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Chaudhary P, Hamdani N, Sharma P. The Effects of Visuomotor Training Using Pablo System on Hand Grip Strength and Wrist Movements in Adults and Elderly. Iranian Rehabilitation Journal 2019; 17 (3) :215-224
URL: http://irj.uswr.ac.ir/article-1-811-fa.html

Objectives: The primary study objective was to assess the effects of visuomotor training on grip strength and wrist movements in adults and the elderly to be efficiently used in rehabilitation. The secondary objective was to compare the post-training changes between the two groups.
Methods: This was a pre-test-post-test quasi-experimental study, including healthy individuals aged 25-44 (adults) and 65-79 (elderly) years. Individuals suffering from neuromuscular or musculoskeletal system disorders were excluded from the study. Grip strength (kg) and wrist movements (˚) were recorded by the equipment (Pablo system). Moreover, the scores of the Michigan Hand Outcome Questionnaire (MHQ) were recorded after interviewing the individuals. The study subjects were then provided with training (game-based) by Pablo system for 24 min/ d, thrice a week. Finally, post-test scores were recorded after 4 weeks of training. 
Results: Groups 1 and 2 had the Mean±SD age of 35.8±9 and 68.5±7.2 years, respectively. The obtained data were analyzed using the Analysis of Variance (ANOVA) and Tukey-Kramer multiple comparison test. The within-group analysis of group 1 demonstrated differences (pre-post) of 1.09 kg, 4.39°, and 3.7° in grip strength, wrist extension, and flexion, respectively, after the training. The differences between the different parameters of MHQ viz. function, work, pain, and satisfaction were 2.7, 1, 1.1, and 0.3, respectively. No change was observed in the Activities of Daily Living (ADLs) and satisfaction. The within-group analysis of group 2 indicated the mean score differences of 0.3 kg and 6.53° in grip strength and wrist extension, respectively. Wrist flexion revealed a decrease from pre-test to post-test phases. The difference in MHQ parameters; function, ADLs, work, pain, aesthetics, and satisfaction were 2.4, 1.2, 2.4, 4, 0.5, and 1.59, respectively. The between-group analysis suggested better improvement of grip strength, wrist flexion, and function in adults; while wrist extension, ADL, and work were better in the elderly. There was no significant difference in this area.
Discussion: Previous studies have explored the visuomotor training, using game-based rehabilitation, non-immersive virtual reality, or robotic therapy. They have suggested that it would provide neuroplasticity and cortical reorganization, and enhance brain reward system. The low scores obtained in some subjective parameters like satisfaction could be due to different perceptions in individuals. Degenerative changes like osteoarthritis could be a possible reason for the high score of pain in the elderly. Future studies are required with larger sample sizes, control groups, incorporating other factors, and so on. This study may be beneficial in overcoming the limitations of conventional protocols such as labor, compliance, and adherence. It could also play an important role in rehabilitation, especially neurorehabilitation, by providing a new perspective.