JMIR Publications

ABSTRACT

Background:

Duchenne muscular dystrophy (DMD) is caused by a mutation in the gene that produces dystrophin, responsible for maintaining muscle properties. DMD is a very common disease with an incidence of 1 in 3,500-6000 live male births [1] The lack of dystrophin produces a progressive degeneration of muscle fibres, which becomes connective tissue and fat. [2] These diseases, without a cure today, produce muscle weakness as the main symptom, progressively leading to a loss of function and independence, and compromising the respiratory system in advanced stages of the disease. [3] A systematic review of the effectiveness of VR in the manual function of children with cerebral palsy (CP) has been performed with the results showing little evidence of effectiveness. [17] Compared with CP affected, individuals with DMD presented preservation of the strength of musculature of the upper extremities for longer than in lower, especially distal muscle [18]. In CP, distal muscle used in fine motor is most affected in hemi paresis and tetra paresis cases. [17] Virtual reality games in individuals with DMD who have considerable and progressive loss of movement, could help to create safe rehabilitative settings to improve responsiveness or regulate treatment strategies. [19]

Objective:

A systematic review is performed to study the effectiveness of the use of virtual reality systems applied in the rehabilitation of the upper limbs of individuals with DMD.

Methods:

Two evaluators independently conducted the searches following the PRISMA recommendations for systematic reviews for articles. Two independent evaluators collated the results. Article quality was determined using the PEDro scale. This systematic review is recorded in PROSPERO (CRD42018102548).

Results:

A total of seven clinical trials were included. A synthesis of the studies using new technologies as a tool for physiotherapeutic rehabilitation of the upper limbs of patients with DMD was conducted. Studies show improvement in functionality, quality of life and motivation with the use of VR in the rehabilitation of upper limbs of individuals with DMD

Conclusions:

The treatment of neuromuscular diseases has changed in recent years, from being a palliative work of symptom management to a preventive one of capacity building. The use of VR, through interactive games with individuals with DMD, is beginning to be necessary in progressive diseases involving movement difficulties, providing freedom and facilitating the improvement of results in capacity training. Given that new technologies are increasingly accessible, rehabilitation and physiotherapy programmes employ, more frequently, VR environments to improve task performance and promote the transfer of this practice to daily life in the real world, which is essential for people with disabilities. VR can be a great ally for the future of physiotherapy in DMD. The conclusion is that VR can be used for DMD rehabilitation programs to improve their performance during the training.