Browsing by Author "Maldonado, Marcos"
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Item Teleneurorehabilitation program (virtual reality) for patients with balance disorders: descriptive study(2021) Maldonado, Marcos; Vargas, Patricia; Vasquez, Ricardo; González, Felipe; Rivero, Betel; Hidalgo, Viviane; Gutierrez, TaniaBackground: Balance disorders are common in patients with neurological or vestibular diseases. Telerehabilitation program is a treatment to be as safe as conventional treatment. One of the most used methods to perform telerehabilitation is the incorporation of Virtual Reality. In general, rehabilitation programs train predictive postural control, so the patient does not always acquire the necessary autonomy to react to situations of instability. On the other hand, the objective and systematic supervision and measurement of these programs is limited, making it necessary to create clinical protocols with precise and measurable rehabilitation objectives. This study present the training selection methodology and clinical protocol for patients with balance disorders inserted in a Telerehabilitation Program based on Virtual Reality. Methods: Descriptive study where physiotherapists were trained to use RehaMetrics®. To evaluate their level of agreement in the selection of the exercise clusters developed, the Interobserver Reliability was measured through the kappa statistic. Subsequently, the exercises were applied to a group of patients recruited with sedentary trunk control (Berg Balance Scale = 3 points in item 3), mild or normal cognitive level (Montreal Cognitive Assessment> 21 points), and prescribed for tele-rehabilitation by a doctor. Results: The agreement among the expert physiotherapists irrespective of the cluster exceeds 80%, which indicates a very good strength of agreement, while the novices reached a level of agreement of 45%, which suggests a moderate strength of agreement. All clinical outcomes showed statistically significant differences between the median times, as did the Maximum Width Left Side (MWLS) (cm). The average number of minutes of training was 485.81 (SD 246.49 min), and the number of sessions performed during the 4 weeks of intervention was 17 (SD 7.15 sessions).Publication Visual attention during non-immersive virtual reality balance training in older adults with mild to moderate cognitive impairment: an eye-tracking study(2025) Maldonado, Marcos; Jara, Gonzalo; González Seguel, FelipeBackground: Older adults with cognitive impairment often present with balance deficits, reduced walking speed, and attentional difficulties-particularly in executive function. These challenges increase fall risk and complicate traditional rehabilitation approaches. Eye-tracking technology offers an objective way to evaluate attention by analyzing oculomotor behavior during tasks, but its use in clinical rehabilitation contexts is still limited. Objective: The aim of this study is to investigate visual attention using eye-tracking metrics during a non-immersive virtual reality-based balance training program in older adults with mild to moderate cognitive impairment. Methods: This was an exploratory pilot study with a prospective, descriptive cohort, based on a non-controlled, quasi-experimental design of seven older adults with mild to moderate cognitive impairment. Each patient underwent VR-based balance training using RehametricsⓇ software, while their attention was assessed via eye-tracking (Tobii Pro Glasses 2 Refurbished Wireless). Clinical assessments included the Mini-BESTest, Functional Gait Assessment, 6-Minute Walk Test, 4-Meter Walk Test, and Montreal Cognitive Assessment (MoCA). Eye-tracking data focused on fixation patterns, microsaccades, and pupil diameter as indicators of attentional processing. Results: Patients showed a small numerical increase, without reaching statistical significance in task difficulty progression (p = 0.016), lower limb endurance (p = 0.016), and single-leg support time (p = 0.031). Clinical tests revealed a slight increase, though results were not statistically significant in balance and walking speed (p = 0.063). Eye-tracking data indicated increased fixation stability and decreased pupil diameter, suggesting more efficient attention allocation during motor tasks. Conclusions: Eye-tracking provided valuable metrics into attentional behavior during balance training in older adults with cognitive impairment. Its integration into non-immersive virtual reality rehabilitation may help better understand and address cognitive-motor interactions. Further studies with larger samples are needed to confirm these preliminary findings.