Efficacy of a Computerized Sensor System for Evaluation and Training of Dizzy Patients

Patients with vestibular hypofunction often experience dizziness and unsteadiness while moving their heads. Appropriate sensors can effectively detect a patient’s dynamic visual acuity and associated body balance control. Forty-one vestibular-deficit patients and 10 normal individuals were invited to participate in this study. Questionnaires, clinical assessment scales and objective measures were evaluated on participants’ first visits. After 12 sessions of training, all scales were evaluated again on vestibular-deficit patients. The computerized system was composed of sensors, including a gyro and strain gauges, data acquisition accessories and LabVIEW software. Results revealed that the system could effectively distinguish normal subjects from subjects with vestibular deficits. In addition, after a rehabilitation program, subjects’ subjective and objective performances were significantly improved. Based on our results, we concluded that the present system, which uses a gyro and strain gauges, may provide an effective method for assessing and treating vestibular-deficit patients

Quantifying head acceleration during vestibular rehabilitation

Dizziness can often be a serious and confounding condition that ranges in severity from annoying to debilitating and affects many people. The most common and effective treatment for persistent dizziness is vestibular rehabilitation therapy, which falls into three categories: adaptation, sensory substitution, and habituation. While more is known about adaptation and sensory substitution, questions remain regarding the exact mechanisms of recovery for habituation. Precisely, the optimal stimulation to the vestibular system, as measured in intensity of head accelerations, is unknown for habituation treatment. In this dissertation are drafts of two manuscripts. The first explores the average intensity of linear and angular head accelerations in non-symptomatic and symptomatic subjects across age and self-reports of dizziness and imbalance during four commonly-used habituation exercises. The second paper presents a mathematical formula for transposing angular displacement in the traditional anatomical planes to the planes of the semicircular canal pairs for collected data on angular displacement of the head. This mathematical model allows for conversion of measurement from overall head accelerations into angular acceleration in the planes of each paired set of semicircular canals, and increases research and clinical knowledge of vestibular stimulation during head-movement exercises

Vibrotactile Sensory Augmentation and Machine Learning Based Approaches for Balance Rehabilitation

Vestibular disorders and aging can negatively impact balance performance. Currently, the most effective approach for improving balance is exercise-based balance rehabilitation. Despite its effectiveness, balance rehabilitation does not always result in a full recovery of balance function. In this dissertation, vibrotactile sensory augmentation (SA) and machine learning (ML) were studied as approaches for further improving balance rehabilitation outcomes. Vibrotactile SA provides a form of haptic cues to complement and/or replace sensory information from the somatosensory, visual and vestibular sensory systems. Previous studies have shown that people can reduce their body sway when vibrotactile SA is provided; however, limited controlled studies have investigated the retention of balance improvements after training with SA has ceased. The primary aim of this research was to examine the effects of supervised balance rehabilitation with vibrotactile SA. Two studies were conducted among people with unilateral vestibular disorders and healthy older adults to explore the use of vibrotactile SA for therapeutic and preventative purposes, respectively. The study among people with unilateral vestibular disorders provided six weeks of supervised in-clinic balance training. The findings indicated that training with vibrotactile SA led to additional body sway reduction for balance exercises with head movements, and the improvements were retained for up to six months. Training with vibrotactile SA did not lead to significant additional improvements in the majority of the clinical outcomes except for the Activities-specific Balance Confidence scale. The study among older adults provided semi-supervised in-home balance rehabilitation training using a novel smartphone balance trainer. After completing eight weeks of balance training, participants who trained with vibrotactile SA showed significantly greater improvements in standing-related clinical outcomes, but not in gait-related clinical outcomes, compared with those who trained without SA. In addition to investigating the effects of long-term balance training with SA, we sought to study the effects of vibrotactile display design on people’s reaction times to vibrational cues. Among the various factors tested, the vibration frequency and tactor type had relatively small effects on reaction times, while stimulus location and secondary cognitive task had relatively large effects. Factors affected young and older adults’ reaction times in a similar manner, but with different magnitudes. Lastly, we explored the potential for ML to inform balance exercise progression for future applications of unsupervised balance training. We mapped body motion data measured by wearable inertial measurement units to balance assessment ratings provided by physical therapists. By training a multi-class classifier using the leave-one-participant-out cross-validation method, we found approximately 82% agreement among trained classifier and physical therapist assessments. The findings of this dissertation suggest that vibrotactile SA can be used as a rehabilitation tool to further improve a subset of clinical outcomes resulting from supervised balance rehabilitation training. Specifically, individuals who train with a SA device may have additional confidence in performing balance activities and greater postural stability, which could decrease their fear of falling and fall risk, and subsequently increase their quality of life. This research provides preliminary support for the hypothesized mechanism that SA promotes the central nervous system to reweight sensory inputs. The preliminary outcomes of this research also provide novel insights for unsupervised balance training that leverage wearable technology and ML techniques. By providing both SA and ML-based balance assessment ratings, the smart wearable device has the potential to improve individuals’ compliance and motivation for in-home balance training.PHDMechanical EngineeringUniversity of Michigan, Horace H. Rackham School of Graduate Studieshttps://deepblue.lib.umich.edu/bitstream/2027.42/143901/1/baotian_1.pd

The role of non-invasive camera technology for gait analysis in patients with vestibular disorders

Purpose of the study Current balance assessments performed in clinical settings do not provide objective measurements of gait. Further, objective gait analysis typically requires expensive, large and dedicated laboratory facilities. The aim of this pilot study was to develop and assess a low-cost, non-invasive camera technology for gait analysis, to assist the clinical assessment of patients with vestibular disorders. Materials and methods used This is a prospective, case-controlled study that was developed jointly by the local Neurotology Department and the Centre for Sports Engineering Research. Eligible participants were approached and recruited at the local Neurotology Clinic. The gait assessment included two repetitions of a straight 7-metre walk. The gait analysis system, comprised of a camera (P3215-V, Axis Communications, Sweden) and analysis software was installed in an appropriately sized clinic room. Parameters extruded were walking velocity, step velocity, step length, cadence and step count per meter. The effect sizes (ESB) were calculated using the MatLab and were considered large, medium or small if >0.8, 0.5 and 0.2 respectively. This study was granted ethical approval by the Coventry and Warwickshire Research Ethics Committee (15/WM/0448). Results Six patients with vestibular dysfunction (P group) and six age-matched healthy volunteers (V group) were recruited in this study. The average velocity of gait for P group was 1189.1 ± 69.0 mm·s-1 whereas for V group it was 1351.4 ± 179.2 mm·s-1, (ESB: -0.91). The mean step velocities were 1353.1 ± 591.8 mm·s-1 and 1434.0 ± 396.5 mm·s-1 for P and V groups respectively (ESB: -0.20). The average cadence was 2.3 ± 0.9 Hz and 2.0 ± 0.5 Hz for P and V groups respectively (ESB: 0.60). The mean step length was 620.5 ± 150.7 mm for the P group and 728.5 ± 86.0 mm for the V group (ESB = -1.26). The average step count per meter was 1.7 ± 0.3 and 1.4 ± 0.1 for P and V groups respectively (ESB = 3.38). Conclusion This pilot study used a low-cost, non-invasive camera technology to identify changes in gait characteristics. Further, gait measurements were obtained without the application of markers or sensors to patients (i.e. non-invasive), thus allowing current, clinical practice to be supplemented by objective measurement, with minimal procedural impact. Further work needs to be undertaken to refine the device and produce normative data. In the future, similar technologies could be used in the community setting, providing an excellent diagnostic and monitoring tool for balance patients

Vestibular deficits in neurodegenerative disorders: balance, dizziness, and spatial disorientation

The vestibular system consists of the peripheral vestibular organs in the inner ear and the associated extensive central nervous system projections—from the cerebellum and brainstem to the thalamic relays to cortical projections. This system is important for spatial orientation and balance, both of critical ecological importance, particularly for successful navigation in our environment. Balance disorders and spatial disorientation are common presenting features of neurodegenerative diseases; however, little is known regarding central vestibular processing in these diseases. A ubiquitous aspect of central vestibular processing is its promiscuity given that vestibular signals are commonly found in combination with other sensory signals. This review discusses how impaired central processing of vestibular signals—typically in combination with other sensory and motor systems—may account for the impaired balance and spatial disorientation in common neurodegenerative conditions. Such an understanding may provide for new diagnostic tests, potentially useful in detecting early disease while a mechanistic understanding of imbalance and spatial disorientation in these patients may enable a vestibular-targeted therapy for such problems in neurodegenerative diseases. Studies with state of the art central vestibular testing are now much needed to tackle this important topic

Effects of Vestibular Rehabilitation Using the Dizziness Handicap Inventory

Vertigo, which may be caused by a variety of problems, is a significant symptom in patients with vestibular disorders. The Dizziness Handicap Inventory is a disease-specific questionnaire used to measure how vertigo affects an individual\u27s quality-of-life. This study assessed patient outcomes following vestibular rehabilitation, using the Dizziness Handicap Inventory. Forty-nine former patients of a vestibular rehabilitation program participated in a phone survey following vestibular rehabilitation. Subjects answered the Dizziness Handicap Inventory based on how they . felt before and after they had received physical therapy intervention. Patient outcomes were assessed by comparing Dizziness Handicap Inventory total and sub-scores before and after physical therapy intervention using the Sign test at the .05 alpha level. Statistically significant improvements in Dizziness Handicap Inventory total and sub-scores were determined following vestibular rehabilitation. A significant difference in score change was determined in 57% of the patients. The significant improvement in scores demonstrated that following vestibular rehabilitation, patient perceived outcomes improved. The Dizziness Handicap Inventory demonstrated to be useful to assess patient outcomes and can assist in making treatment goals and outcomes more patient focused and measurable

ERS statement on standardisation of cardiopulmonary exercise testing in chronic lung diseases

The objective of this document was to standardise published cardiopulmonary exercise testing (CPET) protocols for improved interpretation in clinical settings and multicentre research projects. This document: 1) summarises the protocols and procedures used in published studies focusing on incremental CPET in chronic lung conditions; 2) presents standard incremental protocols for CPET on a stationary cycle ergometer and a treadmill; and 3) provides patients’ perspectives on CPET obtained through an online survey supported by the European Lung Foundation. We systematically reviewed published studies obtained from EMBASE, Medline, Scopus, Web of Science and the Cochrane Library from inception to January 2017. Of 7914 identified studies, 595 studies with 26 523 subjects were included. The literature supports a test protocol with a resting phase lasting at least 3 min, a 3-min unloaded phase, and an 8- to 12-min incremental phase with work rate increased linearly at least every minute, followed by a recovery phase of at least 2–3 min. Patients responding to the survey (n=295) perceived CPET as highly beneficial for their diagnostic assessment and informed the Task Force consensus. Future research should focus on the individualised estimation of optimal work rate increments across different lung diseases, and the collection of robust normative data.The document facilitates standardisation of conducting, reporting and interpreting cardiopulmonary exercise tests in chronic lung diseases for comparison of reference data, multi-centre studies and assessment of interventional efficacy. http://bit.ly/31SXeB

Perturbation-based detection and prosthetic correction of vestibulopathic gait

Thesis (Ph. D.)--Harvard-MIT Division of Health Sciences and Technology, February 2007.Includes bibliographical references.While being able to balance is something most of us take for granted, each year approximately 400,000 Americans are diagnosed with a balance disorder. In order to prevent fall-related injuries due to postural instability, it is important to create both diagnosis techniques so that therapy can be applied before a fall occurs and devices which can aid the balance-impaired population. The aims of this research are twofold: 1) to develop metrics that quantify the locomotor stability of individuals with reduced vestibular function and 2) to assess the capability of a noninvasive vibrotactile balance prosthesis for improving postural and gait stability. The clinical standards of practice for assessing vestibular deficiency include testing postural stability while standing but not during locomotion. This research examines one prospective locomotor-based technique involving the analysis of postural recovery from controlled surface perturbations. The research also investigates the use of a novel wearable vibrotactile sensory substitution device for enhanced postural and locomotor stability. The balance prosthesis is composed of an inertial motion-sensing system mounted on the lower back, a vibrotactile display worn around the torso, and a computer controller.(cont.) It can serve as a permanent or temporary replacement of motion cues, a tool for vestibular rehabilitation, or an additional sensory channel for military troops, pilots, and astronauts. This research demonstrates that well-compensated vestibulopathic patients can be differentiated from young and age-matched controls during over ground locomotion based on step width variability. Prior to this research, unilateral and bilateral vestibulopathic patients donning the vibrotactile balance prosthesis have demonstrated increased postural stability during single-axis support surface perturbations using single-axis sway information. This work shows that multi-directional vibrotactile tilt feedback reduces postural sway during multi-directional support surface perturbations, and has both short- and long-term effects on increasing postural stability. Finally, this research demonstrates for the first time that medial-lateral (M/L) tilt feedback can be used by balance-deficient subjects to reduce factors associated with fall risk (M/L tilt and M/L step width variability) during various locomotor tasks.by Kathleen H. Sienko.Ph.D

Heart Rate Variability Training and Control of Emotions

This thesis outlines an investigation into the effects of heart rate variability training (HRVT) on stress and performance, and participants’ experiences of undertaking HRVT. Data were collected from male Middle-Eastern adolescent student-athletes. Study 1 examined the acute effects of a single 20-minute HRVT session on performance under pressure. Thirty-six participants completed a reactive stress tolerance test after both HRVT and a control condition (group discussion about pre-competition routines). Completing HRVT did not improve performance. Study 2 built on Study 1 by exploring the effects of a 5-week HRVT protocol consisting of five lab-based and five home-based 20-minute HRVT sessions on biomarkers of the stress response. Fifty-seven participants were randomly assigned to an experimental (n=30) and a control (n=27) group, comprising five educational sessions. There were acute effects of HRVT on a-amylase levels within each session, with a-amylase levels decreasing over the course of the session. Both cortisol and a-amylase levels reduced over the course of the 5-week HRVT protocol. There were significantly lower cortisol levels and skin conductance levels in the experimental compared to the control group at the end of the training programme. Study 3 focused on the reflections of 22 participants who took part in the HRVT programme in Study 2. Participants proposed that apart from the identification of the individualized resonant breathing frequency, the customization of the inhalation-exhalation ratio is highly related to the participants’ experience. That change to the HRVT programme may further enhance effectiveness, and, that effectiveness can be increased by practicing it regularly and including it as part of a pre-competition routine

Effects of long-term balance training with vibrotactile sensory augmentation among community-dwelling healthy older adults: a randomized preliminary study

Abstract Background Sensory augmentation has been shown to improve postural stability during real-time balance applications. Limited long-term controlled studies have examined retention of balance improvements in healthy older adults after training with sensory augmentation has ceased. This pilot study aimed to assess the efficacy of long-term balance training with and without sensory augmentation among community-dwelling healthy older adults. Methods Twelve participants (four males, eight females; 75.6 ± 4.9 yrs) were randomly assigned to the experimental group (n = 6) or control group (n = 6). Participants trained in their homes for eight weeks, completing three 45-min exercise sessions per week using smart phone balance trainers that provided written, graphic, and video guidance, and monitored trunk sway. During each session, participants performed six repetitions of six exercises selected from five categories (static standing, compliant surface standing, weight shifting, modified center of gravity, and gait). The experimental group received vibrotactile sensory augmentation for four of the six repetitions per exercise via the smart phone balance trainers, while the control group performed exercises without sensory augmentation. The smart phone balance trainers sent exercise performance data to a physical therapist, who recommended exercises on a weekly basis. Balance performance was assessed using a battery of clinical balance tests (Activity Balance Confidence Scale, Sensory Organization Test, Mini Balance Evaluation Systems Test, Five Times Sit to Stand Test, Four Square Step Test, Functional Reach Test, Gait Speed Test, Timed Up and Go, and Timed Up and Go with Cognitive Task) before training, after four weeks of training, and after eight weeks of training. Results Participants in the experimental group were able to use vibrotactile sensory augmentation independently in their homes. After training, the experimental group had significantly greater improvements in Sensory Organization Test and Mini Balance Evaluation Systems Test scores than the control group. Significant improvement was also observed for Five Times Sit to Stand Test duration within the experimental group, but not in the control group. No significant improvements between the two groups were observed in the remaining clinical outcome measures. Conclusion The findings of this study support the use of sensory augmentation devices by community-dwelling healthy older adults as balance rehabilitation tools, and indicate feasibility of telerehabilitation therapy with reduced input from clinicians.https://deepblue.lib.umich.edu/bitstream/2027.42/140764/1/12984_2017_Article_339.pd