The use of biofeedback for gait retraining: A mapping review

Background: Biofeedback seems to be a promising tool to improve gait outcomes for both healthy individuals and patient groups. However, due to differences in study designs and outcome measurements, it remains uncertain how different forms of feedback affect gait outcomes. Therefore, the aim of this study is to review primary biomechanical literature which has used biofeedback to alter gait-related outcomes in human participants. Methods: Medline, Cinahl, Cochrane, SPORTDiscus and Pubmed were searched from inception to December 2017 using various keywords and the following MeSHterms: biofeedback, feedback, gait, walking and running. From the included studies, sixteen different study characteristics were extracted. Findings: In this mapping review 173 studies were included. The most common feedback mode used was visual feedback (42%, n=73) and the majority fed-back kinematic parameters (36%, n=62). The design of the studies were poor: only 8% (n=13) of the studies had both a control group and a retention test; 69% (n=120) of the studies had neither. A retention test after 6 months was performed in 3% (n=5) of the studies, feedback was faded in 9% (n=15) and feedback was given in the field rather than the laboratory in 4% (n=8) of the studies. Interpretation: Further work on biofeedback and gait should focus on the direct comparison between different modes of feedback or feedback parameters, along with better designed and field based studies

Haptic wearables as sensory replacement, sensory augmentation and trainer - a review

Sensory impairments decrease quality of life and can slow or hinder rehabilitation. Small, computationally powerful electronics have enabled the recent development of wearable systems aimed to improve function for individuals with sensory impairments. The purpose of this review is to synthesize current haptic wearable research for clinical applications involving sensory impairments. We define haptic wearables as untethered, ungrounded body worn devices that interact with skin directly or through clothing and can be used in natural environments outside a laboratory. Results of this review are categorized by degree of sensory impairment. Total impairment, such as in an amputee, blind, or deaf individual, involves haptics acting as sensory replacement; partial impairment, as is common in rehabilitation, involves haptics as sensory augmentation; and no impairment involves haptics as trainer. This review found that wearable haptic devices improved function for a variety of clinical applications including: rehabilitation, prosthetics, vestibular loss, osteoarthritis, vision loss and hearing loss. Future haptic wearables development should focus on clinical needs, intuitive and multimodal haptic displays, low energy demands, and biomechanical compliance for long-term usage

An investigation into the utility of wearable sensor derived biofeedback on the motor control of the lumbar spine

Lower back pain (LBP) is a disability that affects a large proportion of the population and treatment for this has been shifting towards a more individualized, patient-centered approach. There has been a recent uptake in the utilization and implementation of wearable sensors that can administer biofeedback in various industrial, clinical, and performance-based settings. The overall aim of this Master’s thesis was to investigate how wearable sensors can be used in a sensorimotor (re)training approach, including how sensory biofeedback from wearable sensors can be used to improve measures of spinal motor control and proprioception. Two complementary research studies were completed to address this overall aim. As a systematic review, Study #1 focused on addressing the lack of consensus surrounding wearable sensor derived biofeedback and spine motor control. The results of this review suggest that haptic/vibrotactile feedback is the most common and that it is administered in an instantaneous real-time manner within most experimental paradigms. Further, study #1 identified clear gaps within the research literature. Specifically, future research would benefit from more clarity regarding study design, and movement instructions, and explicit definitions of biofeedback parameters to enhance reproducibility. The aim of Study #2 was to assess the acute effects of wearable sensor-derived auditory biofeedback on gross lumbar proprioception. To assess this, participants completed a target repositioning protocol, followed by a training period where they were provided with auditory feedback for two of four targets based on a percentage of their lumbar ROM. Results suggest that mid-range targets benefitted most from the acute auditory feedback training. Further, individuals with poorer repositioning abilities in the pre-training assessment showed the greatest improvements from the auditory feedback training. This suggests that auditory biofeedback training may be an effective tool to improve proprioception in those with proprioceptive deficits. Collectively these complimentary research studies will improve the understanding surrounding the ecological utility of wearable sensor derived biofeedback in industrial, clinical, and performance settings to enhance to sensorimotor control of the lumbar region

Master of Science

thesisComputing and data acquisition have become an integral part of everyday life. From reading emails on a cell phone, to kids playing with motion sensing game consoles, we are surrounded with sensors and mobile devices. As the availability of powerful mobile computing devices expands, the road is paved for applications in previously limited environments. Rehabilitative devices are emerging that embrace these mobile advances. Research has explored the use of smartphones in rehabilitation as a means to process data and provide feedback in conjunction with established rehabilitative methods. Smartphones, combined with sensor embedded insoles, provide a powerful tool for the clinician in gathering data and may act as a standalone training technique. This thesis presents continuing research of a sensor integrated insole system that provides real-time feedback through a mobile platform, the Adaptive Real-Time Instrumentation System for Tread Imbalance Correction (ARTISTIC). The system interfaces a wireless instrumented insole with an Android smartphone application to receive gait data and provide sensory feedback to modify gait patterns. Revisions to the system hardware, software, and feedback modes brought about the introduction of the ARTISTIC 2.0. The number of sensors in the insole was increased from two to 10. The microprocessor and a vibrotactile motor were embedded in the insole and the communications box was reduced in size and weight by more than 50%. Stance time iv measurements were validated against force plate equipment and found to be within 13.5 ± 3.3% error of force plate time measurements. Human subjects were tested using each of the feedback modes to alter gait symmetry. Results from the testing showed that more than one mode of feedback caused a statistically significant change in gait symmetry ratios (p < 0.05). Preference of feedback modes varied among subjects, with the majority agreeing that several feedback modes made a difference in their gait. Further improvements will prepare the ARTISTIC 2.0 for testing in a home environment for extended periods of time and improve data capture techniques, such as including a database in the smartphone application

Ergowear: desenvolvimento de um vestuário inteligente para monitorização postural e biofeedback

Dissertação de mestrado em Engenharia Biomédica (especialização em Eletrónica Médica)Atualmente, as Lesões Musculoesqueléticas Relacionadas com o Trabalho (LMERT) são considera das o ”problema relacionado com o trabalho mais prevalente”na União Europeia, levando a um custo estimado de cerca de 240 biliões de euros. Em casos mais severos, estes distúrbios podem causar danos vitalícios à saúde do trabalhador, reduzindo a sua qualidade de vida. De facto, LMERTs são con sideradas a principal causa da reforma precoce dos trabalhadores. Foi reportado que os segmentos da parte superior do corpo são mais suceptíveis ao desenvolvimento de LMERTs. Para mitigar a prevalência de LMERTs, ergonomistas maioritariamente aplicam métodos de avaliação observacionais, que são alta mente dependentes da experiência do analista, e apresentam baixa objetividade e repetibilidade. Desta maneira, esforços têm sido feitos para desenvolver ferramentas de avaliação ergonómica baseadas na instrumentação, para compensar essas limitações. Além disso, com a ascensão do conceito da indústria 5.0, o trabalhador humano volta a ser o foco principal na indústria, juntamente com o robô colaborativo. No entanto, para alcançar uma relação verdadeiramente colaborativa e simbiótica entre o trabalhador e o robô, este último precisa de reconhecer as intenções do trabalhador. Para superar este obstáculo, sis temas de captura de movimento podem ser integrados nesta estrutura, fornecendo dados de movimento ao robô colaborativo. Esta dissertação visa a melhoria de um sistema de captura de movimento autónomo, da parte supe rior do corpo, de abordagem inercial que servirá, não apenas para monitorizar a postura do trabalhador, mas também avaliar a ergonomia do usuário e fornecer consciencialização postural ao usuário, por meio de motores de biofeedback. Além disso, o sistema foi já idealizado tendo em mente a sua integração numa estrutura colaborativa humano-robô. Para atingir estes objetivos, foi aplicada uma metodologia de design centrado no utilizador, começando pela análise do Estado da Arte, a avaliação das limitações do sistema anterior, a definição dos requisitos do sistema, o desenvolvimento da peça de vestuário, arquite tura do hardware e arquitetura do software do sistema. Por fim, o sistema foi validado para verificar se estava em conformidade com os requisitos especificados. O sistema é composto por 9 Unidades de Medição Inercial (UMI), posicionados na parte inferior e superior das costas, cabeça, braços, antebraços e mãos. Também foi integrado um sistema de atuação, para biofeedback postural, composto por 6 motores vibrotáteis, localizados na região lombar e próximo do pescoço, cotovelos e pulsos. O sistema é alimentado por uma powerbank e todos os dados adquiridos são enviados para uma estação de processamento, via WiFi (User Datagram Protocol (UDP)), garantindo autonomia. O sistema tem integrado um filtro de fusão Complementar Extendido e uma sequência de calibração Sensor-para-Segmento estática, de maneira a aumentar a precisão da estimativa dos ângulos das articulações. Além disso, o sistema é capaz de amostrar os dados angulares a 240 Hz, enquanto que o sistema anterior era capaz de amostrar no máximo a 100 Hz, melhorando a resolução da aquisição dos dados. O sistema foi validado em termos de hardware e usabilidade. Os testes de hardware abordaram a caracterização da autonomia, frequência de amostragem, robustez mecânica e desempenho da comuni cação sem fio do sistema, em diversos contextos, e também para verificar se estes estão em conformidade com os requisitos técnicos previamente definidos, que foi o caso. Adicionalmente, as especificações da nova versão do sistema foram comparadas com a anterior, onde se observou uma melhoria direta signifi cativa, como por exemplo, maior frequência de amostragem, menor perda de pacote, menor consumo de corrente, entre outras, e com sistemas comerciais de referência (XSens Link). Testes de usabilidade foram realizados com 9 participantes que realizaram vários movimentos uniarticulares e complexos. Após os testes, os usuários responderam a um questionário baseado na Escala de Usabilidade do Sistema (EUS). O sistema foi bem aceite pelos os usuários, em termos de estética e conforto, em geral, comprovando um elevado nível de vestibilidade.Nowadays, Work-Related Musculoskeletal Disorders (WRMSDs) are considered the ”most prevalent work-related problem” in the European Union (EU), leading to an estimated cost of about 240 billion EUR. In more severe cases, these disorders can cause life-long impairments to the workers’ health, reducing their quality of life. In fact, WRMSDs are the main cause for the workers’ early retirement. It was reported that the upper body segments of the worker are more susceptible to the development of WRMSDs. To mitigate the prevalence of WRMSD, ergonomists mostly apply observational assessment methods, which are highly dependant on the analyst’s expertise, have low objectivity and repeatability. Therefore, efforts have been made to develop instrumented-based ergonomic assessment tools, to compensate for these limitations. Moreover, with the rise of the 5.0 industry concept, the human worker is once again the main focus in the industry, along with the Collaborative Robot (cobot). However, to achieve a truly collaborative relation between the worker and the cobot, the latter needs to know the worker’s intentions. To surpass this obstacle, Motion Capture (MoCap) systems can be integrated in this framework, providing motion data to the cobot. This dissertation aims at the improvement of a stand-alone, upper-body, inertial, MoCap system, that will serve to not only monitor the worker’s posture, but also to assess the user’s ergonomics and provide posture awareness to the user, through biofeedback motors. Furthermore, it was also designed to integrate a human-robot collaborative framework. To achieve this, a user-centred design methodology was applied, starting with analyzing the State of Art (SOA), assessing the limitations of the previous system, defining the system’s requirements, developing the garment, hardware architecture and software architecture of the system. Lastly, the system was validated to ascertain if it is in conformity with the specified requirements. The developed system is composed of 9 Inertial Measurement Units (IMUs), placed on the lower and upper back, head, upper arms, forearms and hands. An actuation system was also integrated, for postural biofeedback, and it is comprised of 6 vibrotactile motors, located in the lower back, and in close proximity to the neck, elbows and wrists. The system is powered by a powerbank and all of the acquired data is sent to a main station, via WiFi (UDP), granting a standalone characteristic. The system integrates an Extended Complementary Filter (ECF) and a static Sensor-to-Segment (STS) calibration sequence to increase the joint angle estimation accuracy. Furthermore, the system is able to sample the angular data at 240 Hz, while the previous system was able to sample it at a maximum 100 Hz, improving the resolution of the data acquisition. The system was validated in terms of hardware and usability. The hardware tests addressed the char acterization of the system’s autonomy, sampling frequency, mechanical robustness and wireless commu nication performance in different contexts, and ascertain if they comply with the technical requirements, which was the case. Moreover, the specifications of the new version were compared with the previous one, where a significant direct improvement was observed, such as, higher sampling frequency, lower packet loss, lower current consumption, among others, and with a commercial system of reference (XSens Link). Usability tests were carried out with 9 participants who performed several uni-joint and complex motions. After testing, users answered a questionnaire based on the System Usability Scale (SUS). The system was very well accepted by the participants, regarding aesthetics and overall comfort, proving to have a high level of wearability

Novel Bidirectional Body - Machine Interface to Control Upper Limb Prosthesis

Objective. The journey of a bionic prosthetic user is characterized by the opportunities and limitations involved in adopting a device (the prosthesis) that should enable activities of daily living (ADL). Within this context, experiencing a bionic hand as a functional (and, possibly, embodied) limb constitutes the premise for mitigating the risk of its abandonment through the continuous use of the device. To achieve such a result, different aspects must be considered for making the artificial limb an effective support for carrying out ADLs. Among them, intuitive and robust control is fundamental to improving amputees’ quality of life using upper limb prostheses. Still, as artificial proprioception is essential to perceive the prosthesis movement without constant visual attention, a good control framework may not be enough to restore practical functionality to the limb. To overcome this, bidirectional communication between the user and the prosthesis has been recently introduced and is a requirement of utmost importance in developing prosthetic hands. Indeed, closing the control loop between the user and a prosthesis by providing artificial sensory feedback is a fundamental step towards the complete restoration of the lost sensory-motor functions. Within my PhD work, I proposed the development of a more controllable and sensitive human-like hand prosthesis, i.e., the Hannes prosthetic hand, to improve its usability and effectiveness. Approach. To achieve the objectives of this thesis work, I developed a modular and scalable software and firmware architecture to control the Hannes prosthetic multi-Degree of Freedom (DoF) system and to fit all users’ needs (hand aperture, wrist rotation, and wrist flexion in different combinations). On top of this, I developed several Pattern Recognition (PR) algorithms to translate electromyographic (EMG) activity into complex movements. However, stability and repeatability were still unmet requirements in multi-DoF upper limb systems; hence, I started by investigating different strategies to produce a more robust control. To do this, EMG signals were collected from trans-radial amputees using an array of up to six sensors placed over the skin. Secondly, I developed a vibrotactile system to implement haptic feedback to restore proprioception and create a bidirectional connection between the user and the prosthesis. Similarly, I implemented an object stiffness detection to restore tactile sensation able to connect the user with the external word. This closed-loop control between EMG and vibration feedback is essential to implementing a Bidirectional Body - Machine Interface to impact amputees’ daily life strongly. For each of these three activities: (i) implementation of robust pattern recognition control algorithms, (ii) restoration of proprioception, and (iii) restoration of the feeling of the grasped object's stiffness, I performed a study where data from healthy subjects and amputees was collected, in order to demonstrate the efficacy and usability of my implementations. In each study, I evaluated both the algorithms and the subjects’ ability to use the prosthesis by means of the F1Score parameter (offline) and the Target Achievement Control test-TAC (online). With this test, I analyzed the error rate, path efficiency, and time efficiency in completing different tasks. Main results. Among the several tested methods for Pattern Recognition, the Non-Linear Logistic Regression (NLR) resulted to be the best algorithm in terms of F1Score (99%, robustness), whereas the minimum number of electrodes needed for its functioning was determined to be 4 in the conducted offline analyses. Further, I demonstrated that its low computational burden allowed its implementation and integration on a microcontroller running at a sampling frequency of 300Hz (efficiency). Finally, the online implementation allowed the subject to simultaneously control the Hannes prosthesis DoFs, in a bioinspired and human-like way. In addition, I performed further tests with the same NLR-based control by endowing it with closed-loop proprioceptive feedback. In this scenario, the results achieved during the TAC test obtained an error rate of 15% and a path efficiency of 60% in experiments where no sources of information were available (no visual and no audio feedback). Such results demonstrated an improvement in the controllability of the system with an impact on user experience. Significance. The obtained results confirmed the hypothesis of improving robustness and efficiency of a prosthetic control thanks to of the implemented closed-loop approach. The bidirectional communication between the user and the prosthesis is capable to restore the loss of sensory functionality, with promising implications on direct translation in the clinical practice

The Evaluation of Electromyography Biofeedback on Proprioception and Balance in Healthy Young Athletes

Introduction: We evaluated the effect of electromyography biofeedback on proprioception and functional balance in healthy young athletes. Materials and Methods: In this clinical trial, 24 athletes were randomly divided into two study (n=12) and control (n=12) groups. The study group received rehabilitation exercises, including one-foot standing, squatted standing, and isometric contraction of quadriceps muscle at different knee angles, including 30, 45, and 90 degrees of knee flexion along with electromyography biofeedback. The control group received only rehabilitation exercises without electromyography biofeedback. Exercises were performed by both groups for a 4-week period in three sessions per week. Functional balance and proprioception before and after exercises were measured using the star excursion balance test and a system consisting of digital photography non-reflective markers, respectively. The data of the center of pressure and time of vertical ground reaction force using a force plate was also collected to evaluate static balance and dynamic balance, respectively. Results: The absolute error in knee joint reconstruction for 30° (P=0.005), 45° (P=0.001), and 90° (P=0.033) angles significantly decreased after the intervention in the study group compared to the control group. Star excursion balance test scores in all directions did not show any significant differences between the two groups (P>0.05), except for the anterior-lateral direction (P=0.03). Moreover, all variables related to static and dynamic balance did not show a significant difference between two the groups after the interventions (P>0.05). Conclusion: The electromyography biofeedback intervention can probably be used as a rehabilitation protocol in recovering and healing proprioception injuries resulting from sports injuries