Background Several studies have shown that robotic devices can effectively improve motor function in stroke patients through limb activation. However, the effects of robot-assisted therapy on perceptual deficits after stroke is unclear. Objective This review aimed to evaluate the effectiveness of robotic limb activation in patients with unilateral spatial neglect (USN) after stroke. Methods In this systematic review, a literature search was performed using MEDLINE, EMBASE, CENTRAL, CINAHL, and LILACS databases without language restrictions. Randomized controlled trials (RCTs) and quasi-RCTs of robot-assisted therapy for USN after stroke were selected. Two reviewers independently assessed the risk of bias and certainty of the evidence of the included studies. Results A total of 630 studies were identified, including five studies for qualitative synthesis and four meta-analyses. The results of RCTs comparing robotic limb activation with a control group suggested an improvement in the degree of USN measured by the line bisection test (standardized mean difference [SMD], −0.64; 95% confidence interval [CI], −1.13 to −0.15; P = .01). There were no differences between the groups in the motor-free visual perception test 3rd edition (SMD, 0.27; 95% CI, −0.25–0.79; P = .31), star cancellation test (SMD, 0.26; 95% CI, −0.42−0.94; P = .54), Albert’s test (SMD, −0.67; 95% CI, −2.01−0.66; P = .32), and Catherine Bergego Scale (SMD, −0.81; 95% CI, −2.07−0.45; P = .21). Conclusion The study demonstrated that limb activation through robotic therapy can improve midline perception. However, there was no impact on tasks assessing visual scanning, functionality, or activities of daily living.

Introdução: A queda no idoso está relacionada com a taxa de crescimento da população idosa, e pode ser definida como um deslocamento não intencional do corpo do indivíduo para um nível inferior à posição que se encontrava inicialmente, caracterizado pela incapacidade de correção deste deslocamento involuntário em tempo hábil, determinado por circunstâncias multifatoriais do indivíduo que afetam a estabilidade ao corpo. Objetivo: Verificar os fatores associados ao risco de queda em idosos. Metodologia: Pesquisa descritiva, transversal e análise quantitativa, aprovada pelo comitê de ética de pesquisa da FUNORTE. Amostra composta por idosos atendidos no Campus Amazonas, foram aplicados o questionário de funcionalidade Lawton e Brody, os testes de TUG – Timed Up And Go, Escala de equilíbrio de BERG e levantar e Sentar. Resultados: dezoito idosos contemplaram os critérios de inclusão e exclusão, sendo 55,6% do sexo feminino e 44,4% do sexo masculino, com média de idade de 70 anos. Destes, 55,6% foram classificados em independentes para realização de todas as atividades, 44,7% apresentaram mobilidade regular, 72,2% um bom equilíbrio e com relação a força muscular de membros inferiores o público masculino se sobressaiu em relação ao feminino. Conclusão: Foi possível observar relação entre alteração de força em membros inferiores e equilibrio com o risco de queda, ou seja, uma associação inversamente proporcional, na qual os maiores valores de força foram associados com os menores tempos de execução no TUG e, portanto, com maior equilíbrio dinâmico. Já com relação a funcionalidade, não foi possível identificar que a alteração funcional influenciou no risco de queda da amostra investigada.

Objectives New types of treatments have emerged, such as non-invasive brain stimulation (NIBS), to treat chronic vestibular dysfunction (VD). Considering that NIBS is a promising approach to reduce VD symptoms, this review was aimed to analyze the effects of NIBS in patients with VD. Methods We adhered to the methods described in the Cochrane Handbook for Intervention Reviews. The eligibility criteria were as follows: (a) individuals with vestibulopathy having clinical and neuroimaging; (b) Interventions: non-invasive brain stimulation, this intervention comprised transcranial direct current stimulation (tDCS) and repetitive transcranial magnetic stimulation (rTMS); (c) Control: any comparison or sham; and (d) Outcomes: dizziness and balance. We included randomized controlled trials and non-randomized studies from July 2004 to February 2020. We searched the PubMed, CINAHL, Web of Science, Scopus, Cochrane, and Ovid databases. Two pairs of reviewers independently screened all titles and abstracts. Two authors assessed the risk of bias for each study using the criteria outlined in the Cochrane Handbook for Systematic Reviews of Interventions and used the Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology to rate the certainty of the evidence for each outcome. Results We identified 136 studies, and included two studies. Both studies used tDCS application. One study used anodal cerebellar tDCS or sham at 2 mA for 25 min associated with vestibular rehabilitation therapy (VRT), and the other study used anodal tDCS over the left dorsolateral prefrontal cortex (F3) for 25–30 min associated with VRT at home. Both studies showed clinical improvement in the Dizziness Handicap Inventory (DHI), State-Trait Anxiety Inventory (STAI), Activities-Specific Balance Confidence (ABC), and Self-Rating Depression Scale (SDS) scores. Both studies presented higher-quality evidence on the GRADE scale and a low risk of bias. Conclusions Based on two studies, anodal tDCS over F3 or the cerebellum associated with VRT improved chronic vestibular symptoms.

This study aims to evaluate the additional acute effect of virtual reality (VR) head-mounted displays (HMD) when associated with balance exercises in balance outcomes in non-disabled individuals. Methods: Thirty individuals were randomized into two groups: balance exercise group (GBE; n = 15); and virtual reality + balance exercise group (GVR + BE; n = 15). The individuals were evaluated by static and dynamic balance using the tandem test (TT), single-leg stance (SLS), and Fukuda stepping test (FST). Both groups performed 30 min of balance exercises. The GVR + BE performed 8 additional minutes of virtual reality prior to balance exercises. A roller coaster application was used for the HMD. The Mann-Whitney test was used for intra-group and differences of inter-group analysis, considering a significance level of p < 0.05. Results: In the GBE group analysis, there was observed an increase of time in TT with closed eyes (p = 0.025) and SLS with closed eyes (p = 0.003). In the same way, the GVR + BE group increase TT with closed eyes (p = 0.003) and SLS with closed eyes (p = 0.002) after the intervention. In the intergroup analysis, the increase in the SLS with closed eyes was superior in the GVR + BE group when compared with GBE (p = 0.006; d = 1.67). Conclusion: The use of HMD in combination with balance exercise has an acute effect on increasing static balance in non-disabled individuals.