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Mohammed A, Li S, Liu X. Exploring the Potentials of Wearable Technologies in Managing Vestibular Hypofunction. Bioengineering (Basel) 2024; 11:641. [PMID: 39061723 PMCID: PMC11274252 DOI: 10.3390/bioengineering11070641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2024] [Revised: 05/26/2024] [Accepted: 05/31/2024] [Indexed: 07/28/2024] Open
Abstract
The vestibular system is dedicated to gaze stabilization, postural balance, and spatial orientation; this makes vestibular function crucial for our ability to interact effectively with our environment. Vestibular hypofunction (VH) progresses over time, and it presents differently in its early and advanced stages. In the initial stages of VH, the effects of VH are mitigated using vestibular rehabilitation therapy (VRT), which can be facilitated with the aid of technology. At more advanced stages of VH, novel techniques that use wearable technologies for sensory augmentation and sensory substitution have been applied to manage VH. Despite this, the potential of assistive technologies for VH management remains underexplored over the past decades. Hence, in this review article, we present the state-of-the-art technologies for facilitating early-stage VRT and for managing advanced-stage VH. Also, challenges and strategies on how these technologies can be improved to enable long-term ambulatory and home use are presented.
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Affiliation(s)
- Ameer Mohammed
- School of Information Science and Technology, Fudan University, Shanghai 200433, China; (A.M.); (S.L.)
- State Key Laboratory of Integrated Chips and Systems, Fudan University, Shanghai 201203, China
| | - Shutong Li
- School of Information Science and Technology, Fudan University, Shanghai 200433, China; (A.M.); (S.L.)
- State Key Laboratory of Integrated Chips and Systems, Fudan University, Shanghai 201203, China
| | - Xiao Liu
- School of Information Science and Technology, Fudan University, Shanghai 200433, China; (A.M.); (S.L.)
- State Key Laboratory of Integrated Chips and Systems, Fudan University, Shanghai 201203, China
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Kelty-Stephen DG, Kiyono K, Stergiou N, Mangalam M. Spatial variability and directional shifts in postural control in Parkinson's disease. Clin Park Relat Disord 2024; 10:100249. [PMID: 38803658 PMCID: PMC11129103 DOI: 10.1016/j.prdoa.2024.100249] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2024] Open
Abstract
Individuals with Parkinson's disease exhibit tremors, rigidity, and bradykinesia, disrupting normal movement variability and resulting in postural instability. This comprehensive study aimed to investigate the link between the temporal structure of postural sway variability and Parkinsonism by analyzing multiple datasets from young and older adults, including individuals with Parkinson's disease, across various task conditions. We used the Oriented Fractal Scaling Component Analysis (OFSCA), which identifies minimal and maximal long-range correlations within the center of pressure time series, allowing for detecting directional changes in postural sway variability. The objective was to uncover the primary directions along which individuals exerted control during the posture. The results, as anticipated, revealed that healthy adults predominantly exerted control along two orthogonal directions, closely aligned with the anteroposterior (AP) and mediolateral (ML) axes. In stark contrast, older adults and individuals with Parkinson's disease exhibited control along suborthogonal directions that notably diverged from the AP and ML axes. While older adults and those with Parkinson's disease demonstrated a similar reduction in the angle between these two control directions compared to healthy older adults, their reliance on this suborthogonal angle concerning endogenous fractal correlations exhibited significant differences from the healthy aging cohort. Importantly, individuals with Parkinson's disease did not manifest the sensitivity to destabilizing task settings observed in their healthy counterparts, affirming the distinction between Parkinson's disease and healthy aging.
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Affiliation(s)
- Damian G. Kelty-Stephen
- Department of Psychology, State University of New York at New Paltz, New Paltz, NY 12561, USA
| | - Ken Kiyono
- Graduate School of Engineering Science, Osaka University, Osaka 560-8531, Japan
| | - Nick Stergiou
- Division of Biomechanics and Research Development, Department of Biomechanics, Center for Research in Human Movement Variability, University of Nebraska at Omaha, Omaha, NE 68182, USA
- Department of Physical Education & Sport Science, Aristotle University, Thessaloniki 570 01, Greece
| | - Madhur Mangalam
- Division of Biomechanics and Research Development, Department of Biomechanics, Center for Research in Human Movement Variability, University of Nebraska at Omaha, Omaha, NE 68182, USA
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Schonhaut EB, Howard KE, Jacobs CJ, Knight HL, Chesnutt AN, Dean JC. Altered foot placement modulation with somatosensory stimulation in people with chronic stroke. J Biomech 2024; 166:112043. [PMID: 38484654 PMCID: PMC11009041 DOI: 10.1016/j.jbiomech.2024.112043] [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: 06/15/2023] [Revised: 03/05/2024] [Accepted: 03/05/2024] [Indexed: 04/13/2024]
Abstract
Many individuals who experience a stroke exhibit reduced modulation of their mediolateral foot placement, an important gait stabilization strategy. One factor that may contribute to this deficit is altered somatosensory processing, which can be probed by applying vibration to the involved muscles (e.g., the hip abductors). The purpose of this study was to investigate whether appropriately controlled hip abductor vibration can increase foot placement modulation among people with chronic stroke. 40 people with chronic stroke performed a series of treadmill walking trials without vibration and with vibration of either the hip abductors or lateral trunk (a control condition) that scaled with their real-time mediolateral motion. To assess participants' vibration sensitivity, we also measured vibration detection threshold and lateral sway evoked by abductor vibration during quiet standing. As a group, foot placement modulation increased significantly with either hip or trunk vibration, compared to without vibration. However, these changes were quite variable across participants, and were not predicted by either vibration detection threshold or the lateral sway evoked by hip vibration during standing. Overall, we found that somatosensory stimulation had small, positive effects on post-stroke foot placement modulation. Unexpectedly, these effects were observed with both hip abductor and lateral trunk vibration, perhaps indicating that the trunk can also provide useful somatosensory feedback during walking. Future work is needed to determine whether repeated application of such somatosensory stimulation can produce sustained effects on this important gait stabilization strategy.
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Affiliation(s)
- Ethan B Schonhaut
- College of Health Professions, Medical University of South Carolina, Charleston, SC, USA
| | - Keith E Howard
- College of Health Professions, Medical University of South Carolina, Charleston, SC, USA
| | - Camden J Jacobs
- College of Health Professions, Medical University of South Carolina, Charleston, SC, USA
| | - Heather L Knight
- College of Health Professions, Medical University of South Carolina, Charleston, SC, USA
| | - Alyssa N Chesnutt
- College of Health Professions, Medical University of South Carolina, Charleston, SC, USA
| | - Jesse C Dean
- College of Health Professions, Medical University of South Carolina, Charleston, SC, USA; Ralph H. Johnson VA Health Care System, USA.
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Vimal VP, Panic AS, Lackner JR, DiZio P. Vibrotactile feedback as a countermeasure for spatial disorientation. Front Physiol 2023; 14:1249962. [PMID: 38028769 PMCID: PMC10657135 DOI: 10.3389/fphys.2023.1249962] [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: 06/29/2023] [Accepted: 09/29/2023] [Indexed: 12/01/2023] Open
Abstract
Spaceflight can make astronauts susceptible to spatial disorientation which is one of the leading causes of fatal aircraft accidents. In our experiment, blindfolded participants used a joystick to balance themselves while inside a multi-axis rotation device (MARS) in either the vertical or horizontal roll plane. On Day 1, in the vertical roll plane (Earth analog condition) participants could use gravitational cues and therefore had a good sense of their orientation. On Day 2, in the horizontal roll plane (spaceflight analog condition) participants could not use gravitational cues and rapidly became disoriented and showed minimal learning and poor performance. One potential countermeasure for spatial disorientation is vibrotactile feedback that conveys body orientation provided by small vibrating devices applied to the skin. Orientation-dependent vibrotactile feedback provided to one group enhanced performance in the spaceflight condition but the participants reported a conflict between the accurate vibrotactile cues and their erroneous perception of their orientation. Specialized vibrotactile training on Day 1 provided to another group resulted in significantly better learning and performance in the spaceflight analog task with vibrotactile cueing. In this training, participants in the Earth analog condition on Day 1 were required to disengage from the task of aligning with the gravitational vertical encoded by natural vestibular/somatosensory afference and had to align with randomized non-vertical directions of balance signaled by vibrotactile feedback. At the end of Day 2, we deactivated the vibrotactile feedback after both vibration-cued groups had practiced with it in the spaceflight analog condition. They performed as well as the group who did not have any vibrotactile feedback. We conclude that after appropriate training, vibrotactile orientation feedback augments dynamic spatial orientation and does not lead to any negative dependence.
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Affiliation(s)
- Vivekanand Pandey Vimal
- Ashton Graybiel Spatial Orientation Laboratory, Brandeis University, Waltham, MA, United States
- Volen Center for Complex Systems, Brandeis University, Waltham, MA, United States
| | - Alexander Sacha Panic
- Ashton Graybiel Spatial Orientation Laboratory, Brandeis University, Waltham, MA, United States
| | - James R. Lackner
- Ashton Graybiel Spatial Orientation Laboratory, Brandeis University, Waltham, MA, United States
- Volen Center for Complex Systems, Brandeis University, Waltham, MA, United States
- Psychology Department, Brandeis University, Waltham, MA, United States
| | - Paul DiZio
- Ashton Graybiel Spatial Orientation Laboratory, Brandeis University, Waltham, MA, United States
- Volen Center for Complex Systems, Brandeis University, Waltham, MA, United States
- Psychology Department, Brandeis University, Waltham, MA, United States
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Candreia C, Rust HM, Honegger F, Allum JHJ. The Effects of Vibro-Tactile Biofeedback Balance Training on Balance Control and Dizziness in Patients with Persistent Postural-Perceptual Dizziness (PPPD). Brain Sci 2023; 13:brainsci13050782. [PMID: 37239254 DOI: 10.3390/brainsci13050782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 04/18/2023] [Accepted: 05/05/2023] [Indexed: 05/28/2023] Open
Abstract
BACKGROUND Patients with persistent postural-perceptual dizziness (PPPD) frequently report having problems with balance control. Artificial systems providing vibro-tactile feedback (VTfb) of trunk sway to the patient could aid recalibration of "falsely" programmed natural sensory signal gains underlying unstable balance control and dizziness. Thus, the question we examine, retrospectively, is whether such artificial systems improve balance control in PPPD patients and simultaneously reduce the effects of dizziness on their living circumstances. Therefore, we assessed in PPPD patients the effects of VTfb of trunk sway on balance control during stance and gait tests, and on their perceived dizziness. METHODS Balance control was assessed in 23 PPPD patients (11 of primary PPPD origin) using peak-to-peak amplitudes of trunk sway measured in the pitch and roll planes with a gyroscope system (SwayStar™) during 14 stance and gait tests. The tests included standing eyes closed on foam, walking tandem steps, and walking over low barriers. The measures of trunk sway were combined into a Balance Control Index (BCI) and used to determine whether the patient had a quantified balance deficit (QBD) or dizziness only (DO). The Dizziness Handicap Inventory (DHI) was used to assess perceived dizziness. The subjects first underwent a standard balance assessment from which the VTfb thresholds in eight directions, separated by 45 deg, were calculated for each assessment test based on the 90% range of the trunk sway angles in the pitch and roll directions for the test. A headband-mounted VTfb system, connected to the SwayStar™, was active in one of the eight directions when the threshold for that direction was exceeded. The subjects trained for 11 of the 14 balance tests with VTfb twice per week for 30 min over a total of 2 consecutive weeks. The BCI and DHI were reassessed each week and the thresholds were reset after the first week of training. RESULTS On average, the patients showed an improved balance control in the BCI values after 2 weeks of VTfb training (24% p = 0.0001). The improvement was greater for the QBD patients than for the DO patients (26 vs. 21%), and greater for the gait tests than the stance tests. After 2 weeks, the mean BCI values of the DO patients, but not the QBD patients, were significantly less (p = 0.0008) than the upper 95% limit of normal age-matched reference values. A subjective benefit in balance control was spontaneously reported by 11 patients. Lower (36%), but less significant DHI values were also achieved after VTfb training (p = 0.006). The DHI changes were identical for the QBD and DO patients and approximately equal to the minimum clinical important difference. CONCLUSIONS These initial results show, as far as we are aware for the first time, that providing VTfb of trunk sway to PPPD subjects yields a significant improvement in balance control, but a far less significant change in DHI-assessed dizziness. The intervention benefitted the gait trials more than the stance trials and benefited the QBD group of PPPD patients more than the DO group. This study increases our understanding of the pathophysiologic processes underlying PPPD and provides a basis for future interventions.
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Affiliation(s)
- Claudia Candreia
- Department of ORL, Cantonal Hospital, CH-6016 Luzern, Switzerland
| | - Heiko M Rust
- Department of Neurology, University of Basel Hospital, CH-4031 Basel, Switzerland
| | - Flurin Honegger
- Department of ORL, University of Basel Hospital, CH-4031 Basel, Switzerland
| | - John H J Allum
- Department of ORL, Cantonal Hospital, CH-6016 Luzern, Switzerland
- Department of ORL, University of Basel Hospital, CH-4031 Basel, Switzerland
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Prasanna S, D'Abbraccio J, Filosa M, Ferraro D, Cesini I, Spigler G, Aliperta A, Dell'Agnello F, Davalli A, Gruppioni E, Crea S, Vitiello N, Mazzoni A, Oddo CM. Uneven Terrain Recognition Using Neuromorphic Haptic Feedback. SENSORS (BASEL, SWITZERLAND) 2023; 23:s23094521. [PMID: 37177725 PMCID: PMC10181691 DOI: 10.3390/s23094521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Revised: 04/21/2023] [Accepted: 05/02/2023] [Indexed: 05/15/2023]
Abstract
Recent years have witnessed relevant advancements in the quality of life of persons with lower limb amputations thanks to the technological developments in prosthetics. However, prostheses that provide information about the foot-ground interaction, and in particular about terrain irregularities, are still missing on the market. The lack of tactile feedback from the foot sole might lead subjects to step on uneven terrains, causing an increase in the risk of falling. To address this issue, a biomimetic vibrotactile feedback system that conveys information about gait and terrain features sensed by a dedicated insole has been assessed with intact subjects. After having shortly experienced both even and uneven terrains, the recruited subjects discriminated them with an accuracy of 87.5%, solely relying on the replay of the vibrotactile feedback. With the objective of exploring the human decoding mechanism of the feedback startegy, a KNN classifier was trained to recognize the uneven terrains. The outcome suggested that the subjects achieved such performance with a temporal dynamics of 45 ms. This work is a leap forward to assist lower-limb amputees to appreciate the floor conditions while walking, adapt their gait and promote a more confident use of their artificial limb.
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Affiliation(s)
- Sahana Prasanna
- The BioRobotics Institute, Sant'Anna School of Advanced Studies, 56127 Pisa, Italy
- Department of Excellence in Robotics & AI, Sant'Anna School of Advanced Studies, 56127 Pisa, Italy
| | - Jessica D'Abbraccio
- The BioRobotics Institute, Sant'Anna School of Advanced Studies, 56127 Pisa, Italy
- Department of Excellence in Robotics & AI, Sant'Anna School of Advanced Studies, 56127 Pisa, Italy
| | - Mariangela Filosa
- The BioRobotics Institute, Sant'Anna School of Advanced Studies, 56127 Pisa, Italy
- Department of Excellence in Robotics & AI, Sant'Anna School of Advanced Studies, 56127 Pisa, Italy
- Interdisciplinary Research Center Health Science, Sant'Anna School of Advanced Studies, 56127 Pisa, Italy
| | - Davide Ferraro
- The BioRobotics Institute, Sant'Anna School of Advanced Studies, 56127 Pisa, Italy
- Department of Excellence in Robotics & AI, Sant'Anna School of Advanced Studies, 56127 Pisa, Italy
| | - Ilaria Cesini
- The BioRobotics Institute, Sant'Anna School of Advanced Studies, 56127 Pisa, Italy
- Department of Excellence in Robotics & AI, Sant'Anna School of Advanced Studies, 56127 Pisa, Italy
| | - Giacomo Spigler
- The BioRobotics Institute, Sant'Anna School of Advanced Studies, 56127 Pisa, Italy
- Department of Excellence in Robotics & AI, Sant'Anna School of Advanced Studies, 56127 Pisa, Italy
| | - Andrea Aliperta
- The BioRobotics Institute, Sant'Anna School of Advanced Studies, 56127 Pisa, Italy
- Department of Excellence in Robotics & AI, Sant'Anna School of Advanced Studies, 56127 Pisa, Italy
| | - Filippo Dell'Agnello
- The BioRobotics Institute, Sant'Anna School of Advanced Studies, 56127 Pisa, Italy
- Department of Excellence in Robotics & AI, Sant'Anna School of Advanced Studies, 56127 Pisa, Italy
| | - Angelo Davalli
- Centro Protesi INAIL (Italian National Institute for Insurance against Accidents at Work), 40054 Budrio, Italy
| | - Emanuele Gruppioni
- Centro Protesi INAIL (Italian National Institute for Insurance against Accidents at Work), 40054 Budrio, Italy
| | - Simona Crea
- The BioRobotics Institute, Sant'Anna School of Advanced Studies, 56127 Pisa, Italy
- Department of Excellence in Robotics & AI, Sant'Anna School of Advanced Studies, 56127 Pisa, Italy
- Interdisciplinary Research Center Health Science, Sant'Anna School of Advanced Studies, 56127 Pisa, Italy
- IRCCS Fondazione Don Carlo Gnocchi, 50143 Florence, Italy
| | - Nicola Vitiello
- The BioRobotics Institute, Sant'Anna School of Advanced Studies, 56127 Pisa, Italy
- Department of Excellence in Robotics & AI, Sant'Anna School of Advanced Studies, 56127 Pisa, Italy
- Interdisciplinary Research Center Health Science, Sant'Anna School of Advanced Studies, 56127 Pisa, Italy
- IRCCS Fondazione Don Carlo Gnocchi, 50143 Florence, Italy
| | - Alberto Mazzoni
- The BioRobotics Institute, Sant'Anna School of Advanced Studies, 56127 Pisa, Italy
- Department of Excellence in Robotics & AI, Sant'Anna School of Advanced Studies, 56127 Pisa, Italy
| | - Calogero Maria Oddo
- The BioRobotics Institute, Sant'Anna School of Advanced Studies, 56127 Pisa, Italy
- Department of Excellence in Robotics & AI, Sant'Anna School of Advanced Studies, 56127 Pisa, Italy
- Interdisciplinary Research Center Health Science, Sant'Anna School of Advanced Studies, 56127 Pisa, Italy
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Ma CZH, Bao T, DiCesare CA, Harris I, Chambers A, Shull PB, Zheng YP, Cham R, Sienko KH. Reducing Slip Risk: A Feasibility Study of Gait Training with Semi-Real-Time Feedback of Foot-Floor Contact Angle. SENSORS (BASEL, SWITZERLAND) 2022; 22:3641. [PMID: 35632054 PMCID: PMC9144019 DOI: 10.3390/s22103641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 04/30/2022] [Accepted: 05/02/2022] [Indexed: 11/16/2022]
Abstract
Slip-induced falls, responsible for approximately 40% of falls, can lead to severe injuries and in extreme cases, death. A large foot-floor contact angle (FFCA) during the heel-strike event has been associated with an increased risk of slip-induced falls. The goals of this feasibility study were to design and assess a method for detecting FFCA and providing cues to the user to generate a compensatory FFCA response during a future heel-strike event. The long-term goal of this research is to train gait in order to minimize the likelihood of a slip event due to a large FFCA. An inertial measurement unit (IMU) was used to estimate FFCA, and a speaker provided auditory semi-real-time feedback when the FFCA was outside of a 10-20 degree target range following a heel-strike event. In addition to training with the FFCA feedback during a 10-min treadmill training period, the healthy young participants completed pre- and post-training overground walking trials. Results showed that training with FFCA feedback increased FFCA events within the target range by 16% for "high-risk" walkers (i.e., participants that walked with more than 75% of their FFCAs outside the target range) both during feedback treadmill trials and post-training overground trials without feedback, supporting the feasibility of training FFCA using a semi-real-time FFCA feedback system.
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Affiliation(s)
- Christina Zong-Hao Ma
- Department of Mechanical Engineering, University of Michigan, Ann Arbor, MI 48109, USA; (C.Z.-H.M.); (T.B.); (C.A.D.); (I.H.)
- Department of Biomedical Engineering, The Hong Kong Polytechnic University, Hong Kong 999077, China;
| | - Tian Bao
- Department of Mechanical Engineering, University of Michigan, Ann Arbor, MI 48109, USA; (C.Z.-H.M.); (T.B.); (C.A.D.); (I.H.)
| | - Christopher A. DiCesare
- Department of Mechanical Engineering, University of Michigan, Ann Arbor, MI 48109, USA; (C.Z.-H.M.); (T.B.); (C.A.D.); (I.H.)
| | - Isaac Harris
- Department of Mechanical Engineering, University of Michigan, Ann Arbor, MI 48109, USA; (C.Z.-H.M.); (T.B.); (C.A.D.); (I.H.)
| | - April Chambers
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA 15260, USA; (A.C.); (R.C.)
- Department of Health and Human Development, University of Pittsburgh, Pittsburgh, PA 15260, USA
| | - Peter B. Shull
- Department of Mechanical Engineering, Shanghai Jiao Tong University, Shanghai 200240, China
| | - Yong-Ping Zheng
- Department of Biomedical Engineering, The Hong Kong Polytechnic University, Hong Kong 999077, China;
| | - Rakie Cham
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA 15260, USA; (A.C.); (R.C.)
| | - Kathleen H. Sienko
- Department of Mechanical Engineering, University of Michigan, Ann Arbor, MI 48109, USA; (C.Z.-H.M.); (T.B.); (C.A.D.); (I.H.)
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Lee H, Eizad A, Park J, Kim Y, Hwang S, Oh MK, Yoon J. Development of a Novel 2-Dimensional Neck Haptic Device for Gait Balance Training. IEEE Robot Autom Lett 2022. [DOI: 10.1109/lra.2022.3143568] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Kahya M, Hackman D, Jacobs L, Nilsson D, Rumsey Y, Oddsson LIE. Wearable Technologies Using Peripheral Neuromodulation to Enhance Mobility and Gait Function in Older Adults - A Narrative Review. J Gerontol A Biol Sci Med Sci 2022; 78:831-841. [PMID: 35179580 PMCID: PMC10172983 DOI: 10.1093/gerona/glac045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Mounting evidence suggests that wearable technologies using peripheral neuromodulation can provide novel ways of improving mobility and gait function in various patient populations including older adults. The purpose of this narrative review is to provide an overview of wearable technologies/devices to improve mobility and gait function through noninvasive peripheral neuromodulation in older adults over the age of 65 and to indicate the suggested mechanism of action behind these technologies. METHODS We performed searches for articles and conference abstracts written in English, using the following databases: Embase Classic+Embase from 1947 to July 15, 2021; Ovid MEDLINE®; Epub Ahead of Print, In-Process, In-Data-Review & Other Non-Indexed Citations, Daily and Versions® from 1946 to July 15, 2021; PubMed; and Scopus. RESULTS Forty-one technologies met the inclusion/exclusion criteria. We found that the primary implementation of the 41 technologies can be divided into three main categories: sensory substitution, sensory augmentation (open loop, closed loop), and motor stimulation. Using these technologies, various aspects of mobility are treated or addressed, including e.g., gait function, fall risk, foot drop, navigating environment, postural control. CONCLUSIONS This narrative review summarizes wearable technologies that are currently commercially available and in stages of research and development. Overall, studies suggest that wearable peripheral neuromodulation technologies can improve aspects of mobility for older adults. Existing literature suggests that these technologies may lead to physiological changes in the brain through sensory re-weighting or other neuroplastic mechanisms to enhance the performance of mobility and gait function in older adults over the age of 65.
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Affiliation(s)
- Melike Kahya
- Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Harvard Medical School, MA, USA
| | | | | | | | | | - Lars I E Oddsson
- University of Minnesota, MN, USA.,RxFunction Inc. MN, USA.,Ben Gurion University of the Negev, Israel
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Fu QA, Simeonov P, Hsiao H, Woolley C, Armstrong TJ. Selected movement and force pattern differences in rail- and rung-climbing of fire apparatus aerial ladders at 52.5° slope. APPLIED ERGONOMICS 2022; 99:103639. [PMID: 34753097 PMCID: PMC11298859 DOI: 10.1016/j.apergo.2021.103639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 10/22/2021] [Accepted: 11/01/2021] [Indexed: 06/13/2023]
Abstract
This study compares human climbing performance, including climbing speed and movement and force patterns, between rail- and rung-climbing styles for a moderate aerial ladder slope (52.5°). Hand and foot movements and forces were recorded for 9 male and 10 female firefighters as they ascended and descended a 3.4-m ladder using elevated handrails (rail-climbing) or rungs (rung-climbing) for hand support. The results indicated that climbers used three or more points of contact 54% of the time for rung-climbing and 100% of the time for rail-climbing. Furthermore, rail-climbing was 10% faster than rung-climbing. In rail-climbing, the lateral hand forces were mostly directed away from the body; while during rung-climbing, they were alternated in lateral and medial directions. Overall, the results suggested that rail-climbing provides better control over body positioning and faster climbing speed. Furthermore, the continuous contact of both hands in rail-climbing may reduce the fall risk by facilitating the recovery from a slip or perturbation.
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Affiliation(s)
- Qianyi Albert Fu
- Center for Ergonomics, University of Michigan, Ann Arbor, MI, USA.
| | - Peter Simeonov
- Division of Safety Research, National Institute for Occupational Safety and Health, Morgantown, WV, USA
| | - Hongwei Hsiao
- Division of Safety Research, National Institute for Occupational Safety and Health, Morgantown, WV, USA
| | - Charles Woolley
- Center for Ergonomics, University of Michigan, Ann Arbor, MI, USA
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Knapp HA, Sobolewski BA, Dean JC. Augmented Hip Proprioception Influences Mediolateral Foot Placement During Walking. IEEE Trans Neural Syst Rehabil Eng 2021; 29:2017-2026. [PMID: 34550889 DOI: 10.1109/tnsre.2021.3114991] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Hip abductor proprioception contributes to the control of mediolateral foot placement, which varies with step-by-step fluctuations in pelvis dynamics. Prior work has used hip abductor vibration as a sensory probe to investigate the link between vibration within a single step and subsequent foot placement. Here, we extended prior findings by applying time and location varying vibration in every step, seeking to predictably manipulate the continuous, step-by-step relationship between pelvis dynamics and foot placement. We compared participants' (n = 32; divided into two groups of 16 with slightly different vibration control) gait behavior across four treadmill walking conditions: 1) No feedback; 2) Random feedback, with vibration unrelated to pelvis motion; 3) Augmented feedback, with vibration designed to evoke proprioceptive feedback paralleling the actual pelvis motion; 4) Disrupted feedback, with vibration designed to evoke proprioceptive feedback inversely related to pelvis motion. We hypothesized that the relationship between pelvis dynamics and foot placement would be strengthened by Augmented feedback but weakened by Disrupted feedback. For both participant groups, the strength of the relationship between pelvis dynamics at the start of a step and foot placement at the end of a step was significantly (p ≤ 0.0002) influenced by the feedback condition. The link between pelvis dynamics and foot placement was strongest with Augmented feedback, but not significantly weakened with Disrupted feedback, partially supporting our hypotheses. Our approach to augmenting proprioceptive feedback during gait may have implications for clinical populations with a weakened relationship between pelvis motion and foot placement.
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Wrisley DM, McLean G, Hill JB, Oddsson LIE. Long-Term Use of a Sensory Prosthesis Improves Function in a Patient With Peripheral Neuropathy: A Case Report. Front Neurol 2021; 12:655963. [PMID: 34248817 PMCID: PMC8260940 DOI: 10.3389/fneur.2021.655963] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Accepted: 05/27/2021] [Indexed: 12/25/2022] Open
Abstract
Background: Peripheral neuropathy (PN) can result in either partial or complete loss of distal sensation resulting in an increased fall risk. Walkasins® uses a shoe insert to detect the magnitude and direction of sway and sends signals to a leg unit that provides sensory balance cues. The objective of this case report is to describe the long-term influence of the Walkasins® lower limb sensory neuroprosthesis on balance and gait for an individual with diabetic PN. Case Description: A 51-year-old male with a 3-year history of PN and a 10-year history of type II diabetes mellitus was fitted bilaterally with Walkasins® and utilized them 8-10 hours/day for more than 2 years. Although, vibration and tactile sensation thresholds were severely impaired at his 1st metatarsophalangeal joint and the lateral malleolus bilaterally he could perceive tactile stimuli from the Walkasins® above the ankles. Outcomes: Following Walkasins® use, his Activities-specific Balance Confidence Scale (ABC) scores improved from 33 to 80%. His mean Vestibular Activities of Daily Living (VADL) scores decreased from 3.54 to 1. His Functional Gait Assessment (FGA) scores increased from 13/30 to 28/30 and his miniBESTest scores improved from 15/28 to 26/28. Gait speed increased from 0.23 to 1.5 m/s. The patient described a decrease in pain and cramping throughout his lower extremities and an increase in function. Discussion: Gait and balance improved with the use of the Walkasins® and participation in a wellness program. This improvement suggests that the use of sensory substitution devices, such as the Walkasins®, may replace sensory deficits related to gait and balance dysfunction experienced by patients with PN. Further research is needed to determine if other patients will have a similar response and what the necessary threshold of sensory function is to benefit from use of the Walkasins®.
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Affiliation(s)
- Diane M. Wrisley
- Department of Physical Therapy, Wingate University, Wingate, NC, United States
- Doctor of Physical Therapy Program, College of St Mary, Omaha, NE, United States
| | - Gillian McLean
- Department of Physical Therapy, Wingate University, Wingate, NC, United States
- Fyzical Therapy and Balance Centers, Las Vegas, NV, United States
| | - Jennifer Baity Hill
- Department of Physical Therapy, Wingate University, Wingate, NC, United States
- OrthoCarolina Outpatient Winston-Salem, Winston-Salem, NC, United States
| | - Lars I. E. Oddsson
- Department of Rehabilitation Medicine, Medical School, University of Minnesota, Minneapolis, MN, United States
- Recanati School of Community Health, Ben Gurion University of the Negev, Beersheba, Israel
- RxFunction Inc., Eden Prairie, MN, United States
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Handelzalts S, Ballardini G, Avraham C, Pagano M, Casadio M, Nisky I. Integrating Tactile Feedback Technologies Into Home-Based Telerehabilitation: Opportunities and Challenges in Light of COVID-19 Pandemic. Front Neurorobot 2021; 15:617636. [PMID: 33679364 PMCID: PMC7925397 DOI: 10.3389/fnbot.2021.617636] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Accepted: 01/07/2021] [Indexed: 12/02/2022] Open
Abstract
The COVID-19 pandemic has highlighted the need for advancing the development and implementation of novel means for home-based telerehabilitation in order to enable remote assessment and training for individuals with disabling conditions in need of therapy. While somatosensory input is essential for motor function, to date, most telerehabilitation therapies and technologies focus on assessing and training motor impairments, while the somatosensorial aspect is largely neglected. The integration of tactile devices into home-based rehabilitation practice has the potential to enhance the recovery of sensorimotor impairments and to promote functional gains through practice in an enriched environment with augmented tactile feedback and haptic interactions. In the current review, we outline the clinical approaches for stimulating somatosensation in home-based telerehabilitation and review the existing technologies for conveying mechanical tactile feedback (i.e., vibration, stretch, pressure, and mid-air stimulations). We focus on tactile feedback technologies that can be integrated into home-based practice due to their relatively low cost, compact size, and lightweight. The advantages and opportunities, as well as the long-term challenges and gaps with regards to implementing these technologies into home-based telerehabilitation, are discussed.
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Affiliation(s)
- Shirley Handelzalts
- Department of Physical Therapy, Ben-Gurion University of the Negev, Be'er Sheva, Israel
- The Translational Neurorehabilitation Lab at Adi Negev Nahalat Eran, Ofakim, Israel
| | - Giulia Ballardini
- Department of Informatics, Bioengineering, Robotics and Systems Engineering, University of Genoa, Genoa, Italy
- S.C.I.L Joint Lab, Department of Informatics, Bioengineering, Robotics and System Engineering (DIBRIS), Santa Corona Hospital, Pietra Ligure, Italy
| | - Chen Avraham
- Department of Biomedical Engineering, Ben-Gurion University of the Negev, Be'er Sheva, Israel
- Zlotowski Center for Neuroscience, Ben-Gurion University of the Negev, Be'er Sheva, Israel
| | - Mattia Pagano
- Department of Informatics, Bioengineering, Robotics and Systems Engineering, University of Genoa, Genoa, Italy
- S.C.I.L Joint Lab, Department of Informatics, Bioengineering, Robotics and System Engineering (DIBRIS), Santa Corona Hospital, Pietra Ligure, Italy
| | - Maura Casadio
- Department of Informatics, Bioengineering, Robotics and Systems Engineering, University of Genoa, Genoa, Italy
- S.C.I.L Joint Lab, Department of Informatics, Bioengineering, Robotics and System Engineering (DIBRIS), Santa Corona Hospital, Pietra Ligure, Italy
| | - Ilana Nisky
- The Translational Neurorehabilitation Lab at Adi Negev Nahalat Eran, Ofakim, Israel
- Department of Biomedical Engineering, Ben-Gurion University of the Negev, Be'er Sheva, Israel
- Zlotowski Center for Neuroscience, Ben-Gurion University of the Negev, Be'er Sheva, Israel
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14
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Stirling L, Kelty-Stephen D, Fineman R, Jones MLH, Daniel Park BK, Reed MP, Parham J, Choi HJ. Static, Dynamic, and Cognitive Fit of Exosystems for the Human Operator. HUMAN FACTORS 2020; 62:424-440. [PMID: 32004106 DOI: 10.1177/0018720819896898] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
OBJECTIVE To define static, dynamic, and cognitive fit and their interactions as they pertain to exosystems and to document open research needs in using these fit characteristics to inform exosystem design. BACKGROUND Initial exosystem sizing and fit evaluations are currently based on scalar anthropometric dimensions and subjective assessments. As fit depends on ongoing interactions related to task setting and user, attempts to tailor equipment have limitations when optimizing for this limited fit definition. METHOD A targeted literature review was conducted to inform a conceptual framework defining three characteristics of exosystem fit: static, dynamic, and cognitive. Details are provided on the importance of differentiating fit characteristics for developing exosystems. RESULTS Static fit considers alignment between human and equipment and requires understanding anthropometric characteristics of target users and geometric equipment features. Dynamic fit assesses how the human and equipment move and interact with each other, with a focus on the relative alignment between the two systems. Cognitive fit considers the stages of human-information processing, including somatosensation, executive function, and motor selection. Human cognitive capabilities should remain available to process task- and stimulus-related information in the presence of an exosystem. Dynamic and cognitive fit are operationalized in a task-specific manner, while static fit can be considered for predefined postures. CONCLUSION A deeper understanding of how an exosystem fits an individual is needed to ensure good human-system performance. Development of methods for evaluating different fit characteristics is necessary. APPLICATION Methods are presented to inform exosystem evaluation across physical and cognitive characteristics.
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Affiliation(s)
| | | | - Richard Fineman
- 2167 Harvard-MIT Health Science and Technology Program, Cambridge, MA, USA
| | - Monica L H Jones
- 1259 University of Michigan Transportation Research Institute, Ann Arbor, USA
| | | | - Matthew P Reed
- 1259 University of Michigan Transportation Research Institute, Ann Arbor, USA
| | - Joseph Parham
- 155353 U.S. Army Combat Capabilities Development Command Soldier Center, Natick, MA, USA
| | - Hyeg Joo Choi
- 155353 U.S. Army Combat Capabilities Development Command Soldier Center, Natick, MA, USA
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15
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Salmito MC, E Maia FCZ, Gretes ME, Venosa A, Ganança FF, Ganança MM, Mezzalira R, Bittar RSM, Gasperin AC, Pires APBDÁ, Ramos BF, Bertoldo C, Ferreira C, Real D, Guimarães HA, Oiticica J, Lavinsky J, Lopes KC, Duarte JA, Morganti LOG, Santos LMAD, Joffily L, Lavinsky L, Santos MADO, Mano PM, Araújo PIMPD, Mangabeira Albernaz PL, Cal R, Dorigueto RS, Guimarães RDCC, Carvalho RCBD. Neurotology: definitions and evidence-based therapies - Results of the I Brazilian Forum of Neurotology. Braz J Otorhinolaryngol 2020; 86:139-148. [PMID: 31902583 PMCID: PMC9422724 DOI: 10.1016/j.bjorl.2019.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Accepted: 11/06/2019] [Indexed: 11/27/2022] Open
Abstract
INTRODUCTION Neurotology is a rapidly expanding field of knowledge. The study of the vestibular system has advanced so much that even basic definitions, such as the meaning of vestibular symptoms, have only recently been standardized. OBJECTIVE To present a review of the main subjects of neurotology, including concepts, diagnosis and treatment of Neurotology, defining current scientific evidence to facilitate decision-making and to point out the most evidence-lacking areas to stimulate further new research. METHODS This text is the result of the I Brazilian Forum of Neurotology, which brought together the foremost Brazilian researchers in this area for a literature review. In all, there will be three review papers to be published. This first review will address definitions and therapies, the second one will address diagnostic tools, and the third will define the main diseases diagnoses. Each author performed a bibliographic search in the LILACS, SciELO, PubMed and MEDLINE databases on a given subject. The text was then submitted to the other Forum participants for a period of 30 days for analysis. A special chapter, on the definition of vestibular symptoms, was translated by an official translation service, and equally submitted to the other stages of the process. There was then a in-person meeting in which all the texts were orally presented, and there was a discussion among the participants to define a consensual text for each chapter. The consensual texts were then submitted to a final review by four professors of neurotology disciplines from three Brazilian universities and finally concluded. Based on the full text, available on the website of the Brazilian Association of Otorhinolaryngology and Cervical-Facial Surgery, this summary version was written as a review article. RESULT The text presents the official translation into Portuguese of the definition of vestibular symptoms proposed by the Bárány Society and brings together the main scientific evidence for each of the main existing therapies for neurotological diseases. CONCLUSION This text rationally grouped the main topics of knowledge regarding the definitions and therapies of Neurotology, allowing the reader a broad view of the approach of neurotological patients based on scientific evidence and national experience, which should assist them in clinical decision-making, and show the most evidence-lacking topics to stimulate further study.
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Affiliation(s)
- Márcio Cavalcante Salmito
- Universidade Federal de São Paulo (Unifesp), Escola Paulista de Medicina, Departamento de Otorrinolaringologia e Cirurgia Cérvico-Facial, Disciplina de Otologia e Otoneurologia, São Paulo, SP, Brazil.
| | | | - Mário Edvin Gretes
- Pontifícia Universidade Católica de Campinas (PUC-Campinas), Faculdade de Medicina, SP, Brazil
| | | | - Fernando Freitas Ganança
- Universidade Federal de São Paulo (Unifesp), Escola Paulista de Medicina, Departamento de Otorrinolaringologia e Cirurgia Cérvico-Facial, Disciplina de Otologia e Otoneurologia, São Paulo, SP, Brazil
| | - Maurício Malavasi Ganança
- Universidade Federal de São Paulo (Unifesp), Escola Paulista de Medicina, Departamento de Otorrinolaringologia e Cirurgia Cérvico-Facial, Disciplina de Otologia e Otoneurologia, São Paulo, SP, Brazil
| | - Raquel Mezzalira
- Universidade de Campinas (Unicamp), Disciplina de Otorrinolaringologia Cabeça e Pescoço, Campinas, SP, Brazil
| | - Roseli Saraiva Moreira Bittar
- Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), Setor de Otoneurologia, São Paulo, SP, Brazil
| | | | | | | | - César Bertoldo
- Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), Setor de Otoneurologia, São Paulo, SP, Brazil
| | - Cícero Ferreira
- Universidade Federal de São Paulo (Unifesp), Escola Paulista de Medicina, Departamento de Otorrinolaringologia e Cirurgia Cérvico-Facial, Disciplina de Otologia e Otoneurologia, São Paulo, SP, Brazil
| | - Danilo Real
- Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), Setor de Otoneurologia, São Paulo, SP, Brazil
| | | | - Jeanne Oiticica
- Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), Setor de Otoneurologia, São Paulo, SP, Brazil
| | - Joel Lavinsky
- Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil; Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Santa Casa de Porto Alegre, Porto Alegre, RS, Brazil
| | | | - Juliana Antoniolli Duarte
- Universidade Federal de São Paulo (Unifesp), Escola Paulista de Medicina, Departamento de Otorrinolaringologia e Cirurgia Cérvico-Facial, Disciplina de Otologia e Otoneurologia, São Paulo, SP, Brazil
| | - Lígia Oliveira Gonçalves Morganti
- Universidade Federal de Minas Gerais (UFMG), Faculdade de Medicina, Departamento de Otorrinolaringologia, Belo Horizonte, MG, Brazil
| | | | - Lúcia Joffily
- Hospital Universitário Gaffrée e Guinle, Universidade Federal do Estado do Rio de Janeiro (Unirio), Rio de Janeiro, RJ, Brazil
| | - Luíz Lavinsky
- Universidade Federal do Rio Grande do Sul (UFRGS), Faculdade de Medicina, Disciplina de Otorrinolaringologia, Porto Alegre, RS, Brazil
| | - Mônica Alcantara de Oliveira Santos
- Irmandade da Santa Casa de Misericórdia de São Paulo, Faculdade de Ciências Médicas, Departamento de Otorrinolaringologia, São Paulo, SP, Brazil; Instituto de Assistência Médica ao Servidor Público Estadual de São Paulo, São Paulo, SP, Brazil
| | - Patrícia Mauro Mano
- Hospital Federal dos Servidores do Rio de Janeiro, Departamento de Otorrinolaringologia e Cirurgia de Cabeça e Pescoço, Rio de Janeiro, RJ, Brazil
| | | | | | - Renato Cal
- Universidade Federal do Pará (UFPa), Faculdade de Medicina, Belém, PA, Brazil
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Bao T, Klatt BN, Carender WJ, Kinnaird C, Alsubaie S, Whitney SL, Sienko KH. Effects of long-term vestibular rehabilitation therapy with vibrotactile sensory augmentation for people with unilateral vestibular disorders – A randomized preliminary study. J Vestib Res 2020; 29:323-334. [PMID: 31609716 PMCID: PMC9249282 DOI: 10.3233/ves-190683] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND AND OBJECTIVE: This pilot study aimed to investigate the effects of incorporating vibrotactile sensory augmentation (SA) on balance performance among people with unilateral vestibular disorders (UVD). METHODS: Eight participants with UVD were recruited. Participants completed 18 balance training sessions across six weeks in a clinical setting. Four participants (68.1±7.5 yrs) were randomized to the experimental group (EG) and received trunk-based vibrotactile SA while performing the balance exercises, and four participants (63.1±11.3 yrs) were assigned to the control group (CG); CG participants completed the balance training without SA. Clinical and kinematic balance performance measures were collected before training; midway through training; and one week, one month, and six months after training. RESULTS: All participants, regardless of group, demonstrated improvements in a subset of the clinical or balance metrics immediately following completion of the balance training protocol. The EG showed significantly greater improvements than the CG for the Activities-specific Balance Confidence Scale and postural stability during the two standing balance exercises with head movements. The EG also had larger improvements than the CG for the Sensory Organization Test (SOT), Mini Balance Evaluations Systems Test, Gait Speed Test, Dynamic Gait Index, Functional Gait Assessment, and vestibular reliance metric calculated based on the SOT. CONCLUSIONS: Incorporating vibrotactile SA into vestibular rehabilitation programs may lead to additional benefits that may be retained up to six months after training compared to training without vibrotactile SA. A larger study is warranted to demonstrate statistical significance between the groups.
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Affiliation(s)
- Tian Bao
- Department of Mechanical Engineering, University of Michigan, Ann Arbor, MI, USA
| | - Brooke N. Klatt
- Department of Physical Therapy, School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, PA, USA
| | - Wendy J. Carender
- Otolaryngology, Michigan Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Catherine Kinnaird
- Department of Mechanical Engineering, University of Michigan, Ann Arbor, MI, USA
| | - Saud Alsubaie
- Department of Physical Therapy, School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, PA, USA
- Department of Physical Therapy and Health Rehabilitation, Prince Sattam bin Abdulaziz University, Alkharj, Saudi Arabia
| | - Susan L. Whitney
- Department of Physical Therapy, School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, PA, USA
- Department of Otolaryngology, School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, PA, USA
| | - Kathleen H. Sienko
- Department of Mechanical Engineering, University of Michigan, Ann Arbor, MI, USA
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Abstract
Purpose of review Bilateral vestibular deficits exist and their prevalence is more important than believed by the medical community. Their severe impact has inspired several teams to develop technical solutions in an attempt to rehabilitate patients. A particularly promising pathway is the vestibular implant. This article describes the main milestones in this field, mainly focusing on work conducted in human patients. Recent findings There have been substantial research efforts, first in animals and more recently in humans, toward the development of vestibular implants. Humans have demonstrated surprising adaptation capabilities to the artificial vestibular signal. Today, the possibility of restoring vestibular reflexes, particularly the vestibulo-ocular reflex, and even achieving useful function in close-to-reality tasks (i.e. improving visual abilities while walking) have been demonstrated in humans. Summary The vestibular implant opens new perspectives, not only as an effective therapeutic tool, but also pushes us to go beyond current knowledge and well-established clinical concepts.
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Afzal MR, Lee H, Eizad A, Lee CH, Oh MK, Yoon J. Effects of Vibrotactile Biofeedback Coding Schemes on Gait Symmetry Training of Individuals With Stroke. IEEE Trans Neural Syst Rehabil Eng 2019; 27:1617-1625. [PMID: 31247557 DOI: 10.1109/tnsre.2019.2924682] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Variations in biofeedback coding schemes for postural control, in recent research, have shown significant differences in performance outcomes due to variations in coding schemes. However, the application of vibrotactile biofeedback coding schemes to gait symmetry training is not well explored. In this paper, we devised various vibrotactile biofeedback modes and identified their efficacy during gait symmetry training of individuals suffering from hemiparesis due to stroke. These modes are composed of variations in vibration type (on-time or intensity), and relation type (proportional or inversely-proportional) with the error in symmetry ratio. Eight individuals with stroke participated in walking trials. From dependent t-tests on the collected data, we found improved achievement of temporal gait symmetry while utilizing all the provided biofeedback modes compared to no biofeedback (P < 0.001). Furthermore, two-way repeated measures ANOVA revealed statistically significant difference in symmetry ratio for main effect of vibration type (P-value = 0.016, partial eta squared = 0.585). The participants performed better with modes of biofeedback with varying vibration on-times. Furthermore, participants showed better performance when the biofeedback varied proportionally with the error. These findings suggest that biofeedback coding schemes may have a significant effect on the performance of gait training.
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Fleszar Z, Mellone S, Giese M, Tacconi C, Becker C, Schöls L, Synofzik M, Ilg W. Real-time use of audio-biofeedback can improve postural sway in patients with degenerative ataxia. Ann Clin Transl Neurol 2019; 6:285-294. [PMID: 30847361 PMCID: PMC6389757 DOI: 10.1002/acn3.699] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Revised: 09/16/2018] [Accepted: 10/26/2018] [Indexed: 11/08/2022] Open
Abstract
Objective Cerebellar ataxia essentially includes deficient postural control. It remains unclear whether augmented sensory information might help cerebellar patients, as the cerebellum underlies processing of various sensory modalities for postural control. Here, we hypothesized that patients with cerebellar degeneration can still exploit audio-biofeedback (ABF) of trunk acceleration as a real-time assistive signal to compensate for deficient postural control. Methods Effects on postural sway during stance were assessed in an ABF intervention group versus a no-ABF disease control group (23 vs. 17 cerebellar patients) in a clinico-experimental study. A single-session ABF paradigm of standing plus short exergaming under ABF was applied. Postural sway with eyes open and eyes closed was quantified prior to ABF, under ABF, and post ABF. Results Postural sway in the eyes closed condition was significantly reduced under ABF. Both benefit of ABF and benefit of vision correlated with the extent of postural sway at baseline, and both types of sensory benefits correlated with each other. Patients with strongest postural sway exhibited reduced postural sway also with eyes open, thus benefitting from both vision and ABF. No changes were observed in the no-ABF control group. Interpretation Our findings provide proof-of-principle evidence that subjects with cerebellar degeneration are still able to integrate additional sensory modalities to compensate for deficient postural control: They can use auditory cues functionally similar to vision in the absence of vision, and additive to vision in the presence of vision (in case of pronounced postural sway). These findings might inform future assistive strategies for cerebellar ataxia.
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Affiliation(s)
- Zofia Fleszar
- Department of Cognitive Neurology Hertie Institute for Clinical Brain Research Tübingen Germany.,Centre for Integrative Neuroscience (CIN) Tübingen Germany.,Department of Neurodegeneration Hertie Institute for Clinical Brain Research and Centre of Neurology Tübingen Germany
| | - Sabato Mellone
- Personal Health Systems Lab Department of Electrical Electronic and Information Engineering «Guglielmo Marconi» University of Bologna Bologna Italy
| | - Martin Giese
- Department of Cognitive Neurology Hertie Institute for Clinical Brain Research Tübingen Germany.,Centre for Integrative Neuroscience (CIN) Tübingen Germany
| | - Carlo Tacconi
- Health Sciences and Technologies - Interdepartmental Center for Industrial Research University of Bologna Bologna Italy
| | - Clemens Becker
- Department of Clinical Gerontology Robert-Bosch-Hospital Stuttgart Germany
| | - Ludger Schöls
- Department of Neurodegeneration Hertie Institute for Clinical Brain Research and Centre of Neurology Tübingen Germany.,German Research Center for Neurodegenerative Diseases (DZNE) Tübingen Germany
| | - Matthis Synofzik
- Department of Neurodegeneration Hertie Institute for Clinical Brain Research and Centre of Neurology Tübingen Germany.,German Research Center for Neurodegenerative Diseases (DZNE) Tübingen Germany
| | - Winfried Ilg
- Department of Cognitive Neurology Hertie Institute for Clinical Brain Research Tübingen Germany.,Centre for Integrative Neuroscience (CIN) Tübingen Germany
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20
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Ma CZH, Ling YT, Shea QTK, Wang LK, Wang XY, Zheng YP. Towards Wearable Comprehensive Capture and Analysis of Skeletal Muscle Activity during Human Locomotion. SENSORS 2019; 19:s19010195. [PMID: 30621103 PMCID: PMC6339139 DOI: 10.3390/s19010195] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Revised: 12/22/2018] [Accepted: 01/04/2019] [Indexed: 11/21/2022]
Abstract
Background: Motion capture and analyzing systems are essential for understanding locomotion. However, the existing devices are too cumbersome and can be used indoors only. A newly-developed wearable motion capture and measurement system with multiple sensors and ultrasound imaging was introduced in this study. Methods: In ten healthy participants, the changes in muscle area and activity of gastrocnemius, plantarflexion and dorsiflexion of right leg during walking were evaluated by the developed system and the Vicon system. The existence of significant changes in a gait cycle, comparison of the ankle kinetic data captured by the developed system and the Vicon system, and test-retest reliability (evaluated by the intraclass correlation coefficient, ICC) in each channel’s data captured by the developed system were examined. Results: Moderate to good test-retest reliability of various channels of the developed system (0.512 ≤ ICC ≤ 0.988, p < 0.05), significantly high correlation between the developed system and Vicon system in ankle joint angles (0.638R ≤ 0.707, p < 0.05), and significant changes in muscle activity of gastrocnemius during a gait cycle (p < 0.05) were found. Conclusion: A newly developed wearable motion capture and measurement system with ultrasound imaging that can accurately capture the motion of one leg was evaluated in this study, which paves the way towards real-time comprehensive evaluation of muscles and joint motions during different activities in both indoor and outdoor environments.
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Affiliation(s)
- Christina Zong-Hao Ma
- Department of Biomedical Engineering, The Hong Kong Polytechnic University, Hong Kong, China.
- Department of Rehabilitation, Jönköping University, 551 11 Jönköping, Sweden.
| | - Yan To Ling
- Department of Biomedical Engineering, The Hong Kong Polytechnic University, Hong Kong, China.
| | - Queenie Tsung Kwan Shea
- Department of Biomedical Engineering, The Hong Kong Polytechnic University, Hong Kong, China.
| | - Li-Ke Wang
- Department of Biomedical Engineering, The Hong Kong Polytechnic University, Hong Kong, China.
| | - Xiao-Yun Wang
- Guangdong Work Injury Rehabilitation Center, Guangzhou 510440, China.
| | - Yong-Ping Zheng
- Department of Biomedical Engineering, The Hong Kong Polytechnic University, Hong Kong, China.
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21
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Sienko KH, Seidler RD, Carender WJ, Goodworth AD, Whitney SL, Peterka RJ. Potential Mechanisms of Sensory Augmentation Systems on Human Balance Control. Front Neurol 2018; 9:944. [PMID: 30483209 PMCID: PMC6240674 DOI: 10.3389/fneur.2018.00944] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Accepted: 10/22/2018] [Indexed: 12/30/2022] Open
Abstract
Numerous studies have demonstrated the real-time use of visual, vibrotactile, auditory, and multimodal sensory augmentation technologies for reducing postural sway during static tasks and improving balance during dynamic tasks. The mechanism by which sensory augmentation information is processed and used by the CNS is not well understood. The dominant hypothesis, which has not been supported by rigorous experimental evidence, posits that observed reductions in postural sway are due to sensory reweighting: feedback of body motion provides the CNS with a correlate to the inputs from its intact sensory channels (e.g., vision, proprioception), so individuals receiving sensory augmentation learn to increasingly depend on these intact systems. Other possible mechanisms for observed postural sway reductions include: cognition (processing of sensory augmentation information is solely cognitive with no selective adjustment of sensory weights by the CNS), “sixth” sense (CNS interprets sensory augmentation information as a new and distinct sensory channel), context-specific adaptation (new sensorimotor program is developed through repeated interaction with the device and accessible only when the device is used), and combined volitional and non-volitional responses. This critical review summarizes the reported sensory augmentation findings spanning postural control models, clinical rehabilitation, laboratory-based real-time usage, and neuroimaging to critically evaluate each of the aforementioned mechanistic theories. Cognition and sensory re-weighting are identified as two mechanisms supported by the existing literature.
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Affiliation(s)
- Kathleen H Sienko
- Department of Mechanical Engineering, University of Michigan, Ann Arbor, MI, United States
| | - Rachael D Seidler
- Department of Applied Physiology and Kinesiology, University of Florida, Gainesville, FL, United States
| | - Wendy J Carender
- Michigan Balance Vestibular Testing and Rehabilitation, Department of Otolaryngology, Michigan Medicine, Ann Arbor, MI, United States
| | - Adam D Goodworth
- Department of Rehabilitation Sciences, University of Hartford, Hartford, CT, United States
| | - Susan L Whitney
- Departments of Physical Therapy and Otolaryngology, University of Pittsburgh, Pittsburgh, PA, United States
| | - Robert J Peterka
- Department of Neurology, Oregon Health & Science University and National Center for Rehabilitative Auditory Research, VA Portland Health Care System, Portland, OR, United States
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22
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Evaluating the Effects of Kinesthetic Biofeedback Delivered Using Reaction Wheels on Standing Balance. JOURNAL OF HEALTHCARE ENGINEERING 2018; 2018:7892020. [PMID: 29991995 PMCID: PMC6016170 DOI: 10.1155/2018/7892020] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/15/2018] [Revised: 04/20/2018] [Accepted: 05/08/2018] [Indexed: 11/17/2022]
Abstract
Aging, injury, or ailments can contribute to impaired balance control and increase the risk of falling. Provision of light touch augments the sense of balance and can thus reduce the amount of body sway. In this study, a wearable reaction wheel-based system is used to deliver light touch-based balance biofeedback on the subject's back. The system can sense torso tilt and, using reaction wheels, generates light touch. A group of 7 healthy young individuals performed balance tasks under 12 trial combinations based on two conditions each of standing stance and surface types and three of biofeedback device status. Torso tilt data, collected from a waist-mounted smartphone during all the trials, were analyzed to determine the efficacy of the system. Provision of biofeedback by the device significantly reduced RMS of mediolateral (ML) trunk tilt (p < 0.05) and ML trunk acceleration (p < 0.05). Repeated measures ANOVA revealed significant interaction between stance and surface on reduction in RMS of ML trunk tilt, AP trunk tilt, ML trunk acceleration, and AP trunk acceleration. The device shows promise for further applications such as virtual reality interaction and gait rehabilitation.
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Navarro E, González P, López-Jaquero V, Montero F, Molina JP, Romero-Ayuso D. Adaptive, Multisensorial, Physiological and Social: The Next Generation of Telerehabilitation Systems. Front Neuroinform 2018; 12:43. [PMID: 30042671 PMCID: PMC6049338 DOI: 10.3389/fninf.2018.00043] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2017] [Accepted: 06/12/2018] [Indexed: 12/05/2022] Open
Abstract
Some people require special treatments for rehabilitating physical, cognitive or even social capabilities after an accident or degenerative illness. However, the ever-increasing costs of looking after an aging population, many of whom suffer chronic diseases, is straining the finances of healthcare systems around Europe. This situation has given rise to a great deal of attention being paid to the development of telerehabilitation (TR) systems, which have been designed to take rehabilitation beyond hospitals and care centers. In this article, we propose which features should be addressed in the development of TR systems, that is, they should consider adaptive, multisensorial, physiological and social aspects. For this aim, the research project Vi-SMARt is being conducted for evaluating whether and how different technologies, such as virtual reality (VR), multi-sensorial feedback, or telemonitoring, may be exploited for the development of the next generation of TR systems. Beyond traditional aural and visual feedback, the exploitation of haptic sense by using devices such as haptic gloves or wristbands, can provide patients with additional guidance in the rehabilitation process. For telemonitoring, Electroencephalography (EEG) devices show signs of being a promising approach, not only to monitor patients’ emotions, but also to obtain neuro-feedback useful for controlling his/her interaction with the system and thus to provide a better rehabilitation experience.
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Affiliation(s)
- Elena Navarro
- LoUISE Research Group, Computing Systems Department, University of Castilla-La Mancha, Albacete, Spain
| | - Pascual González
- LoUISE Research Group, Computing Systems Department, University of Castilla-La Mancha, Albacete, Spain
| | - Víctor López-Jaquero
- LoUISE Research Group, Computing Systems Department, University of Castilla-La Mancha, Albacete, Spain
| | - Francisco Montero
- LoUISE Research Group, Computing Systems Department, University of Castilla-La Mancha, Albacete, Spain
| | - José P Molina
- LoUISE Research Group, Computing Systems Department, University of Castilla-La Mancha, Albacete, Spain
| | - Dulce Romero-Ayuso
- Department of Physical Therapy, Occupational Therapy Division, Faculty of Health Sciences, University of Granada, Granada, Spain
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Afzal MR, Pyo S, Oh MK, Park YS, Yoon J. Evaluating the effects of delivering integrated kinesthetic and tactile cues to individuals with unilateral hemiparetic stroke during overground walking. J Neuroeng Rehabil 2018; 15:33. [PMID: 29661237 PMCID: PMC5902868 DOI: 10.1186/s12984-018-0372-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2017] [Accepted: 03/27/2018] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Integration of kinesthetic and tactile cues for application to post-stroke gait rehabilitation is a novel concept which needs to be explored. The combined provision of haptic cues may result in collective improvement of gait parameters such as symmetry, balance and muscle activation patterns. Our proposed integrated cue system can offer a cost-effective and voluntary gait training experience for rehabilitation of subjects with unilateral hemiparetic stroke. METHODS Ten post-stroke ambulatory subjects participated in a 10 m walking trial while utilizing the haptic cues (either alone or integrated application), at their preferred and increased gait speeds. In the system a haptic cane device (HCD) provided kinesthetic perception and a vibrotactile feedback device (VFD) provided tactile cue on the paretic leg for gait modification. Balance, gait symmetry and muscle activity were analyzed to identify the benefits of utilizing the proposed system. RESULTS When using kinesthetic cues, either alone or integrated with a tactile cue, an increase in the percentage of non-paretic peak activity in the paretic muscles was observed at the preferred gait speed (vastus medialis obliquus: p < 0.001, partial eta squared (η2) = 0.954; semitendinosus p < 0.001, partial η2 = 0.793) and increased gait speeds (vastus medialis obliquus: p < 0.001, partial η2 = 0.881; semitendinosus p = 0.028, partial η2 = 0.399). While using HCD and VFD (individual and integrated applications), subjects could walk at their preferred and increased gait speeds without disrupting trunk balance in the mediolateral direction. The temporal stance symmetry ratio was improved when using tactile cues, either alone or integrated with a kinesthetic cue, at their preferred gait speed (p < 0.001, partial η2 = 0.702). CONCLUSIONS When combining haptic cues, the subjects walked at their preferred gait speed with increased temporal stance symmetry and paretic muscle activity affecting their balance. Similar improvements were observed at higher gait speeds. The efficacy of the proposed system is influenced by gait speed. Improvements were observed at a 20% increased gait speed, whereas, a plateau effect was observed at a 40% increased gait speed. These results imply that integration of haptic cues may benefit post-stroke gait rehabilitation by inducing simultaneous improvements in gait symmetry and muscle activity.
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Affiliation(s)
- Muhammad Raheel Afzal
- School of Integrated Technology, Gwangju Institute of Science and Technology, 123 Cheomdangwagi-ro, Buk-gu, Gwangju, 61005 Republic of Korea
| | - Sanghun Pyo
- School of Integrated Technology, Gwangju Institute of Science and Technology, 123 Cheomdangwagi-ro, Buk-gu, Gwangju, 61005 Republic of Korea
| | - Min-Kyun Oh
- Department of Rehabilitation Medicine, Gyeongsang National University School of Medicine, Gyeongsang National University Hospital, Jinju, 52727 Republic of Korea
| | - Young Sook Park
- Department of Physical Medicine and Rehabilitation, Sungkyunkwan University School of Medicine, Samsung Changwon Hospital, Changwon, 51353 Republic of Korea
| | - Jungwon Yoon
- School of Integrated Technology, Gwangju Institute of Science and Technology, 123 Cheomdangwagi-ro, Buk-gu, Gwangju, 61005 Republic of Korea
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25
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Sienko KH, Whitney SL, Carender WJ, Wall C. The role of sensory augmentation for people with vestibular deficits: Real-time balance aid and/or rehabilitation device? J Vestib Res 2018; 27:63-76. [PMID: 28387692 DOI: 10.3233/ves-170606] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
This narrative review highlights findings from the sensory augmentation field for people with vestibular deficits and addresses the outstanding questions that are critical to the translation of this technology into clinical and/or personal use. Prior research has demonstrated that the real-time use of visual, vibrotactile, auditory, and multimodal sensory augmentation technologies can improve balance during static and dynamic stance tasks within a laboratory setting. However, its application in improving gait requires additional investigation, as does its efficacy as a rehabilitation device for people with vestibular deficits. In some locomotor studies involving sensory augmentation, gait velocity decreased and secondary task performance worsened, and subjects negatively altered their segmental control strategies when cues were provided following short training sessions. A further question is whether the retention and/or carry-over effects of training with a sensory augmentation technology exceed the retention and/or carry-over effects of training alone, thereby supporting its use as a rehabilitation device. Preliminary results suggest that there are short-term improvements in balance performance following a small number of training sessions with a sensory augmentation device. Long-term clinical and home-based controlled training studies are needed. It is hypothesized that sensory augmentation provides people with vestibular deficits with additional sensory input to promote central compensation during a specific exercise/activity; however, research is needed to substantiate this theory. Major obstacles standing in the way of its use for these critical applications include determining exercise/activity specific feedback parameters and dosage strategies. This paper summarizes the reported findings that support sensory augmentation as a balance aid and rehabilitation device, but does not critically examine efficacy or the quality of the research methods used in the reviewed studies.
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Affiliation(s)
- K H Sienko
- Department of Mechanical Engineering, University of Michigan, Ann Arbor, MI, USA.,Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI, USA
| | - S L Whitney
- Department of Physical Therapy, University of Pittsburgh, Pittsburgh, PA, USA.,Rehabilitation Research Chair, Department of Rehabilitation Sciences, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia
| | - W J Carender
- Department of Otolaryngology, University of Michigan Health System, Ann Arbor, MI, USA
| | - C Wall
- Jenks Vestibular Diagnostic Laboratory, Massachusetts Eye and Ear Infirmary, Boston, MA, USA.,Department of Otology and Laryngology, Harvard Medical School, Boston, MA, USA
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26
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Allum JHJ, Honegger F. Vibro-tactile and auditory balance biofeedback changes muscle activity patterns: Possible implications for vestibular implants. J Vestib Res 2018; 27:77-87. [PMID: 28387687 DOI: 10.3233/ves-170601] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND The two different types of balance prostheses being developed, implants and vibro-tactile/auditory feedback prostheses, rely on different measures to prove efficacy (those based on vestibular ocular reflexes versus balance control, respectively). Here we provide evidence that examining muscle activity might provide a useful alternative for both. METHODS The muscle activity of 6 bilateral vestibular loss (BVL) and 7 age-matched healthy controls (HC) was examined while standing eyes closed on a foam support surface. Pelvis and upper trunk angular movements were recorded in the roll and pitch planes. Surface EMG was recorded from the lower leg, trunk and upper arm muscles. BVL subjects were first assessed without feedback of pelvis sway, then received training with combined vibro-tactile and auditory feedback, before being re-assessed with feedback. RESULTS Feedback reduced the amplitudes of pelvis and shoulder sway to values of HC without feedback. Both the level of background EMG activity and the EMG area amplitudes changed when feedback was provided in a manner consistent with the reduced amplitude modulation of muscle synergies of HC. CONCLUSIONS The results of this study indicate that changed muscle synergy amplitudes underlie improvements in sway achieved by BVL subjects. The concept of this investigation may provide a means to prove efficacy for different types of balance prostheses, including implants.
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27
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Bao T, Carender WJ, Kinnaird C, Barone VJ, Peethambaran G, Whitney SL, Kabeto M, Seidler RD, Sienko KH. Effects of long-term balance training with vibrotactile sensory augmentation among community-dwelling healthy older adults: a randomized preliminary study. J Neuroeng Rehabil 2018; 15:5. [PMID: 29347946 PMCID: PMC5774163 DOI: 10.1186/s12984-017-0339-6] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2017] [Accepted: 12/11/2017] [Indexed: 12/11/2022] Open
Abstract
Background Sensory augmentation has been shown to improve postural stability during real-time balance applications. Limited long-term controlled studies have examined retention of balance improvements in healthy older adults after training with sensory augmentation has ceased. This pilot study aimed to assess the efficacy of long-term balance training with and without sensory augmentation among community-dwelling healthy older adults. Methods Twelve participants (four males, eight females; 75.6 ± 4.9 yrs) were randomly assigned to the experimental group (n = 6) or control group (n = 6). Participants trained in their homes for eight weeks, completing three 45-min exercise sessions per week using smart phone balance trainers that provided written, graphic, and video guidance, and monitored trunk sway. During each session, participants performed six repetitions of six exercises selected from five categories (static standing, compliant surface standing, weight shifting, modified center of gravity, and gait). The experimental group received vibrotactile sensory augmentation for four of the six repetitions per exercise via the smart phone balance trainers, while the control group performed exercises without sensory augmentation. The smart phone balance trainers sent exercise performance data to a physical therapist, who recommended exercises on a weekly basis. Balance performance was assessed using a battery of clinical balance tests (Activity Balance Confidence Scale, Sensory Organization Test, Mini Balance Evaluation Systems Test, Five Times Sit to Stand Test, Four Square Step Test, Functional Reach Test, Gait Speed Test, Timed Up and Go, and Timed Up and Go with Cognitive Task) before training, after four weeks of training, and after eight weeks of training. Results Participants in the experimental group were able to use vibrotactile sensory augmentation independently in their homes. After training, the experimental group had significantly greater improvements in Sensory Organization Test and Mini Balance Evaluation Systems Test scores than the control group. Significant improvement was also observed for Five Times Sit to Stand Test duration within the experimental group, but not in the control group. No significant improvements between the two groups were observed in the remaining clinical outcome measures. Conclusion The findings of this study support the use of sensory augmentation devices by community-dwelling healthy older adults as balance rehabilitation tools, and indicate feasibility of telerehabilitation therapy with reduced input from clinicians.
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Affiliation(s)
- Tian Bao
- Department of Mechanical Engineering, University of Michigan, 2350 Hayward St., Ann Arbor, 48109, MI, USA
| | - Wendy J Carender
- Department of Otolaryngology, Michigan Medicine, University of Michigan, 1500 E Medical Center Dr, Ann Arbor, MI, 48109, USA
| | - Catherine Kinnaird
- Department of Mechanical Engineering, University of Michigan, 2350 Hayward St., Ann Arbor, 48109, MI, USA
| | - Vincent J Barone
- Department of Mechanical Engineering, University of Michigan, 2350 Hayward St., Ann Arbor, 48109, MI, USA
| | - Geeta Peethambaran
- Physical Medicine & Rehabilitation, Michigan Medicine, University of Michigan, 1500 E Medical Center Dr, Ann Arbor, MI, 48109, USA
| | - Susan L Whitney
- Department of Physical Therapy and Otolaryngology, School of Health and Rehabilitation Sciences, University of Pittsburgh, 4028 Forbes Tower, Pittsburgh, PA, 15260, USA
| | - Mohammed Kabeto
- Department of Internal Medicine, University of Michigan, 1500 East Medical Center Drive, Ann Arbor, 48109, MI, USA
| | - Rachael D Seidler
- School of Kinesiology, University of Michigan, 1402 Washington Heights, Ann Arbor, MI, 48109, USA.,Department of Psychology, University of Michigan, 530 Church St, Ann Arbor, MI, 48109, USA.,Department of Applied Physiology and Kinesiology, University of Florida, Gainesville, USA
| | - Kathleen H Sienko
- Department of Mechanical Engineering, University of Michigan, 2350 Hayward St., Ann Arbor, 48109, MI, USA. .,Department of Biomedical Engineering, University of Michigan, 2200 Bonisteel Blvd, Ann Arbor, MI, 48109, USA.
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Shull PB, Zhu X, Cutkosky MR. Continuous Movement Tracking Performance for Predictable and Unpredictable Tasks with Vibrotactile Feedback. IEEE TRANSACTIONS ON HAPTICS 2017; 10:466-475. [PMID: 28368831 DOI: 10.1109/toh.2017.2689023] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
The purpose of this paper was to determine human movement tracking performance in response to vibrotactile feedback tracking for predictable and unpredictable continuous movement tasks. Thirteen subjects performed elbow flexion/extension and knee flexion/extension continuous movement tracking tasks while receiving tactile stimulation proportional to limb joint position error. Subjects followed 0.2-2.0 Hz desired movements for predictable tasks (single sinusoid) and unpredictable tasks (combination of three sinusoids). Tactile stimulation reaction times at the forearm to induce elbow flexion/extension and at the shank to induce knee flexion/extension were also recorded. Results of frequency tracking showed that 100 percent of participants correctly tracked unpredictable tasks at all frequencies, but only 60-80 percent of participants correctly tracked predictable tasks at frequencies less than 1 Hz and only 20-60 percent of participants correctly tracked predictable tasks at frequencies greater than 1 Hz. Subjects had less phase lag for predictable tasks than for unpredictable tasks. Reaction times at the forearm were 379 ms and at the shank 437 ms. These findings suggest that continuous vibrotactile feedback based on position errors may not be the most effective means of training higher frequency human movements and serve to inform future vibrotactile feedback design related to training human limb movements for predictable and unpredictable tasks.
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29
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Burzynski J, Sulway S, Rutka JA. Vestibular Rehabilitation: Review of Indications, Treatments, Advances, and Limitations. CURRENT OTORHINOLARYNGOLOGY REPORTS 2017. [DOI: 10.1007/s40136-017-0157-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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30
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Yoon HU, Anil Kumar N, Hur P. Synergistic Effects on the Elderly People's Motor Control by Wearable Skin-Stretch Device Combined with Haptic Joystick. Front Neurorobot 2017; 11:31. [PMID: 28690514 PMCID: PMC5481371 DOI: 10.3389/fnbot.2017.00031] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2017] [Accepted: 06/06/2017] [Indexed: 11/13/2022] Open
Abstract
Cutaneous sensory feedback can be used to provide additional sensory cues to a person performing a motor task where vision is a dominant feedback signal. A haptic joystick has been widely used to guide a user by providing force feedback. However, the benefit of providing force feedback is still debatable due to performance dependency on factors such as the user's skill-level, task difficulty. Meanwhile, recent studies have shown the feasibility of improving a motor task performance by providing skin-stretch feedback. Therefore, a combination of two aforementioned feedback types is deemed to be promising to promote synergistic effects to consistently improve the person's motor performance. In this study, we aimed at identifying the effect of the combined haptic and skin-stretch feedbacks on the aged person's driving motor performance. For the experiment, 15 healthy elderly subjects (age 72.8 ± 6.6 years) were recruited and were instructed to drive a virtual power-wheelchair through four different courses with obstacles. Four augmented sensory feedback conditions were tested: no feedback, force feedback, skin-stretch feedback, and a combination of both force and skin-stretch feedbacks. While the haptic force was provided to the hand by the joystick, the skin-stretch was provided to the steering forearm by a custom-designed wearable skin-stretch device. We tested two hypotheses: (i) an elderly individual's motor control would benefit from receiving information about a desired trajectory from multiple sensory feedback sources, and (ii) the benefit does not depend on task difficulty. Various metrics related to skills and safety were used to evaluate the control performance. Repeated measure ANOVA was performed for those metrics with two factors: task scenario and the type of the augmented sensory feedback. The results revealed that elderly subjects' control performance significantly improved when the combined feedback of both haptic force and skin-stretch feedback was applied. The proposed approach suggest the feasibility to improve people's task performance by the synergistic effects of multiple augmented sensory feedback modalities.
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Affiliation(s)
- Han U Yoon
- Department of Mechanical Engineering, Texas A&M UniversityCollege Station, TX, United States
| | - Namita Anil Kumar
- Department of Mechanical Engineering, Texas A&M UniversityCollege Station, TX, United States
| | - Pilwon Hur
- Department of Mechanical Engineering, Texas A&M UniversityCollege Station, TX, United States
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31
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Harris LR, Sakurai K, Beaudot WHA. Tactile Flow Overrides Other Cues To Self Motion. Sci Rep 2017; 7:1059. [PMID: 28432328 PMCID: PMC5430733 DOI: 10.1038/s41598-017-01111-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2016] [Accepted: 03/22/2017] [Indexed: 11/09/2022] Open
Abstract
Vestibular-somatosensory interactions are pervasive in the brain but it remains unclear why. Here we explore the contribution of tactile flow to processing self-motion. We assessed two aspects of self-motion: timing and speed. Participants sat on an oscillating swing and either kept their hands on their laps or rested them lightly on an earth-stationary surface. They viewed a grating oscillating at the same frequency as their motion and judged its phase or, in a separate experiment, its speed relative to their perceived motion. Participants required the phase to precede body movement (with or without tactile flow) or tactile flow by ~5° (44 ms) to appear earth-stationary. Speed judgments were 4-10% faster when motion was from tactile flow, either alone or with body motion, compared to body motion alone (where speed judgments were accurate). By comparing response variances we conclude that phase and speed judgments do not reflect optimal integration of tactile flow with other cues to body motion: instead tactile flow dominates perceived self-motion - acting as an emergency override. This may explain why even minimal tactile cues are so helpful in promoting stability and suggests that providing artificial tactile cues might be a powerful aid to perceiving self-motion.
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Affiliation(s)
- Laurence R Harris
- Centre for Vision Research, York University, 4700 Keele St., Toronto, Ontario, M3J 1P3, Canada.
| | - Kenzo Sakurai
- Department of Human Science, Tohoku Gakuin University, 2-1-1 Tenjinzawa, Izumi-ku, Sendai, Miyagi, 981-3193, Japan.,Division of Human Informatics, Graduate School of Tohoku Gakuin University, 2-1-1 Tenjinzawa, Izumi-ku, Sendai, Miyagi, 981-3193, Japan.,KyberVision Japan LLC, 5-2-8 Takamori, Izumi-ku, Sendai, Miyagi, 981-3203, Japan
| | - William H A Beaudot
- Division of Human Informatics, Graduate School of Tohoku Gakuin University, 2-1-1 Tenjinzawa, Izumi-ku, Sendai, Miyagi, 981-3193, Japan.,KyberVision Japan LLC, 5-2-8 Takamori, Izumi-ku, Sendai, Miyagi, 981-3203, Japan
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Husman MAB, Maqbool HF, Awad MI, Abouhossein A, Dehghani-Sanij AA. A wearable skin stretch haptic feedback device: Towards improving balance control in lower limb amputees. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2016; 2016:2120-2123. [PMID: 28268750 DOI: 10.1109/embc.2016.7591147] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Haptic feedback to lower limb amputees is essential to maximize the functionality of a prosthetic device by providing information to the user about the interaction with the environment and the position of the prostheses in space. Severed sensory pathway and the absence of connection between the prosthesis and the Central Nervous System (CNS) after lower limb amputation reduces balance control, increases visual dependency and increases risk of falls among amputees. This work describes the design of a wearable haptic feedback device for lower limb amputees using lateral skin-stretch modality intended to serve as a feedback cue during ambulation. A feedback scheme was proposed based on gait event detection for possible real-time postural adjustment. Preliminary perceptual test with healthy subjects in static condition was carried out and the results indicated over 98% accuracy in determining stimuli location around the upper leg region, suggesting good perceptibility of the delivered stimuli.
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Plauché A, Villarreal D, Gregg RD. A Haptic Feedback System for Phase-Based Sensory Restoration in Above-Knee Prosthetic Leg Users. IEEE TRANSACTIONS ON HAPTICS 2016; 9:421-6. [PMID: 27323375 PMCID: PMC5033686 DOI: 10.1109/toh.2016.2580507] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Persons with amputations lack important senses from the amputated limb. With the absence of proprioception in the amputated leg, amputees have far more difficulty maintaining a natural gait with balance and stability. The biggest determinant of temporal limb behavior during locomotion is the phase in the gait cycle, which can be estimated using the center of pressure (COP) under the feet. We hypothesize that feedback from the COP of the prosthetic foot can help restore a more robust sense of phase in transfemoral (above-knee) amputees. This paper presents a device that provides vibrotactile feedback based on the COP from the prosthesis, providing proprioception and potentially an improved sense of phase to the user. Experiments showed that the haptic device significantly decreased variability of stride length, step width, and trunk sway in novice (able-bodied) users of a transfemoral prosthetic leg during treadmill locomotion (N=9), indicating improved gait stability.
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Affiliation(s)
- Aaron Plauché
- Department of Bioengineering, University of Texas at Dallas, Richardson, TX 75080, USA
| | - Dario Villarreal
- Department of Bioengineering, University of Texas at Dallas, Richardson, TX 75080, USA
| | - Robert D. Gregg
- Department of Bioengineering and Department of Mechanical Engineering at The University of Texas at Dallas, Richardson, TX 75080, USA
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34
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Ma CZH, Wong DWC, Lam WK, Wan AHP, Lee WCC. Balance Improvement Effects of Biofeedback Systems with State-of-the-Art Wearable Sensors: A Systematic Review. SENSORS 2016; 16:434. [PMID: 27023558 PMCID: PMC4850948 DOI: 10.3390/s16040434] [Citation(s) in RCA: 60] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/31/2016] [Revised: 03/19/2016] [Accepted: 03/21/2016] [Indexed: 12/26/2022]
Abstract
Falls and fall-induced injuries are major global public health problems. Balance and gait disorders have been the second leading cause of falls. Inertial motion sensors and force sensors have been widely used to monitor both static and dynamic balance performance. Based on the detected performance, instant visual, auditory, electrotactile and vibrotactile biofeedback could be provided to augment the somatosensory input and enhance balance control. This review aims to synthesize the research examining the effect of biofeedback systems, with wearable inertial motion sensors and force sensors, on balance performance. Randomized and non-randomized clinical trials were included in this review. All studies were evaluated based on the methodological quality. Sample characteristics, device design and study characteristics were summarized. Most previous studies suggested that biofeedback devices were effective in enhancing static and dynamic balance in healthy young and older adults, and patients with balance and gait disorders. Attention should be paid to the choice of appropriate types of sensors and biofeedback for different intended purposes. Maximizing the computing capacity of the micro-processer, while minimizing the size of the electronic components, appears to be the future direction of optimizing the devices. Wearable balance-improving devices have their potential of serving as balance aids in daily life, which can be used indoors and outdoors.
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Affiliation(s)
- Christina Zong-Hao Ma
- Interdisciplinary Division of Biomedical Engineering, The Hong Kong Polytechnic University, Hong Kong, China.
- Rehabilitation Engineering Research Institute, China Rehabilitation Research Center, Beijing 100068, China.
| | - Duo Wai-Chi Wong
- Interdisciplinary Division of Biomedical Engineering, The Hong Kong Polytechnic University, Hong Kong, China.
| | - Wing Kai Lam
- Li Ning Sports Science Research Center, Beijing 101111, China.
| | - Anson Hong-Ping Wan
- Interdisciplinary Division of Biomedical Engineering, The Hong Kong Polytechnic University, Hong Kong, China.
| | - Winson Chiu-Chun Lee
- Interdisciplinary Division of Biomedical Engineering, The Hong Kong Polytechnic University, Hong Kong, China.
- Institute of Active Ageing, The Hong Kong Polytechnic University, Hong Kong, China.
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35
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Whitney SL, Alghadir AH, Anwer S. Recent Evidence About the Effectiveness of Vestibular Rehabilitation. Curr Treat Options Neurol 2016; 18:13. [DOI: 10.1007/s11940-016-0395-4] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Ma CZH, Wan AHP, Wong DWC, Zheng YP, Lee WCC. A Vibrotactile and Plantar Force Measurement-Based Biofeedback System: Paving the Way towards Wearable Balance-Improving Devices. SENSORS 2015; 15:31709-22. [PMID: 26694399 PMCID: PMC4721802 DOI: 10.3390/s151229883] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/29/2015] [Revised: 12/01/2015] [Accepted: 12/10/2015] [Indexed: 11/16/2022]
Abstract
Although biofeedback systems have been used to improve balance with success, they were confined to hospital training applications. Little attempt has been made to investigate the use of in-shoe plantar force measurement and wireless technology to turn hospital training biofeedback systems into wearable devices. This research developed a wearable biofeedback system which detects body sway by analyzing the plantar force and provides users with the corresponding haptic cues. The effects of this system were evaluated in thirty young and elderly subjects with simulated reduced foot sensation. Subjects performed a Romberg test under three conditions: (1) no socks, system turned-off; (2) wearing five layers of socks, system turned-off; (3) wearing five layers of socks, and system turned-on. Degree of body sway was investigated by computing the center of pressure (COP) movement measured by a floor-mounted force platform. Plantar tactile sensation was evaluated using a monofilament test. Wearing multiple socks significantly decreased the plantar tactile sensory input (p < 0.05), and increased the COP parameters (p < 0.017), indicating increased postural sway. After turning on the biofeedback system, the COP parameters decreased significantly (p < 0.017). The positive results of this study should inspire future development of wearable plantar force-based biofeedback systems for improving balance in people with sensory deficits.
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Affiliation(s)
- Christina Zong-Hao Ma
- Interdisciplinary Division of Biomedical Engineering, The Hong Kong Polytechnic University, Hong Kong, China.
- Rehabilitation Engineering Research Institute, China Rehabilitation Research Center, Beijing 100068, China.
| | - Anson Hong-Ping Wan
- Interdisciplinary Division of Biomedical Engineering, The Hong Kong Polytechnic University, Hong Kong, China.
| | - Duo Wai-Chi Wong
- Interdisciplinary Division of Biomedical Engineering, The Hong Kong Polytechnic University, Hong Kong, China.
| | - Yong-Ping Zheng
- Interdisciplinary Division of Biomedical Engineering, The Hong Kong Polytechnic University, Hong Kong, China.
| | - Winson Chiu-Chun Lee
- Interdisciplinary Division of Biomedical Engineering, The Hong Kong Polytechnic University, Hong Kong, China.
- Institute of Active Ageing, The Hong Kong Polytechnic University, Hong Kong, China.
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Lee BC, Thrasher TA, Fisher SP, Layne CS. The effects of different sensory augmentation on weight-shifting balance exercises in Parkinson's disease and healthy elderly people: a proof-of-concept study. J Neuroeng Rehabil 2015; 12:75. [PMID: 26329918 PMCID: PMC4557900 DOI: 10.1186/s12984-015-0064-y] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2015] [Accepted: 08/18/2015] [Indexed: 11/22/2022] Open
Abstract
Background Earlier versions of biofeedback systems for balance-related applications were intended primarily to provide “alarm” signals about body tilt rather than to guide rehabilitation exercise motion. Additionally, there have been few attempts to evaluate guidance modalities for balance rehabilitation exercises. The purpose of this proof-of-concept study is to evaluate the effects of guidance modalities during common dynamic weight-shifting exercises used in clinical settings. Methods A motion guidance system providing visual biofeedback, vibrotactile biofeedback, or both, was used during weight-shifting exercises. Eleven people with idiopathic Parkinson’s disease (PD) and nine healthy elderly people participated. Each participant wore a six-degree-of-freedom inertial measurement unit (IMU) located near the sacrum and four linear vibrating actuators (Tactors) attached to the skin over the front, back, and right and left sides of the abdomen. The IMU measured angular displacements and velocities of body tilt in anterior-posterior (A/P) and medial-lateral (M/L) directions. Participants were instructed to follow a slow moving target by shifting their weight in either the A/P or M/L direction up to 90 % of their limits of stability (LOS). Real-time position error was provided to participants in one of three sensory modalities: visual, vibrotactile, or both. Participants performed 5 trials for each biofeedback modality and movement direction (A/P and M/L) for a total of 30 trials in a random order. To characterize performance, position error was defined as the average absolute difference between the target and participant movements in degrees. Results Simultaneous delivery of visual and vibrotactile biofeedback resulted in significantly lower position error compared to either visual or vibrotactile biofeedback alone regardless of the movement direction for both participant cohorts. The pairwise comparisons were not significantly different between visual and vibrotactile biofeedback. Conclusion The study is the first attempt to assess the effects of guidance modalities on common balance rehabilitation exercises in people with PD and healthy elderly people. The results suggest that combined visual and vibrotactile biofeedback can improve volitional responses during postural tracking tasks. Index Terms – sensory augmentation, weight-shifting balance exercise, guidance modality, vibrotactile biofeedback, visual biofeedback, Parkinson’s disease.
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Affiliation(s)
- Beom-Chan Lee
- Department of Health and Human Performance, University of Houston, Houston, TX, USA. .,Center for Neuromotor and Biomechanics Research, University of Houston, Houston, TX, USA.
| | - Timothy A Thrasher
- Department of Health and Human Performance, University of Houston, Houston, TX, USA. .,Center for Neuromotor and Biomechanics Research, University of Houston, Houston, TX, USA.
| | - Stanley P Fisher
- Center for Neuromotor and Biomechanics Research, University of Houston, Houston, TX, USA. .,Movement Disorders and Neurorehabilitation Center, Houston Methodist Neurological Institute, Houston, TX, USA.
| | - Charles S Layne
- Department of Health and Human Performance, University of Houston, Houston, TX, USA. .,Center for Neuromotor and Biomechanics Research, University of Houston, Houston, TX, USA. .,Center for Neuro-Engineering and Cognitive Science, University of Houston, Houston, TX, USA.
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Shelhamer M. Trends in sensorimotor research and countermeasures for exploration-class space flights. Front Syst Neurosci 2015; 9:115. [PMID: 26321927 PMCID: PMC4531325 DOI: 10.3389/fnsys.2015.00115] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2015] [Accepted: 07/30/2015] [Indexed: 11/13/2022] Open
Abstract
Research in the area of sensorimotor and neurovestibular function has played an important role in enabling human space flight. This role, however, is changing. One of the key aspects of sensorimotor function relevant to this role will build on its widespread connections with other physiological and psychological systems in the body. The firm knowledge base in this area can provide a strong platform to explore these interactions, which can also provide for the development of effective and efficient countermeasures to the deleterious effects of space flight.
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Affiliation(s)
- Mark Shelhamer
- NASA Human Research Program, NASA Johnson Space Center Houston, TX, USA
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Shull PB, Damian DD. Haptic wearables as sensory replacement, sensory augmentation and trainer - a review. J Neuroeng Rehabil 2015; 12:59. [PMID: 26188929 PMCID: PMC4506766 DOI: 10.1186/s12984-015-0055-z] [Citation(s) in RCA: 75] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2015] [Accepted: 07/13/2015] [Indexed: 12/24/2022] Open
Abstract
Sensory impairments decrease quality of life and can slow or hinder rehabilitation. Small, computationally powerful electronics have enabled the recent development of wearable systems aimed to improve function for individuals with sensory impairments. The purpose of this review is to synthesize current haptic wearable research for clinical applications involving sensory impairments. We define haptic wearables as untethered, ungrounded body worn devices that interact with skin directly or through clothing and can be used in natural environments outside a laboratory. Results of this review are categorized by degree of sensory impairment. Total impairment, such as in an amputee, blind, or deaf individual, involves haptics acting as sensory replacement; partial impairment, as is common in rehabilitation, involves haptics as sensory augmentation; and no impairment involves haptics as trainer. This review found that wearable haptic devices improved function for a variety of clinical applications including: rehabilitation, prosthetics, vestibular loss, osteoarthritis, vision loss and hearing loss. Future haptic wearables development should focus on clinical needs, intuitive and multimodal haptic displays, low energy demands, and biomechanical compliance for long-term usage.
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Affiliation(s)
- Peter B Shull
- State Key Laboratory of Mechanical System and Vibration, School of Mechanical Engineering, Shanghai Jiao Tong University, Room 930, Mechanical Engineering Bld, 800 Dong Chuan Road, Shanghai, 200240, China.
| | - Dana D Damian
- Boston Children's Hospital, Harvard University, 330 Longwood Avenue, Boston, Massachusetts, 02115, USA.
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A Portable Gait Asymmetry Rehabilitation System for Individuals with Stroke Using a Vibrotactile Feedback. BIOMED RESEARCH INTERNATIONAL 2015; 2015:375638. [PMID: 26161398 PMCID: PMC4486481 DOI: 10.1155/2015/375638] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/30/2015] [Revised: 04/21/2015] [Accepted: 04/28/2015] [Indexed: 11/29/2022]
Abstract
Gait asymmetry caused by hemiparesis results in reduced gait efficiency and reduced activity levels. In this paper, a portable rehabilitation device is proposed that can serve as a tool in diagnosing gait abnormalities in individuals with stroke and has the capability of providing vibration feedback to help compensate for the asymmetric gait. Force-sensitive resistor (FSR) based insoles are used to detect ground contact and estimate stance time. A controller (Arduino) provides different vibration feedback based on the gait phase measurement. It also allows wireless interaction with a personal computer (PC) workstation using the XBee transceiver module, featuring data logging capabilities for subsequent analysis. Walking trials conducted with healthy young subjects allowed us to observe that the system can influence abnormality in the gait. The results of trials showed that a vibration cue based on temporal information was more effective than intensity information. With clinical experiments conducted for individuals with stroke, significant improvement in gait symmetry was observed with minimal disturbance caused to the balance and gait speed as an effect of the biofeedback. Future studies of the long-term rehabilitation effects of the proposed system and further improvements to the system will result in an inexpensive, easy-to-use, and effective rehabilitation device.
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Afzal MR, Byun HY, Oh MK, Yoon J. Effects of kinesthetic haptic feedback on standing stability of young healthy subjects and stroke patients. J Neuroeng Rehabil 2015; 12:27. [PMID: 25889581 PMCID: PMC4367920 DOI: 10.1186/s12984-015-0020-x] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2014] [Accepted: 02/24/2015] [Indexed: 11/29/2022] Open
Abstract
Background Haptic control is a useful therapeutic option in rehabilitation featuring virtual reality interaction. As with visual and vibrotactile biofeedback, kinesthetic haptic feedback may assist in postural control, and can achieve balance control. Kinesthetic haptic feedback in terms of body sway can be delivered via a commercially available haptic device and can enhance the balance stability of both young healthy subjects and stroke patients. Method Our system features a waist-attached smartphone, software running on a computer (PC), and a dedicated Phantom Omni® device. Young healthy participants performed balance tasks after assumption of each of four distinct postures for 30 s (one foot on the ground; the Tandem Romberg stance; one foot on foam; and the Tandem Romberg stance on foam) with eyes closed. Patient eyes were not closed and assumption of the Romberg stance (only) was tested during a balance task 25 s in duration. An Android application running continuously on the smartphone sent mediolateral (ML) and anteroposterior (AP) tilt angles to a PC, which generated kinesthetic haptic feedback via Phantom Omni®. A total of 16 subjects, 8 of whom were young healthy and 8 of whom had suffered stroke, participated in the study. Results Post-experiment data analysis was performed using MATLAB®. Mean Velocity Displacement (MVD), Planar Deviation (PD), Mediolateral Trajectory (MLT) and Anteroposterior Trajectory (APT) parameters were analyzed to measure reduction in body sway. Our kinesthetic haptic feedback system was effective to reduce postural sway in young healthy subjects regardless of posture and the condition of the substrate (the ground) and to improve MVD and PD in stroke patients who assumed the Romberg stance. Analysis of Variance (ANOVA) revealed that kinesthetic haptic feedback significantly reduced body sway in both categories of subjects. Conclusion Kinesthetic haptic feedback can be implemented using a commercial haptic device and a smartphone. Intuitive balance cues were created using the handle of a haptic device, rendering the approach very simple yet efficient in practice. This novel form of biofeedback will be a useful rehabilitation tool improving the balance of stroke patients.
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Affiliation(s)
- Muhammad Raheel Afzal
- School of Mechanical & Aerospace Engineering & ReCAPT, Gyeongsang National University, Jinju, Republic of Korea.
| | - Ha-Young Byun
- Department of Rehabilitation Medicine, Gyeongsang National University Hospital, Jinju, Republic of Korea.
| | - Min-Kyun Oh
- Department of Rehabilitation Medicine, Gyeongsang National University Hospital, Jinju, Republic of Korea.
| | - Jungwon Yoon
- School of Mechanical & Aerospace Engineering & ReCAPT, Gyeongsang National University, Jinju, Republic of Korea.
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Vibrotactile Stimulation as an Instructor for Mimicry-Based Physical Exercise. ADVANCES IN HUMAN-COMPUTER INTERACTION 2015. [DOI: 10.1155/2015/953794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
The present aim was to investigate functionality of vibrotactile stimulation in mimicry-based behavioral regulation during physical exercise. Vibrotactile stimuli communicated instructions from an instructor to an exerciser to perform lower extremity movements. A wireless prototype was tested first in controlled laboratory conditions (Study 1) and was followed by a user study (Study 2) that was conducted in a group exercise situation for elderly participants with a new version of the system with improved construction and extended functionality. The results of Study 1 showed that vibrotactile instructions were successful in both supplementing and substituting visual knee lift instructions. Vibrotactile stimuli were accurately recognized, and exercise with the device received affirmative ratings. Interestingly, tactile stimulation appeared to stabilize acceleration magnitude of the knee lifts in comparison to visual instructions. In Study 2 it was found that user experience of the system was mainly positive by both the exercisers and their instructors. For example, exercise with vibrotactile instructions was experienced as more motivating than conventional exercise session. Together the results indicate that tactile instructions could increase possibilities for people having difficulties in following visual and auditory instructions to take part in mimicry-based group training. Both studies also revealed development areas that were primarily related to a slight delay in triggering the vibrotactile stimulation.
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Bark K, Hyman E, Tan F, Cha E, Jax SA, Buxbaum LJ, Kuchenbecker KJ. Effects of vibrotactile feedback on human learning of arm motions. IEEE Trans Neural Syst Rehabil Eng 2014; 23:51-63. [PMID: 25486644 DOI: 10.1109/tnsre.2014.2327229] [Citation(s) in RCA: 77] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Tactile cues generated from lightweight, wearable actuators can help users learn new motions by providing immediate feedback on when and how to correct their movements. We present a vibrotactile motion guidance system that measures arm motions and provides vibration feedback when the user deviates from a desired trajectory. A study was conducted to test the effects of vibrotactile guidance on a subject's ability to learn arm motions. Twenty-six subjects learned motions of varying difficulty with both visual (V), and visual and vibrotactile (VVT) feedback over the course of four days of training. After four days of rest, subjects returned to perform the motions from memory with no feedback. We found that augmenting visual feedback with vibrotactile feedback helped subjects reduce the root mean square (rms) angle error of their limb significantly while they were learning the motions, particularly for 1DOF motions. Analysis of the retention data showed no significant difference in rms angle errors between feedback conditions.
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