This study sought to explore the existence of a relationship between age and/or military affiliation (active, veteran, or family member) and awareness of local community mental health programs available for the treatment of post-traumatic stress disorder. The study separated age from military affiliation to better distinguish between influences on awareness level. Considerations that remain critical regarding post-traumatic stress disorder were described and used to guide a comprehensive review of the literature to find directions to fulfill the goal of this study. A survey was conducted and 586 active military, veterans, and their family members responded to an instrument that contained 40 items. This study was constrained to three items from the survey; age, military affiliation, self-rated awareness of treatment for PTSD. Multiple analysis techniques found no significant (p < .05) correlation between either age and awareness or military affiliation and awareness. Further analysis found a significant (p = .003) correlation between veterans and awareness, as well as between family members of veterans (p = .017) and awareness. Veterans and their family members indicated a greater awareness of local community mental health programs available for the treatment of post-traumatic stress disorder than did active troops and/or their family members. The significance of this finding presents new opportunities to study and improve both the marketing and the delivery of mental health treatment for PTSD to the active military population. Multiple opportunities for future research are discussed.

Thesis (PhD)--Stellenbosch University, 2013. / ENGLISH ABSTRACT: Research objective To test a novel concept that exposing patients with fibromyalgia syndrome (FMS) to visuals of exercise activities elicits neurophysiological changes in functional brain areas associated with pain catastrophization; thereby providing preliminary support for the further development/testing of a virtual reality exposure therapy (VRET) exercise program aimed at reducing pain catastrophization toward exercise therapy in patients with FMS. Methods The main study of this research consisted of a three-phase exploratory fMRI study. Phase 1 involved the development/validation of the fMRI visual task. Phase 2 involved the exploration of the differences in neural correlates associated with pain catastrophizing between participants with FMS and healthy controls when exposed to various visuals of exercise and passive/relaxing activities. Phase 3 involved the testing of the preliminary efficacy of a novel VRET exercise program on pain catastrophization in participants with FMS. The fMRI task consisted of two stimuli: active (exercise activity visuals)/passive (relaxing activity visuals). Structural images as well as blood-oxygenation-level-dependent (BOLD) contrasts were acquired for the conditions and compared within-subjects/groups and between-groups. The condition of interest was the active>passive condition (where brain activations for the passive condition were subtracted from the active condition). The brain volumes collected during ‗on‘ conditions were compared with the brain volumes collected during ‗off‘ conditions using Students‘ t test. Statistic images were thresholded using clusters determined by Z>2.3 and a (corrected) cluster significance threshold of p=0.05. Results The right (R) middle and inferior frontal gyrus and R posterior cerebellum were significantly activated for the participants with FMS, and not the healthy control group, during the active>passive condition (phase 2). At baseline, during the active>passive condition (phase 3), the intervention/VRET group showed significant activation (p<0.05) in the R insular cortex, R anterior and posterior cerebellum, R parahippocampal gyrus, R middle frontal gyrus, R corpus callosum, R thalamus, R supramarginal gyrus and R middle and superior temporal gyrus; the control group showed significant activation in the R anterior and posterior cerebellum, R middle and superior temporal gyrus, R middle frontal gyrus, R insular cortex, R supramarginal gyrus and R precentral gyrus. Post-intervention, during the active>passive condition, R posterior cerebellum activation was still significant (p<0.05) for the intervention group; R anterior cerebellum, left (L) middle and inferior frontal gyrus, and R superior parietal lobe activation was found to be significant (p<0.000) for the control group, although these areas were not found to be significantly activated at baseline for the control group. Conclusion We could not provide confirmatory evidence for the efficacy of a novel VRET program for pain catastrophization in patients with FMS. However, the findings of this study does suggest that pain catastrophization in patients with FMS could be confirmed with fMRI. Research is therefore warranted to further develop a proper VRET exercise program and to test the effect of this program on pain catastrophization in patients with FMS. / AFRIKAANSE OPSOMMING: Navorsing doelstelling Om 'n nuwe konsep dat die blootstelling van pasiënte met fibromialgie sindroom (FMS) aan beeldmateriaal van oefening, ontlok neurofisiologiese veranderinge in funksionele brein-areas wat verband hou met pyn katastrofering te toets; sodoende voorlopige steun vir die verdere ontwikkeling/toetsing van 'n virtuele realiteit blootstelling terapie (VRET) oefenprogram wat gemik is op die vermindering van pyn katastrofering na oefenterapie in pasiënte met die FMS te bied. Metodes Die hoofstudie van hierdie navorsing bestaan uit 'n drie-fase verkennende fMRI studie. Fase 1 het die ontwikkeling/validering van die fMRI visuele taak behels. Fase 2 het die ondersoek van die verskille in die neurale korrelate geassosieer met pyn katastrofering tussen deelnemers met FMS en gesonde kontroles wanneer hulle blootgestel word aan verskeie beeldmateriaal van oefening en passiewe/ontspannende aktiwiteite behels. Fase 3 het die toets van die voorlopige effektiwiteit van 'n nuwe VRET oefenprogram op pyn katastrofering in deelnemers met FMS behels. Die fMRI taak het bestaan uit twee stimuli: aktiewe (oefening aktiwiteit beeldmateriaal)/passiewe (ontspannende aktiwiteit beeldmateriaal). Strukturele beelde sowel as bloed-suurstof-vlak-afhanklike (BSVA) kontraste is vir die toestande verkry en vergelyk binne-deelnemers/groepe en tussen-groepe. Die toestand van belang was die aktiewe>passiewe toestand (waar brein aktivering vir die passiewe toestand afgetrek is van die aktiewe toestand). Die brein volumes wat ingesamel tydens die 'aan' toestande is vergelyk met die brein volumes wat ingesamel is gedurende die 'af' toestande met die gebruik van Studente se t-toets. Drempel statistiek beelde is gegroepeer deur Z> 2,3 en 'n (gekorrigeerde) groepeerde betekenisvolle drempel van p = 0.05. Resultate Die regter (R) middel- en inferior-frontale gyrus en R posterior serebellum is betekenisvol geaktiveer vir die deelnemers met FMS, maar nie vir die gesonde kontrole groep nie, gedurende die aktiewe>passiewe toestand (fase 2). By basislyn, tydens die aktiewe>passiewe toestand (fase 3), die intervensie / VRET groep het betekenisvolle aktivering (p <0.05) in die R insulaire korteks, R anterior en posterior serebellum, R para- hippokampus gyrus, R middel-frontale gyrus, R korpus kallosum, R talamus, R supramarginale gyrus en R middel- en superior-temporale gyrus; die kontrole groep het betekenisvolle aktivering in die R anterior en posterior serebellum, R middel- en superior-temporale gyrus, R middel-frontale gyrus, R insulaire korteks, R supramarginale gyrus en R presentrale gyrus. Post-intervensie, tydens die aktiewe>passiewe toestand, was R posterior serebellum aktivering betekenisvol (p <0.05) vir die intervensie groep; R anterior serebellum, links (L) middel- en inferior-frontale gyrus en R superior pariëtale lob aktivering was betekenisvol (p <0.000) vir die kontrole groep, alhoewel geen betekenisvolle basislyn aktivering in hierdie areas by die kontrole groep plaasgevind het nie. Gevolgtrekking Ons kan nie bewyse vir die effektiwiteit van 'n nuwe VRET program vir pyn katastrofering in pasiënte met FMS bevestig nie. Nietemin, dui die bevindinge van hierdie studie wel daarop dat pyn katastrofering in pasiënte met FMS bevestig kon word met fMRI. Verdere navorsing is dus geregverdig om 'n behoorlike VRET oefenprogram te ontwikkel en die uitwerking van hierdie program op pyn katastrofering in pasiënte met FMS te toets.

Social anxiety disorder (SAD) is the 3rd most common psychiatric diagnosis, and is associated with significant social, occupational, health, and educational impairment. Fortunately, both pharmacological and psychological treatments can reduce symptoms. Cognitive behavioral therapy is considered the gold standard treatment for SAD, and a robust literature supports its effectiveness. In contrast, process related factors, including the role of the working alliance, have received less attention in treatment of SAD. The current study examined development of the working alliance for a SAD sample. The working alliance is characterized as the collaborative relationship between a client and therapist, and includes shared goals, strategies, and an attachment bond. Within the context of SAD, the working alliance is particularly interesting, as the alliance itself is a social relationship that may elicit anxiety, which, in turn, may impact development of the alliance. The present study also investigated whether treatment type, that is, exposure group therapy (EGT) versus virtual reality exposure (VRE) therapy, or pre-treatment symptom severity influenced the working alliance trajectory. Data were provided by an adult sample presenting with a primary diagnosis of SAD. Participants were randomly assigned to one of two treatment conditions, both involved use of a manualized CBT treatment approach. Standardized measures of social anxiety were administered pre-treatment whereas working alliance ratings were obtained after each session. Results indicated high levels of working alliance and significant change in ratings over time. Treatment condition did not contribute to significant differences in the working alliance trajectory. Regarding the impact of SAD symptoms, initially high ratings of fear was associated with progressively increasing rates of growth in the working alliance whereas high initial ratings of avoidance signified steeper increase in the working alliance earlier in treatment followed by a declining rate of change over time. The current study contributes to the limited literature regarding the working alliance trajectory for clients with SAD, and is the first to consider the impact of VRE treatment on this trajectory. Findings also provide preliminary evidence for the differential impact of initial fear and avoidance as well as a potential curvature for the working alliance trajectory when using CBT.

Despite evidence supporting a robust relation between common factors- aspects of the therapeutic setting that are common across all types of treatment- and treatment response, little is known about the mechanisms by which these common factors effect change. Two of the most well-researched common factors include the client’s expectations about the effectiveness of treatment (termed outcome expectancy), and the quality of the therapeutic relationship (termed working alliance). Using archival data, the present study tests the hypothesis that the relation between outcome expectancy and symptom reduction is mediated by the alliance following treatment for social anxiety disorder. Data were collected in a sample of 65 individuals who received cognitive behavioral therapy for social phobia with public speaking fears. Mediation analyses were conducted using Andrew Hayes’ Process Macro (Hayes, 2013). None of the mediation analyses were significant. These findings suggest that the mechanisms of common factor variables may vary by disorder.

A Paralisia Cerebral (PC) é definida como um grupo de desordens permanentes do desenvolvimento da postura e movimento, causando limitação em atividades. Assim, com o intuito de promover melhora de desempenho motor, os programas de reabilitação utilizam cada vez mais ambientes de realidade virtual, entretanto com poucas evidências de sua eficácia na transferência de desempenho para ambientes reais. Portanto, o objetivo deste trabalho é verificar se o treino de tarefa em ambiente virtual (sem toque) auxilia na melhora de desempenho em tarefas em ambiente com característica mais real (com toque) nas pessoas com PC. Para a realização deste trabalho foram avaliadas 80 pessoas, divididas em dois grupos: 40 no grupo PC e 40 no grupo controle composto por indivíduos com desenvolvimento típico (DT) com idade entre 8 e 21 anos (13,7 ± 3,6 anos), 24 do sexo masculino e 16 do sexo feminino, sendo o grupo DT pareado por idade e sexo ao grupo PC. Os resultados apontam que o ambiente mais virtual (kinect for windows) apresentou pior desempenho em todas as fases do estudo. Para o grupo PC a prática constante apontou pior desempenho apenas no ambiente mais virtual, enquanto no grupo DT, o pior desempenho foi encontrado para o ambiente mais real. Além disto, a prática prévia em ambiente virtual promoveu melhor desempenho na tarefa com características mais reais. Os participantes de ambos os grupos retiveram o desempenho adquirido, exceto pelos que realizaram a prática da primeira sequência no ambiente mais virtual. Todos também transferiram o desempenho para tarefa em maior velocidade e com interação pelo toque no botão do teclado. O grupo com PC apresentou pior desempenho que o grupo DT apenas nas fases de retenção e transferências. Concluímos então, que todos os indivíduos, tanto do grupo controle como experimental, conseguiram melhorar o desempenho durante a prática em ambos ambientes (real e virtual) e transferir o desempenho para a tarefa com maior velocidade e com características mais reais, independentemente se iniciaram pela prática aleatória ou constante. Além disto, a prática prévia em ambiente virtual promoveu melhor desempenho quando a mesma tarefa foi realizada em ambiente com características mais reais / Cerebral Palsy (CP) is defined as a group of permanent disorders of the development of posture and movement, causing limitation in activities. Thus, with the aim of promoting motor performance improvement, rehabilitation programs increasingly use virtual reality environments, but with little evidence of their effectiveness in transferring performance to real environments. Therefore, the goal of this work is to verify if the task training in virtual environment (without touch) helps the improvement of performance in tasks in environment with more real characteristic (with touch) in people with CP. Eighty people were evaluated, divided into two groups: 40 in the CP group and 40 in the control group composed of individuals with typical development (TD) aged between 8 and 21 (13.7 ± 3.6 years) , 24 males and 16 females. The TD group matches the CP group on both age and gender distribution. The results show that the most virtual environment (kinect for windows) presented worse performance in all phases of the study. For the CP group, the constant practice showed worse performance only in the most virtual environment, whereas in the TD group, the worst performance was found at the most real environment. In addition, the previous practice in virtual environment resulted in better performance in the task with more real characteristics. Participants in both groups retained their performance, except for those who performed the first sequence in the most virtual environment. Everyone also transferred the performance to task at a higher speed and with interaction by touching the keyboard button. The CP group presented worse performance than the TD group only in the retention and transfer phases. We conclude that all individuals, both control and experimental, were able to improve performance during practice in both real and virtual environments and transfer performance to the task with higher speed and with more real characteristics, regardless of whether they started with practice. In addition, previous practice in virtual environment promoted better performance when the same task was performed in an environment with more real characteristics

Orientadores: Simone Botelho Pereira, Cássio Luís Zanettinni Riccett / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas / Made available in DSpace on 2018-08-27T01:20:14Z (GMT). No. of bitstreams: 1 Silva_ValeriaRegina_M.pdf: 1669073 bytes, checksum: 323991e89ad6dee82fb3e930b3074e31 (MD5) Previous issue date: 2015 / Resumo: Introdução: A literatura recente tem investigado o efeito do treinamento abdominopélvico (TAP) como meio de prevenção e tratamento das disfunções do assoalho pélvico. Neste contexto, exercícios que promovam o treinamento muscular de forma global estão sendo explorados na pesquisa clinica. No presente estudo foram utilizados dois protocolos de TAP: um por meio de cinesioterapia e outro por meio de realidade virtual, a fim de investigar a interação dos músculos do compartimento abdominopélvico e, consequentemente, o comportamento dos músculos do assoalho pélvico (MAP) e Transverso do Abdômen (Tra) associado ao Obliquo Interno (OI), nas situações de contração voluntaria máxima (CVM), e de coativação. Objetivos: Investigar a atividade elétrica dos músculos do assoalho pélvico (MAP) e dos músculos abdominais (Tra/OI) frente a dois protocolos de treinamento: TAP Cinesioterapia (TAP CAP) e TAP Realidade Virtual (TAP RV); bem como identificar a presença de coativação entre os músculos. Pacientes e Métodos: Participaram desta pesquisa 47 mulheres jovens, nulíparas, continentes com idade média de 25,79 (±3,85) anos, divididas de forma randomizada em dois grupos: (G1) TAP_CAP (n=22) e (G2) TAP_RV (n=25). Os protocolos foram supervisionados por fisioterapeuta treinado, com duração de 30 minutos por sessão, três vezes por semana, totalizando 10 sessões. As mulheres foram avaliadas antes e após a realização dos protocolos, por meio de palpação digital (PD) dos MAP e eletromiografia (EMG) simultânea dos MAP e Tra/OI. Resultados: Os grupos apresentaram-se homogêneos quanto às condições sociodemográficas. Na avaliação por Palpação Digital observou-se aumento significativo na contratilidade dos MAP tanto no TAP_CAP (p=0,001) como no TAP_RV (p=0,0001), sem diferença entre os grupos (p=0,1). Em contrapartida, quando avaliado por EMG, não foi verificado diferença significativa na análise pré e pós- treinamento (p=0,05) em nenhum dos grupos. Ao solicitar a contração voluntária máxima do músculo Transverso do abdômen/ obliquo interno, para observação da coativação, observou-se resultado significativo (p=0,001) no grupo TAP RV após o treinamento. Entretanto, não foram encontrados resultados significativos no grupo TAP_CAP. Conclusão: O treinamento abdominopélvico por meio de realidade virtual proporcionou melhora da coativação dos músculos do assoalho pélvico em resposta à contração do Tra / Abstract: Introduction: Recent literature has investigated the abdominopelvic training effect (APT) effect as means of to prevent and treat pelvic floor dysfunction. In this context, globally muscle training exercises are being explored in clinical research. In the present study, two abdominopelvic protocols were used: by kinesiotherapy and by virtual reality, aiming to investigate the interaction of abdominopelvic enclosure muscles, and consequently, the behavior of the pelvic floor muscles (PFM) and transversus abdominis/internal obliquos (Tra/IO) muscle, in some peculiarly situations like maximum voluntary contraction (MVC) and coactivation. Aims: To investigate the pelvic floor and abdominal muscle¿s electrical activity using two training protocols: APT by kinesiotherapy (APT K) and APT by virtual reality (APT VR); as well as to indentify the presence of coactivation between these muscles. Patients and Methods: 47 young, nulliparous and continent women (mean age 25.79±3.85 years) participated in this study. They were randomly divided into two groups: (G1) APT_K (n=22) and (G2) APT_VR (n=25). The protocols were supervised by a physiotherapist, lasting 30 minutes per session, three times per week, during 10 sessions. The women were assessed before and after the completion of the protocols by digital palpation (DP) and electromyography (EMG) of simultaneous MAP and Tra/IO. Results: The groups were homogeneous in demographic conditions. There was a significant increase in PFM contractility in both APT_K (p = 0.001) and APT_VR (p=0.0001) groups when assessed by digital palpation, with no difference in the comparison between groups (p=0.1). In contrast, when measured by EMG, PFM electromyography activity did not showed a significant difference in pre and post training analysis (p=0.05). When requesting the Transverse / internal oblique maximum voluntary contraction, for observation of coactivation, a significant result (p=0.001) was observed in APT_VR group after training. However, no significant results were found in APT_K group. Conclusion: The abdominopelvic training by virtual reality showed an improvement in the coactivation of pelvic floor muscle contraction in response to Tra / Mestrado / Fisiopatologia Cirúrgica / Mestra em Ciências

A Paralisia Cerebral (PC) é definida como um grupo de desordens permanentes do desenvolvimento da postura e movimento, causando limitação em atividades. Assim, com o intuito de promover melhora de desempenho motor, os programas de reabilitação utilizam cada vez mais ambientes de realidade virtual, entretanto com poucas evidências de sua eficácia na transferência de desempenho para ambientes reais. Portanto, o objetivo deste trabalho é verificar se o treino de tarefa em ambiente virtual (sem toque) auxilia na melhora de desempenho em tarefas em ambiente com característica mais real (com toque) nas pessoas com PC. Para a realização deste trabalho foram avaliadas 80 pessoas, divididas em dois grupos: 40 no grupo PC e 40 no grupo controle composto por indivíduos com desenvolvimento típico (DT) com idade entre 8 e 21 anos (13,7 ± 3,6 anos), 24 do sexo masculino e 16 do sexo feminino, sendo o grupo DT pareado por idade e sexo ao grupo PC. Os resultados apontam que o ambiente mais virtual (kinect for windows) apresentou pior desempenho em todas as fases do estudo. Para o grupo PC a prática constante apontou pior desempenho apenas no ambiente mais virtual, enquanto no grupo DT, o pior desempenho foi encontrado para o ambiente mais real. Além disto, a prática prévia em ambiente virtual promoveu melhor desempenho na tarefa com características mais reais. Os participantes de ambos os grupos retiveram o desempenho adquirido, exceto pelos que realizaram a prática da primeira sequência no ambiente mais virtual. Todos também transferiram o desempenho para tarefa em maior velocidade e com interação pelo toque no botão do teclado. O grupo com PC apresentou pior desempenho que o grupo DT apenas nas fases de retenção e transferências. Concluímos então, que todos os indivíduos, tanto do grupo controle como experimental, conseguiram melhorar o desempenho durante a prática em ambos ambientes (real e virtual) e transferir o desempenho para a tarefa com maior velocidade e com características mais reais, independentemente se iniciaram pela prática aleatória ou constante. Além disto, a prática prévia em ambiente virtual promoveu melhor desempenho quando a mesma tarefa foi realizada em ambiente com características mais reais / Cerebral Palsy (CP) is defined as a group of permanent disorders of the development of posture and movement, causing limitation in activities. Thus, with the aim of promoting motor performance improvement, rehabilitation programs increasingly use virtual reality environments, but with little evidence of their effectiveness in transferring performance to real environments. Therefore, the goal of this work is to verify if the task training in virtual environment (without touch) helps the improvement of performance in tasks in environment with more real characteristic (with touch) in people with CP. Eighty people were evaluated, divided into two groups: 40 in the CP group and 40 in the control group composed of individuals with typical development (TD) aged between 8 and 21 (13.7 ± 3.6 years) , 24 males and 16 females. The TD group matches the CP group on both age and gender distribution. The results show that the most virtual environment (kinect for windows) presented worse performance in all phases of the study. For the CP group, the constant practice showed worse performance only in the most virtual environment, whereas in the TD group, the worst performance was found at the most real environment. In addition, the previous practice in virtual environment resulted in better performance in the task with more real characteristics. Participants in both groups retained their performance, except for those who performed the first sequence in the most virtual environment. Everyone also transferred the performance to task at a higher speed and with interaction by touching the keyboard button. The CP group presented worse performance than the TD group only in the retention and transfer phases. We conclude that all individuals, both control and experimental, were able to improve performance during practice in both real and virtual environments and transfer performance to the task with higher speed and with more real characteristics, regardless of whether they started with practice. In addition, previous practice in virtual environment promoted better performance when the same task was performed in an environment with more real characteristics

Objetivo: Construir um programa de Exposição à Realidade Virtual para tratar Fobia Social, avaliá-lo e aperfeiçoá-lo por meio de uma análise quantitativa e qualitativa. Método: Finalizaram o tratamento 21 sujeitos (11 homens e 10 mulheres) entre 18 e 63 anos diagnosticados pelo Manual Diagnóstico Estatístico de Transtornos Mentais 4a edição- texto revisado (DSM -IV- TR) para fobia social. Foram excluídos os sujeitos com depressão grave, com risco de suicídio, transtornos psicóticos e abuso de substância. Principais medidas de avaliação quantitativa: Escala de Ansiedade Social de Liebowitz - LSAS; Escala de Impressão Clínica Global - CGI; Escala para Incapacitação de Sheehan; Escala de Adequação Social - EAS; e Questionário de Pensamentos Automáticos - ATQ 30. Avaliação qualitativa: Questionário Metodológico Qualitativo de Avaliação de Ansiedade Social. Procedimento: as Escalas e os Instrumentos foram aplicados no pré-tratamento, no pós-tratamento e no seguimento após seis meses de tratamento. O Questionário Metodológico Qualitativo de Avaliação de Ansiedade Social foi aplicado no pós-tratamento. O tratamento consistiu em até 12 sessões de 50 minutos cada de exposição à Realidade Virtual. Resultados: Observou-se redução significativa no escore pós-tratamento que se manteve no seguimento, nas escalas que avaliaram ansiedade, fobia e disfunções cognitivas (LSAS, ATQ e EAS). Na CGI, houve redução na gravidade da doença após o tratamento e isto se manteve no seguimento. Os pacientes apresentaram melhora do transtorno que também se manteve no período do seguimento. A Escala de Incapacitação de Sheehan mostrou melhora significativa da vida profissional, social e familiar. O número médio de sessões para a diminuição da ansiedade social foi de 7. Conclusão: O tratamento utilizado neste estudo teve boa aceitação, boa adesão, auxilia na diminuição da ansiedade social como também no enfrentamento das situações temidas. Estudos controlados ulteriores deverão ser realizados para verificar se ratificam estes resultados preliminares / Objectives: To build a Virtual Reality Exposure software for the treatment of Social Phobia, to evaluate and improve it based on quantitative and qualitative analysis. Method: The treatment was completed by 21 subjects (11 men and 10 women) aged between 18 and 63, diagnosed with social phobia by the Diagnostic Statistical Manual of Mental Disorders 4th edition - revised text (DSM - IV-TR). Subjects were excluded on account of deep depression, suicide risk, psychotic disorders or substance abuse. The main measurement instruments for quantitative evaluation were: Liebowitz Social Anxiety Scale - LSAS, Clinical Global Impression Scale - CGI, Sheehan Disability Scale, Social Adjustment Scale - SAS, Automatic Thoughts Questionnaire - ATQ 30. Qualitative evaluation: Methodological Qualitative Questionnaire for the Evaluation of Social Anxiety. Procedure: The Scales and Instruments were applied in the pre-treatment and post-treatment phases and in the follow-up assessment six months after treatment. The Methodological Qualitative Questionnaire for the Evaluation of Social Anxiety was applied in the post-treatment phase. The treatment consisted of twelve 50-minute sessions of exposure to Virtual Reality. Results: A significant decrease in the score in scales that measure anxiety, phobia and cognitive dysfunctions (LSAS, ATQ and SAS) was observed after treatment and it was maintained on follow-up. Patients have shown improvement of the disorder that was also preserved on follow-up. The Sheehan Disability Scale has shown significant improvement in professional, social and family life. The average number of sessions to achieve a reduction of social anxiety was seven. Conclusion: The treatment used in this study has been well received; patients have shown adherence to it and it has helped them to reduce their social anxiety and deal with situations they feared. Further controlled trials should be undertaken to endorse these preliminary results

Os objetivos do presente estudo foram analisar os efeitos dos videogames interativos Kinect Adventures comparados com a fisioterapia convencional por meio de um treinamento multimodal no controle postural, na marcha, na aptidão cardiorrespiratória e na cognição de idosos da comunidade e verificar a duração dos efeitos das intervenções após 30 dias de seguimento. Tratou-se de um ensaio clínico aleatorizado e cego. Participaram do estudo 50 idosos que foram aleatorizados entre grupo controle e grupo experimental, 25 em cada grupo. Todos os sujeitos foram submetidos a 14 sessões de intervenção, duas vezes por semana, por sete semanas. O grupo controle realizou treinamento multimodal, que incluiu aquecimento, treinamento de equilíbrio estático e dinâmico, condicionamento físico, treinamento de força muscular, treinamento de coordenação motora, flexibilidade muscular e desaquecimento. O grupo experimental praticou quatro jogos do Kinect Adventures, cinco tentativas de cada jogo por sessão. Todos os participantes foram submetidos a três avaliações: inicial (pré), final (pós) e trinta dias após as intervenções (seguimento), realizadas por um avaliador cego em relação ás intervenções. O desfecho primário do estudo foi o controle postural, avaliado por meio do Mini-Balance Evaluation Systems Test. Os desfechos secundários foram: (1) marcha, avaliada por meio Functional Gait Assessment; (2) aptidão cardiorrespiratória, avaliada por meio do Teste do Degrau de seis minutos e (3) cognição, avaliada por meio da Avaliação Cognitiva de Montreal. A análise estatística foi realizada por meio da ANOVA de medidas repetidas e do teste de pós hoc de Tukey para a verificação de possíveis diferenças entre os grupos e avaliações. Foi adotado alfa de 0,05. Não houve diferença entre os grupos após as intervenções e no seguimento em todos os desfechos. Ambos os grupos apresentaram melhora no controle postural, na marcha e na cognição após as intervenções (testes de Pós hoc de Tukey, P < 0,05). Em relação à aptidão cardiorrespiratória, o grupo experimental apresentou melhora após a intervenção e manutenção dos resultados no período de seguimento. Já o grupo controle apresentou melhora somente no período de seguimento. Conclui-se que ambas as intervenções podem proporcionar efeitos positivos no controle postural, na marcha na aptidão cardiorrespiratória e na cognição de idosos da comunidade, sem superioridade entre elas / The objectives of the present study were to analyze the effects of Kinect Adventures interactive videogames compared to conventional physiotherapy through multimodal training in postural control, gait, cardiorespiratory fitness and cognition of the elderly in the community and to verify the duration of the effects of the interventions after 30 days of follow-up. It was a randomized, blinded clinical trial. Fifty elderly individuals who were randomized between the control group and the experimental group participated in the study, 25 in each group. All subjects underwent 14 intervention sessions, twice a week, for seven weeks. The control group performed multimodal training, which included warm-up, static and dynamic balance training, physical conditioning, muscle strength training, motor coordination training, muscle flexibility and cooling. The experimental group practiced four games of Kinect Adventures, five attempts of each game per session. All participants were submitted to three evaluations: initial (pre), final (post) and thirty days after the interventions (follow-up), performed by a blind evaluator in relation to the interventions. The primary endpoint of the study was postural control, evaluated through the Mini-Balance Evaluation Systems Test. The secondary outcomes were: (1) gait assessed by Functional Gait Assessment; (2) cardiorespiratory fitness assessed by the Six-Minute Step Test and (3) cognition assessed through the Montreal Cognitive Assessment. Statistical analysis was performed using repeated measures ANOVA and Tukey post hoc test to verify possible differences between groups and evaluations. Alpha of 0.05 was adopted. There was no difference between the groups after the interventions and in the follow-up in all the outcomes. Both groups showed improvement in control, gait and cognition after the interventions (Tukey Post hoc tests, P < 0.05). Regarding cardiorespiratory fitness, the experimental group presented improvement after the intervention and maintenance of the results in the follow-up period. The control group showed improvement only in the follow-up period. It is concluded that both interventions can provide positive effects on postural control, gait in cardiorespiratory fitness and on the cognition of elderly in the community, without any superiority between them

O Transtorno do Espectro do Autismo (TEA) é uma deficiência do desenvolvimento neurológico, em que tem sido relatada dificuldade com a integração multisensorial, o que pode dificultar as habilidades cognitivas e motoras para permitir aprendizagem de diferentes tarefas e comunicação social. Considerando a possibilidade de interação em tarefas 3D por meio de dispositivos que necessitem de contato físico ou não, optou-se por avaliar pessoas com TEA e com DT em uma tarefa virtual variando o dispositivo de interação em duas seqüências de prática. Objetivou-se verificar se as pessoas com TEA são capazes de melhorar o desempenho em uma tarefa executada em um ambiente mais virtual (sem contato físico) ou mais real (com contato físico), e se essa melhora de desempenho pode ser transferida entre esses ambientes. Para a realização deste trabalho foram avaliadas 100 pessoas, divididas em dois grupos: 50 no grupo TEA, com idade entre 7 e 15 anos (11,3 ± 2,4 anos), 38 do sexo masculino e 12 do sexo feminino; e 50 pessoas com desenvolvimento típico - grupo DT, pareados por idade e sexo ao grupo TEA. Todos os participantes que realizaram ambas as seqüências mostraram uma tendência de atraso de movimento, mas os participantes que realizaram a seqüência B - a tarefa na barra de espaço primeiro - apresentaram mais atraso (m = 511 ms) do que os participantes que realizaram a seqüência A - tarefa no kinect -primeiro (m = 305 ms). Para ambas as seqüências, o erro absoluto foi maior para a interface kinect. Além disso, o grupo TEA reduziu significativamente o EV com a prática, enquanto que para o grupo DT esta diferença não ocorreu. Para o erro absoluto na fase de transferência, os resultados mostraram diferenças significativas para o grupo TEA entre os blocos A1 para a interface barra de espaço na Seqüência A (m = 475 ms) e Seqüência B (m = 718 ms). Desta forma, a prática na interface kinect (ambiente mais virtual) promoveu um melhor desempenho na interface de pressionar a barra de espaço (ambiente mais real), mas apenas para pessoas com TEA. Podemos concluir que pessoas com TEA melhoraram o seu desempenho independente do ambiente estimulado, porém com desempenho inferior ao grupo com desenvolvimento típico. E apenas o grupo TEA conseguiu transferir a prática do ambiente com características mais virtuais para com características mais reais / Autism Spectrum Disorder (ASD) is a deficiency of neurological development, in which difficulty has been reported with multisensory integration, which may hamper cognitive and motor skills to allow learning of different tasks and social communication. Considering the possibility of interaction in 3D tasks through devices that require physical contact or not, we opted to evaluate people with ASD and DT in a virtual task by varying the interaction device in two practice sequences. The objective was to verify if people with ASD are able to improve performance in a task executed in a more virtual (no physical contact) or more real (with physical contact) environment, and if this improvement of performance can be transferred between these environments. For the accomplishment of this work 100 people were evaluated, divided into two groups: 50 in the TEA group, with ages between 7 and 15 years (11.3 ± 2.4 years), 38 males and 12 females; And 50 people with typical development - DT group, matched by age and sex to the TEA group. All participants who performed both sequences showed a tendency of movement delay, but the participants who performed the sequence B - the task in the space bar first - presented more delay (m = 511 ms) than the participants who performed the sequence A - task in kinect - first (m = 305 ms). For both sequences, the absolute error was higher for the kinect interface. In addition, the TEA group significantly reduced the EV with the practice, whereas for the DT group this difference did not occur. For the absolute error in the transfer phase, the results showed significant differences for the TEA group between blocks A1 for the space bar interface in Sequence A (m = 475 ms) and Sequence B (m = 718 ms). In this way, practice in the kinect interface (more virtual environment) promoted a better performance in the interface of pressing the space bar (more real environment), but only for people with ASD. We can conclude that people with ASD improved their performance independent of the stimulated environment, but with inferior performance to the group with typical development. And only the TEA group managed to transfer the practice of the environment with more virtual characteristics to more real characteristics