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

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

Fall Prediction and Prevention Systems: Recent Trends, Challenges, and Future Research Directions.

Fall prediction is a multifaceted problem that involves complex interactions between physiological, behavioral, and environmental factors. Existing fall detection and prediction systems mainly focus on physiological factors such as gait, vision, and cognition, and do not address the multifactorial nature of falls. In addition, these systems lack efficient user interfaces and feedback for preventing future falls. Recent advances in internet of things (IoT) and mobile technologies offer ample opportunities for integrating contextual information about patient behavior and environment along with physiological health data for predicting falls. This article reviews the state-of-the-art in fall detection and prediction systems. It also describes the challenges, limitations, and future directions in the design and implementation of effective fall prediction and prevention systems

Uner Tan Syndrome: History, Clinical Evaluations, Genetics, and the\ud Dynamics of Human Quadrupedalism

Abstract: This review includes for the first time a dynamical systems analysis of human quadrupedalism in Uner Tan syndrome, which is characterized by habitual quadrupedalism, impaired intelligence, and rudimentary speech. The first family was discovered in a small village near Iskenderun, and families were later found in Adana and two other small villages near Gaziantep and Canakkale. In all the affected individuals dynamic balance was impaired during upright walking,and they habitually preferred walking on all four extremities. MRI scans showed inferior cerebellovermian hypoplasia with slightly simplified cerebral gyri in three of the families, but appeared normal in the fourth. PET scans showed a decreased glucose metabolic activity in the cerebellum, vermis and, to a lesser extent the cerebral cortex, except for one patient,\ud whose MRI scan also appeared to be normal. All four families had consanguineous marriages in their pedigrees,\ud suggesting autosomal recessive transmission. The syndrome was genetically heterogeneous. Since the initial discoveries\ud more cases have been found, and these exhibit facultative quadrupedal locomotion, and in one case, late childhood onset. It has been suggested that the human quadrupedalism may, at least, be a phenotypic example of reverse evolution. From the viewpoint of dynamic systems theory, it was concluded there may not be a single factor that predetermines human quadrupedalism in Uner Tan syndrome, but that it may involve self-organization, brain plasticity, and rewiring, from the many decentralized and local interactions among neuronal, genetic, and environmental subsystems

Effects on mobility training and de-adaptations in subjects with Spinal Cord Injury due to a Wearable Robot: A preliminary report

open7noopenSale, Patrizio; Russo, Emanuele Francesco; Russo, Michele; Masiero, Stefano; Piccione, Francesco; Calabrò, Rocco Salvatore; Filoni, SerenaSale, Patrizio; Russo, Emanuele Francesco; Russo, Michele; Masiero, Stefano; Piccione, Francesco; Calabrò, Rocco Salvatore; Filoni, Seren

Effects of dance therapy on balance, gait and neuro-psychological performances in patients with Parkinson's disease and postural instability

Postural Instability (PI) is a core feature of Parkinson’s Disease (PD) and a major cause of falls and disabilities. Impairment of executive functions has been called as an aggravating factor on motor performances. Dance therapy has been shown effective for improving gait and has been suggested as an alternative rehabilitative method. To evaluate gait performance, spatial-temporal (S-T) gait parameters and cognitive performances in a cohort of patients with PD and PI modifications in balance after a cycle of dance therapy

Stride-level analysis of mouse open field behavior using deep-learning-based pose estimation.

Gait and posture are often perturbed in many neurological, neuromuscular, and neuropsychiatric conditions. Rodents provide a tractable model for elucidating disease mechanisms and interventions. Here, we develop a neural-network-based assay that adopts the commonly used open field apparatus for mouse gait and posture analysis. We quantitate both with high precision across 62 strains of mice. We characterize four mutants with known gait deficits and demonstrate that multiple autism spectrum disorder (ASD) models show gait and posture deficits, implying this is a general feature of ASD. Mouse gait and posture measures are highly heritable and fall into three distinct classes. We conduct a genome-wide association study to define the genetic architecture of stride-level mouse movement in the open field. We provide a method for gait and posture extraction from the open field and one of the largest laboratory mouse gait and posture data resources for the research community

Doctor of Philosophy in Rehabilitation Science

dissertationMultiple Sclerosis (MS) is a chronic, neurological disorder characterized by imbalance and falls. Accurate perception and integration of three sensory inputs - the vestibular, vision, and somatosensory, is critical to produce human gaze and posture orientation. In MS, demyelination of pathways within the brainstem and cerebellum adversely affect gaze and postural stability. However, the deficits and the psychometric properties of these measures remain less examined. Moreover, the benefits of training on gaze and postural stability are unknown in MS. This study examined the deficits in gaze stability, dynamic balance, and self-report measures in persons with MS as compared to controls; assessed the test-retest reliability and response stability of gaze stability, postural sway, and dynamic balance tests; and investigated the effects of training on gaze stability, galvanic-induced postural sway, dynamic balance, and self-report measures in persons with MS. We hypothesized that persons with MS will demonstrate deficits in gaze and postural stability; that study measures will demonstrate moderate to good reliability and acceptable response stability; and that persons with MS will demonstrate significant improvements after training. Nineteen persons with MS at fall-risk and 14 controls were recruited and the assessments were carried out on 2 occasions. The participants then completed a 2-week training followed by re-assessments. Persons with MS demonstrated significant differences in the gaze stability, dynamic balance, and self-report measures versus controls. In addition, significant inter-relationships were found. The majority of gaze stabilization measures demonstrated moderate while the postural sway and dynamic balance measures showed good reliability. The aVOR gain, FGA, and FSST showed SEM % <20 and MDD95% <20, suggesting acceptable response stability. After training, gaze stability was achieved by recruiting substitutive oculomotor strategies whereas postural stability was achieved by sway response adaptations. Consistent improvements in dynamic balance and self-report measures suggest clinically meaningful changes. Taken together, these findings support the study hypothesis and suggest that significant deficits in gaze and posture may be present in persons with MS. This highlights the utility of these assessments in fall-risk evaluations in persons with MS. Moreover, the different strategical mechanisms for improvements after training suggest the clinical value of a focused training intervention