercise,' 'fall risk and physical therapy,' and 'balance and rehabilitation' in Community Index to Nursing and Allied Health Literature (CINAHL) and PubMed. Interventions must be able to be reproduced in standard rehabilitation practice or at home or easily in the community recreation center. Results: The literature is robust with reports that describe the benefits and limitations of balance retraining exercises programs, most in combination with other objectives such as strength training, mobility improvement, functional improvement, and fall prevention within the timeframe of 2000 to 2013. Randomized controlled trial studies are becoming more evident in the literature and assist with greater generalizability; however, much more study is warranted to understand priorities of intervention selection, dosing, duration, and sensitive outcome measures. Conclusion: Multicomponent exercise programs that specifically address the older adult's physical impairments based on a therapist evaluation is more effective in promoting increased strength, balance, and fall prevention than general, nonspecific approaches. This individualized approach, whether conducted in a health care facility or at home guided specifically by a rehabilitation clinician, will result in more immediate gains. This may also improve the long-term compliance that is needed for long-term balance improvement, fall prevention, and maximizing physical function in older adults. Rehabilitation professionals should consider expanding their role in prevention and ongoing primary care practices that monitor the physical function of older adults on a routine basis to assist in optimal aging.

Mumford, N. and P. H. Wilson (2009). "Virtual reality in acquired brain injury upper limb rehabilitation: evidence-based evaluation of clinical research." Brain Injury 23(3): 179-191.
	PRIMARY OBJECTIVE: Acquired brain injury (ABI) is associated with significant cognitive, behavioural, psychological and physical impairment. Hence, it has been important to leverage assessment approaches in rehabilitation by using current and emerging technologies, including virtual reality (VR). A number of VR rehabilitation programmes have been designed in recent years, mainly to improve upper limb function. However, before this technology gains widespread use, evaluation of the scientific evidence supporting VR-assisted rehabilitation is needed. The present review aimed to assess the rationale, design and methodology of research investigating the clinical impact of VR on ABI upper-limb rehabilitation. RESEARCH DESIGN: A total of 22 studies were surveyed using a Cochrane-style review. RESEARCH METHODS: Studies were classified on a number of key criteria: theoretical bases and aims, sample populations and recruitment procedures, characteristics of the VR systems, evaluation design including control procedures and statistical analysis of results. Studies were rated using the Downs and Black (DB) scale. RESULTS: The review demonstrated that few studies used a conventional randomized controlled study design. Moderate support was shown for both teacher-animation and game-like systems. CONCLUSION: While VR-assisted rehabilitation shows early promise, clinicians are advised to be cautious about adopting these technologies before adequate data is available.

Murphy, J. K., et al. (1986). "Race and cardiovascular reactivity. A neglected relationship." Hypertension 8(11): 1075-1083.
	The magnitude of the cardiovascular response to stress has been implicated in the pathogenesis of cardiovascular disease. Psychological stress procedures have received increased usage as an alternative to expensive physical (exercise) stress procedures. In the present investigation, 213 healthy, black or white, male or female children between the ages of 6 and 18 years were exposed to the psychological stress of a video game. The video game challenge was administered by a black or a white experimenter and was played under three levels of increasing stress, 1) personal challenge, 2) experimenter's challenge, and 3) experimenter's challenge accompanied by a financial incentive, while blood pressure and heart rate were monitored. Results indicated that the video games provoked significant and incremental cardiovascular reactivity across the games. Black children demonstrated significantly greater reactivity than white children; the racial difference was more reliably observed for systolic and diastolic blood pressure than for heart rate. Furthermore, the race of the experimenter exerted a significant effect and often interacted with the race of the child, such that greater reactivity occurred in same-race pairings than in mixed-race pairings. These results suggest that reactivity is affected by an individual's race and social milieu and that reactivity may be one mechanism responsible for the greater prevalence of hypertension among blacks.

Muther, M., et al. (2014). "Impact of the 2012 London Olympic and Paralympic Games on physical activity of rheumatology patients." J Clin Rheumatol 20(7): 376-378.
	BACKGROUND: Lack of physical activity in the general population is one of the biggest health challenges we face. For rheumatology patients, and other patients with chronic disease, exercise is an essential part of disease management. However, very few patients exercise effectively.One of the aspirations of the London 2012 Olympic/Paralympic Games was to catalyze people into long-term physical activity. METHODS: We surveyed our rheumatology patients at 3 high-profile times in the year after the Olympics. RESULTS: Two hundred fifty-three patients were enrolled within the study; the largest diagnosis subgroup being rheumatoid arthritis (36%). Ninety-five percent of our patients regard exercise as beneficial; 36% still think it does harm. Most common barriers to exercise were pain (53%), tiredness (44%), and lack of time (36%). Forty-five percent exercise daily, mostly just walking. Twnety-seven patients (16%) were motivated by the 2012 Olympic and Paralympic Games toward physical activity. They were mostly motivated by athletics' individual stories (67%), taking part in a big sports festival (11%) and demonstration of top sporting levels (4%). Eighteen patients in total (7%) increased their amount of exercise in response to the London 2012 Olympic and Paralympic Games. There was no difference between patient diagnostic groups. CONCLUSIONS: Only a small minority of patients increased their amount of exercise in response to the 2012 Olympic and Paralympic Games. The message about the importance of physical exercise to health needs to be clear, unambiguous, and consistent, because a significant number of patients still think that physical activity does harm. Big sporting events such as the London 2012 Olympic and Paralympic Games can be used as an opportunity to remind patients that physical activity does good and is not harmful. Athletes' individual stories could be used in future as part of a strategy to encourage exercise for all patients.

mx7jx, R. B. R. (2017). "Effects of using Nintendo Wii® video game in patients with Parkinson's disease to study upper limb function." https://trialsearch.who.int/Trial2.aspx?TrialID=RBR-4mx7jx.
	INTERVENTION: H02.403.680 Non‐immersive virtual reality training (Experimental Group) The experimental group will consist of 15 individuals. Patients will perform two sessions to familiarize themselves with the Nintendo Wii®. The training will last three months, totaling 24 sessions distributed in two weekly sessions with 60 minutes each, directed to the Nintendo Wii Sports Resort® (Canoeing, Table Tennis, Bowling and Sword Play), Super Monkey Bool®, Wii Play® (Mobile target shooting), Deca Sports® (tennis) and Sports Resort (Golf)®games practice. The volunteers will perform bilateral movements in some games and in other games they will perform unilateral movements. The participants will be asked to use their dominant upper limb alternatively with their non‐dominant upper limb. The training will begin with the dominant upper limb and after seven and a half minutes using the dominant limb, volunteers will begin training with the non‐dominant limb, which will also last seven minutes. During the sessions, if necessary, the volunteer can rest, but the time will not be interrupted. In summary, on the first sitting of each week, four games will be used: Nintendo Wii Sports Resort® (Canoeing, Table Tennis, Bowling and Sword Play). At the second session of each week, the games will be: Super Monkey Bool®, Wii Play® (mobile target shooting), Deca Sports 2® (tennis) and Wii Sports Resort (Golf)®. Each game will last for 15 minutes. After each training period an evaluation using clinical outcomes will be performed. After 4 weeks of the research completion, the tests will be applied again to evaluate the possible retention effect caused by the physical training with non‐immersive VR. Conventional Physiotherapy for upper limbs (Control Group) The control group will consist of 15 individuals. Volunteers will perform the conventional physiotherapy training, following the protocol especially structured for them. The training will take three months, totalling 24 sessions distributed in two weekly me CONDITION: C10.228.140.079.862.500 F01.145.632 H02.010.625 Parkinson's disease, motor activity, physical therapy (specialty) ; C10.228.140.079.862.500 ; H02.010.625 ; F01.145.632 PRIMARY OUTCOME: To analyze on the previous and post training period the following variables: quality of life, stage of disease, functionality of upper limbs and manual dexterity, using the questionnaire PDQ‐39, UPDRS, TEMPA and nine hole peg test, respectively. To verify the efficiency of the protocol based on non‐immersive virtual reality as a therapeutic tool to improve upper limb' functionality in patients with Parkinson's disease. SECONDARY OUTCOME: We do not have secondary outcomes INCLUSION CRITERIA: Individuals must be between 60 and 70 years old of both genders.To present a diagnosis of Parkinson's disease classified in stages 2, 2,5 and 3 of the modified scale of Hoehn and Yahr , obtaining more than 13 points in the Mini‐Mental State Examination (MMSE) For illiterate, 18 points for low or medium education and 26 for education above 9 years, be able to copy the pentagon and must be without physiotherapy treatment for at least 3 months prior to the training program.

Na (2014). "Abstracts." Journal of Burn Care & Research 35: S60-S208.
	Introduction: Commercially available, interactive video games used clinically in burn rehabilitation have been shown to facilitate functional range of motion (ROM) but their efficacy with burn patients has not yet been proven. This pilot prospective, randomized controlled trial was conducted to investigate whether rehabilitation with interactive video games is more effective than traditional physical therapy in recovery of ROM after burn injury. Methods: School aged children (N=17) with limited shoulder ROM from burn injury were randomized to receive therapy using standard ROM activities (ST) or interactive video games (VG). Patients received 3 weeks of the designated therapy intervention twice/ day. They were then given a home program of either video games or standard exercises to do regularly for 6 months. Standard goniometry and 3D motion analysis during functional tasks were used to assess ROM at baseline, 3 weeks, 3 months and 6 months. Pain was measured before and after each treatment session during the 3 week intervention. Linear mixed models and correlations were used to analyze data. Results: Demographic data is reported in Table 1. Patients in both the ST and VG groups showed significant improvement in shoulder flexion (p<.001), shoulder abduction (p<.001), shoulder external rotation (p=.01), shoulder internal rotation (p=.05), and elbow flexion (p=.01) range of motion from baseline to 6 months as measured with goniometry. Subjects in both groups also showed significant gains in elbow flexion (p=.04) and shoulder flexion (p=.06) during the task of hand to head and shoulder flexion during high reach (p=.04). There was no difference in ROM gains between the groups. VG subjects had less pain over time during the intervention compared to ST subjects (VG r=‐0.044, ST r=.073, p=.08). Conclusions: This pilot study is the first prospective randomized controlled trial to evaluate the therapeutic efficacy of using video games throughout a 6 month course of rehabilitation with burn patients. Therapy with interactive video games resulted in similar improvements in ROM and function as traditional therapy and subjects showed less pain over time with video game therapy. Interactive video games are a useful adjunct to therapy and should be considered for home use following hospital discharge to maintain ROM after burn injury.

Natali, F., et al. (2020). "Enriched environment or enriched therapy? Time for clarification." Physiother Theory Pract 36(11): 1175-1178.
	
Nathan, D., et al. (2015). "Estimating physical activity energy expenditure with the Kinect Sensor in an exergaming environment." PLoS ONE [Electronic Resource] 10(5): e0127113.
	Active video games that require physical exertion during game play have been shown to confer health benefits. Typically, energy expended during game play is measured using devices attached to players, such as accelerometers, or portable gas analyzers. Since 2010, active video gaming technology incorporates marker-less motion capture devices to simulate human movement into game play. Using the Kinect Sensor and Microsoft SDK this research aimed to estimate the mechanical work performed by the human body and estimate subsequent metabolic energy using predictive algorithmic models. Nineteen University students participated in a repeated measures experiment performing four fundamental movements (arm swings, standing jumps, body-weight squats, and jumping jacks). Metabolic energy was captured using a Cortex Metamax 3B automated gas analysis system with mechanical movement captured by the combined motion data from two Kinect cameras. Estimations of the body segment properties, such as segment mass, length, centre of mass position, and radius of gyration, were calculated from the Zatsiorsky-Seluyanov's equations of de Leva, with adjustment made for posture cost. GPML toolbox implementation of the Gaussian Process Regression, a locally weighted k-Nearest Neighbour Regression, and a linear regression technique were evaluated for their performance on predicting the metabolic cost from new feature vectors. The experimental results show that Gaussian Process Regression outperformed the other two techniques by a small margin. This study demonstrated that physical activity energy expenditure during exercise, using the Kinect camera as a motion capture system, can be estimated from segmental mechanical work. Estimates for high-energy activities, such as standing jumps and jumping jacks, can be made accurately, but for low-energy activities, such as squatting, the posture of static poses should be considered as a contributing factor. When translated into the active video gaming environment, the results could be incorporated into game play to more accurately control the energy expenditure requirements.

nckrq, R. B. R. (2016). "Effects of physiotherapy assisted by virtual games in the recovery of daily activities and well-being of patients with kidney disease on hemodialysis." https://trialsearch.who.int/Trial2.aspx?TrialID=RBR-9nckrq.
	INTERVENTION: E02.831 E02.870.300 F04.754.137.506.662 Sample size were calculated based on the functional capacity assessed by previous studies using a power of 0.95, with a 1.19 effect size and a 0.05 alpha. Thus 40 patients will be recruited, 20 for each study group. Eligible participants will be selected and recruited in your dialysis unit, they will be randomly assigned to two groups (intervention and control) .The patients assigned to the control group will maintain its conventional treatment which involves dialysis 3 times a week, for average 4 hours. It is noteworthy that this group does not perform any physical exercise during or after replacement therapy. Conversely, patients allocated to the intervention group will start physical training program during dialysis sessions within the first two hours of therapy. They will practice exercise for 12 weeks with a frequency of three times a week and initial duration of 30 minutes progressing to 60 minutes of exercise. The protocol will follow the principles of subjectivity, overload and reversibility, according to the patient assessment. The training program will consist of aerobic exercise as the cycle ergometer and the race simulation by Nintendo Wii and resistance exercises in which the movements associated with virtual reality games will be held with the use of sand leggings weighing about 0.5 kg to 2kg and Thera‐Band® with different color‐coded levels of resistance. The whole exercise will be done with upper limb without the arteriovenous fistula and both lower limbs, with the individual kept in the sitting position. The intensity will be individualized based on the perceived exertion Borg scale (respecting the perception threshold in the range 13 or less), heart rate training should stay within 50‐75% of maximum heart rate and measurements of blood pressure (measured by sphygmomanometer). CONDITION: Chronic kidney disease, end‐stage renal disease, hemodialysis ; N18.0 ; E02.870.300 E02.870.300 N00‐N99 PRIMARY OUTCOME: Questionnaire Duke Activity Status Index (DASI) was applied to evaluate the perception of the individual as their functionality. There is no cut‐off point for the analysis of this questionnaire were therefore considered their total value and the average of each group making a comparison using independent t test for the presence of statistical differences. Each question answered positively sum equivalent points in METs to the activities that he can develop. The higher the score, the greater the functional capacity. This score ranges from zero to 58.2. Sample size estimates were calculated between the intervention and control groups based on the functional capacity assessed by previous studies using a power of 0.95, with a 1.19 effect size and a 0.05 alpha.; The first functional variable was the gait speed test which followed the classification proposed by SCHMID et al. (2007) in which the individual was considered with full ambulation capacity in the community> 0.8 m/s. Changes between 0.1 and 0.2 m/s seems to be clinically important according to previous studies. The next functional test was Time Up and Go (TUG). Following the recommendations of Roshanravan et al. (2013) the individual was considered fast if accomplished the performance with a time <12 seconds and slow> 12 sec; Every 1 second longer was associated with an 8% increase in risk of death (95% CI, 1%, 14%). To assess depression we used the screening scale for depressive symptoms ‐ Center for Epidemiological ‐Depression Scale (CES‐D). Originally, the CES‐D scale cutoff point for identifying the presence of depressive symptoms is ?16 points, but their use in chronic renal patients demonstrates that a ? cutoff 18 points present a better diagnostic accuracy (NOVAK et al. , 2010). To evaluate the quality of life, we used the questionnaire Kidney Disease Quality Of Life‐Short Form (KDQOL‐SFTM 1.3) according to the recommendations of the Working Group KDQOL. The scores of questions were generated by the standard tool by the group and available at Excel. The means will be compared between groups for verification of statistical differences within each domain. A 5‐point cutoff point intra‐group for each domain was used to assess the clinical relevance. SECONDARY OUTCOME: Adverse effects will be investigated descriptively throughout the study in both groups. Analysis of Blood Pressure: All monitoring will be based on V Guideline for Ambulatory Blood Pressure (2011). The results will be assessed by the mean and compared between groups. ; Analysis of Heart Rate Variability (HRV): patients will be instrumented with a heart rate monitor (Polar RS800CX) and a pickup belt is positioned in the distal third of the sternum, allowing the recording of heart rate (HR) .The results will be evaluated by the average and comparison between groups. ; Hospitalization and mortality from various causes within 12 weeks of follow‐up of the individual. INCLUSION CRITERIA: Volunteer both genders; older than 18 years; sedentary; performing hemodialysis three times per week for at least three months; stable clinical condition in terms of no hospitalizations or cardiovascular events within the 3 months prior to screening; Systolic blood pressure (SBP) <200 mmHg and diastolic blood pressure (DBP) <110 mmHg at baseline.

Nct (2008). "Effectiveness of Virtual Reality Exercises in STroke Rehabilitation (EVREST)." https://clinicaltrials.gov/show/NCT00692523.
	A pilot, randomized (1:1) controlled trial to compare the safety and feasibility of Nintendo Wii gaming versus other recreational therapy activities (playing cards) in post‐stroke patients. All patients will continue to receive all other standard medical and physiotherapy treatments while in the study.

Nct (2009). "Brain Computer Interface (BCI) Based Robotic Rehabilitation for Stroke." https://clinicaltrials.gov/show/NCT00955838.
	The proposed rehabilitation device is the first neuro‐rehabilitation system which combines non‐invasive BCI and robotic rehabilitation for the paralysed stroke upper extremity within 6 months of stroke.Spontaneous recovery after stroke takes place over the first 6‐12 months after stroke. The first 3‐6 months are the most crucial periods as this is the period of maximal neurological recovery and neuroplasticity. Differential rates of recovery occur for various types of impairments post‐stroke. In general, motor functions (mobility, walking, upper limb function, activities of daily living (ADL)) recover faster than cognitive or language impairments which may recover over 12 months. A number of approaches to stroke injury rehabilitation have been introduced to facilitate intrinsic recovery or aid adaptive compensation for stroke‐related impairments. Generally for rehabilitative training to be effective, it must be commenced as early as possible after stroke. Current research proves that rehabilitation using traditional neuro‐facilitation approaches is effective in improving neurological and functional recovery and is superior to no treatment or nursing care alone. Rehabilitated patients have shorter total hospitalization stays, lower complication rates, earlier and higher rates of discharge home than patients who do not receive rehabilitation. In addition, rehabilitation involving a multidisciplinary team approach led by rehabilitation physician or specialist result in better functional outcomes compared to acute general ward‐based therapies. In order for rehabilitation to be effective in modifying cortical neuroplasticity, it must be targeted at the specific stroke impairment, task specific, exercise must be repetitive and intensive, goal directed and command the attention of the stroke patient. Some of the components of rehabilitation include physical therapy, gait and balance training, aerobic conditioning, functional Activities of Daily Living (ADL) training, physical modalities to treat pain, Functional Electrical Stimulation (FES) or Neuro‐Muscular Electrical Stimulation (NMES). Other methods include specific treatments to address complications of rehabilitation such as spasticity, ataxia, contractures and bladder or bowel incontinence. Often, one‐to‐one and highly labour‐intensive and expensive therapies with close hand‐over‐hand treatments are required. Limitations of current physiotherapy and occupational therapy techniques include the following:(1) Difficulties in rehabilitation for the severely paralysed arm and hand which are often treated with passive modalities such as NMES, passive ROMs and other modalities. (2) Difficulties in achieving intensive rehabilitation and high repetitions in those with moderate to severe upper extremity paralysis either due to non participation or pain which is commoner in those with severe paralysis. (3)Problems in motivating and sustaining patient interest in repetitive exercises.(4)Therapy is often perceived to be boring and due to lack of immediate biofeedback. (I) Robot Aided Rehabilitation: MIT (USA) has developed a robot, named the MIT‐MANUS, to aid therapy of stroke victims. Small clinical trials have reported that the robot significantly improved patients' recovery of arm motor movement and function with sustained gains several months after cessation of treatment. This system is being clinically used as a rehabilitation training tool in over 20 centres world‐wide. Advantages of robot aided rehabilitation include the ability to document and store motion and force parameters, the ability to achieve thousands of repetitions per treatment session (100 times more than conventional treatment or FES) without causing tissue injury or pain, high intensity with low friction, attention training and increased biofeedback through the incorporation of interactive video games, which can simulate trajectories, mazes, ADL tasks such as preparing a meal and spatial task simulation such as going shopping. In addition, after the initial training period, upervision of the patient by the therapist can be reduced due to the sustainability of participation of the patient from the robot or BCI based Robotic Rehabilitation. Hence, productivity of the human therapist is increased by the robot. The robot thus acts as a high technology aid to the clinician and therapist. The system is also portable, giving rise to the possibility of tele‐rehabilitation options with the performance and progress of the patient being monitored by the institution remotely. (II)BCI‐based BCI based Robotic Rehabilitation:This non invasive device aims to use a novel approach in robotic training, which has not been employed in the therapeutic realm before.In the MIT‐MANUS and related commercially available systems, there is no direct communication between the patient's mind or thinking processes or motor volitional thinking and the robotic system. Although some sensors are used to detect the patient's weak movement, it never knows when and how the patient wants to move. The robot arm to which the patient is tethered or constrained plans the trajectory of movement for the patient and reduces its active role as the patient recovers voluntary motion. In most times, the patient can only passively follow the predefined program, which may not fully explore the patient's motor initiatives and potential or attention processes.

Nct (2009). "Use of Wii Fit (TM) to Increase Compliance With Home Exercises in Treating Patellofemoral Syndrome." https://clinicaltrials.gov/show/NCT01007643.
	Patellofemoral syndrome (PFS) is a very common diagnosis amongst adolescents and young adults. Symptoms can be chronic in nature and interfere with sporting activity and activities of daily living. Current treatment consists of home exercises to increase muscular strength and flexibility. Adolescents are known to have poor compliance with treatments for chronic illnesses. There is a paucity of published literature surrounding the Wii TM Interactive Video Game. There has been one published report of the use of Wii Fit TM in rehabilitation where participants used the Wii Fit TM to train proprioception after ankle injury. Individuals that participated in the Wii Fit TM group found improvement in their balance on objective measures as well as increased enjoyment with their treatment plan. One anecdotal report used the Wii TM video game in physiotherapy treatments of a college athlete and found a dramatic increase in attendance compliance after introduction of the video game. This randomized controlled study will determine if using the Wii Fit TM for home exercise completion will increase compliance and subsequently improve symptoms related to patellofemoral syndrome in adolescent females.

Nct (2009). "Wii-fit for Activity, Balance and Gait in Assisted Living." https://clinicaltrials.gov/show/NCT01000038.
	Purpose of the study: Falls in Alzheimer's Disease (AD) are common and lead to fractures, acute hospitalizations and increased rate of institutionalization. Poor balance and gait abnormalities, commonly associated with AD, are risk factors for falls. Improving balance and gait abnormalities is critical to prevent falls in AD. Exercise interventions improve gait and balance in elderly. Walking is the most commonly recommended home‐based exercise program for elderly by primary care providers. However, it is difficult to engage patients with AD in long term exercise programs. Barriers to exercise programs include lack of motivation, poor engagement, and external factors such as the cost of physical therapy (PT). Use of readily available technology might bridge this gap by providing high level of engagement via use of multimedia at an affordable price. Wii‐Fit is a Nintendo gaming console used for aerobics, strength training, and balance activities. This device includes a balance board that senses weight, movement and balance. Wii‐Fit is a TV based self‐directed activity not limited by the constraint of a therapist's presence. Virtual trainers talk the user through the activity while tracking progress. Furthermore, visual and auditory feedback improves engagement. Some skilled nursing facilities have started using the Wii‐Fit as an adjunct to PT, and note improvement in balance along with social benefits but no systematic studies are done to generalize the findings. The investigators propose an 8 week prospective randomized study with the treatment group receiving the exercise program delivered by Wii‐Fit system and the comparison arm receiving a walking exercise program.

Nct (2010). "Cognitive Control and Physical Exercise." https://clinicaltrials.gov/show/NCT01183819.
	Epidemiological evidence suggest that a set of lifetime exposures including educational and occupational attainment and leisure activities later in life are associated with more preserved cognitive and day‐to‐day functioning and reduced risk of dementia. However, the specific set of activities that can maintain or improve function in late life are relatively unexplored. In the current study, we will test the combined efficacy of two such activities: cognitive training and aerobic exercise. These activities have been shown to increase cognitive function and brain plasticity, respectively. The cognitive intervention that we will use is training with the Space Fortress task. This task is aimed at improving cognitive control processes that underlie multiple activities and are particularly affected by aging. We hypothesize that combining these two interventions will produce synergistic effects that will significantly improve cognitive and day‐to‐day function in healthy older adults. A total of 90 cognitively‐healthy older adults will be recruited and randomly assigned to one of three conditions: control video game, control exercise and combined exercise and space fortress training. A range of cognitive and day‐to‐day functioning will be assessed at baseline and after three months of training. We will also assess compliance with a home‐based version of the training program from the end of the 3‐month laboratory‐based training and the effect of this compliance on measures of cognition and day‐to‐day functioning. We hypothesize that the interventions can be sustained over a 1‐year period and that larger benefits will be observed in participants that adhere to the protocol. We also propose two complementary approaches to investigating the neural correlates of the beneficial effects of aerobic exercise on cognition: 1) imaging ‐‐ we will use a combination of structural, metabolic, and cognitive activation fMRI studies to evaluate the neural substrates of the effect of aerobic exercise on cognition. 2) important correlates ‐‐ we will explore the effects of apolipoprotein E (APOE) genotype, inflammatory markers and cognitive reserve on the cognitive effects of aerobic exercise.

Nct (2010). "Physiotherapy on the Airway of Bruxist Children." https://clinicaltrials.gov/show/NCT01178229.
	The physiotherapeutic intervention was based on the Awareness Through Movement (ATM) (Goldman 2003, Malmgren‐Olson et al 2001) technique. It is an established method of movement re‐education where coordination and posture are significant factors. Its proponents believe more effective and efficient actions can emerge from guided exploration of movement that promotes improved attention and awareness and refines the ability to detect information and make perceptual discriminations. "Awareness through Movement" (ATM) (Stephens et al 2006) is a process which facilitates the learning of strategies for improving organization and coordination of body movement by developing spatial and kinesthetic awareness of body‐segment relationships at rest and during motion, awareness of ease of movement, reducing effort in action, and increasing learning of feeling the muscles longer in action and while breathing . Ten physiotherapeutic sessions were planed during a ten week period, all of them based in children games. Each session lasted three hours. The children of the experimental group and their parents were guided by two expert physiotherapist previously standardized and the sessions took place in a room rounded by mirrors, where the children were able to see their own movements. The parents helped their own children during the session and in their home plan indicated weekly. Each session pursued the following steps: 1. Presentation to the parents of the somatic awareness technique for each day. 2. Movements, games, motor tales and exercises performed by the children, guided by the parents and with the guide of the physiotherapists. 3. In each session, a guide book with cartoons was given to the children and their parents to reinforce the exercises at home to keep a long‐term result regarding the body and head posture. The guide book was designed and created by physiotherapists, teachers and advertisers that were not participating in the study. 4. After the first session, a feedback was given before starting the next session, so the exercises at home and the difficulties were reviewed and solved. All the children assisted together to all the sessions and the instructions and instruments given to the children and their parents were the same for all of them. Error of method There were not statistically significant differences, regarding the age of the two groups. Standardizations of the examiners and calibration of all the techniques to evaluate the children regarding the clinical examination and the physiotherapeutic evaluation were made on 12 subjects different from the ones included in the investigation. The Intratester (ICC> 0.9 2‐way ANOVA) and intertester error (Kappa > 0.7) were not statistically significant. A calibration of the x‐ray technique and a standardization of the digital tracing of both the cephalogram were also performed. The tracing of the cephalogram was standardized between three investigators with 5 x‐rays, scanned and traced two times each by each of three of the investigators. To determine the Intratester and intertester reliability, the intraclass correlation coefficient (ICC > 0.3) and Kappa test were applied. A lateral cephalogram was taken before and immediately after the 10 session physiotherapeutic intervention for each child with the Natural Head Posture technique, described previously by different authors (Solow and Tallgren 1976). The technique is reproducible (Siersbaek‐Nielsen and Solow 1982) and allows the clinician to evaluate the natural position of the cervical vertebras and the inclination of the cervical column and head posture. Afterwards, the digital record of lateral cephalograms were processed in agree with Sayinsu et al 2006, using a program developed under Matlab 5.3 (MathWorks, Inc., MA. USA). Anteroposterior measurements of the nasopharynx, oropharynx and hypopharynx were taken in a lateral cephalogram with standardized techniques. The method error ranged from 0.27 to 0.64 degrees and the coefficients of reliability from 0.97 to 1.00 Data analysis The sample size wa calculated with a confidence of 95% and a statistical power of 80%. The number of subjects required in each group in order to make the comparisons was 12. Distributions were tested using the Shapiro‐Wilk test. The data were compared using the Mann Whitney and chi square tests. For all tests, significance was set at 5% (p < 0.05). Comparisons among and between groups were performed for all the variables (measurements of the airway) in order to answer the research question. Results: Statistically significant increases were found for the measurements of the oropharynx (3 mm increase. 95% CI 0.22 to 0.32) and hypopharynx (3 mm increase 95% CI 0.11 to 0.20) for the children that received treatment with physiotherapy. Conclusion: The physical therapy to change the head posture in bruxist children was useful to increase some of the dimensions of the airway in bruxist children.

Nct (2011). "Ankle Sprain Rehabilitation With the Wii Balance Board." https://clinicaltrials.gov/show/NCT01449760.
	Physical activity and in particular sport is beneficial to health. Nevertheless, some of these activities may create a risk of injury. Ankle sprain is the most common sport related injury. Sports that are causing the highest number of ankle sprains are: football (30%), handball‐basketball‐volleyball‐rugby (24%), gymnastics sports (6%), skiing (6%), cycling (6%), athletics (4%) and contact sports (4%). A recent study in the Netherlands identified a total of 1.3 million sports injuries. 47% of these patients required medical care. The total costs (direct and indirect) were assessed 84.240.000 EUR per year. Prospective studies demonstrated that athletes with a ankle sprain have a twofold risk of re‐injury during the first year after the trauma, and in half of patients with an ankle sprain recurrence this could lead to instability or chronic pain of the ankle. The Wii Balance Board ® is a tool that is increasingly used in the field of health. In some hospitals, therapists are beginning to use it for the rehabilitation of patients after surgery, fractures or strokes. Patients are asked to complete their physical therapy session by practicing "sports" via video games such as skiing, bowling or hula hoop. Currently, there are no randomized controlled studies that publish on the effectiveness of this tool. Recently, a study investigated the efficacy of the Wii Balance Board ® to improve balance, strength, joint mobility and level of physical activity. After 10 weeks of training, people an increased strength and balance was found. However, these results still require statistical confirmation. Thus this objectives of this study are ‐ To assess the efficacy of exercise training with the Wii Balance Board ® Platform ‐ To evaluate the effectiveness of physical therapy (based on current guidelines) ‐ To compare these two types of care (conventional physiotherapy versus Wii) to a control group (non‐treatment).

Nct (2011). "Effects of Game-based Balance Exercise for Older Adults With Fall History." https://clinicaltrials.gov/show/NCT01381237.
	Due to the many problems associated with reduced balance and mobility, providing an effective and engaging rehabilitation regimen is essential to progress recovery from impairments and to help prevent further degradation of motor skills. The purpose was to examine effects of physical therapy based on the task‐oriented approach delivered in an engaging, interactive video game paradigm. The intervention focused on performing targeted dynamic tasks, which included reactive balance controls and environmental interaction. Thirty community dwelling and ambulatory older adults attending the Day hospital for balance and mobility limitation treatment participated in this study. Participants were randomly assigned to either a control group or experimental group. The control group received the typical rehabilitation program provided at the Day Hospital, consisting of strengthening and balance exercises. The experimental group received a program of dynamic balance exercises coupled to video game play, using a centre of pressure (COP) position signal as the computer mouse. The tasks were performed while standing on a fixed floor surface with progression to a compliant sponge pad. Each group received 16 sessions, scheduled two per week, each lasting 45 minutes. Balance performance measures and spatial‐temporal gait variables were obtained pre‐ and post‐treatment Findings demonstrated significant improvements for both groups in balance performance scores post‐treatment, and change scores were significantly greater in the experimental compared to control group. No significant treatment effect was observed in either group for the spatial‐temporal gait variables. In conclusion dynamic balance exercises on fixed and compliant sponge surfaces were feasibly coupled to interactive game‐based exercise. This in turn resulted in a greater improvement in dynamic standing balance control compared to the typical exercise program. However there was no transfer of effect to gait function. Key Words: Balance, Postural; Rehabilitation; Therapy, computer‐assisted; Video Games; Center of Pressure.

Nct (2011). "Efficacy of Virtual Reality Exercises in STroke Rehabilitation: A Multicentre Study (EVREST Multicentre)." https://clinicaltrials.gov/show/NCT01406912.
	Virtual reality (VR) gaming systems are novel and potentially useful technologies that allow users to interact in three dimensions with a computer‐generated scenario (a virtual world). In particular, the Nintendo Wii gaming system applies relevant concepts in rehabilitation (i.e. repetition, intensity, and task‐oriented training of the paretic extremity) showing benefits in motor function improvement after stroke. While standard rehabilitation (i.e. physiotherapy and occupational therapy) helps improve motor function after stroke, the magnitude of its benefit is suboptimal. The implementation of conventional rehabilitation is resource‐intensive and costly, usually requiring transportation of patients and affecting adherence. Moreover, as improvement of motor function may be achieved after multiple sessions over a period of rehabilitation. The duration and intensity of the rehabilitation strategy are important factors in its effectiveness. Some studies compared an intervention plus conventional physical therapy versus conventional physical therapy alone, which by necessity allowed for more rehabilitation time in the experimental group. This creates a bias in favour of the new intervention as the intensity and frequency of rehabilitation per se is known to directly and beneficially affect functional outcomes. Therefore, the investigators are proposing comparing VR Wii versus an active control [(recreational activities (RA)].

Nct (2011). "Health Related Quality of Life Effects of Off-the-shelf Computer Gaming in Alzheimer and Related Disorders Populations." https://clinicaltrials.gov/show/NCT01416012.
	Interactive games (virtual reality) have recently been the center of interest and scientific discussion in the field of cognitive and functional rehabilitation. From their entertaining and contextual aspects, off‐the‐shelf video games are potentially interesting tools as adjunct to the patient care, especially for maintaining instrumental activities of daily living (IADL) autonomy. Disease and physical inactivity worsen the patient's ability in the IADLs, thus reducing health related quality of life (HRQL). This decrease in cognitive and functional abilities can be slowed down using adapted rehabilitation program. However, there is no randomized controlled study comparing usual physical therapy to virtual reality gaming consoles such as the Nintendo Wii or the Xbox 360 Kinect. Off‐the‐shelf gaming consoles offer a large range of games where cognitive and functional abilities from geriatric patients could be stimulated and consequently HRQL improved. However, a better knowledge of the potential cognitive and functional improvement processes from virtual reality rehabilitation in institutional routine is needed to enhance the quality and the range of the available care in old adults. This study will not only be a validation platform of virtual reality as stand alone rehabilitation process but also will assess the cost effectiveness of off‐the‐shelf gaming consoles in HRQL improvement of old adults. The investigators will compare the efficacy of two off‐the‐shelf gaming consoles in HRQL changes of patients with Alzheimer disease and related disorders. •Method This study is a randomized controlled trial that comprises two study phases : Phase one; comparing three parallel groups where therapists and assessors will be kept blind of study objectives, and Phase two, the investigators will take the most cost‐effective gaming console from phase one (Nintendo Wii or Xbox 360 Kinect) and the investigators will use it as an adjunct to physical therapy compared to physical therapy alone, with respect to the same amount of rehabilitation time. The interventions are of 120min/week for 6 weeks and a follow‐up at 4 weeks after intervention. Patients will be randomized in either Xbox 360 Kinect group ‐ a Nintendo Wii group ‐ or physical therapy as the 'gold' standard condition. All groups will receive the same amount of rehabilitation time. Power and sample calculation for phase two will be based on phase one results.

Nct (2011). "Virtual Environment Rehabilitation for Chronic Stroke." https://clinicaltrials.gov/show/NCT01414686.
	Objective: To determine if playing active video games results in improved balance and motor performance. Design: Randomized‐matched, single‐blind, control group cross‐over study Setting: Laboratory Patients: Participants with chronic hemiparesis post‐stroke were randomly assigned to a gaming group or normal activity control group. Interventions: Gaming systems provided an interactive interface of real‐time movement of either themselves or an avatar on the screen. Participants played games 1 hour/day, 4 days/week, for 5 weeks, totaling 20 hours of game‐play. The intervention was strictly game‐play without physical therapy. All games were played in standing position and trainers supervised to protect against loss of balance. Measurements: Both groups were tested prior to and following the 5 weeks (post‐test) and 3 months following the completion of the intervention/control. Outcome measures included: Fugl‐Meyer Motor Exam, Single Leg Stance time, symmetrical weight bearing, Berg Balance Scale, Dynamic Gait Index, Timed Up and Go, Six Minute Walk, 3 Meter Walk, step length differential, and perception of recovery.

Nct (2012). "Assessment and Evaluation of Pharmacokinetic Profile of E004 in Healthy Adults." https://clinicaltrials.gov/show/NCT01737892.
	This study is a randomized, evaluator‐blind, single dose, two‐arm, crossover, PK study, to be conducted in ~18 healthy, male and female, adult volunteers. PK will be studied using E004‐d3 at 125 mcg per inhalation (Arm T). A previously marketed Epinephrine CFC‐MDI, labeled "For Investigational Use Only" will be used as a Reference Control (Arm C). The main features of the study design are: (1) All candidates must be screened and must satisfy all enrollment criteria. All enrolled subjects will participate in two Study Visits, corresponding to two randomized treatments. Each Study Visit consists of a pre‐dose baseline assessment and a post‐dose evaluation for 6 hours. (2) It is important to minimize physical and psychological disturbances to the endogenous epinephrine concentrations in the study subjects, before and during the study visits. All subjects must maintain a reclining or recumbent resting position during the entire Study Visit, with physical activities restricted to a minimum necessity for bathroom trips and study activities. Caffeine‐containing (including de‐caffeinated) foods or beverages are prohibited. Physical exercise, unnecessary physical activities, and video games are prohibited throughout the study visit. (3)At the Screening Visit and the beginning of each Study Visit, each subject will be trained on the correct self‐administration of MDI, using a simulation MDI unit that contains no active drug. The following two randomized treatments will be self‐administered at two Study Visits: Treatment T: Two (2) inhalations of E004‐d3 (125 mcg/inhalation), totaling 250 mcg of epinephrine‐d3; Treatment C: Two (2) inhalations of Epinephrine CFC‐MDI (220 mcg/inhalation, totaling 440 mcg of epinephrine base equivalent). (4) PK blood samples will be taken from a vein in a hand or arm via an indwelling anticoagulated IV catheter, or by venipunctures, at scheduled time points of predose baseline (within 30 minutes of dosing), and at 2±1, 5±1, 7.5±1, 10±1, 12.5, 15, 20, 25, 30, 45, 60, 90, 120, 240 and 360 minutes postdose. The total volume of blood taken per subject shall not exceed 500 mL in any 30‐day period. Study visit schedule may be adjusted to avoid overdrawing blood in any 30‐day period. (5) At each PK sampling point, blood samples (~ 5mL), will be collected in ice‐chilled potassium‐EDTA sample tubes, each containing pre‐added 1% (V:V) of a 1.0 M sodium metabisulfite solution as an antioxidant. Sample tubes will be labeled with a sample ID# (consisting of subject ID#, Study Visit#, and sample#). The sample tubes will be kept on ice or refrigerated, and will be centrifuged within 60 minutes of collection. The harvested plasma from each sample tube will be transferred to, and stored in, 2 storage tubes, respectively, and frozen at NMT ‐20 degrees C until analysis. (6) PK samples will be analyzed with an established LC/MS/MS method, with a quantitative detection limit of 5 pg/mL, for both epinephrine‐d3 (MW=186) and epinephrine (MW=183). (7) Safety parameters and adverse drug events, if any, will be monitored and documented at each study visit. An End‐of‐Study (EOS) safety evaluation will be conducted at the end of, or within 7 days after, Study Visit‐2.

Nct (2012). "Effects of Training in a Virtual Environment in Healthy Elderly." https://clinicaltrials.gov/show/NCT01741402.
	The objective of this work is to compare the effects of two balance training programs, one Nintendo Wii Fit‐based and the other traditionally‐based without the use of a gaming system, on balance, gait, functionality and cognition ability in older adults. It is a prospective, single blinded, randomized clinical trial performed at Center of Research of the courses of Speech Therapy, Physical Therapy and Occupational Therapy of São Paulo University. Thirty‐two older adults are randomly in control and experimental group, 16 each one. Both groups performed 14 training sessions, twice a week, for seven weeks. Each session is composed of a 30 minute‐global‐exercise series including stretching, muscle strength and axial mobility exercises. After this, both groups performed more 30 minutes of balance training: the control group performed balance exercises without external cues, visual or auditory feedbacks or cognitive stimulations; the experimental group performed the balance training with 10 Wii Fit games which stimulated motor and cognitive functions. The main outcome measures are: (1) Mini‐BESTest of Dynamic Balance Evaluation; (2) Dynamic Gait Index (DGI); (3) Montreal Cognitive Assessment (MoCA); and (4) Falls Efficacy Scale ‐ International (FES‐I).

Nct (2012). "Functional Improvement in Patients With Parkinson's Disease After Training in Real or Virtual Environment." https://clinicaltrials.gov/show/NCT01580787.
	The objective of this work was to compare the effects of two balance training programs, one Nintendo Wii Fit‐based and the other traditionally‐based without the use of a gaming system, on the balance, functionality and cognition of patients with Parkinson´s disease. It was a prospective, single blinded, randomized clinical trial performed at Brazil Parkinson Association and Center of Research of the courses of Speech Therapy, Physical Therapy and Occupational Therapy of São Paulo University. 32 patients with Parkinson´s disease on stages 1 and 2,5 of Hoehn e Yahr participated of this work. Patients were randomized in control and experimental group, 16 each one. Both groups performed 14 training sessions, twice a week, for seven weeks. Each session was composed of a 30 minute‐global‐exercise series including stretching, muscle strengthen and axial mobility exercises. After this, both groups performed more 30 minutes of balance training: the control group performed balance exercises without external cues, visual or auditory feedbacks or cognitive stimulations; the experimental group performed the balance training with 10 Wii Fit games which stimulated motor and cognitive functions. The main outcome measures were: (1) Unified Parkinson´s Disease Rating Scale (UPDRS); (2) Berg Balance Scale (BBS); (3) Unipedal Stance Test (UST) and (4) Montreal Cognitive Assessment (MoCA). The statistical analysis was done by repeated measures ANOVA in order to assess the possible differences among the analyzed variables. Both groups showed improvement in the section II of UPDRS, BBS, UST and MoCA. Patients with Parkinson´s disease showed balance and cognitive improvement with positive repercussion on daily living activities after 14 sessions of balance training without additional advantages to the virtual training.

Nct (2012). "Train the Brain - Cognitive and Physical Training for Slowing Dementia." https://clinicaltrials.gov/show/NCT01725178.
	Train The Brain is a clinical and experimental study on the effectiveness of cognitive and physical training in slowing progression to dementia, and on the relationship between (changes in) mental and cardiovascular fitness. Cognitive decline due to ageing is becoming a major clinical and economic issue. Italy has 700,000 patients with dementia and 100,000 new cases are detected every year. Most common causes of dementia are Alzheimer's Disease (AD) and vascular dementia (VD). No treatment is available for the two conditions: drugs currently used are poorly effective and do not prevent, heal, stop, or delay the progression of the disease. It is therefore crucial to find interventions to counteract and slow cognitive decline from an early stage. A combined physical and cognitive training could convey benefits. Several studies have shown that both the strengthening of social and cognitive abilities and physical exercise do exert a positive effect on brain function in the elderly, and they reduce the risk of developing dementia by 20‐50%; experimental studies on animal models support these findings, and also show a reversion of cognitive decline. On the other hand, controlled intervention studies on human beings are few and show methodological limitations. It is now established that subclinical cerebral alterations, detectable with structural and functional neuroimaging, appear well before clinical disease occur; this is called "Mild Cognitive Impairment" (MCI) and dramatically raises the risk of developing dementia in comparison to individuals without MCI. In this condition, a progressive decrease of the number and quality of synaptic connections in specific areas of the brain has been hypothesized; interventions aimed at counteracting the decrease in synaptic function and density, augmenting neural plasticity and the development and sparing of mnemonical circuits, could slow the progression to overt dementia. An early detection of cognitive impairment could allow to exploit the residual plasticity of the nervous system through therapeutic/rehabilitative interventions. The working hypothesis for this project is that physical and cognitive stimulation could positively affect cognitive decline in subjects at risk for dementia or with dementia at its early stage. This could delay the loss of self‐sufficiency, therefore improving quality of life both for the patient and his caregivers with a safe and relatively cheap intervention, also reducing direct and indirect costs for caregiving for the families and the National Health Service. The present study is interventional, in parallel groups with random allocation: ‐ Baseline evaluation; allocation to intervention or control; ‐ Measurement of brain volumetry and function; cardiovascular assessment; ‐ Intervention, or usual care for the control group; ‐ Evaluation after 7 months of intervention and 7 months after the completion. Symptoms will be identified with an advanced set of diagnostic tests. In perspective, the aim is to develop a non‐pharmacologic therapeutic strategy, which could be easily applied in the clinical practice by the structures of the National Health Service. The presence of a protocol of physical training allows also to improve knowledge about the relationship between cardiovascular and cerebral fitness in conditions of cognitive decline, an aspect virtually unexplored and absent from the current medical literature. Recent studies highlight that vascular damage and systolic hypertension in MCI subjects represent a risk factor for progression into overt AD, but also suggest that these alterations are an ideal target for secondary prevention. When the study is completed, it will be possible to discern if the chosen program of physical exercise and cognitive stimulation has been able to reduce, to a statistically significant degree, the progression of cognitive decline, as measured with neuropsychological tests, and brain damage, evaluated with morpho‐functional techniques, in subjects with AD/VD in the intervention arm as compared to a con rol group. If this is the case, the combined physical/cognitive intervention procedure will be proposed as non‐pharmacological preventive and therapeutic strategy. A final follow‐up evaluation, seven months after the end of the intervention, will provide information about the duration of the effects. Primary endpoint: Evaluation of the effectiveness of a combined intervention (physical exercise + cognitive stimulation) on symptom progression in patients with MCI due to early AD/VD. Outcome indexes: ‐ Main: Cognitive decline, as the score in neuropsychological tests ‐ Rate of grey matter and white matter loss in the cortex and the hippocampus ‐ Variations in EEG tracing ‐ Improvement in cardiovascular parameters; non‐invasive evaluation of vascular biomarkers (endothelial function, local and global vascular stiffness, pulse wave analysis) with dedicated techniques and computer equipment, according to current guidelines and recommendations, to improve accuracy and reduce variability ‐ Variations in vascular reactivity to stimuli: variations in cerebral flow, carotid arteries flow and diameter in response to carbon dioxide (CO2) inhalation ‐ Increase in brain activity, measured with functional magnetic resonance imaging, during cognitive tasks In each and every subject, variations in cognitive function, as measured with functional tests and imaging, will be correlated with variations in the cardiovascular parameters, so to explore the relationship between (changes in) brain and cardiovascular fitness. If the study shows any benefit in the intervention arm, another objective will be the development of a non‐pharmacological preventive/therapeutic strategy easily applicable to man. The study population will be made of elderly subjects with mild cognitive impairment confirmed at the neurological examination; severe pathologies barring participation to the cognitive or physical training program will be the only substantial exclusion criteria. This is an intervention study, in comparison to a control group (i.e., no intervention other than standard care), in parallel groups with random allocation. It will be conducted according to the following steps: Phase 1 ‐ Patient recruitment and baseline cognitive evaluation: a first screening with mini‐mental state examination (MMSE), then a clinical confirmation with a standard set of neuropsychological tests (baseline cognitive status); a comprehensive collection of medical history and physical, cognitive and affective examination; subjects with a confirmed diagnosis of MCI and matching inclusion criteria will be randomly assigned either to intervention or control group, and will all undergo the baseline instrumental evaluation. Phase 2 ‐ Baseline instrumental evaluation: measurements of brain volumetry and function (functional magnetic resonance, EEG); cardiovascular assessment with ultrasound (flow‐mediated dilation of the brachial artery, measurement of carotid intima‐media thickness and stiffness, aortic stiffness, pulse wave analysis and central blood pressures, modifications in brain blood flow, carotid blood flow and carotid diameter in response to stimuli); Phase 3 ‐ Intervention (7 months for each patient). A protocol of aerobic physical activity will be undertaken, 1 hour three times per week, with the help of trained and experienced personnel, including (but not limited to) physiotherapists and personal trainers. The protocol includes a combination of aerobic exercises, muscular strengthening, balance improvement and joint flexibility. After three months, workload will be adjusted according to a new cardiovascular evaluation, to optimize training level. For cognitive training, patients will undergo the selected activities three times per week: activities include formal training, game activities and lessons with practical tips on strategies for counteracting symptoms of cognitive decline. Patients will be similarly reevaluated after three months. In its turn, the control group will stick to usual, standard care. Phase 4 ‐ End of intervention: b th groups, intervention and control, will undergo a complete re‐evaluation after 7 months of training / usual care. Phase 5 ‐ Follow up: 7 months after the end of the training period, both groups will be re‐evaluated for any change or persistence of effects. The whole project, from the recruitment of the first patients to the follow‐up examination of the last, is expected to be completed in a maximum of three years.

Nct (2012). "Upper Arm Reahabilitation After Stroke and Video Game." https://clinicaltrials.gov/show/NCT01554449.
	Introduction : Stroke constitutes one of the most disabiliting desease in industrialized countries, leading to major deficiencies, especially in the upper arm (concerning 50 to 80% of post‐stroke patients). Upper arm rehabilitation after stroke improved during the last ten years, with the development of new rehabilitation methods including constraint induced therapy, mirror therapy, mental imaging, virtual reality and robotics. Video games and virtual reality are very promising in this field, and the development of new adaptative games dedicated to upper arm rehabilitation after stroke is necessary to enhance the benefit of those devices in therms of sensori‐motor and functional recovery. Objectives: To prove the efficiency of video‐gaming (using dedicated adaptative games) on recovery of motor function of the upper armafter stroke, compared to a "conventional" rehabilitation program. Design: Multicentric Randomized Controlled TrialParticipants: 50 early stroke patients and 12 healthy control persons will be included in this trial. Inclusion criteria for patients are as follow: age>18, onset of stroke <6 weeks, first unique supra‐tentorial ischemic or haemorrhagic stroke, Fugl Meyer score of the upper arm < 30/66 at inclusion. Exclusion criteria are as follow: severe neglect or aphasia, upper arm severe orthopedic limitation, shoulder pain > 5/10, contra‐indication to MRI. Methods:All patient will get a "standard program" of rehabilitation 5 days/week duiong six weeks, including physiotherapy (one or two sessions/day), occupational therapy (one session/day) and speech therapy if necessary (one session/day). Patients will be randomized in two groups: the "treated group" receiving an additional session of 30 to 45 minutes of daily rehabilitation with video games under the supervision of an occupational therapist, and the "control group" receiving the same anount of "standard rehabilitation" provided by an occupational therapist.Assesment will be conducted at inclusion (J0), at the end of the program (Week 6: W6) and at follow‐up (end of month 6: M6)). Recorded datas: The primary endpoint is the difference in increasing the upper arm Fugl Meyer Score (FMS) between both groups at W6. Secondary criterions include: FMS at M6, Box and Block Test at W6 and M6, Nine Hole Peg test at W6 and M6, Wolf Motor Function Test at W6 and M6, Motor Activity Log at W6 and M6, Barthel Index at W6 and M6, SF‐36 at W6 and M6. Functional MRI and tensor diffusion imaging will also be conducted in 25 patients and 12 controls, at J0 and W6. Evolution of cerebral plasticity and correlations between cerebral re‐organisations and kinematic characteristics of upper arm movements will be provided.

Nct (2012). "The Utilization of Nintendo Wii™ in Outpatient Rehabilitation Following Total Knee Replacement." https://clinicaltrials.gov/show/NCT01548664.
	The use of video games in rehabilitation is growing in popularity and frequency. The Nintendo Wii™ gaming system in particular, is gaining increased attention in the rehabilitation setting. There is currently very little evidence to support its clinical use. Canadian total knee replacement (TKR) rates have risen significantly in the past decade and its patient demographic has shifted to reflect a younger overall population. These changes indicate increased emphasis on TKR patients returning to higher levels of function and the potential need for new intervention options when caring for these patients. The Nintendo Wii™ Sports application has the potential to encourage standing, while participating in an interesting and engaging activity. The objective of this study is to determine whether the utilization of the Nintendo Wii™ gaming system, as an adjunct to standard outpatient rehabilitation therapy, influence outcomes of patients following total knee replacement. Patients who consent to participate in this study will be randomized to either a control group which will receive 15 minutes of lower extremity exercise or a study group which will receive 15 minutes of gaming activity on the Wii Fit™. Both control and study interventions will be provided following each regularly scheduled 60 minute physiotherapy session, in a separate treatment area. The Nintendo Wii™ console and its accompanying Wii™ Sports game will be utilized for the purposes of this study. To minimize rotational movement and therefore the risk of injury following total knee replacement, only the tennis and bowling games will be used. It will be required that these games are played in standing position. Without including the time required for start‐up, each session of Nintendo Wii™ game activity will be 15 minutes in duration, and will be provided twice weekly. Recovery status will be measured in all participants on admission, and every 2 weeks until discharge, an expected average of 5 weeks. A combination of self‐administered questionnaires, objective and subjective outcome measures will be used to measure function (2 Minute Walk Test, Lower Extremity Functional Scale) range of motion (Goniometry), pain (Numeric Pain Rating Scale) and satisfaction with therapy services. Change within each measure will be statistically analyzed to detect whether a significant difference exists between control and study groups. It is projected that 60 patients will be recruited for this study. Patients in the study group could potentially benefit from increased improvements in pain, physical status, function, and satisfaction at the completion of their outpatient rehabilitation therapy program.

Nct (2012). "Village Interactive Training and Learning Study." https://clinicaltrials.gov/show/NCT01709799.
	Research Participants take part in a 16 week Wellness Program, which includes either traditional physical exercise with brain training(Group A), Wii exergaming with brain training(Group B) or brain training alone (Group C). Participants are randomly assigned to groups. A comprehensive battery of neuropsychological tests, surveys and assessments are given prior to start of the intervention, at completion of the 16 weeks, and again 3 months post completion. The program involves 4 days of physical activity each week for groups A & B. The physical exercise/activity portion will involve warm up stretching and then either Group A‐traditional exercise (like riding a stationary recumbent bicycle or walking on a treadmill), Group B‐ playing Nintendo Wii Exergames with a television based video game, or Group C‐ NO exercise at all. Every 4th week the 16 week intervention period, all participants in all three groups will also complete 80 minutes of brain training activities each day of the week. This is in addition to the previously assigned physical activity for Groups A & B. The brain training regimen consists of Posit Science Insight computer based brain games. The Insight program consists of five different modules that focus on visual processing, attention, and memory. Each of the modules are described below: 1. Bird Safari: This module involves identifying and ordering simple visual stimuli that flash on a screen. The goal is to improve ability to respond quickly to visual stimuli and to segment rapidly changing visual pictures. 2. Jewel Diver: This module involves tracking objects as they become hidden by distractors. The goal is to improve ability of visual system to rapidly identify and discriminate objects in the visual periphery. 3. Master Gardener: This module involves visual working memory and matching pairs of pictures. 4. Road Tour: This is a simulated driving exercise that involves divided attention to oncoming cars and road signs. The goal is to improve ability of visual system to continuously track multiple objects against a field of distractors. 5. Sweep Seeker: In this exercise, participants identify complex moving visual stimuli. The goal is to improve rapid, sequential eye movements to salient visual targets, process relevant information and then make rapid decisions to identify, discriminate and classify targets. Questionnaires regarding the participants mood before and after the brain training weekly are administered. In addition, brief questionnaires on attention and memory are given to measure thinking and memory progress.

Nct (2013). "Applicability of Video Games and Vibrational Therapy in Reducing Pain Secondary to Breast Cancer." https://clinicaltrials.gov/show/NCT01893944.
	After physiotherapy assessment individuals will be randomly divided into three groups: Group Virtual Reality ‐ Cinesioterapia (G1), Group Vibration Therapy ‐ Cinesioterapia (G2) and Control Group (G3), which will be submitted to the respective treatment protocols. Group Virtual Reality Cinesioterapia (G1) participate in this group 20 women will be treated through the games Xbox 360 ®, attributed to this, customized applications using virtual and augmented reality to be developed. Vibration Therapy Group ‐ Cinesioterapia (G2) ‐ will participate in this group 20 women who will undergo 15 minutes of continuous vibration through the blanket vibrating members higher, with frequency 40 Hz, 3 function and intensity tolerable, keeping the limb supported and elevated to 120 º. At the end held muscle stretching exercises, dissociation of shoulder girdle and upper limb exercises assets. Control group (G3) ‐ participate in this group 20 women who are treated with conventional cinesioterapia through muscle stretching exercises for flexors, extensors, adductors and abductors shoulder for 20 seconds each; dissociation girdle; financial assets and Active assisted for groups flexors, extensors, abductors and adductors of the upper limbs, which will be performed three sets of 10 repetitions for each exercise. Implementation of treatment protocols for the groups G1, G2 and G3 will run for two weeks, being Monday through Friday feira.totalizando 10 consecutive treatment sessions lasting 30 minutes each session. You will be prompted to patients groups G1, G2 and G3 to respond individually and without any aid the visual numeric scale of pain, 10 minutes pre‐therapy, 15 minutes after the start and 10 minutes after the end of therapy. Patients will undergo the assessment of pain, electromyographic activity of muscles, muscle strength, range of motion analysis and perimetry in the first day of treatment, and after completing all the sessions patients were reassessed.

Nct (2013). "Effects of Training in a Virtual Environment in Chronic Stroke Patients." https://clinicaltrials.gov/show/NCT01886183.
	The objective of this work is to compare the effects of two balance training programs, one Nintendo Wii Fit‐based and the other traditionally‐based without the use of a gaming system, motor function, cognition, balance and gait in chronic stroke patients. It is a prospective, single blinded, randomized clinical trial performed at Center of Research of the courses of Speech Therapy, Physical Therapy and Occupational Therapy of São Paulo University. Forty chronic stroke patients are randomly in control and experimental group, 20 each one. Both groups conduct 14 training sessions, twice a week, for seven weeks. Each session will consist a 30 minute‐global‐exercise series including stretching, muscle strength and axial mobility exercises. After this, both groups will performed more 30 minutes of balance training: the control group will performed balance exercises without external cues, visual or auditory feedbacks or cognitive stimulations; the experimental group will performed the balance training with 10 Wii Fit games which stimulate motor and cognitive functions. The main outcome measures will be: (1) the lower limb subscale of the Fugl‐Meyer Assessment (FMA‐LE); (2) Montreal Cognitive Assessment (MoCA) (3); Balance Evaluation Systems Test (BESTest) and (4) 6‐ minute walk test (6MWT).

Nct (2013). "Mobility in Older People." https://clinicaltrials.gov/show/NCT01910740.
	The main aim of this study is to investigate whether increasing the amount of physical activity in frail older people during hospital based rehabilitation is associated with better mobility outcomes compared to usual care. A second aim is to investigate whether this physical activity intervention is associated with improvements in health related quality of life. Finally we plan to investigate whether increasing the amount of physical activity during rehabilitation is cost effective, measured from a health system perspective, compared with usual care. Older people receiving inpatient rehabilitation will be randomly assigned to an intervention group, who will receive extra physical activity on weekdays and weekends or a control group, who will receive additional activities based on social interaction. The activity sessions will be individualized to the particular participant. Both groups of people will be assessed at baseline, discharge from hospital and at 6 months following discharge. The intervention group will be provided with one or two extra sessions on weekdays and two extra sessions on weekends for the duration of their rehabilitation stay. To account for the extra physiotherapy time that the intervention group receives, the people in the control group will spend the same amount of time performing other activities, such as cards, board games or reading, whilst seated. To ensure the safety of the participants in this study, each physical activity session will be supervised by either a physiotherapist or allied health assistant. Hypothesis 1: The primary hypothesis is that, compared with usual care, increasing the amount of physical activity in frail older people during rehabilitation will lead to more optimal mobility at discharge, as measured by gait speed. Secondary hypotheses are that, compared with usual care, increasing the amount of physical activity during rehabilitation will: Hypothesis 2: lead to significantly greater improvements in mobility and function both at discharge and six months following discharge. Hypothesis 3: lead to better quality of life six months following hospital discharge, measured using the EuroQol Health (EQ5D) Questionnaire and the EuroQol‐Visual Analogue Scale (EQ‐VAS). Hypothesis 4: be cost effective compared to usual care

Nct (2014). "Combined Cognitive and Physical Exercises Through Computer Games in Elderly: The LLM Project." https://clinicaltrials.gov/show/NCT02267499.
	The multicenter study was part of the Long Lasting Memories (LLM) project (www.longlastingmemories.eu), which was funded by the European Commission (Information and Communication Technologies Policy Support Program (ICT‐PSP) for a three year period (2009‐2012). It used a pre‐post‐test design with the between‐participant factor group [intervention vs. passive control]. Post‐test was conducted within 2 weeks after completion of the exercise period. Interventions were carried out in Athens and Thessaloniki (Greece) within day care centers, hospitals, senior care centers, a memory outpatient center, local parishes, at university campus facilities (university community installations), and at participants' homes. Institutions had to provide at least 5 exercise weeks, with a frequency of at least 1 physical and 2 cognitive exercise sessions per week, resulting in at least 5 physical and 10 cognitive exercise sessions in total.

Nct (2014). "Effects of Physical Activity in Psychosis." https://clinicaltrials.gov/show/NCT02205684.
	Outpatients in treatment will be recruited in this randomized controlled trial (RCT). The patients will be randomized to either a Computer gaming Skills Group (CSG) or to a physical Exercise Group (EG). The groups are identically organized in two locations. The interventions last for 12 weeks, and treatment as usual will be continued for all patients. Patients will be assessed when entering the study (after randomization and allocation to one of the clinical groups), as well as post‐treatment and 4 months post‐treatment. Thus, the planned study is prospective with a longitudinal design. It is single blind in the sense that the assessment of psychiatric symptom level and neurocognitive function will be performed by research staff blind for group membership. The physiological testing will be performed by staff involved in training and will not be blinded. EG participants will perform aerobic high intensity training (HIT) consisting of supervised walking/running on a treadmill 2 times a week for 12 weeks. Each session will have the following structure; eight‐minute warm‐up, followed by four times four minutes intervals with 85‐95% of maximum heart rate, with active pauses of three minutes of walking at 70% of maximum heart rate. The exercise session will end with a five minute cool‐down period. HIT performed as 4 x 4 intervals has been proven feasible and safe among patients with schizophrenia and in other clinical populations. Participants in the CSG take part in sessions in the clinic playing computer games (Nintendo Wii Sports). The time spent with activities in the clinic will be the same in both groups. When absent from scheduled physical exercise/playing computer games the subjects will be offered to participate on a following day. If absent for a whole week, the training period/computer games playing period will be prolonged accordingly. In this randomized controlled trial we investigate the effects of HIT in outpatients with schizophrenia on symptoms and well‐being, cognition and brain structure, smoking habits and substance use, as well as metabolic indices. The participating outpatient clinics are catchment area based and cover a population of 200 000 persons with more than 250 patients in the diagnostic group in treatment at one time.

Nct (2014). "Functional Engagement in Assisted Therapy Through Exercise Robotics." https://clinicaltrials.gov/show/NCT02290353.
	A) Purpose: The similarity of functional impairments in the two target hemiplegic populations, teenagers with hemiparetic cerebral palsy CP or acquired brain injury (post‐acute phase) and hemiparetic stroke survivors, leads us to pursue a unified rehabilitation strategy. Although age‐dependency is clearly a factor in rate of motor learning, intensive therapies have shown similar returns of function with similar intensities and length of treatment across different populations [1]. By involving both adults and children in the same study, the investigators can directly compare the effects of identical interventions using the innovative hardware and software solutions that are developed. The team of investigators have developed a system that includes a camera (PS3 Eye), 2 modified PS3 Move controllers, and a computer [2]. A software is designed to search through the camera feed to find the glowing balls attached to the two PS3 Move controllers, and changes the position of the computer's mouse cursor based on the position of the two glowing balls. This allows the participants to play simple 2D Facebook games that involve point‐and‐click by holding on to the Move controllers and moving their arms in space in order to control the cursor and play games. B) Hypothesis: The investigators hypothesize that the following strategies will deliver effective, long‐term therapy: (1) use a bimanual approach, based on recent research that shows the powerful integrative value of involving both limbs and both cerebral hemispheres in recovery of function post‐stroke [3]; (2) target hand‐function, following the proven efficacy of this approach (CIMT and GRASP) over exercising arm motions only; (3) directly target patient motivation by embedding the therapy in a social construct of multi‐user online gaming such as Facebook Games [4, 5]. C) Justification: The quality of life of Canadians with stroke declined from 1998 to 2005, a disturbing finding that is directly related to impaired arm function [6]. Traditional (standard) physical therapy includes a range of interventions aimed at improving posture, joint range of motion, muscle tone, muscle strength and motor control. However, no single approach has been proven to have superior effectiveness over any other in upper or lower limb recovery. These are sobering data that illustrate a critical need for novel interventions that will improve function and lead to better quality of life for persons living with hemiplegia. Motor rehabilitation programs based on low‐cost exercise devices such as the Nintendo Wii, Nike Fit and Microsoft Kinect have proven efficacy [5], but participants are required to be in the same room at the same time. Online games such as Farmville on Facebook support cooperative tasks, but there are no appropriate devices to support bimanual input. Our approach will fill this gap by supporting collaborative, bilateral motor‐learning that involves force and movement therapy and social media effectively. D) Objectives: Our objective is to demonstrate that motivation in adherence to a therapy regimen can be enhanced by the use of online games in conjunction with motion capture devices that require the user to interact bimanually with the game. Our project has 4 phases, each with its own milestones: 1. Start‐up: In‐clinic focus group meetings with rehabilitation professionals and follow‐on focus groups with therapy clients; design of hardware and software based on the outcomes of these focus group meetings (months M1‐M9). This phase is finished. 2. Pilot study: Hardware and software development (M10‐12), followed by in‐clinic usability studies with adult stroke survivors and children with hemiplegia; development of final hardware and software based on the outcomes of the usability studies; integrative Knowledge Transition activities (months M7‐M24). This phase is finished. 3. Home‐based studies: Two parallel 6‐month studies, one with adults and one with teenagers (months M25‐M30). The investigators have finished planning of this phase and ha e received the ethics approval to start recruiting. 4. Knowledge translation: Data analysis, reporting and dissemination (months M30‐M36) E) Research Method (Only Phase 3 is included): The study will have a randomized cross‐over design with an early and a late intervention group. A maximum of 20 stroke survivors will be divided into a late intervention and an early intervention group (10 in each group, randomly assigned), and a maximum of 20 teens with hemiplegia will be divided into a late intervention and an early intervention group (10 in each group, randomly assigned). The procedures for late intervention groups are the same. Similarly, the procedures for the early intervention groups are the same. Note that this study is asking the same research question for two different clinical populations. Each intervention group will be involved in the study for 6 months. Both groups will start with a baseline assessment of outcome measures in week 1. The early intervention group will receive the FEATHERS intervention in weeks 1‐8. There will be another round of outcome measure assessments at the end of week 8 (assessing motor recovery). There will be a period of no intervention between weeks 9‐16, followed by another round of outcome measure assessments (assessing retention). Finally, weeks 17‐24 will also be a no intervention period, followed by another round of outcome measure assessments (assessing variation of the outcomes even without a therapy intervention). The late intervention group will receive 2 months of no intervention followed by a round of outcome measure assessments (assessing variation of the outcomes even without a therapy intervention). Then they will receive the FEATHERS intervention in weeks 9‐16. There will be another round of outcome measure assessments at the end of week 16 (assessing motor recovery). Weeks 17‐24 will be another period of no intervention followed by another round of outcome measure assessments (assessing retention). Primary Outcome (functional outcomes) and secondary outcomes (participation outcomes) of this study are as follows: i.Primary Outcome: Wolf Motor Function Test WMFT (this is the test for which the investigators conducted the a priori power calculation; it is expected to have ~80% chance of detecting an effect with given this sample size). ii.Secondary Outcomes: 1. Body Structure/Function: Motricity index; grip/pinch strength; NIH stroke scale; modified rankin test; reach performance scale. 2. Activity/Participation: Canadian occupational performance measure; confidence scale; paediatric motivation scale, usability of the system. More details on the measures are provided under "Outcome Measures". F) Statistical Analysis: Phase 3: Based on previous research, the investigators estimate a standardized effect size of 0.60 to 0.80 improvement (Cohen's d) from baseline to terminal assessment on the WMFT. By recruiting 20 stroke subjects and 20 CP subjects, it is expected to have a statistical power (1‐β error probability) of approximately 80% for the within‐subject change. Our principal statistical test is thus the within‐subject t‐test comparing pre‐intervention WMFT scores to terminal WMFT test scores, combining data from both the early and the late intervention group. In addition to this a priori comparison, WMFT test scores will be analyzed in a Group (early versus delayed intervention) by Time (Weeks 0‐8, 9‐16, and 17‐24) mixed‐factorial ANOVA. Secondary outcomes will include motion log files, scoring from the games themselves, functional outcome measures, discussions with participants and exit surveys. Secondary outcomes of function/structure and activity/participation will be analyzed using the same Group by Time mixed‐factorial ANOVA. Exploratory comparisons can also be undertaken. For instance, the investigators data analysis will allow us to compare the motor learning between younger and older persons with hemiplegia and the effect of the social media framework on motivation using both quantitative and qualitative metrics (between‐subj cts t‐tests on the functional outcomes and motivation surveys). The investigators will be investigating whether there is a statistical correlation between subjective measures of motivation and the observed changes in functional outcomes.

Nct (2015). "Effectiveness of a Program Using Video Games Associated With Conventional Physiotherapy in Physical Functioning in Frail Elderly Compared to Conventional Physiotherapy." https://clinicaltrials.gov/show/NCT02333214.
	Frailty is considered a biological geriatric syndrome, characterized by a decreased resistance to stresses and functional reserve due to the cumulative decline in multiple physiological systems, with consequent increased state of vulnerability [2]. Negative health related outcomes, such as disability, recurrent hospitalization, institutionalization, falls and mortality [2‐4] are associated with frailty, considered an emerging public health problem [2, 5]. Physical exercise has been recommended as an intervention strategy for the prevention and rehabilitation of the mobility‐related outcome in the frail elderly whit positive impact on functional capacity and performance [8]. A functional downward spiral characterized by an impairment of several functional domains, such as strength, muscular endurance and motor‐cognitive processes, ultimately leading to restricted mobility and decreased physical activity level is commonly observed in frail older people. Interventions that promote the integration of multisensory, cognitive and motor skills can be able to motivate the older people to remain more active for longer periods, despite their limitations. Exergames involve tasks in virtual environments that combine physical and cognitive demands in an attractive and challenging way. The player is encouraged to achieve goals and overcome limits during the game, providing immediate feedback in relation to their performance. The game experience can create a greater sense of self‐efficacy and generate a more positive perception of personal skills, modulated by a positive environment reinforcement, consequently increasing motivation and engagement. This combination of greater sense of self‐efficacy and greater motivation could provide a positive and necessary influence for most older people to overcome their limitations and create new lifestyle habits [25], decreasing disability. This study sought to investigate the effectiveness of adding exercises using interactive videogames (exergames) in improving physical functioning on frail and pre frail older people when compared to conventional physiotherapy.

Nct (2015). "Effects of a Physical Rehabilitation Program Using the Nintendo Wii on Children With Osteogenesis Imperfecta (OI)." https://clinicaltrials.gov/show/NCT02542540.
	Children with osteogenesis imperfecta are described as extremely sedentary and therefore fatigable, which strongly impacts their daily activities. The physical rehabilitation of these children is a fundamental aspect of treatment. It has been shown that playing Wii console causes the same increase in energy expenditure than practicing moderate exercise, while ensuring user safety. This type of physical exercise with this type of fun game console might have a role in the treatment of OI children on the physical side but also on the psychological side.

Nct (2015). "Use of Virtual Reality Games for the Treatment of Balance and Reducing the Occurrence of Falls in Patients After Stroke." https://clinicaltrials.gov/show/NCT02475083.
	Randomized clinical trial conducted with patients of both sexes with hemiparesis after stroke of 18 to 65 years. They excluded those who had less than six months of injury, with sensory or perceptual deficit. Patients included were randomized into two groups, a treatment group, which conducted rehabilitation with virtual reality associated with conventional physical therapy and the control group that performed only conventional physiotherapy. Randomization was done by a computer program in blocks, by a third person, respecting the allocation concealment. After selection and randomization, patients were evaluated at baseline, when they were collected demographic and clinical data, investigated the occurrence of falls in the three months prior to evaluation and rated the balance in motion using the Dynamic Gait Index (DGI). Patients were followed for 20 physiotherapy sessions, visits twice a week for an hour each. The assessment of the balance and the investigation of the occurrence of falls were repeated at the end of treatment, which occurred on average three months after the start of the intervention, by the same examiner, who remained blind to the group that the patient belonged.

Nct (2016). "An Animated Home-based Physical Exercise Program as a Treatment Option for Patients With Rheumatoid Arthritis." https://clinicaltrials.gov/show/NCT02658370.
	The purpose of this pilot study is to investigate feasibility and patients´ assessment using an animated home‐based exercise program (Software Wii‐fit of the Nintendo Wii game console) for patients with rheumatoid arthritis.

Nct (2016). "Comparing Gamification With Remote Monitoring Against Standard Rehabilitation, for Patients After Arthroscopic Subacromial Decompression Surgery." https://clinicaltrials.gov/show/NCT02705521.
	Background: Musculoskeletal problems are one of the most common reasons for seeking medical advice, with estimates of up to 20% of adults annually consulting their general practitioner. The prevalence of shoulder problems in the population is approximately 2.5%(Jordon et al 2010). In 2012/13, there were over 7.1 million outpatient appointments for trauma and orthopaedics in England (accounting for 9.3% of all outpatient attendances) and over 4 million of these visits were followup after the initial consultation (Hospital Episode Statistics). The average cost for each outpatient follow up is £76. At a time when the NHS is under considerable financial burden we are constantly looking at ways and means of reducing the number of outpatient appointments and the length of time for which a patient required followup. By improving rehabilitation protocols patients may complete their recovery more rapidly which may reduce clinician patient face‐to‐face interactions. This may free up this valuable resource which can be directed towards more complex clinical requirements. Patient Engagement: One of the major factors that influence patient outcomes is their engagement with the rehabilitation program. Rehabilitation professionals have long suspected that a patient's motivation plays an important role in determining the outcome of therapy, despite the lack of a clear definition of the phenomenon (Maclean et al. 2002). It is estimated that up to 65% of patients are non/partially adherent to their home exercise program (Meichenbaum 1987). Classically, patients have completed home exercise diaries. However, studies have suggested that these are often completed retrospectively. This may encourage patients to exaggerate the amount of activity performed. Hoelscher at al (1984), timed patients at home performing a relaxation exercise program and compared this to patient reported duration. They found that the latter tended to suggest a higher level of adherence. The Exergames programmes actively track patient interaction with the software. Each activity records the length of interaction, progress through rehabilitation allowing the clinician to have a clearer indication of patient engagement in rehabilitation. Patient activation describes the knowledge, skills and confidence a person has in managing their own health and health care. Intervening to increase activation can improve a patient's engagement and health outcomes. This is an important factor in helping patients manage their health (Kings Fund 2015). As a part of this study we will quantify patient engagement. Through this we can develop and validate a new tool to comprehensively measure patient outcomes using four domains. These will be Patient reported pain and function (P), shoulder range of movement i.e. Kinematics (K), patient activation or engagement (E) and patient experience (X). Gamification: Traditional evaluation of the patient's range of motion usually occurs in a clinic, often using subjective and informal methods of angle measurement. This has the potential to create discrepancies in findings between clinicians. To reduce the use of healthcare resources, make the clinical assessment more convenient for the patient, to improve the quality of the information collected and the assessment conducted, electronic measurement has the potential to perform repeatable validated objective results. If combined with appropriate principles of gamification, these measurements can become a part of the rehabilitation process with potentially faster clinical improvement and comprehensive analysis of patient generated outcomes. In light of this, there has been a wave of support for the implementation of gaming elements in healthcare technologies. 'Gamification' involves the incorporation of game mechanics in a non‐game setting and a tailored user interface for better learning which encourages engagement (King 2013). Reward systems, competition and immediate feedback improve user experience and have been implemented in healthcare related fields where patients have become a niche arget group (Lin 2013). This may in turn increase patient activation allowing them to manage their own health. MIRA: MIRA Rehab is a company who has developed software designed for the rehabilitation of medical conditions. Combined with a Microsoft Kinect sensor it accurately traces the range of motion in the shoulder. MIRA uses games which are built based upon the best clinical practice and expertise from specialist clinicians. The MIRA programme enables patients to progress through different levels within the games whilst engaging in their rehabilitation programme. Research Design and Methodology: Methodology: 90 patients will be recruited to a 3 month rehabilitation programme following a standard subacromial decompression +/biceps tenotomy for impingement syndrome. Patients will be randomised into two groups: 1. Standard postoperative physiotherapy regime without the use of accessory software (Treatment as usual Group). 2. Postoperative regime of physiotherapy plus Exergames utilizing principles of gamification. Power calculation: A sample size calculation was performed using Oxford Shoulder Score (OSS) sample data collected on patients previously undergoing arthroscopic subacromial decompression. [Alpha error set at 0.05, and beta error at 0.8, mean difference of 5 points12 in the OSS, standard deviation 6.96] Based upon this, a sample size of 32 patients in each group would be required. A second sample size calculation was performed based on the disabilities of arm shoulder and hand (DASH) outcome measure. [Alpha error set at 0.05, and beta error at 0.8, mean difference of 15 points in the DASH13, standard deviation 23] Based upon this, a sample size of 37 patients in each group would be required. Therefore, a target of 45 patients per group was chosen to allow for some participants withdrawing from the study (20%). Treatment as usual Group: Patients will attend physiotherapy on a weekly basis for assessment. They will be assessed for progression and be provided with a home exercise program. Range of motion in their shoulder will be collected on a weekly basis using the MIRA technology. Patients will be required to complete an exercise diary documenting the exercises performed as well as duration and frequency. Treatment as usual plus Exergames Group: Prior to commencing the study the physiotherapists will set up and initially demonstrate the Exergames to the intervention participants in the home setting. This will ensure the safety of the patients and address any technological issues that may arise. Patients will attend physiotherapy on a weekly basis as well as partaking in a set of tailored Exergames to play in the home system. The MIRA software will record the patient engagement with the system including number of sessions and duration of play. Patients will also be asked to complete an exercise diary. VISIT SUMMARY Baseline (Clinic Consultation): Patient's eligibility to participate in the study will be assessed; inclusion/ exclusion criteria must be met. The Patient Information Sheet will be given to the patient when they are listed for surgery. Prior to their surgery date, the patient will be contacted by a member of the research team, to see if they would like to participate in the study. Patient will be asked to give their consent to the study on the day of surgery. Past medical history will be reviewed and patient demographics will be documented. Relevant questions and scoring will be taken for baseline reference. + 24 hours (following baseline assessments) The patient reported outcome measures questionnaires will be repeated by all patients. Day 1 Patient attends hospital for surgical treatment. Confirmation of study consent must be confirmed. A study diary will be dispensed to patient. Study coordinator will give full explanation regarding completion of the diary. Day 7,14,21,28,35,42,49,56,63,70,77. Patient must attend physiotherapy clinic at day 7,14,21,28,35,42,49,56,63,70,77. A scheduled visit window to allow flexibility is +/‐ 2 days. Patient is to continue with their post‐operative physiothera y regime depending on the treatment group they have been randomised. Range of Movement will be assessed and documented by the research physiotherapist. Each patient diary will be reviewed and assessed. Day 84/85 Patient diary will be reviewed and returned. On completion of the 12 week programme all patients (N=90) will complete all outcome questionnaires, Patients randomised to Exergames arm will complete a Systems Usability score for the MIRA software. Range of movement will be recorded by MIRA and documented by the research physio‐therapist. Day 365 One year post surgery all patients (N=90) will complete the scoring questionnaires.

Nct (2016). "A Comparison of Land Based and Water Based Plyometric Training Effects on the Physical Fitness of Field Hockey Players in Jamaica." https://clinicaltrials.gov/show/NCT02802800.
	Plyometric training has been used in a variety of sports to improve power. There is minimal research however regarding its use among hockey players and even less research exploring water based training. International field hockey competitions are played on wet turf and it is felt that water training may be beneficial to these players. The study will explore whether water based plyometrics will prove to have additional benefits compared to land based plyometrics for the Jamaican hockey athletes. The members of the Jamaica hockey clubs will be recruited to participate in this study. Recruitment will be done by the principal investigator Dr. Roopchand‐Martin. A total of 34 persons will be recruited and they will be randomly allocated to aquatic or land based training. All training programmes will be conducted at the section of physical therapy and training will be done two times per week for 6 weeks. Baseline assessments will be done independent evaluators for lower limb power using the Standing Broad Jump and Vertical Jump Test, anaerobic power using the Running Anaerobic Sprint test, agility using the Illinois agility and T tests, flexibility using the Sit and Reach Test and performance during game play on wet artificial turf in relation to time‐motion analysis for total distance covered, and total time, average and maximum pace, average and maximum heart rate, time in heart zones 1‐5, and changes in rate of perceived exertion.

Nct (2016). "Cross Education in Patients With Sensorimotor Impairment." https://clinicaltrials.gov/show/NCT02795507.
	40 post‐stroke subjects will be recruited from neurological rehabilitation department at Loewenstein Hospital Rehabilitation Center, Raanana, Israel. Hospitalized patients, discharged patients from this department and patients that visit the clinic at this department will be recruited. The patients will be randomly assigned to one of two groups: 1) Experimental group. 2) Control group. The 3 weeks intervention (15 sessions) in each group will include daily 30 minutes of structured training followed by 30 minutes of standard physical therapy exercises of the upper limbs (conventional sensorimotor active and passive exercises of the upper limb). During the structured training in the experimental group, patient's hand will be positioned in a specialized motion control apparatus (Rehabit‐Tec System). This device consists of a forearm and wrist rest, and the fingers of each hand are individually strapped to the device with palms facing down. The finger is connected to a piston that moves a plunger on a potentiometer according to the degree of flexion. A control module reads the location of every potentiometer on each finger of the 'moving' hand and powers motors that push/pull the corresponding other hand finger to equalize the potentiometer's position. Each finger channel is independent and acts as a stand‐alone control circuit. The device restricts voluntary movement of the 'other' hand fingers since only 'moving' hand finger movement activates the motors. Thus when the hands are strapped to the device, and the device is turned on, voluntary hand finger movement results in passive yoking of the corresponding 'other' hand fingers. The patient can`t see his real hands and the device. Visual feedback of virtual hands are provided through a VR headset used for 3D gaming. The patient will wear motion‐sensing gloves (5DT Data Glove Ultra) that allow online monitoring of individual finger flexure in each hand. The training setup contains a head‐mounted specialized 3D camera (PLAYSTATION Eye digital camera device) to provide online visual feedback of the real environment. These devices allow detection of the patient's real hand movements and translate them by customized software to the virtual hand movements presented on the screen. The virtual hands are embedded in a specific location in space and are presented only when the patient look down towards his real hand. In this group, the patients will move their non‐involved hand, and will receive a visual feedback of a moving virtual hand in the non‐involved side. A passive movement (providing kinesthetic feedback) of the non‐involved hand will occur simultaneously by the device. For example: in a left hemiparetic patient, a movement of the right hand will result in observation of the left virtual hand and a passive movement of the left hand. The structured pre‐training of the control group will be similar except that the patient will not receive a visual and kinesthetic feedback (passive movement) of the hemiparetic hand. The subjects will be asked to move their non‐involved fingers as accurately and fast as they can. Before and after each intervention the following tests will be used: Fugl‐Meyer Assessment and box and blocks test as motor clinical assessment tests of the upper limb, and the ability to move the fingers (using the aforementioned gloves, For example: amount of flexion). Normalized lesion data will be computed using the ABLE module within MEDx software (Medical Numerics). Only before the intervention, sensory ability will be characterized using: Fugl‐Meyer assessment of sensorimotor function (Sensory section) and Semmes‐Weinstein filaments. In Cases with specific theoretical interest, the subjects will be offered to be examined also in a fMRI/DTI using Magnetic Resonance Imaging (MRI) System ‐ Siemens Prisma 3T scanner. The task during the imaging will be as during the structured pre‐training. Differences between groups will be done using t‐tests or Mann‐Whitney, depending on distribution of normality with corrections for multip e comparisons. Correlations or voxel‐based lesion symptom mapping (VLSM) analyses will be conducted to investigate the relation between lesion extent and location and responsiveness to the treatments.

Nct (2016). "The Effect of Cervical Taping on Neck Pain and Kinematics in Patients With Chronic Neck Pain." https://clinicaltrials.gov/show/NCT02915887.
	Neck pain is a common disorder, affecting 30‐50% of the general population annually, comprising approximately 25% of the patients receiving physiotherapy in outpatient clinics. Symptoms include pain and stiffness in the neck, headache, dizziness, and pain radiating to the shoulders or upper limbs. Physical impairments associated with neck pain can include decreased cervical range of motion (ROM), increased fatigability, compromised strength and endurance of the cervical muscles, and impaired sensorimotor control. A variety of Physiotherapeutic interventions have been described for the treatment of neck pain. Taping is a passive technique, widely used for the treatment of sport injuries, muscle imbalance, and impaired neural control. Clinically, taping is used for neck pain in spite of lack of research regarding its effectiveness. In addition, the mechanism by which elastic tape application affects tissue and function is yet unknown, but various effects have been described such as the ability to increase ROM, facilitate muscles and proprioception, and decrease pain. A literature search retrieved only 3 relevant studies examining the use and efficacy of elastic tape on the cervical spine. Gonzalez‐Iglesias et al. (2009) conducted a randomized trial in whiplash patients, Karatas et al. (2012) studied the effect of taping in surgeons with cervical pain after performing surgery, and Saavedra‐Hernandez et al (2012)‐ in patients with mechanical neck pain. All three studies demonstrated short‐term effectiveness of elastic taping on pain relief and cervical ROM. However, all samples were small, of mostly young participants, and effect size was not described. Reported changes were small implying that further research is needed. The objective of this study was to evaluate the short‐term effect of cervical elastic taping on pain intensity, disability and neck kinematics in patients with chronic neck pain. Materials and Methods This study was a non‐controlled trial with a pre‐post test design and a single intervention group. Ethics approval was obtained from the ethics committee, the Faculty of Social welfare and Health Sciences at the University of Haifa, and from the Helsinki committee at Rambam Health Care Campus Helsinki Committee. Participants A convenience sample of 27 individuals, 13 males and 14 females, was recruited via electronic media. Inclusion criteria were (a) chronic neck pain (>3 months), with or without referral to the upper limb; (b) age of 18 years or more; (c) pain intensity≥ 30% on Visual Analogue Scale (VAS). Subjects were excluded if they had physiotherapy in the previous 2 months, known skin allergy to the tape, evidence for active vestibular disorders, medical conditions that may affect performance such as Rheumatic Arthritis, Diabetes Mellitus, neurological disorders, head injuries, lower limb pathologies, local or systemic infections, inability to communicate and provide informed consent, unstable fracture/dislocation, post‐orthopaedic surgery in the upper body or spine, and pregnancy. Following screening, each participant signed a consent form. Virtual Reality Assessment A neck virtual reality (VR) system was used to assess cervical motion kinematics by the protocol of Sarig‐Bahat et al. (2010). This system included off‐the‐shelf hardware and customized software. Hardware included a head‐mounted display with a built‐in tracker. Virtual environment software was developed using Unity‐pro software, version 3.40f520. Cervical motion was elicited by interaction with images during a video game displayed on the two monitors embedded in the HMD. All dynamic motion data was recorded during the VR session and analysed by the software in real‐time. During the game, the participant acts as a pilot flying an airplane. The position of the airplane was controlled by the participant's head motion. Yellow targets were displayed on the HMD monitors and the participant had to contact them within 5 seconds by aligning the airplane with the virtual target. Once the target was contacted a new target would appear at a random location and the player's task was to move towards it. Based on this principle, the VR assessment included (a) evaluating cervical ROM, (b) cervical motion velocity, and (c) cervical motion accuracy during a smooth head pursuit task. Taping Technique Kinesio®Tex Tape 23 was used in this study. Two strips of tape were applied: The first layer was a Y‐shaped strip with 2 tails on 2 sides of the cervical vertebrae, placed over the posterior cervical extensor muscles and applied from the insertion to origin. The second strip was an I‐shaped approximately 20cm long, transversally applied over the C5‐C7 vertebra with a tension‐on‐base technique in a space correction technique. Study Procedure Patients were screened by inclusion and exclusion criteria. The physiotherapist performing the assessments and taping techniques was a qualified physiotherapist with 13 years of clinical experience in musculoskeletal physiotherapy and was a qualified Kinesio® taping practitioner. Each patient was assessed 3 times: pre‐ and 20 minutes post‐taping on day 1, and in a follow‐up assessment 7 days later. Following the subjective examination and completion of the questionnaires, an explanatory VR session was provided to minimize training effects and to reach a stable level of VR control. Patients were evaluated in upright sitting position, with the trunk strapped to the back of a rigid chair to eliminate thoracic motion. Calibration was performed at each session for each participant, as instructed by the manufacturer. Each VR evaluation took up to 15 minutes. Breaks were provided when needed. Following the assessment, tape was applied. After a washout period 20 minutes post‐taping application, the second examination was performed. No other physiotherapy procedures were provided. Patients were instructed to maintain the elastic tape for up to 5 days. They were instructed to remove the tape if symptoms were aggravated or if any topical irritation appeared. The third examination was one‐week after the initial examination and included VR assessment without tape application. A paired‐samples t‐test was used to evaluate the pre‐post differences in studied outcome measures. Two paired‐sample t‐tests were run: pre‐ vs. immediate post‐, and pre‐ vs. one week post‐taping. Significance level was set at 5%. Cohen's d was calculated to determine the effect size. Data were analyzed using the SPSS software, version 17.

Nct (2016). "Feasibility of a Tablet-based Fall Prevention Program for Older Adults." https://clinicaltrials.gov/show/NCT02949986.
	Twenty community‐dwelling older adults who satisfy the study criteria will be recruited to participate in this study. This group of participants will be selected to represent the general community‐dwelling older adults as much as possible. They will demonstrate a range of ability in terms of their balance and mobility in which some are non‐fallers and some fallers. All adults who meet the inclusion/exclusion criteria and have access to the internet via wireless connection will be included. Participants will be consented for the research study and will be assessed initially, after 1 month of exercise and at the end of 2 months of exercise. Assessment will include questionnaires about health history, including falls, physical activity, balance confidence and system usability. Participants will also complete strength, balance and mobility physical performance tests. Age, sex, presence of comorbidities, medication list, functional abilities, balance confidence, fear of fall behavior and fall history will be assessed by questionnaire. Usability of the tablet‐based questionnaire will be assessed by questionnaire. Participants will be tested with standard clinical tests of balance and gait. Participants will be closely supervised by a Doctor of Physical Therapy (DPT) student during training in how to use the exercise program. Participants will complete a full set of exercises with the tablet in the presence of the DPT student. The DPT student will determine whether participants are safe with the program before allowing them to perform the program on their own at home. If the research team determines that a participant is unable to exercise safely on his/her own he/she will be withdrawn from the study. The tablet‐based, video game exercise program is called Health in Motion and was developed by Blue Marble Game Company. Health in Motion was tested in a pilot study and found to reduce fall risk in 8 of 15 older participants without any adverse events. Participants will complete 2 months of the home‐based balance exercise program using the Health in Motion app. Participants will be asked to perform the exercises for 30 minutes 3x/week. Participants will be asked to perform the exercise program for 2 months. Performance scores from the clinical gait and balance measures obtained during the initial visit will be compared to the performance scores obtained after 1 month and 2 months of performing the exercise program. We hypothesize that balance and gait will improve following 2 months of performing the tablet‐based fall prevention exercise program at home. The assessments performed by the DPT students and by the participant using the app will be compared. We hypothesize that the scores from self‐assessment will closely correlate to the students' assessment. The system usability score will be examined to understand issues associated with using technology. We hypothesize that older adults will enjoy performing the exercises using the tablet format.

Nct (2017). "Cognitive and Physical Home-rehabilitation by Information and Communications Technology. Games for Older Adults Active Life (GOAL)." https://clinicaltrials.gov/show/NCT03383549.
	30 patients will be allocated in the treatment arm (Telerehabilitation program, GOAL group) by randomization. Randomization will be applied with a ratio of 1:1. The Telerehabilitation program is conceived as a combined protocol to train both cognitive and physical domains. Participants will be requested to perform the cognitive training three times weekly and physical training two times weekly, on alternate days. The subject will access the Telerehabilitation contents by using a web application configured on a touchscreen notebook, that will be provided to each participant by the research institute. Physical exercises are going to be chosen according to adaptive physical activity model, and each session will be made up of eleven exercises, divided in three categories: warm‐up, strengthening and stretching/relaxation. The participants will perform the exercises according to instructions received in a sequence of videos. Every session will last 30 minutes. Cognitive training will be based on BrainHQ exercises (BrainHQ, Posit Science,USA) which are characterized by adaptive control of the difficulty levels. The chosen exercises aim to train different cognitive domains including: attention, executive function, memory, processing speed, reasoning, and visuospatial memory. Each session will last 20 minutes, and will include four different types of exercise. While enrolled in the 8 weeks program, participants will also be requested to wear an actigraph. The actigraph will be placed on the non‐dominant arm and will be used to monitor daily activity and sleep quality. At the end of the tele‐rehabilitation program, participants will undergo a final assessment.

Nct (2017). "Comparison of Training in Virtual Environment With and Without Physiotherapeutic Intervention in Chronic Stroke Patients." https://clinicaltrials.gov/show/NCT03361241.
	The aim of this study is to compare the effects of a balance training program in a virtual environment (using a gaming system with balance board device) with and without verbal/manual physiotherapeutic intervention, on the motor function, balance and gait in chronic stroke patients. It is a prospective, single blinded, randomized clinical trial, performed at Center of Research of the Department of Speech Therapy, Physical Therapy and Occupational Therapy of São Paulo University. Forty chronic stroke patients will be randomly in control and experimental group, 20 each one. Both groups conduct 14 training sessions, twice a week, for seven weeks. Each session will consist a 30 minute‐global‐exercise series including stretching, muscle strength and axial mobility exercises. After this, both groups will perform more 30 minutes of balance training using eight Wii Fit games which stimulate motor and cognitive functions. The main outcome measures will be: the lower limb subscale of the Fugl‐Meyer Assessment (FMA‐LE); Balance Evaluation Systems Test (BESTest) and 6‐ minute walk test (6MWT).

Nct (2017). "Effect of High-intensity Intermittent Games on Cardiorespiratory Fitness and Body Composition in Children." https://clinicaltrials.gov/show/NCT03308500.
	Background Physical activity is associated with many health benefits, but most children fail to meet the international recommendation. This is a concerning matter for the future health‐care population, as cardio‐metabolic risk factors in children and adolescents can lead to coronary heart disease, metabolic diseases (obesity, type II diabetes) and mortality in adulthood. According to children participated in different types of physical activity or early sports practice in the first stages of life has been positively associated with lower occurrence of chronic diseases in adulthood. Ultimately, daily participation in outdoor games, fitness activities, and recreational sports will be a major factor in the improvement of health and well‐being of children and adolescents. Unlike adults, children's habitual physical activity patterns are highly intermittent in nature, characterised by rapid changes from rest to vigorous physical activity. High‐intensity intermittent training (HIIT) describes physical exercise as a brief, intermittent burst of vigorous activity, interspersed by rest periods or low‐intensity exercise. HIIT offers infinite variations with the specific physiological adaptations induced by this form of training determined by several factors including the precise nature of the exercise stimulus. In recent years HIIT has received great scientific interest, the studies have examined the physiological effects of HIIT in children and adolescents and reported positive findings on cardiorespiratory fitness, fat‐free mass index, a change in body mass index (BMI) and percentage body fat. Objective The objective of the study is to verify the effects of a high‐intensity intermittent games intervention (HIIG) versus a moderate intensity group on cardiorespiratory fitness and body composition in children. The hypotheses formulated was: high‐intensity intermittent games intervention contribute to the improvement cardiorespiratory fitness and body composition in children. Methods Study Setting This study is performed in a public school setting in the city of Valparaiso, Chile. Participants timeline Will be recruited through information to the parents 54 children from 8 to 12 years old belonging to a public school of Valparaiso, Chile. Interventions The intervention will last for 12‐weeks, each group included participation in twice‐week 40 minutes exercise sessions. In HIIG children took part in 5 games per session; 2 velocity games and 3 small‐sided games (such 3 vs 3 and 4 vs 4). This session included 4 minutes games and 2 minutes recovery. In MIG children took part in 5 games per session. This session included 4 minutes games and 3 minutes recovery. A standardised warm‐up protocol consisting of 5 minutes of running and stretching is performed before each training session. Cool down is after class 5 minutes of static stretching. The intensity will be continuously monitored during each session through heart rate (Polar M400, Finland) and rating of perceived exertion (RPE). The intervention will be based on the protocols described by different authors of the area. These sessions will be conducted inside of the children's normal physical education lessons. A Physical Education Professor will make the interventions. Thus, the study will be divided into four moments: T1 (recruitment and screening), T2 assessment before the intervention, and T3 and T4 for assessment after intervention and assessment follow up. Sample size The sample is calculated a with variance analysis (ANOVA one way) (one independent variable) with an anticipated statistical power of 0.95, an error probability of 0.05, and effect size of 0.5, predicted that the appropriate sample size for the present study is 54 participants (G‐power program 3.1.3, Germany). The subject sample is comprised of 54 elementary school students aged 9‐12 years. Participants and their parents had to sign a written consent containing all the information of the study prior to the commencing day. Statistical analysis The normality distribution of the data ill be checked with the Kolmogorov‐Smirnov test. All data will be expressed as averages and standard deviations (DS). ANOVA will be used to ensure that all 2 groups are homogeneous according to cardiorespiratory fitness and body composition before training. The effects of training will be statistically analysed using post‐hoc Tukey test in order to compare the variables present among the mean value groups between pre and post test (time effect). For each variable, there is an effect that could be attributed to the intervention or the gender. Therefore, in both groups, data for boys and girls will be collected and analysed by a 2‐way ANOVA. The threshold for statistical significance is set at p ≤ 0.05. All analyses will be performed using Statistical Package for the Social Sciences (IBM SPSS) version 22.0. The study contributes to scientific knowledge since it studies the effects of a new method of physical exercise which still lacks full clarity regarding its implementation and effect in variables like cardiorespiratory fitness and body composition in children. The study is guided by practice‐based scientific evidence for the use of HIIT in children. Upon completion of data collection, it is expected that the HIIG volunteers will benefit from increased cardiorespiratory fitness through the 20 meters shuttle run test, improved body composition through the decreased body fat mass and increased body muscle mass, reductions in scores on the IMC, and waist circumference. In the MIG, no significant changes in the values of any variable analysed are expected. It is believed that the desired results could be attributed to physiological effects of exercises of high‐intensity intermittent exercises associated with the proposed exercise protocol.

Nct (2017). "Effect of Video Game Based Physical Activity Training in Persons With Multiple Sclerosis." https://clinicaltrials.gov/show/NCT03045380.
	MS is an inflammatory, demyelinating, and neurodegenerative disease of the central nervous system. The most common clinical signs and symptoms are fatigue, spasticity, affecting mobility, cognitive impairment, chronic pain, depression, decreased quality of life, and bladder and bowel dysfunction. In order to increase and maintain the quality of life of individuals with MS these disease‐related progressive symptoms need to be managed. For this reason, patients need long‐term rehabilitation. This situation reduces the motivation of the people over time and makes the continuity of treatment difficult. Developments in rehabilitation technology aim to contribute to the treatment process as well as to increase the active participation of individuals with chronic diseases. Current literature has shown that video‐based physical activity training as non‐pharmacological therapy may be an effective method for symptoms such as balance, tremor, fatigue, cognitive functions in persons with MS. The primary purpose of the study was to examine the effects and persistence of 8‐week video games‐based physical activity training in MS patients on upper extremity functions, walking, balance, cognitive functions, quality of life, depression and fatigue. The second aim of the study was to investigate the effect and persistence of traditional physiotherapy of 8 weeks on MS patients on upper extremity functions, walking, balance, cognitive functions, quality of life, depression and fatigue. The third aim of the study is to compare the effects of 8‐week videogame‐based physical activity training and traditional physiotherapy in MS patients. Volunteers from persons with MS who are in routine control of the MS Outpatient Clinic of Neurology Department, Faculty of Medicine, Dokuz Eylül University will participate in the study. In accordance with the inclusion criteria, 51 patients were randomly assigned to three groups: 17 patients in the game based rehabilitation group, 17 patients in the conventional rehabilitation group and 17 patients in the no intervention group. Based on the physical levels of the patients, appropriate games will be selected and video game based physical activity training will be started. Video games will be played with Xbox One with motion sensor (Microsoft) and a 52'' Liquid Crystal Display. Depending on the prognosis of the patients, the grades of the games and types of the games will be changed. The program will be administered once a week for 8 weeks. A conventional physiotherapy program including balance, upper extremity, and core stabilization exercises will be implemented. Sessions will take 5‐10 minutes warm up, 15‐20 minutes exercise and 5‐10 minute cool down periods. The program will be administered once a week for 8 weeks. No intervention group formed from waitlist will receive no intervention.

Nct (2017). "Effects of Physical Exercise, Virtual Reality and Brain Exercise on Balance of the Elderly." https://clinicaltrials.gov/show/NCT03118414.
	This study used healthy elderly participants with the age of 65‐85 years. Eighty‐four elderly participants were recruited by announcing the study information at the elderly homes. Sample size calculation was performed using G*Power software (G*Power version 3.1.9.2, University Kiel, Germany). To our knowledge, no study compare the effects of physical exercise, virtual reality and brain exercise on balance of the elders. Based on previous finding on the effects of virtual reality on balance of the elderly, a total of 84 participants were required at confidence level (α) of .05 and power (1‐β) of 0.80. Participants who were interested in participation underwent a screening process using inclusion‐exclusion criteria and receive brief information regarding the study. If they met all inclusion criteria, the consent process was performed. To ensure they understood the study, they were simply asked regarding the study (i.e. objectives, benefits, etc.) before signing the consent form. After the participants provided a written informed consent, all participants filled out the information sheet and demographic data were collected. After that, age matching with range of ± 5 years and random allocation to different studies groups were done. Pretest assessment for balance by BBS and TUG, cognitive function by TUGC and MOCA, muscle strength by 5 TSTST and Hand Grip Strength (HG) and fear of falling by FES‐I and perspective of exercise by questionnaires were done and recorded by blinded assessor. In this study, random allocation of the participants to different study groups; physical exercise group (PE), virtual reality group (VR), brain exercise group (BE) and control group; was done by the medical doctor and intervention was given the physical therapist from the study area which is the elderly home. All the assessments were done by the principal researcher. The assessor was blinded to reduce the bias which might come from the assessor's expectation. After that, all the participants from intervention groups were explained and demonstrated about the respective interventions until they clearly understand about the intervention program before commencing the intervention program. The PE, VR and BE groups got their respective intervention for 30 minutes per sessions, 3 non‐consecutive days per week for 8 weeks. The control group was reminded not to participate in any other exercise or intervention program except their routine daily activities for 8 weeks. Participants from PE group needed to do the 5‐minute warm‐up, 20‐minute core content (upper and lower limb strengthening exercises and balance challenging exercises), and 5‐minute cool down exercise programs. For the virtual reality group, the participants were reminded to play the game according to the program and try to get as high a score as possible they can. This intervention program included 10 games. The participants were asked to choose 6 games from the list before each 30‐minute session, and were asked to choose the games to include the upper limbs, lower limbs, and also for both strength and balance challenges instead of choosing the games that need to use only upper limbs or lower limbs, and were just for strength and balance gain. For the brain exercise, participants needed to play cognitive stimulating games; Chinese Checker, Jenga and Memory Matched pair game; in the sitting position. The participants needed to paly 10 minutes for each game and total duration for all 3 games was about 30 minutes. After 8‐week study period, post‐test assessments were done to find out the effect of interventions. The statistical analyses were performed by using SPSS for windows version 18.0, statistical software package. The value of p<0.05 was considered to indicate statistical significance. As the objective of this study was to find out the effects of PE, VR and BE on balance, cognitive function, muscle strength and fear of falling in the elderly. Two‐way mixed ANOVA was used to test the variance differences among the four groups with post‐hoc analysis as appropriately. Prior to utilization of statistical tests, descriptive statistics were performed and statistical assumptions were tested. Transformation will be performed if the data were not normally distributed. Appropriate statistical tests (parametric vs. non‐parametric) were performed to determine the effects of different interventions in this study on balance, cognitive function, muscle strength and fear of falling in the elderly. Post‐hoc power analysis was also performed.

Nct (2017). "Home Exercise Intervention in Childhood Obesity." https://clinicaltrials.gov/show/NCT03080376.
	In recent years there has been a decline in levels of physical activity (PA) in both children and adults. The promotion of PA is also a key element in the treatment of obesity, along with changing eating habits, but usually has very low levels of adherence. Active video games may be an alternative for the promotion of PA in the treatment of obesity. The objective of this project is to evaluate the impact of a physical exercise Web‐based program with or without support on Body Composition, Physical Fitness and Blood Pressure values.

Nct (2017). "Music and/or Video Games During Labor." https://clinicaltrials.gov/show/NCT03024411.
	For decades, investigators have been evaluating the efficacy of music for pain relief. Music for pain management has been studied in the field of palliative care, oncology, physical therapy, pediatrics, post‐operative procedural pain and childbirth. A 2006 Cochrane review found that listening to music reduces pain intensity levels and opioid requirements, but the magnitude of the benefits is small and the clinical importance unclear. Previous studies in obstetrics vary, as some evaluate music for pain control at time of cesarean section and others during labor. A 2014 study investigated the effect of progressive muscle relaxation exercises and music on low back pain and quality of life in pregnancy. Some previous studies investigating music or white noise for pain control during labor revealed beneficial results. One prospective trial of 25 women found little practical value of audio‐analgesia. However, most studies evaluating music therapy for pain relief in labor were limited by sample size. Specifically, a 2011 Cochrane review investigating randomized controlled trials comparing relaxation methods as a method of pain management in labor found insufficient evidence for the role of music and audio‐analgesia and the need for further research. Excluded from this review was a trial by Phumdoung et al. due to the inability to obtain additional methodological and statistical information from the authors. More recently, a randomized controlled trial (RCT) done in Turkey randomized 156 women into a music and control group. Mothers in the music group were found to have a significantly lower level of pain and anxiety in all stages of labor. Pain and anxiety were evaluated by a visual analog scale. While this evidence is the best to date, there is a lack of generalizability for other populations and the primary outcome was subjective. A 2012 systematic review of video games found improvement in psychological therapy, physical therapy, physical activity, clinical skills, health education, pain distraction, and disease self‐management outcomes. Labor induction is a common obstetrical procedure. Labor results in severe pain for many women and typically requires medical treatment for pain relief. Types of analgesia for pain control on labor include parenteral (Fentanyl, Nalbuphine, Meperidine) and regional (spinal, epidural, combined spinal epidural) analgesia. However, all types of analgesia pose risks to the mother and fetus. Administration of parenteral agents result in minimal‐to‐absent reduction in pain scores and high doses affect fetal heart rate tracing and later increase the number of infants requiring naloxone therapy. While regional analgesia provides superior pain relief, common complications include hypotension, fever, postdural puncture headache, transient fetal heart rate decelerations, pruritus, and inadequate pain relief. Due to these risks and other reasons, many women prefer to go through labor without medical therapies or with minimal medical therapy and desire complementary therapies to help manage their pain. Data are lacking regarding the use of music and video games for the management of pain in labor. In view of the lack of good quality evidence from well designed RCTs, we propose a randomized controlled trial to determine the utility of music and video games for pain management during induction of labor. Pregnant women that are scheduled for labor induction with Foley bulb after 37 weeks will be approached for participation in the study. The study informed consent will be obtained. Patients will be randomized to a music/video games group (group 1) and a non‐music/video games group (group 2). Those randomized to group with music/video games will be given an iPod for those purposes. The iPod will include free music applications such as Pandora as well as some of the most commonly downloaded games. Randomization will be performed using a computer generated random list of numbers assigning patients to the 2 groups of the study. Randomization will occur after the Foley bulb is placed. Study a signment and the list of random number assignments will be kept secure in opaque envelopes until the end of the study. Prospective subjects presenting for induction of labor in labor and delivery, and willing to participate in the study will be evaluated for their eligibility. After the Foley bulb is placed, patients will be randomized. Those assigned to the music/video game group will be given an iPod to use during labor. These patients will have the choice of listening to music via earphones or a speaker which amplifies the sound. Patients assigned to the non‐music/video game group will not be given an iPod and will be asked to avoid using their own personal devices (if applicable) as much as possible. Understanding that patients randomized to the non‐music/video game may still elect to use their own electronic devices, time of use of electronics for music/video game purposes will be recorded in both groups with assistance from the patients and nursing staff. All nurses will be educated regarding the study procedure. Nurses will not ask any patient if they desire pain medicine to avoid prompting the patient. Every patient enrolled will receive a Foley bulb inserted just superior to the internal cervical os and then inflated with normal saline for mechanical dilation of the cervix. The Foley bulb will be placed under traction by taping the tubing to the patient's leg. No additional traction will be applied to the Foley bulb after placement and initial traction. After twelve hours, if the Foley balloon is still in place, the Foley balloon will be deflated and removed and the remainder of obstetrical care will be left to the discretion of the supervising faculty. After six hours or after epidural placement the use of music/video games will be continued or ceased pending patient desire. The study will be explained as in the consent form and if agreed, patients will elect either to participate in the study or not after all risks and benefits are explained. Data to be collected will consist of age, gravida/para, gestational age, body mass index, time and date of intervention, time and date of delivery, mode of delivery, bishop score at admission (bishop score is a score that assesses cervical readiness for delivery and is measured by digital pelvic exam. A score < 7 is considered unfavorable and is an indication for cervical ripening to induce labor), time and date of pain medication request, type and amount of parenteral medication, time from Foley bulb placement until expulsion, patient pain score by visual analog scale, and patient satisfaction. Data will be extracted from patients' medical records as well as from direct interview with the patient. If elected to participate consents will be obtained and stored in patient chart. A copy of the consent will be given to the patient. Patients will be consented in either English or Spanish by research personnel fluent in the language. The primary outcome will be the time for patients to request pain medications after Foley bulb placement. The two groups will be compared for differences in pain outcomes.

Nct (2017). "Virtual Reality and Active Video Games to Improve Balance in Children With Brain Injury." https://clinicaltrials.gov/show/NCT03386968.
	The purpose of this pilot feasibility study is to assess the feasibility of using the Playstation Xbox 360 and Rutgers V‐step via a Kinect Sensor with active video game software as a part of a physical therapy intervention to improve obstacle negotiation, gait speed, and stair negotiation in ambulatory children with Cerebral Palsy (CP) hemiparesis or spastic diplegia, or non‐progressive brain injury (BI). Children will be assessed using perceptual, balance, functional and gait assessments.

Nct (2018). "Body-Brain Training MS Cognition." https://clinicaltrials.gov/show/NCT03737825.
	You will be asked to attend one initial session for cognitive tests and answer questions regarding your medical history to see if you are eligible for the study. This process takes about 45 minutes. If you are eligible you will be asked to schedule the following appointments to participate: First you will be randomized into one of two different training programs. You will not be able to choose which program you are placed in, but have equal chances of being randomized into each: ‐ Program 1 involves interactive brain training games displayed on a large screen. Participants will use whole‐body movements to complete game tasks. Tasks involve aerobic movements such as reaching, stepping, and jogging in place. These movements are tracked by a motion sensor. Stretching, warm‐up, and cool down sessions will be mandated prior to and following the tasks. ‐ Program 2 involves brain training games on a tablet device. Time between alternating game tasks will involve guided, light physical exercise. Exercise tasks involve aerobic movements such as reaching, stepping, and stretching. Stretching, warm‐up, and cool down sessions will be mandated prior to and following the tasks. Baseline Visit: This session should take about one hour. You will be given some cognitive, visual and physical tests. You will be given questionnaires about your mood, fatigue and function. You will receive a Fitbit Flex to be worn daily for the duration of the study. The Fitbit will track daily active step count, number of active minutes, quality/length of sleep cycles. Week 1‐4 Visits (12 sessions in total): These sessions will be 1 hour and 30 minutes each (Note: the first session will be 2 hours to account for calibrations). You will come in three times a week for four weeks to attend on‐site sessions. You will be asked to complete digital, cognitive and physical training followed by 45 minutes of cognitive and physical assessment at the end of each session. You will be asked to come in for a final follow‐up visit 6 months after you have completed your last training session. This visit will take about 45 minutes. You will be asked to complete some cognitive, visual and physical tests. You will be given questionnaires on mood, fatigue and function. You will return the Fitbit Flex you received at the start of the study.

Nct (2018). "Comparison of Three Balance Training Protocols for Individuals Post Stroke." https://clinicaltrials.gov/show/NCT03757026.
	This study compares conventional balance training to a reactive slip protocol and novel, high intensity, harnessed balance training using video gaming. It examines the impact of these three interventions on fall risk and on aspects of balance including overall mobility, quality of life and community participation. The study includes 60‐69 adults who had a stroke more than 6 months ago and who walk independently. Participants will complete 14 sessions: 4 sessions (2 pre‐, 2 post‐) of testing and 10 intervention sessions. There will be one to two sessions per week depending on scheduling and participant preference. The first session will begin with screening and the consent process after which participants will be randomly assigned to one of the following three groups of 20‐22 participants each: conventional balance training (PT), reactive slip training (Slip), and multi‐directional harnessed gaming training (MHG). The first individual entering the study will be randomly assigned to one of the three groups, the next person will be randomly assigned to one of the two remaining groups, and the third person will be placed in the remaining group. This process will be repeated with the next group of three individuals entering the study, and so on. Approximately midway through the study, researchers will assess group mix for impairment severity levels and adjust if necessary. All 14 sessions are outlined below including descriptions of testing and intervention procedures. During session one, the screening, consent and randomization process will be followed by the clinical testing, falls history and falls diary initiation, then scheduling of subsequent visits. Participants will be questioned as to any falls within the last 12 months, and if any ‐ how long ago for each fall and the circumstances of and any injuries from the fall as they recall them. The falls diary will be explained to the participants and participants will be asked to keep it during the weeks of the 14 sessions and for 6 months afterwards. The stability (RPS) scale will be explained to the participants and remaining clinical testing will be administered including the Mini‐Balance Evaluation Systems Test (miniBEST). The limits of stability testing (LOS), including the reactive perturbation testing portion of the miniBEST will be performed with motion capture. If time, participant scheduling, and participant tolerance for activity permit, the LOS testing will be done at the second pre‐test session because this will allow motion marker placement for one session rather than two, saving the participant time. If timing or participant activity tolerance do not allow, the LOS testing will be performed, with motion capture, at the first pre‐test session. The second session will continue the pre‐test portion of the protocol with treadmill perturbation testing and LOS testing. All participants will be supported in a fall‐arresting harness for all treadmill perturbation testing. First, the treadmill will be used to measure the participant's normal then fast walking speeds. For perturbations, the treadmill will be run at the participant's determined normal walking speed. It will randomly accelerate at mid‐stance of the hemiparetic foot, then return to its usual speed. The participant will be asked to try to maintain his/her balance and continue walking as before, but that if the participant needs to stop, the investigator will halt the treadmill and provide a rest break. After each perturbation, the participant will be asked to score it on the RPS scale. Throughout all of the treadmill perturbation testing force, motion, and load cell data will be recorded and vital signs will be monitored consistent with Physical Therapy and exercise standards. There will be up to 18 perturbations. The initial perturbation intensity will be based on the participant's miniBEST scores and normalized to that individual's maximum gait speed. Each subsequent perturbation intensity will be determined based on the participant's response to the previous perturbations: hree consecutive falls (>30% of participant's body weight as measured by load cell) leads to a decrease in perturbation intensity; three consecutive recoveries (<5%of participant's body weight as measured by load cell) leads to an increase in perturbation intensity; and if the three previous perturbations were mixed (some combination of falls, recoveries, and harness assists) the perturbation will be unchanged. The outcome of each trial (fall, recovery, or harness assist) will be recorded. After pretesting, 10 intervention sessions will begin based on group assignment, as described above. The conventional balance training group (PT) will receive individualized standard of care physical therapy with the goal of improving balance and mobility during sessions 3 through 12. This will be completed by an experienced community physical therapist who will be blinded to the other groups' activities and to all pre‐testing results. The first visit will have approximately 60 minutes allotted for the initial evaluation and limited treatment while the remaining 9 sessions will consist of 45 minutes of PT treatment. The only instructions to the PT are that the focus of the course of care should be on "balance and mobility" and that there should be 10 sessions total. The investigators will be blinded to the specifics of the individual treatments provided by the PT(s). The reactive slip training group (Slip) will complete one standing slip session using the current protocol of scaling slip distance and force to each individual and modulating the slip intensity across the session based on participant responses. To match intervention time to the other two groups, the remaining 9 sessions will involve 45 minutes of supervised walking with vital sign and distance monitoring, and rest as necessary. All participants will use a full‐body, fall‐arresting harness throughout all slip testing. All participants will be informed that during the experimental procedures the Slip Trainer platform, on which they are standing, may move suddenly and unexpectedly under their feet. The participants will be asked to react as naturally as possible to the perturbation. The participants will also be informed that if they are unable to catch themselves, the full‐body safety harness they will be wearing will prevent a fall from occurring. Participants will be reminded that they may request a rest break at any time. Participants will be guarded by an investigator (both licensed Physical Therapists) or by a Student PT supervised by an investigator. The Slip Trainer is a low platform on rollers which allow only anterior‐posterior (forward‐backward) slips, not side to side. Participants will stand quietly on the trainer and slips will be induced by the (randomly timed and unannounced) release of weights from a designated height, causing the weights to fall and the platform to be pulled backward or forward approximately 15 ‐ 30 centimeters. The amount of weight released will range from 15‐40% of the participant's body weight. Up to 17 slips will be induced. The participants will self‐rate their stability during the slip with the RPS immediately after each slip recovery. Motion, load cell and outcomes data will be collected throughout slip testing. Initial perturbation intensity (percent body weight and slip distance) will be based on the participant's miniBEST score and each subsequent perturbation intensity will be determined based on the participant's response to the previous perturbations. If this algorithm leads to the perturbations being reduced below 5% and 5 cm or above 40% and 30 cm, the trials will be stopped. The remaining nine intervention sessions will consist of accompanied walking for up to 45 minutes. Participants will come to Cleveland State University and will walk at a comfortable pace while accompanied by a researcher in the areas in or adjacent to the Health Sciences spaces. Researchers will monitor the participants' vital signs as indicated and in the manner consistent with standard PT/exercise practice. Participants may request r st breaks as needed. The researcher will record the distances walked, the rests taken, and the vital signs as taken. The multidirectional harness group (MHG) will use a harness with the Open Area Support System (OASUS) multidirectional harness framework and play selected Kinect™ active video games with varied balance demands, while standing on multiple balance training surfaces (e.g., solid floor, rocker board, foam, slider platform). Participants will wear the fall‐arresting harness in the OASUS system for all game play. This harness allows participants to move freely in any direction except it limits their vertical descent to a pre‐set height. This will be adjusted to a height that allows the participants to touch the floor or support surface with only their feet when fully suspended in the harness in any direction; no other body part will be able to reach the ground. This will be re‐adjusted each time the participant changes the playing surface. Initial game and training surface combinations as well as subsequent difficulty levels and training conditions will be chosen using a progression algorithm in conjunction with the Rate of Perceived Stability (RPS). Motion data will be collected during gaming for Sessions 2, 6, and 10. RPS scores will be collected during and immediately after all gaming sessions. Participants are able to use rest breaks and will be monitored throughout all sessions consistent with standard physical therapy/exercise practice. At the first session of MHG, participants will be introduced to each game and given time to practice playing that game until they feel comfortable with each game. All participants will progress with the prescribed sequence of games and surfaces, progressing based on their rating of the previous three bouts of play. Two post‐test sessions will follow the 10 intervention sessions. These will be equivalent to the two‐pretest session above with the treadmill testing at session 13, LOS testing at either session 13 or 14, and the remaining clinical testing and follow up at session 14. All participants will be reminded of previous protocols/instructions completed in their pretest sessions. The 14th and final session will also include reviewing the participants' falls diaries and setting up procedures for contacting participants weekly or biweekly about falls. The participant will have a chance to ask any questions about the overall study and the payment forms will be signed.

Nct (2018). "Effect of Two Methods for the Application of Cryotherapy." https://clinicaltrials.gov/show/NCT03707327.
	After the contact, explanation of the study procedures and acceptance of the participants, the data collection will be started and performed in the teaching laboratory of the Physiotherapy course of the State University of Londrina. Initially, the demographic data of the sample (age, height, weight, limb and time of pain) and signature of the consent term will be collected. After this step, the participants should point to the Visual Analogue Scale (EVA) and the Patellofemoral Disorders Scale (AKPS). Before performing the cryotherapy technique, the basal skin temperature in the anterior region of the knee will be recorded by means of a thermographic camera, and the participants will be submitted to five sets of the sit and stand test in 30 ', with rest of one minute between them. They will then re‐signal the EVA and the skin temperature will be retained by the camera. Finally, they will undergo the application of cryotherapy according to the category which has been "randomized". The two different intervention techniques will be: ‐ Ice pack group (CPG): where the participant will have a plastic bag containing 500 grams of crushed ice over the anterior region of the knee, and lie flat with the lower limb extended and supported on the ground for 20 minutes; ‐ Group Cryotherapy + Compression by Game Ready® (CCGR): where the participant will have the knee joint wrapped and compressed by the equipment where temperature, compression and time will be controlled, maximum compression, for 20 minutes by the equipment itself; lie in the same manner as for the other intervention. Immediately thereafter, the EVA will be applied and the skin surface temperature recorded in the knee region, as well as 10, 20, 30 and 60 minutes thereafter.

Nct (2018). "Effectiveness of Commercial Video Games in Subacute Stroke Rehabilitation." https://clinicaltrials.gov/show/NCT03528395.
	To determine the effectiveness of a structured protocol using semi‐immersive virtual reality with commercial videogames for balance, postural control, functional independence, quality of life and motivation in patients who have suffered an ischemic and / or hemorrhagic stroke in subacute phase and are being treated in a mid‐stay hospital. Patients and methods: Randomized Controlled Trial. Simple blind. Control group will receive conventional therapy (physical therapy and occupational therapy) intervention being based on a task‐oriented approach, with five weekly sessions of Physical Therapy and Occupational Therapy with duration of 45 minutes per session. The experimental group will receive in addition to the above an experimental intervention during 8 weeks providing additional treatment using virtual reality semi‐immersive complement is added by means of commercial video games implemented with the Xbox 360º video game console in conjunction with the Kinect device.

Nct (2018). "The Effectiveness of the Jamboxx Respiratory Therapy Device: Study 3." https://clinicaltrials.gov/show/NCT03547349.
	Testing Plan: Study participants will be enrolled sequentially in one of three study groups: • Group 1 ‐ the first 25 patients will be consented to participate by a member of the research team. These study patients will receive a study information/authorization sheet about the study prior to surgery during their pre‐operative clinic visit. This subgroup will be provided postoperatively with an incentive spirometer connected to a tablet interface. This tablet device uses a digital interface to mimic the look and function of the standard issue incentive spirometer. Subjects in this group will receive current standard of care with routine surgical and RN encouragement to use the spirometer. The tablet will monitor and record spirometer device utilization. Demographic data (age ( or >89), gender, ethnicity) and body mass index (BMI) will be collected. No patient identifiers will be collected. At 72 hours or at discharge, the devices will be exchanged for standard issue incentive spirometer. Research staff will extract the demographic data described above as well as BMI. Randomized Study Subgroups: • Groups 2 and 3 are active study groups. ‐Patients will be randomized via a random number generator post‐operatively to group 2 or 3, stratified by surgery type (laparoscopic or open) . Each subgroup will include a total of 72 randomized participants Group 2 : These study patients will be consented by members of the research team prior to surgery at their pre‐operative clinic visit. The patient will receive RT or RN education preoperatively as to the importance of incentive spirometry in prevention of post‐operative respiratory complications. This subgroup will be provided with an incentive spirometer connected to a tablet interface. This tablet device uses a digital interface to mimic the look and function of the standard issue incentive spirometer, and will set a spirometry goal while collecting usage and pulmonary function data. Subjects in this group will also receive daily intensive education from a study team member during the postoperative time up until 72 hours or until discharge. This education will be done to reinforce the standard instruction provided by the hospital staff. Research staff will collect data on pain, utilization of incentive spirometry, and room air oximetry. The oximetry measurements will be collected after patients have been off of oxygen for between 3.5 to 4 minutes. For patients requiring high levels of supplemental oxygen (pulse oximetry measurement (<90%), oxygen will not be removed for pulse oximetry measurements. The additional education and oximetry measure will be collected by a respiratory therapist three times a day at the preferred times of 0600, 1200 and 1800 post operatively. Patients will remain on study for 72 hours post‐surgery, return to the OR, SICU admission or medical prescription of directed chest physiotherapy. A Chest x‐ray will be obtained at 48 hours post‐surgery. Demographic data (age ( or >89), gender, ethnicity), pulmonary function data and body mass index (BMI) will be collected. No patient identifiers will be collected. At 72 hours or at discharge, the devices will be exchanged for standard issue incentive spirometer. Group 3: These study patients will be consented by a member of the research team prior to surgery at their pre‐operative clinic visit. The patients will receive RT or RN education preoperatively as to the importance of incentive spirometry in prevention of post‐operative respiratory complications. This subgroup will be provided with both intensive education reinforcement and a spirometry tablet device that also includes multiple gaming programs. The games are meant to encourage incentive spirometry and are programmed to progress in accordance with the patient's personal increasing capacity. This tablet device uses a digital interface to mimic the look and function of the standard issue incentive spirometer, and will set a spirometry goal while collecting usage and pulmonary function data. Subjects in this group will also receiv daily intensive education from a study team member during the postoperative time up until 72 hours or until discharge. This education will be done to reinforce the standard instruction provided by the hospital staff. Research staff will collect data on pain, utilization of incentive spirometry, and room air oximetry. The oximetry measurements will be collected after patients have been off of oxygen for between 3.5 to 4 minutes. For patients requiring high levels of supplemental oxygen (pulse oximetry measurement <90%),oxygen will not be removed for pulse oximetry measurements. The additional education and oximetry measure will be collected by a respiratory therapist three times a day at the preferred times of 0600, 1200 and 1800 post operatively. Patients will remain on study for 72 hours post‐surgery, return to the OR, SICU admission or medical prescription of directed chest physiotherapy. A Chest x‐ray will be obtained at 48 hours post‐surgery. Demographic data (age ( or >89), gender, ethnicity), pulmonary function data and body mass index (BMI) will be collected. No patient identifiers will be collected. At 72 hours or at discharge, the devices will be exchanged for standard issue incentive spirometer.

Nct (2018). "Gamification in Knee Replacement Rehabilitation." https://clinicaltrials.gov/show/NCT03717727.
	After total knee arthroplasty (TKA), knee is usually swollen, painful, and stiff. The main goal of post‐operative physical rehabilitation is to achieve full extension and flexion of the knee to avoid contractures and stiffness. Also strengthening of quadriceps muscle and balance to help activities of daily living and overall mobility are important. The post‐operative knee replacement rehabilitation includes the standard protocol in hospital phase and the standard home exercise instructions. Computer based exercising games (exergames) may be new method to increase training adherence and volume after TKA and thus improve results and effectiveness of the rehabilitation. However, evidence of effectiveness of rehabilitative exergaming on physical functioning is sparse and more research is needed to conduct evidence‐based rehabilitation practices. Therefore the present study examines the effectiveness of a 16‐week gamified physiotherapy on physical functioning, life satisfaction and pain for patients after TKA compared to treatment as usual home exercise. The second objective is to validate the psychometric properties of WHODAS 2.0 (WHO Disability Assessment Schedule) and brief ICF (International classification of functioning, disability and health) core set of osteoarthritis questionnaire. Other objectives are to find out, what kind of understanding and experiences the participants have about the rehabilitation with exergames and to evaluate the usability and user experience of exergames.

Nct (2018). "Impact of Active Video Game on Cardiorespiratory, Macro and Microcirculation Function of Adolescents With Overweight." https://clinicaltrials.gov/show/NCT03532659.
	This study evaluates the effects of physical exercise through active videogame in the microcirculation, macrocirculation, cardiorespiratory function and physical fitness in overweight adolescents. For that, they will be randomized into two groups, one being a control group and the other intervention group. The randomization will be made by school. The intervention group will perform the physical exercise through the active video game, three times a week, for 50 minutes, during 8 weeks. Reassessments will be performed before and after the intervention to evaluate the outcome variables.

Nct (2018). "Is EMG-based Serious Games Effective in Improving Gait in Children With Cerebral Palsy ? Interest of Electromyography Feedback (EMG)." https://clinicaltrials.gov/show/NCT03628261.
	Cerebral palsy (CP) is a major motor dysfunction manifesting early in childhood, with severe consequences to performance in daily functions. CP children are typically unable to voluntarily activate individual muscles, hindering motor coordination and therefore the ability to produce movements as smooth as those seen in control cohorts. Muscles spanning distal joints are more likely affected by CP, resulting in abnormal gait patterns. While commercially available and customised games have been considered for CP rehabilitation in the last decade, they are mainly based on the analysis of movement kinematics and none seems to deal directly with the key source of motor impairment: the skeletal muscle. Surface electromyograms (EMGs), on the other hand, provide clinicians with the possibility of directly assessing and controlling the neural drive or command to muscles. The benefits of surface EMG as a feedback tool for improving posture control and for stroke rehabilitation are well established. The treatment with EMG‐based "serious games" is expected to assist CP children in activating the ankle muscles in both paretic and healthy limbs at similar instants within the gait cycle. Given such EMG‐oriented rehabilitation applies directly to the muscle, its effect on muscle and therefore gait function is likely to be greater than that achieved with conventional means. If this hypothesis is verified, it will be further expect to observe a smoother gait, that is smoother changes in gait kinematics and morphology of the paretic foot, in CP children treated with EMG‐based serious game than otherwise. Primary objective consists in verifying whether Surface electromyography (sEMG)‐based games are effective in reducing the degree of muscular hyperactivity in the ankle plantar flexor and thus improve the ankle dorsi flexor function in children with cerebral palsy. The study design is an open, prospective, monocentric, randomized and controlled trial. Participants will be randomly assigned to either the first group or to the second group. For the first group, the design will be: "physical therapy + serious games" during the first month then "physical therapy" during the second month. For second group, the the design will be: "physical therapy" during the first month then "physical therapy + serious games" during the second month.

Nct (2018). "KİNECT® - Video Games Based Physiotherapy Programme in Patients With Breast Cancer Surgery." https://clinicaltrials.gov/show/NCT03618433.
	Introduction: Breast cancer is the most common cancer seen in women. 1.7 million new cases have been reported in the world and have been shown as the fifth cause of death among women.There are many risk factors in etiogenesis, including gender, family history, age, obesity, malnutrition in postmenopausal period, hormone therapy, after 30 years of first birth, alcohol consumption and physical activity inadequacy. Pain and functional disorders are common complications after post‐mastectomy in upper extremity. After mastectomy surgery ,pain in the shoulder, fatigue, decrease in range of motion, restriction of daily living activities, decrease of muscle strength, postural inbalance,, neuropathy and lymphedema may occur in the acute and chronic period. Patients with breast cancer need a multidisciplinary and ongoing physiotherapy program.New technologies provide more motivational involvement for patients according to regular care and standard programs. Microsoft Kinect® is a virtual exercise program that is an application. It has been in use for rehabilitation among physical therapists for different deseas.The Kinect® application is a special technological approach that allows to follow the movements of the body. Microsoft Kinect® virtuel reality video games are promissing rehabilitation options because they involve upper extremity practise. Subjects and methods: A randomized clinical trial, the examiner being blinded unaware of the intervention group to which subjects were assigned. Participants will be randomly assigned to two groups: Experimental group‐ where the participants will be treated with standart exercise therapy and Kinect® video‐game‐based technology Control Group ‐ Standart exercise therapy and upper extremity rehabilitation‐oriented physiotherapy program will be applied. The evaluations will be repeated at the beginning of the study and at the end of the sixth week. Data obtained from the study will be analyzed using appropriate statistical methods. Patients will be received to therapy which upper extremity rehabilitation or Kinect based video game play under physiotherapist supervision for two days a week for six weeks. Patients will be supported by the home exercise program, except during sessions. Participants' joint range of motion in the initial assessments will be measured by electro‐goniometer, muscle strength assessment by JTech hand dynamometer at appropriate evaluation positions and grip force asssessment by Saehan Hydraulic Hand Dynamometer . In assessing pain, pain levels at rest and during activity will be questioned using Visual Analog Scale. Fear of movement of individuals will be assessed via Tampa Kinesiophobia Scale and functional levels will be assessed via Disabilities of the Arm Shoulder and Hand Anketi (DASH). Environmental measurement differences between upper extremities with and without operation will be assessed with made in the arm, forearm and the wrist. In assessing Quality of life will be assessed European Organization for Research and Treatment of Cancer EORTC QLQ‐C30 ‐ EORTC‐ BR23 and finally fatique of individuals will be assessed via Cancer Fatigue Scale ‐CFS. Sample size: 17 women for each group. Data Analysis:Data obtained from the study will be analyzed using appropriate statistical methods.

Nct (2018). "Rehabilitation Specific Gaming in CP." https://clinicaltrials.gov/show/NCT03403010.
	Forty children are recruited via the Cerebral Palsy Reference Centre (University Hospital Leuven, Pellenberg). Children are recruited when they have been diagnosed with bilateral spastic CP, Gross Motor Function Classification (GMFCS) level III‐IV, aged between 6 and 15y and standardly receive physiotherapy at an intensity of minimally 2 times per week, 45 minutes per session. Children are randomized into the intervention group (conventional, usual therapy including the use of rehabilitation‐specific gaming) or the control group (PT, usual physiotherapy not including gaming), followed by a cross‐over. After the intervention period of 3 months, wash‐out period will be organized to evaluate follow‐up effects. During the intervention period, the usual individual physiotherapy program of the child will be continued as performed before the study and will be executed by the child's usual, familiar physiotherapist. The therapist will be asked to use the rehabilitation‐specific gaming software every therapy session, for at least 15 to 20 minutes. The therapist will receive an extensive introduction and demonstration of the software and the researchers will participate in at least one therapy session. During the control period, the usual, conventional physiotherapy of the child will be continued and the therapist will be asked not to use any gaming activities. Also during the control period, the frequency and duration of the therapy sessions will not be influenced by the researchers. A wash‐out period in between both programs, assumes that therapy effects are still present for a certain period after the intervention and therefore aims to wash‐out these effects. Therefore, this period is considered after each intervention period. As during the control period, therapy will be continued as usual during the washout‐period but no gaming is allowed during therapy. All intervention and control periods will have the same duration of 3 months. During all periods, therapists will receive a diary to register the exact amount of therapy performed. The diary that will be provided during the intervention, will also question the specific games played and will register the therapy goals strived for. Children will be evaluated before and after each intervention or control period using a multidimensional assessment protocol. In addition, children will also receive a follow‐up evaluation 3 months after the last intervention period. This will result in 4 evaluation moments for each child. The evaluation exist of the Goal Attainment Scale, the Gross Motor Function Measure, the Pediatric Balance Scale, the Trunk Control Measurement Scale and the Dimensions of Mastery Motivation Questionnaire (DMQ).

Nct (2018). "Socially Assistive Robot in Upper-Limb Neurorehabilitation." https://clinicaltrials.gov/show/NCT03651063.
	Randomized Control Trial (RCT) longitudinal Intervention study. The RCT will be in accordance with the Consolidated Standards of Reporting Trials (CONSORT) statement . In this study there will be 3 groups of intervention: 1. Socially Assistive Robotic (SAR) intervention group. 2. Computer intervention group. 3. Self‐training intervention group. Participants A total of 30 subacute, one year post first stroke survivors, age 45‐85, females and males, will be randomly allocated into 3 intervention groups. The participants will be recruited from Aleh Negev rehabilitation center, from the ambulatory day care by Dr. Oren Barzel‐MD, a Rehabilitation Medicine specialist. Procedure All patients that will be recruited to the study will be randomly allocated to each of the three intervention groups. The measurements and therapy sessions will take place in Aleh Negev rehabilitation center, in the Day‐Care unit, by a physiotherapist and a PhD student from Ben Gurion University (GCP). Evaluations for all patients will be conducted in three points of time: T1: entrance to the study, before randomization. T2: following 15 intervention sessions (after 5 weeks). T3: one month after end of the intervention. MMSE and FM‐UE scores will be recorded as screening tools. FM‐UE is a screening tool and a primary outcome measures. At each time point (T1, T2 and T3), the measurements described below will be performed on two separate days to avoid effect of fatigue. Participants will come for a total of 21 sessions: 2 sessions of evaluations, 15 sessions of treatment, 2 sessions of evaluation at the end of the intervention, 2 sessions of evaluations one month post intervention. Intervention Program The intervention program consists of 15 therapy sessions, 3 times a week, an hour session each time for 5 weeks (over all 15 hours of intervention). Our proposed intervention is a graduated functional RTG games using real objects (like a cup or a jar), in different sizes, shapes, weights, textures and different environments (i.e. different heights or location on the table). The RTG game selected for a participant will be based on the upper limb movement and functional ability of the participant, as was measured by the therapist in the inclusion to the study. The progression will be starting from low table and progressing to higher table, starting from low weights objects (i.e. an empty jar) and progressing to higher weights (i. e. a jar full with flour). Our program is based on two critical parameters of upper limb rehabilitation: 1. the amount of practice‐it has been recommended that individuals post‐stroke perform as many repetitions per session as they can tolerate . 2. Practicing challenging tasks and not simple repetitive tasks, is likely to elicit motor learning and associated neural reorganization. Since a correlation between cognition and arm motor improvement has been lately described, the games we developed contain upper limb movement as well as cognitive aspects (like working memory). In each meeting the participant will have a one‐hour session of RTG games, based on his\ her ability, as was measured upon enrollment in the study and based on his\her fatigue etc. The patient will be able to rest up to 5 minutes between a trial to trial in order to avoid fatigue. In addition, a patient will be able to stop a session at any time if desired. Even though our aim is to evaluate the motivation and performance of the patient outside the individual physiotherapy session with the therapist, we assume that during self‐practice at the clinic and at home there is someone with the patient. Therefore during the therapy session of the intervention study a physiotherapist or a student will be present in the room (to help with problems that can arise). All sessions will be filmed and recorded upon agreement of the participant. Group 1: Upper‐limb functional RTG games with a humanoid robot (the "ROBOT group"). The robot that will be used in this study is the Pepper robot (Aldebaran Soft Bank robotics) ‐a humanoid off the shelf robot†with human‐like face, 120 cm in height (see Figure 1). Pepper has a touch screen tablet on its chest. The participant will sit in front of the robot, and will play RTG games with the robot using real objects like a cup or a jar, open a drawer, order jars on a shelf etc. The robot will give the participant feedback on his\ her performance: the speed and the accuracy of the movement. There is no physical touch between the robot and he participant. There are no modulation of the off‐the‐shelf features of the robot for the study, besides recording the sentences of the robot speech for Hebrew in order for the patients to understand his speech. Pepper is off‐the shelf humanoid robot, with human‐like face. It can interact with the patient by gestures of voice (talk to the patient, encourage him\her to keep on training), by gestures of movement (like hand clapping, hand raising etc.) and by changing its color of eyes. Group 2: Upper‐limb functional RTG games with a computer (the "COMPUTER group"). The games are the same as described for the "ROBOT" group. In this group the pictures of the cups and the feedback on performance will be displayed on a standard computer screen (17''). There is no physical touch between computer and the participant. Group 3: Upper‐limb functional RTG games with self‐training cards (the "Self‐Training group"). In this group the participant will choose the cards for the game, will choose when to continue to the next level, when to take breaks and when to stop. No feedback on performance will be given in this group. The games are the same as described for the "ROBOT" and the "COMPUTER" group, but in this group, there is no presence of the robot or of a computer. An example of a game: the cup game. In each trial, a row of colored cups will be displayed on the robot's chest tablet. The participant have to organize a corresponding set of actual physical cups on the table according to the picture shown on the screen. There are three levels of game difficulty: in Level 1 participants are asked to arrange four cups in the correct order, in Level 2 there are five cups, and in Level 3 there are six cups. The instructions and feedback will be provided by either the robot, or displayed on the computer screen or written on a paper. The picture with the target order of the cups will disappear from the screen after 1‐2 min. In the computer and robot groups, when they complete the task, participants will have to press a push button. In the robot and computer groups, after each trial, the robot\ computer will either give feedback on the performance (e.g., "try to do it faster next time") or a feedback on results (e.g., "you succeeded!", "you were not right but try again!"). The feedback given by the robot is both verbal and with head and arm gestures (e.g. hand clapping). The feedback by the computer will be displayed on the screen. In the self‐training group no feedback is given. After two trials on the basic level (four cups) and four trials on the second level (five cups), the participant could choose to either continue at the same level or change to a harder level of game (more cups). A. Games description and progression 1. The cup game: Ordering a row of cups according to the picture. Progression 1: number of cups: start from 3 cups, continue to 6 cups. Progression 2: Height of table: start low, continue to high, continue to different heights, different weights of cups. 2. A dartboard: ordering cups on a dartboard according to a picture. Progression 1: number of cups: start from 3 cups continue up to 7 cups. Progression 2: start close to body (at arm's length) continue longer than arm length. Progression 3: height of table. Progression 4: weight of cups. 3. Ordering Jars on different heights shelves: according to a picture. Progression 1: start 3 jars, add jars. Progression 2: start low height, continue high and different heights. Progression 3: different weights of jars. 4. Open drawer and order objects according to a picture (memory game). Progression 1: number of drawers‐start with 2 an add drawers. Progression 2: different heights drawers. Progression 3: start with a handle of different kinds (straight handle, round handle) continue to a key opening. 5. Taking objects (i.e. keys) out of a jar and putting it in a jar according to its color (stroop game).

Nct (2018). "Virtual Reality for Post Operative Pain Management After Total Knee Arthroplasty." https://clinicaltrials.gov/show/NCT03665233.
	Introduction: Postoperative pain frequently occurs after total knee arthroplasty. The IASP defines pain as "an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage". Pain is a major cause of post‐operative distress and has a variety of side effects and complications. Chronic post surgical pain is probably the most feared complication of acute pain. Therefore, adequate pain control after surgery is mandatory. In modern western healthcare, multi‐modal pain treatment is the standard of care. This means that a variety of drugs, acting on different receptors, are used alongside non‐pharmacological interventions, to decrease pain. Such an approach enables the physician to use a lower concentration of a specific drug, in order to avoid adverse effects that can occur when giving higher doses of one individual drug. These drugs are based on the analgesic ladder of the WHO to relief cancer pain. From the different drugs that are used, the major concern will be with the opioids, as they are known to have major complications. Especially today in the USA there is an epidemic of opioid related deaths. Very often these drugs have been prescribed in a post‐operative setting. The search for a different non‐pharmacological analgesic treatment is today, more than ever, a pressing need. Virtual reality (VR) is a non‐pharmacological way to decrease pain in a number of different situations. It has been around for some years, some articles describing VR in medicine are 25 years old but it only recently became a popular medical treatment since the introduction of the Oculus Rift in 2014. Before that HMDs (head‐mounted display) were expensive and very bulky devices. Since the introduction of the Oculus Rift HMD the availability and usability of VR has increased dramatically. In the post‐operative period pain at rest is generally reported to be acceptable by our patients (VAS<3), but if movements are involved the pain increases to unacceptable levels. Postoperative physiotherapy generally involves the use of a continuous passive motion (CPM), a machine used for passive bending of the knee. This postoperative mobilization is one of the major causes of pain in the aftermath of a total knee arthroplasty. Available evidence: Virtual Reality (VR) has been shown to reduce pain in different situations. From experimental pain in healthy subjects to changing dressing of burn patients, several studies have shown the use of immersive VR therapy as an adjunct for pain treatment. The use of VR in children has frequently been studied, as it decreases pain and anxiety during painful medical procedures. The combination of VR and standard treatment (ST) has shown to have a superior analgesic efficacy compared to VR or ST alone . In the medical VR world there are different types of applications. Some of these act as "distractors" (playing games, looking at natural scenery) and some have included elements of therapeutic hypnosis. With these applications the patients are (self)‐induced in a hypnotic state. Medical hypnosis has been shown to have a tremendous impact on post‐operative recovery, reducing anxiety and pain. Medical hypnosis is a one on one intervention, making it time and labor consuming and people using hypnosis need to be well trained to perform the technique safely. Bringing a patient in a hypnotic state can only be achieved by using appropriate verbal quotes and this can be problematic if the patient speaks another language. Although the surgical population would benefit greatly by using medical hypnosis, only few patients are offered this technique. Using a VR application with therapeutic hypnotic elements can be a great way to share with many patients the positive effects of hypnotic therapy. Trial : the investigators decided therefore to use a medical VR application that includes therapeutic hypnotic elements. They want to compare the analgesic efficacy of standard treatment with and without medical virtual reality in postoperative pain manage ent, after the patient have had a session of physiotherapy, as this is a painful moment in the post operative period. Each includable patient will be approached before the day of surgery and asked for participation in the study, after verifying the absence of any exclusion criteria. The investigators will present the study to the patients, using a patient oriented explicatory form, after which they will look at the informed consent together with the patient. If necessary they will give the patient some time to reflect and come back after a while, to sign and collect, or not, the informed consent. Randomization will be done earlier using a web based block randomization program : www.randomization.com Each patient will be assigned to either a standard treatment group (ST‐group) or a standard treatment with Virtual reality group (VR‐group). The virtual reality will be an application designed by Oncomfort®. It is a session called AQUA, which includes an underwater experience guided by a whale. The HMD is a VR Gear from Samsung‐Oculus and the mobile phone used is a Samsung Galaxy 7. Interventions happen on the day of surgery (DOS), on post operative day 1‐2 and 3 (POD1, POD2 and POD3. ) On the day of surgery : Before going to the OR each included patient (both VR and ST group) fills in a STAI Y questionnaire gives a VAS pain score Before going to the OR, patients in the VR group get additionally a 45 min session of VR : AQUA Before this session the patient gets a is a specific introduction for the patient on how to use and experience the VR session. Each patient gets a TKA. There is no interference with the anaesthesia protocol. This is, as usual, decided between the patient and the anaesthetist working in the OR. Some parts of the peri‐operative and the post‐operative protocols however are standardized: Peroperative General anesthesia Paracetamol 1g every 6 h If there are no contra‐indications : anti‐inflammatory drugs (ketorolac) 3x/d IV, (including a PPI (proton pump inhibitor) if necessary) Dexamethasone 0,5 ‐1 mg/kg Tranexamic acid 1 g Use of a tourniquet by the surgeon Infiltration of the posterior part of the knee by the surgeon with levobupivacaine 0.2% PCIA Morphine Femoral nerve block single shot (with 15 ml levobupivacaine 0,25% ) , before the start of the surgery Postoperative Paracetamol Anti‐inflammatory drugs PCIA morphine Ice application 3 times a day Rescue medication : Tramadol 50 mg, max 6 per day POD1‐POD2 ‐POD3 During the post operative days patients get passive mobilization of the knee with the CPM device (Kinetec). During this exercise patients in the VR‐group get a 45 minute VR session, the physiotherapist or another investigator will put on the mask. The CPM device starts 15 min after the start of the VR session. All the patients get standard care, which means they can use their PCIA morphine, as required. After each session a blinded investigator measures the VAS pain score, the anxiety score with the STAY‐I questionnaire and the morphine consumed. On POD3 or on the day of discharge (if earlier) patients will be asked to rate their satisfaction (with a VAS). The physiotherapist will also rate their appreciation of the functional rehabilitation, by comparing the increase of passive flexion between POD1 and POD3. Total morphine consumption (until POD3) and length of stay will be recorded.

Nct (2018). "VR Error Augmentation for Bimanual Task Exercise." https://clinicaltrials.gov/show/NCT03766711.
	(Main Phase Only ‐ Data Collected with Clinical Population) The FEATHERS project at the RREACH Lab at The University of British Columbia focuses on developing and evaluating novel physical exercise technologies for kids with motor disabilities. The study team would like to study how immersive virtual reality (VR) technology can be used to benefit upper limb rehabilitation for persons with hemiplegia. The purpose of the experiment is to see how the use of error augmentation (i.e. adding visual or game element feedback to accentuate deviation from the desired exercise motion) might encourage persons with hemiplegia to engage their affected side more effectively by comparing the symmetry between the stronger and weaker limbs. It is also hypothesized that the immersive environment of VR and the ability to provide 1:1 direct visual feedback will increase active engagement to rehabilitative exercises in these populations. The study will address the question of whether error augmentation aids in the rehabilitation of the affected upper limb movement quality in hemiparesis when practicing bilateral reaching tasks. Specifically, can visual amplification of paretic asymmetry in an immersive VR environment improve movement quality in the affected side? Adolescents and young adults with hemiplegia (i.e. due to ABI, CP, etc.) and their adjoining therapists will be recruited for from the community. We will conduct testing in a single‐session setup at the participant chosen location with an easily transportable system including a standard 2‐3 sensor Oculus system hardware setup and software developed by the research team. Sessions conducted outside the research lab rooms will require a minimum of a 2m x 1.5m space for calibration. The participants will test all augmentation factors in a randomized order and the sessions are expected to take between 90‐120 minutes. A short post‐session usability survey will be administered and sample population demographic data will be recorded including age, gender, and handedness. Manual Ability Classification System (MACS) and Bimanual Fine Motor Function (BFMF) scores will be recorded or assessed to classify the upper limb motor ability of the sample set.

Nct (2018). "Wii Fit Game Based Abdomino-Pelvic Training In Urinary Incontinence." https://clinicaltrials.gov/show/NCT03727269.
	Loss of bladder control results causes the accidental leak of urine is called urinary incontinence. It may be slightly bothersome or totally debilitating. It may leads to embarrassment and keeps them away from enjoying many physical activities, including exercising. Urinary incontinence may develop emotional distress because of some outside factors, such as difficulty getting to standing position or only being able to walk slowly, which prevent them from getting to the toilet on time. Old women experience urinary incontinence more than young women or young girls. Muscles in the wall of bladder contracts during urination. Sphincter muscles surrounding the urethra relax which let the urine to pass out from the body. Incontinence will occur when the muscles of bladder suddenly contracts or are not strong enough to hold back the urine. Then the urine may escape with less pressure than usual when the muscles are damaged, this causing a change in the position of the bladder. Stress incontinence is the most common type of urinary incontinence. 80% of the females suffering from urinary incontinence have stress urinary incontinence. Obese women having greater intra‐abdominal pressure leads to weakening of pelvic floor muscle which causes stress incontinence. During pregnancy, child birth and menopause physical changes results in the weakening of muscles of bladder. As the result of physical exertions, muscles of bladder become weak that increase intra‐abdominal pressure leakage may cause. Leakage may occur during coughing, sneezing or heavy lifting. Wii fit games are computer‐generated scenario that simulates experience through senses and perception. This approach is being used by physical therapist so than their patient stick to their exercise protocol and it enhance their training and functional level. Wii fit game based pelvic floor muscle exercises helps the pelvic floor muscle to strengthen by different movements such as anteversion,, retroversion, lateral tilting, truck rotation, circumduction and pelvic stabilization. video game based treatment that enhance patients' motivation, functional training and hence adherence to exercise regimen. As clinical practice in women's health physical therapy lacks options for pelvic floor muscle training and wii fit game based pelvic floor rehabilitation is an innovated method so could be a valuable adjunct in management of female urinary incontinence protocol.

Nct (2019). "The ASsessment and Physiotherapy managEment of Ataxia in Children Following Surgical Resection of Posterior Fossa Tumour." https://clinicaltrials.gov/show/NCT03945682.
	Brain tumours are the most common group of solid tumours in children accounting for nearly a quarter of all childhood cancers. There are approximately 500 new cases of central nervous system (CNS) tumours in children/adolescents reported in the UK per year. Although prognosis has improved over the last 30 years, brain tumours remain the leading cause of tumour‐associated death in children. Surgical resection is a mainstay of management of children with brain tumours, as for several tumour types there is strong evidence that survival and progression free survival are influenced by the degree of resection. Therefore extensive tumour removal is an operative goal, but the morbidity of surgery along with any subsequent oncological treatment should also be considered. The NICE guidelines for improving outcomes in children and young people with cancer identify that 'Survivors of CNS malignancy are among the neediest of all cancer survivors, because of the effects of the tumour and multimodality therapy, all of which affect neurological, psychological, endocrine and academic function and become more evident with increasing age'. Children with posterior fossa tumours (PFT), which account for approximately 50% of all childhood brain tumours, have a distinctive set of issues e.g. potential for gross change pre/post operatively, rapid onset of ataxia, hydrocephalus and increased intra‐cranial pressure adding deficits distinct from ataxia, in addition to potential problems from any subsequent oncological management such as radiotherapy. Of these issues, ataxia is the predominant motor problem in children with posterior fossa tumours. Ataxia can describe a related number of impairments including upper limb control, balance, gait difficulties, eye movement issues and speech problems. It is a presenting sign in 58‐90% of children with posterior fossa tumours. Ataxia and balance problems also persist long term following surgery, Piscione et al found 70% of children with posterior fossa tumours will have long term post‐operative balance problems. Lannering et al specified that truncal ataxia was the most disabling motor impairment in children with brain tumours. Access to neuro‐rehabilitation is recognized as crucial in paediatric neuro‐oncology with physiotherapy integral to this; yet there is no consensus as to the type, intensity or timing of interventions. A literature review of physical therapy/physiotherapy for children with ataxia (of any origin) was carried out in preparation for this project to confirm the literature gap, and consider interventions that have been of value in other pathologies causing ataxia. Ten papers in total were identified which included three review papers that covered adult and paediatric literature though the data were not separated in the studies to enable consideration of paediatrics as a distinct group. Overall the reviews concurred there was a suggestion of the benefit of physiotherapy (including treadmill training, rehabilitation, virtual training) though treatment modalities were often not consistently defined and evidence was typically of low quality (level III/IV). The recommendations from these reviews are that the next step would be to undertake RCTs (randomised controlled trials) in more homogenous patient groups. Looking at the paediatric literature, there were three case studies identified (and one case series with a population of three adolescents) again in differing diagnoses though none were examining children with brain tumours that is the most common acute cause for ataxia in the paediatric population. The largest paediatric study (n=10) identified through the literature review was a cohort study by Ilg et al evaluating the effect of virtual training. Virtual training refers to the use of computer technologies that provide an interactive environment that requires limb movement to react to on screen game play. Ilgs study found positive results and proposed that virtual training should then complement/supplement therapy treatment tailored according to the individual and c ntinued in the home environment. Virtual training has also been explored in other paediatric populations e.g. cerebral palsy. Overall the literature review highlighted that there is a gap in the literature regarding physiotherapy intervention for children with ataxia, in particular there is no literature on effectiveness of physiotherapy for children with brain tumours. However, there is an emerging evidence base in adults with ataxia and to a lesser extent paediatric populations as described above, from similar (though non acute) lesions in the cerebellum reporting the benefits of balance therapies including virtual training. This suggests the potential for recovery from ataxia in similar conditions i.e. children with damage to the cerebellum following surgical resection of posterior fossa tumour.

Nct (2019). "Effectiveness of a Novel Gaming System on Post-operative Rehabilitation Outcomes After Total Knee Arthroplasty: A Pilot Study." https://clinicaltrials.gov/show/NCT04080401.
	This is a randomised controlled trial investigating the effectiveness of a novel, game‐based rehabilitation system, consisting a sensor‐equipped knee sleeve and a mobile application, on rehabilitation outcomes after Total Knee Arthroplasty (TKA). All patients receiving TKA will be screened for eligibility. Patients who meet inclusion criteria and provide informed consent will be allocated to either intervention or control group using block randomisation. A study team member blinded to subject characteristics will allocate subjects to either group. Subjects in the intervention group will be guided to do their post‐TKA rehabilitation exercises using the investigator's game‐based system, which includes the wearable sensor device and mobile application games. Subjects in the control group will be guided to do their post‐TKA rehabilitation exercises using conventional, paper‐based exercise brochures. From post‐operative day 1, all subjects who are medically fit for physiotherapy will receive 2 sessions of physiotherapy, daily; for at least the first 3 post‐operative days. The first session consists of individualised physiotherapy that includes bed exercises and ambulation training. In the second session of physiotherapy, subjects will perform their bed exercises using the game‐based system or paper‐based exercise brochures. Upon discharge, subjects in the intervention group will continue home‐based rehabilitation exercises using the game‐based system, while those in the control group continue to use the exercise brochures.

Nct (2019). "Effects of a Computerised Exercise System on Functionality of the Arm,Cognition and Quality of Life in Stroke Patients." https://clinicaltrials.gov/show/NCT04036422.
	In developed countries only 5‐10% of chronic stroke patients receive an active rehabilitation program. In Turkey, there is no community based rehabilitation program available to stroke patients in the subacute ‐ chronic phase of the disease, even though it is known that functional gain can continue in this part of the disease when supported by an adequate rehabilitation program. Equally, functional gain can be lost over time if appropriate physical therapy is discontinued. Recent Advances in technology have allowed for the development of new approaches in stroke rehabilitation. Computer based treatment options include virtual reality (VR), robotic training and computer based task specific games. Computer based rehabilitation can encourage patients in performing high intensity, repetitive exercises which in turn aids neuroplasticity; the benefits of such treatments in upper extremity rehabilitation following stroke have been established. It is also believed that the stimulating environment provided by computed based exercises can enhance the development of problem solving and functionality in stroke patients. However, the effects of such technology on cognitive function in stroke patients has not been established in the literature. The disadvantages of VR and robotic training is that the necessary hard and software is often expensive and use of the machinery requires special training. Therefore, these options are often unavailable in rehabilitation centres. Contrary to this, computerized task specific gaming systems can be more economical and practical for both therapist and patient and can be used in the home environment without the necessity of direct supervision of a physiatrist. A review by Johansson et al. on home computer based task specific gaming exercises in stroke patients concluded that patients enjoyed the treatment but determining the benefits of treatment require further randomized control studies of better quality to be conducted. A pilot study based on a six week computer based task specific gaming exercise program in chronic stroke patients resulted in an improvement in learnt tasks and clinical evaluation. Rejoyce (Rehabilitation Joystick for Computerized Exercise), is a computer game based task specific exercise system developed by Rehabtronics Inc. for use as part of the treatment of stroke and spinal cord injury patients. Rejoyce aims to improve upper extremity and hand function by encouraging neuroplasticity through repeated task specific games. The aim of this study was to study the effects of computer game based task specific exercise system on upper extremity and hand function as well as cognitive function and quality of life compared to conventional rehabilitation in stroke patients. Patients who have developed a stroke in the past year and who have been admitted to our Physical and Rehabilitation Medicine (PRM) Department in Turkey for stroke rehabilitation will be included in the study. The total number of patients to be included in the study to obtain a study power of 80% and 5% type I error is thirty.

Nct (2019). "Effects of Group Physical Therapy on Walking Speed in Patients With Parkinson Disease." https://clinicaltrials.gov/show/NCT04187963.
	The current study was carried out during November 2014 ‐ July 2017, in the Clinical Rehabilitation Hospital in Cluj‐Napoca, Cluj county, Romania. A total of 60 subjects diagnosed with typical, idiopathic PD participated in this study. All patients met the following inclusion criteria: (1) stable medication usage; (2) Hoehn and Yahr stage 2, 3 or 4; (3) ability to walk independently or by using an assistive walking device; (4) age 50 to 70 years; (5) no severe cognitive impairments (Mini‐Mental State Examination ‐ MMSE score, ≥24); (6) no other severe neurologic, cardiopulmonary or orthopedic disorders; and (7) not having participated in a PT or rehabilitation program in the previous 2 months. The patients were randomly divided into 2 treatment groups: group physical therapy ‐GPT (n=30) and individual physical therapy ‐ IPT (n=30). Treatment protocol for each group included 10 sessions of physical therapy, each 1.5 hour long, on a daily basis for 2 weeks. All treatment sessions occurred at the same time of day throughout the study, in the morning, 60‐90 minutes after intake of pharmaceutical treatment for PD. For the GPT, there were groups of 6 patients, supervised by 1 physical therapist. The group sizes were kept small to promote efficiency and motivation. The patients undertaking IPT were alone with the physical therapist during the sessions. Both groups had their encounters in the same physical therapy room setting. The rehabilitation protocol for the IPT consisted of cardiovascular warm‐up activities, stretching exercises, strengthening exercises, functional, gait and balance training, recreational games and ended with relaxation exercises. In addition, the GPT protocol followed the exact same pattern, except for 5‐10 minute breaks for informal socialization between participants, at the beginning of the session, mid‐session and at the end of the session. Also, both groups had access to external cues, which were applied during a variety of tasks and environmental situations, like gait initiation and termination, heel strike and push‐off, sideways and backwards stepping, walking while dual tasking, and walking over various surfaces and long distances. There is evidence in the literature to support each of the components contained in the intervention.19‐25 In order to facilitate initiation and speed of movement, most activities employed visual and auditory cues as triggers. Visual cues were looking at and follow the therapist's movements in the IPT group or the other group member's movements in the GPT group. A mirror was also used. Auditory cues were music with regular rhythm, and verbal suggestions and reinforcement from the therapist, in the IPT group or the therapist and other participants, in the GPT group. All patients were evaluated at the beginning and at the end of the physical therapy program. The evaluation included the 6‐minute walking test and the 10‐meter walking test. Gait speed for each participant was calculated as the ratio between the walked distance and the time unit, and it was measured in meters/seconds. For each subject, all assessment sessions were performed in the morning, by the same person and all tests were performed in the same order, to control for variations in performance because of medication cycle. All assessments were conducted in the "on" state for the subjects experiencing motor fluctuations.

Nct (2019). "Evaluating Effect of Cognitive Game Based Treadmill Exercise Program in Parkinson Disease." https://clinicaltrials.gov/show/NCT03835611.
	Parkinson's disease (PD) is the second most commonly occurring neurological disorder in Canada, affecting approximately 99,000 individuals, and the number is expected to grow to 140,000 individuals by the year 2025. The hallmark of PD pathology is a progressive degeneration of dopaminergic neurons in the basal ganglia (BG). Therefore, there is a significant deterioration of balance and gait function, and especially when concurrently performing a cognitive task (dual‐task walking). Fifty percent of individuals with PD also show deficiencies in one or more cognitive area. In addition, up to 80% of PD patients eventually develop dementia. Over 60% of PD, individuals fall each year and a significant portion of those who fall will experience multiple falls. Most falls occur during walking, and the consequences of these falls are often severe, leading to disability, loss of independence (i.e. safe community ambulation). For individuals with PD, community ambulation is strongly associated with the preservation of skills for independent living, leisure/recreational activities, social participation and healthy aging. Daily activities afford numerous situations in which walking must be combined with a cognitive task, such as, navigation, negotiating terrains and obstacles, tracking visual targets, reading, and recall. Walking and cognitive abilities are closely linked, and several studies have demonstrated that walking while performing various cognitive tasks (dual‐task walking) results in greater gait disturbances, threats to stability and provokes freezing of gait in PD. Numerous studies have shown that modest levels of physical activity and targeted physical therapy improves muscle strength, balance, mobility and reduces the risk of falls among older adults. Several studies have also shown improved cognitive function with physical activity, and others report that interventions that enhance cognitive skills led to improvements in fall risk. Because physical and executive cognitive decline both contribute to mobility limitations and an increased fall risk with age, several PD researchers and clinicians have developed balance‐walking programs augmented with interactive cognitive activities (Dual‐task training). Maximizing participation is also seen as a main goal of interventions. Long‐term exercise/training programs are often fraught with low compliance and adherence. An emerging methodology is to combine exercise and activities with computer games, making the training experience more engaging and enjoyable. This approach can be an important tool for rehabilitation because it has the potential to increase participation and exercise adherence. Importantly digital media in the form of computer games can also challenge and train many different aspects of executive cognitive function. For example, many computer games are now readily available in which processing speed, cognitive inhibition, task switching, working memory and problem solving are the main components of the interactive game events. Based on this information, investigators have has developed and validated an engaging, game‐based treadmill platform (GTP), which provides an integrated approach to treat and assess the decline in balance, mobility, Visuomotor and visuospatial executive cognitive function. The GTP consists of 1) a standard treadmill instrumented with a pressure mapping system which to compute several spatiotemporal gait variables and gait stability measures; 2) an innovative interactive computer game subsystem for dual‐tasking; and 3) an automated monitoring application which uses advanced data logging and analysis method to record the client's actions and choices while walking and playing targeted cognitive games. Therefore, physical and cognitive performance during exercise can be monitored synchronously and quantified electronically. Proof of principle has been established for the use of the GTP in assessment and treatment of older adult's age70‐80 with fall history. Purpose of this exploratory study is to assess the potential for su cessful implementation of the novel intervention, predict the feasibility and acceptability of the dual‐task exercise program and identify unpredicted harm.

Nct (2019). "Innovative Game-Aided Rehabilitation Platform for Rehabilitation of Balance in Children With Cerebral Palsy." https://clinicaltrials.gov/show/NCT03873441.
	The research project focuses on the evaluation of an innovative, engaging computer game‐aided rehabilitation platform for use in rehabilitation of young children with cerebral palsy. The goal of this research program is to produce high quality therapeutic point‐of‐care approaches and cost‐effective delivery systems leading to better long‐term health outcomes. At present, the challenges entailed in providing therapy services continue to put identified children at risk of missing opportunities to maximize the neurodevelopmental capacities, sustain any behavioral recovery and prevent future complications. Canada and India face a growing population of children with neurodevelopmental disabilities distributed across broad geographic regions. Cerebral palsy (CP) is the most common neurodevelopmental disability in childhood. The prevalence of CP in developing countries is estimated to be 5 to 10 times greater than in North America. Children with CP face a substantial amount of balance impairments which results in limitations of the mobility functions necessary for activities of daily living. The ability to perform functional tasks in sitting and standing while maintaining the balance is an important predictor of success in daily activities and participation in school, leisure and other aspects of community life. There are many things to consider when developing therapy programs designed to improve dynamic balance skills for these affected children to maximize the neurodevelopmental capacities and to prevent the development of secondary disabilities. Intense repetitive task practice (RTP) such as, constraint‐induced movement therapy is one of the few effective neuro‐rehabilitative strategies shown to improve motor function in children with CP, with potential to overcome developmental difficulties. Constraint induced movement therapy consists of constraining the use of the unaffected limb to encourage use of the affected limb. However it is often difficult to engage children in therapy and sustain motivation to engage in intense RTP and achieve the therapy goals. Thus, there is a need for effective approaches and tools that motivate young children with CP to complete long‐term neuro‐rehabilitation programs and to provide developmental opportunities. Digital media and gaming have received considerable interest from researchers and clinicians as a model for learning a broad range of complex tasks and facilitating the transfer of skills to daily life. These emerging rehabilitation technologies have the potential to improve clinical outcomes and child participation because these are engaging, motivating and now accessible. For this purpose a computer game‐aided rehabilitation platform (CRP) has been developed. This approach combines motor exercises with fun games appropriate for children with neuro‐ developmental disorders. The approach is designed to provide engaging, high‐quality, personalized therapy in the clinical rehabilitation setting. Research Goal: This research project focuses on the evaluation of an engaging exercise computer game‐aided platform and embedded assessment tools for use in clinical practice. The program is grounded on the technological developments and on current research documenting the benefits of computer‐aided learning tools, exercise gaming applications in rehabilitation and principles of adaptive learning and neuroplasticity. A pilot study to examine the feasibility and benefits of a computer‐aided, game‐aided repetitive task practice (RTP) program designed for training of dynamic balance skills in young children with CP will be conducted. RESEARCH PROJECT OBJECTIVE 1 The CGR includes a designed rehabilitation assessment game which is capable of monitoring every child's performance during therapy. It quantifies motor skill parameters, as well as, visual‐spatial skills and executive cognitive functions. It produces electronic records for these outcome measures and thus allows us to track change over time. It also provides timely feedback to child, parents and the t erapist. Objective: To evaluate the test‐retest reliability and convergent validity of the assessment tool embedded in the game‐aided rehabilitation platform. Specifically for dynamic balance in children aged 3‐8 years (n= 50) diagnosed with CP. The new tool will be compared to commonly used outcome measures i.e. Peabody Developmental Motor Scale version 2 (PDMS‐2) and Gross Motor Function Measure (GMFM). This will provide a reliable test protocol and valid measures that can accurately and quickly quantify dynamic balance control function independent of object‐task type, for use in daily clinical practice and research. It is hypothesized that the performance measures of the game‐based assessment tool would: 1. Exhibit high test retest reliability (Intra class correlations >0.7), and Standard error of measures less than 20% of the group mean. 2. Show moderate convergent validity (correlations, r>0.06) with the primary outcome measures. RESEARCH PROJECT OBJECTIVE 2 An feasibility randomized clinical trial will be conducted to examine recruitment, acceptability, compliance and therapy dosage of the CRP program and to estimate the treatment effect of the repetitive task practice game‐aided exercise program on dynamic balance skills, transfers from sitting to standing, turning, stepping, and gait function in children aged 3‐8 years (n= 50) diagnosed with CP. Preliminary estimation of treatment effects and the calculation of effect size and sample size for a full scale definitive RCT will be determined on the basis of pre and post scores of the primary outcome measures. Two groups of children will be examined, one group will receive the experimental game‐aided balance training program and the other group will receive usual conventional balance training program. Each program would take 12 weeks, three therapy sessions per week. Using a process of randomization, every child will be assigned to either experimental or control group after the initial assessment and screening. Before the treatment sessions begin, after the end of 12 weeks, a clinician will conduct regular assessment sessions with the participant to mark the progress till date. The feasibility of assessment tool embedded in the game‐aided rehabilitation platform and also the usability, safety and appeal of the protocol will be examined. An estimation of effectiveness on this sample using mixed method Analysis of Variance for within (repeated measure) and between group effects will be observed. RESEARCH PROJECT OBJECTIVE 3 It is important to develop evidence on quality and actual dosage of an intervention to be delivered to create a positive outcome on the transfer of skills to functional performance. Thus during each session the dosage of intervention will be determined by recording the duration, intensity and quality of the balance and mobility exercises delivered with this treatment model at each session. In turn the aim is to develop a dose‐response relationship for clinical use of this CRP program in rehabilitation of children with CP. STUDY DESIGN: Feasibility Randomized Clinical Trial METHOD OF COLLECTION OF DATA: Ethical clearance for the study will be obtained from the Institutional Ethical Committee of S. D. M. College of Medical Sciences and Hospital, Dharwad. Participants will be recruited by clinicians working in Outpatient Department of Physiotherapy, S.D.M. Hospital, Dharwad, Karnataka, India. Parents of the participants will be approached for consent to take part in the study, the study participants in experimental group will be asked to sit or stand (as per the screening result) on fixed and compliant surfaces and to use objects instrumented with the miniature motion mouse to play various therapeutic yet entertaining games while handling and moving the test therapeutic objects using bi‐manual grip gradually progressing to head rotations (with the mouse mounted on a cap worn by the participant) and finally using trunk movements as a part of experimental therapy protocol. The head movements and trunk movements will increase the b dy sway and hence increase the balance cost of the exercises to result in improvement in balance control. The speed and the amount of head or trunk movements (i.e. balanced costs) will be graded by adjusting the difficulty level of game play. While performing CGR the children will be standing on a thin pressure mat (placed over fixed or compliant surface). This will allow us to record the information of Center of Foot Pressure (COP) displacement [body sway] while game‐aided balance training intervention implementation. This information will be used to quantify the intensity and duration of each exercise (i.e. therapy dose) for objective 3. The following is a summary of the experimental balance training protocol: 1. Sitting Balance exercises while the child maintains sitting balance while playing the interactive computer games starting with bi‐manual object placed in hands for controlling the games, then using the head rotation movements to control the games and then progressing to use of trunk motions to control games while balancing on the compliant surface (air bladder); in order to progress by increasing the balance costs. 2. Standing Balance exercises progressing from a fixed support surface to uneven and compliant support surfaces like progression from standing over ground then on sponge and then on air bladder as the child tolerates, i.e. increased balance costs. 3. Progression then to balancing while performing the visuomotor and visuospatial game tasks such as playing the games starting with bimanual object placed in hands for controlling the games, then using the head rotation movements to control the games and then progressing to use of trunk motions to control games while balancing on the compliant surface. 4. Progression to single‐leg stance and to stepping activities. The control group participants will be receiving the conventional physical therapy protocol for balance rehabilitation. The following is a summary of the conventional physical therapy balance training protocol: 1. Active‐assisted stretching exercises for lower limb musculature focusing on postural control and improvement in dynamic stability, 2. Balance and weight bearing exercises with multi‐directional reach outs associated with trunk movements on fixed surface gradually progressing to unstable movable and compliant surfaces, 3. Weight transfer exercises with multi‐directional reach outs and 4. Stepping exercises in different directions on variety of surfaces. Further if parents have any queries regarding the study can be reported to the principal investigators. The parents would be reassured that information would be kept confidential and will be used only for study purpose.

Nct (2019). "Intensive Neurorehabilitation for Cerebral Palsy." https://clinicaltrials.gov/show/NCT04093180.
	Intensive Neurophysiologic Rehabilitation System (INRS) is an intensive multimodal rehabilitation system, whereby versatile and multi‐faceted methods are combined with the aim of improvement of functioning and quality of life of children with CP. Treatment components are addressing different functional goals in the Body Functions domain of the International Classification of Functioning (joint mobility, muscle tone, voluntary movement, pain, intellectual functions) and Activities and Participation domains (fine hand use, walking, moving around, interpersonal interactions and family relationships. The Intensive correction course includes up to four hours of daily training. The treatment program is tailored individually according to the patient's condition and incorporates some of the following component according to individual indications and contraindications: Physical therapy, Occupational therapy, Full body massage, Spinal manipulative therapy, Joint mobilization techniques, Paraffin and wax applications, Reflexotherapy, Strength training, Computer game therapy, Suit therapy, Vibration therapy, Treadmill training, Group session of "rhythmic gymnastics". The influence of one technique complements and potentiates other rehabilitation components. The aim of the study is to evaluate effects of Intensive Neurophysiological Rehabilitation System in children with cerebral palsy in a randomized controlled trial. A single‐blinded randomized controlled trial with two groups will be conducted. The experimental group will undergo treatment course according to INRS, control group will continue receive usual home activity and care while staying on the waiting list. To avoid possible information leak about patient group allocation, the study should be performed in two independent centers: Evaluation center and Treatment center. Assessments will be conducted three times: at the baseline, in 3 weeks, and 7 weeks after the baseline.

Nct (2019). "Multi-domain Versus Uni-Domain Training on Executive Control and Memory Functions of Older Adults." https://clinicaltrials.gov/show/NCT03823183.
	All participants complete one of the four combinations of cognitive training with video games and physical exercise. The cognitive component will be either a brain training video game program selected from Lumosity (cognitive intervention, CI) or video games not specifically designed to train attention and executive control (cognitive control, CC). The physical exercise component will be either Body‐attack, a combination of dance, aerobic, strength, and muscular resistance (exercise intervention, EI) or its control condition composed of stretching, toning and relaxation (exercise control, EC).

Nct (2019). "Pilates Training in Multiple Sclerosis." https://clinicaltrials.gov/show/NCT04011579.
	Devices and technologies for at‐home interventions could provide to PwMS with mild disability useful tools to successfully maintain own physical, cognitive and emotional status by performing at‐home physical activity/exercises and avoiding outpatient interventions. Together, new devices and technologies could help in overcoming all barriers (i.e. transportations, working time, etc.) hindering the adherence to and, consequently, efficacy of the outpatient treatments. Although Pilates did not show any significant advantage over standardized physical therapy in the current literature, it is a good method to promote physical activity, sensorimotor integration and cognitive stimulation. Thus, it could be a treatment option to improve fatigue, balance and walking abilities in PwMS; consequently, Pilates could be suggested by the clinician as a physical activity to be integrated in the daily life. This possibility could be made more feasible using new tools such as those offered by low cost devices. The main MS‐FIT project purposes are to provide and to test a tool based on serious game concept of Pilates‐inspired exercises for daily use at home, by mixing the entertainment aspects typical of the videogames and the possibility to perform physical activity. The MS‐FIT tool does not pursue therapeutic aims as rehabilitation does, but it could have a positive impact on prevention and health in MS. MS‐FIT, by using the Microsoft Kinect Motion Controller Xbox or similar to deliver adapted physical activity, offers the possibility to transform the Pilates exercises into a virtual reality game. MS‐FIT, through a multicentre approach, would provide: ‐ Feasibility study ‐ RCT study All the 14 participating centres will select a dedicated therapist who will be responsible for patient training in using the MS‐FIT tool. All the subjects recruited following the inclusion/exclusion criteria will sign an informed consent and all the procedures (feasibility and RCT) will be in agreement with the Declaration of Helsinki (1964) and approved by Local Ethical Committee. No trial‐specific procedures will be conducted before informed consent has been obtained, and participants will be reminded that they may withdraw from the trial at any time without it affecting the quality of their care in the future. Participants with relapses during the period of their involvement in the project will be considered as drop out and will be considered in the analysis for the entire period of study participation. Feasibility study Primary objective: • the refinement of the tool for the final customized version to be used in a RCT MS study. The primary objective will be reached by fixing eventual bugs relieved during the feasibility study and taking into account results from the assessment in terms of technology acceptability and satisfaction‐to‐use, adherence to the intervention, intervention safety and the physical effects of the intervention. Secondary Objectives: ‐ the estimation of human resources necessary for the RCT. ‐ the estimation of the effect of the intervention and its variance necessary to calculate the appropriate sample size for the RCT. Due to the nature of the feasibility study and based on previous literature showing that a sample size of 25‐40 subjects per arm is adequate for a feasibility trial, the investigators will recruit 28 PwMS per arm. All the 14 participating centres will recruit a total of 56 recruited patients following the inclusion and exclusion criteria. In the range of EDSS inclusion criteria 28 subjects will be recruited with lower disability (EDSS 2‐3) and 28 with higher disability (EDSS of 3.5 or 4). For both levels the subjects will be randomized into two groups: MSFITFeas (MS‐FIT at‐home + "unspecific physical activities") and CTRLFeas ("unspecific physical activities"). Randomization will be provided by an independent randomization service at FISM accessed via a web‐based system, using computer‐based block randomization (1 factor: EDSS score 2‐3 and 3.5‐4). Patient will b allocated to MSFITFeas and CTRLFeas in a 1:1 ratio. Confirmation emails will be sent to Centres PI. The MSFITFeas group will self‐manage MS‐FIT at‐home for 6 weeks, performing at least 3 sessions/week for a total of 30 minutes of exercises (also distributed during the day with a minimum slot of 10 minutes) for each session. During this period Xbox One and Microsoft Kinect 2.0 will be delivered to the participants for the aims of the study. Before starting the at‐home intervention each subject will be trained to the use of the platform by a therapist. No rehabilitative interventions except sphincter and speech rehabilitation and psychological support, are admitted for the 6 weeks of participation to the project. The execution of unspecific physical activities, if not already practiced, will be suggested to the participants. For the 6 weeks of participation to the project CTRLFeas will be similar to MSFITFeas group except for the execution of MS‐FIT at‐home. The protocol for the Feasibility study will consist on (Figure 2): ‐ T0 evaluation (PRE) ‐ 6 weeks of intervention ‐ MSFITFeas: unspecific physical activities + MS‐FIT at‐home ‐ CTRLFeas: unspecific physical activities ‐ T1 evaluation (POST) The evaluation for the Feasibility study are described in the section Outcome Measures. Deliverables Deliverables of the Feasibility study will be the final customized tool, a set of indications for the management of the RCT, the sample size estimation for the RCT. Focus group A nested qualitative study on 14 participants will explore patients' experiences of MS‐FIT via Focus Group Meeting (FGM). The objectives are to provide insight into the quantitative results, explore strengths and limitations of the intervention with MS‐FIT, so as to guide the RCT. The report of each FGM analysis will be submitted to FGM participants for review (respondent validation). Deliverables Deliverables of the nested qualitative study will be the delivery of the report of the FGM analysis. RCT study Primary Objective: • evaluation of the change in TUG. Secondary Objectives: ‐ evaluation of the physical effects also in terms of self‐reported outcome, upper limb performances, resistance in walking and physical activity, cognitive and psychosocial effects, quality of life and wellbeing. Differences in physical and cognitive performances due to the genetic features will be evaluated also considering subgroups identified through the polymorphism analysis. ‐ evaluation of the acceptability and satisfaction‐to‐use, adherence to the intervention, intervention safety through the measurements of endpoint already listed for the Feasibility study. The RCT sample size will be definitively calculated based on the results from the feasibility study. However, by considering the literature about Pilates in MS, the investigators can preliminary estimate the needed sample size. In particular, the investigators refer to the TUG post‐intervention improvement found by Karlon et al. in a group of PwMS performing Pilates. For our aim, the investigators can consider this result even if no differences between Pilates group and control group (Physiotherapy) were found. Pilates group improved the performance in TUG of about 1.8s, that could be considered as clinically relevant for PwMS. By considering a variability of about 3.4s, a power of 80%, a level of significance (two sided) of 5% and a potential loss of 15% of patients at follow‐up, the estimation of the necessary sample size consists of approximately 63 subjects for the experimental group (a total of 126). All the 14 participating centres will be involved in the patients' enrolment. The subjects will be randomized into two groups: MSFITRCT (MS‐FIT at‐home + "unspecific physical activities") and CTRLRCT ("unspecific physical activities"). The randomization will be carried out using a web based procedure and will be centrally managed. A stratified minimization/adaptive algorithm will be used in order to balance the baseline EDSS (2‐3 vs 3.5‐4) factors across the two gro ps. The MSFITRCT group will self‐manage MS‐FIT at‐home for 12 weeks, performing at least 3 sessions/week for a total of 30 minutes of exercises (also distributed during the day with a minimum slot of 10 minutes) for each session. During this period Xbox One and Microsoft Kinect 2.0 will be delivered to the participants for the aims of the study. Before starting the at‐home intervention each subject will be trained to the use of the platform by a therapist. The follow‐up (FU) evaluation will be after 6 weeks since the end of the intervention. No rehabilitative interventions except sphincter and speech rehabilitation and psychological support, are admitted for the 18 (12 + 6) weeks of participation to the project. The execution of unspecific physical activities, if not already practiced, will be suggested to the participants. For the 18 (12 + 6) weeks of participation to the project CTRLFeas will be similar to MSFITFeas group except for the execution of MS‐FIT at‐home. At the end of the 18 weeks, the participants of the CTRLRCT group will be offered the MS‐FIT intervention. The requirement that the enrolled patients will have not to perform any supervised physical activity or rehabilitative intervention is in line with recent studies showing that most of PwMS with mild disability (78.34% EDSS <4) were not treated with rehabilitation. The subjects involved in the feasibility study will be excluded from the RCT study in order to avoid bias effects. The protocol design for the RCT study will consist on (Figure 3): ‐ T0 evaluation (PRE) ‐ 12 weeks of intervention ‐ MSFITRCT: unspecific physical activities + MS‐FIT at‐home ‐ CTRLRCT: unspecific physical activities ‐ T1 evaluation (POST) ‐ T2 evaluation (FU) ‐ after 6 weeks from T1 The evaluation for the RCT study are described in the section Outcome Measures. Moreover, blood samples will be collected at T0 to investigate if genetic polymorphisms of candidate regulators of neuronal plasticity could be correlated to the response to the proposed protocol. According to previous report MS subjects of the two RCT groups could be subdivided in subgroups with respect to the polymorphism features. For example, for the CNR1 gene the subdivision could be based on the number of AAT repetitions (short AAT: homozygous or heterozygous for allele with ≤11 repeats of AAT triplets; long AAT: homozygous for allele with ≥12 repeats of AAT triplets). Differences among subgroups in terms of physical and cognitive performances will be evaluated. In particular, all patients will be genotyped for a total of 55 genetic polymorphisms of 23 potential regulators, like: Homer1; AKT1; RAPTOR; D2R; GAPD; CHAT; p53; BRCA2; LIG4; XRCC5; CYP3A4; NBS1; MDM2; CNR1, ATTn; CNR2; GRIN1; GRIN2B; TRPV1; FAAH, COMPT; (Brain‐derived neurotrophic factor) BDNF. Blood sample will be assessed from participants early in the morning after awakening (8h). To synchronize the sample for lifestyle variables, subjects were requested to avoid excessive physical activity the last three days before the blood sampling, sleep for 7‐8h the night before study, avoid starving, and eat a usual breakfast in the morning (approximately 1h before the time of the breakfast). The samples will be collected by each participant centre and shipped to the IRCCS Neuromed, Pozzilli, Isernia (Prof. Diego Centonze) for the analyses. Deliverables Deliverables will be the report of the results of the trial and the final guidelines to make available and easy‐to‐use the MS‐FIT tool Criteria for Premature Withdrawal Criteria for the premature withdrawal are: 1. Patients withdrawal of the consent anytime; 2. Any medical conditions that the investigator determines jeopardize the patient's safety if she/he continues the study and/or study results; 3. Patient's no‐compliance to complete the study procedures 4. MS Treatment changes during the study

Nct (2019). "A Pilot Study on the Efficacy, Acceptability, Tolerability and Feasibility of a Therapeutic Virtual Reality Application." https://clinicaltrials.gov/show/NCT04042090.
	Rationale: 21,2% of the Dutch population is suffering from chronic low‐back pain. 90% of these patients suffers from chronic low‐back pain not attributable to a recognisable, specific pathology (non‐specific low‐back pain). 30‐40% of all patients suffering from chronic pain visit their GP for treatment. Treatment includes mostly analgesics, in particular NSAIDs and opioids. Adequate treatment of chronic pain is important as chronic pain negatively impacts, amongst others, quality of life, activities of daily living and feelings of helplessness. A systematic review by Bala et al. however shows that chronic pain treatment is often inadequate. Moreover, each different type of analgesic has its own associated side effects. NSAIDs increase the risk of cardiovascular and gastrointestinal complications. Common side effects of opioid analgesics include sedation, dizziness, nausea, vomiting, constipation, physical dependence, and even cases of hyperalgesia. Recently, more attention has been given to psychological interventions for relieving chronic pain. A systematic review by Castelnuovo et al. shows the efficacy of a range of psychological interventions, including acceptance and commitment therapy (ACT), mindfulness‐based interventions, hypnotherapy, eye movement and desensitization and reprocessing (EMDR) therapies and virtual reality based interventions. All of these psychological interventions focus on changing people's attitudes, feelings and behaviors on chronic pain, to improve their quality of life. The first psychological intervention is the commonly used acceptance and commitment therapy (ACT). ACT is a cognitive behavioral therapy for treating chronic pain that uses exposure‐based and experiential methods aiming at improving patients' abilities to cope with their chronic pain. Several systematic reviews indicate that ACT is effective in improving health outcomes of chronic pain patients. Mindfulness‐based interventions seem to work as well for chronic pain relief. This set of interventions aims at learning strategies for pain awareness and acceptance. Furthermore, hypnotherapy is a mind‐body based intervention that uses hypnoses to learn patients to cope with their pain. It focuses attention away from pain, thereby blocking its experience. Hypnotherapy seems effective in reducing pain experience. Then, eye movement desensitization and reprocessing (EMDR) is another psychotherapeutic approach in treating chronic pain. EMDR has already shown to be effective in treating posttraumatic stress disorder, and has recently as well been introduced as a treatment for chronic pain. Early research findings indicate EMDR to be effective in treating chronic pain. Finally, one of the most recent fields of inquiry in treating chronic pain by means of psychological interventions is Virtual Reality. VR consists of a Head Mounted Device (HMD) and a sound system which immerses the user in a three‐dimensional (3D) virtual world. There are multiple mechanisms behind the efficacy of VR in treating chronic pain. The most commonly studied mechanism is distraction. VR seems to be effective in reducing pain via distraction as it diverts attention away from pain. As both the VR application and the pain require attention and the brain has only limited attentional capacity, less attention is available for pain processing. In this manner, it reduces current feelings of pain, anxiety and stress. Though, the distraction mechanism only diverts attention away from pain shortly. To actually treat chronic pain by means of VR, it seems that other strategies, apart from distraction, are required. Several studies aimed to find alternative mechanisms behind pain reduction by VR. The use of psychological interventions in VR, such as ACT or hypnosis, appears to be effective. Although the context of VR is different from traditional psychotherapy, the idea of how change occurs is not. Moreover, the immersiveness of VR provides opportunities to even better influence cognitions and emotions of patients suffering from chronic pain. Multipl virtual reality interventions have been designed with this knowledge in mind. A proof‐of‐concept study by Gromala et al., for example, looked into the application Virtual Meditative Walk (VMW). VNW focuses on mindfulness‐based stress reduction via VR. The user study shows VNW's efficacy compared to non‐VR interventions. Likewise, Guarino et al. proved that using virtual mindfulness therapy eight times over a period of a month is effective in chronic pain reduction. Therapeutic hypnosis has as well been tested in several case report studies. All conclude that virtual reality hypnosis seems to be effective in dealing with chronic pain. The VR serious game Reducept is a novel psychological VR intervention for treating chronic pain. It incorporates several psychological therapies into one application: hypnotherapy, mindfulness, ACT and EMDR. Reducept has been made in co‐creation with patients, researchers, psychologists and developers and can be installed and played on the VR goggles Oculus Go. It consists of an education module and three games. ‐ Education: Reducept provides its players with information about the biological mechanisms underlying chronic pain. Learning about chronic pain helps to cope with it in daily life. ‐ Control: Reducept's first game has been based on the mechanisms of hypnotherapy. The patient should shoot away painful stimuli in the nervous system. By visualizing their pain, they learn to control and cope with it. ‐ Relaxation: the second game within Reducept is a mindfulness‐based intervention. It takes place in the spinal cord. Players should collect positive neurotransmitters and focus on their respiration rate. ‐ Processing: game three has been based on the mechanisms of ACT and EMDR. It asks players to recover negative patterns in the brain. Players have to switch attention between the pain and the game, helping them to decrease their experience of pain. In this study, we aim to gain a first understanding in the ability of the therapeutic VR intervention Reducept to treat chronic low‐back pain. We will define a wide range of outcome measures, including quality of life indicators, pain, stress and anxiety measures and measures on ability to execute daily activities. What outcome measures does it affect? What outcome measures will be left unaffected? Moreover, tolerability, feasibility and acceptability of Reducept in relation to different patient characteristics (age, gender, Motivaction profiling) will be measured to understand which patients might benefit most from virtual reality based psychological interventions. We focus on patients with non‐specific chronic low‐back pain as this group represents a large part of all chronic pain patients. This explorative study is necessary as an input for future studies on the actual effects of therapeutic virtual reality interventions on quality of life of patients. Objective: To investigate whether a therapeutic virtual reality application can improve the quality of life of people suffering from non‐specific chronic low‐back pain, compared to a control condition. Study design: This explorative study uses a randomised controlled parallel design (1:1). Participants will be randomly assigned to either the control group or the intervention group. In the control group, participants are placed on the waiting list to receive the common treatment to handle their chronic pain. As they are placed on the waiting list, they will receive no therapeutic treatment yet (apart from the during intake prescribed physiotherapy and medication). Participants placed in the intervention group, who are also placed on the waiting list and only receive, when prescribed, physiotherapy and medication, will use the therapeutic virtual reality intervention meanwhile at home during a period of 28 days for at least ten minutes each day and in addition the education module at least during day 1 (which lasts 25 minutes). The randomisation is not blinded: both researchers and participants know which participants are part of the intervention and control group. tudy population: Adult patients, males and females, suffering from daily non‐specific chronic low‐back pain are eligible for this study. Patients' pain should have last for at least three months. Patients should report a pain score of ≥4 during the intake questionnaires filled in before intake at the Rijnstate Pijncentrum. Intervention (if applicable): Participants will be randomly assigned to either the intervention group or the control group. Participants assigned to the intervention group will receive virtual reality glasses with the Reducept application. They are asked to use the therapeutic virtual reality intervention at home over a period of 28 days starting the day after collecting the virtual reality goggles. Participants are asked to use the therapeutic virtual reality intervention at least once a day for ten minutes. In addition, they should, on the first day, and preferably during more days, watch the whole education program which lasts 25 minutes. Participants can decide themselves to use the application more often. Participants assigned to the control group will receive no intervention, they are, just as the intervention group, placed on the waiting list to receive normal treatment. Unfortunately, we cannot provide all patients with the opportunity to use the virtual reality application, as we are in need of a control group that does not use it over the study period. We will study the possibility of continuing the virtual reality treatment for all participants want‐ing to after finishing this study. At least they will be able to buy themselves the virtual reality glasses for using the therapeutic virtual reality. Nature and extent of the burden and risks associated with participation, benefit and group relatedness: There is no risk involved in exposure to the therapeutic virtual reality application. Participants can leave the study at any time for any reason if they wish to do so without any consequences. As mentioned before, the burden for participants associated with this study is mainly related to measurements of endpoints, which will take approximately 30‐45 minutes three times over a period of five months. The intervention group will spend at least ten minutes a day on the therapeutic virtual reality application and in addition on day 1 25 minutes.. As explained in the rationale, we expect no or only minimal adverse effects from this intervention.

Nct (2019). "Video Game-based Physical Activity Training in People With Multiple Sclerosis During Relapse Treatment." https://clinicaltrials.gov/show/NCT04125823.
	Multiple sclerosis (MS) is an inflammatory, demyelinating, neurodegenerative disease of the central nervous system. The most common clinical signs and symptoms are fatigue, spasticity, cognitive impairment, chronic pain, depression, decreased quality of life, and bladder and bowel dysfunction. Current medical treatment is divided into three groups: disease‐modifying, symptom management, and prognosis and relapse management. Intravenous methylprednisolone treatment is generally used in the management of relapses and prognosis. It is also thought that physiotherapy during the intravenous methylprednisolone treatment provides better treatment results. Therefore, treatment planning of people with MS during hospitalization should be done by a multidisciplinary team. Studies have shown that video games based physical activity training as a non‐pharmacological therapy may be an effective method for managing symptoms such as balance, gait, fatigue, and cognitive functions in people with MS, but its feasibility in the inpatient period is unknown. The primary aim of the study is to investigate the feasibility and acceptability of the video game‐based physical activity training program in the inpatient period. The secondary aims are to investigate its effectiveness on upper extremity functions, walking, balance, cognitive functions, quality of life, depression, and fatigue in persons with MS comparing to conventional rehabilitation. Volunteers from people with MS who are in the inpatient period due to relapse in the Neurology Department, Faculty of Medicine, Dokuz Eylül University will participate in the study. In accordance with the inclusion criteria, 30 patients were randomly assigned to two groups: 15 patients in the game‐based rehabilitation group and 15 patients in the conventional rehabilitation group. Based on the physical levels of the patients, appropriate games will be selected and video game based physical activity training will be started. Video games will be played with Xbox One with a motion sensor (Microsoft) and a 52'' Liquid Crystal Display. Depending on the prognosis of the patients, the grades and types of games will be changed. A conventional physiotherapy program including balance, upper extremity, and core stabilization exercises will be implemented. Treatments will be given by the physiotherapist for 45 minutes once daily during the hospital stay. Evaluations will be made before and after the treatment (discharge) and 4 weeks after the end of treatment. Physical and clinical evaluations will be made by physicians and physiotherapists, and cognitive evaluation will be performed by psychologists.

Nct (2019). "Virtual Reality and Video Games in Cardiac Rehabilitation Programs." https://clinicaltrials.gov/show/NCT04166422.
	Cardiovascular diseases (CVD) are the leading cause of morbidity and mortality in developed countries. The consequent healthcare costs in Europe alone are estimated at 196,000 million euros annually, approximately 54% of the total investment in health, resulting in productivity losses of 24% [1‐3]. In recent years, the impact of CVD in non‐Western countries has been growing [4,5]; therefore, prevention is presented as a primordial tool to improve quality of life and patient survival [6,7]. Cardiac rehabilitation (CR) is defined as a multidisciplinary program of clinical application of preventive measures for risk reduction and global and long‐term care of the cardiac patient. In secondary prevention, it is shown to reduce the morbimortality by almost 50% in patients with heart disease. However, the participation of patients in cardiac rehabilitation remains low, especially among the following groups: the elderly, women and patients with a low socioeconomic profile. According to the latest Euroaspire V data, participation in CR programs in Spain is around 50%. The Reureca registry reports that only 10% of patients with a CR indication attend the programs. Therefore, new technologies within the health field, specifically within cardiac rehabilitation programs through the use of virtual reality (VR) and video games, are shown as promising aids with the aim of increasing adherence, satisfaction with programs and participation rates, offering the ability to perform physical exercise [8‐11]. Virtual reality is a simulation of a real or imaginary environment created by a computer system, which allows the user to feel immersed and to interact with objects in that environment [12‐14]. Thus, the basic elements that constitute a VR system are simulation, interaction and immersion [15]. Moreover, the creation of more adaptable and accessible videogame platforms has meant that the phenomenon of technological expansion can be understood not only as a form of leisure but also as an important means of learning and skills training, especially in people with motor, cognitive and sensory (neurological and non‐neurological) deficits [16]. In contrast to traditional CR procedures, which can be repetitive, causing a loss of interest on the part of patients, video games and VR systems offer the opportunity to participate in enjoyable tasks with a therapeutic purpose through physical interaction with the game. The design of exercise‐based videogames (exergames) provides the possibility of practicing physical skills in an entertaining way and of adjusting the game according to the abilities of the subject and the level of intensity. In addition, it is known that the level of enjoyment of an activity has been identified as one of the predictive factors of the effectiveness of an exercise program, and for this reason, interactive technology based on exercise is becoming the all‐time most popular strategy for the implementation of physical activity [17‐23]. It is important to emphasize that VR allows the creation of environments suitable for activities related to CR. The users of these systems can develop simulated tasks and activities in a safe way, since the clinicians have the capacity to control the duration and intensity of the exercise and, in this way, to control and supervise the delivery of stimuli in the virtual environment [24]. Furthermore, knowledge of results regarding the performance of the task in real time, gained through extrinsic feedback, as well as the playful nature of the activities proposed through VR and videogame devices, generates a competitiveness and challenge component that further increases the degree of patient motivation. In this regard, Klasen et al. [25] point out that this increase in motivation is related to the influence of videogames on activation of the mesolimbic dopaminergic pathways and their repercussions on the reward system of the brain. All this promotes active participation on the part of the patient and thus increases adherence to the rehabilitation treatment. The aim of the resent work is to carry out a RCT to provide information on the application of VR and videogame systems within CR programs in patients with cardiac diseases.

Nct (2019). "Virtual Reality Approach in Multiple Sclerosis." https://clinicaltrials.gov/show/NCT04212689.
	Multiple Sclerosis (MS) is a neuromuscular disease that causes various degrees of disability in mobility and functional activities, causing restrictions on the individual's social and professional life, creating advanced disability and impairing quality of life. Problems in upper limb function affect quality of life and functional independence of the patients. Recovery of restricted daily life functions (such as dressing, personal care, eating and body care) is one of the main goals of physiotherapy and rehabilitation in MS and currently, conventional physiotherapy and rehabilitation methods are most commonly used. The main purpose of this method is to reduce pain, increase range of motion and muscle strength. With the developing technology various virtual reality applications have begun to take place in physiotherapy and rehabilitation programs recently. These virtual reality applications are used to motivate the patient and keep their interest in the rehabilitation. The aim of our study is to investigate the effects of game‐based virtual reality exercises added to conventional physiotherapy and rehabilitation program in patients with MS.

Nct (2019). "Virtual Reality Approach in Subacromial Impingement Syndrome." https://clinicaltrials.gov/show/NCT03912493.
	Subacromial Impingement Syndrome (SIS) is the result of contraction of the structures passing through the subacromial area. Problems in upper limb function in people with SIS adversely affect quality of life and functional independence of the patients. Recovery of restricted daily life functions (such as dressing, personal care, eating and body care) is one of the main goals of physiotherapy and rehabilitation in SIS and currently, conventional physiotherapy and rehabilitation methods are most commonly used. The main purpose of this method is to reduce pain, increase range of motion and muscle strength. With the developing technology various virtual reality applications have begun to take place in physiotherapy and rehabilitation programs recently. These virtual reality applications are used to motivate the patient and keep their interest in the rehabilitation. In addition, the diversity of virtual reality applications is increasing day by day so that participation of the patients and the interest in the treatment can be increased. Various measurements of the user's performance can be transferred to the clinician simultaneously with these systems. Also for most of these systems exercise modes, difficulty and duration are programmable so that the training sessions can be varied. The aim of our study is to investigate the effects of game‐based virtual reality exercises added to conventional physiotherapy and rehabilitation program in patients with SIS.

Nct (2020). "Active Videogames Against Obesity in Children." https://clinicaltrials.gov/show/NCT04418713.
	Childhood obesity is one of the main problems in developed societies, and entails enormous expenditure for the National Health System. In addition, childhood obesity is strongly associated with adult obesity and with all types of cardiovascular and metabolic pathologies. Physical exercise has been shown to be the great non‐pharmacological enemy of both childhood and adult obesity, however sport practice and adherence to it is not easy in the overweight/obese population. In this context, active video games are presented as an exercise option for children with little interest in traditional sports. The main objectives of this study are: (1) To evaluate the effects of an active video game program on cardiometabolic risk in overweight/obese children; (2) to identify the effect of this intervention on physical fitness and (3) to study possible changes in the sedentary lifestyles of children after the exercise program. This is a randomized crossover study, with 2 intervention periods of 9 months each, and a 3‐month period of washing. Ninetytwo children between 9 and 11 years old who are overweight or obese will be included and randomly assigned to one of the 2 homogeneous groups (control‐intervention). Both groups will receive education in healthy lifestyles, and the intervention group will also follow a physical exercise program with active video games (3‐4 days/week). The sessions will last between 30 and 45 minutes and will include different moderate‐vigorous aerobic activities and muscular strength exercises. Body composition, physical fitness, levels of leptin, adiponectin and visfatin, lipid and ferric profiles, and markers of inflammation and metabolic risk such as insulin resistance, TNF‐α, CRP, ALT, AST, gamma‐GT and IL‐6will be measured before and after the intervention. In addition, dietary habits (24h recalls), physical activity (accelerometers), blood pressure, waist and neck circumference, and pubertal development will be also assessed.

Nct (2020). "Design and Testing of a Immersive Virtual Reality Physical Exercise Program to Improve Balance and Reduce the Risk of Falls in Older People." https://clinicaltrials.gov/show/NCT04336670.
	TITLE: Desing and validation of a Immersive Virtual Reality exercise program to improve balance in older people INTRO: Older people grow around the world at a faster rate than any other age group, resulting in an accelerated aging of the population and an increase in life expectancy. In response to this new reality, active aging programs and strategies are especially relevant and it based in physical activity practice, whose main objective is to maintain or improve the functionality of the person, even though the loss of balance in the elderly represents a significant difficulty in their lives, since this aspect reduces their postural control, increasing the risk of falls and injuries. Our project REVIEM (Inmersive Virtual Reality Exergaming in Olders) is a new strategy to improve the balance in older people, using a exercise program with Virtual Reality glasses for this purpose. HYPOTHESIS: The practice of REVIEM protocol based on balance training in older adults collaborates in the maintenance and improvement of functional capacities, reducing the number of falls and increasing their personal autonomy. GENERAL GOALS: 1.1 Design and validate a REVIEM exercise program / protocol to improve balance in older people 1.2 Analyze the effects of this REVIEM program / protocol, in the short and long term in institutionalized individuals. 1.3 Identify if there is a relationship between the variables that induce fragility and functional dependence and the REVIEM protocol SPECIFIC GOALS: 2.1 Determine the REVIEM protocol based on balance training differential effects for 6 minutes a day (3 days a week for 3 months) 2.1.1 The improvement of the functional independence of individuals by improving balance, reducing the risk of falls and proper development in activities of daily living. 2.1.2 The improvement of gait. 2.1.3 The improvement of quality of life. METHODS: Design: Randomized controlled trial. The institutionalized elderly from the geriatric center Saraiva Senior Center in Pontevedra, Spain, will be invited to take part in the study. After they meet the selection criteria, they will be assigned to on experimental group and one control group. Information regarding sociodemographic characteristics and a clinical anamnesis of the participants will be collected. Intervention: Two groups (experimental and control). Experimental group will perform the REVIEM protocol sessions (6 min) focused on the upper and lower limbs. (3 sessions per week for 3 months). All sessions will begin with a warm‐up focused on the stimulation of coordination and joint mobilization, so that the body is predisposed both centrally and peripherally for the performance of the session and will end with a stretching routine accompanied by breathing cycles calm and controlled. The session will be supervised by the physiotherapist, occupational therapist or expert in physical exercise of the center. Control group will participate in the usual activities proposed by the center management. Assessments: 4 evaluations will be carried: initial, intermediate (at 1 month), final (at 3 months) and follow‐up (1 month after to end the program). The contents of the assessmentens will be: 1. Characteristics of patients: "ad hoc" record sheet that will include data on age, sex, associated pathologies and pharmacological treatment. 2. REVIEM protocol. Safety (Simulator Sickness Questionnaire), Usability (System Usability Scale) and personal experiences (Game Experience Questionnaire and "ad hoc" interview notebook) 2. Balance, gait and fall risk (Tinetti Test) 3. Functional balance (Berg Balance Scale) 4. Functional autonomy (Timed Up and Go Test) 5. Quality of life (SF‐12 Scale) Hypothesis : our findings aim to support the use of new health technologies in the field of rehabilitation and healthcare for the elderly, achieving a feasible and safety Immersive Virtual Reality exergaming program.

Nct (2020). "THE EFFECT OF AEROBIC AND GAME BASED EXERCISES ON COGNITIVE FUNCTIONS IN DEMENTIA." https://clinicaltrials.gov/show/NCT04271943.
	With the positive contribution of technological developments to living conditions and improvements in health services, the ratio of elderly population to general population is increasing all over the world. The slowdown in the process speed, which also explains the slowdown in learning speed in geriatric individuals, is the modality most affected by aging. It has been reported that cognitive speed decreased by 20% at the age of 40 and by 40‐60% at the age of 80. Motor speed also decreases with aging. Cognitive decline and deterioration are among the most feared in the elderly. Dementia is one of the most common diseases of old age. The prevalence of dementia increases in societies where the elderly population increases. At first, while memory is impaired, functions such as attention, language, visuospatial skills, perception and problem solving are impaired. Attention is the first non‐memory cognitive domain affected by dementia. Personality changes, behavior and psychiatric symptoms, physical activity problems, vestibular balance and gait problems are added to the table. Although data on the prevalence of dementia are variable, studies are consistent in showing that the prevalence of elderly disease is increasing. It is estimated that the number of people living with dementia in the world is now 35.6 million, and it will reach 131.5 million by 2050. Since there is no treatment or effective disease modifying drug to treat the most common types of dementia to date, the research should focus on the development and implementation of non‐pharmacological interventions as an alternative or as an additional treatment. Non‐pharmacological interventions represent an important complement to standard pharmacological treatment in dementia. Cognitive, physical and psychosocial rehabilitation can improve global function, mental status, and quality of life. These interventions can further reduce social costs. Different approaches such as cognitive rehabilitation, occupational therapy, physical activity, music therapy, art therapy and other interventions have been proposed. Interventions that reach patients before they can be diagnosed with dementia can have the greatest impact. Therefore, it is desirable to develop interventions that are moderate, perhaps diagnosed with mild cognitive impairment, or that target those known at risk. In the field of rehabilitation; regular physical exercises, such as walking, strength and balance exercises can improve physical and cognitive functions such as daily and executive functions, language and working memory in people living with dementia. Movement activation groups such as psychomotor group therapy have been found to have a positive effect on the social behavior of people living with emotional and dementia. Recent meta‐analyzes have shown that physical exercise can help maintain and even improve cognitive function in healthy elderly adults. There is evidence that exercise increases the volume of the prefrontal cortex and anterior hippocampus and may increase neurogenesis. Since there is no effective treatment for dementia, early diagnosis of symptoms and identification of methods that slow down the progression of the disease have been the main focus of relevant medical research in recent years. While treatments remain unclear, older adults and families are seeking accessible, affordable and effective ways to prevent or improve mild cognitive impairment (MCI). Exergame is a unique form of dual task training that combines physical exercise with cognitive compelling tasks in an interactive game‐based way. Unlike the more traditional motor‐cognitive dual task exercises that combine different training tasks, the preliminary examination typically involves cognitive challenges directly placed in physical body movements that must be performed to complete the game tasks projected on a screen. Since Exergame is a convenient, relatively safe and fun way to be physically active, it is expected that it will positively affect any negative subjective norms related to exercise. Computer‐b sed cognitive education has received great attention as a safe, relatively inexpensive and scalable intervention aimed at protecting cognition in older adults. It is an innovative way of exercising in a virtual reality or game environment that can help dementia patients to be physically active while being cognitively stimulated. It was seen that the number of studies on this subject is small and the devices used in the studies were made with game consoles and there were problems in working with game consoles in patients with dementia. Within the framework of all this information, we aimed to investigate the cognitive effects of physical activity and their differences according to each other with computer assisted exergame study written for rehabilitation in demented individuals; We aim to increase cognitive functions and increase quality of life and reaction time of exergamine dementia individuals. The study is planned to be carried out in a special care center between April 2019 and May 2020 with the patients who are between the ages of 11‐25 and the Mini Mental State Scale (MMSE) aged 65 and over. Inclusion Criteria: ‐ 65 years or older and MMSE scale between 11‐25 ‐ No traumatic brain injury or stroke history Exclusion Criteria: ‐ Cooperation problem ‐ Unstable or severe medical condition, ‐ Presence of Bipolar Disorder or Psychotic Disorder ‐ Any co‐morbidity that prevents exercise. The study was planned as a randomized controlled clinical trial; The cases will be divided into two groups by simple randomization method. The sample size of the study is planned to be 15 for each group and the total number of cases is 30. TREATMENT PROTOCOL The patients included in the treatment will be divided into two groups that we formed as a result of simple randomization. Group 1 ‐ Study group: 8 weeks, 3 days a week for 45 minutes See‐ME Virtual Rehabilitation system with the physical therapist will perform cognitive and physical activity exercises. Group 2: Control group: will exercise aerobic exercise prescribed according to maximum heart rate for a total of 45 minutes with a 5 minute warm‐up and 35 minutes constant speed exercise for 5 minutes with exercise bike for 3 weeks a week for 8 weeks. Cardiac values will also be monitored throughout the session. Evaluations of both groups will be made and analyzed at the beginning of the treatment, at the end of the 4th week and at the end of the treatment.

Nct (2020). "Effectiveness of Structured Closed Kinetic Chain and Video Based Game Exercise Program in Rotator Cuff Lesion." https://clinicaltrials.gov/show/NCT04426929.
	INTRODUCTION: Rotator Cuff muscles are injured due to frequent use, repeated subacromial loadings and circulatory failure, traction, compression, contusion, subacromial abrasion, inflammation, injection and age‐related degeneration, causing Rotator Cuff ruptures. The prevalence of rotator Cuff ruptures increases with age, it usually starts at the age of 40, and its incidence increases by 54% at 60, and 60‐80% at 80. Rotator Cuff treatment strategies vary according to the stage of the disease. While conservative treatment is preferred in Stage 1 and Stage 2 of Rotator Cuff injuries, surgical approaches are performed in stage 3. The most common conservative methods used in its treatment are corticosteroid injections, nonsteroidal anti‐inflammatory drugs and physiotherapy methods. When the literature is examined, there is no consensus about physiotherapy methods among conservative treatment approaches. It is stated in the literature that there is no standard exercise protocol for Rotator Cuff rehabilitation and specific exercise programs are needed. In recent years, closed kinetic chain exercises have become the preferred exercises for the rehabilitation of musculoskeletal system problems. In the clinic, these exercises are preferred because they put less stress on the healing tissue, which is more functional and safe. In the literature, the study involving closed kinetic chain exercises related to Rotator Cuff ruptures is very few, and there is no structured exercise protocol in this regard. In addition, the virtual reality treatment approach, the most common example of the use of technology in rehabilitation, has begun to take part in rehabilitation studies. AIM: The aim of the project is to examine the effectiveness of video‐based game exercise therapy in individuals with Rotator Cuff rupture, to develop a new exercise protocol with closed kinetic chain exercises and to investigate the most effective treatment method for Rotator Cuff ruptures. METHOD: The project will include 45 Rotator Cuff partial ruptures in accordance with the inclusion criteria in the Physiotherapy and Rehabilitation Policlinic in Esenler Medipol University Hospital. Individuals who have been diagnosed with Rotator Cuff partial rupture between the ages of 18‐60, who do not have a professional sports history, who have had pain for more than 4 weeks, and have not undergone any shoulder surgery will be included in our project. Individuals with symptomatic neurological findings of cervical origin, having an additional orthopedic problem on the shoulder, having mental problems, and individuals with neurological, vascular, cardiac problems that limit function will not be included in our project. Pain with Visual Analog Scale, pain threshold with algometer, Functionality with Arm, Shoulder and Hand Problems Survey, quality of life with Life Quality Scale with Rotator Cuff Patients, normal range of motion and proprioception with Fizyosoft applications, muscle strength with myometer, shoulder aproximation with Fizyosoft balance system will be evaluated in all participants before and after treatment. Individuals participating in our project will be randomly divided into 3 groups. Electrotherapy program will be applied to all individuals. conventional exercise therapy will be applied to the first group. An exercise program consisting of 3 phases that runs from simple to difficult and includes closed kinetic chain exercises and proprioceptive exercises will be implemented in second group. Video group exercise program will be applied to the third group. By comparing the groups at the end of the treatment, it is aimed to find the most effective treatment method for individuals with Rotator Cuff rupture.

Nct (2020). "Effects of Physical Therapy on Gait Parameters in Patients With Parkinson Disease." https://clinicaltrials.gov/show/NCT04287023.
	The rehabilitation protocol for the individual physical therapy will consist of cardiovascular warm‐up activities, stretching exercises, strengthening exercises, functional, gait and balance training, recreational games and ended with relaxation exercises. In addition, the group protocol will follow the exact same pattern, except for 5‐10 minute breaks for informal socialization between participants, at the beginning of the session, mid‐session and at the end of the session. Also, both groups will have access to external cues, which will be applied during a variety of tasks and environmental situations, like gait initiation and termination, heel strike and push‐off, sideways and backwards stepping, walking while dual tasking, and walking over various surfaces and long distances. All patients will be evaluated at the beginning and at the end of the physical therapy program. The evaluation includes the 6‐minute walking test and the 10‐meter walking test. Gait speed for each participant will be calculated as the ratio between the walked distance and the time unit, and it was measured in meters/seconds.

Nct (2020). "Effects of Robot-Assisted Upper Extremity Training on Cognitive and Physical Functions After Stroke." https://clinicaltrials.gov/show/NCT04335422.
	This study is planned as a prospective randomized single blind controlled study. It was approved by the Ethics Committee of Ankara University, Faculty of Medicine and will be conducted in accordance with the Declaration of Helsinki. The study will include 38 stroke survivors who are admitted for rehabilitation at the Department of Physical Medicine and Rehabilitation, Ankara University Medical Faculty. Patients fulfilling the inclusion criteria of the study will randomly be divided into 2 groups as robotic group and control group. Random allocation software (RAS) program will be used to assign the patients to the treatment groups with "block randomization" method and to create the randomization scheme. In this single blinded study, all patients will be evaluated by the same physician (Dr. Merve Dayi). The physician will be blind to patient's assignment. Routine physical and rehabilitation medicine program including physical therapy and exercises, walking and balance training, and occupational therapy to improve activities of daily living will be given to all patients for a total of 6 weeks, 5 days/week, 1 hour/day. Robotic group will additionally receive upper extremity robotic training therapy with Armeo Spring V2.0 exoskeleton (Hocoma Inc.,Zurich, Switzerland) for 6 weeks, 5 days/week, 1 hour/day. The Armeo Spring is an adjustable suspension system for the upper limb that connects to virtual reality, which has settings with several degrees of complexity. The system is an exoskeleton that supports the patient's arm and magnifies any residual active movement of the hemiparetic arm in 3‐dimensional space. The patients will receive 30 sessions of robotic therapy under the supervision of physiotherapists, who will adjust the patient's arm and hand in the device and select the virtual reality computer games according to the functional level of the patient's upper limb. All individuals participating in the study will be assessed before and immediately after the treatment and also 3 months at follow‐up. Each assessment will include evaluation of cognitive functions, upper extremity motor functions, hand dexterity, upper extremity activities and daily living activities. Statistical Analysis As the primary outcome variable, the difference in cognitive functions measured by the Montreal Cognitive Assessment Scale (MoCA) between baseline and post‐treatment will be used (Δ MoCA). Group sample sizes of 19 and 19 achieve 80% power to detect a Δ MoCA of 1.0 between robotic and control groups with estimated group standard deviations of 2.5 and 2.5 and with a significance level of 0.05 using a two‐sided Mann‐Whitney U test. Stratified block randomization will be used to ensure an equal number of subjects in each group. Educational status and age has been chosen as stratification variables. Difference between two groups for continuous variables will be evaluated by Student's t test. Mann‐Whitney U test will be used to assess difference between two groups in terms of ordinal variables. The differences in proportions between groups will be compared by using Chi‐Square. The repeated‐measures ANOVA will be used to test within‐group and between‐group comparisons for continuous variables and interaction between them. p<0.05 will be considered statistically significant.

Nct (2020). "Home-based Exercise Rehabilitation With a Novel Digital Biofeedback System for Chronic Low Back Pain." https://clinicaltrials.gov/show/NCT04401683.
	Low back pain (LBP) has for long been the world's leading cause of years leaved with disability, and, considering that the overall life expectancy is rising, this pandemic only tends to get worse. Nearly everyone is affected by LBP at some moment in life (70‐80% of lifetime prevalence). As a consequence, LBP is also presented as a leading cause of work absenteeism worldwide. Thus, although the estimate costs of LBP may be difficult to compare between different countries, its overwhelming socio‐economic impact in modern society is evident. In the absence of an effective treatment, LBP can become chronic, causing a huge impact in patients' daily life, and ultimately promoting a high consumption of healthcare resources. In the US alone, health expenditures for adults with spinal problems were estimated at $6000 per person, representing a total cost of $102 billion each year. The dim picture described above highlights the urgent need for effective interventions that minimize disability, improve quality of life and decrease productivity losses. Current guidelines on CLBP management recommend patient education, exercise, physical therapy, and behavioural therapy as the mainstays treatments for this condition. Despite some discrepancy in the type of exercise program (e.g. aquatic exercises, stretching, back schools, McKenzie exercise approach, yoga, tai‐chi) and mode of delivery (e.g., individually designed programs, supervised home exercise, and group exercise), exercise therapy is recommended nearly transversally, with most studies concluding that exercise intervention programs should include a combination of muscular strength, flexibility and aerobic fitness exercises. Moreover, home exercises with a regular therapist follow‐up has proven highly effective. Importantly, however, the main driver of the direct cost component in the care of LBP is physical therapy, meaning new ways of delivering therapy are warranted. Besides exercise therapy, opioid prescription is also a common practice, despite known opioid‐related morbidity and mortality rates. Because the prevalence of CLBP is continuously rising, and opioid misuse is an issue of great concern globally, identifying effective non‐opioid alternatives for CLBP is of paramount importance. Thus, SWORD Health has developed an evidence‐based program for this disorder based on two main pillars ‐ patient education and therapeutic exercise ‐ the latter delivered through our digital therapist, directly at the patient´s home, and with continuous clinical supervision. This approach has already demonstrated to be feasible, safe and to lead to better outcomes than conventional home‐based rehabilitation after joint replacement. These results were explained by (a) the positive impact of a kinematic biofeedback tool on patient performance, especially regarding error correction and stimulation of a greater range of motion; (b) patient empowerment regarding their rehabilitation process; (c) high patient engagement through the use of gamification strategies; (d) the positive effect of remote monitoring on patient effort and (e) the availability of objective data for clinical review, enabling data‐driven decisions. The present study is a a single‐center, prospective, non‐blind, parallel‐group, randomized controlled trial, designed to evaluate the clinical impact of a home‐based program using a new digital solution on the treatment of non‐specific CLBP in adults versus standard of care. The hypothesis is that all the clinical outcomes measured will significantly improve after the program, and patients using this novel system will attain better outcomes than the ones in the standard of care group.

Nct (2020). "Improving Maximal Strength in the Initial Postoperative Phase After Anterior Cruciate Ligament Reconstruction Surgery: Randomized Controlled Trial of an App-Based Serious Gaming Approac." https://clinicaltrials.gov/show/NCT04224376.
	The study is designed as a prospective randomized control trial. Patients awaiting primary ACL reconstruction surgery were recruited at a single tertiary healthcare center between April 2016 and February 2018. An ethical approval has been given by MHH ethic committee and an IRB was involved. Due to different postoperative treatment protocols and different surgical approaches we could include patients between 13 and 46 years. A computer based randomization was performed by generating a list of randomized numbers which have been provided in sealed envelopes by an independent examiner. The postoperative treatment protocol was apart from the use of the GenuSport knee trainer identically standardized. The pain management was the same for all patients, none of the patients received a continuous peripheral nerve block. The postoperative physiotherapy protocol included gait training, assisted walking with crutches, active and passive knee mobilization, strength exercises and stair climbing. In the training group each patient was additionally provided with a GenuSport knee trainer device (prototype plus tablet with software application) with the active knee extension training program for 6 weeks. Except of that fact the postoperative protocol was identical in both groups. Patients had to train five times daily with the knee trainer starting at the day of surgery.

Nct (2020). "Individualized Virtual Reality in the Upper Extremity Rehabilitation of Hemiparetic Cerebral Palsy." https://clinicaltrials.gov/show/NCT04630678.
	Participants Forty children (20 boys, 20 girls) were included in the study, and their demographic information was recorded. The participants were divided, using "randomizer.org" with a simple randomization method, into two different groups: the Virtual Reality or Activity Training (control) groups. Study Design All children were assessed at baseline and after eight weeks of treatment. The children in both groups were evaluated by the same physiotherapist who was blinded. The treatment was given by a different physiotherapist who has been working in the field of pediatric physiotherapy for ten years Interventions The participants were randomized into two groups. The first group was received conventional physiotherapy and virtual reality therapy for 60 minutes. The second group was received conventional physiotherapy and, activity training which the same movement patterns with virtual reality games for 60 minutes. Both treatments were given three times a week for eight weeks. The conventional physiotherapy interventions, including joint and muscle mobilization, strengthening, and stretching exercises by neurodevelopmental treatment principles and special for the needs of the child, was applied to both groups. The virtual reality therapy group received that simulate daily life and contain individual scenarios by using the USE‐IT system for thirty minutes. USE‐IT (Most Rehabilitation, Ankara, Turkey) is a 2D non‐immersive virtual reality system that plays games on a 50‐inches touchscreen. The children played "the matching, plumber, plumber, math, and car wash games" in accordance with their reaching map results. As the system detects not only hand but also object touch the real‐life materials (cloths and hoses etc.) were used to stimulate grip and sense during games. The children in the activity training group received unilateral, bilateral, and bimanual activity training that supported manual skills for thirty minutes. Similar activity patterns were presented to the virtual reality group and activity training group.

Nct (2020). "Learning Through Gamification in Higher Education." https://clinicaltrials.gov/show/NCT04284163.
	‐ 51 students of "Health legislation, management and administration" subject of the Physical Therapy University Degree of the Catholic University of Murcia will be recruited. ‐ Participants will be randomly assigned into two groups: control group (traditional teaching methods) and intervention group (gamification). ‐ Class attendance and academic results will be register for future analysis.

Nct (2020). "Rehabilitation Including Play and Movement Activities for Preschool Children With Cancer." https://clinicaltrials.gov/show/NCT04672681.
	Aim Project RePlay aims to investigate the effectiveness of a play‐based physical activity intervention on gross motor functioning measured by Peabody Developmental Motor Scales, Second Edition (PDMS‐2) with the primary end‐point six months after diagnosis in children with newly diagnosed cancer aged 1‐5 years old. The investigators hypothesize that the intervention will reduce short‐ and long‐term physical and psychosocial consequences, including reduced gross motor function and lack of social interaction. 1. Background Physical play and movement activities are essential for preschool children's gross motor, social, and personal development. Through play and movement, children develop motor skills crucial for participation in physical and social activities throughout life. A study showed that an 18‐week play intervention among healthy preschool children significantly improved (p<.0005) gross motor function in the intervention group compared with the control group. Play is also the children's first arena for socializing, and these interactions have an immense role in developing emotional, personal, and social skills. Physical play and movement activities are more than just physical exercise; it is social teamwork, emotions, and learning. Reduced physical activity or inactivity in children is highly dependent on three factors; 1) reduced dynapenia (muscle strength and power), 2) exercise deficit disorder (physical inactivity), and 3) physical illiteracy (reduced competence, confidence, and knowledge in movement). Due to more intensive treatment with chemotherapy, radiation, and surgery, children with cancer experience acute adverse events such as myopathy and neuropathy, resulting in muscle weakness, physical incompetence, and inactivity. Furthermore, treatment‐related complications such as infections can cause extended periods of hospitalization, periods of isolation, and long‐term bed rest. Thus, many children with cancer experience several physical side effects as impaired motor skills, physical capacity, and decreased motivation to engage in physical activity. The cancer treatment has a significant impact on the children's physical development and socialization as the lack of motor development leads to inactivity and less participation in sport and leisure activities. This leads to a reduced understanding of the social playing field in joint activities, and the children feel more isolated from peers. Children with cancer experiences challenges in all three factors leading to physical inactivity. Compared with siblings and the general population, these social and physical challenges persist for the rest of their lives. Hence, children diagnosed with cancer have lower school performance, lower education level, higher unemployment, and increased socioeconomic challenges. Thus, the investigators hypothesize that early initiated rehabilitation programs during initial treatment, focusing on maintaining a typical physical activity level, are crucial for continuing everyday activities during and after treatment. The rehabilitation, including social and physical activity and education in children and teenagers with cancer (RESPECT) study for children with cancer aged 6‐18 years, showed that it is feasible to carry out physical tests and motivate them to participate in physical activities. Physical activity maintained the hospitalized children's physical fitness and gross motor function during treatment compared with hospitalized children who did not receive physical activity intervention. A systematic review covering international studies show similar findings; that physical activities positively affect mobility, physical fitness, muscle strength, and quality of life in children with cancer. Additionally, children with cancer who participate in structured physical activities during treatment have fewer admission days than children who received standard care, corresponding to a 17% reduction in hospitalization's total economic cost. Most studies focusing on physical activity as part of an early initia ed rehabilitation program designed interventions for school children aged 6‐18. Only a few of the studies include children under the age of 6 years. Each year 200 children and adolescents aged 0‐18 years are diagnosed with cancer in Denmark. Of these, approximately one‐third is diagnosed before the age of 5. None of the published studies on physical activity in pediatric oncology designed interventions for preschool children (1‐5 years old). Thus, there is a lack of studies with an intervention designed for preschool children with cancer focusing on physical and social rehabilitation. Improvements in cure‐rates of childhood cancer mean that today's 5‐year survival is 85%. Thus, more research into the best strategies for physical activity and rehabilitation for all age groups of children with cancer is needed. A single study of parent‐controlled physical activity at home included children with cancer from age 1‐17. The intervention didn't improve the children's motor function compared with the control group, mainly due to poor adherence to the intervention. Project RESPECT shows that motivation and adherence to physical activity interventions are dependent on the support from "significant others" such as parents and exercise professionals. Parents are an essential resource for children with cancer. The parents follow the child's treatment closely, and the parents' support throughout the treatment is crucial for the child's need for presence and support so the child can feel safe and in control. Furthermore, the focus on home‐based care is increasing to minimize hospital visits. Consequently, parents play an essential role in physical activity and rehabilitation for children with cancer. For preschool children, the parents' role is even more essential. When small children and parents play together, it creates a unique and safe environment where the children can be challenged physically and socially. Children's development is dependent on parents, and parents of a child with cancer must acquire the necessary skills concerning play and movement for the child. With project RePlay, the aim is to develop prophylactic strategies by investigating a play‐based physical activity intervention for children with cancer aged 1‐5 years to ensure the retention of natural motor and social development and participation in everyday activities. The hypothesis is that individual and social play and movement activities, with parents as resources, can reduce gross motor and social development impairments. Thus, the objectives of RePlay are: ‐ To investigate the effects of a six‐month play‐based physical activity intervention in children with cancer, aged 1‐5 years on gross motor function compared with a control group receiving usual care. ‐ To investigate the children with cancer and the parents' experiences with a play‐based physical activity intervention during treatment and the influence on the children's social and personal development. 2. Research plan Design: The randomized controlled trial study takes place at the Department of Pediatric Hematology/Oncology at Rigshospitalet. RePlay will include 84 children aged 1‐5 years diagnosed with cancer. The children are randomized to either the intervention‐ or control group after the children have performed the baseline testing. The children will be stratified by age at inclusion (respectively, over and under three years old) and treatment group (hematologic malignancy, solid tumors, CNS‐tumors). The intervention group will participate in a six‐month play‐based physical activity intervention starting from initiated treatment. The study will be an open‐ended cohort where newly diagnosed patients are included on an ongoing basis. The intervention will consist of 45 min daily play‐based physical activities inspired by Mighty Moves from the study of Bellows et al. [5], where the activities are playful and focus on gross motor skills. The intervention combines hospital and home‐based physical activity. Three days a week, there will be 45 minutes of gr up‐based physical activity at the hospital for the children, siblings, and parents during admissions or appointments at the outpatient clinic. An exercise professional or pediatric physiotherapist administers the group‐based sessions at the hospital. Children isolated in the hospital room are offered individual sessions as a substitute for the group‐based sessions. During the other four days a week or on days where the family is at home, the parents administer the play‐based physical activity. The parents receive education and supervision on conducting play‐based physical activity with their child in the hospital room or at home. The parents will receive inspiration material containing numerous different plays, games, and activities in different intensities, ensuring that their child is physically active every day with different intensity. The material is designed to engage the child in choosing what activities to do. Due to age‐specific development and movement, the children in the intervention group are split into two groups for the group‐based sessions: • Tumble: 1‐2 years old • Tumble turbo: 3‐5 years old An example of a weekly schedule: Monday: parent administered play Tuesday: parents administered play OR group‐based session at the hospital Wednesday: parent administered play Thursday: parents administered play OR group‐based session at the hospital Friday: parents administered play OR group‐based session at the hospital Saturday: parents administered play Sunday: parents administered play The control group will receive standard treatment and physiotherapy if needed. After six months of treatment, the child and parents will receive a status on the child's motor development and be invited to receive individual instructions and invited to participate in the social sessions. Sample size: Since there is no evidence on the potential effect of gross motor function in children with cancer, the sample size is estimated based on Bellows et al.'s (2013). The study objective was to research the potential of a play intervention on gross motor function in healthy preschool children measured by Peabody Developmental Motor Scales, Second Edition (PDMS‐2). The sample size is estimated with an Alpha = 0,05 and Power = 80%. Based on a mean (SD) in the interventions group = 99,31 (9,07) and a mean (SD) in the control group = 93,24, n=70 (35 intervention group; 35 control group) are to be included. Assuming a 20% dropout rate, RePlay will include 84 children.

Nct (2020). "The StayFitLonger Study: an Innovative Computerized Home-based Training to Foster Independent Life at Home." https://clinicaltrials.gov/show/NCT04237519.
	Finding ways to improve and maintain functional abilities and quality of life in older people has become a worldwide priority. It is well recognized that reduced engagement in physical, cognitive and social activities has negative influence on the health of older adults. This leads to more vulnerabilities both physically and cognitively. Sedentary behaviors can ultimately induce physical frailty, defined as a state of high vulnerability with accumulation of adverse health outcomes. Fear of falling and/or unsteady gait are common factors of physical frailty. Moreover, falls are particularly common in older adults. In addition to mobility limitation and falls, cognitive decline has been identified as a major cause of disability and dependency in older populations. Through non‐pharmacological interventions focusing on alterable lifestyle factors, experts believe in the possibility to protect older people from the deleterious effects of physical and brain aging that can lead to dementia. In other words, keeping a healthy mind in a healthy body might be the gold standard for healthy aging. Several studies have shown that physical activity, through aerobic, gait and strength training, induces many beneficial effects including improvement of general health, cognition and quality of life. In addition, a growing number of cognitive interventions have been conducted in healthy seniors and older adults with mild cognitive impairment (MCI) and results show improved cognition and delayed cognitive decline. As well, cognitive deficits, mainly in executive functions, have been associated with an increase number of falls and abnormal gait among others. Improvement of these physical functions was observed in response to cognitive interventions. Because aging is complex and different interventions are likely to potentiate their effects, an increasing number of studies have reported on combined interventions targeting two or more modifiable factors. However, accessibility to these interventions remain a major challenge because older adults may not have access to specialized expertise and resources. The use of a computerized system to deliver lifestyle interventions have several advantages: it can be used to support home‐based training, reducing costs and increasing access; training can be self‐paced and last over practically a unlimited time; it allows providing immediate feedback; it offers potential for scaling up for wider use if efficacy is proven; it provides an excellent interface for active control interventions. Surprisingly, whereas many studies assessed computerized cognitive training programs, only a few have used home‐based interventions which combine cognitive training with physical activity and, to our knowledge, only one study used computerized tasks for both physical and cognitive training in healthy older adults. The StayFitLonger study was designed to test efficacy of a home‐based computerized training program targeted at older adults, which combine physical exercises and cognitive training. The main goal of the program is to improve physical health and prevent frailty through an innovative approach using videos of 50 physical exercises focusing on gait and strength, which could be easily implemented in older adults (Test‐and‐Exercise home‐based program). The program was also designed to enhance cognitive functions through a series of activities in form of serious games. These activities train executive control through dual‐task exercises that was found to increase divided attention and frontal lobe function general knowledge learning and problem solving training. Other features of the program that are unique include: 1) Prospective memory exercises embedded in the physical exercises; 2) Social interactions whereby participants can create and share with other participants their learning material and can chat with their peers about topics of interest and find solutions to common real‐life problems; 3) Psycho‐educational content on cognition, physical health, nutrition and on ways to apply newly learned strategies in real life to empower participants and promoting self‐management; 4) A virtual coach aimed to improve adherence by guiding participants, reminding them to use the program regularly, and providing feedback and rewards through a system of virtual credits; 5) Possibility to personalize the application settings to tailor the environment to the participant's tastes and wishes; 6) Wearable motion sensors used during physical exercises for movement detection as a game input and for providing measurements on mobility for a better characterization of the potential benefits of the program. The StayFitLonger study will test the effect of the training on key outcomes using a double‐blind, parallel‐group, randomised control trial (RCT) over 6 months. The primary objective is to assess whether the 6‐month StayFitLonger programme leads to better performance than those observed following the active control condition on the Timed‐Up & Go (TUG), a functional physical task, which is associated with lower‐body strength and balance. The efficacy study also includes a few secondary objectives. One is to assess whether the StayFitLonger programme improves other physical capabilities as well as cognitive performances and scores of affective variables (e.g., mood, fear of falling), and psycho‐social domains (e.g., quality of life, daily living activities, participant's expectation). In addition, the study will also assess whether a similar gain is found in robust vs pre‐frail seniors. In Switzerland, Canada and Belgium, a total of 128 older participants will be recruited. Following the initial eligibility screening, participants will be randomized to one of two home‐based computerized intervention conditions, the StayFitLonger training program (experimental) or the active control training program . Enrolled participants will be evaluated at two time points: at baseline (T0) and after 6 months of training (T1, end of the RCT). The training will take place at home for 6 months. Prior to the start of the training and within a month following T0 assessment, introductory courses in groups of a maximum of 6 people will take place to introduce the features of the program and describe the different physical and cognitive exercises. Participants will be supervised through home visits and monthly phone calls to ensure a good use of the program in both groups.

Nct (2020). "Virtual Reality Therapy Influence on Heart Rate Variability of Inpatients With COVID-19." https://clinicaltrials.gov/show/NCT04537858.
	To carry out this study, an experimental protocol will be used, where patients admitted to an inpatient unit of the São Paulo hospital will perform a rehabilitation protocol at two different times using virtual reality tasks and conventional therapies. In the first moment, in the initial evaluation, only on the first day of care with the patient, the Medical Research Council Scale, Visual Analog Scale, BORG Scale, Brunel Mood Scale and Satisfaction Scale will be applied. At the end of the therapy, a BORG scale is applied to assess and monitor the patient's perception of effort. For the evaluation and characterization of the sample will be used: Medical Research Council scale (MRC) The Medical Research Council (MRC) was created in 1943, it is an instrument adapted to assess muscle strength in critically ill patients. The result is obtained through the evaluation of six movements of upper limbs (upper limbs) and lower limbs (lower limbs) and the strength is graded between 0 (plegia) to 5 points (normal strength). The maximum sum can reach 60 points, values below 48 are considered that the patient has muscle weakness. Visual Analog Scale (EVA) The visual analog scale (VAS) is an instrument to assess the degree of pain in the patient, it consists of a 10 cm line that has, in general, the phrases "absence of pain and unbearable pain" as extremes. Borg scale The Borg scale is a tool for monitoring the intensity of physical effort, it is considered as one of the most used instruments for the evaluation and quantification of the sensations of physical effort, also known as subjective perception of effort (PSE). This is used both in the area of high performance sports and in the area of physical rehabilitation, to monitor the changes caused by physical exercise in the cardiorespiratory, metabolic, neuromuscular systems. Satisfaction Scale (EVA‐S) The 10 cm Visual Analogue Scale (VAS) assesses the level of satisfaction of the interviewed individuals. Patients will answer the questionnaire, and they will be asked to mark with a vertical line at the scale location that indicates satisfaction with rehabilitation, in which zero (0) indicates very dissatisfied and 10 indicates very satisfied. This scale was developed to allow a quick measurement of the mood of adults and adolescents. BRUMS contains 24 simple mood indicators, such as feelings of anger, disposition, nervousness and dissatisfaction that are noticeable by the individual being assessed. The evaluated responds the scale according to how they feel about such sensations. The score is 5 points (0 = nothing to 4 = extremely). The form put in the question is "How do you feel now", although other forms: "How have you felt this past week, including today", or "How do you normally feel" can be used. BRUMS takes about one to two minutes to respond. The 24 indicators on the scale comprise six subscales: anger, confusion, depression, fatigue, tension and vigor. Respiratory Rate (RR) Respiratory rate (RR) is defined as the number of breaths a person takes 1 minute (breaths / min), being an important vital sign. It varies in response to metabolic demand and the normal range for an adult is 12 to 20 breaths. Before starting therapy with VR and conventional therapy, RF will be measured. At the end of the respective therapies, the RF will be checked again. Heart Rate (HR) All heart rate records will be performed using a cardiofrequency meter (V800, Polar). After placing the brace and monitor, individuals will be placed in supine position and will remain at rest breathing spontaneously for 15 minutes and then for another 10 minutes during interventions, whether during VR or conventional. Oxygen Saturation (Spo2) Pulse oximetry is widely used for patients who need continuous monitoring of oxygen saturation. Its main purpose is the early detection of hypoxemia in various situations and the monitoring of perfusion and circulation. It is a non‐invasive monitoring. Heart Rate Variability (HRV) HRV is a simple, reliable, inexpensive and non‐invasive measure to capture autonomic impul es. The widespread use and cost‐effectiveness of the technique and the ease of data acquisition make HRV a capable choice for the interpretation of cardiac autonomic functioning and a promising clinical tool to assess and identify physiological changes. Fluctuations in HRV patterns provide an early and sensitive diagnosis of the human body's physiological behavior and the individual's health status. HRV has emerged as a simple and non‐invasive measure of autonomic impulses, representing one of the most promising quantitative markers of autonomic balance. HRV describes oscillations in the interval between consecutive heartbeats (R‐R intervals), as well as oscillations between consecutive instantaneous heart rates. It is a measure that can be used to assess the modulation of the ANS under physiological conditions, such as in waking and sleeping situations, different body positions, physical training, and also in pathological conditions. Changes in HRV patterns provide a sensitive and early indicator of health impairments Virtual Reality Training Participants will perform the tasks individually in a room equipped with a computer, table and chair, in the presence of the evaluator responsible for providing the instructions and recording the results. The chair and footrest will be adjusted according to the individual's height and needs, so that they are positioned correctly during the task. Participants will be instructed to sit in a way they think is most comfortable. Before starting the task, the researcher will explain the task verbally and will demonstrate how the game works. Then, participants will complete a one‐time trial in order to verify that they understand the instructions. Intervention After performing all the tests and questionnaires of the initial evaluation, individuals will be divided into two groups, being Group A: Subjects with COVID ‐19 who will start the first day of the protocol with Virtual Reality tasks in the morning and then in the second period in the afternoon, they will perform conventional exercises (n = 25); And Group B: Subjects with COVID ‐19 who will start the first day with conventional exercises in the morning and in the second period, in the afternoon, will perform activity with virtual reality (n = 25). After the application of therapies, final evaluations will be carried out. The rehabilitation protocol will be applied during hospitalization. Participants will perform the virtual tasks individually in a room equipped with a computer, table and chair, in the presence of the evaluator responsible for providing the instructions and recording the results. The chair and footrest will be adjusted according to the individual's height and needs, so that they are positioned correctly during the task. Participants will be instructed to sit in a way they think is most comfortable. Before starting the task, the researcher will explain clearly and objectively how the game works. Then, participants will complete a one‐time attempt to make sure they understand the instructions. MoveHero Software developed at the School of Arts, Sciences and Humanities of the University of São Paulo will be used. The game features balls that fall, in four imaginary columns on the computer screen, to the rhythm of the chosen music. The task is not to let the balls fall. However, the balls can only be touched when they reach four circles placed in parallel (at two height levels), two on the left and two on the right of the participant (0 0 \ o / 0 0), called targets 1, 2 , 3 and 4, as viewed from left to right. The game captures the participant's movements through a webcam, not requiring physical contact to perform the task, so the participant must move his arms, at a distance of one and a half meters from the computer screen. The participant must wait for the balls to fall, until they begin to overlap one of the target circles. Therefore, the game requires the participant to have a strategy of anticipating the movement to reach the balls within those circles. The game offers hit feedback through a numbering (+1) that appears next to the sphere that has been successfully hit within the target, in addition, the total score is visible in the upper left corner of the screen, with 10 points for each hit. Conventional task Participants will perform the tasks individually in the inpatient sector, in the presence of the evaluator responsible for providing instructions and recording the results. Statistical analysis Statistical analyzes will be performed using IBM‐SPSS (version 26.0, IBM Corp., Armonk, NY, USA). As dependent variables, all HRV indices will be considered. If the data meet the assumptions of normality, Multiple Analysis of Variances (MANOVA) will be used to compare the study groups (Virtual Group and Conventional Group) and intra‐group comparison (virtual and conventional group, when comparing the same subject), with Minimum Significant Difference (LSD) post‐test. If the data do not meet the assumptions of normality, the differences between the groups will be analyzed using the Kruskal‐Wallis test. Dunn's post hoc tests will be performed on each pair of groups, with Dunn‐Bonferroni post‐test on each pair of groups66. Values of p <0.05 will be considered significant.

Nct (2020). "Virtual Reality versusTask-oriented for Gait in CP." https://clinicaltrials.gov/show/NCT04533789.
	This research aims to evaluate the effect of virtual reality (VR) games on balance recovery of children with cerebral palsy (CP) by quantitatively synthesizing the existing literature, and to further determine the impact of VR game intervention (the duration of each intervention, intervention frequency, intervention cycle, and total intervention time) on the balance recovery of children with CP. A high‐intensity task‐oriented training programme designed to improve hemiplegic gait and physical fitness was feasible in the present study and the effectiveness exceeds a low intensity physiotherapy‐programme in terms of gait speed and walking capacity in hemiplegic cp. In a future study, seems appropriate to additionally use measures to evaluate physical fitness and energy expenditure while walking.

Nct (2020). "Xbox Kinect Training on Upper Limb Motor Function in Stroke Patients." https://clinicaltrials.gov/show/NCT04669431.
	Physical therapy is the best adopted cure strategy in all over the world towards "excellence of life in post stroke patients." Physical therapy can be well‐defined as "the health approach whose purpose is to make people able with good health conditions, undergoing or prone to undergo disability for the attainment and maintenance of optimum functioning in collaboration with the surroundings. The main objective of stroke physical therapy is to reduce disability and make people as healthy as to perform their daily life activities independently, do not relay on others and integrate into social life up to their own desires and expectations. Significant reduction in impairments of upper limbs in stroke patient was noticed after goal oriented computer gaming. Motor function of upper limb has shown significant results after mirror therapy in comparison to conservative treatment. Among new approaches used for rehabilitation, Robotic assisted therapy is also included. After neurological injury, the current technological advances ensure to the improvement of robotic devices to offer harmless and intensive recovery to the person with mild to moderate motor impairments. Robotic devices in physical therapy, offer more power, repeated, and task based interactive treatment session for impaired motor function of upper limb by providing patient's progress. So it's considered as the reliable source of rehabilitation. Rather like physical therapy exercises robotic devices can also be used to affect arm by high power and task specific movement. Repetitive movements are guided through a stereotyped procedure. If the movements are facilitated by external forces applied to the limb, highly repetitive stereotyped movements can be effective in stroke subjects. A comparatively novel tool evolving in the field of physical rehabilitation is virtual reality based rehabilitation. Virtual reality (VR) can be well defined as an non natural and artificial computer generated reproduction or creation of a real life environment or condition permitting the user to navigate through interact with. Virtual reality consists of computer hardware and software, provides a sort of interactive simulation to users which are almost near to real environment. Subjects participate in VR environment with pronounced motivation and enjoyable manner due to realistic visual sensory perception and thus simulates body movements of daily life. There are two main types of VR. Non‐immersive virtual reality and immersive virtual reality. In non‐immersive environment user feels both the real and virtual environment. While in immersive, real world perception of subjects is being blocked and only virtual images are being seen. The use of VR in physical rehabilitation programs can offer several benefits. First, environments and situations that are excessively dangerous, costly or impossible in real life can be computer‐generated with the use of VR. Second, these virtual environments (VEs) are fully controllable by therapists and researchers, giving the chance to bring real environments or situations. Third, VE are artificially made and can therefore easily be changed, constructing the possibility to design modified environments and therapies. Fourth, VR has the potential to increase patient 's enthusiasm by creating more exciting training environments causing in more repetitions and longer training duration, eventually improving patients' treatment compliance. VR interventions are advantageous for motor rehabilitation of the stroke survivors. VR systems enhance movement intensity which is compulsory for the induction of neuronal plasticity. VR actually provides immediate feedback which allows users to interact with full attention and patient does so because he was determined to attain maximum scores. VR works upon the cortical reorganisation which is also facilitated by sensory visual and auditory feedback.There is an enormous literature supports for the use of Virtual reality based rehabilitation as compared with conventional therapies

Nct (2021). "COgnitive and Physical Exercise to Improve Outcomes After Surgery (COPE-iOS) Study." https://clinicaltrials.gov/show/NCT04889417.
	The COgnitive and Physical Exercise to improve Outcomes after Surgery (COPE‐iOS) study is testing the hypothesis that a pragmatic program combining computerized cognitive training and physical training throughout the perioperative period will improve long‐term cognitive and disability outcomes in older surgical patients at high risk for decline. To accomplish these goals, the Investigators are randomizing 250 patients ≥60 years old undergoing elective major non‐cardiac surgery with expected hospitalization ≥3 days to a pragmatic comprehensive training program (computerized cognitive training and supervised progressive physical exercise) or to active control (control computer game, stretching exercises) for 2‐4 weeks prior to surgery and for 3 months after discharge. At baseline and after discharge, the Investigators will assess global cognition, activities of daily living, depression, endothelial and blood brain barrier function (blood biomarkers), and neuroimaging (anatomical and functional MRI). In this early stage trial, the Investigators will determine if certain subgroups benefit most, program aspects with greatest effect on outcomes, mechanistic associations with outcomes, and additional exploratory analyses.

Nct (2021). "Cognitive Enhancement in Healthy Elderly People." https://clinicaltrials.gov/show/NCT04997226.
	Aging is associated with several physiological changes that affect global functioning, daily activity and quality of life. For instance, cognitive functions progressively decline during normal aging, as evidenced by decreased episodic memory and working memory (WM) performance. The above mentioned cognitive decline reaches medical attention for about 5‐25% of the elderly population (over 65 years of age) as they suffer from Mild Cognitive Impairment (MCI). MCI is usually referred to as an intermediate phase between the expected cognitive decline of normal aging and the pathological cognitive decline linked to dementia. Around 46% of people with MCI develop dementia within three years, compared to 3% of the age‐matched population. According to Peterson's initial definition (Petersen, 2004), The selected technique to improve cognition as we propose here is transcranial non invasive brain stimulation (TES). We will employ a couple of these techniques of neuromodulation that have proven to influence performance in different cognitive domains. Here we propose to combine our expertise and to investigate the effects on cognition and health of brain stimulation‐based treatment in MCI patients compared to matched healthy controls, combine it with cognitive training and explore the longer term effects of the intervention. Objectives. The main objective of the proposed research is to explore the potential intervention based on non‐invasive brain stimulation and cognitive training to improve cognition in the elderly. In particular we aim to explore: 1. The immediate efficacy of various stimulation protocols with cognitive training on cognitive improvement in the elderly. 2. The long term effect of a selected stimulation protocol on MCI improvement in the elderly. According to a large controlled study on cognitive stimulation for people with MCI, the treatment proved effective in improving the functioning in several cognitive areas compared to a control group (Ball, Berch, Helmers et al., 2002).The cognitive training in this study included a computerized training, which is more enjoyable and effective than pencil‐and paper training due to its immediate feedback and engaging nature. In their systematic review of 26 studies on computerized cognitive training (CCT) for older people with known MCI, Hill et al. (2016) concluded that CCT is an efficient tool for cognitive enhancement in older people with MCI. The overall effect size on cognition score was moderate (Hedges' g=0.35); a large significant effect size on working memory; and there were moderate significant effect sizes for specific cognitive domains, such as verbal memory, non‐verbal learning, attention and on psychological functioning measures. In contrast, and consistent with findings of previous CCT meta‐analysis (Motter, Pimontel et al., 2016), there were insignificant results regarding executive functions, processing speed and non‐verbal memory. The results on dementia patients, as opposed to MCI ones, were less optimistic: there was only a small but statistically significant effect size of the overall efficacy of the CCT on cognition enhancement. The researchers have previous works that revealed an enhanced training effect when it was combined with non‐invasive brain stimulation, for example Lavidor reported better cognitive control following training combined with Transcranial direct current stimulation (tDCS) compared to training alone (Ditye et al., 2012). Transcranial direct current stimulation (tDCS) is a safe, low‐cost, non‐invasive neurophysiological technique that consists in the application of mild (1‐2 milliamper (mA)) electrical current on the scalp (Jacobson et al., 2012). There is growing evidence that tDCS, combined with cognitive stimulation, improves cognitive functioning among healthy adult subjects. Specifically, tDCS to the prefrontal cortex has been proved effective. Anodal stimulation of the left dorsolateral prefrontal cortex (DLPFC) increases the performance on a working memory task in young healthy adults. In a combine treatment of behavioral training and tDCS stimulation of ten sessions for 10 days, healthy elderly subjects increased working memory skills for up to 28 days (Park et al., 2014). tDCS has also been proved efficient for people with AD or other types of dementia. In one study, anodal tDCS was applied to both hemispheres of the temporal cortex in 30 minutes sessions for five successive days. Results showed a significant improvement in a visual recognition memory task. tDCS anodal stimulation of the Broca's region within the left inferiorfrontal gyrus (IFG) had some positive effects on verbal fluency among patients with MCI in a double‐blind, crossover, sham‐controlled stimulation study. Additional fMRI analysis of these results indicated that there was also a reduction of compensatory upregulated activity within the frontal cortices. Manenti et al. (2016) have used anodal tDCS combined with physical therapies in MCI patients with Parkinson's disease (PD). Following daily administration of 2 mA stimulation for two weeks, subjects have improved their PD Cognitive Rating Scale scores and their verbal fluency test, in comparison with the sham control group. The efficacy of using tDCS in combination with cognitive training is yet controversial. A study on AD patients which used anodal tDCS to stimulate the left DLPFC in a name‐face association learning task, found no additional effect to the tDCS stimulation beyond that of the behavioral training. In contrast to these findings, in a study of healthy subjects, the combination of tDCS stimulation and simultaneous cognitive behavioral training has been proved more effective than tDCS stimulation to the left DLPFC by itself (Martin, Liu, Alonzo et al., 2015). In a recent study (André, Heinrich, Kayser, Menzler et al., 2016), four sessions of anodal tDCS stimulation over the left DLPFC, in combination with different cognitive tasks, were applied to 21 patients with mild vascular dementia. There was a significant improvement up to two weeks later in visual short term memory (in a pictures naming task), verbal working memory (2‐back task) and executive control (go/no go task) in the anodal stimulation group, Yet, there are still some considerable limitations to the research on tDCS effects on cognition and to its clinical applications. For instance, choosing the target area or network is, of course, critical. Various target areas have been used in different studies: frontal lobe, especially the DLPFC and the IFG, are natural candidates. Few studies have targeted the inferior parietal lobe, which might require further research. To overcome some of the problems we will test another brain stimulation technique, transcranial alternating current stimulation (tACS) where promising previous results suggest that tACS over prefrontal areas might be a better tool to improve cognitive functions in the elderly. tACS, a specific subtype of Non‐invasive Brain Stimulation methods (NIBS), is based on the application of low‐intensity electrical currents oscillating sinusoidally at a predetermined frequency (Antal et al., 2008). TACS‐mediated physiological and behavioral changes seems to be frequency‐dependent, thus, tACS could interact with the on‐going brain activity through cortical oscillatory entrainment. Since episodic memory decline is one of the most important markers of MCI, we will test brain stimulation protocols that were found to affect different types of memory performance. Possible effects of transcranially applied oscillating currents on memory functions have been investigated on humans by using transcranial Slow Oscillation Stimulation (SO‐tDCS; i.e., anodal transcranial direct current stimulation oscillating at 0.75 Hz in a trapezoid waveform‐fashion, applied bi‐frontally) in combination with on‐line EEG recording during slow wave sleep (Marshall et al., 2006). Ripple‐range oscillations in the hippocampus have also been associated with declarative memory consolidation. The co‐PI, Prof. Antal and her team reported that bilateral 140 Hz tACS over both DLPF during encoding may have a positive effect on the consolidation of declarative material (Ambrus et al., 2015). Novel cross‐frequency protocols (theta‐gamma coupling) of tACS affected spatial working memory performance in humans: enhancement of working memory performance and increase of global neocortical connectivity were observed when bursts of high gamma oscillations (80‐100 Hz) coincided with the peaks of the theta waves, whereas superimposition on the trough of the theta wave and low gamma frequency protocols were ineffective. In sum, evidence from recent studies portray a promising picture of this new line of research, suggesting that non‐invasive brain stimulation techniques, in general, and tDCS and tACS, in particular, may be used to ameliorate cognitive dysfunction in patients in pre‐dementia. Though prospects seem promising, the mixed results and inconclusive findings of several studies call for cautious. Hopefully, the proposed research will narrow the gap between theoretical knowledge and the clinical applicability of the findings for the sake of a treatment that can truly affect many people's lives. Our approach is to employ cognitive enhancement tools aiming to develop effective protocols that will preserve (and ultimately improve) cognitive abilities in MCI and healthy elderly. The main method are non‐invasive brain stimulation tools, tDCS and tACS, combined with computer‐based cognitive training in a multiple session design. Patient Registries: Each subject is met by the experimenters (PhD students) for 16 individual meetings. The baseline measurements and cognitive evaluation that is manually conducted by the experimenters is inserted and saved in local Excel files. The subjects' performance in the computerized games (the cognitive training) is automatically saved on the lab's computer. Quality assurance: the completeness and accuracy of the training log files is checked after every session. Standard Operating Procedures ‐ a paper file is prepared for each subject to keep background and contact details, printed records of his/her performance in the memory evaluation tests (at baseline, immediately after completing the intervention, and 3 months after completing the intervention). Sample size assessment: The sample size was a priori calculated using More Power software (Campbell & Thompson, 2012) based on the effect size reported for memory enhancement by transcranial electrical stimulation by Jacobson et al. (2012) (d = 0.49). This established that with a α = 0.05, power = 0.95, 60 participants are necessary to detect a moderate‐large effect. Statistical analysis plan: data will be analyzed with IBM SPSS Statistics for Windows, version 23 (IBM Corp., Armonk, N.Y., USA). The main analysis is a mixed design analysis that compares the experimental conditions (between subject factors) regarding their effect on memory performance in 2 episodic memory tests and 3 time points (within subjects variables). The cognitive status at baseline will serve as a covariate (the baseline scores). In addition, we plan hierarchical regression to check how ongoing scores in the cognitive training predict episodic memory score at the end of the intervention.

Nct (2021). "Computerized Cognitive Rehabilitation of Executive Deficits in Stroke Patients." https://clinicaltrials.gov/show/NCT05169632.
	This is an exploratory Randomized Controlled Trial with the purpose of evaluating the potential of two sets of gamified cognitive and physical exercises in the neurorehabilitation of cognitive deficits following a stroke. Upon recruitment, eligible study participants (see 'Eligibility Criteria') receive a detailed oral and written description about the scientific background, aims and methods of the study. Additional information will be provided about potential benefits and risks associated with study participation, as well as about the voluntary nature of participation throughout the study. The participant's written informed consent is required for study enrollment. After inclusion in the study, participants are randomized into one of two different training programs with equal chance of attribution and without possibility of choosing: ‐ Program 1 involves brain training games with a physical exercise component. ‐ Program 2 involves cognitive training games with a physical exercise component. Independently of program attribution, participants engage in a pre‐training assessment, a six‐week training period, a post‐training assessment and a 6‐month‐follow‐up assessment. Before the start of the training, participants are required to perform several cognitive and physical tests and fill out a number of questionnaires on subjective cognitive function, mood and quality of life. The exercises and the questionnaires serve as a baseline evaluation of cognitive and physical function. Following the first assessment, study participants engage in a 6‐week training period. In both programs, participants engage in 3 weekly trainings of 90 minutes duration each. After completion of the training period, study participants engage in a post‐training assessment to evaluate the effect of training on cognitive and physical performance. This session incorporates the same tasks and questionnaires as in the pre‐training visit. The aim of the post‐training assessment is to demonstrate immediate training effect of the two programs. A final follow‐up visit is scheduled 6 months after the completion of the last training session. The cognitive and physical testing together with the questionnaires will be repeated to examine the long‐term effects of the training programs.

Nct (2021). "Development and Evaluation of a Psychological Intervention in Videogame Format for the Promotion of Active Aging." https://clinicaltrials.gov/show/NCT04982497.
	The social and health challenges of the aging population have led to the recommendation of active aging programs to increase the number of healthy and independent elderly people. These interventions have been shown to offer benefits in terms of quality of life, wellbeing, dietary and physical exercise habits, and cultural and social activity. However, there is a current need to investigate more‐effective alternative means to disseminate these interventions beyond in‐person formats such as serious videogames, aimed at promoting behavioral changes and providing education for purposes such as health or learning. The main objective of this project is to improve on a videogame intervention for the promotion of aging and to evaluate its efficacy via a randomized controlled trial. It is expected that after the intervention and in the follow‐ups (at 3, 6, and 12 months), participants in the videogame arm of the study will have higher health status compared to the control group subjects. The first months of the study will be devoted to revising the materials and fine‐tuning the intervention tested in a previous pilot study. After that, the randomized controlled trial will be conducted. Participants will be recruited through clinics and health care centers in the Autonomous Community of Galicia (Spain). To participate in the study, participants must: (a) be at least 45 years old, (b) have normal cognitive functioning, and (c) reside in Galicia. Participants will be excluded if they: (a) have serious mental or medical disorders; (b) have been receiving psychological or psychopharmacological treatment during the two months prior to the study or are participating in other studies related to active aging; and finally, (c) do not have the appropriate devices to play the game, cannot communicate in Spanish, or have problems that make it impossible to play the videogame. Information on various sociodemographic and clinical variables will be collected during the pre‐intervention evaluation. The main outcome will be perceived health status, as evaluated using the SF‐36 health questionnaire. A total of 574 participants will be randomly assigned to a cognitive‐behavioral intervention administered through a serious online interactive multimedia game with a complementary App (CBI‐V, experimental group) or to a control group that will receive information on active aging in an online format (CG). The randomization sequence will be generated automatically by the evaluation platform (concealment or blinding of randomization), and the participants in the CBI‐V group will be given access to the first module of the intervention, while those in the CG will receive the first informational module. The participants in both groups will then complete the next seven modules for each condition. After the intervention, the participants will be evaluated in the postintervention assessment and follow‐up assessments at 3, 6 and 12 months. In terms of its impact, this study will contribute to the development and rigorous evaluation of the worlds first psychological intervention to promote active aging managed through an interactive online multimedia videogame with a complementary app. In addition, confirmation of the programs clinical validity will be of great relevance in terms of health, social and economic benefits.

Nct (2021). "Effect of Exercise Mode in Breast Cancer-Related Lymphedema." https://clinicaltrials.gov/show/NCT04724356.
	Breast cancer‐related lymphedema is a common and debilitating side effect of cancer treatment. This study compared the effect of Xbox kinect rehabilitation and resistance exercises on breast cancer‐related lymphedema volume and severity, as well as participant's physical function and quality of life. Women diagnosed with unilateral breast cancer related lymphedema were randomly divided into two groups: the kinect based rehabilitation group KBRG and resistance exercise group REG. woman in The KBRG received virtual reality therapy using Xbox Kinect‐based games, the REG received resistance training in addition both groups received complex decongestive physiotherapy. The intervention was five sessions per week for 8 weeks. The outcome measures included limb volume, symptoms severity, physical function (muscle strength and range of motion) and quality of life. All these outcomes were assessed at pretreatment (baseline) and after the end of treatment at week eight (W8).

Nct (2021). "Effectiveness of Virtual Bodily Illusion Intervention in Upper Limb Motor Function in People With Incomplete Spinal Cord Injury." https://clinicaltrials.gov/show/NCT05142943.
	Approximately 60% of people with a spinal cord injury have an incomplete injury. This causes alterations in strength, sensitivity and muscle tone, which leads to a marked loss of functionality. This supposes a profound psychological and socioeconomic impact on the life of the affected person, in addition to the implicit physical impact. After an injury of this type, there is a spontaneous functional recovery that may have a different path depending on the characteristics of the injury and the person. Previous studies have shown that the neuroplasticity of the residual corticospinal fibers, the motor cortex and the spinal neurons plays an important role in the spontaneous functional recovery of people with neurological or musculoskeletal pathology. However, it is also possible to stimulate the neuroplasticity mechanisms of these structures through techniques aimed at rehabilitating different deficits (for example, motor function or sensitivity). In general, intervention programs are usually carried out, in most cases, using low‐cost strategies such as therapeutic physical exercise programs. This nervous reorganization and recovery can also be influenced by the activity of mirror neurons, which are found in motor and premotor areas and also in other cortical and subcortical areas; and they report activation when they observe an action with a specific purpose. The activity of these neurons has been studied in different populations with involvement of the nervous and musculoskeletal system, such as cerebrovascular accidents, head injuries, Parkinson's, Alzheimer's or carpal tunnel syndrome. For its study, experimental investigations have been carried out applying different interventions that modify the activity of mirror neurons, such as mirror therapy, virtual reality therapies or Action‐Observation therapies. Of these, in general, promising results have been obtained in all these populations, except in the case of Alzheimer's disease in advanced stage. However, these treatments have not been investigated in the recovery of the upper limb in people with incomplete spinal cord injury. For all the above, the objective of this study is to analyze the effectiveness of visual illusion therapies in combination with conventional exercises on the symptoms and signs related to different pathologies of the nervous and musculoskeletal system that affect the upper limb. Specifically, it is intended to know the impact of visual illusion therapy on: ‐ The motor function of the arm and hand. ‐ The functionality . ‐ The isometric strength of the upper extremities. ‐ Muscle tone, rigidity and elasticity of the muscles of the arms. ‐ Neuropathic pain. ‐ The fine motor skills of the hand. ‐ The upper limb functionality. Therefore, this study aims to provide knowledge to the scientific community on how neuroplasticity mechanisms and specifically mirror neurons can influence the rehabilitation of people with incomplete spinal cord injury and, in addition, propose a specific treatment methodology for the rehabilitation of the upper extremities in this type of population. All procedures will be carried out under the principles of the Declaration of Helsinki (World Medical Association) and will be approved by the ethics committee of the University of Valencia. In addition, all participants will be asked to sign an informed consent that will include all the sections required by this committee. A minimum of 20 participants per group is established, establishing a power of 80%, an ability to detect a small effect size (Coehn's d = 0.3) for the main variable mobility measured with Nedcodo Agile and a probability of type I error. of 0.05, resulting in a total of 80 participants. In order to minimize possible losses, 25% more patients will be added per group, so 100 people will participate in the study. The inclusion criteria will be the following: i. spinal cord injury with AIS C, D or E, ii. ability to understand instructions (Mini‐Mental State Examination> 23 points). The exclusion criteria will be the following: i. traumat c pathology in upper limbs, ii. other alterations of the central nervous system or peripheral, iii. alterations in the vestibular system and iv. concomitant diseases. The participants will be divided into the four groups described above randomly using a computer program. Compliance with the inclusion criteria will be verified by the physiotherapists specializing in the pathologies understudy at the Faculty of Physiotherapy (Universitat de València). The study will include the realization of three measurements that will be carried out one day before starting the program, one day after finishing it, and one month later (follow‐up). These will be carried out by team members who are blind to the assignment of the interventions. In the first evaluation, anthropometric and demographic data (i.e. height, weight, age, educational level, possible comorbidities, etc.) will be collected in order to control, in case of heterogeneity, these confounding variables. The clinical assessment will be composed of the study of the following variables: ‐ Motor function and motor skills: Hand assessment app, Nedcodo Agile. ‐ Upper limb isometric force: load cell (CTCS; Mutronic). ‐ Muscle activation: BTS FreeEMG Electromyograph. ‐ Pain: Brief Pain Inventory, Visual Analog Pain Scale. ‐ Muscle tone: Modified Ashworth Scale and MyotonPRO. ‐ Quality of life: Quality of life index, Spinal cord injury, version III. ‐ Functionality: Spinal Cord Independence Measure. The data analysis will be carried out using the SPSS statistical program (version 26). The normality of the sample will be analyzed using the Shapiro Wilk test and homoscedasticity using the Levene test. For the comparison between groups, a mixed factorial ANOVA will be used, and for the comparison between pairs of groups the Bonferroni correction will be used. In the event that there may be a confounding factor that meets the requirements to be analyzed as a covariate, an ANCOVA will be used. Statistically significant differences will be assumed when the p‐value is less than 0.05. All interventions will last eight weeks and will be planned according to the availability of volunteers. In each session, it will be recorded if any type of adverse effect occurs. There will be four types of interventions: i. Visual Illusion (IV) and therapeutic exercise program (PE): the patient will be seated in a chair with a table in front of it. The front part of the trunk will be covered with a black blanket that will be attached to the table. On the table, you will see arms and hands projected performing different types of functional manual activities that will include mobility and strength tasks. The projected arms will be adapted to the dimensions of each subject so that the patient can recognize the projected arms as theirs. This program will last 10 minutes. Then a physical exercise program for the upper extremities will be carried out: ‐ General mobility and warm‐up: flexion‐extension joint movements, rotations, deviations, abduction‐adduction, etc. ‐ Gross mobility and coordination: ball games. ‐ Fine mobility and coordination: writing tasks, puzzles, abacus ... ‐ Strength exercises: shoulder, elbow, wrist, fingers. ‐ Stretching. ii. IV placebo and PE: the configuration of the work table will be the same as in real IV, although videos of landscapes will be projected on them without any type of human or animal movement appearing on them. This program will last 10 minutes. Afterward, a physical exercise program for the upper extremities will be carried out. iii. IV: only the visual illusion program will be carried out.i. iv. IV placebo: only the placebo visual illusion program will be carried out.

Nct (2021). "Effects of a User-centered Exergame Training on Motor and Cognitive Functions in PwMS." https://clinicaltrials.gov/show/NCT04963335.
	The study was designed to examine the feasibility of the intervention as well as to get preliminary results about the effects of the user‐centered exergame training on motor and cognitive functions in persons with multiple sclerosis (PwMS). The entire study last 5 months (March 2021 to July 2021) and is performed in three study locations (two rehabilitation clinics and one physiotherapy). PwMS are informed by their local physiotherapists and research associates about the study. All interested PwMS are then screened for eligibility. A sample size of 30 PwMS is anticipated where 15 participants are allocated to the intervention group and 15 participants to the control group (quasi‐randomization). Measurements are performed before, in‐between, and after the intervention period to assess feasibility parameters as well as motor and cognitive functions in all participants. Intervention group:The user‐centered exergames were developed within a interdisciplinary team to meet the requirements of the end‐users. The individualized exergames were designed for the Dividat Senso, a pressure sensitive plate connected to a personal computer and a frontal screen. The pressure‐sensitive plate allows a precise analysis of the user's movements through several high‐resolution sensors. Furthermore, this plate detects position and timing information that are then used to provide the user with real‐time feedback and/or game adaptations. To support users with potential balance issues and to avoid fall events, a handrail is mounted around the plate.This concurrent motor‐cognitive training aims to improve motor and cognitive functions in an ecological valid setting. The cognitive functions are triggered by specific stimuli in the game scenarios. The video games are controlled via specific (whole body) movements as steps, weight shifting, jumps, and arm movements. The training focus is mainly on multi‐tasking, balance and coordination as well as executive functions and attention. Furthermore, the meaningful games (colorful and appealing visuals) were designed to motivate the players to move. Participants in the intervention group perform 16 training session over a period of 4 to 8 weeks (depending on in‐ or out‐patient). One training session lasts between 15‐25 minutes. Since the difficulty of the games is adaptive to the ability level of each participant, they should neither be over‐ nor under‐challenged. Each participant starts the exergame training at the lowest level to get familiar with the game control system. As the exergame will automatically adapt (individual progression) during play time, participants are challenged at their individual motor and cognitive level. Furthermore, participants write down the amount, type, and duration of activities besides the exergames training in an activity diary. Control group:Participants of the control group are instructed to continue their normal daily activities over the period of eight weeks. To evaluate the amount of active time, the participants get an activity diary where they can write down the amount, type, and duration of their activities.

Nct (2021). "Effects of Exer Gaming on Balance and Gait in Parkinson's Patients." https://clinicaltrials.gov/show/NCT05043727.
	Parkinsons Disease is a progressive neuro degenerative disorder manifested by a broad spectrum of motor and non‐motor features. Approximately 500 000 people suffer from Parkinson's Disease in the United States and there are approximately 50,000 new cases reported annually . Postural instability, impaired gait, and freezing episodes are all common occurrences in Parkinson's. Agility activities, including supine‐to‐stand, ambulation, turning, and reaching activities, have been used to reduce freezing episodes, particularly in the early stages of disease. Conventional physical therapy(balance training, stretching and strengthening exercises) being used for the balance and gait training in Parkinson. In recent time, there has been development in such treatment plan. Virtual reality based games have been used for such purposes. This study will look at the effects of virtual reality gaming in patients suffering from Parkinson's disease and its outcomes in term of gait and balance training. A randomized clinical trial will be performed. total 16 patients will be included in the study and will be divided into two groups. VR Group will be receiving virtual reality based exercise plan while the CONVENTIONAL group will receive conventional physical therapy . Division will be done through lottery method. Unified parkinson's disease rating scale and dynamic gait index will be used to collect the data. Treatment frequency will be three days per week for three months .

Nct (2021). "Effects of Kinect-based Virtual Reality Training in Postmenopausal Women With Osteopenia." https://clinicaltrials.gov/show/NCT04862910.
	Osteoporosis in Pakistan is estimated at about 9.9 million people, 7.2 million of whom are women. Moreover, an estimated 40 million Pakistanis were equally distributed in Osteopenia between men and women. Osteoporosis prevalence in Pakistan is expected to increase in future years, projected at 11.3 million in 2020 and 12.9 million in 2050. in Pakistan, respectively. International Osteoporosis Foundation surveyed the Pakistani population in 2009. The findings of this study were based on ultrasound investigations. It was found that 40 million people ranging between 45 and 70 were Osteopenic, while almost 10 million people were found to be Osteoporotic. Osteoporosis's overall prevalence was found to be 16%, while that of Osteopenia was found to be 34%. Regular exercise involving different functions and subsystems of the human body is beneficial all life. There is ever‐growing evidence that exercise prevents at least some harmful effects of Menopause, such as bone loss, increased risk of heart disease, or chronic diseases, such as diabetes. Wii Fit effectively balances women with bone loss. The purpose of this study was to estimate the effectiveness of a Wii Fit controlled exergame compared with traditional balancing exercises, Quality of life, fear of fall and well‐being in bone loss women. The Wii group or control Group comprised thirty‐eight female participants aged over 65 years with a bone loss. A supervised Wii fit equilibrium training may be helpful to improve equilibrium issues among women with bone loss. Bone consistency is greatly affected by physical activity. The following guidelines can be made for physical activity and exercise based on data derived from controlled clinical trials and meta‐analyzes (randomized/nonrandomized). 1. Adolescent and prepubertal girls will benefit most from bone loading. Education is an efficient way of growing the peak bone mass of this age group and allows for the prevention of lifelong fractures. 2. Exercises with high impacts, such as jumping or skipping, or strength training paired with movement with high or irregular impacts, are the most powerful for bone.3. In order to preserve or strengthen bone, two to four short workouts (30 mins/day or less) a week for an extended period. 4. Other weight‐bearing activities such as resistance training, unique positions of yoga, aerobics, low load, or walking can preserve or boost bone density in older women with risk factors that prevent them from engaging in high impact activities. 5. Additional practices that protect or increase mobility and strength often benefit, as they reduce risk of falling and thus reduce fracture risk. High‐Intensity Resistance and Impact Training (HiRIT) Improves BMD and Physical Function in Postmenopausal Women with Osteopenia and Osteoporosis. A short, controlled, twice‐week HiRIT training procedure was productive and superior to previous bone enhancement programs, clinically appropriate locations, stature, functional Performance, and falls in postmenopausal women with low to high bone mass. Effects of circuit training interventions on bone metabolism markers and bone density of older women with Osteopenia. The conclusion indicated that the circuit training intervention showed positive effects on bone metabolism markers and bone density of older women with Osteopenia, being viewed as an effective intervention program applicable to prevent and control Osteopenia Osteoporosis in line with bone density decrease. Given the psychological findings, VR exercise has benefited mental stress reduction and HRQOL improvement. Traditional physical therapy can be seen as a repeated and lifeless activity, which also intimidates people. Physical activity (PA) health benefits have been well established in recent decades . Despite its well‐known advantages, about 25% of adults and 80% of teenagers worldwide, according to the World Health Organization (WHO), are physically inactive, somewhat through a change in culture and lifestyle. In light of psychological outcomes, VR exercise showed positive impacts on elieving mental tension and improving HRQOL. Effects of 24 weeks of aerobic dancing on the BMD, physical fitness and health‐related Quality of life (HRQOL) in postmenopausal women. The results suggested that 24‐week aerobic dance intervention could lower bone fracture incidence by increasing BMD and decreasing fall risk for postmenopausal women. The program adherence in the present study was 81%. Differences were statistically detected in femoral neck BMD, muscle strength and agility. VR exercise may positively affect the conventional exercise on individual physiological, psychological and rehabilitative outcomes. However, existing studies are far from optimal in terms of consistency, quantity and samples. To confirm these positive effects, therefore, more laborious studies are needed. Effects of virtual reality training on postmenopausal osteoporotic women. They concluded that virtual reality training has broad beneficial effects on BMD, bone mineral content and Quality of life in postmenopausal osteoporotic women, which may further reduce the risk of osteoporotic fracture. There have been few drawbacks during the whole analysis. The sample was small, and the second sample did not examine the long‐term effects of this training. In future studies, the association between BMD and the Quality of life in osteoporotic women after Menopause is proposed. A Planned, structured and repetitive exercise program is often perceived as boring and hard, thereby causing the individuals to be away from Physical Activity‐related behaviours after long days of work. Instead, individuals are more interested in leisure activities, such as video games, where entertainment can be obtained while relaxing. Thus, virtual reality‐based video games may trigger their interest, motivation and adherence to exercise. To the best of the researcher's knowledge, no study has investigated the effects of Kinect‐based virtual reality training on BMD, fracture risk, physical function, and Quality of life in postmenopausal women with Osteopenia. Although a study has been done to check its effects on postmenopausal women with Osteoporosis; however, considering several limitations in this study, it seemed that more scientific research needs to be done to find out the facts. Asociation between BMD and Quality of life resulting from Kinect‐based virtual reality training is also recommended for further research in previous literature. Therefore, the purpose of this study will be to find out the effects of Kinect‐based virtual reality training on BMD, future fracture risk, physical function, and Quality of life in postmenopausal women with Osteopenia and to find out the association between BMD and Quality of life. It is hypothesized that Kinect‐based virtual reality training for 24 weeks will lead to significant improvements in the outcome measures and will contribute to its role in delaying the progress of Osteopenia to Osteoporosis in postmenopausal women.

Nct (2021). "Effects of Kinesthetic Stimuli During XBOX Kinect Training on People With Parkinson's Disease." https://clinicaltrials.gov/show/NCT04717271.
	BACKGROUND: Despite evidences indicate the benefit of motor interventions based on video games in people with Parkinson's Disease (PD), practice guidelines for the therapeutic use in physiotherapy were still not established. Although visual and auditory stimuli provided by video games are pointed as one of the main advantages for their therapeutic use, the effects of kinesthetic stimuli offered through physical therapist manual intervention during this type of training in people with PD have not been investigated yet. The answer to this question is relevant to guide the physical therapist (PT) conduct during this kind of intervention. PURPOSE: To compare the effects of motor training using video games with and without kinesthetic stimuli offered by physical therapist manual guidance during intervention on the functionality of people with PD. METHODS: A blind randomized clinical trial in people with idiopathic PD, staging of 1 to 3 according to disability scale of Hoehn and Yahr, will be performed. Participants will be randomized into two groups: the Movement Guidance Group (MVG) and NO‐MVG Group. Both groups will receive 8 individual sessions, twice a week, for 4 weeks. Each session consist of 10 minutes of warm‐up and 40 minutes of XBOX Kinect training for balance and gait. In the MVG Group, the PT will provide kinesthetic stimuli by assisting manually the participant movements. In the NO‐MVG Group, the involvement of the PT will be restricted to ensure participant safety. The two groups will be evaluated before (BT) and after (AT) training and after 60 days (follow‐up). A blind physiotherapist will conduct the assessments. Measurements are categorized according to the International Functioning Classification (ICF), those associated with the activity level were established as primary measures: Balance Evaluation Systems Test (BESTest); International Falls Effectiveness Scale (FES‐I); 30‐second Gait Test; Six Minute Walk Distance (6MWD); Five Times Sit to Stand Test (FTSTS) and Unified Parkinson's Disease Rate Scale (UPDRS) session II. Secondary measures were the evaluation of function using UPDRS session III; Rapid Turns Test (RTT); Montreal Cognitive Assessment (MOCA); Geriatric Depression Scale (GDS‐15), and participation using the Parkinson's Disease Quality of Life Questionnaire (PDQ‐39). STATISTICAL ANALYSIS: An ANOVA to repeated measures will be use, having as factors: group (MVG Group and NO‐MVG Group) and evaluations (BT, AT and FU). Followed by post hoc Tukey Test to the significance factors. A significance of 5% will be considered.

Nct (2021). "Efficacy of Virtual Reality in Pain Reduction in Orthopedic Pediatric Patients." https://clinicaltrials.gov/show/NCT04901793.
	INTRODUCTION Pediatric patients are exposed to procedures that can result in pain and anxiety. The International Association Study of Pain 2011 defines pain as an unpleasant sensory and emotional experience associated with actual or potential tissue damage. Pharmacological interventions have been used but consequences of this therapy, specifically opioids, are of concern. Distraction techniques have been implemented recently but there is a significant range of these techniques such as breathing, music, and play therapy, among others. Some studies indicate child preferences and temperament can optimize outcomes in regards to therapy. Non‐pharmacological analgesics have been shown to benefit patients overall. Watching videos, biofeedback, mental imagery, and hypnosis have all been reported to have analgesic effects in the literature. Additionally cognitive behavioral strategies particularly distraction have been shown to reduce pain reports as high as 85% of patients. The most recent emerging technique is virtual reality. Virtual reality creates the illusion that user is immersed in another environment. A three dimensional world is seen through the eyepieces, and the user can interact with the world in several ways: by moving their head and neck to look around the environment and a hand held trigger allows you to shoot at objects within the environment. Because this is a more interactive environment and more attention capturing than simple distractions, VR is thought to be more beneficial than basic distraction techniques. Additionally, using a head‐mounted display (HMD) prevents visual perception of the real world, decreasing the chance of distraction. Previous uses of distraction show that children only pay attention to the distraction for 2/3 of the procedure, but virtual reality prevents the distraction of the procedure's visual stimuli. In this study the investigators will attempt to determine the benefit of using virtual reality distraction techniques with a head‐mounted display in standard orthopedic consultations that involve pain. The literature review indicates that excepting burns, this study has not been performed previously. Additionally heart rate monitoring has not been previously been included in the analysis of pain reduction. The investigators will assess pain reduction using patient feedback and pain scales, but also heart rate monitoring pre‐procedure, during procedure, and post‐procedure. In this study, the only procedure will be cast removal. OBJECTIVE To prospectively determine if pediatric patients undergoing orthopedic procedures can benefit from employing virtual reality for pain management. SPECIFIC AIMS To identify any benefits from virtual reality use as pain management in the pediatric population by means of patient feedback and by heart rate monitoring during orthopedic care. By doing this we can determine if virtual reality should become a standard of care in pain management for the pediatric population. RATIONALE AND SIGNIFICANCE Post‐surgical pain has been reported to be difficult to manage and can potentially limit outcomes in the pediatric population. Pharmacologic management is not ideal and intolerable for some patients. In 2009, a study of 182 children in the burns and orthopedic department at Royal Children's Hospital, Brisbane, Australia, found that multimodal distraction devices (MMD) reduced pain and anxiety significantly as well as reduced future procedural pain. Multimodal devices are interactive devices that prepare the child for a procedure and uses developmentally appropriate distraction stories and games to alleviate the pain. Virtual reality provides an alternative method with high rewards. In a case study of post‐surgical twice‐daily physiotherapy regimen, using a subjective pain scale, it was found to reduce pain by 41.2% compared to the control patients. Studies looking at IV placement with VR in children suggest satisfaction for children, parents, and nurses. That study suggested analyzing affective pain, anxiety, overall satisfaction, and pain in ensity. A literature review from 2008‐2013 also found that distraction techniques would be a simple and efficient non‐pharmacological acute pain relief strategy and should be implemented in pediatric care settings. It suggested further exploring the use of virtual reality, which was emerging at the time. Virtual reality distraction has also been used in chemotherapy, during burn wound care, intravenous port access in pediatric patients, to reduce pain and anxiety for invasive medical procedures, to help adolescents with cerebral palsy endure physiotherapy, and to reduce preoperative anxiety. Another study of VR during routine blood draw, found that VR was more effective than the standard of care for reducing pain and anxiety. They determined VR has the capacity to act as a preventive intervention transforming the blood draw experience into a potentially pain‐free routine medical procedure particularly for patients with high anxiety. VR has the potential to both reduce outcomes for children but also reduce distress in their caregivers. Uncontrolled pain is thought to have serious psychological and physiological consequences, including an increased risk of morbidity and even mortality in children. Recent estimates have shown that around 27% of children experience moderate to severe pain in the hospital; teenagers and infants experience higher amounts of 38% and 32% respectively. Pediatric patients with untreated pain are more susceptible to developing sensitization, hyperalgesia, chronic pain, and allodynia. Long‐term effects can include alterations in circuitry that impact pain processing in the future which predispose to decreased sensitivity or hypersensitivity to painful stimuli. METHODS/PROCEDURE Patients who present to have a cast removed, percutaneous bone pin removed, or cast applied will undergo heart rate monitoring via a pulse oximeter and give feedback post‐procedure. Patients will be selected if they are between the ages of 5 and 18 years of age, have no significant co‐morbidities, and are not undergoing an emergent procedure. Approximately 100 patients will be enrolled in the study, with 50 participants in each of two groups. The two groups will be the intervention group‐ those with the VR headset, and a control group‐ those without a VR headset. The groups will be randomized, and demographic data including age and sex will be obtained. Patients who qualify for the study will be consented by a member of the study team during the visit. The two groups will be randomized via GraphPad software through https://www.graphpad.com/quickcalcs/randomize2/. The website will randomly assign 50 subjects each to two groups, for a total of 100 subjects. The results will be copied into a secure computer database to keep track of the assigned groups. Patients will be assigned a study number from 001 through 100, according to the chronological order in which they are consented. From there, the investigators will match up the patient's study number with the results from GraphPad and determine the patient's group assignment. Enrolled patients will be located at the Ochsner Medical Center, New Orleans, Louisiana. There will be no charges to the patient and no reduction of patient care. If the patient requires admission for management of their pain, they will be admitted to the inpatient unit and followed by the team. Patients will undergo heart rate monitoring before, during, and after the cast removal procedure. All patient data collected will be de‐identified and stored on a secured database. We will analyze our data with T‐tests with 2‐tailed and 2‐sample unequal variance as the parameters. PROTOCOL This study will involve patients in the pediatric orthopedic setting at Ochsner Medical Center in New Orleans, Louisiana. This will be a prospective consecutive case series to evaluate the severity and reduction of pain in the pediatric population. Randomization of study groups will be performed prior to any patient enrollment. There will be two study groups with approximately 50 subjects in each group. Part cipants in group 'A' will be fitted with the VR headset during their procedure. Participants in group 'B' will not be fitted with the VR headset and they will act as the control group. Prior to enrollment in this study, all patients will be properly informed and consented about the requirements, risks, benefits, and other relevant information of the study. Patients will experience the standard of care and any abnormalities or distress will be addressed. If the patients require admission for pain management, they will be admitted to Ochsner Medical Center. Patients will continue to be monitored for the utmost patient care. The anticipated number of participants in the study is about 100 patients. All factors between the groups will be kept as similar as possible with any changes being formally documented. Patients will be given follow‐up instructions that are consistent with the standard of care for cast removal. It is our goal to determine if virtual reality should become a standard of care in the pediatric population in regard to orthopedic procedures.

Nct (2021). "Exergames in In-patient Rehabilitation." https://clinicaltrials.gov/show/NCT04872153.
	This study is a pilot trial with two arms: an intervention group where the conventional treatment during the stay in the in‐patient rehabilitation clinic is extended with a technology‐based cognitive‐motor intervention and a control group following just the conventional treatment. Participants will be randomly allocated to one of the two groups. The selected methods to evaluate the primary and secondary endpoints include quantitative and qualitative measures. This national study will be conducted in Switzerland in a multicentre setup; three rehabilitation clinics are involved as study centres. The study will include at least 40 patients in each of the rehabilitation clinics involved as study centres (20 patients in the intervention group, 20 patients in the control group), resulting in a total sample size of 120 patients. At clinic entry, patients potentially fulfilling all inclusion criteria will be informed in oral and written about the study and asked if they wish to participate. All interested participants will then be screened for eligibility. The included participants will then undergo a baseline assessment battery and will be subsequently randomly allocated to the intervention or the control group using a block randomization. Screening as well as baseline measurements (T1‐measurements) are conducted within the first two days upon entry at the rehabilitation clinic. T1‐measurements will last around 60‐70 minutes. One day after T1‐ measurements, the intervention will begin (for patients in the intervention group). The intervention period will be equal to the length of the stay in the rehabilitation clinic (between 2‐3 weeks, according to each cantonal/regional regulations and insurance coverage) and will include short daily training sessions using the Dividat Senso (5x/week à 10‐15min), resulting in 10 to 15 training sessions in total. The training sessions will be supervised by a qualified study investigator (carefully observing patients while training and also preventing/aiding in case of adverse events). At the last two days before discharge from the clinic, post‐measurements (T2‐measurements) will be performed with all (intervention & control) study participants. T2‐measurements last around 70‐80 minutes. Intervention group: The patients allocated to the intervention group will conduct simultaneously combined cognitive‐ motor training on a technological device providing exergames, the Dividat Senso. Both, the hardware (Dividat Senso) and the software (exergames) are specifically developed considering the needs and requirements of older adults but also clinicians/therapists. The Dividat Senso is a platform for the dynamic recording of steps, weight shifts and other body movements producing forces. The platform includes 20 sensors (strain gauges), 5 vibration motors and an light‐emitting diode (LED) control. It is certified as a medical device class 1 and used by clinics, hospitals and nursing and care homes in 15 countries worldwide. It is connected to a small computer (running the software) and a large screen. The Dividat exergames specifically target all cognitive functions relevant for the successful mastering of activities of daily living such as executive and attentional functions and physical functions such as balance and coordination. The games are played by conducting body movements, mainly steps in four directions (front, right, left, back) but also body weight shifting. The Dividat software is a web‐based environment that includes data backing (Dividata), an administrative interface (Dividat Manager) and an intelligent, adaptable training environment with the exergames for motor‐cognitive training (Dividat Play). In the Dividat Manager, participants can be registered as users and their training program can be managed. The training software (Dividat Play) contains an algorithm for automatic, real‐time adaptation of the difficulty of a training game to the skills of a user. Moreover, the training applied in this study is progressive in the course of the interven ion period; patients start with the easier games in the first week, progressing to more difficult games in the second week and so on. Therapists and study investigators have the opportunity to individually adapt the training plan to meet each patient's functional capacity in the Dividat Manager. Thus, personalized training and optimal challenge for each patient are ensured. The intervention period in the rehabilitation setting will be equal to the length of the stay in the rehabilitation clinic (between 2‐3 weeks, according to each cantonal/regional regulations and insurance coverage) and will include short daily training sessions using the Senso (5x/week à 10‐ 15min), resulting in 10 to 15 training sessions in total. Each session contains various combinations of the Dividat exergames (each of the games lasts around 2‐3min). Control group: The patients of the control group follow the standard rehabilitation procedure including per week: 3x 30min physiotherapy, 8x 30min group therapy, 3x 45min group therapy (group therapy includes body‐ focused therapy, mindfulness therapy, respiratory therapy, gymnastics, hiking etc.).

Nct (2021). "The Feasibility and Efficacy of an Immersive Virtual Reality Software in Parkinson's Disease Patients." https://clinicaltrials.gov/show/NCT04699617.
	The Dolphin 2.0 is a platform that runs an immersive virtual reality software, based on an oceanic environment, where players control simulated creatures (dolphin, orca, axolotl). Video games lead to high levels of motivation and arousal, provide immediate feedback and playback, provide explicit reward and implicit success, and titrate difficulty levels. This encourages the practice of exercise, being an important complement to physiotherapy sessions. The main goal of this study is to evaluate the feasibility, safety and efficacy of an immersive virtual reality software (Dolphin, 2.0) in Parkinson's disease symptomatic control, in a two‐arm, randomized, single‐blind (blind rater for primary and secondary outcomes), delayed‐start feasibility and efficacy trial.

Nct (2021). "Feasibility of a Novel Exergame-Based Intervention Concept for Older Adults With Mild Neurocognitive Disorder." https://clinicaltrials.gov/show/NCT04996654.
	After recruitment, interested subjects will be screened on eligibility between July and September 2021. All potential subjects will be fully informed about the study procedures by providing verbal explanations and an information sheet. Expected effects, benefits and risks of the study will be explained by the investigator, who will also be available to answer open questions and clarify uncertainties of participants. It will further be verified, that withdrawal is permitted at any time during the study without giving any reason. After sufficient time for considerations, suitable patients willing to take part in the study will provide written informed consent prior to any measurements and the first study appointment will be scheduled. At the first scheduled appointment, pre‐measurements (PRE) will be performed. Thereafter, participants will be randomly allocated to the intervention group (i.e. 'exergame group') or active control group (i.e. 'usual care'). Subsequently, participants in the exergame group will be familiarized with the exergame training system 'Dividat Senso' (Dividat AG, Schindellegi, Switzerland; CE certification), and the study intervention will be started according to the newly developed exergame‐based intervention concept. After completing the twelve‐week training intervention, post‐measurements (POST) will be performed for both groups. Both, the pre‐ and the post‐measurements will take place and within two weeks prior to starting or after completing the intervention. INTERVENTIONS: Usual Care: An active control group will proceed with usual care as provided by the memory clinics where the patients are recruited. Exergame Group: Participants will perform a twelve‐week training intervention in addition to their usual care as provided by the memory clinics where the patients are recruited. The training intervention will be prescribed according to a newly developed exergame‐based intervention concept. The training intervention concept was planned and reported using the Consensus on Exercise Reporting Template (CERT): It consists of an individually adapted multi‐domain exergame‐based simultaneous cognitive‐motor training with incorporated cognitive tasks that will be adopted with a deficit‐oriented focus on the neurocognitive domains of (1) learning and memory, (2) executive function, (3) complex attention, and (4) perceptual‐motor function. According to the training concept, each participant is instructed to train 5x/week for 21 min per session resulting in a weekly exercise volume of 105 min. All training sessions are planned to take place at participant's homes using the exergame training system Dividat Senso (Dividat AG, Schindellegi, Switzerland; CE certification). In case the training cannot be performed at home, the training sessions will be performed at ETH Hönggerberg and the instructed training frequency is reduced to 3x/week for 21 min per session resulting in a weekly volume of 63 min. Nonetheless, it is still recommended to train at the suggested optimal frequency (5x/week) and volume (105 min/week). The training concepts is structured in three phases. It starts with a familiarization period of two weeks. During this phase, most of the training sessions (i.e. 4 out of 5 sessions) are supervised. After this initial guided familiarization period, supervision of training sessions is gradually reduced to 1x/week during a four‐week transition phase. This transition phase aims to lead participants to being able to train independently. In this transition phase, the amount of supervision of training sessions is individually determined within a predefined range in accordance with the capabilities and preferences of the participants. From the 7th week until completion of the training intervention, semi‐autonomous training with one supervised training session per week are prescribed for each participant. Throughout the training intervention period, all sessions will be prescribed following the same basic structure: Each session consists of three blocks with 3 phases pe block. Phase 1 ‐ Facilitation aims to apply a moderate physical intensity in the context of challenging but feasible cognitive and motoric demands mainly intending to trigger neurophysiological mechanisms, which promote neuroplasticity while additionally using cognitive stimulation to guide these neuroplastic processes. This phase includes games focusing on neurocognitive domains that are least impaired. The external task demand is individually adapted to ensure an appropriate internal training load. More specifically, the internal training load is subdivided into a fixed component (i.e. physical intensity) and a variable component (i.e. neurocognitive (game‐) demand). An additional stepping task is used to set the level of physical intensity. It includes walking on the spot at a predefined stepping frequency that is needed to reach a moderate level of physical intensity (i.e. ranging between 40 and 59 % heart rate reserve (HRR))). The stepping frequency will be individually determined for each participant. A battery figure add‐on is visible in the center of the screen that provides real‐time visual feedback whether the predefined stepping frequency is reached. More specifically, if the predefined minimal required stepping frequency is reached or exceeded, the battery stays at equilibrium or fills. As long as the battery level is above 80 % (indicated by a line), the battery stays green. If the participants' stepping frequency falls below the predefined minimal required stepping frequency, the battery level decreases, and the battery turns orange (40 ‐ 80 %) or red (below 40 %) indicating that the stepping frequency should be increased. On top of this fixed physical intensity, a variable amount of neurocognitive (game‐) demands (e.g. game type, task complexity, predictability of required tasks) is applied. Since the physical intensity is kept constant, changes in the overall internal training load can mainly be attributed to these neurocognitive and motoric (game‐) demands and, accordingly, the internal training load can be adjusted on basis of these game characteristics. Therefore, the neurocognitive demands of the exergame are individually adapted in order to ensure an appropriate total internal training load. The monitoring and adaption of the internal training load will be based on predefined progression rules for adapting characteristics of external training load. Phase 2 ‐ Guidance aims to make use of the triggered neurophysiological mechanisms from phase 1 to specifically guide neuroplastic processes of the mainly impaired neurocognitive domain. Therefore, games focusing on the mainly impaired neurocognitive domain for the individual participant (e.g. amnestic single domain => learning and memory) are used. These games solely focus on cognitive and motoric demands, but not on physical exercise intensity. The cognitive‐motoric demands of the exergame (also called 'external load') are individually adapted in order to ensure an appropriate internal training load. The monitoring and adaption of the internal training load will be based on predefined progression rules for adapting characteristics of external training load. Phase 3 ‐ Coherence aims to implement a structured approach as a surrogate for the breaks between games. More specifically, resonance breathing training guided by heart rate variability biofeedback (HRVB) is used. HRVB training is a behavioral intervention aiming to increase cardiac autonomic control, to enhance homeostatic regulation, and to regulate emotional state. It includes paced breathing for two minutes following the rhythm of the individually predetermined resonance frequency visualized on the screen of the exergame device. The resonance frequency will be evaluated for each participant before starting the training intervention.

Nct (2021). "The Influence of Interactive Media on Child Development in Children." https://clinicaltrials.gov/show/NCT04831229.
	The interactive media has different modes and levels of interactivity, being considered the use of active mode, when the child uses it with a high level of interactivity, performing tasks such as dragging, rotating and zooming on an object (as in games) or mode passive, when participants have a low level of interactivity, participants only understand the display of screen content and basic activities such as touching specific objects (eg play / pause when viewing videos and stories). The growth in the use of interactive media is mainly attributed to greater ease of access, due to its portability, as they are light, mobile and intuitive, being used from moments of leisure and entertainment to educational learning. Both groups will receive interventions with the Interactive Tablet Media for 30 minutes, three times a week for a period of 16 weeks. The interventions will be carried out in an environment provided by the educational institution. In the week before the start of the interventions, specific training will be carried out (on / off, ringing, double‐tapping, increasing / decreasing, holding, increasing / decreasing volume) on the use of the equipment with the participating children. Children who are not included or who are excluded will remain in their classrooms carrying out activities already provided for in the institutional calendar. Physiotherapists and physiotherapy students will be in the rooms conducting the interventions and elucidating possible doubts that may arise regarding the handling of the equipment. Experimental Intervention 1 AIMG children will perform active activities on the interactive tablet media. The games and applications that will be used during this intervention were selected through a search in the online application store compatible with the tablet used during the intervention (Google Play). The search term used was "games for children aged 2 to 3 years" and they were analyzed for the following criteria: (1) interactivity: critical thinking, active participation, decision making; (2) learning: activities that stimulate cognitive development, fine motor, receptive language, expressive and social‐emotional language (see table 1 to view activities); (3) suitability: age, period of development, multiple domains and (4) results: challenging activity, not frustrating, providing feedback. Experimental Intervention 2 PIMG children will go to the intervention room where they will use interactive tablet media in passive activities, such as: watching videos and children's stories that they often watch at home. This survey will be possible thanks to the questionnaire on the Use of Interactive Media where parents will list which drawings, stories and videos children use to watch. Treatment Contrast The main difference between the types of interventions is the mode of use and the level of interactivity of the interactive media, where the AIMG actively performs activities, that is, there is user interaction with the equipment through touch or verbal response and the performance of activities like rotating an object, dragging and zooming. PIMG is not the same, the user is just a spectator, having contact with the equipment only when switching on / off, choosing the content, performing activities such as increasing / decreasing the volume and touching certain specific objects such as giving "play" / pause ". Both groups will have a total of 48 intervention sessions. Sample Size Calculation The G.Power 3.1® statistical program was used to determine the number of children. The sample size was based on the study by Huber and collaborators (2018) with results from the comparison of executive function tests in Australian children aged 24 to 48 months. For the trial, 64 children and their parents or guardians will be needed (n = 64). Participants will be randomly randomized into two groups: active interactive media group (n = 32) and passive interactive media group (n = 32), considering an independent t test with 80% power (beta error, type I), equal alpha at 0.05 and effect size of 0.63. Data Manag ment Plan Personal, demographic and economic data will be collected only once, before interventions start. Each child will be identified by code using the initial CMEI of origin and ascending order of numbering. This identification will be carried out by a person who will not participate in any phase of the research and will be stored in a safe place. The data generated after evaluation will be analyzed and displayed in graphs, tables or images. They will be saved and stored on the computers of the main researchers, password protected, and on online platforms and will be accessed through common software. Data that is available on paper will be kept in a key office. It is important to note that all data will be treated confidentially. The data will be preserved for at least five years after the end of the research by the responsible physiotherapist (SG), who will be closely supervised by the supervising professor (JS). If the project is discontinued by the responsible physiotherapist, the supervising professor will assume the role of the person responsible for the project at the Federal University of Vallyes do Jequitinhonha and Mucuri, Campus JK. Responsibility and decision making will be signed between all members of the project team in a homogeneous manner, always ensuring the security and quality of the data. Data analysis A specific database will be elaborated in the Software SPSS22.0 (Statistical Package for the Social Sciences) in which specific research data will be allocated. For purposes of descriptive analysis, the frequency distribution of the categorical variables involved in the study evaluation and analysis of measures of central tendency and dispersion of continuous variables will be carried out. The normality of the data will be tested using the Kolmogorov‐Smirnov test. For statistical analysis, in the case of parametric distribution, paired T tests will be used to compare the scores of the Bayley Test intragroup in the pre and post intervention moments with media. The student T test will be used to compare between the AIMG and PIMG groups. In case of non‐parametric distribution, the Mann‐Whitney and Kruskal‐Wallis tests will be used. The significance level of 5% will be considered. All children in the groups will be reassessed, as an intention‐to‐treat analysis will be performed. This strategy analyzes the data of all participants included in the group for which they were selected, regardless of whether they completed the intervention. Shielding In all phases of the project, care with blinding will be taken and supervised. Initially, as previously mentioned, the randomization of the participants will be blinded because it will be carried out by a person without involvement in the research. Assessors will also be blinded as they will not have access to which group the child and their parents are participating in and the same is identical for the groups. In the case of participants and physiotherapists and physiotherapy students who are connected to the intervention, blinding will be carried out as far as possible. One of the measures to be taken to avoid contact and contamination between groups is to carry out the intervention at different times. Physiotherapists and physiotherapy students involved in the treatment of AIMG will not be involved in providing PIMG intervention and vice versa. Outcome evaluators (statisticians) will also be completely blinded. Ethic This study will be carried out in accordance with the Declaration of Helsinki. It was submitted and approved by the Research Ethics Committee (REC) of the Federal University of the Valleys of Jequitinhonha and Mucuri (UFVJM). The complete protocol will be registered in the Clinical Trials and in the Brazilian Registry of Clinical Trials. Participants will be asked for consent prior to any project related procedures. This work was carried out with the support of the Coordination for the Improvement of Higher Education Personnel ‐ Brazil (CAPES) ‐ Financing Code and by the Research Support Foundation of the State of Minas Gerais ‐ APEMIG (CDS ‐ APQ‐01887‐17). Funders will not influence any decision making about the conduct of the study and will have no relationship with the manuscripts from the study

Nct (2021). "Integrative Neuromuscular Training in Adolescents and Children Treated for Cancer." https://clinicaltrials.gov/show/NCT04706676.
	Improved childhood cancer survival rates call for novel strategies to reduce acute and long‐term physical complications of anti‐cancer treatment. Children with cancer have markedly impaired muscle strength, cardiorespiratory fitness, and physical function occurring few days after diagnosis ‐ further declining because of anti‐cancer treatment and physical inactivity during the treatment trajectory. Moreover, these impairments persist years after ended treatment. Further, the children become physically illiterate, which include a lack of confidence, competence and motivation to engage in physical activities. The combination of persistent physical complications and physical illiteracy predispose for metabolic‐ as well as musculoskeletal dysfunction that lead to severe medical conditions such as metabolic syndrome, diabetes and cardiovascular disease with reduced life‐expectancy. Studies indicate that structured exercise aimed to optimize both muscle and neuronal functions ('integrative neuromuscular training'), should be explored further to effectively counteract the impairment in physical function caused by childhood cancer and its treatment and found a more healthy lifestyle after ended treatment. This age‐adjusted, strength‐based exercise concept, based on games and play, is hypothesized to improve physical function in children and adolescents diagnosed with cancer. The primary objective of this study is to investigate the effects of a 6‐months integrative neuromuscular training intervention on knee extension strength in children and adolescents, ages 6‐18 years, with cancer during anti‐cancer treatment, compared with an active control group. Our secondary objectives are to investigate the effects of the intervention on markers of metabolic syndrome, hospitalized days, health‐related quality of life, upper body muscle strength, cardiorespiratory fitness, physical function, physical activity behavior and body composition. All outcomes, except hospitalized days, will be measured within 2 weeks of treatment initiation, 3‐months after inclusion, after 6‐months after inclusion, one month after ended treatment and 1 year after ended treatment. The primary endpoint for the primary objective and secondary objectives, besides metabolic syndrome, are 6 months after treatment initiation. The primary endpoint for markers of metabolic syndrome will be 1 year after cessation of treatment The INTERACT study is a national multicenter, two arm parallel group, randomized controlled superiority trial with 12 months follow‐up after ended treatment, based in all national centers for pediatric oncology: University Hospital of Copenhagen (Rigshospitalet), Aarhus University Hospital and Odense University Hospital. The study will include 127 children aged 6‐18 years with any type of cancer that will be randomized (2:2) to either the intervention group (integrative neuromuscular training + motivational‐counseling sessions + usual care) or active control group (home‐based training program + motivational‐counseling sessions + usual care) and stratified by sex, pubertal stage and diagnosis as 1) treatment for extracranial solid tumors and CNS‐tumors; 2) treatment for hematologic malignancy 3) stem cell transplantation, within each hospital. This intervention, integrative neuromuscular training (INT), contains a multifaceted range of developmentally appropriate activities that incorporate general and specific strength and conditioning elements such as strength, power, motor skill training, dynamic stability, core‐focused strength, plyometric and agility. INT can be camouflaged as games and play or performed as structured strength and conditioning program, depending on the participant's age, motor skill level and diagnosis. The intervention is designed to enhance health‐ and skill‐related components of physical fitness. The integrative neuromuscular training group will in addition to usual care receive the intervention for six months. All participants are recommended to participate in a minimum of 2 training session per week the first 7 weeks, and a minimum of three session per week from week 8‐24. During the intense phase of treatment (first six months of treatment), all participants indifferent of cancer type will receive combinations of treatment requiring either hospitalization or visits to the outpatient clinic at least once per week. The participants, therefore, receives supervised training at least once per week. All other training session is conducted as home‐based training. If there are weeks, without any visits to the hospital or outpatient clinic, all training session will be conducted at home. In this case, the participants will receive a phone call from the intervention physiotherapist concerning questions, exercise choice and intensity of exercises. Parents or guardians will receive education in conducting INT at home, alongside an exercise‐kit consisting of training equipment corresponding to the child's age and fitness level (fitness ropes, medicine ball, dumbbells). The active control group is, in addition to usual care, offered a home‐based training program consisting of combined aerobic, strength and stretching exercises. Participants in both groups will receive a monthly 30‐minute motivational‐counseling session to adjust the intervention and training program according to the child's physical capacity and preferences. Further, the session will determine potential barriers towards performing physical exercise using the Self‐efficacy for Exercise Scale. Both groups receive standardized hospital care, usual care, including physiotherapy if needed Sample size: A difference of 10 % as a result of physical exercise is regarded as a clinically relevant change (1). Based on a mean 41.4 +/‐ 7.6 (2) and a 10% increase, an alpha level of 0.05 and power of 80%, 106 children are needed. Approximately, 60 children with cancer at the age of 6‐18 years will be diagnosed pr. year at Copenhagen University Hospital, Rigshospitalet Aarhus University Hospital and Odense University Hospital. Assuming a 20 % dropout rate, a total of 2.2 years is needed to include the required number of children with cancer (n=127). A blinded statistician will randomize participants to either intervention or active control group using a computer‐generated concealed allocation procedure, to secure a proportionate stratified random sample. Due to the nature of the intervention, neither participants, nor assessors, will be blinded to the allocation.

Nct (2021). "Investigation of the Effects of Technology Supported Different Physiotherapy Approaches on Patients With Multiple Sclerosis." https://clinicaltrials.gov/show/NCT04891341.
	Multiple Sclerosis (MS) is an autoimmune disease characterized by chronic inflammation, demyelination and axonal loss of the central nervous system. The etiology of the disease is not known exactly and possible causes are; genetic, vitamin D deficiency, viral, environmental and autoimmune factors have been identified. Common findings of MS are in the literature; sensory, visual problems, fatigue, urinary retention / incontinence, motor problems (inability to walk, upper extremity skills, coordination and balance problems), cognitive deficits, tone, speech and swallowing disorders. In the rehabilitation of MS; It is seen that balance, coordination, strengthening, aerobic and neurodevelopmental exercise methods are used and these approaches have reached moderate / high level evidence in the literature. Task‐oriented circuit therapy(TOECT), one of the current neurophysiology‐based approaches; It is a motor learning‐based exercise approach based on the theory of dynamic systems, one of the theories of motion control, aiming at the acquisition of skills for a specific functional activity. When the existing studies are examined, it has been determined that there are a limited number of randomized controlled studies examining the effects of TOECT and that sufficient evidence cannot be obtained with these studies. In previous studies, it has been observed that standardization of exercise approaches applied to the control group could not be achieved and the control groups generally included applications that could create passive or effect summation compared to the experimental groups. In addition, in the literature, TOECT, which includes rehabilitation games to be applied in the form of station training, in MS patients; There is no randomized controlled study examining the effects on balance, walking, fatigue, trunk and upper extremity functions and kinematics. In this direction, the purpose of the research is; To examine the effects of technology‐supported TOECT and technology‐supported home program applied as station training on walking, quality of life, fatigue, balance, trunk and upper extremity functions of patients with MS, using kinematic and clinical methods. Volunteers who agree to participate in the study will be divided into two groups by the block randomization method. Both groups will receive exercise training 3 sessions per week (24 sessions in total) for 8 weeks. Evaluations will be made before and after 8 weeks treatment

Nct (2021). "Leap Motion Controller on the Functionality of Upper Limbs in Parkinson's Disease." https://clinicaltrials.gov/show/NCT04796246.
	STUDY METHODOLOGY 1. RESEARCH DESIGN: The proposed work will be characterized as a Randomized Clinical Trial, with evaluators outside the experimental groups (single‐blind). The sample will be probabilistic, from individuals diagnosed with Parkinson's disease. 2. TYPE OF STUDY: Randomized Clinical Trial. 3. AREA OF SCOPE: Major area: Health Sciences. Area: Physiotherapy and Occupational Therapy. 4. LOCATION: The place where the entire study will be carried out will be in the home environment of each research participant. 5. PARTICIPANTS: Participants will be recruited from an existing pre‐existing list of research conducted on individuals with Parkinson's Disease from the UFCSPA. Individuals who: ‐ are diagnosed with Parkinson's disease; ‐ Classified as I‐III on the Hoehn & Yahr motor staging scale; ‐ Are over 18 years old (above this, without age restriction). ‐ Residents in the city of Porto Alegre / RS. ‐ Have signed the informed consent form (Appendix A). Individuals who: ‐ Do not show the understanding of the games on the first day of familiarization; ‐ Have a cerebral pacemaker implant; ‐ Have recent injuries or limitations that make the MMSS impossible. ‐ Do not perform / abstain from two appointments out of the 16 proposed in the intervention protocol, regardless of the group that will be allocated. The study will consist of two groups: intervention group (IG), which will receive treatment with Leap Motion Controller; and the control group (CG), who will receive treatment with conventional physiotherapy. 6. EVALUATION INSTRUMENTS: A participant identification form will be filled out, containing full name, date of birth, gender, address, telephone number, education, diagnosis, time of diagnosis, onset of symptoms (laterality), associated diseases, PD subtype and medicines. Individuals will be assessed for: the motor aspects of experiences and activities of daily living using the TEMPA test and the Unified Assessment Scale for Parkinson's Disease (MDS‐UPDRS) part II; Motor Assessment and subtype of the disease, using the MDS‐UPDRS scale III; motor staging of PD using the Hoehn & Yahr scale; muscle strength and endurance, using the handgrip dynamometer (TEMPA test); manual dexterity, through the Box and Block test and the Nine Hole Peg test; cognitive issues through the Montreal Cognitive Assessment (MoCA); and quality of life, through the Questionnaire on Parkinson's Disease (PDQ‐39). 7. EXPECTED DURATION: The present research project contemplates different objectives, this being a study proposal to be developed during four years. 8. PROCEDURES: The formation of each of the groups will be done through the generation of a random sequence through the tool available at http://www.randomize.com. Therefore, individuals will be divided into two groups: Intervention Group and Control Group. Subsequently, the initial assessment will be made,TEMPA, MDS‐UPDRS‐II e III, motor staging of the disease (H&Y), Box and Block Test, Nine Hole Peg Test), MoCA and PDQ‐39.The IG will carry out a 2‐month intervention protocol, with 16 40‐minute interventions, twice a week. The CG will perform a conventional physiotherapy protocol for the same period as the IG. Therefore, all groups will receive the same evaluation procedures that will be performed before the intervention (PRE), after the intervention (POST) and, finally, 30 days after the intervention (follow‐up). The researchers responsible for the intervention will not be aware of the evaluations carried out and the evaluators will not be aware of the group to which the participant will belong. Both groups will be able to follow their routine activities (physical and / or physical therapy) and all procedures will be performed in the home environment of each research participant. 9. ETHICAL AND LEGAL PROCEDURES The study project in question will be submitted to the Research Ethics Committee of the Federal University of Health Sciences of Porto Alegre (UFCSPA) and will only be applied after due approval. All participants will be informed a out the procedures, objectives, justifications, potential risks and benefits of their participation in the study. The research will not present risks to the participant, but if there is any discomfort during any activity, the treatment will be stopped immediately and the necessary measures taken. In addition, all participants must sign the informed consent form and receive a copy of it. The use of any type of image will not identify the participant and will only be used with written consent. The data in the medical record (name, telephone and address) will be used for screening in the identification and contact of individuals and stored in a database that will be accessed only by researchers.

Nct (2021). "Modulation of Upper Limb Spasticity Post-Stroke." https://clinicaltrials.gov/show/NCT05069480.
	Stroke is an acute, medical event, which mainly results in neurological damage leading to disability and mortality. Stroke is a common, serious, and disabling problem. The most widely recognized impairment caused by stroke is motor impairment of one side of the body called hemiplegia, which restricts function in muscle movement or mobility. Following a stroke, many upper limb impairments may influence the patient's ability to perform functional activities. These include spasticity, muscle weakness, restricted and in‐coordinated movement. The impact of upper limb dysfunctions on participation in home, work, community life, and daily living activities is great. Upper limb recovery after stroke is unacceptably poor; with only 50% of stroke survivors likely to regain some functional use. In many neurological disabilities associated with spasticity such as hemiplegia post‐stroke, the rehabilitation process is of long duration and clinicians face the challenge of identifying a variety of meaningful and motivating intervention tasks that could be effective in controlling spasticity and preventing its negative hazards. Current rehabilitation techniques have focused on teaching and reinforcing different strategies that encourage the use of the non‐involved upper extremity to decrease functional limitations. Treatment options for controlling spasticity and enhancing upper limb functions include physical therapy, occupational therapy, neurodevelopmental therapy, peripheral splinting and casting, constrained induced movement therapy, pharmacotherapy (e.g., botulinum toxin type A), and surgery. Till now, there is a lack of strong evidence of successful treatment with any of these approaches. Virtual reality is a relatively recent approach to stroke rehabilitation. It has been shown to be an interactive and enjoyable medium that, with sufficient use, may improve upper limb motor function in adults with stroke. Enhanced feedback provided by a virtual reality system has been shown to promote motor learning in normal subjects. The main advantage of virtual game‐based rehabilitation over conventional approaches is the inclusion of an interactive and motivating exercise environment. Until now, there have been limited researches involving the inclusion of virtual reality‐based therapy systems in neuro‐rehabilitation and spasticity management of the involved upper limb for hemiplegic patients post‐stroke. Therefore, the purpose of this study was to evaluate the efficacy of virtual reality technology on modulating spasticity and improving the function of the involved upper extremity in patients having a chronic stroke.

Nct (2021). "On Field Functional Rehabilitation -Comparing Two Programs-framework." https://clinicaltrials.gov/show/NCT05163470.
	Background Nowadays, in elite demanding football, injuries are a delicate issue as affects player's availability for the teams to win games and attain trophies(1). Injury was defined, using a time‐loss definition, as any physical complaint sustained by a player that results from a football match or football training and led to the player being unable to take full part in future football training or match (2).An elite football team, constituted from about 25 players, presented an injury incident of 6.6./1000 hours of exposure, (decreased 3% the last years) regarding the study of Ekstrand,2021(1). Following an injury, the appropriate recovery is vital to return athletes quickly and safely to their sport, based on pre injury physical and psychological levels. Delay in rehabilitation can result in prolonged pain and a delayed return to sports, a finding that emphasizes the importance of proper rehabilitation procedure during injury recovery (3). Rehabilitation is defined as a set of interventions designed to optimize function and reduce disability in individuals with healthy conditions in interaction with their environment (4). This interaction refers to the observation of animals , so in fact the person, as the animals, has the ability to execute an action or movement based on the environment he lives(5). The last one is applied in ecological theory in sports with a wealth of benefits for the player during training or injury recovery on filed. Ecological theory bring us closer to the sport from a realistic approach , can provide an explanation to many situations that arise in sports(6) ,understands the athlete as a part of his/her own surroundings where there is only perception and action and also presented the large degree of freedom that can exist in a movement which surpasses the conscious capacity of control in nervous system(7). Ideally, through injury recovery , the focus should be more on the biological time needed for the injury to recover, while trying to maintain the skills of the athlete during the rehabilitation process.(3) Adequate and appropriate cognitive and neuromuscular skills should be maintained in high level, in activities that normally occurred during training or games. In this Context, application of ecological theory in football on field functional rehabilitation provide to the player the ability to maintain this skills, according with the high demands of elite football players(3,6,7).The successful persistence of athlete skills during injury rehabilitation and decision making process will come through neuroplasticity which exerts an important role and allows to correct, modify, and adapt neuromuscular patterns, allowing the athlete to protect the injured part during the biological time needed for it to heal and to maintain the sports skills. This would allow adaption and healing of the injured tissue, restoring as quickly as possible the specific movements or loads expected from the injured muscle or joint(3).The maximum retention of football specific skills and the adaptation of injured tissue in an injury football player take place on his/her natural environment of action , the field (3,7). What we know? Until today, disunity of opinions prevalent among sports medicine community about on filed functional rehabilitation during injury recovery(8).The majority of the clinicians apply on field functional rehabilitation, called as traditional on filed rehabilitation, as the late phase of injury recovery ,where the player comeback on filed activity when he had already restore maximum or the average strength and function based on pre injury screening or standard value(8).The progression of the player during the late phase of injury recovery based on load monitoring with GPS(global position system) to control progression and risk of reinjury. In the editorial of Buckthorpe ,2018 (8) traditional rehabilitation is described and analyzed more specifically as the overlap period between the rehabilitation and return to sports .On the contrary in the editorial of Pruna et al.,2018 (3) emphasized the ea ly return to filed activity for the injury player to maintain sports specific skills as much as he can during injury recovery. In the literature review there is a absence of evidence to refer to a specific framework for on field functional rehabilitation in regard of recovery an injured football player (elite or amateur ) on field. References ,with a lack of evidence ,exist only in some specific rehabilitation protocols such as muscle injury rehabilitation (9) tendons injuries management (10) or ACLR rehabilitation (11,12,13) as the late phase of injury recovery. The editorial of Taberner ,2019 (14), present on field functional rehabilitation framework of 5 stages based on traditional rehabilitation for short and long term injuries based on load monitoring through GPS(global position system) as a work based on experience and lacking of evidence. Aim The overall objective of the proposed research is to conduct a prospective randomized controlled trial to evaluate the effectiveness of ''On FI.RE. framework'' (on filed rehabilitation framework),namely the early return to on field activities during an injury recoveryIncluded a specific 5 stages program‐framework , and a daily session planning framework for on field functional rehabilitation. The effectiveness will be evaluated with the time that the player will be needed to return to full participation in teams training. Protocol The eligible study population will consist of men elite football players that participate in Greek football professional categories ,between 17‐40 years old ,with an acute low limb musculoskeletal injury that sustained in game or training. The subjects of the study will be divided in two groups. One group will be treated with 'On FI.RE. framework' during on field functional rehabilitation and the other group(control group)will be treated with 'traditional rehabilitation' framework. Each group will be categorized in subgroups based on the nature of injury such as muscle tear, ligament tear, acute overuses syndromes and fractures or cartilage lesions. All players fulfilling the inclusion and not meeting the exclusion criteria will be asked to participate in the study. After the player´s enrolment has been confirmed and informed consent is obtained a set of questionnaires is provided for background data on medical history based on FIFA medical examination paper(15). A physician will make the evaluation and diagnostic imaging prescription to make a diagnosis of the injury . When the procedure is completed, the patient is randomized. One physiotherapist, different for each group, will apply the general(physiotherapy and exercises in the Gym) and specific(on filed functional rehabilitation) program. The intervention program analyzed in chapter 8. If a player don't complete or quit from the procedure he will withdraw for the data collection. After the completion of the rehabilitation program the physician will evaluate the player to permit or not, the full participation in team training. After the return of player's to team training will follow a secondary prevention program for two months. Participation in this study will last maximum twelve months. Statistical analysis plan To address the primary and secondary objectives, a statistical analysis by using SPSS(statistical package for the social sciences)will be performed. Depending on the data distribution ,a X² test or Mann‐Whitney U test will be applied to calculate the means between the two groups based on time player needed to return in team training. The importance of the presented study lie on the presentation and development of evidence in clinical practice regarding the ideal of on field functional rehabilitation framework ,for low limb musculoskeletal injuries for elite football players in the matter of faster and safety return to play.

Nct (2021). "Virtual Reality in Physical Therapy in Multiple Sclerosis." https://clinicaltrials.gov/show/NCT04807738.
	In 60 ‐ 75% of people with multiple sclerosis (MS) an upper limb mobility dysfunction (unilateral or bilateral manual dexterity, sensibility impairment, tremor) is present, resulting in reduced participation in activities of daily living. Physiotherapy has a crucial impact on upper limb mobility, although there are many approaches applied (exercise/strengthening exercise, endurance training, sensory training, constraint‐induced movement therapy, robotic rehabilitation therapy, etc.). Virtual reality is an innovative technological concept using game mechanisms that facilitate concentration and motivation in task performance. Current research implies that VR is a safe and effective method in gait and balance//stability rehabilitation therapy and with less evidence, for upper limb mobility improvement. It is expected that a greater therapeutic effect is a result of multifactorial sense stimulation and dopamine centres in the brain. A pilot project showed that virtual reality without the prompt feedback of a physiotherapist is not more effective than standard therapy. A new therapeutic software using virtual reality spontaneously motivating the patient for movement realization was developed in cooperation with the Department of informatics and computer science Faculty of applied sciences University West Bohemia. Accurate execution of neuroproprioceptive "facilitation and inhibition techniques" physical therapy combining key principles from proprioceptive neuromuscular stabilization (PNS) and motor program activating therapy (MPAT), ensures a present physiotherapist. These principles have shown the effect in therapy in pwMS. Participants will be randomized into two arms of the study, both implementing neuroproprioceptive "facilitation and inhibition" physical therapy, first in a real environment and second in VR. The investigators expect that VR intervention shall improve upper limb motor functions, trunk muscles coordination, improve the performance of activities of daily living and quality of life in pwMS more than identical therapy not using VR. The effect of both interventions will be assessed using validated tests for clinical examination‐ Five times Sit to Stand test (5STS), Nine Hole Peg Test (9HPT), Hand Grip Strength (HGS), Box and Block Test (BNB), accelerometer for tremor examination. Validated questionnaires will be used, specifically the Multiple Sclerosis Impact Scale (MSIS‐29), EQ‐5D‐3L health questionnaire, Visual Analogue Scale, and a questionnaire dealing with individual virtual reality intervention evaluation.

Nct (2022). "Changes in Motor Function and Brain Connectivity on Subacute Stroke Patients, Associated With Videogame Therapy." https://clinicaltrials.gov/show/NCT05283369.
	This intervention protocol aims to validate four interactive applications for telerehabilitation, as an effective therapeutic complement for the rehabilitation of patients with subacute ischemic stroke compared to conventional rehabilitation when it is administered in the subacute stage (weeks 2 to 16 after stroke). The intervention contemplates first a phase of application of standardized tests in the rehabilitation unit of the National Institute of Neurology and Neurosurgery (INNN) in Mexico City, to determine, among other things, if the patient meets the established inclusion criteria. Patients who meet these criteria will be randomly assigned to the control or experimental group. In the same INNN, standardized tests will be applied to record their motor and cognitive capacity at the beginning of the protocol. Patients assigned to the experimental group will be given training for using the video games at home. The trained staff of the Laboratory for Research and Development of Interactive Applications for Neurorehabilitation (LANR) will be responsible for the virtual rehabilitation program. Regarding the dose and frequency of treatment, all patients, both in the control and experimental groups, will receive the same number of physical therapy sessions in the INNN rehabilitation unit. Patients in the experimental group will commit to doing additional video game therapy, consisting of 300 minutes distributed over at least 5 days per week for 2 months (8 weeks) for a total of 40 effective days of performing the therapy. Once a week they must send a video showing how they are performing all the exercises and every 15 days they will be scheduled for a supervised virtual therapy session at the INNN, to check that the exercises are being performed correctly. Patients in the control group will receive the prescribed sessions of conventional occupational therapy for 8 weeks. Some of the patients assigned to the control group and the experimental group will be summoned to undergo functional magnetic resonance imaging in the National Institute of Rehabilitation (INR), which will serve as a reference to assess possible changes in functional connectivity once the treatment is finished. In the case of the experimental group, four interactive applications will be tested, each with a different sensor and virtual environment, as well as its own therapeutic objective, these applications are part of the National Autonomous University of Mexico (UNAM) virtual rehabilitation platform.

Nct (2022). "Computer Application (ICOGNI) Based Training Along With Routine Physical Therapy on Executive Functions and Motor Skills in Cerebral Palsy." https://clinicaltrials.gov/show/NCT05399810.
	This study design will be randomized controlled trial. Subjects will be selected for data collection from the Physiotherapy Department, Institute of Pediatric and Rehabilitation of The University of Lahore Teaching Hospital and Central Park Teaching Hospital, Lahore. Subjects will be randomly allocated into two equal groups, conventional group (group A) and an experimental group (group B). Conventional group will be receiving routine physical therapy and an Experimental group will be receiving Computer application‐based training and routine physical therapy. Training will be given once a day, five times a week for total 8 weeks. For conventional group, the training duration for each session will be 30 minutes with 5 minutes of rest period and for experimental group, 60 minutes with 10 minutes of rest period in between. Participants in conventional group will be given routine physiotherapy which will include range of motion exercises, stretching and strengthening exercises of upper extremity, fine motor activities, functional activities, and cognitive activities (art and crafts, placing objects in specific positions, organizing objects, color sorting games, teamwork, and moving and tracing objects). Participants in experimental group will be given routine physiotherapy along with App‐based training. The routine physiotherapy will be the same as given to the control group and app‐based training will include multiple games with multiple levels. Pre and post intervention data will be taken from Gross Motor Function Classification System, Manual Ability Classification System, Mini‐Mental State Examination for Children and Quality of Upper Extremity Skills Test for data analysis. For the assessment of executive function skills, Mini‐mental State Examination For Children (MMC) will be used and for motor skills, Quality Of Upper Extremity Skills Test (QUEST) will be used.

Nct (2022). "Effect of Virtual Video Reality Gaming on Fine Motor Skills in Children With Down's Syndrome." https://clinicaltrials.gov/show/NCT05392322.
	Down's syndrome is a genetic disorder caused by trisomy 21. Down's syndrome is characterized by a variety of dysmorphic features, congenital malformations and other health problems and medical conditions. Not all of them are present in each affected individual. The impact of Down's syndrome for each person is variable some are more affected, some are mild affected and some are fully independent.Children with Down's syndrome are characterized by awkward movements, gait, increased flexibility of joints, timing of mastering of basic skills, under development of fine motor skills. Virtual video gaming is a best method for development of fine motor skills in Down's syndrome children. Virtual Reality Therapy (VRT) is a technique that uses interactive games as a physical therapy resource and has shown positive results in cortical reorganization, improving functional mobility, and quality of movement. This is an experimental study in which randomized controlled trials study design is being used. Data will be collected from rising sun institute within 6 months after the approval of synopsis. Randomized sampling method will be used. Sample size will be 16 children with Down's syndrome. One group is Control group (self‐help skills) in which only self‐help skills effect on fine motor skills in Down's syndrome children will be assessed. Other group is Experimental group (virtual video gaming) in which effect of virtual video gaming on fine motor skills will be assessed. ABILHAND‐KIDS tool will be used for measurement of effectiveness of virtual video gaming in children with Down' s syndrome. The objective of study is to determine the effects of virtual reality video gaming on fine motor skills in children with Down' s syndrome.

Nct (2022). "Effect Virtual Reality Fully Immersive Based Exercise Game on Reducing Fear of Movement in People With CLBP." https://clinicaltrials.gov/show/NCT05267756.
	Significance of the Study. Based on the Fear‐Avoidance model, the fear comes from the pain perception which increases level of disability (Leeuw et al., 2007). Thus, to break the fear cycle, we need first to reduce the pain intensity. This can be done by a virtual environment into a Head Mounted Displays (HMDs) that provides a fully immersive experience to engage the patients in a virtual environment and distract them from the pain while performing their exercises. Moreover, based on recent clinical guidelines for LBP rehabilitation, exercises are one of the most effective treatments for LBP. Therefore, we believe that a fully immersive based exercise game integrated with physical exercises that include a series of trunk movements such as moving forward, backward, sideways, and rotation. This solution will enhance the rehabilitation outcome since the patients who are suffering from CLBP with fear of movement and high level of disability can use the system at their home and train more for long period of time using a low‐cost virtual reality device.

Nct (2022). "Effects of Virtual Reality in Adhesive Capsulitis on Pain, Range of Motion and Function." https://clinicaltrials.gov/show/NCT05398549.
	Adhesive capsulitis (AC) also known as frozen shoulder typically manifests to decrease range of motion (ROM) and function and increase pain in shoulder. Objective of this study is to find the effects of virtual reality (VR) in adhesive capsulitis on pain, range of motion and function to decrease pain and improve range of motion and function. The study design will be a quasi‐experimental study that will be used to compare the effects of virtual reality with conventional physical therapy. Subjects with adhesive capsulitis meeting the predetermined inclusion & exclusion criteria will be divided into two groups using lottery method. Pre assessment will be done using visual analogue scale (VAS), shoulder pain and disability index (SPADI) tool and active shoulder flexion and abduction as subjective measurements. Subjects in group A will be treated with virtual reality stimulation given for 30 minutes per session through kinetic Xbox with sensory accelerator model no.1414. Two traditional training activities will be used to improve shoulder Range of motion i.e. shoulders finger ladder training activity and single curved shoulder training activity 12 times (3 rounds in each practice) of the training 1 . Patients will be required to complete standard training task by interacting with designed VR rehabilitative training games under the supervision of physical therapists and subjects in group B will be treated with conventional physical therapy i.e. grade 1 and 2 mobilization and stretching exercise. Baseline treatment protocol hot pack will be applied to both groups. Treatment duration for both groups will be 30 minutes. Each subject will receive a total 6 week protocol with 02 treatment sessions per week. Post treatment reading will be recorded after the end of 2 nd , 4th and 6th treatment weeks. Recorded values will be analyzed for any change using SPSS 21.

Nct (2022). "Effects of Virtual Reality-based Balance Training on Balance of Diabetic Peripheral Neuropathy Patients." https://clinicaltrials.gov/show/NCT05258240.
	A randomized control trial will be conducted at the study setting Safi Hospital Faisalabad after the approval of the synopsis. The study will be a single‐blinded randomized control study. A convenient sampling technique will be used for the enrollment of the patient. Patient selection will be done based on defined insertion and omission criteria. Two groups would be made, the intervention group would receive the virtual gaming exercise tutoring and the control group would receive the regular physiotherapy exercises. The evaluation of the patients will be done at the start of the study, after six weeks, and after twelve weeks. Follow‐up will be in the 16th weeks after the cessation of therapy. The patient's outcome will be measured on Berg Balance Scale and the Single Leg Stance test and the patient's data will be recorded before and after treatment, comparisons between before the treatment and after the treatment data will be made after 12 weeks. Informed consent/approval would be taken from each patient. Analysis and entry of data will be done by Statistical Package of Social Sciences Version 22 Software.

Nct (2022). "An End-to-end System for Assessment and Intervention of Frailty." https://clinicaltrials.gov/show/NCT05371210.
	SAIF is a personalised, community‐based system for both assessment and intervention of frailty. It comprises of 8 modules categorised into 1. Interface: virtual nurse and caregiver gateway 2. Assessment: computerised screening using Fried Frailty Phenotype (FFP) and FRAIL instruments, Gamified Walking While Talking to assess frailty status and predictive analytics to predict participant's frailty risk 3. Intervention: Physical exercise kiosks (Cycling and Taichi) incorporated with games, polypharmacy management and nutrition recommendation A total of 105 eligible community‐dwelling older adults were recruited and randomised either to control arm or intervention arm using a single‐consent Zelen's design. Allocation concealment was achieved using permutated block randomisation; both research assistant and participant were blinded to randomisation list during enrolment. All participants completed baseline assessment and subsequent follow‐up assessments (2‐month, 4‐month and 7‐month). Additionally, participants in the intervention arm began SAIF interaction for a period of 4 months upon completion of their baseline assessment.

Nct (2022). "Immersive Virtual Reality for Upper Limb Rehabilitation in Multiple Sclerosis." https://clinicaltrials.gov/show/NCT05320237.
	The aim of this study is to investigate the feasibility of an eight‐week intervention of co‐produced virtual reality (VR) games delivered using the Oculus Quest for improving the upper limb function of people with MS. This study is also a randomised controlled trial with two arms, one group will undergo the intervention using VR and the other will be a control group. This study aims to recruit up to 30 people with MS who have some degree of self‐reported upper limb mobility difficulties from MS clinics in NHS Lanarkshire and MS Revive, a third sector in Glasgow. Participants will be randomly allocated to a group: an eight week intervention study using VR and exercise games or a control group of usual care. All groups will have assessments at baseline, week 4 and week 8. However, only the VR intervention group will undertake the USE questionnaire and only a select number of participants in the VR group will participate in the semi‐structured interviews. The VR intervention group will involve participants travelling to a research site twice a week for eight weeks and each session will be approximately 30 minutes. This 30‐minute intervention will include participating in game play and the participant using the game's interface (e.g. navigating through menus, selecting which games to play). The games for the intervention will involve facilitating and replicating upper limb movements: pushing buttons for the interface; individual finger movement; grasp and release and one game includes holding a controller for elbow flexion and extension (see table). The intervention group will undergo exercises in a fully immersive VR environment using the Oculus Quest VR headsets. For health and safety reasons participants will complete their programme whilst seated. The control group will not receive a specific exercise programme but will be asked to continue with their usual care, which could generally include any ongoing physiotherapy or occupational therapy support or none whatsoever. Any ongoing physiotherapy or occupational therapy (NHS or non‐NHS) will be recorded, detailing the exercises and frequency. After completion of the week 8 assessment, participants within the control group will be offered the opportunity to take part in a 30‐minute session trialling the VR games.

Nct (2022). "Use of Virtual Reality and Video Games in the Physiotherapy Treatment of Stroke Patients." https://clinicaltrials.gov/show/NCT05278403.
	21 participants who will be divided by randomization between a control group and an experimental group. The results will be quantified with the following scales: Modified Asworth (spasticity). Daniels et al (muscle strength) Tinetti (balance and gait) Berg (balance) Joint range

Nct (2022). "Using Exergame-based Program in Elders of Rural LTCF." https://clinicaltrials.gov/show/NCT05360667.
	Background: Sarcopenia is the progressive loss of skeletal muscle mass and decline of muscle function associated with aging. The prevalence of sarcopenia among people older than 65 years old in Taiwan is over 20%. Sarcopenia is one of the most important causes of functional decline and loss of independence, even mortality in older adults. Frailty is theoretically defined as a clinically recognizable state of increased vulnerability resulting from aging‐associated decline in reserve and function across multiple physiologic systems such that the ability to cope with everyday or acute stressors is comprised. Both sarcopenia and frailty are getting more and more concerns in Taiwan, which is now an aged‐society. Resistant, aerobic, and multi‐component exercise have been proved to improve muscle strength and function in older adults. The principles of progressive resistance training and multi‐component exercise programs include regular, mass‐practiced, mild overwhelming engagement. These principles demand devoting time, workforce, and money to achieve. Staffing constraints and resources shortage have made it challenging to promote regular exercise programs in long‐term care facilities. Exergames have been defined as any type of video game that requires the movement of the player's entire body, allowing real‐time interaction. Exergames breaks down the barriers of repetitive and monotonous physical exercise since they contain attractive and multisensory game environments with an immersive environment in which the interaction takes place through global body movements. Moreover, the gamified approach and immersive scenarios motivate older people to acquire a greater commitment to the practice of physical and rehabilitative exercises. Therefore, by playing exergames, it reduces staff time for intervention, encourages patients to perform relatively high‐energy movements, and increase participants' motivation. Therefore, investigators in this study aim to evaluate the feasibility and clinical application of a novel exergame‐based multicomponent training via Nintendo Switch® Ringfit Adventure (RFA), (which could deliver optimal exercise intensity for each player and perform fine‐tuned up‐ and downregulation based on performance after each game), among older adults in rural care facilities in this current study. Methods: The investigators will conduct a prospective randomized controlled trial (RCT) comparing an exergame‐based multicomponent training (Exergame‐based REH) to standard of care in older users of LTCF in Ci‐Shan and Mei‐Nong district, Kaohsiung city, Taiwan. Participants in the intervention group will receive standard care with additional exergame‐based REH for 12 weeks, while participants in the control group will receive standard care that routinely applied in the long term care facilities as usual. The Exergame‐based REH contains progressive resistance training and functional movement of the four extremities but mainly upper limbs. The investigators will use the commercialized exergame Ringfit Adventure (RFA) to deliver the program. The Exergame‐based REH will be performed twice per week, at least 48 hours apart from each training session, 50 minutes (10 minutes for warm‐up and cool‐down, 30 minutes for main program) per time, for a total 12 weeks. Criteria of sarcopenia including (1) handgrip strength of dominant hand (HGS), (2) walking speed, and (3) appendicular skeletal muscle mass index of 4 extremities (ASMMI), and study of osteoporotic fractures index, will be measured as primary outcomes. (1) Range of motions in dominant upper extremity (ROM), (2) maximal voluntary isometric contraction of biceps/triceps brachial muscles of dominant side (MVC of biceps/triceps), (3) box and block test (BBT), (4) Sonographic thickness of Biceps and Triceps Brachii, quadriceps, and gastrocnemius muscles, (5) Kihon checklist‐Taiwan version, (6) 36‐Item Short Form Survey questionnaire (SF‐36), and (7) brain health test (BHT) will be measured as secondary outcomes before, during, an after the programs. Hypothesis 1. After three months of participating in the Exergame‐based REH, the primary outcomes will show statistically significant increase. 2. After three months of participating in the Exergame‐based REH, the secondary outcomes will show statistically significant increase. Flow of the research: Participants meet the inclusion criteria are first selected from the long term care facilities (including daycare centers and nursing homes) in Chi‐Shan and Mei‐Nong districts in rural Kaohsiung city. The participants are classified into the intervention and control group randomly. All the outcomes measured are done at the baseline (pre‐test), 6 weeks after the intervention (mid‐term evaluation), and 3 months after the intervention (post‐test). Apparatus in this study: Nintendo Switch® RingFit Adventrue with RIng‐Con and Joy‐con. InBody S10 Body Composition & Scale JAMAR Hand Dynamometer MicroFET3 Dynamometer and range of motion evaluator Goniometer Box and Block Test Apparatus A portable LOGIQ e ultrasound (General Electric Company, U.S.A., 2010), equipped with a 5‐12 MHz linear array transducer

Nct (2022). "Xbox Kinect Virtual Reality and Motor Imagery on Lower Limb Function in Chronic Stroke Patients." https://clinicaltrials.gov/show/NCT05411653.
	Stroke is focal neurological disorder that occurs due to the compromised blood flow to the brain. It results in mobility deficit, functional and gait impairment. Multiple rehabilitation methods have been designed and used, motor imagery (MI) and virtual reality (VR) are among the emerging techniques that are being used for the rehabilitation of patients with neurological conditions that improve motor learning through explicit and implicit processes. After stroke the residual symptoms such as muscle hyper tonicity, attention deficiency, hemi neglect, abnormal reflexes and sensorimotor functional impairment may persist. Additional to these neurological symptoms certain balance issues may cause decrease in proprioception, muscle strength, increased load on non‐paretic extremity and postural oscillations. It has been reported that every year approximately 25.7 million people survive stroke attacks, 6.5 million die because of stroke and 113 million people have disability‐adjusted life‐years. Kinect based rehabilitation and virtual feedback have shown relevant activation changes in the primary sensorimotor cortex and can be responsible for that part of brain reorganization for improving in upper limb in stroke patients. Use of exer gaming is one of the emerging technologies that are being used for the physical, cognitive and motor rehabilitation of stroke patients. It is combination of video games and motion sensors incorporated in a virtual reality environment that engage the patients and improves motor learning therefore activating the motor areas of the brain for long term results. Non immersive virtual reality gaming has been used for improving balance among the stroke patients. Not only is it considered more beneficial as compared to the conventional therapies but also maintains the interest of patients in their rehabilitation protocol. The Kinect based games use sensors that catch movements of the patients and they are able to watch them in real time with immediate feedback that becomes a source of motivation for them. Xbox Kinect virtual gaming creates 3D environment with sensors and requires no controllers for patients to perform exercise whereas motor imagery is a state in which a particular motor action is internally activated without any motor output. Not only is VR and MI training motivating as compare to conventional therapies but also provide positive learning experience and neuroplasticity. With xbox kinect based VR therapies and MI, the exercise plan is tailored according to the needs of the patient. It will be a single blinded randomized control trial in which control group will be given conventional physiotherapy protocol for 30 minutes and experimental group will receive the VR and MI training with conventional treatment for a total 60 minutes, 3 days a week for 6 weeks. Motor function will be assessed by fugl‐meyer scale (LE), dynamic mobility by berg balance scale and 6 minute walk test, quality of life by barthel index and gait with dynamic gait index. Patient will be assessed at baseline and at the end of six weeks. The data will be analyzed using SPSS 25 software.

Neri, S. G., et al. (2017). "Do virtual reality games improve mobility skills and balance measurements in community-dwelling older adults? Systematic review and meta-analysis." Clinical Rehabilitation 31(10): 1292-1304.
	OBJECTIVE: To summarize evidence on the effectiveness of virtual reality games and conventional therapy or no-intervention for fall prevention in the elderly. DATA SOURCES: An electronic data search (last searched December 2016) was performed on 10 databases (Web of Science, EMBASE, PUBMED, CINAHL, LILACS, SPORTDiscus, Cochrane Library, Scopus, SciELO, PEDro) and retained only randomized controlled trials. REVIEW METHOD: Sample characteristics and intervention parameters were compared, focusing on clinical homogeneity of demographic characteristics, type/duration of interventions, outcomes (balance, reaction time, mobility, lower limb strength and fear of falling) and low risk of bias. Based on homogeneity, a meta-analysis was considered. Two independent reviewers assessed the risk of bias. RESULTS: A total of 28 studies met the inclusion criteria and were appraised ( n: 1121 elderly participants). We found that virtual reality games presented positive effects on balance and fear of falling compared with no-intervention. Virtual reality games were also superior to conventional interventions for balance improvements and fear of falling. The six studies included in the meta-analysis demonstrated that virtual reality games significantly improved mobility and balance after 3-6 and 8-12 weeks of intervention when compared with no-intervention. The risk of bias revealed that less than one-third of the studies correctly described the random sequence generation and allocation concealment procedures. CONCLUSION: Our review suggests positive clinical effects of virtual reality games for balance and mobility improvements compared with no-treatment and conventional interventions. However, owing to the high risk of bias and large variability of intervention protocols, the evidence remains inconclusive and further research is warranted.

Nesterchuk, N., et al. (2021). "Modern approaches to ergotherapy of children with the Down syndrome." Journal of Physical Education and Sport 21: 2981-2986.
	The issue of limited social interactions, household possibilities, and self-care gain increasing social importance. Under the general term of ergotherapy interventions, scientists use a wide array of different approaches used separately or in combination. In particular, this article discusses the ergotherapeutical intervention where we analyzed the stages, goals, directions, and principles of ergotherapy that have a positive effect on the social adaptation of children suffering from Down syndrome. We have found that ergotherapy is aimed at helping children suffering from Down syndrome to build or improve basic social or household skills through a series of special exercises, which will allow them to achieve the maximum level of independence and self-sufficiency in life. It was also identified that the important role in the program of ergotherapy is dedicated to a game, which is often the only way in which children can express themselves because of their specific needs. Ergotherapy was found to be one of the methods if holistic rehabilitation for children with Down syndrome, since its main goal is to develop independence and socialization. The positive effect such therapy has when performed both in specialized institutions and at home is undoubted. Apart from that, it should be noted that there is no established correlation between the number of exercises and their ultimate effect. Although a lot of research sheds light on some of the aspects of the issue in question, there is no holistic picture of how to organize practical social activities for children with Down syndrome during the ergotherapy sessions. However, the systematic study of other research indicated the insufficient evidence basis of the majority of methods as well as the low quality of the mentioned research.

Newnham, D. (2013). "Older but wiser." Nurs Stand 28(12): 31.
	I told him so. I tried to warn him. I said: 'Listen son, you could do yourself an injury.' But was he bothered? Teenagers are never bothered.

Newton, V. (2008). "The Wii: a new approach in rehab." Nursing Spectrum -- New York & New Jersey Edition 20(14): 12-13.
	Wii games used in rehab at St. Francis give patients the time to strengthen muscles while enjoying the means of getting there.

Nie, Y., et al. (2021). "Association Between Physical Exercise and Mental Health During the COVID-19 Outbreak in China: A Nationwide Cross-Sectional Study." Front Psychiatry 12: 722448.
	The COVID-19 has undergone several mutations, and caused deleterious effects on physical and mental health of people worldwide. Whilst physical exercise is known for its positive effect on enhancing immunity and reducing the negative consequences of unhealthy emotional states caused by the pandemic; there is a severe lack of psychological exercise intervention measures and mitigation strategies to advance the knowledge and role of physical exercise to improve mental health in most countries. This study surveyed the association between physical exercise and mental health burden during the COVID-19 outbreak in China to better understand the influence of different physical exercise types on reducing mental health burden during the pandemic. ANOVA, binary logistic regression, the chi-square test, and Spearman's correlation analysis were used for statistical analysis. 14,715 participants were included. The results showed that Chinese residents had several poor mental health conditions during the COVID-19 outbreak. And there was a significant positive correlation between the extent of adverse effects on mental health and provincial proportions of confirmed COVID-19 cases (r = 0.365, p < 0.05). Some main factors caused an unhealthy psychological status, including epidemic severity (62.77%, 95% CI 58.62-65.64%), prolonged home quarantine (60.84%, 95% CI 58.15-63.25%), spread of large amounts of negative information about COVID-19 in the media (50.78%, 95% CI 47.46-53.15%), limitations in daily life and social interaction (45.93%, 95%CI 42.46-47.55%), concerns about students' learning (43.13%, 95% CI 40.26-45.48%), and worries about being infected (41.13%, 95% CI 39.16-45.23%). There was a significant association between physical exercise and mental health. The largest associations were seen for home-based group entertainment exercise (i.e., family games, rope skipping, and badminton), Chinese traditional sports (i.e., Chinese martial arts, Taijiquan and Qigong), and popular sports (i.e., yoga, video dancing, sensory-motor games, and whole-body vibration), as well as durations of 30-60 min per session, frequencies of three to five times per week and a total of 120-270 min of moderate-intensity exercise weekly during the COVID-19 outbreak (p < 0.05).

Nightingale, S. (2012). "VETERINARY PHYSIOTHERAPY AT THE OLYMPIC GAMES 2012." SportEX Medicine(54): 32-33.
	A personal narrative is presented which explores the author's experience being part of the headquarters team of veterinary physiotherapists that treated the horses in Greenwich Park during the Olympic Games 2012 in London, England.

Nilsagard, Y. E., et al. (2013). "Balance exercise for persons with multiple sclerosis using Wii games: a randomised, controlled multi-centre study." Multiple Sclerosis 19(2): 209-216.
	BACKGROUND: The use of interactive video games is expanding within rehabilitation. The evidence base is, however, limited. OBJECTIVE: Our aim was to evaluate the effects of a Nintendo Wii Fit(R) balance exercise programme on balance function and walking ability in people with multiple sclerosis (MS). METHODS: A multi-centre, randomised, controlled single-blinded trial with random allocation to exercise or no exercise. The exercise group participated in a programme of 12 supervised 30-min sessions of balance exercises using Wii games, twice a week for 6-7 weeks. Primary outcome was the Timed Up and Go test (TUG). In total, 84 participants were enrolled; four were lost to follow-up. RESULTS: After the intervention, there were no statistically significant differences between groups but effect sizes for the TUG, TUGcognitive and, the Dynamic Gait Index (DGI) were moderate and small for all other measures. Statistically significant improvements within the exercise group were present for all measures (large to moderate effect sizes) except in walking speed and balance confidence. The non-exercise group showed statistically significant improvements for the Four Square Step Test and the DGI. CONCLUSION: In comparison with no intervention, a programme of supervised balance exercise using Nintendo Wii Fit(R) did not render statistically significant differences, but presented moderate effect sizes for several measures of balance performance.

Norouzi-Gheidari, N., et al. (2019). "Feasibility, Safety and Efficacy of a Virtual Reality Exergame System to Supplement Upper Extremity Rehabilitation Post-Stroke: A Pilot Randomized Clinical Trial and Proof of Principle." International Journal of Environmental Research & Public Health [Electronic Resource] 17(1): 113.
	(1) Background: Increasing the amount of therapy time has been shown to improve motor function in stroke survivors. However, it is often not possible to increase the amount of therapy time provided in the current one-on-one therapy models. Rehabilitation-based virtual reality exergame systems, such as Jintronix, can be offered to stroke survivors as an adjunct to traditional therapy. The goal of this study was to examine the safety and feasibility of providing additional therapy using an exergame system and assess its preliminary clinical efficacy. (2) Methods: Stroke survivors receiving outpatient rehabilitation services participated in this pilot randomized control trial in which the intervention group received 4 weeks of exergaming sessions in addition to traditional therapy sessions. (3) Results: Nine subjects in the intervention and nine subjects in the control group completed the study. The intervention group had at least two extra sessions per week, with an average duration of 44 min per session and no serious adverse events (falls, dizziness, or pain). The efficacy measures showed statistically meaningful improvements in the activities of daily living measures (i.e., MAL-QOM (motor activity log-quality of movement) and both mobility and physical domains of the SIS (stroke impact scale) with mean difference of 1.0%, 5.5%, and 6.7% between the intervention and control group, respectively) at post-intervention. (4) Conclusion: Using virtual reality exergaming technology as an adjunct to traditional therapy is feasible and safe in post-stroke rehabilitation and may be beneficial to upper extremity functional recovery.

Norton, D., et al. (2011). "Evaluation of activ8: the effectiveness of a joint dietetic and physiotherapy weight management group intervention in children and adolescents." Journal of Human Nutrition and Dietetics 24(3): 297-297.
	With the prevalence of overweight and obesity in the under 18 s on the rise, there are increasing numbers of weight management programmes offering treatment within and outside of the NHS, however only a few are formally evaluated (Aicken et al., 2008). Activ8 is a 6-week community based group intervention targeting overweight and obese children aged between 5 and 18 years. The course consists of weekly 1-h sessions that combine game based physical activities and nutritional education sessions. The aim of this study was to evaluate the effect of the Activ8 intervention on anthropometry and body composition. Routinely collected data was pooled from all children attending Activ8 during 2009. Information recorded included gender, date of birth and measurements for weight, height and body fat percentage (%BF), measured using bioelectrical impedance analysis. Patients with only a single measurement, missing birth date and attending siblings under the 91st percentile for BMI for age were excluded. The prevalence of co-morbidities such as type 2 diabetes and sleep apnoea were not assessed. Statistical analysis was carried out using SPSS comparing anthropometric and body compositional variables before and after attendance and examining the effect of age and gender on outcomes. Ethical approval was received from the Research Ethics Review Panel of the London Metropolitan University prior to the commencement of data collection. In 2009, 15 courses were organised. Of the 133 children starting, 70 completed the course. All but two of the participants were clinically obese at the start of the course (mean BMI centile = 99.69 (0.60). Mean age was 10.62 (2.97) years. Girls represented 52.9% of the sample, whilst 86.7% were from ethnic minority backgrounds. The results indicated that at the end of the intervention average absolute BMI decreased by −0.29 kg m (SD = 0.49, P = 0.000, CI = 95%), which remained significant when converted to z-scores and percentiles. Whilst %BF decreased on average by −0.79%, this did not reach statistical significance (SD = 2.43, P = 0.080, CI = 95%). Reduction in z-BMI, but not absolute BMI or BMI centile, was significantly greater ( P = 0.046) in boys compared with girls. Some differences in outcomes stratified by age were also observed with the younger age groups achieving significantly greater reductions in absolute BMI ( P = 0.003), z-BMI ( P = 0.000) and BMI centile ( P = 0.009). No significant differences were observed according to age group or gender in the reduction of %BF. The results are in line with the findings of other, similar interventions (Oude Luttikhuis et al., 2009). In line with NICE guidelines, the results indicate that Activ8 appears to be successful in achieving a decrease in adiposity as indicated by BMI, at least in the short term. Whether these results are sustained should be examined in a longer-term follow up study. It is recommended that the reasons behind the relatively high drop out and low uptake rates should be investigated through the adoption of a robust evaluation process. This audit of Activ8 has shown that it compares favourably to similar interventions, however further studies are required to evaluate long term efficacy, to eliminate the possible confounding effect of factors such as ethnicity and co morbidities and to strengthen the quality of the evidence by the use of randomisation and a control group. Aicken, C., Arai, L. & Roberts, H. (2008) Schemes to Promote Healthy Weight Amongst Obese and Overweight Children in England. London: Evidence for Policy and Practice Information Centre, Social Science Research Unit, Institute of Education, University of London. Luttikhuis, H.O. et al. (2009) Interventions for Treating Obesity in Children. Cochrane Database Syst. Rev. , 1-57.

Nowak, R., et al. (2017). "The Impact of the Progressive Efficiency Test on a Rowing Ergometer on White Blood Cells Distribution and Clinical Chemistry Changes in Paralympic Rowers During the Preparatory Stage Before the Paralympic Games in Rio, 2016 - A Case Report." J Hum Kinet 60: 255-263.
	There is a large gap in knowledge regarding research on post-exercise blood changes in disabled athletes. There are relatively few data on adaptive mechanisms to exercise in disabled athletes, including disabled rowers. Two rowers from a Polish adaptive rowing settle TAMix2x that qualified for the Paralympic Games in Rio, 2016 took part in this study. They performed a progressive test on a rowing ergometer until exhaustion. The cardiorespiratory fitness measures, complete blood count, white blood cells' distribution and 30 clinical chemistry variables describing laboratory diagnostic profiles and general health were determined. The extreme effort induced changes in all studied metabolites (glucose, creatinine, urea, uric acid, total and direct bilirubin), albumin, total protein levels in both participants. Furthermore, a post-exercise increase in aspartate transaminase activity, yet a 2-fold decrease during the recovery time in both rowers were found. White blood cell count increased 2-fold after the test. The percentages of natural killer cells were higher and total T lymphocytes were lower after the exercise protocol. There were higher percentages of suppressor/cytotoxic and lower percentages of helper/inducer T lymphocyte subsets in both studied rowers. No changes in B lymphocytes distribution were observed. Lack of inflammatory symptoms during the experiment suggests a high level of rowers' biological adaptation to the physical effort. The different changes in physiological, biochemical and immunological variables are related to the adaptive mechanism to physical exercise allowing for improvement of performance.

Ntr (2010). "Effect of Virtual Reality training on reach after stroke." https://trialsearch.who.int/Trial2.aspx?TrialID=NTR2247.
	INTERVENTION: Twenty stroke patients receive reach training for the affected arm during 6 weeks, 3 times 30 minutes per week. The intervention group (10 persons, randomized) will train using the FurballHunt game and the control group (10 persons, randomized) will perform standardized reaching exercises in a conventional physical therapy setting, with equal intensity. CONDITION: ; Stroke, Chronic ; ; PRIMARY OUTCOME: Before and after the training (including follow‐up after 1 month) changes in general arm function (Action Research Arm test and Fugl‐Meyer assessment) and in motivation (Intrinsic Motivation Inventory) are quantified. SECONDARY OUTCOME: Besides clinical measures of arm function, additionally changes in reach performance are determined (during a maximal reach test). INCLUSION CRITERIA: 1. At least 6 months post‐stroke; 2. First ever stroke; 3. Stroke affecting the medial cerebral artery region (MCA); 4. Demonstrable motor limitations in upper proximal extremity (Fugl‐Meyer< 45), with reach(‐like) movement ability; 5. Ability to understand and follow instructions; 6. Ability to complete measurement and training sessions.

Ntr (2015). "Improvement of engagement in physical activities and quality of life in dementia: study into the (cost-)effectiveness of exergaming." https://trialsearch.who.int/Trial2.aspx?TrialID=NTR5537.
	INTERVENTION: Exergaming (doing physical exercises in a virtual cognitive gaming environment) as compared to regular activities in day care CONDITION: Dementia, Informal care‐givers, Physical activity, Quality of life ; ; PRIMARY OUTCOME: Physical activity (lichamelijke activiteit) SECONDARY OUTCOME: Physical functioning (lichamelijk functoneren) ; ; Cognitief functioning (cognitief functioneren) ; ; Social functioning (sociaal functioneren) ; ; Behaviour and mood (gedrag en stemming) ; ; Quality of life (kwaliteit van leven) ; ; Experienced burden (ervaren belasting mantelzorgers) ; ; INCLUSION CRITERIA: diagnosis of dementia, severity mild to moderate severe living in the community attending day care primary caregiver involved

Ntr (2017). "ReValidate! trial - A Serious Game for Rehabilitation after Distal Radius Fractures." https://trialsearch.who.int/Trial2.aspx?TrialID=NTR6295.
	INTERVENTION: We investigate the effect of a serious game for wrist rehabilitation, played on a smartphone or tablet and controlled using a motion sensor. The effect on functional outcome is compared to the current standard rehabilitation protocol after distal radius fractures, consisting of instructions for home‐exercises with or without a physiotherapy referral. CONDITION: Distal radius fracture ; ; PRIMARY OUTCOME: PRWE SECONDARY OUTCOME: ‐ Active and passive range of motion in the wrist. ; ; ‐ Grip strength. ; ; ‐ Pain score (VAS). ; ; ‐ Self‐reported treatment adherence. INCLUSION CRITERIA: 1. Any type of closed distal radius fracture with no injury to the skin of the affected limb. 2. Good position after reposition or operative fixation, defined by <10 degrees of inclination in any direction, <5 mm shortening of the radius compared to the ulna, <2 mm disposition of intra‐articular fragments. 3. Fracture primarily treated with conservative (cast) immobilization or operative fixation (ORIF). 4. Fracture considered to be consolidated by treating physician (trauma‐ or orthopedic surgeon or surgical resident in training) 5. Possible to start rehabilitation exercises within 5 days after cast removal or operative fixation, as judged by treating physician (trauma‐ or orthopedic surgeon or surgical resident in training) 6. Age = 18 years. 7. Written informed consent.

Nuic, D., et al. (2020). "Abstracts of the MDS Virtual Congress 2020." Mov Disord 35 Suppl 1(SUPPL 1): S1-S702.
	Objective: To test the efficacy of an exergame rehabilitation programme at home to treat dopa‐resistant gait and balance disorders in Parkinson's disease (PD) patients. Background: Gait and balance disorders with falls represent the main motor disability in Parkinson's disease (PD) patients. With time, these motor signs become dopa‐resistant and no effective treatment exists to treat them. Rehabilitation plays an important role in the PD management. Recently, exergame‐based physical therapy has emerged as a motivating tool, and has been qualified as a safe, feasible and probably effective tool for rehabilitation in PD. Methods: The effects of 18 training sessions using the exergame “ToapRun” at home will be tested in 50 PD patients with dopa‐resistant gait and balance disorders in a single‐blinded randomised controlled trial. Twenty‐five PD patients are randomly allocated to receive active treatment with whole body movements using Kinect® system to play, placing the patient in front of a screen, and 25 patients to receive non‐active treatment by playing on the computer. All patients performed 2‐3 sessions/week over a 6‐9 weeks period. A complete clinical and neurophysiological assessment of gait and balance disorders is performed at baseline (before the first training session) and after the last training session. The primary outcome is the duration of the Stand‐Walk‐Sit Test (SWST), videotaped and rated by a blinded investigator. Secondary outcomes include cognitive and emotional assessments, quality of life, and feasibility/usability questionnaires relative to the exergame. Results: To this day, 28 PD patients have been included in the study (mean age 67.3 ± 7.9 yrs; disease duration 11.3 ± 6.1 yrs), with 14 patients per group. After the last training session compared to the baseline assessment, the mean decreases in the SWST duration were 6.1 ± 24.1 sec and 0.4 ± 1.5 sec in the treated and control groups, respectively. The mean decreases in the motor parkinsonian disability and axial scores were 0.2 ± 6.9 and 2.9 ± 5.3; and 1.3 ± 2.0 and 0.2 ± 1.9, in the treated and control groups, respectively. We observed no serious adverse events. Conclusions: These preliminary results suggest that the rehabilitation program using home exergame training may improve dopa‐resistant gait and balance disorders in advanced forms of PD.

Nuic, D., et al. (2018). "The feasibility and positive effects of a customised videogame rehabilitation programme for freezing of gait and falls in Parkinson's disease patients: a pilot study." J Neuroeng Rehabil 15(1): 31.
	BACKGROUND: Freezing of gait and falls represent a major burden in patients with advanced forms of Parkinson's disease (PD). These axial motor signs are not fully alleviated by drug treatment or deep-brain stimulation. Recently, virtual reality has emerged as a rehabilitation option for these patients. In this pilot study, we aim to determine the feasibility and acceptability of rehabilitation with a customised videogame to treat gait and balance disorders in PD patients, and assess its effects on these disabling motor signs. METHODS: We developed a customised videogame displayed on a screen using the Kinect system. To play, the patient had to perform large amplitude and fast movements of all four limbs, pelvis and trunk, in response to visual and auditory cueing, to displace an avatar to collect coins and avoid obstacles to gain points. We tested ten patients with advanced forms of PD (median disease duration = 16.5 years) suffering from freezing of gait and/or falls (Hoehn&Yahr score >/= 3) resistant to antiparkinsonian treatment and deep brain stimulation. Patients performed 18 training sessions during a 6-9 week period. We measured the feasibility and acceptability of our rehabilitation programme and its effects on parkinsonian disability, gait and balance disorders (with clinical scales and kinematics recordings), positive and negative affects, and quality of life, after the 9th and 18th training sessions and 3 months later. RESULTS: All patients completed the 18 training sessions with high feasibility, acceptability and satisfaction scores. After training, the freezing-of-gait questionnaire, gait-and-balance scale and axial score significantly decreased by 39, 38 and 41%, respectively, and the activity-balance confidence scale increased by 35%. Kinematic gait parameters also significantly improved with increased step length and gait velocity and decreased double-stance time. Three months after the final session, no significant change persisted except decreased axial score and increased step length and velocity. CONCLUSIONS: This study suggests that rehabilitation with a customised videogame to treat gait and balance disorders is feasible, well accepted, and effective in parkinsonian patients. These data serve as preliminary evidence for further larger and controlled studies to propose this customised videogame rehabilitation programme at home. TRIAL REGISTRATION: ClinicalTrials.gov NCT02469350 .

Nuntanee, S. and S. Daranee (2019). "Effect of Motorized Elephant-Assisted Therapy Program on Balance Control of Children with Autism Spectrum Disorder." Occup Ther Int 2019: 5914807.
	Children with autism spectrum disorder (ASD) have poor balance, and this limitation has effects on their daily living activities. The purpose of this study was to create the motorized elephant-assisted therapy program (METP) and examine the effect of the METP on balance control improvement in individuals with ASD. Twenty participants, aged 8 to 19 years, were recruited from occupational therapy clinics around Chiang Mai city and were divided into 2 groups: control and experimental. Participants' balance control was tested by measuring their postural sways in a bipedal stance by using a Swaymeter under four conditions: "floor-eyes open," "floor-eyes closed," "foam-eyes open," and "foam-eyes closed." Pretests were administered one week before participation in the METP, and then, posttests were administered one week after completing the METP. Each participant took a 1.5-hour session of the METP, twice a week for a 4-week duration. In one session, 2 participants were assigned to work with two motorized elephants in 4 activities: washing the elephant, climbing up and down the elephant, riding the elephant, and playing a game while riding the elephant. Results showed that the pretest control and experimental groups were not significantly different in their balance control, but at posttest, the postural sway of the experimental group was significantly different from that of the control group in two conditions: floor-eyes open and floor-eyes closed. Their lesser anteroposterior range of postural sway showed that the experimental group gained balance control improvement. In conclusion, the finding of this study showed that the METP could be an alternative treatment method to facilitate better balance control in individuals with ASD.

Nye, E. A., et al. (2016). "Optimizing Cold-Water Immersion for Exercise-Induced Hyperthermia: An Evidence-Based Paper." J Athl Train 51(6): 500-501.
	UNLABELLED: Reference: Zhang Y, Davis JK, Casa DJ, Bishop PA. Optimizing cold water immersion for exercise-induced hyperthermia: a meta-analysis. Med Sci Sports Exerc. 2015;47(11):2464-2472. Clinical Questions: Do optimal procedures exist for implementing cold-water immersion (CWI) that yields high cooling rates for hyperthermic individuals? DATA SOURCES: One reviewer performed a literature search using PubMed and Web of Science. Search phrases were cold water immersion, forearm immersion, ice bath, ice water immersion, immersion, AND cooling. STUDY SELECTION: Studies were included based on the following criteria: (1) English language, (2) full-length articles published in peer-reviewed journals, (3) healthy adults subjected to exercise-induced hyperthermia, and (4) reporting of core temperature as 1 outcome measure. A total of 19 studies were analyzed. DATA EXTRACTION: Pre-immersion core temperature, immersion water temperature, ambient temperature, immersion duration, and immersion level were coded a priori for extraction. Data originally reported in graphical form were digitally converted to numeric values. Mean differences comparing the cooling rates of CWI with passive recovery, standard deviation of change from baseline core temperature, and within-subjects r were extracted. Two independent reviewers used the Physiotherapy Evidence Database (PEDro) scale to assess the risk of bias. MAIN RESULTS: Cold-water immersion increased the cooling rate by 0.03 degrees C/min (95% confidence interval [CI] = 0.03, 0.04 degrees C/min) compared with passive recovery. Cooling rates were more effective when the pre-immersion core temperature was >/=38.6 degrees C (P = .023), immersion water temperature was </=10 degrees C (P = .036), ambient temperature was >/=20 degrees C (P = .013), or immersion duration was </=10 minutes (P < .001). Cooling rates for torso and limb immersion (mean difference = 0.04 degrees C/min, 95% CI = 0.03, 0.06 degrees C/min) were higher (P = .028) than those for forearm and hand immersion (mean difference = 0.01 degrees C/min, 95% CI = -0.01, 0.04 degrees C/min). CONCLUSIONS: Hyperthermic individuals were cooled twice as fast by CWI as by passive recovery. Therefore, the former method is the preferred choice when treating patients with exertional heat stroke. Water temperature should be <10 degrees C, with the torso and limbs immersed. Insufficient published evidence supports CWI of the forearms and hands.

Oberschmidt, K., et al. (2022). "Patient Values Associated with an Exergame Supporting COPD Treatment." Studies in Health Technology & Informatics 294: 730-734.
	Exercise games (exergames) can help COPD patients stay active and prevent exacerbation. When evaluating such exergames, patient values are an important variable to take into account. In this study, seven COPD patients used an exergame technology at the physiotherapist for six months. Their values regarding treatment and the exergames were identified in interviews. Values were very stable throughout the study, and closely interconnected. Personal Guidance and Independence were important values. Additionally, patients sometimes held conflicting values that they prioritized differently at different times or based on specific events. As the study identified important values that appeared stable over a period of time, albeit with different prioritization, they are worth considering when designing new technology. However, values cannot be looked at in isolation because of the strong connection between values.

Obrero-Gaitan, E., et al. (2021). "An Innovative Approach for Online Neuroanatomy and Neurorrehabilitation Teaching Based on 3D Virtual Anatomical Models Using Leap Motion Controller During COVID-19 Pandemic." Frontiers in Psychology 12: 590196.
	After the World Health Organization had declared a pandemic of coronavirus disease (COVID-19) on March 11, 2020 many governments, including the Government of Spain, declared the state of alarm enforcing a quarantine that have left millions of students confined to their homes. This home confinement has affected students of all levels, including university students, and has forced faculties to adapt online teaching strategies. Thus, traditional classroom face-to-face teaching has suddenly been replaced by online classes. This has revealed particularly challenging for medical courses. For such purpose we have designed an online teaching proposal addressed to the Degree in Physiotherapy and the Double Degree in Nursing and Physiotherapy of the University of Jaen (Spain). The objective is to implement an online virtual teaching protocol through the use of Virtual Reality. For such a goal, the Leap Motion Controller (LMC) will be used to teach the neuroanatomy of the brain and spinal cord and to teach and practice neurorehabilitation exercises. Along with devices like the LMC students will be asked to use Health Sciences databases in order to achieve a significative learning of the course topics. The project is structured in two phases. First, students will learn neuroanatomy and neurophysiology of the most relevant neurological conditions using LMC-based models. Then, they will learn to combine LMC games and conventional physiotherapy for neurorehabilitation purposes. The work of students will include the recording of videoreports demonstrating the acquisition of neuroanatomy concepts and simulating a clinical case. With this project we will assess the usability of LMC as an educative tool, the perception, satisfaction and self-regulated learning of physiotherapy students.

O'Brien, M. and A. Robertson (2010). "Women and sport." Scottish Medical Journal 55(2): 25-28.
	Women have historically taken part in sports for many centuries. The first recorded female game competitions were the Herean Games in approximately 1,000 BC, named after the Goddess Hera. Held at Olympia in Greece, these games were for women alone and were thought to have originated as part of ancient fertility rights. Historically there is evidence of sporting activities involving women, but nothing of significance until after the 1948 summer Olympic Games, when 385 female athletes participated. Over the last six decades there has been a noted rise in the number of female athletes, reaching its maximum with the 2008 Beijing Olympics, where over 42% of the 11,028 athletes were women. Similarly in 2006, at the Turin Winter Olympics in Italy, 40% of the 2,500 athletes were females. In the 2012 Olympics, the Olympic Committee anticipates that approximately 44% of all athletes participating will be female. Despite there being a significant rise in the number of elite athletes in the UK, there appears to be an overall decrease in the amount and intensity of physical exercise undertaken by teenage girls. This is considered to be due to the fact that physical education is no longer an integral part of the school curriculum in the UK. There is, however, a small but significant group of elite athletes who start to train at a very early age (9-10 years old) especially in gymnastics, skating, swimming and athletics.

O'Donovan, C., et al. (2012). "Energy expended playing Xbox Kinect and Wii games: a preliminary study comparing single and multiplayer modes." Physiotherapy 98(3): 224-229.
	OBJECTIVES: It has been reported that a higher galvanic skin response is seen when playing video games against another human player than when playing alone, which suggests increased effort. The objectives of this study were to compare energy expenditure when playing two popular active video game consoles, and to compare energy expenditure when playing in single and multiplayer modes. DESIGN: Crossover trial with randomised playing order. PARTICIPANTS: Fourteen healthy adults with a mean age of 21 [standard deviation (SD) 3] years. METHODS AND INTERVENTIONS: Energy expenditure was measured using an indirect calorimeter at rest, during 10 minutes of play on Xbox Kinect Reflex Ridge in both single and multiplayer modes, and during 10 minutes of play on Wii Sports Boxing in both single and multiplayer modes. MAIN OUTCOME MEASURES: Metabolic equivalents (METs), heart rate, oxygen consumption and kilocalories expended. RESULTS: The energy expenditure during all gaming conditions was of a light intensity. Playing on the Xbox Kinect elicited greater energy expenditure than playing on the Wii [mean difference=0.9 METs, 95% confidence interval (CI) 0.2 to 1.5]. Playing games in multiplayer mode led to greater energy expenditure (mean difference=0.5 METs, 95% CI 0.1 to 0.9) and heart rate (mean difference=7.9 beats/minute, 95% CI 2.0 to 13.8) than playing in single player mode. CONCLUSIONS: No gaming condition required moderate-intensity activity in this group of young healthy adults. Potential explanations for the difference in energy expenditure seen between consoles and modes are discussed.

Ogundele, A., et al. (2018). "Comparison of virtual-reality-gaming and activity-based gait and balance training on gait, balance and quality of life in patients with Parkinson's disease." Movement disorders 33: S20‐.
	Objective: Investigate and compare the effects of virtual‐realitygaming( VRG) and activity‐based gait and balance training (AGBT) on gait and balance parameters (cadence(CD), stride length (SDL), step length (SL), gait velocity (GV) and balance (BS)) and quality of life in patients with Parkinson's disease. Background: Parkinson's disease poses significant health burden worldwide owing to increase in global aging population and chronic illnesses. Mobility and balance limitations are some of the most significant effects of Parkinson's Disease. Virtual reality gaming is emerging as an effective tool in rehabilitation especially in the Caucasian population. There is however dearth of studies investigating effect of virtual reality gaming on gait, balance and quality of life of patients with Parkinson's disease in sub‐Sahara Africa. Methods: Forty‐three consenting patients with PD from the outpatient clinics of Neurology and Physiotherapy departments of the Obafemi Awolowo Unversity Teaching Hospitals Complex, Nigeria participated in this pretest‐posttest quasi‐experimental study. Participants were randomly assigned to (Virtual reality gaming) VRG (n=21) and (Activity‐based gait and balance training) AGBT (n=22) groups. VRG had 8weeks of Virtual Reality Gaming which included Kinect Adventure Games: river rush, bubble game and tight rope tension game. AGBT had 8weeks of conventional activity based training which included Treadmill training and balance board training. These interventions were carried out for both groups twice weekly for 8weeks. BS, SL, SDL, GV and CD assessed using the BTS Gait device and QoL using PDQ‐39 at 4th week and 8th week. Data were analysed using descriptive statistics and inferential statistics. Alpha level was set at p<0.05. Results: Both groups were comparable in physical and clincal characteristics. VRG had improvements in their physical functioning and QoL across the 3‐points of the study. AGBT had improvements in physical functioning and QoL across the 3‐points of the study. The two groups were comparable in BS, right SL, CD and the QoL at 4th week. However, AGBT had significantly higher left SL, SDL and GV. The two groups at 8th week showed they were comparable in BS, right SL, left SL, SDL, CD and the QoL. However, AGBT had significantly higher GV. Conclusions: This study concluded that VRG and AGBT were capable of significantly improving physical functioning (balance, step length, stride length, cadence, gait velocity) and QoL of patients with PD. AGBT led to higher improvements in the stride length and gait velocity.

Ogundele, A., et al. (2019). "Abstract book of the 5th World Parkinson Congress, Kyoto, Japan, June 4–7, 2019." Journal of parkinson's disease 9(s1): 1-278.
	Background: Parkinson's disease (PD) poses significant health burden worldwide owing to increasing ageing population and chronic illnesses. Mobility and balance limitations are some of the most significant consequences of PD leading to functional impairments and reduced quality of life (QoL). Virtual reality gaming (VRG), an emerging rehabilitation means, seems to encourage people to exercise. There is however dearth of studies investigating the effects of VRG on gait, balance and QoL in patients with PD Purpose: To assess and compare the effect of VRG and conventional activity based gait and balance training (CAGBT) on gait, balance and QoL in patients with PD Methods: 43 patients (33 males, 10 females) with idiopathic PD, H&Y (2.60±0.44) purposively recruited from the Physiotherapy department of Obafemi Awolowo University Teaching Hospitals Ileife, Nigeria, volunteered to participate in this pretest, posttest, quasiexperimental study and were assigned to both groups. Baseline parameters of balance, gait and quality of life were assessed using Berg balance scale, BTS G‐walk gait device and PDQ‐39 respectively. Participants in both groups had 5‐10 minutes warm‐up and warm‐down periods. VRG consisted of 3 kinect games: river rush, bubble game and tight rope tension for 10minutes each (30minutes) while participants in the CAGBT had treadmill training at moderate intensity for 25 minutes and balance board training for 5 to 10minutes. Both groups had two sessions per week for 8 weeks. Gait, balance and QoL were re‐assessed after 4 weeks and 8 weeks of intervention. Results: The mean age, height, weight and BMI of the participants were 68.18±8.81 years, 1.67±0.09 m, 64.13±12.50 kg and 22.85 kg/m2 respectively. Participants in VRG had significant improvements in balance (F=689.30, p=0.001), stride length (F=721.20, p=0.001) and QoL (F=107.01, p=0.001), as well as the CAGBT: balance (F=1030, p=0.001), stride length (F=546.70, p=0.001) and QoL (F=35.76, p=0.001). Comparison between the two groups showed that participants in the CAGBT had significantly higher stride length (t=‐2.075, p=0.045) and gait velocity (t=‐2.52, p=0.016) at the end of 8 weeks. Conclusion(s): VRG and CAGBT were comparably effective in improving gait, balance and QoL of patients with PD. Conventional intervention led to a more considerable increase in stride length and gait velocity.

Oliveira, J., et al. (2022). "Barriers and Motives for Physical Activity and Sports Practice among Trans People: A Systematic Review." Sustainability 14(9): 5295.
	This study aimed to analyze the research conducted between 2016 and 2021, regarding barriers and motives for the practice of physical activity (PA), physical exercise (PE), and sports among trans individuals. The searches were carried out in the PubMed, Scopus, and Web of Science databases between January 2022 and April 2022, and included papers published between October 2016 and December 2021. After reading the full text of the studies, and according to the eligibility criteria previously defined, only six studies met the inclusion criteria. Internal barriers were related to body dissatisfaction and discomfort, discrimination, and fear of other people’s reactions. Regarding external barriers, sports environment, PE environment, and sports participation policies and regulations are the main factors expressed by trans individuals that hinder the practice of sports and PE. The desire to achieve a specific physical form and the role that PE plays in the preparation and/or replacement of gender-confirming surgery are the most important motives for the practice. This study highlights the importance of continuing to fight the barriers encountered in the practice of PE and sports, suggesting the main motives that could help create better interventions, plans, and inclusive policies that may help promote its practice.

Oliveira, L. M., et al. (2020). "2D Virtual Reality-Based Exercise Improves Spatial Navigation in Institutionalized Non-robust Older Persons: A Preliminary Data Report of a Single-Blind, Randomized, and Controlled Study." Frontiers in neurology [electronic resource]. 11: 609988.
	Background: Spatial navigation is a prodromal dementia marker. Exercise used alongside virtual reality improves many cognitive functions, but effects on spatial navigation are still unclear. Objective: To investigate the effect of virtual reality-based physical exercise with 2D exergames on spatial navigation in institutionalized non-robust older persons. Method: A total of 14 older persons (aged >== 60) were randomly allocated to the exergame (EG) and active control (ACG) groups. EG performed exercises with 2D exergames, while the ACG used the same movements as the EG, but without the use of virtual reality. Spatial navigation was assessed through the Floor Maze Test, where the immediate maze time (IMT) and delayed maze time (DMT) were recorded. Results: Spatial navigation was enhanced in EG participants compared to ACG individuals. A significant (p = 0.01) IMT reduction between groups was observed, while DMT time without prior planning was significantly different at the significance threshold (p = 0.07). Conclusions: Virtual reality-based exercise improves the spatial navigation of institutionalized non-robust older persons. This study should be replicated to confirm the findings reported herein. Clinical Trial Registration: This study was registered in the Brazilian Registry of Clinical Trials (Protocol RBR-8dv3kg - https://ensaiosclinicos.gov.br/rg/RBR-8dv3kg).

Oliveira, S. M. S., et al. (2018). "Electroencephalographic changes using virtual reality program: technical note." Neurological Research 40(3): 160-165.
	The aim of the study was to describe the technique of an electroencephalographic (EEG) assessment using the Emotiv EPOC(R) during the performance of a virtual reality motor task and compare theta, alpha, beta and gamma power frequencies between left and right hemispheres. This is technical note in which 9 healthy young subjects were submitted to an evaluation with Emotiv EPOC(R) during the Nintendo(R) Wii 'Basic Step' virtual game using the Wii Balance Board (WBB) on a support 13 centimeters high. The Wilcoxon statistical test was applied and pairing between the cerebral hemispheres was performed. Participants had a mean age of 22.55 +/- 2.78 years, 77.8% were right-handed, and 22.8% had no experience with the selected virtual game. According to dominancy (right handed n = 7; and left handed n = 2), it was observed that the right-handed individuals showed significantly greater difference in the right hemisphere in the EEG in front region (gamma power in channels AF4, p = 0.028 and F4, p = 0.043) and parietal region (theta and beta power in P8 channel, p = 0.043), while alpha power showed a greater activity in the left hemisphere (P7 channel, p = 0.043). Considering the inter-hemispheric analysis, it was observed that the right hemisphere presented a higher activation potential in the frontal lobe for gamma waves (p = 0.038 for AF3-AF4 channels), and in the temporal lobe for beta and alpha waves (p = 0.021). This study showed that the virtual environment can provide distinct cortical activation patterns considering an inter-hemispheric analysis, highlighting greater activation potential in the right hemisphere.

Oliveira, T. D. P., et al. (2015). "Improvement of balance and gait in patients with stroke after training based on Nintendo Wii Fit™ games: randomized controlled trial." Physiotherapy 101: eS1207‐.
	Background: Stroke causes sensory‐motor impairment, leading to balance problems, falls, and functional limitations which result in the incapacity to perform different tasks of daily living. Hemiplegia is the most common result of a stroke. Body asymmetry and difficulty to transfer the weight to the paretic side affect the capacity to maintain postural control. This impedes the orientation and stability necessary for proper movement of the trunk and limbs. The Nintendo Wii Fit™ (NWF) has been proposed as a novel therapeutic tool for motor rehabilitation as a portable, easy‐to‐use, low‐cost alternative that offers good reliability. Many of the NWF games demand the body symmetry, postural control and transferring weight to the paretic side. Purpose: To investigate the effect of balance training based on NWF games versus balance exercise therapy on balance, gait and functional performance in patients with chronic sequel of stroke. Methods: A randomized controlled trial was conducted with a total of 28 participants 14 female, mean age of 54,6 years (SD = 10,2), mean post‐stroke duration 6,7 years (SD = 10,2), 18 left paretic side, took part in the study, with blinded baseline and follow‐up assessments. Patients were randomly allocated into an experimental group (EG) that performed the balance training based on NWF games and a control group (CG) that performed a similar kind and amount of balance exercise. The 14 individual intervention sessions (2 per week) were composed of usual exercises to improve the mobility and balance exercises in standing, without upper limb support, with reduction the base of support and slow and fast movements of the center of gravity. Both programs were similar apart from the use of NWF games for EG which played 10 different games, performed 5 per session. Balance, cognition and functional assessments were applied at baseline (BT), 1‐week (FU7d) and 2‐month follow‐up (FU60d) through Lower Limb subscale of the Fugl‐Meyer Assessment (FMA‐LE) to assess lower limb motor function; Dynamic Gait Index (DGI) for gait; Balance Evaluation Systems Test (BESTest) for balance, Limits of Stability for paretic side (LOS) and Rhythmic Weight Shift (RWS) to assess balance on force plate (Balance Master Neurocom™). Results: Five 2X3 RM‐ANOVA using as factor Groups (EG; CG), and evaluations (BT, FU7d; FU60d) as repeated measures were performed for each outcome score. The results showed a significant interaction between the factors for FMA‐LE, DGI, LOS, RWS and BESTest (p = .01, ES = .88; p = .0004, ES = .98; p = .02, ES = .83; p = .01, ES = .88). Tukey pos‐hoc test (TT) for all of these measures showed a significant increase in the score for EG only, that remained at end of the study. Additionally, EG obtained a significant superior performance after training in comparison to the CG for all outcomes. Conclusion(s): The effects of balance training based on NWF games were superior to improve the balance, gait and functionality in patients with chronic sequels of the stroke in comparison to the similar training program performed without the games. Implications: Balance training associated with NWF games can improve the efficacy of intervention for balance, gait and functionality in patients with chronic sequel of stroke.

Oliver, M., et al. (2018). "Ambient Intelligence Environment for Home Cognitive Telerehabilitation." Sensors 18(11): 29.
	Higher life expectancy is increasing the number of age-related cognitive impairment cases. It is also relevant, as some authors claim, that physical exercise may be considered as an adjunctive therapy to improve cognition and memory after strokes. Thus, the integration of physical and cognitive therapies could offer potential benefits. In addition, in general these therapies are usually considered boring, so it is important to include some features that improve the motivation of patients. As a result, computer-assisted cognitive rehabilitation systems and serious games for health are more and more present. In order to achieve a continuous, efficient and sustainable rehabilitation of patients, they will have to be carried out as part of the rehabilitation in their own home. However, current home systems lack the therapist's presence, and this leads to two major challenges for such systems. First, they need sensors and actuators that compensate for the absence of the therapist's eyes and hands. Second, the system needs to capture and apply the therapist's expertise. With this aim, and based on our previous proposals, we propose an ambient intelligence environment for cognitive rehabilitation at home, combining physical and cognitive activities, by implementing a Fuzzy Inference System (FIS) that gathers, as far as possible, the knowledge of a rehabilitation expert. Moreover, smart sensors and actuators will attempt to make up for the absence of the therapist. Furthermore, the proposed system will feature a remote monitoring tool, so that the therapist can supervise the patients' exercises. Finally, an evaluation will be presented where experts in the rehabilitation field showed their satisfaction with the proposed system.

O'Neil, M., et al. (2019). "Scientific Posters." Developmental Medicine & Child Neurology 61(S3): 77-232.
	Background and Objective(s): Ambulatory youth with cerebral palsy (CP) participate in functional tasks requiring different levels and intensities of physical activity (PA). Physical therapy (PT) goals for youth with CP include increasing functional mobility, fitness and participation in daily tasks and routines. To achieve these goals it is important to know the PA demands of functional tasks and to dose PT interventions accordingly. The purpose of this study was to measure levels and intensities of PA in youth with CP to inform PT plans of care. Study Design: Cross‐sectional study. Study Participants and Settings: Twenty ambulatory youth with CP participated (mean age: 13.10y, SD=0.72). Most participants were boys (n=12, 60%). Youth were GMFCS Levels I (n=1, 5%), II (n=14, 70%) and III (n=5, 25%). Youth were recruited from a primary care medical home for children and youth with special health care needs in an urban children's hospital and from a pediatric outpatient PT department within the same health system. Youth were also recruited from neighboring community schools and PT networks. The study was conducted in the outpatient PT department at the urban children's hospital. Materials and Methods: Caregivers and youth completed Consent and Assent Forms. Youth participated in a PA protocol consisting of six functional tasks across a range of PA intensities (i.e., sedentary, light, moderate). All youth participated in four tasks: supine rest (SR), short obstacle course (OC), comfortable speed 6 minute walk test (CW), and brisk speed 6 minute walk test (BW). Youth were randomly assigned to two tasks: writing task (WT) or cleaning task (CT) and active video game (AVG) or stair climbing task (ST). PA level (step cadence (SC) and intensity (heart rate (HR) and oxygen consumption (VO2) were measured during the PA protocol. Youth wore: (1) a hip accelerometer to measure SC; (2) a portable indirect calorimeter with face mask to measure VO2 and (3) a HR monitor. Metabolic equivalents (METs) were calculated from VO2 and predicted resting metabolic rate. Withingroup analyses were done on data from the four tasks all participants completed (Friedman's chi‐square test with post hoc Wilcoxon signed rank z‐test). Between group analyses were done (Independent T‐test using boot‐strapped means methods) on data from randomly assigned tasks. A Bonferroni correction was used to account for family‐wise error on post hoc tests for 6 within‐group comparisons (critical p=0.008). Results: The Friedman's chi‐square omnibus test indicated statistically significant differences (p<0.001) on all measures (HR, VO2, and SC) for the four tasks (SR, OC, CW, BW) performed by all participants. Paired comparisons indicated significant differences (p<0.001) on all measures (HR, VO2 and SC) between all paired tasks. For the between‐group comparisons (WT vs CT and AVG vs ST), Independent T‐tests were significant (p<0.025) on all measures (HR, VO2, SC). Conclusions or Significance: Results suggest that PA demands differ across functional tasks and daily activities for ambulatory youth with CP. PT interventions should include 'variable dosing' strategies to promote PA, fitness, and participation in functional tasks. PT should partner with medical homes to facilitate education among providers and promote health and function in youth with CP.

O'Neil, M. E., et al. (2016). "Reliability and Validity of Objective Measures of Physical Activity in Youth With Cerebral Palsy Who Are Ambulatory." Physical Therapy 96(1): 37-45.
	BACKGROUND: Physical therapy for youth with cerebral palsy (CP) who are ambulatory includes interventions to increase functional mobility and participation in physical activity (PA). Thus, reliable and valid measures are needed to document PA in youth with CP. OBJECTIVE: The purpose of this study was to evaluate the inter-instrument reliability and concurrent validity of 3 accelerometer-based motion sensors with indirect calorimetry as the criterion for measuring PA intensity in youth with CP. METHODS: Fifty-seven youth with CP (mean age=12.5 years, SD=3.3; 51% female; 49.1% with spastic hemiplegia) participated. Inclusion criteria were: aged 6 to 20 years, ambulatory, Gross Motor Function Classification System (GMFCS) levels I through III, able to follow directions, and able to complete the full PA protocol. Protocol activities included standardized activity trials with increasing PA intensity (resting, writing, household chores, active video games, and walking at 3 self-selected speeds), as measured by weight-relative oxygen uptake (in mL/kg/min). During each trial, participants wore bilateral accelerometers on the upper arms, waist/hip, and ankle and a portable indirect calorimeter. Intraclass coefficient correlations (ICCs) were calculated to evaluate inter-instrument reliability (left-to-right accelerometer placement). Spearman correlations were used to examine concurrent validity between accelerometer output (activity and step counts) and indirect calorimetry. Friedman analyses of variance with post hoc pair-wise analyses were conducted to examine the validity of accelerometers to discriminate PA intensity across activity trials. RESULTS: All accelerometers exhibited excellent inter-instrument reliability (ICC=.94-.99) and good concurrent validity (rho=.70-.85). All accelerometers discriminated PA intensity across most activity trials. LIMITATIONS: This PA protocol consisted of controlled activity trials. CONCLUSIONS: Accelerometers provide valid and reliable measures of PA intensity among youth with CP.

O'Neil, O., et al. (2018). "Virtual Reality for Neurorehabilitation: Insights From 3 European Clinics." Pm & R 10(9 Suppl 2): S198-S206.
	Virtual reality for the treatment of motor impairment is a burgeoning application of digital technology in neurorehabilitation. Virtual reality systems pose an opportunity for health care providers to augment the dose of task-oriented exercises delivered both in the clinic, and via telerehabilitation models in the home. The technology is almost exclusively applied as an adjunct to traditional approaches and is typically characterized by the use of gamified exergames which feature task-oriented physiotherapy exercises. At present, evidence for the efficacy of this technology is sparse, with some reviews suggesting it is the same or no better than conventional approaches. The purpose of this article is to provide real-world insights on the adoption of a virtual reality by 3 European clinics in 3 different service delivery models. These include an inpatient setting for Parkinson disease, a kiosk model for pediatric neurorehabilitation, and a home-based telerehabilitation model for neurologic patients. Motivations, settings, requirements for the pathology, outcomes, and challenges encountered during this process are reported with the objective of priming clinicians on what to expect when implementing virtual reality in neurorehabilitation.

Ontañón, S. and J. Zhu (2021). The Personalization Paradox: the Conflict between Accurate User Models and Personalized Adaptive Systems. Ithaca, Cornell University Library, arXiv.org.
	Personalized adaptation technology has been adopted in a wide range of digital applications such as health, training and education, e-commerce and entertainment. Personalization systems typically build a user model, aiming to characterize the user at hand, and then use this model to personalize the interaction. Personalization and user modeling, however, are often intrinsically at odds with each other (a fact some times referred to as the personalization paradox). In this paper, we take a closer look at this personalization paradox, and identify two ways in which it might manifest: feedback loops and moving targets. To illustrate these issues, we report results in the domain of personalized exergames (videogames for physical exercise), and describe our early steps to address some of the issues arisen by the personalization paradox.

Orava, S. and J. Puranen (1978). "Exertion injuries in adolescent athletes." Br J Sports Med 12(1): 4-10.
	A series of 147 cases of exertion injuries in less than or equal to 15 years old athletes is presented. All injuries occurred during training or athletic performances without trauma and caused symptoms that prevented athletic exercises. There were 67 girls (46%) and 80 boys (54%) in the material. About 90% of them had been training for more than one year before the onset of the symptoms; 65% were interested in track and field athletics, 13% in ball games, 11% in skiing, 4% in swimming, and 3% in orienteering. The rest were interested in other sports. About 33% of the injuries were growth disturbances or osteochondroses seen also in other children. About 15% were anomalies, deformities or earlier osteochondritic changes, which caused first symptoms during the physical exercise; 50% were typical overuse injuries that may bother adult athletes, too; 43% of the injuries were localized in ankle, foot and heel, 31% in knee, 8% in back and trunk, 7% in pelvic and hip region, and the rest in other parts of the body. The injuries were generally slight, no permanent disability was noticed. Rest and conservation therapy cured most cases; operative treatment was used in only eight cases.

Ortega, M. A. C., et al. (2021). "Digital and blended curriculum delivery in health professions education: an umbrella review with implications for Doctor of Physical Therapy education programs." Physical Therapy Reviews 27(1): 4-24.
	Physical therapy education programs are incorporating digital delivery strategies into their curricula more than ever during the COVID-19 pandemic. The literature on digital and blended strategies within physical therapy education is limited. However, there is extensive literature across all health professions necessitating an overarching synthesis to determine best practices. In this umbrella review, we provide a critical overview of recent systematic reviews examining digital and blended curriculum delivery strategies in graduate health professions education and discuss their implementation in graduate, entry-level physical therapy education programs. Searches were conducted in PubMed, Embase, CINAHL, ERIC, and the Cochrane Database of Systematic Reviews. Systematic reviews published from January 2011-January 2020 focusing on digital or blended curriculum delivery strategies in doctoral-level health professions education programs were included. Reviews with a primary or exclusive focus on simulation, clinical education, or residency education were excluded. Overall, digital strategies were found to be at least as effective as traditional strategies for learner satisfaction, attitude, knowledge, and skill. The evidence supports incorporating digital strategies as an adjunct to or replacement for portions of a traditional curriculum. Considerable heterogeneity across reviews and individual studies confounded the ability to draw broad conclusions. The evidence suggests that it is unnecessary for physical therapy education programs to abandon all of their recently implemented digital strategies once the pandemic ends. Further research is needed on programs with a substantial digital delivery component and on broader outcomes at the level of the student, the program/institution, and the greater community.

Ottiger, B., et al. (2021). "Getting into a "Flow" state: a systematic review of flow experience in neurological diseases." J Neuroeng Rehabil 18(1): 65.
	BACKGROUND: Flow is a subjective psychological state that people report when they are fully involved in an activity to the point of forgetting time and their surrounding except the activity itself. Being in flow during physical/cognitive rehabilitation may have a considerable impact on functional outcome, especially when patients with neurological diseases engage in exercises using robotics, virtual/augmented reality, or serious games on tablets/computer. When developing new therapy games, measuring flow experience can indicate whether the game motivates one to train. The purpose of this study was to identify and systematically review current literature on flow experience assessed in patients with stroke, traumatic brain injury, multiple sclerosis and Parkinson's disease. Additionally, we critically appraised, compared and summarized the measurement properties of self-reported flow questionnaires used in neurorehabilitation setting. DESIGN: A systematic review using PRISMA and COSMIN guidelines. METHODS: MEDLINE Ovid, EMBASE Ovid, CINAHL EBSCO, SCOPUS were searched. Inclusion criteria were (1) peer-reviewed studies that (2) focused on the investigation of flow experience in (3) patients with neurological diseases (i.e., stroke, traumatic brain injury, multiple sclerosis and/or Parkinson's disease). A qualitative data synthesis was performed to present the measurement properties of the used flow questionnaires. RESULTS: Ten studies out of 911 records met the inclusion criteria. Seven studies measured flow in the context of serious games in patients with stroke, traumatic brain injury, multiple sclerosis and Parkinson's disease. Three studies assessed flow in other activities than gaming (song-writing intervention and activities of daily living). Six different flow questionnaires were used, all of which were originally validated in healthy people. None of the studies presented psychometric data in their respective research population. CONCLUSION: The present review indicates that flow experience is increasingly measured in the physical/cognitive rehabilitation setting in patients with neurological diseases. However, psychometric properties of used flow questionnaires are lacking. For exergame developers working in the field of physical/cognitive rehabilitation in patients with neurological diseases, a valid flow questionnaire can help to further optimize the content of the games so that optimal engagement can occur during the gameplay. Whether flow experiences can ultimately have positive effects on physical/cognitive parameters needs further study.

Owen, G. (2011). "What we need is evidence...First of a continuing series." Frontline (20454910) 17(17): 33-34.
	Most physios now know that evidencing their practice is important. But what does that mean? In the first of a continuing series, CPD adviser Gwyn Owen sets out the rules of the game.

Owoeye, O. B. A., et al. (2019). "Sticking with it? Adherence to a neuromuscular training injury prevention warm-up program in youth basketball...Third World Congress of Sports Physical Therapy, October 4-5, 2019, Vancouver, British Columbia." International Journal of Sports Physical Therapy 14(6): S19-S19.
	Objectives: To determine coach and player adherence and explore coach-related factors associated with adherence to the SHRED Injuries Basketball neuromuscular training (NMT) warm-up (SIB) in youth basketball. Methods: This study is based on a cluster randomized controlled trial (RCT) investigating two different delivery methods for SIB. All teams were asked to perform the SIB before every practice and game sessions. Adherence was tracked prospectively, for 34 youth basketball teams, at the team level by team designates, through daily reports, and at the player level by study physiotherapist by random mid-season direct observation of six teams (three per RCT group). Team adherence was measured as utilization utilization fidelity (UF, proportion of total number of expected exercises) and cumulative utilization (CU, proportion of total sessions possible); and player adherence as exercise fidelity (EF, proportion of player observations in which all aspects of exercise components were performed correctly). A cut-point of 80% was indicated as in optimal adherence based NMT dose-response literature. Factors explored included age, years of coaching experience, level of education and post-workshop intention to use SIB through the season. Results: Overall, 31 teams with baseline coach information and all 63 observations from 45 players were analyzed. UF, CU and EF were 93.5%, 71.0% and 47.6%, respectively. Delivery methods for SIB had no impact on adherence. Among the factors evaluated, younger age (t=2.40; p=0.023) and less years of coaching experience (z=1.99; p=0.047) were significantly associated with optimal adherence. Conclusion: While adherence to the SIB program was high based on CU, proper program execution was suboptimal at both the team and player levels. Determinants of optimal adherence to NMT programs need further evaluation. Clinical implications: Coaches and players need to be thoroughly educated on the importance of proper program execution for optimum injury risk mitigation.

Ozdemir, C., et al. (2008). "Soccer related sudden deaths in Turkey." Journal of Sports Science & Medicine 7(2): 292-298.
	Regular physical exercise is recommended by the medical community, because it offers the potential to reduce the incidence of coronary events. On the other hand, vigorous exertion may act as a trigger of acute myocardial infarction and sudden cardiac death in susceptible individuals. Death during sports activities differs among sports disciplines and countries. In Turkey, soccer attracts more spectators than any other sports activity and the attention of the press and media, and is preferred over other sports by many young and middle-aged individuals. As autopsy-based studies are infrequent in literature and there is a lack of data detailing sudden death during physical activity in Turkey, we present a Turkish series of sudden deaths that occurred during soccer games based on data provided by the Morgue Specialization Department of the Council of Forensic Medicine. We identified 15 male cases of soccer-related sudden death aged from 10 to 48 years. Coronary artery disease was identified as the cause of sudden death in 11 cases. Key pointsThis study is one of the largest series of soccer related SD with reported 15 cases.In our series, CAD is the most common cause of SCD also in very young athletes in contrast with international literature.In autopsy, detailed cardio-vascular system evaluation and toxicological analysis including doping agents are essential to determine precise cause of exercise induced SD.Medical screening is important for all people interested in sport, not only for athletes, as a powerful means of prevention.

Ozen, S., et al. (2021). "Computer Game Assisted Task Specific Exercises in the Treatment of Motor and Cognitive Function and Quality of Life in Stroke: A Randomized Control Study." Journal of Stroke & Cerebrovascular Diseases 30(9): 105991.
	OBJECTIVES: Computer game assisted task specific exercises (CGATSE) are rehabilitation gaming systems (RGS) used in stroke rehabilitation to facilitate patient performance of high intensity, task based, repetitive exercises aiming to enhance neuroplasticity. CGATSE maybe an appealing option in home based rehabilitation of stroke patients, especially during the COVID-19 pandemic. This study aimed to determine the effects of CGATSE on hemiplegic arm-hand function, cognitive function and quality of life in stroke. MATERIALS AND METHODS: Thirty stroke patients were randomized into two groups. All participants received twenty sessions of physical therapy. In addition, the therapy group undertook thirty minutes of CGATSE using the Rejoyce gaming system; while the control group undertook thirty minutes of occupational therapy (OT). Motor function was evaluated before and after treatment using the Fugl Meyer upper extremity (FMUE), Brunnstrom stages of stroke recovery (BSSR) arm and hand. The CGATSE group also completed the Rejoyce arm hand function test (RAHFT). Cognitive function was evaluated using the mini mental state examination, Montreal Cognitive Assessment (MoCA) and Stroke Specific Quality of Life (SS-QOL) scale. RESULTS: The FMUE, BSSR arm and SSQOL improved in both groups (p < 0.05). BSSR of the hand improved only in the CGATSE group (p = 0.024). RAHFT scores improved in the CGATSE group (p = 0.008). MoCA scores significantly improved in the control group (p = 0.008). CONCLUSIONS: CGATSE may be beneficial in providing continuation of care after stroke, especially during the Covid-19 pandemic when home based rehabilitation options are becoming increasingly important. Benefits of CGATSE in improving cognitive function is less clear. RGS aimed at improving motor function may be compared to gaming systems designed to target cognitive development and more detailed higher cortical function deficit tests can be used as outcome measures.

Paap, K. R., et al. (2020). "Interference scores have inadequate concurrent and convergent validity: Should we stop using the flanker, Simon, and spatial Stroop tasks?" Cogn Res Princ Implic 5(1): 7.
	BACKGROUND: Two-hundred one college undergraduates completed four nonverbal interference tasks (Simon, spatial Stroop, vertical Stroop, and flanker) and trait scales of self-control and impulsivity. Regression analyses tested 11 predictors of the composite interference scores derived from three of the four tasks and each task separately. The purpose of the study was to examine the relationships between laboratory measures of self-control, self-report measures, and the degree to which control might be related to extensive experience in activities that logically require self-control. RESULTS: Fluid intelligence and sex were significant predictors of the composite measure, but bilingualism, music training, video gaming, mindfulness/meditation, self-control, impulsivity, SES, and physical exercise were not. CONCLUSIONS: Common laboratory measures of inhibitory control do not correlate with self-reported measures of self-control or impulsivity and consequently appear to be measuring different constructs. Bilingualism, mindfulness/meditation, playing action video games, and music training or performance provide weak and inconsistent improvements to laboratory measures of interference control. Flanker, Simon, and spatial Stroop effects should not be used or interpreted as measures of domain-general inhibitory control.

Pacheco, T. B. F., et al. (2017). "Brain activity during a lower limb functional task in a real and virtual environment: A comparative study." Neurorehabilitation 40(3): 391-400.
	BACKGROUND: Virtual Reality (VR) has been contributing to Neurological Rehabilitation because of its interactive and multisensory nature, providing the potential of brain reorganization. Given the use of mobile EEG devices, there is the possibility of investigating how the virtual therapeutic environment can influence brain activity. OBJECTIVE: To compare theta, alpha, beta and gamma power in healthy young adults during a lower limb motor task in a virtual and real environment. METHODS: Ten healthy adults were submitted to an EEG assessment while performing a one-minute task consisted of going up and down a step in a virtual environment - Nintendo Wii virtual game "Basic step" - and in a real environment. RESULTS: Real environment caused an increase in theta and alpha power, with small to large size effects mainly in the frontal region. VR caused a greater increase in beta and gamma power, however, with small or negligible effects on a variety of regions regarding beta frequency, and medium to very large effects on the frontal and the occipital regions considering gamma frequency. CONCLUSIONS: Theta, alpha, beta and gamma activity during the execution of a motor task differs according to the environment that the individual is exposed - real or virtual - and may have varying size effects if brain area activation and frequency spectrum in each environment are taken into consideration.

Pachoulakis, I., et al. (2018). "Kinect-Based Exergames Tailored to Parkinson Patients." International Journal of Computer Games Technology 2018: 1-14.
	Parkinson’s disease (PD) is a progressive neurodegenerative movement disorder where motor dysfunction gradually increases. PD-specific dopaminergic drugs can ameliorate symptoms, but neurologists also strongly recommend physiotherapy combined with regular exercise. As there is no known cure for PD, traditional rehabilitation programs eventually tire and bore patients to the point of losing interest and dropping out of those programs just because of the predictability and repeatability of the exercises. This can be avoided with the help of current technology, character-based, interactive 3D games promote physical training in a nonlinear fashion, and can provide experiences that change each time the game is played. Such “exergames” (a combination of the words “exercise” and “game”) challenge patients into performing exercises of varying complexity in a playful and interactive environment. In this work we present a Unity3D-based platform hosting two exergames tailored to PD patients with mild to moderate symptoms. The platform employs Microsoft Kinect, an affordable off-the-shelf motion capture sensor that can be easily installed in both home and clinical settings. Platform navigation and gameplay rely on a collection of gestures specifically developed for this purpose and are based upon training programs tailored to PD. These gestures employ purposeful, large-amplitude movements intended to improve postural stability and reflexes and increase upper and lower limb mobility. When the patient’s movements, as detected by Kinect, “match” a preprogrammed gesture, an onscreen 3D cartoon avatar responds according to the game context at hand. In addition, ingame decision-making aims at improving cognitive reaction.

Pachoulakis, I., et al. (2015). Are Game Platforms suitable for Parkinson Disease patients? Ithaca, Cornell University Library, arXiv.org.
	Parkinson's Disease (PD) is a progressive neurodegenerative movement disorder that affects more that 6 million people worldwide. Motor dysfunction gradually increases as the disease progress. It is usually mild in the early stages of the disease but it relentlessly progresses to a severe or very severe disability that is characterized by increasing degrees of bradykinesia, hypokinesia, muscle rigidity, loss of postural reflexes and balance control as well as freezing of gait. In addition to a line of treatment based on dopaminergic PD-specific drugs, attending neurologists strongly recommend regular exercise combined with physiotherapy. However, the routine of traditional rehabilitation often create boredom and loss of interest. Opportunities to liven up a daily exercise schedule may well take the form of character-based virtual reality games which engage the player to physically train in a non-linear and looser fashion, providing an experience that varies from one game loop the next. Such "exergames", a word that results from the amalgamation of the words "exercise" and "game" challenge patients into performing movements of varying complexity in a playful and immersive virtual environment. In fact, today's game consoles using controllers like Nintendo's Wii, Sony PlayStation Eye and the Microsoft Kinect sensor present new opportunities to infuse motivation and variety to an otherwise mundane physiotherapy routine. But are these controllers and the games built for them appropriate for PD patients? In this paper we present some of these approaches and discuss their suitability for these patients mainly on the basis of demands made on balance, agility and gesture precision.

Pachoulakis, I., et al. (2015). Parkinson's disease patient rehabilitation using gaming platforms: lessons learnt. Ithaca, Cornell University Library, arXiv.org.
	Parkinson's disease (PD) is a progressive neurodegenerative movement disorder where motor dysfunction gradually increases as the disease progress. In addition to administering dopaminergic PD-specific drugs, attending neurologists strongly recommend regular exercise combined with physiotherapy. However, because of the long-term nature of the disease, patients following traditional rehabilitation programs may get bored, lose interest and eventually drop out as a direct result of the repeatability and predictability of the prescribed exercises. Technology supported opportunities to liven up a daily exercise schedule have appeared in the form of character-based, virtual reality games which promote physical training in a non-linear and looser fashion and provide an experience that varies from one game loop the next. Such "exergames", a word that results from the amalgamation of the words "exercise" and "game" challenge patients into performing movements of varying complexity in a playful and immersive virtual environment. Today's game consoles such as Nintendo's Wii, Sony PlayStation Eye and Microsoft's Kinect sensor present new opportunities to infuse motivation and variety to an otherwise mundane physiotherapy routine. In this paper we present some of these approaches, discuss their suitability for these PD patients, mainly on the basis of demands made on balance, agility and gesture precision, and present design principles that exergame platforms must comply with in order to be suitable for PD patients.

Pachoulakis, I., et al. (2016). "A Kinect-Based Physiotherapy and Assessment Platform for Parkinson's Disease Patients." J Med Eng 2016: 9413642.
	We report on a Kinect-based, augmented reality, real-time physiotherapy platform tailored to Parkinson's disease (PD) patients. The platform employs a Kinect sensor to extract real-time 3D skeletal data (joint information) from a patient facing the sensor (at 30 frames per second). In addition, a small collection of exercises practiced in traditional physiotherapy for PD patients has been implemented in the Unity 3D game engine. Each exercise employs linear or circular movement patterns and poses very light-weight processing demands on real-time computations. During an exercise, trainer instruction demonstrates correct execution and Kinect-provided 3D joint data are fed to the game engine and compared to exercise-specific control routines to assess proper posture and body control in real time. When an exercise is complete, performance metrics appropriate for that exercise are computed and displayed on screen to enable the attending physiotherapist to fine-tune the exercise to the abilities/needs of an individual patient as well as to provide performance feedback to the patient. The platform can operate in a physiotherapist's office and, following appropriate validation, in a home environment. Finally, exercises can be parameterized meaningfully, depending on the intended purpose (motor assessment versus plain exercise at home).

Padala, K. P., et al. (2017). "Efficacy of Wii-Fit on Static and Dynamic Balance in Community Dwelling Older Veterans: A Randomized Controlled Pilot Trial." Journal of Aging Research 2017: 4653635.
	Background/Objectives. Balance problems are well-established modifiable risk factors for falls, which are common in older adults. The objective of this study was to establish the efficacy of a Wii-Fit interactive video-game-led physical exercise program to improve balance in older Veterans. Methods. A prospective randomized controlled parallel-group trial was conducted at Veterans Affairs Medical Center. Thirty community dwelling Veterans aged 68 (+/-6.7) years were randomized to either the exercise or control groups. The exercise group performed Wii-Fit program while the control group performed a computer-based cognitive program for 45 minutes, three days per week for 8-weeks. The primary (Berg Balance Scale (BBS)) and secondary outcomes (fear of falling, physical activity enjoyment, and quality of life) were measured at baseline, 4 weeks, and 8 weeks. Results. Of 30 randomized subjects, 27 completed all aspects of the study protocol. There were no study-related adverse events. Intent-to-treat analysis showed a significantly greater improvement in BBS in the exercise group (6.0; 95% CI, 5.1-6.9) compared to the control group (0.5; 95% CI, -0.3-1.3) at 8 weeks (average intergroup difference (95% CI), 5.5 (4.3-6.7), p < 0.001) after adjusting for baseline. Conclusion. This study establishes that the Wii-Fit exercise program is efficacious in improving balance in community dwelling older Veterans. This trial is registered with ClinicalTrials.gov Identifier NCT02190045.

Padala, K. P., et al. (2017). "Home-Based Exercise Program Improves Balance and Fear of Falling in Community-Dwelling Older Adults with Mild Alzheimer's Disease: A Pilot Study." Journal of Alzheimer's Disease 59(2): 565-574.
	BACKGROUND/OBJECTIVE: Balance problems are common in older adults with Alzheimer's disease (AD). The objective was to study the effects of a Wii-Fit interactive video-game-led physical exercise program to a walking program on measures of balance in older adults with mild AD. METHODS: A prospective randomized controlled parallel-group trial (Wii-Fit versus walking) was conducted in thirty community-dwelling older adults (73+/-6.2 years) with mild AD. Home-based exercises were performed under caregiver supervision for 8 weeks. Primary (Berg Balance Scale, BBS) and secondary outcomes (fear of falls and quality of life) were measured at baseline, 8 weeks (end of intervention), and 16 weeks (8-weeks post-intervention). RESULTS: At 8 weeks, there was a significantly greater improvement (average inter-group difference [95% CI]) in the Wii-Fit group compared to the walking group in BBS (4.8 [3.3-6.2], p < 0.001), after adjusting for baseline. This improvement was sustained at 16 weeks (3.5 [2.0-5.0], p < 0.001). Analyses of the secondary outcome measures indicated that there was a significantly greater improvement in the Wii-Fit group compared to walking group in Activity-specific Balance Confidence scale (6.5 [3.6-9.4], p < 0.001) and Falls Efficacy Scale (-4.8 [-7.6 to -2.0], p = 0.002) at 8 weeks. However, this effect was not sustained at 16 weeks. Quality of life improved in both groups at 8 weeks; however, there were no inter-group differences (p = 0.445). CONCLUSION: Home-based, caregiver-supervised Wii-Fit exercises improve balance and may reduce fear of falling in community-dwelling older adults with mild AD.

Padilla-Castaneda, M. A., et al. (2018). "An Orthopaedic Robotic-Assisted Rehabilitation Method of the Forearm in Virtual Reality Physiotherapy." J Healthc Eng 2018: 7438609.
	The use of robotic rehabilitation in orthopaedics has been briefly explored. Despite its possible advantages, the use of computer-assisted physiotherapy of patients with musculoskeletal injuries has received little attention. In this paper, we detailed the development and evaluation of a robotic-assisted rehabilitation system as a new methodology of assisted physiotherapy in orthopaedics. The proposal consists of an enhanced end-effector haptic interface mounted in a passive mechanism for allowing patients to perform upper-limb exercising and integrates virtual reality games conceived explicitly for assisting the treatment of the forearm after injuries at the wrist or elbow joints. The present methodology represents a new approach to assisted physiotherapy for strength and motion recovery of wrist pronation/supination and elbow flexion-extension movements. We design specific game scenarios enriched by proprioceptive and haptic force feedback in three training modes: passive, active, and assisted exercising. The system allows the therapist to tailor the difficulty level on the observed motion capacity of the patients and the kinesiology measurements provided by the system itself. We evaluated the system through the analysis of the muscular activity of two healthy subjects, showing that the system can assign significant working loads during typical physiotherapy treatment profiles. Subsequently, a group of ten patients undergoing manual orthopaedic rehabilitation of the forearm tested the system, under similar conditions at variable intensities. Patients tolerated changes in difficulty through the tests, and they expressed a favourable opinion of the system through the administered questionnaires, which indicates that the system was well accepted and that the proposed methodology was feasible for the case study for subsequently controlled trials. Finally, a predictive model of the performance score in the form of a linear combination of kinesiology observations was implemented in function of difficult training parameters, as a way of systematically individualising the training during the therapy, for subsequent studies.

Palestra, G., et al. (2018). "Evaluation of a Rehabilitation System for the Elderly in a Day Care Center." Information 10(1): 3.
	This paper presents a rehabilitation system based on a customizable exergame protocol to prevent falls in the elderly population. The system is based on depth sensors and exergames. The experiments carried out with several seniors, in a day care center, make it possible to evaluate the usability and the efficiency of the system. The outcomes highlight the user-friendliness, the very good usability of the developed system and the significant enhancement of the elderly in maintaining a physical activity. The performance of the postural response is improved by an average of 80%.

Palmer, J. L., et al. (2003). "Senior recreational golfers: a survey of musculoskeletal conditions, playing characteristics, and warm-up patterns." Physiotherapy Canada 55(2): 79-85.
	Purpose: This survey was initiated to obtain information about senior golfers relevant to physical therapists, including preexisting musculoskeletal conditions, injuries that participants linked directly to golf, and patterns of warm-up.Method: One hundred members of two local golf courses, one public and the other private, volunteered to a request to fill out a survey. The minimum age was 50 years or older (sample = 45 women and 55 men; mean age = 69.9 +/- 8.7 years). A self-report questionnaire regarding subject demographics, history of illness and injury, exercise patterns, golf ability, and golf behaviors relating to such factors as warm-up, power cart use, and frequency of play.Results: Half of the 100 respondents reported having musculoskeletal conditions in the last 3 years that affected their golf game: 46% affecting the upper extremity, 40% in the lower extremity, and 34% involving the spine. The most common problem directly related to the sport was low back pain, which had been experienced by 42% following a round of golf. Two-thirds of the sample indicated that they regularly walked their course rather than used a power cart, but only 25% of golfers spent at least 5 minutes in warm-up and stretching activities before playing.Conclusion: Although there are known health benefits to this popular physical activity among the older population, senior recreational golfers also reported a history of musculoskeletal conditions that interfered with participation in the sport. There is an apparent need for physiotherapy research on effective delivery of preventive educational strategies and golf-related therapeutic programs aimed at this age group.

Pan, Y., et al. (2022). "After-School Extracurricular Activities Participation and Depressive Symptoms in Chinese Early Adolescents: Moderating Effect of Gender and Family Economic Status." International Journal of Environmental Research & Public Health [Electronic Resource] 19(7): 01.
	Although Western studies showed that participation in extracurricular activities was intimately linked to adolescents' psychological adjustment, very few studies have addressed this issue among early adolescents in China. Based on a nationally representative sample of 9672 Chinese junior high school students (Mage = 14.54 years, SD = 0.70 years), this study investigated the relationship between participation in different extracurricular activities and depressive symptoms among Chinese early adolescents, and the moderating role of gender and family economic status. Results indicated that time spent completing homework, attending extracurricular tutoring, and playing online games after school was positively related to students' depressive symptoms, whereas time spent on participating in physical exercise was negatively associated with students' depressive symptoms. Besides, the relationships between after-school activities participation and student depressive symptoms were moderated by gender and family economic status. The theoretical and practical implications for the arrangement of after-school activities for Chinese early adolescents are discussed.

Pan, Y., et al. (2022). "Participation in After-School Extracurricular Activities and Cognitive Ability Among Early Adolescents in China: Moderating Effects of Gender and Family Economic Status." Front Pediatr 10: 839473.
	Although theories and research suggest that participation in extracurricular activities plays an important role in adolescents' cognitive development, few studies have addressed this issue among early adolescents in China. Based on the responses of 9,830 Chinese junior high school students (M age = 14.54 years, SD = 0.70 years), we investigated the relationships between different types of extracurricular activities and cognitive ability among junior high school students and the moderating effects of gender and family economic status. Using multi-level multiple regression analyses, results indicated that while time spent completing homework and physical exercise was positively associated with students' cognitive ability, time spent on extracurricular tutoring, interest classes, watching TV, and surfing online and playing games was negatively related to students' cognitive ability. The observed relationships were also moderated by gender and family economic status. Specifically, time spent on completing homework had a stronger positive relationship with boys' cognitive ability, whereas time spent attending extracurricular tutoring on weekdays had a stronger negative relationship with girls' cognitive ability, and time spent on physical exercise was more strongly related to girls' cognitive ability in a positive manner. Besides, time spent attending interest classes on weekdays had a stronger negative relationship with cognitive ability among students from wealthy families, and time spent watching TV and physical exercise had stronger negative and positive effects on the cognitive ability among students from economically disadvantaged families, respectively. The theoretical and practical implications of the findings regarding the role of extra-curricular activities on adolescent development are discussed.

Papastergiou, M. (2009). "Exploring the potential of computer and video games for health and physical education: A literature review." Computers & Education 53(3): 603-622.
	This study aims at critically reviewing recently published scientific literature on the use of computer and video games in Health Education (HE) and Physical Education (PE) with a view: (a) to identifying the potential contribution of the incorporation of electronic games as educational tools into HE and PE programs, (b) to present a synthesis of the available empirical evidence on the educational effectiveness of electronic games in HE and PE, and (c) to define future research perspectives concerning the educational use of electronic games in HE and PE. After systematically searching online bibliographic databases, 34 relevant articles were located and included in the study. Following the categorization scheme proposed by [Dempsey, J., Rasmussen, K., & Lucassen, B. (1996). The instructional gaming literature: Implications and 99 sources. University of South Alabama, College of Education, Technical Report No. 96-1], those articles were grouped into the following four categories: (a) research, (b) development, (c) discussion and (d) theory. The overviewed articles suggest that electronic games present many potential benefits as educational tools for HE and PE, and that those games may improve young people’s knowledge, skills, attitudes and behaviours in relation to health and physical exercise. Furthermore, the newly emerged physically interactive electronic games can potentially enhance young people’s physical fitness, motor skills and motivation for physical exercise. The empirical evidence to support the educational effectiveness of electronic games in HE and PE is still rather limited, but the findings present a positive picture overall. The outcomes of the literature review are discussed in terms of their implications for future research, and can provide useful guidance to educators, practitioners and researchers in the areas of HE and PE, and to electronic game designers.

Paraskevopoulos, I. T., et al. (2014). "Design guidelines for developing customised serious games for Parkinson’s Disease rehabilitation using bespoke game sensors." Entertainment Computing 5(4): 413-424.
	The research presented in this paper proposes a set of design guidelines in the context of a Parkinson’s Disease (PD) rehabilitation design framework for the development of serious games for the physical therapy of people with PD. The game design guidelines provided in the paper are informed by the study of the literature review and lessons learned from the pilot testing of serious games designed to suit the requirements of rehabilitation of patients with Parkinson’s Disease. The proposed PD rehabilitation design framework employed for the games pilot testing utilises a low-cost, customized and off-the-shelf motion capture system (employing commercial game controllers) developed to cater for the unique requirement of the physical therapy of people with PD. Although design guidelines have been proposed before for the design of serious games in health, this is the first research paper to present guidelines for the design of serious games specifically for PD motor rehabilitation.

Pardalis, A. A., et al. (2021). "Exploring the Acceptability and Feasibility of Providing a Balance Tele-Rehabilitation Programme to Older Adults at Risk for Falls: An Initial Assessment." Annual International Conference Of The IEEE Engineering In Medicine And Biology Society 2021: 6915-6919.
	Falls are a major health concern. The HOLOBALANCE tele-rehabilitation system was developed to deliver an evidence based, multi-sensory balance rehabilitation programme, to the elderly at risk of falls. The system delivers a series of balance physiotherapy exercises and cognitive and auditory training tasks prescribed by an expert balance physiotherapist following an initial balance assessment. The HOLOBALANCE system uses augmented reality (AR) to deliver exercises and games, and records task performance via a combination of body worn sensors and a depth camera. The HOLOBALANCE tele-rehabilitation system provides feedback to the supervising clinical team regarding task performance, participant usage and user feedback. Herewith we present the findings from the first 25 study participants regarding the feasibility and acceptability of the proposed system. The results of the clinical study indicate that the system is acceptable by the end users and also feasible for using in hospital and home environments.

Parekh, A., et al. (2021). "Restoring Moderate to Severe Loss of Upper Extremity Function Post-stroke with a Neuromotor Prosthesis: A Case Report." Archives of physical medicine and rehabilitation 102(10): e51-e52.
	To study the effect of a wearable, powered exoskeleton orthosis controlled by a brain-computer interface (BCI) on upper extremity function in a single participant with moderate to severe hemiparesis. Single subject design with pretest, mid, and posttest. Home and outpatient. Participant was a 41-year old right-hand-dominant male with moderate to severe (Fugl-meyer upper extremity [FM-UE] 33/66) left-sided hemiparesis due to a stroke that occurred 18 months prior, with left homonymous hemianopsia, left hemi-neglect, left central VII nerve palsy, and spasticity in the weakened left upper extremity. The stroke lesioned the right lentiform nucleus and adjacent white matter. Brain implants were surgically placed within the right precentral gyrus region of the cortex, representing the left hand. The 12-week intervention consisted of neuromotor prosthesis training with BCI controlling the powered exoskeleton and biofeedback for controlling a game cursor; physical therapy once/week; occupational therapy twice/week. Action Research Arm Test (ARAT), FM-UE, Motor Activity Log (MAL) domains of Amount of Use (AOU) and Quality of Movement (QOM) ARAT scores with the powered exoskeleton were greater with BCI (change: 10-point, 18%) than with myoelectric control (change: 5-points, 9%). Upper extremity outcomes exceeded the minimal clinically important difference thresholds for FM-UE (change: 8-point, 21%), MAL-AOU (change: 18.5-points, 12%), and MAL-QOM (Change: 17-point, 11%). The results indicate promising outcomes of the neuromotor prosthesis on upper extremity function for a single participant with potential for future research with implanted systems combined with therapy. Drs. Serruya and Napoli are inventors on a US provisional patent application that has been filed by Thomas Jefferson University on the software methods used in this study to map neural activity into orthosis control.

Pareto, L., et al. (2016). "Using virtual reality technologies to support everyday rehabilitation." Journal of Pain Management 9(3): 197-198.
	The article focuses on benefits of advanced technologies like virtual reality (VR) as an effective approach to support rehabilitation of every-day activities; and mentions use of VR for cognitive testing to help diagnose level of impairment of injuries of individuals.

Park, D. S., et al. (2017). "Abstracts of the 27th Annual Scientific Meeting of the Stroke Society of Australasia 23 - 25 August 2017. Queenstown, New Zealand." Int J Stroke 12(3_suppl): 3-59.
	Background: The Kinect gaming system is shown to be of therapeutic benefit in rehabilitation, the applicability of Kinect‐based virtual reality (VR) training to improve motor function following a stroke has not been investigated. This study aimed to investigate the effects of virtual reality training, using the Xbox Kinect‐based game system, on the motor recovery in patients with chronic hemiplegic stroke. Methods: This was randomized controlled trial. Twenty patients with hemiplegic stroke were randomly assigned to either the intervention or control groups. Participants in the intervention group (n=10) received 30 minutes of conventional physical therapy plus 30 minutes VR training using Xbox Kinect‐based game, and those in the control group (n=10) received 30 minutes of conventional physical therapy only. All intervention consists of daily sessions for a 6‐week period. All measurements using Fugl‐Meyer Assessment (FMA‐LE), Berg Balance Scale (BBS), Timed Up and Go test (TUG), and 10 meter Walk Test (10mWT) were performed at baseline and at the end of 6 weeks. Results: The scores on the FMA, BBS, TUG, and 10mWT improved significantly from baseline to post‐intervention for both intervention and control groups after training compared with baseline. In the intervention group, pre‐post difference scores on BBS, TUG, and 10mWT were significant improved than for the control group (p<.05). Scores on the FMA‐LE and BBS, TUG, and 10mWTwere significantly correlated. Conclusion: Evidence from the present study supports the use of VR training with the Xbox Kinect gaming system as an effective therapeutic approach for improving motor function in the stroke rehabilitation.

Park, D. S., et al. (2017). "Effects of Virtual Reality Training using Xbox Kinect on Motor Function in Stroke Survivors: A Preliminary Study." Journal of Stroke & Cerebrovascular Diseases 26(10): 2313-2319.
	BACKGROUND: Although the Kinect gaming system (Microsoft Corp, Redmond, WA) has been shown to be of therapeutic benefit in rehabilitation, the applicability of Kinect-based virtual reality (VR) training to improve motor function following a stroke has not been investigated. This study aimed to investigate the effects of VR training, using the Xbox Kinect-based game system, on the motor recovery of patients with chronic hemiplegic stroke. METHODS: This was a randomized controlled trial. Twenty patients with hemiplegic stroke were randomly assigned to either the intervention group or the control group. Participants in the intervention group (n = 10) received 30 minutes of conventional physical therapy plus 30 minutes of VR training using Xbox Kinect-based games, and those in the control group (n = 10) received 30 minutes of conventional physical therapy only. All interventions consisted of daily sessions for a 6-week period. All measurements using Fugl-Meyer Assessment (FMA-LE), the Berg Balance Scale (BBS), the Timed Up and Go test (TUG), and the 10-meter Walk Test (10mWT) were performed at baseline and at the end of the 6 weeks. RESULTS: The scores on the FMA-LE, BBS, TUG, and 10mWT improved significantly from baseline to post intervention in both the intervention and the control groups after training. The pre-to-post difference scores on BBS, TUG, and 10mWT for the intervention group were significantly more improved than those for the control group (P <.05). CONCLUSIONS: Evidence from the present study supports the use of additional VR training with the Xbox Kinect gaming system as an effective therapeutic approach for improving motor function during stroke rehabilitation.

Park, H. and J. H. You (2022). "Sports Injury and Physiotherapy Services in the 2018 PyeongChang Winter Paralympic Games: Considerations and Potential Recommendations for Future Paralympics." Archives of physical medicine and rehabilitation 103(3): e32-e32.
	To highlight the demographic and clinical characteristics of injured athletes and non-athletes and the physiotherapy services provided during the PyeongChang 2018 Winter Paralympic Games. Prospective descriptive epidemiology study. Physiotherapy Department of Paralympic Village Polyclinic, Republic of Korea, during the 2018 PyeongChang Winter Paralympic Games. The study group comprised 201 participants (51 athletes and 150 non-athletes) who were admitted to and utilized the polyclinic physiotherapy service from March 1 to March 20, 2018. The five major comprehensive physiotherapy services included advice (counseling, consultation, referral), therapeutic exercise, manual manipulative therapy, therapeutic modalities, and assistive (prophylactic) devices. The selection of physiotherapy service items was based on the recommendation and guidelines of International Olympic Committee (IOC)/IPC medical commissions and clinical evidence in current literature. Types and number of patients and number of physiotherapy modalities used. Chronic injuries were the most common (n=100, 51%) in athletes and non-athletes. Anatomical injury site analysis revealed the spine and shoulder areas were injured with equal frequency for athletes (n=14, 54.9%) and non-athletes, with the frequencies of 36.7% (n=55) and 26% (n=39), respectively. The Pyeongchang WPG showed a high rate of athletes visiting the physiotherapy service during the pre-competition period (n=50, 33.3%), perhaps led to a lower incidence rate of traumatic injury. The physiotherapy treatment service analysis demonstrated that manual therapy (n=230, 35.4%) was most commonly utilized. We established the importance of prophylactic and preventive physiotherapy services to reduce the risk of sports injuries during WPG. The authors report no conflict of interest.

Park, S. B., et al. (2020). "Energy System Contributions and Physical Activity in Specific Age Groups during Exergames." International Journal of Environmental Research & Public Health [Electronic Resource] 17(13): 4905.
	Exergames have been recommended as alternative ways to increase the health benefits of physical exercise. However, energy system contributions (phosphagen, glycolytic, and oxidative) of exergames in specific age groups remain unclear. The purpose of this study was to investigate the contributions of three energy systems and metabolic profiles in specific age groups during exergames. Seventy-four healthy males and females participated in this study (older adults, n = 26: Age of 75.4 +/- 4.4 years, body mass of 59.4 +/- 8.7 kg, height of 157.2 +/- 8.6 cm; adults, n = 24: Age of 27.8 +/- 3.3 years, body mass of 73.4 +/- 17.8 kg, height of 170.9 +/- 11.9 cm; and adolescents, n = 24: Age of 14 +/- 0.8 years, body mass of 71.3 +/- 11.5 kg, height of 173.3 +/- 5.2 cm). To evaluate the demands of different energy systems, all participants engaged in exergames named Action-Racing. Exergames protocol comprised whole-body exercises such as standing, sitting, stopping, jumping, and arm swinging. During exergames, mean heart rate (HRmean), peak heart rate (HRpeak), mean oxygen uptake (VO2mean), peak oxygen uptake (VO2peak), peak lactate (Peak La(-)), difference in lactate (DeltaLa(-)), phosphagen (WPCr), glycolytic (WLa(-)), oxidative (WAER), and total energy demands (WTotal) were analyzed. The contribution of the oxidative energy system was higher than that of the phosphagen or glycolytic energy system (65.9 +/- 12% vs. 29.5 +/- 11.1% or 4.6 +/- 3.3%, both p < 0.001). The contributions of the total energy demands and oxidative system in older adults were significantly lower than those in adults and adolescents (72.1 +/- 28 kJ, p = 0.028; 70.3 +/- 24.1 kJ, p = 0.024, respectively). The oxidative energy system was predominantly used for exergames applied in the current study. In addition, total metabolic work in older adults was lower than that in adolescents and adults. This was due to a decrease in the oxidative energy system. For future studies, quantification of intensity and volume is needed to optimize exergames. Such an approach plays a crucial role in encouraging physical activity in limited spaces.

Park, Y. S., et al. (2021). "Effects of a Rehabilitation Program Using a Wearable Device on the Upper Limb Function, Performance of Activities of Daily Living, and Rehabilitation Participation in Patients with Acute Stroke." International Journal of Environmental Research & Public Health [Electronic Resource] 18(11).
	This study investigated the effects of a rehabilitation program using a wearable device on upper limb function, the performance of activities of daily living, and rehabilitation participation in acute phase stroke patients. A total of 44 patients were randomly divided into two groups. The experimental group (n = 22) was requested to wear a glove-type device while they were administered a game-based virtual reality (VR) rehabilitation program of 30 mins per session, 5 sessions per week, for 4 weeks. The program was given in addition to conventional physical therapy. The control group (n = 22) was administered only conventional physical therapy. To examine the intervention effects, the Fugl-Meyer assessment scale, hand strength test, and Jebsen-Taylor hand function tests were performed to examine upper limb function. The Korean version of the modified Barthel Index was used to assess the performance of activities of daily living, and the Pittsburgh rehabilitation participation scale was used to estimate rehabilitation participation. Neither the experimental nor the control group showed significant differences in the pre-intervention homogeneity test, while both groups showed significant improvement in all post-intervention dependent variables. Notably, the experimental group showed a significantly greater improvement in the results of the hand strength test, Jebsen-Taylor hand function test, and Modified Barthel Index. The findings suggest that the rehabilitation program using a wearable device, in addition to conventional physical therapy, is more effective than conventional therapy alone for improving upper limb function, the performance of activities of daily living, and rehabilitation participation in acute phase stroke patients. Our findings suggest that the novel rehabilitation program using a wearable device will serve not only as an effective therapy for enhancing the upper limb function, the performance of activities of daily living, and rehabilitation participation in acute phase stroke patients but also as a highly useful intervention in actual clinical practice alongside conventional physical therapy.

Parker, R. and V. J. Madden (2020). "State of the art: What have the pain sciences brought to physiotherapy?" S Afr J Physiother 76(1): 1390.
	BACKGROUND: Pain is the most common reason for patients to seek help from a health care professional. In the past few decades, research has yielded gains in the Pain Sciences - multiple fields of scientific research that, when integrated, help to clarify what causes and influences human pain. OBJECTIVES: In this article, we discuss the key areas in which the Pain Sciences have shifted the physiotherapy profession. METHOD: A narrative review of the Pain Sciences literature was conducted. The review analyses how the Pain Sciences have influenced physiotherapy in several categories: assessment; clinical reasoning; treatment; research rigor and building the profile of the profession. RESULTS: Scientific research on pain has largely converged in support of three 'game-changing' concepts that have shifted the physiotherapy profession's understanding and treatment of pain: (1) pain is not a signal originating from bodily tissues, (2) pain is not an accurate measure of tissue damage and (3) the plasticity of the nervous system means the nervous system itself is a viable target of treatment. These three concepts have influenced physiotherapy assessment and treatment approaches, and research design to consider pain mechanisms using patient-centred models. CONCLUSION: The Pain Sciences have shifted physiotherapists' assessment and treatment approaches and shifted the status of the physiotherapy profession. Ultimately the Pain Sciences have embedded interdisciplinary teams and expanded physiotherapy practice. CLINICAL IMPLICATIONS: We believe that the pain sciences should be embedded in undergraduate and postgraduate education and training of physiotherapists (including the three key concepts regarding pain) to benefit physiotherapists and their patients.

Parry, I., et al. (2015). "A Pilot Prospective Randomized Control Trial Comparing Exercises Using Videogame Therapy to Standard Physical Therapy." Journal of Burn Care & Research 36(5): 534-544.
	Commercially available, interactive videogames that use body movements for interaction are used clinically in burn rehabilitation and have been shown to facilitate functional range of motion (ROM) but their efficacy with burn patients has not yet been proven. The purpose of this pilot randomized control study was to prospectively compare planar and functional ROM, compliance, pain, enjoyment, and exertion in pediatric burn patients receiving two types of rehabilitation therapy. Seventeen school‐aged children with 31 affected limbs who demonstrated limited shoulder ROM from burn injury were randomized to receive exercises using either standard therapy ROM activities (ST) or interactive videogame therapy (VGT). Patients received 3 weeks of the designated therapy intervention twice daily. They were then given a corresponding home program of the same type of therapy to perform regularly for 6 months. Standard goniometry and three‐dimensional motion analysis during functional tasks were used to assess ROM. Measures were taken at baseline, 3 weeks, 3 months, and 6 months. Pain was measured before and after each treatment session during the 3‐week intervention. There was no difference in compliance, enjoyment, or exertion between the groups. Patients in both the ST and VGT groups showed significant improvement in shoulder flexion (P <.001), shoulder abduction (P <.001), shoulder external rotation (P =.01), and elbow flexion (P =.004) ROM from baseline to 6 months as measured with goniometry. Subjects also showed significant gains in elbow flexion (P =.04) during hand to head and shoulder flexion (P =.04) during high reach. There was no difference in ROM gains between the groups. Within group comparison showed that the VGT group had significantly more recovery of ROM during the first 3 weeks than any other timeframe in the study, whereas ST had most gains at 3 months. There was a significant difference between the groups in the subjects' pain response. ST subjects showed an increase in pain during the intervention, whereas VGT subjects did not (VGT: r =.047, ST: r =.18; P =.015). In this study, interactive videogames were equally effective as traditional therapy for overall ROM gains and resulted in quicker recovery of motion with less pain experienced. Such videogames are a useful adjunct to therapy and should be considered as part of a holistic approach to rehabilitation within the hospital and at home after discharge in pediatric patients recovering from burn injury.

Patrick, R., et al. (2016). "Chronic Ucl Injury: A Multimodal Approach to Correcting Altered Mechanics and Improving Healing in a College Athlete- a Case Report." International Journal of Sports Physical Therapy 11(4): 614-626.
	BACKGROUND: Ulnar collateral ligament (UCL) tears and associated Tommy Johns surgical intervention from excessive and poor quality pitching has increased immensely-with more college and professional pitchers undergoing the surgery in 2014 alone than in the 1990s as a whole.(1) Faulty mechanics developed at young ages are often well-engrained by the late adolescent years and the minimal healing ability of the largely avascular UCL often leads to delayed safe return to sport.(2). PURPOSE: The purpose of this case study was to describe an innovative, multimodal approach to conservative management of a chronic UCL injury in a college-aged baseball pitcher. This innovative approach utilizes both contractile and non-contractile dry needling to enhance soft tissue healing combined with standard conservative treatment to decrease pain and improve sport performance as measured by the Disabilities of Arm, Shoulder and Hand (DASH), Numeric Pain Report Scale (NPRS), and return to sport. STUDY DESIGN: Retrospective Case Report. CASE DESCRIPTION: A collegiate athlete presented to an outpatient orthopedic physical therapy clinic for treatment of UCL sprain approximately six weeks post-injury and platelet-rich plasma injection. Diagnostic testing revealed chronic ligamentous microtrauma. Impairments at evaluation included proximal stabilizing strength deficits, myofascial trigger points throughout the dominant upper extremity, improper pitching form, and inability to pitch in game conditions due to severe pain. Interventions included addressing strength deficits throughout the body, dry needling, and sport-specific biomechanical training with pitching form analysis and correction. OUTCOMES: Conventional DASH and Sport-Specific scale on the DASH and the numeric pain rating scale improved beyond both the minimally clinically important difference and minimal detectable change over the 12 week treatment(3,4) At 24-week follow up, conventional DASH scores decreased from 34.20% disability to 3.33% disability while sport-specific DASH scores decreased from 100% disability to 31.25% disability. Although initially unable to compete due to high pain levels, the subject is currently completing his pitching role full-time with 1/10 max pain. DISCUSSION: The approach used in this case study provides an innovative approach to conservative UCL partial tear treatment. Dry needling of both contractile and non-contractile tissue in combination with retraining of faulty mechanics may encourage chronically injured ligamentous tissue healing and encourage safe return to sport. LEVEL OF EVIDENCE: Level 4.

Pazzola, M., et al. (2015). "Responses of hematological parameters, beta-endorphin, cortisol, reactive oxygen metabolites, and biological antioxidant potential in horses participating in a traditional tournament." Journal of Animal Science 93(4): 1573-1580.
	Several concerns have been raised over the health of animals used in equestrian games that have their origins in historical or religious events and are currently held in many countries. This study investigated physiological stress response and health status of horses participating in the Sartiglia, a historical horse tournament held in the city of Oristano, Italy, which is principally based on the attempts of masked horsemen at a gallop to run a sword through a hole in a suspended silver star. Blood samples were collected from 21 horses the day before the tournament (D0), during the tournament (D1), and the day after the tournament (D2). Samples were analyzed for complete blood count and biochemical, hormonal, and oxidative stress assays. Data were analyzed using the mixed effect model with sampling session as one of the fixed effects. On the whole, blood parameters evidenced an optimal health status of horses at D0. Significant dehydration and increase of circulating glucose, enzymes, cortisol, and beta-endorphin were registered at D1 (P < 0.001) with a complete recovery of physiological values just at D2. The reactive oxygen metabolites (d-ROM), from which the prooxidant activity can be evaluated, showed an increase from D0 to D1 and D2. Concentration of biological antioxidant potential, which measured the antioxidant capacity, was characterized by the maximum level registered during the tournament and counteracted the simultaneous increase of d-ROM. It can be hypothesized that the tournament played an important role in causing high levels of oxidant markers not only because of the physical exercise represented by the gallop but also because the emotional stressors. In conclusion, the tournament caused significant changes of most parameters, which rapidly recovered to baseline values within the day after. These data will certainly be useful for a future implementation of tests in equine medicine and for the improvements of knowledge of changes of blood parameters and health of horses in similar tournaments.

Pedreira da Fonseca, E., et al. (2017). "Therapeutic Effect of Virtual Reality on Post-Stroke Patients: Randomized Clinical Trial." Journal of Stroke & Cerebrovascular Diseases 26(1): 94-100.
	OBJECTIVES: The study aimed to check the therapeutic effect of virtual reality associated with conventional physiotherapy on gait balance and the occurrence of falls after a stroke. METHODS: This was a randomized, blinded clinical trial conducted with post-stroke patients, randomized into two groups-treatment group and control group-and subjected to balance assessments by the Dynamic Gait Index and investigation of falls before and after 20 intervention sessions. Statistically significant difference was considered at P < .05. RESULTS: We selected 30 patients, but there were three segment losses, resulting in a total of 13 patients in the control group and 14 in the treatment group. There was an improvement in gait balance and reduced occurrence of falls in both groups. After intervention, the differences in gait balance in the control group (P = .047) and the reduction in the occurrence of falls in the treatment group (P = .049) were significant. However, in intergroup analysis, there was no difference in the two outcomes. CONCLUSIONS: Therapy with games was a useful tool for gait balance rehabilitation in post-stroke patients, with repercussions on the reduction of falls.

Peebles, A. T., et al. (2022). "A Virtual Reality Game Suite for Graded Rehabilitation in Patients With Low Back Pain and a High Fear of Movement: Within-Subject Comparative Study." JMIR Serious Games 10(1): e32027.
	BACKGROUND: Complex movement pathologies that are biopsychosocial in nature (eg, back pain) require a multidimensional approach for effective treatment. Virtual reality is a promising tool for rehabilitation, where therapeutic interventions can be gamified to promote and train specific movement behaviors while increasing enjoyment, engagement, and retention. We have previously created virtual reality-based tools to assess and promote lumbar excursion during reaching and functional gameplay tasks by manipulating the position of static and dynamic contact targets. Based on the framework of graded exposure rehabilitation, we have created a new virtual reality therapy aimed to alter movement speed while retaining the movement-promoting features of our other developments. OBJECTIVE: This study aims to compare lumbar flexion excursion and velocity across our previous and newly developed virtual reality tools in a healthy control cohort. METHODS: A total of 31 healthy participants (16 males, 15 females) took part in 3 gamified virtual reality therapies (ie, Reachality, Fishality, and Dodgeality), while whole-body 3D kinematics were collected at 100 Hz using a 14-camera motion capture system. Lumbar excursion, lumbar flexion velocity, and actual target impact location in the anterior and vertical direction were compared across each virtual reality task and between the 4 anthropometrically defined intended target impact locations using separate 2-way repeated measures analysis of variance models. RESULTS: There was an interaction between game and impact height for each outcome (all P<.001). Post-hoc simple effects models revealed that lumbar excursion was reduced during Reachality and Fishality relative to that during Dodgeality for the 2 higher impact heights but was greater during Reachality than during Fishality and Dodgeality for the lowest impact height. Peak lumbar flexion velocity was greater during Dodgeality than during Fishality and Reachality across heights. Actual target impact locations during Dodgeality and Fishality were lower relative to those during Reachality at higher intended impact locations but higher at lower intended impact locations. Finally, actual target impact location was further in the anterior direction for Reachality compared to that for Fishality and for Fishality relative to that for Dodgeality. CONCLUSIONS: Lumbar flexion velocity was reduced during Fishality relative to that during Dodgeality and resembled velocity demands more similar to those for a self-paced reaching task (ie, Reachality). Additionally, lumbar motion and target impact location during Fishality were more similar to those during Reachality than to those during Dodgeality, which suggests that this new virtual reality game is an effective tool for shaping movement. These findings are encouraging for future research aimed at developing an individualized and graded virtual reality intervention for patients with low back pain and a high fear of movement.

Pellegrini-Laplagne, M., et al. (2022). "Acute Effect of a Simultaneous Exercise and Cognitive Task on Executive Functions and Prefrontal Cortex Oxygenation in Healthy Older Adults." Brain Sciences 12(4): 455.
	The rapid increase in population aging and associated age-related cognitive decline requires identifying innovative and effective methods to prevent it. To manage this socio-economic challenge, physical, cognitive, and combined stimulations are proposed. The superiority of simultaneous training compared to passive control and physical training alone seems to be an efficient method, but very few studies assess the acute effect on executive function. This study aimed to investigate the acute effect of simultaneous physical and cognitive exercise on executive functions in healthy older adults, in comparison with either training alone. Seventeen healthy older adults performed three experimental conditions in randomized order: physical exercise, cognitive exercise, and simultaneous physical and cognitive exercise. The protocol involved a 30 min exercise duration at 60% of theoretical maximal heart rate or 30 min of cognitive exercise or both. Executive functions measured by the Stroop task and pre-frontal cortex oxygenation were assessed before and after the intervention. We found a main effect of time on executive function and all experimental condition seems to improve inhibition and flexibility scores (&lt;0.05). We also found a decrease in cerebral oxygenation (Delta[HbO2]) in both hemispheres after each intervention in all cognitive performance assessed (p &lt; 0.05). Simultaneous physical and cognitive exercise is as effective a method as either physical or cognitive exercise alone for improving executive function. The results of this study may have important clinical repercussions by allowing to optimize the interventions designed to maintain the cognitive health of older adults since simultaneous provide a time-efficient strategy to improve cognitive performance in older adults.

Pelosi, M. B., et al. (2019). "O uso de jogos interativos por crianças com síndrome de Down." Cadernos Brasileiros de Terapia Ocupacional 27(4): 718-733.
	In this scenario, through the use of platforms and virtual games, the occupational therapist can combine a playful activity with the treatment process, guaranteeing the individual better performance. [...]the activity encourages the active participation of the child, even with physical and/or cognitive disability; provides a motivating environment for learning; and facilitates the study of the characteristics of the individuals' perceptual and motor skills and abilities (SCHIAVINATO et al., 2011). Children with Down syndrome have neuropsychomotor developmental delay and some intellectual disability, expressed by significant limitations in both cognitive functioning and adaptive behavior in conceptual, social and practical skills, and in the physical aspects and clinical complications that influence the development of their motor and communication skills (BRASIL, 2013). The use ofvirtual reality games is becoming more frequent in the rehabilitation programs for people with disabilities; however, the virtual reality games available in the market have many stimuli in general, requiring the speed and the use of multiple movements from the player, which may impair the rehabilitation process when it is used without supervision (TRESSER, 2012; REIFENBERG et al., 2017). Another study compared children who received occupational therapy care with those who received occupational therapeutic care associated with the use of virtual reality, and the data revealed better motor performance, visual skills integration, and sensory integration functions of children in the second group (WUANG et al., 2011).

Pelosin, E., et al. (2012). "A game-console to improve balance in Parkinson Disease: preliminary results using the Nintendo Wii." Italian Journal of Physiotherapy 2(2): 45-49.
	AIM: Balance impairment is a common problem in idiopathic Parkinson's disease (PD) often responsible for increased risk of falls, mobility restriction and loss of independence. Conventional exercises are often repetitive and may induce patients to lose their interest and to interrupt physical therapy at home. This study was aimed at evaluating theeffect of 5 days training with a low-cost, commercially available playing system, the Nintendo Wii® (NW), in improving balance in PD. METHODS: Ten patients with PD and ten aged-match normal subjects (NS) were recruited and performed 30 minutes exercises playing with NW every day for one week. Subjects were evaluated by means of static posturography and Berg Balance Scale (BBS) before and after training. RESULTS: The 5-day training, based on video-game system, induced a significant decrease in all the posturographic parameters in both groups improving postural stability of PD to a level comparable to baseline condition in NS. BBS score improved after training in PD patients. CONCLUSION: These preliminary results suggest that a video game-based approach can exert a positive effect improving postural stability in PD patients. Because the NW device promotes better compliance, has wide applicability and is enjoyable to use, this treatment concept holds promise for PD rehabilitation

Peng, L., et al. (2021). "Virtual reality-based rehabilitation in patients following total knee arthroplasty: a systematic review and meta-analysis of randomized controlled trials." Chin Med J (Engl) 135(2): 153-163.
	BACKGROUND: Physical therapy is regarded as an essential aspect in achieving optimal outcomes following total knee arthroplasty (TKA). The coronavirus disease 2019 (COVID-19) pandemic has made face-to-face rehabilitation inaccessible. Virtual reality (VR) is increasingly regarded as a potentially effective option for offering health care interventions. This systematic review and meta-analysis investigate VR-based rehabilitation's effectiveness on outcomes following TKA. METHODS: From inception to May 22, 2021, PubMed/Medline, Embase, Web of Science, the Cochrane Central Register of Controlled Trials, Scopus, PsycINFO, Physiotherapy Evidence Database, China National Knowledge Infrastructure, and Wanfang were comprehensively searched to identify randomized controlled trials (RCTs) evaluating the effect of VR-based rehabilitation on patients following TKA according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement and the Cochrane Handbook for Systematic Reviews of Interventions. RESULTS: Eight studies were included in the systematic review, and seven studies were included in the meta-analysis. VR-based rehabilitation significantly improved visual analog scale (VAS) scores within 1 month (standardized mean difference [SMD]: -0.44; 95% confidence interval [CI]: -0.79 to -0.08, P = 0.02), the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) within 1 month (SMD: -0.71; 95% CI: -1.03 to -0.40, P < 0.01), and the Hospital for Special Surgery Knee Score (HSS) within 1 month and between 2 months and 3 months (MD: 7.62; 95% CI: 5.77 to 9.47, P < 0.01; MD: 10.15; 95% CI: 8.03 to 12.27, P < 0.01; respectively) following TKA compared to conventional rehabilitation. No significant difference was found in terms of the Timed Up and Go (TUG) test. CONCLUSIONS: VR-based rehabilitation improved pain and function but not postural control following TKA compared to conventional rehabilitation. More high-quality RCTs are needed to prove the advantage of VR-based rehabilitation. As the COVID-19 pandemic continues, it is necessary to promote this rehabilitation model.

Pepino, A., et al. (2012). "MInD: moving in the dark." Studies in Health Technology & Informatics 180: 1212-1214.
	Visually-impaired people can develop several unhealthy behaviors, including the lack of physical activity or sports, due to the incomplete maturity in the control of their body in the space. This research focuses on the creation of an "exergame" - a videogame especially designed to stimulate physical exercise - that, through voice commands, allows the visually impaired users to practice physical activity and train their abilities. This tool has been developed starting from an existing dance-game, by generating some appropriate interfaces that also involve the sensory channel of sight. Our research aims to study the effects related to this exergame on the motor control mechanism in a blind children's group, aged between 8 and 13 years: it focuses also on the joint use of movement analysis systems and of videogames in order to stimulate the physical activity in these subjects.

Pereira, L. B., et al. (2019). "Development of Games Controlled by Kinect to Spine Physical Therapy." IEEE Int Conf Rehabil Robot 2019: 193-197.
	This project aims to develop serious games for spine rehabilitation using the Kinect device and the Unity game engine. First, this paper shows a brief review about the low-cost Kinect device and the main spine movements. After, we explain the game developed and the validation of the data obtained through Kinect to spine movements. From the experimental results the game developed with the Kinect is ready to be used in patients.

Pereira, M. F., et al. (2020). "Application of AR and VR in hand rehabilitation: A systematic review." Journal of Biomedical Informatics 111: 103584.
	BACKGROUND: The human hand is the part of the body most frequently injured in work related accidents, accounting for a third of all accidents at work and often involving surgery and long periods of rehabilitation. Several applications of Augmented Reality (AR) and Virtual Reality (VR) have been used to improve the rehabilitation process. However, there is no sound evidence about the effectiveness of such applications nor the main drivers of therapeutic success. OBJECTIVES: The objective of this study was to review the efficacy of AR and VR interventions for hand rehabilitation. METHODS: A systematic search of publications was conducted in October 2019 in IEEE Xplore, Web of Science, Cochrane library, and PubMed databases. Search terms were: (1) video game or videogame, (2) hand, (3) rehabilitation or therapy and (4) VR or AR. Articles were included if (1) were written in English, (2) were about VR or AR applications, (3) were for hand rehabilitation, (4) the intervention had tests on at least ten patients with injuries or diseases which affected hand function and (5) the intervention had baseline or intergroup comparisons (AR or VR intervention group versus conventional physical therapy group). PRISMA protocol guidelines were followed to filter and assess the articles. RESULTS: From the eight selected works, six showed improvements in the intervention group, and two no statistical differences between groups. We were able to identify motivators of patients' adherence, namely real-time feedback to the patients, challenge, and increased individualized difficulty. Automated tracking, easy integration in the home setting and the recording of accurate metrics may increase the scalability and facilitate healthcare professionals' assessments. CONCLUSIONS: This systematic review provided advantages and drivers for the success of AR/VR application for hand rehabilitation. The available evidence suggests that patients can benefit from the use of AR or VR interventions for hand rehabilitation.

Pereira, M. J., et al. (2015). "Estimating the monetary value of relief of tennis elbow: a contingent valuation study of willingness-to-pay." Value in health 18(7): A654‐.
	Objectives: To estimate the willingness‐to‐pay (WTP) for symptom relief of tennis elbow and examine whether WTP is related to injury characteristics, clinical outcomes, or other socio‐demographic factors. Methods: This cross‐sectional WTP, contingent valuation study was performed alongside a randomised controlled trial comparing the addition of physiotherapy to corticosteroid injection in 165 participants with tennis elbow. The contingent value scenario constructed required participants to decide the monetary value (AUD) they would pay for a quick and non‐invasive new treatment for relief of their elbow condition. Participants were told to consider that their symptoms would persist for the next 12 months if left untreated. The efficacy of this new treatment was defined as complete recovery in 50% of people treated. Two WTP approaches (bidding game and binary response) were administrated in blocks of 15 consecutive participants. For both methods, participants were randomly allocated a starting bid from values of $50, $650, $1250 or $1850. Results: The bidding game approach was performed in 73 participants. WTP values ranged from $50 ‐ 10000 [median WTP (IQR): $695 ($390, $940)]. WTP was significantly associated with an individual's gross income, greater pain and disability and a worsening condition. The binary response approach was performed in 87 participants. All participants accepted a $50 bid, while more than half accepted $650 and $1250 bids. Using this approach, participants were more likely to accept higher values if they had experienced greater pain and disability, a worsening condition and reduced pain‐free grip of their affected arm. Conclusions: This study examined the economic value that participants with tennis elbow ascribe to relief of their condition. The relationship between this monetary value and an individual's injury characteristics and income was also demonstrated. In future work, we propose to compare these WTP estimates with indicators of health‐related quality‐of‐life, which were also collected during this study.

Perez, S. A., et al. (2020). "Personalized Tracking of Physical Activity in Children Using a Wearable Heart Rate Monitor." International Journal of Environmental Research & Public Health [Electronic Resource] 17(16): 5895.
	Serious games are video games that are intended to support learning while entertaining. They are considered valuable tools to improve user-specific skills or facilitate educational or therapeutic processes, especially in children. One of the disadvantages of computer games, in general, is their promotion of sedentary habits, considered as a significant risk factor for developing diseases such as obesity and hypertension. Exergames are serious games created to overcome the disadvantages of traditional computer games by promoting physical activity while playing. This study describes the development and evaluation of an adaptive component to monitor physical activity in children while using an exergame. The system is based on wearable technology to measure heart rate and perform real-time customizations in the exergame. To evaluate the adaptive component, an experiment was conducted with 30 children between 5 and 7 years of age, where the adaptive system was contrasted with a conventional interactive system (an exergame without adaptive component). It was demonstrated that the computer game, using the adaptive component, was able to change in real-time some of its functionalities based on the user characteristics. Increased levels of heart rate and caloric expenditure were significant in some of the game scenarios using the adaptive component. Although a formal user experience evaluation was not performed, excellent game playability and adherence by users were observed.

Perez-Gomez, J., et al. (2022). "Physical exercises for preventing injuries among adult male football players: A systematic review." J Sport Health Sci 11(1): 115-122.
	BACKGROUND: Football is the most practised sport in the world and is associated with the risk of injuries in the players. Some studies have been published that identify injury prevention programs, but there is no review of the full body of evidence on injury prevention programs for use by football coaches. The aim of this article was to carry out a systematic review of published studies on injury prevention programs for adult male footballers, identify points of common understanding and establish recommendations that should be considered in the design of injury prevention strategies. METHODS: PubMed and EMBASE databases were used to identify relevant published articles using the following keywords: "soccer" AND "injury" AND "prevention". RESULTS: A total of 2512 studies were identified initially, but only 11 studies met the inclusion criteria, and their outcomes are presented. Results revealed that injury prevention programs in football have focused on strength training, proprioceptive training, multicomponent programs (balance, core stability, and functional strength and mobility), and warm-up programs. CONCLUSION: Based on results from the studies analyzed, football players can lower the incidence of match and training injuries by participating in dynamic warm-up programs that include preventive exercises before games or during training sessions, and by adding strength, balance, and mobility training to the training sessions.

Perrea, A., et al. (2014). "Comparison of the short-term oxidative stress response in National League basketball and soccer adolescent athletes." Angiology 65(7): 624-629.
	Physical exercise is considered protective against oxidative stress-related disorders. However, there is increasing evidence that strenuous activity may induce increased oxidative stress response. This study investigated the impact of vigorous physical activity on serum oxidative stress markers in 36 soccer and 12 basketball National League adolescent athletes 40 minutes before and 15 minutes after a National League game. Serum total peroxide, fibrinogen, polymorphonuclear (PMN) elastase, and myeloperoxidase levels were determined. No significant differences in any of the measured parameters were observed before the match. Soccer players exhibited significantly lower total peroxide (P < .05) and higher PMN elastase concentrations (P < .05) than that of the basketball athletes after the game. A number of important differences between these 2 sports, such as duration or total aerobic and anaerobic demands, may affect oxidative status. These parameters need to be further examined in order to elucidate the different effects of these 2 sports on postexercise oxidative status.

Peterlin Potisk, K., et al. (2019). "ePoster Sessions." European Journal of Neurology 26: 347-935.
	Background and aims: Parkinson's disease (PD) is a progressive neurodegenerative disease of the extrapyramidal system with an unknown cause. Despite mixed reports on the success of physiotherapy in persons with PD, positive effects on functional improvement of movement and motivation were reported. The use of virtual reality‐based computer games has been recently introduced in the rehabilitation programs in patients with Parkinson's disease. We hypothesized that 3D virtual reality equipment is better at increasing internal motivation compared to the 2D exergaming. Methods: In the study 20 patients (10 in 3D and 2D equipment groups) with Parkinson's disease (Hoehn and Yahr stage 2‐3) practised pick and place task with a virtual cube.They were randomized into 2 groups; one group using an LCD screen and the other using 3D goggles enabling to follow the task in virtual environment. Their task was to collect 10 virtual cubes one‐by‐one and put them in the virtual treasure box. Clinical tests including UPDRSIII and BBT were carried out prior and after the training sessions and statistically analysed using Matlab statistical toolbox. Results: We have demonstrated that the application of 3D virtual reality (VR) exergaming may significantly increase motivation (perceived competence by 40%) and motor function (20.2%). The outcomes of the clinical tests demonstrated substantial improvements; box and blocks (48‐>50, U3=0.6) and UPDRS III for upper limbs (20.5 ‐>18.7, U3=0.35). Conclusion: Our findings are in line with recent studies, reporting on increased intrinsic motivation when using 3D VR equipment compared with the 2D exergaming.

Peters, K., et al. (2015). "Serious game scores as health condition indicator for cancer patients." Studies in Health Technology & Informatics 210: 892-896.
	In this paper we present INTERACCT (Integrating Entertainment and Reaction Assessment into Child Cancer Therapy), a multidisciplinary research project aiming at creating a communication tool for pediatric patients after cancer treatment with HSCT (hematopoietic stem cell transplantation) in after care. The communication platform should foster communication between patients and clinicians, but also increase motivation for treatment compliance by using appropriate designs and gamification elements. A state of the art web interface enables the physicians to evaluate data submitted by the patients, joining data from various sources (lab data, survey data, physiotherapy performance) using HL7 and visualizing imporant changes. This contribution outlines the challenges of designing such a system and presents a solution for the medical data interface and evaluation.

Petersen, P. and C. E. Petersen (1984). "Bilateral handskills in children with mild hemiplegia." Physical & Occupational Therapy in Pediatrics 4(1): 77-87.
	
Petta, T., et al. (2015). "Perception of the learning experience of physiotherapy students when a falls prevention case study is presented as a serious game." Physiotherapy 101: e433-e434.
	
Phillips, A. A., et al. (2017). "2015 ParaPan American Games: Autonomic Function, But Not Physical Activity, Is Associated with Vascular-Cognitive Impairment in Spinal Cord Injury." Journal of Neurotrauma 34(6): 1283-1288.
	Autonomic dysfunction and diminished capacity for physical exercise are commonly implicated in the 3- to 4-fold increased risk of cerebrovascular disease after spinal cord injury (SCI). We assessed cerebrovascular function (transcranial Doppler; neurovascular coupling [NVC], and cerebral pressure-flow regulation) in elite national level wheelchair rugby players (n = 23), normally active SCI individuals (n = 12), and able-bodied controls (n = 13). Cognitive (Stroop test) and autonomic function (postural change) also were evaluated. SCI individuals demonstrated reduced posterior cerebral blood flow, as well as impaired cerebrovascular and cognitive function. Autonomic dysfunction but not physical activity was related to impaired NVC and cerebral pressure-flow regulation after SCI. Routine upper-body exercise, as utilized by elite wheelchair rugby athletes, may not elicit beneficial cerebrovascular effects. On the other hand, autonomic dysfunction needs to be considered a key culprit in cerebrovascular diseases after SCI.

Phillips, J. S., et al. (2001). "Injury surveillance in taekwondo and judo during physiotherapy coverage of the seventh All-Africa Games." South African Journal of Physiotherapy 57(1): 32-34.
	Objective: To obtain data relating to the incidence of injuries sustained during taekwondo and judo competitions at the 7th All Africa Games.Methods: Prospective recording of injuries sustained by athletes who sought physiotherapy services at the games. Details of type of injury, injury sites and injury severity were obtained.Results: Seventy athletes out of 390 participants reported injuries. The overall injury risk ratio was 0.18. Injuries reported were strains/sprains (65,6%), bruises/contusions (16.1%) and dislocations or fractures (12,9%). The upper limbs were more commonly injured. Of the injuries sustained, approximately 18%, 69% and 13% were respectively classified as mild, moderate and severe injuries.Conclusions: The high incidence of moderate to severe injuries highlights the need for injury prevention programs and the presence of medical staff at major tournaments in order to make early diagnosis and appropriate intervention.

Phillips, N., et al. (2015). "Using criteria-based interview models for assessing clinical expertise to select physiotherapists at major multisport games." Br J Sports Med 49(5): 312-317.
	BACKGROUND: Benchmarking is an established means of identifying levels of specialist practice and competence-based interviews are a tool used to facilitate this. The London 2012 Olympic and Paralympic Games (LOCOG) provided an opportunity to introduce a pragmatic approach to assess expert behaviour in large numbers of volunteer physiotherapists. AIM: To test inter-tester repeatability of an assessment matrix used to score clinical expertise in a sporting context, followed by reporting on the findings for physiotherapy selection. METHODS: Four volunteers were videoed answering an identical sport-specific clinical scenario. Recordings were initially scored by two experienced assessors (gold standard). Subsequently, nine assessors scored the same videos then compared with the gold standard. 602 physiotherapists were assessed during volunteer interviews for LOCOG. Scores were compared to those based on self-reported clinical experience. Cross-tabulation was used to determine levels of agreement for the initial scoring matrix and the relationship between the two scoring systems was analysed. RESULTS: Levels of agreement ranged from 22% to 88%. A good correlation (r=0.754 p>0.001) was found between self-reported clinical experience and scenario scores. Marginal data points in the correlational analysis indicated that only 52% of participants attained the same score across assessments. CONCLUSIONS: A tool to facilitate assessment for large scale selection could be used for Host Nation physiotherapist selection for Major Games. There is a need to train assessors in this environment, as well as provide detailed matrices, specific to each context being assessed, to ensure that observations can be made on domain-specific and general, non-technical aspects.

Phomsoupha, M. and G. Laffaye (2020). "Injuries in badminton: A review." Science & Sports 35(4): 189-199.
	Summary Objectives The aim of this review is to provide an overview of the injury risks in badminton, by exploring and takes a global approach related to the eyes, and upper and lower limbs. This explain how the injury occurred and as well as medical and training recommendations for athletic population. News Badminton injuries are around 1–5% of all sports injuries. It ranked six after soccer, basketball, volleyball, long-distance running and cycling. Prospects and projects Such knowledge could help coaches and fitness trainers focus on the specific muscular activities required to prevent injuries. The relationship between scientists and coaches, particularly in terms of biomechanics and physiotherapy, will help improve performance and prevent injury. Conclusion Badminton will be influenced by the evolution of intensity of the game. It is apparent that the movement patterns and movement demands are related to an increase in injuries and the generation of new injuries. Eye injury occurs when shuttlecock impact from an opponent's stroke. Wearing glasses can considerably reduce the risk of eye injury. Injuries to the arm and shoulder are due to faulty technique, while leg and back injuries are caused mainly by a lack of strength or mobility. The contribution of the trunk to the prevention of lower limb injuries suggests that specific attention should be paid to this area. Fatigue influences the way that lunges are performed, and the jump is received by making these tendons less powerful and more unstable. Training program increases body strength to prevent injuries. Résumé Objectifs L’objectif de cette revue est de fournir un aperçu sur les risques de blessures en badminton en explorant et en adoptant une approche globale des blessures des yeux, des membres supérieurs et inférieurs. Cela explique comment la blessure a eu lieu et de ce fait, propose des recommandations médicales et d’entraînement pour les sportifs. Actualités Les blessures en badminton sont autour de 1–5 % des blessures sportives. Elles sont classées sixième après celles du football, du basketball, du volleyball, de la course à pied et du vélo. Perspectives et projets Les connaissances pourraient aider les entraîneurs et les préparateurs physiques à se focaliser sur les activités musculaires spécifiques dans la prévention des blessures. La relation entre les scientifiques et les entraîneurs, notamment en biomécanique et en physiothérapie contribuera à améliorer les performances et prévenir les blessures. Conclusion Le badminton sera influencé par l’évolution de l’intensité des échanges. Il est visible que les modèles et les exigences des mouvements vont augmenter le nombre de blessures et d’en générer de nouvelles. Une blessure oculaire survient suite à un coup de volant frappé par l’adversaire. Le port de lunette peut réduire considérablement le risque de blessure aux yeux. Les blessures au bras et à l’épaule sont dues à une mauvaise technique, tandis que les blessures aux jambes et au dos sont principalement causées par un manque de force ou de mobilité. La contribution du tronc dans la prévention des blessures des membres inférieurs suggère une attention toute particulière à cette zone. La fatigue influence la production des fentes et la réception des sauts rend les tendons moins puissants et plus instables. Les programmes ciblés d’entraînements augmentent la force du corps afin de prévenir les blessures.

Photiou, A., et al. (2008). "Lifestyle, body composition, and physical fitness changes in Hungarian school boys (1975-2005)." Research Quarterly for Exercise & Sport 79(2): 166-173.
	General socioeconomic conditions as well as the physical environment have undergone remarkable changes in Hungary during the past 30 years. Unfortunately, these positive processes have resulted in a reduction of habitual physical activity along with unfavorable changes in dietary habits. Therefore, the purpose of the present study was to compare some selected morphological and functional parameters of 7-14-year-old Hungarian schoolboys living in the middle of the 1970s and at the beginning of the new millennium. It was hypothesized that there would be significant differences in morphological and functional characteristics of the Hungarian schoolboy populations, because they were assessed 30 years apart. Means of height, body mass, body mass index (BMI), the sum of five skinfold tests, percentage of body fat, and two running performance times (400 m and 1,200 m) of the boys (N = 3,672) studied in 1975 were compared to those of the boys (N = 3,758) in 2005. Data were analyzed using two-tailed independent samples t tests (p < .05). We observed significant secular changes in body mass and height. In addition, boys in 2005 had significantly more subcutaneous fat compared to 1975. The running times for the two distances were significantly poorer at the time of the second investigation. The remarkable and unfavorable changes in body composition and cardiorespiratory performance were attributed to the continuously decreasing intensity of habitual physical exercise and a lifestyle that had become more sedentary (watching TV playing computer games, etc.). Radical interventions are necessary to reduce these risks associated with the high prevalence of cardiovascular disease in Hungary, and the challenge to resolve the problem requires combined efforts at the educational, societal, corporate, and governmental levels.

Pichierri, G., et al. (2012). "The effect of a cognitive-motor intervention on voluntary step execution under single and dual task conditions in older adults: a randomized controlled pilot study." Clinical Interventions In Aging 7: 175-184.
	BACKGROUND: This randomized controlled pilot study aimed to explore whether a cognitive-motor exercise program that combines traditional physical exercise with dance video gaming can improve the voluntary stepping responses of older adults under attention demanding dual task conditions. METHODS: Elderly subjects received twice weekly cognitive-motor exercise that included progressive strength and balance training supplemented by dance video gaming for 12 weeks (intervention group). The control group received no specific intervention. Voluntary step execution under single and dual task conditions was recorded at baseline and post intervention (Week 12). RESULTS: After intervention between-group comparison revealed significant differences for initiation time of forward steps under dual task conditions (U = 9, P = 0.034, r = 0.55) and backward steps under dual task conditions (U = 10, P = 0.045, r = 0.52) in favor of the intervention group, showing altered stepping levels in the intervention group compared to the control group. CONCLUSION: A cognitive-motor intervention based on strength and balance exercises with additional dance video gaming is able to improve voluntary step execution under both single and dual task conditions in older adults.

Piech, J. and K. Czernicki (2021). "Virtual Reality Rehabilitation and Exergames—Physical and Psychological Impact on Fall Prevention among the Elderly—A Literature Review." Applied Sciences 11(9): 4098.
	The present review is aimed at the effectiveness of virtual reality (VR) and exergames in the prevention of falls among the elderly. Falls become a significant problem in the aging population and lead to psychological, social, and physical impairment. Prevention of falls is crucial to the well-being of the elderly population and is one of the challenges of contemporary rehabilitation. Recently, in view of the threat of the SARS-CoV-2 pandemic, contactless methods of rehabilitation, including telerehabilitation, appear as valuable rehabilitation tools. This review is based on the PRISMA guidelines and was carried out in five databases: PubMed, Medline, Web of Science, Scopus, and PEDro. Twenty-one randomized controlled trials, focused on the application of VR and exergames in the prevention of falls, were included. This review suggests that VR training in rehabilitation appears to be a promising complement to traditional techniques of physiotherapy to improve specific physical outcomes. VR and exergames could be considered as a complement of standard physiotherapy and its possible continuation at home for elderly. However, further high-quality studies, with carefully designed protocols and proper blinding, are needed.

Pietrzak, E., et al. (2014). "Using commercial video games for falls prevention in older adults: the way for the future?" Journal of Geriatric Physical Therapy 37(4): 166-177.
	BACKGROUND AND PURPOSE: Falls in older adults are an increasingly costly public health issue. There are many fall prevention strategies that are effective. However, with an increasing population of older people and ever-decreasing availability of health practitioners and health funding, novel modes of intervention are being developed, including those relying on computer technologies.The aim of this article was to review the literature on the use of exergaming to prevent falls in older adult persons living in the community. METHODS: The Cochrane, Medline, and Embase databases were searched using prespecified search terms. To be included, studies had to investigate the effect of using commercially available consoles and video games on outcome measures such as a decrease in falls, improvements in balance control or gait parameters, decreased fear of falling, and attitude to exercise in older adult persons living in the community. All study designs with the exception of single-person case studies were included. Articles had to be published in peer-reviewed journals in the English language. RESULTS: Nineteen studies fulfilled the inclusion criteria. The following outcomes were observed: (1) using computer-based virtual reality gaming for balance training in older adults was feasible; (2) the majority of studies showed a positive effect of exergaming on balance control; (3) some studies showed a positive effect on balance confidence and gait parameters; (4) the effect was seen across the age and sex spectrum of older adults, including those with and without balance impairment. CONCLUSIONS: There is as yet no evidence that using virtual reality games will prevent falls, but there is an indication that their use in balance training may improve balance control, which in turn may lead to falls prevention.

Pillay, T. and J. M. Frantz (2012). "Injury prevalence of netball players in South Africa: the need for injury prevention." South African Journal of Physiotherapy 68(3): 7-10.
	This study aimed to establish baseline data for injury prevalence, mechanism of injury, injury severity and management of injuries in netball players in South Africa. A cross sectional descriptive design was employed to collect data by means of a questionnaire in 2010. Participants consisted of 254 netball players who participated in a netball tournament. Permission was obtained from all the relevant organizations and informed consent obtained from the participants. The general injury rate was 61.8% with an injury rate of 1.9 injuries per player for the past season. The most commonly injured structures were the ankle 37.5 % and the knee 28.6% with the most common mechanism of injury being landing, 19% and 29% respectively. Of those who sustained injuries, 86 (44%) of the injured athletes' sustained severe injuries, 31(16%) sustained moderate injuries and 78 (40%) sustained mild injuries. 67% of players reported they were able to continue with the game and 33% received medical assistance losing game and training time. The most common form of management accessed was physiotherapy, which accounted for 31%. It is evident that the ankle and knee injury rates amongst South African netball players are high in comparison to other netball playing nations. Injury surveillance is an integral part of developing preventative measures. The article lays a platform for developing these strategies against the backdrop of its findings and comparison with other authors.

Pin, T. W. (2019). "Effectiveness of interactive computer play on balance and postural control for children with cerebral palsy: A systematic review." Gait & Posture 73: 126-139.
	BACKGROUND: Interactive computer play (ICP) becomes popular in rehabilitation for children with cerebral palsy (CP). With the nature of ICP, it could be an effective intervention specifically to improve balance and postural control for children with CP. The present paper aimed to review the effectiveness of ICP on postural control and balance for children with CP. METHODS: Electronic databases including Medline, AMED, EBSCOhost, PsycINFO, Embase, the Cochrane Library and the DARE were searched up to September 2018. Studies were included if (1) participants were aged under 18 and had CP, (2) ICP intervention was performed, (3) an explicit objective was postural control and balance of the participants, and (4) results were fully published in English-language peer-reviewed journals. Characteristics of study participants, ICP protocols and study results were extracted. Level of evidence of each studies was graded using the guidelines from the American Academy of Cerebral Palsy and Developmental Medicine. Methodological quality was graded using the Physiotherapy Evidence Database (PEDro) scale. Effect sizes were calculated on available data. RESULTS: Twenty studies were included, with nine of level I or II evidence. Most studies had fair methodological rigor. Huge variations in the study designs and protocols of ICP were found among the studies. CONCLUSIONS: ICP seemed to be more effective than conventional therapy in improving postural control and balance, with medium to large effect sizes for children with mild to moderate severity of CP. Future studies of high methodological rigour are required to verify the role of on-site guidance of the children during ICP and the effect on children with more severe CP.

Pin, T. W. and P. B. Butler (2019). "The effect of interactive computer play on balance and functional abilities in children with moderate cerebral palsy: a pilot randomized study." Clinical Rehabilitation 33(4): 704-710.
	OBJECTIVES:: To investigate the feasibility and potential efficacy of a six-week interactive computer play training on balance and gross motor function in children with moderate cerebral palsy. DESIGN:: A pilot single-blinded matched randomized controlled study. SETTING:: Community. PARTICIPANTS:: In total, 18 children with moderate cerebral palsy were recruited, paired according to age and severity of cerebral palsy and randomized into intervention group or control group. INTERVENTION:: The intervention group received additional trunk control training using the interactive computer play in sitting four times per week, 20 minutes per session for six weeks. All study children continued their usual physiotherapy programme. MEASUREMENTS:: All study children were assessed at baseline, week 3, week 6 (completion of intervention) and week 12 using the Pediatric Reach Test, Gross Motor Function Measure-66-Item Set and 2-Minute Walk Test. RESULTS:: All intervention children completed and enjoyed the training with no reported adverse event. All children were assessed at all time points. No significant difference was found between the two groups in all assessments. In both groups of children, significant improvements were found in the Gross Motor Function Measure-66-Item Set between week 3 (intervention group: mean 53.41, SD 5.34; control group: mean 52.86, SD 8.33) and week 6 (intervention group: mean 55.00, SD 6.32; control group: mean 54.20, SD 8.35). CONCLUSION:: The intervention protocol of a six-week interactive computer play training was feasible and safe for children with moderate cerebral palsy in special school settings. Future studies with larger sample sizes or using single-subject designs are recommended.

Pineda-Espejel, A., et al. (2021). "Motivation Towards Sports & The Intention To Be Physically Active In Teenagers." Medicine & Science in Sports & Exercise 53(8S): 322-322.
	Self-determination theory (SDT) suggests that behavior is directed by motivation regulations that vary in levels of self-determination. When individuals feel that their behavior is internally regulated from within, they experience autonomous motivation. When individuals feel that their behavior is externally regulated by outside forces, such as other people or rewards and punishments, they experience controlled motivation. Also recognizes amotivation, characterized by a lack of or absence of motivation. The intention of being physically active is considered a psychological predictor of habitual physical activity levels, and it participates as the most immediate variable of physical activity. PURPOSE: Identify the relationship between motivation regulations towards sport participation, and the intention of being physically active in teenagers who are involved in school sports. METHODS: The study has a correlational design. The simple consisted on 407 middle-school students (207 girls and 200 boys), in a range of age from 12 to 15 years old, who particpated in the National School Sport Games of the Elementary Education, in Mexico. RESULTS: The descriptive analysis reflected that, based on the midpoint of the response scales, the sample on average has a high autonomous motivation (M=5.15; SD=1.18), and moderate controlled motivation (M=3.51; SD=1.25), and low amotivation (M=3.33; SD=1.7) to participate in their sport at school, as well as low intention to be physically active outside school (M=2.13; SD=1.31). The correlational analysis showed no significant relationship (p>.05) between motivational regulations, and the low intention to be physically active. CONCLUSION: Although these participants, mainly, enjoy and have an interested in school sports, this is not enough for them to have a desire of doing physically activities outside school time, consistently. The reason for this may be that, in the prepubertal phase, the interest in physical exercise and sport decreases as a result of power conflicts with adults (i.e. teacher, coach). Participating in a school sports team may be due to the need for social interaction with peers, which is satisfied within the school, and not required to be satisfied outside the school. The study complies with the ACSM statement.

Pinelli, L., et al. (1989). "Physical exercise and insulin dependent diabetes in the young: general approaches." Indian Journal of Pediatrics 56 Suppl 1: S77-79.
	Exercise is worth while for general health and well being; and is beneficial and safe for the young with IDDM as well. The patient must learn to adapt to insulin and/or diet, attending education and training program. The many examples of world-class athletes and participants in the Olympic Games with diabetes serve as impressive evidence that in spite of being dependent on insulin, they are able to participate successfully and without complications in physical activities and high-performance sports.

Pintado-Izquierdo, S., et al. (2020). "Video Game-Based Therapy on Balance and Gait of Patients with Stroke: A Systematic Review." Applied Sciences 10(18): 6426.
	Background: Stroke patients with motor, sensory and cognitive diseases can take profits from information and communication technologies—in particular, from the latest commercial video consoles, which are based on motion capture. These technologies are positioning themselves as complementary therapeutic tools for treating gait and balance disorders. In this paper, a systematic review of the effect of video game-based therapy on balance and gait in stroke patients is shown and compared with other types of treatments. Methods: A systematic review of prospective controlled clinical trials published in the main biomedical databases in English and Spanish between 2005 and 2020 was performed. The systematic review presented in this paper has been done following the Cochrane Manual recommendations and the PRISMA Declaration by two independent reviewers. Data about participants, intervention, outcome measurements and outcome measurement results were extracted. The quality of evidence of each study was assessed using Cochrane’s standard quality assessment format, which includes a description of the risk of bias. Additionally, the Physiotherapy Evidence Database (PEDro) scale was used to assess the methodological quality of each paper. Results: A total of 18 papers, including 479 patients, were included in this systematic review, in which the use of video consoles (in combination with conventional rehabilitation or exclusively) was compared with conventional rehabilitation to treat balance or gait in post-stroke patients. In all studies, a tendency to improve balance was found in both intervention groups, finding, in 10 of 17 studies that analysed it, a better capacity in the experimental group that included video consoles compared to the conventional rehabilitation control group. Regarding gait, in six of seven studies that analysed it, improvements were found in both intervention groups, and these improvements were greater in the experimental group than compared to the control group in three of them. Conclusions: Commercial video game systems, in combination with conventional rehabilitation, have shown positive results on balance and gait in post-stroke patients. There were variations between the trials in terms of the video consoles used and the duration, frequency and number of sessions with commercial video games. Future studies should compare the effects of commercial video game treatments on balance and gait in stroke patients with a nonintervention group to know their real efficacy.

Pinzur, M. S. (2018). "The Numbers Game." Foot Ankle Int 39(7): 880.
	A personal narrative is presented which explores the role of author as quality medical director for physician university-based department of orthopedic surgery.

Piskorz, J. and M. Czub (2014). "Distraction of attention with the use of virtual reality. Influence of the level of game complexity on the level of experienced pain." Polish Psychological Bulletin 45(4): 480-487.
	Research done in recent years shows that Virtual Reality (VR) can be an effective tool for distracting attention from pain. The purpose of this study was to test how the complexity of Virtual Environment (VE) influences the experienced intensity of thermal pain stimuli. A within-subjects design experiment was conducted, using cold pressor test for pain stimulation. Research was done on 31 students of Wroclaw Universities. Participants played games created for the purpose of the study, using head mounted displays and movement sensors. Two Virtual Environments differing in the level of complexity and non-VR control condition were used. The order of all conditions was counterbalanced. Participants reported significantly lower pain intensity (Visual Analogue Scale) after playing the high complexity game, compared to the low complexity game. There were also significant differences between non-VR control condition and high complexity game, but not between non-VR and low complexity game. The pain tolerance (measured by time of keeping the hand in cold water) was significantly higher in both VR conditions comparing to non-VR conditions. However, no significant differences between VE's were found in pain tolerance ratings. Results of this study provide preliminary evidence that game complexity can be related to pain experience during VR interventions.

Polechonski, J., et al. (2019). "Exergaming Can Be a Health-Related Aerobic Physical Activity." BioMed Research International 2019: 1890527.
	The purpose of the study was to assess the intensity of aerobic physical activity during exergame training sessions with a moderate (MLD) and high (HLD) level of difficulty of the interactive program "Your Shape Fitness Evolved 2012" for Xbox 360 Kinect in the context of health benefits. The study involved 30 healthy and physically fit students. During the game, the HR of the participants was monitored using the Polar M400 heart rate monitor. The average percentage of maximum heart rate (%HRmax) and heart rate reserve (%HRR) during the game was calculated and referred to the criterion of intensity of aerobic physical activity of American College of Sports Medicine and World Health Organization health recommendations. During the MLD training, the participants achieved on average 69.6 +/- 8.7% HRmax and 57.0 +/- 11.9% HRR (moderate intensity), while performing HLD exercises, they achieved 78.9 +/- 8.1% HRmax and 70.2 +/- 11.3% HRR (vigorous intensity). The time spent in recommended moderate-to-vigorous intensity during 15-min exergame session was 14.6 min (97,1%) for MLD and 14.8 min (99%) for HLD. The intensity of aerobic PA during exergame "Your Shape Fitness Evolved 2012" both medium and high level of difficulty almost all the training sessions was at the level recommended for health benefits. Active video games, especially exergames, containing an element of physical activity, can be used to increase the weekly dose of PA in the direction recommended for health benefits.

Polechonski, J., et al. (2020). "Can Physical Activity in Immersive Virtual Reality Be Attractive and Have Sufficient Intensity to Meet Health Recommendations for Obese Children? A Pilot Study." International Journal of Environmental Research & Public Health [Electronic Resource] 17(21): 01.
	Immersive virtual reality (IVR) is a technology that blurs the line between the physical world and a digital environment. Using appropriate pointing devices, it is possible to engage in physical activity (PA). The main aim of the study was to assess the attractiveness and intensity of physical exercise while playing active video games (AVGs) in IVR on an omnidirectional treadmill by obese children and to present the results compared to health recommendations (PA). It was also assessed whether the AVGs storyline can effectively motivate the participants to undertake locomotor activity by increasing the intensity of their effort (moving in a limited space vs. having to follow a set route). Eleven children aged 8 to 12 years with diagnosed obesity participated in the experiment. The attractiveness of PA was assessed with a questionnaire, while the intensity of exercise was estimated on the basis of heart rate. The answers show that AVGs are attractive and more enjoyable for the respondents than conventional video games. All participants declared their willingness to practice this form of PA. The intensity of PA of obese children during two games was high but during the game where the player was supposed to follow a set route, it was significantly higher (83.3 +/- 9.2% HRmax) than during the game whose storyline assumed moving in a limited space (77.4 +/- 9.8% HRmax). Due to the high intensity of PA while playing the AVGs studied, it can be assumed that obese children can benefit for their health if the games are used on a regular basis. However, further research is needed to verify this thesis.

Pompeu, J. E., et al. (2012). "Effect of Nintendo Wii-based motor and cognitive training on activities of daily living in patients with Parkinson's disease: a randomised clinical trial." Physiotherapy 98(3): 196-204.
	OBJECTIVES: To investigate the effect of Nintendo Wii-based motor cognitive training versus balance exercise therapy on activities of daily living in patients with Parkinson's disease. DESIGN: Parallel, prospective, single-blind, randomised clinical trial. SETTING: Brazilian Parkinson Association. PARTICIPANTS: Thirty-two patients with Parkinson's disease (Hoehn and Yahr stages 1 and 2). INTERVENTIONS: Fourteen training sessions consisting of 30 minutes of stretching, strengthening and axial mobility exercises, plus 30 minutes of balance training. The control group performed balance exercises without feedback or cognitive stimulation, and the experimental group performed 10 Wii Fit games. MAIN OUTCOME MEASURE: Section II of the Unified Parkinson's Disease Rating Scale (UPDRS-II). RANDOMISATION: Participants were randomised into a control group (n=16) and an experimental group (n=16) through blinded drawing of names. STATISTICAL ANALYSIS: Repeated-measures analysis of variance (RM-ANOVA). RESULTS: Both groups showed improvement in the UPDRS-II with assessment effect (RM-ANOVA P<0.001, observed power=0.999). There was no difference between the control group and the experimental group before training {8.9 [standard deviation (SD) 2.9] vs 10.1 (SD 3.8)}, after training [7.6 (SD 2.9) vs 8.1 (SD 3.5)] or 60 days after training [8.1 (SD 3.2) vs 8.3 (SD 3.6)]. The mean difference of the whole group between before training and after training was -0.9 (SD 2.3, 95% confidence interval -1.7 to -0.6). CONCLUSION: Patients with Parkinson's disease showed improved performance in activities of daily living after 14 sessions of balance training, with no additional advantages associated with the Wii-based motor and cognitive training. Registered on http://www.clinicaltrials.gov (identifier: NCT01580787).

Pompeu, J. E., et al. (2016). "Abstracts of the Twentieth International Congress of Parkinson's Disease and Movement Disorders." Mov Disord 31 Suppl 2: S1-S802.
	Objective: To compare the effects obtained through the European Physiotherapy Guideline (EPG) for Parkinson's disease (PD) with the Kinect Adventures games training on postural control, cognition and quality of life of PD patients. Background: EPG for PD was developed by specialists based on the best scientific evidence about the effects of exercises on motor symptoms of the disease. On the other hand, new therapeutic strategies have been shown positive effects on PD, among them the virtual reality training performed through video games. Studies suggested that the video games can promote an integrated motor‐cognitive training with potential to improve balance, cognition and independence on daily living activities of PD patients. However, there are no studies that have compared the effects of the EPG with virtual reality training in order to know what is the best intervention strategy. Methods: A randomized clinical trial was conducted with 15 individuals of both genders with idiopathic PD during period on of dopaminergic replacement, mean age of 64 [standard deviation (SD) 10.5] years, on stages 1 to 3 on the Hoehn and Yahr scale and mean score 52.87 (SD 3.1) on Berg Balance Scale. Intervention of the control group (CG, n=7) was performed in group was based on the EPG and the experimental group (EG, n=8) performed individual Kinect‐Adventures‐based training (KABT). All subjects performed 14 training sessions twice a week, for seven weeks and both groups were assessed before and after the end of the training and after an interval of 30 days of the end of the intervention (follow‐up, FU). Postural control outcomes were Limits of Stability (LOS) and Balance Functional Reserve (BFR) assessed with eyes open and closed. Quality of life and cognition outcomes were Parkinson's disease Questionnaire (PDQ‐39) and Montreal Cognitive Assessment (MoCA), respectively. Results: EG showed increased scores of the LOS, BFR, PDQ‐39 and MoCA after training and FU (P<0.05). CG showed improvement in all measures (P<0,05), except BFR with eyes open. Conclusions: EPG and KABT showed positive effects on balance, cognition and quality of life PD patients, but it is be necessary to increase the sample size in order to more robust results.

Ponce-Blandon, J. A., et al. (2020). "Sedentary Behaviors of a School Population in Brazil and Related Factors." International Journal of Environmental Research & Public Health [Electronic Resource] 17(19): 23.
	Background. Overweight and obesity arise from a complex range of genetic, environmental, behavioral, educational, and socioeconomic factors. The present study explored the sedentary practices and some life habits related to health among children from the school population of Uruguaiana (Rio Grande do Sul, Brazil). Methods: A cross-sectional descriptive study was conducted to characterize the life habits of the school boys and girls from fourth grade (9-10 years old). Results: A total of 470 fourth-grade boys and girls (9-10 years old) participated in the study. As regards the variables linked to habits, 24% of the boys and girls answered they had not had breakfast the day they completed the questionnaire and 51.8% stated they did not have breakfast any given day of the week. Regarding sedentary habits, 25.3% of children watched TV or played video games five or more hours a day and 9% rarely played sports with their parents or caregivers. Statistical significance was recorded between "number of hours watching TV and playing video games" and "playing sports with parents or caregivers" (p < 0.05). Conclusions: Association between the times spent watching TV or playing video games and the practice of physical exercise in the family proves once again the importance of the family in education for the health of children. The school provides direct access to schoolchildren and their parents to launch numerous health education programs.

Pooranawatthanakul, K. and A. Foongchomcheay (2015). "Effect of video game commercial on short term balance training in Thai elderly." Physiotherapy 101: eS398.
	Background: Fall is one of the leading causes to incapability of individuals over the age of 65 years old and commonly used as an indicator to reveal the ability to control balance. Consequence of falls can lead to fractures, activity avoidance, health decline, disability, fear of falling and hospitalization. Numbers of research reported that the most effective fall‐prevention programs involved a variety of tasks which challenge balance, such as multisensory balance training and a training program done by a game console or video games. Purpose: The objectives of this study were to compare the effect of video game commercial exercise and home based exercise on short‐term effect in improving balance in the elderly. Methods: Forty‐eight healthy elderly, age 65‐80 years were included. Participants were randomized into a video game based exercise (Wii) group (n = 24) and a home based exercise group (n = 24). TheWii group was set at Phra Nung Kloa hospital elderly club and received video game exercise 30‐45 minutes per day, 3 days a week, for 4 weeks. The home based group was received self‐monitored exercise for 30 minutes, 3 times a week, for 4 weeks. The home based group was reminded about the exercises by the researcher via telephone twice a week and also received a handbook to prevent fall. Berg Balance Scale (BBS), Fullerton Advance Balance Scale (FAB), and Functional Reach Test (FRT) were evaluated at the beginning of training, the end of week 1, 2, 3 and at the completed of the training on week 4. Results: Repeated two way ANOVA showed no significantly different reach distance (FRT) when compared Wii group and home base group at the end of week 4 (p = 0.144). Both groups showed significantly improved reach distance (FRT) started at the end of week 1, score of FAB and BBS at the end of week 2 and 3 respectively (p < 0.05). No significantly different between groups in BBS and FAB was found. Conclusion(s): Video game based exercise and home based exercise improved balance in the elderly demonstrating by increased scores of BBS, FAB and reach distance (FRT) after 4 weeks training, indicating improvement of balance and implied the reduction of risks of fall in the elderly. Implications: A minimal of 3 weeks training of video game based or a home based exercise especially lower limb muscles strengthening have potential to improve balance in elderly.

Popescu, V., et al. (1999). "PC-based telerehabilitation system with force feedback." Studies in Health Technology & Informatics 62: 261-267.
	A PC-based orthopedic rehabilitation system was developed for use at home, while allowing for remote monitoring from the clinic. The home rehabilitation station has a Pentium II PC with graphics accelerator, Polhemus tracker, and a novel Multipurpose Haptic Control Interface with its own Pentium board. This interface is used to sample patient's hand positions and to provide resistive forces using the Rutgers Master II (RMII) glove. A library of virtual rehabilitation routines was developed using WorldToolKit software. At the present time, it consists of two physical therapy exercises (DigiKey and Ball) and two functional rehabilitation exercises (Peg Board test and Ball game). All VR exercises allow automatic and transparent patient data collection into an Oracle database. A remote Pentium II PC is connected with the home-based PC over the Internet and an additional video-conferencing connection. The remote computer running Oracle server is used to maintain the patient database, monitor progress and change exercise level of difficulty. This allows for timely patient progress monitoring and repeat evaluations over time from the Clinic. The system will soon start clinical trails at Stanford Medical School, with progress being monitored remotely from Rutgers University. Other rehabilitation haptic interfaces under development include devices for elbow, and knee rehabilitation connected to the Multipurpose Haptic Control Interface.

Popescu, V. G., et al. (2000). "A virtual-reality-based telerehabilitation system with force feedback." IEEE Transactions on Information Technology in Biomedicine 4(1): 45-51.
	A PC-based orthopedic rehabilitation system was developed for use at home, while allowing remote monitoring from the clinic. The home rehabilitation station has a Pentium II PC with graphics accelerator, a Polhemus tracker, and a multipurpose haptic control interface. This novel interface is used to sample a patient's hand positions and to provide resistive forces using the Rutgers Master II (RMII) glove. A library of virtual rehabilitation routines was developed using WorldToolKit software. At the present time, it consists of three physical therapy exercises (DigiKey, ball, and power putty) and two functional rehabilitation exercises (peg board and ball game). These virtual reality exercises allow automatic and transparent patient data collection into an Oracle database. A remote Pentium II PC is connected with the home-based PC over the Internet and an additional video conferencing connection. The remote computer is running an Oracle server to maintain the patient database, monitor progress, and change the exercise level of difficulty. This allows for patient progress monitoring and repeat evaluations over time. The telerehabilitation system is in clinical trails at Stanford Medical School (CA), with progress being monitored from Rutgers University (NJ). Other haptic interfaces currently under development include devices for elbow and knee rehabilitation connected to the same system.

Popovic, M. D., et al. (2014). "Feedback-mediated upper extremities exercise: increasing patient motivation in poststroke rehabilitation." BioMed Research International 2014: 520374.
	PURPOSE: This proof-of-concept study investigated whether feedback-mediated exercise (FME) of the affected arm of hemiplegic patients increases patient motivation and promotes greater improvement of motor function, compared to no-feedback exercise (NFE). METHOD: We developed a feedback-mediated treatment that uses gaming scenarios and allows online and offline monitoring of both temporal and spatial characteristics of planar movements. Twenty poststroke hemiplegic inpatients, randomly assigned to the FME and NFE group, received therapy five days a week for three weeks. The outcome measures were evaluated from the following: (1) the modified drawing test (mDT), (2) received therapy time-RTT, and (3) intrinsic motivation inventory-IMI. RESULTS: The FME group patients showed significantly higher improvement in the speed metric (P < 0.01), and smoothness metric (P < 0.01), as well as higher RTT (P < 0.01). Significantly higher patient motivation is observed in the FME group (interest/enjoyment subscale (P < 0.01) and perceived competence subscale (P < 0.01)). CONCLUSION: Prolonged endurance in training and greater improvement in certain areas of motor function, as well as very high patient motivation and strong positive impressions about the treatment, suggest the positive effects of feedback-mediated treatment and its high level of acceptance by patients.

Porter, G. K., Jr. and T. W. Kaminski (2001). "In the game. New and improved: new concepts in muscle training produce better results." Advance for Directors in Rehabilitation 10(8): 25-26.
	
Posner, M. I., et al. (2015). "Enhancing attention through training." Current Opinion in Behavioral Sciences 4: 1-5.
	Attention can be improved by repetition of a specific task that involves an attention network (network training), or by exercise or meditation that changes the brain state (state training). We first review the concept of attention networks that link changes in orienting, alerting and executive control to brain networks. Network training through video games or computer exercises can improve aspects of attention. The extent of transfer beyond the trained task is a controversial issue. Mindfulness is a form of meditation that keeps attention focused on the current moment. Some forms of meditation have been shown to improve executive attention reduce stress and produce specific brain changes. Additional research is needed to understand the limits and mechanisms of these effects.

Postolache, G. B., et al. (2017). "Contextual Design of ICT for Physiotherapy: Toward Knowledge and Innovation Ecosystem." EAI Endorsed Transactions on Creative Technologies 4(13).
	With advances in information and communication technologies (ICT), changes have been produced in physiotherapy provision. However, low adoption of the new technologies calls attention for better theoretical model and methods for ICT design, which may fulfil the needs of health professionals and their patients. In this work we discuss the framework for designing ICT for physiotherapy context based on some of the results obtained during research on requirements and barriers of electronic health records adoption in physiotherapy. We underscore the importance of considering the context - the conditions in social and physical environment as well as end-users internal conditions - for requirements elicitation of the healthcare information system. Identification, training and collaboration with champion/leader in the target community may contribute to creation and evolution of knowledge and innovation ecosystem for dynamic progress in designing and developing of ICT tailored to the people’ needs, expectations and values.

Prevost, L., et al. (2020). Design and Implementation of a Mobile Exergaming Platform. Ithaca, Cornell University Library, arXiv.org.
	This paper describes the design, implementation, and initial testing of a reusable platform for the creation of pervasive games with geo-localization services. We concentrate on role-playing games built by combining several types of simpler mini-games having three major components: Quests; Collectables; and Non-player characters (NPC). Quests encourage players to be active in their physical environment and take part in collaborative play; Collectables provide motivation; and NPCs enable player-friendly interaction with the platform. Each of these elements poses different technical requirements, which were met by implementing the gaming platform using the inTrack pervasive middle-ware being developed by our group. Several sample games were implemented and tested within the urban environment of Kyoto, Japan, using gaming clients running on mobile phones from NTT DoCoMo, Japan's largest mobile provider.

Prieto Mondragon, L. D. P., et al. (2015). "Effect of a physical training program based on the development sequence on postural balance in soccer players: randomized controlled trial." Physiotherapy 101: e1224-e1225.
	Background: In sports practice, soccer has the highest risk of muscle injury especially in the lower limb, causing long absences from competition and imposing costs to the teams. Preventive strategies have gained importance in the training routines in these strategies the balance training is a factor as it is required to maintain stability during game development, the transition movement is based in multisensory integration. Through the individual sensorimotor development generates a series of stimuli that contribute to the activation of the sensory systems involved in the generation and execution of a motor program, improving proprioception and balance both synaptic efficacy (short‐term improvement) and by structural change in the organization and in the number of synaptic connections (long‐term improvement) through motor learning, which is why the training in the various positions of the normal sequence of development skills and work balance equilibrium reactions however is little current research that integrates the balance from motor learning and is included from training methodology, therefore, is important to determine the effect of a physical training program based on the sequence of development, the postural balance of players. Purpose: Determine the effect of a physical training program based on the development sequence on postural balance in soccer players. Methods: Randomized controlled trial. 19 young adult male elite soccer players from the National University of Colombia (Age 19.4±1.2 years; height 1.73±0.1 cm; body mass 64.4±8.1 kg) took part in the investigation. Subjects signed an informed consent document before the investigation. Before training, an anthropometric evaluation, a static balance with Error Scoring System test (BESS) and the Dynamic Balance with the Star Excursion Balance Test (SEBT) is performed. Participants were randomized into two groups, the intervention group (IG) (n = 11) in which the sequence‐based development program is applied and a control group (CG) (n = 8) traditional training in football for 6 weeks duration each. Results: The evaluation of dynamic balance with test SEBT the p‐values obtained was < 0.5, which confirms an improvement in all evaluated directions in both legs in IG compared with CG. In the IG, the intra‐group relationship shows a 3:1 correlation, which represents a measure of protection, per 3 subjects improved in the IG, 1 improved in the CG. The results have shown improvements in excursion distances, which can be associated with an increased dynamic postural control. Conclusion(s): The use of a fitness program based on the sequence of development generates significant improvements in static and dynamic balance. Implications: This project is an exciting opportunity for the academic and clinical perspective, because it contributes to the development of knowledge and practice of the physiotherapist in sports generating an intervention option in athletes supported from the base of sensorimotor neurodevelopment. Additionally, its application would allowa reduction of costs in medical procedures, rehabilitation, at the time of disability and loss of physical performance in soccer players.

Primack, B. A., et al. (2012). "Role of video games in improving health-related outcomes: a systematic review." American Journal of Preventive Medicine 42(6): 630-638.
	CONTEXT: Video games represent a multibillion-dollar industry in the U.S. Although video gaming has been associated with many negative health consequences, it also may be useful for therapeutic purposes. The goal of this study was to determine whether video games may be useful in improving health outcomes. EVIDENCE ACQUISITION: Literature searches were performed in February 2010 in six databases: the Center on Media and Child Health Database of Research, MEDLINE, CINAHL, PsycINFO, EMBASE, and the Cochrane Central Register of Controlled Trials. Reference lists were hand-searched to identify additional studies. Only RCTs that tested the effect of video games on a positive, clinically relevant health consequence were included. Study selection criteria were strictly defined and applied by two researchers working independently. Study background information (e.g., location, funding source); sample data (e.g., number of study participants, demographics); intervention and control details; outcomes data; and quality measures were abstracted independently by two researchers. EVIDENCE SYNTHESIS: Of 1452 articles retrieved using the current search strategy, 38 met all criteria for inclusion. Eligible studies used video games to provide physical therapy, psychological therapy, improved disease self-management, health education, distraction from discomfort, increased physical activity, and skills training for clinicians. Among the 38 studies, a total of 195 health outcomes were examined. Video games improved 69% of psychological therapy outcomes, 59% of physical therapy outcomes, 50% of physical activity outcomes, 46% of clinician skills outcomes, 42% of health education outcomes, 42% of pain distraction outcomes, and 37% of disease self-management outcomes. Study quality was generally poor; for example, two thirds (66%) of studies had follow-up periods of <12 weeks, and only 11% of studies blinded researchers. CONCLUSIONS: There is potential promise for video games to improve health outcomes, particularly in the areas of psychological therapy and physical therapy. RCTs with appropriate rigor will help build evidence in this emerging area.

Prochazka, A., et al. (2011). "Research Report Abstracts." Physiotherapy 97: eS18-eS1415.
	Purpose: We report on the first randomized controlled trial of Internet‐supervised exercise therapy (ET) for upper extremity function performed by clients at home. One group performed conventional ET, while the other performed FES‐ET on a purpose‐built gaming workstation, the Rehabilitation Joystick For Computerized Exercise (“ReJoyce”). ET was tele‐supervised over the Internet 1 hour/day, 5 days/week in both groups. Relevance: Exercise therapy (ET), particularly when assisted with functional electrical stimulation (FES), can significantly improve upper extremity function after stroke, traumatic brain injury and spinal cord injury, but regular ET is hard to deliver and maintain, particularly after clients return to their communities. Participants: Thirteen C5/6 tetraplegic people (7 men, 6 women) took part, five performing the study with one hand, then the other, for a total of 18 hands studied. Methods: Participants were block‐randomized into two groups, group 1 receiving tele‐supervised conventional ET 1 hour/day for 6 weeks, followed by a 1 month washout period and then ReJoyce FES‐ET 1 hour/day for 6 weeks. Group 2 received the same treatments in reverse order. Because five participants completed the study with both hands, the groups each had a sample size of 9. Primary outcome measure: Action Research Arm Test(ARAT). Secondary outcome measures: grasp and pinch forces and the ReJoyce automated hand function test (RAHFT). Analysis: A repeated measures analysis of variance (ANOVA) was used to test for significant differences in outcome measures. A multivariate regression analysis was also performed. Descriptive statistics were calculated for all dependent variables. Results: ARAT scores improved significantly more after ReJoyce FES‐ET (13.0±9.8%) than after conventional ET (4.0±9.6%) (F = 10.6, p < 0.01). RAHFT scores also improved significantly more after ReJoyce ET (16.9±8.6%) than after conventional ET (3.3±10.2%) (F = 20.4, p < 0.01). Conclusions: (1) FES‐ET performed on a purpose‐designed gaming workstation resulted in more improvement in upper extremity function in tetraplegic subjects than conventional treatment. (2) Internet‐based tele‐supervision of ET is feasible and effective. Implications: The improvements resulting from FESET exceeded the minimal clinically important difference (MCID), which is often used as a criterion to introduce a treatment into best practice. The ReJoyce workstation provides a standardized and cost‐efficient means of delivery of ET. The combination of new technologies used in this study signal a radical change in upper extremity rehabilitation.

Proffitt, R. and B. Lange (2015). "Considerations in the efficacy and effectiveness of virtual reality interventions for stroke rehabilitation: moving the field forward." Physical Therapy 95(3): 441-448.
	In the past 2 decades, researchers have demonstrated the potential for virtual reality (VR) technologies to provide engaging and motivating environments for stroke rehabilitation interventions. Much of the research has been focused on the exploratory phase, and jumps to intervention efficacy trials and scale-up evaluation have been made with limited understanding of the active ingredients in a VR intervention for stroke. The rapid pace of technology development is an additional challenge for this emerging field, providing a moving target for researchers developing and evaluating potential VR technologies. Recent advances in customized games and cutting-edge technology used for VR are beginning to allow for researchers to understand and control aspects of the intervention related to motivation, engagement, and motor control and learning. This article argues for researchers to take a progressive, step-wise approach through the stages of intervention development using evidence-based principles, take advantage of the data that can be obtained, and utilize measurement tools to design effective VR interventions for stroke rehabilitation that can be assessed through carefully designed efficacy and effectiveness trials. This article is motivated by the recent calls in the field of rehabilitation clinical trials research for carefully structured clinical trials that have progressed through the phases of research.

Pryor, R. R., et al. (2015). "Athletic training services in public secondary schools: a benchmark study." J Athl Train 50(2): 156-162.
	CONTEXT: Authors of the most recent study of athletic training (AT) services have suggested that only 42% of secondary schools have access to athletic trainers. However, this study was limited by a small sample size and was conducted more than 10 years ago. OBJECTIVE: To determine current AT services in public secondary schools. DESIGN: Cross-sectional study. SETTING: Public secondary schools in the United States. PATIENTS OR OTHER PARTICIPANTS: A total of 8509 (57%) of 14,951 secondary schools from all 50 states and Washington, DC, responded to the survey. MAIN OUTCOME MEASURE(S): Data on AT services were collected for individual states, National Athletic Trainers' Association districts, and the nation. RESULTS: Of the 8509 schools that responded, 70% (n = 5930) had AT services, including full-time (n = 3145, 37%), part-time (n = 2619, 31%), and per diem (n = 199, 2%) AT services, and 27% (n = 2299) had AT services from a hospital or physical therapy clinic. A total of 4075 of 8509 schools (48%) provided coverage at all sports practices. Eighty-six percent (2,394,284/2,787,595) of athletes had access to AT services. CONCLUSIONS: Since the last national survey, access to AT services increased such that 70% of respondent public secondary schools provided athletic trainers at sports games or practices. Approximately one-third of all public secondary schools had full-time athletic trainers. This number must increase further to provide appropriate medical coverage at athletic practices and games for secondary school athletes.

Psychouli, P. and C. R. Kennedy (2016). "Modified Constraint-Induced Movement Therapy as a Home-Based Intervention for Children With Cerebral Palsy." Pediatr Phys Ther 28(2): 154-160.
	PURPOSE: This study was designed to investigate the benefit to upper limb function of a home-based version of pediatric constraint-induced movement therapy, which was delivered across 2 months. METHODS: Nine children (mean age: 6 years, 9 months) with hemiplegic cerebral palsy participated in this A1-B-C-A2 design, where A1 and A2 were nonintervention phases. In phases B and C, participants wore a splint on the unaffected hand. In phase C, motivating feedback through a computer game was added. RESULTS: The Melbourne Assessment of Unilateral Upper Limb Function and the Quality of Upper Extremity Skills Test scores were significantly higher at the end of phases B (P = .037 and P = .006, respectively) and C (P = .001 and P = .001, respectively). Melbourne scores remained higher at the end of phase A2 (P = .001). CONCLUSIONS: A nonintensive form of home-based constraint-induced movement therapy was found to be effective. Improvements were larger after the second month of intervention.

pt72m, R. B. R. (2017). "Combination of physical exercises and training in video games for post stroke people." https://trialsearch.who.int/Trial2.aspx?TrialID=RBR-4pt72m.
	INTERVENTION: Three interventions will be held, with the first group, the real multimodal group (RMG) receive sessions in multimodal training group in real environment. The second group, the combined multimodal group (CMG) will receive a real environment intervention associated with the use of games in a virtual environment. And the third group virtual multimodal group (VMG) will receive a composed only intervention virtual reality games. Therefore, the study will have three groups, each group being composed of approximately 12 participants, totaling 36 subjects. The sessions are approximately 60 minutes long, 2 times a week for 15 weeks for all groups, taught by physical therapists and physical education professionals, and graduate trainees in the fields of Physical Therapy and Physical Education. Intervention in real environment that receive RMG aims to improve quality of life and functional independence of the subjects; using for this game, aerobic circuits and force split stations for performing strength training, balance, coordination and mobility; following the detailed guidelines published by Billinger (2014) in his summarization of recommendations for exercises and physical activities for individuals after stroke. The CMG receive the same assistance from the RMG, but with a duration of one hour per week only, plus a practice one hour per week of games in Virtual Reality, held at the Laboratory of Motor Behavior (LACOM), also located in the School of Physical Education and sport at the University of São Paulo. The virtual reality sessions will be taught by the same individuals involved in the planning and implementation of other intervention. For virtual reality sessions were selected from eight distinct STABLE games. The games were divided into two sessions with four games each, these sessions will be made alternately: odd Session: City Ride, Hit the Mole, Ballon Pop and 2D Maze 1; Session pair: Roads Encounters, Stepping Roads, Hit Knees and Paper Fligth. CONDITION: I00‐I99 Stroke ; I64 PRIMARY OUTCOME: Variation in the ADL/ AIDL domain of the health‐related quality of life verified by means of the AVE Impact Scale, the variations are represented by a statistically significant (p <5%) in pre‐ and post‐intervention measurements, as well as follows ‐up for 1 month. SECONDARY OUTCOME: Variation in cognition verified by the Montreal Cognitive Assessment (MoCA), variation is represented by a statistically significant difference (p less than 5%) in the pre and post intervention measurements, as well as in the 1‐month follow‐up. ; ; Variation in balance verified by the Berg Balance Scale, variation is represented by a statistically significant difference (p less than 5%) in the pre and post intervention measurements, as well as in the 1‐month follow‐up. ; ; Variation in cardiorespiratory fitness verified by the 6‐minute Walk Test, variation is represented by a statistically significant difference (p less than 5%) in pre and post intervention measurements, as well as in the 1‐month follow‐up. ; ; Variation in gait velocity verified by the 10‐Meter Walk Test, variation is represented by a statistically significant difference (p less than 5%) in pre and post intervention measurements, as well as in the 1‐month follow‐up. ; ; Variation in balance verified by the Time Up and Go, variation is represented by a statistically significant difference (p less than 5%) in pre and post intervention measurements, as well as in the 1‐month follow‐up. INCLUSION CRITERIA: Chronic phase stroke; territory of the Cerebral Media or in the Anterior Cerebral Artery; both types of stroke (ischemic and hemorrhagic); cognition greater than 24 points in the Mini Mental State Examination; to less than 2 months of use in forms and the Wings of Empowerment with physical exercises; (community) and without experience in Virtual Reality games.

Punt, I. M., et al. (2017). "Effect of Wii Fit exercise therapy on gait parameters in ankle sprain patients: A randomized controlled trial." Gait & Posture 58: 52-58.
	Ankle sprains are the most common sport related injuries. An alternative to physical therapy in the treatment of ankle sprains is home based exercise therapy. This study aims to compare the effectiveness of Wii Fit exercise therapy in ankle sprain patients on temporal-spatial and kinematic gait parameters with a) conventional therapy and b) a control group not receiving exercise therapy. Ninety patients were randomly assigned to a Wii Fit, physical therapy or control group. Temporal-spatial and kinematic gait parameters were assessed at baseline, 6 weeks and 6 months follow-up. All groups improved gait speed, cadence and step length between baseline and 6-week follow-up (P<0.036). Single support time improved only in the Wii Fit group (P<0.001). Symmetry index of the single support time improved in the Wii Fit group and physical therapy group (P<0.048). No between-group differences were found for temporal-spatial gait parameters (P>0.050). Maximum plantar flexion improved in the physical therapy and control group between baseline and 6-week follow-up (P<0.035). However, none of the groups improved dorsiflexion (P>0.050). In conclusion, an unsupervised home-based 6-week Wii Fit exercise therapy can be applied in ankle sprain patients. However, it was not more effective compared to physical therapy or no exercise therapy at all.

Punt, I. M., et al. (2016). "Wii Fit exercise therapy for the rehabilitation of ankle sprains: Its effect compared with physical therapy or no functional exercises at all." Scandinavian Journal of Medicine & Science in Sports 26(7): 816-823.
	Lateral ankle sprains represent the most common sports-related injuries. The Nintendo Wii Fit could be useful in the treatment of ankle sprains. The aim of this study was to compare the effectiveness of exercise training using the Wii Fit in ankle sprain patients: (a) with physical therapy; and (b) a control group not receiving any treatment. Ninety lateral ankle sprain patients were randomized to a Wii Fit, physical therapy, or control group. We assessed the following outcome measures before, and 6 weeks after starting the allocated treatment: Foot and Ankle Ability Measure, pain during rest and walking, delay before return to sport, patient satisfaction, and effectiveness of the allocated treatment. Six weeks after the baseline measures, foot and ankle ability scores had improved in all groups, and pain had decreased during walking (P < 0.050). No between-group differences were detected between Wii Fit treatment, and both other groups (P > 0.050). In conclusion, the Wii Fit could be used as an exercise therapy to treat ankle sprain patients. However, Wii Fit was not more effective than only physical therapy, or no exercise therapy at all. Patients who did not receive treatment showed similar results as people who got any kind of exercise therapy.

Puppi, G. N., et al. (2021). "Lumbar Spine Injury-Soccer." Medicine & Science in Sports & Exercise 53(8S): 407-407.
	HISTORY: A 28-year-old male professional attacking midfielder sustained a trauma in his left lumbar region during the second half of a match in Brazil's Division 1 Soccer League. After receiving the ball, he suffered impact from the knee of an opposite's team player in his left lumbar region. The player received sideline examination, presenting with pain in the site of trauma and mild pain during flexion of the spine; the remaining physical examination showed no other abnormalities. He returned to the field and played the rest of the game. In the locker room, after the match, and on the following day, before the scheduled practice, he still reported back pain. PHYSICAL EXAMINATION: Sideline examination revealed moderate tenderness to palpation of his left lumbar region. The athlete had normal sensation, reflexes and strength of his lower extremities. He presented with normal active range of motion of his spine, but mild pain on flexion. The same symptoms persisted after the game. On the next day, his clinical features were still unchanged. DIFFERENTIAL DIAGNOSIS: 1. Soft tissue contusion 2. Lumbar Vertebral Fracture 3. Acute Spondylolysis or Spondylolisthesis 4. Visceral Injury TEST AND RESULTS: Lumbar Spine Computed Tomography revealed fractures of the Left Transverse Processes of the L3 and L4 vertebrae, without any adjacent injuries. FINAL/WORKING DIAGNOSIS: Fracture of Left Transverse Processes of the L3 and L4 vertebrae. TREATMENT AND OUTCOMES: 1. Removed from activities with the rest of the group. 2. In the first week after the injury, the athlete used a brace, analgesic medication and received analgesic physical therapy, composed of electrotherapy, laser therapy and myofascial release techniques. 3. From the 2nd until the 4th week, initiated active mobility of the spine, isometric exercises for lumbar stabilization, hydrotherapy and impact free aerobic exercises. 4. From weeks 4 to 6, started strength exercises for the superior and inferior limbs, and spine. Also submitted to gradual exposition to the sporting gesture in the training field. 5. Returned to soccer practice after 40 days from the date of injury.

Puthenveettil, S., et al. (2012). "Classification of hand preshaping in persons with stroke using Linear Discriminant Analysis." Annual International Conference Of The IEEE Engineering In Medicine And Biology Society 2012: 4563-4566.
	OBJECTIVE: This study describes the analysis of hand preshaping using Linear Discriminant Analysis (LDA) to predict hand formation during reaching and grasping tasks of the hemiparetic hand, following a series of upper extremity motor intervention treatments. The purpose of this study is to use classification of hand posture as an additional tool for evaluating the effectiveness of therapies for upper extremity rehabilitation such as virtual reality (VR) therapy and conventional physical therapy. Classification error for discriminating between two objects during hand preshaping is obtained for the hemiparetic and unimpaired hands pre and post training. METHODS: Eight subjects post stroke participated in a two-week training session consisting of upper extremity motor training. Four subjects trained with interactive VR computer games and four subjects trained with clinical physical therapy procedures of similar intensity. Subjects' finger joint angles were measured during a kinematic reach to grasp test using CyberGlove(R) and arm joint angles were measured using the trackSTAR system prior to training and after training. RESULTS: The unimpaired hand of subjects preshape into the target object with greater accuracy than the hemiparetic hand as indicated by lower classification errors. Hemiparetic hand improved in preshaping accuracy and time to reach minimum error. CONCLUSION: Classification of hand preshaping may provide insight into improvements in motor performance elicited by robotically facilitated virtually simulated training sessions or conventional physical therapy.

Pyae, A., et al. (2017). "Investigating the Finnish elderly people’s user experiences in playing digital game-based skiing exercise: A usability study." Gerontechnology 16(2): 65-80.
	Elderly people's engagement in regular physical exercises is vital in old age. Digital games are promising to promote their engagement in physical exercises. The existing commercial games are not suitable for elderly people. More studies are required to undertake to investigate effective guidelines for designing digital games for elderly people. The main objective of this study is to investigate the Finnish elderly people's user experiences in playing a digital game-based exercise called 'The Skiing Game'. Furthermore, we aimed at studying the difference between elderly people's attitude towards physical and digital game-based exercises. Lastly, we intended to investigate if digital games can be an alternative solution for elderly people to exercise. We conducted a usability evaluation of the game with 21 Finnish elderly participants in Finland. The findings show that the Skiing game is a simple, easy, and user-friendly game for the elderly participants. Their in-game and post-game experiences were moderately positive. Their attitudes towards digital games were moderately negative. Flowever, their attitudes have changed more positively after the gameplay. They also showed their interests in the game, and recommend that digital games can be an effective way of exercising for them. Through participants' observation, we recommend a number of usability and game guidelines for designing digital games for elderly people. The findings from this study can help researchers and practitioners in the related areas to gain insightful knowledge about adopting and utilizing digital games for promoting elderly people's physical exercise activities.

Pyae, A., et al. (2017). "Lessons Learned from the Usability Testing of Physical Activity Games for the Elderly." EAI Endorsed Transactions on Game-Based Learning 4(13).
	In this paper, we discuss usability lessons in designing physical activity games for the elderly. Physical activity games in this study refer to game-based activity that can enhance the elderly’s experiences in doing physical exercise and improve their physical well-being. We learned these usability lessons through the usability testing of different physical activity games including commercial games as well as the games produced by the Gamified Solutions in Healthcare (GSH) project. The discussion is based on the findings from the observational study, interview, and questionnaires in the usability testing. These usability lessons are insightful and useful for our future game design and development as well as for researchers working on game usability for the elderly.

pyq, R. B. R. (2018). "Comparison of active videogames And running practices on Endothelial, Inflammatory, Cardiovascular And Metabolic Parameters in Type 1 Diabetes people." https://trialsearch.who.int/Trial2.aspx?TrialID=RBR-528pyq.
	INTERVENTION: Experimental group: 10 diabetic subjects will participate in two different sessions of physical exercise (running and active videogame ‐ 30 minutes), being controlled the parameters of heart rate, blood pressure, blood glucose, oxygen consumption and blood parameters (lipid profile, reactive protein, leukogram and glycemia ) after 24 hours. G11.427.410.568.610 G11.427.410.698.277 I03.450.642.693.930 CONDITION: C08.127.108.110 C19.246.099 Diabetes complications; Exercise‐Induced Asthma ; C19.246.099 ; C08.127.108.110 PRIMARY OUTCOME: Apresentation of the Expected outcome 1; the general hypothesis is that Active Video Games practice will present responses similar to running without severe hypoglicemia (<50 miligram per deciliter), verified by glucometer method, before, immediately after, 30 minutes after and each six hours until 24 hours. Final outcome 3, an active video game session shown a similar inflammatory response (leukogram e C‐reactive protein) 24h after session compared to a running session in young DM1 checked by blood sample (leukogram ~ 0% variation and 17% reduction after run session and 41% reduction after VGA session); Final outcome 4, an active video game session shown similar cardiovascular responses (heart rate, heart rate variability, blood pressure and double product) during and after (immediately after and after 30 min, 24 h and 48 h) compared to a running session in young DM1 verified by cardiac monitor and automatic blood pressure meter; Otherwise, with high values. Final outcome 5, an active video game session will exhibit similar metabolic responses (oxygen consumption, energy expenditure and metabolic equivalents) during and after the session (30 minutes, 24 hours and 48 hours) compared to a running session in young Diabetics Type 1, verified by direct metabolic analyzer (4.6 METs in the running session and 3.9 METs in the VGA session). Found outcome 1, the running shows up severe hypoglycemia immediately after, 30 minutes and 24 hours later verified by glucometer (170mg/dL vs 60, 56,56, 62.66, 34 e 34. Found outcome 2, the sessions presented significant increase in relation to rest, but with the session running with greater magnitude after 30 minutes after and 24 hours after (greater than >30% in relation to rest). Found outcome 5, an active video game session will present similar metabolic responses (oxygen consumption, energy expenditure and metabolic equivalents) during and after the session by analyzing 30 minutes, 24 hours and 48 hours compared to a running session. Outcome 2 for the endothelium; the Active Video Games practice will present endothelial responses similar to a running session on the treadmill with vasodilation, verified by the ultrasound method; before, 30 minutes after and 24 hours after. Outcome 3, for inflammatory responses, an active video game session will present similar inflammatory response compared to a running session after 24 hours of the session. Outcome 4, an active video game session will present cardiovascular responses similar to a running session, analyzing before, during, immediately after, 30 minutes and 24 hours after the sessions. SECONDARY OUTCOME: At endpoint 6, the motivation to practice was greater than the running session (7.7 points vs 9.5 points), analyzing by non‐numerical psychometric scale. Outcome 6, the motivation to practice will be greater in the active video game session analyzing after each session. INCLUSION CRITERIA: Were included male and female subjects Patients who regularly use insulin and do not use anceolytics; anti‐inflammatories; antibiotics and or beta‐blockers; do not have an osteo‐articular; muscular restriction; peripheral neuropathy or any involvement or complication caused by diabetes that prevents the sessions.

Qi, L. and Y. Tang (2022). "A Neural Network Approach for Chinese Sports Tourism Demand Based on Knowledge Discovery." Comput Intell Neurosci 2022: 9400742.
	With the vigorous development of the Chinese economy and people's pursuit of quality, sports activities of people pursuit are no longer limited to simple physical exercise, but a way that pursues higher-quality sports tourism. As a new industry, it cannot guarantee that sports tourism will be accepted by all people, and it will be limited by geographical, economic, time, and other conditions. The participation number of Chinese sports tourism is more concerned by organizers or operators. Predicting the participation number of sports tourism based on the knowledge discovery method is meaningful and economical work. In this paper, a variety of sports tourism data are classified by clustering method, and the categories with similar characteristics are classified. Then, the convolution and long short-term memory hybrid neural network are used to extract the spatial and temporal information of sports tourism characteristics, which completes the prediction of Chinese sports tourism categories. The research results show that the clustering method has high accuracy for the classification of sports tourism categories, and the weights occupied by the categories are relatively uniform. The ConvLSTM neural network also has obvious advantages in predicting Chinese sports tourism methods. The largest error is only 2.89%, and the correlation coefficient also reaches 0.98, which is enough to be trusted for the prediction of Chinese sports tourism categories.

Qin, H., et al. (2021). "Environmental enrichment for stroke and other non-progressive brain injury." Cochrane Database of Systematic Reviews 11(11): CD011879.
	BACKGROUND: Rehabilitation is effective for recovery after stroke and other non-progressive brain injuries but it is unclear if the rehabilitation environment itself, outside of limited therapy hours, is maximally conducive to recovery. Environmental enrichment is a relatively new concept within rehabilitation for humans. In this review, this is defined as an intervention designed to facilitate physical (motor and sensory), cognitive and social activity by the provision of equipment and organisation of a structured, stimulating environment. The environment should be designed to encourage (but not force) activities without additional specialised rehabilitation input. OBJECTIVES: To assess the effects of environmental enrichment on well-being, functional recovery, activity levels and quality of life in people who have stroke or non-progressive brain injury. SEARCH METHODS: We conducted the search on 26 October 2020. We searched the Cochrane Central Register of Controlled Trials (CENTRAL) in the Cochrane Library; MEDLINE (from 1950); Embase (from 1980); the Cumulative Index to Nursing and Allied Health Literature (CINAHL; from 1982); the Allied and Complementary Medicine Database (AMED; from 1985); PsycINFO (from 1806); the Physiotherapy Evidence Database (PEDro; from 1999); and 10 additional bibliographic databases and ongoing trial registers. SELECTION CRITERIA: We planned to include randomised controlled trials (RCTs) that compared environmental enrichment with standard services. DATA COLLECTION AND ANALYSIS: Two review authors independently assessed eligible studies, extracted data, and assessed study quality. Any disagreements were resolved through discussion with a third review author. We determined the risk of bias for the included study and performed a 'best evidence' synthesis using the GRADE approach. MAIN RESULTS: We identified one RCT, involving 53 participants with stroke, comparing environmental enrichment (which included physical, cognitive and social activities such as reading material, board and card games, gaming technology, music, artwork, and computer with Internet) with standard services in an inpatient rehabilitation setting. We excluded five studies, found two studies awaiting classification and one ongoing study which described environmental enrichment in their interventions. Of the excluded studies, three were non-RCTs and two described co-interventions with a significant component of rehabilitation. Based on the single small included RCT at high risk of bias, data are insufficient to provide any reliable indication of benefit or risk to guide clinical practice in terms of the provision of environmental enrichment. AUTHORS' CONCLUSIONS: The gap in current research should not, however, be interpreted as proof that environmental enrichment is ineffective. Further research is needed with robust study designs, such as cluster RCTs, and consistent outcome measurement evaluating the effectiveness of environmental enrichment in different settings (inpatient versus outpatient), the relative effectiveness of various components of environmental enrichment, cost-effectiveness, and safety of the intervention in people following stroke or other non-progressive brain injuries. It should be noted, however, that it is challenging to randomise or double-blind trials of environmental enrichment given the nature of the intervention.

Quadros, X., et al. (2016). "Abstracts for the 10th World Stroke Congress, 2016." International journal of stroke 11(3_suppl): 4-288.
	Objectives: Trunk training is an important component in the early stages of stroke rehabilitation. Virtual reality training is a new approach to stroke rehabilitation. Our aim was to analyse the effect of virtual reality training using Jintronix rehabilitation system in patients with stroke on sitting and reaching activities, trunk control and motor function. Methods: 26 patients with acute stroke (12+/‐6.2 days) and trunk impairments were assigned randomly either to an experimental group or to a control group. Both groups received 6 sessions of 30 mins of conventional physical therapy for 6 sessions. In addition, in each session the experimental group received an additional 30 mins of Kinect based virtual reality training using the Jintronix Rehabilitation System that included games encouraging trunk movements. The control group played computer games using a computer mouse for the additional 30 minutes. Clinical outcome measures were assessed before and after the training (Sit and Reach Test (measured in cms), Trunk impairment scale (TIS), Motor Assessment Scale (MAS)). Results: Mann‐Whitney U tests compared between‐group data since data were not normally distributed. Statistically significant improvements in TIS and MAS (p=0.001, p=0.028) did not reach clinical significance. The Sit and Reach distance for the experimental group changed significantly (p=0.009) from pre‐test median of 14.5 (11,16) to 19.5 (13,18.5) cms compared to control (15 (13,20) to 16.5 (16,24) cms) respectively. Conclusion: Kinect‐based training with the Jintronix Rehabilitation System is an effective means to augment stroke rehabilitation to improve sitting and reaching during the early phase of stroke rehabilitation.

Quemelo, P. R. V., et al. (2012). "Prevalence of sport injuries during the 53th regional games in Franca (SP), Brazil." Fisioterapia e Pesquisa 19(3): 256-260.
	
Quinn, M. (2013). "Introduction of active video gaming into the middle school curriculum as a school-based childhood obesity intervention." Journal of Pediatric Health Care 27(1): 3-12.
	School-based physical education (PE) interventions are encouraged as a recommendation to support an increase in moderate to vigorous physical therapy by modifying curricula to allow for more active time in PE class. Based on these recommendations, the goal of this project was to incorporate a video gaming system as a fitness activity into a traditional PE class to enhance the curriculum and increase student participation and active time. The sample consisted of 86 sixth-grade students at a pilot middle school. A paired samples t test was conducted to evaluate whether students (n = 82) increased their participation in PE class after the intervention. The results indicated that the postintervention students (M = 4.37, SD = .80) were significantly more active in PE class than before the intervention (M = 4.16, SD = .88, t81 = -2.27, p = .026). Significant findings included an increase in the percentage of students using the software options of Just Dance and Dance Dance Revolution before and after the intervention. Prior to implementation, the use of Just Dance was reported at 11.6%; the percentage more than doubled to 25.6% after the intervention. Similar findings were noted for Dance Dance Revolution, as pre-implementation use was reported to be 10.5% and postintervention usage was reported to be 19.8%. This project has proved to be an effective intervention to meet state and national PE standards while increasing adolescent activity as a measure to decrease the childhood obesity epidemic. The intervention also suggests that positive modeling behaviors proposed in school can encourage positive behaviors at home. Long-term efficacy and continued usage within this school and expansion to other schools and to alternate age groups warrants further investigation.

Quintas-Hijos, A., et al. (2020). "Analysis of the applicability and utility of a gamified didactics with exergames at primary schools: Qualitative findings from a natural experiment." PLoS ONE [Electronic Resource] 15(4): e0231269.
	One of the main objectives of Physical Education in elementary schools is to encourage motivation so that the subject enhances academic performance and the practice of physical exercise. Didactic research should evaluate the effectiveness of educational methods to know if they are applicable, useful, and in what sense. Exergames are digital motor games that aim to stimulate players' motor skills. Gamification refers to the use of game-based elements in nongame contexts to motivate actions. This research evaluates a gamified exergaming intervention, designed to improve children's academic performance by focusing on understanding applicability and usefulness. A natural experiment was set up in schools according to a mixed methods design. The qualitative data herein reported were collected during a natural experiment with a nonrandomized controlled design. The qualitative research design was used with field notes, an open-questions questionnaire, individual semi-structured interviews and focus group interviews. Eight teachers and 417 students took part. A content analysis was chosen as the methodological orientation. The facilitators were the realism of their didactic design and their adaptability to different educational contexts. The main barriers were the required materials and facilities. Teachers and students' attitudes were very positive, although future use was inconclusive. These findings may imply that this study is one of the few to provide positive evidence for educational gamification. The "Mechanics-Dynamics-Aesthetics" gamification model and the "Just Dance Now" exergame may be applicable and useful for didactics in Physical Education, but all the participants' suggestions need to be considered to improve teaching interventions.

Quist, M., et al. (2019). "Ineffective Homeschooling in a Child with a Learning Disability." Journal of Developmental & Behavioral Pediatrics 40(2): 152-153.
	CASE: Charles is a 10-year-old African-American male who presents to the Developmental Behavioral Pediatrics Clinic for evaluation of his learning. His primary care provider (PCP) was concerned that his developmental delays were negatively affecting his ability to engage in his homeschooling curriculum and also that his mother seemed unaware of the severity of his delays. Neuropsychological evaluation had been recommended by the PCP several times in the past, but the family declined. At one point, the PCP had considered potential child protective services (CPS) referral for medical neglect because of missed appointments and lack of follow-through on recommendations, which motivated the parent to bring him to this appointment.Medical history was significant for failure to thrive and hypotonia in infancy. Charles received physical therapy through early childhood for hypotonia and motor coordination deficits. His mother removed him from public school and initiated homeschooling in kindergarten after he suffered a dental injury at recess of which she was not notified. The current homeschooling (fourth grade) approach was described as "off and on" activities for 3 hours daily. His mother acknowledged that she struggled to get him to participate as he preferred using the computer and tablet rather than doing school work, and they also argued regularly about his impulsive eating. The patient's mother also described her own medical conditions that contributed to a high degree of stress and fatigue, which she felt made homeschooling more difficult.On examination, the patient was obese and had widely set, almond-shaped eyes; a wide-based gait; an immature pencil grasp; and a mild truncal and appendicular hypotonia. Performance on the Kaufman Brief Intelligence Test, second edition, was below average for the verbal scale (78) and low average for the nonverbal scale (89). On the Wechsler Individualized Achievement Test, third edition, he was unable to perform any multiplication, could not write his own last name (was practicing tracing at home per maternal report), and read at a below first-grade reading level (standardized scores could not be calculated). His conversations with the examiner were mainly limited to the topic of video games. He spoke in short sentences with approximately 85% intelligibility but with coordinated gaze. He appeared mentally exhausted as testing progressed.Feedback to the parent included concern for a learning disability possibly associated with a genetic condition such as Prader-Willi syndrome (because of the history of hypotonia and impulsive eating), and genetic testing was recommended. Because of Charles' difficulty accessing the homeschool curriculum, a special education evaluation through the local public school district was also recommended, but his mother resisted, stating that she felt public special education "keeps children like him down" by focusing primarily on African-American children and stigmatizing their differences.The mother does not return phone calls made 1 month later to follow-up on considering a special education evaluation, and team members raise concern about medical neglect. What would you do next?

Qurat Ul Ain, A., et al. (2022). "Role of virtual reality and active video games in motor and executive functions in cerebral palsy: A systematic review." J Pak Med Assoc 72(5): 929-934.
	OBJECTIVE: To explore current evidence on the role of virtual reality and active video games in motor and executive functions compared to conventional physical therapies in cerebral palsy patients. METHODS: The systematic review was conducted at the University Institute of Physical Therapy, Lahore, Pakistan, and comprised search on MEDLINE via PubMed, Pedro and Cochrane Central related to randomised and clinical controlled trials published from 2005 to 2020. For critical appraisal of the studies, the Pedro tool was used, while methodological quality assessment was done using the Cochrane risk of bias tool. RESULTS: Of the 15 articles reviewed, 14(93.3%) reported significant effect of virtual reality and active video games on motor functions. Critical appraisal found the quality of the studies from fair to high. Low risk was found in 4(26.7%) articles in terms of selection, 3(20%) allocation, 6(40%) detection, and 8(53.3%) had attrition bias. Unclear risk was reported in the performance and reporting bias domain in all the 15(100%) articles. CONCLUSIONS: Virtual reality games cannot be used as a substitute for therapy, but along with the conventional physical therapy, they are very effective and produce significant changes in motor functions in cerebral palsy patients. As for executive functions, more research needs to be done to determine the impact of these games at a higher level of brain.

qzm6s, R. B. R. (2012). "Physical Exercises, neuropsychiatric disturbances and Activity Daily Living performance on women with Alzheimer´s Disease." https://trialsearch.who.int/Trial2.aspx?TrialID=RBR-4qzm6s.
	INTERVENTION: E02.779.483 The intervention protocol was basically aerobics (moderate intensity over long duration) and it was composed by different types of activities that simultaneously benefited other components of functional capacity, such as flexibility (stretching), muscular resistance (specific exercises for large muscle groups and with series over 15/20 repetitions according to the volume overload), motor coordination (i.e. rhythmic activities, sequences to be completed) and balance (i.e. games and recreational motor activities with priority on changes on the gravidity center and on direction, unipodal support exercises and unexpected perturbances on systems involved on balance). The intensity previwed for the protocol was between 60 and 80% of the Maximal Heart Rate (according the age and monitored). All participants recruited were invited to participate of this research, however only 10 of them accepted to eralize the sessions of physical exercises during the 24 weeks (six months), with 3 sessions per week, and 60 minutes of duration always at the afternoon period (since 5 to 6 p.m.). The other elderlies invited to the study that did not realized the referred protocol did composed the control group and did not realized any kind of physical exercises on the period of the research. CONDITION: Aging, Alzheimer´s Disease, Physical Exercise ; G07.700.320.124 ; C10.228.140.380.100 ; F01.145.632 ; F04.096.544.504 C10.228.140.380.100 F01.145.632 F04.096.544.504 G07.700.320.124 PRIMARY OUTCOME: Cognitive Functions were evaluated by Mini‐Mental State Examination and the Neuropsychiatric Disturbances were measured by Neuropsychiatric Inventory (NPI) to verify specific domains as: hallucinations, delusions, agitation, depressive symptoms, anxiety, euphoria, apathy/indifference, disinhibition, irritability/lability, aberrant motor behavior, nighttime disturbances and appetite/eating changes Instrumental Day‐living activities were evaluated by the Pfeffer Instrumental Activities Questionnaire SECONDARY OUTCOME: It was expected the attenuation of neuropsychiatric disorders and a possible improvement in the performance of instrumental activities of daily life by improving mobility and functional components of these participants in relation to the control group ; The functional capacity was not included in this study but data were collected to monitor this parameter through the Battery Test Engines AAHPERD adapted for the elderly. INCLUSION CRITERIA: Women over 60 years with clinical diagnosis of probable Alzheimer's disease in mild to moderate stages of the disease, residents in the community with independent locomotion.

Radwan, N. L., et al. (2021). "Effect of Wii-habilitation on spatiotemporal parameters and upper limb function post-burn in children." Burns 47(4): 828-837.
	BACKGROUND: Limb burns can cause different functional disorders that greatly impact one's quality of life. AIM: The purpose of the current study was to compare the effect of Nintendo Wii sports intervention, and traditional treatment methods on spatiotemporal parameters and upper limb function post-burn in children. METHODS: Thirty children their age ranging from 7-12 years, with dominant side upper limb burn participated in the study.Vicon3-D motion analysis system and Jebsen hand function test were used to evaluate spatiotemporal parameters (movement duration, peak velocity, and time to peak velocity percentage in three functional tasks) and upper limb function respectively. The children were randomly divided into study and control groups. The study group was rehabilitated with Wii training in addition to traditional therapy, while the control group rehabilitated only with the traditional therapy program. For the study group, the games selected were Wii Bowling, Baseball, and Tennis. Both groups were trained for 60 min daily, three times/week for six weeks. The outcomes were measured pre and post the treatment period. RESULTS: The whole-time duration and peak velocity improved significantly in the study group across the hand to head task (p = 0.001, p < 0.001, respectively), hand to mouth (p = 0.001), and hand to shoulder (p < 0.001, p = 0.0018, respectively) compared with the control group. The time to peak velocity percentage was enhanced significantly in the study group (p < 0.001) than the control group in all three-measured tasks. Moreover, the Jebsen hand function test improved significantly (p < 0.001) in the study group than in the control group. CONCLUSION: Wii-habilitation could be advised as an effective tool in the rehabilitation program of children with post-burn injuries.

Rafie, F., et al. (2017). "Effect of exercise intervention on the perceptual-motor skills in adolescents with autism." Journal of Sports Medicine & Physical Fitness 57(1-2): 53-59.
	BACKGROUND: Motor skill impairment has been reported in many studies of autistic adolescents. The aim of this study was to examine the effect of selected physical exercise on Perceptual-motor skills in adolescents with autism. METHODS: Twenty adolescents with autism that were under special education in Tehran based on their Childhood Autism Rating Scale (CARS) scores and level of abilities were selected. Measurement tool was Bruininks-Oseretsky Test of Motor Proficiency (BOTMP). Selected group motor program in this study includes motor activities, games and sports for adolescents that were performed for 10 weeks. RESULTS: Results showed that selected physical exercise training has significant effects on all of the variables (P<0.001) except the speed of running and agility (P=0.61), bilateral coordination (P=0.12) and response speed (P=0.42). CONCLUSIONS: It seems that miscellaneous physical exercise programs which include ball games, delightful play and targeted play can improve perceptual-motor skills in adolescents with autism.

Rahane, P., et al. (2020). "Effectiveness of conventional physiotherapy exercises versus kinesiotaping in recreational football players with plantar fasciitis." Indian journal of forensic medicine and toxicology 14(2): 172‐178.
	Background: Plantar fasciitis is a disorder in which there is non‐inflammatory structural breakdown of the plantar fascia. It is more common in sports that involve running and long‐distance walking. Many of the literature suggest that there is 21.7 % of prevalence rate of plantar fasciitis in individuals who play sports, especially in football players who uses studs/cleats shoes. Attachment of the cleats place the foot in a dorsiflexed position throughout the stance phase of running which produces and increases pressure upon the calcaneus. This creates a pull from soft tissue attachments such as plantar fascia which further leads to disorders like plantar fasciitis which needs to be treated early and by more advanced techniques to prevent further overuse injuries. Objective: To find the effect of conventional physiotherapy exercises versus kinesiotaping in football players with plantar fasciitis. Material and Method: In this pre‐post intervention study 40 football players having plantar fasciitis were included. They were randomly divided into 2 groups with 20 individuals each. Group A was treated with conventional exercises and Group B with kinesiotaping along with conventional exercises for two weeks. After pre‐post assessment, data was analysed with help of appropriate statistical methods. Results: According to the result, in Group A and Group B there is significant difference in pain and measures of foot function index with p value < 0.0001. Conclusion: The results obtained by studying both the groups in this study suggests that in treatment of plantar fasciitis, Conventional Therapy along with Kinesiotaping is more effective than Conventional Therapy alone.

Raleigh, R., et al. (2018). "Commonwealth Games 2018 pharmacy." Journal of Pharmacy Practice and Research 48(5): 478-482.
	The article focuses on the pharmacy for Gold Coast 2018 Commonwealth Games (GC2018) organized by Gold Coast 2018 Commonwealth Games Corporation (GOLDOC), Australia. Topics discussed include face-to-face training sessions to volunteer pharmacists, exemptions for medical practitioners as per Major Events Act 2014 and Australian Sports Anti-doping Authority (ASADA), and chart on challenges of polyclinic pharmacy.

Ramirez-Granizo, I. A., et al. (2020). "The Effect of Physical Activity and the Use of Active Video Games: Exergames in Children and Adolescents: A Systematic Review." International Journal of Environmental Research & Public Health [Electronic Resource] 17(12): 14.
	The aim of this study is to develop a systematic review on the relationship between the use of active video games "exergames" and the practice of physical activity. The Web of Science (WOS) repository was used as the main search engine, using as criteria the selection of longitudinal and experimental studies published in the last five years. A total of eight research papers were obtained, in which intervention programs based on the use of exergames were applied to improve different parameters, such as adherence to Physical Activity practice or improvement on a psychological level. As the main findings, it was possible to observe the need to include these types of devices in the classroom since they can work transversally across much content, and the resources are so accessible that they allow improvements at academic level. Likewise, they favor motivation to physical exercise since with adequate volume and intensity parameters, they are related to healthier lifestyles, and the areas of motor skills and logical thinking benefited the most.

Ramkumar, P. N., et al. (2019). "Epidemiology and Impact of Prior Musculoskeletal Injury and Orthopaedic Surgery on Draft Rank, Availability, and Short-term Performance in Major League Baseball: A Summary Analysis and Matched Cohort of 1890 Predraft Players." Orthop J Sports Med 7(5): 2325967119844268.
	BACKGROUND: Despite the many reports of injury rates in Major League Baseball (MLB), little is known about the epidemiology or impact of prior musculoskeletal injuries and surgical procedures among players entering the MLB draft. PURPOSE: To determine the (1) epidemiology of all musculoskeletal injuries and surgical procedures among players entering the MLB draft, (2) impact of injury or surgery on draft rank, (3) impact of injury or surgery on availability within the first 2 years of play in the MLB, and (4) impact of injury or surgery on performance. STUDY DESIGN: Cohort study; Level of evidence, 3. METHODS: We retrospectively reviewed 1890 medical records that were completed by MLB team physicians as preparticipation physical assessment prior to the draft from 2014 to 2018. Players were divided into 3 groups: noninjured, nonoperative, and operative. Draft status, overall draft rank, missed games, batting average, and earned run average for the first 2 seasons of MLB play were obtained for all available players. Players across all 3 groups were compared with linear, logistic, and beta regression models, controlling for age, position, injury status, and draft rank. Unadjusted differences among groups were assessed with 1-way analysis of variance. RESULTS: Overall, 750 position players and 1140 pitchers were included, of whom 22.8% had no reported injury history; 48.8% reported injury treated nonoperatively; and 28.5% were treated operatively. The most common predraft injuries were elbow tendinitis (n = 312), ulnar collateral ligament injury (n = 212), and shoulder labral tear (n = 76). The most common predraft treatments were physical therapy (n = 922), ulnar collateral ligament reconstruction (n = 115), and fracture fixation (n = 69). Of the 1890 players, 719 were drafted and played for at least 2 years. No difference was found among noninjured, nonoperative, and operative groups in terms of draft rank, games missed, or performance. Players with a nonoperative injury had a decreased odds ratio of being drafted (0.738; P = .017). CONCLUSION: More than half of the players entering the MLB reported a history of musculoskeletal injury requiring treatment, and the most commonly affected joints were the shoulder and elbow. Musculoskeletal history did not affect draft rank, short-term availability, or performance for MLB prospects.

Ramkumar, P. N., et al. (2019). "The Impact of Prior Musculoskeletal Injury and Orthopaedic Surgery on Draft Position, Availability, and Performance in Major League Baseball: A Summative Analysis of 1,890 Predraft Players." Orthopaedic Journal of Sports Medicine 7(7_suppl5): 1-1.
	Objectives: Despite the value to future coaches, franchise management, and medical personnel, little is known about the epidemiology of musculoskeletal injuries and surgeries and their future impact prior to the MLB draft. The purpose of this study was to determine the (1) epidemiology of all musculoskeletal injuries and surgeries for predraft MLB players; (2) risk of injury or surgery on draft position; (3) risk of injury or surgery on availability within the first two years; and (4) risk of injury or surgery on performance. Methods: A total of 1,890 medical records conducted by MLB team physicians prior to the draft were retrospectively reviewed from 2014 to 2018. Players were divided into three groups: non-injured (no musculoskeletal history), non-operative (previously injured but treated non-operatively), and operative (previous injury requiring surgery). Game statistics, including draft round, missed games, batting average (BA), and earned run average (ERA) for the first 2 seasons of MLB play were obtained for all available players, Players were matched for position, and confounders were analyzed for age, draft round using ANOVA analysis. Results: A total of 927 pitchers and 963 position players were evaluated, and 38.9% had no reported injury history, 48.6% reported injury but were treated non-operatively, and 12.4% were treated operatively. The most common pre-draft injuries were elbow tendonitis (n=312), UCL injury (n=212), and shoulder labral tear (n=76). The most common pre-draft treatments were physical therapy (922, 25.3%), UCL reconstruction (115, 3.2%), and fracture fixation (69, 1.9%). No difference was found between non-injured, non-operative, and operative groups in terms of draft position, games missed, and performance (BA for position players, p = 0.7246; ERA for pitchers, p=0.1956). After position matching, age and draft round were non-confounding. Conclusion: More than half of players entering the MLB report a musculoskeletal injury requiring treatment, with the most common pathology involves the shoulder and elbow. After position matching and analyzing for confounding factors like age and draft round, musculoskeletal history did not macroscopically impact draft position, short-term availability, or performance.

Ramnath, U., et al. (2021). "Efficacy of interactive video gaming in older adults with memory complaints: A cluster-randomized exercise intervention." PLoS ONE [Electronic Resource] 16(5): e0252016.
	PURPOSE: The effects of aging on physical and mental health may be ameliorated by regular participation in physical activity (PA). There is also evidence for the benefits of various training modalities on cognition and functional ability in older adults. The aim of this study was to compare effects of a 12-week active video gaming intervention (X Box Kinect Sports) to conventional multimodal supervised exercise on fitness, functional ability and cognitive performance in older adults with memory complaints. METHODS: Participants (n = 45, 72+/-5 yrs.) were recruited from 6 retirement homes and cluster-randomized into the Interactive Video Gaming (IVG) group (N = 23) or Conventional Multimodal (CM) group (N = 22), meeting 2 x 1 hour sessions, weekly for 12 weeks. Pre-post measures included: 6 min walk, timed up and go, dynamic balance, functional reach, Mini-Mental State Examination, N-back Task and the Modified Stroop task. RESULTS: The IVG group demonstrated significant improvement in the total number correct responses on the Stroop task (P = 0.028) and for average reaction time of correct colour-words (P = 0.024), compared to the CM group. Functional ability improved significantly in the IVG group, including the 6-min walk (P = 0.017), dynamic balance (P = 0.03), timed up and go (P<0.001) and functional reach (P<0.0010). CONCLUSION: An active interactive video gaming intervention was more effective than conventional multimodal exercise in improving executive and global cognitive performance and functional capacity in older adults with subjective memory complaints. TRIAL REGISTRATION: Pan African Clinical Trial Registry-PACTR202008547335106.

Randolph, A. M. (2012). Analysis of the Effectiveness of a Preseason Strength and Conditioning Program for Collegiate Men's and Women's Lacrosse, Lindenwood University: 207 p-207 p.
	Lacrosse participation in recent years has experienced tremendous growth. Though lacrosse has been documented as the oldest team sport in North America, lack of research exists regarding appropriate strength and conditioning systems for the sport. Therefore, the purpose of this study was to investigate the effectiveness of two lacrosse-specific preseason strength and conditioning programs offered to NCAA DII men's and women's lacrosse players. This synthesizes literature covering lacrosse's past; lacrosse's current status; differences in play between men's and women's lacrosse; physiological profiles of male and female lacrosse athletes; injury prevalence in both genders; and the various strength training and conditioning programs offered to lacrosse players of both genders that have been published to date. Performance testing data was collected from the head strength coach at three different testing intervals, and these secondary data underwent a statistical analysis in order to determine whether or not the strength and conditioning programs increased lacrosse-specific performance abilities.The results of this study indicate that each strength and conditioning program increased the performance of male and female lacrosse athletes as measured by a timed 40-yard dash, timed 5-10-5 agility drill, vertical jump measured in inches, 1 rep max bench press measured in pounds, and 1 rep max squat measured in pounds. The increases in performance were similar for both male and female athletes. The results are not broadly generalizable, as other performance testing parameters exist that are more specific to the game of lacrosse than those used by the strength coach in this study. Lastly, this study does not examine any effect that the strength and conditioning programs may have had on injury prevention.

Ranelli, S., et al. (2014). "Soreness during non-music activities is associated with playing-related musculoskeletal problems: an observational study of 731 child and adolescent instrumentalists." J Physiother 60(2): 102-108.
	QUESTION: Is exposure to non-music-related activities associated with playing-related musculoskeletal problems in young instrumentalists? Is non-music-activity-related soreness associated with playing-related musculoskeletal problems in this group of instrumentalists? DESIGN: Observational study using a questionnaire and physical measures. PARTICIPANTS: 859 instrumentalists aged 7 to 17 years from the School of Instrumental Music program. RESULTS: Of the 731 respondents who completed the questionnaire adequately, 412 (56%) experienced instrument-playing problems; 219 (30%) had symptoms severe enough to interfere with normal playing. Children commonly reported moderate exposure to non-music-related activities, such as watching television (61%), vigorous physical activity (57%), writing (51%) and computer use (45%). Greater exposure to any non-music activity was not associated with playing problems, with odds ratios ranging from 1.01 (95% CI 0.7 to 1.5) for watching television to 2.08 (95% CI 0.5 to 3.3) for intensive hand activities. Four hundred and seventy eight (65%) children reported soreness related to non-music activities, such as vigorous physical activity (52%), writing (40%), computer use (28%), intensive hand activities (22%), electronic game use (17%) and watching television (15%). Non-music-activity-related soreness was significantly associated with instrument playing problems, adjusting for gender and age, with odds ratios ranging from 2.6 (95% CI 1.7 to 3.9) for soreness whilst watching television, to 4.3 (95% CI 2.6 to 7.1) for soreness during intensive hand activities. CONCLUSION: Non-music-activity-related soreness co-occurs significantly with playing problems in young instrumentalists. The finding of significant co-occurrence of music and non-music-related soreness in respondents in this study suggests that intervention targets for young instrumentalists could include risk factors previously identified in the general child and adolescent population, as well as music-specific risk factors. This is an important consideration for the assessment and management of the musculoskeletal health of young musicians.

Rapello, F., et al. (2019). "Injuries surveillance in Brazilian male elite youth soccer athletes: a retrospective study...Third World Congress of Sports Physical Therapy, October 4-5, 2019, Vancouver, Canada." International Journal of Sports Physical Therapy 14(6): S5-S5.
	Objective: To describe the injury incidence in an elite youth male soccer team over a season. Methods: A retrospective analysis of 2018 injuries data of 246 Brazilian elite male youth soccer athletes were performed. The athletes were divided in two groups: under 11 to under 15 (group A, n=149) and under 17 to under 20 (group B, n=107). Descriptive and Chi-Square statistical analysis were used to characterize the sample and compare groups A and B. Results: A total of one hundred and eleven injuries were recorded over the season. Athletes of group A had ten trauma injuries, eighteen non-contact acute injuries and thirteen overuse injuries. In group B, twenty-five athletes had trauma injuries, twenty-five had non-contact acute injuries and twenty had overuse injuries, with significant differences between groups for all types of injuries (p=0.01, p=0.17 and p=0.19 respectively). Eighty-eight training injuries and twenty-one during game injuries were identified, but only during game injuries showed differences between groups (p=0.01). Hip, knee and overuse injuries were more frequent in artificial grass field compared to natural grass field (p=0.01) in both groups. Athletes of group A had an injury-time loss of ten days, while group B had twenty-four days of absence. Conclusion: Elite youth soccer athletes under 17 to under 20 had suffered more total and during game injuries, and more injury-days loss than under 11 to under 15 players. Moreover, hip, knee and overuse injuries were more frequent on artificial grass field in both groups. Clinical implications: this research shows injury incidence in elite youth soccer players and can contribute to future researches in analysis and development of injuries risk patterns and preventive programs for these athletes.

Rathinam, C., et al. (2019). "Effectiveness of virtual reality in the treatment of hand function in children with cerebral palsy: A systematic review." Journal of Hand Therapy 32(4): 426-434 e421.
	STUDY DESIGN: Systematic review. INTRODUCTION: Children with cerebral palsy (CP) may have limited use of their hands for functional activities and for fine motor skills. Virtual reality (VR) is a relatively new and innovative approach to facilitate hand function in children with CP. PURPOSE OF THE STUDY: The primary purpose of this study was to determine the effectiveness of VR as an intervention to improve hand function in children with CP compared to either conventional physiotherapy or other therapeutic interventions. The secondary purpose was to classify the outcomes evaluated according to the International Classification of Functioning, Disability and Health (ICF) dimensions. METHODS: A International prospective register of systematic reviews (PROSPERO)-registered literature search was carried out in August 2015 in MEDLINE, CINAHL, ERIC, HealthSTAR, AMED, BNI, Embase, PsycINFO, PEDro, Cochrane Central Register, DARE, OTSeeker, REHABDATA, HaPI, CIRRIE, and Scopus. PRISMA guidelines were followed. Only randomized controlled trials (RCTs) were included, and their methodological qualities were examined using the Cochrane collaboration's risk of bias (RoB) tool. A narrative synthesis was performed. RESULTS: The 6 RCTs published on this topic provide conflicting results. Four studies reported improved hand function (2 low RoB, 1 high RoB, and 1 unclear RoB), whereas 2 studies reported no improvement. All of the RCTs reported the activity element of ICF, but no study explicitly described the effect of VR intervention based on the ICF model. CONCLUSION: The role of VR ti imrpove hand fucntion in children with CP is unclear due to limited evidence; use as an adjunct has some support.

Ray, U. S., et al. (2001). "Aerobic capacity & perceived exertion after practice of Hatha yogic exercises." Indian Journal of Medical Research 114(DEC.): 215-221.
	BACKGROUND & OBJECTIVES: Reports on the effect of yogic exercises on aerobic capacity are few. There is also no literature available on the effect of yogic exercise on perceived exertion (PE) after maximal exercise. In this study the effect of training in Hatha yogic exercises on aerobic capacity and PE after maximal exercise was observed. METHODS: Forty men from the Indian army (aged 19-23 yr) were administered maximal exercise on a bicycle ergometer in a graded work load protocol. The oxygen consumption, carbon dioxide output, pulmonary ventilation, respiratory rate, heart rate (HR) etc., at maximal exercise and PE score immediately thereafter were recorded. The subjects were divided into two equal groups. Twelve subjects dropped out during the course of study. One group (yoga, n = 17) practiced Hatha yogic exercises for 1 h every morning (6 days in a week) for six months. The other group (PT, n = 11) underwent conventional physical exercise training during the same period. Both groups participated daily in different games for 1 h in the afternoon. In the 7th month, tests for maximal oxygen consumption (VO2Max) and PE were repeated on both groups of subjects. RESULTS: Absolute value of VO2Max increased significantly (P < 0.05) in the yoga group after 6 months of training. The PE score after maximal exercise decreased significantly (P < 0.001) in the yoga group after 6 months but the PT group showed no change. INTERPRETATION & CONCLUSION: The practice of Hatha yogic exercises along with games helps to improve aerobic capacity like the practice of conventional exercises (PT) along with games. The yoga group performed better than the PT group in terms of lower PE after exhaustive exercise.

Raywood, E., et al. (2020). "Protocol for Project Fizzyo, an analytic longitudinal observational cohort study of physiotherapy for children and young people with cystic fibrosis, with interrupted time-series design." BMJ Open 10(10): e039587.
	INTRODUCTION: Daily physiotherapy is believed to mitigate the progression of cystic fibrosis (CF) lung disease. However, physiotherapy airway clearance techniques (ACTs) are burdensome and the evidence guiding practice remains weak. This paper describes the protocol for Project Fizzyo, which uses innovative technology and analysis methods to remotely capture longitudinal daily data from physiotherapy treatments to measure adherence and prospectively evaluate associations with clinical outcomes. METHODS AND ANALYSIS: A cohort of 145 children and young people with CF aged 6-16 years were recruited. Each participant will record their usual physiotherapy sessions daily for 16 months, using remote monitoring sensors: (1) a bespoke ACT sensor, inserted into their usual ACT device and (2) a Fitbit Alta HR activity tracker. Real-time breath pressure during ACTs, and heart rate and daily step counts (Fitbit) are synced using specific software applications. An interrupted time-series design will facilitate evaluation of ACT interventions (feedback and ACT-driven gaming). Baseline, mid and endpoint assessments of spirometry, exercise capacity and quality of life and longitudinal clinical record data will also be collected.This large dataset will be analysed in R using big data analytics approaches. Distinct ACT and physical activity adherence profiles will be identified, using cluster analysis to define groups of individuals based on measured characteristics and any relationships to clinical profiles assessed. Changes in adherence to physiotherapy over time or in relation to ACT interventions will be quantified and evaluated in relation to clinical outcomes. ETHICS AND DISSEMINATION: Ethical approval for this study (IRAS: 228625) was granted by the London-Brighton and Sussex NREC (18/LO/1038). Findings will be disseminated via peer-reviewed publications, at conferences and via CF clinical networks. The statistical code will be published in the Fizzyo GitHub repository and the dataset stored in the Great Ormond Street Hospital Digital Research Environment. TRIAL REGISTRATION NUMBER: ISRCTN51624752; Pre-results.

Reilly, C. A., et al. (2021). "Virtual reality-based physical therapy for patients with lower extremity injuries: feasibility and acceptability." OTA International : The Open Access Journal of Orthopaedic Trauma 4(2): e132.
	INTRODUCTION: Traditional physical therapy (PT) requires patients to attend weekly in-office supervised physical therapy appointments. However, between 50% and 70% of patients who would benefit do not receive prescribed PT due to barriers to access. Virtual Reality (VR) provides a platform for remote delivery of PT to address these access barriers. METHODS: We developed a VR-PT program consisting of training, games, and a progress dashboard for 3 common lower extremity physical therapy exercises. We enrolled orthopaedic trauma patients with lower extremity injuries. Patients completed a VR-PT session, consisting of training and one of the exercise-based games. Pre- and post-VR-PT questionnaires were completed. RESULTS: We enrolled 15 patients with an average age of 51 years. Fourteen patients said they would enroll in a randomized trial in which they had a 50% chance of receiving VR-PT vs receiving standard of care. When asked to rate their experience using the VR-PT module on a scale from 0-10-with 0 being anchored as "I hated it" and 10 being anchored as "I loved it"-the average rating was 7.5. Patients rated the acceptability of VR-PT as a 3.9 out of 5, the feasibility as a 4.0 out of 5, and the usability as a 67.5 out of 100. CONCLUSION: The response to VR-PT in this pilot study was positive overall. A VR-based PT program may add value for both patients and clinicians in terms of objective data collection (to aid in compliance monitoring, progression toward goals and exercise safety), increased engagement and increased access.

Reinthal, A., et al. (2012). "ENGAGE: Guided Activity-Based Gaming in Neurorehabilitation after Stroke: A Pilot Study." Stroke Res Treat 2012: 784232.
	Introduction. Stroke is a leading cause of disability in healthy adults. The purpose of this pilot study was to assess the feasibility and outcomes of a novel video gaming repetitive practice paradigm, (ENGAGE) enhanced neurorehabilitation: guided activity-based gaming exercise. Methods. Sixteen individuals at least three months after stroke served as participants. All participants received concurrent outpatient therapy or took part in a stroke exercise class and completed at least 500 minutes of gaming. Primary baseline and posttest outcome measures included the Wolf motor function test (WMFT) and the Fugl-Meyer assessment (FMA). ENGAGE uses a game selection algorithm providing focused, graded activity-based repetitive practice that is highly individualized and directed. The Wilcoxon signed ranks test was used to determine statistical significance. Results. There were improvements in the WMFT (P = 0.003) and the FMA (P = 0.002) that exceeded established values of minimal clinically important difference. Conclusions. ENGAGE was feasible and an effective adjunct to concurrent therapy after stroke.

Ren, Z. and J. Wu (2019). "The Effect of Virtual Reality Games on the Gross Motor Skills of Children with Cerebral Palsy: A Meta-Analysis of Randomized Controlled Trials." International Journal of Environmental Research & Public Health [Electronic Resource] 16(20).
	This review aimed to systematically evaluate the rehabilitatitive effect of Virtual Reality Games (VRGs) for gross motor skills of children with cerebral palsy (CP), and to give scientific grounds for the formulation of rehabilitation therapy for these children. To this end, the literature in Chinese databases (CNKI and Wanfang Data) as well as the databases of other countries (Web of Science, PubMed, EBSCOhost, Informit, Scopus, Science Direct and ProQuest) from the establishment dates of these databases to June 3rd 2019 was retrieved in order to collect randomized controlled trials with regard to the intervention effect of VRGs and traditional therapy on gross motor skills of children with CP, and the literature was screened as per inclusion and exclusion criteria. The PEDro scale was then used to evaluate the methodological quality of the included literature, and the software Review Manager 5.3 was employed to analyze the combined effect size. As a result, 7 randomized controlled trials and 234 children with CP were included. Meta-analysis showed that VRGs could improve gross motor skills of children with CP. Combined effect size of gross motor skills SMD = 0.37 [95% CI = (0.06, 0.68), p = 0.02)]. In conclusion, the VRG intervention program can enhance gross motor skills of children with CP to some extent. In view of the limitations regarding methodologies and the quality and quantity of the literature in this research, more quality randomized controlled trials are needed so as to draw convincing conclusions of effect of VRG intervention on gross motor skill development of children with CP in future studies.

Rendon, A. A. (2011). "Virtual Reality Gaming as a Tool for Rehabilitation in Physical Therapy." Dissertation/ thesis: 64 p.
	
Rendon, A. A., et al. (2012). "The effect of virtual reality gaming on dynamic balance in older adults." Age & Ageing 41(4): 549-552.
	BACKGROUND: physical therapy interventions that increase functional strength and balance have been shown to reduce falls in older adults. AIM: this study compared a virtual reality group (VRG) and a control group (CG). DESIGN: randomised controlled 6-week intervention with pre- and post-test evaluations. SETTING: outpatient geriatric orthopaedic and balance physical therapy clinic. POPULATION: forty participants were randomised into two groups. METHOD: the VRG received three different Nintendo(R) Wii FIT balance interventions three times per week for 6 weeks and the CG received no intervention. RESULTS: compared with the CG, post-intervention measurements showed significant improvements for the VRG in the 8-foot Up & Go test [median decrease of 1.0 versus -0.2 s, (P=0.038) and the Activities-specific Balance Confidence Scale (6.9 versus 1.3%) (P=0.038)]. CONCLUSION: virtual reality gaming provides clinicians with a useful tool for improving dynamic balance and balance confidence in older adults.

Ribeiro, B. C., et al. (2021). "Different physiotherapy protocols after coronary artery bypass graft surgery: A randomized controlled trial." Physiotherapy Research International 26(1): e1882.
	BACKGROUND AND PURPOSE: The aim of this study was to investigate the influence of different physiotherapy protocols on heart rate variability (HRV) and hospital length of stay in older adults undergoing coronary artery bypass graft (CABG). METHODS: Randomized controlled trial with allocation and researcher blinding and intention-to-treat analysis. Forty-eight patients undergoing CABG were randomly assigned to a control group (CG), early mobilization group (EMG), or virtual reality group (VRG). CG performed respiratory physiotherapy and metabolic exercises, the EMG performed cycle ergometer exercises and ambulation, and the VRG performed the same activities as the EMG, with the addition of two Nintendo Wii games during 3 postoperative days. The variables of heart rate variability on preoperative and fourth postoperative day, and time of discharge of hospital was analyzed. RESULTS: The VRG presented a shorter hospital length of stay (p = 0.03). The CG showed a decline in HRV from the preoperative period to fourth postoperative day on square root of the mean of the squared differences between successive RR intervals (33.18 +/- 9.89-9.74 +/- 6.88, p < 0.05), standard deviation of all RR intervals (25.48 +/- 7.50-15.23 +/- 11.27, p < 0.05), and dispersion of points perpendicular to identity line (28.26 +/- 21.6-2.73 +/- 1.31, p < 0.05). The EMG and VRG presented a higher cardiac autonomic modulation compared to the CG (p < 0.05), with improved parasympathetic activity. CONCLUSIONS: Different protocols of physiotherapy intervention affected autonomic modulation of the heart rate and hospital length of stay in patients undergoing CABG.

Ribeiro, S. O., et al. (2017). "Influence of virtual reality on postural balance and quality of life of pregnant women: controlled clinical trial randomized." Fisioterapia em Movimento 30(suppl 1): 111-120.
	Introduction: During pregnancy women undergo several transformations, which promote changes in their gravity center (GC) and can result in postural and balance changes. Objective: To evaluate the influence of Nintendo WiiFit Plus® on postural balance and quality of life of pregnant women in the third trimester. Methods: 250 pregnant women enrolled through a non-probabilistic sampling process. The sample consisted of 32 women selected according to the eligibility criteria (nulliparity; low-risk pregnancy, absence of musculoskeletal disorders or surgical procedures in the spine, pelvis, hip or knee), musculoskeletal disorders, allocated as follows: 17 pregnant women in the control group (CG) and 15 pregnant women in the experimental group (EG). The intervention was performed in 12 sessions of 30 minutes each, three times a week. Sociodemographic and obstetric data were presented as median and interquartile range (25% - 75%). A comparison of the relative values of variables before and after the exercise program was performed using the 2x2 ANOVA test (5% significance level). Results: There were no significant statistical differences in variables related to postural balance (P > 0.06) and quality of life (P > 0.13). Conclusion: The use of Nintendo WiiFit Plus games was not able to promote improvement in postural balance and quality of life of the pregnant women studied.
Introdução: Durante a gravidez as mulheres passam por várias transformações, que promovem mudanças no seu centro de gravidade (CG) e pode resultar em alterações posturais e de equilíbrio. Objetivo: Avaliar a influência da Nintendo Wii Fit Plus® no equilíbrio postural e qualidade de vida das mulheres grávidas no terceiro trimestre. Métodos: 250 gestantes cadastradas através de um processo de amostragem do tipo não-probabilística. A amostra foi composta por 32 mulheres selecionadas de acordo com os critérios de elegibilidade (nuliparas, gestação de baixo risco, ausência de disfunções musculoesqueléticas ou cirurgia na coluna vertebral, pelve, quadril ou joelho) alocadas da seguinte maneira: 17 gestantes no grupo controle (GC) e 15 gestantes no grupo experimental (GE). A intervenção foi realizada em 12 sessões de 30 minutos cada, três vezes por semana. Os dados sociodemográficos e obstétricos foram apresentados como mediana e interquartil (25% - 75%). Uma comparação entre os valores relativos das variáveis antes e depois do programa de exercícios foi realizada utilizando o teste ANOVA 2x2 (nível de significância de 5%). Resultados: A mediana gestacional e idade cronológica foram, respectivamente, 30,50 (27,2 - 32,0) anos e 28,5 (27,7 - 30,0) semanas. Não houve diferenças estatisticamente significativas nas variáveis relacionadas ao equilíbrio postural (P > 0,06) e qualidade de vida (P > 0,13). Conclusões: O uso de jogos Nintendo Wii Fit Plus não foi capaz de promover a melhora no equilíbrio e qualidade de vida das gestantes estudadas postural.

Ricklin, S., et al. (2018). "Dual-task training of children with neuromotor disorders during robot-assisted gait therapy: prerequisites of patients and influence on leg muscle activity." J Neuroeng Rehabil 15(1): 82.
	BACKGROUND: Walking in daily life is complex entailing various prerequisites such as leg strength, trunk stability or cognitive and motor dual task (DT) activities. Conventional physiotherapy can be complemented with robot-assisted gait therapy (RAGT) and exergames to enhance the number of step repetitions, feedback, motivation, and additional simultaneously performed tasks besides walking (e.g., dual-task (DT) activities). Although DT gait training leads to improvements in daily ambulation in adult patient groups, no study has evaluated RAGT with a DT exergame in children with neurological gait disorders. Therefore, we investigated children's functional and cognitive prerequisites to walk physiologically during RAGT with a DT exergame and analysed the influence of DT on leg muscle activity. METHODS: Children and adolescents (6-18 years) with neurological gait disorders completed RAGT with and without a DT exergame in this quasi-experimental study. We assessed several measures on the body function and activity domains (according to the International Classification of Functioning, Disability, and Health (ICF)) and determined whether these measures could distinguish well between children who walked physiologically during the DT RAGT or not. We measured leg muscle activity with surface electrodes to identify changes in EMG-amplitudes and -patterns. RESULTS: Twenty-one children participated (7 females, 6.5-17.3 years, Gross Motor Function Classification System (GMFCS) levels I-IV). Most activity measures distinguished significantly between participants performing the DT exergame physiologically or not with moderate to good sensitivity (0.8 </= sensitivity</=1.0) and specificity (0.5 </= specificity</=0.9). Body function measures differentiated less well. Despite that the EMG-amplitudes of key stance muscles were significantly lower during DT versus no DT exergaming, the mean activation patterns of all muscles correlated high (rho > 0.75) between the conditions. CONCLUSION: This study is the first that investigated effects of a DT exergame during RAGT in children with neurological gait disorders. Several performance measures could differentiate well between patients who walked with physiological versus compensatory movements while performing the DT exergame. While the DT exergame affected the leg muscle activity amplitudes, it did not largely affect the activity patterns of the muscles.

Righi, M., et al. (2021). "A System for Neuromotor Based Rehabilitation on a Passive Robotic Aid." Sensors 21(9): 3130.
	In the aging world population, the occurrence of neuromotor deficits arising from stroke and other medical conditions is expected to grow, demanding the design of new and more effective approaches to rehabilitation. In this paper, we show how the combination of robotic technologies with progress in exergaming methodologies may lead to the creation of new rehabilitation protocols favoring motor re-learning. To this end, we introduce the Track-Hold system for neuromotor rehabilitation based on a passive robotic arm and integrated software. A special configuration of weights on the robotic arm fully balances the weight of the patients' arm, allowing them to perform a purely neurological task, overcoming the muscular effort of similar free-hand exercises. A set of adaptive and configurable exercises are proposed to patients through a large display and a graphical user interface. Common everyday tasks are also proposed for patients to learn again the associated actions in a persistent way, thus improving life independence. A data analysis module was also designed to monitor progress and compute indices of post-stroke neurological damage and Parkinsonian-type disorders. The system was tested in the lab and in a pilot project involving five patients in the post-stroke chronic stage with partial paralysis of the right upper limb, showing encouraging preliminary results.

Rinne, P., et al. (2016). "Democratizing Neurorehabilitation: How Accessible are Low-Cost Mobile-Gaming Technologies for Self-Rehabilitation of Arm Disability in Stroke?" PLoS ONE [Electronic Resource] 11(10): e0163413.
	Motor-training software on tablets or smartphones (Apps) offer a low-cost, widely-available solution to supplement arm physiotherapy after stroke. We assessed the proportions of hemiplegic stroke patients who, with their plegic hand, could meaningfully engage with mobile-gaming devices using a range of standard control-methods, as well as by using a novel wireless grip-controller, adapted for neurodisability. We screened all newly-diagnosed hemiplegic stroke patients presenting to a stroke centre over 6 months. Subjects were compared on their ability to control a tablet or smartphone cursor using: finger-swipe, tap, joystick, screen-tilt, and an adapted handgrip. Cursor control was graded as: no movement (0); less than full-range movement (1); full-range movement (2); directed movement (3). In total, we screened 345 patients, of which 87 satisfied recruitment criteria and completed testing. The commonest reason for exclusion was cognitive impairment. Using conventional controls, the proportion of patients able to direct cursor movement was 38-48%; and to move it full-range was 55-67% (controller comparison: p>0.1). By comparison, handgrip enabled directed control in 75%, and full-range movement in 93% (controller comparison: p<0.001). This difference between controllers was most apparent amongst severely-disabled subjects, with 0% achieving directed or full-range control with conventional controls, compared to 58% and 83% achieving these two levels of movement, respectively, with handgrip. In conclusion, hand, or arm, training Apps played on conventional mobile devices are likely to be accessible only to mildly-disabled stroke patients. Technological adaptations such as grip-control can enable more severely affected subjects to engage with self-training software.

Riva, G. and C. Tuena (2021). "FRAILTY VR: VR for the Rehabilitation of Frailty in the Elderly." Cyberpsychology, behavior and social networking 24(10): 695-696.
	
Riva, S., et al. (2014). "Interactive sections of an Internet-based intervention increase empowerment of chronic back pain patients: randomized controlled trial." Journal of Medical Internet Research 16(8): e180.
	BACKGROUND: Chronic back pain (CBP) represents a significant public health problem. As one of the most common causes of disability and sick leave, there is a need to develop cost-effective ways, such as Internet-based interventions, to help empower patients to manage their disease. Research has provided evidence for the effectiveness of Internet-based interventions in many fields, but it has paid little attention to the reasons why they are effective. OBJECTIVE: This study aims to assess the impact of interactive sections of an Internet-based self-management intervention on patient empowerment, their management of the disease, and, ultimately, health outcomes. METHODS: A total of 51 patients were recruited through their health care providers and randomly assigned to either an experimental group with full access to the Internet-based intervention or a control group that was denied access to the interactive sections and knew nothing thereof. The intervention took 8 weeks. A baseline, a mid-term after 4 weeks, and a final assessment after 8 weeks measured patient empowerment, physical exercise, medication misuse, and pain burden. RESULTS: All patients completed the study. Overall, the intervention had a moderate effect (F1.52=2.83, P=.03, eta(2)=0.30, d=0.55). Compared to the control group, the availability of interactive sections significantly increased patient empowerment (midterm assessment: mean difference=+1.2, P=.03, d=0.63; final assessment: mean difference=+0.8, P=.09, d=0.44) and reduced medication misuse (midterm assessment: mean difference=-1.5, P=.04, d=0.28; final assessment: mean difference=-1.6, P=.03, d=-0.55) in the intervention group. Both the frequency of physical exercise and pain burden decreased, but to equal measures in both groups. CONCLUSIONS: Results suggest that interactive sections as part of Internet-based interventions can positively alter patients' feelings of empowerment and help prevent medication misuse. Detrimental effects were not observed. TRIAL REGISTRATION: ClinicalTrials.gov: NCT02114788; http://www.clinicaltrials.gov/ct2/show/NCT02114788 (Archived by WebCite at http://www.webcitation.org/6ROXYVoPR).

Rivera, M. J., et al. (2017). "Proprioceptive Training for the Prevention of Ankle Sprains: An Evidence-Based Review." J Athl Train 52(11): 1065-1067.
	Reference: Schiftan GS, Ross LA, Hahne AJ. The effectiveness of proprioceptive training in preventing ankle sprains in sporting populations: a systematic review and meta-analysis. J Sci Med Sport. 2015;18(3):238-244. CLINICAL QUESTION: Does the use of proprioceptive training as a sole intervention decrease the incidence of initial or recurrent ankle sprains in the athletic population? DATA SOURCES: The authors completed a comprehensive literature search of MEDLINE, CINAHL, SPORTDiscus, and Physiotherapy Evidence Database (PEDro) from inception to October 2013. The reference lists of all identified articles were manually screened to obtain additional studies. The following key words were used. Phase 1 population terms were sport*, athlet*, and a combination of the two. Phase 2 intervention terms were propriocept*, balance, neuromusc* adj5 train*, and combinations thereof. Phase 3 condition terms were ankle adj5 sprain*, sprain* adj5 ankle, and combinations thereof. STUDY SELECTION: Studies were included according to the following criteria: (1) the design was a moderate- to high-level randomized controlled trial (>4/10 on the PEDro scale), (2) the participants were physically active (regardless of previous ankle injury), (3) the intervention group received proprioceptive training only, compared with a control group that received no proprioceptive training, and (4) the rate of ankle sprains was reported as a main outcome. Search results were limited to the English language. No restrictions were placed on publication dates. DATA EXTRACTION: Two authors independently reviewed the studies for eligibility. The quality of the pertinent articles was assessed using the PEDro scale, and data were extracted to calculate the relative risk. Data extracted were number of participants, intervention, frequency, duration, follow-up period, and injury rate. MAIN RESULTS: Of the initial 345 studies screened, 7 were included in this review for a total of 3726 participants. Three analyses were conducted for proprioceptive training used (1) to prevent ankle sprains regardless of history (n = 3654), (2) to prevent recurrent ankle sprains (n = 1542), or (3) as the primary preventive measure for those without a history of ankle sprain (n = 946). Regardless of a history of ankle sprain, participants had a reduction in ankle-sprain rates (relative risk [RR] = 0.65, 95% confidence interval [CI] = 0.55, 0.77; numbers needed to treat [NNT] = 17, 95% CI = 11, 33). For individuals with a history of ankle sprains, proprioceptive training demonstrated a reduction in repeat ankle sprains (RR = 0.64, 95% CI = 0.51, 0.81; NNT = 13, 95% CI = 7, 100). Proprioceptive training as a primary preventive measure demonstrated significant results (RR = 0.57, 95% CI = 0.34, 0.97; NNT = 33, 95% CI = 16, 1000). CONCLUSIONS: Proprioceptive training programs were effective in reducing the incidence rates of ankle sprains in the athletic population, including those with and those without a history of ankle sprains.

Riviere, D. (2004). "Sport et fonctions métaboliques." Bulletin de l'Académie Nationale de Médecine 188(6): 913-922.
	RÉSUMÉ Les travaux épidémiologiques actuels mettent l’accent sur l’augmentation de la prévalence des maladies métaboliques, obésité, diabète de type II et syndrome polymétabolique de l’adulte. De manière encore plus préoccupante, la prévalence de l’obésité augmente chez l’enfant et c’est surtout la sédentarisation liée en particulier à la télévision et aux consoles de jeux vidéos plus encore que l’alimentation qui expliquerait cette très nette augmentation. De nombreuses études mettent en évidence que la pratique régulière des activités physiques et sportives apporte des bénéfices sur les différentes fonctions de l’organisme, en particulier métaboliques. Le but de cette présentation est, après avoir exposé les principaux bénéfices de l’exercice physique sur certaines anomalies métaboliques de l’adulte, de s’intéresser à la place de l’activité physique dans la prise en charge du véritable problème de santé publique que constitue l’augmentation de l’obésité infantile. SUMMARY Current epidemiological studies emphasize the increased of metabolic diseases of the adults, such as obesity, type-2 diabetes and metabolic syndromes. Even more worrying is the rising prevalence of obesity in children. It is due more to sedentariness, caused more by inactivity (television, video, games, etc.) than by overeating. Many studies have shown that regular physical activities benefit various bodily functions including metabolism. After dealing with the major benefits of physical exercise on some adult metabolic disorders, we focus on the prime role played by physical activity in combating the public health problem of childhood obesity.

rngmb, R. B. R. (2019). "Physiotherapy in the treatment of patients with Parkinson's disease through video game therapy." https://trialsearch.who.int/Trial2.aspx?TrialID=RBR-6rngmb.
	INTERVENTION: Physical Therapy Modalities Procedure/surgery The two groups in this study will be evaluated, perform 10 interventions twice a week and then reevaluated. * Experimental group will consist of 10 participants, who will receive physiotherapy intervention through virtual reality: Participants will be submitted to game therapy in which they will play the games selected by the authors in Kinect Adventure (rapids, space pop and ridge of reflexes); * Control group will consist of 10 participants, who will have the treatment performed through conventional physiotherapy: passive stretching (hip abductors and adductors, quadriceps, femoral biceps, gastrocnemius), 3 sets of 20 seconds, treadmill training for 10 minutes and active free exercise for lower limbs (hip, knee, ankle and foot) 3 sets of 10 repetitions. Virtual Reality Exposure Therapy CONDITION: G00‐G99 Parkinson Disease Parkinson´s disease ; Parkinson Disease PRIMARY OUTCOME: Evaluate the balance in the Berg scale and baropodometry, considering a significant improvement an improvement of more than 5% between the experimental groups. SECONDARY OUTCOME: To evaluate the balance in the Berg scale and baropodometry, before and after the intervention in the same experimental group. INCLUSION CRITERIA: Participants with clinical diagnosis of Parkinson's disease (ICD 10: G20); both sexes; age range between 50 and 75 years; signature of the TCLE; Have performed a physiotherapeutic review that freed him for therapy.

Robertson, J., et al. (2016). "Understanding the Importance of Context: A Qualitative Study of a Location-Based Exergame to Enhance School Childrens Physical Activity." PLoS ONE [Electronic Resource] 11(8): e0160927.
	Many public health interventions are less effective than expected in 'real life settings', yet little work is undertaken to understand the reasons why. The effectiveness of complex public health interventions can often be traced back to a robust programme theory (how and why an intervention brings about a change in outcome(s)) and assumptions that are made about the context in which it is implemented. Understanding whether effectiveness (or lack thereof) is due to the intervention or the context is hugely helpful in decisions about whether to a) modify the intervention; b) modify the context; c) stop providing the intervention. Exergames-also known as Active Video Games or AVGS-are video games which use the player's bodily movements as input and have potential to increase physical activity in children. However, the results of a recent pilot randomised controlled trial (RCT) of a location-based exergame (FitQuest) in a school setting were inconclusive; no significant effect was detected for any of the outcome measures. The aim of this study was to explore whether the programme theory for FitQuest was correct with respect to how and why it would change children's perceptions of physical activity (PA) and exercise self-efficacy in the school setting. A further aim was to investigate the features of the school setting (context) that may impact on FitQuest's implementation and effectiveness. Qualitative data (gathered during the RCT) were gathered from interviews with teachers and children, and observation of sessions using FitQuest. Thematic analysis indicated that whilst children enjoyed playing the game, engaged with goal setting within the game context and undertook low to vigorous physical activity, there were significant contextual factors that prevented it from being played as often as intended. These included environmental factors (e.g. size of the playground), school factors (cancellations due to other activities), school technology policy (rules relating to mobile phone usage) and teacher factors (engagement with the intervention). A revised logic model for the FitQuest intervention indicates how both the design of exergame technology (intervention) and features of the school environment (context) could be improved to increase chances of effectiveness in the future.

Robichaux-Edwards, L., et al. (2019). "A Rare Cooccurrence of Tillaux-Chaput and Volkmann Fracture in an Adolescent Male: A Case Report." J Orthop Case Rep 9(4): 44-47.
	INTRODUCTION: Tillaux-Chaput fractures and Volkmann fractures rarely occur together in adolescent patients despite the common occurrence of ankle injuries in adolescent athletics. This particular injury has not previously been well documented in literature. CASE REPORT: This article describes the cooccurrence of these two fracture types in a 16-year-old male who suffered significant blunt trauma during a football game resulting in a loss of consciousness and a severe left ankle injury. History and physical examination necessitated radiographs confirming a Salter-Harris IV fracture of the left distal tibial concerning for a Tillaux-Chaput fracture. Computed tomography scans were taken to confirm the full extent of the injury. These images revealed a fracture of the left distal tibia that involved the posterior tibial metaphysis extending into the tibial plafond with no significant step-off and an avulsion fracture of the anterolateral tibial epiphysis that was laterally and anteriorly displaced. CONCLUSION: The fracture was treated surgically with close follow-up and physical therapy. Due to the complexity of this injury, long-term follow-up is indicated to prevent fear of use after injury and monitor appropriate healing to lower the risk of post-traumatic arthritis.

Rocha, R. S. B., et al. (2018). "Analysis of autonomic modulation of heart rate in patients with Parkinson's disease and elderly individuals submitted to game therapy training." Geriatrics & gerontology international 18(1): 20-25.
	AIM: Elderly patients and individuals with Parkinson's disease have a reduction in autonomic heart rate modulation, which may influence the survival of these patients, and rehabilitation can minimize this event. We tested the hypothesis that rehabilitation protocol with game console would influence the cardiac autonomic modulation of patients with Parkinson's Disease. METHODS: Eight-seven volunteers were divided into two groups, control (n = 45) and Parkinson's (n = 42), they completed the study 40 volunteers in the control group (CG) and 31 patients in the Parkinson group (PG), and subjected to 24 sessions of game therapy physiotherapy, thrice a week. Analysis of autonomic HR modulation was conducted before and after the rehabilitation program using a Polar RS800CX HR sensor. For the analysis of heart rate variability the data were transferred to the Kubios HRV 2.2 program. Statistical analysis was performed in the Biostat 5.2 program, the comparison of the data by ANOVA followed by Tukey test, and the general characteristics by the chi-square test. The critical value for rejecting the null hypothesis was set at P < 0.05. RESULTS: HR variability in patients with PD exhibited higher influence on the sympathetic nervous system before protocol implementation and, following the protocol, patients did not attain the normality values of the control group, exhibiting a discreet improvement and maintenance of autonomic modulation of HR values. CONCLUSION: Subjects with PD exhibit less autonomic modulation of HR and the rehabilitation protocol with game therapy improved autonomic modulation of HR. Geriatr Gerontol Int 2018; 18: 20-25.

Roche, N. (2016). "Auto-rehabilitation at home for stroke patients." Annals of physical and rehabilitation medicine 59: e38.
	Opinion/Feedback/Introduction Stroke is the greatest cause of morbidity in industrialised countries and the third cause of mortality (50,000 deaths per year). The annual incidence is around 300 per 100,000 inhabitants, equivalent to 150,000 new cases each year in France. Around half of survivors are left with some disability as a result of multiple impairments including motor impairments with a loss of strength, stereotyped movements, and changes in muscle tone and limitations in activities. Physiotherapy is essential and helps to reduce impairment and improve activities in patients with hemiparesis. It has been shown to be effective for the treatment of motor impairment and the improvement of function following stroke. Different techniques have been developed, however studies that have compared their effectiveness have not shown that any one technique is more effective than another. Nevertheless, it has been demonstrated that the intensity, the frequency, the specificity and the duration of physiotherapy is positively correlated with recovery. This means that increasing the frequency, the specificity and the duration of physiotherapy should lead to greater improvement in impairments and functional limitations. Since few years, several studies demonstrated the interest to associate usual physiotherapy to self-rehabilitation program. To that end, several devices such as self-rehabilitation logbook, web apps and games on games consoles (Wii®; Kinect®). Objectives In this session, we will study the different supports already available, those which already demonstrated scientifically their interest and their respective limits. The national scientific program actually performed will also be briefly presented. Results To summarize, over the past 15 years, there has been an increase in the number of studies of different home-based self-rehabilitation programs. These results suggest that this type of rehabilitation in the chronic phase of stroke can be effective to prevent deterioration as well as to continue improvement and ensure a good quality of life for patients.

Rodrigues, E. V., et al. (2014). "Effects of Video Game Training on the Musculoskeletal Function of Older Adults." Topics in Geriatric Rehabilitation 30(4): 238-245.
	This systematic review and meta-analysis aimed to evaluate the effects of video game exercise training (VGET) on the musculoskeletal function of older adults. The review was carried out in the PubMed, LILACS, WEB OF SCIENCE, WEB OF KNOWLEDGE, PEDro, and Cochrane CENTRAL. Sixteen controlled clinical trials were included, and the risks of bias were measured using the JADAD scale. There was no evidence that VGET might be effective on functional mobility (standardized mean difference [SMD] = 0.23, 95% confidence interval [Cl]: -0.13 to 0.59) or on balanced self-efficacy (SMD = 0.15, 95% Cl: -0.29 to 0.60). Future randomized controlled trials with greater methodological rigor, focusing on the parameters used to prescribe the exercises, are necessary.

Rodrigues, J., et al. (2020). "Immersive Environment for Occupational Therapy: Pilot Study." Information 11(9): 405.
	There has been increasing interest in the application of virtual reality (VR) to occupational therapy and rehabilitation fields. This work presents a VR-based city adventure framework designed for occupational therapy. Its concept is based on taking the user to travel around a virtual city, where the motion is powered by the execution of some type of physical exercise, namely cycling in the current example. This framework is extensible and may integrate different goals focused on improving/maintaining motor and cognitive skills necessary for daily activities, mainly through upper and lower limb exercises and mental challenges. This led to the development of an immersive system, which was tested with an elderly sample (15 participants) in a day center and at a retirement home. Usability, satisfaction, performance and side effects were evaluated to understand future applicability and work directions.

Rodriguez Hernandez, J., et al. (2020). "ESO-WSO 2020 Joint Meeting Abstracts." International journal of stroke 15(1_suppl): 3-752.
	Background and Aims: Background: The global burden of stroke is increasing representing an important public health problem and the second cause of death, worldwide. The clinical manifestations of stroke differ according to the location of the injury. Scope for the use of video games is their ability to produce a plastic reorganization of the central nervous system. Commercial video games adapted to neurological patients with functional deficits can promote motivation, self‐esteem and patient adherence to interventions. Aim. Determine the effects of a structured protocol based on commercial video games, on balance, postural control, functionality and motivation outcomes in patients with subacute stroke Methods: A randomized controlled trial was conducted. A control group (n=25) received eight weeks of conventional rehabilitation consisting of five weekly sessions comprising 45 minutes of physical therapy and 45 minutes of occupational therapy, oriented to motor training. The experimental group (n=23) received conventional rehabilitation + semi‐immersive virtual reality treatment during eight weeks. We used commercial video games using the Xbox 360° video games and the KinectÒ device. Results: In the between‐groups comparison, statistically significant differences were observed in the Modified Rankin scores (p<.01) In the experimental group, significant differences were found in the baropodometry (p<.01). Regarding the scale of motivation statistically significant differences were achieved in motivation (p<.01), self‐esteem (p<.01) and adherence (p<.01) variables Conclusions: A protocol of semi‐immersive structured virtual reality protocol using commercial video games, combined with conventional therapy, led to improvements of balance, postural control, functionality, level of motivation, adherence, and satisfaction in patients with subacute stroke.

Rogers, C., et al. (2021). "Older Adults’ Experience of an Exergaming Intervention to Improve Balance and Prevent Falls: A Nested Explanatory Qualitative Study." Applied Sciences 11(24): 11678.
	Falls are frequent and life-changing events for older adults worldwide. The ageing phenomenon has arrived in developing countries, which experience tensions between curative and rehabilitative services, combined with an increase in non-communicable diseases. Policies addressing issues of ageing have been poorly implemented, and there are few fall prevention initiatives. Compelling evidence from the Global North supports exercise-based interventions to improve balance and reduce fall risk in older adults. More recently, attention has focused on interactive videogaming, known as exergames, as a novel way to manage fall risk with exercise. Commercially available exergames have inherent appeal for low- and middle-income country contexts, where rehabilitation professionals and resources are scanty. The aim of this study was to explore the feasibility of a large-scale randomized control trial comparing an exergaming intervention with the gold-standard Otago Exercise Programme and a no-intervention arm. Exercise adherence was poor in both intervention arms, and this prompted a shift to mixed methodology to explore the construct of falls and participants’ experience of the exergaming intervention. Focus groups were conducted, and the results were analysed using content analysis. Whereas the results demonstrated improvements in physical outcome measures (e.g., Timed-Up-and-Go, MiniBESTest) related to balance and falls that were encouraging in both the gold-standard and exergaming intervention groups, few participants achieved optimal adherence. Attitudes toward falls and fall prevention were explored, as well as participants’ experiences of the exergaming programme. Consistent with a developing country context, participants acknowledged both intrinsic and extrinsic fall risk factors. Exergaming participants enjoyed the fun and playful aspects of the exercise programme, yet these were not sufficient to maximize adherence. The focus groups described the barriers and facilitators to participation, which included motivation. The focus groups discussed strategies to enhance participation, and these are discussed in the context of exergaming.

Rogers, D. (1993). "Student Physiotherapists' Experiences at the World Student Games." Physiotherapy 79(11): 785-786.
	Followlng a successful application to join the Great Britain team attending the World Student Games as a student physiotherapist, Davld Rogers from the Queen Ellzabeth School of Physiotherapy, Blrmlngham, and Helen Frank from Leeds Physlotherapy School, attended the World Student Games In Buffalo, USA, In July 1993. Here Is an account of David's experlenees at the games.

Rogers, J. M., et al. (2019). "Elements virtual rehabilitation improves motor, cognitive, and functional outcomes in adult stroke: evidence from a randomized controlled pilot study." J Neuroeng Rehabil 16(1): 56.
	BACKGROUND: Virtual reality technologies show potential as effective rehabilitation tools following neuro-trauma. In particular, the Elements system, involving customized surface computing and tangible interfaces, produces strong treatment effects for upper-limb and cognitive function following traumatic brain injury. The present study evaluated the efficacy of Elements as a virtual rehabilitation approach for stroke survivors. METHODS: Twenty-one adults (42-94 years old) with sub-acute stroke were randomized to four weeks of Elements virtual rehabilitation (three weekly 30-40 min sessions) combined with treatment as usual (conventional occupational and physiotherapy) or to treatment as usual alone. Upper-limb skill (Box and Blocks Test), cognition (Montreal Cognitive Assessment and selected CogState subtests), and everyday participation (Neurobehavioral Functioning Inventory) were examined before and after inpatient training, and one-month later. RESULTS: Effect sizes for the experimental group (d = 1.05-2.51) were larger compared with controls (d = 0.11-0.86), with Elements training showing statistically greater improvements in motor function of the most affected hand (p = 0.008), and general intellectual status and executive function (p </= 0.001). Proportional recovery was two- to three-fold greater than control participants, with superior transfer to everyday motor, cognitive, and communication behaviors. All gains were maintained at follow-up. CONCLUSION: A course of Elements virtual rehabilitation using goal-directed and exploratory upper-limb movement tasks facilitates both motor and cognitive recovery after stroke. The magnitude of training effects, maintenance of gains at follow-up, and generalization to daily activities provide compelling preliminary evidence of the power of virtual rehabilitation when applied in a targeted and principled manner. TRIAL REGISTRATION: this pilot study was not registered.

Rogers, Y. and S. Price (2009). How Mobile Technologies Are Changing the Way Children Learn. Mobile Technology for Children. A. Druin. Boston, Morgan Kaufmann: 1-22.
	Publisher Summary This chapter describes how mobile technologies are transforming learning in children. Several researchers have suggested that the world is entering a new era of technology-enhanced learning, characterized as mobile learning, seamless learning, and ubiquitous learning. Central to these notions is the idea that mobile technologies can be designed to enable children to move in and out of overlapping physical, digital, and communicative spaces. It is assumed that mobile technologies provide continuity across various learning experiences, enabling children to make connections between what they are observing, collecting, accessing, and thinking about over time, place, and people. There is an ongoing debate about how this kind of mobile learning can encourage new forms of social interaction, thinking, or reflection. Several researchers have sought to explain the principles behind mobile learning. Some have proposed existing learning theories, such as constructivism; others have suggested that new theories are needed. A number of mobile applications and tools have been developed to augment learning. These can be classified into four types: physical exercise games, participatory simulations, field trips and visits, and content creation. A review of the literature on mobile learning reveals three main benefits of mobile learning, as compared with the sedentary PC-based learning. First, using mobile devices in the wild can be highly motivating, increasing children's engagement with their learning. Second, being mobile while learning can encourage children to participate more, facilitating a diversity of key social and cognitive processes. Third, it offers quite different forms of information flow and information management compared with the conventional use of PCs, enabling children to better integrate their ideas and knowledge with ongoing physical activities.

Roovers, J. (2016). "Serious game-enhanced biofeedback supported self-management versus pelvic physiotherapy in women with mild to moderate stress urinary incontinence - a multinational, non-blinded randomized controlled trial." Http://www.trialregister.nl/trialreg/admin/rctview.asp? TC=5838.
	
Rosa, J. P. P., et al. (2022). "Are exergames an option to cope with sleep disorders during the COVID-19 outbreak?" Sleep Science 15(Spec 2): 393-397.
	During the COVID-19 pandemic, factors related to the isolation and quarantine period increased psychobiological distress in the general population around the world, increasing anxiety, emotional stress, and depression, as well as worsening of the quality of sleep. Seeking alternatives to provide support for the implementation of some interventions for well-being and health under pandemic conditions, exergames (active video games) seem to be a feasible alternative to keep people physically active and to positively impact sleep health. In this overview article, we discussed the feasibility of exergames as an option to cope with sleep disorders and improve sleep quality during the COVID-19 outbreak through increasing physical exercise and physical fitness levels.

Rowland, J. L., et al. (2016). "Perspectives on Active Video Gaming as a New Frontier in Accessible Physical Activity for Youth With Physical Disabilities." Physical Therapy 96(4): 521-532.
	This perspective article explores the utility of active video gaming as a means of reducing sedentary behavior and increasing physical activity among youth with physical disabilities and limitations in lower extremity function who typically are excluded from mainstream exercise options. Youth with physical disabilities are disproportionately affected by health problems that result from sedentary behavior, lack of physical activity, and low fitness levels. Physical, programmatic, and attitudinal barriers have a synergistic and compounded impact on youths' ability to participate in physical activity. A recent health and wellness task force recommendation from the American Physical Therapy Association's Section on Pediatrics supports analyzing individualized health behaviors and preferences that are designed to improve fitness, physical activity, and participation in pediatric rehabilitation. This recommendation represents an opportunity to explore nontraditional options to maximize effectiveness and sustainability of pediatric rehabilitation techniques for youth with disabilities who could best benefit from customized programming. One new frontier in promoting physical activity and addressing common physical activity barriers for youth with physical disabilities is active video games (AVGs), which have received growing attention as a promising strategy for promoting health and fitness in children with and without disabilities. The purpose of this article is to discuss the potential for AVGs as an accessible option to increase physical activity participation for youth with physical disabilities and limitations in lower extremity function. A conceptual model on the use of AVGs to increase physical activity participation for youth with physical disabilities is introduced, and future research potential is discussed, including a development project for game controller adaptations within the Rehabilitation Engineering Research Center on Interactive Exercise Technologies and Exercise Physiology for People With Disabilities (RERC RecTech) at the University of Alabama at Birmingham (UAB)/Lakeshore Foundation Research Collaborative.

Royer, H. and I. Yanez (2013). "Accompagnement éducatif et thérapeutique d’un petit groupe de jeunes enfants polyhandicapés présentant des difficultés visuelles." Motricité Cérébrale : Réadaptation, Neurologie du Développement 34(1): 14-24.
	Résumé Dans son projet d’intégration sociale précoce, la halte-garderie RAMDAM accueille un petit groupe de jeunes enfants polyhandicapés. Nous vous expliquerons les idées essentielles qui animent notre équipe pluridisciplinaire, puis notre approche de l’évaluation des difficultés visuelles. Nous partagerons avec vous notre expérience de l’accompagnement éducatif de ces jeunes enfants, nous décrirons les objectifs et les moyens mis en œuvre comme l’aménagement de l’espace, les installations et les activités-jeux proposés. Nous développerons l’accompagnement thérapeutique en ergothérapie, kinésithérapie et orthophonie, ainsi que l’approche du psychologue. Enfin, nous développerons quelques vignettes cliniques de jeunes enfants polyhandicapés présentant les difficultés visuelles que nous avons le plus souvent rencontrées. In the context of early social integration, the day nursery RAMDAM takes care of a small group of young polyhandicaped children. We will introduce the essential ideas that motivate us as a multidisciplinary team, along with the way we approach visual impairments evaluation. Furthermore, we will share our experience of close follow-up of those young children: we will describe the goals and means used such as spatial organization, orthopedic installations, and games which can be proposed. We will go through the therapeutic care in physiotherapy, speech-language pathology, occupational therapy as well as a psychological analysis. This article is accompanied by clinical vignettes to give a detailed description of the most common visual deficiencies we come across.

Rusakiewicz, F., et al. (2018). "Medical experience in the paralympic games in Rio 2016." Annals of physical and rehabilitation medicine 61: e77.
	Introduction/Background When paralympic means «beside» the Olympic games and the International Paralympic Committee's catchword is: «Spirit In Motion»; we wanted to report how the paralympic movement has increased during the last game. The medical team wanted therefore to present how the paralympic games in Rio were completed on their part. Material and method There were 5 sport federations united in the French team composed of 126 athletes (42 women and 84 men). They competed in 17 sports. The medical team was made up of 3 PRM doctors whose one was able to do ultrasounds and two others were sports physicians. There was also one adapted sport physician and 3 nurses. 14 Physiotherapists were split between the sports team. The medical team needed to answer all transport issues between France and Brasil depending on the impairment. They also had to bring many specific materials and organise an health space adapted to all athletes’ needs. They collected all possibly data during the games concerning each athlete. Results There were 35 orthopedic impairments, 48 neurologic impairments, 6 visual impairments and 5 cognitive impairments among the athletes. All athletes had a personal medical record reviewed by the physicians and all therapeutic use exemptions had been required. There was a daily medical and paramedical meeting. There was a medical room with a drugstore and a moblie ultrasonography apparatus, a physical therapy room with many specific equipment and a cryotherapy bath. There were mainly ENT and digestive illnesses, followed by skins disorders and urinary infections. Sports injuries were tendinopathy and musculoskeletal disorders (50 ultrasounds and one punction). They had to order 3 medical rapatriations due to acute psychiatric disorders. Conclusion All data collected bring up in-depth discussions about injury prevention and athlete's follow-up.

Russell, T. G. and A. F. Jones (2011). "Implications of regulatory requirements for smartphones, gaming consoles and other devices." J Physiother 57(1): 5-7.
	
Russell, W. D. and M. Newton (2008). "Short-Term Psychological Effects of Interactive Video Game Technology Exercise on Mood and Attention." Journal of Educational Technology & Society 11(2): 294-308.
	Recent interest in interactive video game technology (IVGT) has spurred the notion that exercise from this technology may have meaningful physiological and psychological benefits for children and adolescents. The purpose of this study was to examine the short-term psychological effects of interactive video game exercise in young adults and whether IVGT participation was capable of improving mood as has been shown for traditional forms of exercise. In addition, we were interested in comparing both actual physical exercise output and perceived exertion of that output across the exercise conditions. One-hundred and sixty-eight college students were assigned to one of three 30-minute conditions: (1) interactive video game cycle ergometer exercise, (2) regular cycle ergometer exercise, or (3) a video game-only control condition. Positive and negative mood (PANAS; Watson, Clark, & Tellegen, 1988) was assessed before and twice-after experimental conditions, and measures of actual and perceived physical exertion were collected at five-minute intervals across exercise conditions. Participants in the video-game control had higher post-activity negative affect immediately and 10-minutes post activity than either exercise group. In addition, exercise condition participants had higher positive mood at 10-minutes post activity compared to the video game control participants. Results do not support IVGT mood benefits over other forms of exercise, but do support immediate affective benefits of exercise compared to sedentary activity. It is concluded that while there is potential for interactive video-game based applications to elicit affective benefits, there is a need to examine circumstances under which these benefits are most likely to occur.

Rutkowska, A., et al. (2022). "Use of Virtual Reality-Based Therapy in Patients with Urinary Incontinence: A Systematic Review with Meta-Analysis." International Journal of Environmental Research & Public Health [Electronic Resource] 19(10): 6155.
	It is estimated that over 400 million people worldwide experience some form of urinary incontinence (UI). Pelvic floor muscle training (PFMT) is commonly used in cases of urine loss. Game therapy (GT) has been suggested as a new conservative modality for UI treatments. GT represents a form of virtual reality (VR) that allows users to interact with elements of a simulated scenario. The purpose of this review was to assess the potential of using VR-based PFMT in the treatment of UI with a particular focus on the impact of this form of therapy on the patients' muscle function, symptoms of UI and quality of life (QoL). The following electronic databases were searched: PubMed, Embase, Cochrane Library, Scopus and Web of Science. Systematic review methods were based on the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) statement. Electronic medical databases were searched from inception to 28 January 2021. From a total of 38 articles, 26 were analyzed after removing duplicates, then 22 records were excluded according to inclusion criteria and 4 were assessed as full texts. Finally, 2 randomized controlled trials (RCT) with 79 patients were included. For the International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF), the meta-analysis showed a significant difference in favor of the control condition (MD = 2.22; 95% CI 0.42, 4.01; I(2) = 0%). Despite the popularity of the use of VR in rehabilitation, we found a scarcity of literature evaluating the application of VR in the field of UI therapy. Only one study matched all of the criteria established. The effects of VR training improved PFM function and QoL; however, these changes were comparable to those of traditional PFMT. It is not possible to reach final conclusions from one study; thus, further development of VR interventions in the field of UI treatments are needed.

Ryan, G. (1998). "It's not football." Disability & Rehabilitation 20(6-7): 272-274.
	Today I am as happy as I could ever be. I have created a lot out of very little, I have worked full time, played full time, got full-time friends, full-time independence, had full-time love and am lucky enough to be with my new full-time love who helps me a great deal both physically and mentally. It is definitely no fun coughing until your chest is sore in the morning, afternoon and evening. Having wringing night-sweats from cepacia. Wanting to sleep more than Mr Sleep from Sleepland. Taking tablets the size of which sunk the Belgrano. Finding time for physiotherapy, eating the right meals, playing on my Playstation. Depression has got through on previous occasions, but not for long, and it has never resulted in anything more than a 'wake up and smell the coffee' call from myself. Having CF is no ball game (otherwise it would be called football or something!), but I have had a lot of fun and will continue to do so for however long. Two years, five years, 20 years--who's to say, not me. We could all have the same left, I just hope that everyone has as much fun.

rytw, R. B. R. (2016). "Physical Exercise and Health of Institutionalized Older Adults." https://trialsearch.who.int/Trial2.aspx?TrialID=RBR-6rytw2.
	INTERVENTION: F04.754.137.506.662 G11.427.590.530.698.277 Randomized stduy with parralell groups. Interventions were applied in two groups: 1) exercise with virtual reality (experimental group, n=9) and 2) exercise without virtual reality (active control group, n=9). Interventions lasted 16 sessions. Experimental group performed in each session six exercises with virtual games (squat, center of mass displacements, gait, boxing and dance). Active control group performed the same exercises of the experimental group, however without virtual reality games. Each session lasted from 30 to 45 min. Individuals were evaluated before (pre) and after (post) study. These evaluations aims to verify the chronic effects of intervention. Additionally, evaluations before and after first session occurred. These amis to verify acute effect of session on cognitive functions. CONDITION: C10.228.140.079.862.500 C10.228.140.380 F01.145.126.350 Institutionalized older adults, healthy, depressive, demented, parkinsonism ; M01.774.500 ; F01.145.126.350 ; C10.228.140.380 ; C10.228.140.079.862.500 M01.774.500 PRIMARY OUTCOME: Enhancement of 10% are expected in cognitive performance pre‐ and post‐intervention. Primary outcomes are: global cognitive function, executive function, short‐term memory, work memory and semantic memory, verified by Mini Mental of State Exam, Trail Test and Floor Maze Test, Digit Span Forward, Digit Span Backward, Verbal Fluency Test, respectively. Preliminarly, acute results were up to 21% higher. Chronic effect is still being analyzed. SECONDARY OUTCOME: Enhancement of 10% are expected in physical performance pre‐ and post‐intervention. Primary outcomes are: functional capacity, postural balance and gait, verified by Senior Fitness Test, posturography and kinematic analysis, respectively. There is no analysis of acute effect. Chronic effect is still being analyzed. INCLUSION CRITERIA: Living at long term care institution for elderly; Aged 60 years or more.

s2nbf, R. B. R. (2018). "Effect of the nintendo wii sport video game on rehabilitation of the arms of patients with post polio syndrome: Application research, security and acceptance of the game." https://trialsearch.who.int/Trial2.aspx?TrialID=RBR-8s2nbf.
	INTERVENTION: E02.760.169.063.500.477 F04.754.137.506.662 Will be participating in the study 32 patients diagnosed with Post Polio Syndrome of both genders and aged 40 to 75 years. Individuals will perform 14 treatment sessions, with two weekly sessions lasting 50 minutes each. Patients will be randomly divided into 02 groups, Group Experiment (GE) composed of 16 patients and Control Group (CG) composed of 16 patients. The patients of the GC will do exercises of Conventional Motor Physical Therapy that consist of exercises of MMSS, seated in a chair with back. The exercises were flexion and extension of the shoulder and elbow, adduction and abduction of the shoulder, adduction and horizontal abduction of the shoulder and circumference, all bilateral. And trunk anterior, posterior and lateral trunk inclination exercises. The GE patients will be properly positioned by a chair‐backed therapist and trunk stabilization strip (if necessary) on the front was positioned the television monitor and Nintendo® Wii console. The control of the video game was offered to the patient and the same one chose with which dominate member to use for the accomplishment of the games. The therapist will perform the initial guidelines on how to perform each game and then supervision during the games, but without interference in the therapy process or any type of feedback to the patient during the intervention. The games used will be: Tennis, Bowling, Golf and Boxing. Individuals will practice 10 minutes each game. Both groups will be evaluated before, after the 14 intervention sessions and after 30 days of the end of the intervention. CONDITION: C02.782.687.359.764.650 C05.651.515 G11.427.550 L01.453.245.945.450 Post polio syndrome, muscular weakness, muscular fatigue, international classification of functioning, disability and health ; C02.782.687.359.764.650 ; C05.651.515 ; G11.427.550 ; L01.453.245.945.450 PRIMARY OUTCOME: Analyze the safety and applicability of nintendo wii sports games for post poliomielitys syndrome patients Test box and block which is a test of manual dexterity for upper limbs The following scales shall be used; MFM‐32 scale is a validated motor function measure for patients with neuromuscular diseases; SECONDARY OUTCOME: Check the effects of the nintendo wii sports videogame on the functionality of patients with post poliomielitys syndrome ; Severity of Fatigue Scale that verifies the presence of muscular fatigue ; The following scales and measures shall be used: ; MIF scale that verifies the Functional Independence Measure of the patients ; The functional range test adapted to the sitting position to verify the flexibility of patients ; Verify the occurrence of adverse events such as fatigue and pain resulting from training with the nintendo wii sports video game Visual analog pain scale that checks the presence or absence of pain INCLUSION CRITERIA: Patients diagnosed with SPP established by the consensus of Healsted & Rossi (1985), patients who are not performing rehabilitation and or physical exercise during the application of the treatment protocol, patients with muscle strength greater than or equal 3 on shoulders and elbows

Sabel, M., et al. (2013). "Abstracts of the 45th Congress of the International Society of Paediatric Oncology (SIOP) 2013. Hong Kong, China. September 25-28, 2013." Pediatr Blood Cancer 60 Suppl 3: S2-264.
	Purpose/Objective: Childhood brain tumour therapy carries a substantial risk of impaired intellectual development in the survivors. Voluntary physical activity appears to have a positive effect on executive function in humans and on neurogenesis in animal models. We hypothesized that exercise gaming could be used to achieve regular, enjoyable, physical exercise. Materials and Methods: Children 7‐17 years who completed treatment, including radiotherapy, for a malignant brain tumour 1‐5 years earlier were randomized to an exercise group or a wait‐list group. After 10 weeks the groups shifted in a cross‐over fashion. A motion‐controlled video console (Nintendo Wii) was used for home‐based physical exercise during the exercise period, for a minimum of 30 min per day, at least 5 days a week, for 10 weeks. The children had weekly contact with a coach using internet based videoconferencing technology, to improve compliance, assess the past weeks gaming, and stimulate continuous exercise‐gaming. Every second week patients wore a multisensory activity monitor, SenseWearPro2 Armband, calculating energy expenditure and intensity of activities as Metabolic Equivalent of Task (METs). All children were tested with cognitive tests, motor and process skills before and after each period. Results: 13 children, mean age 12.5 years, completed the program. 8/13 reached the target of 10 weeks exercise‐gaming, 4/13 completed 9 weeks and 1/13 7 weeks (mean 9.5 weeks). Reasons for non‐compliance were mainly intercurrent illness or travel and only rarely lack of motivation. The participants rated 49% of the gaming weeks as 'OK/good', 35% as 'fun' and 1.5% as 'boring'. Mean energy expenditure was 1.9 METs at baseline, 1.99 during gaming weeks and 3.0 during gaming sessions. Conclusions: Exercise gaming can be used as a home based intervention in childhood brain tumour survivors accomplishing a moderate physical exercise, although not increasing their overall physical activity. Coaching probably improves compliance.

Sabel, M., et al. (2016). "Active video gaming improves body coordination in survivors of childhood brain tumours." Disability & Rehabilitation 38(21): 2073-2084.
	PURPOSE: We investigated whether active video gaming (AVG) could bring about regular, enjoyable, physical exercise in children treated for brain tumours, what level of physical activity could be reached and if the children's physical functioning improved. METHODS: Thirteen children, aged 7-17 years, were randomised to either AVG or waiting-list. After 10-12 weeks they crossed-over. Weekly Internet coaching sessions were used to sustain motivation and evaluate enjoyment. Energy expenditure (EE) levels were measured as Metabolic Equivalent of Task (MET), using a multisensory activity monitor. Single-blinded assessments of physical functioning were done, using the Bruininks-Osteretsky Test of Motor Performance, second edition, evaluating participants before and after the intervention period, as well as comparing the randomisation groups after the first period. RESULTS: All patients completed the study. AVG sessions (mean duration 47 minutes) were performed on 72% of all days. Mean EE level during AVG sessions was 3.0 MET, corresponding to moderate physical activity. The Body Coordination score improved by 15% (p = 0.021) over the intervention period. CONCLUSIONS: In this group of childhood brain tumour survivors, home-based AVG, supported by a coach, was a feasible, enjoyable and moderately intense form of exercise that improved Body Coordination. Implications for Rehabilitation Childhood brain tumour survivors frequently have cognitive problems, inferior physical functioning and are less physically active compared to their healthy peers. Active video gaming (AVG), supported by Internet coaching, is a feasible home-based intervention in children treated for brain tumours, promoting enjoyable, regular physical exercise of moderate intensity. In this pilot study, AVG with Nintendo Wii improved Body Coordination.

Sadusky, J. (1999). "Rehab economics. Private practice: Fischer Sports is at the top of the private practice game." Rehab Management: The Interdisciplinary Journal of Rehabilitation 12(2): 55-64.
	
Sager, N. (2009). "On Lok Lifeways gets into 'wii-hab'." Aging Today 30(6): 2p-2p.
	
Saha, M., et al. (2018). "Obesity and Its Risk Factors of among School Children in Sylhet, Bangladesh." J Nepal Health Res Counc 16(2): 205-208.
	BACKGROUND: Childhood obesity is found in affluent society, less physical activity and changes in food pattern. This study was designed to see prevalence and risk factors of childhood obesity among school children of Sylhet city. METHODS: Students of class five and six of two schools of Sylhet city were randomly selected. Demographic and anthropometric data were collected and recorded in predesigned data sheet. BMI and percentile were calculated using official centre for disease control growth chart for 2 to 20 years. Logistic regression analysis was done to see association of various factors with childhood obesity. P value of ?0.05 was taken as significant. RESULTS: Total 288 children were included in this study. Age varied from 10 to 14 years. Among them 5.6% and 8.7% were found to be obese and overweight respectively. Obesity was significantly higher among girls (6.8% vs3.6%).Prevalence of obesity and overweight (p=0.001) was more among those who spent less time in physical exercise and outdoor games. Food habit, television watching, computer gaming and duration of sleep were not found as significant predictor of obesity. CONCLUSIONS: Obesity was significantly higher among girls (6.8% vs3.6%). Girls with less physical activity were mainly associated with overweight and obesity.

Sahiner, T. A. H. and N. Cinar (2018). "Effects of online computerized cognitive training program beynex on the cognitive tests of individuals with subjective cognitive impairment (sci)." Alzheimer's & dementia 14(Suppl 7): 981‐982.
	Background: Clinical trials conducted on the efficacy of computerized cognitive training have not lead to any important breakthroughs. There is a growing consensus that this can, at least partially, be explained by methodological difficulties. Methods: 60 patients with SCI diagnosis, aged 69.90+/‐9.44 on average, were subjected to Montreal Cognitive Assessment (MOCA), Cambridge Cognition (CANTAB tests: MOT, PRM, DMS, SWM, PAL, RTI) and Bayer Activity of Daily Living (ADL) Scale (BAYER). Later the age groups and education levels were normalized to randomly divide the subjects into two groups of 30. The first group was provided with a password to access a web‐based program BEYNEX and asked to complete tasks, which included playing 3 varying 5‐minute long computer games, on a daily basis; and answering questions on ADL. They were expected to watch and practice a 3‐minute physical exercise video as well. All tasks are designed within the parameters used by clinicians and take 15‐20 minutes to complete daily. BEYNEX exercises are completely unique and are not in commercial use. Patients' total activity time, ADL and game performances were monitored only by clinicians under 9 different graphics (ADL, Memory, Visual Perception, Speed, Problem‐solving, Flexibility, Attention, Language Skills, Arithmetic). After 3 months or at least 1200 minutes of BEYNEX use, the diagnostic tests (MOCA, CANTAB, BAYER) were repeated for both test and control groups. Results: Among the two groups, there are no meaningful differences determined between the beginning and final results of MOCA and BAYER scales; whereas CANTAB results indicated statistically meaningful changes. The results of exercise practicing group showed positive improvement in parameters of Motor screening (MOT Median), Delayed Matching sample (DMS; Percent correct and Percent correct (all delays)), Paired Associated Learning (PAL; Total errors (adjusted) and Total errors (6 shapes, adjusted)). Pattern recognition memory (PRM), Spatial working memory (SWM) and Reaction time (RTI) parameters showed no change. Conclusions: Regularly practiced Internet‐based activities positively affect particularly memory related cognitive parameters in elderly individuals with memory impairment. Though, it can be hard to detect the minor changes in diagnostic tests (MOCA), it's significant to observe mild changes in different CANTAB test parameters. [Figure presented] [Figure presented] [Figure presented] Copyright © 2018

Sahiner, T. A. H. and N. Cınar (2006). "P2‐626: Effects of Online Computerized Cognitive Training Program “Beynex” on Cognitive Tests of Alzheimer's Patients on Rivastigmine Therapy." Alzheimer's & dementia 14(7S_Part_18): P981‐P982.
	Background: Computerized Cognitive Training (CCT) is a safe and inexpensive approach, yet its efficacy on patients on Rivastigmine has not been evaluated. There are numerous studies demonstrating the positive affects of Choline Esterease inhibitors on cognitive tests in the first 6 months. This study examines whether CCT has any further contribution to this effect. Methods: 60 patients diagnosed with Alzheimer's (and started Rivastigmine patch 10 cm2 18 mg treatment), aged 72.58+/‐7.80 on average, were subjected to Montreal Cognitive Assessment (MoCA), Cambridge Cognition (CANTAB tests: MOT, PRM, DMS, SWM, PAL, RTI) and Bayer Activity of Daily Living (ADL) Scale (BAYER). The age, gender and education levels were normalized to randomly form two groups of 30. The first group was provided with a password to access a web‐based program BEYNEX and asked to complete tasks, which included playing 3 varying 5‐minute long computer games and practicing a 3‐minute physical exercise video on a daily basis; and answering questions on ADL once a week. BEYNEX exercises are completely unique and are not in commercial use. Patients' total activity time, ADL and game performances were monitored only by clinicians under 9 graphs (ADL, Memory, Visual Perception, Speed, Problem‐solving, Flexibility, Attention, Language Skills, Arithmetic). After 6 months or at least 1200 minutes of BEYNEX use, the diagnostic tests (MoCA, CANTAB, BAYER) were repeated for both test and control groups. Results: Meaningful differences determined between the initial and final MoCA,BAYER and CANTAB scores. Final MoCA scores of the BEYNEX‐practicing group demonstrate meaningful increase, whereas they decrease in control group. Final BAYER scores of BEYNEX‐ practicing group meaningfully decreased, indicating an improvement in ADL. CANTAB scores of BEYNEX group showed improvement in parameters of Motor screening (MOT), Delayed Matching sample (DMS), Paired Associated Learning (PAL), Pattern recognition memory (PRM), Spatial‐working memory (SWM). Reaction time (RTI) parameters showed no change. Conclusions: Domain‐specific analyses of the exercising group indicated improvement in executive functions, attentional processing and visuospatial skills. Performance improvements in patients using Choline Esterease inhibitors in the initial 6‐months are well documented. Online CCTs positively contributes to the improvements. [Figure presented] [Figure presented] Copyright © 2018

Sahiner, T. A. H. and N. Cınar (2006). "Td‐P‐002: Effects of Online Computerized Cognitive Training Program Beynex on the Cognitive Tests of Individuals with Subjective Cognitive Impairment (Sci)." Alzheimer's & dementia 14(7S_Part_3): P186.
	Background: Clinical trials conducted on the efficacy of computerized cognitive training have not lead to any important breakthroughs. There is a growing consensus that this can, at least partially, be explained by methodological difficulties. Methods: 60 patients with SCI diagnosis, aged 69.90+/‐9.44 on average, were subjected to Montreal Cognitive Assessment (MOCA), Cambridge Cognition (CANTAB tests: MOT, PRM, DMS, SWM, PAL, RTI) and Bayer Activity of Daily Living (ADL) Scale (BAYER). Later the age groups and education levels were normalized to randomly divide the subjects into two groups of 30. The first group was provided with a password to access a web‐based program BEYNEX and asked to complete tasks, which included playing 3 varying 5‐minute long computer games, on a daily basis; and answering questions on ADL. They were expected to watch and practice a 3‐minute physical exercise video as well. All tasks are designed within the parameters used by clinicians and take 15‐20 minutes to complete daily. BEYNEX exercises are completely unique and are not in commercial use. Patients' total activity time, ADL and game performances were monitored only by clinicians under 9 different graphics (ADL, Memory, Visual Perception, Speed, Problem‐solving, Flexibility, Attention, Language Skills, Arithmetic). After 3 months or at least 1200 minutes of BEYNEX use, the diagnostic tests (MOCA, CANTAB, BAYER) were repeated for both test and control groups. Results: Among the two groups, there are no meaningful differences determined between the beginning and final results of MOCA and BAYER scales; whereas CANTAB results indicated statistically meaningful changes. The results of exercise practicing group showed positive improvement in parameters of Motor screening (MOT Median), Delayed Matching sample (DMS; Percent correct and Percent correct (all delays)), Paired Associated Learning (PAL; Total errors (adjusted) and Total errors (6 shapes, adjusted)). Pattern recognition memory (PRM), Spatial working memory (SWM) and Reaction time (RTI) parameters showed no change. Conclusions: Regularly practiced Internet‐based activities positively affect particularly memory related cognitive parameters in elderly individuals with memory impairment. Though, it can be hard to detect the minor changes in diagnostic tests (MOCA), it's significant to observe mild changes in different CANTAB test parameters. [Figure presented] [Figure presented] [Figure presented] Copyright © 2018

Sainsbury, M. J. and E. Young (1965). "Physiotherapy and Psychiatry." Australian Journal of Physiotherapy 11(2): 54-58.
	I feel quite sure there must be many words written about the wedding of these two disciplines somewhere, but among my personal library which includes some well-known psychiatric text books, I was rather appalled at the paucity of information which I could use in this talk. An example of what I found was in the section on treatment in a book entitled “Aids to Psychiatry.” It read like this:—“Various manipulations and exercises may be prescribed in convalescence with the object of stimulating mind and body. Persons suffering from mental disorders tend to hold themselves in careless, relaxed attitudes, so that respiration is insufficiently performed, and oxygenation is less active than normal. Outdoor games of all kinds are to be encouraged as a means of improving the general health, and as a counteraction to introspection. Such measures tend also to foster the social instinct.”1 There followed brief comments on relaxation exercises for use in anxiety neurosis and insomnia, special exercises in hysterical paralysis and exercises for some forms of tic and habit spasm.

Salem, Y., et al. (2012). "Effectiveness of a low-cost virtual reality system for children with developmental delay: a preliminary randomised single-blind controlled trial." Physiotherapy 98(3): 189-195.
	OBJECTIVES: Physical and occupational therapists have started to use the Nintendo Wii gaming system with adults and children as part of their regular treatment. Despite the growing use of the Wii and trend towards evidence-based practice, limited evidence is available on the effectiveness of virtual reality using the Wii for children with developmental delay. The purpose of this study was to determine the feasibility and preliminary effectiveness of a low-cost gaming system for young children with developmental delay. STUDY DESIGN: Single-blind, randomised controlled trial. PARTICIPANTS AND SETTING: Forty children with developmental delay (age 39 to 58 months) who attended a segregated or integrated preschool participated in this study. All children's parents read and signed an informed consent form approved by the institutional review board. Children were assigned at random to an experimental (Wii) group (n=20) or a control group (n=20). INTERVENTION: Two weekly sessions for 10 weeks using Nintendo Wii Sports and Nintendo Wii Fit, including balance, strength training and aerobics games. MAIN OUTCOME MEASURES: Participants were evaluated 1 week before and 1 week after the programme by a blinded investigator. Primary outcomes were gait speed, timed up and go test, single leg stance test, five-times-sit-to-stand test, timed up and down stairs test, 2-minute walk test and grip strength. The Gross Motor Function Measure (GMFM) was used to assess gross motor skills. RESULTS: The two groups were homogenous regarding all parameters at baseline. The Wii training was feasible and enjoyable for those in the experimental group. There were no adverse effects or injuries reported over 267 training sessions. Comparison of groups following the intervention indicated that the experimental group showed significant improvements compared with the control group in single leg stance test {mean difference 1.03 [standard deviation (SD) 1.7], 95% confidence interval (CI) 0.2 to 1.9; P=0.017}, right grip strength [mean difference 1.11 (SD 1.84), 95% CI 0.15 to 2.06; P=0.024] and left grip strength [mean difference 0.90 (SD 1.67), 95% CI 0.03 to 1.77; P=0.043]. Although changes in other outcome measures were not significant between the study groups, there were trends towards greater improvements in the experimental group compared with the control group. CONCLUSION: This study supports use of the Wii as a feasible, safe and potentially effective therapeutic tool to augment the rehabilitation of young children with developmental delay. The potential application of the Wii to increase the intensity of therapy or as a rehabilitation tool in children's homes and rural settings is an area worthy of investigation. The promising results of this study suggest that further studies are warranted to validate the potential benefits of a low-cost commercially available gaming system as a treatment strategy to supplement rehabilitation of children with disabilities.

Salem, Y., et al. (2011). "Research Report Abstracts." Physiotherapy 97: eS18-eS1415.
	Purpose: The purpose of this randomized single‐blinded controlled trial was to determine the feasibility and preliminary effectiveness of a low cost gaming system using the NintendoWii gaming system for young children with developmental delay. Relevance: Physical therapists have begun to use the Nintendo Wii gaming system with adults and children as part of their regular treatment. Despite the growing use of the Wii gaming system and trend toward evidence‐based practice, limited evidence is available on the effectiveness of virtual reality using theWii gaming system for children with developmental delay. Participants: Forty children with developmental delay (ages 36‐58 months) who attended a segregated or integrated preschool participated in this study. All children's parents read and signed an Institutional Review Board approved informed consent. Methods: Children were randomly assigned to an intervention/ Wii group (n = 20) or a control group (n = 20). Intervention consisted of 2 weekly sessions for 10 weeks. Intervention was performed using the NintendoWii Fit games software, including balance, strength training, and aerobics games. Participants were evaluated one week before and one week after the program by a blind investigator. Primary outcomes were walking speed, Timed Up and Go, Timed One Legged Stance, Timed Up and Down Stairs, Five Times‐Sitto‐ Stand test, Two‐Minute Walk test, and grip strength. Analysis: The 2‐way repeated measure analysis of variance (ANOVA) for repeated measures on the time factor was used to compare difference between groups (experimental and control) and timing (preintervention, postintervention) for each studied outcome. Results: The two groups were homogenous regarding all parameters at baseline. The training was feasible and enjoyable for those participated in the study. There were no adverse effects or injury reported over 267 training sessions. Significant improvements for walking speed, Timed One Legged Stance, Timed Up and Down Stairs, Two‐Minute Walk test, and grip strength were observed in both groups. Relative to the control group, participants in the Wii group had statistically significant improvements in Timed One Legged Stance and grip strength. Conclusions: This study demonstrated that the use of theWii gaming system is feasible, safe, enjoyable and potentially efficacious in enhancing motor function in young children with developmental delay. The potential application of the Wii to increase intensity of therapy or as a rehabilitation tool in children homes and rural settings is an area worthy of investigation. Implications: The findings of this study support the use of theWii as a feasible, safe, and potentially effective therapeutic tool to augment the rehabilitation of young children with developmental delay. The promising results of this study suggest that further studies arewarranted to validate the potential benefits of a low cost, commercially available gaming system as a treatment strategy to supplement rehabilitation of children with disabilities.

Salvo Myers, B. (2013). "Keeping Pace with Technology." Rehab Management: The Interdisciplinary Journal of Rehabilitation 26(1): 36-41.
	The article describes how physical therapists can integrate technology to improve outcomes in gait and balance training and assessment. It states that “low-tech” interventions have been used in assessment and treatment of gait and balance; Assessment and treatment aim to improve functional skills, mostly for prevention of falls. Approaches like computerized video games, vibration plates, and aquatic therapy can increase the efficacy of treatment planning and goal setting.

Samuel, G. S., et al. (2015). "The use of virtual reality-based therapy to augment poststroke upper limb recovery." Singapore Medical Journal 56(7): e127-130.
	Stroke remains one of the major causes of disability worldwide. This case report illustrates the complementary use of biomechanical and kinematic in-game markers, in addition to standard clinical outcomes, to comprehensively assess and track a patient's disabilities. A 65-year-old patient was admitted for right-sided weakness and clinically diagnosed with acute ischaemic stroke. She participated in a short trial of standard stroke occupational therapy and physiotherapy with additional daily virtual reality (VR)-based therapy. Outcomes were tracked using kinematic data and conventional clinical assessments. Her Functional Independence Measure score improved from 87 to 113 and Fugl-Meyer motor score improved from 56 to 62, denoting clinically significant improvement. Corresponding kinematic analysis revealed improved hand path ratios and a decrease in velocity peaks. Further research is being undertaken to elucidate the optimal type, timing, setting and duration of VR-based therapy, as well as the use of neuropharmacological adjuncts.

Sanchis-Gomar, F., et al. (2013). "Effects of acute exercise and allopurinol administration on soluble urokinase plasminogen activator receptor (suPAR)." Clinical Laboratory 59(1-2): 207-210.
	BACKGROUND: Although physical exercise acutely increases the most widely used inflammatory biomarkers, there is no information on its effect on soluble urokinase plasminogen activating receptor (suPAR), a circulating biomarker increasingly used for the assessment of systemic inflammation. METHODS: suPAR was assessed with the quantitative suPARnostic Standard ELISA Assay (Virogates, Birkerod, Denmark) in 12 professional football players before and after a football match. The athletes were divided into two experimental groups. An oral dose of 300 mg of allopurinol was administered to one group of six participants four hours before a match; the other six participants received placebo. RESULTS: Serum suPAR concentration did not vary significantly after the match in both the placebo and allopurinol group. No significant differences were observed between placebo and allopurinol groups at baseline and after the game. CONCLUSIONS: At variance with other consolidated inflammatory biomarkers, suPAR is not influenced by either physical exercise or administration of xanthine oxidase inhibitors.

Sandlund, M., et al. (2012). "Motion interactive video games in home training for children with cerebral palsy: parents' perceptions." Disability & Rehabilitation 34(11): 925-933.
	PURPOSE: To explore parents' perceptions of using low-cost motion interactive video games as home training for their children with mild/moderate cerebral palsy. METHOD: Semi-structured interviews were carried out with parents from 15 families after participation in an intervention where motion interactive games were used daily in home training for their child. A qualitative content analysis approach was applied. RESULTS: The parents' perception of the training was very positive. They expressed the view that motion interactive video games may promote positive experiences of physical training in rehabilitation, where the social aspects of gaming were especially valued. Further, the parents experienced less need to take on coaching while gaming stimulated independent training. However, there was a desire for more controlled and individualized games to better challenge the specific rehabilitative need of each child. CONCLUSIONS: Low-cost motion interactive games may provide increased motivation and social interaction to home training and promote independent training with reduced coaching efforts for the parents. In future designs of interactive games for rehabilitation purposes, it is important to preserve the motivational and social features of games while optimizing the individualized physical exercise.

Sanko, J. S., et al. (2021). "A Multisite Study Demonstrates Positive Impacts to Systems Thinking Using a Table-top Simulation Experience." Nurse Educ 46(1): 29-33.
	BACKGROUND: Systems thinking (ST) is the ability to recognize, understand, and synthesize interactions and interdependencies in a set of components designed for a purpose. Systems thinking has been shown to improve systems and decrease error. Despite these benefits, ST has not yet been consistently integrated into all health care education programs. PURPOSE: This study examined the impact of Friday Night at the ER (FNER), a table-top simulation designed to teach ST to a variety of prelicensure and postlicensure health care students. METHODS: A multisite study was conducted in 5 academic institutions targeting both graduate and prelicensure students enrolled in nursing, medicine, physical therapy, public health, psychology, and pharmacy programs. RESULTS: The FNER simulation was followed by statistically significant improvements in ST scores. CONCLUSIONS: The FNER table-top simulation was found to improve ST in a wide variety of health-related majors.

Sanko, J. S., et al. (2021). "A comparison of learning outcomes from two poverty simulation experiences." Public Health Nurs 38(3): 427-438.
	OBJECTIVES: Five nationally representative U.S. federal data sources consistently showed the link between poverty and poor health outcomes. To determine the modality effective in teaching students about poverty and health, this study compared the attitudes toward poverty of students participating in the Community Action Poverty Simulation (CAPS) and the poverty table-top simulation (Dwell). METHODS: In this quasi-experimental study, undergraduate and graduate nursing students and physical therapy students participated in either CAPS or a table-top simulation (TTS) depending on their semester of enrollment in the relevant course. The Undergraduate Perception of Poverty Tracking Survey (UPPTS) was administered before and after each simulation. RESULTS: The analysis included 118 matched pairs. Using MANOVA tests, the authors found no group difference in the overall change of attitude after the simulations (p = .232). However, by the subscale analyses, TTS significantly increased students' willingness to help (p = .008, eta(2) = 0.058) and their empathy toward those living in poverty (p = .039, eta(2) = 0.039). CONCLUSION: TTS participants had more elements of improvement, but both modalities were found to change participants' attitudes.

Santana, M., et al. (2016). "Efectos de la Nintendo Wii sobre el estado cardiorrespiratorio de adultos mayores: ensayo clínico aleatorizado. Estudio piloto." Fisioterapia 38(2): 71-77.
	Resumen Objetivo Comparar los resultados de un programa de ejercicios realizados en la videoconsola Nintendo Wii con el entrenamiento aeróbico estándar de oro en bicicleta estática, sobre el estado cardiorrespiratorio de adultos mayores sedentarios. Material y métodos Ensayo clínico aleatorizado. Participaron 16 sujetos adultos mayores, divididos en 2 grupos (n=8 intervención 1 y n=8 intervención 2). El grupo intervención 1 realizó 30min de entrenamiento en bicicleta estática. El grupo intervención 2 realizó 30min de ejercicios aeróbicos en la Nintendo Wii. Ambos entrenamientos fueron realizados 3 veces por semana en un período de 8 semanas. Los efectos agudos de esta intervención se determinaron mediante la medición de la frecuencia cardíaca y de la presión arterial antes, durante y después de ambos entrenamientos. Se utilizó el Test de la Marcha de 6 Minutos para determinar los efectos cardiorrespiratorios crónicos. Resultados Se observó un aumento de la frecuencia cardíaca y de la presión arterial durante la realización de ambos programas de ejercicios. Hubo una diferencia significativa en la distancia recorrida en el Test de la Marcha de 6 Minutos en los 2 grupos. Conclusión Los efectos cardiorrespiratorios agudos y crónicos de los ejercicios en la Nintendo Wii y del entrenamiento en bicicleta estática en adultos mayores son similares. Estos ejercicios pueden ser una modalidad alternativa a los entrenamientos tradicionales de intensidad moderada recomendados por el Colegio Americano de Medicina del Deporte. Objective To compare the results of a physical exercise program performed in the video game Nintendo Wii with gold standard aerobic training on exercise bike, on the cardiorespiratory status of sedentary older adults. Material and methods A randomized clinical trial was performed with the participation of 16 older adult subjects divided into 2 groups (n=8 intervention 1 and n=8 intervention 2). Intervention group 1 performed 30min of training on exercise bike. Intervention group 2 performed 30min of aerobic exercises in NW. Both trainings were performed 3 times a week over a period of 8 weeks. The acute effects of this intervention were determined by measuring heart rate and blood pressure before, during and after both workouts. The Six-Minute Walk Test was used to determine the chronic cardiorespiratory effects. Results An increase in heart rate and blood pressure during the performance of both exercise programs was observed. There was a significant difference in the distance traveled in the Six-Minute Walk Test in the 2 groups. Conclusion Acute and chronic cardiorespiratory effects of exercise with the Nintendo Wii and training on exercise bike are similar in older adults. These exercises can be an alternative to traditional training of moderate intensity recommended by the American College of Sports Medicine mode.

Santos, P., et al. (2019). "Effects of the Nintendo Wii training on balance rehabilitation and quality of life of patients with Parkinson's disease: A systematic review and meta-analysis." Neurorehabilitation 44(4): 569-577.
	BACKGROUND: Randomized clinical trials (RCTs) used the Nintendo Wii (NW) in the treatment of Parkinson Disease, however, no meta-analysis was developed to determine the effects in these patients. OBJECTIVE: To analyze RCTs that investigated the effects of NW versus traditional physiotherapy on balance rehabilitation and quality of life of patients with PD. METHODS: Electronic research was conducted between December 2018 and January 2019 in the MEDLINE, PEDro, CENTRAL, LILACS and SciELO databases. The methodological quality was evaluated by the PEDro scale and the completeness of the description of the interventions by the TIDieR checklist. Weighted mean differences (WMD) and 95% confidence interval (CI) were calculated. RESULTS: Five studies were included and presented an average of 5.4 (1.5) on the PEDro scale and 6.7 (1.4) on the TIDieR. Compared to traditional physiotherapy, combined NW and traditional physiotherapy resulted in improvement in balance WMD 1.24 (95% CI: CI: 0.2 to 2.3 N = 72) and quality of life WMD- 8.9 (95% CI: -15.2 to -2.6 N = 56). CONCLUSION: combined NW and traditional physiotherapy was more effective on balance rehabilitation and quality of life of patients with PD, but the values demonstrated a poor methodological quality and a low level of completeness of the intervention descriptions.

Santos, S. D. S., et al. (2020). "Effects of Physical Exercise during Hospitalization in Children and Adolescents with Cancer: A Systematic Review." Rev Paul Pediatr 39: e2019313.
	OBJECTIVE: To identify the effects of exercise programs during hospitalization on children and adolescents with cancer. DATA SOURCE: This is a systematic review, carried out in PubMed/ Medical Literature Analysis and Retrieval System Online (MEDLINE), Latin American and Caribbean Health Sciences Literature (LILACS), Scientific Electronic Library Online (SciELO), Latin American and Caribbean Center on Health Sciences Information (BIREME), and Physiotherapy Evidence Database (PEDro). We selected studies that included children and adolescents diagnosed with cancer (solid or hematologic) and submitted to exercise protocols during hospitalization. Studies involving patients with other pathologies or with a medical contraindication for exercise were excluded. We used the following search strategy: Neoplasm OR Leukemia OR Cancer OR Tumor OR Medical Oncology AND Hospitalization OR Inpatient Care Units OR Intrahospital AND Exercise. The methodological quality of the studies was analyzed by the PEDro scale. DATA SYNTHESIS: Among the 626 articles found, only 9 fulfilled the inclusion criteria, obtaining a regular methodological quality. The samples had 172 participants, aged 4 to 18 years. Only 6 studies presented both intervention group and control group. The intervention group received strength, aerobic, and muscle stretching exercises, and games, among others. The control group received the standard treatment. The studies varied regarding time, frequency, intensity, and type of exercise. Most studies showed an increase in muscle strength (4/5), followed by an improvement in physical fitness (2/3) and functional capacity (2/4). No adverse events were reported during the interventions. The methodological quality was considered regular. CONCLUSIONS: The findings suggest that. during hospitalization of children and adolescents with cancer, exercise improves muscle strength, physical fitness, and functionality.

Sañudo, B., et al. (2020). "Aerobic Exercise with Superimposed Virtual Reality Improves Cognitive Flexibility and Selective Attention in Young Males." Applied Sciences 10(22): 8029.
	The literature to date is limited regarding the implantation of VR in healthy young individuals with a focus on cognitive function. Thirty healthy males aged between 22.8 and 24.3 years volunteered to participate in the study randomly and were assigned to one of two groups with alike exercises: an experimental group (GE, n = 15) that performed an exercise protocol with a VR game and a controlled group that performed the exercise protocol without the VR (CON, n = 15). A 128-card computerized version of the Wisconsin Card Sorting Task (WCST) and the Stroop test were completed before and after the exercise protocol. There was a significant interaction effect between time and condition for WCST preservation errors (F1,30 = 4.59, p = 0.041, η2p = 0.141) and a significant time effect for all WCST and Stroop outcomes in GE. Results of preliminary findings suggest that the use of a VR platform offers effective benefits with respect to cognitive flexibility and selective attention. In addition, participants can achieve additional benefits in cognitive flexibility by engaging in a traditional exercise protocol of a similar volume.

Sapi, M., et al. (2019). "Is Kinect Training Superior to Conventional Balance Training for Healthy Older Adults to Improve Postural Control?" Games for Health Journal 8(1): 41-48.
	OBJECTIVE: To investigate the effects of balance training to improve postural control in adults older than 60. Our aim was to find out if Kinect training is superior to the conventional balance training in aspects of functional balance tests and posturography measurements testing postural stability through visual feedback. MATERIALS AND METHODS: Thirty subjects participated in the Kinect training group (29 women and 1 man), practiced Kinect Adventures and Sports, 23 volunteers (22 women and 1 man) attended the conventional balance training, and 22 participants (18 women and 4 men) were allocated to the no-intervention control group. Both interventions lasted for 6 weeks, three times a week, and 30 minutes per session. The Four-Square Step Test, Functional Reach Test, Timed Up and Go test, Timed Up and Go cognitive dual-task test were measured, and for the assessment of the limit of stability (LOS), we used computerized posturography. Measurements were taken before the training at baseline and 6 weeks after (follow-up) the interventions. Statistical analysis was done through two-factor mixed analysis of variance and Newman-Keuls post hoc test. RESULTS: Both training groups showed progress in the follow-up measurements; however, more statistically significant improvements were found in favor of the Kinect balance training group (Timed Up and Go test [P < 0.05], Timed Up and Go cognitive dual-task test [P < 0.05], Four-Square Step Test [P < 0.05], Functional Reach Test [P < 0.05], LOS movement velocity [P < 0.05]). CONCLUSION: Our results suggest that Kinect balance training may be a preferable and safe method for the healthy older adults to improve postural control and reduce the possibility of falling.

Saptharishi, L., et al. (2009). "Community-based Randomized Controlled Trial of Non-pharmacological Interventions in Prevention and Control of Hypertension among Young Adults." Indian J Community Med 34(4): 329-334.
	CONTEXT: Hypertension is a major chronic lifestyle disease. Several non-pharmacological interventions are effective in bringing down the blood pressure (BP). This study focuses on the effectiveness of such interventions among young adults. AIMS: To measure the efficacy of physical exercise, reduction in salt intake, and yoga, in lowering BP among young (20-25) pre-hypertensives and hypertensives, and to compare their relative efficacies. SETTINGS AND DESIGN: The study was done in the urban service area of JIPMER. Pre-hypertensives and hypertensives, identified from previous studies, constituted the universe. The participants were randomized into one control and three interventional groups. MATERIALS AND METHODS: A total of 113 subjects: 30, 28, 28 and 27 in four groups respectively participated for eight weeks: control (I), physical exercise (II) - brisk walking for 50-60 minutes, four days/week, salt intake reduction (III) - to at least half of their previous intake, and practice of yoga (IV) - for 30-45 minutes/day on at least five days/week. STATISTICAL ANALYSIS USED: Efficacy was assessed using paired t test and ANOVA with Games Howell post hoc test. An intention to treat analysis was also performed. RESULTS: A total of 102 participants (29, 27, 25 and 21 in groups I, II, III and IV) completed the study. All three intervention groups showed a significant reduction in BP (SBP/DBP: 5.3/6.0 in group II, 2.6/3.7 in III, and 2.0/2.6 mm Hg in IV respectively). There was no significant change (SBP/DBP: 0.2/0.5 mmHg) of BP in control group (I). Physical exercise was most effective (considered individually); salt intake reduction and yoga were also effective. CONCLUSIONS: Physical exercise, salt intake reduction, and yoga are effective non-pharmacological interventions in significantly reducing BP among young hypertensives and pre-hypertensives. These can therefore be positively recommended for hypertensives. There is also a case to deploy these interventions in the general population.

Sarig Bahat, H., et al. (2010). "The effect of neck pain on cervical kinematics, as assessed in a virtual environment." Archives of Physical Medicine & Rehabilitation 91(12): 1884-1890.
	OBJECTIVE: To compare cervical kinematics during functional motion in patients with neck pain and in asymptomatic participants using a novel virtual reality assessment. DESIGN: Clinical comparative trial. SETTING: Participants were recruited from university staff and students, and from a local physical therapy clinic. PARTICIPANTS: Patients with chronic neck pain (n=25) and asymptomatic participants (n=42). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Kinematic measures (response time, peak and mean velocity, number of velocity peaks, time to peak velocity percentage) were sampled while participants were engaged in the virtual game. Group and motion direction differences were assessed with a 2-way repeated-measures analysis of variance, Tukey-Kramer testing, and contrast analysis when relevant. RESULTS: Participants with neck pain had lower peak and mean velocities than the asymptomatic participants (P<.0001). They also demonstrated a greater number of velocity peaks, indicating impaired motion smoothness (P=.0036). No significant group differences were found for response time or for time to peak velocity percentage. Cervical rotations were significantly faster and smoother than flexion and extension movements (P<.05). The overall impairment percentage in velocity and smoothness of cervical motion in patients with neck pain ranged from 22% to 44% compared with asymptomatic participants. CONCLUSIONS: Velocity and smoothness of cervical motion were more restricted in patients with chronic neck pain than found previously. Unlike range of motion and other static measurements, these dynamic variables reflect functional cervical motion and therefore contribute to a better understanding of the impairment associated with neck pain. Because the ability to move quickly in response to external stimuli is a commonly occurring phenomenon, this deficit is highly relevant to clinical assessment and management.

Sarmento, H., et al. (2014). "Match analysis in football: a systematic review." Journal of Sports Sciences 32(20): 1831-1843.
	Abstract The main focus of this paper was to review the available literature on match analysis in adult male football. The most common research topics were identified, their methodologies described and the evolutionary tendencies of this research area systematised. A systematic review of Institute for Scientific Information (ISI) Web of Knowledge database was performed according to PRISMA (Preferred Reporting Items for Systematic reviews and Meta-analyses) guidelines. The following keywords were used: football and soccer, each one associated with the terms: match analysis, performance analysis, notational analysis, game analysis, tactical analysis and patterns of play. Of 2732 studies initially identified, only 53 were fully reviewed, and their outcome measures abstracted and analysed. Studies that fit all inclusion criteria were organised according to their research design as descriptive, comparative or predictive. Results showed that 10 studies focused predominantly on a description of technical, tactical and physical performance variables. From all comparative studies, the dependent variables more frequently used were "playing position" and "competitive level". Even though the literature stresses the importance of developing predictive models of sports performance, only few studies (n = 8) have focused on modelling football performance. Situational variables like game location, quality of opposing teams, match status and match half have been progressively included as object of research, since they seem to work as effective covariables of football performance. Taking into account the limitations of the reviewed studies, future research should provide comprehensive operational definitions for the studied variables, use standardised categories and description of activities and participants, and consider integrating the situational and interactional contexts into the analysis of football performance.

Satish Reddy, B. (2020). Exergames for telerehabilitation. Ithaca, Cornell University Library, arXiv.org.
	Recent advancements in technology have improved the connectivity between humans enhancing the transfer of information. Leveraging these technological marvels in the healthcare industry has led to the development of telehealth allowing patients and clinicians to receive and administer treatment remotely. Telerehabilitation is a subset of telehealth that facilitates remote rehabilitation treatment for patients. Providing rehabilitative services to the aging baby boomer population requires tech-savvy solutions to augment the therapists and clinicians for effective remote monitoring and tele-medicine. Hence, this thesis develops easy-to-use exergames for low-cost mechatronic devices targeting rehabilitation of post-stroke patients. Specifically, it demonstrates wearable inertial sensors for exergames consisting of an animated virtual coach for providing patients with instructions for performing range of motion exercises. Next, a gaming environment is developed for task-specific rehabilitation such as eating. Finally, exergames are developed for rehabilitation of pincer grasping. In addition to gamified interfaces providing an engaging rehabilitation experience to the user, the data acquired from the mechatronic devices facilitate data-driven telerehabilitation.

Satoh, M., et al. (2017). "Physical Exercise with Music Maintains Activities of Daily Living in Patients with Dementia: Mihama-Kiho Project Part 21." Journal of Alzheimer's Disease 57(1): 85-96.
	BACKGROUND: Recent studies suggest that combined non-pharmacological interventions are more beneficial than single interventions for primary and secondary prevention of dementia. We previously reported enhanced effects of physical exercise with music (ExM) on cognitive function in normal elderly people compared to exercise alone. OBJECTIVE: To identify if ExM improves cognitive function and activities of daily livings (ADLs) in dementia patients over cognitive stimulation (CS). METHODS: We enrolled 85 patients with mild to moderate dementia. Forty-three subjects performed ExM developed by the Yamaha Music Foundation, and 42 subjects performed cognitive stimulation using portable game consoles and drills involving easy calculations, mazes, and mistake-searching in pictures. Interventions were performed once a week for 40 minutes. Before and after the six-month intervention, patients were assessed using neuropsychological batteries, and ADLs were assessed by patients' caregivers using the functional independence measure (FIM). Voxel-based specific regional analysis system for Alzheimer's disease (VSRAD) was used to assess medial temporal lobe atrophy. RESULTS: Twenty-three subjects dropped out during the intervention. Thirty-one patients from each group were analyzed. Post-intervention, both groups showed significantly improved visuospatial function. Significant benefits were observed in psychomotor speed or memory in the ExM or CS groups, respectively. FIM scores, reflecting ADLs, and VSRAD scores were significantly preserved in the ExM group, but significantly worsened in the CS group. CONCLUSIONS: ExM produced greater positive effects on cognitive function and ADLs in patients with mild to moderate dementia than CS, excluding memory. Optimal interventions for dementia will likely be achieved by combining ExMand CS.

Savazzi, F., et al. (2018). "Engaged in learning neurorehabilitation: Development and validation of a serious game with user-centered design." Computers & Education 125: 53-61.
	The presence of Serious Games (SGs) in the medical educational field is spreading due to their beneficial results in terms of learning outcomes and user' engagement. The effectiveness of these tools for physical therapy students is, however, still to be proven and prototypes for this user target are lacking. We adopted a user-centered design (UCD) approach to develop and validate a SG on dual task motor and cognitive rehabilitation for junior physical therapists training. The SG development and validation consisted in two phases: a design-evaluation-redesign phase with two groups of junior and senior physiotherapists (group 1, N = 10; group 2, N = 28), and the SG prototype testing phase comparing outcomes of junior physiotherapists in lab (N = 20) and physical therapy students in real context (N = 23). Usability, motivation, flow state, affective engagement and learning were tested. Results showed a high usability of the tool together with good levels of engagement in all groups. Interestingly, we observed a decrease in physiotherapists' negative affect and an increment of students' positive affect after experiencing the prototype. The adoption of the UCD for the validation of a SG on neurorehabilitation allowed the development of a usable and engaging prototype. Future research on SG topics should include a rehabilitation paradigm in their content.

Sawa, R., et al. (2022). "The Potential Application of Commercially Available Active Video Games to Cardiac Rehabilitation: Scoping Review." JMIR Serious Games 10(1): e31974.
	BACKGROUND: Commercially available active video games (AVGs) have recently been used for rehabilitation in some specific patient populations but rarely in those with cardiovascular disease (CVD). Commercially available AVGs are designed to increase motivation for continuous play, which could be applicable to the long-term cardiac rehabilitation process. OBJECTIVE: The objective of this scoping review was to assess the effectiveness of AVG-induced physical exercise, safety management, and patient adherence by applying commercially available AVGs to cardiac rehabilitation. METHODS: Four databases (CINAHL, MEDLINE, PubMed, and SPORTDiscus) were searched for all years up to August 12, 2020. Articles were retained if they were written in English, included patients with CVD who were aged 18 years or older, and used AVGs as part of a physical exercise program. The included studies were then evaluated from the viewpoints of effectiveness as physical exercise, safety, and adherence management. RESULTS: Among 120 nonduplicate articles reviewed, 5 (4.2%) were eligible for inclusion, of which 3 (2.5%) were reported by the same research group. The AVG consoles used were Xbox Kinect and Nintendo Wii, and sports-related programs were adopted for the intervention. No adverse cardiac events occurred in the identified studies, and dropout rates tended to be low. CONCLUSIONS: AVGs appear to be safe and feasible for promoting an active lifestyle in patients with CVD. However, the effectiveness of AVGs alone as a therapeutic exercise to improve physical function may be limited.

Saxena, A. and D. Hofer (2018). "Triple Achilles Tendon Rupture: Case Report." Journal of Foot & Ankle Surgery 57(2): 404-408.
	We present a case report with 1-year follow-up data of a 57-year-old male soccer referee who had sustained an acute triple Achilles tendon rupture injury during a game. His triple Achilles tendon rupture consisted of a rupture of the proximal watershed region, a rupture of the main body (mid-watershed area), and an avulsion-type rupture of insertional calcific tendinosis. The patient was treated surgically with primary repair of the tendon, including tenodesis with anchors. Postoperative treatment included non-weightbearing for 4 weeks and protected weightbearing until 10 weeks postoperative, followed by formal physical therapy, which incorporated an "antigravity" treadmill. The patient was able to return to full activity after 26 weeks, including running and refereeing, without limitations.

Scanlon, A. M., et al. (2011). "Research Report Abstracts." Physiotherapy 97: eS18-eS1415.
	Purpose: The aim of this pilot study was to evaluate the use and effect of Nintendo Wii on the balance of older Irish adults at risk of falls. The objectives were: to assess the acceptability of Nintendo Wii among older adults; to compare changes in balance measures between those undergoing conventional balance rehabilitation and Wii‐therapy; and to measure the effect that balance training had on balance confidence. Relevance: One in three adults over the age of 65 years fall each year. Nintendo Wii is purported to improve balance through its pre‐programmed games. However, limited evidence supports its use in clinical practice. Therefore, it is relevant to clinicians to determine the use and effectiveness of Nintendo Wii among older adults who are at risk of falls. Participants: Thirteen older adults at risk of falling. Methods: The study was carried out in an Age‐Related Day Hospital attached to a large urban teaching hospital in Dublin, Ireland. A convenience sample (n = 13) of older adults at risk of falls was recruited. Those with medical causes of falls, including unstable disease, dementia and stroke within the previous 6 months were excluded. The primary outcome measure was the Berg Balance Scale. Secondary outcome measures included the modified System Usability Questionnaire (mSUQ), Timed Up & Go (TUG), Single Leg Stance (SLS) and the Activities‐specific Balance Confidence Scale (UK version). Outcomes were assessed one week pre and post interventions by an assessor blind to group allocation. Participants were randomised to a control (n = 6) or intervention (n = 7) group. Each participant underwent a 40 minute intervention, once weekly over six weeks. The control group underwent conventional balance training exercises. The intervention group participated in Wii activities. Analysis: Descriptive statistics were used to describe the acceptability of Nintendo Wii among older adults at risk of falls. Independent and related t‐tests analysed Berg scores. Mann‐Whitney U and Wilcoxon tests analysed the secondary outcome measures. Results: Baseline scores were comparable. Poor acceptability (mean 38.5%) was found for Nintendo Wii. A high drop‐out rate was also noted (n = 4/7) in the intervention group, compared to one drop‐out in the control group. No statistically significant change in balance (p = 0.37 Berg, TUG; p = 0.23 SLS) or balance confidence (p = 0.10) was noted in either group. Most participants demonstrated reduced balance confidence following physiotherapy interventions. Furthermore, pooled data demonstrated no significant changes between baseline and post‐intervention scores. Conclusions: Due to a low recruitment rate (n = 13) and the subsequent risk of Type II error, no definitive conclusions could be reached regarding the effectiveness of Nintendo Wii on the balance of older adults at risk of falls. However, the raw data would suggest that Nintendo Wii may have a positive effect on the balance ability of older Irish adults at risk of falls. Implications: Larger scale interventions are necessary to determine the effect of Nintendo Wii on the balance of older adults at risk of falls.

Scapin, S., et al. (2018). "Virtual Reality in the treatment of burn patients: A systematic review." Burns 44(6): 1403-1416.
	AIM: To identify studies that approach immersive virtual realities and its main effects in the treatment of burn patients in the context of the scientific world of literature. METHODS: A systematic review following the steps of Cochrane. The search was conducted in eight databases between May and August 2016. RESULTS: 34 studies were analyzed, including 23 randomized clinical trials. VR was applied using three-dimensional features and video games. The findings demonstrate the association of this technology with increased enjoyment and the reduction of pain, anxiety and stress during dressing changes and also during physical rehabilitation and physiotherapy. Few side effects have been reported. CONCLUSION: VR is a complementary drug strategy that has proven beneficial results in the treatment of burn patients.

Schaeffer, E., et al. (2022). "Effects of exergaming on hippocampal volume and brain-derived neurotrophic factor levels in Parkinson's disease." European Journal of Neurology 29(2): 441-449.
	BACKGROUND AND OBJECTIVE: Cognitive impairment is among the most burdensome non-motor symptoms in Parkinson's disease (PD) and has been associated with hippocampal atrophy. Exercise has been reported to enhance neuroplasticity in the hippocampus in correlation with an improvement of cognitive function. We present data from the Training-PD study, which was designed to evaluate effects of an "" training protocol on neuronal plasticity in PD. METHODS: We initiated a 6-week exergaming training program, combining visually stimulating computer games with physical exercise in 17 PD patients and 18 matched healthy controls. Volumetric segmentation of hippocampal subfields on T1- and T2-weighted magnetic resonance imaging and brain-derived neurotrophic factor (BDNF) serum levels were analyzed before and after the training protocol. RESULTS: The PD group showed a group-dependent significant volume increase of the left hippocampal subfields CA1, CA4/dentate gyrus (DG) and subiculum after the 6-week training protocol. The effect was most pronounced in the left DG of PD patients, who showed a significantly smaller percentage volume compared to healthy controls at baseline, but not at follow-up. Both groups had a significant increase in serum BDNF levels after training. CONCLUSIONS: The results of the present study indicate that exergaming might be a suitable approach to induce hippocampal volume changes in PD patients. Further and larger studies are needed to verify our findings.

Schaer, A., et al. (2021). "Integrated Pedal System for Data Driven Rehabilitation." Sensors 21(23): 8115.
	We present a system capable of providing visual feedback for ergometer training, allowing detailed analysis and gamification. The presented solution can easily upgrade any existing ergometer device. The system consists of a set of pedals with embedded sensors, readout electronics and wireless communication modules and a tablet device for interaction with the users, which can be mounted on any ergometer, transforming it into a full analytical assessment tool with interactive training capabilities. The methods to capture the forces and moments applied to the pedal, as well as the pedal's angular position, were validated using reference sensors and high-speed video capture systems. The mean-absolute error (MAE) for load is found to be 18.82 N, 25.35 N, 0.153 Nm for Fx, Fz and Mx respectively and the MAE for the pedal angle is 13.2 degrees . A fully gamified experience of ergometer training has been demonstrated with the presented system to enhance the rehabilitation experience with audio visual feedback, based on measured cycling parameters.

Schattin, A., et al. (2016). "Adaptations of Prefrontal Brain Activity, Executive Functions, and Gait in Healthy Elderly Following Exergame and Balance Training: A Randomized-Controlled Study." Frontiers in aging neuroscience 8: 278.
	During aging, the prefrontal cortex (PFC) undergoes age-dependent neuronal changes influencing cognitive and motor functions. Motor-learning interventions are hypothesized to ameliorate motor and cognitive deficits in older adults. Especially, video game-based physical exercise might have the potential to train motor in combination with cognitive abilities in older adults. The aim of this study was to compare conventional balance training with video game-based physical exercise, a so-called exergame, on the relative power (RP) of electroencephalographic (EEG) frequencies over the PFC, executive function (EF), and gait performance. Twenty-seven participants (mean age 79.2 +/- 7.3 years) were randomly assigned to one of two groups. All participants completed 24 trainings including three times a 30 min session/week. The EEG measurements showed that theta RP significantly decreased in favor of the exergame group [L(14) = 6.23, p = 0.007]. Comparing pre- vs. post-test, EFs improved both within the exergame (working memory: z = -2.28, p = 0.021; divided attention auditory: z = -2.51, p = 0.009; divided attention visual: z = -2.06, p = 0.040; go/no-go: z = -2.55, p = 0.008; set-shifting: z = -2.90, p = 0.002) and within the balance group (set-shifting: z = -2.04, p = 0.042). Moreover, spatio-temporal gait parameters primarily improved within the exergame group under dual-task conditions (speed normal walking: z = -2.90, p = 0.002; speed fast walking: z = -2.97, p = 0.001; cadence normal walking: z = -2.97, p = 0.001; stride length fast walking: z = -2.69, p = 0.005) and within the balance group under single-task conditions (speed normal walking: z = -2.54, p = 0.009; speed fast walking: z = -1.98, p = 0.049; cadence normal walking: z = -2.79, p = 0.003). These results indicate that exergame training as well as balance training positively influence prefrontal cortex activity and/or function in varying proportion.

Schattin, A., et al. (2019). "Effects of exergame training combined with omega-3 fatty acids on the elderly brain: a randomized double-blind placebo-controlled trial." BMC Geriatrics 19(1): 81.
	BACKGROUND: Older adults often suffer from age- and behavior-related brain changes affecting neuronal functioning and, therefore, cognitive and motor functions. The improvement of these functions might decrease falls and improve mobility. Previous studies indicate that video game-based physical exercise, so-called exergames, or omega-3 fatty acids (FAs) improve motor and cognitive functioning through brain adaptations. The aim of this study was to assess the effects of exergame training combined with fish oil supplementation on neuronal system levels in the brain and behavioral measurements in older adults. We hypothesized that the combination would differently affect these factors compared to the sole administration of exergame. METHODS: Fifty-eight participants were randomly assigned to one of two groups (N = 29 each group) in a parallel, double-blind, randomized controlled trial lasting 26 weeks. The experimental group received daily fish oil, whereas the control group received daily olive oil. After 16 weeks, both groups started with an exergame training. Measurements were performed pre, during, and post intervention. Primary outcomes were recruitment curves using transcranial magnetic stimulation and response-locked potentials using electroencephalography. Secondary outcomes included executive functions and gait parameters. Blood samples were taken to control for FAs. RESULTS: Forty-three individuals (mean age 69.4 +/- 4.6 years) completed the study (Nexperimental = 22, Ncontrol = 21). The results showed no significant time x group interaction effects for any parameters. Blood samples demonstrated significant time x group interaction effects. Post-hoc tests showed a significant increase of omega-3 FAs (p < .001) and a significant decrease of omega-6 FAs (p < .001) for the experimental group. CONCLUSION: The combination of exergame training and fish oil did not lead to additional beneficial effects. To trigger possible effects, future studies should carefully consider study design aspects; e.g. study duration, individual nutritional supplementation dose, omega-3 FAs supplementation composition, and placebo. Furthermore, studies should consider neuroimaging methods as these might be more sensitive to assess early brain adaptations. Thus, future studies should be aware of several aspects running a combinatory study that includes omega-3 FAs according to their expected effects. TRIAL REGISTRATION: Swiss National Clinical Trials SNCTP000001623 and ISRCTN12084831 registered 30 November 2015.

Schattin, A. and E. D. de Bruin (2016). "Combining Exergame Training with Omega-3 Fatty Acid Supplementation: Protocol for a Randomized Controlled Study Assessing the Effect on Neuronal Structure/Function in the Elderly Brain." Frontiers in aging neuroscience 8: 283.
	A common problem in the older population is the risk of falling and related injury, immobility, and reduced survival. Age-related neuronal changes, e.g., decline in gray-and white-matter, affect neuronal, cognitive, and motor functioning. The improvement of these factors might decrease fall events in elderly. Studies showed that administration of video game-based physical exercise, a so-called exergame, or omega-3 fatty acid (FA) may improve motor and/or cognitive functioning through neuronal changes in the brain of older adults. The aim of this study is to assess the effects of a combination of exergame training with omega-3 FA supplementation on the elderly brain. We hypothesize that an intervention using a combination approach differently affects on the neuronal structure and function of the elderly's brain as compared to the sole administration of exergame training. The study is a parallel, double-blinded, randomized controlled trial lasting 26 weeks. Sixty autonomous living, non-smoking, and right-handed healthy older (>65 years) adults who live independently or in a senior residency are included, randomized, and allocated to one of two study groups. The experimental group receives a daily amount of 13.5 ml fish oil (including 2.9 g of omega-3 FA), whereas the control group receives a daily amount of 13.5 ml olive oil for 26 weeks. After 16 weeks, both groups start with an exergame training program three times per week. Measurements are performed on three time-points by treatment blinded investigators: pre-intervention measurements, blood sample after 16 week, and post-intervention measurements. The main outcomes are motor evoked potentials of the right M. tibialis anterior (transcranial magnetic stimulation) and response-related potentials (electroencephalography) during a cognitive test. For secondary outcomes, reaction time during cognitive tests and spatio-temporal parameters during gait performance are measured. Statistics will include effect sizes and a 2 x 2-ANOVA with normally distributed data or the non-parametric equivalent for data not fulfilling normal distribution. The randomized controlled study is the first to investigate the effectiveness of exergame training combined with omega-3 FA in counteracting age- and behavioral-dependent neuronal changes in the brain. This study has been registered in the Swiss National Clinical Trials (SNCTP000001623) and the ISRCTN (ISRCTN12084831) Portals.

Schattin, A., et al. (2021). "Design and Evaluation of User-Centered Exergames for Patients With Multiple Sclerosis: Multilevel Usability and Feasibility Studies." JMIR Serious Games 9(2): e22826.
	BACKGROUND: Multiple sclerosis (MS) is a chronic inflammatory disease of the central nervous system. Patients with MS experience a wide range of physical and cognitive dysfunctions that affect their quality of life. A promising training approach that concurrently trains physical and cognitive functions is video game-based physical exercising (ie, exergaming). Previous studies have indicated that exergames have positive effects on balance and cognitive functions in patients with MS. However, there is still a need for specific, user-centered exergames that function as a motivating and effective therapy tool for patients with MS and studies investigating their usability and feasibility. OBJECTIVE: The aim of this interdisciplinary research project is to develop usable and feasible user-centered exergames for the pressure-sensitive plate Dividat Senso by incorporating theoretical backgrounds from movement sciences, neuropsychology, and game research as well as participatory design processes. METHODS: Focus groups (patients and therapists) were set up to define the user-centered design process. This was followed by the field testing of newly developed exergame concepts. Two sequential usability and feasibility studies were conducted on patients with MS. The first study included a single exergaming session followed by measurements. Between the first and second studies, prototypes were iterated based on the findings. The second study ran for 4 weeks (1-2 trainings per week), and measurements were taken before and after the intervention. For each study, participants answered the System Usability Scale (SUS; 10 items; 5-point Likert Scale; score range 0-100) and interview questions. In the second study, participants answered game experience-related questionnaires (Flow Short Scale [FSS]: 13 items; 7-point Likert Scale; score range 1-7; Game Flow questionnaire: 17 items; 6-point Likert Scale; score range 1-6). Mixed methods were used to analyze the quantitative and qualitative data. RESULTS: In the first study (N=16), usability was acceptable, with a median SUS score of 71.3 (IQR 58.8-80.0). In the second study (N=25), the median SUS scores were 89.7 (IQR 78.8-95.0; before) and 82.5 (IQR 77.5-90.0; after), and thus, a significant decrease was observed after training (z=-2.077; P=.04; r=0.42). Moreover, high values were observed for the overall FSS (pre: median 5.9, IQR 4.6-6.4; post: median 5.8, IQR 5.4-6.2) and overall Game Flow Questionnaire (pre: median 5.0, IQR 4.7-5.3; post: median 5.1, IQR 4.9-5.3). A significant decrease was observed in the item perceived importance (FSS: z=-2.118; P=.03; r=0.42). Interviews revealed that user-centered exergames were usable, well accepted, and enjoyable. Points of reference were identified for future research and development. CONCLUSIONS: The project revealed that the newly developed, user-centered exergames were usable and feasible for patients with MS. Furthermore, exergame elements should be considered in the development phase of user-centered exergames (for patients with MS). Future studies are needed to provide indications about the efficacy of user-centered exergames for patients with MS.

Schega, L., et al. (2015). "Evaluation of a supervised multi-modal physical exercise program for prostate cancer survivors in the rehabilitation phase: Rationale and study protocol of the ProCaLife study." Contemporary Clinical Trials 45(Pt B): 311-319.
	BACKGROUND: After treatment for localized prostate cancer, many survivors experience severe physical and psychological/psychosocial impairments, such as urinary incontinence, erectile dysfunction, fatigue, depressive symptoms and decreased physical functioning. Physical activity and exercise can positively influence such side effects and improve quality of life. However, the majority of prostate cancer survivors are not physically active. Thus, supportive interventions, such as supervised exercise programs, are necessary. But particularly in the post-treatment phase, infrastructure and resources are limited and specific exercise recommendations for prostate cancer survivors do not yet exist. METHODS/DESIGN: The ProCaLife study is a quasi-randomized controlled intervention trial evaluating a specific 26-week physical exercise program for prostate cancer survivors in the rehabilitation phase following medical treatment. Participants are assigned to one of two intervention groups (supervised multi-modal physical exercise including or not including further behavior-oriented techniques) or a control group (not receiving any supervised intervention). Exercise sessions are performed twice weekly and contain specific aerobic, strengthening, flexibility, balance, relaxation and pelvic floor/sphincter exercises as well as mixed games. Behavior-oriented techniques include physical activity-related knowledge transfer and barriers management. The primary endpoint quality of life and secondary psychological/psychosocial, urological, physical fitness and physical activity outcomes are assessed at pre-intervention, post-intervention and follow-up time points. DISCUSSION/CONCLUSION: By evaluating a specific supervised multi-modal physical exercise program, the ProCaLife study contributes to identify effective forms of physical exercise for prostate cancer survivors in the rehabilitation phase. This is of great importance for establishing specific exercise recommendations which are missing so far.

Scheper, W. J. (1989). Special topics: an introduction. Simulation-Gaming. J. H. G. Klabbers, W. J. Scheper, C. A. T. Takkenberg and D. Crookall. Amsterdam, Pergamon: 283-285.
	Publisher Summary This chapter discusses simulation games concerning environmental planning. A simulation game dealing with the imbalance between supply and demand of dental health care services is described in the chapter. Ten Brummeler and van Dijkum describe a simulation game directed at the quality of treatment and the related costs of physiotherapy. As countries do have different interests, potential conflict is inherent in their multilateral relationships. It is in everyone's interest to keep the probability of a conflict as low as possible. It is in this realm of international relations that diplomats are operating. While representing and defending the interests of their countries, they encounter in their daily work a wide variety of issues such as trade, security, development, culture, and human rights.

Schleichkorn, J. S. (1953). "Adapting games for handicapped children." Physical Therapy Reviews 33(5): 245-247.
	
Schlogl, M., et al. (2022). "Teaching geriatric medicine through gamification: a tool for enhancing postgraduate education in geriatric medicine." Aging-Clinical & Experimental Research 34(2): 455-463.
	BACKGROUND: Polypharmacy is becoming increasingly common and all doctors must be prepared to manage it competently. AIMS: The aim of this project is to evaluate the feasibility and use of a novel gamification-based teaching intervention on polypharmacy among doctors undergoing advanced geriatric training. Among others, one of the learning goals for the students was to be able to describe the adherence to medication. METHODS: Electronic questionnaire sent to students of the third session "evidence-based medicine in geriatrics" of advanced postgraduate course in geriatrics of the European Academy for Medicine of Ageing. RESULTS: Most students reported issues with forgetting doses and remembering sufficiently to establish a medication routine due to busy schedules as well as social influences around medication taking. Reflecting on the challenges of the game, most students reported that their own prescribing practice was likely to change. DISCUSSION AND CONCLUSION: The current model of learning appears to be a feasible approach for postgraduate medical education or in other areas of healthcare such as nursing or physiotherapy. Learning through action and reflection promotes deeper thinking and can lead to behavioral change, in this case thus enhancing the attitudes and understanding regarding pharmacological issues associated with ageing. Recommendations for future research in medical education about medication adherence are outlined.

Schott, G. and D. Hodgetts (2006). "Health and digital gaming: the benefits of a community of practice." Journal of Health Psychology 11(2): 309-316.
	Psychologists have a tendency to focus on the negative side of life. Our discipline has become preoccupied with illness rather than health. Where the media are concerned we explore the consequences of unhealthy messages for the population in general or young people in particular. This commentary breaks with tradition by outlining ways in which digital games can enhance health. Positive health consequences of gaming are explored in relation to surgical training and therapeutic interventions, physical exercise, health education and community participation.

Schroder, J., et al. (2019). "Combining the benefits of tele-rehabilitation and virtual reality-based balance training: a systematic review on feasibility and effectiveness." Disabil Rehabil Assist Technol 14(1): 2-11.
	PURPOSE: A motivational surrounding is desirable in stroke rehabilitation considering the need to train repetitively to improve balance, even after discharge from rehabilitation facilities. This review aims to investigate whether it is feasible to combine virtual reality (VR) which allows exercising in game-like environments with tele-rehabilitation in a community-dwelling stroke population. METHODS: Literature searches were conducted in five databases, for example, PubMed and the Cochrane Library. Randomized controlled trial (RCT) and non-RCT investigating feasibility and effectiveness of VR-based tele-rehabilitation were included. Based on the risk of bias and study design, methodological quality is ranked according to the GRADE guidelines. RESULTS: Seven studies (n = 120) were included, of which four are RCTs. Evidence regarding therapy adherence and perceived enjoyment of VR, as well as a cost-benefit of tele-rehabilitation emphasizes feasibility. Equal effects are reported comparing this approach to a therapist-supervised intervention in the clinical setting on balance and functional mobility. CONCLUSIONS: Tele-rehabilitation could be a promising tool to overcome burdens that restrict accessibility to rehabilitation in the future. VR can increase motivation allowing longer and more training sessions in community-dwelling stroke survivors. Therefore, combining the benefits of both approaches seems convenient. Although evidence is still sparse, functional improvements seem to be equal compared to a similar intervention with therapist-supervision in the clinic, suggesting that for cost-efficient rehabilitation parts of therapy can be transferred to the homes. Implications for rehabilitation The use of tele-rehabilitation could be a promising tool to overcome burdens that restrict the access of stroke survivors to long-term rehabilitative care. VR-based interventions are game-like and therefore seem to provide a motivational environment which allows longer exercise sessions and greater adherence to therapy.

Schultz, C. L. (1984). "‘Yes, but what about the Student?’." Australian Journal of Physiotherapy 30(1): 16-18.
	Student evaluations of a simulated case conference in a rehabilitation setting were discussed and analysed, on the basis of the proposition that role-playing and simulated gaming are educational techniques of value in the training of health professionals. Eighteen fourth-year physiotherapy students responded positively in terms of insights gained from participation in a simulated group exercise. Students expressed interest in similar exercises to enable them to gain further insights into specific situations of relevance to their future professional lives.

Schumacher, H., et al. (2018). "A prospective, randomized evaluation of the feasibility of exergaming on patients undergoing hematopoietic stem cell transplantation." Bone Marrow Transplant 53(5): 584-590.
	The positive effects of physical and sports therapy for strain dependent physical practice and improved quality of life (QoL) are well known. Nevertheless, the available capacities and problem-oriented therapies in the setting of hematopoietic stem cell transplantation (HSCT) are limited. We conducted a prospective, randomized study among 42 HSCT recipients in order to investigate the influence of exergaming on Nintendo Wii((R)) or classical physiotherapy (PT) on physical fitness and psychological well-being. The trial included evaluation of muscle strength, endurance, physical activity, distress, QoL, anxiety, and depression. Within the first 2 weeks after HSCT endurance, muscle strength and physical well-being decreased, while the value of distress increased significantly in both groups. However, exergaming on Nintendo Wii((R)) resulted in a decrease of anxiety and depression and improved emotional well-being, while the PT group showed a contrariwise pattern of these features. Analysis of the FACT-BMT revealed a decline of QoL domains 2 and 4 weeks after HSCT and an improvement afterwards. The decrease of functional status after HSCT was accompanied by a drop of QoL and an increase of distress in both groups. However, our prospective study demonstrates that exergaming using the Nintendo Wii((R)) is feasible and well tolerated in HSCT recipients.

Schuster, C., et al. (2013). "Evaluating efficacy and user'/INS;s expectations of a virtual reality training system: A multi-centre randomised controlled trial using mixed methods." Journal of the neurological sciences 333: e549‐.
	Background and objective: Virtual reality (VR),widely used in gaming, has now found its way into neurorehabilitation. The aimof this study is the efficacy evaluation of a VR training system including two nested qualitative evaluations of patients' and therapists' perspectives. Methods: Sixty stroke patients will be randomly allocated to an experimental VR (EG) or a control group using conventional physiotherapy or occupational therapy (16 sessions, 45 min each). Using custom data gloves, patients' finger and arm movements are displayed in real‐time on a monitor and move and manipulate objects in various virtual environments. A blinded assessor will test patients' motor and cognitive performance twice before, once during and twice after the intervention using the Box and Block Test, Chedoke‐McMaster stroke assessments (subscale hand, arm shoulder pain), Chedoke‐McMaster Arm and Hand Activity Inventory, Line Bisection Text, Stroke Impact Scale, Mini‐Mental‐State Examination, and Extended Barthel Index. Semi‐structured interviews will be conducted with patients in EG after intervention finalisation focussing on the expectations and experiences regarding the VR training. Therapists' perspective on VR training will be reviewed in focus groups. Results: Therapists in all centres completed the study training. Until now, seven patients were recruited (one female, age 66.6 ± 5.3 y). One patient finished the study and took part in a semi‐structured interview. After verbatim transcription the data coding and categorisation based on a phenomenological approach have started. Conclusion: The study protocol including the patients' interviews.

Schuster-Amft, C., et al. (2014). "Using mixed methods to evaluate efficacy and user expectations of a virtual reality-based training system for upper-limb recovery in patients after stroke: a study protocol for a randomised controlled trial." Trials [Electronic Resource] 15(1): 350.
	BACKGROUND: In recent years, virtual reality has been introduced to neurorehabilitation, in particular with the intention of improving upper-limb training options and facilitating motor function recovery. METHODS/DESIGN: The proposed study incorporates a quantitative part and a qualitative part, termed a mixed-methods approach: (1) a quantitative investigation of the efficacy of virtual reality training compared to conventional therapy in upper-limb motor function are investigated, (2a) a qualitative investigation of patients' experiences and expectations of virtual reality training and (2b) a qualitative investigation of therapists' experiences using the virtual reality training system in the therapy setting. At three participating clinics, 60 patients at least 6 months after stroke onset will be randomly allocated to an experimental virtual reality group (EG) or to a control group that will receive conventional physiotherapy or occupational therapy (16 sessions, 45 minutes each, over the course of 4 weeks). Using custom data gloves, patients' finger and arm movements will be displayed in real time on a monitor, and they will move and manipulate objects in various virtual environments. A blinded assessor will test patients' motor and cognitive performance twice before, once during, and twice after the 4-week intervention. The primary outcome measure is the Box and Block Test. Secondary outcome measures are the Chedoke-McMaster Stroke Assessments (hand, arm and shoulder pain subscales), the Chedoke-McMaster Arm and Hand Activity Inventory, the Line Bisection Test, the Stroke Impact Scale, the MiniMentalState Examination and the Extended Barthel Index. Semistructured face-to-face interviews will be conducted with patients in the EG after intervention finalization with a focus on the patients' expectations and experiences regarding the virtual reality training. Therapists' perspectives on virtual reality training will be reviewed in three focus groups comprising four to six occupational therapists and physiotherapists. DISCUSSION: The interviews will help to gain a deeper understanding of the phenomena under investigation to provide sound recommendations for the implementation of the virtual reality training system for routine use in neurorehabilitation complementing the quantitative clinical assessments. TRIAL REGISTRATION: Cliniclatrials.gov Identifier: NCT01774669 (15 January 2013).

Schwarz, A., et al. (2021). "Does Dynamic Tailoring of A Narrative-Driven Exergame Result in Higher User Engagement among Adolescents? Results from A Cluster-Randomized Controlled Trial." International Journal of Environmental Research & Public Health [Electronic Resource] 18(14): 7444.
	Physical activity interventions for youth are direly needed given low adherence to physical activity guidelines, but many interventions suffer from low user engagement. Exergames that require bodily movement while played may provide an engaging form of physical activity intervention but are not perceived as engaging to all. This study aimed to evaluate whether dynamic tailoring in a narrative-driven mobile exergame for adolescents played in leisure settings, can create higher user engagement compared to a non-tailored exergame. A cluster-randomized controlled trial assessed differences in user engagement between a dynamically tailored (based on an accelerometer sensor integrated in a T-shirt) and non-tailored condition. In total, 94 participants (M age = 14.61 +/- 1.93; 35% female) participated and were assigned to one of the two conditions. User engagement was measured via a survey and game metric data. User engagement was low in both conditions. Narrative sensation was higher in the dynamically tailored condition, but the non-tailored condition showed longer play-time. User suggestions to create a more appealing game included simple and more colorful graphics, avoiding technical problems, more variety and shorter missions and multiplayer options. Less cumbersome or more attractive sensing options than the smart T-shirt may offer a more engaging solution, to be tested in future research.

Schwarz, A., et al. (2018). "Mobile Exergaming in Adolescents' Everyday Life-Contextual Design of Where, When, with Whom, and How: The SmartLife Case." International Journal of Environmental Research & Public Health [Electronic Resource] 15(5): 835.
	Exergames, more specifically console-based exergames, are generally enjoyed by adolescents and known to increase physical activity. Nevertheless, they have a reduced usage over time and demonstrate little effectiveness over the long term. In order to increase playing time, mobile exergames may increase potential playing time, but need to be engaging and integrated in everyday life. The goal of the present study was to examine the context of gameplay for mobile exergaming in adolescents&rsquo; everyday life to inform game design and the integration of gameplay into everyday life. Eight focus groups were conducted with 49 Flemish adolescents (11 to 17 years of age). The focus groups were audiotaped, transcribed, and analyzed by means of thematic analysis via Nvivo 11 software (QSR International Pty Ltd., Victoria, Australia). The adolescents indicated leisure time and travel time to and from school as suitable timeframes for playing a mobile exergame. Outdoor gameplay should be restricted to the personal living environment of adolescents. Besides outdoor locations, the game should also be adaptable to at-home activities. Activities could vary from running outside to fitness exercises inside. Furthermore, the social context of the game was important, e.g., playing in teams or meeting at (virtual) meeting points. Physical activity tracking via smart clothing was identified as a motivator for gameplay. By means of this study, game developers may be better equipped to develop mobile exergames that embed gameplay in adolescents&rsquo; everyday life.

sdrvb, R. B. R. (2020). "Training Effectiveness Using Complementary Video Game for Rehabilitation in PET / MAH Patients: Randomized Trial." https://trialsearch.who.int/Trial2.aspx?TrialID=RBR-8sdrvb.
	INTERVENTION: Carrier of human T‐lymphotropic virus type‐ 1 [HTLV‐1] infection Other Rehabilitation They will be divided into two groups of 8 subjects each group, totaling 16 volunteers at the end of the research. The treatment will be performed in 15 sessions, 3 times a week, for a total of 5 weeks. Each session will have an average duration of 45 minutes. Both groups will perform training with conventional physical therapy, consisting of: 3 sets of 30‐second active stretching for the lumbar spine (using verbal command to hug the legs and keeping the contralateral side extended unilaterally and then bilaterally) ) and passive to the lower limbs (keeping the lower limb fully extended to the extent tolerable by the subject); active exercises divided into 3 sets of 10 repetitions for lower limbs (consisting of maintaining a fully extended lower limb and raising it to the knee height of the contralateral lower limb, which will remain flexed during the activity); core abdominal (bridge exercises); proprioceptive neuromuscular facilitation (PNF), with one diagonal for the lower limbs and one for the trunk; and balance training by positioning the feet to reduce the footing, performing 3 sets of 30 seconds each, expected to last 30 minutes. After applying this protocol, the experimental group will perform the training using VR. Initially, they will be positioned in front of the Xbox Kinect® sensor at a distance of 1.5 meters for equipment recognition and collection standardization. In the first session, they will be informed about how the Xbox Kinect® works and the therapist will demonstrate how each game works. After this introduction, patients will attempt each game to adapt to therapy. Afterwards, they will make a new attempt, which will collect the score values ??achieved by them. In the following sessions, they will perform the training for about 5 minutes in each of th Virtual Reality CONDITION: A00‐B99 Carrier of human T‐lymphotropic virus type‐ 1 [HTLV‐1] infection Carrier of human T‐lymphotropic virus type‐ 1 [HTLV‐1] infection ; Carrier of human T‐lymphotropic virus type‐ 1 [HTLV‐1] infection PRIMARY OUTCOME: The primary end point is to compare whether virtual reality associated with conventional physical therapy treatment provided a greater effect than conventional treatment associated with placebo, in the balance of these patients with pet / mah, compared between the moments before and after application of the protocols. As an evaluation method, the force platform will be used, an instrument that measures the center of pressure, and from the collected data, it is possible to verify the displacement area, velocity and amplitude, for example. In addition to the platform, a miniBESTest clinical assessment scale will also be used, which assesses balance through predetermined tasks and scores them between 0 and 2, with a total of 14 questions, reaching 28 points. SECONDARY OUTCOME: The secondary outcome aims to verify whether the virtual reality associated with conventional physical therapy treatment provided a superior effect to conventional treatment associated with placebo, in the quality of life and pain of these patients with pet / mah, compared between the pre and post application of the protocols. For this evaluation, a clinical scale called short‐form 36 or SF‐36 will be used, which measures domains such as functional capacity, physical aspects, pain, general health status, vitality, social aspects, emotional aspects and mental health. The scale ranges from 0 to 100 in each of the domains, with the highest values related to improvement. INCLUSION CRITERIA: Have the confirmed diagnosis of PET / MAH, by an infectologist; refer to mild pain or acute second visual analogue scale (VAS); gait alteration (claudication, use of orthoses as a cane or crutch) and age range between 30 and 60 years.

Seamon, B., et al. (2017). "Use of the Xbox Kinect virtual gaming system to improve gait, postural control and cognitive awareness in an individual with Progressive Supranuclear Palsy." Disability & Rehabilitation 39(7): 721-726.
	PURPOSE: The purpose of this report is to describe an intervention using the Xbox Kinect virtual gaming system to improve gait, postural control and cognitive awareness in order to reduce falls and improve the quality of life for an individual with Progressive Supranuclear Palsy. METHODS: A 65-year-old woman with a five-year history of PSP and frequent falls presented for physical therapy. Her case was complicated by poor ability to visually track objects, axial rigidity, retropulsion, poor postural control with reaching and declines in cognitive awareness. Intervention was provided using the Xbox Kinect for 12 one-hour sessions over six weeks in an outpatient setting. Games were selected to challenge functional motor and cognitive tasks based on patient enjoyment. RESULTS: The Xbox Kinect intervention may have contributed to a decline in falls and maintenance of scores on the BBS, TUG and 10 Meter Walk Tests above fall risk values. A decline in quality of life measures, PDQ-39 and FFABQ, may be attributed to an increase in cognitive awareness of deficits promoted by the intervention structure. CONCLUSION: Implementation of a gaming intervention using the Xbox Kinect is feasible for reducing fall risk, maintaining function and improving cognitive awareness when used in an outpatient setting. Implications for Rehabilitation Progressive Supranuclear Palsy is a rare and rapidly progressive neurodegenerative disease wherethere is a lack of long-term rehabilitation options to help slow their rapid progressions. Our case demonstrates the feasibility of an intervention using a virtual gaming system to helpmaintain functional mobility, balance and independence for an individual with PSP. Collaborative interactions between game companies and physical therapists will improve theability of virtual games to address rehabilitation goals within neurodegenerative populations.

Segal, A. D., et al. (2020). "A Gesture-Controlled Rehabilitation Robot to Improve Engagement and Quantify Movement Performance." Sensors 20(15): 31.
	Rehabilitation requires repetitive and coordinated movements for effective treatment, which are contingent on patient compliance and motivation. However, the monotony, intensity, and expense of most therapy routines do not promote engagement. Gesture-controlled rehabilitation has the potential to quantify performance and provide engaging, cost-effective treatment, leading to better compliance and mobility. We present the design and testing of a gesture-controlled rehabilitation robot (GC-Rebot) to assess its potential for monitoring user performance and providing entertainment while conducting physical therapy. Healthy participants (n = 11) completed a maze with GC-Rebot for six trials. User performance was evaluated through quantitative metrics of movement quality and quantity, and participants rated the system usability with a validated survey. For participants with self-reported video-game experience (n = 10), wrist active range of motion across trials (mean +/- standard deviation) was 41.6 +/- 13 degrees and 76.8 +/- 16 degrees for pitch and roll, respectively. In the course of conducting a single trial with a time duration of 68.3 +/- 19 s, these participants performed 27 +/- 8 full wrist motion repetitions (i.e., flexion/extension), with a dose-rate of 24.2 +/- 5 (reps)/min. These participants also rated system usability as excellent (score: 86.3 +/- 12). Gesture-controlled therapy using the GC-Rebot demonstrated the potential to be an evidence-based rehabilitation tool based on excellent user ratings and the ability to monitor at-home compliance and performance.

Selfridge, N. (2013). "Longevity in Olympic Medalists: Competitive Edge?" Integrative Medicine Alert 16(3): 45-47.
	Evidence suggests that regular physical exercise is a habit that confers health benefits, including reduced all-cause mortality. Several studies have suggested that higher exercise intensity and volume may correlate inversely with mortality risks. For example, in an observational study involving more than 250,000 men and women aged 50-71 years, vigorous exercise at least three times weekly combined with regular moderate exercise most days of the week was associated with a 50% decreased mortality risk. The Framingham Heart Study has shown that moderate and high levels of physical activity, compared to low levels, increase life expectancy for both men and women. In a meta-analysis of 33 observational studies (102,980 participants) analyzing risk of all-cause mortality related to cardiorespiratory fitness (CRF), subjects with low CRF had an increased risk of all-cause mortality compared to those with high CRF (relative risk [RR], 1.7; 95% confidence interval [CI], 1.5-1.9) and intermediate CRF (RR, 1.4; 95% CI, 1.3-1.5). These data certainly beg the question whether a longevity advantage exists in the most elite of athletes. Clarke et al analyzed a remarkable database to determine whether Olympic medalists live longer than the general population. The authors constructed a retrospective cohort study using a database created in the 1980s by an international consortium of Olympic historians and statisticians, called OlyMADMen, which has been collecting data on all Olympians. OlyMadMen is stated by the authors to be regarded as the most authoritative source of information on Olympians. Resources for this database include official Olympic records, other official public records and sources, books, newspaper and magazine articles, interviews, obituaries, and international professional sporting organizations. The OlyMADMen database contains information on 118,442 athletes who participated in 27 summer and 21 winter games held between 1896 and 2010. The authors chose to analyze data from nine country groups (United States, Nordic countries, Russia, Germany, United Kingdom, France, Italy, Australia and New Zealand, Canada), accounting for 63.8% of Olympic medalists during this time period. They excluded medalists with missing birthdates. Those medalists who represented more than one country or won more than one medal were classified based on their status when they won their first medals. Survival among medalists was calculated using an actuarial technique by Tallis et al, which removes bias in survival estimates occurring because of missing data due to unidentified loss of follow-up. In the article, these authors demonstrate that if a conditional variable is chosen for their formulas that is greater than median survival, their formulas will yield data uncontaminated by lost information, as long as unidentified loss to follow-up does not exceed 10-15%. For this reason, Clarke et al chose 60 years for their conditional variable. Estimated loss to follow-up was made on OlyMADMen data before 1928 and was determined to be about 8%, well within the acceptable range for these analyses. Relative survival, then, was calculated using publically available life tables for the general population from each country group, matched by birth year; sex, and age. After overall relative conditional survival was calculated, relative survival by country group, medal, and sport was determined. Being an Olympic medalist appears to confer a longevity advantage in this study. At 10 years, 2% more of the medalists were alive compared to the general population, which is a relative conditional survival of 1.02 (CI, 1.01-1.02). At 30 years, 8% more of the medalists were alive (1.08; 95% CI, 1.07-1.09). Medalists lived, on average, 2.8 years longer than the general population. Survival advantage occurred in all country groups except Canada. There was no difference in survival advantage when medalists were grouped according to medal won, nor was there any difference in survival advantage when medalists were grouped by sport category (endurance, mixed, power).

Sen, M., et al. (2018). "Examination of a board game approach to children's involvement in family-based weight management vs. traditional family-based behavioral counseling in primary care." European Journal of Pediatrics 177(8): 1231-1238.
	The most effective intervention model for childhood obesity is known as family-based behavioral group treatments. There are also studies that investigate the effects of educational games for children to gain healthy eating and physical exercise habits. The aim of this study was to compare the efficacy of a family-based group treatment with an educational game (Kaledo) intervention in childhood obesity. Kaledo is a board game that was designed to improve nutritional knowledge and healthy life style habits. It is played with nutrition and activity cards that players can select from, and a total score is calculated in the end of the game according to energy intake and expenditure. Obese children between 9 and 12 ages were involved in this study. Participants randomly divided into behavioral and game intervention groups. Clinical evaluation was performed in the first and second counseling in both groups. Marmara University Family Medicine Department Obese Children and Adolescents Interview Form, Physical Activity Evaluation Form, and Three-day Food Record Form were used for this purpose. Strengths and Difficulties Questionnaire-Parent Report Version and Children's Depression Inventory were used for the assessment of psychiatric symptoms. After the clinical evaluation, an education session about healthy eating and physical activity was attended by both groups. After that, for the behavioral groups, parents and children were assigned to different groups, while for the game intervention group, parents were assigned to behavioral sessions and children were assigned to game (Kaledo) sessions. A total of six sessions with 1-h duration and 2-week interval were performed in both groups. Height and weight were measured in each session and analysis was performed on the data of the children who participated in all of the sessions. Although a total of 108 children were clinically evaluated, 52 children and their parents, 26 in the behavioral group and 26 in the game intervention group, participated in two or more sessions. Twenty-four participants, 12 in behavioral and 12 in the game intervention group, finished the study by participating in all of the six sessions. Thus, dropout rate was 74%. BMI and BMI z-scores decreased in both groups compared with the initial measures and these changes were statistically significant. For the behavioral group, these changes were - 1.01 (25.44 to 24.43, p = 0.03) and - 0.17 (2.07 to 1.90, p = 0.000) and for the game group, - 0.74 (26.98 to 26.24, p = 0.007) and - 0.09 (2.07 to 1.98, p = 0.003). There were no significant differences between behavioral and game intervention groups in point of BMI and BMI z-scores (p = 0.130 and p = 0.706). CONCLUSION: Family-based behavioral group treatment and game (Kaledo) intervention were found to be effective in childhood obesity management in this research. There was no significant difference between the two interventions. According to this study, these intervention models can be advised to primary care physicians to be used in the management of childhood obesity. What is Known: - Family-based behavioral group treatment is known as the most efficient model for childhood obesity management. What is New: - In this study, for the first time, a game (Kaledo) intervention was found to be effective in childhood obesity management. - Compared with family-based behavioral group treatment, there was no significant difference between the two interventions.

Sgandurra, G., et al. (2011). "Upper limb children action-observation training (UP-CAT): a randomised controlled trial in hemiplegic cerebral palsy." BMC Neurology 11(1): 80.
	BACKGROUND: Rehabilitation for children with hemiplegic cerebral palsy (HCP) aimed to improve function of the impaired upper limb (UL) uses a wide range of intervention programs. A new rehabilitative approach, called Action-Observation Therapy, based on the recent discovery of mirror neurons, has been used in adult stroke but not in children. The purpose of the present study is to design a randomised controlled trial (RCT) for evaluating the efficacy of Action-Observation Therapy in improving UL activity in children with HCP. METHODS/DESIGN: The trial is designed according to CONSORT Statement. It is a randomised, evaluator-blinded, match-pair group trial. Children with HCP will be randomised within pairs to either experimental or control group. The experimental group will perform an Action-Observation Therapy, called UP-CAT (Upper Limb-Children Action-Observation Training) in which they will watch video sequences showing goal-directed actions, chosen according to children UL functional level, combined with motor training with their hemiplegic UL. The control group will perform the same tailored actions after watching computer games. A careful revision of psychometric properties of UL outcome measures for children with hemiplegia was performed. Assisting Hand Assessment was chosen as primary measure and, based on its calculation power, a sample size of 12 matched pairs was established. Moreover, Melbourne and ABILHAND-Kids were included as secondary measures. The time line of assessments will be T0 (in the week preceding the onset of the treatment), T1 and T2 (in the week after the end of the treatment and 8 weeks later, respectively). A further assessment will be performed at T3 (24 weeks after T1), to evaluate the retention of effects. In a subgroup of children enrolled in both groups functional Magnetic Resonance Imaging, exploring the mirror system and sensory-motor function, will be performed at T0, T1 and T2. DISCUSSION: The paper aims to describe the methodology of a RCT for evaluating the efficacy of Action-Observation Therapy in improving UL activity in children with hemiplegia. This study will be the first to test this new type of treatment in childhood. The paper presents the theoretical background, study hypotheses, outcome measures and trial methodology. TRIAL REGISTRATION: NCT01016496.

Sgandurra, G., et al. (2013). "Randomized trial of observation and execution of upper extremity actions versus action alone in children with unilateral cerebral palsy." Neurorehabilitation & Neural Repair 27(9): 808-815.
	BACKGROUND: The properties of the mirror neuron system suggest a new type of upper limb (UL) rehabilitation in children with unilateral cerebral palsy (UCP), based on observation of action therapy followed by execution of a variety of observed movements (AOT). OBJECTIVE: We tested the effects of AOT in the Upper Limb Children Action Observation Training (UP-CAT) trial. METHODS: In a randomized, evaluator-blinded, block-designed trial, 24 UCP children with mild to moderate hand impairment were assigned to 2 groups. The experimental group observed, 1 hour per day for 3 consecutive weeks, video sequences of unimanual or bimanual goal-directed actions and subsequently executed observed actions with the hemiparetic UL or both ULs. The control group performed the same actions in the same order as the experimental sample, but had watched computer games. The Assisting Hand Assessment (AHA) scale was the primary outcome measure; the Melbourne assessment and ABILHAND-Kids were secondary ones. Outcomes were assessed at 1 week (T1), 8 weeks (T2), and 24 weeks (T3) after the end of the training. RESULTS: The experimental group improved more (P = .008) in score changes for the AHA at the primary endpoints T1 (P = .008), T2 (P = .019), and T3 (P = .049). No between-group significant changes were found for ABILHAND-Kids or Melbourne assessment. CONCLUSIONS: UP-CAT improved daily UL activities in UCP children, suggesting a new rehabilitation approach based on a neurophysiological model of motor learning.

Shahmoradi, L., et al. (2020). "Learning promotion of physiotherapy in neurological diseases: Design and application of a virtual reality-based game." J Educ Health Promot 9: 234.
	INTRODUCTION: The virtual reality-based (VR) game can be considered as a new approach to education and to enhance the skills of health-care students. AIMS: The purposes of this research were to design a VR game and to apply it to teach physiotherapy in neurological diseases. METHODOLOGY: In this study, at first, a VR game was designed for upper limb rehabilitation in brain-injured patients based on the literature and the opinions of physiotherapy experts and game designers. Then, the designed game was used for teaching physiotherapy in neurological diseases. Thereafter, the opinions of 31 undergraduate students about the teaching session were evaluated by two anonymous questionnaires. Data analysis was performed using descriptive statistics through SPSS (version 19). RESULTS: The VR game developed under expert supervision. The evaluation showed that the median score for students' perception of learning was 3.11. The median scores of questions related to the "facilitating level of virtual reality" and "student satisfaction" were 8.66 and 9, respectively. The analysis of students' responses to open-ended questions highlighted the therapeutic aspect of the game compared to its educational aspect. CONCLUSIONS: Application of VR games in education can enhance the students' perception of learning. Furthermore, it can provide a better understanding of physiotherapy in patients with neurological diseases as well as the satisfaction of students. However, the survey indicated that the good results of this teaching method are due to the use of VR for guiding the patient's movements.

Sharfnadel, M. G. and D. M. Aronov (1980). "Prolonged intensive training as a method of nondrug therapy and rehabilitation of patients who have had a myocardial infarct." Kardiologiia 20(6): 35‐38.
	The authors examined 75 males (average age 49 years) who had suffered myocardial infarction 4‐‐8 months before the examination. Two groups equal in value, the main and control groups, were formed at random. Patients of the main group were given physical training for one year, including therapeutical physical exercises combined with dosaged running, elements of sport games and training on a bicycle ergometer. The examination showed that long‐term intense training is a very effective non‐drug measure aimed at improving the physical working capacity of patients after myocardial infarction.

Shaw, L. A., et al. (2016). "Competition and cooperation with virtual players in an exergame." PeerJ Computer Science 2.
	Two cross-sectional studies investigated the effects of competition and cooperation with virtual players on exercise performance in an immersive virtual reality (VR) cycle exergame. Study 1 examined the effects of: (1) self-competition whereby participants played the exergame while competing against a replay of their previous exergame session (Ghost condition), and (2) playing the exergame with a virtual trainer present (Trainer condition) on distance travelled and calories expended while cycling. Study 2 examined the effects of (1) competition with a virtual trainer system (Competitive condition) and (2) cooperation with a virtual trainer system (Cooperative condition). Post exergame enjoyment and motivation were also assessed. The results of Study 1 showed that the trainer system elicited a lesser distance travelled than when playing with a ghost or on one’s own. These results also showed that competing against a ghost was more enjoyable than playing on one’s own or with the virtual trainer. There was no significant difference between the participants’ rated enjoyment and motivation and their distance travelled or calories burned. The findings of Study 2 showed that the competitive trainer elicited a greater distance travelled and caloric expenditure, and was rated as more motivating. As in Study 1, enjoyment and motivation were not correlated with distance travelled and calories burned. Conclusion Taken together, these results demonstrate that a competitive experience in exergaming is an effective tool to elicit higher levels of exercise from the user, and can be achieved through virtual substitutes for another human player.

Sherrington, C., et al. (2018). "The effectiveness of affordable technology in rehabilitation to improve mobility and physical activity: Amount (activity and mobility using technology) rehabilitation trial." Annals of physical and rehabilitation medicine 61.
	Introduction/Background: Technology may enable a higher dose of exercise to improve rehabilitation outcomes. Aim: To evaluate the effect of the addition of affordable technology to usual care on physical activity and mobility in people with mobility limitations admitted to inpatient aged and neurological rehabilitation compared to usual care alone. Material and method: A pragmatic, assessor‐blinded, parallel‐group randomised trial of 300 consenting rehabilitation inpatients. The intervention group received technology‐based exercise prescribed by a physiotherapist to target mobility and physical activity problems for 6 months. Technology included video and computer games/exercises, tablet applications and activity monitors. The control group received no additional intervention and both groups received usual rehabilitation care. The co‐primary outcomes were objectively assessed physical activity (average minutes per day spent upright using activPAL) and mobility (Short Physical Performance Battery, SPPB, 0‐3 continuous score) at 6 months after randomisation. Linear models assessed the effect of group allocation with baseline scores entered as covariates. Results: Participants (mean age 74 (SD14); 50% female; 54% with neurological conditions limiting mobility) received on average 11 (SD11) inpatient sessions using 4 (SD1) different technologies and 15 physiotherapy contacts to support technology use in the post‐hospital phase. At 6‐months physical activity was similar between groups (mean between group difference (95% CI) uptime in minutes: ‐3.1 (‐39.4 to 33.2; P = 0.87)) and mobility was significantly better in the intervention group compared to the control group (mean SPPB between group change score 6‐month to baseline 0.2 points (95% CI 0.1 to 0.3, P < 0.01)). Secondary outcomes of mobility also favoured the intervention group as did other aspects of physical activity (e.g. self‐reported physical activity), particularly for younger participants. Conclusion: A tailored intervention using technology, targeting specific mobility limitations and promoting physical activity in addition to usual rehabilitation, improved mobility and some aspects of physical activity and appears to have greater impact in younger people. Copyright © 2018

Shida, N., et al. (2021). "The Effects of Exergames on Muscle Architecture: A Systematic Review and Meta-Analysis." Applied Sciences 11(21): 10325.
	Muscle architectural parameters play a crucial role in the rate of force development, strength, and sports performance. On the other hand, deteriorated muscle architectural parameters are associated with injuries, sarcopenia, mortality, falls, and fragility. With the development of technology, exergames have emerged as a complementary tool for physical therapy programs. The PRISMA 2020 statement was followed during the systematic review and meta-analysis. CENTRAL, CINAHL, PROQUEST, PubMed, and OpenGrey databases were searched last time on 22 September 2021. In total, five controlled trials were included in the systematic review. Twelve weeks of virtual dance exercise (Dance Central game for Xbox 360®) showed a medium effect on the improvement of hamstrings (g = 0.55, 95% CI (−0.03, 1.14), I2 = 0%) and the quadriceps femoris muscle cross-sectional area (g = 0.58, 95% CI (0.1, 1.00), I2 = 0%) in community-dwelling older women. Additionally, a four-week virtual balance-training program (the ProKin System) led to significant increments in the cross-sectional areas of individual paraspinal muscles (14.55–46.81%). However, previously investigated exergame programs did not show any medium or large effects on the architectural parameters of the medial gastrocnemius muscle in community-dwelling older women. Distinct exergame programs can be used as a complementary therapy for different prevention and rehabilitation programs.

Shifman, L., et al. (1986). "Utilizing a game for both needs assessment and learning in adolescent sexuality education." Social Work with Groups 9(2): 41-56.
	A fact-gathering, experimental game proved to be an effective instrument in the needs assessment phase of an adolescent sexuality educational program aimed at low-income females. The game ("Family Few"), which covered the topics of menstruation and reproduction, was played by 35 Black, Hispanic, and white females aged 13-16 years recruited from medical and psychiatric clinics in Miami, Florida. The goals of the game were to elicit terminology used by participants, identify and correct misconceptions and misinformation, and determine if learning could occur. Although 57% of participants reported prior exposure to formal sex education, misinformation about the need for activity curtailment during menstruation and the importance of early pregnancy detection was widespread. Group members believed they needed to restrict activities involving physical exercise, sexual relations, water, and cold during menses and were not likely to seek medical or family consultation regarding a missed period until the end of the 1st trimester of pregnancy. Also evident was a need for accurate information on the side effects, risk factors, benefits, and effectiveness of contraceptive methods. The group responses enabled the sex educators to prepare a culturally responsive, developmentally oriented curriculum for further work with disadvantaged female adolescents. The group process was ranked highly on the Likert Scale by these teenagers as an enjoyable, useful means of information dissemination and problem solving.
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Shimizu, R., et al. (2019). "A survey of acute injury in wheelchair basketball players: relation to the functional classification...Third World Congress of Sports Physical Therapy, October 4-5, 2019, Vancouver, British Columbia." International Journal of Sports Physical Therapy 14(6): S8-S8.
	Objective: Wheelchair basketball (WB) players are classified into eight groups depending on their degree of physical ability. The risk of acute injury is higher than chronic injury in WB. The intensity of shoulder pain has been reported to differ depending on the functional classification. Similarly, the type and cause of injury might be different. However, there is no research from this point of view. This study aimed to investigate the injury in WB players focused on the functional classification. Methods: A questionnaire survey was conducted for 96 WB players in Japan. The question items were the basic information about the injury (type, cause, etc.). The definition of injury was "injury caused by a single impact, having left the game for a day or more, or having consulted a medical institution". According to the classification system, the players were grouped into four classes: Class 1 (most severe disability), 1.0 and 1.5 point; Class 2, 2.0 and 2.5 point; Class 3, 3.0 and 3.5 point; Class 4, 4.0 and 4.5 point. Results: Valid answers were obtained from 85 people (89%). The incidence of injury for Class 1, 2, 3, and 4 were 36%, 20%, 19%, and 25%, respectively. The most common injury types were as follows: in Class 1, 2, and 4, soft tissue injury (41%, 50%, and 41%, respectively); in Class 3, fracture (53%). The cause of injury ranked in descending order was as follows: in Class 1, 3, and 4, fall (31%, 53%, and 91%, respectively), rebound (22%, 24%, and 5%, respectively); in Class 2, fall (44%), shooting (28%). Conclusion: The tendency of the cause of injury differed from each class. Most injuries in Class 4 were caused by falls. Injuries in Class 1 were caused not only by falls but by WB play. It was suggested that WB players with severe disability are often injured by a minor impact. Clinical implications: This study might provide information for injury prevention in consideration of the functional classification to reduce the risk of acute injury in WB players.

Shires, L., et al. (2016). "Evaluating the Microsoft Kinect for use in upper extremity rehabilitation following stroke as a commercial off-the-shelf gaming system." Journal of Pain Management 9(3): 323-331.
	Motion controlled video games have been shown to have a positive effect for physical rehabilitation on the upper extremity in stroke survivors when combined with conventional physical therapy. The study investigates the therapeutic potential of the Microsoft Kinect for the Xbox360, a multimodal gaming peripheral. The Kinect allows users to interact with games using bodily motions and gestures. A list of important joint motions and movement synergies were identified by looking at leading stroke motor function tests for the upper limb. These have been verified by working with Occupational Therapists. A study group of occupational and physiotherapists were asked to record their experience of playing three Kinect mini-games and evaluate them with respect to their motor function requirements and exertion for each identified joint motion. Quality information was also gathered relating to the perceived usability and safety issues that could arise by presenting the device to a stroke survivor. The Kinect provides opportunities for gross arm movement exercise, while the requirement for highly raised arm movements will present a potential barrier for stroke users. Fine motor control movements of the hand and fingers are not tracked sufficiently for effective rehabilitation of the hand. A probable risk of falling while using the Kinect, and potential injury from overexerting the impaired limb while playing existing games, were also identified. We conclude that as the experience have been designed for able bodied users, the games present significant barriers for using the Kinect as a commercial off-the-shelf system for stroke rehabilitation.

Shiwlochan, D. G., et al. (2020). "The Effectiveness of Ketamine in Pediatric Acute Deafferentation Pain after Spinal Cord Injury." Case Rep Anesthesiol 2020: 8835292.
	Deafferentation pain and allodynia commonly occur after spinal cord trauma, but its treatment is often challenging. The literature on effective therapies for pediatric deafferentation pain, especially in the setting of spinal cord injury, is scarce. We report the case of a 12-year-old patient with acute allodynia after a gunshot injury to the spine. The pain was refractory to multiple analgesics, but resolved with ketamine, which also improved the patient's physical function and quality of life, a trend that continued many months after the injury. We suggest that early initiation of ketamine may be effective for acute pediatric deafferentation pain secondary to spinal cord injury, as well as preventing chronic pain states in that population.

Short, S. M., et al. (2016). "Rehabilitation and Return to Sport Following Surgical Repair of the Rectus Abdominis and Adductor Longus in a Professional Basketball Player: A Case Report." Journal of Orthopaedic & Sports Physical Therapy 46(8): 697-706.
	Study Design Case report. Background Acute traumatic avulsion of the rectus abdominis and adductor longus is rare. Chronic groin injuries, often falling under the athletic pubalgia spectrum, have been reported to be more common. There is limited evidence detailing the comprehensive rehabilitation and return to sport of an athlete following surgical or conservative treatment of avulsion injuries of the pubis or other sports-related groin pathologies. Case Description A 29-year-old National Basketball Association player sustained a contact injury during a professional basketball game. This case report describes a unique clinical situation specific to professional sport, in which a surgical repair of an avulsed rectus abdominis and adductor longus was combined with a multimodal impairment- and outcomes-based rehabilitation program. Outcomes The patient returned to in-season competition at 5 weeks postoperation. Objective measures were tracked throughout rehabilitation and compared to baseline assessments. Measures such as the Copenhagen Hip and Groin Outcome Score and numeric pain-rating scale revealed progress beyond the minimal important difference. Discussion This case report details the clinical reasoning and evidence-informed interventions involved in the return to elite sport. Detailed programming and objective assessment may assist in achieving desired outcomes ahead of previously established timelines. Level of Evidence Therapy, level 4. J Orthop Sports Phys Ther 2016;46(8):697-706. Epub 3 Jul 2016. doi:10.2519/jospt.2016.6352.

Shuai, L., et al. (2021). "Influences of digital media use on children and adolescents with ADHD during COVID-19 pandemic." Global Health 17(1): 48.
	OBJECTIVE: To explore the influences of digital media use on the core symptoms, emotional state, life events, learning motivation, executive function (EF) and family environment of children and adolescents diagnosed with attention deficit hyperactivity disorder (ADHD) during the novel coronavirus disease 2019 (COVID-19) pandemic. METHOD: A total of 192 participants aged 8-16 years who met the diagnostic criteria for ADHD were included in the study. Children scoring higher than predetermined cut-off point in self-rating questionnaires for problematic mobile phone use (SQPMPU) or Young's internet addiction test (IAT), were defined as ADHD with problematic digital media use (PDMU), otherwise were defined as ADHD without PDMU. The differences between the two groups in ADHD symptoms, EF, anxiety and depression, stress from life events, learning motivation and family environment were compared respectively. RESULTS: When compared with ADHD group without PDMU, the group with PDMU showed significant worse symptoms of inattention, oppositional defiant, behavior and emotional problems by Swanson, Nolan, and Pelham Rating Scale (SNAP), more self-reported anxiety by screening child anxiety-related emotional disorders (SCARED) and depression by depression self-rating scale for children (DSRSC), more severe EF deficits by behavior rating scale of executive function (BRIEF), more stress from life events by adolescent self-rating life events checklist (ASLEC), lower learning motivation by students learning motivation scale (SLMS), and more impairment on cohesion by Chinese version of family environment scale (FES-CV). The ADHD with PDMU group spent significantly more time on both video game and social media with significantly less time spend on physical exercise as compared to the ADHD without PDMU group. CONCLUSION: The ADHD children with PDMU suffered from more severe core symptoms, negative emotions, EF deficits, damage on family environment, pressure from life events, and a lower motivation to learn. Supervision of digital media usage, especially video game and social media, along with increased physical exercise, is essential to the management of core symptoms and associated problems encountered with ADHD.

Siconolfi-Morris, G. C. (2012). Use of a video game based balance training intervention on the balance and function of children with developmental disabilities, University of Kentucky: 298 p-298 p.
	Many children with developmental disabilities (DD) have physical impairments and limitations in their participation. Rehabilitation research often focuses on either physical impairments or participation restrictions, when both need to be investigated.The purposes of these two studies were to evaluate an at home therapist directed video game balance training intervention on balance, gait velocity (GV), hip strength and activities of children with DD. The pilot study was a single-subject non-concurrent multiple baseline design. Balance measures included: weight bearing symmetry; center of pressure area and velocity; time to boundary mean minima and standard deviation; and timed up and go. The participant's enjoyment and perceived difficulty was also explored. Five children (7 to 10 years) with cerebral palsy (CP) participated in a 6 week, 30 minute intervention 3 times per week, with four preselected balance games. Minimal improvements were found in balance, GV, and hip strength, and participants reported the intervention enjoyable and challenging. Three of five participants had significant increases in activities, as measured by the Activities Scale for Kids (ASK).The second study expanded on pilot study results and included 5 children (5 to 10 years) with different diagnoses. Another non-concurrent multiple baseline design was utilized, and the same measures of balance were used except single leg stance time was substituted for timed up and go. No changes were made to the intensity of intervention, but two games were added to the repertoire. There were minimal changes in balance and hip strength; and no changes were found in the ASK. A majority of participants increased GV, and reported the intervention was enjoyable and challenging.Positive changes were found in the combined results for: center of pressure area with eyes open and closed; time to boundary mean minima with eyes closed in the anterior-posterior direction; and GV. These studies suggest this intervention was insufficient to make improvements in the majority of balance measurements and hip strength for children with DD. Increased activities in children with CP were found in the pilot study. These results suggest video game balance training alone for children with DD was insufficient to demonstrate clinically meaningful change.KEYWORDS: Balance, Developmental Disabilities, Gait Velocity, Hip Strength, Activities and Participation.

Silva, A. P., et al. (2015). "Measurement of the effect of physical exercise on the concentration of individuals with ADHD." PLoS ONE [Electronic Resource] 10(3): e0122119.
	Attention Deficit Hyperactivity Disorder (ADHD) mainly affects the academic performance of children and adolescents. In addition to bringing physical and mental health benefits, physical activity has been used to prevent and improve ADHD comorbidities; however, its effectiveness has not been quantified. In this study, the effect of physical activity on children's attention was measured using a computer game. Intense physical activity was promoted by a relay race, which requires a 5-min run without a rest interval. The proposed physical stimulus was performed with 28 volunteers: 14 with ADHD (GE-EF) and 14 without ADHD symptoms (GC-EF). After 5 min of rest, these volunteers accessed the computer game to accomplish the tasks in the shortest time possible. The computer game was also accessed by another 28 volunteers: 14 with ADHD (GE) and 14 without these symptoms (GC). The response time to solve the tasks that require attention was recorded. The results of the four groups were analyzed using D'Agostino statistical tests of normality, Kruskal-Wallis analyses of variance and post-hoc Dunn tests. The groups of volunteers with ADHD who performed exercise (GE-EF) showed improved performance for the tasks that require attention with a difference of 30.52% compared with the volunteers with ADHD who did not perform the exercise (GE). The (GE-EF) group showed similar performance (2.5% difference) with the volunteers in the (GC) group who have no ADHD symptoms and did not exercise. This study shows that intense exercise can improve the attention of children with ADHD and may help their school performance.

Silva, K. G., et al. (2017). "Effects of virtual rehabilitation versus conventional physical therapy on postural control, gait, and cognition of patients with Parkinson's disease: study protocol for a randomized controlled feasibility trial." Pilot & Feasibility Studies 3: 68.
	BACKGROUND: There is an association among postural instability, gait dysfunction, and cognitive impairment in subjects with Parkinson's disease (PD). Difficulty in dividing attention, response inhibition, and visuospatial attention deficiencies may contribute to the impairment of motor performance during daily activities. There are strong evidences that physical therapy can prevent physical and cognitive decline in individuals with PD. Recently, the European Physiotherapy Guideline (EPG) was developed based on randomized clinical trials about the effectiveness of the physical therapy to improve the functional deficiencies of individuals with PD. The EPG did not include the use of promising new intervention as virtual reality in PD due the lack of studies about its safety, feasibility and effectiveness. Therefore, this study protocol had as objective to evaluate the feasibility, safety and effectiveness of a physical therapy program-based on the European Physiotherapy Guideline (EPG) compared to Kinect-based training on postural control, gait, cognition, and quality of life (QoL) of Individuals with PD. METHODS/DESIGN: A single-blind, parallel, randomized, controlled feasibility trial will be conducted with a sample of 32 individuals diagnosed with idiopathic PD. Participants will be allocated into control group (CG) and experimental group (EG). The intervention of the CG will be conventional physical therapy, and the intervention of the EG will be a supervised practice of five Kinect games. Both groups will perform 14 sessions of 1 h each one, twice a week over 7 weeks. Process outcomes will be safety, feasibility, adherence, and acceptability. Safety will be assessed by the proportion of participants who experienced intervention-related adverse events or any serious adverse event during the study period. Feasibility will be assessed through the scores of the games recorded in all training sessions. Adherence will be assessed through the participant's attendance. Acceptability will be the motivation of the participants regarding the interventions. Clinical outcomes will be (1) postural control, (2) cognitive function, (3) balance, (4) gait, and (5) QoL. Individuals will be assessed pre- and post-interventions and after 30 days by a blinded evaluator. DISCUSSION: This protocol will clarify if an intervention based on Kinect games will be feasible, safe, and acceptable for individuals with PD compared to conventional physical therapy. We will verify whether the proposed interventions can improve clinical outcomes as postural control, gait, cognition, and QoL of individuals with PD. Our hypothesis is that both Kinect games and conventional physical therapy will be feasible, safe, and acceptable for individuals with PD and will promote positive clinical effects. The results of this feasibility study will be used to design a future definitive clinical trial. TRIAL REGISTRATION: Unique identification number in WHO Trial Registration: U1111-1171-0371. Brazilian Clinical Trial Registration Number RBR-27kqv5, registration date: February, 2016.

Simsek, T. T. and K. Cekok (2016). "The effects of Nintendo Wii(TM)-based balance and upper extremity training on activities of daily living and quality of life in patients with sub-acute stroke: a randomized controlled study." International Journal of Neuroscience 126(12): 1061-1070.
	OBJECTIVE: The aim of this study was to investigate the effects of Nintendo Wii(TM)-based balance and upper extremity training on activities of daily living and quality of life in patients with subacute stroke. METHODS: 42 adults with stroke (mean age (SD) = 58.04 (16.56) years and mean time since stroke (SD) = (55.2 +/- 22.02 days ( approximately 8 weeks)) were included in the study. Participants were enrolled from the rehabilitation department of a medical center (a single inpatient rehabilitation facility). Participants were randomly assigned to Nintendo Wii group (n = 20) or Bobath neurodevelopmental treatment (NDT) (n = 22). The treatments were applied for 10 weeks (45-60 minutes/day, 3 days/week) for both of two groups. Nintendo Wii group used five games selected from the Wii sports and Wii Fit packages for upper limb and balance training, respectively. The patients in Bobath NDT group were applied a therapy program included upper extremity activites, strength, balance gait and functional training. The functional independence in daily life activities and health-related quality of life was assessed with Functional Independence Measure (FIM) and Nottingham Health Profile (NHP), respectively. Participant's treatment satisfaction was recorded by using Visual Analogue Scale. A second evaluation (FIM and NHP) occurred after 10 weeks at the end of rehabilitative treatment (post-training). Treatment satisfaction was measured after 10 sessions. RESULTS: There were significant difference between FIM and NHP values in NDT and Nintendo Wii group (p < 0.05). However, a significant difference was not found between the groups with regard to FIM and NHP (p > 0.05). The patients in Nintendo Wii group were detected to be better satisfied from the therapy (p < 0.05). A significant difference was found between subparameters and total FIM score, all subparameters and total NHP score in both groups (p < 0.05). CONCLUSION: These findings suggested that the Nintendo Wii training was as effective as Bobath NDT on daily living functions and quality of life in subacute stroke patients.

Singh, D. K., et al. (2013). "Effects of substituting a portion of standard physiotherapy time with virtual reality games among community-dwelling stroke survivors." BMC Neurology 13(1): 199.
	BACKGROUND: Evidence indicates that the continuation of therapy among community-dwelling stroke survivors improves physical function. Community rehabilitation programmes often face limitations in terms of resources. It is imperative to include new motivational interventions to encourage some level of non-clinician management. The aim of this study was to determine whether there were any changes in physical function and activities of daily living when substituting a portion of the standard physiotherapy time with virtual reality games among community-dwelling stroke survivors. METHODS: In this controlled trial, the experimental group received 30 minutes of virtual reality balance games in addition to 90 minutes of standard physiotherapy. The control group continued with their two hours of routine standard physiotherapy. Both groups received 12 therapy sessions: two-hour sessions twice per week for six continuous weeks. Changes in physical function, activities of daily living and balance ability were assessed using the Timed Up and Go test, 30-second Sit to Stand test, Timed Ten-Metre Walk test, Six-Minute Walk test and the Barthel Index, and static balance was assessed using a probalance board. RESULTS: Twenty-eight participants completed post-intervention assessments. The results showed a significant within-subject effect on the Timed Up and Go test: F (1, 26) = 5.83, p = 0.02; and the 30-second Sit to Stand test; F (1, 26) = 13.50, p = 0.001. The between-subject effect was not significant (p > 0.05) for any of the outcome measurements. CONCLUSION: Substituting a portion of the standard physiotherapy time with virtual reality games was equally effective in maintaining physical function outcomes and activities of daily living among community-dwelling stroke survivors. TRIAL REGISTRATION: Australia and New Zealand Clinical Trials Register, ACTRN12613000478718.

Singh, D. K. A. (2018). "Effectiveness of virtual reality games as an adjunct to usual physiotherapy care in improving upper limb strength, dexterity, sensory function, activities of daily living and quality of life among stroke survivors."
	
Sisodia, V., et al. (2015). "Efficacy of vestibular rehabilitation in management of balance deficit in Indian collegiate football players, with sport-related concussion – randomized clinical trial." Physiotherapy 101: e1403-e1404.
	Background: Football (Soccer) is a popular sport in India, next only to Cricket and is played for both professional and recreational pursuits. Football players need to be mentally and physically fit in order to cater to the imposing demands of game and training which require exceptional levels of attention, planning, memory, and other higher mental functions. Balance is an essential prerequisite to improve sport performance and to prevent lower extremity injury and concussion. Purpose: To evaluate the efficacy of vestibular rehabilitation in the management of sport related Balance deficit in Indian Collegiate Foot Ball Players with or without concussion. Methods: An observer‐blinded randomized clinical trial with concealed treatment allocation was performed by randomly assigning 67 male foot ball players age (18+/‐1.2 to 25.02+/‐2.7 years) with sport related balance deficit into either of two intervention group ‐ the conventional/standard group (as per the NATA regime) or the treatment group (vestibular rehabilitation). The treatment was given, taught and supervise daily for at least 3 month. Pre and post outcome measurement includes a balance error scoring system (BESS) for assessing static balance and sport concussion assessment tool‐2 (SCAT‐2) concussion symptoms assessment. Between‐group and within‐group comparison were analyzed using Student's t‐test at 95% confidence interval in Statistical Package for Social Science (SPSS Inc., Chicago, IL) version 16.0 for Windows. Results: Treatment group showed statistically significant (p < .05) improvement compared to standard grouped in change scores for both outcomes (BESS: 5.43+/‐3.4; SCAT‐ 2: 14.45+/‐8.34). The improvement in outcomes were well beyond the minimum clinically importance difference for both measures studied. Conclusion(s): Vestibular rehabilitation was better than standard treatment in improving balance and concussion related symptoms of the Indian collegiate football players. Implications: Study was conducted only on Indian collegiate football players.

Skedros, J. G., et al. (2022). "Presumed Glenoid SLAP Tear in an Adolescent Football Player Belied the Presence of a Coracoid Growth Plate Fracture: A Diagnostic Conundrum." Case Reports in Orthopedics 2022: 1756611.
	We report the case of a 13-year-old male who sustained a right shoulder injury while playing quarterback in an American football game. A noncontrast MRI scan showed evidence of a possible grade 1 SLAP tear (SLAP = superior labral anterior-posterior), and surgery was recommended. However, at the preoperative visit, the surgeon was suspicious that the main source of pain had been missed. Bilateral shoulder radiographs taken for comparative analysis revealed a Salter-Harris type I coracoid growth-plate fracture. Therefore, the surgeon planned to manage the patient nonoperatively and postponed the proposed SLAP tear surgery. The patient was instructed to cease participation in athletic events and undergo physical therapy. Hoping to expedite his healing with platelet or stem cell injections, the parents sought an opinion from another physician who obtained a right shoulder MRI with intra-articular contrast. This confirmed that there was no SLAP tear. We concluded that the patient initially had glenohumeral and coracoclavicular ligament strains and a coracoid growth-plate fracture. The SLAP tear suggested by the initial MRI proved to be a red herring, belying an accurate diagnosis. The patient ultimately recovered fully with physical therapy and without surgery or other interventions.

Slapak, M. (2005). "Sport and transplantation." Annals of Transplantation 10(1): 60-67.
	This review paper outlines the physiological evidence for the benefit derived from sport after an organ transplant. The psychological and social benefit which follows the taking part in sporting competitions is also briefly examined. The part played by the World Transplant Games Federation, the proficiency, the results achieved and details of the various events held are described. The surprisingly effective part which graded physical exercise plays in overcoming the handicaps imposed on the recipients of a successful organ transplant by the effects of preceding long-term illness, necessary medication including immunosuppressive therapy and a non innervated organ is examined.

sm6qj, R. B. R. (2016). "The use of educational game as a strategy to confront the childhood obesity." https://trialsearch.who.int/Trial2.aspx?TrialID=RBR-7sm6qj.
	INTERVENTION: Device F01.145.113.547 I03.450.642.693.930 J01.897.280 The study aims to determine the effects of using a serious game as an educational strategy obesity coping in school children. the participants that will be randomized patients are already attending to the Interactive Media Laboratory and Physical Exercise of the School of Physical Education and Sports Ribeirão Preto ‐ EEFERP and the designation to define the groups will be given by lot. Participants will be randomly assigned to the intervention group (IG) and control (CG). Number of participants GI: 30 Number of participants GC: 30 Before starting the procedure, the pre‐test will be done, which will be to survey the exposure of children to the risk factors for obesity, check the stage of change eating behavior and physical activity, their food consumption habits and drinks as well as their knowledge of healthy eating and exercise through validated questionnaires. This will be done in both groups (control and intervention). Therefore, the control group will continue with the monitoring and coping strategies for childhood obesity already adopted by the unit and there is no intervention, only monitoring and observation of the activities already developed by them. But the experimental group will receive the serious game as an additional strategy in addition to the usual strategy for coping with the disease. The procedure consists in playing a game stage for a period of 30 minutes at a rate of 4 visits for this procedure, each visit and a total of 30 minutes intervention. The researcher will be next to the child and present the game through a tablet, leaving them to play freely for the period of 30 minutes. After the intervention period, it will be the post‐test, in which children will be reassessed in all questionnaires previously seen in the pre‐test in order to compare the data obtained. CONDITION: C18.654.726.500 F01.145.113.547 J01.897.280 L01.700.508 Nutritional and metabolic diseases; Obesity; Feeding Behavior; Educational Technology; Medical Informatics Applications. ; C18.654.726.500 ; J01.897.280 ; L01.700.508 ; F01.145.113.547 PRIMARY OUTCOME: Expected outcome: change of behavior of school children in relation to obesity.; ; It will be identified stage of change eating behavior and physical activity through the Stage of Change Questionnaire (SOC).; ; To respond to the objective of the research will be compared to changing the behavior of participants in the intervention group (IG) and control group (CG) in the first time and after 6 months of application of the intervention (serious game), using the chi‐square test . It will be used the Statistical Package for Social Sciences (SPSS) version 15.0 for Windows for processing and analysis of data. For the main dependent variables were estimated hazard ratio measures and confidence intervals at 95%. It will be adopted as significance level the value 0.05. SECONDARY OUTCOME: Secondary outcomes are not expected INCLUSION CRITERIA: aged 8‐14 years; with body mass index (BMI) percentile 85; allowed to play video games; who can read; that are being followed in an outpatient clinic obesity.

Smart, R. (2001). "At the heart of a new profession: Margaret Stansfeld, a radical English educationalist." International Journal of the History of Sport 18(1): 119-148.
	It is argued here that Margaret Stansfeld, as Principal of Bedford Physical Training College from 1903 to 1945, succeeded in developing a strong and distinctive 'female tradition' which was widely disseminated by her students. She was realistic in recognizing the strength of opposition from a male-dominated society to women's participation in sport and physical exercise, and steadily overcame it. She achieved this partly by insisting on acceptably 'ladylike' behaviour from her students in conventional social situations, and also by bringing the work of the college into the public arena, through displays of gymnastics, through the use of elementary schools for part of the student teaching experience, through the running of a physiotherapy clinic where treatment was given free of charge, and through the use of students in the outpatients ward of the local hospital. Stansfeld herself was PE organizer for Bedford from 1923. But she was not afraid to fight against prejudice which was demonstrably based on false premises, e.g. medical opposition to women taking part in strenuous physical exercise, or to insist on appropriate clothing for women, however indecorous some might have considered it. The college's long-term success resulted from a series of factors: its curriculum and ethos, the networking process it fostered, the quality of the teachers it produced, the strength of the Old Students' Association, Stansfeld's willingness to embrace new ideas, and the growing academic respectability of the subject. The pivot of the whole process was Stansfeld herself - autocratic, austere, but an inspirational teacher - feared and loved. Students who succeeded were empowered - 'She prepared us for LIFE!' The success of her Old Students was the most important feature, e.g. Phyllis Colson, originator and director of the Central Council of Physical Recreation. Hundreds of others, less well known, in schools all over Britain and abroad, gave their pupils pride in themselves, not only through the experience of games, gymnastics and dance, but through moral example - 'fair play' - and many brought the newest innovations into schools (e.g. Elizabeth Swallow was the first to introduce Laban into a maintained school in 1939). Stansfeld's indomitable spirit was always in evidence, even at the end of her life - she returned to the office of Principal in 1948 at age 88, three years before her own death, after the unexpected death of her successor. It was this strength of will and character above all else which empowered her students as women and as teachers, and which enabled them in their turn to empower their own pupils, and so to replace the myth that physical activities were damaging to women with the growing realization that sport and physical recreation are as beneficial to women as they are to men. Stansfeld was justifiably recognized in her time as a pioneer in the advancement of women's PE, e.g. by the McNair Report (1942), which argued that nothing comparable had been achieved for men. She was the last survivor of the originators of women's PE, and the most influential. It is ironic that the rise of feminism in the second half of the century coincided with the dissipation of the female tradition, epitomised by Stansfeld, as physical education for women, developed by women, in the first half of the century increasingly came to be controlled by men in the second half. It is perhaps the ultimate demonstration of the success of Stansfeld's work that, despite this, at the beginning of the twenty-first century women are free to participate in and enjoy sport and physical leisure in a way that would have seemed impossible at the beginning of the twentieth.

Smeddinck, J. D. (2020). Human-Computer Interaction with Adaptable & Adaptive Motion-based Games for Health. Ithaca, Cornell University Library, arXiv.org.
	Physical activity plays a major role both in prevention and in the treatment of afflictions linked to a modern sedentary lifestyle and improvements on life expectancy, for example though the application area of physiotherapy. Motion-based games for health (MGH) are being discussed in research and industry for their ability to play a supportive role in health, by offering motivation to engage in treatments, objective insights on status and development, and guidance regarding treatment activities. Difficulty settings in games are typically limited to few discrete tiers. For most serious applications in health, more fine-grained and far-reaching adjustments are required. The need for applying adjustments on complex sets of parameters can be overwhelming for patient-players and even trained professionals. Automatic adaptivity and efficient manual adaptability are thus major concerns for the design and development of MGH. Despite a growing amount of research on specific methods for adaptivity, general considerations on human-computer interaction with adaptable and adaptive MGH are rare. This thesis therefore focuses on establishing and augmenting theory for adaptability and adaptivity in human-computer interaction in the context of MGH. Working with older adults and people with Parkinson's disease as frequent target groups that can benefit from tailored activities, explorations and comparative studies that investigate the design, acceptance, and effectiveness of MGH are presented. The outcomes encourage the application of adaptivity for MGH following iterative human-centred design that considers the respective interests of stakeholders, provided that the users receive adequate information and are empowered to exert control over the automated system when desired or required, and if adaptivity is embedded in such a way that it does not interfere with the users' sense of competence or autonomy.

Smith, A. C. J., et al. (2021). ""Think of It Like a Game": Older Adults' and Health Professionals' Perspectives on Interactive Exercise Technology Design." Physiotherapy Canada 73(3): 286-295.
	Purpose: Interactive exercise technology (IET) is an effective and practical way to support physiotherapy for older adults. The purpose of this study was to use design thinking to collect feedback on the first iteration of an IET prototype from older adults and health professionals and to use that feedback to gain an understanding of their needs and values, with the goal of developing recommendations to inform the second iteration of the IET prototype. Method: This study was conducted using three steps of design thinking: (1) test, in which four focus groups were conducted, asking older adults and health professionals about their perspectives on an IET prototype; (2) empathize, in which the focus group discussions were recorded and transcribed and thematic content analysis was conducted; and (3) define, in which the needs and values of the participants were identified. Results: The participants were 19 health professionals and four older adults. Four themes, which represented the values that these groups held regarding IET design, were revealed: instruction, safety, accessibility, and motivation. Conclusions: Older adults and health professionals have specific needs for the design of IET, which should be considered in the development of future IET.

Smits-Engelsman, B., et al. (2018). "Evaluating the evidence for motor-based interventions in developmental coordination disorder: A systematic review and meta-analysis." Research in Developmental Disabilities 74: 72-102.
	BACKGROUND: As part of the process of creating an update of the clinical practice guidelines for developmental coordination disorder (DCD) (Blank, Smits-Engelsman, Polatajko, & Wilson, 2012), a systematic review of intervention studies, published since the last guidelines statement was conducted. AIM: The aim of this study was to 1) systematically review the evidence published from January 2012 to February 2017 regarding the effectiveness of motor based interventions in individuals with DCD, 2) quantify treatment effects using a meta-analysis, 3) examine the available information on different aspects of delivery including use of group intervention, duration and frequency of therapy, and 4) identify gaps in the literature and make recommendations for future intervention research. METHOD: An electronic search of 5 databases (PubMed, Embase, Pedro, Scopus and Cochrane) was conducted for studies that evaluated motor-based interventions to improve performance for individuals with DCD. RESULTS: Thirty studies covering 25 datasets were included, 19 of which provided outcomes on standardized measures of motor performance. The overall effect size (Cohen's d) across intervention studies was large (1.06), but the range was wide: for 11 interventions, the observed effect was large (>0.80), in eight studies moderate (>0.50), and in five it was small or negligible (<0.50). Positive benefits were evident for activity-oriented approaches, body function-oriented combined with activities, active video games, and small group programs. CONCLUSION: Results showed that activity-oriented and body function oriented interventions can have a positive effect on motor function and skills. However, given the varied methodological quality and the large confidence intervals of some studies, the results should be interpreted with caution.

Smits-Engelsman, B. C. M., et al. (2017). "The effect of exergames on functional strength, anaerobic fitness, balance and agility in children with and without motor coordination difficulties living in low-income communities." Hum Mov Sci 55: 327-337.
	Children with Developmental Coordination Disorder (DCD) are physically less active, preferring more sedentary behavior and are at risk of developing health problems or becoming overweight. 18 children (age 6-10years) with lower levels of motor coordination attending a primary school in a low-income community in South Africa (score on Movement Assessment Battery for Children Second edition equal to or below the 5th percentile) were selected to participate in the study and were age-matched with typically developing peers (TD). Both groups of children engaged in 20min of active Nintendo Wii Fit gaming on the balance board, twice a week for a period of five weeks. All children were tested before and after the intervention using the lower limb items of the Functional Strength Measurement, the 5x10 meter sprint test, the 5x10 meter slalom sprint test, and the Balance, Running speed and Agility subtest of the Bruininks Oseretsky Test of Motor Proficiency 2nd edition (BOT-2). After intervention, both groups of children improved in functional strength and anaerobic fitness. The magnitude of these changes was not related to participant's motor coordination level. However, differences in change between the TD and DCD group were apparent on the motor performance tests; children with DCD seemed to benefit more in balance skills of the BOT-2, while the TD children improved more in the Running speed and Agility component of the BOT-2. Compliance to the study protocol over 5weeks was high and the effect on physical functioning was shown on standardized measures of physical performance validated for children with and without DCD.

smwr, R. B. R. (2016). "Evaluation and treatment of pain in the shoulder after Stroke by game ShoulderForce." https://trialsearch.who.int/Trial2.aspx?TrialID=RBR-55smwr.
	INTERVENTION: E02.779 Group Intervention: Comprised of 15 individuals with pain and subluxation of the shoulder after stroke to conduct a protocol with the exergame ShoulderForce for 24 weeks 2 times a week, totaling 48 interventions. Each session lasting 30 minutes divided by 15 minutes for initial global stretching and end 15 minutes into the game. Evaluation and re‐evaluation will be conducted by the Visual Analogue Scale (VAS); McGill questionnaire; thermography; analysis of shoulder range of motion by ShoulderForce exergame and goniometer and SF‐36 Scale Control Group: Comprised of 15 individuals with pain and subluxation of the shoulder after stroke who hold conventional physiotherapy for the same period and subject to the same assessment tools in the intervention group. I03.450.642.693.930 Q65.060 CONDITION: C05.550.091.700 C10.228.140.300.775 Stroke , Shoulder pain ; C10.228.140.300.775 ; C05.550.091.700 PRIMARY OUTCOME: Improved features related to pain, determined by visual analogue scale and McGill questionnaire at the beginning and end of the study compared to the control;; Increased range of motion determined by the goniometer and the ShoulderForce exergame at the beginning and end of the study compared to control SECONDARY OUTCOME: Secondary outcomes are expected not INCLUSION CRITERIA: Individuals diagnosed with stroke in chronic phase; both genders; aged between 40 and 80; presenting the painful shoulder syndrome; spasticity less than two in Ashworth scale; voluntary movement of flexion and abduction

So, K., et al. (2009). "Physiotherapy and occupational therapy perspectives of video games in rehabilitation." Physiotherapy Canada 61: 25-25.
	
Soancatl Aguilar, V., et al. (2017). "Visual Data Exploration for Balance Quantification in Real-Time During Exergaming." PLoS ONE [Electronic Resource] 12(1): e0170906.
	Unintentional injuries are among the ten leading causes of death in older adults; falls cause 60% of these deaths. Despite their effectiveness to improve balance and reduce the risk of falls, balance training programs have several drawbacks in practice, such as lack of engaging elements, boring exercises, and the effort and cost of travelling, ultimately resulting in low adherence. Exergames, that is, digital games controlled by body movements, have been proposed as an alternative to improve balance. One of the main challenges for exergames is to automatically quantify balance during game-play in order to adapt the game difficulty according to the skills of the player. Here we perform a multidimensional exploratory data analysis, using visualization techniques, to find useful measures for quantifying balance in real-time. First, we visualize exergaming data, derived from 400 force plate recordings of 40 participants from 20 to 79 years and 10 trials per participant, as heat maps and violin plots to get quick insight into the nature of the data. Second, we extract known and new features from the data, such as instantaneous speed, measures of dispersion, turbulence measures derived from speed, and curvature values. Finally, we analyze and visualize these features using several visualizations such as a heat map, overlapping violin plots, a parallel coordinate plot, a projection of the two first principal components, and a scatter plot matrix. Our visualizations and findings suggest that heat maps and violin plots can provide quick insight and directions for further data exploration. The most promising measures to quantify balance in real-time are speed, curvature and a turbulence measure, because these measures show age-related changes in balance performance. The next step is to apply the present techniques to data of whole body movements as recorded by devices such as Kinect.

Sobrinho, A. S. F., et al. (2020). "Low-Cost Joystick for Pediatric Respiratory Exercises." Journal of Medical Systems 44(10): 186.
	The use of body signals for health care applications has become ubiquitous in the last decade. One utilization of such measurements is the monitoring of respiratory flow for physiotherapy assistance. This application is based on relative flow measures which can rely on inexpensive sensors. Based on that, we present a low-cost electronic device that detects blows and suctions with a pressure sensor and emulates a keyboard for interfacing with computers. This joystick allows children to control free internet games by associating blows and suctions with different intensities to keyboard actions. Also, the intensity can be calibrated according to the user's pulmonary capacities. This feature is adequate for gradual respiratory physiotherapy and can be customized for each patient. In order to verify the operation of the proposed device, practical tests were performed with three online free games, where the joystick functionality was assessed with different therapeutic configurations.

Sokolov, A. A., et al. (2020). "Serious video games and virtual reality for prevention and neurorehabilitation of cognitive decline because of aging and neurodegeneration." Current Opinion in Neurology 33(2): 239-248.
	PURPOSE OF REVIEW: Cognitive decline because of aging and neurodegeneration has become increasingly prevalent. This calls for the implementation of efficacious, motivating, standardized and widely available cognitive interventions for the elderly. In this context, serious video games and virtual reality may represent promising approaches. Here, we review recent research on their potential for cognitive prevention and neurorehabilitation of age-related cognitive decline and mild cognitive impairment (MCI). RECENT FINDINGS: The majority of currently available data in this evolving domain lacks the methodological quality to draw reliable conclusions on the potential of novel technology for cognitive training in older people. However, single well designed randomized controlled trials have reported promising effects of cognitive interventions involving serious video games and virtual reality. The cognitive benefits of exergames promoting physical exercise with and without combined cognitive training remain unclear. SUMMARY: The immersion into stimulating and motivating environments along with training content based on neuroscientific and neuropsychological models may represent a significant advance as compared with conventional computerized cognitive training. Additional research with sound methodology including sufficient sample sizes, active control groups and meaningful outcome measures of everyday function is needed to elucidate the potential of serious video games and virtual reality in multifactorial neurorehabilitation of cognitive decline in aging and neurodegeneration.

Sokolov, A. A., et al. (2018). "Cognitive Deficits in Multiple Sclerosis: Recent Advances in Treatment and Neurorehabilitation." Current Treatment Options in Neurology 20(12): 53.
	PURPOSE OF REVIEW: This article highlights recent progress in research on treatment and neurorehabilitation of cognitive impairment in multiple sclerosis (MS) including pharmacological interventions, physical exercise, and neuropsychological rehabilitation, both in conventional and technology-assisted settings. RECENT FINDINGS: The most consistent evidence in terms of improvement or preservation of circumscribed cognitive scores in MS patients comes from moderately sampled randomized clinical trials on multimodal approaches that combine conventional or computerized neuropsychological training with psychoeducation or cognitive behavioral therapy. Disease-modifying treatments also appear to have beneficial effects in preventing or attenuating cognitive decline, whereas there is little evidence for agents such as donepezil or stimulants. Finally, physical exercise may yield some cognitive improvement in MS patients. Despite substantial and often promising research efforts, there is a lack of validated and widely accepted clinical procedures for cognitive neurorehabilitation in MS. Development of such approaches will require collaborative efforts towards the design of interventions that are fundamentally inspired by cognitive neuroscience, potentially guided by neuroimaging, and composed of conventional neuropsychological training and cognitive behavioral therapy as well as physical exercise and therapeutic video games. Subsequently, large-scale validation will be needed with meaningful outcome measures reflecting transfer to everyday cognitive function and maintenance of training effects.

Sousa, A. C. d. S. d., et al. (2021). "Identificação de papéis ocupacionais em atletas do esporte adaptado." Cadernos Brasileiros de Terapia Ocupacional 29: 1-10.
	The MOHO considers the human as an open system, whose internal organization depends on three subsystems: the volition deals with values, interests, and the individual's knowledge related to their effectiveness in an activity; the habituation deals with the habit acquired by the repetition of behavior and the set of them; while the performance capacity delineates the musculoskeletal, neurological and cardiopulmonary systems, in addition to symbolic images, skills necessary for the achievement of behavior. Given the bibliographic context and the research scenario, this study aims to describe the occupational roles played by athletes from the Paraná Association of Physically Disabled. 2Methodology This is a quantitative, observational, analytical cross-sectional research, which is an integral part of a research project entitled "Parasport, Physical Rehabilitation and Occupational Therapy", approved by the Research Ethics Committee on Human Beings under the opinion n° 2495358, on 02/15/2018, which guarantees the confidentiality and anonymity of the research for scientific purposes and the signing of the Informed Consent Form - ICF, according to Resolution N° 466/12 of the National Health Council - CNS. The participants of the research were 37 athletes from 6 sports: athletics, basketball, fencing, swimming, table tennis, and shooting sports, which were chosen using convenience sampling. For data analysis, we considered considerations and orientations of the scale and we performed a statistical exposure of the data through the Computational Program Statistical Package for Social Sciences - SPSS, version 22.0.

Souza Miranda, C., et al. (2016). "Virtual reality training promotes improvement in motor performance not transferable to gait in real environment in patients with chronic sequels of stroke." Cerebrovascular diseases. Conference: 25th european stroke conference. Venice italy. Conference start: 20160413. Conference end: 20160415. Conference publication: (var.pagings) 41: 77.
	Background: Gait disorders can limit the recovery of activity levels and independence in patients with chronic sequels of stroke. Improvement of gait outcomes is one of the main goals for these patients, which has been stimulating the search for more efficient strategies in physiotherapy's field. In this direction, Virtual Reality (VR) has been proposed as a novel therapeutic tool for motor rehabilitation. Despite the large number of studies involving the use of several VR devices including the commercial games for motor rehabilitation in stroke, the controlled evidences about the ability to transfer the gains obtained in VR to tasks in real environment remains limited. Objectives: To investigate the transference of improvements obtained by motor training in VR to gait performance in real environment in patients with chronic sequels of the stroke. Methods: A parallel, prospective, single‐blind, randomised clinical trial was conducted with a total of 29 patients, 15 men, mean age of 50.96 (SD=10.99), mean time post‐stroke 4.12 (SD=2.68) years; 17 with left hemiparesis. Patients were randomly allocated into an experimental group (EG) which performed three sessions of experimental training (ET) that consist of motor training in VR using five games from Nintendo Wii FitTM(NWF), and a control group (CG) which received only posture orientations with the same duration of the ET, considered as a control training. The transference of gains obtained in VR training was assessed through performance in gait outcomes measured using a force plate Balance MasterTM in two assessment time points: at baseline (BA) and at end of study (EA). The outcomes measured were step width, step length, speed, and step symmetry. RM‐ANOVA using as factor Groups (EG; CG), and evaluations (BA, EA) as repeated measures were performed for each outcome score. Results: Analyses of the NWF game scores for EG at baseline and at end of the study revealed statistically significant effects of the training session for all games (p<0.01). Analyses of the score in gait outcomes at baseline and at end of the study revealed no statically significant differences for both groups. Conclusion: Patients with chronic sequels of stroke were able to improve their performance in VR tasks through training. However, they were unable to transfer the improvements obtained in VR to gait peformance. Thus, the use of VR training in order to improve the gait performance in patients with chronic sequels of Stroke has to be considered with parsimony.

Sparrer, I., et al. (2013). "Vestibular rehabilitation using the Nintendo(R) Wii Balance Board -- a user-friendly alternative for central nervous compensation." Acta Otolaryngol 133(3): 239-245.
	CONCLUSION: The Nintendo(R) Wii Balance Board is a cost-effective and user-friendly alternative to other popular frequently used systems that aid vestibular compensation, particularly in elderly patients. In addition, further treatment in the home environment is possible. OBJECTIVE: This cohort study was designed to investigate the impact of the Nintendo(R) Wii Balance Board as a visual compensation device after acute vestibular neuritis. METHODS: Subjects were randomly assigned to one of two treatment groups. Group A (n = 37) performed customized exercises with the Nintendo(R) Wii Balance Board. Group B (n = 34) performed only two elected exercises as a control group for comparison of the results. Both groups underwent additive therapy with steroids (intravenous) in decreasing doses (250 mg decreasing to 25 mg over 10 days). The Sensory Organization Test (SOT), Dizziness Handicap Inventory (DHI), Vertigo Symptom Scale (VSS), and Tinneti questionnaire were evaluated immediately before treatment (baseline), at the end of treatment, i.e. at day 5, and after 10 weeks. RESULTS: The early use of a visual feedback system in the context of the balance training supports the central nervous vestibular compensation after peripheral labyrinthine disorders. Patients in group B (without training) required a longer in-patient stay (average 2.4 days, SD 0.4) compared with patients following early Wii rehabilitation. The absence of nystagmus under Frenzel's goggles in group A was observed 2.1 days (SD 0.5) earlier than in group B. Group A showed significantly better results in the SOT, DHI, VSS, and Tinneti questionnaire at all time points measured (p < 0.05).

Spear, L. (2021). "How Did the Rise of Telemedicine Change Airway Clearance Therapy for Cystic Fibrosis Patients?" RT: The Journal for Respiratory Care Practitioners 34(2): 6-10.
	The article focuses on patients with cystic fibrosis (CF), airway clearance physical therapy appointments have moved online and at-home lung function testing has become commonplace during the COVID-19. Topics include the CF patients this mucus is thicker, heavier, and a breeding ground for harmful pathogens that can lead to life-threatening infection or even respiratory failure, and the act of pushing mucus out of the respiratory system, is a part of daily routine care for most CF patients.

Spil, T. A. M., et al. (2020). "Are serious games too serious? Diffusion of wearable technologies and the creation of a diffusion of serious games model." Int J Inf Manage: 102202.
	Today globally, more people die from chronic diseases than from war and terrorism. This is not due to aging alone but also because we lead unhealthy lifestyles with little or no exercise and typically consume food with poor nutritional content. This paper proffers the design science research method to create an artefact that can help people study the diffusion of serious games. The ultimate goal of the study is to create a serious game that can help people to improve their balance in physical exercise, nutrition and well-being. To do this, first we conducted 97 interviews to study if wearables can be used for gathering health data. Analysis indicates that designers, manufacturers, and developers of wearables and associated software and apps should make their devices reliable, relevant, and user friendly. To increase the diffusion, adoption, and habitual usage of wearables key issues such as privacy and security need to be addressed as well. Then, we created a paper prototype and conducted a further 32 interviews to validate the first prototype of the game, especially with respect to the diffusion possibilities of the game. Results are positive from a formal technology acceptance point of view showing relevance and usefulness. But informally in the open questions some limitations also became visible. In particular, ease of use is extremely important for acceptance and calling it a game can in fact be an obstruction. Moreover, the artefact should not be patronizing and age differences can also pose problems, hence the title not to make the serious game too serious. Future research plans to address these problems in the next iteration while the future implementation plan seeks for big platforms or companies to diffuse the serious game. A key theoretical contribution of this research is the identification of habit as a potential dependent variable for the intention to use wearables and the development of a diffusion model for serious games. The hedonic perspective is added to the model as well as trust and perceived risks. This model ends the cycle of critical design with an improvement of theory as result contributing to the societal goal of decreasing Obesities and Diabetes.

Squiers, J. (2016). A Snow Angel in Dayton. Alexandria, Virginia, American Physical Therapy Association. 8: 66-67.
	An essay is presented in which the author emphasizes the importance of motivation in the physical rehabilitation of patients. The case of a young patient at the Dayton Children's Hospital is narrated using a pizza-making game to integrate with the pediatric physical therapy regiments. Another case involving a four year old girl with Down syndrome whose walking exercises are motivated by peek calls from parents is foretold. Reference was also made on the use of the snowman building activity.

Srikesavan, C. S., et al. (2013). "Task-oriented training with computer gaming in people with rheumatoid arthritisor osteoarthritis of the hand: study protocol of a randomized controlled pilot trial." Trials [Electronic Resource] 14(1): 69.
	BACKGROUND: Significant restriction in the ability to participate in home, work and community life results from pain, fatigue, joint damage, stiffness and reduced joint range of motion and muscle strength in people with rheumatoid arthritis or osteoarthritis of the hand. With modest evidence on the therapeutic effectiveness of conventional hand exercises, a task-oriented training program via real life object manipulations has been developed for people with arthritis. An innovative, computer-based gaming platform that allows a broad range of common objects to be seamlessly transformed into therapeutic input devices through instrumentation with a motion-sense mouse has also been designed. Personalized objects are selected to target specific training goals such as graded finger mobility, strength, endurance or fine/gross dexterous functions. The movements and object manipulation tasks that replicate common situations in everyday living will then be used to control and play any computer game, making practice challenging and engaging. METHODS/DESIGN: The ongoing study is a 6-week, single-center, parallel-group, equally allocated and assessor-blinded pilot randomized controlled trial. Thirty people with rheumatoid arthritis or osteoarthritis affecting the hand will be randomized to receive either conventional hand exercises or the task-oriented training. The purpose is to determine a preliminary estimation of therapeutic effectiveness and feasibility of the task-oriented training program. Performance based and self-reported hand function, and exercise compliance are the study outcomes. Changes in outcomes (pre to post intervention) within each group will be assessed by paired Student t test or Wilcoxon signed-rank test and between groups (control versus experimental) post intervention using unpaired Student t test or Mann-Whitney U test. DISCUSSION: The study findings will inform decisions on the feasibility, safety and completion rate and will also provide preliminary data on the treatment effects of the task-oriented training compared with conventional hand exercises in people with rheumatoid arthritis or osteoarthritis of the hand. TRIAL REGISTRATION: ClinicalTrials.gov: NCT01635582.

Stamm, O., et al. (2020). "Virtual reality in pain therapy: a requirements analysis for older adults with chronic back pain." J Neuroeng Rehabil 17(1): 129.
	BACKGROUND: Today immersive environments such as Virtual Reality (VR) offer new opportunities for serious gaming in exercise therapy and psychoeducation. Chronic back pain (CBP) patients could benefit from exergames in VR. The requirements in older CBP patients for a VR pain therapy have not yet been determined in studies. The aim of the study was to perform a requirements analysis for the user group of geriatric patients with CBP for a VR exergame. The objective was to find out the expectations, desires, preferences and barriers in order to collect them as requirements for this vulnerable group and to determine frameworks of therapy by physiotherapists and psychotherapists. METHODS: We conducted a requirements analysis through semi-structured interviews with 10 elderly participants with CBP. Furthermore, two focus groups were conducted with three physiotherapists and two psychotherapists to determine frameworks of therapy programs for the target group. The qualitative data were transcribed and examined through a structuring content analysis. Subsequently, the results of the analysis were prioritized by all participants of the study. RESULTS: The results of the requirements analysis indicate mandatory requirements for the overall system, hardware, software and gamification elements. The key requirements were target-group-specific applications of the VR exergame through e.g. individual briefing, user-friendly handling, inclusion of movement limitations, presentation of everyday scenarios in combination with biofeedback, age-appropriate feedback through praise and awards and a maximum exercise duration of 30 min and 15 min of relaxation. CONCLUSION: It should be possible to use the determined requirements productively to create user-friendly VR exergames that motivate elderly chronic back pain patients to perform exercises regularly. TRIAL REGISTRATION: The study is registered in the German Clinical Trials Register (DRKS-ID: DRKS00015294 12.10.2018).

Stanmore, E. K., et al. (2019). "The effectiveness and cost-effectiveness of strength and balance Exergames to reduce falls risk for people aged 55 years and older in UK assisted living facilities: a multi-centre, cluster randomised controlled trial." BMC Medicine 17(1): 49.
	BACKGROUND: Falls are the leading cause of fatal and non-fatal unintentional injuries in older people. The use of Exergames (active, gamified video-based exercises) is a possible innovative, community-based approach. This study aimed to determine the effectiveness of a tailored OTAGO/FaME-based strength and balance Exergame programme for improving balance, maintaining function and reducing falls risk in older people. METHODS: A two-arm cluster randomised controlled trial recruiting adults aged 55 years and older living in 18 assisted living (sheltered housing) facilities (clusters) in the UK. Standard care (physiotherapy advice and leaflet) was compared to a tailored 12-week strength and balance Exergame programme, supported by physiotherapists or trained assistants. Complete case analysis (intention-to-treat) was used to compare the Berg Balance Scale (BBS) at baseline and at 12 weeks. Secondary outcomes included fear of falling, mobility, fall risk, pain, mood, fatigue, cognition, healthcare utilisation and health-related quality of life, and self-reported physical activity and falls. RESULTS: Eighteen clusters were randomised (9 to each arm) with 56 participants allocated to the intervention and 50 to the control (78% female, mean age 78 years). Fourteen participants withdrew over the 12 weeks (both arms), mainly for ill health. There was an adjusted mean improvement in balance (BBS) of 6.2 (95% CI 2.4 to 10.0) and reduced fear of falling (p = 0.007) and pain (p = 0.02) in the Exergame group. Mean attendance at sessions was 69% (mean exercising time of 33 min/week). Twenty-four percent of the control group and 20% of the Exergame group fell over the trial period. The change in fall rates significantly favoured the intervention (incident rate ratio 0.31 (95% CI 0.16 to 0.62, p = 0.001)). The point estimate of the incremental cost-effectiveness ratio (ICER) was pound15,209.80 per quality-adjusted life year (QALY). Using 10,000 bootstrap replications, at the lower bound of the NICE threshold of pound20,000 per QALY, there was a 61% probability of Exergames being cost-effective, rising to 73% at the upper bound of pound30,000 per QALY. CONCLUSIONS: Exergames, as delivered in this trial, improve balance, pain and fear of falling and are a cost-effective fall prevention strategy in assisted living facilities for people aged 55 years or older. TRIAL REGISTRATION: The trial was registered at ClinicalTrials.gov on 18 Dec 2015 with reference number NCT02634736 .

Steiner, B., et al. (2020). "Gamification in Rehabilitation of Patients With Musculoskeletal Diseases of the Shoulder: Scoping Review." JMIR Serious Games 8(3): e19914.
	BACKGROUND: Gamification has become increasingly important both in research and in practice. Particularly in long-term care processes, such as rehabilitation, playful concepts are gaining in importance to increase motivation and adherence. In addition to neurological diseases, this also affects the treatment of patients with musculoskeletal diseases such as shoulder disorders. Although it would be important to assist patients during more than one rehabilitation phase, it is hypothesized that existing systems only support a single phase. It is also unclear which game design elements are currently used in this context and how they are combined to achieve optimal positive effects on motivation. OBJECTIVE: This scoping review aims to identify and analyze information and communication technologies that use game design elements to support the rehabilitation processes of patients with musculoskeletal diseases of the shoulder. The state of the art with regard to fields of application, game design elements, and motivation concepts will be determined. METHODS: We conducted a scoping review to identify relevant application systems. The search was performed in 3 literature databases: PubMed, IEEE Xplore, and Scopus. Following the PICO (population, intervention, comparison, outcome) framework, keywords and Medical Subject Headings for shoulder, rehabilitation, and gamification were derived to define a suitable search term. Two independent reviewers, a physical therapist and a medical informatician, completed the search as specified by the search strategy. There was no restriction on year of publication. Data synthesis was done by deductive-inductive coding based on qualitative content analysis. RESULTS: A total of 1994 articles were screened; 31 articles in English, published between 2006 and 2019, were included. Within, 27 application systems that support patients with musculoskeletal diseases of the shoulder in exercising, usually at home but also in inpatient or outpatient rehabilitation clinics, were described. Only 2 application systems carried out monitoring of adherence. Almost all were based on in-house developed software. The most frequently used game components were points, tasks, and avatars. More complex game components, such as collections and teams, were rarely used. When selecting game components, patient-specific characteristics, such as age and gender, were only considered in 2 application systems. Most were described as motivating, though an evaluation of motivational effects was usually not conducted. CONCLUSIONS: There are only a few application systems supporting patients with musculoskeletal diseases of the shoulder in rehabilitation by using game design elements. Almost all application systems are exergames for supporting self-exercising. Application systems for multiple rehabilitation phases seem to be nonexistent. It is also evident that only a few complex game design elements are used. Patient-specific characteristic are generally neglected when selecting and implementing game components. Consequently, a holistic approach to enhance adherence to rehabilitation is required supporting patients during the entire rehabilitation process by providing motivational game design elements based on patient-specific characteristics.

Stella, S. G., et al. (2005). "Effects of type of physical exercise and leisure activities on the depression scores of obese Brazilian adolescent girls." Brazilian Journal of Medical & Biological Research 38(11): 1683-1689.
	Several studies have indicated that depressive states may lead to hypokinesia with diminished metabolic rate and energy use. Hypokinesia associated with certain eating behaviors may lead to an unfavorable energy balance that can contribute to the emergence and prevalence of obesity among children and adults. The purpose of the present study was to examine the possibility of reducing depression inventory scores in female adolescents with third-degree obesity while testing the effectiveness of different exercise programs in reducing anxiety and depression scores. The sample consisted of 40 female subjects (mean age 16 +/- 1.56 years) divided into 4 groups (aerobic training, anaerobic training, leisure activities, and control). Subjects had a body mass index of 95% or more in relation to the 50th percentile. The aerobic program consisted of three ergometric bicycle sessions per week over a 3-month period (12 weeks) and the activities were prescribed after determining the anaerobic ventilatory threshold (VO2 threshold). Anaerobic training was based on the Wingate anaerobic power test. The leisure program consisted of a varied range of activities (games, exercises, etc.). A nutritionist interviewed the members of these two groups and the control group every week in order to adapt them to the nutritional guidelines proposed for the study. The study showed that all three programs (aerobic exercise, anaerobic exercise and leisure activities) were effective in reducing body mass. However, we found a significant reduction when analyzing the depression scores only for aerobic exercise (18.9 +/- 9.33 to 10.6 +/- 9.56 or 43.9%) but no significant alterations for anaerobic exercise (11.36 +/- 5.23 to 9.63 +/- 4.78 or 15.22%) and leisure (17.28 +/- 7.55 to 15.07 +/- 7.54 or 12.78%), thus indicating that in principle this type of activity could be included to improve emotional well-being of obese adolescent girls.

Stephenson, A., et al. (2020). "Evaluation of the acceptability and usability of the MAGIC-GLASS virtual reality solution as part of the care pathway in people with acute, sub-acute and chronic stroke: a study protocol." Physical Therapy Reviews 25(2): 118-127.
	Background: Intensive rehabilitation is one of the most important aspects of care for people with stroke, and there is evidence that it leads to better recovery and higher levels of independence. However, pressure on resources in government funded secondary and primary healthcare settings means that for many people with stroke, intense rehabilitation is not available. Effective and efficient ways of increasing rehabilitation intensity, engagement, and motivation for rehabilitation are needed; as well as innovative treatment approaches that enable people with stroke to self-manage this rehabilitation. Technology offers a solution; virtual reality (VR) computer games have the potential to enhance engagement, improve adherence, and outcomes in stroke rehabilitation therapy. However, their integration into current health care pathways needs to be tested. Aims: The aim of the trial is to test the feasibility of incorporating VR computer games into a stroke rehabilitation system called 'MAGIC-GLASS', and its integration into the current care pathway for people with stroke. Design: Multicenter, prospective uncontrolled, pre-post intervention study. Setting: Participants will be recruited from Stroke Services, GP Practices or via Stroke Support Groups, and the intervention will be carried out in the hospital setting, or at home after discharge. Population: Adults (≥18 years) who have had a stroke. Interventions: Magic Glass is a clinician facilitated VR-based stroke rehabilitation system. Clinical facilitation includes a minimum of one initial face-to-face contact followed by up to 13 weekly/fortnightly remote contacts (to month six) with a clinician. Outcomes: The usability and acceptability of the intervention; process and resource requirements for the new care pathway; changes in clinical outcomes and potential cost-effectiveness of the solution will be measured to assess change from baseline to six months post intervention. Sample size: In order to have 50 patients in the subgroups identified (time since stroke; severity of stroke; age) we plan to recruit 300 participants, 150 in Northern Ireland and 150 in Italy. Fifty is considered the optimal sample size for this feasibility analysis. Duration: 18 months. Follow up will be post intervention (up to six months post entry into the study). The nested qualitative study will start once the first cohort of participants has completed and will continue throughout the intervention period.

Stephenson, C., et al. (2010). "Is this justice?...'Rough game,' 6 October." Frontline (20454910) 16(18): 4-5.
	
Stern, L. M., et al. (1989). "Training inspiratory resistance in Duchenne dystrophy using adapted computer games." Developmental Medicine & Child Neurology 31(4): 494-500.
	Computer games were modified to encourage respiratory effort by two groups of patients with Duchenne muscular dystrophy. One group trained during the first six months of the study, the other during the second six months. Inspiratory effort was increased by their having to breathe through a mask to both start and continue the games. Pulmonary function tests were done at the beginning of the trial and six, 12 and 18 months later, when forced vital capacity, respiratory muscle endurance and strength were measured. Although there were some individual improvements, over-all the results were not statistically significant.

Sternberg, W. F., et al. (2001). "Sex-dependent components of the analgesia produced by athletic competition." Journal of Pain 2(1): 65-74.
	Competing in various athletic events (track meet, basketball game, or fencing match) can produce analgesia to cold pressor stimuli in male and female college athletes compared with baseline assessments. This competition-induced analgesia has been attributed to the stress associated with competition, which has components related to both physical exercise and the cognitive aspects of competing. This study evaluated the analgesic effect of exercise-related stress, and that caused by the cognitively stressful components of competing independent of exercise. Cold pressor pain ratings were assessed after competition in a track meet and after treadmill exercise or sedentary video game competition in both athletes and nonathletes. As expected, competing in athletics resulted in a decrease in cold pressor ratings in both male and female athletes. Independent of athletic status, treadmill running induced analgesia in women, but not in males, whereas sedentary video game competition produced analgesia in men, but not in women. These findings suggest that different components of the competitive athletic experience might be responsible for the analgesic effects in a sex-dependent manner.

Stowell, E., et al. (2019). Caring for Alzheimer's Disease Caregivers: A Qualitative Study Investigating Opportunities for Exergame Innovation. Ithaca, Cornell University Library, arXiv.org.
	The number of informal caregivers for family members with Alzheimer's Disease (AD) is rising dramatically in the United States. AD caregivers disproportionately experience numerous health problems and are often isolated with little support. An active lifestyle can help prevent and mitigate physical and psychological health concerns amongst AD caregivers. Research has demonstrated how pervasive exergames can encourage physical activity (PA) in the general population, yet little work has explored how these tools can address the significant PA barriers that AD caregivers face. To identify opportunities for design, we conducted semi-structured interviews and participatory design sessions with 14 informal caregivers of family members with AD. Our findings characterize how becoming an AD caregiver profoundly impacts one's ability to be active, perspectives on being active, and the ways that exergames might best support this population. We discuss implications for design and how our findings challenge existing technological approaches to PA promotion.

Straker, L., et al. (2015). "Can active video games enhance motor coordination in children with developmental coordination disorder?" Physiotherapy 101: eS680‐.
	Background: Developmental coordination disorder (DCD) is a common paediatric disorder linked with poorer physical and mental health outcomes for children. Traditional interventions are often therapist‐time intensive. New video game technology requiring whole limb or body movement had been suggested as a means of encouraging children with DCD to practice movement and thus improve their coordination. However, whether active video game use at home can enhance motor coordination for children with DCD by encouraging appropriate movement is unknown. Purpose: The aim of this study was to determine if use of active video games in a home context could improve motor coordination in children with DCD. Methods: A cross‐over randomised controlled trial was conducted in Perth, Australia with 21 children (11 boys) aged 11.0 (SD 1.0) years (height 148.3 (9.5) cm, weight 47.0 (12.5) kg). All children were at risk of DCD (DSM IV) (scored ≤16th percentile on the Movement Assessment Battery for Children‐2 (MABC‐2) and≤15th percentile Developmental Coordination Disorder Questionnaire). Each child participated in the study for 8 months; 4 months with home access to active video games and 4 months with home access to sedentary video games. Order of conditions was randomized. During the active video game condition children were provided with Microsoft Xbox Kinect and Play Station 3 Move and a variety of non‐violent games. Children were encouraged to play for a minimum of 20 minutes on most days. Motor coordination was assessed using 3D motion analysis during upper limb (touching finger and nose) and balance tasks, MABC‐2 clinical evaluation, and child and parent ratings of perceived coordination. Linear mixed models were used to compare scores at the end of each condition. Results: Finger‐nose path distance and balancing centre of mass path distance were not significantly different following active video games and sedentary video games conditions (differences respectively ‐0.1 (95%CI ‐3.0, 4.2) cm/sec; ‐0.4 (95%CI‐1.2, 0.4%)). Neither was MABC‐2 total score percentile (difference 0.7 (95%CI ‐4.9, 6.3)). Child perceptions of skill were greater following active video game use (difference 1.8 (95%CI 1.1, 2.5/5) and parent reported DCDQ difference approached significance (2.4 (95%CI ‐0.3, 5.1)). Conclusion(s): Home access to a range of active video games was not able to improve motor skills in children with DCD as measured by motion analysis and clinical testing. However children perceived enhanced motor skills following active video game exposure. Implications: Current active video games are not able to enhance motor coordination in children with DCD but may be useful as an adjunct to individually tailored therapy.

Stratford, P. W., et al. (2003). "Hierarchical linear modelling: an effective analytic technique for examining change in clinical longitudinal data." Physiotherapy Canada 55(3): 145-152.
	Purpose: This article summarizes the assumptions associated with repeated measures analysis of variance (ANOVA) and multivariate ANOVA (MANOVA) and introduces a less restrictive analysis, hierarchical linear modelling (HLM).Summary of Key Points: Clinicians are often asked the following questions: When will I be better? Will I be able to play in the big game in 2 weeks? When will I be able to return to work? To answer these questions with confidence, clinicians must have access to information detailing the predictors, pattern, and expected rate of change of the outcome of interest. Unfortunately, there is a paucity of research providing this information. We speculate that one reason for this deficiency relates to the restrictive assumptions associated with popular statistical methods-such as repeated measures ANOVA-used to investigate change. HLM provides a useful method for modelling change over time. It does not need an equal number of observations per patient, nor does it require that patients be assessed at the same points in time. An example describing change in functional status, as measured by the Lower Extremity Functional Scale, of patients after knee arthroplasty is provided to demonstrate the merits of HLM.Recommendation: Researchers interested in modelling change over time may find HLM a more useful analytic method than repeated measures ANOVA or MANOVA.

Straudi, S., et al. (2017). "The effects of video game therapy on balance and attention in chronic ambulatory traumatic brain injury: an exploratory study." BMC Neurology 17(1): 86.
	BACKGROUND: Patients with traumatic brain injury often have balance and attentive disorders. Video game therapy (VGT) has been proposed as a new intervention to improve mobility and attention through a reward-learning approach. In this pilot randomized, controlled trial, we tested the effects of VGT, compared with a balance platform therapy (BPT), on balance, mobility and selective attention in chronic traumatic brain injury patients. METHODS: We enrolled chronic traumatic brain injury patients (n = 21) that randomly received VGT or BPT for 3 sessions per week for 6 weeks. The clinical outcome measures included: i) the Community Balance & Mobility Scale (CB&M); ii) the Unified Balance Scale (UBS); iii) the Timed Up and Go test (TUG); iv) static balance and v) selective visual attention evaluation (Go/Nogo task). RESULTS: Both groups improved in CB&M scores, but only the VGT group increased on the UBS and TUG with a between-group significance (p < 0.05). Selective attention improved significantly in the VGT group (p < 0.01). CONCLUSIONS: Video game therapy is an option for the management of chronic traumatic brain injury patients to ameliorate balance and attention deficits. TRIAL REGISTRATION: NCT01883830 , April 5 2013.

Stringer, H. (2012). "Pre tee time." Today in PT 6(6): 30-31.
	Personalized physical therapy regminens help golfers improve their game.

Subramanian, H., et al. (2011). "Non-pharmacological Interventions in Hypertension: A Community-based Cross-over Randomized Controlled Trial." Indian J Community Med 36(3): 191-196.
	BACKGROUND: Hypertension is the most prevalent non-communicable disease causing significant morbidity/mortality through cardiovascular, cerebrovascular, and renal complications. OBJECTIVES: This community-based study tested the efficacy of non-pharmacological interventions in preventing/controlling hypertension. MATERIALS AND METHODS: This is a cross-over randomized controlled trial (RCT) of the earlier RCT (2007) of non-pharmacological interventions in hypertension, conducted in the urban service area of our Institute. The subjects, prehypertensive and hypertensive young adults (98 subjects: 25, 23, 25, 25 in four groups) were randomly allotted into a group that he/she had not belonged to in the earlier RCT: Control (New Group I), Physical Exercise (NG II)-brisk walking for 50 to 60 minutes, three to four days/week, Salt Intake Reduction (NG III) to at least half of their previous intake, Yoga (NG IV) for 30 to 45 minutes/day, five days/week. Blood pressure was measured before and after eight weeks of intervention. Analysis was by ANOVA with a Games-Howell post hoc test. RESULTS: Ninety-four participants (25, 23, 21, 25) completed the study. All three intervention groups showed significant reduction in BP (SBP/DBP mmHg: 5.3/6.0 in NG II, 2.5/2.0 in NG III, and 2.3/2.4 in NG IV, respectively), while the Control Group showed no significant difference. Persistence of significant reduction in BP in the three intervention groups after cross-over confirmed the biological plausibility of these non-pharmacological interventions. This study reconfirmed that physical exercise was more effective than Salt Reduction or Yoga. Salt Reduction, and Yoga were equally effective. CONCLUSION: Physical exercise, salt intake reduction, and yoga are effective non-pharmacological methods for reducing blood pressure in young pre-hypertensive and hypertensive adults.

Sucher, H., et al. (2019). "P373 The use of active video games in the respiratory physiotherapy in patients with cystic fibrosis." Journal of cystic fibrosis 18: S163.
	
Sugumaran, A. and A. Prakash (2011). "Wii can rehabilitate?" GM: Midlife & Beyond 41(4): 228-229.
	The gaming device Nintendo Wii is now recognised as a successful tool in young and elderly rehabilitation. Not just a physical therapy, 'Wii-habilitation' is helpful even in palliative patients as a means of distraction and improving concentration skills. Our review reflects current practice and discusses the varied scope of the Wii as an enjoyable therapy.

Suleiman-Martos, N., et al. (2022). "Effects of active video games on physical function in independent community-dwelling older adults: A systematic review and meta-analysis." Journal of Advanced Nursing 78(5): 1228-1244.
	AIM: To analyse the effects of active video games on physical function in independent community-dwelling older adults. DESIGN: Systematic review and meta-analysis of randomized controlled trials. DATA SOURCES: The CINAHL, LILACS, Medline, Proquest and Scopus databases were consulted, with no restriction by year of publication. REVIEW METHODS: Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed. The meta-analysis was performed using RevMan software. RESULTS: The analysis included 22 randomized controlled trials with a total of 1208 participants (all >/=55 years old). In our meta-analyses, the effects produced by playing the active video games (mean differences) were statistically significant for the variables Gait speed and Timed up-and-go. The differences between the control and experimental groups were not significant in the following tests: 6-minute walk, 30-second chair stand, balance (measured with the Berg Balance Scale), cadence, grip strength, knee extension strength, 8-Foot Up-and-Go or velocity. CONCLUSIONS: Physical exercise from participation in active video games has beneficial effects on two clinical parameters (Gait speed and Timed up-and-go) in independent community-dwelling older adults. However, the effects on other parameters do not differ from those obtained with conventional exercise training. Therefore, the clinical significance of these benefits is limited. IMPACT: Older adults usually perform little physical activity. In consequence, researchers have increasingly considered alternatives to traditional forms of exercise. One such is that provided by active video games, which can be a source of stimulation, encouraging adherence and motivation in exercise programmes. Our review shows that active video games can improve gait speed and mobility, but in other respects obtain no differences from conventional exercises. Further tailored randomized clinical trials should be undertaken with diverse populations of older adults to evaluate different physical function variables to determine the most appropriate training approach and its optimal design and duration.

Sullivan, B., et al. (2012). "Improvements in Dynamic Balance Using an Adaptive Snowboard with the Nintendo Wii." Games for Health Journal 1(4): 269-273.
	OBJECTIVE: The purpose of this case report is to see if a novel balance board could improve balance and gait of a subject with dynamic balance impairments and enjoyment of virtual rehabilitation training. MATERIALS AND METHODS: A novel Adaptive Snowboard (developed by two of the authors, B.S. and J.D.) was used in conjunction with the Nintendo((R)) (Redmond, WA) Wii snowboarding and wakeboarding games with a participant in a physical therapy outpatient clinic. Baseline measurements were taken for gait velocity and stride length, Four Square Step Test, Star Balance Excursion Test, Sensory Organization Test, and the Intrinsic Motivation Inventory. Two 60-90-minute sessions per week for 5 weeks included seven to nine trials of Wii snowboarding or wakeboarding games. RESULTS: Improvements were seen in every outcome measure. CONCLUSIONS: This study had comparable results to studies performed using a wobble board in that improvements in balance were made. Use of virtual snowboard simulation improved the subject's balance, gait speed, and stride length, as well as being an enjoyable activity.

Sun, T. L. and C. H. Lee (2013). "An impact study of the design of exergaming parameters on body intensity from objective and gameplay-based player experience perspectives, based on balance training exergame." PLoS ONE [Electronic Resource] 8(7): e69471.
	Kinect-based exergames allow players to undertake physical exercise in an interactive manner with visual stimulation. Previous studies focused on investigating physical fitness based on calories or heart rate to ascertain the effectiveness of exergames. However, designing an exergame for specific training purposes, with intensity levels suited to the needs and skills of the players, requires the investigation of motion performance to study player experience. This study investigates how parameters of a Kinect-based exergame, combined with balance training exercises, influence the balance control ability and intensity level the player can tolerate, by analyzing both objective and gameplay-based player experience, and taking enjoyment and difficulty levels into account. The exergame tested required participants to maintain their balance standing on one leg within a posture frame (PF) while a force plate evaluated the player's balance control ability in both static and dynamic gaming modes. The number of collisions with the PF depended on the frame's travel time for static PFs, and the leg-raising rate and angle for dynamic PFs. In terms of center of pressure (COP) metrics, significant impacts were caused by the frame's travel time on MDIST-AP for static PFs, and the leg-raising rate on MDIST-ML and TOTEX for dynamic PFs. The best static PF balance control performance was observed with a larger frame offset by a travel time of 2 seconds, and the worst performance with a smaller frame and a travel time of 1 second. The best dynamic PF performance was with a leg-raising rate of 1 second at a 45-degree angle, while the worst performance was with a rate of 2 seconds at a 90-degree angle. The results demonstrated that different evaluation methods for player experience could result in different findings, making it harder to study the design of those exergames with training purposes based on player experience.

Suresh, J. and C. Harish (2019). "Effectiveness of Virtual Reality Using PS4 Gaming Technology in Stroke Rehabilitation for Improving Upper Limb Function-A Pilot Study." Indian Journal of Public Health Research & Development 10(4): 1315‐1320.
	Background: Hemiparesis resulting in functional limitation of an upper extremity and lower limb is common among stroke survivors. Virtual reality is one of the way of improving motor function in stroke, limited evidence is available on the efficacy of virtual reality for stroke rehabilitaton. Methods: In this pilot study 2 parallel groups involving stroke patients, we compared the feasibility, safety and efficacy of virtual reality using the sony PS4 gaming technology to evaluate upper limb motor improvement.The primary feasibility outcome was the total time receiving the intervention. The primary safety outcome was the proportion of patients experiencing intervention‐related adverse events during the study period. Efficacy, a secondary outcome measure, was evaluated with wolf motor function test and Spasticity Grading at 4 weeks after intervention. OUTCOME MEASURE: WOLF Motor function test and Box and Block test. Result: This study shows that mean values obtained from WOLF motor function test showed no statistical significance and the mean values of Box and Block test showed statistical significance. Conclusion: This study concludes that the PS4 gaming technology is a feasible, safe, and potentially effective intervention to enhance motor function recovery in patients with a recent stroke.

Sütçü, G. and M. Kılınç (2021). "Investigation of the Effects of Game Supported Rehabilitation Program on Motor and Cognitive Skills in a Patient with Co-occurrence of Multiple Sclerosis and Parkinson’s Disease: A Case Report." Turkish Journal Of Neurology 27(2): 195-200.
	Multiple sclerosis (MS) and Parkinson's disease (PD) are progressive central nervous system diseases that cause significant activity limitation and participation restrictions by causing motor and non-motor symptoms in patients. With this case report, we aimed to present the effects of the game-supported rehabilitation in a patient with co-occurrences of MS and PD that we rarely encounter. A 54-year-old female patient with co-occurrence of MS and PD who was mobilized with a wheelchair was evaluated as a case. The patient was treated for 1 hour, 3 days a week for 8 weeks. After a 30-minute neurophysiologic exercise program, the patient was taken to 30-minute game therapy using the "Smart Physiotherapy Game System (USE-IT)". USE-IT, a game console developed in line with our clinical experience, is also a TUBITAK 1512 project. On the game console, the patient played six games using different grip materials. Before and after the treatment, diseases levels and findings were evaluated using the expanded disability status scale, the modified Hoehn and Yahr scale, and the unified PD rating scale. Frequency of falling was asked to the patient and relatives, rigidity was determined using manual evaluations, muscle strength was assessed through gross muscle strength assessment, cognitive status was evaluated using the Montreal cognitive assessment scale, posture was evaluated with New York posture rating scale, manual skills were evaluated with the Minnesota manual dexterity test, and fatigue was evaluated with fatigue impact scale. Functional condition was evaluated using the functional independence measurement and quality of life was evaluated with MS quality of life questionnaire and PD questionnaire. As a result, it is seen that there are clinically significant improvements in the severity of disease, fatigue, falling, postural disorders, manual skills, physical, cognitive and emotional state, mobility, activities of daily living and quality of life of the patient.
Multipl skleroz (MS) ve Parkinson hastalığı (PH), motor ve non-motor semptomlara sebep olarak hastalarda önemli derecede aktivite limitasyonu ve katılım kısıtlılıkları yaratan progresif merkezi sinir sistemi hastalıklarıdır. Olgu raporu ile nadiren karşılaştığımız MS ve PH birlikteliğine sahip hastada oyun destekli rehabilitasyonun olumlu etkilerini sunmayı amaçladık. MS ve PH birlikteliğine sahip tekerlekli sandalye ile mobilizasyonu sağlanan 54 yaşındaki kadın hasta olgu olarak incelendi. Hasta 8 hafta süreyle haftada 3 gün 1'er saat olmak üzere tedaviye alınmıştır. Hasta 30 dakika nörofizyolojik egzersiz programı sonrasında "Akıllı Fizyoterapi Oyun Sistemi (USE-IT)" ile 30 dakika oyun tedavisine alındı. Klinik tecrübelerimiz doğrultusunda geliştirilmiş bir oyun konsolu olan USE-IT aynı zamanda bir TÜBİTAK 1512 projesidir. Oyun konsolunda hasta farklı kavrama malzemeleri kullanarak altı oyun oynadı. Tedavi öncesi ve sonrası hastalıkların seviyeleri ve bulguları, genişletilmiş durum özürlülük skalası, modifiye Hoehn ve Yahr skalası ve birleşik PH derecelendirme ölçeği ile, düşme frekansı hasta ve yakınına sorularak, rijiditesi manuel değerlendirmeler ile, kas kuvveti kaba kas kuvvetleri değerlendirmesi ile, kognitif durumu Montreal bilişsel değerlendirme ölçeği ile, postürü New York postür değerlendirme ölçeği ile, el becerileri Minnesota el beceri testi ile, yorgunluğu yorgunluk etki ölçeği ile, fonksiyonel durumu fonksiyonel bağımsızlık ölçeği ile ve yaşam kalitesi MS yaşam kalitesi anketi ve PH anketi ile değerlendirilmiştir. Sonuç olarak, hastanın hastalık şiddetinde, yorgunluk, düşme ve postüral bozukluklarında, el becerilerinde, fiziksel, kognitif ve emosyonel durumunda, mobilitesinde, günlük yaşam aktivitelerinde, ve yaşam kalitesinde klinik olarak anlamlı gelişmeler olduğu görülmektedir.

Svensson, A. and L. Hansson (1985). "Blood pressure and response to "stress" in 11-16 year old children." Acta Medica Scandinavica - Supplementum 693: 51-55.
	Blood pressure at rest and cardiovascular response to "stress" were studied in 27 girls and 33 boys 11-16 years old. One group (HT, n = 23) had hypertensive mothers with a previous hypertensive pregnancy, another group (NT, n = 20) had normotensive mothers with a previous hypertensive pregnancy and the control group (C, n = 17) had normotensive mothers with normotensive pregnancies. Resting blood pressure was 124/71 mmHg (HT), 117/67 mmHg (NT) and 112/65 mmHg in the 3 groups. Systolic pressure was significantly different in all 3 groups (p less than 0.05 - p less than 0.001). Responses to noise stimulation (100 dBA) were identical in all groups with increases in diastolic and mean arterial blood pressure and cardiac output. During a video game session increases in blood pressure and heart rate were equal in the groups but during physical exercise a slight decrease in diastolic blood pressure was seen in the NT and C groups only. Differences in blood pressure in children with varying maternal history of hypertension do not seem to reflect alterations in the cardiovascular response pattern to "stress".

Synofzik, M. and W. Ilg (2014). "Motor training in degenerative spinocerebellar disease: ataxia-specific improvements by intensive physiotherapy and exergames." BioMed Research International 2014: 583507.
	The cerebellum is essentially involved in movement control and plays a critical role in motor learning. It has remained controversial whether patients with degenerative cerebellar disease benefit from high-intensity coordinative training. Moreover, it remains unclear by which training methods and mechanisms these patients might improve their motor performance. Here, we review evidence from different high-intensity training studies in patients with degenerative spinocerebellar disease. These studies demonstrate that high-intensity coordinative training might lead to a significant benefit in patients with degenerative ataxia. This training might be based either on physiotherapy or on whole-body controlled videogames ("exergames"). The benefit shown in these studies is equal to regaining one or more years of natural disease progression. In addition, first case studies indicate that even subjects with advanced neurodegeneration might benefit from such training programs. For both types of training, the observed clinical improvements are paralleled by recoveries in ataxia-specific dysfunctions (e.g., multijoint coordination and dynamic stability). Importantly, for both types of training, the retention of the effects seems to depend on the frequency and continuity of training. Based on these studies, we here present preliminary recommendations for clinical practice, and articulate open questions that might guide future studies on neurorehabilitation in degenerative spinocerebellar disease.

Szekely, A. and D. Gambetta (2020). "Does information about toughness decrease fighting? Experimental evidence." PLoS ONE [Electronic Resource] 15(2): e0228285.
	Will fights erupt when resources are scarce and the rules regulating their distribution are absent or ignored? We conjecture that the answer depends on whether credible information about individuals' toughness is available. When people send credible signs and signals of their toughness disputes may be solved without violence. We use a laboratory experiment in which subjects create information about their toughness and decide whether to take others' resources and resist in case others' attempt to take theirs. Subjects perform a potentially painful but safe physical exercise to create information and to determine who wins and loses fights. This, realistically, ranks subjects according to their toughness and implicates toughness, a quality important in real conflict, in fighting. We find that, consistent with theory, information reduces fighting. This suggests that, in addition to the theories traditionally used to explain prisoner behavior, the availability of credible information about toughness influences prison conflict.

Szer, J. (1983). "Video games as physiotherapy." Medical Journal of Australia 1(9): 401-402.
	
Szturm, T., et al. (2011). "Effects of an interactive computer game exercise regimen on balance impairment in frail community-dwelling older adults: a randomized controlled trial." Physical Therapy 91(10): 1449-1462.
	BACKGROUND: Due to the many problems associated with reduced balance and mobility, providing an effective and engaging rehabilitation regimen is essential to progress recovery from impairments and to help prevent further degradation of motor skills. OBJECTIVES: The purpose of this study was to examine the feasibility and benefits of physical therapy based on a task-oriented approach delivered via an engaging, interactive video game paradigm. The intervention focused on performing targeted dynamic tasks, which included reactive balance controls and environmental interaction. DESIGN: This study was a randomized controlled trial. SETTING: The study was conducted in a geriatric day hospital. PARTICIPANTS: Thirty community-dwelling and ambulatory older adults attending the day hospital for treatment of balance and mobility limitations participated in the study. INTERVENTIONS: Participants were randomly assigned to either a control group or an experimental group. The control group received the typical rehabilitation program consisting of strengthening and balance exercises provided at the day hospital. The experimental group received a program of dynamic balance exercises coupled with video game play, using a center-of-pressure position signal as the computer mouse. The tasks were performed while standing on a fixed floor surface, with progression to a compliant sponge pad. Each group received 16 sessions, scheduled 2 per week, with each session lasting 45 minutes. MEASUREMENTS: Data for the following measures were obtained before and after treatment: Berg Balance Scale, Timed "Up & Go" Test, Activities-specific Balance Confidence Scale, modified Clinical Test of Sensory Interaction and Balance, and spatiotemporal gait variables assessed in an instrumented carpet system test. RESULTS: Findings demonstrated significant improvements in posttreatment balance performance scores for both groups, and change scores were significantly greater in the experimental group compared with the control group. No significant treatment effect was observed in either group for the Timed "Up & Go" Test or spatiotemporal gait variables. LIMITATIONS: The sample size was small, and there were group differences at baseline in some performance measures. CONCLUSION: Dynamic balance exercises on fixed and compliant sponge surfaces were feasibly coupled to interactive game-based exercise. This coupling, in turn, resulted in a greater improvement in dynamic standing balance control compared with the typical exercise program. However, there was no transfer of effect to gait function.

Szturm, T., et al. (2015). "Games and Telerehabilitation for Balance Impairments and Gaze Dysfunction: Protocol of a Randomized Controlled Trial." JMIR Research Protocols 4(4): e118.
	BACKGROUND: Digital media and gaming have received considerable interest from researchers and clinicians as a model for learning a broad range of complex tasks and facilitating the transfer of skills to daily life. These emerging rehabilitation technologies have the potential to improve clinical outcomes and patient participation because they are engaging, motivating, and accessible. Our research goal is to develop preventative and therapeutic point-of-care eHealth applications that will lead to equivalent or better long-term health outcomes and health care costs than existing programs. We have produced a novel computer-aided tele-rehabilitation platform that combines computer game-based exercises with tele-monitoring. OBJECTIVE: Compare the therapeutic effectiveness of an in-home, game-based rehabilitation program (GRP) to standard care delivered in an outpatient physical therapy clinic on measures of balance, gaze control, dizziness, and health-related quality of life. METHODS: A randomized, controlled, single-blind pilot trial will be conducted. Fifty-six participants with a diagnosis of peripheral vestibular disorder will be randomly assigned to either usual physical therapy (comparator group) or to a game-based intervention (experimental group). Measures to be assessed will include gaze control, dynamic balance, and self-reported measures of dizziness. RESULTS: The project was funded and enrollment was started in August 2014. To date, 36 participants have been enrolled. There have been 6 drop-outs. It is expected that the study will be completed January 2016 and the first results are expected to be submitted for publication in Spring of 2016. CONCLUSIONS: A successful application of this rehabilitation program would help streamline rehabilitation services, leverage therapist time spent with clients, and permit regular practice times at the client's convenience. TRIAL REGISTRATION: Clinicaltrials.gov: NCT02134444; https://clinicaltrials.gov/ct2/show/NCT02134444 (Archived by WebCite at http://www.webcitation.org/6cE18bqqY).

Szturm, T., et al. (2022). "Game-Based Dual-Task Exercise Program for Children with Cerebral Palsy: Blending Balance, Visuomotor and Cognitive Training: Feasibility Randomized Control Trial." Sensors 22(3): 761.
	The objective of this exploratory randomized controlled trial (RCT) was to provide evidence for the feasibility and therapeutic value of a novel game-based dual-task balance exercise program in children with cerebral palsy (CP). Twenty children with CP were recruited and randomized into two groups: (a) the conventional balance training group (CG) and (b) the experimental group (XG), which received a game-based dual-task (DT) balance exercise program. Both groups received their respective therapy programs for 12 weeks at a frequency of three sessions per week. Semi-structured interviews with the parents and children and qualitative analysis were conducted to evaluate the children's experiences with the game-based exercise program. The quantitative analysis included (a) the Pediatric Balance Scale (PBS), (b) Gross Motor Function Measure-88 (GMFM-88), and (c) computerized measures of standing balance performance during various dual-task conditions. Compliance was 100% for all 20 participants. Four themes captured the range of each participant's experiences and opinions: (a) reasons for participation, (b) likes and dislikes with the technologies, (c) positive effects of the program, and (d) future expectations. Children in the XG demonstrated greater improvements in PBS, GMFM, and DT balance measures as compared to children in the CG. The findings demonstrate feasible trial procedures and acceptable DT-oriented training with a high compliance rate and positive outcomes. These findings support further research and development and progression to the next phase of a full-scale RCT to evaluate the clinical effectiveness of the game-based DT balance exercise program for children with CP.

Taheri, H., et al. (2014). "Design and preliminary evaluation of the FINGER rehabilitation robot: controlling challenge and quantifying finger individuation during musical computer game play." J Neuroeng Rehabil 11(1): 10.
	BACKGROUND: This paper describes the design and preliminary testing of FINGER (Finger Individuating Grasp Exercise Robot), a device for assisting in finger rehabilitation after neurologic injury. We developed FINGER to assist stroke patients in moving their fingers individually in a naturalistic curling motion while playing a game similar to Guitar Hero. The goal was to make FINGER capable of assisting with motions where precise timing is important. METHODS: FINGER consists of a pair of stacked single degree-of-freedom 8-bar mechanisms, one for the index and one for the middle finger. Each 8-bar mechanism was designed to control the angle and position of the proximal phalanx and the position of the middle phalanx. Target positions for the mechanism optimization were determined from trajectory data collected from 7 healthy subjects using color-based motion capture. The resulting robotic device was built to accommodate multiple finger sizes and finger-to-finger widths. For initial evaluation, we asked individuals with a stroke (n = 16) and without impairment (n = 4) to play a game similar to Guitar Hero while connected to FINGER. RESULTS: Precision design, low friction bearings, and separate high speed linear actuators allowed FINGER to individually actuate the fingers with a high bandwidth of control (-3 dB at approximately 8 Hz). During the tests, we were able to modulate the subject's success rate at the game by automatically adjusting the controller gains of FINGER. We also used FINGER to measure subjects' effort and finger individuation while playing the game. CONCLUSIONS: Test results demonstrate the ability of FINGER to motivate subjects with an engaging game environment that challenges individuated control of the fingers, automatically control assistance levels, and quantify finger individuation after stroke.

Takeuchi, T., et al. (2019). "Injuries tendency during fall league match in the Japanese Chushikoku area collegiate American Football league match, past 7 seasons (2012 - 2018)...Third World Congress of Sports Physical Therapy, October 4-5, 2019, Vancouver, Canada." International Journal of Sports Physical Therapy 14(6): S8-S8.
	Objective: American Football (AF) is a sport with intense physical contact, and there are many injuries. According to the surveys on injuries in collegiate AF in Japan, ligament injuries were the most frequent (37 - 39%). These studies were conducted in the Kanto or Kansai leagues, which have sufficient players. However, no surveys on injuries has been conducted in leagues with a small number of players, such as in the Chushikoku league. Therefore, this study aimed to investigate the occurrence of injury in the Chushikoku Collegiate AF league. Methods: The survey period spanned 103 games played over 7 seasons. The survey subjects had described in the injury report of the Japan AF Association. The injury report was described when a "timeout for the injured" was called by the referee. The survey items included the player's position, injury type, injury location, the quarter (Q) during which the injury occurred, and the number of injuries per game. Results: The total number of injuries was 424. The number of injuries per games was 4.1 per game. The most frequent type of injury was bruising in 138 cases (32.5%). In addition, there were 114 cases (26.9%) of muscle cramps and 74 cases (17.5%) of ligament injuries. There were 189 cases among offensive players and 235 cases among defensive players. The timing of the injury was the 3Q in 127 cases and 4Q in 183 cases. Overall, 73.1% of injuries occurred late in the game. Conclusion: Previous studies reported the number of injuries for the Kanto Collegiate AF league to be 1.3 per game. In contrast, the number of injuries in Chushikoku league was 4.3 per game, and the prevalence of bruises and muscle cramps was overwhelmingly large. This high number could be due to several factors, such as few players per team (few opportunities for substitution), and the participation of students with lower skills. Clinical implications: The injury rates in the Chushikoku league tended to differ from those of other leagues.

Tallner, A., et al. (2013). "Web-based physical acticity enhancement in persons with multiple sclerosis." Neurologie und rehabilitation 19(1): 35‐46.
	Due to its pervasiveness and technical opportunities, the internet has been increasingly used in therapeutic settings as well. In this regard, internetdelivered interventions have proven effective in ameliorating several health behaviors, amongst them physical activity behavior. The different kinds of internet‐delivered activities comprise online‐counseling, web‐based interventions, internet‐operated therapeutic software and other online activities like social networks. Internet‐delivered interventions have also shown positive effects on physical activity and physical function in persons with MS. In a randomised and controlled study (internet‐based activation to physical exercise, ms‐intakt Study Erlangen), we combined an initial face‐to‐face introductory session with a subsequent online training support for several months. We put the main focus of the intervention on education, strength and endurance training, and an online physical activity diary. The intervention led to significant increase in muscle force, sports activities and lung function in the intervention group compared to the waitlist control group. Global outcomes like health‐related quality of life were not subject to change. An explanation for this might be the social interaction and support that is less in internet‐delivered interventions compared to face‐to‐face group interventions. The integration of social networks seems to be promising in this respect. A survey among the participants of the ms‐intakt study showed high acceptance and satisfaction with the intervention. A striking fact was the training frequency, though, which decreased over time. Decreasing compliance is a major issue in internet‐delivered interventions. A possible remedy might be the implementation of game‐design elements to increase compliance and long‐term adherence to internet‐delivered interventions. © Hippocampus Verlag 2013.

Tan, K. K., et al. (2014). "Development of telerehabilitation application with designated consultation categories." Journal of Rehabilitation Research & Development 51(9): 1383-1396.
	Telerehabilitation (TR) is getting ever more popular because it is effective in bringing rehabilitation services to rural populations by means of audiovisual systems and its initial implementation studies presented encouraging results. TR is proven to be helpful, with benefits in terms of reduced travel time, cost, and availability of specialists' support in local communities. However, TR systems that are usable under low-bandwidth network environments are rare. This article introduces the development of a TR system with customized consultation categories for users to choose from, depending on requirements. Each category, with its preset parameter values, is discussed in detail by demonstrating relevant rehabilitation exercises. A novel bandwidth adaptation algorithm is also presented for optimal utilization of the dynamic network conditions, which ensures the system functionality even under narrow-bandwidth environments. Experiment results show that the system is able to perform effectively in each consultation category while the rehabilitation exercises are being performed. The proposed algorithm is also verified for its ability to adapt the content quality and effectively utilize the network under constrained conditions. A survey conducted on the video quality of the system under low-bandwidth conditions shows encouraging results for a large scale deployment of the application.

Tanner, T., et al. (2020). "Consumption of snacks and dental caries among Finnish young men: a cross-sectional epidemiological study." Odontology/The Society of the Nippon Dental University 108(3): 486-492.
	The aim of this study was to investigate the frequency of consumption of snack products, as well as the association between snacking and restorative treatment need, and associated factors among a healthy Finnish male population. Approximately 8500 conscripts answered a computer-based questionnaire covering their snacking habits and other health behaviours. Restorative treatment need and history (DT, DMFT) were examined by trained and calibrated dentists. Cross-tabulations were used to investigate the associations between snacking habits and the other researched variables, and logistic regression analyses (odds ratio and 95% confidence interval) were used to investigate the variables influencing the restorative treatment need. In the present study, almost one-third of the study group consumed snack products daily, most often fizzy and energy drinks. Only 10% had received a diet counselling. The most common situations involving snacking were at the cinema and while playing computer games. According to Pearson's Chi square test, snacking was associated with smoking and snuffing and infrequent tooth brushing (p < 0.001). According to the regression analyses, daily snacking, smoking, and doing exercise daily increased the odds for restorative treatment need whereas higher education level and tooth brushing twice or more often per day decreased the odds for restorative treatment need. It can be concluded that daily snacking is common among Finnish young men and is associated with restorative treatment need. Snacking is also associated with other harmful oral and general health habits. Individual dietary counselling should be routinely offered to everybody in dental clinics.

Tannous, H., et al. (2016). "A New Multi-Sensor Fusion Scheme to Improve the Accuracy of Knee Flexion Kinematics for Functional Rehabilitation Movements." Sensors 16(11): 1914.
	Exergames have been proposed as a potential tool to improve the current practice of musculoskeletal rehabilitation. Inertial or optical motion capture sensors are commonly used to track the subject's movements. However, the use of these motion capture tools suffers from the lack of accuracy in estimating joint angles, which could lead to wrong data interpretation. In this study, we proposed a real time quaternion-based fusion scheme, based on the extended Kalman filter, between inertial and visual motion capture sensors, to improve the estimation accuracy of joint angles. The fusion outcome was compared to angles measured using a goniometer. The fusion output shows a better estimation, when compared to inertial measurement units and Kinect outputs. We noted a smaller error (3.96 degrees ) compared to the one obtained using inertial sensors (5.04 degrees ). The proposed multi-sensor fusion system is therefore accurate enough to be applied, in future works, to our serious game for musculoskeletal rehabilitation.

Tanriverdi, M., et al. (2018). "Abstracts from the 18th International Symposium on Pediatric Neuro-Oncology (ISPNO 2018) June 30 – July 3, 2018 Hyatt Regency Hotel Denver, Colorado, USA." Neuro-oncology 20(suppl_2): i27-i213.
	Balance disorders has seen in children with brain tumors. Purpose of our study is to examine the effects of balance education and compare the efficiency of video game exercise systems to conventional methods. 30 patients between 6‐18 years of age included in the study and they are randomized into two groups; Wii Fit and conventional. Both groups received their exercises under supervision of a physiotherapist for 8 weeks total, twice a week 1 hour per session. Assessments performed at the beginning of the exercise program and at the end of the 8th week including disease affect, timed performance, functional capacity, balance and daily living activities. There was no significant difference between two groups and in group assessment of disease affect (p>0,05). There were significant differences in groups for timed performance (p<0,05) and functional capacity (p<0,05) but there was no difference between the two groups. Both groups results for balance improved and there was no significant difference between groups even though the Wii Fit group improved more statistically (p≈0). There was no difference between total scores of daily living activities but only social communication score was better in favor of Wii Fit group. Treatment program has no effect on the disease affect instruments yet timed performance tests, functional capacity and balance skills of the patients improved. These improvements were even better for the Wii Fit group. These results show that physiotherapy and rehabilitation is beneficial for children with brain tumor even though it doesn't have any effects on the disease itself.

Tao, G., et al. (2021). "Immersive virtual reality health games: a narrative review of game design." J Neuroeng Rehabil 18(1): 31.
	BACKGROUND: High quality head-mounted display based virtual reality (HMD-VR) has become widely available, spurring greater development of HMD-VR health games. As a behavior change approach, these applications use HMD-VR and game-based formats to support long-term engagement with therapeutic interventions. While the bulk of research to date has primarily focused on the therapeutic efficacy of particular HMD-VR health games, how developers and researchers incorporate best-practices in game design to achieve engaging experiences remains underexplored. This paper presents the findings of a narrative review exploring the trends and future directions of game design for HMD-VR health games. METHODS: We searched the literature on the intersection between HMD-VR, games, and health in databases including MEDLINE, Embase, CINAHL, PsycINFO, and Compendex. We identified articles describing HMD-VR games designed specifically as health applications from 2015 onwards in English. HMD-VR health games were charted and tabulated according to technology, health context, outcomes, and user engagement in game design. FINDINGS: We identified 29 HMD-VR health games from 2015 to 2020, with the majority addressing health contexts related to physical exercise, motor rehabilitation, and pain. These games typically involved obstacle-based challenges and extrinsic reward systems to engage clients in interventions related to physical functioning and pain. Less common were games emphasizing narrative experiences and non-physical exercise interventions. However, discourse regarding game design was diverse and often lacked sufficient detail. Game experience was evaluated using primarily ad-hoc questionnaires. User engagement in the development of HMD-VR health games primarily manifested as user studies. CONCLUSION: HMD-VR health games are promising tools for engaging clients in highly immersive experiences designed to address diverse health contexts. However, more in-depth and structured attention to how HMD-VR health games are designed as game experiences is needed. Future development of HMD-VR health games may also benefit from greater involvement of end-users in participatory approaches.

Taylor, M. J., et al. (2014). "Comparing the energy expenditure of Wii-Fit-based therapy with that of traditional physiotherapy in an older adult population." Journal of the American Geriatrics Society 62(1): 203-205.
	
Tctr (2018). "Movement game activity enhances executive functions in overweight children: A randomized controlled trial." https://trialsearch.who.int/Trial2.aspx?TrialID=TCTR20180414002.
	INTERVENTION: The movement program was modified from Davis et al. (2011), and was selected based on ease of comprehension, fun, and eliciting intermittent vigorous movement, which includes running games, jump rope, and modified basketball (Davis et al., 2011; Gutin, Riggs, Ferguson, & Owens, 1999). Each lesson lasted for 40 min and was led by nationally‐certified physical education instructors. Each lesson began with a 10‐minute warm‐up (moderate cardiovascular activity, static and dynamic stretching) followed by a 30‐minute movement game activity. Bouts ended with a water break, light cool down with cardiovascular activity, and static stretching. The experimental procedure consisted of four stages: 1) confirmation, 2) pre‐test, 3) treatments, and 4) post‐test. During the confirmation stage, which took place during the spring semester in 2017, each participant and his/her parent came to the school and were asked to read and complete the consent form that was approved by the Universityâ??s IRB and a medical history questionnaire. Each participant then entered the pre‐test stage, during which the Stroop Test and Determination Test were administered. For the Stroop Test, the given participant was asked to complete verbally the previously described word, color, color‐word, word‐color conditions as rapidly as possible. The time duration for each condition was used to assess Stroop Test performance. Next, the participant was given a 5â??10‐min rest in a quiet classroom before being instructed to perform verbally the Determination Test according to the various color stimuli and acoustic signals presented. Trial errors during the response for the Stroop Test and Determination Test would be identified by the examiner, and for any error, the participant was asked to repeat the trial until the correct response was given. During the treatment stage, participants in the experimental group were asked to participate in a childrenâ??s movement program three times a we CONDITION: cognitive benefits, executive function, physical exercise overweight children ; cognitive benefits, executive function, physical exercise PRIMARY OUTCOME: Executive function [Timeframe 30 minutes Neuropsychological tasks assessed by the Stroop Test and the Determination Test] SECONDARY OUTCOME: Executive function [Timeframe 30 minutes Neuropsychological tasks assessed by the Stroop Test and the Determination Test] INCLUSION CRITERIA: INCLUSION CRITERIA: 1) body mass index‐for‐age between 5 and 19 years greater than 1 standard deviation above the WHO Growth Reference median (WHO, 2018); 2) reported as being free of intellectual disability, brain injury, and neural diseases; and 3) aged 10 to 12 years.

tdrmw, R. B. R. (2020). "The effectiveness of a physical therapy treatment with the use of a video game in the ability to improve epigenetic markers, strength, balance and cognition in elderly women." https://trialsearch.who.int/Trial2.aspx?TrialID=RBR-9tdrmw.
	INTERVENTION: Device Games, Experimental The study population will be comprised of women over the age of 55, attending the Clínica Escola de Fisioterapia of Uri de Erechim ‐ URICEPP, who meet the inclusion criteria and agree to participate in the research by signing the Free and Informed Consent. The sample will be stratified into two groups, with patients selected according to the order of agreement in participate in the project, until the number of patients stipulated and randomized to one of the groups ‐ intervention group or control group and will consist of 24 patients, with an intervention group (kinesiotherapeutic exercise using exergame) composed of 12 participants and a control group (kinesiotherapeutic exercise without the use of exergame) composed of 12 participants. The sample n was based on in studies that used similar methodology, which evaluated the effect of exercise on epigenetic markers, as well as the effect of improved functional mobility induced by running in the elderly related to epigenetic markers. Data collection will take place in three moments: pre‐intervention, intervention and post‐intervention.During the pre‐intervention, questionnaires will be applied for respective order: Assessment of cognitive dysfunction using the Montreal Cognitive Assessment (MoCA) protocol; 2) Balance will be assessed through the Time Up and Go (TUG) test; 3) Graduation of muscle strength through dynamometry. For the analysis of epigenetic markers, blood collections will be performed in the pre and post intervention moments. For the analysis of epigenetic markers, collections will be performed in the pre and post intervention periods. The blood will be collected in the antecubital region, by a suitably qualified professional and qualified, as well as the place previou CONDITION: Cognition Epigenomics Epigenomics; Exercise; Occlusal Adjustment; Power Plants; Cognition ; Epigenomics ; Exercise ; Occlusal Adjustment ; Power Plants ; Cognition Exercise Occlusal Adjustment Power Plants PRIMARY OUTCOME: It is expected that the sample numbers will be reached, and, after analyzing the data, there are significant differences between the individuals who performed the protocol of; conventional kinesiotherapeutic intervention and kinesiotherapeutic intervention associated with an exergame in improving cognitive function and how; potential epigenetic modulating agents in a group of elderly women SECONDARY OUTCOME: There is a possibility that the sample number initially proposed by statistics will not be reached, since the study depends on availability ; other people and not researchers. In addition, significant differences may not be observed between the groups that will perform the intervention protocol with the use of the game and those that will not perform the exercises with the use of the game associated with physical exercise, rejecting the ; proposed hypothesis INCLUSION CRITERIA: Ability to walk; do not have neurological or cardiac disease as well as any other disease that makes physical exercise impossible; to be 55 years old or more; preserved cognitive, proven through the Montreal Cognitive Assessment

Tece Bayrak, A., et al. (2016). "Reviewing the Evidence: In Pursuit of a Framework for Parkinson Disease Rehabilitation with Games." Studies in Health Technology & Informatics 231: 9-17.
	Exercise gaming has been receiving a significant interest from both consumers and researchers. Be it for the purposes of weight loss, physical fitness or even just enjoyment, the potential of games to support rehabilitation has also been under investigation for a while. Due to our aging society, game based therapies could be a solution for optimizing resources and reducing rehabilitation costs. This paper aims to discuss the potential capacity of games as systems to enhance the relation of physical exercise and cognition for the rehabilitation of Parkinson Disease. Our investigation demonstrates that there is no established methodology for games in rehabilitation of Parkinson's addressing how games can encapsulate physical exercise strategies while providing safety, continuous monitoring and cognitive development exercises in facilitation of rehabilitation. Since rehabilitation with games is trending, yet to be developed rehabilitation strategies would benefit from new insights into the relationship between game worlds, physical exercise and motor-cognitive training. Therefore, it is useful to do further research into realizing (1) a relational model that demonstrates the relation between game world (composed of game features including formal game elements, audio-visual features, mechanics and dynamics), motor skills, cognition and physical exercise for both generic and specific rehabilitation purposes, (2) a structured task creation approach for game features that reconciles specific rehabilitation outcomes, correct level of engagement, task difficulty and safety requirements for target demographic.

Teel, E., et al. (2021). "Perceptual Cognitive Training Does Not Improve Clinical Outcomes at 4 and 12 Weeks Following Concussion in Children and Adolescents: A Randomized Controlled Trial." J Head Trauma Rehabil 36(2): E97-E107.
	OBJECTIVE: To determine whether a perceptual-cognitive training program using 3D-multiple object tracking (3D-MOT) can improve symptoms following acute pediatric concussion. SETTING: Research laboratory within a pediatric trauma center. PARTICIPANTS: Children and adolescents (n = 62, age= 13.27 +/- 2.50) with diagnosed concussion. DESIGN: Randomized controlled trial. Children were randomized into either 3D-MOT, 2048 game, or standard care-only groups. Participants and parents completed the Post-Concussion Symptom Inventory (PCSI) at baseline, 4, 8, and 12 weeks postinjury. Intervention participants completed either the 3D-MOT protocol or the 2048 game at 6 sessions between the baseline and 4-week assessment. MAIN MEASURES: A 3 (group) x 10 (time) mixed-model analysis of variance evaluated PCSI total scores. The rate of persistent postconcussive symptom (PPCS) was evaluated at 4 weeks using chi2 analysis. RESULTS: Symptoms decreased throughout the study using both child-reported (F(9,374) = 22.03, P < .001) and parent-reported scores (F(9,370) = 28.06, P < .001). Twenty-four (44.4%) children met the study definition for PPCS using the child-reported PCSI, while 20 (37.7%) children had PPCS using parent reports. The intervention did not significantly affect symptom resolution or PPCS rates. CONCLUSION: There is no benefit to prescribing 3D-MOT training for acute rehabilitation in pediatric patients with concussion and clinicians should instead focus on more effective programs.

Tefertiller, C., et al. (2019). "Results From a Randomized Controlled Trial to Address Balance Deficits After Traumatic Brain Injury." Archives of Physical Medicine & Rehabilitation 100(8): 1409-1416.
	OBJECTIVE: To evaluate the efficacy of an in-home 12-week physical therapy (PT) intervention that utilized a virtual reality (VR) gaming system to improve balance in individuals with traumatic brain injury (TBI). SETTING: Home-based exercise program (HEP). PARTICIPANTS: Individuals (N=63; traditional HEP n=32; VR n=31) at least 1 year post-TBI, ambulating independently within the home, not currently receiving PT services. MAIN OUTCOME MEASURES: Primary: Community Balance and Mobility Scale (CB&M); Secondary: Balance Evaluation Systems Test (BESTest), Activities-Specific Balance Confidence Scale (ABC), Participation Assessment with Recombined Tools-Objective (PART-O). RESULTS: No significant between-group differences were observed in the CB&M over the study duration (P=.9983) for individuals who received VR compared to those who received a HEP to address balance deficits after chronic TBI nor in any of the secondary outcomes: BESTest (P=.8822); ABC (P=.4343) and PART-O (P=.8822). However, both groups demonstrated significant improvements in CB&M and BESTest from baseline to 6, 12, and at 12 weeks follow-up (all P's <.001). Regardless of treatment group, 52% of participants met or exceeded the minimal detectable change of 8 points on the CB&M at 24 weeks and 38% met or exceeded the minimal detectable change of 7.81 points on the BESTest. CONCLUSION: This study did not find that VR training was more beneficial than a traditional HEP for improving balance. However, individuals with chronic TBI in both treatment groups demonstrated improvements in balance in response to these interventions which were completed independently in the home environment.

Telles, S., et al. (2013). "Effect of yoga or physical exercise on physical, cognitive and emotional measures in children: a randomized controlled trial." Child & Adolescent Psychiatry & Mental Health [Electronic Resource] 7(1): 37.
	BACKGROUND: Previous studies have separately reported the effects of physical exercise and yoga in children, showing physical, cognitive and emotional benefits. OBJECTIVES: The present randomized controlled trial assessed the effects of yoga or physical exercise on physical fitness, cognitive performance, self-esteem, and teacher-rated behavior and performance, in school children. METHODS: 98 school children between 8 to 13 years were randomized as yoga and physical exercise groups {n = 49 each; (yoga: 15 girls, group mean age 10.4 +/- 1.2 years), (physical exercise: 23 girls, group mean age 10.5 +/- 1.3 years)}. Both groups were blind assessed after allocation, using: (i) the Eurofit physical fitness test battery, (ii) Stroop color-word task for children, (iii) Battle's self-esteem inventory and (iv) the teachers' rating of the children's obedience, academic performance, attention, punctuality, and behavior with friends and teachers. After assessments the yoga group practiced yoga (breathing techniques, postures, guided relaxation and chanting), 45 minutes each day, 5 days a week. During this time the physical exercise group had jogging-in-place, rapid repetitive movements and relay races or games. Both groups were assessed at the end of 3 months. Data were analyzed with RM ANOVA and post-hoc tests were Bonferroni adjusted. RESULTS: There was one significant difference between groups. This was in social self-esteem which was higher after physical exercise compared to yoga (p < 0.05). All the changes reported below are based on after-before comparisons, within each group. Both groups showed an increase in BMI, and number of sit-ups (p < 0.001). Balance worsened in the physical exercise group, while plate tapping improved in the yoga group (p < 0.001). In the Stroop task both groups showed improved color, word- and color-word naming (p < 0.01), while the physical exercise group showed higher interference scores. Total, general and parental self-esteem improved in the yoga group (p < 0.05). CONCLUSION: Yoga and physical exercise are useful additions to the school routine, with physical exercise improving social self-esteem. TRIAL REGISTRATION: The study was registered in the Clinical Trials Registry of India (CTRI/2012/11/003112).

Templar, J. H. (2013). "Video games: increasing activity in sedentary individuals." Physiotherapy 99(3): 266-267.
	
Tepper, D. (2004). "Inside PT. Video game design and physical therapy." PT: Magazine of Physical Therapy 12(8): 4-4.
	
Tepper, D. (2008). "Leading edge technology." PT: Magazine of Physical Therapy 16(5): 6-6.
	
Tepper, D. and J. Simkins (2018). "EMERGING LEADERS AND APTA FELLOWS: A DIALOGUE." PT in Motion 10(11): 14-22.
	The article provides insights from American Physical Therapy Association (APTA) Emerging Leaders and Catherine Worthingham Fellows of the APTA about professional issues on PT. Emerging leader Tarang Kumar Jain said gamification, virtual reality, and telerehabilitation are being used in rehabilitation settings. Lymphedema specialist Alexandra Hill discussed devices that act as an adjunct to patient care. Physical therapist Blair Packard cites examples of the limitations of technology.

Tepper, D. E. (2006). "A gold medal team." PT: Magazine of Physical Therapy 14(10): 46-49.
	Seth Wescott won a gold medal for the United States at the 2006 Olympic Winter Games. That achievement required years of practice and conditioning... and rehabilitation after a serious injury. Physical therapy has played an important role.

Thalmann, M., et al. (2021). "Usability Study of a Multicomponent Exergame Training for Older Adults with Mobility Limitations." International Journal of Environmental Research & Public Health [Electronic Resource] 18(24): 13422.
	The global population aged 60 years and over rises due to increasing life expectancy. More older adults suffer from "geriatric giants". Mobility limitations, including immobility and instability, are usually accompanied by physical and cognitive decline, and can be further associated with gait changes. Improvements in physical and cognitive functions can be achieved with virtual reality exergame environments. This study investigated the usability of the newly developed VITAAL exergame in mobility-impaired older adults aged 60 years and older. Usability was evaluated with a mixed-methods approach including a usability protocol, the System Usability Scale, and a guideline-based interview. Thirteen participants (9 female, 80.5 +/- 4.9 years, range: 71-89) tested the exergame and completed the measurement. The System Usability Scale was rated in a marginal acceptability range (58.3 +/- 16.5, range: 30-85). The usability protocol and the guideline-based interview revealed general positive usability. The VITAAL exergame prototype received positive feedback and can be considered usable by older adults with mobility limitations. However, minor improvements to the system in terms of design, instructions, and technical aspects should be taken into account. The results warrant testing of the feasibility of the adapted multicomponent VITAAL exergame, and its effects on physical and cognitive functions, in comparison with conventional training, should be studied.

Then, J. W., et al. (2020). "Gamification in rehabilitation of metacarpal fracture using cost-effective end-user device: A randomized controlled trial." Journal of Hand Therapy 33(2): 235-242.
	STUDY DESIGN: This is a two-group randomized controlled trial. INTRODUCTION: Finger stiffness after treatment for metacarpal fractures often occurs due to poor compliance to the conventional rehabilitation programs. Gamification has shown success in improving adherence to and effectiveness of various therapies. PURPOSE OF THE STUDY: The purpose of this study was to evaluate whether gamification, using cost-effective devices was comparable with conventional physiotherapy in improving hand functions and adherence to rehabilitation in metacarpal fractures. METHODS: A 2-group randomized controlled trial involving 19 patients was conducted. Participants were randomized to a control (conventional physiotherapy, n = 10) or interventional group (gamification, n = 9). The grips strength and composite finger range of motion were measured at the baseline and each follow-up together with Patient-Rated Wrist and Hand Evaluation scores and compliance. RESULTS: There were no significant differences on improvements of grip strength (means difference 24.38 vs 20.44, P = .289) and composite finger range of motion (means difference 50.50 vs 51.11, P = .886). However, the gamification group showed better results in Patient-Rated Wrist and Hand Evaluation (mean 0.44 vs 8.45, P = .038) and compliance (P < .05). No adverse events were reported. DISCUSSION: Our results suggest that gamification using a cost-effective device demonstrated similar effectiveness as conventional physiotherapy in post-metacarpal fracture rehabilitation. CONCLUSIONS: Gamification using a mobile device is an inexpensive and safe alternative to conventional physiotherapy for hand rehabilitation after metacarpal fractures. It effectively serves as a guide for future development of cost-effective technology-enhanced therapy.

Thivel, D., et al. (2013). "Daily energy balance in children and adolescents. Does energy expenditure predict subsequent energy intake?" Appetite 60(1): 58-64.
	Both physical and sedentary activities primarily impact energy balance through energy expenditure, but they also have important implications in term of ingestive behavior. The literature provides scarce evidence on the relationship between daily activities and subsequent nutritional adaptations in children and adolescents. Sedentary activities and physical exercise are generally considered distinctly despite the fact that they represent the whole continuum of daily activity-induced energy expenditure. This brief review paper examines the impact of daily activities (from vigorous physical activity to imposed sedentary behaviors) on acute energy intake control of lean and obese children and adolescents, and whether energy expenditure is the main predictor of subsequent energy intake in this population. After an overview of the available literature, we conclude that both acute physical activity and sedentary behaviors induce food consumption modifications in children and adolescents but also that the important discrepancy between the methodologies used does not allow any clear conclusion so far. When considering energy intake responses according to the level of energy expenditure generated by those activities, it is clear that energy expenditure is not the main predictor of food consumption in both lean and obese children and adolescents. This suggests that other characteristics of those activities may have a greater impact on calorie intake (such as intensity, duration or induced mental stress) and that energy intake may be mainly determined by non-homeostatic pathways that could override the energetic and hormonal signals.

Thompson, K. G. (2010). "Where does the sport physiologist fit in?" Int J Sports Physiol Perform 5(4): 429-430.
	The author discusses the importance of sports physiologists among other service providers such as sports physicians, physiotherapists, and lifestyle advisors. He cites various examples related to the English Institute of Sport and Beijing 2008 Olympic Games. The author mentions that in elite sport, the roles of physiologists, nutritionists, psychologists, and biomechanists have become more project-focused. He also states that sports physiologists are much sought after in power and team sports.

Thorn, E. (2014). "Keep Your Hands in the Game with Paraffin Therapy." Massage Magazine(217): 67-67.
	The article discusses the use of paraffin wax in massage therapy to maintain hand health. It is inferred that paraffin therapy has been considered a moist-heat therapy or thermotherapy which has been used to manage pain in chronic arthritis in the early 1900s. The techniques for the appropriate use of paraffin wax in massage are described.

Timm, K. E. (1995). "In the game of workers' compensation, it's time to pass on the hot (pack) potato." Journal of Orthopaedic & Sports Physical Therapy 21(3): 131-131.
	
Timpka, T., et al. (2002). "Injuries in competitive youth bandy: an epidemiological study of a league season." Medicine & Science in Sports & Exercise 34(6): 993-997.
	PURPOSE: Bandy, with a century-long tradition in northern Europe, is a winter team-sport similar to ice hockey. To investigate the occurrence of injuries during competitive youth bandy games, injury incidence, injury types, and age-related risks were analyzed for one youth league season. METHODS: The National Athletic Injury/Illness Reporting System (NAIRS) definition of sports injury was used for the injury registration. All 416 games during the 1999-2000 season in the Swedish southeastern youth bandy league were included in the study. Primary data was collected by a questionnaire and completed by the team coaches after each game. At the end of the season, physician interviews with each team coach were performed to assure that no injuries had been missed as well as to ascertain whether there was any remaining disability. RESULTS: In total, 2.0 injuries (95% confidence interval 1.2-2.9 injuries) per 1000 player game hours were recorded. Sixty-eight percent of the injuries caused the injured player to be absent from bandy play for more than a week. Collision was the most common cause of injury (36%), and contusion was the most common injury type (41%). The injury incidence in the leagues for older players (Youth 14 -Youth 16) was slightly higher than in the leagues for the younger players (Youth 12 -Youth 13), while participation by under-aged players in games organized for older players led to an almost four-fold increase of injury risk. For severe injuries, the mean rehabilitation time away from bandy practice or competition was 27 d (range 8-56 d). CONCLUSION: The overall injury incidence during youth bandy games is low, but the injuries that occur cause extensive absences from the only four months long bandy season. From a public health perspective, bandy can be recommended for consideration when physical exercise is to be promoted among school-age children in countries with a winter climate.

tk7fw, R. B. R. (2019). "The effect of virtual reality on rehabilitation of elderly with balance disorder." https://trialsearch.who.int/Trial2.aspx?TrialID=RBR-3tk7fw.
	INTERVENTION: Other This is an experimental study, a randomized clinical trial that will be performed at the Clinical School of Physiotherapy of the Cesmac University Center. The elderly will be recruited by an initial assessor and will be randomized to two groups: Experimental Group (Virtual Reality Treatment Group) and Control Group (Conventional Treatment Group) All elderly in both groups will be evaluated by balance tests. , and after this initial assessment, will undergo a balance‐focused intervention as follows: Experimental group: 20 elderly aged between 60 and 79 years old, with altered postural control and balance and consequent risk of falls will undergo a balance training protocol through Immersive Virtual Reality, using Oculus Rift, where virtual games will be implemented. stimulate postural changes, changes in the center of gravity and constant stimulation of postural control. Control group: 20 elderly, aged between 60 and 79 years old, with altered postural control and balance and consequent risk of falls will undergo a conventional balance training protocol, through already implemented and validated physical exercises, with wide use in practice. This clinic will be performed in a circuit mode, with activities that stimulate postural changes, changes in the center of gravity and constant stimulation of postural control. Both groups will hold 16 sessions, twice a week and lasting 40 minutes. After these 16 intervention sessions, the initial evaluation tests will be reapplied, and two months after this reevaluation, for follow‐up purposes, another evaluation will be performed, also with the same tests. The results of the initial and final evaluations and follow up will be compared based on inferential statistics, aiming to verify if the training with the researched resource (Oculus Rift) was effective in the balance gain. Virtual Reality Exposure Therapy CONDITION: Accidental Falls Accidental Falls; Postural Balance ; Accidental Falls ; Postural Balance Postural Balance PRIMARY OUTCOME: A significant gain in postural control and balance after 16 sessions is expected to be verified by the balance assessment methods using the Dynamic Gait Index test from the change in the high or moderate risk rating from low to no risk fall. SECONDARY OUTCOME: It is expected to find a decrease in fear of falling after 16 sessions, verified by the Falls Efficacy Scale – International from an increase of at least 15 points in the final result of the scale. It is expected to find an improvement in dizziness perception and symptomatology after 16 sessions, verified by the Dizziness Handicap Inventory Scale, from a decrease of at least 20 points in the final result of the scale. INCLUSION CRITERIA: Male and female individuals; aged between 60 and 79 years old; with balance changes, previously diagnosed by a specialist doctor (otolaryngologist, neurologist or geriatrician).

Tornero-Aguilera, J. F., et al. (2021). "Airsoft: an efficient and motivating cardiovascular training choice." Journal of Sports Medicine & Physical Fitness 61(1): 124-130.
	BACKGROUND: Obesity and sedentarism have reached pandemic levels, postulating World Health Organization physical exercise as an important key factor for the prevention and treatment. In order to find a motivating and effective physical activity, we conducted this research intending to analyze the physiological and mechanical demands of an airsoft game. METHODS: Cardiovascular and mechanical activity were analyzed by heart rate monitors and GPS in 32 sedentary subjects (27.3+/-6.2 years; 26.3+/-7.9 BMI). RESULTS: Participants performed moderate to vigorous aerobic intensity for 3 hours and 20 min of which 55.2% was between 60-70% of their maximal heart rate and 14.2% above 70% of it, turned into distance 9.5 km of which 91.5% was moderate and 8.5% vigorous intensity. CONCLUSIONS: A single airsoft game performed by sedentary subject exceed the international recommendation of physical activity and weekly physical activity of US adults' citizens. This motivating and outdoor activity is an effective alternative to increase the population's physical activity levels.

Torres, A., et al. (2016). "Using Non-Traditional Interfaces to Support Physical Therapy for Knee Strengthening." Journal of Medical Systems 40(9): 194.
	Physical therapy consists mainly in the execution of rehabilitation processes that aim to help overcome injuries, as well as develop, maintain, or restore maximum body movement. Knee rehabilitation is one kind of physical therapy that requires daily exercises which could be considered monotonous and boring by the patients, discouraging their improvement. This is coupled with the fact that most physical therapists assess exercise performance through verbal and visual means with mostly manual measurements, making it difficult to constantly verify and validate if patients perform the exercises correctly. This article describes a physical therapy monitoring system that uses wearable technology to assess exercise performance and patient progress. This wearable device is able to measure and transfer the movement's data from the patient's limb to a mobile device. Moreover, the user interface is a game, which provides an entertaining approach to therapy exercising. In this article, it is shown that the developed system significantly increases daily user engagement in rehabilitation exercises, through a gameplay that matches physical therapy requirements for knee rehabilitation, as well as offering useful quantitative information to therapists.

Toth, A. J., et al. (2020). "Converging Evidence Supporting the Cognitive Link between Exercise and Esport Performance: A Dual Systematic Review." Brain Sciences 10(11): 15.
	(1) Background: Research into action video games (AVG) has surged with the popularity of esports over the past three decades. Specifically, evidence is mounting regarding the importance of enhanced cognitive abilities for successful esports performance. However, due to the sedentary nature in which AVGs are played, concerns are growing with the increased engagement young adults have with AVGs. While evidence exists supporting the benefits of exercise for cognition generally in older adult, children and clinical populations, little to no work has synthesized the existing knowledge regarding the effect of exercise specifically on the cognitive abilities required for optimal esports performance in young adults. (2) Method: We conducted a dual-systematic review to identify the cognitive abilities integral to esports performance (Phase 1) and the efficacy of exercise to enhance said cognitive abilities (Phase 2). (3) Results: We demonstrate the importance of four specific cognitive abilities for AVG play (attention, task-switching, information processing, and memory abilities) and the effect that different types and durations of physical exercise has on each. (4) Conclusion: Together, these results highlight the role that exercise can have on not only combating the sedentary nature of gaming, but also its potential role in facilitating the cognitive aspects of gaming performance.

Tracy, J. F. and R. Hovatter (2022). "Dodgeball: The Joke’s on Us." Journal of Physical Education, Recreation & Dance 93(3): 5-6.
	A recent social media post about dodgeball was an all-too-familiar attempt to validate the game as credible physical education content. It was evident by the many replies and comments to the post, that many in our profession are (a) still playing this "hall-of-shame" game; (b) think that all students love it; (c) believe it is teaching some kind of life skill; and (d) if we don't play it, we are making kids "soft". Dodgeball has been in the mock "physical education hall of shame" for over 20 years. How is this still a go-to for so many in our profession? Additionally, why do so many in our profession continue to defend the game with conviction and shame those who oppose it?

Tramontano, M., et al. (2020). "Sensor-based technology for upper limb rehabilitation in patients with multiple sclerosis: A randomized controlled trial." Restor Neurol Neurosci 38(4): 333-341.
	BACKGROUND: Sensor-based technological therapy devices may be good candidates for neuromotor rehabilitation of people with Multiple Sclerosis (MS), especially for treating upper extremities function limitations. The sensor-based device rehabilitation is characterized by interactive therapy games with audio-visual feedback that allows training the movement of shoulders, elbows, and wrist, measuring the strength and the active range of motion of upper limb, registering data in an electronic database to quantitatively monitoring measures and therapy progress. OBJECTIVE: This study aimed to investigate the effects of sensor-based motor rehabilitation in add-on to the conventional neurorehabilitation, on increasing the upper limb functions of patients with MS. METHODS: Thirty patients were enrolled in the study and randomly assigned to the experimental group and the control group. The training consisting of twelve sessions of upper limb training was compared with twelve sessions of upper limb sensory-motor training, without robotic support. Both rehabilitation programs were performed for 40 minutes three times a week, for 4 weeks, in addition to conventional therapy. All patients were evaluated at the baseline (T0) and after 4 weeks of training (T1). RESULTS: The within-subject analysis showed a statistically significant improvement in both groups, in the Modified Barthel Index and in the Rivermead Mobility Index scores and a significant improvement in Multiple Sclerosis Quality of Life-54 in the experimental. The analysis of effectiveness revealed that, compared with baseline (T0), the improvement percentage in all clinical scale scores was greater in the experimental group than the control group. CONCLUSIONS: Proposed training provides an intensive and functional-oriented rehabilitation that objectively evaluates achieved progress through exercises. Therefore, it can represent a good complementary strategy for hand rehabilitation in MS patients.

Travers, B. G., et al. (2018). "Biofeedback-Based, Videogame Balance Training in Autism." J Autism Dev Disord 48(1): 163-175.
	The present study examined the effects of a visual-based biofeedback training on improving balance challenges in autism spectrum disorder (ASD). Twenty-nine youth with ASD (7-17 years) completed an intensive 6-week biofeedback-based videogame balance training. Participants exhibited training-related balance improvements that significantly accounted for postural-sway improvements outside of training. Participants perceived the training as beneficial and enjoyable. Significant moderators of training included milder stereotyped and ritualistic behaviors and better starting balance. Neither IQ nor BMI moderated training. These results suggest that biofeedback-based balance training is associated with balance improvements in youth with ASD, most robustly in those with less severe repetitive behaviors and better starting balance. The training was perceived as motivating, further suggesting its efficacy and likelihood of use.

Trinh, T., et al. (2017). "Targeted upper-limb Wii-based Movement Therapy also improves lower-limb muscle activation and functional movement in chronic stroke." Disability & Rehabilitation 39(19): 1939-1949.
	PURPOSE: Post-stroke hemiparesis may manifest as asymmetric gait, poor balance, and inefficient movement patterns. We investigated improvements in lower-limb muscle activation and function during Wii-based Movement Therapy (WMT), a rehabilitation program specifically targeting upper-limb motor-function. METHODS: Electromyography (EMG) was recorded bilaterally from tibialis anterior (TA) in 20 stroke patients during a 14-day WMT program. EMG amplitude and burst duration were analyzed during stereotypical movement sequences of WMT activities. Functional movement ability was assessed pre- and post-therapy including 6-min walk test (6MWT), stair-climbing speed, and Wolf Motor Function Test timed-tasks. RESULTS: TA EMG burst duration during Wii-golf increased by 30% on the more-affected side (p = 0.04) and decreased by 28% on the less-affected side. Patients who did not step during Wii-tennis had a 16% decrease in more-affected TA burst sum (p = 0.047) resulting in more symmetrical activation ratio at late-therapy, with the ratio changing from 3.24 +/- 2.25 to 0.99 +/- 0.11 (p = 0.047). Six-minute walk and stair-climbing speed improved (p = 0.005 and 0.03, respectively), as did upper-limb movement (p </= 0.001). CONCLUSION: This study provides physiological evidence for lower-limb improvements with WMT. Different patterns of muscle activation changes were evident across the WMT activities. Despite the relatively good pre-therapy lower-limb function, muscle activation and symmetry improved significantly with upper-limb WMT. Implications for rehabilitation WMT is an upper-limb neurorehabilitation program that also improves lower-limb motor-function. We report a shift towards more symmetrical muscle activation of tibialis anterior on the more- and less-affected sides that were reflected in increased distance walked during the 6MWT. The use of standing during therapy not only improves lower-limb function but also permits larger and more powerful upper-limb movements. Targeted upper-limb rehabilitation can also significantly improve mobility and balance, whether dynamic or static, that should reduce the risk of falls post-stroke.

Trombini, M., et al. (2021). "A Study Protocol for Occupational Rehabilitation in Multiple Sclerosis." Sensors 21(24): 8436.
	Digital medical solutions can be very helpful in restorative neurology, as they allow the patients to practice their rehabilitation activities remotely. This work discloses ReMoVES, an IoMT system providing telemedicine services, in the context of Multiple Sclerosis rehabilitation, within the frame of the project STORMS. A rehabilitative protocol of exercises can be provided as ReMoVES services and integrated into the Individual Rehabilitation Project as designed by a remote multidimensional medical team. In the present manuscript, the first phase of the study is described, including the definition of the needs to be addressed, the employed technology, the design and the development of the exergames, and the possible practical/professional and academic consequences. The STORMS project has been implemented with the aim to act as a starting point for the development of digital telerehabilitation solutions that support Multiple Sclerosis patients, improving their living conditions. This paper introduces a study protocol and it addresses pre-clinical research needs, where system issues can be studied and better understood how they might be addressed. It also includes tools to favor remote patient monitoring and to support the clinical staff.

Trombini, M., et al. (2021). "A Solution for the Remote Care of Frail Elderly Individuals via Exergames." Sensors 21(8): 2719.
	Internet of Things (IoT) solutions are a concrete answer to many needs in the healthcare framework since they enable remote support for patients and foster continuity of care. Currently, frail elderly people are among end users who most need and would benefit from IoT solutions from both a social and a healthcare point of view. Indeed, IoT technologies can provide a set of services to monitor the healthcare of the elderly or support them in order to reduce the risk of injuries, and preserve their motor and cognitive abilities. The main feature of IoT solutions for the elderly population is ease of use. Indeed, to fully exploit the potential of an IoT solution, patients should be able to autonomously deal with it. The remote-monitoring validation engineering system (ReMoVES) described here is an IoT solution that caters to the specific needs of frail elderly individuals. Its architecture was designed for use at rehabilitation centers and at patients' homes. The system is user-friendly and comfortably usable by persons who are not familiar with technology. In addition, exergames enhance patient engagement in order to curb therapy abandonment. Along with the technical presentation of the solution, a real-life scenario application is described referring to sit-to-stand activity.

Trueland, J. (2008). "All I want for Christmas." Physiotherapy Frontline 14(21): 23-26.
	Across the country, young and old alike are happy for physios to prescribe Wiihab, finds Jennifer Trueland.

Trupiano, T. P., et al. (1997). "Fracture of the first cervical vertebra in a high school football player: a case report." J Athl Train 32(2): 159-162.
	OBJECTIVE: To present the case of a high school football player with a burst fracture of the ring of C1 resulting from a "spearing" tackle. BACKGROUND: Cervical spine fractures are rare in collision sports, but their potentially grave consequences mean that they must be given special attention. Spearing was banned by the National Collegiate Athletic Association and the National Federation of High School Athletic Associations in 1976, and the number of cervical spine fractures in high school and college football players has fallen dramatically. However, cervical spine fractures do still occur, and they present a diagnostic challenge to sports medicine professionals. DIFFERENTIAL DIAGNOSIS: Cervical sprain. TREATMENT: Treatment consists of halo-vest immobilization. Surgical fusion may be necessary for unstable C1-C2 fractures, although initial halo-vest treatment is usually attempted. UNIQUENESS: A 17-year-old defensive back attempted to make a tackle with his head lowered. He was struck on the superolateral aspect of the helmet by the opposing running back. He remained in the game for another play, but then left the field under his own power, complaining of neck stiffness and headache. Physical examination revealed upper trapezius and occiput tenderness, bilateral cervical muscle spasm, and pain at all extremes of voluntary cervical movement. He was alert and oriented, with a normal neurologic examination. Treatment with ice was attempted but was discontinued due to increased pain and stiffness. Heat resulted in decreased pain and stiffness, but his symptoms persisted, and he was trans- ported to the emergency room. Plain radiographs were read as negative, but a CT scan demonstrated a burst fracture of Cl. He was treated with halo-vest immobilization for 8 weeks and a rigid cervical collar for 8 additional weeks. Physical therapy was then initiated, and normal cervical range of motion and strength were restored within 6 weeks. The athlete competed in track 6 months after the injury and continues to play recreational sports without difficulty. At clinical follow-up 8 months after injury, he had full, painless cervical range of motion and a normal neurologic examination. CONCLUSIONS: A potentially devastating cervical spine injury can present insidiously, without dramatic signs or symptoms. Therefore, sports medicine professionals must retain a high index of suspicion when evaluating athletes with cervical spine complaints.

Tsang, W. W. N., et al. (2015). "Is virtual reality exercise effective in reducing falls among older adults with a history of falls?" Physiotherapy 101: e1539-e1540.
	Background: Falls have been identified as one of the major causes of morbidity and mortality in the older adults. Virtual reality (VR) technologies have been used as an assessment and treatment tool in rehabilitation. Purpose: This single‐blinded randomized controlled clinical trial was to determine the effectiveness of VR exercise in reducing falls risk and incidence among the older adults with a history of falls using Nintendo's Wii Fitalpha balance board. Methods: Sixty older subjects aged 65 and above who lived in a nursing home participated this study. They were randomly allocated to balance training with either Wii Fit equipment or conventional exercise. The exercise was organized in one hour session which was held on three days a week for six weeks. Physiological Profile Assessment (PPA) scores and incidence of falls were observed with subsequent intent‐to‐treat statistical analyses. Results: Independent t‐tests showed that there was no statistically significant difference in the average pre‐test PPA values and numbers of falls over previous one year between the two groups. Two‐way repeated measures of ANOVA did, however, show significant interactions in the PPA z‐scores and falls incidence. Within both the Wii Fit and conventional training groups, paired t‐tests showed that there were significant differences in their PPA z‐scores and falls incidence before and after the respective interventions. However, independent t‐tests showed that there were statistically significant differences in the post‐test PPA z‐scores and number of falls between the two groups. The subjects of the Wii Fit training group showed significantly greater improvement in both outcome measures. Conclusion(s): Wii Fit balance training was more effective than conventional balance training in reducing falls risk and incidence among these institutionalized older persons with a history of falls. Implications: The virtual reality exercise in the form of action‐video games can be a choice of falls prevention program for older adults with a history of falls.

Tubez, F., et al. (2015). "Biomechanical analysis of abdominal injury in tennis serves. A case report." Journal of Sports Science & Medicine 14(2): 402-412.
	The serve is an important stroke in any high level tennis game. A well-mastered serve is a substantial advantage for players. However, because of its repeatability and its intensity, this stroke is potentially deleterious for upper limbs, lower limbs and trunk. The trunk is a vital link in the production and transfer of energy from the lower limbs to the upper limbs; therefore, kinematic disorder could be a potential source of risk for trunk injury in tennis. This research studies the case of a professional tennis player who has suffered from a medical tear on the left rectus abdominis muscle after tennis serve. The goal of the study is to understand whether the injury could be explained by an inappropriate technique. For this purpose, we analyzed in three dimensions the kinematic and kinetic aspects of the serve. We also performed isokinetic tests of the player's knees. We then compared the player to five other professional players as reference. We observed a possible deficit of energy transfer because of an important anterior pelvis tilt. Some compensation made by the player during the serve could be a possible higher abdominal contraction and a larger shoulder external rotation. These particularities could induce an abdominal overwork that could explain the first injury and may provoke further injuries. Key pointsIn the proximal-distal sequence, energy is transmitted from lower limbs to upper limps via trunk.The 3D analysis tool is an indispensable test for an objective evaluation of the kinematic in the tennis serve.Multiple evaluations techniques are useful for fuller comprehension of the kinematics and contribute to the awareness of the player's staff concerning pathologies and performance.

Tyler, T. F. (2003). "In the game. Moving forward: helping patients reach milestones through the phases of shoulder rehab...second in a two-part series." Advance for Directors in Rehabilitation 12(2): 31-34.
	
Ucgun, H., et al. (2022). "Video game-based exercise in children and adolescents with non-cystic fibrosis bronchiectasis: A randomized comparative study of aerobic and breathing exercises." Pediatric Pulmonology.
	BACKGROUND: Video game-based systems have been proposed to improve effectiveness and compliance with exercise training in children and adolescents with noncystic fibrosis bronchiectasis (NCFB). This study aimed to investigate the effects of aerobic and breathing video game-based exercises (VGE) on pulmonary function, respiratory and peripheral muscle strength, functional capacity, and balance in children and adolescents with NCFB. METHOD: Thirty-nine children and adolescents aged between 8 and 18 years with NCFB were randomly allocated into three groups as "home-based chest physiotherapy group" (CP), "aerobic VGE given in addition to home-based chest physiotherapy group" (CP + aerobic VGE), and "breathing VGE given in addition to home-based chest physiotherapy group" (CP + breathing VGE). All three groups performed chest physiotherapy program twice a day for 7 days per week for 8 weeks. Pulmonary function, respiratory and peripheral muscle strength, functional capacity, and balance were assessed at baseline and after 8 weeks of training. RESULTS: The improvement in maximum expiratory pressure and balance scores were significantly higher in both CP + aerobic and CP + breathing VGE groups. The significant improvement in maximum inspiratory pressure was greater in the CP + breathing VGE group. The changes in peripheral muscle strength and functional capacity were significantly higher in the CP + aerobic VGE group. CONCLUSIONS: The present study showed that aerobic VGE provides additional benefits in improving peripheral muscle strength and functional capacity, while breathing VGE provides further increase in improving respiratory muscle strength. In addition, both aerobic and breathing VGE were effective in improving balance, but they were not superior to each other.

Unes, S., et al. (2021). "Effectiveness of Physical Therapy on Ataxia-Telangiectasia: A Case Report." Pediatr Phys Ther 33(3): E103-E107.
	BACKGROUND AND PURPOSE: This case report investigated the benefits of a 12-week physical therapy program for a child with ataxia-telangiectasia (AT). CASE DESCRIPTION: A 9-year-old girl with a diagnosis of AT participated. The physical therapy program consisted of balance and strength exercise and Wii Fit Balance-based video games training with a pediatric physical therapist for 12 weeks. MEASUREMENTS: The motor performance, Gross Motor Function Measurement (GMFM), Pediatric Berg Balance Scale (PBBS), Trunk Control Measurement Scale (TCMS), participation as measured by the Life Habits Questionnaire (LIFE-H), and the Pediatric Quality of Life Inventory (PedsQL). OUTCOMES: Positive changes were observed in the TCMS, PBBS, GMFM, and motor performance, participation, and quality of life. CONCLUSIONS: Notable improvements were observed in both body structure and function, and activities and participation level. WHAT THIS ADDS TO EVIDENCE: This case report is the first to support the effectiveness of physical therapy in a child with AT.

Ushotanefe, U., et al. (2000). "Physiotherapy utilisation by sports physicians for musculoskeletal injuries in selected elite sports in Nigeria." South African Journal of Physiotherapy 56(3): 19-23.
	In Nigeria, the majority of injured athletes seen in sports physiotherapy units are referred by sports physicians. The extent to which a physician utilises the services of physiotherapy in sport depends largely on the level of awareness or knowledge of physiotherapy services that such physicians have. This survey evaluated the degree of utilisation of physiotherapy services for the treatment of injuries during preparation for multi-sports events by sports physicians in selected elite sporting events in Nigeria.One hundred and twenty-eight athletes, coaches, sports administrators, scientists, medical doctors and physiotherapists located at four different camping sites, were sampled. The responses between different professional groups on the non-utilisation of physiotherapy services by sports physicians during preparation for multi-sport events, was not significant. However, Nigerian professionals who were surveyed, accepted the hypothesis that sports physicians did not utilize physiotherapy services for the management of musculoskeletal injuries during training and pre-games preparation in selected elite sports in Nigeria.This retrospective study of the actual referral records at the clinic of the sports medicine centre revealed that 20 (97%) different types of musculoskeletal injuries sustained by volley ball players were referred for physiotherapy. Nine (56.3%) injuries sustained by basketball players, 62 (87.3%) by track and field athletes, and 6 (74%) by football players were referred for physiotherapy between 1992 and 1995. The majority of the injuries sustained were ligamentous sprain and muscular strain with joints of the lower limbs and the back mostly affected.

Ustinova, K. I., et al. (2011). "Development of a 3D immersive videogame to improve arm-postural coordination in patients with TBI." J Neuroeng Rehabil 8(1): 61.
	BACKGROUND: Traumatic brain injury (TBI) disrupts the central and executive mechanisms of arm(s) and postural (trunk and legs) coordination. To address these issues, we developed a 3D immersive videogame--Octopus. The game was developed using the basic principles of videogame design and previous experience of using videogames for rehabilitation of patients with acquired brain injuries. Unlike many other custom-designed virtual environments, Octopus included an actual gaming component with a system of multiple rewards, making the game challenging, competitive, motivating and fun. Effect of a short-term practice with the Octopus game on arm-postural coordination in patients with TBI was tested. METHODS: The game was developed using WorldViz Vizard software, integrated with the Qualysis system for motion analysis. Avatars of the participant's hands precisely reproducing the real-time kinematic patterns were synchronized with the simulated environment, presented in the first person 3D view on an 82-inch DLP screen. 13 individuals with mild-to-moderate manifestations of TBI participated in the study. While standing in front of the screen, the participants interacted with a computer-generated environment by popping bubbles blown by the Octopus. The bubbles followed a specific trajectory. Interception of the bubbles with the left or right hand avatar allowed flexible use of the postural segments for balance maintenance and arm transport. All participants practiced ten 90-s gaming trials during a single session, followed by a retention test. Arm-postural coordination was analysed using principal component analysis. RESULTS: As a result of the short-term practice, the participants improved in game performance, arm movement time, and precision. Improvements were achieved mostly by adapting efficient arm-postural coordination strategies. Of the 13 participants, 10 showed an immediate increase in arm forward reach and single-leg stance time. CONCLUSION: These results support the feasibility of using the custom-made 3D game for retraining of arm-postural coordination disrupted as a result of TBI.

Ustinova, K. I. P. P. (2017). "Decomposition of postural movements in individuals with mild TBI while reaching to intercept a moving virtual target." Physiother Theory Pract 33(7): 527-534.
	The study analyzed postural and arm movement coordinations in patients with traumatic brain injury (TBI) while standing and reaching for a target moving in a 3D virtual environment. Thirteen individuals with mild TBI and 13 height, sex, and age-matched healthy control individuals were involved. While standing in front of the screen, the participants interacted with the projected environment by reaching for virtual targets. Coordination was analyzed as the percentage of reach-to-intercept cycle time during which their movement toward the target was decomposed with 0% indicating simultaneous motion in three planes or 100% indicating motion in one or two planes only. Decomposition was calculated for the postural movements (DIp), arm movements (DIa), and arm-postural coordination (DIa-p). The latter index represented the percentage of reach-to-intercept cycle time during which either the posture or arm moved alone. DIp and DIa-p were larger in the TBI group compared to the control group (p < 0.01). In the TBI group, DIp and DIa-p correlated negatively with postural stability (r = - 0.71 and r = - 0.60; p < 0.01). Results suggest that individuals with TBI decompose postural and arm-postural coordinations during a reach-to-intercept task. This may be either a result of impaired postural control or an effort to compensate for instability. These abnormalities should be taken into consideration while planning physical therapy programs for individuals after brain injury.

Valenzuela-Pascual, F., et al. (2022). "Use of a gamified website to increase pain neurophysiology knowledge and improve satisfaction and motivation among students studying for a degree in physiotherapy: a quasi-experimental study." BMC Medical Education 22(1): 389.
	BACKGROUND: The scientific evidence highlights the difficulties that healthcare professionals experience when managing patients with chronic pain. One of the causes of this difficulty could be related to the acquired training and the lack of knowledge about the neurophysiology of pain. In the present study, we assessed the effectiveness of a gamified web platform in acquiring knowledge about pain neurophysiology and determining the satisfaction and motivation of students of the Degree in Physiotherapy at the University of Lleida. METHODS: A quasi-experimental study was carried out with a sample of 60 students who had access to a gamified web platform that included notes, videos, and clinical cases prepared by the teaching staff and was based on a previous study that included patients and healthcare professionals. RESULTS: The results show that after the intervention, there was a statistically significant increase in knowledge about the neurophysiology of pain, and the effect size was in the desired area of effect. Likewise, many students considered that their motivation had increased as a result of the methodology used in the present study. CONCLUSIONS: The results support the use of this methodology to promote knowledge about the neurophysiology of pain while improving students' motivation.

Valeriani, F., et al. (2021). "Exergames in Childhood Obesity Treatment: A Systematic Review." International Journal of Environmental Research & Public Health [Electronic Resource] 18(9): 4938.
	In the last decade, active video games (exergames) have been proposed in obesity prevention and treatment as a potential tool to increase physical activity. This review was aimed to assess the possible role of exergames in reducing weight-related outcomes among overweight/obese children and/or adolescents. The databases PubMed, Scopus, Web of Science and SPORTDiscus were interrogated to detect controlled studies involving healthy overweight/obese children and adolescents in interventions based exclusively on exergames. Out of a total of 648 articles found, 10 met the inclusion criteria and were included in the review. The included studies differ for duration, setting and type of intervention, frequency of active game sessions, and outcomes considered. Seven out of ten studies reported better outcomes in children/adolescents involved in the interventions, with significant differences between groups in four, while three studies found better outcomes in control groups. These results suggest a possible positive effect of active video games on weight-related outcomes in obese children and adolescents. However, further research is still needed to define if they can be effectively used in childhood obesity treatment and which may be the most effective approach. The potentiality of the new digital media in this field should be explored.

Vallejo, D., et al. (2020). "Personalized Exergames Language: A Novel Approach to the Automatic Generation of Personalized Exergames for Stroke Patients." Applied Sciences 10(20): 7378.
	Physical rehabilitation of stroke patients is based on the daily execution of exercises with face-to-face supervision by therapists. This model cannot be sustained in the long term, due to the involved economic costs, the growing number of patients, and the aging population. Remote rehabilitation tools have emerged to address this unmet clinical need, but they face the double challenge of motivating patients and ensuring an effective remote rehabilitation. In this context, exergames allow patients to play while performing repetitive therapeutic tasks in a safe and ecological environment. This work proposes the design of Personalized Exergames Language (PEL), a language whose sentences can be processed via software in order to automatically generate exergames. The definition of exergames through PEL, guided by an effective methodology of the design and generation of personalized exergames, will include both game mechanics and the necessary metrics to monitor, guide, and adapt the rehabilitation of each patient. The integration of authoring tools are considered to visually guide the therapist when designing exergames. A study has been carried out with stroke patients and therapists from a hospital and two community centers, in order to evaluate several exergames, automatically generated using PEL, in terms of usability, understanding, and suitability.

van Beek, J. J. W., et al. (2019). "Exergaming-Based Dexterity Training in Persons With Parkinson Disease: A Pilot Feasibility Study." Journal of Neurologic Physical Therapy 43(3): 168-174.
	BACKGROUND AND PURPOSE: Many individuals with Parkinson disease (PD) suffer from impaired dexterity, which impacts activities of daily living and quality of life. Exergaming, video game-based training with augmented virtual reality, may have value for improving function. The aim of the present pilot study was to comprehensively evaluate the feasibility of a dexterity training program using exergaming, in individuals with PD. METHODS: Ten participants with PD (aged between 55 and 75 years, Hoehn and Yahr stages II-IV) trained over a period of 4 weeks, twice a week for 30 minutes. Baseline (T0) and postintervention (T1) assessments were done. Primary outcomes with respect to feasibility were the adherence rate, open-end questions, the level of participation (Pittsburgh Rehabilitation Participation Scale), and the usability (System Usability Scale). Dexterous function was measured with the Nine-Hole Peg Test and the Dexterity Questionnaire-24. Upper limb motor impairment was assessed by a modified version of the Movement Disorders Society Unified Parkinson's Disease Rating Scale III. Finally, quality of life was assessed by the 39-item Parkinson's Disease Questionnaire (PDQ-39). RESULTS: Adherence rate was 99%, motivation increased significantly from 3.9 to 4.8 (Pittsburgh Rehabilitation Participation Scale, P = 0.03), and system usability of the exergaming system was acceptable to very good. Regarding potential efficacy, participants with impaired dexterity at T0 significantly improved in the Nine-Hole Peg Test and the PDQ-39. DISCUSSIONS AND CONCLUSIONS: The outcomes of this pilot study suggest that exergaming is feasible and has potential to improve dexterity in individuals with PD. Its efficacy should be investigated in a properly powered randomized controlled trial.Video Abstract available for more insights from the authors (see Supplemental Digital Content 1, available at: http://links.lww.com/JNPT/A270).

Van de Weijer, S. C. F., et al. (2018). "Promising non-pharmacological therapies in PD: Targeting late stage disease and the role of computer based cognitive training." Parkinsonism & Related Disorders 46 Suppl 1: S42-S46.
	Non-pharmacological interventions are increasingly being acknowledged as valuable treatment options to overcome or reduce functional problems in patients with Parkinson's disease (PD). There is a wide range of such non-pharmacological treatments for which the supportive evidence is emerging. Physiotherapy is one good example in this domain. However, there are also several promising non-pharmacological treatment strategies that have thus far received less research attention. Here, we describe two relatively new, but encouraging approaches. First, we focus on a hitherto largely overseen subgroup of PD, namely those with late-stage disease, a population that is often excluded from clinical studies. Importantly, the aims and therapeutic strategies in late-stage PD differ considerably from those in early-stage PD, and an emphasis on non-pharmacological management is particularly important for this vulnerable subgroup. Second, we focus on computer-based cognitive training, as an example of a relatively new intervention that includes innovative elements such as personalized training, artificial intelligence, and virtual reality. We review the latest evidence, practical considerations and future research perspectives, both for non-pharmacological approaches in late-stage PD and for computer-based cognitive training.

van den Heuvel, M. R., et al. (2014). "Effects of augmented visual feedback during balance training in Parkinson's disease: a pilot randomized clinical trial." Parkinsonism & Related Disorders 20(12): 1352-1358.
	BACKGROUND: Balance training has been demonstrated to improve postural control in patients with Parkinson's disease (PD). The objective of this pilot randomized clinical trial was to investigate whether a balance training program using augmented visual feedback is feasible, safe, and more effective than conventional balance training in improving postural control in patients with PD. METHODS: Thirty-three patients with idiopathic PD participated in a five-week training program consisting of ten group treatment sessions of 60 min. Participants were randomly allocated to (1) an experimental group who trained on workstations consisting of interactive balance games with explicit augmented visual feedback (VFT), or (2) a control group receiving conventional training. Standing balance, gait, and health status were assessed at entry, at six weeks, and at twelve weeks follow-up. RESULTS: Sixteen patients were allocated to the control group and seventeen to the experimental group. The program was feasible to apply and took place without adverse events. Change scores for all balance measures favored VFT, but the change in the primary outcome measure, i.e. the Functional Reach test, did not differ between groups (t(28) = -0.116, p = .908). No other differences between groups were statistically significant. CONCLUSIONS: VFT proved to be a feasible and safe approach to balance therapy for patients with PD. In this proof-of-concept study VFT was not superior over conventional balance training although observed trends mostly favored VFT. These trends approached clinical relevance only in few cases: increasing the training load and further optimization of VFT may strengthen this effect. TRIAL REGISTRATION: Controlled Trials, ISRCTN47046299.

van den Heuvel, M. R., et al. (2013). "The effects of augmented visual feedback during balance training in Parkinson's disease: study design of a randomized clinical trial." BMC Neurology 13(1): 137.
	BACKGROUND: Patients with Parkinson's disease often suffer from reduced mobility due to impaired postural control. Balance exercises form an integral part of rehabilitative therapy but the effectiveness of existing interventions is limited. Recent technological advances allow for providing enhanced visual feedback in the context of computer games, which provide an attractive alternative to conventional therapy. The objective of this randomized clinical trial is to investigate whether a training program capitalizing on virtual-reality-based visual feedback is more effective than an equally-dosed conventional training in improving standing balance performance in patients with Parkinson's disease. METHODS/DESIGN: Patients with idiopathic Parkinson's disease will participate in a five-week balance training program comprising ten treatment sessions of 60 minutes each. Participants will be randomly allocated to (1) an experimental group that will receive balance training using augmented visual feedback, or (2) a control group that will receive balance training in accordance with current physical therapy guidelines for Parkinson's disease patients. Training sessions consist of task-specific exercises that are organized as a series of workstations. Assessments will take place before training, at six weeks, and at twelve weeks follow-up. The functional reach test will serve as the primary outcome measure supplemented by comprehensive assessments of functional balance, posturography, and electroencephalography. DISCUSSION: We hypothesize that balance training based on visual feedback will show greater improvements on standing balance performance than conventional balance training. In addition, we expect that learning new control strategies will be visible in the co-registered posturographic recordings but also through changes in functional connectivity.

van Diest, M., et al. (2015). "Quantifying Postural Control during Exergaming Using Multivariate Whole-Body Movement Data: A Self-Organizing Maps Approach." PLoS ONE [Electronic Resource] 10(7): e0134350.
	BACKGROUND: Exergames are becoming an increasingly popular tool for training balance ability, thereby preventing falls in older adults. Automatic, real time, assessment of the user's balance control offers opportunities in terms of providing targeted feedback and dynamically adjusting the gameplay to the individual user, yet algorithms for quantification of balance control remain to be developed. The aim of the present study was to identify movement patterns, and variability therein, of young and older adults playing a custom-made weight-shifting (ice-skating) exergame. METHODS: Twenty older adults and twenty young adults played a weight-shifting exergame under five conditions of varying complexity, while multi-segmental whole-body movement data were captured using Kinect. Movement coordination patterns expressed during gameplay were identified using Self Organizing Maps (SOM), an artificial neural network, and variability in these patterns was quantified by computing Total Trajectory Variability (TTvar). Additionally a k Nearest Neighbor (kNN) classifier was trained to discriminate between young and older adults based on the SOM features. RESULTS: Results showed that TTvar was significantly higher in older adults than in young adults, when playing the exergame under complex task conditions. The kNN classifier showed a classification accuracy of 65.8%. CONCLUSIONS: Older adults display more variable sway behavior than young adults, when playing the exergame under complex task conditions. The SOM features characterizing movement patterns expressed during exergaming allow for discriminating between young and older adults with limited accuracy. Our findings contribute to the development of algorithms for quantification of balance ability during home-based exergaming for balance training.

Van Sant, A. F. (2013). "Backpacks, computer games, and triple burgers with cheese revisited." Pediatr Phys Ther 25(1): 1.
	
van Santen, J., et al. (2019). "The (cost-) effectiveness of exergaming in people living with dementia and their informal caregivers: protocol for a randomized controlled trial." BMC Geriatrics 19(1): 50.
	BACKGROUND: Physical activity is linked to benefits such as increased physical fitness, cognition, emotional and social functioning, general health and well-being in older people. Some evidence suggests that this also applies to people living with dementia. However, it can be harder for them to perform physical activities, due to several barriers, such as issues with orientation and balance problems. A relatively new type of physical activity called exergaming may help them overcome these barriers. Exergaming is "physical exercise interactively combined with cognitive stimulation in a gaming environment". The aim of our study is to evaluate the effectiveness and cost-effectiveness of exergaming compared to regular activities in people living with dementia, who attend day-care centres. Additionally, we want to investigate whether the exergaming activity for the person living with dementia, also (indirectly) affects the informal caregiver, as well as which facilitators and barriers to implementation of exergames for this target group exist. METHODS: A cluster Randomized Controlled Trial (RCT), with economic and process evaluations alongside will be carried out. In the Netherlands, 24 day-care centres are randomized in the experimental or control group. The study group will consist of 224 dyads (community-dwelling participants with dementia and their informal caregivers), who are interviewed at baseline, and at 3 and 6 months of follow-up. The participant with dementia has to visit the day-care centre for at least two days per week, have a diagnosis of mild to moderate dementia and have an informal caregiver present, who is willing to participate. Societal cost data will be collected during interviews, using healthcare utilization diaries, and from day-care centres. The process evaluation will only involve the experimental group, and will include an online survey, qualitative interviews and focus groups. DISCUSSION: This study will contribute to the evidence base that more effective exercise among people with dementia will result in positive effects on their wellbeing and quality of life. This will motivate people with dementia to be physically active. We also envision that there might be a positive effect on the burden of care experienced by their informal caregivers. TRIAL REGISTRATION: This trial was registered at the Netherlands Trial Register (NTR) on December 10, 2015 (number: NTR5537 ), this publication is based on protocol amendment number 01, issue date 28 December 2018. This includes all items from the World Health Organization Trial Registration Data Set [see Additional file 1].

van Santen, J., et al. (2018). "Effects of Exergaming in People with Dementia: Results of a Systematic Literature Review." Journal of Alzheimer's Disease 63(2): 741-760.
	BACKGROUND: Physical exercise benefits functioning, health, and well-being. However, people living with dementia in particular hardly engage in exercise. Exergaming (exercise and gaming) is an innovative, fun, and relatively safe way of exercising in a virtual reality or gaming environment. It may help people living with dementia overcome barriers they can experience regarding regular exercise activities. OBJECTIVE: This systematic literature review aims to provide an overview of the cost-effectiveness of exergaming and its effects on physical, cognitive, emotional, and social functioning, as well as the quality of life in people living with dementia. METHODS: PubMed, Embase, Cinahl, PsycINFO, the Cochrane Library, and the Web of Science Core Collection were searched. Selection of studies was carried out by at least two independent researchers. RESULTS: Three studies were found to be eligible and were included in this review. Two of these showed some statistically significant effects of exergaming on physical, cognitive, and emotional functioning in people living with dementia, although based on a very small sample. No articles were found about the cost-effectiveness of exergaming. CONCLUSIONS: Only a few controlled studies have been conducted into the effectiveness of exergaming, and these show very little significant benefits. More well-designed studies are necessary to examine the effects of exergaming.

van Santen, J., et al. (2020). "Effects of Exergaming on Cognitive and Social Functioning of People with Dementia: A Randomized Controlled Trial." Journal of the American Medical Directors Association 21(12): 1958-1967 e1955.
	OBJECTIVES: Physical activity in people with dementia (PwD) may enhance physical and mental functioning. Exergaming, which combines physical exercise with cognitive stimulation in a gaming environment, was developed to overcome barriers in performing physical activities. We evaluated the effects of exergaming in day care centers (DCCs) for PwD and informal caregivers (ICs). DESIGN: A randomized controlled trial among 23 DCCs across the Netherlands randomized to exergaming (interactive cycling during 6 months) or a care-as-usual control group. SETTING AND PARTICIPANTS: A total of 112 (73 exergaming, 39 control) community-dwelling dyads (PwD, IC), with the PwD visiting a DCC at least twice per week. METHODS: All outcomes were assessed using structured questionnaires during interviews with PwD and ICs at baseline (T0), 3 months (T1), and 6 months (T2). Primary outcomes: physical activity and mobility of the PwD. SECONDARY OUTCOMES: physical, cognitive, emotional and social functioning, and quality of life for PwD. For ICs: experienced burden, quality of life, and positive care experiences. RESULTS: Mixed-model analyses showed no statistically significant effects on primary outcomes. There were statistically significant positive effects on PwD's secondary outcomes at T2 on cognition [Mini-Mental State Examination (MMSE): r = 2.30, 95% confidence interval (CI): 0.65, 3.96, P = .007; and Trail Making Test part A (TMT-A): r = -28.98, 95% CI: -54.89, -3.08, P = .029], social functioning (Behavior Observation Scale for Intramural Psychogeriatrics subscale 1 (GIP): r = -1.86, 95% CI: -3.56, -0.17, P = .031), and positive post-test effects in ICs on distress caused by the PwD's neuropsychiatric symptoms (NPI-Q total distress: r = -3.30, 95% CI: -6.57, -0.03, P = .048) and on sense of competence (SSCQ: r = 2.78, 95% CI: 0.85, 4.71, P = .005). CONCLUSIONS AND IMPLICATIONS: Exergaming appeared not effective on the primary outcomes. Despite the study being underpowered, we found positive effects on secondary outcomes for PwD and ICs, and no negative effects. We therefore recommend further study, dissemination, and implementation.

Van Schaik, P., et al. (2008). "Virtual augmented exercise gaming for older adults." Cyberpsychology & Behavior 11(1): 103-106.
	This paper details the design, development, and testing of virtual augmented exercise (VAE) gaming for older adults. Three versions of an underwater VAE environment were tested with a sample of 22 healthy adults aged 50 or over. Participants strongly preferred VAE to traditional physical exercise, and adherence rate was 100%. The findings suggest that VAE with puzzles changes or negates the expected negative associations among exercise outcomes. Fitness level was not associated with performance in the game, irrespective of VAE type, indicating that persons who are less physically fit can expect to perform similarly to those who are more physically fit. In conclusion, the research found some evidence for the benefits of VAE with cognitive exercise (solving simple puzzles and hitting targets based on the answer). This type of exercise appears to be a promising method of exercise for older adults.

Vandoni, M., et al. (2021). "Combatting Sedentary Behaviors by Delivering Remote Physical Exercise in Children and Adolescents with Obesity in the COVID-19 Era: A Narrative Review." Nutrients 13(12): 4459.
	The coexistence of childhood obesity (or its risk) and COVID-19 pandemic put children and adolescents in greater risk to develop respiratory and cardiovascular diseases. In fact, the restrictions introduced to limit the spread of the virus had detrimental effects on various lifestyle components, especially in young population. This resulted in augmented levels of physical inactivity and sedentary behaviors and a reduced time spent in play outdoors or sport practices. Contrariwise, the increased use of technology led clinicians, teachers, and trainers to maintain relations with obese children/adolescents so as to reduce sedentary behaviors and the associated health risks. This narrative review aims to describe the role of Telehealth and Tele-exercise as useful tools in the management of pediatric obesity during COVID-19 pandemic. Telehealth and Tele-exercise were effective in promoting self-monitoring and behavioral changes, including adherence to exercise training programs in children and adolescents. Moreover, tele-exercise platforms such as applications or exergames allowed flexible scheduling, limiting the infection risks.

Vansant, A. F. (2002). "Backpacks, computer games, and triple burgers with cheese." Pediatr Phys Ther 14(3): 121.
	
Vazquez, F. L., et al. (2018). "Efficacy of video game-based interventions for active aging. A systematic literature review and meta-analysis." PLoS ONE [Electronic Resource] 13(12): e0208192.
	BACKGROUND: Due to the appeal and recent technological advances of video games, the games have gained interest as an intervention tool for active aging. The aim of this systematic literature review and meta-analysis was to determine the efficacy of video games for active aging and to examine the influence of potential moderator variables. METHODS: A systematic search was done using the following databases: Medline, PsycINFO, EMBASE, CINAHL and the Cochrane Central Register of Controlled Trials. In addition, previous reviews and meta-analyses were used to identify randomized controlled trials (RCT) of video game-based interventions for active aging published through February 28, 2018. An evaluation of the methodological quality of the articles and a meta-analysis and moderator analysis was conducted. RESULTS: A total of 22 articles depicting 21 RCT with 1125 participants were included. The results indicated that video game-based interventions produced positive effects on objectively measured physical health, negative affect and social health, with small effect sizes (d = 0.41, d = 0.26 and d = 0.40, respectively). The magnitude of this effect was moderated by the presence of subclinical conditions of participants, the type of game (exergames), the presence of physical activity, the type of prevention (indicated), non-blinded assignation, and older age of participants. The methodological quality of the studies was acceptable, the weakest area being external validity. CONCLUSION: These finding indicate that video game-based interventions may assist adults in leading active aging processes and preventing secondary aging. Although more research is needed, video game-based interventions are a promising and accessible tool for active aging promotion.

Vega-Ramirez, F. A., et al. (2017). "Analysis of home-based rehabilitation in patients with motor impairment in primary care: a prospective observational study." BMC Geriatrics 17(1): 145.
	BACKGROUND: The purpose of health and social policies is to encourage older people more longevity, remain free of disability and experience quality of life while living in their homes. The aim of this study was to describe the characteristics of 473 patients diagnosed with motor impairment in primary care, the objectives of home-based rehabilitation and its functional impact. METHODS: This prospective observational study was conducted in the Almeria Health District. The analysed variables included age, gender, secondary diagnosis, Barthel Index (BI), physiotherapeutic objectives and techniques, and number of sessions. RESULTS: The sample had a mean age of 83 years, and 59% were women. The assessed conditions with a high prevalence included osteoarticular pathology (55%), Alzheimer's disease (15.1%), cardiovascular disease (13.7%) and stroke (6.5%). The techniques applied mainly consisted of functional exercises (57.1%), caregiver education (13.8%), and technical assistance (5.7%). There were statistically significant differences (t = -15.79; p < 0.001) between initial (X = 34.8) and final BI (X = 48.1), with an improvement of 13.4 points in patients' functional capacity (95% confidence interval [CI]: -15.0 to -11.7). An equation was constructed to predict patients' final BI as a function of the initial BI using a multiple linear regression model. The regression model explained 78% of the variance in patients with motor impairment. CONCLUSIONS: Important improvements were obtained in terms of functional capacity with a mean of ten sessions of physiotherapy. Lower patient age was correlated with higher initial and final functional capacities in primary care. This study aimed to present a useful starting point for decision making among management and health administration regarding this population group by approaching the process from the reality of practice and in relation to the rehabilitation provided. TRIAL REGISTRATION: ClinicalTrials.gov identifier: NCT02715245 ; Date of registration: 18 January 2016.

Velasco, M. A., et al. (2017). "Evaluation of cervical posture improvement of children with cerebral palsy after physical therapy based on head movements and serious games." Biomed Eng Online 16(Suppl 1): 74.
	BACKGROUND: This paper presents the preliminary results of a novel rehabilitation therapy for cervical and trunk control of children with cerebral palsy (CP) based on serious videogames and physical exercise. MATERIALS: The therapy is based on the use of the ENLAZA Interface, a head mouse based on inertial technology that will be used to control a set of serious videogames with movements of the head. METHODS: Ten users with CP participated in the study. Whereas the control group (n = 5) followed traditional therapies, the experimental group (n = 5) complemented these therapies with a series of ten sessions of gaming with ENLAZA to exercise cervical flexion-extensions, rotations and inclinations in a controlled, engaging environment. RESULTS: The ten work sessions yielded improvements in head and trunk control that were higher in the experimental group for Visual Analogue Scale, Goal Attainment Scaling and Trunk Control Measurement Scale (TCMS). Significant differences (27% vs. 2% of percentage improvement) were found between the experimental and control groups for TCMS (p < 0.05). The kinematic assessment shows that there were some improvements in the active and the passive range of motion. However, no significant differences were found pre- and post-intervention. CONCLUSIONS: Physical therapy that combines serious games with traditional rehabilitation could allow children with CP to achieve larger function improvements in the trunk and cervical regions. However, given the limited scope of this trial (n = 10) additional studies are needed to corroborate this hypothesis.

Vepsäläinen, H., et al. (2020). "Developing a mobile application to increase pre-schoolers’ vegetable acceptance and self-regulation skills – The ‘Mole Minds Veggies’ game." Proceedings of the Nutrition Society 79(OCE2).
	Introduction: Many pre‐schoolers in Finland eat too little vegetables, fruits and berries. Compared to fruits, vegetables are in general less well accepted. Since most of the Finnish 4‐6‐year‐olds attend pre‐schools, they are an ideal setting for promoting vegetable consumption. However, early educators in the pre‐schools need engaging methods for food education. The aim of this project is to develop a mobile application that can be used in pre‐schools to improve vegetable acceptance among pre‐schoolers. An additional aim of the application is to increase self‐regulation skills, i.e., we aimed to build the application in a way that, instead of immediate reward and impulsivity encourages self‐regulation and delayed gratification. Materials and methods: We organized workshops in three pre‐schools in order to collect ideas and experiences from pre‐schoolers and early childhood professionals. Based on the workshops, a Finnish educational game company NordicEdu designed the first version of the prototype. A multi‐professional team with expertise in early childhood education and pre‐schoolers' health behaviours commented the prototype, which was then updated and uploaded to application stores. The prototype consisted of two sections: a teacher‐led 'Learn' section that encourages a group of children to share their knowledge and feelings about vegetables and fruits with each other and mini‐games as well as physical exercises that can be played in a group. The application also allows the group to record which vegetables they have tasted. The feasibility of the prototype was tested in the three pre‐schools. We collected feedback from the early childhood professionals and children with video‐recordings and interviews. Results: Based on the feasibility tests, the children enjoyed using the application and they also gave positive feedback about the visual identity of the application. However, the early childhood professionals thought that the application could be a bit more challenging. Additional contents as well as tasks requiring more self‐regulation and patience were also hoped for. Discussion: In 2019, the prototype will be further developed into a full demo. Additional vegetables will be added to the 'Learn' sections and organized into seasons. The application will be accompanied by a teacher's guide containing more information about the vegetables and fruits. The full demo will be completed in spring 2019 and translated into English and Polish. The effectiveness of the application to increase the acceptability of vegetables will be tested in a randomized intervention in pre‐schools in Finland, Poland and the UK.

Vercelli, A. and I. Rainero (2019). "My-AHA, an ICT platform to detect frailty risk and propose personalized intervention." Systems medicine 2(1): A32‐A33.
	Stemming from a holistic view of interrelated frailties, cognitive decline, physical frailty, depression and anxiety, social isolation and poor sleep quality, My‐AHA proposes an ICT platform for early detection of pre‐frailty and intervention to sustain active and healthy aging and slowing or reversing further decline. The main aim of My‐AHA is to reduce frailty risk by improving physical activity and cognitive function, psychological state, social resources, nutrition, sleep and overall well‐being in older adults with pre‐frailty symptoms. It will empower older citizens to better manage their own health, providing new ways of health monitoring and disease prevention through individualized profiling and personalized recommendations, feedback and support. An ICT‐based platform will detect defined risks in the frailty domains early and accurately via non‐stigmatizing embedded sensors and data readily available in the daily living environment of older adults. When risk is detected (pre‐frail), My‐AHA will provide targeted ICT‐based interventions. These interventions will follow an integrated approach to motivate users to participate in physical exercise, cognitively stimulating games and social networking to achieve long‐term behavioral change, sustained by continued end user engagement with My‐AHA. A randomized controlled study (RCT), involving 300 subjects receiving intervention, and 300 controls from many EU and non‐EU countries, is undergoing to evaluate intercultural aspects. The ultimate aim is to deliver significant innovation in the area of AHA through cooperation between European health care organizations, Small and Medium Enterprises, and Non‐Governative Organizations.

Vernadakis, N., et al. (2014). "The effect of Xbox Kinect intervention on balance ability for previously injured young competitive male athletes: a preliminary study." Physical Therapy in Sport 15(3): 148-155.
	OBJECTIVES: To explore the outcomes of an Xbox Kinect intervention on balance ability, enjoyment and compliance for previously injured young competitive male athletes. DESIGN: Experimental pre-/post-test design with random assignment. PARTICIPANTS: Sixty-three previously injured young competitive male athletes, aged 16 +/- 1 years. INTERVENTIONS: Participants were divided into three groups: one group received Xbox Kinect (XbK) training, one group received Traditional physiotherapy (TP) training, and one group did not receive any balance training (Control). Intervention involved a 24 min session, twice weekly for 10 weeks. MAIN OUTCOME MEASURES: Overall stability index (OSI) and limits of stability (LOS) scores using the Biodex Stability System. Enjoyment using the Physical Activity Enjoyment Scale. Self-reported compliance. RESULTS: Both experimental groups demonstrated an improvement in OSI and LOS mean scores for the right and the left limb after the intervention. In addition, the results revealed important differences between the experimental groups and the control group on balance test indices. Group enjoyment rating was greater for XbK compared with TP, while the compliance rating was not. CONCLUSIONS: These findings suggest that the use of XbK intervention is a valuable, feasible and pleasant approach in order to improve balance ability of previously injured young competitive male athletes.

Viana, R. B., et al. (2021). "Comment on: Problematic online gaming and the COVID-19 pandemic - The role of exergames." J Behav Addict 10(1): 1-3.
	Although significant increases in gaming may not always be beneficial, exergames (a new generation of video games also known as exergaming or active video games) appear as an alternative, feasible, attractive, and safe way to perform physical exercise for most clinical and nonclinical populations. Therefore, it is important to recognize that exergames can be considered a useful tool for coping with the COVID-19 outbreak and the recommended social distancing period.

Viana, R. B., et al. (2018). "Profiling exercise intensity during the exergame Hollywood Workout on XBOX 360 Kinect(R)." PeerJ 6: e5574.
	BACKGROUND: Despite the increasing popularity of exergame practice and its promising benefits in counteracting physical inactivity, limited research has been performed to document the physiological responses during an exergame session. This study aims (i) to investigate the responses of heart rate (HR) and oxygen uptake ( V O2 ) during an exergame session and to compare with HR and V O2 measured during joystick session and (ii) to compare HR and V O2 obtained during exergame and joystick session with those HR and V O2 associated with first and second ventilatory thresholds (VT1 and VT2, respectively) obtained during a maximal graded exercise test. METHODS: A total of 39 participants performed a maximal graded exercise test to determine maximal oxygen uptake ( V O2max ), VT1, and VT2. On separate days, participants performed an exergame and traditional sedentary game (with a joystick) sessions. The time that participants remained with HR and V O2 below the VT1, between the VT1 and VT2 and above the VT2 were calculated to determine exercise intensity. RESULTS: Heart rate and V O2 were below VT1 during 1,503 +/- 292 s (86.1 +/- 16.7%) and 1,610 +/- 215 s (92.2 +/- 12.3%), respectively. There was an increase in HR and V O2 as a function of exergame phases, since HR mean values in the 'warm-up' period (119 +/- 13 bpm) were lower than the 'main phase' (136 +/- 15 bpm) and 'cool-down' periods (143 +/- 15 bpm) (p < 0.001). Regarding V O2 values, the 'warm-up' (25.7 +/- 2.9 mL.kg(-1).min(-1)) were similar to the 'main phase' (25.1 +/- 2.8 mL.kg(-1).min(-1)) (p > 0.05) and lower than the 'cool-down' (28.0 +/- 4.8 mL.kg(-1).min(-1)) (p < 0.001). For all times of the joystick session, average HR and V O2 were below the VT1 levels. CONCLUSION: Exergames can be classified as light to moderate exercise. Thus, exergames could be an interesting alternative to traditional forms of exercise.

Vidal-Balea, A., et al. (2021). "Developing the Next Generation of Augmented Reality Games for Pediatric Healthcare: An Open-Source Collaborative Framework Based on ARCore for Implementing Teaching, Training and Monitoring Applications." Sensors 21(5): 1865.
	Augmented Reality (AR) provides an alternative to the traditional forms of interaction between humans and machines, and facilitates the access to certain technologies to groups of people with special needs like children. For instance, in pediatric healthcare, it is important to help children to feel comfortable during medical procedures and tests that may be performed on them. To tackle such an issue with the help of AR-based solutions, this article presents the design, implementation and evaluation of a novel open-source collaborative framework that enables to develop teaching, training, and monitoring pediatric healthcare applications. Specifically, such a framework allows for building collaborative applications and shared experiences for AR devices, providing functionalities for connecting with other AR devices and enabling real-time visualization and simultaneous interaction with virtual objects. Since all the communications involved in AR interactions are handled by AR devices, the proposed collaborative framework is able to operate autonomously through a Local Area Network (LAN), thus requiring no cloud or external servers. In order to demonstrate the potential of the proposed framework, a practical use case application is presented. Such an application has been designed to motivate pediatric patients and to encourage them to increase their physical activity through AR games. The presented games do not require any previous configuration, as they use ARCore automatic surface detection technology. Moreover, the AR mobile gaming framework allows multiple players to engage in the same AR experience, so children can interact and collaborate among them sharing the same AR content. In addition, the proposed AR system provides a remote web application that is able to collect and to visualize data on patient use, aiming to provide healthcare professionals with qualified data about the mobility and mood of their patients through an intuitive and user-friendly web tool. Finally, to determine the performance of the proposed AR system, this article presents its evaluation in terms of latency and processing time. The results show that both times are low enough to provide a good user experience.

Villafaina, S., et al. (2019). "Effect of Exergame Training and Detraining on Lower-Body Strength, Agility, and Cardiorespiratory Fitness in Women with Fibromyalgia: Single-Blinded Randomized Controlled Trial." International Journal of Environmental Research & Public Health [Electronic Resource] 17(1): 161.
	The aim of this study was to analyze the effects of a 24 week exergame intervention and 24 weeks of detraining on lower-limb strength, agility, and cardiorespiratory fitness in women with fibromyalgia (FM). It was performed as a single-blinded randomized controlled trial of 55 women with FM. University facilities were used. The 24 week exergame intervention was focused on mobility, postural control, upper- and lower-limb coordination, aerobic fitness, and strength. Participants performed 120 min of exergaming per week, which was divided into two sessions. Twenty-four weeks after the end of the intervention, participants were re-evaluated. A chair-stand test, 10 step stair test, and six-minute walk test were conducted to assess lower-body strength, agility, and cardiorespiratory fitness, respectively. The exergame intervention significantly improved lower-limb strength and cardiorespiratory fitness. However, no significant effects on agility were observed. After the detraining period, lower-limb strength and agility returned to their baseline level, but improvements in cardiorespiratory fitness were sustained over time. Exergaming was therefore shown to be beneficial for physical fitness in people with FM. However, exergames had to be played regularly to maintain the benefits. This long-term intervention (24 weeks) may have changed the lifestyle of women with FM, which could explain why cardiorespiratory fitness improvements remained after the detraining period. Future research should focus on lifestyle changes after long-term interventions.

Villafaina, S., et al. (2019). "Effects of Exergames on Brain Dynamics in Women with Fibromyalgia: A Randomized Controlled Trial." J Clin Med 8(7).
	BACKGROUND: Exergames are non-immersive versions of virtual reality that involve physical exercise and have shown several benefits on physical fitness and quality of life in women with fibromyalgia. However, the effects on brain dynamics are still unknown. AIM: the aim was to evaluate the effects of a 24-week exergame intervention on resting brain dynamics in women with fibromyalgia in a single-blinded, randomized controlled trial. METHODS: Fifty-six women with fibromyalgia were assessed for eligibility; 55 fulfilled the inclusion criteria. The exercise group completed a 24-week exergame-based intervention that focused on mobility, postural control, upper and lower limb coordination, aerobic fitness, and strength. This group received two 60-min sessions per week. We measured electroencephalographic (EEG) signals from 19 channels. Participants were also divided into two subgroups according to the duration of their symptoms. The intervention was more effective in the group with a shorter duration of symptoms, showing between-group differences in F8, T5 and T4. CONCLUSION: Exergames may lead to changes in brain dynamics that could be related to increased cerebral blood flow.

Viscogliosi, C., et al. (2000). "[Effect of a multi-strategic group program on performance of the activities of daily living for elderly people with mild cognitive deficits." Can J Occup Ther 67(5): 314-323.
	OBJECTIVE: The goal of this study was to determine the impact of a group activity program on the level of functioning of a person in instrumental activities of daily living (IADL). This program was specifically designed for people with mild cognitive deficiencies living at home and attending a day centre. METHOD: Using a single subject design of AB type, eleven persons were assigned randomly to a experimental group (n = 7) and to a control group (n = 4). Their cognitive functioning was found to be between the 5th and the 25th percentile on the Modified Mini-Mental State Examination (3MS), which corresponds to stage 3 on the Reisberg Scale. The 18 week long multi-strategic program consisted of two weekly meetings of one and a half hours each. This program included physical exercises, psychomusical techniques, cognitive games and tasks related to IADL. The level of functioning of the subjects in their IADL was measured six times at home using the Assessment of Motor and Process Skills (AMPS), before, during and after the program. FINDINGS: The data derived from each subject were presented as a graphical analysis. Following the application of the program, more of the participants, as compared to the control subjects, improved their functioning in terms of IADL. CONCLUSION: The findings of this study suggest that it would be possible to use coping strategies in the early stages of cognitive deficits.

Vonstad, E. K., et al. (2022). "Performance of machine learning models in estimation of ground reaction forces during balance exergaming." J Neuroeng Rehabil 19(1): 18.
	BACKGROUND: Balance training exercise games (exergames) are a promising tool for reducing fall risk in elderly. Exergames can be used for in-home guided exercise, which greatly increases availability and facilitates independence. Providing biofeedback on weight-shifting during in-home balance exercise improves exercise efficiency, but suitable equipment for measuring weight-shifting is lacking. Exergames often use kinematic data as input for game control. Being able to useg such data to estimate weight-shifting would be a great advantage. Machine learning (ML) models have been shown to perform well in weight-shifting estimation in other settings. Therefore, the aim of this study was to investigate the performance of ML models in estimation of weight-shifting during exergaming using kinematic data. METHODS: Twelve healthy older adults (mean age 72 (+/- 4.2), 10 F) played a custom exergame that required repeated weight-shifts. Full-body 3D motion capture (3DMoCap) data and standard 2D digital video (2D-DV) was recorded. Weight shifting was directly measured by 3D ground reaction forces (GRF) from force plates, and estimated using a linear regression model, a long-short term memory (LSTM) model and a decision tree model (XGBoost). Performance was evaluated using coefficient of determination ([Formula: see text]) and root mean square error (RMSE). RESULTS: Results from estimation of GRF components using 3DMoCap data show a mean (+/- 1SD) RMSE (% total body weight, BW) of the vertical GRF component ([Formula: see text]) of 4.3 (2.5), 11.1 (4.5), and 11.0 (4.7) for LSTM, XGBoost and LinReg, respectively. Using 2D-DV data, LSTM and XGBoost achieve mean RMSE (+/- 1SD) in [Formula: see text] estimation of 10.7 (9.0) %BW and 19.8 (6.4) %BW, respectively. [Formula: see text] was [Formula: see text] for the LSTM in the [Formula: see text] component using 3DMoCap data, and [Formula: see text] using 2D-DV data. For XGBoost, [Formula: see text] [Formula: see text] was [Formula: see text] using 3DMoCap data, and [Formula: see text] using 2D-DV data. CONCLUSION: This study demonstrates that an LSTM model can estimate 3-dimensional GRF components using 2D kinematic data extracted from standard 2D digital video cameras. The [Formula: see text] component is estimated more accurately than [Formula: see text] and [Formula: see text] components, especially when using 2D-DV data. Weight-shifting performance during exergaming can thus be extracted using kinematic data only, which can enable effective independent in-home balance exergaming.

Vonstad, E. K., et al. (2020). "Comparison of a Deep Learning-Based Pose Estimation System to Marker-Based and Kinect Systems in Exergaming for Balance Training." Sensors 20(23): 6940.
	Using standard digital cameras in combination with deep learning (DL) for pose estimation is promising for the in-home and independent use of exercise games (exergames). We need to investigate to what extent such DL-based systems can provide satisfying accuracy on exergame relevant measures. Our study assesses temporal variation (i.e., variability) in body segment lengths, while using a Deep Learning image processing tool (DeepLabCut, DLC) on two-dimensional (2D) video. This variability is then compared with a gold-standard, marker-based three-dimensional Motion Capturing system (3DMoCap, Qualisys AB), and a 3D RGB-depth camera system (Kinect V2, Microsoft Inc). Simultaneous data were collected from all three systems, while participants (N = 12) played a custom balance training exergame. The pose estimation DLC-model is pre-trained on a large-scale dataset (ImageNet) and optimized with context-specific pose annotated images. Wilcoxon's signed-rank test was performed in order to assess the statistical significance of the differences in variability between systems. The results showed that the DLC method performs comparably to the Kinect and, in some segments, even to the 3DMoCap gold standard system with regard to variability. These results are promising for making exergames more accessible and easier to use, thereby increasing their availability for in-home exercise.

Voon, K., et al. (2016). "Xbox Kinect based rehabilitation as a feasible adjunct for minor upper limb burns rehabilitation: A pilot RCT." Burns 42(8): 1797-1804.
	INTRODUCTION: Rehabilitation following burns is integral to improving physical and psychological outcomes. Interactive video game consoles are emerging as therapeutic adjuncts due to their ease of use, affordability, and interactive gameplay. The Xbox Kinect has advantage over similar consoles, with controller free interaction utilising three dimensional motion capture software. Player movements during gameplay have been shown to be comparable to completing daily tasks and therefore the Xbox Kinect has potential for use as a rehabilitation tool. AIM: The objectives of this pilot study were to compare the efficacy of the Xbox Kinect with conventional physiotherapy as an adjunctive tool to promote activity and, to explore their efficacy in influencing functionality and pain. METHOD: A randomised controlled clinical trial design was used. Intervention group participants were asked to complete two daily 30min exercise sessions consisting of 15min of self-directed physiotherapy exercise followed by 15min of Xbox Kinect activities, based on location of burn. Control group participants were asked to complete two daily 30min exercise sessions of self-directed physiotherapy exercises involving two 15min sets of exercises, standardised for location of burn. Participants were recruited for a maximum of 7 days. Outcomes assessed included daily activity time, treatment satisfaction, upper limb disability, pain, and self-reported fear of movement (kinesiophobia). RESULTS: A sample of 30 burn patients admitted to Royal Perth Hospital was randomised into intervention and control groups. The intervention group demonstrated significantly greater total activity time compared to control group (median 49.4 and 26.7min respectively, p<0.0001), irrespective of total burns surface area (TBSA). Significantly greater satisfaction scores were also demonstrated in the intervention group compared to controls (median 8.53 vs 7.8 respectively, p<0.0001). There was no evidence to support differences between group measures for upper limb disability, pain and fear avoidance of movement. CONCLUSION: The Xbox Kinect is a useful tool in increasing rehabilitation exercise time and patient satisfaction compared to conventional physiotherapy without indication of concurrent negative effects on patient recovery.

Wagner, H., et al. (2014). "Individual and team performance in team-handball: a review." Journal of Sports Science & Medicine 13(4): 808-816.
	Team handball is a complex sport game that is determined by the individual performance of each player as well as tactical components and interaction of the team. The aim of this review was to specify the elements of team-handball performance based on scientific studies and practical experience, and to convey perspectives for practical implication. Scientific studies were identified via data bases of PubMed, Web of Knowledge, SPORT Discus, Google Scholar, and Hercules. A total of 56 articles met the inclusion criteria. In addition, we supplemented the review with 13 additional articles, proceedings and book sections. It was found that the specific characteristics of team-handball with frequent intensity changes, team-handball techniques, hard body confrontations, mental skills and social factors specify the determinants of coordination, endurance, strength and cognition. Although we found comprehensive studies examining individual performance in team-handball players of different experience level, sex or age, there is a lack of studies, particularly for team-handball specific training, as well as cognition and social factors. Key PointsThe specific characteristics of team-handball with frequent intensity changes, specific skills, hard body confrontations, mental skills and social factors define the determinants of coordination, endurance, strength and cognition.To increase individual and team performance in team-handball specific training based on these determinants have been suggested.Although there are comprehensive studies examining individual performance in team-handball players of different experience level, sex, or age are published, there is a lack of training studies, particularly for team-handball specific techniques and endurance, as well as cognition and social factors.

Wall, K. M., et al. (2018). "Biomarkers and components of the interactive physical and cognitive exercise system (iPACES™ v2.0) for mild cognitive impairment (MCI): cortisol, dehydroepiandrosterone (Dhea-S), and insulin-like growth factor (IGF1)." FASEB journal 32(1).
	Dementia cases are on the rise among our aging global population, and thus there is increasing urgency to identify efficacious interventions for preserving or ameliorating cognitive decline. Physical exercise, cognitive training and combined physical and cognitive interventions have been found to slow the decline of cognitive abilities in those with mild cognitive impairment (MCI) but the biological mechanisms underlying these changes need further clarification. This quasi‐experimental within‐subjects design compared changes in biomarkers during two‐week exposures to components of the interactive physical and cognitive exercise system (iPACES™). Participants were evaluated over eight weeks at two‐week intervals. Biomarker levels of Cortisol, IGF1 and DHEAS were assessed at each evaluation through saliva (passive drool collection). Each saliva sample was analyzed using enzyme‐linked immunosorbent assays (ELISAs). Additionally, each sample was analyzed using bicinchoninic acid (BCA) protein assay to normalize protein concentration. Cognitive outcomes were also assessed, focusing on executive function via Stroop, Trails, and Flanker tests. This pilot study enrolled 14 older adults, 13 of which met criteria for MCI (MoCA<26), with ten study completers. Paired t‐tests revealed significant (ps<.05) cognitive improvements in Stroop and Flanker from baseline during all active component conditions (e.g., pedaler, game, and iPACES™), but not during placebo. Biomarkers did not change significantly during placebo or pedaler conditions, but during the game intervention, DHEAS declined significantly (p=.04), and during iPACES™ intervention, DHEAS declined further and IGF1 declined significantly (p=.05), consistent with prior research (McTiernan, et al., 2005; Yuichiro, et al., 2010). Furthermore, the changes (from baseline to the end of the 8‐week trial) for cognition were moderately correlated with biomarker changes (r's ranging from ‐.22 to ‐.48), suggesting a link between neurobiological mechanisms and cognitive outcomes. Further research is needed to replicate and extend this pilot research; in particular, it would be useful to compare such interventions in a randomized controlled trial.

Wang, A. I. (2021). "Systematic literature review on health effects of playing Pokémon Go." Entertainment Computing 38: 100411.
	Pokémon Go is one of the most successful mobile games of all time and has motivated its users to become physically active, socialize, and spend more time outdoors. There have been published some systematic literature reviews related to Pokémon Go, but few address health effects beyond the physical health of playing the game. This paper presents the results from a systematic literature review on how the game affects physical, mental, and social health and the players’ motivation for starting, keep on, and stop playing the game. The literature review identified fifty-nine studies related to the topic, which were accepted according to the inclusion and exclusion criteria and the critical appraisal. The main conclusion is that Pokémon Go has an apparent positive effect on its player’s physical, mental, and social health, although this effect only lasts as long as the player plays the game. Further, the motivation and motives for playing the game include having a fun and immersive experience, getting physical exercise, social reasons, and nostalgia related to the Pokémon universe. The reasons for why people stopped playing the game included technical challenges, slow progress in the game that required more effort increasingly, and lack of variation and content.

Wang, C., et al. (2021). "Research on the Influence of Sport Dance on Physical Health in National Fitness Exercise." Revista brasileira de medicina do esporte 27(5): 481-484.
	Introduction: Sports dance is widely known as a competitive game, but as a leisure activity, there is little research on the efficacy of human health and fitness. Sports dance, as a popular national fitness exercise, has sound health promotion effects. At present, domestic and foreign researches mostly focus on the impact of sports dance on young men and women. Objective: This study will explore the influence of regular physical dance exercises on the body shape, function, and quality of middle‐aged and older adults, provide a scientific basis for the role of physical dance in national fitness. Methods: This study recruited 20 healthy middle‐aged and elderly members of a leisure sports dance club without professional dance experience for three months of dance training. The first two weeks are pre‐experiments five times a week. Each exercise time is 60 minutes. The last ten weeks are formal experiments, two times a week, 90 minutes each time, and no other physical exercises are involved in everyday life. By comparing part of the body shape, physical function, and physical fitness index before and after the experiment, the impact of sports dance on middle‐aged and older adults’ healthy physical fitness is evaluated. Results: After three months of physical dance exercise with different dance styles, in male, BMI index, body fat percentage, waist circumference, hip circumference, and thigh circumference indicators all decreased, but there was no significant difference. In women, BMI index, body fat percentage (P<0.01), waist circumference (P<0.05), diastolic blood pressure (P<0.01), sitting body forward bending (P<0.05), and standing with one foot and closed eyes all increased. In women, the indexes of grip strength (P<0.01), forward bending in sitting position (P<0.055), and standing with eyes closed on one foot all increased. Conclusions: It is suggested that long‐term moderate‐intensity aerobic sport dance exercise can improve the body shape of middle‐aged and older adults and help increase physical fitness; meanwhile, sports dance can effectively improve the cardiovascular function of middle‐aged and elderly subjects. Level of evidence II; Therapeutic studies ‐ investigation of treatment results.

Wang, G., et al. (2022). "The Effect of Physical Exercise on Fundamental Movement Skills and Physical Fitness among Preschool Children: Study Protocol for a Cluster-Randomized Controlled Trial." International Journal of Environmental Research & Public Health [Electronic Resource] 19(10).
	Background: Evidence shows that physical exercise promotes preschoolers' fundamental movement skills (FMSs) and physical fitness (PF). However, studies that assess the effectiveness of different types of physical exercise interventions to improve FMSs and PF in preschool children remain scarce. To explore and compare the effectiveness of different physical exercise on FMSs and PF, interventions comprising ball games (BGs), rhythm activities (RAs), basic movements (BMs), and a combination of all related activities (multiple activities, MAs) will be conducted among preschoolers. Methods: A single-blind, five-arm, cluster-randomized trial will be conducted in kindergarten in Shanghai, China. In total, 300 healthy preschoolers, aged 4 to 5 years, will be randomized to four intervention groups (BG, RA, BM, or MA) and one control group (unorganized physical activities). Four intervention groups will receive three 30-min lessons weekly for 16 weeks. At the baseline, the end of the 16-week intervention, and the 6-month follow-up after the end of the intervention, the primary outcomes (FMSs and PF) and physical activity (PA), and sociodemographic and anthropometric data will be assessed. Discussion: This study will provide vital information regarding the effect of different physical exercise interventions on preschool children's FMSs and PF, PA, and the potential interactions between these domains. The most effective intervention strategy can be generalized to kindergarten and other preschool educational institutions in practice to promote preschoolers' development of FMSs and PF. Conclusions: This study protocol aims to provide a method to solve the problem of "how to arrange physical exercise and which kind of physical exercise program can promote FMS and PF better in preschool children".

Wang, H., et al. (2021). "Constructing Sports Multi-Index Data Analysis Based on 5G IoT Technology." Mathematical Problems in Engineering 2021: 1-12.
	The arrival of the new era and the development of 5G Internet of Things (IoT) technology have made our lives and work easier and more convenient. The vigorous development of the IoT has been applied in many fields, among which, especially the data mining technology of the IoT ushered in the spring of this era of information explosion. Full application of data mining technology can provide real data well. Application analysis provides value and decision support. In order to apply 5G Internet of Things technology to the sports industry to help study the multi-index data of various sports activities so as to better help modern people have a healthy sports concept, Nemo builds relevant data analysis based on 5G Internet of Things technology. This article analyzes the research on the construction of sports multi-index data based on 5G IoT, makes full use of the IoT to mine sports-related data, and launches a multi-index discussion on it. First, the literature data method is adopted to learn the theoretical knowledge of IoT, artificial neural network, deep learning, etc., and establish a sports multi-index data analysis research model based on machine learning and massive data processing technology. Finally, for modern people, sports hobbies, types, exercise duration, exercise heart rate, and other aspects are analyzed. The results show that modern people prefer aerobic exercise, especially jogging and cycling, accounting for 47% and 41%, and the proportion of people who spend more than 60 minutes in the gym is as high as 48%. This shows that even though most people are busy at work, they still realize the importance of physical exercise and are willing to do sports.

Wang, R. S. (2001). "The eco-origins, actions and demonstration roles of Beijing Green Olympic Game." Journal of Environmental Sciences (China) 13(4): 514-519.
	The 29th Olympic Game will be held in Beijing in 2008. It will be a green game to promote sustainable development of men, cities and regions through ecological development advocating "man and nature be in one". "Eco" here means a process, a driving force, an action, a culture and a kind of vitality leading to sustainable development. It is a mechanism embodying the Olympic spirit of competition, cooperation and self-reliance. The paper explained the ecological significance, connotation and objectives of Beijing Green Olympic Game. Ten major ecological heritages of Beijing have been investigated including ecologically sound landscape, culture, transportation, physical exercise, health care, sanitation, food, family relationship, agriculture, and human ecological totality. To preserve or restore the above mentioned old tradition, a green Olympic action plan has been made out in Beijing initiated by NGOs, supported by entrepreneurs and coordinated by government agencies. Four kinds of eco-engineering have been planned for blue sky, clean water, green land and eco-city development. The demonstration role of Beijing Green Olympic Game to developing regions and countries is also discussed.

Wang, R. Y., et al. (2018). "A randomized controlled pilot trial of game-based training in individuals with spinocerebellar ataxia type 3." Sci Rep 8(1): 7816.
	Exergames are interactive video games used for exercise and may have therapeutic value in people with degenerative ataxia. The purpose of this study was to investigate potential effects of exergaming training on cerebellar ataxia in people with spinocerebellar ataxia type 3 (SCA3). Nine individuals with SCA3 were recruited and randomized to either exergaming or conventional group for a 4-week training period. The severity of ataxia was measured as the primary outcome by the Scale for the Assessment and Rating of Ataxia (SARA) and by the directional control of the limit of stability test. The secondary outcomes included upper-limb function and gait performance. After training, participants in the exergaming group had a significant decrease in the total SARA score and the gait-posture SARA subscore. Participants in the conventional training group did not show a significant improvement in selected outcome measures after the 4-week training period. No significant difference was found between groups for any of these measures. Our results suggested that the exergaming training program significantly decreased ataxia. These results support implementation of exergaming training for people with SCA3.

Wang, X., et al. (2019). "Technology-assisted rehabilitation following total knee or hip replacement for people with osteoarthritis: a systematic review and meta-analysis." BMC Musculoskeletal Disorders 20(1): 506.
	BACKGROUND: To evaluate the effectiveness and safety of technology-assisted rehabilitation following total hip/knee replacement (THR/TKR). METHODS: Six electronic databases were searched without language or time restrictions for relevant studies: MEDLINE, EMBASE, Cochrane Library, CINAHL, SPORTDiscus, Physiotherapy Evidence Database (PEDro); from inception to November 7th, 2018. Two reviewers independently applied inclusion criteria to select eligible randomised controlled trials (RCTs) that investigated the effectiveness of technology-based interventions, compared with usual care or no intervention for people undergoing THR/TKR. Two reviewers independently extracted trial details (e.g. patients' profile, intervention, outcomes, attrition and adverse events). Study methodological quality was assessed using the PEDro scale. Quality of evidence was critically appraised using the Grading of Recommendations, Assessment, Development and Evaluation approach. RESULTS: We identified 21 eligible studies assessing telerehabilitation, game- or web-based therapy. There were 17 studies (N = 2188) in post-TKR rehabilitation and 4 studies (N = 783) in post-THR rehabilitation. Compared to usual care, technology-based intervention was more effective in reducing pain (mean difference (MD): - 0.25; 95% confidence interval (CI): - 0.48, - 0.02; moderate evidence) and improving function measured with the timed up-and-go test (MD: -7.03; 95% CI: - 11.18, - 2.88) in people undergoing TKR. No between-group differences were observed in rates of hospital readmissions or treatment-related adverse events (AEs) in those studies. CONCLUSION: There is moderate-quality of evidence showed technology-assisted rehabilitation, in particular, telerehabilitation, results in a statistically significant improvement in pain; and low-quality of evidence for the improvement in functional mobility in people undergoing TKR. The effects were however too small to be clinically significant. For THR, there is very limited low-quality evidence shows no significant effects.

Wang, X. and A. C. Perry (2006). "Metabolic and physiologic responses to video game play in 7- to 10-year-old boys." Archives of Pediatrics & Adolescent Medicine 160(4): 411-415.
	OBJECTIVE: To examine the metabolic, physiologic, and hemostatic responses to action video game play in a group of young boys. DESIGN: Comparison study. SETTING: Laboratory of Clinical and Applied Physiology, University of Miami. PARTICIPANTS: Twenty-one boys aged 7 to 10 years. MAIN OUTCOME MEASURES: Blood pressure monitored before and during game play and blood glucose and lactate levels measured before and immediately after game play. Measurements were continuously recorded throughout game play. Dependent t tests were used to compare measurements recorded at baseline and during or after game play. Effect sizes using the Cohen d were examined for comparisons. RESULTS: Significant increases from baseline were found for heart rate (18.8%; P<.001), systolic (22.3%; P<.001) and diastolic (5.8%; P = .006) blood pressure, ventilation (51.9%; P<.001), respiratory rate (54.8%; P<.001), oxygen consumption (49.0%; P<.001), and energy expenditure (52.9%; P<.001). Effect sizes for these comparisons were medium or large. No significant changes were found from baseline to after video game play for lactate (18.2% increase; P = .07) and glucose (0.9% decrease; P = .59) levels. CONCLUSIONS: Video game play results in significant increases in various metabolic and physiologic variables in young children. Thus, it should not be combined with television viewing for the evaluation of sedentary activities. The magnitude of change, however, was lower than that observed during standard physical exercise and below national health recommendations. As such, video game play should not be considered a substitute for regular physical activities that significantly stress the metabolic pathways required for the promotion of cardiovascular conditioning.

Wang, Y., et al. (2020). "Exer-Learning: A New Genre Combines Learning, Exercise and Fun for Children." Procedia Computer Science 174: 735-745.
	The increased burden of school work reduces outdoor exercise of school children, which lead to increased rate of obesity and other health problems. Engaging in both learning activities and physical exercise is essential for the development of children. In this paper, we present a new genre called Exer-Learning especially for children, which combines learning activities with physical exercises in the context of fun games. To exemplify such genre, we design a Playground Game, which integrates physical exercise as a key element in a language learning game. By naturally using location and body movement in the projection area as the way of interaction, the children can learn knowledge and do quizzes in the game. Therefore, they can not only learn knowledge, but also carry out certain physical activities. We conducted a controlled study to understand the optimal design tradeoffs of two elements (level of physical exercise and knowledge provided by the game) under this Exer-Learning genre. Four trade-offs conditions are distinguished and their effects on participants’ exercise benefit, learning efficacy, and fun of the game were examined. Based on the game and participants in this paper, results show that the benefits of exercise and learning are relatively high under the condition of high physical exercise and low knowledge. This trade-off condition leads to good learning effect, as well as good exercise benefit. However, high physical exercise conditions reduce participants’ fun in the learning. How to better combine physical exercise with the fun is a question to be solved in the future.

Wang, Y., et al. (2021). "Interaction Preference Differences between Elderly and Younger Exergame Users." International Journal of Environmental Research & Public Health [Electronic Resource] 18(23): 29.
	Existing motion capture technology can efficiently track whole-body motion and be applied to many areas of the body. This whole-body interaction design has gained the attention of many researchers. However, few scholars have studied its suitability for elderly users. We were interested in exercise-based whole-body interactive games, which can provide mental and physical exercise for elderly users. We used heuristic evaluation to measure participants' actions during exergame tasks and analyzed preference differences between elderly and younger users through the distribution of actions in four dimensions. We found that age affected the actions performed by users in exergame tasks. We discuss the mental model of elderly users during the process of performing these tasks and put forward some suggestions for interactive actions. This model and these suggestions theoretically have guiding significance for the research and application of exergame design for elderly users and may help designers develop more effective exergames or other whole-body interaction interfaces suitable for elderly users.

Wang, Y., et al. (2022). "Prevalence of Achilles tendinopathy in physical exercise: A systematic review and meta-analysis." Sports Medicine and Health Science.
	This comprehensive systematic review and meta-analysis assessed the prevalence of Achilles tendinopathy (AT) in physical exercise (PE). Specifically, we estimate the overall risk of AT in physical exercise and compare sport-specific estimates of AT risk. PubMed, Web of Science, Cochrane Library, and SPORTDiscus were searched before the 1st of October 2021. Random-effects, subgroup analysis, sensitivity analysis and meta-regressions were conducted, involving 16 publications. This meta-analysis found that the overall prevalence of AT was 0.06 (95%CI, 0.04–0.07). The prevalence of Achilles tendon rupture was 0.03 (95%CI, 0.02–0.05). Subgroup analysis showed that the prevalence of AT increased with age, the highest among the group aged over 45 (0.08; 95%CI, 0.04–0.11), and the lowest among the group under 18 years old (0.02; 95%CI, 0.01–0.03). The gymnastics and ball games had the highest prevalence of AT, at (0.17; 95%CI, 0.14–0.20) and (0.06; 95%CI, 0.02–0.11), respectively. The prevalence of AT in athletes (0.06; 95%CI, 0.04–0.08) was higher than that of amateur exercisers (0.04; 95%CI, 0.02–0.06) and there was no difference in the prevalence of AT between males and females. There are differences in the prevalence of AT in different ages, sport events and characteristics of participants. This systematic review and meta-analysis suggested that it was necessary to pay more attention to AT in people who were older or engaged in gymnastics.

Watanabe, K., et al. (2019). "Medical services at the 2017 Sapporo Asian winter games: injury and illness epidemiology at a 34-nation multisport event." Br J Sports Med 53(1): 32-36.
	OBJECTIVES: We describe the medical services provided and report the injuries and illnesses that occurred at the eighth Asian Winter Games 2017. METHODS: A total of 2010 athletes and team officials from 32 National Olympic Committees and 2 guest countries attended this event; medical services were provided for 16 days. Medical data (medical care and physiotherapy) were collected for the same period by the organising committee for athletes and non-athletes (team officials, workforce, media and spectators) and recorded on the electronic medical record system at the medical rooms in the venues and the team residences. RESULTS: We recorded 745 medical encounters (medical care, 443; physiotherapy, 302), of which 549 (74%) were among athletes. There were 214 injuries as well as 144 illnesses and other medical conditions. Of the 1164 athletes, 549 (47%) utilised the services. Ice hockey, snowboarding and alpine skiing had high rate of medical encounters. More than half of the delegations were not accompanied by team doctor, and rate of medical encounters was high in these teams. The vast majority of patients transferred to hospital for further care were mostly athletes (n=36 out of 41), mostly alpine skiers and ice hockey players. CONCLUSION: Injuries and illnesses varied depending on NOC medical staffing and sport events. These data will serve organisers of medical and physiotherapy services in the Asian Winter Games and similar large events.

Weber-Spickschen, T. S., et al. (2017). "Fun During Knee Rehabilitation: Feasibility and Acceptability Testing of a New Android-Based Training Device." The Open Medical Informatics Journal 11: 29-36.
	PURPOSE: The initial goals of rehabilitation after knee injuries and operations are to achieve full knee extension and to activate quadriceps muscle. In addition to regular physiotherapy, an android-based knee training device is designed to help patients achieve these goals and improve compliance in the early rehabilitation period. This knee training device combines fun in a computer game with muscular training or rehabilitation. Our aim was to test the feasibility and acceptability of this new device. METHODS: 50 volunteered subjects enrolled to test out the computer game aided device. The first game was the high-striker game, which recorded maximum knee extension power. The second game involved controlling quadriceps muscular power to simulate flying an aeroplane in order to record accuracy of muscle activation. The subjects evaluated this game by completing a simple questionnaire. RESULTS: No technical problem was encountered during the usage of this device. No subjects complained of any discomfort after using this device. Measurements including maximum knee extension power, knee muscle activation and control were recorded successfully. Subjects rated their experience with the device as either excellent or very good and agreed that the device can motivate and monitor the progress of knee rehabilitation training. CONCLUSION: To the best of our knowledge, this is the first android-based tool available to fast track knee rehabilitation training. All subjects gave very positive feedback to this computer game aided knee device.

Wechsler, S. M., et al. (2020). "Effects of physiotherapy associated to virtual games in pain perception and heart rate variability in cases of low back pain." Manual Therapy, Posturology & Rehabilitation Journal 14: 1-7.
	Introduction: The virtual games when appropriately used can stimulate brain activity and excite the creative energy. Therefore, it is important to assess the implications of their use in pain perception in individuals with low back pain (LBP), a disease that affects about 80% of the world's population. Objective: was to evaluate the effects of virtual games combined with a physiotherapy program on the pain perception and Heart Rate Variability (HRV) in people with LBP. Method: the participants were 21 adults with clinical diagnosis of LBP, aged 24-61 years, of both sexes, divided into two groups. Five weekly meetings were provided. Group 1 participated in a physical therapy program and group 2 participated in the same physical therapy program plus joint sessions with virtual games. The instruments used were a heart rate monitor; a tablet for games; a shortwave equipment; visual analogue scale (VAS); and McGill's Pain Questionnaire. The measurements were performed before and after the program. Results: Reduction in pain was observed in both groups, being higher in group 2, the one that used the games. Conclusion: There was a decrease in parasympathetic activity in group 2, which indicates that the distraction factor promoted by the games influenced the pain perception.

Wedin, J. O. and A. E. Henriksson (2020). "The Influence of Floorball on Hematological Parameters: Consequences in Health Assessment and Antidoping Testing." J Sports Med (Hindawi Publ Corp) 2020: 6109308.
	Assessment of hematological parameters is common in sports medicine. Although physical exercise is an important preanalytical variable, data about acute hematological changes after high-intensity intermittent exercise are scarce. This study aimed to examine floorball as a potential preanalytical variable for hematological parameters used in health assessment and antidoping testing. Twenty-three professional male floorball players participated in a floorball game. Hematological parameters including hemoglobin, erythrocyte count and erythrocyte indices, reticulocytes, white blood cells (WBC), platelets, reticulocytes, and OFF-hr score were assessed at baseline, immediately postgame, and at 2 h postgame. Median hemoglobin concentration decreased significantly from 146 g/L pregame to 141 g/L immediately postgame (p < 0.001). WBC count increased from 7.2 x 10(9)/L pregame to 10.1 x 10(9)/L 2 h postgame (p < 0.001). The median OFF-hr score decreased from 99.5 to 94.2 immediately postgame and remained significantly lower than baseline at 2 h postgame (94.4, p=0.030). Looking at individual results, the highest OFF-hr score increased from 120 at baseline to 124 at 2 h postgame. Our findings suggest that participation in a floorball game affects several hematological parameters and consequently can affect health assessment and antidoping testing.

Wertmann, P., et al. (2020). "New evidence for ball games in Eurasia from ca. 3000-year-old Yanghai tombs in the Turfan depression of Northwest China." Journal of Archaeological Science: Reports 34: 102576.
	Three leather balls discovered in tombs IM157, IM209, and IM214 of the prehistoric Yanghai cemetery (42°48′N, 89°39′E) located about 43 km southeast of the modern city of Turfan, were AMS radiocarbon dated to the time interval between 1189 and 911 BCE (95% probability), and thus predate other currently known antique balls and images of ball games in Eurasia by several centuries. Our study approves the antiquity of the Yanghai balls, but the available data is not enough to answer the question how these balls were played. Although, their use in team and goal sport is likely, a suggested game similar to hockey, golf or polo cannot be confirmed, because no appropriate sticks were found in direct association with the balls. The affiliation of curved wooden sticks in Yanghai with ball games suggested earlier remains hypothetical, as all found sticks are noticeably younger in age, and other forms of use should be verified by future studies. Two of the three balls were found in the burials of the possible horse riders. Given that ball games from ancient times were considered an excellent form of physical exercise and military training, we suggest that balls (and ball games) appeared in the region at the same time as horseback riding and mounted warfare began to spread in the eastern part of Central Asia.

White, P. (1987). "Physical therapy and cognitive learning skills: incorporating the two for children." Clinical Management in Physical Therapy 7(4): 20-22.
	
Whittinghill, D., et al. (2014). "Effect of Pregame Training Tutorials on Player Performance in Kinect-Based Health Games." Games for Health Journal 3(1): 31-39.
	OBJECTIVE: The objective of this study was to examine the influence of pregame tutorials on player performance in Kinect((R)) (Microsoft((R)), Redmond, WA)-based health games and to determine whether the additional exertion caused by longer playtime introduced by the tutorial would influence in-game performance. MATERIALS AND METHODS: Thirty-two college-age test participants were randomly assigned to two groups: pregame training tutorial and pregame verbal instructions. The variable of interest was the degree to which players were able to accurately perform a series of static arm gestures in order to duplicate specific reference poses. Participants played a Kinect-based bird simulator game called "Burnie" that required the player to hold specific, static poses that correspond to physical therapy treatment actions. This study is a pilot conducted in advance of testing the game with its target audience of pediatric cerebral palsy patients. RESULTS: Analysis of variance did not detect a significant difference in pose accuracy between the tutorial and nontutorial groups. However, the tutorial group's pose accuracy was higher on average than that of the nontutorial group. CONCLUSIONS: Given the limited sample size in this study, it cannot be stated with certainty that greater pose accuracy will occur if a pregame tutorial level is administered. However, a trend was observed along most measures that the tutorial group achieved greater accuracy scores than the verbal instruction group. Further study with greater statistical power is strongly recommended.

Whittinghill, D. M. and J. S. Brown (2014). Gamification of Physical Therapy for the Treatment of Pediatric Cerebral Palsy: A Pilot Study Examining Player Preferences. Atlanta, American Society for Engineering Education-ASEE: 24.638.631-624.638.610.
	Gamification of Physical Therapy for the Treatment of Pediatric Cerebral Palsy: A Pilot Study Examining Player PreferencesPhysical therapy of the upper extremities has been demonstrated to be a useful treatment forpediatric cerebral palsy. This paper describes a custom-made Kinect-based health game calledBurnie that gamifies upper arm physical therapy for pediatric cerebral palsy patients by placingthe player in the role of a bird navigating a nature-themed obstacle course. This pilot studyevaluates the game for player satisfaction along the dimensions of graphics, controls, and overallenjoyment. In preparation for later testing with the target population of pediatric patients, aninitial pilot study was conducted with undergraduate students as test subjects using a post-testonly control group design. After subjects played the game for fifteen minutes, they evaluated thegame along the aforementioned dimensions using a pen and paper survey. Average observedratings (on a 10 point scale, higher being better) were: 7.65, 5.4, and 6.75, respectively. Theseresults indicate that Burnie is an enjoyable game experience, but in order to maximizeeffectiveness more research needs to be done on the control scheme to determine why it wasrated lower than the rest of the game. Identification of the specific factors that contribute tocontrol enjoyment is recommended. This work contributes to HCI by presenting a new methodfor leveraging computers to improve the quality of life of pediatric sufferers of cerebral palsy,and contributes to education by providing a new means for teaching individuals how to performspecific therapeutic gestures within a game-based learning session.

Wick, J. M., et al. (2013). "Meningococcemia: the pediatric orthopedic sequelae." AORN J 97(5): 559-578.
	Meningococcal disease affects as many as 3,000 people in the United States per year, with the highest incidence in children younger than two years of age and two-thirds of cases occurring in children younger than five years of age. Children who survive meningococcemia face quality-of-life issues that result from limb deficiencies. Consultation with an experienced pediatric orthopedic surgeon in the early stages of the illness is vital for planning surgical approaches for amputation of the resulting necrotic tissue and for minimizing eventual tissue loss. Early surgical intervention is rarely indicated in cases of extremity gangrene unless a secondary infection is present. Allowing time for tissue demarcation and recovery can be essential for limb length preservation. Maintaining functional joints is important for long-term quality of life and activities of daily living.

Wilcox, B. J., et al. (2016). "Joint-Specific Play Controller for Upper Extremity Therapy: Feasibility Study in Children With Wrist Impairment." Physical Therapy 96(11): 1773-1781.
	BACKGROUND: Challenges with any therapeutic program for children include the level of the child's engagement or adherence. Capitalizing on one of the primary learning avenues of children, play, the approach described in this article is to develop therapeutic toy and game controllers that require specific and repetitive joint movements to trigger toy/game activation. OBJECTIVE: The goal of this study was to evaluate a specially designed wrist flexion and extension play controller in a cohort of children with upper extremity motor impairments (UEMIs). The aim was to understand the relationship among controller play activity, measures of wrist and forearm range of motion (ROM) and spasticity, and ratings of fun and difficulty. DESIGN: This was a cross-sectional study of 21 children (12 male, 9 female; 4-12 years of age) with UEMIs. METHODS: All children participated in a structured in-clinic play session during which measurements of spasticity and ROM were collected. The children were fitted with the controller and played with 2 toys and 2 computer games for 5 minutes each. Wrist flexion and extension motion during play was recorded and analyzed. In addition, children rated the fun and difficulty of play. RESULTS: Flexion and extension goal movements were repeatedly achieved by children during the play session at an average frequency of 0.27 Hz. At this frequency, 15 minutes of play per day would result in approximately 1,700 targeted joint motions per week. Play activity was associated with ROM measures, specifically supination, but toy perception ratings of enjoyment and difficulty were not correlated with clinical measures. LIMITATIONS: The reported results may not be representative of children with more severe UEMIs. CONCLUSIONS: These outcomes indicate that the therapeutic controllers elicited repetitive goal movements and were adaptable, enjoyable, and challenging for children of varying ages and UEMIs.

Willaert, J., et al. (2020). "Does a novel exergame challenge balance and activate muscles more than existing off-the-shelf exergames?" J Neuroeng Rehabil 17(1): 6.
	BACKGROUND: Novel balance-targeting exergames controlled with off-the-shelf hardware, were developed based on current recommendations for balance training in healthy older adults and documented shortcomings of existing games. The aim of this study was to explore the feasibility of these novel exergames as training tool for elderly and, more specifically whether these games can elicit more challenging weight shifts and higher levels of muscle activity compared to existing off-the-shelf exergames. Furthermore, the motivational pull in these new games was studied. METHODS: Sixteen healthy older adults were recruited to play the novel games and two reference games that were found to be the most challenging ones in terms of weight shifts or muscle activity in previous studies. Weight shifts were expressed relative to participants' Functional Limits of Stability (FLOS). Muscular challenge of the games was quantified by dividing the signal into 200 ms blocks and determining the average muscle activity within these blocks. The muscle activity was normalized to maximal voluntary contractions (MVC) to categorize the blocks in zones of < 40, 40-60, 60-80 and > 80% MVC. Subsequently, the number of blocks per intensity level and the number of consecutive blocks above 40% were determined. Motivation to play the games was assessed using the Intrinsic Motivation Inventory (IMI) and scores between the games were analyzed using Generalized Estimated Equations (GEE). RESULTS: The novel exergames successfully elicited center of mass (COM) displacements with medians of around 80% of FLOS or higher for all directions. Furthermore, the COM displacements in the novel games were larger for each direction than in the reference games, although for one game the sideward left direction reached significance only at the third trial. Compared to the existing games, longer blocks of muscle activation above 40% MVC were found, but overall intensity remained low. IMI scores were high on all subscales, indicating that older adults experienced the games as motivating. CONCLUSION: We conclude that affordable hardware can be used to create challenging and enjoyable balance training programs using exergames. The exergames that were successful in eliciting challenging weight shifts and muscle activity should now be further studied in longitudinal randomized controlled interventions, to assess effects on balance, muscle strength and eventually fall risk in healthy older adults.

Wilms, I. L. and S. Nielsen (2014). "Normative perceptual estimates for 91 healthy subjects age 60-75: impact of age, education, employment, physical exercise, alcohol, and video gaming." Frontiers in Psychology 5: 1137.
	Visual perception serves as the basis for much of the higher level cognitive processing as well as human activity in general. Here we present normative estimates for the following components of visual perception: the visual perceptual threshold, the visual short-term memory (VSTM) capacity and the visual perceptual encoding/decoding speed (processing speed) of VSTM based on an assessment of 91 healthy subjects aged 60-75. The estimates were modeled from input from a whole-report assessment based on a theory of visual attention. In addition to the estimates themselves, we present correlational data, and multiple regression analyses between the estimates and self-reported demographic data and lifestyle variables. The regression statistics suggest that education level, video gaming activity, and employment status may significantly impact the encoding/decoding speed of VTSM but not the capacity of VSTM nor the visual perceptual threshold. The estimates will be useful for future studies into the effects of various types of intervention and training on cognition in general and visual attention in particular.

Winkelmann, Z. K. and K. E. Games (2017). "Inguinal Disruption in an Elite Collegiate Basketball Player: A Case Report." International Journal of Athletic Therapy and Training 22(2): 1-6.
	An 18-year-old, male collegiate basketball athlete complained of right testicular pain following basketball activities. The patient's imaging denoted edema within the pubis at the insertion of the adductor longus tendon and rectus sheath aponeurosis consistent with inguinal disruption. The patient underwent conservative rehabilitation and attempted to return to participation with increased pain. Subsequently, the patient underwent surgery. Following surgical intervention, the patient underwent 6 weeks of rehabilitation with basketball-specific considerations. On conclusion, the patient was pain free and returned to activity. This case is unique due to the insidious onset, sport in which the patient participated, and failed conservative management.

Wise, K., et al. (2016). "Randomized Controlled Trial of a Perceptual Training Game for Tinnitus Therapy." Games for Health Journal 5(2): 141-149.
	OBJECTIVE: Abnormal executive top-down control of attention may result in, or be a consequence of, tinnitus. On the basis of a study indicating the feasibility of a game designed to treat tinnitus, a Phase II controlled trial of an auditory attention training game was undertaken. MATERIALS AND METHODS: Measures of tinnitus, as well as behavioral and electrophysiological measures of attention, were compared before and after 20 consecutive days of 30-minute training sessions using a game developed with LabVIEW software (National Instruments Corp., Austin, TX). Fifteen participants played an experimental attention training game ("Terrain"), and 16 participants played a control game ("Tetris") on their home computers. RESULTS: Clinically significant reductions in the primary measure, the Tinnitus Functional Index (TFI), were obtained for "Terrain." The secondary measures of Tinnitus Handicap Inventory and rating scales (ability to ignore and tinnitus annoyance) were significantly improved. The reductions in the TFI were correlated with improvements in a mixed auditory-visual task (Comprehensive Attention Battery((R)); NeuropsychWorks, Inc., Greensboro, NC) and reduction in N1 auditory-evoked potential latency to stimuli remote from tinnitus pitch. CONCLUSIONS: The results suggest that the attention training game may have reduced focus on the tinnitus, potentially through improved selective attention. "Terrain" was superior to "Tetris" in the population tested and therefore shows promise as a management option for tinnitus. Further testing in a larger, more general, population would be enabled through improving the game's accessibility.

Wojciechowski, M. (2018). "Putting the "FUN" Into Functional Recovery: Do some of your patients resist exercise? Try making it joyful." PT in Motion: 34-40.
	The article looks at the different fun-focused strategies that are being used by physical therapists to ensure the functional recovery of their patients who resist exercise. Topics mentioned include the incorporation of hippotherapy into a patient's plan of care, the use of video games that have good design principles, and the inclusion of dancing in neuromuscular reeducation.

Wood, S. R., et al. (2003). "Innovations in practice. Motivating, game-based stroke rehabilitation: a brief report." Topics in Stroke Rehabilitation 10(2): 134-140.
	Stroke-induced hemiparesis is a debilitating impairment that compromises ability to perform many activities of daily living (ADLs). Many new therapies for hemiparesis, although intriguing, require exceptional patient motivation and/or may be difficult to implement in some clinical situations. This brief report revisits a motivating, game-based rehabilitation modality reported nearly three decades ago that has heretofore been ignored. Pilot data, examining the feasibility and efficacy of the device, are presented.

Woods, A. and C. B. Woods (2012). "An exploration of the perspectives of elite Irish rowers on the role of the sports physiotherapist." Physical Therapy in Sport 13(1): 16-21.
	OBJECTIVE: The purpose of this study was to (i) explore the perceptions of elite Irish rowers on the role of sports physiotherapy during their sports career, (ii) to compare their information to the International Federation of Sports Physiotherapists (IFSP) competencies and standards and (iii) to use the information gathered to highlight issues regarding quality of sports physiotherapy services, and how these services could be enhanced. DESIGN: Participants completed a short open-ended questionnaire that evaluated the service provided by sports physiotherapists. Participant anonymity was protected and they were encouraged to be honest and critical of their experiences. RESULTS: Thirteen Irish rowers preparing for the 2008 world championships or the 2008 Olympic Games, with a minimum of nine years rowing experience and participation in international competitions within the 12 months prior to the study beginning participated in the study. Against the competencies and standards of the IFSP this elite group of athletes had a clear understanding of the role of the sports physiotherapist. They identified nine of the eleven competencies recommended by the IFSP for auditing a sports physiotherapist, and advocated the use of sports physiotherapists in all areas that could improve their performance. Reasons as to why the athletes missed two of the competencies are discussed.

Woods, E. N. (1999). "Special Olympics: taking care of the athletes." PT: Magazine of Physical Therapy 7(11): 26-33.
	With the Special Olympics World Summer Games hosted in their state, members of APTA's North Carolina Chapter launched a massive volunteer effort in support of healthy athletes.

Woodward, J. S., et al. (2012). "Non-surgical treatment of a professional hockey player with the signs and symptoms of sports hernia: a case report." International Journal of Sports Physical Therapy 7(1): 85-100.
	STUDY DESIGN: Case Report BACKGROUND: Injury or weakness of lower abdominal attachments and the posterior inguinal wall can be symptoms of a "sports hernia" and an underlying source of groin pain. Although several authors note conservative treatment as the initial step in the management of this condition, very little has been written on the specific description of non-surgical measures. Most published articles favoring operative care describe poor results related to conservative management; however they fail to report what treatment techniques comprise non-operative management. CASE PRESENTATION: The subject of this case report is a professional ice hockey player who sustained an abdominal injury in a game, which was diagnosed as a sports hernia. Following the injury, structured conservative treatment emphasized core control and stability with progressive peripheral demand challenges. Intrinsic core control emphasis continued throughout the treatment progression and during the functional training prior to return to sport. OUTCOME: The player completed his recovery with return to full competition seven weeks post injury, and continues to compete in the NHL seven years later. DISCUSSION: Surgical intervention has been shown to be effective in the treatment of the "sports hernia." However it is the authors' opinion that conservative care emphasizing evaluation of intrinsic core muscular deficits and rehabilitation directed at addressing these deficits is an appropriate option, and should be considered prior to surgical intervention.

Wormley, M. E., et al. (2022). "Doctoral physical therapy students' increased confidence following exploration of active video gaming systems in a problem-based learning curriculum in the United States: a pre- and post-intervention study." J Educ Eval Health Prof 19: 7.
	PURPOSE: Active video gaming (AVG) is used in physical therapy (PT) to treat individuals with a variety of diagnoses across the lifespan. The literature supports improvements in balance, cardiovascular endurance, and motor control; however, evidence is lacking regarding the implementation of AVG in PT education. This study investigated doctoral physical therapy (DPT) students' confidence following active exploration of AVG systems as a PT intervention in the United States. METHODS: This pretest-posttest study included 60 DPT students in 2017 (cohort 1) and 55 students in 2018 (cohort 2) enrolled in a problem-based learning curriculum. AVG systems were embedded into patient cases and 2 interactive laboratory classes across 2 consecutive semesters (April-December 2017 and April-December 2018). Participants completed a 31-question survey before the intervention and 8 months later. Students' confidence was rated for general use, game selection, plan of care, set-up, documentation, setting, and demographics. Descriptive statistics and the Wilcoxon signed-rank test were used to compare differences in confidence pre- and post-intervention. RESULTS: Both cohorts showed increased confidence at the post-test, with median (interquartile range) scores as follows: cohort 1: pretest, 57.1 (44.3-63.5); post-test, 79.1 (73.1-85.4); and cohort 2: pre-test, 61.4 (48.0-70.7); post-test, 89.3 (80.0-93.2). Cohort 2 was significantly more confident at baseline than cohort 1 (P<0.05). In cohort 1, students' data were paired and confidence levels significantly increased in all domains: use, Z=-6.2 (P<0.01); selection, Z=-5.9 (P<0.01); plan of care, Z=-6.0 (P<0.01); set-up, Z=-5.5 (P<0.01); documentation, Z=-6.0 (P<0.01); setting, Z=-6.3 (P<0.01); and total score, Z=-6.4 (P<0.01). CONCLUSION: Structured, active experiences with AVG resulted in a significant increase in students' confidence. As technology advances in healthcare delivery, it is essential to expose students to these technologies in the classroom.

Wriessnegger, S. C., et al. (2018). "Frequency Specific Cortical Dynamics During Motor Imagery Are Influenced by Prior Physical Activity." Frontiers in Psychology 9: 1976.
	Motor imagery is often used inducing changes in electroencephalographic (EEG) signals for imagery-based brain-computer interfacing (BCI). A BCI is a device translating brain signals into control signals providing severely motor-impaired persons with an additional, non-muscular channel for communication and control. In the last years, there is increasing interest using BCIs also for healthy people in terms of enhancement or gaming. Most studies focusing on improving signal processing feature extraction and classification methods, but the performance of a BCI can also be improved by optimizing the user's control strategies, e.g., using more vivid and engaging mental tasks for control. We used multichannel EEG to investigate neural correlates of a sports imagery task (playing tennis) compared to a simple motor imagery task (squeezing a ball). To enhance the vividness of both tasks participants performed a short physical exercise between two imagery sessions. EEG was recorded from 60 closely spaced electrodes placed over frontal, central, and parietal areas of 30 healthy volunteers divided in two groups. Whereas Group 1 (EG) performed a physical exercise between the two imagery sessions, Group 2 (CG) watched a landscape movie without physical activity. Spatiotemporal event-related desynchronization (ERD) and event-related synchronization (ERS) patterns during motor imagery (MI) tasks were evaluated. The results of the EG showed significant stronger ERD patterns in the alpha frequency band (8-13 Hz) during MI of tennis after training. Our results are in evidence with previous findings that MI in combination with motor execution has beneficial effects. We conclude that sports MI combined with an interactive game environment could be a future promising task in motor learning and rehabilitation improving motor functions in late therapy processes or support neuroplasticity.

Wright, J. (2011). "Isle of Man physios pull together for youth games." Frontline (20454910) 17(15): 8-9.
	
Wu, Y. N., et al. (2011). "Combined passive stretching and active movement rehabilitation of lower-limb impairments in children with cerebral palsy using a portable robot." Neurorehabilitation & Neural Repair 25(4): 378-385.
	BACKGROUND: Ankle impairments are closely associated with functional limitations in children with cerebral palsy (CP). Passive stretching is often used to increase the range of motion (ROM) of the impaired ankle. Improving motor control is also a focus of physical therapy. However, convenient and effective ways to control passive stretching and motivate active movement training with quantitative outcomes are lacking. OBJECTIVE: To investigate the efficacy of combined passive stretching and active movement training with motivating games using a portable rehabilitation robot. METHODS: Twelve children with mild to moderate spastic CP participated in robotic rehabilitation 3 times per week for 6 weeks. Each session consisted of 20 minutes of passive stretching followed by 30 minutes of active movement training and ended with 10 minutes of passive stretching. Passive ROM (PROM), active ROM (AROM), dorsiflexor and plantarflexor muscle strength, Selective Control Assessment of the Lower Extremity, and functional outcome measures (Pediatric Balance Scale, 6-minute walk, and Timed Up-and-Go) were evaluated before and after the 6-week intervention. RESULTS: Significant increases were observed in dorsiflexion PROM (P = .002), AROM (P = .02), and dorsiflexor muscle strength (P = .001). Spasticity of the ankle musculature was significantly reduced (P = .01). Selective motor control improved significantly (P = .005). Functionally, participants showed significantly improved balance (P = .0025) and increased walking distance within 6 minutes (P = .025). CONCLUSIONS: Passive stretching combined with engaging in active movement training was of benefit in this pilot study for children with CP. They demonstrated improvements in joint biomechanical properties, motor control performance, and functional capability in balance and mobility.

Wu, Y. Z., et al. (2019). "Effects of a hybrid intervention combining exergaming and physical therapy among older adults in a long-term care facility." Geriatrics & gerontology international 19(2): 147-152.
	AIM: Physical inactivity can cause physical frailty and sarcopenia. We investigated the effects of a hybrid intervention combining commercial exergaming with physical therapy, and clarified the reasons for physical inactivity among older adults. METHODS: This was a pilot study of older participants recruited from a long-term care facility assigned to either an experimental or a control group. The experimental group received a 90-min hybrid intervention twice a week for 12 weeks, whereas the control group received only assessment. The outcomes included muscle strength, walking speed, endurance, the Timed Up and Go test, the Berg Balance Scale, flow state, and safety. RESULTS: We enrolled 17 residents (42.5% of those eligible), with eight in the experimental group. After 12 weeks, the handgrip strength and Timed Up and Go test scores significantly improved in the experimental group. The number of participants with handgrip strength exceeding the cut-off for sarcopenia, Timed Up and Go test scores exceeding the minimal detectable change, and walking speed exceeding the minimum clinically significant difference were greater in the experimental group than in the control group. Furthermore, no significant adverse events were reported; all participants in the experimental group entered the flow state. Overall, 32.5% of participants reported physical inactivity with common reasons, including laziness (77%), a lack of interest (69%) and the hassle of engagement (46%). CONCLUSIONS: The hybrid intervention is safe and feasible, and could delay disability in older adults. Approximately one-third of the participants were physically inactive. Further study is required to reduce physical inactivity. Geriatr Gerontol Int 2019; 19: 147-152.

Wuang, Y. P., et al. (2011). "Effectiveness of virtual reality using Wii gaming technology in children with Down syndrome." Research in Developmental Disabilities 32(1): 312-321.
	This quasi-experimental study compared the effect of standard occupational therapy (SOT) and virtual reality using Wii gaming technology (VRWii) on children with Down syndrome (DS). Children (n = 105) were randomly assigned to intervention with either SOT or VRWii, while another 50 served as controls. All children were assessed with measures of sensorimotor functions. At post-intervention, the treatment groups significantly outperformed the control group on all measures. Participants in the VRWii group had a greater pre-post change on motor proficiency, visual-integrative abilities, and sensory integrative functioning. Virtual reality using Wii gaming technology demonstrated benefit in improving sensorimotor functions among children with DS. It could be used as adjuvant therapy to other proven successful rehabilitative interventions in treating children with DS.

Wynn, P. (2012). "Seasoned players." Today in PT 6(6): 22-24.
	
Xian, Y., et al. (2017). "An Initial Evaluation of the Impact of Pokemon GO on Physical Activity." Journal of the American Heart Association 6(5): 16.
	BACKGROUND: Pokemon GO is a location-based augmented reality game. Using GPS and the camera on a smartphone, the game requires players to travel in real world to capture animated creatures, called Pokemon. We examined the impact of Pokemon GO on physical activity (PA). METHODS AND RESULTS: A pre-post observational study of 167 Pokemon GO players who were self-enrolled through recruitment flyers or online social media was performed. Participants were instructed to provide screenshots of their step counts recorded by the iPhone Health app between June 15 and July 31, 2016, which was 3 weeks before and 3 weeks after the Pokemon GO release date. Of 167 participants, the median age was 25 years (interquartile range, 21-29 years). The daily average steps of participants at baseline was 5678 (SD, 2833; median, 5718 [interquartile range, 3675-7279]). After initiation of Pokemon GO, daily activity rose to 7654 steps (SD, 3616; median, 7232 [interquartile range, 5041-9744], pre-post change: 1976; 95% CI, 1494-2458, or a 34.8% relative increase [P<0.001]). On average, 10 000 "XP" points (a measure of game progression) was associated with 2134 additional steps per day (95% CI, 1673-2595), suggesting a potential dose-response relationship. The number of participants achieving a goal of 10 000+ steps per day increased from 15.3% before to 27.5% after (odds ratio, 2.06; 95% CI, 1.70-2.50). Increased PA was also observed in subgroups, with the largest increases seen in participants who spent more time playing Pokemon GO, those who were overweight/obese, or those with a lower baseline PA level. CONCLUSIONS: Pokemon GO participation was associated with a significant increase in PA among young adults. Incorporating PA into gameplay may provide an alternative way to promote PA in persons who are attracted to the game. CLINICAL TRIAL REGISTRATION: URL: http://www.clinicaltrials.gov. Unique identifier: NCT02888314.

xn3g, R. B. R. (2018). "Impact of active video game on adolescent health." https://trialsearch.who.int/Trial2.aspx?TrialID=RBR-2xn3g6.
	INTERVENTION: Behavioural G11.427.410.698.277 Intervention study with two comparison groups: a) Control group: 54 adolescents who are overweight or obese will not receive treatment. b) "Intervention" group: 54 overweight or obese adolescents should practice physical exercise provided by the use of the active videogame, performed three times a week, with 50 minutes each session, associated with gamification. CONDITION: E00‐E90 Obesity ; E66 PRIMARY OUTCOME: Improvement of cardiorespiratory function: measured by heart rate (measured by heart monitor) and by pulmonary function (through inspiratory and expiratory pressure, frequency, spirometry and manuvacometry), with expected effect of 0.6 points for each outcome. Data will be collected 2 weeks before and 1 week after the intervention. SECONDARY OUTCOME: Improvement of macrocirculation: assessed by carotid doppler. ; Improvement of the microcirculation, evaluated by maximum and resting blood flows, using the Laser Doppler flowmetry technique ; (LDF) with the VMS‐LDF® device (Moor Instruments, UK) with dual flow channel. ; Nutritional status: assessed by body mass index, determined by weight ratio divided by the square of height. ; Dyslipidemia: evaluated through biochemical markers for total cholesterol and fractions, and triglycerides, determined by colorimetric technique. ; Blood pressure: measured by tensiometer. ; For all parameters, the expected effect is 0.6 points. Data collected 2 weeks before and 1 week after the intervention. INCLUSION CRITERIA: To be enrolled and attending the classes from the 5th to the 9th year of the public school network of the urban area of ??Campina Grande‐PB selected for the study; being in the age group of 10 to 18 years; have nutritional status characterized as being overweight or obese.

Xu, L., et al. (2022). "The Effects of mHealth-Based Gamification Interventions on Participation in Physical Activity: Systematic Review." JMIR MHealth and UHealth 10(2): e27794.
	BACKGROUND: It is well known that regular physical exercise has associated benefits; yet, participation remains suboptimal. Mobile health (mHealth) has become an indispensable medium to deliver behavior change interventions, and there is a growing interest in the gamification apps in mHealth to promote physical activity (PA) participation. Gamification could use game design elements (such as points, leaderboards, and progress bars), and it has the potential to increase motivation for PA and engagement. However, mHealth-based gamification interventions are still emerging, and little is known about the application status and efficacy of such interventions. OBJECTIVE: This systematic review aims to investigate gamification apps in mHealth for improving PA levels and simultaneously summarize the impact of gamification interventions on PA participation. METHODS: We searched PubMed, Scopus, Web of Science, Embase, CINAHL (EBSCO host), and IEEE Xplore from inception to December 20, 2020. Original empirical research exploring the effects of gamification interventions on PA participation was included. The papers described at least one outcome regarding exercise or PA participation, which could be subjective self-report or objective indicator measurement. Of note, we excluded studies about serious games or full-fledged games. RESULTS: Of 2944 studies identified from the database search, 50 (1.69%) were included, and the information was synthesized. The review revealed that gamification of PA had been applied to various population groups and broadly distributed among young people but less distributed among older adults and patients with a disease. Most of the studies (30/50, 60%) combined gamification with wearable devices to improve PA behavior change, and 50% (25/50) of the studies used theories or principles for designing gamified PA interventions. The most frequently used game elements were goal-setting, followed by progress bars, rewards, points, and feedback. This review demonstrated that gamification interventions could increase PA participation; however, the results were mixed, and modest changes were attained, which could be attributed to the heterogeneity across studies. CONCLUSIONS: Overall, this study provides an overview of the existing empirical research in PA gamification interventions and provides evidence for the efficacy of gamification in enhancing PA participation. High-quality empirical studies are needed in the future to assess the efficacy of a combination of gamification and wearable activity devices to promote PA, and further exploration is needed to investigate the optimal implementation of these features of game elements and theories to enhance PA participation.

Xu, M., et al. (2021). "The Comparison of the Effects between Continuous and Intermittent Energy Restriction in Short-Term Bodyweight Loss for Sedentary Population: A Randomized, Double-Blind, Controlled Trial." International Journal of Environmental Research & Public Health [Electronic Resource] 18(21): 11645.
	OBJECTIVE: To compare the effects of continuous energy restriction (CER) and intermittent energy restriction (IER) in bodyweight loss plan in sedentary individuals with normal bodyweight and explore the influence factors of effect and individual retention. METHODS: 26 participants were recruited in this randomized controlled and double-blinded trial and allocated to CER and IER groups. Bodyweight (BW), body mass index (BMI), and resting metabolic rate (RMR) would be collected before and after a 4-week (28 days) plan which included energy restriction (CER or IER) and moderate-intensity exercise. Daily intake of three major nutrients (protein, carbohydrate, fat) and calories were recorded. RESULTS: A significant decrease in BW and BMI were reported within each group. No statistically significant difference in the change of RMR in CERG. No statistically significant difference was reported in the effect between groups, neither as well the intake of total calories, three major nutrients, and individual plan retention. The influence factors of IER and CER are different. CONCLUSION: Both CER and IER are effective and safe energy restriction strategies in the short term. Daily energy intake and physical exercise are important to both IER and CER.

Xu, R., et al. (2020). "Effects of long-term game-like aerobic training on cognitive function and daily mood of the elderly." Basic & clinical pharmacology & toxicology 126: 95‐.
	Background : Cognitive dysfunction is a progressive disease commonly seen in the elderly. It often progresses from light disease to severe disease and even develops into dementia. Although mild cognitive impairment (MCI) does not have a significant adverse effect on the daily lives of the elderly, it is important to prevent and treat MCI as necessary to prevent it from developing into dementia. Intervention of the MCI population by appropriate physical exercise can improve or delay the development of the disease, and has been widely recognized and concerned by both doctors and patients. Purpose : To observe the effect of long‐ term game‐ like aerobic training on adjuvant treatment of elderly patients with MCI, and to explore related treatment mechanisms. Methods : The long‐ term elderly residents in Jiaozuo City were selected as the objects of this study. According to the screening criteria of the basic data of the selected candidates, 290 elderly people who had no fitness exercise habits and 290 elderly people who have participated in aerobic training activities for more than 3 years were randomly selected, and the cognitive functions and daily emotional differences of the two types of elderly people were compared. In addition, a total of 42 patients with MCI were screened from the elderly people who had no fitness exercise habits and randomly divided into observation group and control group, each 21 patients in each group. The control group was treated with conventional oral drugs; while the observation group was given game‐ like aerobic training while receiving the same treatment as the control group. At the time of selection and after 6 months of treatment, the two groups of patients were evaluated and compared in terms of the indicators for their cognitive function, ability for daily living and sleep quality; and after the treatment, the satisfaction questionnaire survey was performed on them. Results : After testing and comparison, it was found that the indicators for cognitive function and daily mood of the elderly with game‐ like aerobic training habits of more than 3 years were significantly better than those without fitness exercises (all P < 0.05). After the 42 patients were divided into two groups which were treated for 6 months, the relevant observational indicators of both groups of the patients were significantly improved compared with those before the treatment (both P < 0.05). The comparison of the effects of improvement between the two groups showed that the effect of improvement of the observation group was significantly better than that of the control group ( P < 0.05), and the satisfaction of the observation group derived from the intervention was significantly better than that of the control group ( P < 0.05). Conclusion : Long‐ term game‐ like aerobic training can prevent or avoid cognitive decline in the elderly, and help to keep the good daily moods of the elderly. It has also been confirmed by experiments that, for elderly patients with MCI, the adjuvant intervention using game‐ like aerobic training methods can obviously improve the effect of conventional oral drug treatment, which is conducive to the rehabilitation of the patients and improve their quality of life.

Xu, W., et al. (2020). VirusBoxing: A HIIT-based VR boxing game. Ithaca, Cornell University Library, arXiv.org.
	Physical activity or exercise can improve people's health and reduce their risk of developing several diseases; most importantly, regular activity can improve the quality of life. However, lack of time is one of the major barriers for people doing exercise. High-intensity interval training (HIIT) can reduce the time required for a healthy exercise regime but also bring similar benefits of regular exercise. We present a boxing-based VR exergame called VirusBoxing to promote physical activity for players. VirusBoxing provides players with a platform for HIIT and empowers them with additional abilities to jab a distant object without the need to aim at it precisely. In this paper, we discuss how we adapted the HIIT protocol and gameplay features to empower players in a VR exergame to give players an efficient, effective, and enjoyable exercise experience.

Xu, W., et al. (2021). Effect of Gameplay Uncertainty, Display Type, and Age on Virtual Reality Exergames. Ithaca, Cornell University Library, arXiv.org.
	Uncertainty is widely acknowledged as an engaging gameplay element but rarely used in exergames. In this research, we explore the role of uncertainty in exergames and introduce three uncertain elements (false-attacks, misses, and critical hits) to an exergame. We conducted a study under two conditions (uncertain and certain), with two display types (virtual reality and large display) and across young and middle-aged adults to measure their effect on game performance, experience, and exertion. Results show that (1) our designed uncertain elements are instrumental in increasing exertion levels; (2) when playing a motion-based first-person perspective exergame, virtual reality can improve performance, while maintaining the same motion sickness level as a large display; and (3) exergames for middle-aged adults should be designed with age-related declines in mind, similar to designing for elderly adults. We also framed two design guidelines for exergames that have similar features to the game used in this research.

Xu, Y., et al. (2021). "A Depth Camera-Based, Task-Specific Virtual Reality Rehabilitation Game for Patients With Stroke: Pilot Usability Study." JMIR Serious Games 9(1): e20916.
	BACKGROUND: The use of virtual reality is popular in clinical rehabilitation, but the effects of using commercial virtual reality games in patients with stroke have been mixed. OBJECTIVE: We developed a depth camera-based, task-specific virtual reality game, Stomp Joy, for poststroke rehabilitation of the lower extremities. This study aims to assess its feasibility and clinical efficacy. METHODS: We carried out a feasibility test for Stomp Joy within representative user groups. Then, a clinical efficacy experiment was performed with a randomized controlled trial, in which 22 patients with stroke received 10 sessions (2 weeks) of conventional physical therapy only (control group) or conventional physical therapy plus 30 minutes of the Stomp Joy intervention (experimental group) in the clinic. The Fugl-Meyer Assessment for Lower Extremity (FMA-LE), Modified Barthel Index (MBI), Berg Balance Scale (BBS) score, single-leg stance (SLS) time, dropout rate, and adverse effects were recorded. RESULTS: This feasibility test showed that Stomp Joy improved interest, pressure, perceived competence, value, and effort using the Intrinsic Motivation Inventory. The clinical efficacy trial showed a significant time-group interaction effect for the FMA-LE (P=.006), MBI (P=.001), BBS (P=.004), and SLS time (P=.001). A significant time effect was found for the FMA-LE (P=.001), MBI (P<.001), BBS (P<.001), and SLS time (P=.03). These indicated an improvement in lower extremity motor ability, basic activities of daily living, balance ability, and single-leg stance time in both groups after 2 weeks of the intervention. However, no significant group effects were found for the FMA-LE (P=.06), MBI (P=.76), and BBS (P=.38), while a significant group interaction was detected for SLS time (P<.001). These results indicated that the experimental group significantly improved more in SLS time than did the control group. During the study, 2 dropouts, including 1 participant who fell, were reported. CONCLUSIONS: Stomp Joy is an effective depth camera-based virtual reality game for replacing part of conventional physiotherapy, achieving equally effective improvement in lower extremity function among stroke survivors. High-powered randomized controlled studies are now needed before recommending the routine use of Stomp Joy in order to confirm these findings by recruiting a large sample size.

y6f3j, R. B. R. (2018). "Effect of video game training and conventional physiotherapy on improving the balance of the elderly." https://trialsearch.who.int/Trial2.aspx?TrialID=RBR-7y6f3j.
	INTERVENTION: E02.760.169.063.500.387 Experimental Group: 10 elderlies will participate of 14 training sessions with 4 Kinect Adventures games. Control Group: 10 elderlies will participate of 14 training sessions of motor‐cognitive training. F04.754.137.506.662 CONDITION: Aged, postural balance, gait and cognition ; G11.427.690 ; E01.370.600.250 ; F02.463.188.331 E01.370.600.250 F02.463.188.331 G11.427.690 M00‐M99 PRIMARY OUTCOME: Expected outcome: Improvement of postural balance; ; Method used to verify expected outcome:; Mini‐Balance Evaluation Systems Test (MiniBest); ; Parameters: improvement of the postural control will be considered the increase of at least 10% in the total score of the Minibest after the intervention and 30 days after the end of the intervention. SECONDARY OUTCOME: Expected outcome: improvement in walking speed ; ; Method used to verify expected outcome: ; 10 meter walk test ; ; Parameters: an improvement in walking speed will be considered by increasing at least 10% of gait speed score obtained after intervention and 30 days after the end of the intervention. Expected outcome: improvement in working memory ; ; Method used to verify expected outcome: ; Memory Check‐up Test ; ; Parameters: memory improvement will be considered by increasing at least 10% of the score of the number of hits obtained after the intervention and 30 days after the end of the intervention. Expected outcome: improvement of cardio‐respiratory capacity ; ; Method used to verify expected outcome: ; 6‐minute step test ; ; Parameters: cardio‐respiratory capacity will be considered to be improved by at least 10% increase in the number of step increments obtained after the intervention and 30 days after the end of the intervention. Expected outcome: improvement of postural balance ; ; Method used to verify expected outcome: ; Posturography, data obtained from the records of the Accu Gait Optimized ™ force platform ; ; Parameters: a reduction of at least 10% in the displacement of the center of pressure (COP) during the orthostatic posture obtained after the intervention and 30 days after the end of the intervention will be considered an improvement of the postural balance. INCLUSION CRITERIA: Community dwelling elderly individuals, aged 65 years or over; of both sexes; with a functional state capable of remaining standing, and walking without assistance; without cognitive impairment in the Mini‐Mental State Examination89 (<18 for illiterate individuals and <26 for those with an educational level greater than 8 years); normal or corrected hearing acuity (Whisper Test)90; normal or corrected visual acuity (Snellen)91; with no prior experience with the games of the system; and who sign the Free and Clear Informed Consent.

y7m8z, R. B. R. (2016). "Treatment of efforts urine losses through conventional physical therapy and Virtual Games." https://trialsearch.who.int/Trial2.aspx?TrialID=RBR-6y7m8z.
	INTERVENTION: C12.777.934.852.249 E01.789.800 Gameterapia group: 38 women with stress urinary incontinence will exercises for the pelvic floor twice a week for two months using virtual games. The intervention consists of a heating phase 05 containing rapid contractions of the pelvic floor muscles (MAP), 5 slow contractions supported by three seconds of MAP, 3 cough simulations and 3 jumps on the trampoline. The rest time between exercises will be 30 seconds. Later the games will be held: Lotus Focus, Penguin Slide, Table Tilt and Balance Bubble. Between the first and fourth week, during the execution of the games will be held 2 sets of 8 repetitions of contractions of the MAP; between the fifth and eighth week will be held 3 sets of 8 repetitions of contractions of the MAP. The total duration of the intervention is 40 minutes. Group kinesiotherapy: 38 women with stress urinary incontinence will exercises for the pelvic floor twice a week for two months using virtual games. The intervention consists of a heating phase 05 containing rapid contractions of the pelvic floor muscles (MAP), 5 slow contractions supported by three seconds of MAP, 3 cough simulations and 3 jumps on the trampoline. The rest time between exercises will be 30 seconds. Later exercises will be conducted: diaphragmatic breathing, bridge exercises, abdominal exercises and mobility exercises pélvica.Entre the first and fourth week, during the execution of the games will be held 2 sets of 8 repetitions of contractions of the MAP; between the fifth and eighth week will be held 3 sets of 8 repetitions of contractions of the MAP. The board will be evolved every session, increasing 5 seconds in the exercise maintenance time. The total duration of the intervention is 40 minutes. Q65.060 CONDITION: C12.777.934.852.249 stress urinary incontinence ; C12.777.934.852.249 PRIMARY OUTCOME: Decrease the symptoms of stress urinary incontinence after two months of training, verified by the quality of life questionnaires applied. SECONDARY OUTCOME: Increased strength and coordination of the pelvic floor muscles after two months of training, verified through perineometry, ultrasound and electromyography of the perineal region. INCLUSION CRITERIA: 45 and 70 years of age; no hymen intact; have stress urinary incontinence in Pad Test 1 hour; unable to exercise for the muscles of the pelvic floor; their informed consent; not make use of hormone replacement therapy for three months; not have done perineoplasty; without prolapse grade III or IV; no history of epilepsy.

Yagüe Sebastián, M. P., et al. (2016). "Los videojuegos en el tratamiento fisioterápico de la parálisis cerebral." Fisioterapia 38(6): 295-302.
	Resumen Introducción En nuestro entorno, la parálisis cerebral (PCI) es la causa más frecuente de discapacidad física en población infantil. En la PCI existen alteraciones del tono que producen disfunciones posturales y de equilibrio. La fisioterapia es necesaria desde el nacimiento. El objetivo principal de este estudio es la mejora del desarrollo psicomotor del niño PCI con ayuda de los videojuegos en el tratamiento fisioterápico. Pacientes y método Es un diseño prospectivo, longitudinal, experimental pretest postest con un solo grupo. Participaron 8pacientes con PCI con edades entre 6 y 12años, nivel I-II en GMFCS y puntuación entre 75-100% en GMFM-88. La intervención fisioterápica emplea la videoconsola Nintendo Wii y el juego Wii-fit con tabla de equilibrio durante 15sesiones. Se estudió el equilibrio (escala de Berg), la distribución de cargas y localización del centro de gravedad (con el software de la tabla de equilibrio), así como la motivación en las sesiones de fisioterapia (medidas por una escala ad hoc). El estudio se realizó durante el curso 2013-2014 en la sala de fisioterapia de un colegio. Resultados Este estudio muestra una evidencia estadísticamente significativa que apoya la mejoría en equilibrio, en satisfacción del paciente y una redistribución más adecuada en la carga de miembros inferiores. Discusión y conclusiones La realidad virtual ayuda en la consecución de diferentes objetivos fisioterápicos, siendo interesante su uso para mejorar el equilibrio y el control postural. Los resultados obtenidos apoyan el uso de la videoconsola como un complemento, nunca un sustituto, del tratamiento fisioterápico en niños con PCI. Introduction In our environment, cerebral palsy (CP) is the most common cause of physical disability in children. The people with CP have problems with muscle tone and that cause musculoskeletal deformities and postural and balance disorders. Physiotherapy is required from birth. The main objective of this study is to improve psychomotor development of children with CP using video games in physical therapy treatment. Patients and methods A longitudinal, prospective experimental pretest posttest design type with one group. Participants were 8patients with CP aged between 6 and 12, I-II level in GMFCS and score between 75%-100% in GMFM-88. Physiotherapy intervention uses the Nintendo Wii console and the Wii-fit balance board game for 15 sessions. Balance (Berg scale), location load-distribution center of gravity (with the software of the balance board), and motivation in physical therapy sessions (measured by an ad-hoc scale) were studied. The study was conducted during the 2013-2014 school year in the physiotherapy room of a school. Results This study shows statistically significant evidence supporting the improvement in balance, in patient satisfaction and more adequate distribution in the load of the lower limbs. Discussion and conclusions Virtual reality helps in achieving different objectives of physiotherapy, with interesting use to improve balance and postural control. The results support the use of the Wii console as a complement, never a substitute, the child with PCI physiotherapist treatment.

Yamada, P. M. and J. Priest (2022). "Utilizing a Team Kinesiology Model to Support Rehabilitative Care in Patients." International Journal of Environmental Research & Public Health [Electronic Resource] 19(4): 2079.
	An approach that provides a standardized way of continuing rehabilitative care to help patients return to their lives and activities of daily living (ADL) in an economical and efficient manner is the Team Kinesiology Model (TKM). Many patients who are given a life-altering diagnosis (i.e., paralysis due to spinal cord injury, cerebral palsy, or cancer) are unable to return to employment, their family or a pre-diagnosis quality of life (QOL) given the current health care resources. This is a longstanding, and urgent problem as population aging and rising multi-morbidity is projected to negatively impact all regions of the world. Utilization of mid-level rehabilitation services is a proposed method to increase accessibility to all populations, including those of lower socioeconomic status or minority populations. Capitalizing on this idea, we describe two different programs that use the TKM to provide rehabilitative services to patients who were diagnosed with nervous system dysfunction or cancer. This model benefits the patient by improving physical fitness, psychosocial function, and QOL. Furthermore, we provide specific examples that show how this approach could have further-reaching impacts on society, education and research. Integrating kinesiologists and TKM in health care could assist in workflow, long-term health surveillance, rehabilitation and improvement of QOL.

Yang, Z., et al. (2018). "A Novel Methodology for Extracting and Evaluating Therapeutic Movements in Game-Based Motion Capture Rehabilitation Systems." Journal of Medical Systems 42(12): 255.
	Virtual rehabilitation yields outcomes that are at least as good as traditional care for improving upper limb function and the capacity to carry out activities of daily living. Due to the advent of low-cost gaming systems and patient preference for game-based therapies, video game technology will likely be increasingly utilized in physical therapy practice in the coming years. Gaming systems that incorporate low-cost motion capture technology often generate large datasets of therapeutic movements performed over the course of rehabilitation. An infrastructure has yet to be established, however, to enable efficient processing of large quantities of movement data that are collected outside of a controlled laboratory setting. In this paper, a methodology is presented for extracting and evaluating therapeutic movements from game-based rehabilitation that occurs in uncontrolled and unmonitored settings. By overcoming these challenges, meaningful kinematic analysis of rehabilitation trajectory within an individual becomes feasible. Moreover, this methodological approach provides a vehicle for analyzing large datasets generated in uncontrolled clinical settings to enable better predictions of rehabilitation potential and dose-response relationships for personalized medicine.

Yates, C., et al. (2008). "Traumatic dislocation of the hip in a high school football player." Physical Therapy 88(6): 780-788.
	BACKGROUND: Although traumatic dislocation of the hip often occurs as a result of automobile accidents, dislocations have been reported to occur during sports activities. OBJECTIVE: Using the experience in treating a 17-year-old high school football player with a posterior dislocation, complicated by involvement of the sciatic nerve, this case report provides background information on hip dislocations and provides a description of the immediate treatment by the physician, followed by 6 weeks of immobilization, and a detailed account of the 5-month intervention. CASE DESCRIPTION: The patient was injured while making a tackle during a high school football game when another player fell on him from behind. The case report describes his plan of care after immediate hip reduction surgery and 6 weeks on crutches. Generally, the program utilized a progression of non-weight-bearing resistance training and stretching in the initial stages of intervention and progressed to weight-bearing activities (on land and in the pool) as the patient was able to tolerate more stress. In addition, the treatment of the sciatic nerve using electrical stimulation during treadmill walking is described. OUTCOMES: The patient was seen in an outpatient physical therapy clinic an average of 2 times per week for 5 months. At the end of 5 months, results of the Lower Extremity Functional Scale (LEFS) indicated that recreational and sporting activities were within normal limits, and the patient was able to return to playing on his high school football team the next year.

Yates, M., et al. (2016). "Virtual reality gaming in the rehabilitation of the upper extremities post-stroke." Brain Injury 30(7): 855-863.
	BACKGROUND: Occurrences of strokes often result in unilateral upper limb dysfunction. Dysfunctions of this nature frequently persist and can present chronic limitations to activities of daily living. METHODS: Research into applying virtual reality gaming systems to provide rehabilitation therapy have seen resurgence. Themes explored in stroke rehab for paretic limbs are action observation and imitation, versatility, intensity and repetition and preservation of gains. Fifteen articles were ultimately selected for review. The purpose of this literature review is to compare the various virtual reality gaming modalities in the current literature and ascertain their efficacy. RESULTS: The literature supports the use of virtual reality gaming rehab therapy as equivalent to traditional therapies or as successful augmentation to those therapies. While some degree of rigor was displayed in the literature, small sample sizes, variation in study lengths and therapy durations and unequal controls reduce generalizability and comparability. CONCLUSIONS: Future studies should incorporate larger sample sizes and post-intervention follow-up measures.

Ye, S., et al. (2019). "Effects of School-Based Exergaming on Urban Children's Physical Activity and Cardiorespiratory Fitness: A Quasi-Experimental Study." International Journal of Environmental Research & Public Health [Electronic Resource] 16(21).
	BACKGROUND: Modern-day technology is appealing to children. Few studies, however, have conducted longitudinal analyses of a school-based exergaming program's effect on physical activity (PA) behaviors and fitness in children. Therefore, this study examined the longitudinal effect of an 8-month school-based exergaming intervention on children's objectively-measured PA and cardiorespiratory fitness (CRF). MATERIALS AND METHODS: Eighty-one fourth grade students (Xage = 9.23 +/- 0.62; 39 girls; 54.3% African American, 30.9% Non-Hispanic White, 14.8% other) participated in this study from 2014-2015. The intervention school's children participated in a once-weekly 50-minute exergaming intervention during recess throughout the school year, while the control school continued regular recess. Children's in-school PA and sedentary behavior (SB) were measured with ActiGraphGT3X+ accelerometers, with CRF assessed via the half-mile run. All measurements were taken at baseline, mid-intervention (four months) and post-intervention (eight months). Repeated-measures two-way ANCOVAs using age and race as covariates were conducted to examine between-school differences over time for SB, light PA (LPA), moderate-to-vigorous PA (MVPA), and CRF. RESULTS: Significant time by group interactions were observed for LPA, F(1, 79) = 7.82, eta(2) = 0.09, p < 0.01, and MVPA, F(1, 79) = 4.58, eta(2) = 0.06, p < 0.05, as LPA increased among the control group, while MVPA increased among intervention group. Children in both groups experienced decreased SB during the intervention (intervention: -7.63 minutes; control: -17.59 minutes), but demonstrated lower CRF over time (intervention: +46.73 seconds; control: +61.60 seconds). CONCLUSIONS: Observations suggested that school-based exergaming implementation may be effective in increasing children's MVPA and decreasing their SB over the course an academic year (i.e., ~eight months). More research is needed, however, to discern how modifications to school-based exergaming might also promote improved CRF in children.

Yeh, T. M., et al. (2019). "The Factors Affecting Older Adults' Intention toward Ongoing Participation in Virtual Reality Leisure Activities." International Journal of Environmental Research & Public Health [Electronic Resource] 16(3).
	Due to the aging of organs, older adults may have limited physical strength for participating in outdoor activities. Therefore, indoor activities offer an alternative for maintaining the health of older adults. Following advances in technology, individuals can use virtual reality to exercise in their homes and are no longer subject to the constraints of the outdoor environment or weather conditions. In addition, these activities are easier to participate in when compared to real-world leisure activities. The present research included 294 older adults as its research subjects. They were given firsthand experience of Wii games for 10 weeks, in order to examine the ongoing participation intention of older adults following an experience with virtual reality leisure activities. The study found that experience attributes, experience consequences, and experience values were important factors in determining ongoing participation intention and can effectively predict ongoing participation intention. Four experience attributes-ease of use, usefulness, safety and flexibility, and fun-significantly influenced the experience value and experience consequences of older adults' participants. Experience values also influenced ongoing participation intention.

Yildirim, Y., et al. (2021). "The Effect of Video-Based Games on Hand Functions and Cognitive Functions in Cerebral Palsy." Games for Health Journal 10(3): 180-189.
	Objective: The purpose of this study is to investigate the effect of Leap Motion Based Exergame Therapy (LMBET) on upper limb gross grip strength (GGS), pinch forces, hand functions, gross motor function, and cognitive functions in patients with cerebral palsy (CP). Materials and Methods: Twenty patients with CP (11 hemiplegia and 9 diplegia) were included in the study. Structured Neurodevelopmental Therapy-based hand rehabilitation (SNDTBHR) (first treatment period) was applied a total of 12 sessions, 2 sessions per week (total 6 weeks), and then LMBET (second treatment period) was applied a total of 12 sessions, 2 sessions per week (total 6 weeks). GGS was evaluated by "dynamometer," pinch strengths were evaluated by "pinch meter," hand skills were evaluated by "Manual Ability Classification System (MACS)" and "Jebsen-Taylor Hand Function Test (JHFT)," the gross motor level was evaluated by "Gross Motor Function Classification System (GMFCS)," and cognitive functions were evaluated by "Wisconsin Card Sorting Test (WCST)." Results: Significant difference was found between LMBET and SNDTBHR on GGF, pinch forces, JHFT, and WCST in favor of LMBET (P < 0.017). There was no significant difference between both MACS and GMFCS measurements (P > 0.05). Conclusion: Positive effects of both SNDTBHR and LMBET have been found. However, measurements after LMBET are statistically more significant. Future research should take into account higher patient allocation. Including additional leap motion training to conventional physiotherapy is feasible and might be promising to train cognitive function in children with CP.

Yılmaz Demiriz, S. and A. E. Baki (2018). "Effect of game based exercise programs on pain, functional mobility and balance in patients with knee osteoarthritis: Randomized controlled study." Annals of physical and rehabilitation medicine 61: e480-e481.
	Introduction/Background The aim of this study was to evaluate the effects of virtual reality games on knee pain, functional mobility and balance in patients with knee osteoarthritis. Material and method Fifty patients who were complaining of knee pain, aged 40–70 years, and were diagnosed with Kellgren-Lawrence stage 2, 3, 4 idiopathic knee osteoarthritis were included. Patients were randomly assigned to two equal groups (n=25) as the control and the study group. Age, sex, weight, height, duration of illness was recorded for all patients. In the bilateral two-way knee radiography; Kellgren-Lawrence score of the knee with the higher visual analog scale (VAS) pain score was recorded. Conventional physical therapy program, associated with knee osteoarthritis exercises, was applied routinely to all patients with knee osteoarthritis for three weeks. In the study group, all patients received virtual reality game-based exercise program by using a game console. In both groups, baseline and final values of VAS score, osteoarthritis index total score (WOMAC), and intra-community balance and mobility scale (CB&M) score of each patient were recorded. Mann-Whitney U and Independent Samples T tests were used for statistical analysis, and P-value less than 0.05 was considered significant. Results In both groups, significant change in VAS, WOMAC osteoarthritis index, and CB&M score was observed (P<0.05). In the study group, VAS, WOMAC osteoarthritis index, and CB&M scores were significantly different than control group (P<0.05). The differences between baseline and final scores of VAS and WOMAC were significantly higher (P<0.05) in study group. Conclusion The results of the present study showed that virtual reality game-based exercise programs performed better results than conventional treatment program in patients with knee osteoarthritis.

ynppq, R. B. R. (2020). "Study of the effect of serial casting on children with disabilities." https://trialsearch.who.int/Trial2.aspx?TrialID=RBR-5ynppq.
	INTERVENTION: Device Orthotic Devices Serial Casting Group (Group of children with Cerebral Palsy who will use serial casting boots for 30 days) Orthosis Group (Group of children with Cerebral Palsy who will use continuous orthosis for 30 days) Control Group (Group of children with Cerebral Palsy who will not perform specific interferences for 30 days) All will be evaluated before and after the intervention. CONDITION: Cerebral Palsy ; Infantile cerebral palsy G00‐G99 Infantile cerebral palsy PRIMARY OUTCOME: It is expected to find an increase in ankle range of motion through the use of serial plaster, evaluated using a goniometer and analysis of joint angles using photos and specific software. SECONDARY OUTCOME: It is expected to find higher scores in the real and virtual games, improvement of the static and dynamic balance, evaluated through the virtual game software itself that offers engine performance scores and data, in addition to scores in the real game. The improvement of the static and dynamic balance will be evaluated using the baropodometer. INCLUSION CRITERIA: Children aged 3 to 10 with a diagnosis of Cerebral Palsy levels GMFCS I, II and III who are able to understand simple commands and who are able to understand the virtual game previously presented; individuals who are in attendance at Therapies and other clinics and / or institutions, disregarding the physiotherapy sessions performed by each child; Children who have not undergone bone surgery and / or arthrodesis; have not applied botulinum toxin or serial plaster in the past six months; who have not undergone muscle‐tendon surgeries in the past year and have not undergone intensive treatment during the application of serial plaster; All participants must have a free and informed consent form signed by the legal guardian. In addition to the informed consent form signed by the child.

Youn, S. W., et al. (2015). "The effect of audiovisual biofeedback exercise on standing balance and gait in chronic hemiplegia." Physiotherapy 101: e751-e752.
	Background: Rehabilitation process of the hemiplegic patient is taken a balance and upright posture by providing a stimulus to affected side leg through the visual, auditory, somatosensory feedback. As a result, symmetric gait become recover. Purpose: To elucidate the effect of body driven game type audiovisual biofeedback exercise on the balance ability and gait of chronic hemiplegic patients. Methods: Subjects were 28 chronic hemiplegic patients (M 16, F 12) and they were divided into an audiovisual biofeedback exercise group and a general nervous system exercise group and the two groups performed their respective exercise. In this study, kinetic and clinical balance and gait evaluation tools were applied before and after total 4 week exercise program. To evaluate dynamic balance ability, functional forward reaching tests (FFRT) and timed up and go tests (TUGT) were conducted and to evaluate static balance ability, postural stability tests and weight distribution tests were conducted using balance ability evaluation equipment. The date were processed using the SPSS statistics program for windows by conducting Wilcoxon matched‐pairs signed ranks tests which are non‐parametric tests in order to verify differences of each group between before and after the exercise and conducting Mann‐Whitney U tests which are again non‐parametric tests in order to find out differences between the groups. Results: 1. Through the FFRT and TUGT which is a clinical balance evaluation tool, it was confirmed that dynamic balance and gait ability was improved after the exercise compared to before the exercise in both of the groups (p = .00). Through difference between the two groups, it was confirmed that dynamic balance and gait ability was improved more in the audiovisual biofeedback exercise group compared to the general nervous system exercise group (p < .05). 2. Through the postural stability and weight distribution tests, it was confirmed that static balance ability was improved only in the audiovisual biofeedback exercise group after the exercise compared to before the exercise (p < .05). 3. Through the balance ability tests following head rotations, it was confirmed that static balance ability was improved only in the audiovisual biofeedback exercise group after the exercise compared to before the exercise (p < .05). Conclusion(s): The body driven game type audiovisual biofeedback exercises are more effective in improving balance and gait ability of chronic hemiplegic patients than general nervous system exercise therapies. Implications: It is considered that in future, studies on the applications of diverse biofeedback exercises for a long time are necessary.

yrddt, R. B. R. (2019). "Effects of sports and functional training in quality of life of adults with visual impairment." https://trialsearch.who.int/Trial2.aspx?TrialID=RBR-6yrddt.
	INTERVENTION: Exercise Games, Recreational Group 1: 12 adults with visual impairment will participate the 30 classes (10 weeks with three weekly classes) with sports in Borg ratings of perceived exertion from 3 to 5 in five first weeks and from 6 to 9 in the other weeks. Group 2: 12 adults with visual impairment will participate the 30 classes (10 weeks with three weekly classes) with functional training in Borg ratings of perceived exertion from 3 to 5 in five first weeks and from 6 to 9 in the other weeks. After the ten weeks of intervention, there will be a four week washout for both groups. Then, another ten weeks of training inverting the groups. Other Physical Education and Training Physical exertion CONDITION: Blindness and low vision Blindness; Low vision ; Blindness and low vision H00‐H59 PRIMARY OUTCOME: Levels of physical fitness determined by handgrip strength (strength), sit‐and‐reach test(flexibility) , one‐minute maximal repetition of abdominals (abdominal muscular endurance) and 6‐minute running‐walk test (aerobic power) SECONDARY OUTCOME: Enjoyment in the practice of physical exercises determinated by Physical Activity Entertaiment Scale Quality of life level determinated by WHOQOL questionnaire INCLUSION CRITERIA: The inclusion criteria for the study were to be in the age group of 18 years to 59 years and to have visual impairment (vision worse than 20/60) clinically proven.

Yu, C. W., et al. (2020). "Development and Preliminary Usability Evaluation of a Somatosensory Square Dance System for Older Chinese Persons: Mixed Methods Study." JMIR Serious Games 8(2): e16000.
	BACKGROUND: Chinese square dancing, known as guangchang wu in Chinese, is a well-known public fitness activity that provides an entertaining way for older Chinese women to improve their flexibility, lower extremity strength, overall coordination, and balance. However, injuries, noise conflicts, and lack of space are challenging aspects of this activity. Somatosensory games (SG) are an increasingly popular physical fitness approach to enhance the selective attention of older persons with indoor engagement and exercises. OBJECTIVE: The objectives of this study were to develop a newly designed somatosensory square dance system for older Chinese people and to evaluate its usability. METHODS: This is a mixed methods study. The newly designed somatosensory square dance system is a somatic training tool that provides adequate Chinese square dance fitness training based on Laban Movement Analysis (LMA) and design guidelines established in a previous stage. The usability evaluation involved a questionnaire and interviews. Twelve participants were interviewed before and after experiencing the 15-minute dancing and learning process within the program. In addition, participants scored their experience satisfaction in psychological, physiological, and relaxation sections on a scale of 1 to 5 using a questionnaire. Qualitative content analysis and quantitative analysis of the satisfaction scores supported understanding of usability problems. RESULTS: Based on the interview results, 6/12 (50%) of the participants thought the system could help them correct their dancing movements indoors without being affected by poor outdoor weather. Among the participants, 3/12 (25%) indicated that this indoor system could enable them to enjoy fitness activities in a private space. Moreover, 3/12 participants (25%) stated that this system could promote family relationships by providing easy dancing movements. All participants were highly satisfied with the relaxation aspect of the system (4.45/5). The participants were all psychologically satisfied and interested in the novel features of the system, with an average score of 4.16/5. Physiologically, participants affirmed that the system could help them maintain good health (4.91/5). CONCLUSIONS: The results of this study suggest that the somatosensory square dance system can be used as an indoor fitness tool to improve older Chinese square dancers' health conditions with reasonable dance training. Noise and space conflicts can be addressed. The Laban Elated Square Dance system, which was modified by therapists based on LMA and square dance design guidelines, was highly approved by dancers because it decreased the possibility of injuries, falls, and joint damage by considering the physical and psychological difficulties of older persons. Different features will be considered in the next stage, such as greater selection of exercises and difficulty level settings. Users' social needs will also be explored in subsequent stages.

Yu, R., et al. (2021). "Randomized Controlled Trial on the Effects of a Combined Intervention of Computerized Cognitive Training Preceded by Physical Exercise for Improving Frailty Status and Cognitive Function in Older Adults." International Journal of Environmental Research & Public Health [Electronic Resource] 18(4).
	(1) Objective: This study examined the effects of a combined intervention of Brainastic computerized cognitive training (CCT) preceded by physical exercise (PE) for improving frailty status and cognitive function in older adults. (2) Methods: Older adults aged 50 years or older attending elderly centers, without frailty/history of cognitive impairment, were randomly allocated into either a 12-week (i) multi-domain CCT + PE (n = 117), (ii) two-domain CCT + PE (n = 116) or (iii) video watching + PE (i.e., control, n = 114). Brainastic is an online application for cognitive training through video games. The multi-domain CCT targeted memory, attention, executive function, flexibility and visuospatial ability while the two-domain CCT targeted memory and attention. PE included both aerobic and resistance exercises. Outcomes were changes in frailty levels as measured with a simple frailty questionnaire (FRAIL), global cognition as measured with the Rapid Cognitive Screen (RCS), total learning and verbal memory abilities as measured with the Hong Kong List Learning Test (HKLLT), and executive functions as measured with the Frontal Assessment Battery (FAB) over 12 weeks. (3) Results: Participants in the intervention groups (multi-/two-domain CCT + PE) showed greater improvements in frailty status, total learning ability and verbal memory ability than control participants (all p < 0.05). The multi-domain CCT did not outperform the two-domain CCT in improving frailty status or cognitive function. The training effects were independent of the baseline cognition of the participants. (4) Conclusions: A combined intervention of multi-/two-domain CCT preceded by PE seemed to convey benefit over video watching preceded by PE in improving frailty status and cognitive function among older adults attending elderly centers.

Yu, T. C., et al. (2020). "Effects of Exergames on Physical Fitness in Middle-Aged and Older Adults in Taiwan." International Journal of Environmental Research & Public Health [Electronic Resource] 17(7): 2565.
	Using exergaming for exercise training was found to improve physical fitness. Yet, few studies have used the "Xbox Kinect" to examine its effects on physical fitness in healthy middle-aged and older adults. The purpose of this study was to investigate the effect of 10-weeks of Xbox Kinect training on physical fitness in healthy middle-aged and older adults. Forty participants (average 64.00 +/- 4.44 years old, eight males and 32 females) were randomized to either intervention (n = 20) or control group (n = 20). The intervention group played Xbox Kinect three times per week, for an average of 50 min per session for 10 weeks. The control group was instructed to maintain their levels of physical activity. All the participants completed assessments of body composition, muscle strength, flexibility, balance and cardiopulmonary endurance at baseline and after 10-week intervention. After 10 weeks of training, the intervention group showed significant improvements in cardiopulmonary endurance and leg muscle strength. Moreover, there were significant differences between the intervention and control group in changes in aerobic fitness and leg muscle strength. The exergame program effectively improved cardiopulmonary endurance and leg muscle strength in healthy middle-aged and older adults. It could be an alternative to conventional exercise.

Yue, S. (2021). "Image recognition of competitive aerobics movements based on embedded system and digital image processing." Microprocessors and Microsystems 82: 103925.
	Aerobics Exercise in the form of exercise that combines rhythmic aerobic exercise with stretching and strength training practices improves all the elements. The main purpose of designing the system for receiving the aerobics image is to train based on motion recognition technology. To establish a link between aerobics social adaptation and students’ cultivation at different levels through the impact of experimental data related to aviation training, empirical inquiry, and analysis. The most popular aerobic exercise machine on the treadmill. There are handrails on the treadmill, which is perfect for recovering from an injury. Just like any cardio exercise for a heart-pumping, it can help reduce the risk of heart disease and other chronic diseases, improve sleep, improve your mood, and increase brain function. It is very important to implement training programs that are the best medicine for the heartbeat's precise control (manpower) during exercise on the automatic and treadmill. Treadmill embedding technology can enhance disposal intelligence and add additional features. Treadmill system structure and work patterns are analyzed by scientifically embedded technology and control system design. The systems’ hardware layout is explored and designed, effectively combining embedded technology and serial communication technology to achieve optimal optical treadmill science display layout and game parameters. Therefore, the treadmill control system based on embedded technology has high-cost performance, low cost and relatively complete fashion characteristics, and has a good usability opportunity.

Yusop, N. M. M., et al. (2021). "Measuring the Effectiveness of Exergames among Gen Z using Kinect Sensor and EEG." Turkish Journal of Computer and Mathematics Education 12(3): 1502-1508.
	Nowadays, generation Z are not interested in applying the traditional method in sports or learning activity. General observation found that primary students nowadays are eagerly using technology during learning or sports activity. Exergames using Kinect is one of the solutions to encourage the interest of generation z. This research focusses on the Effectiveness of Exergames using Kinect Sensor among primary students. The research also uses EEG measurement to prove the attention level of students during this activity. The emphasis of this paper is the student's performance and their level of focus. The signals from the EEG set are acquired while the students are playing the games and the Kinect sensor will be able to sense their movements during the session. The Kinect sensor can sense the users' whole body movement and physical activity that makes it more flexible in terms of area of monitoring. Finding from previous research shows that Exergames using Kinect Sensor is more fun and relaxing to increase the attention level of primary students._

z4f, R. B. R. (2016). "Comparison of training with video games and conventional physiotherapy on balance, gait, breathing, memory and quality of life of the elderly: a randomized clinical trial." http://www.ensaiosclinicos.gov.br/rg/RBR-4z4f48/.
	Inclusion criteria: Seniors will be selected aged 60‐80 years; of both genders; which did not show neurological and orthopedic disorders that promote disability of the elderly remain in bipedalism and wade unaided or cardiovascular disease uncompensated such as: angina; heart failure; high blood pressure decompensated; show no signs of cognitive impairment; the normal or corrected visual acuity measured by Snellen chart; normal or corrected hearing is clinically assessed by the whisper of the test; who did not have previous experience with the Kinect system and accepting to participate by signing the Informed Consent and Informed. Exclusion criteria: The elderly will be excluded that during the study period submit any clinical change that makes it impossible to perform physical exercises in standing position as: cardiorespiratory; orthopedic or neurological disorders; seniors who are missing for more than three consecutive sessions without replacement. Aged, postural balance, gait, cognition, quality of life, breath. G11.427.690 G11.561.600.810.541.595 F02.463.188 E01.370.600.250 G11.427.590.530.389 I01.800 K01.752.400.750 SP4.011.077.593 G09.772.770.755 M01.060.116.100;M00‐M99;G11.427.690;G11.561.600.810.541.595;F02.463.188;E01.370.600.250;G11.427.590.530.389;I01.800;K01.752.400.750;SP4.011.077.593;G09.772.770.755;M01.060.116.100 This study it is a randomized clinical trial, which will have an experimental group that will exercise using virtual reality through commercial games video game and an active control group will make a sensory motor training circuit which will be described below. The experimental group (Virtual Reality) will have 16 community elders that is healthy elderly, eight male and eight female, aged 60‐80 years. The control group (sensory motor circuit training) will have 16 community elders that is healthy elderly, eight male and eight female, aged 60‐80 years. Totaling 32 community elders. Virtual reality group (experimental group): group of 16 patients will practice four games Kinect Adventure program! Xbox 360 developed by Microsoft. The virtual reality group sessions will be held individually, lasting an hour each session, twice a week for seven weeks. Each game will have five attempts, and the first three attempts carried out with the help of a physical therapist to correct the movements and posture of patients through the manual and verbal commands directing. The last attempt will be made without interference from the physical therapist for the record score and further analysis of the performance of the participants. Patients remain standing in front of a TV 50 ". The Kinect system games are based on the capture of the player's movements through cameras with infrared sensors signals.In this way, the movement of the player captured by the camera is reproduced by an avatar in the virtual gaming environment. Therefore, patients will interact with the game by means of body movements in accordance with the rules of each game. Overall, the games stimulate quick multidirectional movements and controlled the center of gravity, multidirectional steps, squats, jumps, coordinated movements of upper and lower limbs and trunk movements in the three plans. In addition, the games have cognitive demands as quick decision making, environmental monitoring, selection of visual stimul;E02.779;I03.450.642.693.930;F04.754.137.506.662;E02.779.483;G11.427.590.530.698.277;F04.754.137.301.500 The primary endpoint will be the performance on the Mini bestest test, which is an assessment tool of postural control, consists of 14 items that focuses on the dynamic equilibrium, comprising four domains: anticipatory postural adjustments (transition from the sitting position posture to biped, stay on fingertips, one foot); postural responses (in four different directions‐ previous, posterior, lateral‐lateral); sensory orientation (equilíbrio‐ with open eyes; instável‐ surface with eyes closed, tilt‐with eyes closed); and balance during walking (with change of speed, horizontal head movement, spins, hu dle associated with the dual task). And the 14 items are: evaluation of postural change from sitting to standing; stand on tiptoe; standing on one leg; correction with compensatory step forward, backward, side; eyes opened on a firm surface; eyes closed, foam surface; slope with closed eyes; change in gait speed; walk with head movements; floor and turn on the axis; pass over obstacles and Get up and Go timed double task. Each item is scored from zero to two; a score of zero indicates that a person is unable to perform the task, while the score two is normal. The best score is the maximum amount of points, 32 points. The test reliability coefficients for items and individuals ranging from .91 to .98, indicating stability and the ability of reproduction of the measures in subsequent applications. It is expected that the patients after interventions (video game or functional sensory motor training) present values of at least two points higher after the interventions proposed. That is, so there is a significant clinical difference one has to get two points from the initial score. The secondary endpoint of the study will be: marching, cognition, cardiorespiratory fitness and quality of life, mood will be evaluated by the respective tests and questionnaires. The march will be evaluated by the Dynamic Gait Index (DGI), Functional Gait Assessment (FGA), walk test ten meters (TC10M). Dynamic Gait Index (DGI) is a tool for functional mobility assessment, evaluates the individual's ability to modify the march in response to changing demands of certain tasks in elderly individuals with impairments in balance. It consists of eight tasks involving gait in different sensorial contexts, which include flat surface, changes in gait speed, horizontal and vertical movements of the head, go over and around obstacles; turn on your own body axis, up and down stairs . Items are scored from zero to three, in which 0 indicates severe impairment and 3 ordinary skill, with a maximum score of 24. In order to have clinical significance after the interventions (game or functional sensory motor training) gain of 1.90 points is required to total sample; gain of 1.80 points in subjects with a score lower than 21 points and won 0.60 in subjects with scores above 21 points. Functional Gait Assessment (FGA) is an instrument that assesses postural stability under various conditions in the march. These conditions are: walking on a flat surface; changing gait speed; march with horizontal movements of the head; march with head nodding; turn and spin on its own axis; go over obstacles; up and down stairs; walk back; walk with reduced base and floor with eyes closed. Each item is scored from zero to three: a score zero indicates that the person is unable to perform the task, while a score indicates three levels of normality. The best score is the maximum amount of points, and 30. In order to have clinical significance after the interventions (game or functional sensory motor training) the gain of at least 10% of the initial value is required. Random example: initial value 25 points the final value has to be at least 27.5 points. The walk test ten meters is an instrument used to assess the spatial and temporal attributes kinematic gait. It assesses the speed of the march, by measuring the time that a person needs to travel a distance of ten meters. So that there is clinically significant after the intervention (game or functional sensory motor training) it is necessary to gain at least 0.05 m / s. Cognition is evaluated by the Montreal Cognitive Assessment (MoCA) which is a brief cognitive evaluation test, specifically developed for the assessment of milder forms of cognitive impairment, which provides a quick measure of global cognitive status of the subject. The MoCA evaluate a wide range of cognitive domains, such as: executive functions; visuospatial ability; short‐term memory; language; attention, concentration; working memory and temporal orientation and espacial.A score of this test may vary from zero to thirty points. To have clinical significance after nt rvention (game or functional sensorimotor training) the gain of at least 10% of the initial value is necessary. Random example: initial value 25 points the final value has to be at least 27.5 points. The quality of life will be assessed by quality of life questionnaire WHOQOL‐OLD elderly that has aimed to measure the individual's satisfaction with his life and his perception of the influence that the diseases cause in your life. This questionnaire consists of 24 items with response from one to five, divided into six areas. Domains are: autonomy (independence of the elderly; be able and free to live autonomously and make their own decisions.); operation of directions (impact of the loss of runs senses the quality of life.); past, present and future activities (satisfaction with the achievements in life and goals to be achieved.); social participation (participation in activities of social life, especially those linked to the community.); death and dying (worries and fears about death and dying.); and intimacy (being able to have intimate and personal re ationships. The maximu score achieved is 100 points. In order to have clinical significance after the interventions (game or functional sensory motor training) the gain of at least 10% of the initial value is required. Example random: initial value 80 points the final value has to be at least:. 88 points the mood will be assessed by the geriatric depression scale 15 (GDS‐15) is an instrument used to detect mood and depression in the elderly, consisting of 15 issues, to which the individuals answered yes or no, exploiting the individual has or no signs of depression. for each response indicative of depression added to 1‐point. the scale is from 0 to 15 points, so that the the higher the score, the greater the signs of depression. in order to have clinical significance after the interventions (game or functional sensory motor training) decreased score of at least 10% of the initial value is required. Random example: initial value 10 points the final value has to be at least: 9 points. Cardiorespiratory capacity will be assessed by the six‐minute step test (TD6) that has aimed to verify the cardiorespiratory capacity. The subject is instructed to walk up and down the step for six minutes, aiming at the highest possible number of steps at this time (free rhythm) and can merge the lower limbs, without the support of the upper limbs, which remained stationary throughout the body. oxygen saturation is checked, heart rate, blood pressure and symptoms of dyspnea and fatigue of the lower limbs were found at rest and immediately after the tests and the recovery period. For analysis, we used only test performance (number of ascents on the step). To have clinical significance after intervention (game or functional sensorimotor training) the gain of at least 10% of the initial value is necessary. Random example: initial value 100 steps the final value has to be at least 110 steps.

Zadro, J. R., et al. (2017). "Video-game based exercises for older people with chronic low back pain: a protocol for a feasibility randomised controlled trial (the GAMEBACK trial)." Physiotherapy 103(2): 146-153.
	OBJECTIVES: To investigate the feasibility of implementing a video-game exercise programme for older people with chronic low back pain (LBP). DESIGN: Single-centred single-blinded randomised controlled trial (RCT). SETTING: Physiotherapy outpatient department in a public hospital in Western Sydney, Australia. PARTICIPANTS: We will recruit 60 participants over 55 years old with chronic LBP from the waiting list. INTERVENTIONS: Participants will be randomised to receive video-game exercise (n=30) or to remain on the waiting list (n=30) for 8 weeks, with follow up at 3 and 6 months. Participants engaging in video-game exercises will be unsupervised and will complete video-game exercise for 60minutes, 3 times per week. Participants allocated to remain on the waiting list will be encouraged to maintain their usual levels of physical activity. MAIN OUTCOME MEASURE: The primary outcomes for this feasibility study will be study processes (recruitment and response rates, adherence to and experience with the intervention, and incidence of adverse events) relevant to the future design of a large RCT. Estimates of treatment efficacy (point estimates and 95% confidence intervals) on pain self-efficacy, care seeking, physical activity, fear of movement/re-injury, pain, physical function, disability, falls-efficacy, strength, and walking speed, will be our secondary outcome measures. RESULTS: Recruitment for this trial began in November 2015. CONCLUSION: This study describes the rationale and processes of a feasibility study investigating a video-game exercise programme for older people with chronic LBP. Results from the feasibility study will inform on the design and sample required for a large multicentre RCT. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry: ACTRN12615000703505.

Zago, N. N., et al. (2020). "Serious games therapy associated with conventional physical therapy intervention accelerated hand muscles strengthening and hand functioning after complex fracture of the wrist: A case report." Journal of Hand Therapy 33(4): 580-586.
	STUDY DESIGN: Case report. INTRODUCTION: A severe wrist fracture can cause permanent physical disabilities and deformities, leading to limit patients in their occupation and social environment. PURPOSE OF THE STUDY: We aim at presenting a treatment protocol and the functional outcome of a patient with severe clinical state after a rare wrist fracture. METHODS: We provided physical therapy intervention associated with serious games for muscle strengthening. RESULTS AND DISCUSSION: There was an increase in strengthening and a decrease in Disability of the Arm, Shoulder and Hand score and Patient Rated Wrist Evaluation scores. The International Classification of Functioning scores have changed from severe to light or to absent in many of the domains. CONCLUSION: The use of serious games combined with a conventional physical therapy intervention played a fundamental role in recovery and return to work activities, and there was also an important recovery of general health condition.

Zavala, J., et al. (2017). "Resultados funcionales tras entrenamiento fisioterapéutico que incluye la realidad virtual en mayores de 60 años con artroplastia total de cadera: estudio descriptivo." Fisioterapia 39(6): 236-241.
	Resumen Objetivo El objetivo del presente estudio es describir los cambios en la puntuación del cuestionario WOMAC, Berg Balance y prueba de marcha de 6 min, después de observar un entrenamiento fisioterapéutico que incluye realidad virtual en este tipo de pacientes. Material y método El presente estudio prospectivo, de diseño descriptivo de serie de casos, fue realizado en el Hospital Clínico San Borja Arriarán (Chile). Mediante un muestreo por conveniencia, se seleccionó a 12 pacientes con diagnóstico de artroplastia total de cadera: se observaron 10 sesiones de fisioterapia, que incluían la realidad virtual como parte del tratamiento. Las medidas de resultado fueron: funcionalidad, con el cuestionario WOMAC; riesgo de caída, a través de la escala Berg Balance; diferencia de la carga de peso en las extremidades inferiores, a través del juego Wii Fit™ Plus, y distancia recorrida a través de la prueba de marcha de 6 min. No se registraron pérdidas de participantes. Resultados Postratamiento se observa una reducción en la puntuación del cuestionario WOMAC y un aumento en los valores de la escala de Berg Balance y prueba de marcha de 6 minutos; estos cambios en la puntuación de las variables medidas presentaron una importancia estadística con una p<0,05. Conclusiones Se observan cambios funcionales al evaluar un entrenamiento fisioterapéutico que utiliza realidad virtual en mayores de 60 años con artroplastia total de cadera. Objective The objective of this study is to describe the changes in the WOMAC questionnaire score, the Berg Balance Scale, and the six-minute walk test, after taking part in a physiotherapy training that includes virtual reality in this patient group. Material and method The present prospective, descriptive study was conducted on a series of cases in the Hospital Clínico San Borja Arriarán (Chile). Using a convenience sampling, 12 patients were selected with a diagnosis of total hip arthroplasty. There were 10 physiotherapy sessions, which included the virtual reality as part of the treatment. The outcome measures were: functionality, using the WOMAC questionnaire; risk of falling, using the Berg Balance Scale; difference of weight load in ERIA, using Wii Fit™ Plus game, and distance travelled in the six-minute walk test. There were no losses of participants. Results Post-treatment there was a reduction in the WOMAC questionnaire score, and an increase in the values of the Berg Balance Scale, and six-minute walk test. These changes in the scores of the variables measured were statistically significant with a P<.05. Conclusions Functional changes were observed in the assessment of a physiotherapy training that uses virtual reality in patients older than 60 years with total hip arthroplasty.

Zavala-Gonzalez, J., et al. (2022). "Effectiveness of adding virtual reality to physiotherapeutic treatment in patients with total hip arthroplasty. A randomized controlled trial." Clinical Rehabilitation 36(5): 660-668.
	OBJECTIVE: To determine the clinical effectiveness of adding virtual reality via the Nintendo Wii console and its Wii Balance Board to physiotherapy treatment in patients with total hip arthroplasty. DESIGN: Randomized controlled trial. SETTING: Clinical Hospital San Borja Arriaran, Santiago, Chile. PARTICIPANTS: A total of 73 patients over 50 years of age with total hip arthroplasty were randomly allocated to two groups. INTERVENTIONS: The control group (n = 37) received 6 weeks of physiotherapy treatment; the intervention group (n = 36) received the same treatment plus virtual reality exercises with the Nintendo Wii console. OUTCOME MEASURES: The two groups were assessed at baseline and after the 6 weeks of treatment. The primary outcome assessed was the function with the WOMAC questionnaire. The secondary outcomes were the Berg Balance Scale, distance covered with the six-minute walk test, and difference in weight load on the lower extremities. RESULTS: A total of 73 patients, 37 patients in the control group (20 women; mean age of 70.9 +/- 9.16 years) and 36 patients in the intervention group (18 women; mean age of 70.39 +/- 9.02 years) were analyzed. At the end of the treatment, the difference between groups for the total WOMAC score was -10.4 points (p = 0.00), 4.7 points (p = 0.00) for the Berg Balance Scale, and 45.2 mt (p = 0.00) for the six-minute walk test All differences were in favor of the intervention group. CONCLUSIONS: In the short term, the addition of virtual reality via the Nintendo Wii and its Wii Balance Board platform showed statistically significant differences in the function of patients with total hip replacement, but these differences were not minimally clinically important.Trial registration: This research was registered in the Clinical Trials Registry of Australia and New Zealand, with reference ACTRN12618001252202.

Zernicke, J., et al. (2016). "A prospective pilot study to evaluate an animated home-based physical exercise program as a treatment option for patients with rheumatoid arthritis." BMC Musculoskeletal Disorders 17(1): 351.
	BACKGROUND: Physical exercises and physiotherapy are of great importance for maintenance of joint function in patients with rheumatoid arthritis (RA). However, many RA patients complain about problems to receive prescriptions or have a lack of access to physiotherapy. Recent reports have shown positive effects of the Wii game console on physical and psychosocial conditions of patients with other underlying diseases. The primary objectives of this prospective controlled pilot study were to investigate feasibility and patients' assessment using an animated home-based exercise program. METHOD: This pilot study was conducted as a single-center, cross-over trial with two treatment arms over 24 weeks. Eligibility criteria included patients with RA reaching low disease activity under therapy with a biological disease modifying anti-rheumatic drug (bDMARD). After detailed instruction, 15 patients started with a conventional home-based physical exercise program and 15 patients began with a predefined animated exercise program by using the Wii game console for 12 weeks. Afterwards, patients were crossed-over to the other treatment arm for another period of 12 weeks. Multi-methodical assessments were performed by qualitative analysis of the interview-data as well as statistical analysis of functional tests and patient reported outcomes (PRO's). RESULTS: Evaluation of the interviews indicated feasibility and usefulness of the chosen animated home-based exercise program. Forefoot disabilities were identified as a main limiting factor for performing some of the animated exercises. After 12 weeks, both treatment arms showed improvement of functional tests without significant differences between groups: Overall muscle strength improved for a mean value of 10 Newton (+12 %) and the mean 6-min walk test (6-MWT) distance increased for 28 meters (+5 %). CONCLUSION: This study showed that an animated home-based exercise program by using a Wii game console was feasible and beneficial for RA patients. Compared to standard physical home exercises, similar effects were observed indicating that such an animated program might be an alternative supportive option for RA patients. TRIAL REGISTRATION: ClinicalTrials.gov ID: NCT02658370 (19-Jan-2016).

Zhang, M., et al. (2012). "Virtual Network Marathon with immersion, scientificalness, competitiveness, adaptability and learning." Computers & Graphics 36(3): 185-192.
	In this paper, we present an exergame called VNM (Virtual Network Marathon). The VNM employs specially devised treadmills for running in an immersive virtual environment on a local area network or the Internet. The treadmills have various sensors embedded within them for collecting body performance data. These treadmills are then connected with computers or Set-Top-Boxes (STBs) to synchronously control the player's avatar in a virtual game environment. VNM is implemented on a novel ISCAL (Immersion, Scientificalness, Competitiveness, Adaptability and Learning) model for exergame design. The exercise time and intensity strictly conform to the physical exercise guidelines of the ACSM (American College of Sports Medicine), and a novel demonstration-based non-player modeling technique is employed to simulate a marathon race. The VNM also allows players to learn Chinese culture and obtain knowledge of the Olympics while in tour mode during or after the running exercise. We conducted a pilot study to evaluate the usability of the features of the VNM that we have developed, and with promising results.

Zhang, X., et al. (2021). "Analysis of Unsatisfying User Experiences and Unmet Psychological Needs for Virtual Reality Exergames Using Deep Learning Approach." Information 12(11): 486.
	The number of consumers playing virtual reality games is booming. To speed up product iteration, the user experience team needs to collect and analyze unsatisfying experiences in time. In this paper, we aim to detect the unsatisfying experiences hidden in online reviews of virtual reality exergames using a deep learning method and find out the unmet psychological needs of users based on self-determination theory. Convolutional neural networks for sentence classification (textCNN) are used in this study to classify online reviews with unsatisfying experiences. For comparison, we set eXtreme gradient boosting (XGBoost) with lexical features as the baseline of machine learning. Term frequency-inverse document frequency (TF-IDF) is used to extract keywords from every set of classified reviews. The micro-F1 score of textCNN classifier is 90.00, which is better than 82.69 of XGBoost. The top 10 keywords of every set of reviews reflect relevant topics of unmet psychological needs. This paper explores the potential problems causing unsatisfying experiences and unmet psychological needs in virtual reality exergames through text mining and makes a supplement for experimental studies about virtual reality exergames.

Zhang, Y., et al. (2018). "2018 Americas Conference on Medical Imaging and Clinical Research (AMICR 2018), Panama, 23-25 December 2018." Basic Clin Pharmacol Toxicol 124 Suppl 2: 3-119.
	Objective: Motion sensing technology has become a hot topic of researches among scholars. With the deepening of the related researches, there has appeared many interactive designs of motion sensor in education field. However, there are few experimental studies on the learning effectiveness of motion sensing interaction designs. This paper verifies the effect of motion sensor yoga learning on students' physical health through experiments. Methods: (1) Literature data method: Search the relevant literatures on the Knowledge Discovery Network Platform with “Yoga”, “Effect” and “Experimental Research” as the key words, and analyze the relevant experimental researches on the effects of yoga learning on physical health, and learn from the relevant indicators selected in previous experiments to provide a basis for the selection of experimental indicators in this paper. Body shape indicators include chest circumference, waist circumference, hip circumference, upper arm circumference, thigh circumference, and body fat percentage. The indicators of physical fitness include grip strength, standing long jump, sitting body flexion, sit‐ups, step index, and duration of standing with one leg and the eyes closed. (2) Experimental research: 40 female college students from non‐sports majors were selected as research subjects. These college students previously did not participate in regular physical exercise or have any special diseases. They were randomly divided into an experimental group (20 participants in yoga learning under the motion sensing interaction) and a control group (20 participants in traditional yoga learning). There was no significant difference between the two groups in terms of body shape and physical fitness before the experiment. The experimental group and the control group were both given weekly (90 minutes each time) yoga learning with the same learning content (same yoga posture, same movement sequence). The control group adopted the traditional yoga practice method, led by a teacher. While the students in the experimental group performed yoga exercises in a motion sensing environment. (3) Mathematical statistics method: SPSS was used to carry out an independent sample t test on physical form, physical fitness and other indicators of the two groups measured in the experiment, and the effect of the two different yoga learning methods was judged through data comparison. Results: Before the experiment, students without significant differences in all indicators were selected for the experiment. After 16 weeks of motion sensor yoga learning (experimental group) and traditional yoga learning (control group), there was no significant difference found in chest circumference between the two groups (P > 0.05) while significant differences were found on thigh circumference, waist circumference, hip circumference, upper arm circumference, percentage of body fat, grip strength, and standing long jump between the two groups (P < 0.05). In specific, the experimental group showed significantly lower values in the indicators of thigh circumference, waist circumference, hip circumference, upper arm circumference and percentage of body fat but obviously greater values of grip strength and standing long jump compared with the control group. There was a significant difference on the indicators of sitting body flexion, sit‐ups, step index and duration of standing with one leg and the eyes closed, (P < 0.01), whose data values were significantly larger in the experimental group than in the control group. Conclusion: Through experimental data, it was found that although both methods could improve the physical shape and physical quality of college female students, the effect of motion sensor yoga teaching was more comprehensive and significant. The change in physical fitness indicators of yoga learning is mainly achieved by static stretching of the muscles through posture movements, thereby strengthening the performance of the muscles in strength training, and also increasing flexibility. The change in body shape i dicators is mainly realized as yoga is an oxygen‐tolerant exercise, which has a relatively long exercise time and consumes excess body fat, causing changes in body dimensions and body fat percentage. The main reasons for the differences in the indicators between the two methods are as follows: (1) motion sensing environment stimulated students' interest in learning and improved learning atmosphere The new style of yoga learning applied the new media to its teaching, and the motion sensing interactions made the originally boring classroom relaxed and enjoyable with its own entertainment nature. In addition, the sense of immersive experience and the vivid and lifelike images on the screen played a role in stimulating students' interest in learning. As a result, the negative psychological feelings of resistance and fear in learning, such as the worries of “unable to remember” and “unable to learn” of the students, generated due to the complexity of movements, were gradually alleviated. By learning in the motion sensing environment, students felt as if they were in a game, and the active learning mentality improved the concentration of learning. (2) Motion sensing environment improved students' selfdirected learning awareness The feedback of the completion of the movements in the motion sensor yoga learning method increased the students' desire to challenge and stimulated their morale. It was conducive to cultivating students' self‐learning and selfimprovement consciousness, forming a student‐oriented learning model and highlighting the subjective status of the students. The formation of students' self‐awareness could make them strengthen their self‐requirements. Reflected in the learning process of motion sensor yoga, the students could correct their movements in time through the feedback of the completion of the movements in the motion sensor display device, and constantly regulate his or her movements by comparing their own movement trajectory with the demonstration movement trajectory, so that their movements could be more standard. In this way, their exercise intensity and exercise amount were ensured, and the exercise effect was improved. (3) Teachers played a leading role in the traditional teaching environment, while students lacked an accurate cognition The traditional yoga teaching method is mainly centered on the teacher. During the learning process, students mainly imitate by watching the teacher's action demonstration, and then check their movements through the mirror. Although the teacher keeps emphasizing the standard action essentials, the students mostly judge the completion of their own actions by subjectivity during the practice and do not have an accurate cognition of the completion of their own actions and are in a passive learning state relying on the teacher's supervision. In addition, a teacher's energy is limited and he or she can not manage to guide each student's movements one by one at any time, so the time cycle of mastering the standard movements is relatively long, making the learning effect not as good as that of learning in motion sensing environment. By introducing the motion sensor into yoga learning, it could reduce the sense of boring and tiredness of learning, stimulate students' interest and initiative in learning and improve the learning effect significantly. Therefore, by rationally applying some new and high technologies in the field of yoga teaching, we can break the inherent, rigid and unchanging learning pattern, solve the problems in traditional teaching, and realize the better development of the yoga exercises.

Zhao, X., et al. (2015). ""Wesley says": a children's response inhibition playground training game yields preliminary evidence of transfer effects." Frontiers in Psychology 6: 207.
	Recent studies suggest that the response inhibition ability of children can be modified through training. Based on the notion of embodied cognition, we investigated transfer effects of a 7-day training program using a game named "Wesley says" in 8- to 12-year-old children (n = 15). The game consists of providing commands for performing simple body actions, the actual execution of which is conditional upon the preceding verbal expression "Wesley says." Training effects were assessed with a computer-based visual go/no-go task and the Stroop color-word interference task. Relative to a control group playing other games mainly involving physical exercise (n = 15), the trained group showed a performance improvement on the go/no-go task, but not on the Stroop task. These results suggest the potential of an easy-to-use and ecologically valid training game to improve the inhibition capacity of children on related response inhibition tasks but not on tasks measuring other aspects of inhibition, such as interference control.

Zhou, Y. and J. Qi (2022). "Effectiveness of Interventions on Improving Balance in Children and Adolescents With Hearing Impairment: A Systematic Review." Frontiers in Physiology 13: 876974.
	Although children and adolescents with hearing impairment are at risks of falls from balance problems, reliable information on effects of interventions are scare. Therefore, the purpose of this review is to systematically summarize studies on the evidence of interventions to improve balance ability in children and adolescents with hearing impairment. A systematic literature search was conducted on five major electronic databases. Studies were included if: 1) interventions or trials focusing on improving balance in children and adolescents with hearing impairment; 2) research targeting children with hearing impairment (samples with a mean age below 18 years); 3) studies were published in English peer-reviewed journals due to language barriers and resource limitations; and 4) study designs were randomized controlled trial or quasi-experiment. A nine-item tool adapted from the Consolidated Standards of Reporting Trials Statement was used to assess the quality of the studies. Through the search strategy, 373 articles were identified, and 15 studies published between 1981 and 2021 met the inclusion criteria. Most of the studies reviewed were categorized as medium or low quality, and only three were identified as high quality. Exercise interventions were adopted in 80% of the included studies, whereas studies that employed music + vibration, motor, and game as the intervention modalities accounted for the remaining 20.0%. The results of this review showed that the included trials with exercise interventions had a positive influence on the balance among children and adolescents with hearing impairment (the post-intervention scores were significantly higher than the pre-intervention or the control group scores). In addition, the interventions with duration of 8-16 weeks were more effective than those with less than 8 weeks. However, due to most of the reviewed studies were of low methodological quality, the trials results analyzed by this systematic review should be interpreted with caution. Further investigations of high-quality studies are therefore needed to prove the effectiveness of interventions on improving balance performance in children and adolescents with hearing impairment. Systematic Review Registration: [https://www.crd.york.ac.uk/PROSPERO/], PROSPERO [308803].

Zondervan, D. K., et al. (2015). "Design and Evaluation of the Kinect-Wheelchair Interface Controlled (KWIC) Smart Wheelchair for Pediatric Powered Mobility Training." Assist Technol 27(3): 183-192.
	BACKGROUND: Children with severe disabilities are sometimes unable to access powered mobility training. Thus, we developed the Kinect-Wheelchair Interface Controlled (KWIC) smart wheelchair trainer that converts a manual wheelchair into a powered wheelchair. The KWIC Trainer uses computer vision to create a virtual tether with adaptive shared-control between the wheelchair and a therapist during training. It also includes a mixed-reality video game system. METHODS: We performed a year-long usability study of the KWIC Trainer at a local clinic, soliciting qualitative and quantitative feedback on the device after extended use. RESULTS: Eight therapists used the KWIC Trainer for over 50 hours with 8 different children. Two of the children obtained their own powered wheelchair as a result of the training. The therapists indicated the device allowed them to provide mobility training for more children than would have been possible with a demo wheelchair, and they found use of the device to be as safe as or safer than conventional training. They viewed the shared control algorithm as counter-productive because it made it difficult for the child to discern when he or she was controlling the chair. They were enthusiastic about the video game integration for increasing motivation and engagement during training. They emphasized the need for additional access methods for controlling the device. CONCLUSION: The therapists confirmed that the KWIC Trainer is a useful tool for increasing access to powered mobility training and for engaging children during training sessions. However, some improvements would enhance its applicability for routine clinical use.

Zong, W. and J. Zhang (2019). "Use of smartphone applications and its impacts on urban life: A survey and random forest analysis in Japan." Sustainable Cities and Society 49: 101589.
	This study investigates how various smartphone applications are used, and how that use leads to changes in various aspects of urban life. Different types of applications and the scope of their impacts on urban life are captured based on a life-oriented approach. Data were collected via an online survey of 1000 residents living in different cities of Japan in December 2017. It was found that 75.1% of respondents owned a smartphone and used 3.5 applications on average. Among the users of smartphone application(s), 45.4% experienced at least one life change. Applying a random forest approach, this study examined the relative influence of application usage on urban life as compared to built-environment, individual, and household attributes, as well as interdependencies across life changes, by building 37 forests with 37000 trees. It was revealed that applications of “game”, “photo, video”, “utility, tool, efficiency”, “shopping”, “healthcare, sports, beauty”, “touring”, “education”, “book, comic”, and “navigation, and map” induce changes in work, study, daily trip making, talks between family members, time use, sleeping, expenditure, physical exercise, and shopping in a complicated manner, even though the built environment attributes are the most important predictors to the life changes as a whole.

Zoritch, B., et al. (1996). "Cystic fibrosis and school: the teachers' viewpoint...including commentary by Pachter LM." Ambulatory Child Health 1(4): 302-310.
	Background: School experiences of children with cystic fibrosis (CF) have not been documented in great detail before. The survival and the quality of life of children with CIF have considerably improved in the last decade. Whether CF affects their school performance and what information about CIF is available to their teachers is unknown. Method: A questionnaire was designed in two parts: 1) to ascertain academic progress, practical difficulties, attendance, coping at school and restrictions imposed: 2) to identify teachers' perceived level of information and their actual knowledge of CF. Subjects were 41 children--21 boys and 20 girls with a mean age of 11.5 years. Mann-Whitney tests were used to look at association between variables. Correlation was estimated using Spearman rank correlation test on SPSSPC+ package, Results: The majority of children were making good progress at school, regardless of clinical status, A minority (22%) had sports restrictions, most commonly in outdoor games, The median number of days absent from school in the previous year was 1 (range 0-90). 48% of children had special arrangements organized in the school, usually for medication and physiotherapy. 68% of the teachers felt they were not well informed about CF and this was confirmed by the knowledge questionnaire. Conclusion: Overall, children with CF appear well adjusted to school life. General information on CF should be provided to teachers with more specific and sensitive information given for selected individuals with parental consent. Implication for practice: School health services should have better liaison with the teams caring for children with CF Although well adjusted at school in general, some children with CF are restricted from certain activities and have difficulties with homework and continuous assessment related to their time consuming treatment. In addition, they might benefit from increased use of ambulatory treatment of chest infections, which includes not only IV therapy but also chest physiotherapy, both of which can be given in the school setting to minimize school absence.

Zouch, M., et al. (2014). "Young male soccer players exhibit additional bone mineral acquisition during the peripubertal period: 1-year longitudinal study." European Journal of Pediatrics 173(1): 53-61.
	The aim of this study was to determine whether soccer could have different bone benefits in prepubescent and pubescent boys. We investigated 76 boys aged 10 to 13 years during a 1-year study. All boys were prepubescent at the beginning of the study (T0); pubescent status was determined by a complete 24-h urine hormonal assay of FSH-LH, with LH </= 0.31 IU/24 h and FSH </= 2.19 IU/24 h corresponding to prepubescent Tanner stage I and with 0.31 < LH < 0.95 IU/24 h and 1.57 < FSH < 3.77 IU/24 h corresponding to pubescent Tanner stage II. At the end of the study (T1), 35 boys remained prepubescent (22 soccer players (F1) and 13 controls (C1)), and 41 boys had entered puberty (26 soccer players (F2) and 15 controls (C2)). Soccer players completed 2 to 5 h of training plus one competition game per week during the school year, and controls only had physical education at school. Bone mineral content (BMC) was measured at T0 and T1 by DPX in the lumbar spine, total hip, and whole body (WB) for a comparison between soccer players and controls. At T0, no BMC difference was found between F1 and C1, but BMC was higher in F2 than C2 in WB and weight-bearing sites. At T1, BMC was higher in WB and weight-bearing sites in both F1 and F2 compared to their respective controls. Between T0 and T1, soccer induced a BMC gain at weight-bearing sites in both F1 and F2 compared to C1 and C2, respectively. The soccer-related bone gain was greater in WB and weight-bearing (the lumbar spine, total hip, and supporting leg) and non-weight-bearing bones (dominant arm and nondominant arm) in boys who became pubescent than in boys who remained prepubescent. In conclusion, 1-year study in young male soccer players demonstrates that the process of bone accretion at the very early phase of puberty is more intensely stimulated by the combination of physical exercise and sexual impregnation than by one of these factors alone.

Zouhal, H., et al. (2020). "Effects of Small-Sided Soccer Games on Physical Fitness, Physiological Responses, and Health Indices in Untrained Individuals and Clinical Populations: A Systematic Review." Sports Medicine 50(5): 987-1007.
	BACKGROUND: Small-sided soccer games (SSSG) are a specific exercise regime with two small teams playing against each other on a relatively small pitch. There is evidence from original research that SSSG exposure provides performance and health benefits for untrained adults. OBJECTIVES: The aim of this systematic review was to summarize recent evidence on the acute and long-term effects of SSSG on physical fitness, physiological responses, and health indices in healthy untrained individuals and clinical populations. METHODS: This systematic literature search was conducted in four electronic databases (PubMed, Web of Science, SPORTDiscus) from inception until June 2019. The following key terms (and synonyms searched for by the MeSH database) were included and combined using the operators "AND", "OR", "NOT": ((soccer OR football) AND ("soccer training" OR "football training" OR "soccer game*" OR "small-sided soccer game*") AND ("physical fitness" OR "physiological adaptation*" OR "physiological response*" OR health OR "body weight" OR "body mass" OR "body fat" OR "bone composition" OR "blood pressure")). The search syntax initially identified 1145 records. After screening for titles, abstracts, and full texts, 41 studies remained that examined the acute (7 studies) and long-term effects (34 studies) of SSSG-based training on physical fitness, physiological responses, and selected alth indices in healthy untrained individuals and clinical populations. RESULTS: No training-related injuries were reported in the 41 acute and long-term SSSG studies. Typically, a single session of SSSG lasted 12-20 min (e.g., 3 x 4 min with 3 min rest or 5 x 4 min with 4 min rest) involving 4-12 players (2 vs. 2 to 6 vs. 6) at an intensity >/= 80% of HRmax. Following single SSSG session, high cardiovascular and metabolic demands were observed. Specifically, based on the outcomes, the seven acute studies reported average heart rates (HR) >/= 80% of HRmax (165-175 bpm) and mean blood lactate concentrations exceeding 5 mmol/l (4.5-5.9 mmol/l) after single SSSG sessions. Based on the results of 34 studies (20 with healthy untrained, 10 with unhealthy individuals, and 4 with individuals with obesity), SSSG training lasted between 12 and 16 weeks and was performed 2-3 times per week. SSSG had positive long-term effects on physical fitness (e.g., Yo-Yo IR1 performance), physiological responses including maximal oxygen uptake (VO2max) [+ 7 to 16%], and many health-related markers such as blood pressure (reductions in systolic [- 7.5%] and diastolic [- 10.3%] blood pressure), body composition (decreased fat mass [- 2 to - 5%]), and improved indices of bone health (bone mineral density: [+ 5 to 13%]; bone mineral content: [+ 4 to 5%]), and metabolic (LDL-cholesterol [- 15%] as well as cardiac function (left-ventricular internal diastolic diameter [+ 8%], end diastolic volume [+ 21%], left-ventricular mass index [+ 18%], and left-ventricular ejection fraction [+ 8%]). Irrespective of age or sex, these health benefits were observed in both, untrained individuals and clinical populations. CONCLUSIONS: In conclusion, findings from this systematic review suggest that acute SSSG may elicit high cardiovascular and metabolic demands in untrained healthy adults and clinical populations. Moreover, this type of exercise is safe with positive long-term effects on physical fitness and health indices. Future studies are needed examining the long-term effects on physical fitness and physiological adaptations of different types of SSSG training (e.g., 3 vs. 3; 6 vs. 6) in comparison to continuous or interval training in different cohorts.

zty4w, R. B. R. (2018). "Effects of active videogame system on health of children with Cerebral palsy." https://trialsearch.who.int/Trial2.aspx?TrialID=RBR-3zty4w.
	INTERVENTION: All children should remain attending conventional physiotherapy based on the concepts of neurodevelopmental physiotherapy, both control group (15 children) and intervention group (15 children). The children in the intervention group will be submitted to an additional therapeutic intervention through the use of virtual reality, with active videogame. The duration will be eight consecutive weeks, twice a week, for 45 minutes. The games used will be the Kinect Adventures package commercially available on the Xbox 360 ° Kinect video game. Each session will have two different games, five repetitions of each game, totaling 10 repetitions per session. At the end, 16 sessions will be performed with the exposure time of 12 hours at the end of approximately two months of therapy. The order of application of the games during the intervention will be randomized. Device F04.754.137.506.662 CONDITION: C10.228.140.140.254 Cerebral Palsy ; C10.228.140.140.254 ; G80 G00‐G99 PRIMARY OUTCOME: Expected Outcome 1 ‐ Improvement of the posture control, verified by the decrease of the oscillations of the body identified by the force platform, from the finding of significant difference by the statistical test.; There is no minimum percentage change for this variable. Expected outcome 2 ‐ Improvement of gross motor function, verified by the Gross Motor Function Measure (GMFM), based on an increase of at least 1%, which is considered clinically significant for the instrument. SECONDARY OUTCOME: Expected Outcome 1 ‐ Improvement in gait performance, verified by the BTS‐GWalk equipment, from the observation of increase in the speed of the march, increase in the size of the step and decrease of the phase of balance and of support. Expected Outcome 2 ‐ Improvement in physical fitness evidenced by increased walking distance in the 6‐minute Walk Test (6MWT). INCLUSION CRITERIA: Children to five througth twelve years old. Diagnosis of cerebral palsy. Gross Motor Function Classification System GMFCS) I and II. They are able to understand simple verbal commands.