Mobile phone-based joint angle measurement for functional assessment and rehabilitation of proprioception

International audienceAssessment of joint functional and proprioceptive abilities is essential for balance, posture, and motor control rehabilitation. Joint functional ability refers to the capacity of movement of the joint. It may be evaluated thereby measuring the joint range of motion (ROM). Proprioception can be defined as the perception of the position and of the movement of various body parts in space. Its role is essential in sensorimotor control for movement acuity, joint stability, coordination, and balance. Its clinical evaluation is commonly based on the assessment of the joint position sense (JPS). Both ROM and JPS measurements require estimating angles through goniometer, scoliometer, laser-pointer, and bubble or digital inclinometer. With the arrival of Smartphones, these costly clinical tools tend to be replaced. Beyond evaluation, maintaining and/or improving joint functional and proprioceptive abilities by training with physical therapy is important for long-term management. This review aims to report Smartphone applications used for measuring and improving functional and proprioceptive abilities. It identifies that Smartphone applications are reliable for clinical measurements and are mainly used to assess ROM and JPS. However, there is lack of studies on Smartphone applications which can be used in an autonomous way to provide physical therapy exercises at home

Motion analysis in the elderly: Evaluation of an APA program on the gait of elderly using an inertial motion capture system

Elderly walking performance undergoes a natural physiological decline that, from a biomechanical point of view, it is manifested by an alteration of the spatial-temporal characteristics of the gait. The quantitative assessment of the gait in the elderly requires an objective and reliable evaluation system that can be used under conditions of daily living. The aim of this study was to investigate, using an inertial motion capture system, the effects of five months of a structured Adapted Physical Activity (APA) program on the main characteristics of the gait in the elderly, detected directly within the homecare. Data relating to spatial-temporal parameters have been objectively and systematically acquired, through this wireless inertial sensor positioned on the L5 spinal segment, before and after the implementation of the APA program. The research was carried out in two Italian elderly centres. The sample consisted of 11 elderly aged between 70 and 92 years (82.55 ± 7.43). The results obtained found a substantial improvement in speed, cadence, stride length, symmetry index, cycle time, single support phase and swing duration after the implementation of the APA program. In conclusion, this study revealed a high feasibility of the APA structured program and a readable efficacy in the use of inertial motion capture system for the evaluation of the gait in the elderly homecare. In relation to the number of the sample, the results are more suggestive than conclusive, hence suggest the need for further research on the effects across a larger range of subjects

Upper limb proprioceptive sensitivity in three-dimensional space: effects of direction, posture, and exogenous neuromodulation

abstract: Proprioception is the sense of body position, movement, force, and effort. Loss of proprioception can affect planning and control of limb and body movements, negatively impacting activities of daily living and quality of life. Assessments employing planar robots have shown that proprioceptive sensitivity is directionally dependent within the horizontal plane however, few studies have looked at proprioceptive sensitivity in 3d space. In addition, the extent to which proprioceptive sensitivity is modifiable by factors such as exogenous neuromodulation is unclear. To investigate proprioceptive sensitivity in 3d we developed a novel experimental paradigm employing a 7-DoF robot arm, which enables reliable testing of arm proprioception along arbitrary paths in 3d space, including vertical motion which has previously been neglected. A participant’s right arm was coupled to a trough held by the robot that stabilized the wrist and forearm, allowing for changes in configuration only at the elbow and shoulder. Sensitivity to imposed displacements of the endpoint of the arm were evaluated using a “same/different” task, where participant’s hands were moved 1-4 cm from a previously visited reference position. A measure of sensitivity (d’) was compared across 6 movement directions and between 2 postures. For all directions, sensitivity increased monotonically as the distance from the reference location increased. Sensitivity was also shown to be anisotropic (directionally dependent) which has implications for our understanding of the planning and control of reaching movements in 3d space. The effect of neuromodulation on proprioceptive sensitivity was assessed using transcutaneous electrical nerve stimulation (TENS), which has been shown to have beneficial effects on human cognitive and sensorimotor performance in other contexts. In this pilot study the effects of two frequencies (30hz and 300hz) and three electrode configurations were examined. No effect of electrode configuration was found, however sensitivity with 30hz stimulation was significantly lower than with 300hz stimulation (which was similar to sensitivity without stimulation). Although TENS was shown to modulate proprioceptive sensitivity, additional experiments are required to determine if TENS can produce enhancement rather than depression of sensitivity which would have positive implications for rehabilitation of proprioceptive deficits arising from stroke and other disorders.Dissertation/ThesisDoctoral Dissertation Neuroscience 201

Human inspired humanoid robots control architecture

This PhD Thesis tries to present a different point of view when talking about the development of control architectures for humanoid robots. Specifically, this Thesis is focused on studying the human postural control system as well as on the use of this knowledge to develop a novel architecture for postural control in humanoid robots. The research carried on in this thesis shows that there are two types of components for postural control: a reactive one, and other predictive or anticipatory. This work has focused on the development of the second component through the implementation of a predictive system complementing the reactive one. The anticipative control system has been analysed in the human case and it has been extrapolated to the architecture for controlling the humanoid robot TEO. In this way, its different components have been developed based on how humans work without forgetting the tasks it has been designed for. This control system is based on the composition of sensorial perceptions, the evaluation of stimulus through the use of the psychophysics theory of the surprise, and the creation of events that can be used for activating some reaction strategies (synergies) The control system developed in this Thesis, as well as the human being does, processes information coming from different sensorial sources. It also composes the named perceptions, which depend on the type of task the postural control acts over. The value of those perceptions is obtained using bio-inspired evaluation techniques of sensorial inference. Once the sensorial input has been obtained, it is necessary to process it in order to foresee possible disturbances that may provoke an incorrect performance of a task. The system developed in this Thesis evaluates the sensorial information, previously transformed into perceptions, through the use of the “Surprise Theory”, and it generates some events called “surprises” used for predicting the evolution of a task. Finally, the anticipative system for postural control can compose, if necessary, the proper reactions through the use of predefined movement patterns called synergies. Those reactions can complement or substitute completely the normal performance of a task. The performance of the anticipative system for postural control as well as the performance of each one of its components have been tested through simulations and the application of the results in the humanoid robot TEO from the RoboticsLab research group in the Systems Engineering and Automation Department from the Carlos III University of Madrid. ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------Esta Tesis Doctoral pretende aportar un punto de vista diferente en el desarrollo de arquitecturas de control para robots humanoides. En concreto, esta Tesis se centra en el estudio del sistema de control postural humano y en la aplicación de este conocimiento en el desarrollo de una nueva arquitectura de control postural para robots humanoides. El estudio realizado en esta Tesis pone de manifiesto la existencia de una componente de control postural reactiva y otra predictiva o anticipativa. Este trabajo se ha centrado en el desarrollo de la segunda componente mediante la implementación de un sistema predictivo que complemente al sistema reactivo. El sistema de control anticipativo ha sido estudiado en el caso humano y extrapolado para la arquitectura de control del robot humanoide TEO. De este modo, sus diferentes componentes han sido desarrollados inspirándose en el funcionamiento humano y considerando las tareas para las que dicho robot ha sido concebido. Dicho sistema está basado en la composición de percepciones sensoriales, la evaluación de los estímulos mediante el uso de la teoría psicofísica de la sorpresa y la generación de eventos que sirvan para activar estrategias de reacción (sinergias). El sistema de control desarrollado en esta Tesis, al igual que el ser humano, procesa información de múltiples fuentes sensoriales y compone las denominadas percepciones, que dependen del tipo de tarea sobre la que actúa el control postural. El valor de estas percepciones es obtenido utilizando técnicas de evaluación bioinspiradas de inferencia sensorial. Una vez la entrada sensorial ha sido obtenida, es necesario procesarla para prever posibles perturbaciones que puedan ocasionar una incorrecta realización de una tarea. El sistema desarrollado en esta Tesis evalúa la información sensorial, previamente transformada en percepciones, mediante la ‘Teoría de la Sorpresa’ y genera eventos llamados ‘sorpresas’ que sirven para predecir la evolución de una tarea. Por último, el sistema anticipativo de control postural puede componer, si fuese necesario, las reacciones adecuadas mediante el uso de patrones de movimientos predefinidos llamados sinergias. Dichas reacciones pueden complementar o sustituir por completo la ejecución normal de una tarea. El funcionamiento del sistema anticipativo de control postural y de cada uno de sus componentes ha sido probado tanto por medio de simulaciones como por su aplicación en el robot humanoide TEO del grupo de investigación RoboticsLab en el Departamento de Ingeniería de Sistemas y Automática de la Universidad Carlos III de Madrid

The role of noise in sensorimotor control

Goal-directed arm movements show stereotypical trajectories, despite the infinite possible ways to reach a given end point. This thesis examines the hypothesis that this stereotypy arises because movements are optimised to reduce the consequences of signal-dependent noise on the motor command. Both experimental and modelling studies demonstrate that signal-dependent noise arises from the normal behaviour of the muscle and motor neuron pool, and has a particular distribution across muscles of different sizes. Specifically, noise decreases in a systematic fashion with increasing muscle strength and motor unit number. Simulations of obstacle avoidance performance in the presence of signal-dependent noise demonstrate that the optimal trajectory for reaching the target accurately and without collision matches the observed trajectories. Isometric force generation is also shown to have systematic changes in variability with posture, which can be explained by the presence of signal-dependent noise in the muscles of the arm. These results confirm the tested hypothesis and imply that consideration of the statistics of action is crucial to human movement planning. To investigate the importance of feedback in the motor system, the impact of static position on motor excitability was examined using transcranial magnetic stimulation and systematic changes in motor evoked potentials were observed. Force generated at the wrist following stimulation was analysed in terms of different possible movement representations, and the differences between force fields arising from stimulation over the cervical spinal cord and from stimulation over primary motor cortex are determined. These results demonstrate the structured influence of proprioceptive feedback on the human motor system. All the experiments are discussed in relation to current theories describing the control of human movements and the impact of noise in the motor system

An investigation into the utility of wearable sensor derived biofeedback on the motor control of the lumbar spine

Lower back pain (LBP) is a disability that affects a large proportion of the population and treatment for this has been shifting towards a more individualized, patient-centered approach. There has been a recent uptake in the utilization and implementation of wearable sensors that can administer biofeedback in various industrial, clinical, and performance-based settings. The overall aim of this Master’s thesis was to investigate how wearable sensors can be used in a sensorimotor (re)training approach, including how sensory biofeedback from wearable sensors can be used to improve measures of spinal motor control and proprioception. Two complementary research studies were completed to address this overall aim. As a systematic review, Study #1 focused on addressing the lack of consensus surrounding wearable sensor derived biofeedback and spine motor control. The results of this review suggest that haptic/vibrotactile feedback is the most common and that it is administered in an instantaneous real-time manner within most experimental paradigms. Further, study #1 identified clear gaps within the research literature. Specifically, future research would benefit from more clarity regarding study design, and movement instructions, and explicit definitions of biofeedback parameters to enhance reproducibility. The aim of Study #2 was to assess the acute effects of wearable sensor-derived auditory biofeedback on gross lumbar proprioception. To assess this, participants completed a target repositioning protocol, followed by a training period where they were provided with auditory feedback for two of four targets based on a percentage of their lumbar ROM. Results suggest that mid-range targets benefitted most from the acute auditory feedback training. Further, individuals with poorer repositioning abilities in the pre-training assessment showed the greatest improvements from the auditory feedback training. This suggests that auditory biofeedback training may be an effective tool to improve proprioception in those with proprioceptive deficits. Collectively these complimentary research studies will improve the understanding surrounding the ecological utility of wearable sensor derived biofeedback in industrial, clinical, and performance settings to enhance to sensorimotor control of the lumbar region

The Role of the Central Nervous System in the Integration of Proprioceptive Information

The proprioceptive system provides feedback on human performance that makes it possible to learn and perform novel tasks. Proprioception predominately arises in the peripheral nervous system at the muscle spindle organ. Mechanical stimulus such as vibration has been implicated in altering muscle spindle afferent signals used as feedback. Researchers have utilized this understanding to document gross performance changes resulting from a muscle spindle disruption paradigm. Findings of this work have demonstrated that the altered proprioceptive feedback alters performance both during and after vibration exposure. This has also led many to postulate that altered proprioceptive feedback due to environmental working conditions may be responsible for many incidences of musculoskeletal injury, including low back pain. In order to more fully understand how proprioceptive feedback is integrated into a motor response it was required to investigate activity within the central nervous system, itself the target of the spindle afferent, both before and after receiving a modulate afferent. We developed a protocol based on measures of average velocity to test for this activity. Our investigation began we examining whether or not average velocity, in the form of seated sway velocity, would be sensitive to applied vibration. We found that while vibration was applied; mean sway speed increased significantly above pre vibration levels, regardless of feedback and task difficulty. A computer based pursuit task was then implemented in order to investigate performance relative to timing of vibration exposure. Our results revealed a significant decrease in pursuit velocity during vibration from pre-vibration velocity. Additionally, subjects demonstrated an equal magnitude but opposite increase in pursuit speed after vibration was removed. This protocol was then replicated in a functional-MRI to compare the gross motor pursuit task performance with the corresponding BOLD imaging data. We observed a similar decrease/increase pattern of joystick pursuit velocity. The corresponding cortical activity revealed patterns of inhibition consistent with cognitive inhibition. The current findings support proprioception as a central inhibitory control mechanism that shifts cortical networks dependent on available sensory stimulus

UPPER LIMB MOVEMENT IN VIRTUAL AND REAL-WORLD ENVIRONMENTS

In recent years, virtual reality (VR) systems have experienced significant technological advancements, resulting in increased accessibility and improved product quality. Early VR systems were limited by low visual quality, large size, and high cost, but advancements in technology have propelled VR into the mainstream. As VR becomes increasingly prevalent, it is vital to understand its effects on the human sensorimotor system, particularly with vulnerable populations. The upper limb is within the field of view of current VR headsets and is the main point of contact between the user and virtual environment. It is therefore an essential component of the relationship between user and system. This dissertation is organized into five sections, each contributing to the overarching objective of understanding upper limb movement in real and virtual environments. Chapter I serves as an introduction, providing essential background information and an overview of subsequent chapters. Chapters II and III are dedicated to validating the HTC VIVE tracker as a tool for collecting both static and dynamic data. This establishes the foundation for subsequent studies, which use the tracker to estimate body segment position and orientation. Chapter IV investigates the impact of visuoproprioceptive congruency on upper limb joint position matching within a VR environment, highlighting the pivotal role of vision in the planning and execution of movements. Continuing the exploration of upper limb movements, Chapter V identifies kinematic and kinetic disparities between visually guided reaching movements conducted in VR and the real world (RW). Building upon the findings from Chapter V, Chapter VI investigates the translation of these differences when individuals switch between VR and RW environments. Collectively, these studies contribute to the broader knowledge base of motor control, informing the design and implementation of effective protocols and applications in both real and virtual settings. This dissertation includes previously published and unpublished co-authored material

An investigation into perception of change in the foot-floor interface during repeated stretch-shortening cycles

Proprioceptive input is critical for normal and safe movement. There exists a gap in the literature regarding the assessment of proprioceptive function during dynamic tasks of the lower limb. To fill this gap, the present thesis has investigated perception of change in the foot-floor interface during repeated stretch-shortening cycles. This doctoral research serves as a foundation for considering proprioception as it pertains to dynamic function at the ankle