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Martelli D, Rahman MM, Gurbuz SZ. Validation of a micro-doppler radar for measuring gait modifications during multidirectional visual perturbations. Gait Posture 2024; 113:504-511. [PMID: 39173440 DOI: 10.1016/j.gaitpost.2024.08.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Revised: 06/12/2024] [Accepted: 08/07/2024] [Indexed: 08/24/2024]
Abstract
BACKGROUND Changes in spatio-temporal gait parameters and their variability during balance-challenging tasks are markers of motor performance linked to fall risk. Radio frequency (RF) sensors hold great promise towards achieving continuous remote monitoring of these parameters. RESEARCH QUESTIONS To establish the concurrent validity of RF-based gait metrics extracted using micro-Doppler (µD) signatures and to determine whether these metrics are sensitive to gait modifications created by multidirectional visual perturbations. METHODS Fifteen participants walked overground in a virtual environment (VE) and VE with medio-lateral (ML) and antero-posterior (AP) perturbations. An optoelectronic motion capture system and one RF sensor were used to extract the linear velocity of the trunk and estimate step time (ST), step velocity (SV), step length (SL), and their variability (STV, SVV, and SLV). Intra-class coefficient for consistency (ICC), mean and standard deviation of the differences (MD), 95 % limits of agreement, and Pearson correlation coefficients (r) were used to determine concurrent validity. One-way repeated-measures analysis of variance was used to analyze the main and interaction effects of visual conditions. RESULTS All outcomes showed good to excellent reliability (r>0.795, ICC>0.886). Average gait parameters showed good to excellent agreement, with values obtained with the RF sensor systematically smaller than the values obtained with the markers (MD of 0.001 s, 0.09 m/s, and 0.06 m). Gait variability parameters showed poor to moderate agreement, with values obtained with the RF sensor systematically larger than those obtained with the markers (MD of 1.9 %-3.9 %). Both measurement systems reported decreased SL and SV during ML perturbations, but the gait variability parameters extracted with the radar were not able to detect the higher STV and SLV during this condition. SIGNIFICANCE The radar µD signature is a valid and reliable method for the assessment of average spatio-temporal gait parameters but gait variability measures need to be viewed with caution because of the lower levels of agreement and sensitivity to ML visual perturbations. This work represents an initial investigation for the development of a low-cost system that will facilitate aging-in-place by providing remote monitoring of gait in natural settings.
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Affiliation(s)
- Dario Martelli
- Department of Orthopedics and Sports Medicine, Medstar Health Research Institute, Baltimore, MD, United States.
| | - M Mahbubur Rahman
- Department of Electrical and Computer Engineering, University of Alabama, Tuscaloosa, United States.
| | - Sevgi Z Gurbuz
- Department of Electrical and Computer Engineering, University of Alabama, Tuscaloosa, United States.
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Lin MIB, Wu B, Cheng SW. Changes in Navigation Controls and Field-of-View Modes Affect Cybersickness Severity and Spatiotemporal Gait Patterns After Exposure to Virtual Environments. HUMAN FACTORS 2024; 66:1942-1960. [PMID: 37501376 DOI: 10.1177/00187208231190982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/29/2023]
Abstract
OBJECTIVE To examine the effects of navigation controls and field-of-view modes on cybersickness severity and gait dynamics after cessation of exposure to a virtual environment (VE). BACKGROUND The applications of virtual reality are increasing in various fields; however, whether changes in interaction techniques and visual contents could mitigate the potential gait disturbance following VE exposure remains unclear. METHOD Thirty healthy adults wore a head-mounted display to complete six sessions of 12-min run-and-gun tasks using different navigation controls (gamepad, head, natural) and field-of-view modes (full, restricted). Forward and backward walking tasks were performed before and after VE exposure. The degrees of cybersickness and presence were evaluated using questionnaires, along with the in-session task performance. Spatiotemporal gait measures and their variabilities were calculated for each walking task. RESULTS The participants experienced less cybersickness with the head and natural controls than with the gamepad. Natural control, based on matching body movements, was associated with the highest degree of presence and best performance. VE navigation using the gamepad showed reduced cadences and increased stride times during postexposure forward-walking tasks. When the VE was presented via the restricted field-of-view mode, increased gait variabilities were observed from backward-walking tasks after VE exposure. CONCLUSION Body movement-based navigation controls may alleviate cybersickness. We observed gait adaptation during both ambulation tasks, which was influenced by the navigation control method and field-of-view mode. APPLICATION This study provides the first evidence for gait adaptation during balance-demanding tasks after VE exposure, which is valuable for designing guidelines for virtual reality interactions.
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Affiliation(s)
- Ming-I Brandon Lin
- Department of Industrial and Information Management, National Cheng Kung University, Tainan, Taiwan
- Institute of Information Management, National Cheng Kung University, Tainan, Taiwan
| | - Bonnie Wu
- Department of Industrial and Information Management, National Cheng Kung University, Tainan, Taiwan
| | - Shun-Wen Cheng
- Institute of Information Management, National Cheng Kung University, Tainan, Taiwan
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Biere J, Groen BE, Keijsers NLW. Impact of visual rotations on heading direction and center of mass control during steady-state gait. J Neurophysiol 2024; 131:1260-1270. [PMID: 38748413 DOI: 10.1152/jn.00304.2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Revised: 04/19/2024] [Accepted: 04/29/2024] [Indexed: 06/14/2024] Open
Abstract
Visual information is essential to navigate the environment and maintain postural stability during gait. Visual field rotations alter the perceived heading direction, resulting in gait trajectory deviations, known as visual coupling. It is unclear how center of mass (CoM) control relative to a continuously changing base of support (BoS) is adapted to facilitate visual coupling. This study aimed to characterize mediolateral (ML) balance control during visual coupling in steady-state gait. Sixteen healthy participants walked on an instrumented treadmill, naive to sinusoidal low-frequency (0.1 Hz) rotations of the virtual environment around the vertical axis. Rotations were continuous with 1) high or 2) low amplitude or were 3) periodic with 10-s intervals. Visual coupling was characterized with cross-correlations between CoM trajectory and visual rotations. Balance control was characterized with the ML margin of stability (MoSML) and by quantifying foot placement control as the relation between CoM dynamics and lateral foot placement. Visual coupling was strong on a group level (continuous low: 0.88, continuous high: 0.91, periodic: 0.95) and moderate to strong on an individual level. Higher rotation amplitudes induced stronger gait trajectory deviations. The MoSML decreased toward the deviation direction and increased at the opposite side. Foot placement control was similar compared with regular gait. Furthermore, pelvis and foot reorientation toward the rotation direction was observed. We concluded that visual coupling was facilitated by reorientating the body and shifting the extrapolated CoMML closer to the lateral BoS boundary toward the adjusted heading direction while preserving CoM excursion and foot placement control.NEW & NOTEWORTHY Healthy, naive participants were unaware of subtle, low-frequency rotations of the visual field but still coupled their gait trajectory to a rotating virtual environment. In response, participants decreased their margin of stability toward the new heading direction, without changing the center of mass excursion magnitude and foot placement strategy.
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Affiliation(s)
- Joost Biere
- Department of Research, Sint Maartenskliniek, Nijmegen, The Netherlands
- Department of Sensorimotor Neuroscience, Donders Institute for Brain, Cognition and Behaviour, Radboud University, Nijmegen, The Netherlands
| | - Brenda E Groen
- Department of Research, Sint Maartenskliniek, Nijmegen, The Netherlands
- Department of Rehabilitation, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Noël L W Keijsers
- Department of Research, Sint Maartenskliniek, Nijmegen, The Netherlands
- Department of Sensorimotor Neuroscience, Donders Institute for Brain, Cognition and Behaviour, Radboud University, Nijmegen, The Netherlands
- Department of Rehabilitation, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
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Silva PMM, Silva LWM, Vieira ER, Cavalvanti FAC, Morya E. Go Across Immersive Technology: A Preliminary Study of the Design and Development of a System for Gait Training Using Virtual Reality. Games Health J 2023; 12:472-479. [PMID: 37410502 DOI: 10.1089/g4h.2023.0101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/07/2023] Open
Abstract
Virtual reality (VR) allows visuotactile interaction in a virtual environment. VR has several potential applications such as surgical training, phobia treatments, and gait rehabilitation. However, further interface development is required. Therefore, the objective of this study was to develop a noninvasive wearable device control to a VR gait training program. It consists of custom-made insoles with vibratory actuators, and plantar pressure sensor-based wireless interface with a VR game. System usability testing involved a habituation period and three gaming sessions. Significant gait improvement was associated with game scores (P < 0.05). This VR gait training system allowed real-time virtual immersive interaction with anticipatory stimulus and feedback during gait.
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Affiliation(s)
- Patrícia M M Silva
- Neuroengineering Program, Edmond and Lily Safra International Institute of Neurosciences, Macaíba, Brazil
- Physical Therapy Department, Federal University of Rio Grande do Norte, Natal, Brazil
| | - Léon W M Silva
- Neuroengineering Program, Edmond and Lily Safra International Institute of Neurosciences, Macaíba, Brazil
| | - Edgar R Vieira
- Physical Therapy Department, Florida International University, Miami, Florida, USA
| | | | - Edgard Morya
- Neuroengineering Program, Edmond and Lily Safra International Institute of Neurosciences, Macaíba, Brazil
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Mangalam M, Yarossi M, Furmanek MP, Krakauer JW, Tunik E. Investigating and acquiring motor expertise using virtual reality. J Neurophysiol 2023; 129:1482-1491. [PMID: 37194954 PMCID: PMC10281781 DOI: 10.1152/jn.00088.2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 04/25/2023] [Accepted: 05/11/2023] [Indexed: 05/18/2023] Open
Abstract
After just months of simulated training, on January 19, 2019 a 23-year-old E-sports pro-gamer, Enzo Bonito, took to the racetrack and beat Lucas di Grassi, a Formula E and ex-Formula 1 driver with decades of real-world racing experience. This event raised the possibility that practicing in virtual reality can be surprisingly effective for acquiring motor expertise in real-world tasks. Here, we evaluate the potential of virtual reality to serve as a space for training to expert levels in highly complex real-world tasks in time windows much shorter than those required in the real world and at much lower financial cost without the hazards of the real world. We also discuss how VR can also serve as an experimental platform for exploring the science of expertise more generally.
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Affiliation(s)
- Madhur Mangalam
- Department of Physical Therapy, Movement, and Rehabilitation Science, Northeastern University, Boston, Massachusetts, United States
- Division of Biomechanics and Research Development, Department of Biomechanics, University of Nebraska at Omaha, Omaha, Nebraska, United States
- Center for Research in Human Movement Variability, University of Nebraska at Omaha, Omaha, Nebraska, United States
| | - Mathew Yarossi
- Department of Physical Therapy, Movement, and Rehabilitation Science, Northeastern University, Boston, Massachusetts, United States
- Department of Electrical and Computer Engineering, Northeastern University, Boston, Massachusetts, United States
| | - Mariusz P Furmanek
- Department of Physical Therapy, Movement, and Rehabilitation Science, Northeastern University, Boston, Massachusetts, United States
- Institute of Sport Sciences, The Jerzy Kukuczka Academy of Physical Education in Katowice, Katowice, Poland
- Physical Therapy Department, University of Rhode Island, Kingston, Rhode Island, United States
| | - John W Krakauer
- Department of Neurology, The Johns Hopkins University School of Medicine, Baltimore, Maryland, United States
- Department of Neuroscience, The Johns Hopkins University School of Medicine, Baltimore, Maryland, United States
- Department of Physical Medicine and Rehabilitation, The Johns Hopkins University School of Medicine, Baltimore, Maryland, United States
- The Santa Fe Institute, Santa Fe, New Mexico, United States
| | - Eugene Tunik
- Department of Physical Therapy, Movement, and Rehabilitation Science, Northeastern University, Boston, Massachusetts, United States
- Department of Electrical and Computer Engineering, Northeastern University, Boston, Massachusetts, United States
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Suglia V, Brunetti A, Pasquini G, Caputo M, Marvulli TM, Sibilano E, Della Bella S, Carrozza P, Beni C, Naso D, Monaco V, Cristella G, Bevilacqua V, Buongiorno D. A Serious Game for the Assessment of Visuomotor Adaptation Capabilities during Locomotion Tasks Employing an Embodied Avatar in Virtual Reality. SENSORS (BASEL, SWITZERLAND) 2023; 23:s23115017. [PMID: 37299744 DOI: 10.3390/s23115017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Revised: 05/17/2023] [Accepted: 05/22/2023] [Indexed: 06/12/2023]
Abstract
The study of visuomotor adaptation (VMA) capabilities has been encompassed in various experimental protocols aimed at investigating human motor control strategies and/or cognitive functions. VMA-oriented frameworks can have clinical applications, primarily in the investigation and assessment of neuromotor impairments caused by conditions such as Parkinson's disease or post-stroke, which affect the lives of tens of thousands of people worldwide. Therefore, they can enhance the understanding of the specific mechanisms of such neuromotor disorders, thus being a potential biomarker for recovery, with the aim of being integrated with conventional rehabilitative programs. Virtual Reality (VR) can be entailed in a framework targeting VMA since it allows the development of visual perturbations in a more customizable and realistic way. Moreover, as has been demonstrated in previous works, a serious game (SG) can further increase engagement thanks to the use of full-body embodied avatars. Most studies implementing VMA frameworks have focused on upper limb tasks and have utilized a cursor as visual feedback for the user. Hence, there is a paucity in the literature about VMA-oriented frameworks targeting locomotion tasks. In this article, the authors present the design, development, and testing of an SG-based framework that addresses VMA in a locomotion activity by controlling a full-body moving avatar in a custom VR environment. This workflow includes a set of metrics to quantitatively assess the participants' performance. Thirteen healthy children were recruited to evaluate the framework. Several quantitative comparisons and analyses were run to validate the different types of introduced visuomotor perturbations and to evaluate the ability of the proposed metrics to describe the difficulty caused by such perturbations. During the experimental sessions, it emerged that the system is safe, easy to use, and practical in a clinical setting. Despite the limited sample size, which represents the main limitation of the study and can be compensated for with future recruitment, the authors claim the potential of this framework as a useful instrument for quantitatively assessing either motor or cognitive impairments. The proposed feature-based approach gives several objective parameters as additional biomarkers that can integrate the conventional clinical scores. Future studies might investigate the relation between the proposed biomarkers and the clinical scores for specific disorders such as Parkinson's disease and cerebral palsy.
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Affiliation(s)
- Vladimiro Suglia
- Department of Electrical and Information Engineering (DEI), Polytechnic University of Bari, 70126 Bari, Italy
| | - Antonio Brunetti
- Department of Electrical and Information Engineering (DEI), Polytechnic University of Bari, 70126 Bari, Italy
- Apulian Bioengineering s.r.l., 70026 Modugno, Italy
| | - Guido Pasquini
- IRCCS Fondazione Don Carlo Gnocchi ONLUS, 50143 Florence, Italy
| | - Mariapia Caputo
- Department of Electrical and Information Engineering (DEI), Polytechnic University of Bari, 70126 Bari, Italy
| | - Tommaso Maria Marvulli
- Department of Electrical and Information Engineering (DEI), Polytechnic University of Bari, 70126 Bari, Italy
| | - Elena Sibilano
- Department of Electrical and Information Engineering (DEI), Polytechnic University of Bari, 70126 Bari, Italy
| | | | - Paola Carrozza
- IRCCS Fondazione Don Carlo Gnocchi ONLUS, 50143 Florence, Italy
| | - Chiara Beni
- IRCCS Fondazione Don Carlo Gnocchi ONLUS, 50143 Florence, Italy
| | - David Naso
- Department of Electrical and Information Engineering (DEI), Polytechnic University of Bari, 70126 Bari, Italy
| | - Vito Monaco
- The Biorobotics Institute, Department of Excellence in Robotics and AI, Scuola Superiore Sant'Anna, 56127 Pisa, Italy
| | | | - Vitoantonio Bevilacqua
- Department of Electrical and Information Engineering (DEI), Polytechnic University of Bari, 70126 Bari, Italy
- Apulian Bioengineering s.r.l., 70026 Modugno, Italy
| | - Domenico Buongiorno
- Department of Electrical and Information Engineering (DEI), Polytechnic University of Bari, 70126 Bari, Italy
- Apulian Bioengineering s.r.l., 70026 Modugno, Italy
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Limited transfer and retention of locomotor adaptations from virtual reality obstacle avoidance to the physical world. Sci Rep 2022; 12:19655. [PMID: 36385632 PMCID: PMC9668810 DOI: 10.1038/s41598-022-24085-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2022] [Accepted: 11/09/2022] [Indexed: 11/17/2022] Open
Abstract
Locomotor training based in virtual reality (VR) is promising for motor skill learning, with transfer of VR skills in turn required to benefit daily life locomotion. This study aimed to assess whether VR-adapted obstacle avoidance can be transferred to a physical obstacle and whether such transfer is retained after 1 week. Thirty-two young adults were randomly divided between two groups. A control group (CG) merely walked on a treadmill and an intervention group (IG) trained crossing 50 suddenly-appearing virtual obstacles. Both groups crossed three physical obstacles (transfer task) immediately after training (T1) and 1 week later (T2, transfer retention). Repeated practice in VR led to a decrease in toe clearance along with greater ankle plantarflexion and knee extension. IG participants crossed physical obstacles with a lower toe clearance compared to CG but revealed significantly higher values compared to the VR condition. VR adaptation was fully retained over 1 week. For physical obstacle avoidance there were differences between toe clearance of the third obstacle at T1 and the first obstacle at T2, indicating only partial transfer retention. We suggest that perception-action coupling, and thus sensorimotor coordination, may differ between VR and the physical world, potentially limiting retained transfer between conditions.
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Booij M, van Royen B, Nolte P, Twisk J, Harlaar J, van den Noort J. Total knee arthroplasty improves gait adaptability in osteoarthritis patients; a pilot study. J Orthop 2022; 34:304-309. [PMID: 36176586 PMCID: PMC9513089 DOI: 10.1016/j.jor.2022.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Revised: 07/26/2022] [Accepted: 08/02/2022] [Indexed: 11/15/2022] Open
Abstract
Background Gait adaptability is of utmost importance for keeping balance during gait in patients with knee osteoarthritis, also after total knee arthroplasty (TKA). The aims of this explorative study are: (1) assess the effect of age, knee osteoarthritis and TKA on gait adaptability; (2) assess changes in gait adaptability pre-to post-TKA and (3) their relation to functional outcomes. Methods Gait adaptability was measured using a Target Stepping Test (TST) in knee osteoarthritis patients before (preTKA) and 12 months after TKA (postTKA) and compared to asymptomatic old (AsOld) and young adults (AsYng). TST imposed an asymmetrical gait pattern with projected stepping targets at high walking speed. Gait adaptability was determined through stepping accuracy on the targets. The Oxford Knee Score (OKS) and Timed-Up-and-Go test (TUG) measured patients' physical function. Results 12 preTKA, 8 postTKA, 18 AsYng, 21 AsOld were tested. Age showed no effect on TST-stepping accuracy. PreTKA showed worse TST-stepping accuracy compared to AsYng and AsOld (7.7; 6.2 cm difference). PostTKA showed an improvement of 52% in TST-stepping accuracy compared to preTKA (3.2 cm).Higher stepping accuracy preTKA predicted higher stepping accuracy post-TKA. In addition, low preTKA stepping accuracy predicted more improvement postTKA. Pre-to post-TKA improvement of stepping accuracy was related to improvement on the TUG (Beta = 0.17, p = 0.024), but not to OKS. Conclusions Gait adaptability is improved following TKA in knee osteoarthritis patients and no longer significantly worse than asymptomatic adults. The relation of gait adaptability to function is shown by its relation to the TUG and shows to have predictive value pre-to post-TKA.
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Affiliation(s)
- M.J. Booij
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Rehabilitation Medicine, Amsterdam Movement Sciences, de Boelelaan, 1117, Amsterdam, the Netherlands
| | - B.J. van Royen
- Amsterdam UMC, University of Amsterdam and Vrije Universiteit Amsterdam, Department of Orthopaedic Surgery, Amsterdam Movement Sciences, Meibergdreef 9, Amsterdam, the Netherlands
| | - P.A. Nolte
- Spaarne Gasthuis, Department of Orthopaedic Surgery, Spaarnepoort 1, Hoofddorp, the Netherlands
| | - J.W.R. Twisk
- VU University Medical Centre, Department of Epidemiology and Biostatistics, Amsterdam, the Netherlands
| | - J. Harlaar
- Delft University of Technology, Department of Biomechanical Engineering, Mekelweg 2, Delft, the Netherlands
- Erasmus Medical Center, Department of Orthopedics and Sports Medicine, Dr. Molewaterplein 40, Rotterdam, the Netherlands
| | - J.C. van den Noort
- Amsterdam UMC, University of Amsterdam, Department of Radiology and Nuclear Medicine, Medical Imaging Quantification Center, Amsterdam Movement Sciences, Meibergdreef 9, Amsterdam, the Netherlands
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Delbes L, Mascret N, Goulon C, Montagne G. Validation of an immersive virtual reality device accepted by seniors that preserves the adaptive behavior produced in the real world. Front Bioeng Biotechnol 2022; 10:917486. [PMID: 36118569 PMCID: PMC9479106 DOI: 10.3389/fbioe.2022.917486] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Accepted: 07/11/2022] [Indexed: 11/13/2022] Open
Abstract
Falls in the elderly are a major societal issue. Virtual reality appears as a relevant tool to propose gait training programs to prevent the occurrence of falls. The use of a head-mounted display allows overground walking during fully immersive virtual training sessions. Our long-term ambition is to develop gait training programs with a head-mounted display to propose enjoyable and personalized training content for the elderly. Before proposing these programs, several methodological precautions must be taken. The first concerns the supposed similarity of the adaptive behavior produced in the real world and in virtual reality. The second concerns the acceptance of the virtual reality device before and after use. Twenty older adults performed a locomotor pointing task in three conditions including a real-world condition, a virtual-world condition consisting in a replica of the real-world condition, and a virtual condition in which the locomotor pointing task was performed in a different context. From feet positions in relation to the position of a target, gait adaptability behavior was investigated. In line with previous studies, step adjustments (needed and produced) were investigated through a combination of inter-trial and trial-by-trial analyses. The results highlighted that participants adopted the same gait adaptability behavior whatever the type of environment (real vs. virtual). Gait analyses suggested the use of a generic control mechanism based on information-movement coupling. We also demonstrated that older adults accepted the virtual reality device before and after use. With these methodological locks removed, it is now possible to design training programs in virtual reality to prevent falls in the elderly.
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Petros FE, Klenk ME, Agrawal SK. Changes in Gait Parameters Due to Visual and Head Oscillations in Football Players and Non-Athletes. IEEE Robot Autom Lett 2022. [DOI: 10.1109/lra.2022.3181369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Fitsum E. Petros
- Robotics and Rehabilitation Laboratory, Department of Mechanical Engineering, Columbia University, New York, NY, USA
| | - Matthew E. Klenk
- Department of Mechanical Engineering, Columbia University, New York, NY, USA
| | - Sunil K. Agrawal
- Department of Mechanical Engineering, Department of Rehabilitation and Regenerative Medicine, Columbia University, New York, NY, USA
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Subsensory electrical noise stimulation applied to the lower trunk improves postural control during visual perturbations. Gait Posture 2022; 96:22-28. [PMID: 35561569 DOI: 10.1016/j.gaitpost.2022.05.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Revised: 04/09/2022] [Accepted: 05/05/2022] [Indexed: 02/02/2023]
Abstract
BACKGROUND Low levels of sensory noise applied to the skin through electrical stimulation (ES) can improve balance control through a mechanism called stochastic resonance (SR). Little is known regarding the extent subsensory ES can improve reactive control of balance after unanticipated balance perturbations and the best location where to apply the stimulation. RESEARCH QUESTIONS How efficient is subsensory ES in improving reactive control of balance following visual perturbations delivered in a virtual reality (VR) environment? 2) Does lower trunk stimulation have greater effects than lower legs stimulation? METHODS Eighteen healthy young adults stood on a force plate while wearing a Valve Index VR headset in eyes closed (EC), eyes open (EO), eyes open with anteroposterior visual perturbations (AP) and eyes open with mediolateral visual perturbations (ML) conditions. No-stimulation (NS), leg stimulation (LS), or trunk stimulation (TS) equal to 90% of the sensory threshold (ST) was applied. The 95% confidence ellipse area (95%EA), the lengths of AP and ML sway path (APPath, MLPath), and the AP and ML 50% and 95% power frequencies (APPF50, MLPF50, APPF95, and MLPF95) were calculated. Repeated-measures ANOVA and Tukey post-hoc tests were used to analyze the main and interaction effects of stimulation and visual conditions. RESULTS During AP perturbations, participants showed higher frequencies, longer paths, and larger ellipse areas. TS caused lower APPF50, MLPF50, MLPF95, APPath and EA while LS caused lower MLPF50 and EA. During ML perturbations, TS reduced APPF50 and both LS and TS caused reduction of MLPF95. Higher instability following AP perturbations was associated with greater effects of TS and LS. SIGNIFICANCE The application of subsensory ES improved postural control during AP perturbations and TS reduced postural sway more effectively than LS. TS may be an effective strategy to enhance balance control during reactive postural tasks, thus potentially reducing fall risk.
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Ketterer J, Ringhof S, Gehring D, Gollhofer A. Sinusoidal Optic Flow Perturbations Reduce Transient but Not Continuous Postural Stability: A Virtual Reality-Based Study. Front Physiol 2022; 13:803185. [PMID: 35665227 PMCID: PMC9157535 DOI: 10.3389/fphys.2022.803185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Accepted: 05/02/2022] [Indexed: 11/13/2022] Open
Abstract
Optic flow perturbations induced by virtual reality (VR) are increasingly used in the rehabilitation of postural control and gait. Here, VR offers the possibility to decouple the visual from the somatosensory and vestibular system. By this means, it enables training under conflicting sensorimotor stimulation that creates additional demands on sensory reweighting and balance control. Even though current VR-interventions still lack a well-defined standardized metric to generate optic flow perturbations that can challenge balance in a repeatable manner, continuous oscillations of the VR are typically used as a rehabilitation tool. We therefore investigated if continuous sensory conflicts induced by optic flow perturbations can challenge the postural system sustainably. Eighteen young adults (m = 8, f = 10, age = 24.1 ± 2.0 yrs) were recruited for the study. The VR was provided using a state-of-the-art head-mounted display including the virtual replica of the real environment. After familiarization in quiet stance without and with VR, bipedal balance was perturbed by sinusoidal rotations of the visual scenery in the sagittal plane with an amplitude of 8° and a frequency of 0.2 Hz. Postural stability was quantified by mean center of mass speed derived from 3D-kinematics. A rmANOVA found increased postural instability only during the first perturbation cycle, i.e., the first 5 s. Succeeding the first perturbation cycle, visual afferents were downregulated to reduce the destabilizing influence of the sensory conflicts. In essence, only the transient beginning of sinusoidal oscillation alters balance compared to quiet standing. Therefore, continuous sinusoidal optic flow perturbations appear to be not suitable for balance training as they cannot trigger persisting sensory conflicts and hence challenge the postural system sustainably. Our study provides rationale for using unexpected and discrete optic flow perturbation paradigms to induce sustainable sensory conflicts.
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Palmisano C, Kullmann P, Hanafi I, Verrecchia M, Latoschik ME, Canessa A, Fischbach M, Isaias IU. A Fully-Immersive Virtual Reality Setup to Study Gait Modulation. Front Hum Neurosci 2022; 16:783452. [PMID: 35399359 PMCID: PMC8983870 DOI: 10.3389/fnhum.2022.783452] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2021] [Accepted: 02/03/2022] [Indexed: 01/10/2023] Open
Abstract
Objective: Gait adaptation to environmental challenges is fundamental for independent and safe community ambulation. The possibility of precisely studying gait modulation using standardized protocols of gait analysis closely resembling everyday life scenarios is still an unmet need. Methods: We have developed a fully-immersive virtual reality (VR) environment where subjects have to adjust their walking pattern to avoid collision with a virtual agent (VA) crossing their gait trajectory. We collected kinematic data of 12 healthy young subjects walking in real world (RW) and in the VR environment, both with (VR/A+) and without (VR/A-) the VA perturbation. The VR environment closely resembled the RW scenario of the gait laboratory. To ensure standardization of the obstacle presentation the starting time speed and trajectory of the VA were defined using the kinematics of the participant as detected online during each walking trial. Results: We did not observe kinematic differences between walking in RW and VR/A-, suggesting that our VR environment per se might not induce significant changes in the locomotor pattern. When facing the VA all subjects consistently reduced stride length and velocity while increasing stride duration. Trunk inclination and mediolateral trajectory deviation also facilitated avoidance of the obstacle. Conclusions: This proof-of-concept study shows that our VR/A+ paradigm effectively induced a timely gait modulation in a standardized immersive and realistic scenario. This protocol could be a powerful research tool to study gait modulation and its derangements in relation to aging and clinical conditions.
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Affiliation(s)
- Chiara Palmisano
- Department of Neurology, University Hospital of Würzburg and Julius Maximilian University of Würzburg, Würzburg, Germany
- *Correspondence: Chiara Palmisano
| | - Peter Kullmann
- Human-Computer Interaction, Julius Maximilian University of Würzburg, Würzburg, Germany
| | - Ibrahem Hanafi
- Department of Neurology, University Hospital of Würzburg and Julius Maximilian University of Würzburg, Würzburg, Germany
| | - Marta Verrecchia
- Department of Neurology, University Hospital of Würzburg and Julius Maximilian University of Würzburg, Würzburg, Germany
| | - Marc Erich Latoschik
- Human-Computer Interaction, Julius Maximilian University of Würzburg, Würzburg, Germany
| | - Andrea Canessa
- Department of Neurology, University Hospital of Würzburg and Julius Maximilian University of Würzburg, Würzburg, Germany
- Department of Informatics, Bioengineering, Robotics and System Engineering, University of Genoa, Genova, Italy
| | - Martin Fischbach
- Human-Computer Interaction, Julius Maximilian University of Würzburg, Würzburg, Germany
| | - Ioannis Ugo Isaias
- Department of Neurology, University Hospital of Würzburg and Julius Maximilian University of Würzburg, Würzburg, Germany
- Parkinson Institute Milan, ASST Pini-CTO, Milano, Italy
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Horsak B, Simonlehner M, Schöffer L, Dumphart B, Jalaeefar A, Husinsky M. Overground Walking in a Fully Immersive Virtual Reality: A Comprehensive Study on the Effects on Full-Body Walking Biomechanics. Front Bioeng Biotechnol 2021; 9:780314. [PMID: 34957075 PMCID: PMC8693458 DOI: 10.3389/fbioe.2021.780314] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Accepted: 11/16/2021] [Indexed: 11/24/2022] Open
Abstract
Virtual reality (VR) is an emerging technology offering tremendous opportunities to aid gait rehabilitation. To this date, real walking with users immersed in virtual environments with head-mounted displays (HMDs) is either possible with treadmills or room-scale (overground) VR setups. Especially for the latter, there is a growing interest in applications for interactive gait training as they could allow for more self-paced and natural walking. This study investigated if walking in an overground VR environment has relevant effects on 3D gait biomechanics. A convenience sample of 21 healthy individuals underwent standard 3D gait analysis during four randomly assigned walking conditions: the real laboratory (RLab), a virtual laboratory resembling the real world (VRLab), a small version of the VRlab (VRLab-), and a version which is twice as long as the VRlab (VRLab+). To immerse the participants in the virtual environment we used a VR-HMD, which was operated wireless and calibrated in a way that the virtual labs would match the real-world. Walking speed and a single measure of gait kinematic variability (GaitSD) served as primary outcomes next to standard spatio-temporal parameters, their coefficients of variant (CV%), kinematics, and kinetics. Briefly described, participants demonstrated a slower walking pattern (-0.09 ± 0.06 m/s) and small accompanying kinematic and kinetic changes. Participants also showed a markedly increased gait variability in lower extremity gait kinematics and spatio-temporal parameters. No differences were found between walking in VRLab+ vs. VRLab-. Most of the kinematic and kinetic differences were too small to be regarded as relevant, but increased kinematic variability (+57%) along with increased percent double support time (+4%), and increased step width variability (+38%) indicate gait adaptions toward a more conservative or cautious gait due to instability induced by the VR environment. We suggest considering these effects in the design of VR-based overground training devices. Our study lays the foundation for upcoming developments in the field of VR-assisted gait rehabilitation as it describes how VR in overground walking scenarios impacts our gait pattern. This information is of high relevance when one wants to develop purposeful rehabilitation tools.
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Affiliation(s)
- Brian Horsak
- Center for Digital Health and Social Innovation, St. Pölten University of Applied Sciences, St Pölten, Austria
| | - Mark Simonlehner
- Department of Health, Institute of Health Sciences, St. Pölten University of Applied Sciences, St Pölten, Austria
| | - Lucas Schöffer
- Department of Media and Digital Technologies, Institute of Creative∖Media/Technologies, St. Pölten University of Applied Sciences, St Pölten, Austria
| | - Bernhard Dumphart
- Department of Health, Institute of Health Sciences, St. Pölten University of Applied Sciences, St Pölten, Austria
| | - Arian Jalaeefar
- Department of Media and Digital Technologies, Institute of Creative∖Media/Technologies, St. Pölten University of Applied Sciences, St Pölten, Austria
| | - Matthias Husinsky
- Department of Media and Digital Technologies, Institute of Creative∖Media/Technologies, St. Pölten University of Applied Sciences, St Pölten, Austria
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Kulkarni S, Nagarkar A. Basic gait pattern and impact of fall risk factors on gait among older adults in India. Gait Posture 2021; 88:16-21. [PMID: 33951574 DOI: 10.1016/j.gaitpost.2021.04.043] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 04/21/2021] [Accepted: 04/24/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND An unstable gait pattern is an indicator of an increased risk of falls among older adults. Data on basic gait parameters is useful in the early identification of gait impairment. However, reference gait measurements are not available in low- and middle-income countries. RESEARCH QUESTION What are the normative reference values of gait parameters and do fall risk factors such as impaired balance, functional difficulty, and multimorbidity affect the gait patterns of older adults in India? METHODS A cross-sectional data of 659 older adults were collected using a semi-structured schedule. Gait parameters were measured using wearable sensors. Descriptive statistics, independent t-test, and one-way ANCOVA were used to determine the significant difference (p < 0.05) in gait parameters across the risk factors. RESULTS A mean stride length of 123.00 ± 15.19 cm, stride velocity of 110.57 ± 17.57 cm/s, and a cadence of 106.14 ± 11.44 steps/minute were reported in the study. Functional difficulties and balance impairment were the two major risk factors that affected stride velocity, stride length, and cadence after adjusting for age and height. No difference in gait parameters was observed among participants with and without multimorbidity. SIGNIFICANCE This study provides a baseline or reference values of various gait parameters measured on a large sample of population aged 60 and above from India. Assessment of gait patterns and associated risk factors in a clinical setup will help identify the older adults at risk of falls and reduce the enormous burden of fall injuries. Since gait parameters show a large variation across geographical regions, it is important to have region-specific reference values.
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Affiliation(s)
- Snehal Kulkarni
- Interdisciplinary School of Health Sciences, Savitribai Phule Pune University, Pune, Maharashtra, India.
| | - Aarti Nagarkar
- Interdisciplinary School of Health Sciences, Savitribai Phule Pune University, Pune, Maharashtra, India.
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