Telerehabilitation in Disabled People: Proposal for Practical Intervention With Virtual Reality
Telerehabilitation in Disabled People: Proposal for Practical Intervention With Virtual Reality
This is a cross-sectional study, that is going to be conducted during the quarantine, period
 established by the state of São Paulo to reduce the transmission of COVID-19, between March
 24 2020 and May 31 2020. Thus, the differential of this study is to use 100%
 telerehabilitation, in which the rehabilitation team and participants only had telephone
 contact, communication application (WhatsApp) and software interaction. 40 participants will
 be included. Potential and interested volunteers will be assessed by a detailed screening
 using the eligibility criteria and attended an initial selection for enrolment in the study.
 It wiil be used a platform called MoveHero, available for free use in
 https://movehero.com.br/. The individual needs access the internet, and once he gets online,
 he had to create his own account, inserting his name, email and creating a password.
 Considering that the platform presents different levels of difficulty, after the participant
 is connected to the platform, the researcher directed the participant to the protocol bespoke
 for each participant, playing 3 rounds of the game for 5 minutes each (total of 15 minutes).
 During the intervention, it will be applied BORG scale in order to assess their perceived
 effort.
Instrument In this study, it will be used a platform called MoveHero, available for free use
 in https://movehero.com.br/. The individual needs access the internet, and once he gets
 online, he had to create his own account, inserting his name, email and creating a password.
 Considering that the platform presents different levels of difficulty, after the participant
 is connected to the platform, the researcher directed the participant to the protocol
 specially developed for cerebral palsy. MoveHero is considerate a timing coincident task and
 present several spheres falling down on the computer screen, with a musical rhythm to
 increase engagement. Thus, the participants will be positioned in front of a computer and
 when the game started the webcam captures the participant movements and a representation of
 the players appears on the computer screen as an avatar. The game goals are to intercept all
 falling spheres using upper limb wave movements in the exact moment the spheres reached their
 specific target in the bottom of computer screen. The game presented four columns with fixed
 targets in parallel allocated in two height levels (e.g. two on the left - targets A and B;
 two on the right - targets C and D). The game provides hit and miss feedback - if the
 individual reaches the spheres correctly, the game presented a feedback with the spheres
 changing the color for green (hit information). On the other hand, if the participant do not
 touch the spheres properly, the spheres changing the color for red and the letter X appears
 inside the target (miss information).

 Software score During the game match (each game match lasts for 5 minutes) the participant
 can follow the score determined by the number of spheres hit (i.e. the information from each
 sphere hit appears in the bottom left side of the screen all the time) and at the end of each
 game match the participant had feedback with their total score (when the game match finished
 a total score appears in the middle of the computer screen). The game features 10 different
 and progressive phases of difficulty, considering the number of balls falling. In this study,
 all participants will start at the easiest phase (phase 1) and according to their own score,
 the researcher should move forward to a more difficult phase. The progression in the phase
 was established by the table below. Thus, each participant presents an individual
 progression, considering their performance.

 Assessments

 To characterize the participants it will be used some scales that characterize each disease
 and can be applied such as Pediatric Evaluation of Disability Inventory (PEDI) for children
 and Quality of Life and specific scales for adults. As well as sociodemographic Information:
 some questions will be asked, such as age, sex, income to understand the studied population.

 To analyse the outcome Measures will be used: 1) Brunel Mood Scale (BRUMS) measures six
 identifiable affective states (Tension, Depression, Anger, Vigor, Fatigue, and Confusion)
 through a 24-item self-report inventory, with respondents rating a list of adjectives on a
 5-point Likert scale ranging from 0 (not at all) to 4 (extremely), based on subjective
 feelings. The instructions refer to how participants have been feeling in the past week,
 including today. 2) BORG scale: is Rating of Perceived Exertion used to measure the
 subjective intensity of effort. It is based on the sensations felt during exercise, such as
 muscle fatigue, increased heart rate and increased breathing. 3) System Usability Scale
 (SUS), was proposed by John Brooke in 1986 as the usability test tool. It is a simple scale
 based on a questionnaire and has been widely adopted in product usability evaluations. The
 statements cover a variety of aspects of system usability such as the need for support,
 training, and complexity, and thus have a high level of face validity for measuring usability
 of a system. The SUS instrument is generally used after the respondent has had an opportunity
 to use the system being evaluated. This instrument is a highly robust and versatile tool for
 usability professionals.

 1.5 Procedure and Design

 Contact and assessment scales

 The parent's individuals (for children) or the individual itself will be contacted by phone
 and asked to perform the task at home, they will be assisted by the researcher over the
 phone, with a video call. Important to emphasized that all participants that need assistance,
 will be assisted by their parents or their caregivers. First, they wiil receive a link with
 research information and the assent and consent form to fill out and the inclusion criteria
 will be checked by researcher. When they agree to participate, a link to access a questioner
 will be sent with Brunel Mood Scale, BORG scale, PEDI and Sociodemographic Information. When
 parents and participants finish those scales the gaming platform will be accessed and the
 participant starts the protocol practice.

 Practicing the task

 Participants will perform the task individually in their own house with a family member
 helping and giving support during all protocol. The researcher contacts the family member and
 gives the following instructions using videocall (research interact with the family member
 and the participant during all the protocol): 1) place the computer on a table and login to
 the platform; 2) position the cell phone (to provide videocall) on the side of the computer
 to receive instructions; 3) provide a comfortable sitting position in a chair (individual
 should be positioned at a distance of approximately 1.5 m meters from the computer monitor)
 and adjusted in height according to the needs of the individual (if applicable, participants
 could use their own wheelchair); 4) after being seated and connected to the platform the
 research will explain the task verbally for all participants and ask the family member to
 play ones (demonstrations of how to perform the coincidence timing was given form the family
 member during two minutes); 5) after demonstration, the family member should grab the mobile
 phone (to have the opportunity to move the phone and show the participant performance to the
 researcher during all the protocol) and 6) thus, the therapist (by video call) instructed the
 participant to stay still and wait the first sphere appears on the screen. Once the first
 sphere appears, the individual had to move his or her hand to either touch the sphere exactly
 at the moment coinciding with the bottom target and the game should move on with different
 spheres falling in the computer screen.

 Protocol

 As presented before the parent and participant should answer 4 assessments (Brunel Mood
 Scale, BORG scale, PEDI and Demographic Information), and start to perform the first game
 phase (phase 1), after 5 minutes playing the game the participant will answer the Borg scale
 and researcher will analyze the game score (e.g. according to table 2 the participant should
 repeat phase one or move forward for a more difficult phase); the participant started a
 second practice and after 5 minutes answer the Borg scale (again- the participant should
 repeat last phase or move forward for a more difficult phase); the participant started a
 third and last practice and after 5 minutes had to answer the Borg scale and to finish the
 protocol the BRUMS scale and the System Usability Scale (SUS).
Inclusion Criteria:

 -  agreement to participate

 -  clinical diagnosis of the disease

 -  age ranging from 7 to 80 years old

 Exclusion Criteria:

 -  do not understand the tasks

 -  motor difficulties that impede the completing of the virtual tasks

 -  do not have technology devices to perform the virtual task (computer) or to contact
 the researcher (cell phone or a second computer)

 -  was precluded from completing the task due to some technological failure (such as
 internet crash).