A double closed loop to enhance the quality of life of Parkinson's disease patients: REMPARK system

This paper presents REMPARK system, a novel approach to deal with Parkinson's Disease (PD). REMPARK system comprises two closed loops of actuation onto PD. The first loop consists in a wearable system that, based on a belt-worn movement sensor, detects movement alterations that activate an auditory cueing system controlled by a smartphone in order to improve patient's gait. The belt-worn sensor analyzes patient's movement through real-time learning algorithms that were developed on the basis of a database previously collected from 93 PD patients. The second loop consists in disease management based on the data collected during long periods and that enables neurologists to tailor medication of their PD patients and follow the disease evolution. REMPARK system is going to be tested in 40 PD patients in Spain, Ireland, Italy and Israel. This paper describes the approach followed to obtain this system, its components, functionalities and trials in which the system will be validated.Postprint (published version

Effects of sensory cueing in virtual motor rehabilitation. A review.

Objectives To critically identify studies that evaluate the effects of cueing in virtual motor rehabilitation in patients having different neurological disorders and to make recommendations for future studies. Methods Data from MEDLINE®, IEEExplore, Science Direct, Cochrane library and Web of Science was searched until February 2015. We included studies that investigate the effects of cueing in virtual motor rehabilitation related to interventions for upper or lower extremities using auditory, visual, and tactile cues on motor performance in non-immersive, semi-immersive, or fully immersive virtual environments. These studies compared virtual cueing with an alternative or no intervention. Results Ten studies with a total number of 153 patients were included in the review. All of them refer to the impact of cueing in virtual motor rehabilitation, regardless of the pathological condition. After selecting the articles, the following variables were extracted: year of publication, sample size, study design, type of cueing, intervention procedures, outcome measures, and main findings. The outcome evaluation was done at baseline and end of the treatment in most of the studies. All of studies except one showed improvements in some or all outcomes after intervention, or, in some cases, in favor of the virtual rehabilitation group compared to the control group. Conclusions Virtual cueing seems to be a promising approach to improve motor learning, providing a channel for non-pharmacological therapeutic intervention in different neurological disorders. However, further studies using larger and more homogeneous groups of patients are required to confirm these findings

Effect of Three Cueing Devices for People with Parkinson’s disease with Gait Initiation Difficulties

Background: Freezing of gait (FOG) remains one of the most common debilitating aspects of Parkinson’s disease and has been linked to injuries, falls and reduced quality of life. Although commercially available portable cueing devices exist claiming to assist with overcoming freezing; their immediate effectiveness in overcoming gait initiation failure currently unknown. This study investigated the effects of three different types of cueing device in people with Parkinson’s disease who experience freezing. Methods: Twenty participants with idiopathic Parkinson’s disease who experienced freezing during gait but who were able to walk short distances indoors independently were recruited. At least three attempts at gait initiation were recorded using a ten camera Qualisys motion analysis system and four force platforms. Test conditions were: laser cane, sound metronome, vibrating metronome, walking stick and no intervention. Results: During testing 12 of the 20 participants had freezing episodes, from these participants 100 freezing and 91 non-freezing trials were recorded. Clear differences in the movement patterns were seen between freezing and non-freezing episodes. The laser cane was most effective cueing device at improving the forwards/backwards and side to side movement and had the least number of freezing episodes. The walking stick also showed significant improvements compared to the other conditions. The vibration metronome appeared to disrupt movement compared to the sound metronome at the same beat frequency. Conclusion: This study identified differences in the movement patterns between freezing episodes and non-freezing episodes, and identified immediate improvements during gait initiation when using the laser cane over the other interventions

The Co-Treatment of Physical Therapy and Music Therapy and Its Effect on Parkinson\u27s Disease: A Multidisciplinary Approach

Background. A multidisciplinary approach combining physical therapy and music therapy can improve functional mobility in individuals with Parkinson\u27s Disease. Objective. The authors studied whether a multidisciplinary approach of PT and MT would reduce the primary symptoms associated with PD. Methods. In a single subject design, one patient participated in the following interventions; seated activities, task-specific training, balance and posture, pre-gait activities, and gait activities. The patient was evaluated on the first, mid-term, and last days of treatment. Evaluations included the Parkinson\u27s Disease Questionnaire-39 (PDQ-39), Freezing of Gait Questionnaire (FOGQ), Berg Balance Scale (BBS), Timed-Up-and-Go (TUG), Five Times Sit-to-Stand (STSTS), GAITrite® assessment, and the Functional Reach. Results. The patient improved scores on the PDQ-39, FOGQ, BBS, and the STSTS at the end of 12 weeks of treatment. Improvements were shown on the TUG at mid-term but the patient could not maintain these improvements for the entire length of treatment due to comorbidities. Conclusion. Patients with PD can achieve improvements in functional assessments, outcome measures, functional mobility, and quality of life from a multidisciplinary approach of physical therapy and music therapy

Rhythmic Haptic Cueing Using Wearable Devices as Physiotherapy for Huntington Disease: Case Study

Background: Huntington disease (HD) is an inherited genetic disorder that results in the death of brain cells. HD symptoms generally start with subtle changes in mood and mental abilities; they then degenerate progressively, ensuing a general lack of coordination and an unsteady gait, ultimately resulting in death. There is currently no cure for HD. Walking cued by an external, usually auditory, rhythm has been shown to steady gait and help with movement coordination in other neurological conditions. More recently, work with other neurological conditions has demonstrated that haptic (ie, tactile) rhythmic cues, as opposed to audio cues, offer similar improvements when walking. An added benefit is that less intrusive, more private cues are delivered by a wearable device that leaves the ears free for conversation, situation awareness, and safety. This paper presents a case study where rhythmic haptic cueing (RHC) was applied to one person with HD. The case study has two elements: the gait data we collected from our wearable devices and the comments we received from a group of highly trained expert physiotherapists and specialists in HD. Objective: The objective of this case study was to investigate whether RHC can be applied to improve gait coordination and limb control in people living with HD. While not offering a cure, therapeutic outcomes may delay the onset or severity of symptoms, with the potential to improve and prolong quality of life. Methods: The approach adopted for this study includes two elements, one quantitative and one qualitative. The first is a repeated-measures design with three conditions: before haptic rhythm (ie, baseline), with haptic rhythm, and after exposure to haptic rhythm. The second element is an in-depth interview with physiotherapists observing the session. Results: In comparison to the baseline, the physiotherapists noted a number of improvements to the participant’s kinematics during her walk with the haptic cues. These improvements continued in the after-cue condition, indicating some lasting effects. The quantitative data obtained support the physiotherapists’ observations. Conclusions: The findings from this small case study, with a single participant, suggest that a haptic metronomic rhythm may have immediate, potentially therapeutic benefits for the walking kinematics of people living with HD and warrants further investigation

Efficacy of Rhythmic Auditory Stimulation on Ataxia and Functional Dependence Post-Cerebellar Stroke

Ataxia, from Greek meaning, “lack of order,” is described as irregular movement and discoordination of body, gait, eyes, and speech. Ataxia is associated with cerebellar damage due to stroke and other cerebellar pathologies. Ataxia frequently results in functional impairment. Standard physical and occupational therapies in stroke rehabilitation facilitate motor recovery, especially within 90 days. However, many patients experience movement derangements beyond this time frame. Rhythmic auditory stimulation has been shown to be an effective intervention in chronic motor deficits like those observed after cerebellar stroke. Efficacy among patients with chronic stroke-induced ataxia is unexplored. This randomized control trial seeks to determine the benefit of rhythmic auditory stimulation over standard of care for rehabilitation of cerebellar stroke-induced ataxia. Patient progress will be assessed using validated disability and ataxia scales. It is projected that rhythmic auditory stimulation will improve ataxia and independence among patients with chronic disability post-cerebellar stroke, versus standard rehabilitation

Questioning Classic Patient Classification Techniques in Gait Rehabilitation: Insights from Wearable Haptic Technology

Classifying stroke survivors based on their walking abilities is an important part of the gait rehabilitation process. It can act as powerful indicator of function and prognosis in both the early days after a stroke and long after a survivor receives rehabilitation. This classification often relies solely on walking speed; a quick and easy measure, with only a stopwatch needed. However, walking speed may not be the most accurate way of judging individual’s walking ability. Advances in technology mean we are now in a position where ubiquitous and wearable technologies can be used to elicit much richer measures to characterise gait. In this paper we present a case study from one of our studies, where within a homogenous group of stroke survivors (based on walking speed classification) important differences in individual results and the way they responded to rhythmic haptic cueing were identified during the piloting of a novel gait rehabilitation technique