1
|
Ettefagh A, Roshan Fekr A. Technological advances in lower-limb tele-rehabilitation: A review of literature. J Rehabil Assist Technol Eng 2024; 11:20556683241259256. [PMID: 38840852 PMCID: PMC11151759 DOI: 10.1177/20556683241259256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Accepted: 05/20/2024] [Indexed: 06/07/2024] Open
Abstract
Tele-rehabilitation is a healthcare practice that leverages technology to provide rehabilitation services remotely to individuals in their own homes or other locations. With advancements in remote monitoring and Artificial Intelligence, automatic tele-rehabilitation systems that can measure joint angles, recognize exercises, and provide feedback based on movement analysis are being developed. Such platforms can offer valuable information to clinicians for improved care planning. However, with various methods and sensors being used, understanding their pros, cons, and performance is important. This paper reviews and compares the performance of recent vision-based, wearable, and pressure-sensing technologies used in lower limb tele-rehabilitation systems over the past 10 years (from 2014 to 2023). We selected studies that were published in English and focused on joint angle estimation, activity recognition, and exercise assessment. Vision-based approaches were the most common, accounting for 42% of studies. Wearable technology followed at approximately 37%, and pressure-sensing technology appeared in 21% of studies. Identified gaps include a lack of uniformity in reported performance metrics and evaluation methods, a need for cross-subject validation, inadequate testing with patients and older adults, restricted sets of exercises evaluated, and a scarcity of comprehensive datasets on lower limb exercises, especially those involving movements while lying down.
Collapse
Affiliation(s)
- Alireza Ettefagh
- KITE Research Institute, Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada
- Institute of Biomedical Engineering, University of Toronto, Toronto, ON, Canada
| | - Atena Roshan Fekr
- KITE Research Institute, Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada
- Institute of Biomedical Engineering, University of Toronto, Toronto, ON, Canada
| |
Collapse
|
2
|
Johansson R, Jensen L, Barnett CT, Rusaw DF. Quantitative methods used to evaluate balance, postural control, and the fear of falling in lower limb prosthesis users: A systematic review. Prosthet Orthot Int 2023; 47:586-598. [PMID: 37318276 DOI: 10.1097/pxr.0000000000000250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Accepted: 04/23/2023] [Indexed: 06/16/2023]
Abstract
Problems with balance, postural control, and fear of falling are highly prevalent in lower limb prosthesis users, with much research conducted to understand these issues. The variety of tools used to assess these concepts presents a challenge when interpreting research outcomes. This systematic review aimed to provide a synthesis of quantifiable methods used in the evaluation of balance, postural control, and fear of falling in lower limb prosthesis users with an amputation level at or proximal to the ankle joint. A systematic search was conducted in CINAHL, Medline, AMED, Cochrane, AgeLine, Scopus, Web of Science, Proquest, PsycINFO, PsycArticles, and PubPsych databases followed by additional manual searching via reference lists in the reviewed articles databases. Included articles used quantitative measure of balance or postural control as one of the dependent variables, lower limb prosthesis users as a sample group, and were published in a peer-reviewed journal in English. Relevant assessment questions were created by the investigators to rate the assessment methods used in the individual studies. Descriptive and summary statistics are used to synthesize the results. The search yielded (n = 187) articles assessing balance or postural control (n = 5487 persons in total) and (n = 66) articles assessing fear of falling or balance confidence (n = 7325 persons in total). The most used test to measure balance was the Berg Balance Scale and the most used test to measure fear of falling was the Activities-specific Balance Confidence scale. A large number of studies did not present if the chosen methods were valid and reliable for the lower limb prosthesis users. Among study limitations, small sample size was common.
Collapse
Affiliation(s)
- Robin Johansson
- School of Health and Welfare, Jönköping University, Jönköping, Sweden
| | - Louise Jensen
- School of Health and Welfare, Jönköping University, Jönköping, Sweden
- Southern Älvsborg Hospital, Borås, Sweden
| | - Cleveland T Barnett
- School of Science and Technology, Nottingham Trent University, Nottingham, United Kingdom
| | - David F Rusaw
- School of Health and Welfare, Jönköping University, Jönköping, Sweden
| |
Collapse
|
3
|
Kohler F, Halford GRJ, Lukin M, Hafner BJ, Boone DA, Desmond DM, Franchignoni F, Gailey RS, Hagberg K, Major MJ, Resnik L, Tan JM. Categorization and recommendations for outcome measures for lower limb absence by an expert panel. Prosthet Orthot Int 2023; 47:565-574. [PMID: 37878250 DOI: 10.1097/pxr.0000000000000307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2021] [Accepted: 09/13/2023] [Indexed: 10/26/2023]
Abstract
BACKGROUND Understanding the psychometric strengths and limitations of outcome measures for use with people with lower limb absence (LLA) is important for selecting measures suited to evaluating patient outcomes, answering clinical and research questions, and informing health care policy. The aim of this project was to review the current psychometric evidence on outcome measures in people with LLA to determine which measures should be included in a stakeholder consensus process. METHODS An expert panel was assembled, and a 3-stage review process was used to categorize outcome measures identified in a systematic literature review into 3 distinct categories (recommended for measures with better than adequate psychometric properties; recommended with qualification; and unable to recommend). Panelists were asked to individually categorize measures based on results of a systematic review of identified measures' psychometric properties. Each measure's final categorization was based on ≥70% agreement by all panelists. RESULTS No outcome measure attained the ≥70% consensus threshold needed to achieve a rating of "recommend." Hence, panelists suggested combining "recommend" and "recommend with qualifications" into a single category of "recommend with qualifications." Using this approach, consensus was reached for 59 of 60 measures. Consensus could not be reached on 1 outcome measure (socket comfort score). Thirty-six outcome measures were categorized as "unable to recommend" based on available evidence; however, 23 (12 patient-reported measures and 11 performance-based measures) demonstrated adequate psychometric properties in LLA samples and were thus rated as "recommend with qualification" by the expert panel. The panel of experts were able to recommend 23 measures for inclusion in the subsequent stakeholder review. A key strength of this process was bringing together international researchers with extensive experience in developing and/or using LLA outcome measures who could assist in identifying psychometrically sound measures to include in a subsequent stakeholder consensus process. CONCLUSION The above categorizations represent the current state of psychometric evidence on outcome measures for people with LLA and hence may change over time as additional research becomes available. The results will be used to achieve wider consensus from clinicians, health policymakers, health clinic managers, researchers, and end users (i.e., individuals with LLA) on outcome measures for the International Society of Prosthetics and Orthotics lower limb Consensus Outcome Measures for Prosthetic and Amputation ServiceS.
Collapse
Affiliation(s)
- Friedbert Kohler
- International Society of Prosthetics and Orthotics (ISPO), Copenhagen, Denmark
- South Western Sydney Clinical School, Medicine and Health, University of New South Wales, Sydney, Australia
- South Western Sydney Local Health District, Liverpool, Australia
- Braeside Hospital, HammondCare Health, Sydney, Australia
| | - Gregory R J Halford
- International Society of Prosthetics and Orthotics (ISPO), Copenhagen, Denmark
- School of Physiotherapy, Podiatry, Prosthetics and Orthotics, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Australia
| | - Martina Lukin
- International Society of Prosthetics and Orthotics (ISPO), Copenhagen, Denmark
- South Western Sydney Clinical School, Medicine and Health, University of New South Wales, Sydney, Australia
- South Western Sydney Local Health District, Liverpool, Australia
- Braeside Hospital, HammondCare Health, Sydney, Australia
- School of Physiotherapy, Podiatry, Prosthetics and Orthotics, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Australia
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA
- Orthocare Innovations, Edmonds, WA
- Prosthetics and Orthotics International, Brussels, Belgium
- Exceed Worldwide, Belfast, United Kingdom
- Assisting Living and Learning Institute and Department of Psychology, Maynooth University, Maynooth, Ireland
- Physical and Rehabilitation Medicine Unit, Istituti Clinici Scientifici Maugeri IRCCS, Tradate, Italy
- Department of Physical Therapy, University of Miami Miller School of Medicine, Coral Gables, FL
- Department of Orthopaedics, Sahlgrenska University Hospital and Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Physical Medicine and Rehabilitation, Feinberg School of Medicine, Northwestern University, Jesse Brown VA Medical Center, Chicago, IL
- Providence VA Medical Center, Providence, RI
- Center for Gerontology and Health Care Research, School of Public Health, Brown University, Providence, RI
- La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Australia
| | - Brian J Hafner
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA
| | - David A Boone
- Orthocare Innovations, Edmonds, WA
- Prosthetics and Orthotics International, Brussels, Belgium
- Exceed Worldwide, Belfast, United Kingdom
| | - Deirdre M Desmond
- Assisting Living and Learning Institute and Department of Psychology, Maynooth University, Maynooth, Ireland
| | - Franco Franchignoni
- Physical and Rehabilitation Medicine Unit, Istituti Clinici Scientifici Maugeri IRCCS, Tradate, Italy
| | - Robert S Gailey
- Department of Physical Therapy, University of Miami Miller School of Medicine, Coral Gables, FL
| | - Kerstin Hagberg
- Department of Orthopaedics, Sahlgrenska University Hospital and Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Matthew J Major
- Department of Physical Medicine and Rehabilitation, Feinberg School of Medicine, Northwestern University, Jesse Brown VA Medical Center, Chicago, IL
| | - Linda Resnik
- Providence VA Medical Center, Providence, RI
- Center for Gerontology and Health Care Research, School of Public Health, Brown University, Providence, RI
| | - Jade M Tan
- School of Physiotherapy, Podiatry, Prosthetics and Orthotics, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Australia
- Providence VA Medical Center, Providence, RI
| |
Collapse
|
4
|
B Aledi L, Flumignan CD, Trevisani VF, Miranda F. Interventions for motor rehabilitation in people with transtibial amputation due to peripheral arterial disease or diabetes. Cochrane Database Syst Rev 2023; 6:CD013711. [PMID: 37276273 PMCID: PMC10240563 DOI: 10.1002/14651858.cd013711.pub2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
BACKGROUND Amputation is described as the removal of an external part of the body by trauma, medical illness or surgery. Amputations caused by vascular diseases (dysvascular amputations) are increasingly frequent, commonly due to peripheral arterial disease (PAD), associated with an ageing population, and increased incidence of diabetes and atherosclerotic disease. Interventions for motor rehabilitation might work as a precursor to enhance the rehabilitation process and prosthetic use. Effective rehabilitation can improve mobility, allow people to take up activities again with minimum functional loss and may enhance the quality of life (QoL). Strength training is a commonly used technique for motor rehabilitation following transtibial (below-knee) amputation, aiming to increase muscular strength. Other interventions such as motor imaging (MI), virtual environments (VEs) and proprioceptive neuromuscular facilitation (PNF) may improve the rehabilitation process and, if these interventions can be performed at home, the overall expense of the rehabilitation process may decrease. Due to the increased prevalence, economic impact and long-term rehabilitation process in people with dysvascular amputations, a review investigating the effectiveness of motor rehabilitation interventions in people with dysvascular transtibial amputations is warranted. OBJECTIVES To evaluate the benefits and harms of interventions for motor rehabilitation in people with transtibial (below-knee) amputations resulting from peripheral arterial disease or diabetes (dysvascular causes). SEARCH METHODS We used standard, extensive Cochrane search methods. The latest search date was 9 January 2023. SELECTION CRITERIA We included randomised controlled trials (RCT) in people with transtibial amputations resulting from PAD or diabetes (dysvascular causes) comparing interventions for motor rehabilitation such as strength training (including gait training), MI, VEs and PNF against each other. DATA COLLECTION AND ANALYSIS We used standard Cochrane methods. Our primary outcomes were 1. prosthesis use, and 2. ADVERSE EVENTS Our secondary outcomes were 3. mortality, 4. QoL, 5. mobility assessment and 6. phantom limb pain. We use GRADE to assess certainty of evidence for each outcome. MAIN RESULTS We included two RCTs with a combined total of 30 participants. One study evaluated MI combined with physical practice of walking versus physical practice of walking alone. One study compared two different gait training protocols. The two studies recruited people who already used prosthesis; therefore, we could not assess prosthesis use. The studies did not report mortality, QoL or phantom limb pain. There was a lack of blinding of participants and imprecision as a result of the small number of participants, which downgraded the certainty of the evidence. We identified no studies that compared VE or PNF with usual care or with each other. MI combined with physical practice of walking versus physical practice of walking (one RCT, eight participants) showed very low-certainty evidence of no difference in mobility assessment assessed using walking speed, step length, asymmetry of step length, asymmetry of the mean amount of support on the prosthetic side and on the non-amputee side and Timed Up-and-Go test. The study did not assess adverse events. One study compared two different gait training protocols (one RCT, 22 participants). The study used change scores to evaluate if the different gait training strategies led to a difference in improvement between baseline (day three) and post-intervention (day 10). There were no clear differences using velocity, Berg Balance Scale (BBS) or Amputee Mobility Predictor with PROsthesis (AMPPRO) in training approaches in functional outcome (very low-certainty evidence). There was very low-certainty evidence of little or no difference in adverse events comparing the two different gait training protocols. AUTHORS' CONCLUSIONS Overall, there is a paucity of research in the field of motor rehabilitation in dysvascular amputation. We identified very low-certainty evidence that gait training protocols showed little or no difference between the groups in mobility assessments and adverse events. MI combined with physical practice of walking versus physical practice of walking alone showed no clear difference in mobility assessment (very low-certainty evidence). The included studies did not report mortality, QoL, and phantom limb pain, and evaluated participants already using prosthesis, precluding the evaluation of prosthesis use. Due to the very low-certainty evidence available based on only two small trials, it remains unclear whether these interventions have an effect on the prosthesis use, adverse events, mobility assessment, mortality, QoL and phantom limb pain. Further well-designed studies that address interventions for motor rehabilitation in dysvascular transtibial amputation may be important to clarify this uncertainty.
Collapse
Affiliation(s)
- Luciane B Aledi
- Department of Surgery, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Carolina Dq Flumignan
- Department of Surgery, Division of Vascular and Endovascular Surgery, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Virginia Fm Trevisani
- Medicina de Urgência and Rheumatology, Escola Paulista de Medicina, Universidade Federal de São Paulo and Universidade de Santo Amaro, São Paulo, Brazil
| | - Fausto Miranda
- Department of Surgery, Division of Vascular and Endovascular Surgery, Universidade Federal de São Paulo, São Paulo, Brazil
| |
Collapse
|
5
|
A Novel Virtual Reality Training Strategy for Poststroke Patients: A Randomized Clinical Trial. JOURNAL OF HEALTHCARE ENGINEERING 2021; 2021:6598726. [PMID: 34840701 PMCID: PMC8616657 DOI: 10.1155/2021/6598726] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/03/2021] [Revised: 09/28/2021] [Accepted: 10/27/2021] [Indexed: 02/05/2023]
Abstract
Stroke patients suffer impairments including sensory, motor, visual, and cognitive areas, as well as gait and balance manifestations making activities of daily living difficult. In such conditions, virtual reality training can be a potential rehabilitation tool in comparison to conventional physical therapy to cater to the burden of this disability; hence, this randomized clinical trial compared the effects of virtual reality training and conventional physical therapy on balance and lower extremity function in stroke patients. The sample of 68 poststroke participants from Kanaan Physical Therapy and Spine Clinic, Lahore, Pakistan, were divided into N = 34 cases each using the lottery method with one group given virtual reality training and the other received conventional physical therapy. Each group received 60 minutes intervention, 3 days per week for 6 weeks. The Berg balance scale and the Fugl-Meyer assessment-lower extremity scale were employed for data collection preintervention, immediate postintervention, and 6 weeks postintervention. The statistically significant differences between virtual reality and conventional physical therapy groups for the Berg Balance score (p < 0.001), Fugl-Meyer assessment (FMA)-lower extremity domains of FMA-motor function (p < 0.001), FMA-joint pain, and joint range (p < 0.001); however, there is no significant difference (p=0.202) for time vs. group interaction and significant (p < 0.001) for the time main effect for FMA sensation. Hence, virtual reality training is more effective to restore balance and lower extremity function compared to conventional physical therapy in stroke patients. The results of the study have significant implications for the clinicians with better case management enhancing quality of life of patients along with the dearth of local literature, thus providing base for future research from a developing country's perspective.
Collapse
|
6
|
Tao G, Miller WC, Eng JJ, Esfandiari E, Imam B, Lindstrom H, Payne MW. Group-based telerehabilitation intervention using Wii Fit to improve walking in older adults with lower limb amputation (WiiNWalk): A randomized control trial. Clin Rehabil 2021; 36:331-341. [PMID: 34841917 DOI: 10.1177/02692155211061222] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Determine efficacy of the novel WiiNWalk intervention on walking-related outcomes in older adults with lower limb amputation. DESIGN Multi-site, parallel, evaluator-masked randomized controlled trial. SETTING Home-setting in three Canadian cities. PARTICIPANTS Community-dwelling lower limb prosthesis users over 50 years of age. INTERVENTIONS The WiiNWalk group (n = 38) used modified Wii Fit activities for prosthetic rehabilitation. The attention control group (n = 33) used Big Brain Academy: Wii Degree, comprising of cognitive activities. Both groups completed a 4-week supervised phase with three 1-h sessions/week in groups of three overseen by a clinician via videoconferencing and a 4-week unstructured and unsupervised phase. MAIN MEASURES Primary outcome was walking capacity (2 min walk test); secondary outcomes were balance confidence (activities-specific balance confidence scale), dynamic balance (four-step square test), and lower limb functioning (short physical performance battery). Outcomes were compared across time points with repeated measures analysis of covariance, adjusting for baseline and age. RESULTS Mean age was 65.0 (8.4) years, with 179.5 (223.5) months post-amputation and 80% transtibial amputation. No group difference in a 2 min walk test with an effect size: 1.53 95% CI [-3.17, 6.23] m. Activities balance confidence was greater in the WiiNWalk group by 5.53 [2.53, 8.52]%. No group difference in the four-step square test -0.16 [-1.25, 0.92] s, nor short physical performance battery 0.48 [-0.65, 1.61]. A post-hoc analysis showed the greatest difference in balance confidence immediately after an unsupervised phase. CONCLUSIONS The WiiNWalk intervention improved balance confidence, but not walking-related physical function in older adult lower limb prosthesis users. Future rehabilitation games should be specific to the amputation context.Clinical Trial Registration number, NCT01942798.
Collapse
Affiliation(s)
- Gordon Tao
- Graduate Program in Rehabilitation Sciences, Faculty of Medicine, 8166The University of British Columbia, Vancouver, BC, Canada.,GF Strong Rehabilitation Research Lab, Vancouver Coastal Health Research Institute, Vancouver, BC, Canada
| | - William C Miller
- GF Strong Rehabilitation Research Lab, Vancouver Coastal Health Research Institute, Vancouver, BC, Canada.,Department of Occupational Science and Occupational Therapy, 8166The University of British Columbia, Vancouver, BC, Canada
| | - Janice J Eng
- GF Strong Rehabilitation Research Lab, Vancouver Coastal Health Research Institute, Vancouver, BC, Canada.,Department of Physical Therapy, 8166The University of British Columbia, Vancouver, BC, Canada
| | - Elham Esfandiari
- Graduate Program in Rehabilitation Sciences, Faculty of Medicine, 8166The University of British Columbia, Vancouver, BC, Canada.,GF Strong Rehabilitation Research Lab, Vancouver Coastal Health Research Institute, Vancouver, BC, Canada
| | - Bita Imam
- Graduate Program in Rehabilitation Sciences, Faculty of Medicine, 8166The University of British Columbia, Vancouver, BC, Canada
| | - Heather Lindstrom
- Department of Physical Medicine & Rehabilitation, Faculty of Medicine, 3158University of Alberta, Edmonton, AB, Canada
| | - Michael W Payne
- Department of Physical Medicine & Rehabilitation, Schulich School of Medicine & Dentistry, University of Western Ontario, London, ON, Canada
| |
Collapse
|
7
|
Cabrera IA, Pike TC, McKittrick JM, Meyers MA, Rao RR, Lin AY. Digital healthcare technologies: Modern tools to transform prosthetic care. Expert Rev Med Devices 2021; 18:129-144. [PMID: 34644232 DOI: 10.1080/17434440.2021.1991309] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Digital healthcare technologies are transforming the face of prosthetic care. Millions of people with limb loss around the world do not have access to any form of rehabilitative healthcare. However, digital technologies provide a promising solution to augment the range and efficiency of prosthetists. AREAS COVERED The goal of this review is to introduce the digital technologies that have the potential to change clinical methods in prosthetic healthcare. Our target audience are researchers who are unfamiliar with the field of prostheses in general, especially with the newest technological developments. This review addresses technologies for: scanning of amputated limbs, limb-to-socket rectification, additive manufacturing of prosthetic sockets, and quantifying patient response to wearing sockets. This review does not address biomechatronic prostheses or biomechanical design practices. EXPERT OPINION Digital technologies will enable affordable prostheses to be built on a scale larger than with today's clinical practices. Large technological gaps need to be overcome to enable the mass production and distribution of prostheses digitally. However, recent advances in computational methods and CAD/CAM technologies are bridging this gap faster than ever before. We foresee that these technologies will return mobility and economic opportunity to amputees on a global scale in the near future.
Collapse
Affiliation(s)
- Isaac A Cabrera
- Department of Mechanical and Aerospace Engineering, University of California San Diego, La Jolla, United States
| | - Trinity C Pike
- Department of Mechanical and Aerospace Engineering, University of California San Diego, La Jolla, United States
| | - Joanna M McKittrick
- Department of Mechanical and Aerospace Engineering, University of California San Diego, La Jolla, United States
| | - Marc A Meyers
- Department of Mechanical and Aerospace Engineering, University of California San Diego, La Jolla, United States.,Department of Nanoengineering, University of California San Diego, La Jolla, United States
| | - Ramesh R Rao
- California Institute for Telecommunications and Information Technology (Calit2), La Jolla, United States
| | - Albert Y Lin
- California Institute for Telecommunications and Information Technology (Calit2), La Jolla, United States
| |
Collapse
|
8
|
Correlates of Balance and Aerobic Indices in Lower-Limb Prostheses Users on Arm Crank Exercise. SENSORS 2021; 21:s21206917. [PMID: 34696129 PMCID: PMC8540364 DOI: 10.3390/s21206917] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Revised: 10/14/2021] [Accepted: 10/17/2021] [Indexed: 11/16/2022]
Abstract
Background: The HUMAC Balance System (HBS) offers valid measurement of balance, and the arm crank exercise test (ACE) is a valid measure of physiological capacity. Neither have been used to evaluate associations between balance and physiological capacity in lower-limb amputees. Methods: Thirty-five participants with lower-limb amputations were recruited. Standing balance (center of pressure) was evaluated during eyes opened (EO) and eyes closed (EC) conditions using the HBS. Participants performed ACE graded exercise testing (GXT) to evaluate aerobic capacity. Spearman’s rho was used to identify relationships between variables. Cut-points for three groups were generated for time on ACE. Mann–Whitney U tests were used to explore significant differences in variables of balance and ACE between low and high performers. Results: Relationships between variables of eyes open displacement (EOD), eyes open velocity (EOV), eyes closed displacement (ECD), and eyes closed velocity (ECV) were significant (p < 0.05), and high performers with EO also performed best with EC. Longer exercise times were significantly associated with increased HRpeak, VO2peak, VEpeak, and RERpeak (p < 0.05). HRpeak (143.0 ± 30.6 b/min), VO2peak (22.7 ± 7.9 and 10.6 ± 4.7 mL/kg/min), VEpeak (80.2 ± 22.2 and 33.2 ± 12.7 L/min), and RERpeak (1.26 ± 0.08 and 1.13 ± 0.11) were significantly greater in high performers than low performers, respectively (p < 0.05). There was no significant association among VO2peak and any balance task variables; however, there were significant associations between some balance and physiological variables. Conclusions: Findings differentiated high and low performers; however, participants were still well below able-bodied norms of physical capacity. Training to mitigate deconditioning is suggested.
Collapse
|
9
|
Cánovas-Ambit G, García-Vidal JA, Martín-San Agustín R, Dalla-Vecchia AA, Sánchez-Barbadora M, Medina-Mirapeix F. Validity and reliability of Veloflex to measure active cervical range of motion in asymptomatic and symptomatic subjects. PeerJ 2021; 9:e11228. [PMID: 33868830 PMCID: PMC8029663 DOI: 10.7717/peerj.11228] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Accepted: 03/16/2021] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Neck pain has a high annual incidence and decreases the cervical active range of motion (ROM). Clinicians use various methods to evaluate cervical range of motion (CROM) that some of them have also been proposed to give instant feedback. Accordingly, this study aimed to examine the validity and reliability of Veloflex (VF) to measure the CROM by comparison with the cervical range of motion (CROM) device, and to examine their test-retest reliability. METHODS Thirty-eight healthy and 20 symptomatic participants were evaluated. Cervical flexion-extension, side bending, and rotations were tested in two sessions, first by the CROM and VF and in the second only with the VF. To evaluate the concurrent validity and agreement between CROM and VF, Pearson correlation coefficient (r) and Bland-Altmann plots were used. Reliability were evaluated using intra-class correlation (ICC), standard error of measurement (SEM) and minimal detectable change (MDC). RESULTS CROM and VF showed excellent correlation for all movements (r > 0.960). Both devices provided small mean 'bias' (≤1.29%) in all movements regarding CROM measures. The intra-rater and inter-rater reliability of the VF was excellent (ICC > 0.98). SEMs ranging from 0.72% to 2.38% and the MDC ranging from 1.22° to 2.60° in all participants. The results support the validity and reliability of VF to measure CROM. For its use, with a basic training is enough to get reliable measurements.
Collapse
|
10
|
Abbas RL, Cooreman D, Al Sultan H, El Nayal M, Saab IM, El Khatib A. The Effect of Adding Virtual Reality Training on Traditional Exercise Program on Balance and Gait in Unilateral, Traumatic Lower Limb Amputee. Games Health J 2021; 10:50-56. [DOI: 10.1089/g4h.2020.0028] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Rami L. Abbas
- Physical Therapy Department, Faculty of Health Sciences, Beirut Arab University, Beirut, Lebanon
| | - Didier Cooreman
- International Committee of the Red Cross (ICRC), Geneva, Switzerland
| | - Hala Al Sultan
- International Committee of the Red Cross (ICRC), Geneva, Switzerland
| | - Mayssah El Nayal
- Department of Psychology, Faculty of Human Sciences, Beirut Arab University, Beirut, Lebanon
| | - Ibtissam M. Saab
- Physical Therapy Department, Faculty of Health Sciences, Beirut Arab University, Beirut, Lebanon
| | - Ayman El Khatib
- Physical Therapy Department, Faculty of Health Sciences, Beirut Arab University, Beirut, Lebanon
| |
Collapse
|
11
|
Tao G, Miller WC, Eng JJ, Lindstrom H, Imam B, Payne M. Self-directed usage of an in-home exergame after a supervised telerehabilitation training program for older adults with lower-limb amputation. Prosthet Orthot Int 2020; 44:52-59. [PMID: 32114933 DOI: 10.1177/0309364620906272] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND While home-based exergames help overcome accessibility barriers to rehabilitation, it is unclear what constitutes effective intervention design in using exergames to support self-efficacy and engagement. OBJECTIVE Examine usage of an in-home exergame, compared to control, unsupervised after supervised training by older persons with lower-limb amputation. STUDY DESIGN Secondary analysis of a multi-site parallel evaluator-masked randomized control trial. METHODS WiiNWalk uses the WiiFit and teleconferencing for in-home group-based exergame therapy with clinical supervision. Participants engaged in a 4-week supervised training phase followed by a 4-week unsupervised phase in experimental (WiiNWalk) and attention control groups. Usage between phases and between groups was compared using unsupervised/supervised ratio of session count (over 4 weeks) and session time (mean min/session over 4 weeks) for each phase. RESULTS Participants: n=36 experimental, n=28 control, unilateral lower-limb amputation, age > 50 years, prosthesis usage ≥ 2 hours/day. Session count ratio unsupervised/supervised, median and interquartile range (IQR), was less than parity (p<0.01) for experimental (0.25, IQR 0.00 -0.68) and control (0.18, IQR 0.00 -0.67) groups, with no different between groups (p=0.92). Experimental session time unsupervised/supervised showed consistency (1.12, IQR 0.80 -1.41) between phases (p=0.24); control showed lower (0.76, IQR 0.57 -1.08) ratios compared to experimental (p=0.027). CONCLUSIONS Unsupervised exercise duration remained consistent with supervised, but frequency was reduced. Social and clinical guidance features may remain necessary for sustained lower-limb amputation exergame engagement at home. CLINICAL RELEVANCE This study provides context regarding when prosthesis users are more likely to use exergames such as Wii Fit for exercise therapy. Clinicians may consider our results when applying exergames in their practice or when developing new exergame intervention strategies.
Collapse
Affiliation(s)
- Gordon Tao
- The University of British Columbia, Vancouver, BC, Canada
| | | | - Janice J Eng
- The University of British Columbia, Vancouver, BC, Canada
| | | | - Bita Imam
- The University of British Columbia, Vancouver, BC, Canada
| | | |
Collapse
|
12
|
Escamilla-Nunez R, Michelini A, Andrysek J. Biofeedback Systems for Gait Rehabilitation of Individuals with Lower-Limb Amputation: A Systematic Review. SENSORS (BASEL, SWITZERLAND) 2020; 20:E1628. [PMID: 32183338 PMCID: PMC7146745 DOI: 10.3390/s20061628] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Revised: 03/11/2020] [Accepted: 03/12/2020] [Indexed: 12/17/2022]
Abstract
Individuals with lower-limb amputation often have gait deficits and diminished mobility function. Biofeedback systems have the potential to improve gait rehabilitation outcomes. Research on biofeedback has steadily increased in recent decades, representing the growing interest toward this topic. This systematic review highlights the methodological designs, main technical and clinical challenges, and evidence relating to the effectiveness of biofeedback systems for gait rehabilitation. This review provides insights for developing an effective, robust, and user-friendly wearable biofeedback system. The literature search was conducted on six databases and 31 full-text articles were included in this review. Most studies found biofeedback to be effective in improving gait. Biofeedback was most commonly concurrently provided and related to limb loading and symmetry ratios for stance or step time. Visual feedback was the most used modality, followed by auditory and haptic. Biofeedback must not be obtrusive and ideally provide a level of enjoyment to the user. Biofeedback appears to be most effective during the early stages of rehabilitation but presents some usability challenges when applied to the elderly. More research is needed on younger populations and higher amputation levels, understanding retention as well as the relationship between training intensity and performance.
Collapse
Affiliation(s)
- Rafael Escamilla-Nunez
- Institute of Biomaterials and Biomedical Engineering, University of Toronto, Toronto, ON M4Y 1R5, Canada; (R.E.-N.); (A.M.)
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, ON M4G 1R8, Canada
| | - Alexandria Michelini
- Institute of Biomaterials and Biomedical Engineering, University of Toronto, Toronto, ON M4Y 1R5, Canada; (R.E.-N.); (A.M.)
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, ON M4G 1R8, Canada
| | - Jan Andrysek
- Institute of Biomaterials and Biomedical Engineering, University of Toronto, Toronto, ON M4Y 1R5, Canada; (R.E.-N.); (A.M.)
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, ON M4G 1R8, Canada
| |
Collapse
|
13
|
Littrell ME, Chang YH, Selgrade BP. Development and Assessment of a Low-Cost Clinical Gait Analysis System. J Appl Biomech 2018; 34:503-508. [PMID: 29989476 DOI: 10.1123/jab.2017-0370] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2017] [Revised: 05/10/2018] [Accepted: 05/16/2018] [Indexed: 12/20/2022]
Abstract
Clinically, measuring gait kinematics and ground reaction force (GRF) is useful to determine the effectiveness of treatment. However, it is inconvenient and expensive to maintain a laboratory-grade gait analysis system in most clinics. The purpose of this study was to validate a Wii Balance Board, Kinovea motion-tracking software, and a video camera as a portable, low-cost system, and overground gait analysis system. We validated this low-cost system against a multicamera Vicon system and research-grade force platform (Advanced Mechanical Technology, Inc). After validation trials with known weights and angles, 5 subjects walked across an instrumented walkway for multiple times (n = 8/subject). We collected vertical GRF and segment angles. Average GRF data from the 2 systems were similar, with peak GRF errors below 3.5%BW. However, variability in the balance board's sampling rate led to large GRF errors early and late in stance, when the GRF changed rapidly. The thigh, shank, and foot angle measurements were similar between the single and multicamera, but the pelvis angle was far less accurate. The proposed system has the potential to provide accurate segment angles and peak GRF at low cost but does not match the accuracy of the multicamera system and force platform, in part because of the Wii Balance Board's variable sampling rate.
Collapse
Affiliation(s)
| | | | - Brian P Selgrade
- Georgia Institute of Technology
- North Carolina State University/University of North Carolina at Chapel Hill
| |
Collapse
|
14
|
Gil-Gómez JA, Manzano-Hernández P, Albiol-Pérez S, Aula-Valero C, Gil-Gómez H, Lozano-Quilis JA. USEQ: A Short Questionnaire for Satisfaction Evaluation of Virtual Rehabilitation Systems. SENSORS 2017; 17:s17071589. [PMID: 28686174 PMCID: PMC5539644 DOI: 10.3390/s17071589] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/28/2017] [Revised: 07/03/2017] [Accepted: 07/04/2017] [Indexed: 11/16/2022]
Abstract
New emerging technologies have proven their efficacy in aiding people in their rehabilitation. The tests that are usually used to evaluate usability (in general) or user satisfaction (in particular) of this technology are not specifically focused on virtual rehabilitation and patients. The objective of this contribution is to present and evaluate the USEQ (User Satisfaction Evaluation Questionnaire). The USEQ is a questionnaire that is designed to properly evaluate the satisfaction of the user (which constitutes part of usability) in virtual rehabilitation systems. Forty patients with balance disorders completed the USEQ after their first session with ABAR (Active Balance Rehabilitation), which is a virtual rehabilitation system that is designed for the rehabilitation of balance disorders. Internal consistency analysis and exploratory factor analysis were carried out to identify the factor structure of the USEQ. The six items of USEQ were significantly associated with each other, and the Cronbach alpha coefficient for the questionnaire was 0.716. In an analysis of the principal components, a one-factor solution was considered to be appropriate. The findings of the study suggest that the USEQ is a reliable questionnaire with adequate internal consistency. With regard to patient perception, the patients found the USEQ to be an easy-to-understand questionnaire with a convenient number of questions.
Collapse
Affiliation(s)
- José-Antonio Gil-Gómez
- Instituto Universitario de Automática e Informática Industrial, Universitat Politècnica de València, Camino de Vera s/n, 46022 Valencia, Spain.
| | | | - Sergio Albiol-Pérez
- Aragón Health Research Institute (IIS Aragón), Universidad de Zaragoza, Ciudad Escolar, 44003 Teruel, Spain.
| | | | - Hermenegildo Gil-Gómez
- Instituto Universitario de Automática e Informática Industrial, Universitat Politècnica de València, Camino de Vera s/n, 46022 Valencia, Spain.
| | - José-Antonio Lozano-Quilis
- Instituto Universitario de Automática e Informática Industrial, Universitat Politècnica de València, Camino de Vera s/n, 46022 Valencia, Spain.
| |
Collapse
|
15
|
Imam B, Miller WC, Finlayson H, Eng JJ, Jarus T. A randomized controlled trial to evaluate the feasibility of the Wii Fit for improving walking in older adults with lower limb amputation. Clin Rehabil 2016; 31:82-92. [DOI: 10.1177/0269215515623601] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective: To assess the feasibility of Wii.n.Walk for improving walking capacity in older adults with lower limb amputation. Design: A parallel, evaluator-blind randomized controlled feasibility trial. Setting: Community-living. Participants: Individuals who were ⩾50 years old with a unilateral lower limb amputation. Intervention: Wii.n.Walk consisted of Wii Fit training, 3x/week (40 minute sessions), for 4 weeks. Training started in the clinic in groups of 3 and graduated to unsupervised home training. Control group were trained using cognitive games. Main Measures: Feasibility indicators: trial process (recruitment, retention, participants’ perceived benefit from the Wii.n.Walk intervention measured by exit questionnaire), resources (adherence), management (participant processing, blinding), and treatment (adverse event, and Cohen’s d effect size and variance). Primary clinical outcome: walking capacity measured using the 2 Minute Walk Test at baseline, end of treatment, and 3-week retention. Results: Of 28 randomized participants, 24 completed the trial (12/arm). Median (range) age was 62.0 (50-78) years. Mean (SD) score for perceived benefit from the Wii.n.Walk intervention was 38.9/45 (6.8). Adherence was 83.4%. The effect sizes for the 2 Minute Walk Test were 0.5 (end of treatment) and 0.6 (3-week retention) based on intention to treat with imputed data; and 0.9 (end of treatment) and 1.2 (3-week retention) based on per protocol analysis. The required sample size for a future larger RCT was deemed to be 72 (36 per arm). Conclusions: The results suggested the feasibility of the Wii.n.Walk with a medium effect size for improving walking capacity. Future larger randomized controlled trials investigating efficacy are warranted.
Collapse
Affiliation(s)
- Bita Imam
- Graduate Program in Rehabilitation Sciences, University of British Columbia, Vancouver, Canada
| | - William C Miller
- Graduate Program in Rehabilitation Sciences, University of British Columbia, Vancouver, Canada
- Department of Occupational Science and Occupational Therapy, University of British Columbia, Vancouver, Canada
| | - Heather Finlayson
- Division of Physical Medicine and Rehabilitation, University of British Columbia, Vancouver, Canada
| | - Janice J Eng
- Graduate Program in Rehabilitation Sciences, University of British Columbia, Vancouver, Canada
- Department of Physical Therapy, University of British Columbia, Vancouver, Canada
| | - Tal Jarus
- Graduate Program in Rehabilitation Sciences, University of British Columbia, Vancouver, Canada
- Department of Occupational Science and Occupational Therapy, University of British Columbia, Vancouver, Canada
| |
Collapse
|
16
|
Imam B, Miller WC, Finlayson HC, Eng JJ, Payne MW, Jarus T, Goldsmith CH, Mitchell IM. A Telehealth Intervention Using Nintendo Wii Fit Balance Boards and iPads to Improve Walking in Older Adults With Lower Limb Amputation (Wii.n.Walk): Study Protocol for a Randomized Controlled Trial. JMIR Res Protoc 2014; 3:e80. [PMID: 25533902 PMCID: PMC4376145 DOI: 10.2196/resprot.4031] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2014] [Accepted: 11/25/2014] [Indexed: 11/27/2022] Open
Abstract
Background The number of older adults living with lower limb amputation (LLA) who require rehabilitation for improving their walking capacity and mobility is growing. Existing rehabilitation practices frequently fail to meet this demand. Nintendo Wii Fit may be a valuable tool to enable rehabilitation interventions. Based on pilot studies, we have developed “Wii.n.Walk”, an in-home telehealth Wii Fit intervention targeted to improve walking capacity in older adults with LLA. Objective The objective of this study is to determine whether the Wii.n.Walk intervention enhances walking capacity compared to an attention control group. Methods This project is a multi-site (Vancouver BC, London ON), parallel, evaluator-blind randomized controlled trial. Participants include community-dwelling older adults over the age of 50 years with unilateral transtibial or transfemoral amputation. Participants will be stratified by site and block randomized in triplets to either the Wii.n.Walk intervention or an attention control group employing the Wii Big Brain cognitive software. This trial will include both supervised and unsupervised phases. During the supervised phase, both groups will receive 40-minute sessions of supervised group training three times per week for a duration of 4 weeks. Participants will complete the first week of the intervention in groups of three at their local rehabilitation center with a trainer. The remaining 3 weeks will take place at participants’ homes using remote supervision by the trainer using Apple iPad technology. At the end of 4 weeks, the supervised period will end and the unsupervised period will begin. Participants will retain the Wii console and be encouraged to continue using the program for an additional 4 weeks’ duration. The primary outcome measure will be the “Two-Minute Walk Test” to measure walking capacity. Outcome measures will be evaluated for all participants at baseline, after the end of both the supervised and unsupervised phases, and after 1-year follow up. Results Study staff have been hired and trained at both sites and recruitment is currently underway. No participants have been enrolled yet. Conclusions Wii.n.Walk is a promising in-home telehealth intervention that may have useful applications for older adults with LLA who are discharged from rehabilitation or live in remote areas having limited or no access to existing rehabilitation programs. Trial Registration Clinicaltrial.gov NCT01942798; http://clinicaltrials.gov/ct2/show/NCT01942798 (Archived by WebCite at http://www.webcitation.org/6V0w8baKP).
Collapse
Affiliation(s)
- Bita Imam
- Graduate Program in Rehabilitation Sciences, University of British Columbia, Vancouver, BC, Canada
| | | | | | | | | | | | | | | |
Collapse
|
17
|
Giesbrecht EM, Miller WC, Mitchell IM, Woodgate RL. Development of a wheelchair skills home program for older adults using a participatory action design approach. BIOMED RESEARCH INTERNATIONAL 2014; 2014:172434. [PMID: 25276768 PMCID: PMC4167954 DOI: 10.1155/2014/172434] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/10/2014] [Revised: 06/20/2014] [Accepted: 06/25/2014] [Indexed: 11/30/2022]
Abstract
Restricted mobility is the most common impairment among older adults and a manual wheelchair is often prescribed to address these limitations. However, limited access to rehabilitation services results in older adults typically receiving little or no mobility training when they receive a wheelchair. As an alternative and novel approach, we developed a therapist-monitored wheelchair skills home training program delivered via a computer tablet. To optimize efficacy and adherence, principles of self-efficacy and adult learning theory were foundational in the program design. A participatory action design approach was used to engage older adult wheelchair users, care providers, and prescribing clinicians in an iterative design and development process. A series of prototypes were fabricated and revised, based on feedback from eight stakeholder focus groups, until a final version was ready for evaluation in a clinical trial. Stakeholder contributions affirmed and enhanced the foundational theoretical principles and provided validation of the final product for the target population.
Collapse
Affiliation(s)
- Edward M. Giesbrecht
- Department of Occupational Science and Occupational Therapy, University of British Columbia, T325-2211 Wesbrook Mall, Vancouver, BC, Canada V6T 2B5
| | - William C. Miller
- Department of Occupational Science and Occupational Therapy, University of British Columbia, T325-2211 Wesbrook Mall, Vancouver, BC, Canada V6T 2B5
| | - Ian M. Mitchell
- Department of Computer Science, University of British Columbia, 2366 Main Mall, Vancouver, BC, Canada V6T 1Z4
| | - Roberta L. Woodgate
- Faculty of Nursing, University of Manitoba, 89 Curry Place, Winnipeg, MB, Canada R3T 2N2
| |
Collapse
|