1
|
Vitório R, El-Gohary M, Pearson S, Carlson-Kuhta P, Harker G, Horak FB, Lapidus J, Studer M, Mancini M. Effectiveness of the Mobility Rehab System for Mobility Training in Older Adults: A Pragmatic Clinical Trial. Front Neurol 2021; 12:680637. [PMID: 34552549 PMCID: PMC8451718 DOI: 10.3389/fneur.2021.680637] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Accepted: 07/27/2021] [Indexed: 01/13/2023] Open
Abstract
Introduction: Mobility impairments are among the main causes of falls in older adults and patients with neurological diseases, leading to functional dependence and substantial health care costs. Feedback-based interventions applied in controlled, laboratory environments have shown promising results for mobility rehabilitation, enhancing the benefits of standard therapy. However, the effectiveness of sensor-based feedback to improve gait in actual outpatient physical therapy settings is unknown. The proposed trial examines the effectiveness of a physical therapist-assisted, visual feedback system using wearable inertial sensors, Mobility Rehab, for mobility training in older adults with gait disturbances in an outpatient clinic. Methods: The study is a single site, pragmatic clinical trial in older adults with gait disturbances. Two hundred patients undergoing their outpatient rehabilitation program are assigned, by an independent assistant, for screening by one of four therapists, and assigned to either a standard physical therapy or therapist-assisted feedback therapy. Both groups train twice a week for 6 weeks. Four physical therapists were randomized and stratified by years of experience to deliver standard therapy or therapist-assisted feedback rehabilitation. Each session is 45 min long. Gait is trained for 30 min. The additional 15 min include exercises for endurance, strength, and static and dynamic balance in functional tasks. Mobility Rehab uses unobtrusive, inertial sensors on the feet and belt with real-time algorithms to provide real-time feedback on gait metrics (i.e., gait speed, double support time, foot clearance, angle at foot strike, and arm swing), which are displayed on a hand-held monitor. Blinded assessments are carried out before and after the intervention. The primary outcome measure is subjects' perception of balance as measured by the Activities-specific Balance Confidence scale. Gait speed, as measured with wearable inertial sensors during walking, is the secondary outcome measure. Discussion: We hypothesize that therapist-assisted feedback rehabilitation will be more effective than standard rehabilitation for gait. Feedback of motor performance plays a crucial role in rehabilitation and objective characterization of gait impairments by Mobility Rehab has the potential to improve the accuracy of patient-specific gait feedback. Clinical Trial Registration:www.ClinicalTrials.gov, identifier: NCT03869879.
Collapse
Affiliation(s)
- Rodrigo Vitório
- Department of Neurology, Oregon Health and Science University, Portland, OR, United States
| | - Mahmoud El-Gohary
- APDM Wearable Technologies – an ERT Company, Portland, OR, United States
| | - Sean Pearson
- APDM Wearable Technologies – an ERT Company, Portland, OR, United States
| | - Patricia Carlson-Kuhta
- Department of Neurology, Oregon Health and Science University, Portland, OR, United States
| | - Graham Harker
- Department of Neurology, Oregon Health and Science University, Portland, OR, United States
| | - Fay B. Horak
- Department of Neurology, Oregon Health and Science University, Portland, OR, United States,APDM Wearable Technologies – an ERT Company, Portland, OR, United States
| | - Jodi Lapidus
- Biostatistics and Design Program Core, Oregon Health and Science University, Portland, OR, United States
| | - Mike Studer
- Northwest Rehabilitation Associates, Salem, OR, United States
| | - Martina Mancini
- Department of Neurology, Oregon Health and Science University, Portland, OR, United States,*Correspondence: Martina Mancini
| |
Collapse
|
2
|
De Angelis S, Princi AA, Dal Farra F, Morone G, Caltagirone C, Tramontano M. Vibrotactile-Based Rehabilitation on Balance and Gait in Patients with Neurological Diseases: A Systematic Review and Metanalysis. Brain Sci 2021; 11:brainsci11040518. [PMID: 33921655 PMCID: PMC8072538 DOI: 10.3390/brainsci11040518] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Revised: 04/10/2021] [Accepted: 04/14/2021] [Indexed: 01/06/2023] Open
Abstract
Postural instability and fear of falling represent two major causes of decreased mobility and quality of life in cerebrovascular and neurologic diseases. In recent years, rehabilitation strategies were carried out considering a combined sensorimotor intervention and an active involvement of the patients during the rehabilitation sessions. Accordingly, new technological devices and paradigms have been developed to increase the effectiveness of rehabilitation by integrating multisensory information and augmented feedback promoting the involvement of the cognitive paradigm in neurorehabilitation. In this context, the vibrotactile feedback (VF) could represent a peripheral therapeutic input, in order to provide spatial proprioceptive information to guide the patient during task-oriented exercises. The present systematic review and metanalysis aimed to explore the effectiveness of the VF on balance and gait rehabilitation in patients with neurological and cerebrovascular diseases. A total of 18 studies met the inclusion criteria and were included. Due to the lack of high-quality studies and heterogeneity of treatments protocols, clinical practice recommendations on the efficacy of VF cannot be made. Results show that VF-based intervention could be a safe complementary sensory-motor approach for balance and gait rehabilitation in patients with neurological and cerebrovascular diseases. More high-quality randomized controlled trials are needed.
Collapse
Affiliation(s)
- Sara De Angelis
- Fondazione Santa Lucia IRCCS, 00179 Rome, Italy; (S.D.A.); (A.A.P.); (G.M.); (C.C.)
| | | | | | - Giovanni Morone
- Fondazione Santa Lucia IRCCS, 00179 Rome, Italy; (S.D.A.); (A.A.P.); (G.M.); (C.C.)
| | - Carlo Caltagirone
- Fondazione Santa Lucia IRCCS, 00179 Rome, Italy; (S.D.A.); (A.A.P.); (G.M.); (C.C.)
| | - Marco Tramontano
- Fondazione Santa Lucia IRCCS, 00179 Rome, Italy; (S.D.A.); (A.A.P.); (G.M.); (C.C.)
- Department of Movement, Human and Health Sciences, University of Rome “Foro Italico”, 00185 Rome, Italy
- Correspondence: ; Tel.: +39-06-5150-1420
| |
Collapse
|
3
|
Allum JHJ, Rust HM, Lutz N, Schouenborg C, Fischer-Barnicol B, Haller V, Derfuss T, Kuhle J, Yaldizli Ö. Characteristics of improvements in balance control using vibro-tactile biofeedback of trunk sway for multiple sclerosis patients. J Neurol Sci 2021; 425:117432. [PMID: 33839367 DOI: 10.1016/j.jns.2021.117432] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Revised: 03/27/2021] [Accepted: 03/29/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND AND AIMS Previously, we determined that training with vibrotactile feedback (VTfb) of trunk sway improves MS patients' balance impairment. Here, we posed 5 questions: 1) How many weeks of VTfb training are required to obtain the best short-term carry over effect (CoE) with VTfb? 2) How long does the CoE last once VTfb training terminates? 3) Is the benefit similar for stance and gait? 4) Is position or velocity based VTfb more effective in reducing trunk sway? 5) Do patients' subjective assessments of balance control improve? METHODS Balance control of 16 MS patients was measured with gyroscopes at the lower trunk. The gyroscopes drove directionally active VTfb in a head-band. Patients trained twice per week with VTfb for 4 weeks to determine when balance control with and without VTfb stopped improving. Thereafter, weekly assessments without VTfb over 4 weeks and at 6 months determined when CoEs ended. RESULTS A 20% improvement in balance to normal levels occurred with VTfb. Short term CoEs improved from 15 to 20% (p ≤ 0.001). Medium term (1-4 weeks) CoEs were constant at 19% (p ≤ 0.001). At 6 months improvement was not significant, 9%. Most improvement was for lateral sway. Equal improvement occurred when angle position or velocity drove VTfb. Subjectively, balance improvements peaked after 3 weeks of training (32%, p ≤ 0.05). CONCLUSIONS 3-4 weeks VTfb training yields clinically relevant sway reductions and subjective improvements for MS patients during stance and gait. The CoEs lasted at least 1 month. Velocity-based VTfb was equally effective as position-based VTfb.
Collapse
Affiliation(s)
- J H J Allum
- Dept of Neurology, University of Basel Hospital, Basel, Switzerland; Dept of ORL, University of Basel Hospital, Basel, Switzerland.
| | - H M Rust
- Dept of Neurology, University of Basel Hospital, Basel, Switzerland; Dept of ORL, University of Basel Hospital, Basel, Switzerland
| | - N Lutz
- Bern University of Applied Sciences, Department of Health Professions, Switzerland
| | - C Schouenborg
- Bern University of Applied Sciences, Department of Health Professions, Switzerland
| | | | - V Haller
- Dept of Neurology, University of Basel Hospital, Basel, Switzerland
| | - T Derfuss
- Dept of Neurology, University of Basel Hospital, Basel, Switzerland
| | - J Kuhle
- Dept of Neurology, University of Basel Hospital, Basel, Switzerland
| | - Ö Yaldizli
- Dept of Neurology, University of Basel Hospital, Basel, Switzerland
| |
Collapse
|
4
|
Morris R, Mancin M. Lab-on-a-chip: wearables as a one stop shop for free-living assessments. Digit Health 2021. [DOI: 10.1016/b978-0-12-818914-6.00017-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
|
5
|
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.
Collapse
|
6
|
Afrasiabifar A, Karami F, Najafi Doulatabad S. Comparing the effect of Cawthorne-Cooksey and Frenkel exercises on balance in patients with multiple sclerosis: a randomized controlled trial. Clin Rehabil 2017. [PMID: 28629268 DOI: 10.1177/0269215517714592] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To evaluate the effect of Cawthorne-Cooksey and Frenkel exercises on balance in patients with multiple sclerosis. DESIGN It was a three-arm parallel randomized controlled trial study. SETTING Outpatient clinic. SUBJECTS Patients with multiple sclerosis. INTERVENTIONS Subjects in the intervention groups completed a 12-week program consisted of Cawthorne-Cooksey or Frenkel exercises. The control group only received routine care. MAIN MEASURES The outcome measure was the Berg Balance Scale. RESULTS Seventy-two patients completed the study. At the end of the intervention, there was a statistically significant improvement in Berg Balance Scale in the Cawthorne-Cooksey group ( n = 24) in comparison with the other two groups ( P = 0.001). In the Frenkel group ( n = 23), the improvement was statistically greater than the changes in the control group ( n = 25), but it did not appear to be clinically significant. The Berg Balance Scale score increased to 8.9 in the Cawthorne-Cooksey group and 2.3 in the Frenkel group, while it decreased to 1.2 in the control group. When comparing inter-group changes, Berg Balance Scale showed significant improvements in favor of the Cawthorne-Cooksey group after the intervention ( P < 0.05). CONCLUSION This study demonstrated that in comparison with Frenkel and the control groups, a program of Cawthorne-Cooksey exercise is more effective in improving balance in patients with multiple sclerosis.
Collapse
|