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Hamada N, Tsujinaka R, Oda H, Fukuda S, Matsuoka M, Kunimura H, Hiraoka K. Does Viewing Mirror-Reflected Body Image Affect Static and Dynamic Standing Balance? Percept Mot Skills 2024; 131:1025-1040. [PMID: 38727599 DOI: 10.1177/00315125241253634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/02/2024]
Abstract
In the present study, we examined the immediate effect of allowing healthy participants to view their mirror-reflected body image on static and dynamic balance. We placed a mirror to allow participants to frontally view their own body image while maintaining a quiet stance or while engaged in a dynamic postural standing task. On measures of body sway during quiet stance, there were no effects of this visual feedback, supporting the view that human beings have no central mechanism for viewing the mirror-reflected body image to control body sway during quiet stance. However, the body deviated forward during quiet stance while viewing the mirror-reflected body image, indicating that viewing the mirror-reflected body image contributed to the anterior-posterior positioning of the body, as mediated by an ankle control strategy. For the dynamic standing task, viewing the body image induced unstable peaks of rhythmic lateral shifting of the body weight over the feet. This indicates that viewing the body image caused unstable motor commands for rhythmic lateral weight shifting. When participants made a transition from a bipedal to a unipedal stance in response to a cue, viewing the body image shortened the onset latency of the body sway. Accordingly, viewing the body image seemed to accelerate the motor execution involved in lateral weight shifting, possibly due to predictive activation of the motor system before movement onset. Considered collectively, we found static and dynamic stance balance to be influenced by viewing one's mirror-reflected body image. Viewing the mirror-reflected body image may be a means of changing static and dynamic balance in patients with impaired postural control.
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Affiliation(s)
- Naoki Hamada
- Graduate School of Rehabilitation Science, Osaka Metropolitan University, Habikino, Japan
| | - Ryo Tsujinaka
- Graduate School of Comprehensive Rehabilitation, Osaka Prefecture University, Habikino, Japan
| | - Hitoshi Oda
- Graduate School of Rehabilitation Science, Osaka Metropolitan University, Habikino, Japan
| | - Shiho Fukuda
- Graduate School of Rehabilitation Science, Osaka Metropolitan University, Habikino, Japan
| | - Masakazu Matsuoka
- Graduate School of Rehabilitation Science, Osaka Metropolitan University, Habikino, Japan
| | - Hiroshi Kunimura
- Graduate School of Rehabilitation Science, Osaka Metropolitan University, Habikino, Japan
| | - Koichi Hiraoka
- School of Medicine,Osaka Metropolitan University, Habikino, Japan
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Kwon IH, Shin WS, Choi KS, Lee MS. Effects of Real-Time Feedback Methods on Static Balance Training in Stroke Patients: A Randomized Controlled Trial. Healthcare (Basel) 2024; 12:767. [PMID: 38610189 PMCID: PMC11011765 DOI: 10.3390/healthcare12070767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2024] [Revised: 03/25/2024] [Accepted: 03/29/2024] [Indexed: 04/14/2024] Open
Abstract
BACKGROUND The purpose of this study was to investigate the effects of real-time feedback methods on static balance training in stroke patients. There are two types of real-time feedback methods, as follows: one is Knowledge of Result (KR), and the other is Knowledge of Performance (KP). METHOD Thirty stroke patients participated in this study and were randomly assigned to the KR group (n = 15) or the KP group (n = 15). All of the groups underwent real-time feedback training for four weeks (30 min per session, five sessions per week). The primary outcomes were sway length, sway velocity, and area 95%, which were assessed before and after the intervention. The secondary outcomes included the Berg Balance Scale, the Fugl Meyer Assessment for Lower Extremity, the Postural Assessment Scale for Stroke Trunk Impairment Scale, and the Fall Efficacy Scale. A group × time interaction was assessed using two-way ANOVA with repeated measures. RESULT There was a significant increase over time in all outcomes (p < 0.05). Significant differences were observed for a group × time interaction in sway length and area 95% (p < 0.05). CONCLUSIONS Real-time feedback training for static balance enhanced stroke patients' static balance abilities, clinical outcome assessments, and promoted self-efficacy against falls.
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Affiliation(s)
- Il-Ho Kwon
- Department of Physical Therapy, Graduate School of Daejeon University, 62, Daehak-ro, Dong-gu, Daejeon 34520, Republic of Korea;
| | - Won-Seob Shin
- Department of Physical Therapy, College of Health Medical Science, Daejeon University, 62, Daehak-ro, Dong-gu, Daejeon 34520, Republic of Korea
| | - Kyu-Seong Choi
- Department of Physical Therapy, Graduate School of Health and Medicine, Daejeon University, 62, Daehak-ro, Dong-gu, Daejeon 34520, Republic of Korea;
| | - Myung-Sun Lee
- Department of Beauty Design, College of Design and Art, Daejeon University, 62, Daehak-ro, Dong-gu, Daejeon 34520, Republic of Korea;
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Diaz MA, Vos M, Dillen A, Tassignon B, Flynn L, Geeroms J, Meeusen R, Verstraten T, Babic J, Beckerle P, De Pauw K. Human-in-the-Loop Optimization of Wearable Robotic Devices to Improve Human-Robot Interaction: A Systematic Review. IEEE TRANSACTIONS ON CYBERNETICS 2023; 53:7483-7496. [PMID: 37015459 DOI: 10.1109/tcyb.2022.3224895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/19/2023]
Abstract
This article presents a systematic review on wearable robotic devices that use human-in-the-loop optimization (HILO) strategies to improve human-robot interaction. A total of 46 HILO studies were identified and divided into upper and lower limb robotic devices. The main aspects from HILO were identified, reviewed, and classified in four areas: 1) human-machine systems; 2) optimization methods; 3) control strategies; and 4) experimental protocols. A variety of objective functions (physiological, biomechanical, and subjective), optimization strategies, and optimized control parameters configurations used in different control strategies are presented and analyzed. An overview of experimental protocols is provided, including metrics, tasks, and conditions tested. Moreover, the relevance given to training or adaptation periods was explored. We outline an HILO framework that includes current wearable robots, optimization strategies, objective functions, control strategies, and experimental protocols. We conclude by highlighting current research gaps and defining future directions to improve the development of advanced HILO strategies in upper and lower limb wearable robots.
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Valette R, Gonzalez-Vargas J, Dosen S. The impact of walking on the perception of multichannel electrotactile stimulation in individuals with lower-limb amputation and able-bodied participants. J Neuroeng Rehabil 2023; 20:108. [PMID: 37592336 PMCID: PMC10436512 DOI: 10.1186/s12984-023-01234-4] [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: 03/20/2023] [Accepted: 08/09/2023] [Indexed: 08/19/2023] Open
Abstract
BACKGROUND One of the drawbacks of lower-limb prostheses is that they do not provide explicit somatosensory feedback to their users. Electrotactile stimulation is an attractive technology to restore such feedback because it enables compact solutions with multiple stimulation points. This allows stimulating a larger skin area to provide more information concurrently and modulate parameters spatially as well as in amplitude. However, for effective use, electrotactile stimulation needs to be calibrated and it would be convenient to perform this procedure while the subject is seated. However, amplitude and spatial perception can be affected by motion and/or physical coupling between the residual limb and the socket. In the present study, we therefore evaluated and compared the psychometric properties of multichannel electrotactile stimulation applied to the thigh/residual limb during sitting versus walking. METHODS The comprehensive assessment included the measurement of the sensation and discomfort thresholds (ST & DT), just noticeable difference (JND), number of distinct intervals (NDI), two-point discrimination threshold (2PD), and spatial discrimination performance (SD). The experiment involved 11 able-bodied participants (4 females and 7 males; 29.2 ± 3.8 years), 3 participants with transtibial amputation, and 3 participants with transfemoral amputation. RESULTS In able-bodied participants, the results were consistent for all the measured parameters, and they indicated that both amplitude and spatial perception became worse during walking. More specifically, ST and DT increased significantly during walking vs. sitting (2.90 ± 0.82 mA vs. 2.00 ± 0.52 mA; p < 0.001 for ST and 7.74 ± 0.84 mA vs. 7.21 ± 1.30 mA; p < 0.05 for DT) and likewise for the JND (22.47 ± 12.21% vs. 11.82 ± 5.07%; p < 0.01), while the NDI became lower (6.46 ± 3.47 vs. 11.27 ± 5.18 intervals; p < 0.01). Regarding spatial perception, 2PD was higher during walking (69.78 ± 17.66 mm vs. 57.85 ± 14.87 mm; p < 0.001), while the performance of SD was significantly lower (56.70 ± 10.02% vs. 64.55 ± 9.44%; p < 0.01). For participants with lower-limb amputation, the ST, DT, and performance in the SD assessment followed the trends observed in the able-bodied population. The results for 2PD and JND were however different and subject-specific. CONCLUSION The conducted evaluation demonstrates that electrotactile feedback should be calibrated in the conditions in which it will be used (e.g., during walking). The calibration during sitting, while more convenient, might lead to an overly optimistic (or in some cases pessimistic) estimate of sensitivity. In addition, the results underline that calibration is particularly important in people affected by lower-limb loss to capture the substantial variability in the conditions of the residual limb and prosthesis setup. These insights are important for the implementation of artificial sensory feedback in lower-limb prosthetics applications.
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Affiliation(s)
- Romain Valette
- Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
| | | | - Strahinja Dosen
- Department of Health Science and Technology, Aalborg University, Aalborg, Denmark.
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Krauskopf T, Lauck T, Meyer B, Klein L, Mueller M, Kubosch J, Herget G, von Tscharner V, Ernst J, Stieglitz T, Pasluosta C. Neuromuscular adaptations after osseointegration of a bone-anchored prosthesis in a unilateral transfemoral amputee - a case study. Ann Med 2023; 55:2255206. [PMID: 37677026 PMCID: PMC10486294 DOI: 10.1080/07853890.2023.2255206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Revised: 08/29/2023] [Accepted: 08/30/2023] [Indexed: 09/09/2023] Open
Abstract
PURPOSE Many individuals with a lower limb amputation experience problems with the fitting of the socket of their prosthesis, leading to dissatisfaction or device rejection. Osseointegration (OI)- the implantation of a shaft directly interfacing with the remaining bone- is an alternative for these patients. In this observational study, we investigated how bone anchoring influences neuromuscular parameters during balance control in a patient with a unilateral transfemoral amputation. MATERIAL AND METHODS Center of pressure (CoP) and electromyography (EMG) signals from muscles controlling the hip and the ankle of the intact leg were recorded during quiet standing six months before and one and a half years after this patient underwent an OI surgery. Results were compared to a control group of nine able-bodied individuals. RESULTS Muscle co-activation and EMG intensity decreased after bone anchoring, approaching the levels of able-bodied individuals. Muscle co-activation controlling the ankle decreased in the high-frequency range, and the EMG intensity spectrum decreased in the lower-frequency range for all muscles when vision was allowed. With eyes closed, the ankle extensor muscle showed an increased EMG intensity in the high-frequency range post-surgery. CoP length increased in the mediolateral direction of the amputated leg. CONCLUSIONS These findings point to shifts in the patient's neuromuscular profile towards the one of able-bodied individuals.
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Affiliation(s)
- Thomas Krauskopf
- Laboratory for Biomedical Microtechnology, Department of Microsystems Engineering, University of Freiburg, Freiburg, Germany
- BrainLinks-BrainTools Center, University of Freiburg, Freiburg, Freiburg, Germany
| | - Torben Lauck
- Laboratory for Biomedical Microtechnology, Department of Microsystems Engineering, University of Freiburg, Freiburg, Germany
| | - Britta Meyer
- Laboratory for Biomedical Microtechnology, Department of Microsystems Engineering, University of Freiburg, Freiburg, Germany
| | - Lukas Klein
- Department of Orthopaedics and Trauma Surgery, Medical Center, University of Freiburg, Freiburg, Germany
| | | | - Johanna Kubosch
- Department of Orthopaedics and Trauma Surgery, Medical Center, University of Freiburg, Freiburg, Germany
| | - Georg Herget
- Department of Orthopaedics and Trauma Surgery, Medical Center, University of Freiburg, Freiburg, Germany
| | | | - Jennifer Ernst
- Department of Trauma Surgery, Hannover Medical School, Hannover, Germany
- Department of Trauma Surgery, Orthopedics and Plastic Surgery, University Medical Center Goettingen, Göttingen, Germany
| | - Thomas Stieglitz
- Laboratory for Biomedical Microtechnology, Department of Microsystems Engineering, University of Freiburg, Freiburg, Germany
- BrainLinks-BrainTools Center, University of Freiburg, Freiburg, Freiburg, Germany
- Bernstein Center Freiburg, University of Freiburg, Freiburg, Germany
| | - Cristian Pasluosta
- Laboratory for Biomedical Microtechnology, Department of Microsystems Engineering, University of Freiburg, Freiburg, Germany
- BrainLinks-BrainTools Center, University of Freiburg, Freiburg, Freiburg, Germany
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Krauskopf T, Lauck TB, Klein L, Beusterien ML, Mueller M, Von Tscharner V, Mehring C, Herget GW, Stieglitz T, Pasluosta C. Unilateral transfemoral amputees exhibit altered strength and dynamics of muscular co-activation modulated by visual feedback. J Neural Eng 2022; 19. [PMID: 35100571 DOI: 10.1088/1741-2552/ac5091] [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: 09/19/2021] [Accepted: 01/31/2022] [Indexed: 11/11/2022]
Abstract
OBJECTIVE Somatosensory perception is disrupted in patients with a lower limb amputation. This increases the difficulty to maintain balance and leads to the development of neuromuscular adjustments. We investigated how these adjustments are reflected in the co-activation of lower body muscles and are modulated by visual feedback. APPROACH We measured electromyography (EMG) signals of muscles from the trunk (erector spinae and obliquus external), and the lower intact/dominant leg (tibialis anterior and medial gastrocnemius) in eleven unilateral transfemoral amputees and eleven age-matched able-bodied controls during 30 seconds of upright standing with and without visual feedback. Muscle synergies involved in balance control were investigated using wavelet coherence analysis. We focused on 7 frequencies grouped in three frequency bands, a low-frequency band (7.56 and 19.86 Hz) representing more sub-cortical and spinal inputs to the muscles, a mid-frequency band (38.26 and 62.63 Hz) representing more cortical inputs, and a high-frequency band (92.90, 129 and 170.90 Hz) associated with synchronizing motor unit action potentials. Further, the dynamics of changes in intermuscular coupling over time were quantified using the Entropic Half-Life. MAIN RESULTS Amputees exhibited lower coherency values when vision was removed at 7.56 Hz for the muscle pair of the lower leg. At this frequency, the coherency values of the amputee group also differed from controls for the eyes closed condition. Controls and amputees exhibited opposite coherent behaviors with visual feedback at 7.56 Hz. For the eyes open condition at 129 Hz, the coherency values of amputees and controls differed for the muscle pair of the trunk, and at 170.90 Hz for the muscle pair of the lower leg. Amputees exhibited different dynamics of muscle co-activation at the low frequency band when vision was available. SIGNIFICANCE Altogether, these findings point to the development of neuromuscular adaptations reflected in the strength and dynamics of muscular co-activation.
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Affiliation(s)
- Thomas Krauskopf
- Laboratory for Biomedical Micro-technology, Department of Microsystem Engineering (IMTEK), University of Freiburg, Georges-Koehler-Allee 201, Freiburg im Breisgau, Baden-Württemberg, 79110, GERMANY
| | - Torben B Lauck
- Laboratory for Biomedical Microtechnology, Department of Microsystem Engineering (IMTEK) , University of Freiburg, Georges-Koehler-Allee 201, Freiburg im Breisgau, Baden-Württemberg, 79110, GERMANY
| | - Lukas Klein
- Department of Orthopaedics and Trauma Surgery, Medical Center-University of Freiburg, Hugstetter Straße 55, Freiburg, Baden-Württemberg, 79106, GERMANY
| | - Marvin L Beusterien
- Laboratory for Biomedical Micro-technology, Department of Microsystem Engineering (IMTEK), University of Freiburg, Georges-Koehler-Allee 201, Freiburg im Breisgau, Baden-Württemberg, 79110, GERMANY
| | - Marc Mueller
- Sanitaetshaus Pfaender, Munzinger Straße 5c, Freiburg, 79111, GERMANY
| | | | - Carsten Mehring
- Institute of Biology III & Bernstein Centre , University of Freiburg, Hansastr. 9a, Freiburg im Breisgau, Baden-Württemberg, 79098, GERMANY
| | - Georg W Herget
- Department of Orthopaedics and Trauma Surgery, Medical Center-University of Freiburg, Hugstetter Straße 55, Freiburg, Baden-Württemberg, 79106, GERMANY
| | - Thomas Stieglitz
- Laboratory for Biomedical Micro-technology, Department of Microsystem Engineering (IMTEK), University of Freiburg, Georges-Köhler-Allee 201, Freiburg im Breisgau, Baden-Württemberg, 79110, GERMANY
| | - Cristian Pasluosta
- Laboratory for Biomedical Micro-technology, Department of Microsystem Engineering (IMTEK), University of Freiburg, Georges-Koehler-Allee 201, Freiburg im Breisgau, Baden-Württemberg, 79110, GERMANY
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