RESUMEN
OBJECTIVE: The Childhood Health Assessment Questionnaire (CHAQ), Juvenile Arthritis Functional Assessment Report (JAFAR), and Juvenile Arthritis Functional Status Index (JASI) are widely used functional measures for juvenile idiopathic arthritis (JIA) that differ in content, format, and completion time. We compared the responsiveness and child-parent agreement of the JAFAR, CHAQ, and JASI in a prospective, multicenter study. METHODS: Children and adolescents from 5 rheumatology centers were enrolled. Subjects were about to undergo therapy (intraarticular corticosteroid injections [IAS] and methotrexate or hip surgery (MTX/hip]) expected to produce a functional improvement. All subjects were studied before the intervention and at 6 weeks and 6 months posttreatment. At each study visit, the 3 measures were administered in randomized, balanced order to both parents and children. RESULTS: A total of 92 subjects (mean age 12.8 years) were enrolled in the study, 74 of which were in the IAS group. The responsiveness of all 3 measures was moderate to strong. The standardized response mean at 6 weeks for the IAS group on the JAFAR, CHAQ, and JASI was 0.41 (95% confidence interval [95% CI] 0.18, 0.64), 0.70 (95% CI 0.47, 0.93), and 0.36 (95% CI 0.13, 0.59), respectively. The CHAQ was somewhat more responsive to change at 6 weeks (IAS group: relative efficiency 0.34 [JAFAR], 0.27 [JASI]), but less responsive at 6 months (MTX/hip group: relative efficiency 5.1 [JAFAR], 3.9 [JASI]). All 3 questionnaires showed acceptable parent-child agreement, and overall, there were few differences between the 3 questionnaires. CONCLUSION: The functional outcome measures currently used for JIA are all adequately responsive for use in trials or in the clinic setting. The choice of which measure to use should therefore be based on the time available for completion, the intended clinical/research use, and the depth of content required.
Asunto(s)
Antirreumáticos/uso terapéutico , Artritis Juvenil , Glucocorticoides/uso terapéutico , Encuestas y Cuestionarios , Adolescente , Adulto , Artritis Juvenil/diagnóstico , Artritis Juvenil/tratamiento farmacológico , Artritis Juvenil/fisiopatología , Niño , Quimioterapia Combinada , Femenino , Glucocorticoides/administración & dosificación , Estado de Salud , Humanos , Inyecciones Intraarticulares , Masculino , Metotrexato/uso terapéutico , Padres , Estudios Prospectivos , Reproducibilidad de los Resultados , Autoexamen , Índice de Severidad de la EnfermedadRESUMEN
Voluntary movements result in internal perturbations of balance and equilibrium. One variable regulated during movement is the position of the center of pressure (COP). Sensory information from the visual, vestibular and somatosensory systems is used in establishing relevant frames of reference for postural control. In this study, we were interested in determining whether different limitations of COP movement occur when different approaches to delivering virtual environments are used and when visual information incoherent with vestibular and somatosensory information is provided. Eighteen healthy adults completed voluntary lateral reaches under three conditions: continuous lateral reach (CLR), flatscreen virtual reality (FS), and head-mounted display virtual reality (HMD). Reaching behavior was indexed by force plate measures of maximum anterior-posterior and lateral displacement of the COP. The COP movement decreased in the lateral direction in the HMD condition relative to the FS. The maximum range of COP movement in the anterior-posterior direction increased as a function of reaching task with HMD realizing the greatest amount of movement. The lack of an exocentric frame of reference in HMD coherent with information from other sensory systems results in limiting COP movement within the base of support (BOS) in order to decrease the challenge to the postural control system.
Asunto(s)
Simulación por Computador , Movimiento/fisiología , Percepción/fisiología , Equilibrio Postural/fisiología , Desempeño Psicomotor/fisiología , Interfaz Usuario-Computador , Adulto , Femenino , Humanos , Masculino , Valores de Referencia , Terapia Asistida por Computador/métodosRESUMEN
This paper presents preliminary data from two clinical trials currently underway using flat screen virtual reality (VR) technology for physical rehabilitation. In the first study, we are comparing a VR-delivered exercise program to a conventional exercise program for the rehabilitation of shoulder joint range-of-motion in patients with chronic frozen shoulder. In the second study, we are comparing two exercise programs, VR and conventional, for balance retraining in subjects post-traumatic brain injury. Effective VR-based rehabilitation that is easily adapted for individuals to use both in inpatient, outpatient and home-based care could be used as a supplement or alternative to conventional therapy. If this new treatment approach is found to be effective, it could provide a way to encourage exercise and treatment compliance, provide safe and motivating therapy and could lead to the ability to provide exercises to clients in distant locations through telehealth applications of VR treatment. VR is a new technology and the possibilities for rehabilitation are only just beginning to be assessed.
Asunto(s)
Lesiones Encefálicas/complicaciones , Ejercicio Físico , Dolor de Hombro/etiología , Dolor de Hombro/rehabilitación , Interfaz Usuario-Computador , Humanos , Rango del Movimiento Articular , Articulación del Hombro/fisiopatología , Dolor de Hombro/fisiopatologíaRESUMEN
Sixty percent to 70% of pedestrian injuries in children under the age of 10 years are the result of the child either improperly crossing intersections or dashing out in the street between intersections. The purpose of this injury prevention research study was to evaluate a desktop virtual reality (VR) program that was designed to educate and train children to safely cross intersections. Specifically, the objectives were to determine whether children can learn pedestrian safety skills while working in a virtual environment and whether pedestrian safety learning in VR transfers to real world behavior. Following focus groups with a number of key experts, a virtual city with eight interactive intersections was developed. Ninety-five children participated in a community trial from two schools (urban and suburban). Approximately half were assigned to a control group who received an unrelated VR program, and half received the pedestrian safety VR intervention. Children were identified by group and grade by colored tags on their backpacks, and actual street crossing behavior of all children was observed 1 week before and 1 week after the interventions. There was a significant change in performance after three trials with the VR intervention. Children learned safe street crossing within the virtual environment. Learning, identified as improved street-crossing behavior, transferred to real world behavior in the suburban school children but not in the urban school. The results are discussed in relation to possibilities for future VR interventions for injury prevention.