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Rejc E, Bowersock C, Pisolkar T, Omofuma I, Luna T, Khan M, Santamaria V, Ugiliweneza B, Angeli CA, Forrest GF, Stein J, Agrawal S, Harkema SJ. Robotic Postural Training With Epidural Stimulation for the Recovery of Upright Postural Control in Individuals With Motor Complete Spinal Cord Injury: A Pilot Study. Neurotrauma Rep 2024; 5:277-292. [PMID: 38515546 PMCID: PMC10956531 DOI: 10.1089/neur.2024.0013] [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] [Indexed: 03/23/2024] Open
Abstract
Activity-based training and lumbosacral spinal cord epidural stimulation (scES) have the potential to restore standing and walking with self-balance assistance after motor complete spinal cord injury (SCI). However, improvements in upright postural control have not previously been addressed in this population. Here, we implemented a novel robotic postural training with scES, performed with free hands, to restore upright postural control in individuals with chronic, cervical (n = 5) or high-thoracic (n = 1) motor complete SCI, who had previously undergone stand training with scES using a walker or a standing frame for self-balance assistance. Robotic postural training re-enabled and/or largely improved the participants' ability to control steady standing, self-initiated trunk movements and upper limb reaching movements while standing with free hands, receiving only external assistance for pelvic control. These improvements were associated with neuromuscular activation pattern adaptations above and below the lesion. These findings suggest that the human spinal cord below the level of injury can generate meaningful postural responses when its excitability is modulated by scES, and can learn to improve these responses. Upright postural control improvements can enhance functional motor recovery promoted by scES after severe SCI.
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Affiliation(s)
- Enrico Rejc
- Tim and Caroline Reynolds Center for Spinal Stimulation, Kessler Foundation, West Orange, New Jersey, USA
- Department of Medicine, University of Udine, Udine, Italy
- Kentucky Spinal Cord Injury Research Center, University of Louisville, Louisville, Kentucky, USA
| | - Collin Bowersock
- Kentucky Spinal Cord Injury Research Center, University of Louisville, Louisville, Kentucky, USA
- Department of Mechanical Engineering, Northern Arizona University, Flagstaff, Arizona, USA
| | - Tanvi Pisolkar
- Kentucky Spinal Cord Injury Research Center, University of Louisville, Louisville, Kentucky, USA
| | - Isirame Omofuma
- Department of Mechanical Engineering, Columbia University, New York, New York, USA
| | - Tatiana Luna
- Department of Mechanical Engineering, Columbia University, New York, New York, USA
| | - Moiz Khan
- Department of Radiology at BWH, Harvard Medical School, Boston, Massachusetts, USA
| | - Victor Santamaria
- Department of Physical Therapy, New York Medical College, Valhalla, New York, USA
| | - Beatrice Ugiliweneza
- Kentucky Spinal Cord Injury Research Center, University of Louisville, Louisville, Kentucky, USA
- Department of Neurological Surgery, University of Louisville, Louisville, Kentucky, USA
| | - Claudia A Angeli
- Tim and Caroline Reynolds Center for Spinal Stimulation, Kessler Foundation, West Orange, New Jersey, USA
| | - Gail F Forrest
- Tim and Caroline Reynolds Center for Spinal Stimulation, Kessler Foundation, West Orange, New Jersey, USA
- Department of Physical Medicine and Rehabilitation, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - Joel Stein
- Department of Rehabilitation and Regenerative Medicine, Columbia University, New York, New York, USA
| | - Sunil Agrawal
- Department of Mechanical Engineering, Columbia University, New York, New York, USA
- Department of Rehabilitation and Regenerative Medicine, Columbia University, New York, New York, USA
| | - Susan J Harkema
- Kentucky Spinal Cord Injury Research Center, University of Louisville, Louisville, Kentucky, USA
- Department of Neurological Surgery, University of Louisville, Louisville, Kentucky, USA
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Lim D, Pei W, Lee JW, Musselman KE, Masani K. Feasibility of using a depth camera or pressure mat for visual feedback balance training with functional electrical stimulation. Biomed Eng Online 2024; 23:19. [PMID: 38347584 PMCID: PMC10863251 DOI: 10.1186/s12938-023-01191-y] [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] [Received: 09/26/2023] [Accepted: 12/07/2023] [Indexed: 02/15/2024] Open
Abstract
Individuals with incomplete spinal-cord injury/disease are at an increased risk of falling due to their impaired ability to maintain balance. Our research group has developed a closed-loop visual-feedback balance training (VFBT) system coupled with functional electrical stimulation (FES) for rehabilitation of standing balance (FES + VFBT system); however, clinical usage of this system is limited by the use of force plates, which are expensive and not easily accessible. This study aimed to investigate the feasibility of a more affordable and accessible sensor such as a depth camera or pressure mat in place of the force plate. Ten able-bodied participants (7 males, 3 females) performed three sets of four different standing balance exercises using the FES + VFBT system with the force plate. A depth camera and pressure mat collected centre of mass and centre of pressure data passively, respectively. The depth camera showed higher Pearson's correlation (r > 98) and lower root mean squared error (RMSE < 10 mm) than the pressure mat (r > 0.82; RMSE < 4.5 mm) when compared with the force plate overall. Stimulation based on the depth camera showed lower RMSE than that based on the pressure mat relative to the FES + VFBT system. The depth camera shows potential as a replacement sensor to the force plate for providing feedback to the FES + VFBT system.
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Affiliation(s)
- Derrick Lim
- Institute of Biomedical Engineering, University of Toronto, Toronto, ON, Canada
- KITE - Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada
| | - William Pei
- Institute of Biomedical Engineering, University of Toronto, Toronto, ON, Canada
- KITE - Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada
| | - Jae W Lee
- Institute of Biomedical Engineering, University of Toronto, Toronto, ON, Canada
- KITE - Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada
| | - Kristin E Musselman
- KITE - Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada
- Department of Physical Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
- Rehabilitation Science Institute, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Kei Masani
- Institute of Biomedical Engineering, University of Toronto, Toronto, ON, Canada.
- KITE - Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada.
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Lee HJ, Jin SM, Kim SJ, Kim JH, Kim H, Bae E, Yoo SK, Kim JH. Development and Validation of an Artificial Intelligence-Based Motion Analysis System for Upper Extremity Rehabilitation Exercises in Patients with Spinal Cord Injury: A Randomized Controlled Trial. Healthcare (Basel) 2023; 12:7. [PMID: 38200913 PMCID: PMC10779423 DOI: 10.3390/healthcare12010007] [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: 10/13/2023] [Revised: 12/07/2023] [Accepted: 12/10/2023] [Indexed: 01/12/2024] Open
Abstract
In this study, we developed an AI-based real-time motion feedback system for patients with spinal cord injury (SCI) during rehabilitation, aiming to enhance their interest and motivation. The effectiveness of the system in improving upper-limb muscle strength during the Thera band exercises was evaluated. The motion analysis program, including exercise repetition counts and calorie consumption, was developed using MediaPipe, focusing on three key motions (chest press, shoulder press, and arm curl) for upper extremity exercises. The participants with SCI were randomly assigned to the experimental group (EG = 4) or control group (CG = 5), engaging in 1 h sessions three times a week for 8 weeks. Muscle strength tests (chest press, shoulder press, lat pull-down, and arm curl) were performed before and after exercises. Although both groups did not show significant differences, the EG group exhibited increased strength in all measured variables, whereas the CG group showed constant or reduced results. Consequently, the computer program-based system developed in this study could be effective in muscle strengthening. Furthermore, these findings may serve as a valuable foundation for future AI-driven rehabilitation exercise systems.
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Affiliation(s)
- Hyun Jong Lee
- Department of Clinical Rehabilitation Research, Rehabilitation Research Institute, National Rehabilitation Center, Seoul 01022, Republic of Korea; (H.J.L.); (H.K.)
| | - Seung Mo Jin
- Department of Rehabilitation Exercise, National Rehabilitation Center, Seoul 01022, Republic of Korea
| | - Seck Jin Kim
- Ministry of Health and Welfare, Sejong 30113, Republic of Korea
| | - Jea Hak Kim
- Department of Rehabilitation Exercise, National Rehabilitation Center, Seoul 01022, Republic of Korea
| | - Hogene Kim
- Department of Clinical Rehabilitation Research, Rehabilitation Research Institute, National Rehabilitation Center, Seoul 01022, Republic of Korea; (H.J.L.); (H.K.)
| | | | - Sun Kook Yoo
- Department of Medical Engineering, Yonsei University College of Medicine, Seoul 03722, Republic of Korea
| | - Jung Hwan Kim
- Department of Rehabilitation Exercise, National Rehabilitation Center, Seoul 01022, Republic of Korea
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Noamani A, Riahi N, Vette AH, Rouhani H. Clinical Static Balance Assessment: A Narrative Review of Traditional and IMU-Based Posturography in Older Adults and Individuals with Incomplete Spinal Cord Injury. SENSORS (BASEL, SWITZERLAND) 2023; 23:8881. [PMID: 37960580 PMCID: PMC10650039 DOI: 10.3390/s23218881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Revised: 10/26/2023] [Accepted: 10/30/2023] [Indexed: 11/15/2023]
Abstract
Maintaining a stable upright posture is essential for performing activities of daily living, and impaired standing balance may impact an individual's quality of life. Therefore, accurate and sensitive methods for assessing static balance are crucial for identifying balance impairments, understanding the underlying mechanisms of the balance deficiencies, and developing targeted interventions to improve standing balance and prevent falls. This review paper first explores the methods to quantify standing balance. Then, it reviews traditional posturography and recent advancements in using wearable inertial measurement units (IMUs) to assess static balance in two populations: older adults and those with incomplete spinal cord injury (iSCI). The inclusion of these two groups is supported by their large representation among individuals with balance impairments. Also, each group exhibits distinct aspects in balance assessment due to diverse underlying causes associated with aging and neurological impairment. Given the high vulnerability of both demographics to balance impairments and falls, the significance of targeted interventions to improve standing balance and mitigate fall risk becomes apparent. Overall, this review highlights the importance of static balance assessment and the potential of emerging methods and technologies to improve our understanding of postural control in different populations.
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Affiliation(s)
- Alireza Noamani
- Department of Mechanical Engineering, University of Alberta, Edmonton, AB T6G 1H9, Canada; (A.N.); (N.R.); (A.H.V.)
| | - Negar Riahi
- Department of Mechanical Engineering, University of Alberta, Edmonton, AB T6G 1H9, Canada; (A.N.); (N.R.); (A.H.V.)
| | - Albert H. Vette
- Department of Mechanical Engineering, University of Alberta, Edmonton, AB T6G 1H9, Canada; (A.N.); (N.R.); (A.H.V.)
- Department of Biomedical Engineering, University of Alberta, Edmonton, AB T6G 1H9, Canada
- Glenrose Rehabilitation Hospital, Alberta Health Services, Edmonton, AB T5G 0B7, Canada
| | - Hossein Rouhani
- Department of Mechanical Engineering, University of Alberta, Edmonton, AB T6G 1H9, Canada; (A.N.); (N.R.); (A.H.V.)
- Department of Biomedical Engineering, University of Alberta, Edmonton, AB T6G 1H9, Canada
- Glenrose Rehabilitation Hospital, Alberta Health Services, Edmonton, AB T5G 0B7, Canada
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Bowersock CD, Pisolkar T, Omofuma I, Luna T, Khan M, Santamaria V, Stein J, Agrawal S, Harkema SJ, Rejc E. Robotic upright stand trainer (RobUST) and postural control in individuals with spinal cord injury. J Spinal Cord Med 2023; 46:889-899. [PMID: 35532324 PMCID: PMC10653750 DOI: 10.1080/10790268.2022.2069532] [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] [Indexed: 10/18/2022] Open
Abstract
CONTEXT/OBJECTIVE Assessed feasibility and potential effectiveness of using a novel robotic upright stand trainer (RobUST) to deliver postural perturbations or provide assistance-as-needed at the trunk while individuals with spinal cord injury (SCI) performed stable standing and self-initiated trunk movements. These tasks were assessed with research participants' hands on handlebars for self-balance assistance (hands on) and with hands off (free hands). DESIGN Proof of concept study. PARTICIPANTS Four individuals with motor complete (n = 3) or incomplete (n = 1) SCI who were not able to achieve independent standing and presented a neurological lesion level ranging from cervical 4 to thoracic 2. OUTCOME MEASURES Ground reaction forces, trunk displacement, and electromyography activity of trunk and lower limb muscles. RESULTS Research participants received continuous pelvic assistance via RobUST, and manual trainer assistance at the knees to maintain standing. Participants were able to attempt all tasks. Free hands trunk perturbations resulted in greater load bearing-related sensory information (73% ipsilateral vertical loading), trunk displacement (57%), and muscle activation compared to hands on. Similarly, free hands stable standing with RobUST assistance-as-needed resulted in 8.5% larger bodyweight bearing, 112% larger trunk movement velocity, and higher trunk muscles activation compared to standing with hands on. Self-initiated trunk movements controlled by hands on showed 116% greater trunk displacement, 10% greater vertical ground reaction force, and greater ankle muscle activation compared to free hands. CONCLUSION RobUST established a safe and challenging standing environment for individuals with SCI and has the potential to improve training paradigms and assessments of standing postural control.
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Affiliation(s)
- Collin D. Bowersock
- Kentucky Spinal Cord Injury Research Center, University of Louisville, Louisville, Kentucky, USA
| | - Tanvi Pisolkar
- Kentucky Spinal Cord Injury Research Center, University of Louisville, Louisville, Kentucky, USA
| | - Isirame Omofuma
- Department of Mechanical Engineering, Columbia University, New York, New York, USA
| | - Tatiana Luna
- Department of Mechanical Engineering, Columbia University, New York, New York, USA
| | - Moiz Khan
- Department of Mechanical Engineering, Columbia University, New York, New York, USA
| | - Victor Santamaria
- Department of Mechanical Engineering, Columbia University, New York, New York, USA
| | - Joel Stein
- Department of Rehabilitation and Regenerative Medicine, Columbia University, New York, New York, USA
| | - Sunil Agrawal
- Department of Mechanical Engineering, Columbia University, New York, New York, USA
- Department of Rehabilitation and Regenerative Medicine, Columbia University, New York, New York, USA
| | - Susan J. Harkema
- Kentucky Spinal Cord Injury Research Center, University of Louisville, Louisville, Kentucky, USA
- Department of Neurological Surgery, University of Louisville, Louisville, Kentucky, USA
- Frazier Rehabilitation Institute, University of Louisville Health, Louisville, Kentucky, USA
- Department of Bioengineering, University of Louisville, Louisville, Kentucky, USA
| | - Enrico Rejc
- Kentucky Spinal Cord Injury Research Center, University of Louisville, Louisville, Kentucky, USA
- Department of Neurological Surgery, University of Louisville, Louisville, Kentucky, USA
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Benn NL, Jervis-Rademeyer H, Benson K, Chan K, Lee JW, Inness EL, Wolfe DL, Alizadeh-Meghrazi M, Masani K, Musselman KE. Identifying priorities for balance interventions through a participatory co-design approach with end-users. BMC Neurol 2023; 23:266. [PMID: 37442947 DOI: 10.1186/s12883-023-03312-5] [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: 01/11/2023] [Accepted: 06/29/2023] [Indexed: 07/15/2023] Open
Abstract
BACKGROUND Most individuals living with spinal cord injuries/diseases (SCI/D) or stroke experience at least one fall each year; hence, the development of interventions and technologies that target balance control is needed. The purpose of this study was to identify and explore the priorities for balance-focused interventions and technologies from the perspectives of end-users to assist with the design of an intervention that combines functional electrical stimulation (FES) with visual feedback training for standing balance. METHODS Two individuals with SCI/D, one individual with stroke, two physical therapists (PT) and one hospital administrator were recruited. Participants attended three focus group meetings that followed a participatory co-design approach. A semi-structured interview guide, developed from the FAME (Feasibility, Appropriateness, Meaningfulness, Effectiveness, Economic Evidence) framework, was used to lead the discussion, querying participants' experiences with balance deficits and interventions, and FES. Meetings were audio-recorded and transcribed verbatim. An iterative and reflexive inductive thematic analysis was applied to the transcripts by three researchers. RESULTS Four themes were identified: (1) Balance is meaningful for daily life and rehabilitation. Participants acknowledged various factors influencing balance control and how balance deficits interfered with participation in activities. End-users stressed the importance of continuing to work on one's balance after discharge from hospital-based rehabilitation. (2) Desired characteristics of balance interventions. Participants explained that balance interventions should be tailored to an individual's unique needs and goals, relevant to their lives, balance their safety and risk, and be engaging. (3) Prior experiences with FES to inform future therapeutic use. Participants with stroke or SCI/D described initial apprehension with FES, but experienced numerous benefits that motivated them to continue with FES. Challenges with FES were mentioned, including wires, cost, and time of set up. (4) Potential role of FES in balance interventions. Participants felt that FES would complement balance interventions; however, they had not experienced this combination of therapies previously. CONCLUSIONS End-users described how their experiences with balance deficits, rehabilitation, and FES informed their priorities for balance interventions. The findings inform the design and implementation of future balance interventions for individuals with SCI/D or stroke, including an intervention involving FES and visual feedback training.
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Affiliation(s)
- Natasha L Benn
- Rehabilitation Sciences Institute, University of Toronto, Toronto, Canada
- KITE Research Institute-Toronto Rehabilitation Institute, University Health Network, Toronto, Canada
| | - Hope Jervis-Rademeyer
- Rehabilitation Sciences Institute, University of Toronto, Toronto, Canada
- KITE Research Institute-Toronto Rehabilitation Institute, University Health Network, Toronto, Canada
- Faculty of Medicine, University of Alberta, Edmonton, Canada
| | - Kayla Benson
- KITE Research Institute-Toronto Rehabilitation Institute, University Health Network, Toronto, Canada
| | - Katherine Chan
- KITE Research Institute-Toronto Rehabilitation Institute, University Health Network, Toronto, Canada
| | - Jae W Lee
- KITE Research Institute-Toronto Rehabilitation Institute, University Health Network, Toronto, Canada
- Institute of Biomedical Engineering, University of Toronto, Toronto, Canada
| | - Elizabeth L Inness
- Rehabilitation Sciences Institute, University of Toronto, Toronto, Canada
- KITE Research Institute-Toronto Rehabilitation Institute, University Health Network, Toronto, Canada
- Department of Physical Therapy, University of Toronto, Toronto, Canada
| | - Dalton L Wolfe
- Parkwood Institute, Lawson Health Research Institute, London, Canada
| | | | - Kei Masani
- KITE Research Institute-Toronto Rehabilitation Institute, University Health Network, Toronto, Canada
- Institute of Biomedical Engineering, University of Toronto, Toronto, Canada
| | - Kristin E Musselman
- Rehabilitation Sciences Institute, University of Toronto, Toronto, Canada.
- KITE Research Institute-Toronto Rehabilitation Institute, University Health Network, Toronto, Canada.
- Department of Physical Therapy, University of Toronto, Toronto, Canada.
- SCI Mobility Lab, KITE-Toronto Rehabilitation Institute, UHN, 520 Sutherland Drive, Toronto, M4G 3V9, Canada.
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Walia S, Kumar P, Kataria C. Interventions to Improve Standing Balance in Individuals With Incomplete Spinal Cord Injury: A Systematic Review and Meta-Analysis. Top Spinal Cord Inj Rehabil 2023; 29:56-83. [PMID: 37235196 PMCID: PMC10208260 DOI: 10.46292/sci21-00065] [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: 05/28/2023]
Abstract
Background Incomplete spinal cord injury (iSCI) often results in impaired balance leading to functional impairments. Recovery of standing balance ability is an important aim of rehabilitative programs. However, limited information is available on effective balance training protocols for individuals with iSCI. Objectives To assess the methodological quality and effectiveness of various rehabilitation interventions for improving standing balance in individuals with iSCI. Methods A systematic search was performed in SCOPUS, PEDro, PubMed, and Web of Science from inception until March 2021. Two independent reviewers screened articles for inclusion, extracted data, and evaluated methodological quality of the trials. PEDro Scale was used to assess the quality of randomized controlled trials (RCT) and crossover studies while pre-post trials were assessed using the modified Downs and Black tool. A meta-analysis was performed to quantitatively describe the results. The random effects model was applied to present the pooled effect. Results Ten RCTs with a total of 222 participants and 15 pre-post trials with 967 participants were analyzed. The mean PEDro score and modified Downs and Black score was 7/10 and 6/9, respectively. The pooled standardized mean difference (SMD) for controlled and uncontrolled trials of body weight-supported training (BWST) interventions was -0.26 (95% CI, -0.70 to 0.18; p = .25) and 0.46 (95% CI, 0.33 to 0.59; p < .001), respectively. The pooled effect size of -0.98 (95% CI, -1.93 to -0.03; p = .04) indicated significant improvements in balance after a combination of BWST and stimulation. Pre-post studies analyzing the effect of virtual reality (VR) training interventions on Berg Balance Scale (BBS) scores in individuals with iSCI reported a mean difference (MD) of 4.22 (95% CI, 1.78 to 6.66; p = .0007). Small effect sizes were seen in pre-post studies of VR+stimulation and aerobic exercise training interventions indicating no significant improvements after training on standing balance measures. Conclusion This study demonstrated weak evidence to support the use of BWST interventions for overground training for balance rehabilitation in individuals with iSCI. A combination of BWST with stimulation however showed promising results. There is a need for further RCTs in this field to generalize findings. Virtual reality-based balance training has shown significant improvement in standing balance post iSCI. However, these results are based on single group pre-post trials and lack appropriately powered RCTs involving a larger sample size to support this intervention. Given the importance of balance control underpinning all aspects of daily activities, there is a need for further well-designed and appropriately powered RCTs to evaluate specific features of training interventions to improve standing balance function in iSCI.
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Affiliation(s)
- Shefali Walia
- Amity Institute of Physiotherapy, Amity University, Noida, Uttar Pradesh, India
- Indian Spinal Injuries Centre, New Delhi, India
| | - Pragya Kumar
- Amity Institute of Physiotherapy, Amity University, Noida, Uttar Pradesh, India
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Combined Transcutaneous Electrical Spinal Cord Stimulation and Task-Specific Rehabilitation Improves Trunk and Sitting Functions in People with Chronic Tetraplegia. Biomedicines 2022; 11:biomedicines11010034. [PMID: 36672542 PMCID: PMC9855778 DOI: 10.3390/biomedicines11010034] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 12/19/2022] [Accepted: 12/20/2022] [Indexed: 12/28/2022] Open
Abstract
The aim of this study was to examine the effects of transcutaneous electrical spinal cord stimulation (TSCS) and conventional task-specific rehabilitation (TSR) on trunk control and sitting stability in people with chronic tetraplegia secondary to a spinal cord injury (SCI). Five individuals with complete cervical (C4-C7) cord injury participated in 24-week therapy that combined TSCS and TSR in the first 12 weeks, followed by TSR alone for another 12 weeks. The TSCS was delivered simultaneously at T11 and L1 spinal levels, at a frequency ranging from 20-30 Hz with 0.1-1.0 ms. pulse width biphasically. Although the neurological prognosis did not manifest after either treatment, the results show that there were significant increases in forward reach distance (10.3 ± 4.5 cm), right lateral reach distance (3.7 ± 1.8 cm), and left lateral reach distance (3.0 ± 0.9 cm) after the combinational treatment (TSCS+TSR). The stimulation also significantly improved the participants' trunk control and function in sitting. Additionally, the trunk range of motion and the electromyographic response of the trunk muscles were significantly elevated after TSCS+TSR. The TSCS+TSR intervention improved independent trunk control with significantly increased static and dynamic sitting balance, which were maintained throughout the TSR period and the follow-up period, indicating long-term sustainable recovery.
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Santamaria V, Ai X, Agrawal SK. A motor learning-based postural intervention with a robotic trunk support trainer to improve functional sitting in spinal cord injury: case report. Spinal Cord Ser Cases 2022; 8:88. [PMID: 36433944 PMCID: PMC9700847 DOI: 10.1038/s41394-022-00554-2] [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: 03/26/2022] [Accepted: 11/08/2022] [Indexed: 11/26/2022] Open
Abstract
STUDY DESIGN Single-subject-research-design. OBJECTIVES To improve seated postural control in a participant with spinal cord injury (SCI) with a robotic Trunk-Support-Trainer (TruST). SETTING Laboratory. METHODS TruST delivered "assist-as-needed" forces on the participant's torso during a motor learning-and-control-based intervention (TruST-intervention). TruST-assistive forces were progressed and matched to the participant's postural trunk control gains across six intervention sessions. The T-shirt test was used to capture functional improvements while dressing the upper body. Kinematics were used to compute upper body excursions (cm) and velocity (cm2), and sitting workspace area (cm2). Functional trunk dynamometry was used to examine muscle force (Kg). Surface electromyography (sEMG) was applied to measure trunk muscle activity. The Borg Rating of Perceived Exertion (RPE) was used to monitor physical exertion during TruST-intervention. A two-standard-deviation bandwidth method was adopted for data interpretation. RESULTS After TruST-intervention, the participant halved the time needed to don and doff a T-shirt, increased muscle force of trunk muscles (mean = 3 kg), acquired a steadier postural sitting control without vision (mean excursion baseline: 76.0 ± 2 SD = 5.25 cm and post-intervention: 44.1 cm; and mean velocity baseline: 3.0 ± 2 SD = 0.2 cm/s and post-intervention: 1.8 cm/s), and expanded his sitting workspace area (mean baseline: 36.7 ± 2 SD = 36.6 cm2 and post-intervention: 419.2 cm2). The participant increased his tolerance to counteract greater TruST-force perturbations in lateral and posterior directions. Furthermore, abdominal muscle activity substantially augmented after completion of TruST-intervention across all perturbation directions. CONCLUSIONS Our data indicate a potential effectiveness of TruST-intervention to promote functional sitting in SCI.
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Affiliation(s)
- V Santamaria
- Department of Physical Therapy, New York Medical College, New York, NY, USA
| | - X Ai
- Department of Mechanical Engineering, Columbia University, New York, NY, USA
| | - S K Agrawal
- Department of Mechanical Engineering, Columbia University, New York, NY, USA.
- Department of Rehabilitation and Regenerative Medicine, Columbia University, New York, NY, USA.
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Walia S, Kumar P, Kataria C. Effect of virtual reality training on standing balance in individuals with incomplete spinal cord injury. COMPARATIVE EXERCISE PHYSIOLOGY 2022. [DOI: 10.3920/cep220031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Recovery of balance ability during standing is one of the primary and essential aims of rehabilitative programs in individuals with incomplete spinal cord injury (iSCI). A sample of ten participants (mean age: 35.7 years, range: 25-63 years) with traumatic or non-traumatic iSCI (AIS grade C or D) and were able to stand with or without the support of an assistive device for a minimum of 2 min were recruited from the rehabilitation department of the Indian Spinal Injuries Centre, New Delhi, India. The participants received Virtual Reality (VR) based balance training for one hour, three times a week for four weeks on the Nintendo Wii gaming console. Participants were assessed three times: pre-intervention, post-intervention and follow-up assessment for the total ellipse area (TEA), total sway perimeter (TSP), sway range (anterior-posterior/medio-lateral (AP/ML)) and limits of stability (LOS). At post-intervention assessment, significant increases in comparison with pre-intervention scores was found in LOS (P=0.00), TEA with eyes open (EO) (P=0.00) and eyes closed (EC) (P=0.00), TSP with EO (P=0.00) and EC (P=0.00), sway range in AP direction (SD-AP) with EO (P=0.01) and EC (P=0.02) and sway range in ML direction (SD-ML) with EO (P=0.02) and EC (P=0.01). At follow-up assessment, a significant improvement in comparison to post intervention scores was found in TEA measured both in EO (P=0.01) and EC conditions (P=0.02), TSP measured with EO (P=0.01) and SD-ML both with EO (P=0.04) and EC (P=0.01). No significant changes were found in LOS (P=0.89), TSP measured with EC (P=0.38) and SD-AP both with EO (P=0.50) and EC (P=1). However, significant improvement was seen on comparing follow-up assessment scores with pre-intervention scores for all variables, such as LOS (P=0.00), TEA in EO (P=0.00) and EC (P=0.00), TSP with EO (P=0.00) and EC (P=0.00), SD-AP with EO (P=0.01) and EC (P=0.02) and SD-ML with EO (P=0.01) and EC (P=0.00). VR-based balance training intervention was able to elicit improvements in balance ability and maintain it during follow-up despite a small training dosage suggesting that it is a promising intervention for standing balance rehabilitation among individuals with iSCI. The VR-based balance training challenges elements of balance, which physical therapists may want to consider when designing a comprehensive rehabilitation program. Clinical Trials Registry-India: CTRI/2018/12/016814.
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Affiliation(s)
- S. Walia
- Amity Institute of Physiotherapy, Amity University, Sector 125, Noida, Uttar Pradesh 201303, India
- Indian Spinal Injuries Centre, Sector C, Vasant Kunj, New Delhi 110070, India
| | - P. Kumar
- Amity Institute of Physiotherapy, Amity University, Sector 125, Noida, Uttar Pradesh 201303, India
| | - C. Kataria
- Indian Spinal Injuries Centre, Sector C, Vasant Kunj, New Delhi 110070, India
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11
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Development and validation of the sitting balance assessment for spinal cord injury (SitBASCI). Spinal Cord 2022; 60:826-830. [PMID: 35414698 DOI: 10.1038/s41393-022-00799-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Revised: 03/25/2022] [Accepted: 03/27/2022] [Indexed: 01/22/2023]
Abstract
STUDY DESIGN Multicentric psychometric study. OBJECTIVES The aim of this study is to introduce the development of the Sitting Balance Assessment for Spinal Cord Injury (SitBASCI) and assess its inter-rater reliability and internal consistency. SETTING The study was developed among the three Spinal Units of San Bortolo Hospital in Vicenza, Niguarda Hospital in Milan and AOU Careggi in Florence. METHODS SitBASCI is a 13-item scale developed to evaluate trunk control in individuals with SCI. Subjects were filmed while performing the 13 items of the scale. The videotapes were submitted to 25 examiners who evaluated patients' performances with the scale. The power of the study was estimated. The interclass correlational coefficient (ICC) was used to assess the inter-rater reliability of the examiner's evaluations regarding each item and the total. Cronbach's alpha was used to assess internal consistency of the scale and internal consistency of the scale on the eliminated item. RESULTS The study showed to have a significant power. The inter-rater reliability for the total score was ptot = 0.997 (item's values were p = 0.876-0.998). The internal consistency of the scale was alpha = 0.925, while the internal consistency of the scale on the eliminated item was alpha = 0.912-0.930. CONCLUSION SitBASCI had a high inter-rater reliability and internal consistency. Items had also good inter-rater reliability and item-total correlation. Therefore, SitBASCI could be proposed as a good and reliable instrument for Italian clinicians to evaluate sitting balance and trunk control in patient with SCI despite of aetiology and level of injury.
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Zheng W, Wang L, Yang B, Chen Q, Hu Y, Du J, Li X, Chen X, Qin W, Li K, Lu J, Chen N. Cerebellum regulating cerebral functional cortex through multiple pathways in complete thoracolumbar spinal cord injury. Front Neurosci 2022; 16:914549. [PMID: 35968374 PMCID: PMC9374132 DOI: 10.3389/fnins.2022.914549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Accepted: 07/11/2022] [Indexed: 11/22/2022] Open
Abstract
The previous studies have found significant brain structural and functional changes in cerebral regions after spinal cord injury (SCI), but few studies have explored the cerebellar–cerebral circuit changes in SCI. This study aims to study the brain structural changes of cerebellar subregions and its functional connectivity (FC) changes with cerebrum in complete thoracolumbar SCI (CTSCI), and screen out the regions that play relatively important roles in affecting sensorimotor function. Eighteen CTSCI patients and 18 age- and gender-matched healthy controls (HCs) were recruited. Voxel-based morphometry (VBM) was used to characterize the brain structural changes of cerebellar subregions [from the Anatomical Automatic Labeling (AAL116)], seed-based FC was used to evaluate the cerebellar–cerebral FC changes and support vector machine (SVM) analysis was used to search for sensitive imaging indicators. CTSCI patients showed slightly structural atrophy in vermis_3 (p = 0.046) and significantly decreased FC between cerebellum and cerebral sensorimotor-, visual-, cognitive-, and auditory-related regions (cluster-level FWE correction with p < 0.05). Additionally, SVM weight analysis showed that FC values between vermis_10 and right fusiform gyrus had the greatest weight in functional changes of CTSCI. In conclusion, different degrees of structural and functional changes occurred in each subregion of cerebellum following CTSCI, and FC change between vermis_10 and right fusiform gyrus plays the most important role in dysfunction and may become an important neural network index of rehabilitation therapy.
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Affiliation(s)
- Weimin Zheng
- Department of Radiology and Nuclear Medicine, Xuanwu Hospital, Capital Medical University, Beijing, China
- Beijing Key Laboratory of Magnetic Resonance Imaging and Brain Informatics, Beijing, China
| | - Ling Wang
- Department of Radiology and Nuclear Medicine, Xuanwu Hospital, Capital Medical University, Beijing, China
- Beijing Key Laboratory of Magnetic Resonance Imaging and Brain Informatics, Beijing, China
| | - Beining Yang
- Department of Radiology and Nuclear Medicine, Xuanwu Hospital, Capital Medical University, Beijing, China
- Beijing Key Laboratory of Magnetic Resonance Imaging and Brain Informatics, Beijing, China
| | - Qian Chen
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Yongsheng Hu
- Department of Functional Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Jubao Du
- Department of Rehabilitation Medicine, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Xuejing Li
- Department of Radiology, China Rehabilitation Research Center, Beijing, China
| | - Xin Chen
- Department of Radiology and Nuclear Medicine, Xuanwu Hospital, Capital Medical University, Beijing, China
- Beijing Key Laboratory of Magnetic Resonance Imaging and Brain Informatics, Beijing, China
| | - Wen Qin
- Department of Radiology, Tianjin Medical University General Hospital, Tianjin, China
| | - Kuncheng Li
- Department of Radiology and Nuclear Medicine, Xuanwu Hospital, Capital Medical University, Beijing, China
- Beijing Key Laboratory of Magnetic Resonance Imaging and Brain Informatics, Beijing, China
| | - Jie Lu
- Department of Radiology and Nuclear Medicine, Xuanwu Hospital, Capital Medical University, Beijing, China
- Beijing Key Laboratory of Magnetic Resonance Imaging and Brain Informatics, Beijing, China
| | - Nan Chen
- Department of Radiology and Nuclear Medicine, Xuanwu Hospital, Capital Medical University, Beijing, China
- Beijing Key Laboratory of Magnetic Resonance Imaging and Brain Informatics, Beijing, China
- *Correspondence: Nan Chen,
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Lewis MJ, Bowditch J, Laflen B, Perry N, Yoquelet R, Thomovsky SA. Pilot Study on Feasibility of Sensory-Enhanced Rehabilitation in Canine Spinal Cord Injury. Front Vet Sci 2022; 9:921471. [PMID: 35774972 PMCID: PMC9237616 DOI: 10.3389/fvets.2022.921471] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Accepted: 05/16/2022] [Indexed: 12/31/2022] Open
Abstract
Physical rehabilitation is frequently recommended in dogs recovering from acute thoracolumbar intervertebral disc extrusion (TL-IVDE), but protocols vary widely. The objective of this study was to evaluate the feasibility of incorporating sensory-integrated neurorehabilitation strategies into a post-operative rehabilitation protocol in dogs with TL-IVDE. Non-ambulatory dogs with acute TL-IVDE managed surgically were prospectively recruited to this unblinded cross-over feasibility study. Eligible dogs were randomized to start with tactile-enhanced (artificial grass) or auditory-enhanced (floor piano) basic rehabilitation exercises performed twice daily for the first 4 weeks before switching to the opposite surface for the subsequent 4 weeks. Neurologic examination, open field gait scoring, girth measurements and an owner-completed feasibility questionnaire were performed at baseline and 2, 4, 6, and 8 weeks post-operatively. Twenty-four dogs were enrolled, 12 randomized to each order of exercises. Gait scores did not differ between the two groups at baseline, 4 or 8 week visits. All modified exercises could be performed and compliance was high. Adverse events potentially attributable to the study surface were mild, self-limiting and occurred in 2/24 dogs. The most common surface-related limitations were that the piano was slippery and that both surfaces were too short. The artificial grass was preferred by owners and dogs compared to the floor piano surface, but this was influenced by which surface was utilized first. Auditory and tactile modifications were feasible and safe to incorporate into a standardized rehabilitation protocol. This pilot study could prompt larger efficacy studies investigating the benefit of sensory-integrated rehabilitation in dogs with TL-IVDE.
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Affiliation(s)
- Melissa J. Lewis
- Department of Veterinary Clinical Sciences, Purdue University College of Veterinary Medicine, West Lafayette, IN, United States
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Walia S, Kumar P, Kataria C. Efficacy of Electrical Stimulation-Augmented Virtual Reality Training in Improving Balance in Individuals with Incomplete Spinal Cord Injury: Study Protocol of a Randomized Controlled Trial. Asian Spine J 2021; 15:865-873. [PMID: 33371624 PMCID: PMC8696057 DOI: 10.31616/asj.2020.0047] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Revised: 09/08/2020] [Accepted: 09/30/2020] [Indexed: 11/23/2022] Open
Abstract
STUDY DESIGN This study is a single-blind, parallel, three-group, and randomized controlled trial. PURPOSE This study aimed to investigate the effectiveness of electrical stimulation-augmented virtual reality training in improving balance in individuals with incomplete spinal cord injury (iSCI). OVERVIEW OF LITERATURE Individuals with iSCI often face significant balance and mobility impairments affecting their quality of life. Scientific studies focusing on standing balance training in the iSCI population are limited. Virtual reality-based balance training has shown positive results in several neurological populations. Electrical stimulation has also proved to be effective in improving voluntary muscle strength in partially paralyzed muscles after iSCI as well as promoting neuroplasticity. METHODS Forty-eight iSCI participants will be recruited based on the inclusion criteria. The participants will be randomly assigned to any of the three groups: virtual reality-based balance training along with the electrical stimulation group, virtual reality-based balance training along with sham stimulation group, or virtual reality-based balance training group. The intervention will be delivered as 60-minute sessions, thrice a week for 4 weeks. RESULTS The performance of the participants will be assessed using the lower extremity motor score, static and dynamic balance assessment using TechnoBody ProKin tilting platform and Berg Balance Scale, Walking Index for Spinal Cord Injury, and World Health Organization Quality of Life-BREF at pre-intervention, after 4 weeks post-intervention, and at 1-month follow-up. CONCLUSIONS The trial will provide new knowledge about the effectiveness of electrical stimulation-augmented virtual reality training in improving balance in individuals with iSCI. The study results will contribute to the design of better rehabilitation programs for individuals with iSCI.
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Affiliation(s)
- Shefali Walia
- Amity Institute of Physiotherapy, Amity University Uttar Pradesh, Noida,
India
- ISIC Institute of Rehabilitation Sciences, Indian Spinal Injuries Centre, New Delhi,
India
| | - Pragya Kumar
- Amity Institute of Physiotherapy, Amity University Uttar Pradesh, Noida,
India
| | - Chitra Kataria
- ISIC Institute of Rehabilitation Sciences, Indian Spinal Injuries Centre, New Delhi,
India
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15
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Feasibility and tolerance of a robotic postural training to improve standing in a person with ambulatory spinal cord injury. Spinal Cord Ser Cases 2021; 7:94. [PMID: 34620833 PMCID: PMC8497530 DOI: 10.1038/s41394-021-00454-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Revised: 09/18/2021] [Accepted: 09/19/2021] [Indexed: 11/08/2022] Open
Abstract
An ambulatory elder with SCI, AIS C, balance deficits, and right ankle-foot-orthosis participated. RobUST-intervention comprised six 90 min-sessions of postural tasks with pelvic assistance and trunk perturbations. We collected three baselines and two 1 week post-training assessments-after the first four sessions (PT1) and after the last two sessions (PT2). We measured Berg Balance Scale (BBS), four-stage balance test (4SBT)-including a 30 s-window with and without vision-standing workspace area, and reactive balance (measured as body weight%). Kinematics, center-of-pressure (COP), and electromyography (EMG) were analyzed to compute root-mean-square-COP (RMS-COP), the margin of stability (MoS), ankle range of motion, and integrated EMG (iEMG) normalized to baseline. The Borg Rating of Perceived Exertion (BRPE), and change in the Mean Arterial Pressure (MAP) and heart rate (HR) compared with baseline were collected to address training tolerance. A 2SD-bandwidth method was selected for data interpretation. The maximum BBS was achieved (1-point improvement). In the 4SBT, the participant completed 30 s (baseline = 20 s) with reduced balance variability during semi-tandem position without vision (RMS-COP baseline = 50.32 ± 2 SD = 19.64 mm; PT1 = 21.29 mm; PT2 = 19.34 mm). A trend toward increase was found in workspace area (baseline = 996 ± 359 cm2; PT1 = 1539 cm2; PT2 = 1138 cm2). The participant tolerated higher perturbation intensities (baseline mean = 25%body weight, PT2 mean = 44% body weight), and on average improved his MoS (3 cm), ankle range of motion (4°), and gluteus medius activity (iEMG = 10). RobuST-intervention was moderate-sort of hard (BRPE = 3-4). A substantial reduction in MAP (9%) and HR (30%) were observed. In conclusion, RobUST-intervention might be effective in ambulatory SCI.
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Wang IL, Wang LI, Liu Y, Su Y, Yao S, Ho CS. Application of Real-Time Visual Feedback System in Balance Training of the Center of Pressure with Smart Wearable Devices. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:9637. [PMID: 34574560 PMCID: PMC8469963 DOI: 10.3390/ijerph18189637] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/26/2021] [Revised: 09/08/2021] [Accepted: 09/11/2021] [Indexed: 11/16/2022]
Abstract
Balance control with an upright posture is affected by many factors. This study was undertaken to investigate the effects of real-time visual feedback training, provided by smart wearable devices for COP changes for healthy females, on static stance. Thirty healthy female college students were randomly divided into three groups (visual feedback balance training group, non-visual feedback balance training group, and control group). Enhanced visual feedback on the screen appeared in different directions, in the form of fluctuations; the visual feedback balance training group received real-time visual feedback from the Podoon APP for training, while the non-visual feedback balance training group only performed an open-eye balance, without receiving real-time visual feedback. The control group did not do any balance training. The balance training lasted 4 weeks, three times a week for 30 min each time with 1-2 day intervals. After four weeks of balance training, the results showed that the stability of human posture control improved for the one leg static stance for the visual feedback balance training group with smart wearable devices. The parameters of COP max displacement, COP velocity, COP radius, and COP area in the visual feedback balance training group were significantly decreased in the one leg stance (p < 0.05). The results showed that the COP real-time visual feedback training provided by smart wearable devices can better reduce postural sway and improve body balance ability than general training, when standing quietly.
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Affiliation(s)
- I-Lin Wang
- College of Physical Education, Hubei Normal University, Huangshi 435002, China;
| | - Li-I Wang
- Department of Physical Education and Kinesiology, National Dong Hwa University, Hualien 97046, Taiwan;
| | - Yang Liu
- Graduate Institute, Jilin Sport University, No. 2476, Freedom Road, Nanguan District, Changchun 130022, China; (Y.L.); (Y.S.); (S.Y.)
| | - Yu Su
- Graduate Institute, Jilin Sport University, No. 2476, Freedom Road, Nanguan District, Changchun 130022, China; (Y.L.); (Y.S.); (S.Y.)
| | - Shun Yao
- Graduate Institute, Jilin Sport University, No. 2476, Freedom Road, Nanguan District, Changchun 130022, China; (Y.L.); (Y.S.); (S.Y.)
| | - Chun-Sheng Ho
- Division of Physical Medicine and Rehabilitation, Lo-Hsu Medical Foundation, Inc., Lotung Poh-Ai Hospital, Yilan City 26546, Taiwan
- Department of Physical Therapy, College of Medical and Health Science, Asia University, Taichung 41354, Taiwan
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Cui B, Zheng W, Ren S, Chen Z, Wang Z. Differentiation of Cerebellum-Type and Parkinson-Type of Multiple System Atrophy by Using Multimodal MRI Parameters. Front Aging Neurosci 2021; 13:687649. [PMID: 34413766 PMCID: PMC8369927 DOI: 10.3389/fnagi.2021.687649] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Accepted: 06/29/2021] [Indexed: 11/13/2022] Open
Abstract
Recent studies have demonstrated the structural and functional changes in patients with multiple system atrophy (MSA). However, little is known about the different parameter changes of the most vulnerable regions in different types of MSA. In this study, we collected resting-state structure, perfusion, and patients with functional magnetic resonance imaging (fMRI) data of cerebellum-type of MSA (MSA-c) and Parkinson-type of MSA (MSA-p). First, by simultaneously using voxel-based morphology (VBM), arterial spin labeling (ASL), and amplitude of low-frequency fluctuation (ALFF), we analyzed the whole brain differences of structure, perfusion, and functional activation between patients with MSA-c and MSA-p. Second, we explored the relationships among structure, perfusion, function, and the clinical variables in patients with MSA. Finally, we extracted the MRI parameters of a specific region to separate the two groups and search for a sensitive imaging biomarker. As a result, compared with patients with MSA-p type, patients with MSA-c type showed decreased structure atrophy in several cerebella and vermis subregions, reduced perfusion in bilateral cerebellum_4_5 and vermis_4_5, and an decreased ALFF values in the right lingual gyrus (LG) and fusiform (FFG). Subsequent analyses revealed the close correlations among structure, perfusion, function, and clinical variables in both MSA-c and MSA-p. Finally, the receiver operating characteristic (ROC) analysis showed that the regional cerebral blood flow (rCBF) of bilateral cerebellum_4_5/vermis_4_5 could differentiate the two groups at a relatively high accuracy, yielding the sensitivity of 100%, specificity of 79.2%, and the area under the curve (AUC) value of 0.936. These findings have important implications for understanding the underlying neurobiology of different types of MSA and added the new evidence for the disrupted rCBF, structure, and function of MSA, which may provide the potential biomarker for accurately detecting different types of patients with MSA and new ideas for the treatment of different types of MSA in the future.
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Affiliation(s)
- Bin Cui
- Department of Radiology, Aerospace Center Hospital, Beijing, China
| | - Weimin Zheng
- Department of Radiology, Aerospace Center Hospital, Beijing, China
| | - Shan Ren
- Department of Neurology, Dongfang Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Zhigang Chen
- Department of Neurology, Dongfang Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Zhiqun Wang
- Department of Radiology, Aerospace Center Hospital, Beijing, China
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Zheng W, Wang L, Chen Q, Li X, Chen X, Qin W, Li K, Lu J, Chen N. Functional Reorganizations Outside the Sensorimotor Regions Following Complete Thoracolumbar Spinal Cord Injury. J Magn Reson Imaging 2021; 54:1551-1559. [PMID: 34060693 DOI: 10.1002/jmri.27764] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Revised: 05/20/2021] [Accepted: 05/21/2021] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND Studies have shown that loss of sensorimotor function in spinal cord injury (SCI) leads to brain functional reorganization, which may play important roles in motor function recovery. However, the specific functional changes following SCI are still poorly understood. PURPOSE To investigate whether there are functional reorganizations outside the sensorimotor regions after complete thoracolumbar SCI (CTSCI), and how these reorganizations are associated with clinical manifestations. STUDY TYPE Prospective. SUBJECTS Eighteen CTSCI patients (28-67 years of age; 16 men) and 18 age-, gender-matched healthy controls (HCs) (27-64 years of age; 16 men). FIELD STRENGTH/SEQUENCE Resting-state functional magnetic resonance imaging (RS-fMRI) using echo-planar-imaging (EPI) sequence at 3.0 T. ASSESSMENT Data preprocessing was performed using Data Processing Assistant for Resting-State fMRI (DPARSF). Amplitude of low-frequency fluctuations (ALFF) was used to characterize regional neural function, and seed-based functional connectivity (FC) was used to evaluate the functional integration of the brain network. STATISTICAL TESTS Two-sample t-tests were used for ALFF and FC measures (the data conform to the normal distribution), partial correlation analysis was used to analyze the correlation between clinical and imaging indicators, and receiver operating characteristic (ROC) analysis was used to search for sensitive imaging indicators. RESULTS Compared with HCs, CTSCI patients showed decreased ALFF in right lingual gyrus (LG), increased ALFF in right middle frontal gyrus (MFG), and decreased FC between the right LG and Vermis_3 (cluster-level FWE correction with P < 0.05). Subsequent correlation analyses revealed that decreased FC between the right LG and Vermis_3 positively correlated with the visual analog scale (VAS) (P = 0.043, r = 0.443). Finally, the ROC analysis showed that the area under the curve (AUC) of FC value between right LG and Vermis3 was 0.881. DATA CONCLUSION These findings suggest a possible theoretical basis of the mechanism of visual-, emotion-, and cognition-related techniques in rehabilitation training for CTSCI.
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Affiliation(s)
- Weimin Zheng
- Department of Radiology, Xuanwu Hospital, Capital Medical University, Beijing, China.,Beijing Key Laboratory of Magnetic Resonance Imaging and Brain Informatics, Beijing, China
| | - Ling Wang
- Department of Radiology, Xuanwu Hospital, Capital Medical University, Beijing, China.,Beijing Key Laboratory of Magnetic Resonance Imaging and Brain Informatics, Beijing, China
| | - Qian Chen
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Xuejing Li
- Department of Radiology, China Rehabilitation Research Center, Beijing, China
| | - Xin Chen
- Department of Radiology, Xuanwu Hospital, Capital Medical University, Beijing, China.,Beijing Key Laboratory of Magnetic Resonance Imaging and Brain Informatics, Beijing, China
| | - Wen Qin
- Department of Radiology, Tianjin Medical University General Hospital, Tianjin, China
| | - Kuncheng Li
- Department of Radiology, Xuanwu Hospital, Capital Medical University, Beijing, China.,Beijing Key Laboratory of Magnetic Resonance Imaging and Brain Informatics, Beijing, China
| | - Jie Lu
- Department of Radiology, Xuanwu Hospital, Capital Medical University, Beijing, China.,Beijing Key Laboratory of Magnetic Resonance Imaging and Brain Informatics, Beijing, China
| | - Nan Chen
- Department of Radiology, Xuanwu Hospital, Capital Medical University, Beijing, China.,Beijing Key Laboratory of Magnetic Resonance Imaging and Brain Informatics, Beijing, China
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Li X, Chen Q, Zheng W, Chen X, Wang L, Qin W, Li K, Lu J, Chen N. Inconsistency between cortical reorganization and functional connectivity alteration in the sensorimotor cortex following incomplete cervical spinal cord injury. Brain Imaging Behav 2021; 14:2367-2377. [PMID: 31444779 DOI: 10.1007/s11682-019-00190-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
The aim of this study was to explore whether there will be any alterations in sensorimotor-related cortex and the possible causes of sensorimotor dysfunction after incomplete cervical spinal cord injury (ICSCI). Structural and resting-state functional magnetic resonance imaging (rs-fMRI) of nineteen ICSCI patients and nineteen healthy controls (HCs) was acquired. Voxel based morphometry (VBM) and tract-based spatial statistics were performed to assess differences in gray matter volume (GMV) and white matter integrity between ICSCI patients and HCs. Whole brain functional connectivity (FC) was analyzed using the results of VBM as seeds. Associations between the clinical variables and the brain changes were studied. Compared with HCs, ICSCI patients demonstrated reduced GMV in the right fusiform gyrus (FG) and left orbitofrontal cortex (OFC) but no changes in areas directly related to sensorimotor function. There were no significant differences in brain white matter. Additionally, the FC in the left primary sensorimotor cortex and cerebellum decreased when the FG and OFC, respectively, were used as seeds. Subsequent relevance analysis suggests a weak positive correlation between the left OFC's GMV and visual analog scale (VAS) scores. In conclusion, brain structural changes following ICSCI occur mainly in certain higher cognitive regions, such as the FG and OFC, rather than in the brain areas directly related to sensation or motor control. The functional areas of the brain that are related to cognitive processing may play an important role in sensorimotor dysfunction through the decreased FC with sensorimotor areas after ICSCI. Therefore, cognition-related functional training may play an important role in rehabilitation of sensorimotor function after ICSCI.
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Affiliation(s)
- Xuejing Li
- Department of Radiology, Xuanwu Hospital, Capital Medical University, No. 45 Chang-chun St, Xicheng District, Beijing, China.,Beijing Key Laboratory of Magnetic Resonance Imaging and Brain Informatics, No. 45 Chang-chun St, Xicheng District, Beijing, China
| | - Qian Chen
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, No. 95 Yongan Road, Xicheng District, Beijing, China
| | - Weimin Zheng
- Department of Radiology, Aerospace Central Hospital, No. 15 Yuquan Road, Haidian District, Beijing, China
| | - Xin Chen
- Department of Radiology, Xuanwu Hospital, Capital Medical University, No. 45 Chang-chun St, Xicheng District, Beijing, China.,Beijing Key Laboratory of Magnetic Resonance Imaging and Brain Informatics, No. 45 Chang-chun St, Xicheng District, Beijing, China
| | - Ling Wang
- Department of Radiology, Xuanwu Hospital, Capital Medical University, No. 45 Chang-chun St, Xicheng District, Beijing, China.,Beijing Key Laboratory of Magnetic Resonance Imaging and Brain Informatics, No. 45 Chang-chun St, Xicheng District, Beijing, China
| | - Wen Qin
- Department of Radiology, Tianjin Medical University General Hospital, No. 154, Anshan Road, Heping District, Tianjin, China
| | - Kuncheng Li
- Department of Radiology, Xuanwu Hospital, Capital Medical University, No. 45 Chang-chun St, Xicheng District, Beijing, China.,Beijing Key Laboratory of Magnetic Resonance Imaging and Brain Informatics, No. 45 Chang-chun St, Xicheng District, Beijing, China
| | - Jie Lu
- Department of Radiology, Xuanwu Hospital, Capital Medical University, No. 45 Chang-chun St, Xicheng District, Beijing, China.,Beijing Key Laboratory of Magnetic Resonance Imaging and Brain Informatics, No. 45 Chang-chun St, Xicheng District, Beijing, China
| | - Nan Chen
- Department of Radiology, Xuanwu Hospital, Capital Medical University, No. 45 Chang-chun St, Xicheng District, Beijing, China. .,Beijing Key Laboratory of Magnetic Resonance Imaging and Brain Informatics, No. 45 Chang-chun St, Xicheng District, Beijing, China.
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20
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Go Virtual to Get Real: Virtual Reality as a Resource for Spinal Cord Treatment. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18041819. [PMID: 33668438 PMCID: PMC7918193 DOI: 10.3390/ijerph18041819] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Revised: 02/08/2021] [Accepted: 02/09/2021] [Indexed: 02/05/2023]
Abstract
Increasingly, refined virtual reality (VR) techniques allow for the simultaneous and coherent stimulation of multiple sensory and motor domains. In some clinical interventions, such as those related to spinal cord injuries (SCIs), the impact of VR on people's multisensory perception, movements, attitudes, and even modulations of socio-cognitive aspects of their behavior may influence every phase of their rehabilitation treatment, from the acute to chronic stages. This work describes the potential advantages of using first-person-perspective VR to treat SCIs and its implications for manipulating sensory-motor feedback to alter body signals. By situating a patient with SCI in a virtual environment, sensorial perceptions and motor intention can be enriched into a more coherent bodily experience that also promotes processes of neural regeneration and plasticity. In addition to the great potential of research, the most significant areas of interest concern is managing neuropathic pain, motor rehabilitation, and psychological well-being.
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21
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Unger J, Chan K, Lee JW, Craven BC, Mansfield A, Alavinia M, Masani K, Musselman KE. The Effect of Perturbation-Based Balance Training and Conventional Intensive Balance Training on Reactive Stepping Ability in Individuals With Incomplete Spinal Cord Injury or Disease: A Randomized Clinical Trial. Front Neurol 2021; 12:620367. [PMID: 33603710 PMCID: PMC7884853 DOI: 10.3389/fneur.2021.620367] [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: 10/22/2020] [Accepted: 01/11/2021] [Indexed: 11/13/2022] Open
Abstract
Introduction: Impaired balance leads to falls in individuals with motor incomplete spinal cord injury or disease (iSCI/D). Reactive stepping is a strategy used to prevent falls and Perturbation-based Balance Training (PBT) can improve this ability. Objective: The objective of this study was to determine if PBT results in greater improvements in reactive stepping ability than frequency-matched Conventional Intensive Balance Training (CIBT) in adults with iSCI/D. Design: Randomized clinical trial. Setting: Tertiary SCI/D rehabilitation center. Participants: Twenty-one adults with chronic (>1 year) iSCI/D were randomized. Due to one drop out 20 participants completed the study. Methods: Participants were randomly allocated to complete either PBT or CIBT three times per week for 8 weeks. Both programs included challenging static and dynamic balance tasks, but the PBT group also experienced manual external balance perturbations. Main Outcome Measures: Assessments of reactive stepping ability using the Lean-and-Release test were completed at baseline, and after 4 and 8 weeks of training, and 3 and 6 months after training completion. A blinded assessor evaluated secondary outcomes. Results: Twenty-five participants were screened and 21 consented; one withdrew. Ten PBT and 10 CIBT participants were included in analyses. Across all participants there were improvements in reactive stepping ability (p = 0.049), with retention of improvements at follow up assessments. There were no differences in reactive stepping ability between groups [median (interquartile range): PBT 0.08 (0.68); CIBT 0.00 (0.22)]. One participant in the PBT group experienced a non-injurious fall during training. Conclusions: Balance training is beneficial for individuals with iSCI/D, but the addition of manual perturbations (i.e., PBT) did not prove advantageous for performance on a measure of reactive stepping ability. Clinical Trial Registration:www.ClinicalTrials.gov, identifier: NCT02960178.
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Affiliation(s)
- Janelle Unger
- Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, Canada.,KITE at Toronto Rehabilitation Institute-University Health Network, Toronto, ON, Canada
| | - Katherine Chan
- KITE at Toronto Rehabilitation Institute-University Health Network, Toronto, ON, Canada
| | - Jae W Lee
- KITE at Toronto Rehabilitation Institute-University Health Network, Toronto, ON, Canada.,Institute of Biomedical Engineering, University of Toronto, Toronto, ON, Canada
| | - B Catharine Craven
- Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, Canada.,KITE at Toronto Rehabilitation Institute-University Health Network, Toronto, ON, Canada.,Department of Medicine, Division of Physical Medicine and Rehabilitation, University of Toronto, Toronto, ON, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Avril Mansfield
- KITE at Toronto Rehabilitation Institute-University Health Network, Toronto, ON, Canada.,Evaluative Clinical Sciences, Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, ON, Canada.,Department of Physical Therapy, University of Toronto, Toronto, ON, Canada
| | - Mohammad Alavinia
- KITE at Toronto Rehabilitation Institute-University Health Network, Toronto, ON, Canada
| | - Kei Masani
- KITE at Toronto Rehabilitation Institute-University Health Network, Toronto, ON, Canada.,Institute of Biomedical Engineering, University of Toronto, Toronto, ON, Canada
| | - Kristin E Musselman
- Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, Canada.,KITE at Toronto Rehabilitation Institute-University Health Network, Toronto, ON, Canada.,Department of Physical Therapy, University of Toronto, Toronto, ON, Canada
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22
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Noamani A, Lemay JF, Musselman KE, Rouhani H. Characterization of standing balance after incomplete spinal cord injury: Alteration in integration of sensory information in ambulatory individuals. Gait Posture 2021; 83:152-159. [PMID: 33152610 DOI: 10.1016/j.gaitpost.2020.10.027] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Revised: 10/15/2020] [Accepted: 10/22/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND Up to one-third of individuals with a recent spinal cord injury (SCI) and most of the individuals with an incomplete lesion are able to regain partial balance and walking ability after the first-year post-injury. However, most individuals experience injurious falls while standing and frequent losses of balance post-rehabilitation, which can result in physical injuries and a fear of falling. RESEARCH QUESTION Control of balance during quiet standing depends on the integration of sensory information. Since SCI causes sensory and motor impairments, understanding the underlying mechanisms of how postural control is regulated is of significant importance for targeted and guided rehabilitation post-SCI. METHODS We characterized the impact of a variety of challenging conditions on the standing balance for eight participants with incomplete SCI with walking ability compared to twelve age-matched able-bodied individuals using a waist-mounted inertial measurement unit (IMU). We compared balance biomarkers derived from IMUs' readouts under conditions that challenged balance by affecting somatosensory (i.e., standing on hard vs. foam surfaces) and visual (i.e., eyes open vs. closed) inputs. We performed a three-way ANOVA or a Kruskal-Wallis test to characterize changes in postural control post-SCI based on reliance on somatosensory and visual information using balance biomarkers. RESULTS We observed a reduced stability performance, an increased control demand, and a less effective active correction post-SCI in all standing conditions. Due to impaired somatosensory feedback, individuals with incomplete SCI showed a higher and lower reliance on visual and somatosensory information, respectively, for maintaining balance (p < 0.05). SIGNIFICANCE Using a single waist-mounted IMU, the proposed method could characterize standing balance in individuals with incomplete SCI compared to able-bodied participants. Having high clinical utility and sufficient resolution with discriminatory ability, our method could be used in the future to objectively evaluate the effectiveness of rehabilitative interventions on the balance performance of individuals with SCI.
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Affiliation(s)
- Alireza Noamani
- Department of Mechanical Engineering, University of Alberta, Donadeo Innovation Centre for Engineering, Edmonton, Alberta, T6G 1H9, Canada
| | - Jean-François Lemay
- CIUSSS du Centre-Sud-de-l'Île-de-Montréal (Installation Gingras-Lindsay), Montreal, QC, Canada; School of Rehabilitation, Université de Montréal, Montreal, QC, Canada; SCI Mobility Lab, KITE, Toronto Rehabilitation Institute-University Health Network, Toronto, ON, Canada
| | - Kristin E Musselman
- SCI Mobility Lab, KITE, Toronto Rehabilitation Institute-University Health Network, Toronto, ON, Canada; Department of Physical Therapy, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Hossein Rouhani
- Department of Mechanical Engineering, University of Alberta, Donadeo Innovation Centre for Engineering, Edmonton, Alberta, T6G 1H9, Canada.
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23
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Noamani A, Lemay JF, Musselman KE, Rouhani H. Postural control strategy after incomplete spinal cord injury: effect of sensory inputs on trunk-leg movement coordination. J Neuroeng Rehabil 2020; 17:141. [PMID: 33109209 PMCID: PMC7590439 DOI: 10.1186/s12984-020-00775-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2020] [Accepted: 10/13/2020] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Postural control is affected after incomplete spinal cord injury (iSCI) due to sensory and motor impairments. Any alteration in the availability of sensory information can challenge postural stability in this population and may lead to a variety of adaptive movement coordination patterns. Hence, identifying the underlying impairments and changes to movement coordination patterns is necessary for effective rehabilitation post-iSCI. This study aims to compare the postural control strategy between iSCI and able-bodied populations by quantifying the trunk-leg movement coordination under conditions that affects sensory information. METHODS 13 individuals with iSCI and 14 aged-matched able-bodied individuals performed quiet standing on hard and foam surfaces with eyes open and closed. We used mean Magnitude-Squared Coherence between trunk-leg accelerations measured by accelerometers placed over the sacrum and tibia. RESULTS We observed a similar ankle strategy at lower frequencies (f ≤ 1.0 Hz) between populations. However, we observed a decreased ability post-iSCI in adapting inter-segment coordination changing from ankle strategy to ankle-hip strategy at higher frequencies (f > 1.0 Hz). Moreover, utilizing the ankle-hip strategy at higher frequencies was challenged when somatosensory input was distorted, whereas depriving visual information did not affect balance strategy. CONCLUSION Trunk-leg movement coordination assessment showed sensitivity, discriminatory ability, and excellent test-retest reliability to identify changes in balance control strategy post-iSCI and due to altered sensory inputs. Trunk-leg movement coordination assessment using wearable sensors can be used for objective outcome evaluation of rehabilitative interventions on postural control post-iSCI.
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Affiliation(s)
- Alireza Noamani
- Department of Mechanical Engineering, University of Alberta, 10-368 Donadeo Innovation Centre for Engineering, 9211-116 Street NW, Edmonton, AB, T6G 1H9, Canada
| | - Jean-François Lemay
- CIUSSS du Centre-Sud-de-L'Île-de-Montréal (Installation Gingras-Lindsay), Montreal, QC, Canada
- School of Rehabilitation, Université de Montréal, Montreal, QC, Canada
- SCI Mobility Lab, KITE, Toronto Rehabilitation Institute-University Health Network, Toronto, ON, Canada
| | - Kristin E Musselman
- SCI Mobility Lab, KITE, Toronto Rehabilitation Institute-University Health Network, Toronto, ON, Canada
- Department of Physical Therapy, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Hossein Rouhani
- Department of Mechanical Engineering, University of Alberta, 10-368 Donadeo Innovation Centre for Engineering, 9211-116 Street NW, Edmonton, AB, T6G 1H9, Canada.
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24
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Is Virtual Reality Effective for Balance Recovery in Patients with Spinal Cord Injury? A Systematic Review and Meta-Analysis. J Clin Med 2020; 9:jcm9092861. [PMID: 32899665 PMCID: PMC7564926 DOI: 10.3390/jcm9092861] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Revised: 08/24/2020] [Accepted: 09/01/2020] [Indexed: 12/28/2022] Open
Abstract
Virtual reality (VR) is an emerging tool used in the neurological rehabilitation of patients with spinal cord injury (SCI), focused on recovering balance, mobility, and motor function, among other functional outcomes. The main objective of this study was to analyze the effectiveness of VR systems to recover balance in patients with SCI. The literature search was performed between October and December 2019 in the following databases: Embase, Web of Science, CINAHL, Scopus, Medline, Physiotherapy Evidence Database (PEDro), PubMed, and the Cochrane Central Register of Controlled Trials. The methodological quality of each study was assessed using the Spinal Cord Injury Rehabilitation Evidence (SCIRE) system and the PEDro scale, while the risk of bias was analyzed by the Cochrane Collaboration’s tool. A total of 12 studies, involving 188 participants, were included in the systematic review, of which two were included in the meta-analysis. Statistical analysis showed favorable results for balance measured by the modified Functional Reach Test (standardized mean difference (SMD) = 3.42; 95% confidence interval: 2.54 to 4.29) and by the t-shirt test (SMD= −2.29; 95% confidence interval: −3.00 to −1.59). The results showed that VR interventions provided potential benefits, in addition to conventional physical therapy, to recover balance in patients with SCI.
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25
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Houston DJ, Lee JW, Unger J, Masani K, Musselman KE. Functional Electrical Stimulation Plus Visual Feedback Balance Training for Standing Balance Performance Among Individuals With Incomplete Spinal Cord Injury: A Case Series. Front Neurol 2020; 11:680. [PMID: 32793101 PMCID: PMC7390869 DOI: 10.3389/fneur.2020.00680] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Accepted: 06/05/2020] [Indexed: 11/13/2022] Open
Abstract
Individuals with an incomplete spinal cord injury (iSCI) are highly susceptible to falls during walking or standing. Our objective was to evaluate a therapeutic tool for standing balance that combined functional electrical stimulation, applied bilaterally to the plantarflexors and dorsiflexors, with visual feedback balance training (FES+VFBT). Five adults with iSCI completed 12 FES+VFBT sessions over 4 weeks. During the training sessions, participants completed each of the four balance exercises twice. Visual feedback of the center-of-pressure (COP) location was provided as participants completed the balance exercises and received FES to assist with performance of the exercises. A closed-loop FES system was used in which the COP was continually monitored and the level of electrical current administered was automatically adjusted. Balance abilities were assessed pre- and post- training using clinical balance scales (i.e., Berg Balance Scale, Mini-Balance Evaluation Systems Test, and Activities-specific Balance Confidence Scale) and biomechanical assessments (i.e., postural sway measures and limits of stability test during standing). User acceptability was explored through semi-structured interviews. Improvements were seen for four of the five participants on at least one of the clinical scales following completion of the training intervention. All participants showed greater maximal COP excursion area during the limits of stability test after the training intervention, whereas only one participant demonstrated a reduction in postural sway. Specific components of FES+VFBT, including the ability to safely practice challenging balance exercises, were deemed important by the participants. These results suggest that FES+VFBT has potential as an intervention for standing balance after iSCI.
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Affiliation(s)
- David J Houston
- KITE Toronto Rehab-University Health Network, Toronto, ON, Canada.,Faulty of Medicine, Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, Canada
| | - Jae W Lee
- KITE Toronto Rehab-University Health Network, Toronto, ON, Canada.,Faculty of Engineering, Institute of Biomaterials and Biomedical Engineering, University of Toronto, Toronto, ON, Canada
| | - Janelle Unger
- KITE Toronto Rehab-University Health Network, Toronto, ON, Canada.,Faulty of Medicine, Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, Canada
| | - Kei Masani
- KITE Toronto Rehab-University Health Network, Toronto, ON, Canada.,Faculty of Engineering, Institute of Biomaterials and Biomedical Engineering, University of Toronto, Toronto, ON, Canada
| | - Kristin E Musselman
- KITE Toronto Rehab-University Health Network, Toronto, ON, Canada.,Faulty of Medicine, Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, Canada.,Department of Physical Therapy, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
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26
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Cruz-Montecinos C, Cuesta-Vargas A, Muñoz C, Flores D, Ellsworth J, De la Fuente C, Calatayud J, Rivera-Lillo G, Soto-Arellano V, Tapia C, García-Massó X. Impact of Visual Biofeedback of Trunk Sway Smoothness on Motor Learning during Unipedal Stance. SENSORS 2020; 20:s20092585. [PMID: 32370050 PMCID: PMC7248825 DOI: 10.3390/s20092585] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Revised: 04/24/2020] [Accepted: 04/27/2020] [Indexed: 12/16/2022]
Abstract
The assessment of trunk sway smoothness using an accelerometer sensor embedded in a smartphone could be a biomarker for tracking motor learning. This study aimed to determine the reliability of trunk sway smoothness and the effect of visual biofeedback of sway smoothness on motor learning in healthy people during unipedal stance training using an iPhone 5 measurement system. In the first experiment, trunk sway smoothness in the reliability group (n = 11) was assessed on two days, separated by one week. In the second, the biofeedback group (n = 12) and no-biofeedback group (n = 12) were compared during 7 days of unipedal stance test training and one more day of retention (without biofeedback). The intraclass correlation coefficient score 0.98 (0.93–0.99) showed that this method has excellent test–retest reliability. Based on the power law of practice, the biofeedback group showed greater improvement during training days (p = 0.003). Two-way mixed analysis of variance indicates a significant difference between groups (p < 0.001) and between days (p < 0.001), as well as significant interaction (p < 0.001). Post hoc analysis shows better performance in the biofeedback group from training days 2 and 7, as well as on the retention day (p < 0.001). Motor learning objectification through visual biofeedback of trunk sway smoothness enhances postural control learning and is useful and reliable for assessing motor learning.
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Affiliation(s)
- Carlos Cruz-Montecinos
- Clinical Biomechanics Laboratory, Department of Physical Therapy, University of Chile, 8380453 Santiago, Chile; (C.C.-M.); (C.M.); (D.F.); (J.E.); (G.R.-L.)
- Biomechanics and Kinesiology Laboratory, Hospital San José, 8380419 Santiago, Chile
| | - Antonio Cuesta-Vargas
- Department of Physiotherapy, Faculty of Heath Sciences, University of Malaga, 29071 Málaga, Spain;
- Institute of Biomedical Research in Malaga (IBIMA), 29010 Málaga, Spain
- School of Clinical Science, Faculty of Health Science, Queensland University Technology, Brisbane, QLD 4000, Australia
| | - Cristian Muñoz
- Clinical Biomechanics Laboratory, Department of Physical Therapy, University of Chile, 8380453 Santiago, Chile; (C.C.-M.); (C.M.); (D.F.); (J.E.); (G.R.-L.)
| | - Dante Flores
- Clinical Biomechanics Laboratory, Department of Physical Therapy, University of Chile, 8380453 Santiago, Chile; (C.C.-M.); (C.M.); (D.F.); (J.E.); (G.R.-L.)
| | - Joseph Ellsworth
- Clinical Biomechanics Laboratory, Department of Physical Therapy, University of Chile, 8380453 Santiago, Chile; (C.C.-M.); (C.M.); (D.F.); (J.E.); (G.R.-L.)
| | - Carlos De la Fuente
- Carrera de Kinesiología, Departamento de Cs. de la Salud, Facultad de Medicina, Pontificia Universidad Católica, 7820436 Santiago, Chile;
- Laboratorio LIBFE, Escuela de Kinesiología, Universidad de los Andes, 7620086 Santiago, Chile
- Centro de Salud Deportiva, Clínica Santa María, 7520378 Santiago, Chile
| | - Joaquín Calatayud
- Exercise Intervention for Health Research Group (EXINH-RG), Department of Physiotherapy, University of Valencia, 46010 Valencia, Spain;
| | - Gonzalo Rivera-Lillo
- Clinical Biomechanics Laboratory, Department of Physical Therapy, University of Chile, 8380453 Santiago, Chile; (C.C.-M.); (C.M.); (D.F.); (J.E.); (G.R.-L.)
- Neuroscience Department, University of Chile, 8380453 Santiago, Chile
- Research and Development Unit, Clínica Los Coihues, 9190025 Santiago, Chile
| | | | - Claudio Tapia
- Clinical Biomechanics Laboratory, Department of Physical Therapy, University of Chile, 8380453 Santiago, Chile; (C.C.-M.); (C.M.); (D.F.); (J.E.); (G.R.-L.)
- Universidad Tecnológica de Chile INACAP, Escuela Salud, 8340536 Santiago, Chile
- Correspondence:
| | - Xavier García-Massó
- Human Movement Analysis Group (HuMAG), University of Valencia, 46022 Valencia, Spain;
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27
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Abou L, Malala VD, Yarnot R, Alluri A, Rice LA. Effects of Virtual Reality Therapy on Gait and Balance Among Individuals With Spinal Cord Injury: A Systematic Review and Meta-analysis. Neurorehabil Neural Repair 2020; 34:375-388. [PMID: 32270736 DOI: 10.1177/1545968320913515] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Background and Purpose. The use of virtual reality (VR) therapy among individuals with spinal cord injury (SCI) is a relatively new rehabilitation approach replicating real-life scenarios. The aim of this study was to evaluate the effectiveness of VR therapy for improving gait and balance in individuals with SCI. Methods. Databases of PubMed, Web of Science, Scopus, SportDiscuss, and CINHAL were searched from inception until September 2019. Two independent reviewers screened articles for inclusion, extracted data, and evaluated methodological quality of the trials. Results. Ten trials, including 3 randomized clinical trials (RCTs) and 7 pre-post trials, with a total of 149 participants were analyzed. Meta-analysis of RCTs demonstrated significant improvement in sitting balance (standardized mean difference [SMD] = 1.65; 95% CI 1.21-2.09; P < .01) after VR therapy with conventional rehabilitation compared with only conventional rehabilitation. Also, pre-post studies using VR therapy without a control group showed improvement in standing balance (Berg Balance Scale, MD = 4.22; 95% CI 1.78-6.66; P < .01 and Activities-specific Balance Confidence scale, MD = 8.53; 95% CI 2.52-14.53; P = .01) and a trend for improvement in gait (SMD = 0.34; 95% CI 0.02-0.66; P = .04). Conclusion. This study demonstrated the beneficial effects of VR therapy to enhance sitting and standing balance and showed a trend of gait improvement in individuals with SCI. This conclusion is based on mainly preliminary data and therefore, more RCTs are needed to confirm the effects of the use of VR in individuals with SCI.
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Affiliation(s)
- Libak Abou
- Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Urbana, IL, USA
| | - Vonjiniaina Domohina Malala
- Unité de Formation et de Recherche en Sciences et Techniques des Activités Physiques et Sportives- UFR STAPS, Université Paris Sud, Bures Sur Yvette, Île-de-France, France
| | - Rebecca Yarnot
- Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Urbana, IL, USA
| | - Aditya Alluri
- Department of Molecular and Cellular Biology, University of Illinois at Urbana-Champaign, Urbana, IL, USA
| | - Laura A Rice
- Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Urbana, IL, USA
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28
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Efficacy of Virtual Reality Rehabilitation after Spinal Cord Injury: A Systematic Review. BIOMED RESEARCH INTERNATIONAL 2019; 2019:7106951. [PMID: 31828120 PMCID: PMC6885151 DOI: 10.1155/2019/7106951] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Revised: 08/19/2019] [Accepted: 08/31/2019] [Indexed: 01/01/2023]
Abstract
Background Spinal cord injury (SCI) is often associated with long-term impairments related to functional limitations in the sensorimotor system. The use of virtual reality (VR) technology may lead to increased motivation and engagement, besides allowing a wide range of possible tasks/exercises to be implemented in rehabilitation programs. The present review aims to investigate the possible benefits and efficacy of VR-based rehabilitation in individuals with SCI. Methods An electronically systematic search was performed in multiple databases (PubMed, BVS, Web of Science, Cochrane Central, and Scielo) up to May 2019. MESH terms and keywords were combined in a search strategy. Two reviewers independently selected the studies in accordance with eligibility criteria. The PEDro scale was used to score the methodological quality and risk of bias of the selected studies. Results Twenty-five studies (including 482 participants, 47.6 ± 9.5 years, 73% male) were selected and discussed. Overall, the studies used VR devices in different rehabilitation protocols to improve motor function, driving skills, balance, aerobic function, and pain level, as well as psychological and motivational aspects. A large amount of heterogeneity was observed as to the study design, VR protocols, and outcome measures used. Only seven studies (28%) had an excellent/good quality of evidence. However, substantial evidence for significant positive effects associated with VR therapy was found in most of the studies (88%), with no adverse events (88%) being reported. Conclusion Although the current evidence is limited, the findings suggest that VR-based rehabilitation in subjects with SCI may lead to positive effects on aerobic function, balance, pain level, and motor function recovery besides improving psychological/motivational aspects. Further high-quality studies are needed to provide a guideline to clinical practice and to draw robust conclusions about the potential benefits of VR therapy for SCI patients. Protocol details are registered on PROSPERO (registration number: CRD42016052629).
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29
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Zoulias ID, Armengol M, Poulton A, Andrews B, Gibbons R, Harwin WS, Holderbaum W. Novel instrumented frame for standing exercising of users with complete spinal cord injuries. Sci Rep 2019; 9:13003. [PMID: 31506460 PMCID: PMC6736978 DOI: 10.1038/s41598-019-49237-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2018] [Accepted: 08/15/2019] [Indexed: 11/10/2022] Open
Abstract
This paper describes a Functional Electrical Stimulation (FES) standing system for rehabilitation of bone mineral density (BMD) in people with Spinal Cord Injury (SCI). BMD recovery offers an increased quality of life for people with SCI by reducing their risk of fractures. The standing system developed comprises an instrumented frame equipped with force plates and load cells, a motion capture system, and a purpose built 16-channel FES unit. This system can simultaneously record and process a wide range of biomechanical data to produce muscle stimulation which enables users with SCI to safely stand and exercise. An exergame provides visual feedback to the user to assist with upper-body posture control during exercising. To validate the system an alternate weight-shift exercise was used; 3 participants with complete SCI exercised in the system for 1 hour twice-weekly for 6 months. We observed ground reaction forces over 70% of the full body-weight distributed to the supporting leg at each exercising cycle. Exercise performance improved for each participant by an increase of 13.88 percentage points of body-weight in the loading of the supporting leg during the six-month period. Importantly, the observed ground reaction forces are of higher magnitude than other studies which reported positive effects on BMD. This novel instrumentation aims to investigate weight bearing standing therapies aimed at determining the biomechanics of lower limb joint force actions and postural kinematics.
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Affiliation(s)
| | - Monica Armengol
- School of Biological Sciences, University of Reading, Reading, UK
| | - Adrian Poulton
- School of Computing and Communications, Open University, Milton Keynes, UK
| | - Brian Andrews
- Nuffield Department of Surgical Sciences, Oxford, UK.,School of Engineering, University of Warwick, Warwick, UK
| | - Robin Gibbons
- Aspire CREATe, University College London, London, UK
| | - William S Harwin
- School of Biological Sciences, University of Reading, Reading, UK
| | - William Holderbaum
- School of Biological Sciences, University of Reading, Reading, UK.,School of Engineering, Metropolitan University of Manchester, Manchester, UK
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30
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Physical Exercise for Individuals With Spinal Cord Injury: Systematic Review Based on the International Classification of Functioning, Disability, and Health. J Sport Rehabil 2019; 28:505-516. [DOI: 10.1123/jsr.2017-0185] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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31
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Unger J, Chan K, Scovil CY, Craven BC, Mansfield A, Masani K, Musselman KE. Intensive Balance Training for Adults With Incomplete Spinal Cord Injuries: Protocol for an Assessor-Blinded Randomized Clinical Trial. Phys Ther 2019; 99:420-427. [PMID: 30576475 PMCID: PMC6438350 DOI: 10.1093/ptj/pzy153] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2018] [Accepted: 09/26/2018] [Indexed: 11/13/2022]
Abstract
BACKGROUND Impaired reactive balance control can lead to increased falls in people with neurological impairments. Perturbation-based balance training (PBT), which involves repetitive exposure to destabilizing external perturbations, improves the ability to take reactive steps in older adults and individuals who have had a stroke. OBJECTIVE The objective is to investigate whether PBT or conventional intensive balance training (CIBT) results in greater improvements in reactive stepping ability in individuals with chronic incomplete spinal cord injury (iSCI). DESIGN The design consists of an assessor-blind randomized clinical trial comparing the efficacy of 2 balance training programs (PBT and CIBT) matched for training duration (thrice weekly for 8 weeks). SETTING A tertiary spinal cord injury rehabilitation center is used as the setting. PARTICIPANTS Participants include 24 adults with iSCI classified as a C or D on the American Spinal Association Impairment Scale, who are able to stand independently and exhibit moderate trunk control. INTERVENTION Both PBT and CIBT involve 24 sessions, each 1 hour long, of individualized static and dynamic balance tasks. However, PBT includes external, unexpected balance perturbations provided manually by the trainer at a frequency of roughly 1 per training minute. MEASUREMENTS The primary outcome is the ability to recover balance using a single step during the Lean-and-Release test, a novel method of assessing reactive balance. Secondary outcomes include a number of clinical balance and gait assessments, and the number of falls experienced in a 6-month follow-up period. Semi-structured interviews are conducted 3 months after training completion to gain insight into the participants' perceptions of the impact of the interventions. LIMITATIONS A control group receiving "standard care" for balance training is not included. CONCLUSIONS This trial will provide physical therapists with insight into the efficacy of 2 forms of balance training for individuals with iSCI.
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Affiliation(s)
- Janelle Unger
- Rehabilitation Sciences Institute, University of Toronto; and Toronto Rehabilitation Institute, University Health Network, Toronto, Canada
| | - Katherine Chan
- Rehabilitation Sciences Institute, University of Toronto; and Toronto Rehabilitation Institute, University Health Network
| | - Carol Y Scovil
- Brain and Spinal Cord Rehabilitation Program, Toronto Rehabilitation Institute, University Health Network; and Department of Occupational Science and Occupational Therapy, University of Toronto
| | - B Catharine Craven
- Rehabilitation Sciences Institute, University of Toronto; Toronto Rehabilitation Institute, University Health Network; Brain and Spinal Cord Rehabilitation Program, Toronto Rehabilitation Institute, University Health Network; and Division of Physical Medicine and Rehabilitation, Department of Medicine, University of Toronto
| | - Avril Mansfield
- Toronto Rehabilitation Institute, University Health Network; Sunnybrook Research Institute, Toronto; and Department of Physical Therapy, Faculty of Medicine, University of Toronto
| | - Kei Masani
- Toronto Rehabilitation Institute, University Health Network; and Institute of Biomaterials and Biomedical Engineering, University of Toronto
| | - Kristin E Musselman
- Rehabilitation Sciences Institute, University of Toronto; Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada M4G 3V9; and Department of Physical Therapy, Faculty of Medicine, University of Toronto
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Sayenko DG, Rath M, Ferguson AR, Burdick JW, Havton LA, Edgerton VR, Gerasimenko YP. Self-Assisted Standing Enabled by Non-Invasive Spinal Stimulation after Spinal Cord Injury. J Neurotrauma 2018; 36:1435-1450. [PMID: 30362876 DOI: 10.1089/neu.2018.5956] [Citation(s) in RCA: 123] [Impact Index Per Article: 20.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Neuromodulation of spinal networks can improve motor control after spinal cord injury (SCI). The objectives of this study were to (1) determine whether individuals with chronic paralysis can stand with the aid of non-invasive electrical spinal stimulation with their knees and hips extended without trainer assistance, and (2) investigate whether postural control can be further improved following repeated sessions of stand training. Using a double-blind, balanced, within-subject cross-over, and sham-controlled study design, 15 individuals with SCI of various severity received transcutaneous electrical spinal stimulation to regain self-assisted standing. The primary outcomes included qualitative comparison of need of external assistance for knee and hip extension provided by trainers during standing without and in the presence of stimulation in the same participants, as well as quantitative measures, such as the level of knee assistance and amount of time spent standing without trainer assistance. None of the participants could stand unassisted without stimulation or in the presence of sham stimulation. With stimulation all participants could maintain upright standing with minimum and some (n = 7) without external assistance applied to the knees or hips, using their hands for upper body balance as needed. Quality of balance control was practice-dependent, and improved with subsequent training. During self-initiated body-weight displacements in standing enabled by spinal stimulation, high levels of leg muscle activity emerged, and depended on the amount of muscle loading. Our findings indicate that the lumbosacral spinal networks can be modulated transcutaneously using electrical spinal stimulation to facilitate self-assisted standing after chronic motor and sensory complete paralysis.
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Affiliation(s)
- Dimitry G Sayenko
- 1 Department of Integrative Biology and Physiology, University of California, Los Angeles, California.,2 Department of Neurosurgery, Center for Neuroregeneration, Houston Methodist Research Institute, Houston, Texas
| | - Mrinal Rath
- 1 Department of Integrative Biology and Physiology, University of California, Los Angeles, California.,3 Department of Biomedical Engineering, University of California, Los Angeles, California
| | - Adam R Ferguson
- 4 Brain and Spinal Injury Center, Department of Neurological Surgery, University of California, San Francisco, California
| | - Joel W Burdick
- 5 Division of Engineering and Applied Sciences, California Institute of Technology, Pasadena, California
| | - Leif A Havton
- 6 Departments of Neurology and Neurobiology, University of California, Los Angeles, California
| | - V Reggie Edgerton
- 1 Department of Integrative Biology and Physiology, University of California, Los Angeles, California.,3 Department of Biomedical Engineering, University of California, Los Angeles, California.,7 Institut Guttmann, Hospital de Neurorehabilitació, Institut Universitari adscrit a la Universitat Autònoma de Barcelona, Barcelona, Badalona, Spain.,8 Departments of Neurobiology and Neurosurgery, University of California, Los Angeles, California.,9 Centre for Neuroscience and Regenerative Medicine, Faculty of Science, University of Technology Sydney, Sydney, New South Wales, Australia
| | - Yury P Gerasimenko
- 1 Department of Integrative Biology and Physiology, University of California, Los Angeles, California.,10 Pavlov Institute of Physiology, St. Petersburg, Russia
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Unger J, Jervis Rademeyer H, Furlan JC, Pujol C, Dawe J, Musselman KE. Personalized adapted locomotor training for an individual with sequelae of West Nile virus infection: a mixed-method case report. Physiother Theory Pract 2018; 36:844-854. [PMID: 30136877 DOI: 10.1080/09593985.2018.1510450] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
BACKGROUND West Nile virus (WNV) can have severe consequences, including encephalitis and paralysis. Purpose: To describe the benefits of intensive locomotor training (LT) for an individual with a previous WNV infection resulting in chronic paraplegia. Case Description: The patient, who became a wheelchair user following standard rehabilitation, began LT 3 years post infection. Her goals included standing and walking with an assistive device and transferring independently. The intervention consisted of bodyweight-supported treadmill training and overground training, which involved walking, balancing, strengthening, and transferring activities. Outcomes: Following 5 months of LT, the patient ambulated independently with a walker at a speed = 0.34m/s. She walked 110.1 metres in 6 minutes and increased her Berg Balance Scale score by 17 points. These improvements were either maintained or further increased 3 months post LT. The patient's perspectives on LT were collected through a semi-structured interview. A conventional content analysis, which uses data to drive themes, revealed three themes: (1) recalibrating goals, (2) outcomes (i.e. physical and psychological benefits, such as a sense of accomplishment), and (3) challenges of LT and effective coping strategies. Conclusions: The patient demonstrated improved balance and walking abilities. Intensive LT was feasible and effective for this individual with chronic paraplegia due to WNV infection.
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Affiliation(s)
- Janelle Unger
- Lyndhurst Centre, Toronto Rehabilitation Institute-University Health Network , Toronto, ON, Canada.,Rehabilitation Sciences Institute, Faculty of Medicine, University of Toronto , Toronto, ON, Canada
| | - Hope Jervis Rademeyer
- Lyndhurst Centre, Toronto Rehabilitation Institute-University Health Network , Toronto, ON, Canada.,School of Physical Therapy, College of Medicine, University of Saskatchewan , Saskatoon, SK, Canada
| | - Julio C Furlan
- Lyndhurst Centre, Toronto Rehabilitation Institute-University Health Network , Toronto, ON, Canada.,Department of Medicine, Division of Physical Medicine and Rehabilitation, University of Toronto , Toronto, ON, Canada
| | - Clara Pujol
- Lyndhurst Centre, Toronto Rehabilitation Institute-University Health Network , Toronto, ON, Canada
| | - Jaclyn Dawe
- Lyndhurst Centre, Toronto Rehabilitation Institute-University Health Network , Toronto, ON, Canada.,Rehabilitation Sciences Institute, Faculty of Medicine, University of Toronto , Toronto, ON, Canada
| | - Kristin E Musselman
- Lyndhurst Centre, Toronto Rehabilitation Institute-University Health Network , Toronto, ON, Canada.,Rehabilitation Sciences Institute, Faculty of Medicine, University of Toronto , Toronto, ON, Canada.,School of Physical Therapy, College of Medicine, University of Saskatchewan , Saskatoon, SK, Canada.,Department of Physical Therapy, Faculty of Medicine, University of Toronto , Toronto, ON, Canada
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Rath M, Vette AH, Ramasubramaniam S, Li K, Burdick J, Edgerton VR, Gerasimenko YP, Sayenko DG. Trunk Stability Enabled by Noninvasive Spinal Electrical Stimulation after Spinal Cord Injury. J Neurotrauma 2018; 35:2540-2553. [PMID: 29786465 DOI: 10.1089/neu.2017.5584] [Citation(s) in RCA: 80] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Electrical neuromodulation of spinal networks improves the control of movement of the paralyzed limbs after spinal cord injury (SCI). However, the potential of noninvasive spinal stimulation to facilitate postural trunk control during sitting in humans with SCI has not been investigated. We hypothesized that transcutaneous electrical stimulation of the lumbosacral enlargement can improve trunk posture. Eight participants with non-progressive SCI at C3-T9, American Spinal Injury Association Impairment Scale (AIS) A or C, performed different motor tasks during sitting. Electromyography of the trunk muscles, three-dimensional kinematics, and force plate data were acquired. Spinal stimulation improved trunk control during sitting in all tested individuals. Stimulation resulted in elevated activity of the erector spinae, rectus abdominis, and external obliques, contributing to improved trunk control, more natural anterior pelvic tilt and lordotic curve, and greater multi-directional seated stability. During spinal stimulation, the center of pressure (COP) displacements decreased to 1.36 ± 0.98 mm compared with 4.74 ± 5.41 mm without stimulation (p = 0.0156) in quiet sitting, and the limits of stable displacement increased by 46.92 ± 35.66% (p = 0.0156), 36.92 ± 30.48% (p = 0.0156), 54.67 ± 77.99% (p = 0.0234), and 22.70 ± 26.09% (p = 0.0391) in the forward, backward, right, and left directions, respectively. During self-initiated perturbations, the correlation between anteroposterior arm velocity and the COP displacement decreased from r = 0.5821 (p = 0.0007) without to r = 0.5115 (p = 0.0039) with stimulation, indicating improved trunk stability. These data demonstrate that the spinal networks can be modulated transcutaneously with tonic electrical spinal stimulation to physiological states sufficient to generate a more stable, erect sitting posture after chronic paralysis.
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Affiliation(s)
- Mrinal Rath
- 1 Department of Biomedical Engineering, University of California , Los Angeles, California.,2 Department of Integrative Biology and Physiology, University of California , Los Angeles, California
| | - Albert H Vette
- 3 Department of Mechanical Engineering, University of Alberta , Donadeo Innovation Centre for Engineering, Edmonton, Alberta, Canada .,4 Glenrose Rehabilitation Hospital , Alberta Health Services, Edmonton, Alberta, Canada
| | | | - Kun Li
- 5 Division of Engineering and Applied Sciences, California Institute of Technology , Pasadena, California
| | - Joel Burdick
- 5 Division of Engineering and Applied Sciences, California Institute of Technology , Pasadena, California
| | - Victor R Edgerton
- 1 Department of Biomedical Engineering, University of California , Los Angeles, California.,2 Department of Integrative Biology and Physiology, University of California , Los Angeles, California.,6 Department of Neurobiology and Neurosurgery, University of California , Los Angeles, California.,7 Institut Guttmann, Hospital de Neurorehabilitació, Institut Universitari adscrit a la Universitat Autònoma de Barcelona , Barcelona, Badalona, Spain .,8 Centre for Neuroscience and Regenerative Medicine, Faculty of Science, University of Technology , Sydney, Australia
| | - Yury P Gerasimenko
- 2 Department of Integrative Biology and Physiology, University of California , Los Angeles, California.,9 Pavlov Institute of Physiology , St. Petersburg, Russia
| | - Dimitry G Sayenko
- 2 Department of Integrative Biology and Physiology, University of California , Los Angeles, California.,10 Department of Neurosurgery, Center for Neuroregeneration, Houston Methodist Research Institute , Houston, Texas
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35
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Kręcisz K, Kuczyński M. Attentional demands associated with augmented visual feedback during quiet standing. PeerJ 2018; 6:e5101. [PMID: 30042878 PMCID: PMC6056264 DOI: 10.7717/peerj.5101] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2018] [Accepted: 06/05/2018] [Indexed: 01/04/2023] Open
Abstract
To investigate how additional visual feedback (VFB) affects postural stability we compared 20-sec center-of-pressure (COP) recordings in two conditions: without and with the VFB. Seven healthy adult subjects performed 10 trials lasting 20 seconds in each condition. Simultaneously, during all trials the simple auditory reaction time (RT) was measured. Based on the COP data, the following sway parameters were computed: standard deviation (SD), mean speed (MV), sample entropy (SE), and mean power frequency (MPF). The RT was higher in the VFB condition (p < 0.001) indicating that this condition was attention demanding. The VFB resulted in decreased SD and increased SE in both the medial-lateral (ML) and anterior-posterior (AP) planes (p < .001). These results account for the efficacy of the VFB in stabilizing posture and in producing more irregular COP signals which may be interpreted as higher automaticity and/or larger level of noise in postural control. The MPF was higher during VFB in both planes as was the MV in the AP plane only (p < 0.001). The latter data demonstrate higher activity of postural control system that was caused by the availability of the set-point on the screen and the resulting control error which facilitated and sped up postural control.
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Affiliation(s)
- Krzysztof Kręcisz
- Faculty of Physical Education and Physiotherapy, Opole University of Technology, Opole, Poland
| | - Michał Kuczyński
- Faculty of Physiotherapy, University School of Physical Education in Wroclaw, Wroclaw, Poland
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36
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Tse CM, Chisholm AE, Lam T, Eng JJ. A systematic review of the effectiveness of task-specific rehabilitation interventions for improving independent sitting and standing function in spinal cord injury. J Spinal Cord Med 2018; 41:254-266. [PMID: 28738740 PMCID: PMC6055957 DOI: 10.1080/10790268.2017.1350340] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
CONTEXT Impaired balance function after a spinal cord injury (SCI) hinders performance of daily activities. OBJECTIVE To assess the evidence on the effectiveness of task-specific training on sitting and standing function in individuals with SCI across the continuum of care. METHODS A systematic search was conducted on literature published to June 2016 using people (acute or chronic SCI), task-specific interventions compared to conventional physical therapy, and outcome (sitting or standing balance function). The PEDro scale was used to investigate the susceptibility to bias and trial quality of the randomized controlled trials (RCTs). A standardized mean difference (SMD) was conducted to investigate the effect size for interventions with sitting or standing balance outcomes. RESULTS Nineteen articles were identified; three RCTs, two prospective controlled trials, one cross-over study, nine pre-post studies and four prospective cohort studies. RCT and cross-over studies were rated from 6 to 8 indicating good quality on the PEDro scale. The SMD of task-specific interventions in sitting compared to active and inactive (no training) control groups was -0.09 (95% CI: -0.663 to 0.488) and 0.39 (95% CI: -0.165 to 0.937) respectively, indicating that the addition of task-specific exercises did not affect sit and reach test performance significantly. Similarly, the addition of BWS training did not significantly affect BBS compared to conventional physical therapy -0.36 (95% CI: -0.840 to 0.113). Task-specific interventions reported in uncontrolled trials revealed positive effects on sitting and standing balance function. CONCLUSION Few RCT studies provided balance outcomes, and those that were evaluated indicate negligible effect sizes. Given the importance of balance control underpinning all aspects of daily activities, there is a need for further research to evaluate specific features of training interventions to improve both sitting and standing balance function in SCI.
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Affiliation(s)
- Cynthia M. Tse
- School of Kinesiology, University of British Columbia, Vancouver, BC, Canada,International Collaboration On Repair Discoveries, Vancouver Costal Health Research Institute, Vancouver, BC, Canada
| | - Amanda E. Chisholm
- School of Kinesiology, University of British Columbia, Vancouver, BC, Canada,International Collaboration On Repair Discoveries, Vancouver Costal Health Research Institute, Vancouver, BC, Canada
| | - Tania Lam
- School of Kinesiology, University of British Columbia, Vancouver, BC, Canada,International Collaboration On Repair Discoveries, Vancouver Costal Health Research Institute, Vancouver, BC, Canada,Correspondence to: Tania Lam, School of Kinesiology, University of British Columbia, 210–6081 University Blvd, Vancouver, BC, Canada, V6T 1Z1.
| | - Janice J. Eng
- International Collaboration On Repair Discoveries, Vancouver Costal Health Research Institute, Vancouver, BC, Canada,Department of Physical Therapy, University of British Columbia, Vancouver, BC, Canada,GF Strong Rehabilitation Center, Vancouver, BC, Canada
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Williams AD, Boser QA, Kumawat AS, Agarwal K, Rouhani H, Vette AH. Design and Evaluation of an Instrumented Wobble Board for Assessing and Training Dynamic Seated Balance. J Biomech Eng 2018; 140:2666620. [DOI: 10.1115/1.4038747] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2017] [Indexed: 11/08/2022]
Abstract
Methods that effectively assess and train dynamic seated balance are critical for enhancing functional independence and reducing risk of secondary health complications in the elderly and individuals with neuromuscular impairments. The objective of this research was to devise and validate a portable tool for assessing and training dynamic seated balance. An instrumented wobble board was designed and constructed that (1) elicits multidirectional perturbations in seated individuals, (2) quantifies seated balance proficiency, and (3) provides real-time, kinematics-based vibrotactile feedback. After performing a technical validation study to compare kinematic wobble board measurements against a gold-standard motion capture system, 15 nondisabled participants performed a dynamic sitting task using the wobble board. Our results demonstrate that the tilt angle measurements were highly accurate throughout the range of wobble board dynamics. Furthermore, the posturographic analyses for the dynamic sitting task revealed that the wobble board can effectively discriminate between the different conditions of perturbed balance, demonstrating its potential to serve as a clinical tool for the assessment and training of seated balance. Vibrotactile feedback decreased the variance of wobble board tilt, demonstrating its potential for use as a balance training tool. Unlike similar instrumented tools, the wobble board is portable, requires no laboratory equipment, and can be adjusted to meet the user's balance abilities. While future work is warranted, obtained findings will aid in effective translation of assessment and training techniques to a clinical setting, which has the potential to enhance the diagnosis and prognosis for individuals with seated balance impairments.
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Affiliation(s)
- Andrew D. Williams
- Department of Biomedical Engineering, Research Transition Facility, University of Alberta, 8308-114 Street, Edmonton, AB T6G 2V2, Canada e-mail:
| | - Quinn A. Boser
- Department of Biomedical Engineering, Research Transition Facility, University of Alberta, 8308-114 Street, Edmonton, AB T6G 2V2, Canada e-mail:
| | - Animesh Singh Kumawat
- Faculty of Kinesiology and Physical Education, University of Toronto, WS2021F, 55 Harbord Street, Toronto, ON M5S 2W6, Canada e-mail:
| | - Kshitij Agarwal
- Department of Biomedical Engineering, Research Transition Facility, University of Alberta, 8308-114 Street, Edmonton, AB T6G 2V2, Canada e-mail:
| | - Hossein Rouhani
- Department of Mechanical Engineering, Donadeo Innovation Centre for Engineering, University of Alberta, 9211-116 Street, Edmonton, AB T6G 1H9, Canada e-mail:
| | - Albert H. Vette
- Mem. ASME Department of Mechanical Engineering, Donadeo Innovation Centre for Engineering, University of Alberta, 9211-116 Street, Edmonton, AB T6G 1H9, Canada e-mail:
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Kumar D, González A, Das A, Dutta A, Fraisse P, Hayashibe M, Lahiri U. Virtual Reality-Based Center of Mass-Assisted Personalized Balance Training System. Front Bioeng Biotechnol 2018; 5:85. [PMID: 29359128 PMCID: PMC5765271 DOI: 10.3389/fbioe.2017.00085] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2017] [Accepted: 12/18/2017] [Indexed: 01/05/2023] Open
Abstract
Poststroke hemiplegic patients often show altered weight distribution with balance disorders, increasing their risk of fall. Conventional balance training, though powerful, suffers from scarcity of trained therapists, frequent visits to clinics to get therapy, one-on-one therapy sessions, and monotony of repetitive exercise tasks. Thus, technology-assisted balance rehabilitation can be an alternative solution. Here, we chose virtual reality as a technology-based platform to develop motivating balance tasks. This platform was augmented with off-the-shelf available sensors such as Nintendo Wii balance board and Kinect to estimate one’s center of mass (CoM). The virtual reality-based CoM-assisted balance tasks (Virtual CoMBaT) was designed to be adaptive to one’s individualized weight-shifting capability quantified through CoM displacement. Participants were asked to interact with Virtual CoMBaT that offered tasks of varying challenge levels while adhering to ankle strategy for weight shifting. To facilitate the patients to use ankle strategy during weight-shifting, we designed a heel lift detection module. A usability study was carried out with 12 hemiplegic patients. Results indicate the potential of our system to contribute to improving one’s overall performance in balance-related tasks belonging to different difficulty levels.
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Affiliation(s)
- Deepesh Kumar
- Department of Electrical Engineering, Indian Institute of Technology Gandhinagar, Gandhinagar, India
| | - Alejandro González
- INRIA Camin team and LIRMM, University of Montpellier, Montpellier, France.,Conacyt-Universidad Autonoma de San Luis Potosi, San Luis Potosi, Mexico
| | - Abhijit Das
- AMRI Institute of Neuroscience, Kolkata, India
| | - Anirban Dutta
- Department of Biomedical Engineering, University at Buffalo, Buffalo, NY, United States
| | - Philippe Fraisse
- INRIA Camin team and LIRMM, University of Montpellier, Montpellier, France
| | - Mitsuhiro Hayashibe
- INRIA Camin team and LIRMM, University of Montpellier, Montpellier, France.,Department of Robotics, Tohoku University, Sendai, Japan
| | - Uttama Lahiri
- Department of Electrical Engineering, Indian Institute of Technology Gandhinagar, Gandhinagar, India
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Taccola G, Sayenko D, Gad P, Gerasimenko Y, Edgerton VR. And yet it moves: Recovery of volitional control after spinal cord injury. Prog Neurobiol 2017; 160:64-81. [PMID: 29102670 PMCID: PMC5773077 DOI: 10.1016/j.pneurobio.2017.10.004] [Citation(s) in RCA: 114] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2017] [Revised: 10/09/2017] [Accepted: 10/21/2017] [Indexed: 12/12/2022]
Abstract
Preclinical and clinical neurophysiological and neurorehabilitation research has generated rather surprising levels of recovery of volitional sensory-motor function in persons with chronic motor paralysis following a spinal cord injury. The key factor in this recovery is largely activity-dependent plasticity of spinal and supraspinal networks. This key factor can be triggered by neuromodulation of these networks with electrical and pharmacological interventions. This review addresses some of the systems-level physiological mechanisms that might explain the effects of electrical modulation and how repetitive training facilitates the recovery of volitional motor control. In particular, we substantiate the hypotheses that: (1) in the majority of spinal lesions, a critical number and type of neurons in the region of the injury survive, but cannot conduct action potentials, and thus are electrically non-responsive; (2) these neuronal networks within the lesioned area can be neuromodulated to a transformed state of electrical competency; (3) these two factors enable the potential for extensive activity-dependent reorganization of neuronal networks in the spinal cord and brain, and (4) propriospinal networks play a critical role in driving this activity-dependent reorganization after injury. Real-time proprioceptive input to spinal networks provides the template for reorganization of spinal networks that play a leading role in the level of coordination of motor pools required to perform a given functional task. Repetitive exposure of multi-segmental sensory-motor networks to the dynamics of task-specific sensory input as occurs with repetitive training can functionally reshape spinal and supraspinal connectivity thus re-enabling one to perform complex motor tasks, even years post injury.
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Affiliation(s)
- G Taccola
- Department of Integrative Biology and Physiology, University of California, Los Angeles, CA 90095 USA; Neuroscience Department, International School for Advanced Studies (SISSA), Bonomea 265, Trieste, Italy
| | - D Sayenko
- Department of Integrative Biology and Physiology, University of California, Los Angeles, CA 90095 USA
| | - P Gad
- Department of Integrative Biology and Physiology, University of California, Los Angeles, CA 90095 USA
| | - Y Gerasimenko
- Department of Integrative Biology and Physiology, University of California, Los Angeles, CA 90095 USA; Pavlov Institute of Physiology, St. Petersburg 199034, Russia
| | - V R Edgerton
- Department of Integrative Biology and Physiology, University of California, Los Angeles, CA 90095 USA; Department of Neurobiology, University of California, Los Angeles, CA 90095 USA; Department of Neurosurgery, University of California, Los Angeles, CA 90095 USA; Brain Research Institute, University of California, Los Angeles, CA 90095 USA; The Centre for Neuroscience and Regenerative Medicine, Faculty of Science, University of Technology Sydney, Ultimo, 2007 NSW, Australia; Institut Guttmann, Hospital de Neurorehabilitació, Institut Universitari adscrit a la Universitat Autònoma de Barcelona, Barcelona, 08916 Badalona, Spain.
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40
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Dos Anjos FV, Pinto TP, Gazzoni M, Vieira TM. The Spatial Distribution of Ankle Muscles Activity Discriminates Aged from Young Subjects during Standing. Front Hum Neurosci 2017; 11:190. [PMID: 28469567 PMCID: PMC5395606 DOI: 10.3389/fnhum.2017.00190] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2016] [Accepted: 03/31/2017] [Indexed: 11/13/2022] Open
Abstract
During standing, age-related differences in the activation of ankle muscles have been reported from surface electromyograms (EMGs) sampled locally. Given though activity seems to distribute unevenly within ankle muscles, the local sampling of surface EMGs may provide a biased view on how often and how much elderly and young individuals activate these muscles during standing. This study aimed therefore at sampling EMGs from multiple regions of individual ankle muscles to evaluate whether the distribution of muscle activity differs between aged and young subjects during standing. Thirteen young and eleven aged, healthy subjects were tested. Surface EMGs were sampled at multiple skin locations from tibialis anterior, soleus and medial and lateral gastrocnemius muscles while subjects stood at ease. The root mean square amplitude of EMGs was considered to estimate the duration, the degree of activity and the size of the region where muscle activity was detected. Our main findings revealed the medial gastrocnemius was active for longer periods in aged (interquartile interval; 74.1-98.2%) than young (44.9-81.9%) individuals (P = 0.02). Similarly, while tibialis anterior was rarely active in young (0.7-4.4%), in elderly subjects (2.6-82.5%) it was often recruited (P = 0.01). Moreover, EMGs with relatively higher amplitude were detected over a significantly wider proximo-distal region of medial gastrocnemius in aged (29.4-45.6%) than young (20.1-31.3%) subjects (P = 0.04). These results indicate the duration and the size of active muscle volume, as quantified from the spatial distribution of surface EMGs, may discriminate aged from young individuals during standing; elderlies seem to rely more heavily on the active loading of ankle muscles to control their standing posture than young individuals. Most importantly, current results suggest different conclusions on the active control of standing posture may be drawn depending on the skin location from where EMGs are collected, in particular for the medial gastrocnemius.
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Affiliation(s)
- Fabio V Dos Anjos
- Laboratorio di Ingegneria del Sistema Neuromuscolare, Dipartimento di Elettronica e Telecomunicazioni, Politecnico di TorinoTorino, Italy
| | - Talita P Pinto
- Laboratorio di Ingegneria del Sistema Neuromuscolare, Dipartimento di Elettronica e Telecomunicazioni, Politecnico di TorinoTorino, Italy
| | - Marco Gazzoni
- Laboratorio di Ingegneria del Sistema Neuromuscolare, Dipartimento di Elettronica e Telecomunicazioni, Politecnico di TorinoTorino, Italy
| | - Taian M Vieira
- Laboratorio di Ingegneria del Sistema Neuromuscolare, Dipartimento di Elettronica e Telecomunicazioni, Politecnico di TorinoTorino, Italy
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Roosink M, Robitaille N, Jackson PL, Bouyer LJ, Mercier C. Interactive virtual feedback improves gait motor imagery after spinal cord injury: An exploratory study. Restor Neurol Neurosci 2016; 34:227-35. [PMID: 26890097 PMCID: PMC4927914 DOI: 10.3233/rnn-150563] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Purpose: Motor imagery can improve motor function and reduce pain. This is relevant to individuals with spinal cord injury (SCI) in whom motor dysfunction and neuropathic pain are prevalent. However, therapy efficacy could be dependent on motor imagery ability, and a clear understanding of how motor imagery might be facilitated is currently lacking. Thus, the aim of the present study was to assess the immediate effects of interactive virtual feedback on motor imagery performance after SCI. Methods: Nine individuals with a traumatic SCI participated in the experiment. Motor imagery tasks consisted of forward (i.e. simpler) and backward (i.e. more complex) walking while receiving interactive versus static virtual feedback. Motor imagery performance (vividness, effort and speed), neuropathic pain intensity and feasibility (immersion, distraction, side-effects) were assessed. Results: During interactive feedback trials, motor imagery vividness and speed were significantly higher and effort was significantly lower as compared static feedback trials. No change in neuropathic pain was observed. Adverse effects were minor, and immersion was reported to be good. Conclusions: This exploratory study showed that interactive virtual walking was feasible and facilitated motor imagery performance. The response to motor imagery interventions after SCI might be improved by using interactive virtual feedback.
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Affiliation(s)
- Meyke Roosink
- Center for Interdisciplinary Research in Rehabilitation and Social Integration (CIRRIS), Québec, QC, Canada
| | - Nicolas Robitaille
- Center for Interdisciplinary Research in Rehabilitation and Social Integration (CIRRIS), Québec, QC, Canada
| | - Philip L Jackson
- Center for Interdisciplinary Research in Rehabilitation and Social Integration (CIRRIS), Québec, QC, Canada.,School of Psychology, Laval University, Québec, QC, Canada
| | - Laurent J Bouyer
- Center for Interdisciplinary Research in Rehabilitation and Social Integration (CIRRIS), Québec, QC, Canada.,Department of Rehabilitation, Faculty of Medicine, Laval University, Québec, QC, Canada
| | - Catherine Mercier
- Center for Interdisciplinary Research in Rehabilitation and Social Integration (CIRRIS), Québec, QC, Canada.,Department of Rehabilitation, Faculty of Medicine, Laval University, Québec, QC, Canada
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Claverie L, Ille A, Moretto P. Discrete sensors distribution for accurate plantar pressure analyses. Med Eng Phys 2016; 38:1489-1494. [PMID: 27745875 DOI: 10.1016/j.medengphy.2016.09.021] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2015] [Revised: 06/28/2016] [Accepted: 09/26/2016] [Indexed: 11/26/2022]
Abstract
The aim of this study was to determine the distribution of discrete sensors under the footprint for accurate plantar pressure analyses. For this purpose, two different sensor layouts have been tested and compared, to determine which was the most accurate to monitor plantar pressure with wireless devices in research and/or clinical practice. Ten healthy volunteers participated in the study (age range: 23-58 years). The barycenter of pressures (BoP) determined from the plantar pressure system (W-inshoe®) was compared to the center of pressures (CoP) determined from a force platform (AMTI) in the medial-lateral (ML) and anterior-posterior (AP) directions. Then, the vertical ground reaction force (vGRF) obtained from both W-inshoe® and force platform was compared for both layouts for each subject. The BoP and vGRF determined from the plantar pressure system data showed good correlation (SCC) with those determined from the force platform data, notably for the second sensor organization (ML SCC= 0.95; AP SCC=0.99; vGRF SCC=0.91). The study demonstrates that an adjusted placement of removable sensors is key to accurate plantar pressure analyses. These results are promising for a plantar pressure recording outside clinical or laboratory settings, for long time monitoring, real time feedback or for whatever activity requiring a low-cost system.
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Affiliation(s)
- Laetitia Claverie
- Université de Toulouse III, UPS, PRISSMH, 118 route de Narbonne, F-31062 Toulouse Cedex 9, France
| | - Anne Ille
- Université de Toulouse III, UPS, PRISSMH, 118 route de Narbonne, F-31062 Toulouse Cedex 9, France
| | - Pierre Moretto
- Université de Toulouse III, UPS, Centre de Recherche sur la Cognition animale, Centre de Biologie Intégrative (CBI), 118 route de Narbonne, F-31062 Toulouse Cedex 9, France; CNRS, Centre de Recherche sur la Cognition animale, Centre de Biologie Intégrative (CBI), 118 route de Narbonne, F-31062 Toulouse Cedex 9, France.
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Can augmented feedback facilitate learning a reactive balance task among older adults? Exp Brain Res 2016; 235:293-304. [PMID: 27709269 DOI: 10.1007/s00221-016-4790-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2016] [Accepted: 09/28/2016] [Indexed: 10/20/2022]
Abstract
While concurrent augmented visual feedback of the center of pressure (COP) or center of gravity (COG) can improve quiet standing balance control, it is not known whether such feedback improves reactive balance control. Additionally, it is not known whether feedback of the COP or COG is superior. This study aimed to determine whether (1) concurrent augmented feedback can improve reactive balance control, and (2) feedback of the COP or COG is more effective. Forty-eight healthy older adults (60-75 years old) were randomly allocated to one of three groups: feedback of the COP, feedback of the COG, or no feedback. The task was to maintain standing while experiencing 30 s of continuous pseudo-random perturbations delivered by a moving platform. Participants completed 25 trials with or without feedback (acquisition), immediately followed by 5 trials without feedback (immediate transfer); 5 trials without feedback were completed after a 24-h delay (delayed transfer). The root mean square error (RMSE) of COP-COG, electrodermal level, and co-contraction index were compared between the groups and over time. All three groups reduced RMSE and co-contraction index from the start of the acquisition to the transfer tests, and there were no significant between-group differences in RMSE or co-contraction on the transfer tests. Therefore, all three groups learned the task equally well, and improved balance was achieved with practice via a more efficient control strategy. The two feedback groups reduced electrodermal level with practice, but the no-feedback group did not, suggesting that feedback may help to reduce anxiety.
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dos Anjos F, Lemos T, Imbiriba LA. Does the type of visual feedback information change the control of standing balance? Eur J Appl Physiol 2016; 116:1771-9. [DOI: 10.1007/s00421-016-3434-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2016] [Accepted: 07/12/2016] [Indexed: 11/25/2022]
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Vieira TM, Baudry S, Botter A. Young, Healthy Subjects Can Reduce the Activity of Calf Muscles When Provided with EMG Biofeedback in Upright Stance. Front Physiol 2016; 7:158. [PMID: 27199773 PMCID: PMC4850153 DOI: 10.3389/fphys.2016.00158] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2016] [Accepted: 04/14/2016] [Indexed: 11/13/2022] Open
Abstract
Recent evidence suggests the minimization of muscular effort rather than of the size of bodily sway may be the primary, nervous system goal when regulating the human, standing posture. Different programs have been proposed for balance training; none however has been focused on the activation of postural muscles during standing. In this study we investigated the possibility of minimizing the activation of the calf muscles during standing through biofeedback. By providing subjects with an audio signal that varied in amplitude and frequency with the amplitude of surface electromyograms (EMG) recorded from different regions of the gastrocnemius and soleus muscles, we expected them to be able to minimize the level of muscle activation during standing without increasing the excursion of the center of pressure (CoP). CoP data and surface EMG from gastrocnemii, soleus and tibialis anterior muscles were obtained from 10 healthy participants while standing at ease and while standing with EMG biofeedback. Four sensitivities were used to test subjects' responsiveness to the EMG biofeedback. Compared with standing at ease, the two most sensitive feedback conditions induced a decrease in plantar flexor activity (~15%; P < 0.05) and an increase in tibialis anterior EMG (~10%; P < 0.05). Furthermore, CoP mean position significantly shifted backward (~30 mm). In contrast, the use of less sensitive EMG biofeedback resulted in a significant decrease in EMG activity of ankle plantar flexors with a marginal increase in TA activity compared with standing at ease. These changes were not accompanied by greater CoP displacements or significant changes in mean CoP position. Key results revealed subjects were able to keep standing stability while reducing the activity of gastrocnemius and soleus without loading their tibialis anterior muscle when standing with EMG biofeedback. These results may therefore posit the basis for the development of training protocols aimed at assisting subjects in more efficiently controlling leg muscle activity during standing.
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Affiliation(s)
- Taian M Vieira
- Laboratorio di Ingegneria del Sistema Neuromuscolare, Dipartimento di Elettronica e Telecomunicazioni, Politecnico di TorinoTorino, Italia; Escola de Educação Física e Desportos, Departamento de Arte Corporal, Universidade Federal do Rio de JaneiroRio de Janeiro, Brasil
| | - Stéphane Baudry
- Laboratory of Applied Biology and Neurophysiology, ULB Neuroscience Institute, Université libre de Bruxelles Brussels, Belgium
| | - Alberto Botter
- Laboratorio di Ingegneria del Sistema Neuromuscolare, Dipartimento di Elettronica e Telecomunicazioni, Politecnico di Torino Torino, Italia
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Toumi A, Jakobi JM, Simoneau-Buessinger E. Differential impact of visual feedback on plantar- and dorsi-flexion maximal torque output. Appl Physiol Nutr Metab 2016; 41:557-9. [PMID: 27031663 DOI: 10.1139/apnm-2015-0639] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
The effect of visual feedback on enhancing isometric maximal voluntary contractions (MVC) was evaluated. Twelve adults performed plantar-flexion and dorsi-flexion MVCs in 3 conditions (no visual feedback, visual feedback, and visual feedback with target). There was no significant effect of visual conditions on dorsi-flexion MVC but there was an effect on plantar-flexion. Irrespective of whether a target was evident, visual feedback increased plantar-flexion MVC by ∼15%. This study highlights the importance of optimal feedback to enhance MVC.
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Affiliation(s)
- Anis Toumi
- a Laboratoire d'Automatique, de Mécanique, et d'Informatique industrielles et Humaines (LAMIH) - UMR CNRS 8201, Université de Valenciennes et du Hainaut-Cambrésis (UVHC), F-59313 Valenciennes, France
| | - Jennifer M Jakobi
- b School of Health and Exercise Sciences, University of British Columbia Okanagan, Kelowna, BC V1V 1V7, Canada
| | - Emilie Simoneau-Buessinger
- a Laboratoire d'Automatique, de Mécanique, et d'Informatique industrielles et Humaines (LAMIH) - UMR CNRS 8201, Université de Valenciennes et du Hainaut-Cambrésis (UVHC), F-59313 Valenciennes, France
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Task-specificity of balance training. Hum Mov Sci 2015; 44:22-31. [PMID: 26298214 DOI: 10.1016/j.humov.2015.08.012] [Citation(s) in RCA: 89] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2015] [Revised: 07/30/2015] [Accepted: 08/17/2015] [Indexed: 11/20/2022]
Abstract
Despite much research on balance training, it is still unclear whether balance training leads to highly task-specific adaptations or rather non-specific adaptations. Hence, in this study we examined whether balance training increased performance only in the balance task that was trained or also in non-trained tasks. Forty healthy participants (28 m 12 f, 25 ± 4 years, 177 ± 10 cm, 73 ± 14 kg) were assigned to one of two training groups (TGs) or a control group. Both TGs completed six sessions over 2 weeks, only the training device differed. Before and after the training, performance in the trained task as well as in additional untrained tasks was recorded. ANOVAs showed that each TG outperformed the other groups only in the task they had trained (e.g., task trained by TG1: +225% in TG1, only +41% and +30% in TG2 and control, group*time interaction, p<0.001; Untrained task 1: TG1 +48%, TG2 +48%, and control +30%, no significant interaction, p=0.72). In summary, 2 weeks of balance training resulted in highly task-specific effects, no transfer even to very similar tasks was observed. Therefore, we recommend identifying and training exactly those tasks that need improvement, and test the efficacy of training programs using specific tests instead of general tests with limited functional relevance.
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Virtual feedback for motor and pain rehabilitation after spinal cord injury. Spinal Cord 2014; 52:860-6. [DOI: 10.1038/sc.2014.160] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2014] [Revised: 08/05/2014] [Accepted: 08/27/2014] [Indexed: 12/25/2022]
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Chisholm AE, Malik RN, Blouin JS, Borisoff J, Forwell S, Lam T. Feasibility of sensory tongue stimulation combined with task-specific therapy in people with spinal cord injury: a case study. J Neuroeng Rehabil 2014; 11:96. [PMID: 24906679 PMCID: PMC4057581 DOI: 10.1186/1743-0003-11-96] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2013] [Accepted: 06/02/2014] [Indexed: 11/30/2022] Open
Abstract
Background Previous evidence suggests the effects of task-specific therapy can be further enhanced when sensory stimulation is combined with motor practice. Sensory tongue stimulation is thought to facilitate activation of regions in the brain that are important for balance and gait. Improvements in balance and gait have significant implications for functional mobility for people with incomplete spinal cord injury (iSCI). The aim of this case study was to evaluate the feasibility of a lab- and home-based program combining sensory tongue stimulation with balance and gait training on functional outcomes in people with iSCI. Methods Two male participants (S1 and S2) with chronic motor iSCI completed 12 weeks of balance and gait training (3 lab and 2 home based sessions per week) combined with sensory tongue stimulation using the Portable Neuromodulation Stimulator (PoNS). Laboratory based training involved 20 minutes of standing balance with eyes closed and 30 minutes of body-weight support treadmill walking. Home based sessions consisted of balancing with eyes open and walking with parallel bars or a walker for up to 20 minutes each. Subjects continued daily at-home training for an additional 12 weeks as follow-up. Results Both subjects were able to complete a minimum of 83% of the training sessions. Standing balance with eyes closed increased from 0.2 to 4.0 minutes and 0.0 to 0.2 minutes for S1 and S2, respectively. Balance confidence also improved at follow-up after the home-based program. Over ground walking speed improved by 0.14 m/s for S1 and 0.07 m/s for S2, and skilled walking function improved by 60% and 21% for S1 and S2, respectively. Conclusions Sensory tongue stimulation combined with task-specific training may be a feasible method for improving balance and gait in people with iSCI. Our findings warrant further controlled studies to determine the added benefits of sensory tongue stimulation to rehabilitation training.
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Affiliation(s)
- Amanda E Chisholm
- School of Kinesiology, University of British Columbia, Vancouver, Canada.
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Improved postural control in response to a 4-week balance training with partially unloaded bodyweight. Gait Posture 2014; 40:291-6. [PMID: 24836698 DOI: 10.1016/j.gaitpost.2014.04.186] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2013] [Revised: 03/06/2014] [Accepted: 04/08/2014] [Indexed: 02/02/2023]
Abstract
Balance training (BT) is successfully implemented in therapy as a countermeasure against postural dysfunctions. However, patients suffering from motor impairments may not be able to perform balance rehabilitation with full body load. The purpose of this study was to investigate whether partial unloading leads to the same functional and neuromuscular adaptations. The impact on postural control of a 4-week BT intervention has been compared between full and partial body load. 32 subjects were randomly assigned to a CON (conventional BT) or a PART group (partially unloaded BT). BT comprised balance exercises addressing dynamic stabilization in mono- and bipedal stance. Before and after training, centre of pressure (COP) displacement and electromyographic activity of selected muscles were monitored during different balance tasks. Co-contraction index (CCI) of soleus (SOL)/tibialis (TA) was calculated. SOL H-reflexes were elicited to evaluate changes in the excitability of the spinal reflex circuitry. Adaptations in response to the training were in a similar extent for both groups: (i) after the intervention, the COP displacement was reduced (P<0.05). This reduction was accompanied by (ii) a decreased CCI of SOL/TA (P<0.05) and (iii) a decrease in H-reflex amplitude (P<0.05). BT under partial unloading led to reduced COP displacements comparable to conventional BT indicating improved balance control. Moreover, decreased co-contraction of antagonistic muscles and reduced spinal excitability of the SOL motoneuron pool point towards changed postural control strategies generally observed after full body load training. Thus, BT considering partial unloading is an appropriate alternative for patients unable to conduct BT under full body load.
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