Technological methods used in evaluating the balance

Balance is evaluated within the concept of coordination and is defi ned as the ability to maintain the body’s center of gravity on the support surface. Technological methods used in the assessment of balance are robotic systems, virtual reality applications, tele-rehabilitation, web-based applications and sensor applications. In this review, we aimed to explain today’s technological assessment methods and their relationship with technological rehabilitation in balance assessment. The technological method to be used in balance assessment suitability of the patient, ease of use, time saving, active participation, depending on the person’s fi nancial situation and the severity of the disease although the advantages vary, It seems that it may differ. More studies are needed for a more objective assessment of balance, designing products and using these technologies in different patient groups.No sponso

Stand-alone wearable system for ubiquitous real-time monitoring of muscle activation potentials

Wearable technology is attracting most attention in healthcare for the acquisition of physiological signals. We propose a stand-alone wearable surface ElectroMyoGraphy (sEMG) system for monitoring the muscle activity in real time. With respect to other wearable sEMG devices, the proposed system includes circuits for detecting the muscle activation potentials and it embeds the complete real-time data processing, without using any external device. The system is optimized with respect to power consumption, with a measured battery life that allows for monitoring the activity during the day. Thanks to its compactness and energy autonomy, it can be used outdoor and it provides a pathway to valuable diagnostic data sets for patients during their own day-life. Our system has performances that are comparable to state-of-art wired equipment in the detection of muscle contractions with the advantage of being wearable, compact, and ubiquitous

Wearable Inertial Sensors to Assess Standing Balance: A Systematic Review

Wearable sensors are de facto revolutionizing the assessment of standing balance. The aim of this work is to review the state-of-the-art literature that adopts this new posturographic paradigm, i.e., to analyse human postural sway through inertial sensors directly worn on the subject body. After a systematic search on PubMed and Scopus databases, two raters evaluated the quality of 73 full-text articles, selecting 47 high-quality contributions. A good inter-rater reliability was obtained (Cohen’s kappa = 0.79). This selection of papers was used to summarize the available knowledge on the types of sensors used and their positioning, the data acquisition protocols and the main applications in this field (e.g., “active aging”, biofeedback-based rehabilitation for fall prevention, and the management of Parkinson’s disease and other balance-related pathologies), as well as the most adopted outcome measures. A critical discussion on the validation of wearable systems against gold standards is also presented

Fifteen years of wireless sensors for balance assessment in neurological disorders

Balance impairment is a major mechanism behind falling along with environmental hazards. Under physiological conditions, ageing leads to a progressive decline in balance control per se. Moreover, various neurological disorders further increase the risk of falls by deteriorating specific nervous system functions contributing to balance. Over the last 15 years, significant advancements in technology have provided wearable solutions for balance evaluation and the management of postural instability in patients with neurological disorders. This narrative review aims to address the topic of balance and wireless sensors in several neurological disorders, including Alzheimer's disease, Parkinson's disease, multiple sclerosis, stroke, and other neurodegenerative and acute clinical syndromes. The review discusses the physiological and pathophysiological bases of balance in neurological disorders as well as the traditional and innovative instruments currently available for balance assessment. The technical and clinical perspectives of wearable technologies, as well as current challenges in the field of teleneurology, are also examined

Priming Motor Learning through Exercise in People with Spinocerebellar Ataxia (PRIME-Ataxia)

Background. People with spinocerebellar ataxia (SCA) have symptoms that impact balance, gait, motor learning and control. Independently, balance training (BT) and aerobic exercise (AE) have improved motor function for people with SCA. Studies in stroke and Parkinson disease have evaluated the use of AE prior to BT as a form of motor priming to enhance motor learning. Motor priming has not been explored in SCA. Introduction & Purpose. This was a pilot randomized controlled trial aimed to 1) determine the feasibility and efficacy of an 8-week telehealth intervention of high intensity AE prior to BT (HIBT) compared to low intensity exercise prior to BT (LIBT) on disease specific motor and cognitive outcomes, and 2) explore changes in patient reported outcomes as well as functional outcomes post exercise intervention in people with SCA. Methods. Participants (n=20) were randomized to receive either HIBT, or LIBT, for 60 minutes, twice weekly, for 8-weeks over telehealth. The HIBT group underwent 30 minutes of High Intensity Interval Training (HIIT) prior to 30 minutes of BT, while the LIBT group underwent 30 minutes of low intensity warm up type exercises prior to 30 minutes of BT. Outcomes were assessed at baseline, mid- and post-intervention and included: disease specific measures (e.g., Cerebellar Cognitive Affective Scale (CCAS), Scale for Assessment and Rating of Ataxia at Home (SARAHome), functional measures of balance and gait (e.g., Timed Up and Go test (TUG), 30 second Sit to Stand Test (30secSTS)), patient reported measures (e.g., fatigue severity scale (FSS-49)) and metrics of feasibility. Data for disease specific, and functional outcomes were not normally distributed. Data for patient reported outcomes was normally distributed. Statistical significance of findings are reported as p-value. Results. A total of 93 people were referred to this intervention, and 20 were enrolled (21.5% enrollment). Eighteen participants completed the intervention and post-intervention outcome assessments (90% retention). Both the HIBT and LIBT interventions had high acceptance from on the post-intervention questionnaire. Enrolled participants had a mean (SD) age of 58.1(13.5) yrs; 6M/14F. Diagnoses were early-mid stage SCA types 1, 2, 3, and 6. Participants showed 100% adherence to the intervention, with 1 adverse event of low back pain exacerbation which resolved. Both groups improved on disease specific measures of the CCAS, and SARAHome where outcomes for the SARAHome surpassed the established group minimal detectable change score of 0.3 points. At post-intervention however, there were no between group differences identified on the SARAHome (p > .05), however for the CCAS the LIBT group demonstrated significant improvements at post intervention over the HIBT group (p < .01). There were no differences observed at post-intervention between groups for functional measures such as the TUG test, 30secSTS test, or in any static stance position. The LIBT group showed greater changes in fatigue post-intervention, (p < .05). The HIBT group showed no significant change in fatigue, however they displayed decreased tolerability to engage in BT after engagement in AE. The HIBT group managing to complete an average of only 8.50 BT exercises per session while LIBT completed 10.04. Conclusions. Results from this pilot randomized controlled trial support a telehealth-delivered exercise intervention for people with SCA 1, 2, 3, and 6, with low overall attrition, and high rates of intervention adherence, and acceptability. However, effect estimates do not support the hypothesis of motor priming in people with SCA. Fatigue after engagement in AE limited intervention tolerability for BT in the HIBT group, and this suggests that fatigue may stand as a potential barrier for not only exercise engagement and functional improvement, but also neuroplastic growth and motor learning potential. Future research should aim to optimize exercise prescription to mitigate fatigue in this population