480 research outputs found
A wearable biofeedback device to improve motor symptoms in Parkinson’s disease
Dissertação de mestrado em Engenharia BiomédicaThis dissertation presents the work done during the fifth year of the course Integrated Master’s in
Biomedical Engineering, in Medical Electronics. This work was carried out in the Biomedical & Bioinspired
Robotic Devices Lab (BiRD Lab) at the MicroElectroMechanics Center (CMEMS) established at the
University of Minho. For validation purposes and data acquisition, it was developed a collaboration with
the Clinical Academic Center (2CA), located at Braga Hospital.
The knowledge acquired in the development of this master thesis is linked to the motor
rehabilitation and assistance of abnormal gait caused by a neurological disease. Indeed, this dissertation
has two main goals: (1) validate a wearable biofeedback system (WBS) used for Parkinson's disease
patients (PD); and (2) develop a digital biomarker of PD based on kinematic-driven data acquired with the
WBS. The first goal aims to study the effects of vibrotactile biofeedback to play an augmentative role to
help PD patients mitigate gait-associated impairments, while the second goal seeks to bring a step
advance in the use of front-end algorithms to develop a biomarker of PD based on inertial data acquired
with wearable devices. Indeed, a WBS is intended to provide motor rehabilitation & assistance, but also
to be used as a clinical decision support tool for the classification of the motor disability level. This system
provides vibrotactile feedback to PD patients, so that they can integrate it into their normal physiological
gait system, allowing them to overcome their gait difficulties related to the level/degree of the disease.
The system is based on a user- centered design, considering the end-user driven, multitasking and less
cognitive effort concepts.
This manuscript presents all steps taken along this dissertation regarding: the literature review and
respective critical analysis; implemented tech-based procedures; validation outcomes complemented with
results discussion; and main conclusions and future challenges.Esta dissertação apresenta o trabalho realizado durante o quinto ano do curso Mestrado
Integrado em Engenharia Biomédica, em Eletrónica Médica. Este trabalho foi realizado no Biomedical &
Bioinspired Robotic Devices Lab (BiRD Lab) no MicroElectroMechanics Center (CMEMS) estabelecido na
Universidade do Minho. Para efeitos de validação e aquisição de dados, foi desenvolvida uma colaboração
com Clinical Academic Center (2CA), localizado no Hospital de Braga.
Os conhecimentos adquiridos no desenvolvimento desta tese de mestrado estão ligados à
reabilitação motora e assistência de marcha anormal causada por uma doença neurológica. De facto,
esta dissertação tem dois objetivos principais: (1) validar um sistema de biofeedback vestível (WBS)
utilizado por doentes com doença de Parkinson (DP); e (2) desenvolver um biomarcador digital de PD
baseado em dados cinemáticos adquiridos com o WBS. O primeiro objetivo visa o estudo dos efeitos do
biofeedback vibrotáctil para desempenhar um papel de reforço para ajudar os pacientes com PD a mitigar
as deficiências associadas à marcha, enquanto o segundo objetivo procura trazer um avanço na utilização
de algoritmos front-end para biomarcar PD baseado em dados inerciais adquiridos com o dispositivos
vestível. De facto, a partir de um WBS pretende-se fornecer reabilitação motora e assistência, mas
também utilizá-lo como ferramenta de apoio à decisão clínica para a classificação do nível de deficiência
motora. Este sistema fornece feedback vibrotáctil aos pacientes com PD, para que possam integrá-lo no
seu sistema de marcha fisiológica normal, permitindo-lhes ultrapassar as suas dificuldades de marcha
relacionadas com o nível/grau da doença. O sistema baseia-se numa conceção centrada no utilizador,
considerando o utilizador final, multitarefas e conceitos de esforço menos cognitivo.
Portanto, este manuscrito apresenta todos os passos dados ao longo desta dissertação
relativamente a: revisão da literatura e respetiva análise crítica; procedimentos de base tecnológica
implementados; resultados de validação complementados com discussão de resultados; e principais
conclusões e desafios futuros
Measuring and managing foot muscle weakness
Foot muscle weakness is caused by disease, injury, inactivity and ageing, with disabling consequences. Exercise improves muscle weakness however, adherence to correct technique is challenging. Biofeedback may improve performance. Chapter One reviews the literature on small foot muscles, muscle function, measurement, causes and consequences of foot muscle weakness, and the role of exercise. Chapter Two is a systematic review on the relationship between foot pain, muscle strength and size. Eight studies were identified evaluating the relationship between foot pain and foot muscle strength or size, with a significant association between foot pain and muscle weakness when pain is of high intensity and weakness measured by toe flexion force. Chapter Three is a reliability study assessing size of abductor hallucis and medial belly flexor hallucis brevis muscles by ultrasound in 21 adults and identify their relationship with toe strength, foot morphology, balance. Intra-rater reliability was excellent. Significant associations were found between cross-sectional area of abductor hallucis with great toe flexion force, arch height sit and stand, truncated and full foot length, balance. Significant associations found between cross-sectional area of medial belly flexor hallucis brevis with Foot Posture Index, truncated and full foot length. After controlling for body size, cross-sectional area of abductor hallucis remained a significant correlate of great toe flexor strength. Chapter Four describes the development of the Archie biofeedback device. Device feasibility is evaluated in Chapter Five by repeat testing of 30 adults performing four foot exercises using Archie, with 89% of exercise and foot location variables collected consistently. Biofeedback significantly improved foot location for all exercises and 97% of participants reported biofeedback helped exercise performance. Archie appears to be a safe and feasible biofeedback device to assist participants perform exercise
Effects of external biofeedback interventions in individuals with chronic ankle instability: a scoping review
Clinical scenario: Evidence has demonstrated that about 1 in 3 acute lateral ankle sprains results in chronic ankle instability. Chronic ankle instability (CAI) is a condition characterized by a history of one significant lateral ankle sprain, episodes of the ankle "giving way”, pain, and decreased self-reported function. People with chronic ankle instability show a multitude of mechanical and functional impairments, including a more inverted position of the foot during walking and consequently an increased lateral plantar pressure distribution. These factors contribute to high recurrence of ankle sprains, a decrease in self-reported function and the development of early onset ankle post-traumatic osteoarthritis (OA). Traditional rehabilitation and prevention strategies against the development of CAI have not successfully improved the biomechanics of movement, thus new intervention strategies have been proposed in the last years to specifically target biomechanics impairments in individuals with CAI. Among these, intervention with biofeedback seem to be promising, but the actual effect is still not clear.
Purpose: To perform a literature review and examine the effects of biofeedback interventions on biomechanics during gait and functional tasks in individuals with chronic ankle instability.
Methods: The following literature databases were searched: Pubmed, PEDro, Cochrane Library and Scopus. The search strategy was based on the combination of different keywords associated with the Boolean operators “AND” or “OR” to create a string. Results were screened based on determined inclusion and exclusion criteria and the articles which were assessed as eligible after the screening phase were included in the qualitative evaluation.
Results & discussion: At the end of the study selection, from a total of 178 articles, seven articles were included in the research. Studies assessed interventions using visual biofeedback (n = 4), auditory biofeedback (n = 3), and haptic biofeedback (n = 1). Four articles demonstrated reduced plantar pressure in the lateral column of the foot and a medial shift of the center of pressure after the intervention. One study demonstrated reduced ankle inversion after 8 sessions of biofeedback training and improvements in patient-reported outcomes.
Another study found evidence that biofeedback is able to decrease vertical ground reaction force and ankle joint forces.
One study demonstrated that biofeedback strategy is effective in altering the plantar pressure distribution causing a medial shift of the center of pressure during 4 different functional tasks (step downs, forward lunges, single-limb static balance, lateral hops).
Conclusion: The use of biofeedback in individuals with chronic ankle instability resulted in several positive effects on clinical-oriented outcome as well as patient-reported outcome. Therefore, implementing external biofeedback training into an impairment-based rehabilitation program may allow for a greater improvement in impairments associated with CAI. However, future research to assess long-term effects of external biofeedback strategies in patients with CAI is needed.Clinical scenario: Evidence has demonstrated that about 1 in 3 acute lateral ankle sprains results in chronic ankle instability. Chronic ankle instability (CAI) is a condition characterized by a history of one significant lateral ankle sprain, episodes of the ankle "giving way”, pain, and decreased self-reported function. People with chronic ankle instability show a multitude of mechanical and functional impairments, including a more inverted position of the foot during walking and consequently an increased lateral plantar pressure distribution. These factors contribute to high recurrence of ankle sprains, a decrease in self-reported function and the development of early onset ankle post-traumatic osteoarthritis (OA). Traditional rehabilitation and prevention strategies against the development of CAI have not successfully improved the biomechanics of movement, thus new intervention strategies have been proposed in the last years to specifically target biomechanics impairments in individuals with CAI. Among these, intervention with biofeedback seem to be promising, but the actual effect is still not clear.
Purpose: To perform a literature review and examine the effects of biofeedback interventions on biomechanics during gait and functional tasks in individuals with chronic ankle instability.
Methods: The following literature databases were searched: Pubmed, PEDro, Cochrane Library and Scopus. The search strategy was based on the combination of different keywords associated with the Boolean operators “AND” or “OR” to create a string. Results were screened based on determined inclusion and exclusion criteria and the articles which were assessed as eligible after the screening phase were included in the qualitative evaluation.
Results & discussion: At the end of the study selection, from a total of 178 articles, seven articles were included in the research. Studies assessed interventions using visual biofeedback (n = 4), auditory biofeedback (n = 3), and haptic biofeedback (n = 1). Four articles demonstrated reduced plantar pressure in the lateral column of the foot and a medial shift of the center of pressure after the intervention. One study demonstrated reduced ankle inversion after 8 sessions of biofeedback training and improvements in patient-reported outcomes.
Another study found evidence that biofeedback is able to decrease vertical ground reaction force and ankle joint forces.
One study demonstrated that biofeedback strategy is effective in altering the plantar pressure distribution causing a medial shift of the center of pressure during 4 different functional tasks (step downs, forward lunges, single-limb static balance, lateral hops).
Conclusion: The use of biofeedback in individuals with chronic ankle instability resulted in several positive effects on clinical-oriented outcome as well as patient-reported outcome. Therefore, implementing external biofeedback training into an impairment-based rehabilitation program may allow for a greater improvement in impairments associated with CAI. However, future research to assess long-term effects of external biofeedback strategies in patients with CAI is needed
A review of the effectiveness of lower limb orthoses used in cerebral palsy
To produce this review, a systematic literature search was conducted for relevant articles published in the period between the date of the previous ISPO consensus conference report on cerebral palsy (1994) and April 2008. The search terms were 'cerebral and pals* (palsy, palsies), 'hemiplegia', 'diplegia', 'orthos*' (orthoses, orthosis) orthot* (orthotic, orthotics), brace or AFO
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
Treadmill training augmented with real-time visualisation feedback and function electrical stimulation for gait rehabilitation after stroke : a feasibility study
Motor rehabilitation typically requires patients to perform task-specific training, in which biofeedback can be instrumental for encouraging neuroplasticity after stroke. Treadmill training augmented with real-time visual feedback and functional electrical stimulation (FES) may have a beneficial synergistic effect on this process. This study aims to develop a multi-channel FES (MFES) system with stimulation triggers based on the phase of gait cycle, determined using a 3D motion capture system. A feasibility study was conducted to determine whether this enhanced treadmill gait training systemis suitable for stroke survivors in clinical practice. The real-time biomechanical visual feedback system with computerised MFES was developed using six motion-capture cameras installed around a treadmill.;This system was designed to stimulate the pretibial muscle for correcting foot drop problems, gastro-soleus for facilitating push-off, and quadriceps and hamstring for improving knee stability. Dynamic avatar movement and step length/ratio were displayed on a monitor, providing patients with real-time visual biofeedback. Participants received up to 20 minutes of enhanced treadmill training once or twice per week for 6 weeks. Training programme, pre- and post-training ability, and adverse events of each participant were recorded. Feedback was also collected from participants and physiotherapists regarding their experience. Eight out of ten participants fully completed their programme.;In total, 67 training sessions were carried out. All participants had a good attendance rate. The number and duration of training sessions ranged from 5 to 20, and 11 to 20 minutes, respectively. The MFES system successfully improved gait patterns during training, and feedback from participants and physiotherapists regarding their experience of the research intervention was overwhelmingly positive. In conclusion, this enhanced treadmill gait training system is feasible for use in gait rehabilitation after stroke. However, a well-designed clinical trial with a larger sample size is needed to determine clinical efficacy on gait recovery.Motor rehabilitation typically requires patients to perform task-specific training, in which biofeedback can be instrumental for encouraging neuroplasticity after stroke. Treadmill training augmented with real-time visual feedback and functional electrical stimulation (FES) may have a beneficial synergistic effect on this process. This study aims to develop a multi-channel FES (MFES) system with stimulation triggers based on the phase of gait cycle, determined using a 3D motion capture system. A feasibility study was conducted to determine whether this enhanced treadmill gait training systemis suitable for stroke survivors in clinical practice. The real-time biomechanical visual feedback system with computerised MFES was developed using six motion-capture cameras installed around a treadmill.;This system was designed to stimulate the pretibial muscle for correcting foot drop problems, gastro-soleus for facilitating push-off, and quadriceps and hamstring for improving knee stability. Dynamic avatar movement and step length/ratio were displayed on a monitor, providing patients with real-time visual biofeedback. Participants received up to 20 minutes of enhanced treadmill training once or twice per week for 6 weeks. Training programme, pre- and post-training ability, and adverse events of each participant were recorded. Feedback was also collected from participants and physiotherapists regarding their experience. Eight out of ten participants fully completed their programme.;In total, 67 training sessions were carried out. All participants had a good attendance rate. The number and duration of training sessions ranged from 5 to 20, and 11 to 20 minutes, respectively. The MFES system successfully improved gait patterns during training, and feedback from participants and physiotherapists regarding their experience of the research intervention was overwhelmingly positive. In conclusion, this enhanced treadmill gait training system is feasible for use in gait rehabilitation after stroke. However, a well-designed clinical trial with a larger sample size is needed to determine clinical efficacy on gait recovery
A new approach to study gait impairments in Parkinson’s disease based on mixed reality
Dissertação de mestrado integrado em Engenharia Biomédica (especialização em Eletrónica Médica)Parkinson’s disease (PD) is the second most common neurodegenerative disorder after Alzheimer's disease. PD onset is at 55 years-old on average, and its incidence increases with age. This disease results from dopamine-producing neurons degeneration in the basal ganglia and is characterized by various motor symptoms such as freezing of gait, bradykinesia, hypokinesia, akinesia, and rigidity, which negatively impact patients’ quality of life. To monitor and improve these PD-related gait disabilities, several technology-based methods have emerged in the last decades. However, these solutions still require more customization to patients’ daily living tasks in order to provide more objective, reliable, and long-term data about patients’ motor conditions in home-related contexts. Providing this quantitative data to physicians will ensure more personalized and better treatments. Also, motor rehabilitation sessions fostered by assistance devices require the inclusion of quotidian tasks to train patients for their daily motor challenges. One of the most promising technology-based methods is virtual, augmented, and mixed reality (VR/AR/MR), which immerse patients in virtual environments and provide sensory stimuli (cues) to assist with these disabilities. However, further research is needed to improve and conceptualize efficient and patient-centred VR/AR/MR approaches and increase their clinical evidence. Bearing this in mind, the main goal of this dissertation was to design, develop, test, and validate virtual environments to assess and train PD-related gait impairments using mixed reality smart glasses, integrated with another high-technological motion tracking device. Using specific virtual environments that trigger PD-related gait impairments (turning, doorways, and narrow spaces), it is hypothesized that patients can be assessed and trained in their daily challenges related to walking. Also, this tool integrates on-demand visual cues to provide visual biofeedback and foster motor training. This solution was validated with end-users to test the identified hypothesis. The results showed that, in fact, mixed reality has the potential to recreate real-life environments that often provoke PD-related gait disabilities, by placing virtual objects on top of the real world. On the contrary, biofeedback strategies did not significantly improve the patients’ motor performance. The user experience evaluation showed that participants enjoyed participating in the activity and felt that this tool can help their motor performance.A doença de Parkinson (DP) é a segunda doença neurodegenerativa mais comum depois da doença de Alzheimer. O início da DP ocorre, em média, aos 55 anos de idade, e a sua incidência aumenta com a idade. Esta doença resulta da degeneração dos neurónios produtores de dopamina nos gânglios basais e é caracterizada por vários sintomas motores como o congelamento da marcha, bradicinesia, hipocinesia, acinesia, e rigidez, que afetam negativamente a qualidade de vida dos pacientes. Nas últimas décadas surgiram métodos tecnológicos para monitorizar e treinar estas desabilidades da marcha. No entanto, estas soluções ainda requerem uma maior personalização relativamente às tarefas diárias dos pacientes, a fim de fornecer dados mais objetivos, fiáveis e de longo prazo sobre o seu desempenho motor em contextos do dia-a-dia. Através do fornecimento destes dados quantitativos aos médicos, serão assegurados tratamentos mais personalizados. Além disso, as sessões de reabilitação motora, promovidas por dispositivos de assistência, requerem a inclusão de tarefas quotidianas para treinar os pacientes para os seus desafios diários. Um dos métodos tecnológicos mais promissores é a realidade virtual, aumentada e mista (RV/RA/RM), que imergem os pacientes em ambientes virtuais e fornecem estímulos sensoriais para ajudar nestas desabilidades. Contudo, é necessária mais investigação para melhorar e conceptualizar abordagens RV/RA/RM eficientes e centradas no paciente e ainda aumentar as suas evidências clínicas. Tendo isto em mente, o principal objetivo desta dissertação foi conceber, desenvolver, testar e validar ambientes virtuais para avaliar e treinar as incapacidades de marcha relacionadas com a DP usando óculos inteligentes de realidade mista, integrados com outro dispositivo de rastreio de movimento. Utilizando ambientes virtuais específicos que desencadeiam desabilidades da marcha (rodar, portas e espaços estreitos), é possível testar hipóteses de que os pacientes possam ser avaliados e treinados nos seus desafios diários. Além disso, esta ferramenta integra pistas visuais para fornecer biofeedback visual e fomentar a reabilitação motora. Esta solução foi validada com utilizadores finais de forma a testar as hipóteses identificadas. Os resultados mostraram que, de facto, a realidade mista tem o potencial de recriar ambientes da vida real que muitas vezes provocam deficiências de marcha relacionadas à DP. Pelo contrário, as estratégias de biofeedback não provocaram melhorias significativas no desempenho motor dos pacientes. A avaliação feita pelos pacientes mostrou que estes gostaram de participar nos testes e sentiram que esta ferramenta pode auxiliar no seu desempenho motor
Wearable sensors system for an improved analysis of freezing of gait in Parkinson's disease using electromyography and inertial signals
We propose a wearable sensor system for automatic, continuous and ubiquitous analysis of Freezing of Gait (FOG), in patients affected by Parkinson's disease. FOG is an unpredictable gait disorder with different clinical manifestations, as the trembling and the shuffling-like phenotypes, whose underlying pathophysiology is not fully understood yet. Typical trembling-like subtype features are lack of postural adaptation and abrupt trunk inclination, which in general can increase the fall probability. The targets of this work are detecting the FOG episodes, distinguishing the phenotype and analyzing the muscle activity during and outside FOG, toward a deeper insight in the disorder pathophysiology and the assessment of the fall risk associated to the FOG subtype. To this aim, gyroscopes and surface electromyography integrated in wearable devices sense simultaneously movements and action potentials of antagonist leg muscles. Dedicated algorithms allow the timely detection of the FOG episode and, for the first time, the automatic distinction of the FOG phenotypes, which can enable associating a fall risk to the subtype. Thanks to the possibility of detecting muscles contractions and stretching exactly during FOG, a deeper insight into the pathophysiological underpinnings of the different phenotypes can be achieved, which is an innovative approach with respect to the state of art
Influence of the robotic exoskeleton Lokomat on the control of human gait : an electromyographic and kinematic analysis
Nowadays there is an increasing percentage of elderly
people and it is expected that this percentage will continue
increasing, carrying huge organizational costs in rehabilitation
services. Recent robotic devices for gait training are more and
more regarded as alternatives to solve cost-efficiency issues and
provide novel approaches for training. Nevertheless, there is a
need to address how to target muscular activation and kinematic
patterns for optimal recovery after a neurological damage. The
main objective of this work was to understand the underlying
principles that the human nervous system employs to synchronize
muscular activity during walking assisted by Lokomat. A basic
low-dimensional locomotor program can explain the synergistic
activation of muscles during assisted gait. As a main contribution,
we generated a detailed description of the electro myographic and
biomechanical response to variations in robotic assistance in
intact humans, which can be used for future control strategies to
be implemented in motor rehabilitation
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