1,674 research outputs found

    Rehabilitative devices for a top-down approach

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    In recent years, neurorehabilitation has moved from a "bottom-up" to a "top down" approach. This change has also involved the technological devices developed for motor and cognitive rehabilitation. It implies that during a task or during therapeutic exercises, new "top-down" approaches are being used to stimulate the brain in a more direct way to elicit plasticity-mediated motor re-learning. This is opposed to "Bottom up" approaches, which act at the physical level and attempt to bring about changes at the level of the central neural system. Areas covered: In the present unsystematic review, we present the most promising innovative technological devices that can effectively support rehabilitation based on a top-down approach, according to the most recent neuroscientific and neurocognitive findings. In particular, we explore if and how the use of new technological devices comprising serious exergames, virtual reality, robots, brain computer interfaces, rhythmic music and biofeedback devices might provide a top-down based approach. Expert commentary: Motor and cognitive systems are strongly harnessed in humans and thus cannot be separated in neurorehabilitation. Recently developed technologies in motor-cognitive rehabilitation might have a greater positive effect than conventional therapies

    Robotic biofeedback for post-stroke gait rehabilitation: a scoping review

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    This review aims to recommend directions for future research on robotic biofeedback towards prompt post-stroke gait rehabilitation by investigating the technical and clinical specifications of biofeedback systems (BSs), including the complementary use with assistive devices and/or physiotherapist-oriented cues. A literature search was conducted from January 2019 to September 2022 on Cochrane, Embase, PubMed, PEDro, Scopus, and Web of Science databases. Data regarding technical (sensors, biofeedback parameters, actuators, control strategies, assistive devices, physiotherapist-oriented cues) and clinical (participants’ characteristics, protocols, outcome measures, BSs’ effects) specifications of BSs were extracted from the relevant studies. A total of 31 studies were reviewed, which included 660 stroke survivors. Most studies reported visual biofeedback driven according to the comparison between real-time kinetic or spatiotemporal data from wearable sensors and a threshold. Most studies achieved statistically significant improvements on sensor-based and clinical outcomes between at least two evaluation time points. Future research should study the effectiveness of using multiple wearable sensors and actuators to provide personalized biofeedback to users with multiple sensorimotor deficits. There is space to explore BSs complementing different assistive devices and physiotherapist-oriented cues according to their needs. There is a lack of randomized-controlled studies to explore post-stroke stage, mental and sensory effects of BSs.This work has been supported in part by the FEDER Funds through the COMPETE 2020—Programa Operacional Competitividade e Internacionalização (POCI) and P2020 with the Reference Project SmartOs Grant POCI-01-0247-FEDER-039868, and by FCT national funds, under the national support to R&D units grant, through the reference project UIDB/04436/2020 and UIDP/04436/2020, under scholarship reference 2020.05709.BD, and under Stimulus of Scientific Employment with the grant 2020.03393.CEECIND

    The use of biofeedback for gait retraining: A mapping review

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    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

    An Investigation of Kinetic Visual Biofeedback on Dynamic Stance Symmetry

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    The intent of the following research is to utilize task-specific, constraint-induced therapies and apply towards dynamic training for symmetrical balance. Modifications to an elliptical trainer were made to both measure weight distributions during dynamic stance as well as provide kinetic biofeedback through a man-machine interface. Following a review of the background, which includes research from several decades that are seminal to current studies, a design review is discussed to cover the design of the modified elliptical (Chapter 2). An initial study was conducted in a healthy sample population in order to determine the best visual biofeedback representation by comparing different man-machine interfaces (Chapter 3). Index of gait symmetry measures indicated that one display interface optimized participant performance during activity with the modified elliptical trainer. A second study was designed to determine the effects of manipulating the gain of the signal to encourage increased distribution towards the non-dominant weight bearing limb. The purpose of the second study was to better understand the threshold value of gain manipulation in a healthy sample set. Results analyzing percentage error as a measure of performance show that a range between 5-10% allows for a suitable threshold value to be applied for participants who have suffered a stroke. A final study was conducted to apply results/knowledge from the previous two studies to a stroke cohort to determine short-term carryover following training with the modified elliptical trainer. Data taken from force measurements on the elliptical trainer suggest that there was carryover with decreased error from pre to post training. For one participant GaitRite® data show a significant difference from pre to post measurements in single limb support. The results of the research suggest that visual biofeedback can improve symmetrical performance during dynamic patterns. For a better understanding of visual biofeedback delivery, one display representation proved to be beneficial compared to the others which resulted in improved performance. Results show that healthy human participants can minimize error with visual biofeedback and continue minimizing error until a threshold value of 10%. Finally, results have shown promise towards applying such a system for kinetic gait rehabilitation

    Biofeedback for training balance and mobility tasks in older populations: a systematic review

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    <p>Abstract</p> <p>Context</p> <p>An effective application of biofeedback for interventions in older adults with balance and mobility disorders may be compromised due to co-morbidity.</p> <p>Objective</p> <p>To evaluate the feasibility and the effectiveness of biofeedback-based training of balance and/or mobility in older adults.</p> <p>Data Sources</p> <p>PubMed (1950-2009), EMBASE (1988-2009), Web of Science (1945-2009), the Cochrane Controlled Trials Register (1960-2009), CINAHL (1982-2009) and PsycINFO (1840-2009). The search strategy was composed of terms referring to biofeedback, balance or mobility, and older adults. Additional studies were identified by scanning reference lists.</p> <p>Study Selection</p> <p>For evaluating effectiveness, 2 reviewers independently screened papers and included controlled studies in older adults (i.e. mean age equal to or greater than 60 years) if they applied biofeedback during repeated practice sessions, and if they used at least one objective outcome measure of a balance or mobility task.</p> <p>Data Extraction</p> <p>Rating of study quality, with use of the Physiotherapy Evidence Database rating scale (PEDro scale), was performed independently by the 2 reviewers. Indications for (non)effectiveness were identified if 2 or more similar studies reported a (non)significant effect for the same type of outcome. Effect sizes were calculated.</p> <p>Results and Conclusions</p> <p>Although most available studies did not systematically evaluate feasibility aspects, reports of high participation rates, low drop-out rates, absence of adverse events and positive training experiences suggest that biofeedback methods can be applied in older adults. Effectiveness was evaluated based on 21 studies, mostly of moderate quality. An indication for effectiveness of visual feedback-based training of balance in (frail) older adults was identified for postural sway, weight-shifting and reaction time in standing, and for the Berg Balance Scale. Indications for added effectiveness of applying biofeedback during training of balance, gait, or sit-to-stand transfers in older patients post-stroke were identified for training-specific aspects. The same applies for auditory feedback-based training of gait in older patients with lower-limb surgery.</p> <p>Implications</p> <p>Further appropriate studies are needed in different populations of older adults to be able to make definitive statements regarding the (long-term) added effectiveness, particularly on measures of functioning.</p

    Biofeedback system to improve the human-orthosis interaction

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    Dissertação de mestrado integrado em Engenharia Biomédica (área de especialização em Eletrónica Médica)Every year, 15 million people worldwide suffer a stroke. More than 80 % of stroke survivors present gait disabilities, limiting their motor independence and well-being. The patients may regain their motor independence with active orthoses. Biofeedback systems (BSs) may be used as an orthotic rehabilitation’s complementary tool to inform the user timely and objectively about their behaviour during gait. Thus, teaching the patients how to improve the human-orthosis interaction. Overall, this allows accelerating and increasing the effectiveness of the gait recovery. Nonetheless, there is a lack of BSs for orthotic gait rehabilitation, and no wearable solution is available. This dissertation aims the development of a wearable, stand-alone and modular BS to be integrated into SmartOs-ankle orthosis, following a user-centered design. The developed BS provides sensory, sonorous, and visual stimulation through vibrotactile motors, headphones, and a Red-Green-Blue Light-Emitting Diode, respectively. The BS includes a microcontroller to manage the activation of the stimuli according to the interaction torque and the reference trajectory of the SmartOs-ankle orthosis. The sensory and sonorous stimuli were chosen for developing user-oriented strategies to teach the user, as follows. When and how to perform the paretic and non-paretic foot-floor contact (foot-floor contact biofeedback); the direction of ankle rotation along the gait cycle (joint motion biofeedback); and, the necessary muscular strength along with the gait cycle (user participation biofeedback). The visual stimulus is used to help the therapist to follow the performance of the patients during the therapy and, consequently, help and motivate them – therapist-oriented strategies. From a validation with healthy subjects, the BS increased the user’s motor performance significantly when walking with an orthosis. The system was able to teach the users about the direction of ankle rotation and the necessary muscular strength along with the gait cycle, improving the human-orthosis interaction. Future work towards enhancing the foot-floor contact strategies and extending the BS validation with a large group of participants and longer training period.A cada ano, 15 milhões de pessoas, mundialmente, sofrem um acidente vascular cerebral (AVC). Mais de 80 % dos sobreviventes apresentam incapacidades de marcha, limitando a sua independência motora e bem-estar. Estes pacientes podem recuperar a sua independência motora através do uso de ortóteses ativas. Adicionalmente os sistemas de biofeedback (BSs) podem ser usados como uma ferramenta complementar da reabilitação assistida por ortótese, informando os usuários, oportunamente e objetivamente, acerca do seu comportamento durante a execução de uma tarefa, e ensinando-os a melhorar a sua interação com a ortótese; assim, acelerando e aumentando a eficácia da recuperação. Não obstante, existem poucos BSs desenvolvidos para a reabilitação assistida por ortóteses, os quais não são vestíveis. Esta dissertação tem como objetivo o desenvolvimento de um BS vestível, autónomo e modular para ser integrado na ortótese de tornozelo do sistema SmartOs, baseando-se numa visão centralizada no utilizador. O BS desenvolvido fornece estimulação sensorial, sonora e visual através de motores vibratórios, auscultadores e um díodo emissor de luz vermelha-verde-azul, respetivamente. O BS inclui um microcontrolador que gere a ativação dos estímulos de acordo com o torque de interação e trajetória de referência da ortótese do tornozelo. Os estímulos sensorial e sonoro foram escolhidos para ensinar o utilizador sobre: quando e como executar o contacto entre o pé, parético e não parético, e o solo; o sentido de rotação do tornozelo ao longo do ciclo da marcha; e a força muscular necessária ao longo do ciclo da marcha. O estímulo visual é usado para ajudar o terapeuta a seguir o desempenho dos pacientes ao longo da terapia, de forma que o terapeuta possa ajudá-los e motivá-los. A partir da validação com sujeitos saudáveis, verificou-se que o BS aumentou significativamente o desempenho motor do utilizador durante a marcha com a ortótese. O sistema mostrou-se capaz de ensinar os utilizadores sobre a direção e magnitude da força muscular necessária ao longo do ciclo da marcha, melhorando a interação entre o humano e a ortótese. O trabalho futuro envolve a melhoria das estratégias que visam o contacto entre o pé e o solo e a validação do sistema com mais participantes e treinos mais longos

    Wearable Haptic Devices for Gait Re-education by Rhythmic Haptic Cueing

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    This research explores the development and evaluation of wearable haptic devices for gait sensing and rhythmic haptic cueing in the context of gait re-education for people with neurological and neurodegenerative conditions. Many people with long-term neurological and neurodegenerative conditions such as Stroke, Brain Injury, Multiple Sclerosis or Parkinson’s disease suffer from impaired walking gait pattern. Gait improvement can lead to better fluidity in walking, improved health outcomes, greater independence, and enhanced quality of life. Existing lab-based studies with wearable devices have shown that rhythmic haptic cueing can cause immediate improvements to gait features such as temporal symmetry, stride length, and walking speed. However, current wearable systems are unsuitable for self-managed use for in-the-wild applications with people having such conditions. This work aims to investigate the research question of how wearable haptic devices can help in long-term gait re-education using rhythmic haptic cueing. A longitudinal pilot study has been conducted with a brain trauma survivor, providing rhythmic haptic cueing using a wearable haptic device as a therapeutic intervention for a two-week period. Preliminary results comparing pre and post-intervention gait measurements have shown improvements in walking speed, temporal asymmetry, and stride length. The pilot study has raised an array of issues that require further study. This work aims to develop and evaluate prototype systems through an iterative design process to make possible the self-managed use of such devices in-the-wild. These systems will directly provide therapeutic intervention for gait re-education, offer enhanced information for therapists, remotely monitor dosage adherence and inform treatment and prognoses over the long-term. This research will evaluate the use of technology from the perspective of multiple stakeholders, including clinicians, carers and patients. This work has the potential to impact clinical practice nationwide and worldwide in neuro-physiotherapy

    Advanced technology for gait rehabilitation: An overview

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    Most gait training systems are designed for acute and subacute neurological inpatients. Many systems are used for relearning gait movements (nonfunctional training) or gait cycle training (functional gait training). Each system presents its own advantages and disadvantages in terms of functional outcomes. However, training gait cycle movements is not sufficient for the rehabilitation of ambulation. There is a need for new solutions to overcome the limitations of existing systems in order to ensure individually tailored training conditions for each of the potential users, no matter the complexity of his or her condition. There is also a need for a new, integrative approach in gait rehabilitation, one that encompasses and addresses all aspects of physical as well as psychological aspects of ambulation in real-life multitasking situations. In this respect, a multidisciplinary multinational team performed an overview of the current technology for gait rehabilitation and reviewed the principles of ambulation training
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