APRENDIZADO MOTOR ATRAVÉS DE REALIDADE VIRTUAL EM IDOSOS

Ribeiro-Papa, Denise Cardoso; Massetti, Thais; Crocetta, Tânia Brusque; Menezes, Lilian Del Ciello de; Antunes, Thaiany Pedrozo Campos; Bezerra, Ítalla Maria Pinheiro; Monteiro, Carlos Bandeira de Mello

Brasil

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REVIEWS • MedicalExpress (São Paulo, online) 3 (2) • Mar-Apr 2016 • https://doi.org/10.5935/MedicalExpress.2016.02.01 copiar

APRENDIZADO MOTOR ATRAVÉS DE REALIDADE VIRTUAL EM IDOSOS

Autoria SCIMAGO INSTITUTIONS RANKINGS

INTRODUÇÃO:

O Declínio da função física é uma característica comum de idade avançada e tem consequências importantes em termos de saúde física e qualidade de vida. Nossa capacidade de aprendizagem motora nos permite adaptar movimentos a um ambiente em constante mudança. A expressão Realidade Virtual refere-se a uma ampla variedade de métodos usados para simular uma alternativa ao mundo virtual.

OBJETIVO:

Analisar os resultados apresentados em estudos anteriores sobre aprendizagem motora com o uso de Realidade Virtual em participantes idosos.

MÉTODO:

Para selecionar os artigos, três etapas foram seguidas. Uma revisão sistemática da literatura foi realizada sem limitação de tempo. A pesquisa foi realizada utilizando PubMed, BVS e Web os Science; considerando-se as palavras-chave, incluímos artigos que apresentaram os três seguintes termos:, realidade virtual idosos e aprendizagem motora.

RESULTADOS:

A busca inicial rendeu 49 artigos. Depois da remoção de duplicações, dois dos autores avaliaram independentemente o título e o resumo de cada artigo em relação aos critérios de inclusão do estudo. Destes, 45 artigos foram excluídos com base no título e resumo. Finalmente, quatro artigos preencheram os critérios de inclusão.

CONCLUSÃO:

Embora poucos estudos foram encontrados sobre a aprendizagem motora em pessoas idosas através da realidade virtual e, menos ainda eram de boa qualidade, foi mostrado que as pessoas idosas, com ou sem uma doença específica, podem se beneficiar de intervenções com base na realidade virtual para melhorar a habilidades de aprendizagem motora.

PALAVRAS-CHAVE:
envelhecimento; realidade virtual; idosos; e aprendizagem motora

		Sample		Intervention			Virtual reality
Author (year)	D	Experimental	Control	F	Experimental	Control	Tool Description
Kubicki et al. (2014)²⁵25 Kubicki A, Bonnetblanc F, Petrement G, Mourey F. Motor-prediction improvements after virtual rehabilitation in geriatrics: frail patients reveal different learning curves for movement and postural control. Neurophysiol Clin. 2014;44(1):109-18. http://dx.doi.org/10.1016/j.neucli.2013.10.128. http://dx.doi.org/10.1016/j.neucli.2013....	R	23 patients in short-term rehab, aged 82.2 ± 6.8.	23 patients in short- term rehab, aged, 81.5 ± 4.9.	3	Evaluation session (pre-test); Classical rehab sessions Six VR training sessions Evaluation session (post-test).	Evaluation session (pre-test), Classical rehab sessions Evaluation session (post-test).	.Fovea Interactive^®. Active motion capture system based on vision technology, able to track the marker held by the patient in his or her right hand. When the patient put his right hand on a half-circle placed in the lower part of the screen, a yellow ball appeared somewhere on the screen. Patients have to react as soon as possible and to reach the ball as fast as possible.
Mendes et al. (2012)²⁶26 Mendes FAS, Pompeu JE, Modenesi Lobo A, Guedes da Silva K, Oliveira Tde P, Peterson Zomignani A, et al. 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. 2012 Sep;98(3):217-23. http://dx.doi.org/10.1016/j.physio.2012.06.001. http://dx.doi.org/10.1016/j.physio.2012....	CCT	16 Parkinson's disease patients, aged 68.6 ± 8.0.	11 healthy elderly people, aged 68.7 ± 4.1.	7	Both groups underwent 14 twice-weekly individual training sessions consisting of a) 30-minute warm-up of global mobility exercises b) Training on 10 Wii Fit games; 60 days after last training session: one session in which participants had two attempts at each of the 10 games in order to determine learning retention.		Ten Nintendo Wii Fit games Four games required multidirectional shifts in the player's cener of gravity Four Games involved alternating stepsTwo games required stationary control of the player's center of gravity In terms of cognitive demands, all 10 games involved attention, rapid responses to visual stimuli and performance assessment by visual and auditory feedback between trials.
Pompeu et al. (2012)²⁷27 Pompeu JE, Mendes FAdS, Silva KGd, Lobo AM, Oliveira TdP, Zomignani AP, et al. Effect of Nintendo WiiTM-based motor and cognitive training on activities of daily living in patients with Parkinson's disease: A randomised clinical trial. Physiotherapy. 2012;98(3):196-204. http://dx.doi.org/10.1016/j.physio.2012.06.004. http://dx.doi.org/10.1016/j.physio.2012....	RCT	16 idiopathic Parkinson's disease patients treated with levodopa or its synergists. Mean age of 67.4	16 idiopathic Parkinson's disease patients treated with levodopa or its synergists. Mean age of 67.4	7	Wii Fit-based motor and cognitive training. Additional session 60 days after end of training	Balance exercise therapy, without feedback or cognitive stimulation. Additional session 60 days after end of training.	Ten Nintendo Wii Fit games.Three games for static balance (Single Seven games for dynamic balance
Mirelman et al. (2011)²⁸28 Mirelman A, Maidan I, Herman T, Deutsch JE, Giladi N, Hausdorff JM. Virtual reality for gait training: can it induce motor learning to enhance complex walking and reduce fall risk in patients with Parkinson's disease? J Gerontol A Biol Sci Med Sci. 2011 Feb;66(2):234-40. http://dx.doi.org/10.1093/gerona/glq201. http://dx.doi.org/10.1093/gerona/glq201...	OLT	20 idiopathic Parkinson's patients disease, aged 67.1 ± 6.5	Historical active control group of 9 Parkinson's disease patients	6	Six weeks (3 sessions/week) warm up (only treadmill walking After warm-up, VR simulation.	Similar treadmill training no VR.	Designed specifically for this study.Two LEDs attached to lateral side of participant's shoes to track feet movement .Participants walked on treadmill with safety harness (no body weight support) while viewing the virtual environment with feedback given in multiple ways (scoring of obstacle avoidance, auditory and visual feedback if subject contacted a (virtual) obstacle.

Experimental	Control	Main outcomes		Quality assessment of selected studies
Kubicki et al. (2014)²2 Freedman VA, Martin LG, Schoeni RF. Recent trends in disability and functioning among older adults in the United States: a systematic review. JAMA. 2002;288(24):3137-46. http://dx.doi.org/10.1001/jama.288.24.3137. http://dx.doi.org/10.1001/jama.288.24.31...	Both hand and CoP kinematics were improved. Hand kinematics : hand movement time and reaction time decreased between pre and post-test; mean velocities were increased between pre and post-test; CoP kinematics : mean velocity increased between pre and post-test.	Only mean velocity of hand kinematics improved. Hand kinematics : hand movement time decreased between pre and post-test; mean velocities and reaction time increased between pre and post-test; CoP kinematics : mean velocity decreased between pre and post-test.	VR had a positive effect on motor learning in elderly.	6/10
Mendes et al. (2012)²⁶26 Mendes FAS, Pompeu JE, Modenesi Lobo A, Guedes da Silva K, Oliveira Tde P, Peterson Zomignani A, et al. 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. 2012 Sep;98(3):217-23. http://dx.doi.org/10.1016/j.physio.2012.06.001. http://dx.doi.org/10.1016/j.physio.2012....	Lower scores;similar learning and retention on seven games; worse performance on five games;unable to improve their performance on three games following training.	Higher scores; similar learning and retention on seven games; better performance on five games; good learning and retention on three games following training.	VR had a positive effect on motor learning in both PD and healthy elderly. The ability of patients with PD to learn, retain and transfer performance improvements after VR based training depends particularly on the cognitive demands of the games involved, reiterating the importance of gameselection for rehabilitation purposes.	4/10
Pompeu et al. (2012)²⁷27 Pompeu JE, Mendes FAdS, Silva KGd, Lobo AM, Oliveira TdP, Zomignani AP, et al. Effect of Nintendo WiiTM-based motor and cognitive training on activities of daily living in patients with Parkinson's disease: A randomised clinical trial. Physiotherapy. 2012;98(3):196-204. http://dx.doi.org/10.1016/j.physio.2012.06.004. http://dx.doi.org/10.1016/j.physio.2012....	No differences were found	No differences were found	Both groups (VR training and usual balance therapy) showed improved performance in activities of daily living after 14 sessions of balance training, with no additional advantages associated with the VR-based motor and cognitive training.	7/10
Mirelman et al. (2011)²⁸28 Mirelman A, Maidan I, Herman T, Deutsch JE, Giladi N, Hausdorff JM. Virtual reality for gait training: can it induce motor learning to enhance complex walking and reduce fall risk in patients with Parkinson's disease? J Gerontol A Biol Sci Med Sci. 2011 Feb;66(2):234-40. http://dx.doi.org/10.1093/gerona/glq201. http://dx.doi.org/10.1093/gerona/glq201...	Decrease of errors in obstacles; During dual task, there was an increase in gait speed, stride time, stride length and gait variability, all maintained at follow-up.	Gains under the dual task condition in both gait speed and stride length were significantly lower after training treadmill alone.	The gains in gait speed and stride length during usual walking were similar in both groups. Treadmill training + virtual reality in PD may significantly improve physical performance, gait during complex challenging conditions and cognitive function.	4/10

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