Physical exercises are crucial for enhancing postural balance and muscle strength in children and adolescents with Down syndrome (DS). Virtual reality-based therapy (VRBT), which utilizes exergames, can favor performing physical activity. The aim of this review was to assess the effectiveness of VRBT in improving balance and muscular endurance in children and adolescents with DS. Since inception up to August 2024, we screened in PubMed Medline, SCOPUS, WOS, CINAHL, and PEDro studies that assessed the effectiveness of VRBT, compared to conventional therapy (CT) or usual care (UC), in improving balance and muscular endurance in DS. Methodological quality was assessed using the PEDro scale. Effect size in meta-analyses was calculated with the Cohen’s standardized mean difference (SMD) and its 95% confidence interval (95% CI). Nine studies providing data from 424 participants with good methodological quality (PEDro: 6.3 ± 1.2 points) were included. Our meta-analysis showed that VRBT is more effective than controls in increasing function (SMD = 1.22; 95% CI 0.64 to 1.81; p < 0.001), dynamic balance (SMD = −2.2; 95% CI −3.1 to −1.25; p < 0.001), and muscular endurance (SMD = 1.37; 95% CI 0.58 to 2.2; p < 0.001). This is the first meta-analysis to exclusively focus on children and adolescents with DS, demonstrating the effectiveness of VRBT in enhancing balance and muscular endurance.

Objectives: The aim of this study was to investigate the potential anatomical and physiological interconnections between the visual system and the cervical muscular system, as well as to examine the role of the visual system in the etiology and manifestation of cervical musculoskeletal pain or discomfort. Methods: A systematic review was conducted following the PRISMA guidelines, using databases such as PubMed, Scopus, Web of Science, CINAHL, and PEDro. The protocol was registered in PROSPERO. The included study designs comprised experimental studies, randomized controlled trials (RCTs), and pilot RCTs. Results: The literature search was conducted between January and May 2025 and yielded 51 studies across all databases. Seven experimental studies were finally included, all of which met the inclusion criteria and presented a mean methodological quality score of 5 on the PEDro methodological quality scale. The studies included data from a total of 308 participants (n = 261; 84.74% females). Subjects in the intervention group reported cervical pain or visual fatigue. Conclusions: Our results indicated a relationship between visual accommodation and increased electromyographic activity of the trapezius muscle, suggesting that accommodative stress may induce cervical muscle fatigue and pain.

Background/Objectives: Scoliosis is a condition that involves deformation of the spine in the coronal plane and commonly appears in childhood or adolescence, significantly limiting a person’s life. The cause is multifactorial, and treatment aims to improve the spinal curvature, prevent major pathologies, and enhance aesthetics. The objective of this review was to determine whether high-velocity low-amplitude (HVLA) spinal manipulation is more effective than other treatments for children with idiopathic scoliosis (IS). Methods: The PubMed, Web of Science, Scopus and PEDro databases were searched for both clinical trials and cohort studies. Methodological quality was assessed via the PEDro scale (for clinical trials) and the Newcastle–Ottawa scale (for observational studies). The protocol of this systematic review was registered in PROSPERO (CRD42024532442). Results: Five studies were selected for review. The results indicated moderate improvements in pain and the Cobb angle and limited improvements in quality of life. Conclusions: HVLA spinal manipulation does not seem to have significant effects on reducing spinal deformity in IS patients, nor does it significantly impact quality of life. However, this therapy may have significant effects on reducing pain in these patients.

Objectives: This work aims to evaluate the psychometric properties of the Vertigo Handicap Questionnaire (VHQ) in a Spanish-speaking population. Methods: A total of 150 patients were included. Exploratory Factorial Analysis (EFA), Cronbach’s alpha, weighted kappa, Spearman correlation with respect to the Dizziness Handicap Inventory (DHI) and Activities Balance Confidence Scale (ABC), Kruskal-Wallis test and receiver operating characteristics (ROC) curve analysis were performed. Results: Internal consistency analysis found eight items uncorrelated with the total score, after whose elimination a 17-item VHQ version was generated. The EFA did not find clear factorization but did find a 7-item VHQ subscale that correlated strongly with VHQ_17 and VHQ_25. The Kappa was 0.993, 0.979 and 0.996 for VHQ_25, VHQ_17 and VHQ_7, respectively. Standard Error of Measurement (SEM) was 1.57, 2.11 and 0.60 points, and Minimum Detectable Change (MDC) was 3.08, 4.13 and 1.17 points for the three scales. VHQ_25, VHQ_17 and VHQ_7 strongly correlated with ABC-16 (Rho = −0.716, −0.787 −0.603, respectively) and DHI (Rho = 0.708, 0.696 0.721, respectively). VHQ_7 score was statistically different for different health conditions. The cut-off point >57 in VHQ_25 and >14 in VHQ_7 had 100% sensitivity, while a cut-off point >41 in VHQ_17 had 100% specificity in predicting severe disability due to vertigo. Conclusions: The Spanish version of the VHQ_25 is a valid and reliable instrument for measuring disability, handicap and psychological distress related to vertigo. However, the VHQ_17 and VHQ_7 versions may be viable options, especially the last, which has excellent psychometric properties and may be easier to implement.

Background/Objectives: Slow-paced breathing (SPB) is associated with changes in heart rate variability, although these responses are strongly influenced by respiratory patterns; the effects of incorporating an inspiratory breath-hold into an SPB protocol remain insufficiently characterized. This study evaluated the immediate effects of two SPB protocols on heart rate variability (HRV) and cervical pressure pain thresholds (PPT). Methods: A single-blind, randomized, controlled trial was conducted with 60 healthy adults (aged 18–65) stratified by age and sex, and allocated equally (n = 20 per group) to: Protocol 1 (6 s inhalation, 6 s hold, 6 s exhalation), Protocol 2 (6 s inhalation, 6 s exhalation), or a sham control (general respiratory education). Interventions lasted 5 min. Primary outcomes were time-domain HRV indices, root mean square of successive differences (RMSSD) and standard deviation of normal-to-normal (SDNN), recorded using a Polar H10 chest strap. The secondary outcome was PPT at the fourth cervical vertebra (C4) measured via digital algometry. Results: Repeated measures ANOVA revealed a significant time-by-group interaction for heart rate, RMSSD, and SDNN. Both active breathing protocols significantly increased RMSSD and SDNN compared to control, with high effect sizes (η²). Notably, Protocol 1 (with inspiratory breath-holding) produced the largest changes in HRV, RMSSD, and SDNN. Conversely, changes in cervical PPT were modest and reached only borderline significance with small effect sizes. Conclusions: Both SPB protocols were associated with acute increases in time-domain HRV indices. Protocol 1 (combining inspiratory breath-holding and lower respiratory frequency) produced a larger acute autonomic response, suggesting its potential utility in non-pharmacological interventions for autonomic dysregulation. However, the isolated contribution of breath-holding cannot be separated from the lower respiratory frequency inherent to this protocol.

Background/Objectives: The objective of this study was to validate the Spanish version of the European Evaluation of Vertigo (EEV) and analyse its test–retest reliability, standard error of measurement (SEM), minimum detectable change (MDC), concurrent validity, and discriminant validity. Methods: A cross-sectional validation study was designed. Subjects were recruited from the Otolaryngology Service of the University Hospital of Jaen. Psychometric properties of the EEV were analysed, including the concurrent validity, the SEM, and the MDC. Discriminant validity was calculated using the receiver operating characteristic (ROC) curve. Results: The EEV test–retest reliability was nearly perfect (Kappa index = 0.97). The SEM and the MDC were set at 0.56 and 1.10, respectively. Regarding the discriminant validity, the area under the curve (AUC) was 0.831 (95% CI; 0.743–0.899) for the BPPV prediction, the AUC = 0.731 (95% CI; 0.633–0.815) for the disability prediction from the ABC-16 score, and the AUC = 0.846 (95% CI; 0.760–0.911) for the disability prediction from the ABC-6 score. Furthermore, a cut-off point greater than 12 was a good predictor of disability and the fall risk measured with the ABC scale, whereas a value of 11 points was a good predictor for discriminating BPPV patients. Conclusions: The Spanish version of the EEV is a valid and reliable instrument for evaluating the clinical symptoms of vestibular syndrome. This instrument demonstrated a nearly perfect test-retest reliability, a low measurement error, and good accuracy in discriminating between patients with vestibular disorders and those with BPPV.