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Goo BW, Oh JH, Kim JS, Lee MY. Effects of cervical stabilization with visual feedback on craniovertebral angle and proprioception for the subjects with forward head posture. Medicine (Baltimore) 2024; 103:e36845. [PMID: 38215149 PMCID: PMC10783288 DOI: 10.1097/md.0000000000036845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Accepted: 12/12/2023] [Indexed: 01/14/2024] Open
Abstract
BACKGROUND This study aimed to identify the effect of cervical stabilization exercise with visual feedback on the craniovertebral angle and proprioception in subjects with forward head posture. METHODS Thirty healthy adults were recruited in the study. Participants were randomly assigned to the stabilization exercise with visual feedback (SE-VF) group (N = 15) or stabilization exercise group (N = 15). The SE-VF group performed cervical stabilization exercise while sitting on a chair without a backrest and checking their side profile in real-time via a monitor 3-m away. The stabilization exercise group performed the same cervical stabilization exercise as the SE-VF group but without visual feedback. Craniovertebral angle (CVA) was measured to quantify forward head posture, and the proprioception of the subjects was evaluated. RESULTS There was a significant interaction between group and time in CVA and proprioception (P < .05). Additionally, there was no significant difference pre-intervention between the groups (P > .05); however, there was a significant difference post-intervention (P < .05) in CVA and proprioception. CONCLUSION The findings of this study showed that the cervical stabilization exercise with visual feedback was effective for the proprioception of subjects. Moreover, the results suggest that visual feedback is effective in cervical stabilization exercise.
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Affiliation(s)
- Bon Wook Goo
- Rehabilitation Center, Yeungnam University Medical Center, Daegu, Republic of Korea
| | - Jin Hee Oh
- Department of Medical Science, Graduate School, Daegu Haany University, Gyeongsan, Republic of Korea
| | - Ju Sang Kim
- Department of Physical Therapy, Yeungnam University of College, Daegu, Republic of Korea
| | - Mi Young Lee
- Department of Physical Therapy, College of Biomedical Science, Daegu Haany University, Gyeongsan, Republic of Korea
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Demers M, Cain A, Bishop L, Gunby T, Rowe JB, Zondervan DK, Winstein CJ. Understanding stroke survivors' preferences regarding wearable sensor feedback on functional movement: a mixed-methods study. J Neuroeng Rehabil 2023; 20:146. [PMID: 37915055 PMCID: PMC10621082 DOI: 10.1186/s12984-023-01271-z] [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: 04/07/2023] [Accepted: 10/23/2023] [Indexed: 11/03/2023] Open
Abstract
BACKGROUND In stroke rehabilitation, wearable technology can be used as an intervention modality by providing timely, meaningful feedback on motor performance. Stroke survivors' preferences may offer a unique perspective on what metrics are intuitive, actionable, and meaningful to change behavior. However, few studies have identified feedback preferences from stroke survivors. This project aims to determine the ease of understanding and movement encouragement of feedback based on wearable sensor data (both arm/hand use and mobility) for stroke survivors and to identify preferences for feedback metrics (mode, content, frequency, and timing). METHODS A sample of 30 chronic stroke survivors wore a multi-sensor system in the natural environment over a 1-week monitoring period. The sensor system captured time in active movement of each arm, arm use ratio, step counts and stance time symmetry. Using the data from the monitoring period, participants were presented with a movement report with visual displays of feedback about arm/hand use, step counts and gait symmetry. A survey and qualitative interview were used to assess ease of understanding, actionability and components of feedback that users found most meaningful to drive lasting behavior change. RESULTS Arm/hand use and mobility sensor-derived feedback metrics were easy to understand and actionable. The preferred metric to encourage arm/hand use was the hourly arm use bar plot, and similarly the preferred metric to encourage mobility was the hourly steps bar plot, which were each ranked as top choice by 40% of participants. Participants perceived that quantitative (i.e., step counts) and qualitative (i.e., stance time symmetry) mobility metrics provided complementary information. Three main themes emerged from the qualitative analysis: (1) Motivation for behavior change, (2) Real-time feedback based on individual goals, and (3) Value of experienced clinicians for prescription and accountability. Participants stressed the importance of having feedback tailored to their own personalized goals and receiving guidance from clinicians on strategies to progress and increase functional movement behavior in the unsupervised home and community setting. CONCLUSION The resulting technology has the potential to integrate engineering and personalized rehabilitation to maximize participation in meaningful life activities outside clinical settings in a less structured environment.
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Affiliation(s)
- Marika Demers
- Division of Biokinesiology and Physical Therapy, Herman Ostrow School of Dentistry, University of Southern California, Los Angeles, CA, USA.
- School of Rehabilitation, University of Montreal, 7077 Ave. du Parc, Montreal, QC, H3N 1X7, Canada.
| | - Amelia Cain
- Division of Biokinesiology and Physical Therapy, Herman Ostrow School of Dentistry, University of Southern California, Los Angeles, CA, USA
| | - Lauri Bishop
- Division of Biokinesiology and Physical Therapy, Herman Ostrow School of Dentistry, University of Southern California, Los Angeles, CA, USA
| | - Tanisha Gunby
- Division of Biokinesiology and Physical Therapy, Herman Ostrow School of Dentistry, University of Southern California, Los Angeles, CA, USA
| | | | | | - Carolee J Winstein
- Division of Biokinesiology and Physical Therapy, Herman Ostrow School of Dentistry, University of Southern California, Los Angeles, CA, USA
- Department of Neurology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
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3
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Effects of multi-directional step exercise with weight-shifting as an adjunct to conventional exercises on balance and gait in stroke patients. Sci Rep 2022; 12:17053. [PMID: 36224226 PMCID: PMC9556514 DOI: 10.1038/s41598-022-21073-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Accepted: 09/22/2022] [Indexed: 12/30/2022] Open
Abstract
Stroke patients have gait dysfunctions that affect their activities of daily living. Stroke patients should be able to take multi-directional steps as it is necessary to achieve an independent gait. The study aimed to examine the effects of multi-directional step exercises (MSE) along with weight-shifting as an adjunct to conventional therapeutic exercises (CTE) on functional gait performance and balance in patients with stroke. Twenty-four stroke patients (mean age 56.75 years) participated in the study and were divided into experimental and control groups. The experimental group (EG) included MSE along with weight shifting and CTE. The control group (CG) included only CTE. Treatment intervention lasted for 4 weeks. Gait and balance were measured using the functional gait assessment (FGA) and the berg balance scale (BBS), respectively. EG showed a significant improvement (p = 0.000) in both the BBS and FGA scores. In CG, a significant improvement (p = 0.000) was observed only in FGA scores. EG showed a greater improvement in scores of BBS (p = 0.000) and FGA (p = 0.000) than CG. Four weeks of MSE in conjunction with CTE were more effective in improving balance and functional gait performance compared to CTE alone in the selected stroke population.
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Shin J, Chung Y. The effects of treadmill training with visual feedback and rhythmic auditory cue on gait and balance in chronic stroke patients: A randomized controlled trial. NeuroRehabilitation 2022; 51:443-453. [DOI: 10.3233/nre-220099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
Abstract
BACKGROUND: Many stroke patients show reduced walking abilities, characterized by asymmetric walking patterns. For such patients, restoration of walking symmetry is important. OBJECTIVE: This study investigates the effect of treadmill training with visual feedback and rhythmic auditory cue (VF+RAC) for walking symmetry on spatiotemporal gait parameters and balance abilities. METHODS: Thirty-two patients with chronic stroke participated in this study. Participants were randomized to either the VF+RAC (n = 16) or the Control (n = 16) group. The VF+RAC group received treadmill training with VF and RAC, and the Control group underwent treadmill training without any visual and auditory stimulation. VF+RAC and Control groups were trained three times per week for eight weeks. After eight weeks of training, the spatiotemporal gait parameters, Timed up and go test, and Berg balance scale were measured. RESULTS: The VF+RAC group significantly improved balance and spatiotemporal parameters except for non-paretic single limb support compared to the Control group. CONCLUSIONS: This study demonstrated that treadmill training with VF+RAC significantly improved spatiotemporal gait symmetry, including other gait parameters, and enhanced balance abilities in stroke patients. Therefore, treadmill training with VF+RAC could be a beneficial intervention in clinical settings for stroke patients who need improvement in their gait and balance abilities.
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Affiliation(s)
- Jin Shin
- Department of Physical Medicine and Rehabilitation, Gyeong-in Rehabilitation Center Hospital, Incheon, Republic of Korea
| | - Yijung Chung
- Department of Physical Therapy, College of Health and Welfare, Sahmyook University, Seoul, Republicof Korea
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5
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Nam SM, Lee DY. Effects of Visual Cue Deprivation Balance Training with Head Control on Balance and Gait Function in Stroke Patients. MEDICINA (KAUNAS, LITHUANIA) 2022; 58:629. [PMID: 35630046 PMCID: PMC9148052 DOI: 10.3390/medicina58050629] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Revised: 04/28/2022] [Accepted: 04/29/2022] [Indexed: 11/16/2022]
Abstract
Background and Objectives: Visual cue deprivation is the instability of head control is increased. The purpose of this study is to investigate the effects of visual cue deprivation balance training by applying head control feedback to the balance and gait ability of stroke patients. Materials and Methods: The study was conducted on 41 patients diagnosed with hemiplegia due to stroke. Subjects were randomly assigned to any of the following groups: the experimental group I, the experimental group II or the control group. The randomization method used a simple randomization method. To evaluate changes in balance function, a LOS (Limit of Stability) and a BBS (Berg Balance Scale) were performed. In addition, to evaluate changes in ST (stride time), SL (stride length), and cadence, a LEGSys were performed. Results: A two-way repeated ANOVA was conducted to analyze the differences between groups. There were significant differences between groups in all variables for the balance function. There were significant differences between groups in all variables for the balance function. There were significant differences between groups in SL and cadence for the gait function. Conclusions: Visual cue deprivation balance training applying head control feedback is effective in improving dynamic balance ability and cadence. It is necessary to constantly maintain the head orientation by feedback and to properly control the head movement.
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Affiliation(s)
- Seung-Min Nam
- Department of Sports Rehabilitation & Exercise Management, Yeungnam University College, Daegu-si 42415, Korea;
| | - Do-Youn Lee
- Department of Physical Therapy, Daegu University, Gyeongsan-si 38541, Korea
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6
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Kim H, Kim H, Shin WS. Effects of Vibrotactile Biofeedback Providing Real-Time Pressure Information on Static Balance Ability and Weight Distribution Symmetry Index in Patients with Chronic Stroke. Brain Sci 2022; 12:brainsci12030358. [PMID: 35326314 PMCID: PMC8946531 DOI: 10.3390/brainsci12030358] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 02/24/2022] [Accepted: 03/06/2022] [Indexed: 12/10/2022] Open
Abstract
Training with visual and auditory biofeedback, in patients with stroke, improved balance ability and asymmetric posture. We developed a new biofeedback training device to prevent falls and improve balance ability in patients with stroke. This device corrects motion errors by collecting the pressure information of patients in real-time. This randomized crossover study aimed to investigate the effect of this biofeedback training on the static balance ability and weight distribution symmetry index in 24 patients with chronic stroke. Pressure sensor-based vibrotactile biofeedback, visual biofeedback providing posture information, and standing without biofeedback were randomly applied for 1 d each with 24 h washout intervals to minimize adaptation. The static balance ability was measured for each biofeedback training type, and the weight distribution symmetry index was calculated using the collected weight-bearing rate data. The static balance ability and weight distribution symmetry index differed significantly according to the type of biofeedback training used. Post-hoc analysis revealed significant differences in the order of newly developed vibrotactile biofeedback, visual biofeedback, and standing without biofeedback. These findings provide evidence that pressure sensor-based vibrotactile biofeedback improves static balance ability and weight support rates by proposing better intervention for patients with chronic stroke in the clinical environment.
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Affiliation(s)
- Ho Kim
- Department of Physical Therapy, Graduate School of Health and Medicine, Daejeon University, Daejeon 34520, Korea;
| | - Hongjun Kim
- Department of Computer Engineering, Daejeon University, Daejeon 34520, Korea;
| | - Won-Seob Shin
- Department of Physical Therapy, College of Health and Medical Science, Daejeon University, Daejeon 34520, Korea
- Correspondence: ; Tel.: +82-42-280-2294
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Jandaghi S, Tahan N, Akbarzadeh Baghban A, Zoghi M. Stroke Patients Showed Improvements in Balance in Response to Visual Restriction Exercise. Phys Ther Res 2022; 24:211-217. [PMID: 35036254 DOI: 10.1298/ptr.e10081] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Accepted: 03/04/2021] [Indexed: 11/23/2022]
Abstract
OBJECTIVE Several strategies have been designed to improve balance after stroke. Although recent studies have suggested that the balance training in stroke should include exercises that are performed in different sensory conflict conditions, little attention has been paid to manipulation of visual input. This study aimed to compare effects of balance training on an unstable surface with balance training under visual deprivation conditions in persons with stroke. METHOD Forty-five stroke patients were randomized into three groups: the visual deprivation- stable based training (VD-SBT); unstable based training (UBT); and control (C) groups. Subjects of the VD-SBT group performed balance training on a stable surface with closed eyes. The UBT group performed balance training on an unstable surface with open eyes. Patients were assessed before and after interventions for Timed Up and Go (TUG), Four Square Step (FSS) and Five Times Sit to Stand (FTSS) tests. RESULT There was a significant difference in pre- post intervention time of TUG, FSS and FTSS tests in all three groups. In a comparison of three groups, the UBT and VD-SBT groups had a significant improvement in time of all tests but significant improvement in time of all tests was observed in the VD-SBT group in comparison with the UBT group. In the field of balance training, the manipulation of visual input was more effective than the manipulation of standing surface to reweighting the sensory information. CONCLUSION We recommended balance rehabilitation programs after stroke performed under conditions to stimulate the use of underused sensory input.
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Affiliation(s)
- Shima Jandaghi
- Faculty of Sport Injury and Corrective Exercises, Karaj Branch, Islamic Azad University, Iran
| | - Nahid Tahan
- Department of Physiotherapy, Loghman Hakim Hospital, School of Rehabilitation, Shahid Beheshti University of Medical Sciences, Iran
| | - Alireza Akbarzadeh Baghban
- Proteomics Research Center, Department of Biostatistics, School of Allied Medical Sciences, Shahid Beheshti University of Medical Sciences, Iran
| | - Maryam Zoghi
- Department of Rehabilitation, Nutrition and Sport, School of Allied Health, La Trobe University, Australia
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8
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Hyun SJ, Lee J, Lee BH. The Effects of Sit-to-Stand Training Combined with Real-Time Visual Feedback on Strength, Balance, Gait Ability, and Quality of Life in Patients with Stroke: A Randomized Controlled Trial. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:12229. [PMID: 34831986 PMCID: PMC8625418 DOI: 10.3390/ijerph182212229] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Revised: 11/11/2021] [Accepted: 11/17/2021] [Indexed: 11/29/2022]
Abstract
This study aimed to investigate the effects of lower limbs muscles' strength, balance, walking, and quality of life through sit-to-stand training combined with real-time visual feedback (RVF-STS group) in patients with stroke and to compare the effects of classic sit-to-stand training (C-STS group). Thirty patients with stroke were randomly divided into two groups. The RVF-STS group received sit-to-stand training combined with real-time visual feedback using a Wii Balance Board (n = 15), and the C-STS group received classic sit-to-stand training (n = 15). All participants received training for 20 min once a day, 5 days a week for 6 weeks, and both groups underwent general physical therapy for 30 min before training. Before and after the training, the muscle strength of the hip flexor, abductor, and knee extensor were measured, and the Wii Balance Board was used to perform the center of pressure test and Berg Balance Scale to evaluate static and dynamic balance. Additionally, the 10 m walking test and the Timed Up and Go test were performed to evaluate gait function. The Stroke-Specific Quality of Life was used to measure the quality of life. The results showed that the lower extremity muscle strength, balance ability, walking ability, and quality of life of the RVF-STS group significantly improved in comparison of the pre- and post-differences (p < 0.05), and it also showed significant differences between groups (p < 0.05). This study showed that sit-to-stand training combined with real-time visual feedback was effective at improving the muscle strength of the lower extremities, balance, gait, and quality of life in patients with stroke. Therefore, repeating sit-to-stand training combined with real-time visual feedback could be used as an effective treatment method for patients with stroke.
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Affiliation(s)
- Seung-Jun Hyun
- Graduate School of Physical Therapy, Sahmyook University, Seoul 01795, Korea;
| | - Jin Lee
- Department of Physical Therapy, Sahmyook University, Seoul 01795, Korea;
| | - Byoung-Hee Lee
- Department of Physical Therapy, Sahmyook University, Seoul 01795, Korea;
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9
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Association between Anthropometric Variables, Sex, and Visual Biofeedback in Dynamic Postural Control Assessed on a Computerized Wobble Board. APPLIED SCIENCES-BASEL 2021. [DOI: 10.3390/app11188370] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Anthropometrics and sex influence balance performances, and visual information can change anthropometrics’ relation and the postural sway. Therefore, the aim of the present study was to evaluate the effect of anthropometric characteristics, sex, and visual biofeedback and/or their interaction on a computerized wobble board. Twenty-seven (14 females, 13 males) young adults performed three 30-s double leg stance trials on a wobble board during two conditions: with visual and without visual biofeedback. Visual biofeedback improved (p = 0.010) balance on a wobble board with respect to the condition without visual biofeedback. Regardless of sex, no differences between conditions were found (p = 0.088). When investigating the effect of anthropometrics variables, sex, and their interactions on conditions, a significant main effect of the lower limb/height ratio, sex, and their interaction on the condition without visual biofeedback was found (p = 0.0008; R2 = 0.57). For the visual biofeedback condition, significant effects for sex and body mass (p = 0.0012; R2 = 0.43) and sex and whole-body moment of inertia (p = 0.0030; R2 = 0.39) were found. Results from the present study showed (1) visual biofeedback improved wobble board balance performance; (2) a significant main effect of lower limb/height ratio, sex, and their interaction on the wobble board performances without visual biofeedback emerged; (3) significant effects were found for sex and body mass and sex and moment of inertia in the visual biofeedback condition. Findings from the present study could have an impact on training and evaluations protocols, especially when several populations such as children, athletes, older adults and people with balance disorders are involved.
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10
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Powers J, Wallace A, Mansfield A, Mochizuki G, Patterson KK. The effect of frequency of feedback on overground temporal gait asymmetry post stroke. Top Stroke Rehabil 2021; 29:401-410. [PMID: 34289782 DOI: 10.1080/10749357.2021.1943796] [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: 10/20/2022]
Abstract
BACKGROUND AND OBJECTIVES Temporal gait asymmetry (TGA) affects 55% of people with stroke. This study investigated the effects of augmented feedback during overground gait training, on TGA. METHODS Eighteen people with chronic stroke were randomized to receive one of two feedback displays (A or B) and one of three feedback frequencies; no feedback (0%), after alternate walking trials (50%) or after every trial (100%). Display A depicted the TGA ratio as a vertical line along a horizontal axis with perfect symmetry in the middle. Display B depicted single limb stance duration of each leg as a bar graph. Participants completed 25 repetitions of 30 second trials with their assigned feedback (acquisition). Participants completed 10 repetitions of 30 second trials without feedback 24 hours later (retention). A pressure sensitive mat recorded TGA and speed. Changes in TGA and speed were investigated by plotting individual motor learning curves and fitting a curve with locally estimated scatterplot smoothing (LOESS) for each feedback group. An effect of feedback was defined a priori as a LOESS fitted curve with a decreasing slope from acquisition to retention. RESULTS LOESS curve exhibited a decreasing slope for TGA in the 100B group only and for speed in the 50A and 0FB groups. DISCUSSION This study provides preliminary evidence that visual feedback delivered at a high frequency during a single session of overground walking can change TGA post-stroke without reducing gait speed. An overground gait intervention with high frequency visual feedback to improve TGA post-stroke is worthwhile to investigate.
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Affiliation(s)
- Jessica Powers
- Rehabilitation Sciences Institute, University of Toronto, Toronto, Canada
| | - Aaron Wallace
- Department of Physical Therapy, University of Toronto, Toronto Canada.,KITE - Toronto Rehabilitation Institute, University Health Network, Toronto, Canada
| | - Avril Mansfield
- Rehabilitation Sciences Institute, University of Toronto, Toronto, Canada.,Department of Physical Therapy, University of Toronto, Toronto Canada.,KITE - Toronto Rehabilitation Institute, University Health Network, Toronto, Canada.,Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Canada
| | - George Mochizuki
- Rehabilitation Sciences Institute, University of Toronto, Toronto, Canada.,KITE - Toronto Rehabilitation Institute, University Health Network, Toronto, Canada.,School of Kinesiology and Health Science, York University, Toronto, Canada
| | - Kara K Patterson
- Rehabilitation Sciences Institute, University of Toronto, Toronto, Canada.,Department of Physical Therapy, University of Toronto, Toronto Canada.,KITE - Toronto Rehabilitation Institute, University Health Network, Toronto, Canada
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Koiler R, Bakhshipour E, Glutting J, Lalime A, Kofa D, Getchell N. Repurposing an EMG Biofeedback Device for Gait Rehabilitation: Development, Validity and Reliability. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:6460. [PMID: 34203676 PMCID: PMC8296262 DOI: 10.3390/ijerph18126460] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Revised: 06/09/2021] [Accepted: 06/11/2021] [Indexed: 11/17/2022]
Abstract
Gait impairment often limits physical activity and negatively impacts quality of life. EMG-Biofeedback (EMG-BFB), one of the more effective interventions for improving gait impairment, has been limited to laboratory use due to system costs and technical requirements, and has therefore not been tested on a larger scale. In our research, we aimed to develop and validate a cost-effective, commercially available EMG-BFB device for home- and community-based use. We began by repurposing mTrigger® (mTrigger LLC, Newark, DE, USA), a cost-effective, portable EMG-BFB device, for gait application. This included developing features in the cellphone app such as step feedback, success rate, muscle activity calibration, and cloud integration. Next, we tested the validity and reliability of the mTrigger device in healthy adults by comparing it to a laboratory-grade EMG system. While wearing both devices, 32 adults walked overground and on a treadmill at four speeds (0.3, 0.6, 0.9, and 1.2 m/s). Statistical analysis revealed good to excellent test-retest reliability (r > 0.89) and good to excellent agreement in the detection of steps (ICC > 0.85) at all speeds between two systems for treadmill walking. Our results indicated that mTrigger compared favorably to a laboratory-grade EMG system in the ability to assess muscular activity and to provide biofeedback during walking in healthy adults.
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Affiliation(s)
- Reza Koiler
- Biomechanics and Movement Science Interdisciplinary Program, University of Delaware, Newark, DE 19716, USA; (E.B.); (N.G.)
| | - Elham Bakhshipour
- Biomechanics and Movement Science Interdisciplinary Program, University of Delaware, Newark, DE 19716, USA; (E.B.); (N.G.)
| | - Joseph Glutting
- School of Education, University of Delaware, Newark, DE 19716, USA;
| | - Amy Lalime
- Product & Marketing Manager, mTrigger, LLC, Newark, DE 19713, USA;
| | - Dexter Kofa
- Dexter Kofa, Mobile App Developer, Philadelphia, PA 19120, USA;
| | - Nancy Getchell
- Biomechanics and Movement Science Interdisciplinary Program, University of Delaware, Newark, DE 19716, USA; (E.B.); (N.G.)
- Department of Kinesiology and Applied Physiology, University of Delaware, Newark, DE 19716, USA
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12
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Deutsch JE, James-Palmer A, Damodaran H, Puh U. Comparison of neuromuscular and cardiovascular exercise intensity and enjoyment between standard of care, off-the-shelf and custom active video games for promotion of physical activity of persons post-stroke. J Neuroeng Rehabil 2021; 18:63. [PMID: 33853608 PMCID: PMC8045246 DOI: 10.1186/s12984-021-00850-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Accepted: 03/16/2021] [Indexed: 12/04/2022] Open
Abstract
Background Active video games have been embraced for the rehabilitation of mobility and promotion of physical activity for persons post-stroke. This study seeks to compare carefully matched standard of care stepping activities, off-the-shelf (non-custom) active video games and custom active video games that are either self-paced or game-paced for promoting neuromuscular intensity and accuracy, cardiovascular intensity, enjoyment and perceived effort. Methods Fifteen persons (ages 38–72) with mild to moderate severity in the chronic phase post-stroke (average 8 years) participated in a single group counter balanced repeated measures study. Participants were included if they were greater than 6 months post-stroke, who could walk 100 feet without assistance and stand unsupported for three continuous minutes. They were excluded if they had cardiac, musculoskeletal or neurologic conditions that could interfere with repeated stepping and follow instructions. In a single session located in a laboratory setting, participants executed for 8.5 min each: repeated stepping, the Kinect-light race game, two custom stepping games for the Kinect, one was repeated and self-paced and the other was random and game paced. Custom video games were adjusted to the participants stepping volume. Ten-minute rest periods followed the exercise during which time participants rested and completed the PACES an enjoyment questionnaire. Participants were instrumented with a metabolic cart and heart rate sensor for collection of cardiovascular intensity (METs and % of max HR) data. Stepping frequency, accuracy and pattern were acquired via video. Data were analyzed using a RMANOVA and post-hoc comparison with a Holm's/Sidak correction. Results Neuromuscular intensity (repetitions) was significantly greater for the off-the-shelf and self-paced custom game, however accuracy was greater for the custom games. Cardiovascular intensity for all activities took place in the moderate intensity exercise band. Enjoyment (measured with a questionnaire and rankings) was greater for the custom active video games and rate of perceived exertion was lower for the custom active video games. Conclusions Custom active video games provided comparable intensity but better accuracy, greater enjoyment and less perceived exertion than standard of care stepping activities and a carefully matched off-the-shelf (non-custom) video game. There were no differences between the game-paced and self-paced custom active video games. Trial registration: NCT04538326.
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Affiliation(s)
- Judith E Deutsch
- Rivers Lab, Department of Rehabilitation and Movement Science, Rutgers School of Health Professions, 65 Bergen Street, Newark, NJ, 07101, USA.
| | - Aurora James-Palmer
- Rivers Lab, Department of Rehabilitation and Movement Science, Rutgers School of Health Professions, 65 Bergen Street, Newark, NJ, 07101, USA.,Motor Behavior Lab, Department of Rehab and Movement Science, Rutgers School of Health Professions, 65 Bergen Street, Newark, NJ, 07101, USA
| | - Harish Damodaran
- Rivers Lab, Department of Rehabilitation and Movement Science, Rutgers School of Health Professions, 65 Bergen Street, Newark, NJ, 07101, USA
| | - Urska Puh
- Department of Physiotherapy, Faculty of Health Sciences, University of Ljubljana, Ljubljana, Slovenia
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13
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Vando S, Longo S, Cavaggioni L, Maurino L, Larion A, Invernizzi PL, Padulo J. The Effects of Short-Term Visual Feedback Training on the Stability of the Roundhouse Kicking Technique in Young Karatekas. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18041961. [PMID: 33670474 PMCID: PMC7922084 DOI: 10.3390/ijerph18041961] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Revised: 02/09/2021] [Accepted: 02/11/2021] [Indexed: 11/16/2022]
Abstract
The aim of this study was to assess the efficacy of using real-time visual feedback (VF) during a one-week balance training intervention on postural sway parameters in young karatekas. Twenty-six young male karatekas (age = 14.0 ± 2.3 years) were randomly divided into two groups: real-time VF training (VFT; n = 14) and control (CTRL; n = 12). Their center of pressure (COP) displacement (path length, COPpl; distance from origin, COPod) was assessed pre- and post-training on a Wii Balance Board platform in two positions (Flex: knee of the supporting leg slightly bent, maximum hip and leg flexion of the other leg; Kick: knee of the supporting leg slightly bent, mawashi-geri posture for the kicking leg). Both groups trained twice a day for seven days, performing a one-legged stance on the non-dominant limb in the Kick position. During the training, VFT received real-time VF of COP displacement, while CTRL looked at a fixed point. No interaction effect was found (p > 0.05). VFT exhibited greater changes pre- and post-training in Flex COPpl (-25.2%, g = 1.5), Kick COPpl (-24.1%, g = 1.3), and Kick COPod (-44.1%, g = 1.0) compared to CTRL (-0.9--13.0%, g-range: 0.1-0.7). It is possible that superimposing real-time VF to a week-long balance training intervention could induce a greater sport-specific balance-training effect in young karatekas.
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Affiliation(s)
| | - Stefano Longo
- Department of Biomedical Sciences for Health (SCIBIS), Università degli Studi di Milano, 20133 Milan, Italy; (S.L.); (L.C.); (P.L.I.)
| | - Luca Cavaggioni
- Department of Biomedical Sciences for Health (SCIBIS), Università degli Studi di Milano, 20133 Milan, Italy; (S.L.); (L.C.); (P.L.I.)
| | - Lucio Maurino
- CONI-Italian Olympic Committee, Campania, 80127 Napoli, Italy;
| | - Alin Larion
- Faculty of Physical Education and Sport, Ovidius University of Constanta, 900527 Constanta, Romania;
| | - Pietro Luigi Invernizzi
- Department of Biomedical Sciences for Health (SCIBIS), Università degli Studi di Milano, 20133 Milan, Italy; (S.L.); (L.C.); (P.L.I.)
| | - Johnny Padulo
- Department of Biomedical Sciences for Health (SCIBIS), Università degli Studi di Milano, 20133 Milan, Italy; (S.L.); (L.C.); (P.L.I.)
- Correspondence:
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14
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Chang M, Kim TW, Beom J, Won S, Jeon D. AI Therapist Realizing Expert Verbal Cues for Effective Robot-Assisted Gait Training. IEEE Trans Neural Syst Rehabil Eng 2020; 28:2805-2815. [PMID: 33196441 DOI: 10.1109/tnsre.2020.3038175] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Repetitive and specific verbal cues by a therapist are essential in aiding a patient's motivation and improving the motor learning process. The verbal cues comprise various expressions, sentences, volumes, and timings, depending on the therapist's proficiency. This paper proposes an AI therapist (AI-T) that implements the verbal cues of professional therapists having extensive experience with robot-assisted gait training using the SUBAR for stroke patients. The AI-T was developed using a neuro-fuzzy system, a machine learning technique leveraging the benefits of fuzzy logic and artificial neural networks. The AI-T was trained with the professional therapist's verbal cue data, as well as clinical and robotic data collected from robot-assisted gait training with real stroke patients. Ten clinical data and 16 robotic data are input variables, and six verbal cues are output variables. Fifty-eight stroke patients wore the SUBAR, a gait training robot, and participated in the robot-assisted gait training. A total of 9059 verbal cue data, 580 clinical data of stroke patients, and 144 944 robotic data were collected from 693 training sessions. Test results show that the trained AI-T can implement six types of verbal cues with 93.7% accuracy for the 1812 verbal cue data of the professional therapist. Currently, the trained AI-T is deployed in the SUBAR and provides six verbal cues to stroke patients in robot-assisted gait training.
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15
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Pignolo L, Basta G, Carozzo S, Bilotta M, Todaro MR, Serra S, Ciancarelli I, Tonin P, Cerasa A. A body-weight-supported visual feedback system for gait recovering in stroke patients: A randomized controlled study. Gait Posture 2020; 82:287-293. [PMID: 33002839 DOI: 10.1016/j.gaitpost.2020.09.020] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2020] [Revised: 09/18/2020] [Accepted: 09/20/2020] [Indexed: 02/02/2023]
Abstract
OBJECTIVE The aim of this study was to determine the effectiveness of a novel body-weight-supported (BWS) gait training system with visual feedback, called Copernicus® (Rehalife, Italy). This computerized device provides comfortable, regular and repeatable locomotion in hemiplegic patients. Through visual real-time monitoring of gait parameters, patients are trained to transfer weight loading alternately on both feet. DESIGN A single-blind, randomized controlled study. A single center used a computer-generated randomization code to allocate treatments. SETTING Intensive rehabilitation unit (IRU) at the Institute S. Anna (Italy). PARTICIPANTS 63 first-ever stroke patients (39 men, age: 66.1 ± 9.6 years; 61.6 % with left-sided lesion) randomly distributed into three demographically/clinically matched groups. TREATMENTS All groups were treated five times a week for 2 -h sessions for six consecutive weeks. The first group ("control") underwent a conventional physical therapy; the second group performed advanced BWS gait training sessions without visual feedback (Experimental VF- group); whereas the third group used BWS with visual feedback stimulation (Experimental VF+ group). MAIN OUTCOME MEASURES Absolute changes were recorded using conventional clinical scales and kinematic measurement of static gait balance from baseline to follow-up. RESULTS Significant interaction Group*Time effects scales (F2,126 = 5.1, p-level = 0.005, η²p = 0.25; F2,126 = 4.7, p-level = 0.007, η²p = 0.19; respectively) were detected in the Functional Independence Measure and Tinetti-Balance scales. Post hoc analysis demonstrated that the recovery of motor functioning was greater for the VF + group with respect to other groups (all p's ≤ 0.001). A similar pattern of findings was also obtained with a stabilometric analysis, demonstrating a better clinical improvement in static balance after VF + treatment. CONCLUSION The proposed advanced rehabilitation system with visual feedback was more effective in improving gait recovery with respect to conventional and high-tech therapies without a sensor feedback.
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Affiliation(s)
| | | | | | | | | | | | - Irene Ciancarelli
- Department of Life, Health and Environmental Sciences, University of L'Aquila, Italy
| | | | - Antonio Cerasa
- S. Anna Institute, 88900, Crotone, Italy; Institute for Biomedical Research and Innovation, National Research Council, (IRIB-CNR), 87050, Mangone, CS, Italy.
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Komagata J, Sugiura A, Takamura H, Ohta A, Kitama T. Effect of optokinetic stimulation on weight-bearing shift in standing and sitting positions in stroke patients. Eur J Phys Rehabil Med 2020; 57:13-23. [PMID: 32972091 DOI: 10.23736/s1973-9087.20.06184-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Patients with hemiplegia after stroke tend to bear weight on the non-paretic side and exhibit large postural sway during static standing and walking, which may increase their risk of falls. Improvement of the sitting posture balance in the early phase of rehabilitation by adjusting weight-bearing would minimize the risk of falls as early rehabilitation reportedly improves walking ability and prevents falls in later phases of rehabilitation or at discharge. AIM This study aimed to evaluate the effect of optokinetic stimulation (OKS) on shift of the weight-bearing (displacement of the center of pressure [CoP]) in patients with hemiplegia who are incapable of independent standing. DESIGN Quasi-experimental, cross-sectional study. SETTING Rehabilitation hospital. POPULATION Patients with hemiplegia in the subacute phase after stroke (N.=37). METHODS Standing and sitting balance tests were performed during OKS projected onto a screen. For OKS, a pattern of random dots was presented, which continuously moved in horizontal or torsional directions during both static standing and sitting conditions. Postural sway was assessed during standing and sitting by measuring the sway path, sway area, sway velocity, and mean displacement of CoP. The magnitude of the lateral change in CoP as an indicator of the weight-bearing shift was evaluated by subtraction of the mean CoP of the right-left axis component in the stationary condition from the mean CoP sway during OKS. RESULTS OKS induced a unilateral change of the mean CoP position in patients during both, sitting and static standing, indicating that OKS can shift the weight-bearing in patients after stroke, irrespective of the posture condition. Moreover, the same OKS approach evoked an analogous shift in patients with more severe symptoms, with impairment in independent standing. CONCLUSIONS OKS could induce a significant shift in weight balance in patients with hemiplegia after stroke who are incapable of independent standing, suggesting that the OKS approach can be applied to a broader spectrum of patients, including those with more severe symptoms. CLINICAL REHABILITATION IMPACT OKS approach would improve exercise training in the early phase of rehabilitation of patients with hemiplegia after stroke.
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Affiliation(s)
- Junya Komagata
- Center for Life Science Research, University of Yamanashi, Chuo, Yamanashi, Japan.,Department of Physical Therapy, Health Science University, Minamitsuru-gun, Yamanashi, Japan
| | - Atsushi Sugiura
- Center for Life Science Research, University of Yamanashi, Chuo, Yamanashi, Japan
| | - Hiroshi Takamura
- Department of Physical Therapy, Health Science University, Minamitsuru-gun, Yamanashi, Japan
| | - Akio Ohta
- Department of Rehabilitation, Isawa-Kyoritsu Hospital, Fuefuki, Yamanashi, Japan
| | - Toshihiro Kitama
- Center for Life Science Research, University of Yamanashi, Chuo, Yamanashi, Japan -
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17
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Day KA, Bastian AJ. Providing low-dimensional feedback of a high-dimensional movement allows for improved performance of a skilled walking task. Sci Rep 2019; 9:19814. [PMID: 31875040 PMCID: PMC6930294 DOI: 10.1038/s41598-019-56319-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Accepted: 11/30/2019] [Indexed: 12/28/2022] Open
Abstract
Learning a skilled movement often requires changing multiple dimensions of movement in a coordinated manner. Serial training is one common approach to learning a new movement pattern, where each feature is learned in isolation from the others. Once one feature is learned, we move on to the next. However, when learning a complex movement pattern, serial training is not only laborious but can also be ineffective. Often, movement features are linked such that they cannot simply be added together as we progress through training. Thus, the ability to learn multiple features in parallel could make training faster and more effective. When using visual feedback as the tool for changing movement, however, such parallel training may increase the attentional load of training and impair performance. Here, we developed a novel visual feedback system that uses principal component analysis to weight four features of movement to create a simple one-dimensional 'summary' of performance. We used this feedback to teach healthy, young participants a modified walking pattern and compared their performance to those who received four concurrent streams of visual information to learn the same goal walking pattern. We demonstrated that those who used the principal component-based visual feedback improved their performance faster and to a greater extent compared to those who received concurrent feedback of all features. These results suggest that our novel principal component-based visual feedback provides a method for altering multiple features of movement toward a prescribed goal in an intuitive, low-dimensional manner.
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Affiliation(s)
- Kevin A Day
- Center for Movement Studies, Kennedy Krieger Institute, Baltimore, MD, 21205, USA
- Department of Biomedical Engineering, The Johns Hopkins University School of Medicine, Baltimore, MD, 21205, USA
| | - Amy J Bastian
- Center for Movement Studies, Kennedy Krieger Institute, Baltimore, MD, 21205, USA.
- Department of Neuroscience, The Johns Hopkins University School of Medicine, Baltimore, MD, 21205, USA.
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18
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Madhuranga PVH, Mathangasinghe Y, Anthony DJ. Improving balance with wobble board exercises in stroke patients: single-blind, randomized clinical trial. Top Stroke Rehabil 2019; 26:595-601. [PMID: 31348727 DOI: 10.1080/10749357.2019.1645439] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Background: A primary objective in stroke rehabilitation is to restore functional balance, in order to reduce falls.Objectives: To identify the efficacy and safety of wobble board exercises when combined with conventional physiotherapy, in improving balance in hemiplegic patients following ischemic strokes.Methods: A block-randomized, controlled, observer blinded, superiority trial was conducted on ambulatory hemiplegic patients following ischemic strokes of middle cerebral artery territory. Subjects in the control group received a conventional physiotherapy regime. Subjects in the intervention group received training on a wobble board combined with conventional physiotherapy. Main Outcome measures were the improvement of Four-Square Step Test (FSST) and the Berg Balance Scale (BBS), both of which assess functional balance at the end of 6 weeks.Results: Thirty patients were randomly assigned for intervention (n = 15) and control (n = 15) groups. One patient dropped out from the study, leaving 29 eligible for the analysis. Intervention and control groups were comparable in sociodemographic characteristics and pre-test scores of balance. A repeated-measures MANOVA showed a significant difference in improvement of balance between the two study groups after 6 weeks [F(1,28) = 32.6,p = .000; Wilk's lambda = .46]. The improvement of mean score of balance in interventional group was greater than in the control group [BBS:9.5 (intervention group),5.5 (control group); FSST:3.9 (intervention group),1.7 (control group)]. There were no injuries in both groups.Conclusions: Wobble board exercises, when combined with the conventional physiotherapy, are safe and effective in restoring functional balance in patients with hemiplegia following ischemic strokes.
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Affiliation(s)
| | - Yasith Mathangasinghe
- Department of Anatomy, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka
| | - Dimonge Joseph Anthony
- Department of Allied Health Sciences, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka.,Department of Anatomy, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka
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19
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Ju S, Yoo WG, Oh JS, Kim M. Effects of visual cue and cognitive motor tasks on standing postural control following a chronic stroke. J Phys Ther Sci 2018; 30:601-604. [PMID: 29706715 PMCID: PMC5909011 DOI: 10.1589/jpts.30.601] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2017] [Accepted: 01/23/2018] [Indexed: 11/24/2022] Open
Abstract
[Purpose] The objective of the study was to examine the effects of visual cue and cognitive motor tasks on quiet standing posture center of pressure (COP) and the weight loads to the paretic and non-paretic legs in chronic stroke patients. [Subjects and Methods] Twenty chronic stroke patients were included in the study. COP total distance, sway velocity, and the weight loads to the paretic and non-paretic legs of the participants were measured while they performed a visual cue task, cognitive motor task, and dual task. The parameters were compared using a repeated three-way analysis of variance. [Results] When the visual cue was provided, the COP total distance and sway velocity were significantly reduced compared with when no visual cue was given. When the cognitive motor task was performed, the COP total distance and sway velocity decreased significantly compared to when the task was not performed. [Conclusion] These findings suggest that visual cue and cognitive motor tasks could be used as parts of a rehabilitative training program to improve the control of standing in chronic stroke patients. In addition, visual cues can be used as an intervention to train the paretic leg of stroke patients.
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Affiliation(s)
- Sungkwang Ju
- Department of Physical Therapy, The Graduate School, Inje
University, Republic of Korea
| | - Won-gyu Yoo
- Department of Physical Therapy, Inje University: 197
Inje-ro, Gimhae-si, Gyeongsangnam-do 50834, Republic of Korea
| | - Jae-seop Oh
- Department of Physical Therapy, Inje University: 197
Inje-ro, Gimhae-si, Gyeongsangnam-do 50834, Republic of Korea
| | - Mihyun Kim
- Department of Physical Therapy, Inje University: 197
Inje-ro, Gimhae-si, Gyeongsangnam-do 50834, Republic of Korea
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20
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Khumsapsiri N, Siriphorn A, Pooranawatthanakul K, Oungphalachai T. Training using a new multidirectional reach tool improves balance in individuals with stroke. PHYSIOTHERAPY RESEARCH INTERNATIONAL 2018; 23:e1704. [PMID: 29436087 DOI: 10.1002/pri.1704] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2017] [Revised: 10/23/2017] [Accepted: 01/02/2018] [Indexed: 11/06/2022]
Abstract
BACKGROUND AND PURPOSE Previous studies suggested that limits of stability (LOS) training with visual feedback using commercial equipment could be used to improve balance ability in individuals with stroke. However, this system is expensive. In this study, we created a new tool from inexpensive elements based on LOS training using visual feedback. The aim of this study was to investigate the effect of training using a new multidirectional reach tool on balance in individuals with stroke. METHODS A single-blind randomized control trial was conducted. Individuals with stroke (n = 16; age range 38-72 years) were recruited. Participants in the experimental group were trained with the multidirectional reach training for 30 min and conventional physical therapy for 30 min per day, 3 days a week for 4 weeks. Participants in the control group received conventional physical therapy for 30 min per day, 3 days a week for 4 weeks. The outcomes were LOS, weight-bearing squat, and Fullerton Advanced Balance scale. All of the outcome measures were measured at pretraining, post-training, and 1 month follow-up. RESULTS At post-training and 1-month follow-up, the participants in the experimental group had an improvement of dynamic balance than the control group. Furthermore, the activity assessment by Fullerton Advanced Balance scale was more improved at 1 month follow-up in the experimental group than control group. CONCLUSION The results of this study provide evidence that training using a new multidirectional reach tool is effective for improving balance in individuals with stroke.
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Affiliation(s)
- Numpung Khumsapsiri
- Department of Physical Therapy, Faculty of Allied Health Sciences, Chulalongkorn University, Bangkok, Thailand
| | - Akkradate Siriphorn
- Department of Physical Therapy, Faculty of Allied Health Sciences, Chulalongkorn University, Bangkok, Thailand
| | | | - Tanyarut Oungphalachai
- Department of Physical Therapy, Faculty of Allied Health Sciences, Chulalongkorn University, Bangkok, Thailand
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21
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Ploughman M, Shears J, Quinton S, Flight C, O'brien M, MacCallum P, Kirkland MC, Byrne JM. Therapists' cues influence lower limb muscle activation and kinematics during gait training in subacute stroke. Disabil Rehabil 2017; 40:3156-3163. [PMID: 29041823 DOI: 10.1080/09638288.2017.1380720] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
PURPOSE Symmetrical gait is a key goal of rehabilitation post-stroke. Therapists employ techniques such as verbal instruction and haptic cues to increase activation of paretic muscles. We examined whether verbal or tactile cueing altered spatiotemporal gait parameters, kinematics and electromyography (EMG) of lower limb muscles on the more-affected side within a training session. MATERIALS AND METHODS Patients (n = 10) were recruited from rehabilitation services (<9 months post-stroke). Tactile (to the hip muscles) or verbal cues were provided on two testing days, 7-10 days apart (randomized order). Gait and angular kinematics were recorded using a Vicon motion capture system and muscle activation using EMG; at baseline (PRE), during the cue, directly afterwards without a cue (POST) and 20 min later without a cue (RETEST). RESULTS Both verbal and tactile cueing significantly increased muscle activity in paretic muscles but with no immediate effect on step length asymmetry. Tactile cues, more than verbal, temporarily altered gait speed, cadence and time in double support. Verbal cues caused more robust increases in muscle activation of vastus lateralis at weight acceptance and medial gastrocnemius activity from toe off to midswing. CONCLUSIONS Within a treatment session, tactile cues more effectively altered cadence and double support time while verbal cues more consistently increased vastus lateralis and medial gastrocnemius activity. The effectiveness of these methods in fostering motor relearning in the longer term is an important area for future research. Implications for Rehabilitation Therapist cueing alters muscle activity on hemiparetic side with no effects on symmetry. Tactile cues, more so than verbal cues, increase cadence and reduce time in double support. Verbal cues are more effective at increasing vastus lateralis and plantarflexor muscle activity.
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Affiliation(s)
- Michelle Ploughman
- a Recovery and Performance Laboratory, Faculty of Medicine , Memorial University , St. John's , Newfoundland , Canada
| | - Jennifer Shears
- b Rehabilitation and Continuing Care Program , Eastern Health Authority , St. John's , Newfoundland , Canada
| | - Susan Quinton
- c Janeway Children's Health and Rehabilitation Program , Eastern Health Authority , St. John's , Newfoundland , Canada
| | - Cordell Flight
- c Janeway Children's Health and Rehabilitation Program , Eastern Health Authority , St. John's , Newfoundland , Canada
| | - Michelle O'brien
- c Janeway Children's Health and Rehabilitation Program , Eastern Health Authority , St. John's , Newfoundland , Canada
| | - Phillip MacCallum
- a Recovery and Performance Laboratory, Faculty of Medicine , Memorial University , St. John's , Newfoundland , Canada
| | - Megan C Kirkland
- a Recovery and Performance Laboratory, Faculty of Medicine , Memorial University , St. John's , Newfoundland , Canada
| | - Jeannette M Byrne
- d School of Human Kinetics and Recreation , Memorial University , St. John's , Newfoundland , Canada
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Pellegrino L, Giannoni P, Marinelli L, Casadio M. Effects of continuous visual feedback during sitting balance training in chronic stroke survivors. J Neuroeng Rehabil 2017; 14:107. [PMID: 29037206 PMCID: PMC5644142 DOI: 10.1186/s12984-017-0316-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2017] [Accepted: 10/05/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Postural control deficits are common in stroke survivors and often the rehabilitation programs include balance training based on visual feedback to improve the control of body position or of the voluntary shift of body weight in space. In the present work, a group of chronic stroke survivors, while sitting on a force plate, exercised the ability to control their Center of Pressure with a training based on continuous visual feedback. The goal of this study was to test if and to what extent chronic stroke survivors were able to learn the task and transfer the learned ability to a condition without visual feedback and to directions and displacement amplitudes different from those experienced during training. METHODS Eleven chronic stroke survivors (5 Male - 6 Female, age: 59.72 ± 12.84 years) participated in this study. Subjects were seated on a stool positioned on top of a custom-built force platform. Their Center of Pressure positions were mapped to the coordinate of a cursor on a computer monitor. During training, the cursor position was always displayed and the subjects were to reach targets by shifting their Center of Pressure by moving their trunk. Pre and post-training subjects were required to reach without visual feedback of the cursor the training targets as well as other targets positioned in different directions and displacement amplitudes. RESULTS During training, most stroke survivors were able to perform the required task and to improve their performance in terms of duration, smoothness, and movement extent, although not in terms of movement direction. However, when we removed the visual feedback, most of them had no improvement with respect to their pre-training performance. CONCLUSIONS This study suggests that postural training based exclusively on continuous visual feedback can provide limited benefits for stroke survivors, if administered alone. However, the positive gains observed during training justify the integration of this technology-based protocol in a well-structured and personalized physiotherapy training, where the combination of the two approaches may lead to functional recovery.
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Affiliation(s)
- Laura Pellegrino
- Department Informatics, Bioengineering, Robotics and Systems Engineering, University of Genoa, Via Opera Pia, 16145, Genoa, Italy.
| | - Psiche Giannoni
- Department Informatics, Bioengineering, Robotics and Systems Engineering, University of Genoa, Via Opera Pia, 16145, Genoa, Italy
| | - Lucio Marinelli
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, L.go Daneo, Genoa, 16132, Italy.,Department of Neuroscience, Ospedale Policlinico San Martino, L.go R. Benzi, Genoa, 16132, Italy
| | - Maura Casadio
- Department Informatics, Bioengineering, Robotics and Systems Engineering, University of Genoa, Via Opera Pia, 16145, Genoa, Italy
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Time-Discrete Vibrotactile Feedback Contributes to Improved Gait Symmetry in Patients With Lower Limb Amputations: Case Series. Phys Ther 2017; 97:198-207. [PMID: 28204796 DOI: 10.2522/ptj.20150441] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2015] [Accepted: 09/20/2016] [Indexed: 02/09/2023]
Abstract
Abstract
Background
Reduced sensory feedback from lower leg prostheses results in harmful gait patterns and entails a significant cognitive burden because users have to visually monitor their locomotion.
Objectives
The purpose of this study was to validate a sensory feedback device designed to help elderly patients with transfemoral amputation to improve their temporal gait symmetry after a training program aimed at associating the vibrotactile patterns with symmetrical walking.
Design
This was a prospective quasi-experimental study including 3 elderly patients walking with lower leg prostheses.
Methods
During training sessions, participants walked on a treadmill equipped with a feedback device that controlled vibrotactile stimulators based on signals from a sensorized insole while provided with visual feedback about temporal gait symmetry. The vibrotactile stimulators delivered short-lasting, low-intensity vibrations synchronously with certain gait-phase transitions. During pretraining and posttraining sessions, participants walked without visual feedback about gait symmetry under 4 conditions: with or without vibrotactile feedback while performing or not performing a secondary cognitive task. The primary outcome measure was temporal gait symmetry.
Results
With ≤2 hours of training, the participants improved their temporal gait symmetry from 0.82 to 0.84 during the pretraining evaluation session to 0.98 to 1.02 during the follow-up session across all conditions. Following training, participants were able to maintain good temporal gait symmetry, without any evidence of an increased cognitive burden.
Limitations
The small sample size and short follow-up time do not allow straightforward extrapolations to larger populations or extended time periods.
Conclusions
Low-cost, gait phase–specific vibrotactile feedback after training combined with visual feedback may improve the temporal gait symmetry in patients with transfemoral amputation without representing an additional cognitive burden.
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Stanton R, Ada L, Dean CM, Preston E. Biofeedback improves performance in lower limb activities more than usual therapy in people following stroke: a systematic review. J Physiother 2017; 63:11-16. [PMID: 27989731 DOI: 10.1016/j.jphys.2016.11.006] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2016] [Revised: 08/11/2016] [Accepted: 11/07/2016] [Indexed: 10/20/2022] Open
Abstract
QUESTION Is biofeedback during the practice of lower limb activities after stroke more effective than usual therapy in improving those activities, and are any benefits maintained beyond the intervention? DESIGN Systematic review with meta-analysis of randomised trials with a PEDro score > 4. PARTICIPANTS People who have had a stroke. INTERVENTION Biofeedback (any type delivered by any signal or sense) delivered concurrently during practice of sitting, standing up, standing or walking compared with the same amount of practice without biofeedback. OUTCOME MEASURES Measures of activity congruent with the activity trained. RESULTS Eighteen trials including 429 participants met the inclusion criteria. The quality of the included trials was moderately high, with a mean PEDro score of 6.2 out of 10. The pooled effect size was calculated as a standardised mean difference (SMD) because different outcome measures were used. Biofeedback improved performance of activities more than usual therapy (SMD 0.50, 95% CI 0.30 to 0.70). CONCLUSION Biofeedback is more effective than usual therapy in improving performance of activities. Further research is required to determine the long-term effect on learning. Given that many biofeedback machines are relatively inexpensive, biofeedback could be utilised widely in clinical practice. [Stanton R, Ada L, Dean CM, Preston E (2016) Biofeedback improves performance in lower limb activities more than usual therapy in people following stroke: a systematic review.Journal of Physiotherapy63: 11-16].
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Affiliation(s)
| | - Louise Ada
- Discipline of Physiotherapy, The University of Sydney
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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: 14] [Impact Index Per Article: 1.8] [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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Kim Y, Kang S. Effects of Virtual Reality-Based Exercise on Balance, Gait, and Falls Efficacy in Patients with Parkinson's Disease: A pilot study. ACTA ACUST UNITED AC 2016. [DOI: 10.15268/ksim.2016.4.2.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Park KT, Kim HJ. Effect of the a circuit training program using obstacles on the walking and balance abilities of stroke patients. J Phys Ther Sci 2016; 28:1194-8. [PMID: 27190452 PMCID: PMC4868212 DOI: 10.1589/jpts.28.1194] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2015] [Accepted: 12/23/2015] [Indexed: 11/26/2022] Open
Abstract
[Purpose] The aim of this study was to investigate the impact of a circuit training
program on the walking and balance abilities of stroke patients using an up-to-date
walking analysis device. [Subjects and Methods] The subjects of this study were 12 adults
who were diagnosed with stroke. Evaluation was conducted using the Smart Step test for
walking ability; (BBS) for balance ability; and the Timed Up and Go test (TUG) for
functional mobility and movement ability. The 12 stroke patients were randomly recruited
and divided into two groups; an experimental group which performed circuit training with
obstacles, and a control group which performed flat gait training). [Results]
Between-group comparison of the change in the 10-m walking speed found a statistically
significant difference between the two groups. Between-group comparison of the changes in
BBS and TUG found statistically significant differences between the two groups.
[Conclusion] The circuit training program using obstacles had a positive effect on the
gait and balance abilities of the stroke patients.
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Affiliation(s)
- Ki-Tae Park
- Department of Physical Therapy, Korea National University of Transportation, Republic of Korea
| | - Hyun-Joo Kim
- Department of Physical Therapy, Korea National University of Transportation, Republic of Korea
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Ghomashchi H. Investigating the effects of visual biofeedback therapy on recovery of postural balance in stroke patients using a complexity measure. Top Stroke Rehabil 2016; 23:178-83. [PMID: 27077976 DOI: 10.1080/10749357.2015.1122311] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
BACKGROUND AND PURPOSE Postural balance deficit is one of the common post-stroke disabilities. Providing visual biofeedback while balance activities are performed is a way to improve postural balance disorders following stroke. But among the research publications, there is incoherency about the positive effects of visual biofeedback therapy. The purpose of this study was to investigate the effects of using visual biofeedback as an adjunct to physical therapy exercises on recovery of postural balance of stroke patients. MATERIALS AND METHODS A total of 31 hemiplegic stroke patients were recruited in this study and randomly assigned into case and control groups. Both groups received conventional physical therapy interventions and balance training exercises. During balance training, the case group received visual biofeedback, whereas the control group did not receive visual information. Balance performance of stroke patients were examined quantitatively using the EquiTest testing system. Center of pressure data were collected before starting, during, and after completion of the rehabilitation program and a nonlinear complexity measure, approximate entropy (ApEn), calculated and used for the analysis. RESULTS No significant between-group differences were detected after completion of the program. Noticeable increase was found in ApEn values of both groups along anterior-posterior direction, whereas no statistically significant improvement was found along mediolateral direction after rehabilitation. CONCLUSION Both rehabilitation routines created advances in the postural control system of stroke patients. Visual biofeedback balance training did not produce extra advantage for balance ability of participants who received this treatment program in comparison with those who were treated without visual biofeedback.
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Affiliation(s)
- Hamed Ghomashchi
- a Faculty of Industrial and Mechanical Engineering , Islamic Azad University, Qazvin Branch , Qazvin , Iran
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Park GD, Choi JU, Kim YM. The effects of multidirectional stepping training on balance, gait ability, and falls efficacy following stroke. J Phys Ther Sci 2016; 28:82-6. [PMID: 26957733 PMCID: PMC4755979 DOI: 10.1589/jpts.28.82] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2015] [Accepted: 10/09/2015] [Indexed: 11/25/2022] Open
Abstract
[Purpose] The purpose of this study was to determine whether a multidirectional stepping
training improves balance, gait ability, and falls efficacy in stroke patients. [Subjects]
Firty patients who met the selection criteria and agreed to participate in research at
hospital N were randomly allocated and enrolled in this study. Twenty of the subjects were
assigned to an experimental group that participated in combined stepping exercise, and the
other twenty subjects were assigned to a control group that received general physical
therapy. [Methods] In the two groups, balance was measured using the Berg Balance Scale,
gait ability was measured using the 10-m Walk Test, and falls efficacy was measured using
the Falls Efficacy Scale before training and after 6 weeks of training. [Results]
Comparative analysis of the experimental group’s pretest and post-test results showed
statistically significant differences in the Berg Balance Scale, 10-m Walk Test, and Falls
Efficacy Scale scores. There were significant between-group differences in the Berg
Balance Scale, 10-m Walk Test, and Falls Efficacy Scale scores. [Conclusion] The results
suggest that a combined stepping exercise can be an effective intervention to improve the
balance, gait ability, and falls efficacy in stroke patients.
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Affiliation(s)
- Gi-Deok Park
- Department of Physical Therapy, Korea National University of Transportation, Republic of Korea
| | - Jin-Uk Choi
- Department of Physical Therapy, Graduate School of Physical Therapy, Daegu University, Republic of Korea
| | - Young-Min Kim
- Department of Physical Therapy, Korea National University of Transportation, Republic of Korea
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Souza L, Lemos T, Silva DC, de Oliveira JM, Guedes Corrêa JF, Tavares PL, Oliveira LA, Rodrigues EC, Vargas CD. Balance Impairments after Brachial Plexus Injury as Assessed through Clinical and Posturographic Evaluation. Front Hum Neurosci 2016; 9:715. [PMID: 26834610 PMCID: PMC4724713 DOI: 10.3389/fnhum.2015.00715] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2015] [Accepted: 12/21/2015] [Indexed: 12/03/2022] Open
Abstract
Objective: To investigate whether a sensorimotor deficit of the upper limb following a brachial plexus injury (BPI) affects the upright balance. Design: Eleven patients with a unilateral BPI and 11 healthy subjects were recruited. The balance assessment included the Berg Balance Scale (BBS), the number of feet touches on the ground while performing a 60 s single-leg stance and posturographic assessment (eyes open and feet placed hip-width apart during a single 60 s trial). The body weight distribution (BWD) between the legs was estimated from the center of pressure (COP) lateral position. The COP variability was quantified in the anterior-posterior and lateral directions. Results: BPI patients presented lower BBS scores (p = 0.048) and a higher frequency of feet touches during the single-leg stance (p = 0.042) compared with those of the healthy subjects. An asymmetric BWD toward the side opposite the affected arm was shown by 73% of BPI patients. Finally, higher COP variability was observed in BPI patients compared with healthy subjects for anterior-posterior (p = 0.020), but not for lateral direction (p = 0.818). Conclusions: This study demonstrates that upper limb sensorimotor deficits following BPI affect body balance, serving as a warning for the clinical community about the need to prevent and treat the secondary outcomes of this condition.
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Affiliation(s)
- Lidiane Souza
- Laboratório de Neurobiologia II, Instituto de Biofísica Carlos Chagas Filho, Universidade Federal do Rio de JaneiroRio de Janeiro, Brazil; Núcleo de Pesquisa em Neurociência e Reabilitação, Instituto de Neurologia Deolindo Couto, Universidade Federal do Rio de JaneiroRio de Janeiro, Brazil
| | - Thiago Lemos
- Laboratório de Neurobiologia II, Instituto de Biofísica Carlos Chagas Filho, Universidade Federal do Rio de JaneiroRio de Janeiro, Brazil; Programa de Pós-Graduação em Ciências da Reabilitação, Centro Universitário Augusto MottaRio de Janeiro, Brazil
| | - Débora C Silva
- Laboratório de Neurobiologia II, Instituto de Biofísica Carlos Chagas Filho, Universidade Federal do Rio de JaneiroRio de Janeiro, Brazil; Programa de Pós-Graduação em Ciências da Reabilitação, Centro Universitário Augusto MottaRio de Janeiro, Brazil
| | - José M de Oliveira
- Laboratório de Neurobiologia II, Instituto de Biofísica Carlos Chagas Filho, Universidade Federal do Rio de Janeiro Rio de Janeiro, Brazil
| | - José F Guedes Corrêa
- Núcleo de Pesquisa em Neurociência e Reabilitação, Instituto de Neurologia Deolindo Couto, Universidade Federal do Rio de Janeiro Rio de Janeiro, Brazil
| | - Paulo L Tavares
- Núcleo de Pesquisa em Neurociência e Reabilitação, Instituto de Neurologia Deolindo Couto, Universidade Federal do Rio de Janeiro Rio de Janeiro, Brazil
| | - Laura A Oliveira
- Programa de Pós-Graduação em Ciências da Reabilitação, Centro Universitário Augusto Motta Rio de Janeiro, Brazil
| | - Erika C Rodrigues
- Programa de Pós-Graduação em Ciências da Reabilitação, Centro Universitário Augusto MottaRio de Janeiro, Brazil; Instituto D'Or de Pesquisa e EnsinoRio de Janeiro, Brazil
| | - Claudia D Vargas
- Laboratório de Neurobiologia II, Instituto de Biofísica Carlos Chagas Filho, Universidade Federal do Rio de JaneiroRio de Janeiro, Brazil; Núcleo de Pesquisa em Neurociência e Reabilitação, Instituto de Neurologia Deolindo Couto, Universidade Federal do Rio de JaneiroRio de Janeiro, Brazil
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Modulation of reactive response to slip-like perturbations: effect of explicit cues on paretic versus non-paretic side stepping and fall-risk. Exp Brain Res 2015; 233:3047-58. [PMID: 26289480 DOI: 10.1007/s00221-015-4367-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2015] [Accepted: 06/20/2015] [Indexed: 10/23/2022]
Abstract
This study aimed to examine the effect of explicit cuing on reactive stepping with the paretic limb during slip-like perturbations in stroke survivors and to identify differences in postural stability and fall-risk while stepping with either limb. Eleven chronic hemiparetic stroke survivors received slip-like stance perturbations in no-cue (implicit, no instructions) and cued (explicit, instructions to step with paretic limb) conditions. Frequency of stepping with the paretic limb was recorded. Differences between non-paretic and paretic steps for falls, number of compensatory steps, relative center-of-mass position (X COM/BOS), and velocity (Ẋ(COM/BOS)), and vertical limb support (hip descent-Z hip) were analyzed. Stepping with the paretic limb increased from 6% in no-cue condition to 42% in cued condition with no significant difference in number of falls and steps regardless of stepping limb. At liftoff of the compensatory step, stability was greater (anterior X COM/BOS) with paretic than non-paretic limb stepping whereas, at touchdown (TD) of the step, stability with paretic limb reduced (posterior X COM/BOS and Ẋ(COM/BOS)) due to a smaller compensatory step taken with the paretic versus non-paretic limb. There was no significant difference in peak Z hip regardless of stepping limb; however, the timing of peak Z hip differed (occuring prior to TD during non-paretic stepping and post-TD during paretic stepping). Thus, fall onset was earlier with non-paretic versus paretic stepping. The results support that explicit cueing can facilitate initiation of reactive step from the paretic limb as compared with the no-cue condition. Stepping with the paretic limb in the cued condition however altered time of fall onset. Regardless of the stepping side, individuals demonstrated a fall risk suggesting the need for interventions focusing on reactive step training with both the limbs.
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Oddsson LIE, Finkelstein MJ, Meissner S. Feasibility of early functional rehabilitation in acute stroke survivors using the Balance-Bed-a technology that emulates microgravity. Front Syst Neurosci 2015; 9:83. [PMID: 26074789 PMCID: PMC4445307 DOI: 10.3389/fnsys.2015.00083] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2015] [Accepted: 05/12/2015] [Indexed: 11/13/2022] Open
Abstract
Evidence-based guidelines recommend early functional rehabilitation of stroke patients when risk of patient harm can be managed. Current tools do not allow balance training under load conditions sufficiently low for acute stroke patients. This single-arm pilot study tested feasibility and safety for acute stroke survivors to use "Balance-Bed", a technology for balance exercises in supine initially developed to emulate microgravity effects on balance. Nine acute stroke patients (50-79 years) participated in 3-10 sessions over 16-46 days as part of their rehabilitation in a hospital inpatient setting. Standard inpatient measures of outcome were monitored where lack of progress from admission to discharge might indicate possible harm. Total FIM scores at admission (median 40, range 22-53) changed to (74, 50-96), Motor FIM scores from (23, 13-32) to (50, 32-68) and Berg Balance scores from (3, 0-6) to (19, 7-43) at discharge. Changes reached Minimal Clinical Important Difference for a sufficient proportion (>0.6) of the patients to indicate no harm to the patients. In addition, therapists reported the technology was safe, provided a positive experience for the patient and fit within the rehabilitation program. They reported the device should be easier to set up and exit. We conclude acute stroke patients tolerated Balance-Bed exercises such as standing on one or two legs, squats, stepping in place as well as balance perturbations provided by the therapist. We believe this is the first time it has been demonstrated that acute stroke patients can safely perform whole body balance training including balance perturbations as part of their rehabilitation program. Future studies should include a control group and compare outcomes from best practices to interventions using the Balance-Bed. In addition, the technology is relevant for countermeasure development for spaceflight and as a test-bed of balance function under microgravity-like conditions.
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Affiliation(s)
- Lars I E Oddsson
- Department of Physical Medicine and Rehabilitation, Program in Rehabilitation Science, University of Minnesota Minneapolis, MN, USA ; Technological Leadership Institute, College of Science and Engineering, University of Minnesota Minneapolis, MN, USA ; Recanati School for Community Health Professions, Ben-Gurion University of the Negev Beer Sheva, Israel
| | | | - Sarah Meissner
- Courage Kenny Rehabilitation Institute, Allina Health Minneapolis, MN, USA
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Gowda S, Overduin SA, Chen M, Chang YH, Tomlin CJ, Carmena JM. Accelerating Submovement Decomposition With Search-Space Reduction Heuristics. IEEE Trans Biomed Eng 2015; 62:2508-15. [PMID: 26011861 DOI: 10.1109/tbme.2015.2434595] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE Movements made by healthy individuals can be characterized as superpositions of smooth bell-shaped velocity curves. Decomposing complex movements into these simpler "submovement" building blocks is useful for studying the neural control of movement as well as measuring motor impairment due to neurological injury. APPROACH One prevalent strategy to submovement decomposition is to formulate it as an optimization problem. This optimization problem is nonconvex and finding an exact solution is computationally burdensome. We build on previous literature that generated approximate solutions to the submovement optimization problem. RESULTS First, we demonstrate broad conditions on the submovement building block functions that enable the optimization variables to be partitioned into disjoint subsets, allowing for a faster alternating minimization solution. Specifically, the amplitude parameters of a submovement can typically be fit independently of its shape parameters. Second, we develop a method to concentrate the search in regions of high error to make more efficient use of optimization routine iterations. CONCLUSION Both innovations result in substantial reductions in computation time across multiple nonhuman primate subjects and diverse task conditions. SIGNIFICANCE These innovations may accelerate analysis of submovements for basic neuroscience and enable real-time applications of submovement decomposition.
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Ko Y, Ha H, Bae YH, Lee W. Effect of space balance 3D training using visual feedback on balance and mobility in acute stroke patients. J Phys Ther Sci 2015; 27:1593-6. [PMID: 26157270 PMCID: PMC4483448 DOI: 10.1589/jpts.27.1593] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2015] [Accepted: 01/31/2015] [Indexed: 11/24/2022] Open
Abstract
[Purpose] The purpose of the study was to determine the effects of balance training with Space Balance 3D, which is a computerized measurement and visual feedback balance assessment system, on balance and mobility in acute stroke patients. [Subjects and Methods] This was a randomized controlled trial in which 52 subjects were assigned randomly into either an experimental group or a control group. The experimental group, which contained 26 subjects, received balance training with a Space Balance 3D exercise program and conventional physical therapy interventions 5 times per week during 3 weeks. Outcome measures were examined before and after the 3-week interventions using the Berg Balance Scale (BBS), Timed Up and Go (TUG) test, and Postural Assessment Scale for Stroke Patients (PASS). The data were analyzed by a two-way repeated measures ANOVA using SPSS 19.0. [Results] The results revealed a nonsignificant interaction effect between group and time period for both groups before and after the interventions in the BBS score, TUG score, and PASS score. In addition, the experimental group showed more improvement than the control group in the BBS, TUG and PASS scores, but the differences were not significant. In the comparisons within the groups by time, both groups showed significant improvement in BBS, TUG, and PASS scores. [Conclusion] The Space Balance 3D training with conventional physical therapy intervention is recommended for improvement of balance and mobility in acute stroke patients.
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Affiliation(s)
- YoungJun Ko
- Department of Physical Therapy, Sahmyook University, Republic of Korea
| | - HyunGeun Ha
- Department of Physical Therapy, Sahmyook University, Republic of Korea ; Department of Physical Medicine and Rehabilitation, Samsung Medical Center, Sungkyunkwan University School of Medicine, Republic of Korea
| | - Young-Hyeon Bae
- Department of Physical Medicine and Rehabilitation, Samsung Medical Center, Sungkyunkwan University School of Medicine, Republic of Korea ; Department of Physical Therapy, Angelo State University, USA
| | - WanHee Lee
- Department of Physical Therapy, Sahmyook University, Republic of Korea
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Ki KI, Kim MS, Moon Y, Choi JD. Effects of auditory feedback during gait training on hemiplegic patients' weight bearing and dynamic balance ability. J Phys Ther Sci 2015; 27:1267-9. [PMID: 25995603 PMCID: PMC4434024 DOI: 10.1589/jpts.27.1267] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2014] [Accepted: 01/07/2015] [Indexed: 11/24/2022] Open
Abstract
[Purpose] This study examined the effects of auditory feedback during gait on the weight
bearing of patients with hemiplegia resulting from a stroke. [Subjects] Thirty hemiplegic
patients participated in this experiment and they were randomly allocated to an
experimental group and a control group. [Methods] Both groups received neuro-developmental
treatment for four weeks and the experimental group additionally received auditory
feedback during gait training. In order to examine auditory feedback effects on weight
bearing during gait, a motion analysis system GAITRite was used to measure the duration of
the stance phase and single limb stance phase of the subjects. [Results] The experimental
group showed statistically significant improvements in the duration of the stance phase
and single limb stance phase of the paretic side and the results of the Timed Up and Go
Test after the training. [Conclusion] Auditory feedback during gait training significantly
improved the duration of the stance phase and single limb stance phase of hemiplegic
stroke patients.
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Affiliation(s)
- Kyong-Il Ki
- Department of Physical Therapy, Graduate School, Daejeon University, Republic of Korea
| | - Mi-Sun Kim
- Department of Physical Therapy, Graduate School, Daejeon University, Republic of Korea
| | - Young Moon
- Department of Physical Therapy, Graduate School, Daejeon University, Republic of Korea
| | - Jong-Duk Choi
- Department of Physical Therapy, College of Natural Science, Daejeon University, Republic of Korea
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Afzal MR, Byun HY, Oh MK, Yoon J. Effects of kinesthetic haptic feedback on standing stability of young healthy subjects and stroke patients. J Neuroeng Rehabil 2015; 12:27. [PMID: 25889581 PMCID: PMC4367920 DOI: 10.1186/s12984-015-0020-x] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2014] [Accepted: 02/24/2015] [Indexed: 11/29/2022] Open
Abstract
Background Haptic control is a useful therapeutic option in rehabilitation featuring virtual reality interaction. As with visual and vibrotactile biofeedback, kinesthetic haptic feedback may assist in postural control, and can achieve balance control. Kinesthetic haptic feedback in terms of body sway can be delivered via a commercially available haptic device and can enhance the balance stability of both young healthy subjects and stroke patients. Method Our system features a waist-attached smartphone, software running on a computer (PC), and a dedicated Phantom Omni® device. Young healthy participants performed balance tasks after assumption of each of four distinct postures for 30 s (one foot on the ground; the Tandem Romberg stance; one foot on foam; and the Tandem Romberg stance on foam) with eyes closed. Patient eyes were not closed and assumption of the Romberg stance (only) was tested during a balance task 25 s in duration. An Android application running continuously on the smartphone sent mediolateral (ML) and anteroposterior (AP) tilt angles to a PC, which generated kinesthetic haptic feedback via Phantom Omni®. A total of 16 subjects, 8 of whom were young healthy and 8 of whom had suffered stroke, participated in the study. Results Post-experiment data analysis was performed using MATLAB®. Mean Velocity Displacement (MVD), Planar Deviation (PD), Mediolateral Trajectory (MLT) and Anteroposterior Trajectory (APT) parameters were analyzed to measure reduction in body sway. Our kinesthetic haptic feedback system was effective to reduce postural sway in young healthy subjects regardless of posture and the condition of the substrate (the ground) and to improve MVD and PD in stroke patients who assumed the Romberg stance. Analysis of Variance (ANOVA) revealed that kinesthetic haptic feedback significantly reduced body sway in both categories of subjects. Conclusion Kinesthetic haptic feedback can be implemented using a commercial haptic device and a smartphone. Intuitive balance cues were created using the handle of a haptic device, rendering the approach very simple yet efficient in practice. This novel form of biofeedback will be a useful rehabilitation tool improving the balance of stroke patients.
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Affiliation(s)
- Muhammad Raheel Afzal
- School of Mechanical & Aerospace Engineering & ReCAPT, Gyeongsang National University, Jinju, Republic of Korea.
| | - Ha-Young Byun
- Department of Rehabilitation Medicine, Gyeongsang National University Hospital, Jinju, Republic of Korea.
| | - Min-Kyun Oh
- Department of Rehabilitation Medicine, Gyeongsang National University Hospital, Jinju, Republic of Korea.
| | - Jungwon Yoon
- School of Mechanical & Aerospace Engineering & ReCAPT, Gyeongsang National University, Jinju, Republic of Korea.
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Khadilkar A, Phillips K, Jean N, Lamothe C, Milne S, Sarnecka J. Ottawa Panel Evidence-Based Clinical Practice Guidelines for Post-Stroke Rehabilitation. Top Stroke Rehabil 2015; 13:1-269. [PMID: 16939981 DOI: 10.1310/3tkx-7xec-2dtg-xqkh] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND AND PURPOSE The purpose of this project was to create guidelines for 13 types of physical rehabilitation interventions used in the management of adult patients (>18 years of age) presenting with hemiplegia or hemiparesis following a single clinically identifiable ischemic or hemorrhagic cerebrovascular accident (CVA). METHOD Using Cochrane Collaboration methods, the Ottawa Methods Group identified and synthesized evidence from comparative controlled trials. The group then formed an expert panel, which developed a set of criteria for grading the strength of the evidence and the recommendation. Patient-important outcomes were determined through consensus, provided that these outcomes were assessed with a validated and reliable scale. RESULTS The Ottawa Panel developed 147 positive recommendations of clinical benefit concerning the use of different types of physical rehabilitation interventions involved in post-stroke rehabilitation. DISCUSSION AND CONCLUSION The Ottawa Panel recommends the use of therapeutic exercise, task-oriented training, biofeedback, gait training, balance training, constraint-induced movement therapy, treatment of shoulder subluxation, electrical stimulation, transcutaneous electrical nerve stimulation, therapeutic ultrasound, acupuncture, and intensity and organization of rehabilitation in the management of post stroke.
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Chu VW, Hornby TG, Schmit BD. Perception of lower extremity loads in stroke survivors. Clin Neurophysiol 2015; 126:372-81. [DOI: 10.1016/j.clinph.2014.06.047] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2013] [Revised: 05/28/2014] [Accepted: 06/03/2014] [Indexed: 10/25/2022]
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Boonstra TA, Schouten AC, van Vugt JPP, Bloem BR, van der Kooij H. Parkinson's disease patients compensate for balance control asymmetry. J Neurophysiol 2014; 112:3227-39. [DOI: 10.1152/jn.00813.2013] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
In Parkinson's disease (PD) subtle balance abnormalities can already be detected in early-stage patients. One feature of impaired balance control in PD is asymmetry: one leg produces more corrective joint torque than the other. We hypothesize that in mild to moderately affected PD patients, the least impaired leg compensates for the more impaired leg. Twenty PD patients and eleven healthy matched control subjects participated. Clinical asymmetry was determined by the difference between the left and right body side scores on the Unified Parkinson's Disease Rating Scale. Balance was perturbed with two independent continuous multisine perturbations in the forward-backward direction. Subsequently, we applied closed-loop system identification, which determined the spectral estimate of the stabilizing mechanisms, for each leg. Balance control behavior was similar in PD patients and control subjects at the ankle, but at the hip stiffness was increased. Control subjects exhibited symmetric balance control, but in PD patients the balance contribution of the leg of the clinically least affected body side was higher whereas the leg of the clinically most affected body side contributed less. The ratio between the legs helped to preserve a normal motor output at the ankle. Our results suggest that PD patients compensate for balance control asymmetries by increasing the relative contribution of the leg of their least affected body side. This compensation appears to be successful at the ankle but is accompanied by an increased stiffness at the hip. We discuss the possible implications of these findings for postural stability and fall risk in PD patients.
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Affiliation(s)
- T. A. Boonstra
- Department of Biomechanical Engineering, University of Twente, MIRA Institute for Biomechanical Technology and Technical Medicine, Enschede, The Netherlands
| | - A. C. Schouten
- Department of Biomechanical Engineering, University of Twente, MIRA Institute for Biomechanical Technology and Technical Medicine, Enschede, The Netherlands
- Department of Biomechanical Engineering, Delft University of Technology, Delft, The Netherlands
| | - J. P. P. van Vugt
- Department of Neurology, Medical Spectrum Twente, Enschede, The Netherlands; and
| | - B. R. Bloem
- Radboud University Nijmegen Medical Centre, Donders Institute for Brain, Cognition and Behaviour, Department of Neurology, Nijmegen, The Netherlands
| | - H. van der Kooij
- Department of Biomechanical Engineering, University of Twente, MIRA Institute for Biomechanical Technology and Technical Medicine, Enschede, The Netherlands
- Department of Biomechanical Engineering, Delft University of Technology, Delft, The Netherlands
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Barbosa D, Santos CP, Martins M. The application of cycling and cycling combined with feedback in the rehabilitation of stroke patients: a review. J Stroke Cerebrovasc Dis 2014; 24:253-73. [PMID: 25444025 DOI: 10.1016/j.jstrokecerebrovasdis.2014.09.006] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2014] [Revised: 08/29/2014] [Accepted: 09/06/2014] [Indexed: 01/27/2023] Open
Abstract
Stroke is a leading cause of long-term disabilities, such as hemiparesis, inability to walk without assistance, and dependence of others in the activities of daily living. Motor function rehabilitation after stroke demands for methods oriented to the recovery of the walking capacity. Because of the similarities with walking, cycling leg exercise may present a solution to this problem. The aim of this article is to review the state of the art applications of cycling leg exercise as a (1) motor function rehabilitation method and an (2) aerobic training method for stroke patients as well as the commonly used (3) assessment tools. The cycling characteristics and applications, the applied test protocols as well as the tools used to assess the state and the recovery of patients and types of cycling devices are presented. In addition, the potential benefits of the use of other therapies, like feedback, together with cycling are explored. The application of cycling leg exercise alone and combined with feedback in stroke rehabilitation approaches has shown promising results. Positive effects on motor abilities were found in subacute and chronic patients. However, larger and normalized studies and assessments are needed because there is a high heterogeneity in the patients' characteristics, protocols and metrics. This wil allow the comparison between different studies related with cycling.
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Affiliation(s)
- David Barbosa
- Department of Industrial Electronics, University of Minho, Azurém, Guimarães, Portugal
| | - Cristina P Santos
- Department of Industrial Electronics, University of Minho, Azurém, Guimarães, Portugal.
| | - Maria Martins
- Department of Industrial Electronics, University of Minho, Azurém, Guimarães, Portugal
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Ji SG, Kim MK. The effects of mirror therapy on the gait of subacute stroke patients: a randomized controlled trial. Clin Rehabil 2014; 29:348-54. [DOI: 10.1177/0269215514542356] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective: To investigate the effect of mirror therapy on the gait of patients with subacute stroke. Design: Randomized controlled experimental study. Setting: Outpatient rehabilitation hospital. Subjects: Thirty-four patients with stroke were randomly assigned to two groups: a mirror therapy group (experimental) and a control group. Interventions: The stroke patients in the experimental group underwent comprehensive rehabilitation therapy and mirror therapy for the lower limbs. The stroke patients in the control group underwent sham therapy and comprehensive rehabilitation therapy. Participants in both groups received therapy five days per week for four weeks. Main measures: Temporospatial gait characteristics, such as single stance, stance phase, step length, stride, swing phase, velocity, and cadence, were assessed before and after the four weeks therapy period. Results: A significant difference was observed in post-training gains for the single stance (10.32 SD 4.14 vs. 6.54 SD 3.23), step length (8.47 SD 4.12 vs. 4.83 SD 2.14), and stride length (17.03 SD 6.57 vs 10.54 SD 4.34) between the experimental group and the control group ( p < 0.05). However, there were no significant differences between two groups on stance phase, swing phase, velocity, cadence, and step width ( P > 0.05). Conclusion: We conclude that mirror therapy may be beneficial in improving the effects of stroke on gait ability.
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Affiliation(s)
- Sang Gu Ji
- Department of Physical Therapy, Eulji University Hospital, Daejeon, Republic of Korea
| | - Myoung Kwon Kim
- Department of Physical Therapy, Youngsan University, Kyeongsangnam-do, Republic of Korea
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Veerbeek JM, van Wegen E, van Peppen R, van der Wees PJ, Hendriks E, Rietberg M, Kwakkel G. What is the evidence for physical therapy poststroke? A systematic review and meta-analysis. PLoS One 2014; 9:e87987. [PMID: 24505342 PMCID: PMC3913786 DOI: 10.1371/journal.pone.0087987] [Citation(s) in RCA: 675] [Impact Index Per Article: 67.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2013] [Accepted: 12/30/2013] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Physical therapy (PT) is one of the key disciplines in interdisciplinary stroke rehabilitation. The aim of this systematic review was to provide an update of the evidence for stroke rehabilitation interventions in the domain of PT. METHODS AND FINDINGS Randomized controlled trials (RCTs) regarding PT in stroke rehabilitation were retrieved through a systematic search. Outcomes were classified according to the ICF. RCTs with a low risk of bias were quantitatively analyzed. Differences between phases poststroke were explored in subgroup analyses. A best evidence synthesis was performed for neurological treatment approaches. The search yielded 467 RCTs (N = 25373; median PEDro score 6 [IQR 5-7]), identifying 53 interventions. No adverse events were reported. Strong evidence was found for significant positive effects of 13 interventions related to gait, 11 interventions related to arm-hand activities, 1 intervention for ADL, and 3 interventions for physical fitness. Summary Effect Sizes (SESs) ranged from 0.17 (95%CI 0.03-0.70; I(2) = 0%) for therapeutic positioning of the paretic arm to 2.47 (95%CI 0.84-4.11; I(2) = 77%) for training of sitting balance. There is strong evidence that a higher dose of practice is better, with SESs ranging from 0.21 (95%CI 0.02-0.39; I(2) = 6%) for motor function of the paretic arm to 0.61 (95%CI 0.41-0.82; I(2) = 41%) for muscle strength of the paretic leg. Subgroup analyses yielded significant differences with respect to timing poststroke for 10 interventions. Neurological treatment approaches to training of body functions and activities showed equal or unfavorable effects when compared to other training interventions. Main limitations of the present review are not using individual patient data for meta-analyses and absence of correction for multiple testing. CONCLUSIONS There is strong evidence for PT interventions favoring intensive high repetitive task-oriented and task-specific training in all phases poststroke. Effects are mostly restricted to the actually trained functions and activities. Suggestions for prioritizing PT stroke research are given.
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Affiliation(s)
- Janne Marieke Veerbeek
- Department of Rehabilitation Medicine, MOVE Research Institute Amsterdam, VU University Medical Center, Amsterdam, The Netherlands
| | - Erwin van Wegen
- Department of Rehabilitation Medicine, MOVE Research Institute Amsterdam, VU University Medical Center, Amsterdam, The Netherlands
| | - Roland van Peppen
- Department of Physiotherapy, University of Applied Sciences Utrecht, Utrecht, The Netherlands
| | - Philip Jan van der Wees
- Scientific Institute for Quality of Healthcare (IQ healthcare), Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands
| | - Erik Hendriks
- Department of Epidemiology, Maastricht University, Maastricht, The Netherlands
| | - Marc Rietberg
- Department of Rehabilitation Medicine, MOVE Research Institute Amsterdam, VU University Medical Center, Amsterdam, The Netherlands
| | - Gert Kwakkel
- Department of Rehabilitation Medicine, MOVE Research Institute Amsterdam, VU University Medical Center, Amsterdam, The Netherlands
- Department of Neurorehabilitation, Reade Center for Rehabilitation and Rheumatology, Amsterdam, The Netherlands
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Hendrickson J, Patterson KK, Inness EL, McIlroy WE, Mansfield A. Relationship between asymmetry of quiet standing balance control and walking post-stroke. Gait Posture 2014; 39:177-81. [PMID: 23877032 DOI: 10.1016/j.gaitpost.2013.06.022] [Citation(s) in RCA: 109] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2012] [Revised: 04/29/2013] [Accepted: 06/28/2013] [Indexed: 02/02/2023]
Abstract
Spatial and temporal gait asymmetry is common after stroke. Such asymmetric gait is inefficient, can contribute to instability and may lead to musculoskeletal injury. However, understanding of the determinants of such gait asymmetry remains incomplete. The current study is focused on revealing if there is a link between asymmetry during the control of standing balance and asymmetry during walking. This study involved review of data from 94 individuals with stroke referred to a gait and balance clinic. Participants completed three tests: (1) walking at their usual pace; (2) quiet standing; and (3) standing with maximal loading of the paretic side. A pressure sensitive mat recorded placement and timing of each footfall during walking. Standing tests were completed on two force plates to evaluate symmetry of weight bearing and contribution of each limb to balance control. Multiple regression was conducted to determine the relationships between symmetry during standing and swing time, stance time, and step length symmetry during walking. Symmetry of antero-posterior balance control and weight bearing were related to swing time and step length symmetry during walking. Weight-bearing symmetry, weight-bearing capacity, and symmetry of antero-posterior balance control were related to stance time symmetry. These associations were independent of underlying lower limb impairment. The results support the hypothesis that impaired ability of the paretic limb to control balance may contribute to gait asymmetry post-stroke. Such work suggests that rehabilitation strategies that increase the contribution of the paretic limb to standing balance control may increase symmetry of walking post-stroke.
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Affiliation(s)
- Janna Hendrickson
- Department of Kinesiology, University of Waterloo, Waterloo, ON, Canada; Mobility Team, Toronto Rehabilitation Institute, Toronto, ON, Canada
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Sackley CM, Gladman JRF. The evidence for rehabilitation after severely disabling stroke. PHYSICAL THERAPY REVIEWS 2013. [DOI: 10.1179/ptr.1998.3.1.19] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Hayward KS, Barker RN, Carson RG, Brauer SG. The effect of altering a single component of a rehabilitation programme on the functional recovery of stroke patients: a systematic review and meta-analysis. Clin Rehabil 2013; 28:107-17. [PMID: 23922265 DOI: 10.1177/0269215513497601] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To evaluate the effect of altering a single component of a rehabilitation programme (e.g. adding bilateral practice alone) on functional recovery after stroke, defined using a measure of activity. DATA SOURCES A search was conducted of Medline/Pubmed, CINAHL and Web of Science. REVIEW METHODS Two reviewers independently assessed eligibility. Randomized controlled trials were included if all participants received the same base intervention, and the experimental group experienced alteration of a single component of the training programme. This could be manipulation of an intrinsic component of training (e.g. intensity) or the addition of a discretionary component (e.g. augmented feedback). One reviewer extracted the data and another independently checked a subsample (20%). Quality was appraised according to the PEDro scale. RESULTS Thirty-six studies (n = 1724 participants) were included. These evaluated nine training components: mechanical degrees of freedom, intensity of practice, load, practice schedule, augmented feedback, bilateral movements, constraint of the unimpaired limb, mental practice and mirrored-visual feedback. Manipulation of the mechanical degrees of freedom of the trunk during reaching and the addition of mental practice during upper limb training were the only single components found to independently enhance recovery of function after stroke. CONCLUSION This review provides limited evidence to support the supposition that altering a single component of a rehabilitation programme realises greater functional recovery for stroke survivors. Further investigations are required to determine the most effective single components of rehabilitation programmes, and the combinations that may enhance functional recovery.
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Affiliation(s)
- Kathryn S Hayward
- 1Division of Physiotherapy, The University of Queensland Brisbane, Brisbane, Australia
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Foo J, Paterson K, Williams G, Clark R. Low-cost evaluation and real-time feedback of static and dynamic weight bearing asymmetry in patients undergoing in-patient physiotherapy rehabilitation for neurological conditions. J Neuroeng Rehabil 2013; 10:74. [PMID: 23849318 PMCID: PMC3723838 DOI: 10.1186/1743-0003-10-74] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2012] [Accepted: 06/14/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Weight bearing asymmetry is common in patients with neurological conditions, and recent advances in gaming technology have produced force platforms that are suitable for use in a clinical setting. The aim of this research is to determine whether commercially-available Wii Balance Boards with customized software providing real-time feedback could be used in a clinical setting to evaluate and improve weight-bearing asymmetry in people with various neurological conditions. METHODS Twenty participants (age = 43.25 ± 19.37 years) receiving physiotherapy as a result of a neurological condition performed three trials each of two tasks (static standing and sit-to-stand) with and without visual feedback. Vertical forces were measured using available Wii Balance Boards coupled with customized software that displayed visual feedback in real-time. Primary outcome measures included weight-bearing asymmetry as a percentage of body mass, peak force symmetry index, and a visual analogue scale score rating self-perceived level of asymmetry. RESULTS Weight-bearing asymmetry during the static balance task was significantly reduced (Z = -2.912, p = 0.004, ES = 0.65) with visual feedback. There was no significant difference (Z = -0.336, p = 0.737) with visual feedback for the dynamic task, however subgroup analysis indicated that those with higher weight-bearing asymmetry responded the most to feedback. Correlation analysis revealed little or no relationship between participant perception of weight-bearing asymmetry and the results for the static or dynamic balance task (Spearman's rho: ρ = 0.138, p = 0.561 and ρ = 0.018, ρ =0.940 respectively). CONCLUSIONS These findings suggest that weight-bearing asymmetry can be reduced during static tasks in patients with neurological conditions using inexpensive commercially-available Wii Balance Boards coupled with customized visual feedback software. Further research is needed to determine whether real-time visual feedback is appropriate for reducing dynamic weight-bearing asymmetry, whether improvements result in improved physical function, and how cognitive and physical impairments influence the patient's ability to respond to treatment.
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Relative efficacy of various strategies for visual feedback in standing balance activities. Exp Brain Res 2013; 230:117-25. [DOI: 10.1007/s00221-013-3634-x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2013] [Accepted: 06/24/2013] [Indexed: 10/26/2022]
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Lee SW, Shin DC, Song CH. The effects of visual feedback training on sitting balance ability and visual perception of patients with chronic stroke. J Phys Ther Sci 2013; 25:635-9. [PMID: 24259819 PMCID: PMC3804977 DOI: 10.1589/jpts.25.635] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2012] [Accepted: 01/22/2013] [Indexed: 11/26/2022] Open
Abstract
[Purpose] The purpose of this study was to investigate the effects of visual feedback
training (VFT) in the sitting position on sitting balance ability and visual perception of
chronic stroke patients. [Subjects] Twenty-two hospitalized subjects who had experienced a
stroke more than six months earlier were included in this study. [Methods] Subjects in
both the experimental group (n=12) and the control group (n=10) participated in a
conventional rehabilitation program involving a 60-minute session five days per week for a
period of four weeks. Subjects in the experimental group additionally practiced VFT
30-minute sessions, five days per week, for a period of four weeks. [Results] After the
intervention, the experimental group showed significantly improved static sitting balance
ability (left∙right, anterior∙posterior moment, and velocity moment), and dynamic sitting
balance ability (anterior∙lateral moment). In visual perception tests, motor free visual
perception test (MVPT) scores showed a significant increase of approximately 17% in the
experimental group after the intervention. [Conclusion] The results of this study
demonstrate the effectiveness of VFT in enhancing body function, as evidenced by improved
sitting balance and visual perception of chronic stroke patients.
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Affiliation(s)
- Seok Won Lee
- Department of Physical Therapy, Sahmyook University
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Abstract
QUESTION Is biofeedback during the practice of lower limb activities after stroke effective in improving performance of those activities, and are any benefits maintained after intervention ceases? DESIGN Systematic review with meta-analysis of randomised trials. PARTICIPANTS People who have had a stroke. INTERVENTION Biofeedback during practice of sitting, standing up, standing, or walking. OUTCOME MEASURES Continuous measures of activity congruent with the activity trained. RESULTS 22 trials met the inclusion criteria and 19 contained data suitable for analysis. Effect sizes were calculated as standardised mean differences because different outcome measures were used. Since inclusion of all trials produced substantial statistical heterogeneity, only trials with a PEDro score >4 (11 trials) were included in the final analysis (mean PEDro score 5.7). In the short-term, biofeedback improved lower limb activities compared with usual therapy/placebo (SMD=0.49, 95% CI 0.22 to 0.75). Lower limb activities were still improved compared with usual therapy/placebo 1 to 5 months after the cessation of intervention (SMD=0.41, 95% CI 0.06 to 0.75). CONCLUSION Augmenting feedback through the use of biofeedback is superior to usual therapy/placebo at improving lower limb activities in people following stroke. Furthermore, these benefits are largely maintained in the longer term. Given that many biofeedback machines are relatively inexpensive, biofeedback could be utilised more widely in clinical practice.
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Giggins OM, Persson UM, Caulfield B. Biofeedback in rehabilitation. J Neuroeng Rehabil 2013; 10:60. [PMID: 23777436 PMCID: PMC3687555 DOI: 10.1186/1743-0003-10-60] [Citation(s) in RCA: 272] [Impact Index Per Article: 24.7] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2012] [Accepted: 06/06/2013] [Indexed: 12/22/2022] Open
Abstract
This paper reviews the literature relating to the biofeedback used in physical rehabilitation. The biofeedback methods used in rehabilitation are based on biomechanical measurements and measurements of the physiological systems of the body. The physiological systems of the body which can be measured to provide biofeedback are the neuromuscular system, the respiratory system and the cardiovascular system. Neuromuscular biofeedback methods include electromyography (EMG) biofeedback and real-time ultrasound imaging (RTUS) biofeedback. EMG biofeedback is the most widely investigated method of biofeedback and appears to be effective in the treatment of many musculoskeletal conditions and in post cardiovascular accident (CVA) rehabilitation. RTUS biofeedback has been demonstrated effective in the treatment of low back pain (LBP) and pelvic floor muscle dysfunction. Cardiovascular biofeedback methods have been shown to be effective in the treatment of a number of health conditions such as hypertension, heart failure, asthma, fibromyalgia and even psychological disorders however a systematic review in this field has yet to be conducted. Similarly, the number of large scale studies examining the use of respiratory biofeedback in rehabilitation is limited. Measurements of movement, postural control and force output can be made using a number of different devices and used to deliver biomechanical biofeedback. Inertial based sensing biofeedback is the most widely researched biomechanical biofeedback method, with a number of studies showing it to be effective in improving measures of balance in a number of populations. Other types of biomechanical biofeedback include force plate systems, electrogoniometry, pressure biofeedback and camera based systems however the evidence for these is limited. Biofeedback is generally delivered using visual displays, acoustic or haptic signals, however more recently virtual reality (VR) or exergaming technology have been used as biofeedback signals. VR and exergaming technology have been primarily investigated in post-CVA rehabilitation, however, more recent work has shown this type of biofeedback to be effective in improving exercise technique in musculoskeletal populations. While a number of studies in this area have been conducted, further large scale studies and reviews investigating different biofeedback applications in different clinical populations are required.
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Affiliation(s)
- Oonagh M Giggins
- Clarity Centre for Sensor Web Technologies, University College Dublin, Belfield, Dublin 4, Ireland.
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