1
|
Park S, Kim J, Kim S. Corticostriatal activity related to performance during continuous de novo motor learning. Sci Rep 2024; 14:3731. [PMID: 38355810 PMCID: PMC10867026 DOI: 10.1038/s41598-024-54176-9] [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: 11/21/2023] [Accepted: 02/09/2024] [Indexed: 02/16/2024] Open
Abstract
Corticostriatal regions play a pivotal role in visuomotor learning. However, less research has been done on how fMRI activity in their subregions is related to task performance, which is provided as visual feedback during motor learning. To address this, we conducted an fMRI experiment in which participants acquired a complex de novo motor skill using continuous or binary visual feedback related to performance. We found a highly selective response related to performance in the entire striatum in both conditions and a relatively higher response in the caudate nucleus for the binary feedback condition. However, the ventromedial prefrontal cortex (vmPFC) response was significant only for the continuous feedback condition. Furthermore, we also found functional distinction of the striatal subregions in random versus goal-directed motor control. These findings underscore the substantial effects of the visual feedback indicating performance on distinct corticostriatal responses, thereby elucidating its significance in reinforcement-based motor learning.
Collapse
Affiliation(s)
- Sungbeen Park
- Department of Artificial Intelligence, Hanyang University, 222 Wangsimni-Ro Seongdong-Gu, Seoul, 04763, Republic of Korea
| | - Junghyun Kim
- Department of Data Science, Hanyang University, 222 Wangsimni-Ro Seongdong-Gu, Seoul, 04763, Republic of Korea
| | - Sungshin Kim
- Department of Artificial Intelligence, Hanyang University, 222 Wangsimni-Ro Seongdong-Gu, Seoul, 04763, Republic of Korea.
- Department of Data Science, Hanyang University, 222 Wangsimni-Ro Seongdong-Gu, Seoul, 04763, Republic of Korea.
- Center for Neuroscience Imaging Research, Institute for Basic Science, 2066 Seobu-Ro, Jangan-Gu, Suwon, 16419, Republic of Korea.
| |
Collapse
|
2
|
Pellichero A, Best KL, Routhier F, Viswanathan P, Wang RH, Miller WC. Blind spot sensor systems for power wheelchairs: obstacle detection accuracy, cognitive task load, and perceived usefulness among older adults. Disabil Rehabil Assist Technol 2023; 18:1084-1092. [PMID: 34628996 DOI: 10.1080/17483107.2021.1983654] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Accepted: 09/16/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE Blind spot sensor systems can improve power wheelchair (PWC) safety. This research (1) compared accuracy of obstacle detection in the rear of a wheelchair with and without a sensor system, and (2) explored cognitive task load and perceived usability, safety, confidence and awareness in a laboratory setting, and (3) PWC users' perceptions in real-world settings. MATERIALS AND METHODS A mixed-method design was used. PWC users were provided with the sensor system. In laboratory accuracy of obstacle detection with and without a sensor system, cognitive task load and perceived usability, safety, confidence and awareness were evaluated. Participants then used the sensor system at home for two-months before completing semi-structured interviews. Statistical and thematic analyses were conducted. RESULTS Among 11 PWC users (age = 67.5 ± 7.5y), obstacles were detected more accurately with sensor system than without (p < 0.001). Using the sensor system required lower cognitive task loads (p = 0.005). The system was perceived by most users as easy to use (9/11) and its capabilities meeting their requirements (8/11). Most users did not perceive safety (9/11), confidence (9/11) or increased awareness (10/11) in the laboratory. Three themes emerged in the follow-ups: perceived usefulness, barriers to use, and recommendations. Four participants reported continued use after 2 months, reporting perceived increased awareness, convenience, and independence using the system. Those who discontinued use reported perceived lack of usefulness and technical issues. Recommendations included types of users who can benefit and sensor improvements. CONCLUSIONS Sensor systems may improve obstacle detection accuracy while reducing cognitive task load. However, larger scale implementation should consider recommendations for PWC service provision.IMPLICATIONS FOR REHABILITATIONBlind spot sensors systems increased speed and accuracy of obstacle detection when using a power wheelchair.Technical and hardware issues encountered by PWC users highlight the need for training and support services.Technical support was out of scope for the current research project and will be explored in future research given the critical role it might play in the usability and adoption of assistive technologies.PWC users perceived there to be practical uses for blind spot sensor systems.
Collapse
Affiliation(s)
- Alice Pellichero
- Department of Rehabilitation, Université Laval, Quebec City, Canada
- Centre for interdisciplinary research in rehabilitation and social integration, Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale, Québec City, Canada
| | - Krista L Best
- Department of Rehabilitation, Université Laval, Quebec City, Canada
- Centre for interdisciplinary research in rehabilitation and social integration, Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale, Québec City, Canada
| | - François Routhier
- Department of Rehabilitation, Université Laval, Quebec City, Canada
- Centre for interdisciplinary research in rehabilitation and social integration, Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale, Québec City, Canada
| | | | - Rosalie H Wang
- Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, Canada
| | - William C Miller
- Department of Occupational Science and Occupational Therapy, University of British Columbia, Vancouver, Canada
- Rehabilitation Research Program, GF Strong Rehabilitation Center, Vancouver, Canada
| |
Collapse
|
3
|
Kim H, Kim JW, Ko J. Adaptive Control Method for Gait Detection and Classification Devices with Inertial Measurement Unit. SENSORS (BASEL, SWITZERLAND) 2023; 23:6638. [PMID: 37514932 PMCID: PMC10385410 DOI: 10.3390/s23146638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Revised: 07/20/2023] [Accepted: 07/21/2023] [Indexed: 07/30/2023]
Abstract
Cueing and feedback training can be effective in maintaining or improving gait in individuals with Parkinson's disease. We previously designed a rehabilitation assist device that can detect and classify a user's gait at only the swing phase of the gait cycle, for the ease of data processing. In this study, we analyzed the impact of various factors in a gait detection algorithm on the gait detection and classification rate (GDCR). We collected acceleration and angular velocity data from 25 participants (1 male and 24 females with an average age of 62 ± 6 years) using our device and analyzed the data using statistical methods. Based on these results, we developed an adaptive GDCR control algorithm using several equations and functions. We tested the algorithm under various virtual exercise scenarios using two control methods, based on acceleration and angular velocity, and found that the acceleration threshold was more effective in controlling the GDCR (average Spearman correlation -0.9996, p < 0.001) than the gyroscopic threshold. Our adaptive control algorithm was more effective in maintaining the target GDCR than the other algorithms (p < 0.001) with an average error of 0.10, while other tested methods showed average errors of 0.16 and 0.28. This algorithm has good scalability and can be adapted for future gait detection and classification applications.
Collapse
Affiliation(s)
- Hyeonjong Kim
- Division of Mechanical Engineering, (National) Korea Maritime and Ocean University, Busan 49112, Republic of Korea
| | - Ji-Won Kim
- Division of Biomedical Engineering, Konkuk University, Chungju 27478, Republic of Korea
- BK21 Plus Research Institute of Biomedical Engineering, Konkuk University, Seoul 05029, Republic of Korea
| | - Junghyuk Ko
- Division of Mechanical Engineering, (National) Korea Maritime and Ocean University, Busan 49112, Republic of Korea
| |
Collapse
|
4
|
Battel I, Walshe M. An intensive neurorehabilitation programme with sEMG biofeedback to improve swallowing in idiopathic Parkinson's disease (IPD): A feasibility study. INTERNATIONAL JOURNAL OF LANGUAGE & COMMUNICATION DISORDERS 2023; 58:813-825. [PMID: 36478035 DOI: 10.1111/1460-6984.12824] [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: 03/29/2022] [Accepted: 10/25/2022] [Indexed: 05/12/2023]
Abstract
BACKGROUND Studies suggest swallow intervention programmes that incorporate visual biofeedback and motor programming principles can improve swallowing and quality of life for people with idiopathic Parkinson's disease (IPD) and dysphagia. Few studies have examined outcomes using instrumentation. AIMS Using fibreoptic endoscopic examination of swallowing (FEES), this study examines the effectiveness of a neurorehabilitation intervention involving biofeedback via surface electromyography (sEMG) to improve swallowing in people with IPD, and to explore the feasibility of the intervention approach. METHODS & PROCEDURES We recruited 12 participants with IPD and dysphagia. A total of 10 completed the study. Intervention was delivered for 1 h per day, 5 days per week, for 4 weeks (20 h). Swallowing tasks using sEMG biofeedback incorporated principles of motor learning and neuroplasticity. Instrumental and non-instrumental assessment, including quality-of-life measures carried out at four different time points (two pre-treatment and two post-treatment). The final assessment was at 3 months post-intervention. OUTCOME & RESULTS Statistically significant improvement (p < 0.05) in oral intake methods (95% confidence interval (CI) = 4.70-5.50) and in pharyngeal residue from saliva (95% CI = 2.14-3.15) and solids (95% CI = 2.4-3.5) post-intervention were confirmed using FEES with improvements at 3 months. The intervention protocol was well tolerated. Participants reported positive change in saliva control and duration of mealtimes as well as unanticipated improvements in voice and cognitive attention. CONCLUSIONS & IMPLICATIONS An intensive neurorehabilitation with biofeedback shows positive effects in improving swallow function in IPD. This protocol is feasible with amendments to inform a larger clinical trial. WHAT THIS PAPER ADDS What is already known on the subject Biofeedback has positive effects on increasing swallowing function and quality of life in people with IPD and dysphagia. sEMG is the most common method used to deliver swallowing biofeedback in this population. The quality of the evidence on the intervention, based on findings from a recent systematic review, is low. Included studies in this review were heterogeneous in terms of type and frequency of biofeedback, study design and outcome measures. The majority of outcome measures were subjective and higher quality studies to examine the efficacy of biofeedback using sEMG are needed. What this study adds Recognizing the limitations of earlier studies, this within-subject feasibility study examined the efficacy and effectiveness of an intensive biofeedback intervention using sEMG in a sample of people with dysphagia and IPD. Valid and reliable outcome measures were used and repeated after a 3-month period. The feasibility of the methodological approach was also tested and a qualitative component was included in the study. Positive findings were evident. Qualitative information added new perspectives and provided direction for new outcomes to be included in future studies. This study helps to inform further research trials as well as clinical practice. Clinical implications of this study This intensive intervention using principles of neuroplasticity and motor programming with sEMG biofeedback led not only to positive swallowing outcomes but also to unexpected benefits such as improved voice production and general attention skills. No adverse events were reported. Improvement in function was retained at 3 months post-intervention. Despite the small sample size, participants described the benefits of the treatment, and enjoyed sEMG biofeedback tasks, especially using an sEMG game mode. This suggests that intensive biofeedback not only improved swallowing but also was acceptable to these participants. This intensive protocol has merit and is worth considering further in clinical practice.
Collapse
Affiliation(s)
- Irene Battel
- Department of Clinical Speech & Language Studies, University of Dublin, Trinity College Dublin, Dublin, Ireland
- Department of Biomedical, Surgical and Dental Sciences, University 'La Statale', Milan, Italy
| | - Margaret Walshe
- Department of Clinical Speech & Language Studies, University of Dublin, Trinity College Dublin, Dublin, Ireland
| |
Collapse
|
5
|
Nunn K, Vallila-Rohter S, Middleton EL. Errorless, Errorful, and Retrieval Practice for Naming Treatment in Aphasia: A Scoping Review of Learning Mechanisms and Treatment Ingredients. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2023; 66:668-687. [PMID: 36729701 PMCID: PMC10023178 DOI: 10.1044/2022_jslhr-22-00251] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Revised: 08/27/2022] [Accepted: 10/25/2022] [Indexed: 06/03/2023]
Abstract
PURPOSE Increasingly, mechanisms of learning are being considered during aphasia rehabilitation. Well-characterized learning mechanisms can inform "how" interventions should be administered to maximize the acquisition and retention of treatment gains. This systematic scoping review mapped hypothesized mechanisms of action (MoAs) and treatment ingredients in three learning-based approaches targeting naming in aphasia: errorless learning (ELess), errorful learning (EFul), and retrieval practice (RP). The rehabilitation treatment specification system was leveraged to describe available literature and identify knowledge gaps within a unified framework. METHOD PubMed and CINHAL were searched for studies that compared ELess, EFul, and/or RP for naming in aphasia. Independent reviewers extracted data on proposed MoAs, treatment ingredients, and outcomes. RESULTS Twelve studies compared ELess and EFul, six studies compared ELess and RP, and one study compared RP and EFul. Hebbian learning, gated Hebbian learning, effortful retrieval, and models of incremental learning via lexical access were proposed as MoAs. To maximize treatment outcomes within theorized MoAs, researchers manipulated study ingredients including cues, scheduling, and feedback. Outcomes in comparative effectiveness studies were examined to identify ingredients that may influence learning. Individual-level variables, such as cognitive and linguistic abilities, may affect treatment response; however, findings were inconsistent across studies. CONCLUSIONS Significant knowledge gaps were identified and include (a) which MoAs operate during ELess, EFul, and RP; (b) which ingredients are active and engage specific MoAs; and (c) how individual-level variables may drive treatment administration. Theory-driven research can support or refute MoAs and active ingredients enabling clinicians to modify treatments within theoretical frameworks.
Collapse
Affiliation(s)
- Kristen Nunn
- Department of Communication Sciences and Disorders, MGH Institute of Health Professions, Boston, MA
| | - Sofia Vallila-Rohter
- Department of Communication Sciences and Disorders, MGH Institute of Health Professions, Boston, MA
| | - Erica L. Middleton
- Research Department, Moss Rehabilitation Research Institute, Elkins Park, PA
| |
Collapse
|
6
|
Wang X, Liang H, Li L, Zhou J, Song R. Contribution of the stereoscopic representation of motion-in-depth during visually guided feedback control. Cereb Cortex 2023:7030846. [PMID: 36750266 DOI: 10.1093/cercor/bhad010] [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: 12/06/2022] [Revised: 01/06/2023] [Accepted: 01/07/2023] [Indexed: 02/09/2023] Open
Abstract
Considerable studies have focused on the neural basis of visually guided tracking movement in the frontoparallel plane, whereas the neural process in real-world circumstances regarding the influence of binocular disparity and motion-in-depth (MID) perception is less understood. Although the role of stereoscopic versus monoscopic MID information has been extensively described for visual processing, its influence on top-down regulation for motor execution has not received much attention. Here, we orthogonally varied the visual representation (stereoscopic versus monoscopic) and motion direction (depth motion versus bias depth motion versus frontoparallel motion) during visually guided tracking movements, with simultaneous functional near-infrared spectroscopy recordings. Results show that the stereoscopic representation of MID could lead to more accurate movements, which was supported by specific neural activity pattern. More importantly, we extend prior evidence about the role of frontoparietal network in brain-behavior relationship, showing that occipital area, more specifically, visual area V2/V3 was also robustly involved in the association. Furthermore, by using the stereoscopic representation of MID, it is plausible to detect robust brain-behavior relationship even with small sample size at low executive task demand. Taken together, these findings highlight the importance of the stereoscopic representation of MID for investigating neural correlates of visually guided feedback control.
Collapse
Affiliation(s)
- Xiaolu Wang
- Key Laboratory of Sensing Technology and Biomedical Instrument of Guangdong Province, School of Biomedical Engineering, Sun Yat-sen University, Guangzhou 510006, China
| | - Haowen Liang
- State Key Laboratory of Optoelectronic Materials and Technology, Guangdong Marine Laboratory, School of Physics, Sun Yat-sen University, Guangzhou 510275, China
| | - Le Li
- Institute of Medical Research, Northwestern Polytechnical University, Xi'an 710072, China.,Department of Rehabilitation Medicine, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou 510030, China
| | - Jianying Zhou
- State Key Laboratory of Optoelectronic Materials and Technology, Guangdong Marine Laboratory, School of Physics, Sun Yat-sen University, Guangzhou 510275, China
| | - Rong Song
- Key Laboratory of Sensing Technology and Biomedical Instrument of Guangdong Province, School of Biomedical Engineering, Sun Yat-sen University, Guangzhou 510006, China
| |
Collapse
|
7
|
Winkler Patricia A, Demarch Erica A, Campbell Heather L, Smith Marcia B. Use of Real-time Multimodal Sensory Feedback Home Program Improved Backward Stride and Retention for People with Parkinson Disease: a Pilot Study. Clin Park Relat Disord 2022; 6:100132. [PMID: 35128375 PMCID: PMC8804257 DOI: 10.1016/j.prdoa.2022.100132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Revised: 12/17/2021] [Accepted: 01/07/2022] [Indexed: 11/04/2022] Open
Abstract
Multimodal sensory feedback with home exercises increased backward stride for PwPD. Retention of gains occurred 6 weeks after exercise ended for participants using MMSF. The MMSF home program improvements were likely due to integration of proprioception. Outcomes were highly rated by MMSF participants on a Perceived Outcome Scale.
Introduction Parkinson disease (PD) impairs sensory integration, contributes to motor dysfunction, loss of gait automaticity, and increased fall risk. Employing multimodal sensory feedback (MMSF) has the potential to improve proprioceptive integration and gait safety while reducing exercise burden especially for backward gait. Methods This single-blinded, randomized controlled pilot study used a home program with or without real-time visual, proprioceptive, and auditory feedback with stepping exercises which progressed in speed and distance. Both groups completed a six-week intervention followed by 6 weeks without exercise to assess long-term retention. Six additional weeks of exercises were completed to assess recovery of potential losses after the washout session. Eleven people with PD exercised with real-time MMSF and 7 exercised without MMSF. Outcome measures included backward stride length, velocity, cadence, and double support time. The Dual Timed Up and Go measured automaticity. Self-perceived improvements in gait, activities of daily living, participation, and quality of life were registered by a questionnaire. Results Analysis was by repeated measures ANOVA. Using MMSF significantly improved backward stride length at 12 and 18 weeks, p = .007, η2 = 0.239. Both groups improved in all outcome measures after the initial 6-week exercise program, supporting efficacy of stepping exercises. The MMSF + ex group's significant improvements after a 6-week washout supported automaticity development. Questionnaire items received higher agreement percentages from MMSF + ex participants. Conclusion Using real-time MMSF in a home program for pwPD provided significant and lasting improvements in backward stride, and potentially decreased fall risk and exercise burden compared to the same program without MMSF.
Collapse
|
8
|
Chamorro-Moriana G, Sevillano JL, Perez-Cabezas V. Versatile GCH Control Software for Correction of Loads Applied to Forearm Crutches During Gait Recovery Through Technological Feedback: Development and Implementation Study. J Med Internet Res 2021; 23:e27602. [PMID: 34550073 PMCID: PMC8495581 DOI: 10.2196/27602] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 06/24/2021] [Accepted: 07/27/2021] [Indexed: 01/26/2023] Open
Abstract
Background Measuring weight bearing is an essential aspect of clinical care for lower limb injuries such as sprains or meniscopathy surgeries. This care often involves the use of forearm crutches for partial loads progressing to full loads. Therefore, feasible methods of load monitoring for daily clinical use are needed. Objective The main objective of this study was to design an innovative multifunctional desktop load-measuring software that complements GCH System 2.0–instrumented forearm crutches and monitors the applied loads, displaying real-time graphical and numerical information, and enabling the correction of inaccuracies through feedback technology during assisted gait. The secondary objective was to perform a preliminary implementation trial. Methods The software was designed for indoor use (clinics/laboratories). This software translates the crutch sensor signal in millivolts into force units, records and analyzes data (10-80 Hz), and provides real-time effective curves of the loads exerted on crutches. It covers numerous types of extrinsic feedback, including visual, acoustic (verbal/beeps), concurrent, terminal, and descriptive feedback, and includes a clinical and research use database. An observational descriptive pilot study was performed with 10 healthy subjects experienced in bilateral assisted gait. The Wilcoxon matched-pairs signed-rank test was used to evaluate the load accuracy evolution of each subject (ie, changes in the loads exerted on crutches for each support) among various walks, which was interpreted at the 95% confidence level. Results GCH Control Software was developed as a multifunctional desktop tool complementing GCH System 2.0–instrumented forearm crutches. The pilot implementation of the feedback mechanism observed 96/100 load errors at baseline (walk 0, no feedback) with 7/10 subjects exhibiting crutch overloading. Errors ranged from 61.09% to 203.98%, demonstrating heterogeneity. The double-bar feedback found 54/100 errors in walk 1, 28/100 in walk 2, and 14/100 in walk 3. The first walk with double-bar feedback (walk 1) began with errors similar to the baseline walk, generally followed by attempts at correction. The Wilcoxon matched-pairs signed-rank test used to evaluate each subject’s progress showed that all participants steadily improved the accuracy of the loads applied to the crutches. In particular, Subject 9 required extra feedback with two single-bar walks to focus on the total load. The participants also corrected the load balance between crutches and fluency errors. Three subjects made one error of load balance and one subject made six fluctuation errors during the three double-bar walks. The latter subject performed additional feedback with two balance-bar walks to focus on the load balance. Conclusions GCH Control Software proved to be useful for monitoring the loads exerted on forearm crutches, providing a variety of feedback for correcting load accuracy, load balance between crutches, and fluency. The findings of the complementary implementation were satisfactory, although clinical trials with larger samples are needed to assess the efficacy of the different feedback mechanisms and to select the best alternatives in each case.
Collapse
Affiliation(s)
- Gema Chamorro-Moriana
- Department of Physiotherapy, Area of Physiotherapy Research Group CTS-305, University of Seville, Seville, Spain
| | - Jose Luis Sevillano
- Department of Architecture and Technology of Computers, Robotics and Technology of Computers Research Group TEP-108, University of Seville, Seville, Spain
| | - V Perez-Cabezas
- Department of Nursing and Physiotherapy, Empowering Health by Physical Activity, Exercise and Nutrition Research Group CTS-1038, University of Cadiz, Cadiz, Spain
| |
Collapse
|
9
|
Vibrotactile biofeedback devices in Parkinson's disease: a narrative review. Med Biol Eng Comput 2021; 59:1185-1199. [PMID: 33969461 DOI: 10.1007/s11517-021-02365-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Accepted: 04/25/2021] [Indexed: 10/21/2022]
Abstract
Parkinson's disease (PD) is often associated with a vast list of gait-associated disabilities, for which there is still a limited pharmacological/surgical treatment efficacy. Therefore, alternative approaches have emerged as vibrotactile biofeedback systems (VBS). This review aims to focus on the technologies supporting VBS and identify their effects on improving gait-associated disabilities by verifying how VBS were applied and validated with end-users. It is expected to furnish guidance to researchers looking to enhance the effectiveness of future vibrotactile cueing systems. The use of vibrotactile cues has proved to be relevant and attractive, as positive results have been obtained in patients' gait performance, suitability in any environment, and easy adherence. There seems to be a preference in developing VBS to mitigate freezing of gait, to improve balance, to overcome the risk of fall, and a prevalent use to apply miniaturized wearable actuators and sensors. Most studies implemented a biofeedback loop able to provide rescue strategies during or after the detection of a gait-associated disability. However, there is a need of more clinical evidence and inclusion of experimental sessions to evaluate if the biofeedback was effectively integrated into the patients' motor system.
Collapse
|
10
|
Reh J, Schmitz G, Hwang TH, Effenberg AO. Acoustic Feedback in Gait Rehabilitation-Pre-Post Effects in Patients With Unilateral Hip Arthroplasty. Front Sports Act Living 2021; 3:654546. [PMID: 34027404 PMCID: PMC8138186 DOI: 10.3389/fspor.2021.654546] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2021] [Accepted: 03/31/2021] [Indexed: 11/13/2022] Open
Abstract
It is known that patients after unilateral hip arthroplasty still suffer from a deficient gait pattern compared to healthy individuals one year after surgery. Through the method of gait sonification, it may be possible to achieve a more efficient training and a more physiological gait pattern. Increased loads on the musculoskeletal system could thus be reduced and rehabilitation times shortened. In a previous investigation with this patient group, we found immediate gait pattern changes during training with dual mode acoustic feedback [real-time feedback (RTF) and instructive model sequences (IMS)]. To determine whether an effect persists without the immediate use of acoustic feedback, we analyze data from four times of testing. Following unilateral hip arthroplasty 22 patients participated in an intervention of ten gait training sessions of 20 min each. During gait training the sonification group (SG) (n = 11) received an acoustic feedback consisting of RTF and IMS compared to a control group (CG) (n = 11). Pre-test, intermediate test, post-test, and re-test were conducted using an inertial sensor-based motion analysis system. We found significant effects (α = 0.05) regarding step length and range of motion (RoM) of the hip joint. Step length of the affected leg increased in the SG from intermediate test to post-test but decreased in the CG [intermediate test: (SG) 0.63 m ± 0.12 m, (CG) 0.63 m ± 0.09 m; post-test: (SG) 0.66 m ± 0.11 m, (CG) 0.60 m ± 0.09 m]. However, from the post-test to the re-test a reverse development was observed [re-test: (SG) 0.63 m ± 0.10 m, (CG) 0.65 m ± 0.09 m]. Also, from post-test to re-test a decrease in the RoM of the unaffected hip for the SG but an increase for the CG could be observed [post-test: (SG) 44.10° ± 7.86°, (CG) 37.05° ± 7.21°; re-test: (SG) 41.73° ± 7.38°, (CG) 40.85° ± 9.28°]. Regarding further parameters, significant interactions in step duration as well as increases in stride length, gait speed, cadence, and a decrease in ground contact time from pre-test to re-test were observed for both groups. Clinical Trial Registration: https://www.drks.de/drks_web/, identifier DRKS00022570.
Collapse
Affiliation(s)
- Julia Reh
- Institute of Sports Science, Leibniz University Hannover, Hannover, Germany
| | - Gerd Schmitz
- Institute of Sports Science, Leibniz University Hannover, Hannover, Germany
| | - Tong-Hun Hwang
- Institute of Sports Science, Leibniz University Hannover, Hannover, Germany
| | - Alfred O Effenberg
- Institute of Sports Science, Leibniz University Hannover, Hannover, Germany
| |
Collapse
|
11
|
De Angelis S, Princi AA, Dal Farra F, Morone G, Caltagirone C, Tramontano M. Vibrotactile-Based Rehabilitation on Balance and Gait in Patients with Neurological Diseases: A Systematic Review and Metanalysis. Brain Sci 2021; 11:brainsci11040518. [PMID: 33921655 PMCID: PMC8072538 DOI: 10.3390/brainsci11040518] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Revised: 04/10/2021] [Accepted: 04/14/2021] [Indexed: 01/06/2023] Open
Abstract
Postural instability and fear of falling represent two major causes of decreased mobility and quality of life in cerebrovascular and neurologic diseases. In recent years, rehabilitation strategies were carried out considering a combined sensorimotor intervention and an active involvement of the patients during the rehabilitation sessions. Accordingly, new technological devices and paradigms have been developed to increase the effectiveness of rehabilitation by integrating multisensory information and augmented feedback promoting the involvement of the cognitive paradigm in neurorehabilitation. In this context, the vibrotactile feedback (VF) could represent a peripheral therapeutic input, in order to provide spatial proprioceptive information to guide the patient during task-oriented exercises. The present systematic review and metanalysis aimed to explore the effectiveness of the VF on balance and gait rehabilitation in patients with neurological and cerebrovascular diseases. A total of 18 studies met the inclusion criteria and were included. Due to the lack of high-quality studies and heterogeneity of treatments protocols, clinical practice recommendations on the efficacy of VF cannot be made. Results show that VF-based intervention could be a safe complementary sensory-motor approach for balance and gait rehabilitation in patients with neurological and cerebrovascular diseases. More high-quality randomized controlled trials are needed.
Collapse
Affiliation(s)
- Sara De Angelis
- Fondazione Santa Lucia IRCCS, 00179 Rome, Italy; (S.D.A.); (A.A.P.); (G.M.); (C.C.)
| | | | | | - Giovanni Morone
- Fondazione Santa Lucia IRCCS, 00179 Rome, Italy; (S.D.A.); (A.A.P.); (G.M.); (C.C.)
| | - Carlo Caltagirone
- Fondazione Santa Lucia IRCCS, 00179 Rome, Italy; (S.D.A.); (A.A.P.); (G.M.); (C.C.)
| | - Marco Tramontano
- Fondazione Santa Lucia IRCCS, 00179 Rome, Italy; (S.D.A.); (A.A.P.); (G.M.); (C.C.)
- Department of Movement, Human and Health Sciences, University of Rome “Foro Italico”, 00185 Rome, Italy
- Correspondence: ; Tel.: +39-06-5150-1420
| |
Collapse
|
12
|
Carvalho LP, Mate KKV, Cinar E, Abou-Sharkh A, Lafontaine AL, Mayo NE. A new approach toward gait training in patients with Parkinson's Disease. Gait Posture 2020; 81:14-20. [PMID: 32650238 DOI: 10.1016/j.gaitpost.2020.06.031] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
BACKGROUND Typically, people with Parkinson's Disease (PD) progress to develop a gait pattern that is characterized by quick, short and shuffling steps. Gait cycle is altered and lacks definition and fluidity. Gait training combined with a variety of feedback modalities for PD are usually based on non-immediate and externally-based cues but none of these provide real-time feedback on gait quality and acquired gains tend to abate shortly after rehabilitation. Based on principals of motor learning, our team has developed the Heel2Toe sensor to provide real-time auditory feedback during gait training. RESEARCH QUESTION Is a short-term training using the Heel2Toe sensor feasible and efficient to improve gait in people with PD? Our objectives are to identify the extent of the immediate response to the feedback within the same session and the carry-over response to training and; 2) to identify patients' perceived effects, pleasures and challenges of using the Heel2Toe. METHODS Single-arm, proof-of-concept study. Six people received five sessions of gait training over a 2-3-week period using the Heel2Toe augmented with mobility exercises as an adjunct to gait training. The main outcomes were technically assessed gait parameters collected over a 2-minute walk test, without and with feedback. Heel2Toe signals were analyzed to extract angular velocity(AV), percentage of good steps, average cadence, and AV coefficient of variation(CV). RESULTS An immediate response to the Heel2Toe use and a carry-over response to the short-term training with the sensor were observed: an increase in AV with a reduction in CV (better heel strike and gait regularity); an increase in %good steps; and a near-optimal and homogeneous cadence (∼100 steps/min), which is equivalent to a moderate-intensity walking. SIGNIFICANCE Gait training using the Heel2Toe sensor is feasible and potentially effective for improving gait quality in people with PD. A definitive trial is a logical next step.
Collapse
Affiliation(s)
- Livia P Carvalho
- Department of Medicine, School of Physical and Occupational Therapy, McGill University, Center for Outcomes Research and Evaluation, Research Institute-McGill University Health Center, Montreal, H4A 3S5, Canada.
| | - Kedar K V Mate
- Department of Medicine, School of Physical and Occupational Therapy, McGill University, Center for Outcomes Research and Evaluation, Research Institute-McGill University Health Center, Montreal, H4A 3S5, Canada.
| | - Eda Cinar
- Department of Medicine, School of Physical and Occupational Therapy, McGill University, Center for Outcomes Research and Evaluation, Research Institute-McGill University Health Center, Montreal, H4A 3S5, Canada.
| | - Ahmed Abou-Sharkh
- Department of Medicine, School of Physical and Occupational Therapy, McGill University, Center for Outcomes Research and Evaluation, Research Institute-McGill University Health Center, Montreal, H4A 3S5, Canada.
| | | | - Nancy E Mayo
- Department of Medicine, School of Physical and Occupational Therapy, McGill University, Center for Outcomes Research and Evaluation, Research Institute-McGill University Health Center, Montreal, H4A 3S5, Canada.
| |
Collapse
|
13
|
Yu SH, Wu RM, Huang CY. Attentional Resource Associated With Visual Feedback on a Postural Dual Task in Parkinson's Disease. Neurorehabil Neural Repair 2020; 34:891-903. [PMID: 32830603 DOI: 10.1177/1545968320948071] [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] [Indexed: 11/16/2022]
Abstract
BACKGROUND Restricted attentional resource and central processing in patients with Parkinson's disease (PD) may reduce the benefit of visual feedback in a dual task. OBJECTIVES Using brain event-related potentials (ERPs), this study aims to investigate the neural mechanisms of posture visual feedback and supraposture visual feedback during performing of a posture-motor dual task. METHODS Eighteen patients with PD and 18 healthy controls stood on a mobile platform (postural task) and executed a manual force-matching task (suprapostural task) concurrently with provided visual feedback of platform movement (posture-feedback condition) or force output (force-feedback condition). The platform movement, force-matching performance, and ERPs (P1, N1, and P2 waves) were recorded. RESULTS Both PD and control groups had superior force accuracy in the force-feedback condition. Decreased postural sway by posture-feedback was observed in healthy controls but not in PD. Force-feedback led to a greater frontal area N1 peak in PD group but smaller N1 peaks in control group. In addition, force-feedback led to smaller P2 peaks of the frontal and sensorimotor areas among PD patients but greater P2 peaks of the sensorimotor and parietal-occipital areas among healthy controls. However, P1 modulations was present only in healthy controls. CONCLUSIONS Force-feedback had positive effect on force accuracy in both PD and healthy individuals; however, the beneficial effect of posture-feedback on posture balance is not observed in PD. These findings are the first to suggest that PD could recruit more attentional resources in dual-task preparation to enhance suprapostural accuracy and avoid degrading postural stability by supraposture visual feedback.
Collapse
Affiliation(s)
- Shu-Han Yu
- Physical Therapy Center, National Taiwan University Hospital, Taipei, Taiwan
| | - Ruey-Meei Wu
- Department of Neurology, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Cheng-Ya Huang
- Physical Therapy Center, National Taiwan University Hospital, Taipei, Taiwan.,School and Graduate Institute of Physical Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan
| |
Collapse
|
14
|
Yuan RY, Chen SC, Peng CW, Lin YN, Chang YT, Lai CH. Effects of interactive video-game-based exercise on balance in older adults with mild-to-moderate Parkinson's disease. J Neuroeng Rehabil 2020; 17:91. [PMID: 32660512 PMCID: PMC7359629 DOI: 10.1186/s12984-020-00725-y] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Accepted: 07/06/2020] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND This study aimed to evaluate the effectiveness of a customized interactive video game-based (IVGB) training on balance in older adults with mild-to-moderate Parkinson's disease (PD). METHODS In this 12-week crossover trial, PD patients ≥65 years of age were randomly divided into Group A (a 6-week intervention phase followed by a 6-week control phase) and Group B (a 6-week control phase followed by a 6-week intervention phase). Participants received IVGB exercise training during the intervention phase and no exercise during the control phase. Functional outcomes were measured using behavioral evaluation scales and questionnaires at baseline, week 6 and week 12. RESULTS Twenty-four PD patients were included in this study, and were evenly divided into two groups. After Bonferroni adjustment, the changes in Modified Falls Efficacy Scale (MFES) and two subscales of Multi-Directional Reach Test were significantly different between two groups in the first 6-week period. In addition, the changes in Berg Balance Scale, MFES, and two subscales of Maximum Step Length were significantly different between two groups in the second 6-week period. Compared to controls, 6-week IVGB exercise intervention significantly improved different but overlapping functional outcomes in two groups of PD patients. CONCLUSIONS The customized IVGB exercise training improves balance, postural stability and confidence in preventing falls in older adults with mild-to-moderate PD. However, this IVGB exercise doesn't have a significant impact on quality of life. TRIAL REGISTRATION ClinicalTrials.gov. NCT03689764 . Registered 27 September 2018, retrospectively registered.
Collapse
Affiliation(s)
- Rey-Yue Yuan
- Department of Neurology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
- Department of Neurology, Taipei Medical University Hospital, Taipei, Taiwan
| | - Shih-Ching Chen
- Department of Physical Medicine and Rehabilitation, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
- Department of Physical Medicine and Rehabilitation, Taipei Medical University Hospital, No. 252, Wu-Hsing St., Taipei City, 110 Taiwan
- Taipei Neuroscience Institute, Taipei Medical University, Taipei, Taiwan
| | - Chih-Wei Peng
- Taipei Neuroscience Institute, Taipei Medical University, Taipei, Taiwan
- School of Biomedical Engineering, College of Biomedical Engineering, Taipei Medical University, Taipei, Taiwan
- Graduate Institute of Biomedical Optomechatronics, College of Biomedical Engineering, Taipei Medical University, Taipei, Taiwan
| | - Yen-Nung Lin
- Graduate Institute of Injury Prevention and Control, Taipei Medical University, Taipei, Taiwan
- Department of Physical Medicine and Rehabilitation, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
| | - Yu-Tai Chang
- Department of Physical Medicine and Rehabilitation, Taipei Medical University Hospital, No. 252, Wu-Hsing St., Taipei City, 110 Taiwan
- Taipei Neuroscience Institute, Taipei Medical University, Taipei, Taiwan
| | - Chien-Hung Lai
- Department of Physical Medicine and Rehabilitation, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
- Department of Physical Medicine and Rehabilitation, Taipei Medical University Hospital, No. 252, Wu-Hsing St., Taipei City, 110 Taiwan
- Taipei Neuroscience Institute, Taipei Medical University, Taipei, Taiwan
| |
Collapse
|
15
|
Curtis JA, Dakin AE, Troche MS. Respiratory-Swallow Coordination Training and Voluntary Cough Skill Training: A Single-Subject Treatment Study in a Person With Parkinson's Disease. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2020; 63:472-486. [PMID: 32078392 DOI: 10.1044/2019_jslhr-19-00207] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Purpose Airway protective disorders are common in Parkinson's disease (PD), yet effective methods to rehabilitate these life-threatening impairments are limited. This study examined the effects of two skill-based treatments aimed at improving swallowing and cough in a severely dysphagic person with PD: respiratory-swallow coordination training (RSCT) and voluntary cough skill training (VCST). It was hypothesized that (a) RSCT would improve respiratory-swallow coordination and swallowing safety and efficiency and (b) VCST would improve reflex and voluntary cough effectiveness. Method An 81-year-old man with midstage PD and severe dysphagia was recruited for study participation. The study utilized a multiple-baseline ABACA experimental design with a 2-month delayed retention assessment. Measures of respiratory-swallow coordination, swallowing safety and efficiency, and cough effectiveness were collected at each assessment using respiratory inductive plethysmography, flexible endoscopic evaluations of swallowing, and spirometry. Data were analyzed descriptively using baseline corrected tau and standard mean difference effect sizes (d). Results Large effect sizes were observed immediately following RSCT for respiratory-swallow coordination (d = 9.17), penetration-aspiration (d = 12.88), vallecular residue (d = 1.75), piriform residue (d = 4.15), and overall dysphagia severity (d = 1.83). Large effect sizes were also observed immediately following VCST for single voluntary cough (d = 4.30), sequential voluntary cough (d = 3.28), and reflex cough (d = 5.58). Improvements were maintained 2 months later for all outcome measures except single voluntary cough. Discussion This is the first study to examine the effects of RSCT and VCST in a person with PD. Robust improvements in respiratory-swallow coordination and swallowing safety and efficiency were achieved following four sessions of RSCT, and significant improvements in reflex and voluntary cough strength were seen following four sessions of VCST. Future work is needed to study these treatments in larger cohorts of people with PD.
Collapse
Affiliation(s)
- James A Curtis
- Laboratory for the Study of Upper Airway Dysfunction, Department of Biobehavioral Sciences, Teachers College, Columbia University, New York, NY
| | - Avery E Dakin
- Laboratory for the Study of Upper Airway Dysfunction, Department of Biobehavioral Sciences, Teachers College, Columbia University, New York, NY
| | - Michelle S Troche
- Laboratory for the Study of Upper Airway Dysfunction, Department of Biobehavioral Sciences, Teachers College, Columbia University, New York, NY
| |
Collapse
|
16
|
Bakker M, Beijer L, Rietveld T. Considerations on Effective Feedback in Computerized Speech Training for Dysarthric Speakers. Telemed J E Health 2018; 25:351-358. [PMID: 30074851 DOI: 10.1089/tmj.2018.0050] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Introduction: In this article, we consider the role of feedback in computerized speech training for patients with dysarthric speech due to acquired neurological disorders such as Parkinson's disease and stroke. Methods: Based on literature from different fields, we review several issues that play a role when designing feedback for computerized speech training, including serious games. Results: Which speech dimensions (e.g., articulation, loudness) to target in computerized speech feedback, and at what level of detail to provide the feedback, depend on the focus of the specific speech therapy and the technical feasibility of providing reliable speech feedback. Furthermore, feedback that provides knowledge of results generally appears equally effective as knowledge of performance feedback, and is more easily provided in computerized speech training systems. Implicit feedback can be more motivating than explicit feedback (e.g., in serious games), but may be harder to understand. Multimodal feedback is preferred over unimodal feedback to ensure that the feedback message is optimally perceived. Mild negative task-oriented feedback can enhance effort but should be balanced with positive feedback, such as feedback referring to patients' progress. Finally, a balance should be found between the motivational advantages of high-frequency immediate feedback (e.g., in serious games) and the advantages of low-frequency and delayed feedback in preventing patients from becoming dependent on augmented feedback. Conclusions: Several aspects play a role in designing feedback for computerized speech training for dysarthric speakers. Decisions on these aspects should be made carefully, accounting for the specific characteristics of the patient group that is targeted, the focus of the specific speech therapy, and the technological possibilities that are available.
Collapse
Affiliation(s)
- Marjoke Bakker
- 1 Centre for Language and Speech Technology, Radboud University, Nijmegen, The Netherlands.,2 iXperium/Centre of Expertise Teaching and Learning with ICT, HAN University of Applied Sciences, Nijmegen, The Netherlands
| | - Lilian Beijer
- 3 Faculty of Health and Social Studies, HAN University of Applied Sciences, Nijmegen, The Netherlands.,4 Department of Research, Sint Maartenskliniek, Nijmegen, The Netherlands
| | - Toni Rietveld
- 5 Centre for Language Studies, Radboud University, Nijmegen, The Netherlands
| |
Collapse
|