A pilot study using tactile cueing for gait rehabilitation following stroke

Recovery of walking function is a vital goal of post-stroke rehabilitation. Cueing using audio metronomes has been shown to improve gait, but can be impractical when interacting with others, particularly outdoors where awareness of vehicles and bicycles is essential. Audio is also unsuitable in environments with high background noise, or for those with a hearing impairment. If successful, lightweight portable tactile cueing has the potential to take the benefits of cueing out of the laboratory and into everyday life. The Haptic Bracelets are lightweight wireless devices containing a computer, accelerometers and low-latency vibrotactiles with a wide dynamic range. In this paper we review gait rehabilitation problems and existing solutions, and present an early pilot in which the Haptic Bracelets were applied to post-stroke gait rehabilitation. Tactile cueing during walking was well received in the pilot, and analysis of motion capture data showed immediate improvements in gait

A Gait Rehabilitation pilot study using tactile cueing following Hemiparetic Stroke

Recovery of walking function is a major goal of post-stroke rehabilitation. Audio metronomic cueing has been shown to improve gait, but can be impractical and inconvenient to use in a community setting, for example outdoors where awareness of traffic is needed, as well as being unsuitable in environments with high background noise, or for those with a hearing impairment. Silent lightweight portable tactile cueing, if similarly successful, has the potential to take the benefits out of the lab and into everyday life. The Haptic Bracelets, designed and built at the Open University originally for musical purposes, are self- contained lightweight wireless devices containing a computer, Wi-Fi chip, accelerometers and low-latency vibrotactiles with a wide dynamic range. In this paper we outline gait rehabilitation problems and existing solutions, and present an early pilot in which the Haptic Bracelets were applied to post-stroke gait rehabilitation

Pediatric generalized joint hypermobility with and without musculoskeletal complaints: A localized or systemic disorder?

Objectives. Children with generalized hypermobility of the joints and musculoskeletal complaints frequently visit pediatric clinics, but many show no currently known collagen or other possibly related diseases. Whether the symptoms are confined to the musculoskeletal system is unknown. We assessed whether such children have detectable differences in laxity of connective tissue present in organ systems other than joints. We also assessed whether children with generalized joint hypermobility and musculoskeletal complaints have more profound systemic changes in connective tissue of various organ systems as compared with children with generalized joint hypermobility without musculoskeletal complaints. Methods. Anthropometrics, range of joint motion, muscle strength, skin extensibility, blood pressure, quantitative ultrasound measurements of bone, and degradation products of collagen were studied in 15 prepubertal children with generalized joint hypermobility and musculoskeletal complaints and compared with a population-based reference group of 95 nonsymptomatic prepubertal children. Symptomatic hypermobile children were also compared with children of the population-based reference group who had asymptomatic hypermobility of the joints (n = 16). Results. Children with symptomatic generalized joint hypermobility had significantly higher skin extensibility (5.6 mm/15 kPa, 95% confidence interval [CI]: 4.0-7.1), lower quantitative ultrasound measurements (speed of sound: -26.8 m/s; 95% CI: -41.1 to -12.6) in bone, and lower systolic and diastolic blood pressure (-8.0 mmHg, 95% CI: -13.3 to -2.8; and -6.0 mmHg, 95% CI: -10.0 to -2.2, respectively) as compared with the total reference group. Also, they had significantly lower excretion of urinary hydroxylysylpyridinoline cross-links (mean difference: -51.3 mumol/mmol; 95% CI: -92.2 to -10.4) as well as lysylpyridinoline cross-links (-18.7 mumol/mmol; 95% CI: -36.9 to -0.5). Age, gender, body weight, height, and particularly cross-links excretion did not explain group differences in clinical and bone characteristics. After adjustment for age, gender, body weight, and height, children with symptomatic generalized joint hypermobility (n = 15) had significantly higher total range of joint motion (117.8 degrees; 95% CI: 77.7-158.0), skin extensibility (3.5 mm/15 kPa; 95% CI: 1.6-5.3), lower quantitative ultrasound measurements in bone (speed of sound: -27.9 m/s; 95% CI: -48.4 to -7.5), borderline lower diastolic blood pressure (-4.9 mmHg; 95% CI: -10.7-0.9), and significantly higher degradation products in urine (hydroxyproline/creatinine: 21.2 mumol/mmol; 95% CI: 2.3-40.1) as compared with asymptomatic hypermobile children of the total reference group (n = 16). After adjustment for possible confounders, children with generalized joint hypermobility without musculoskeletal complaints had a significantly higher total range of joint motion and more profound skin extensibility, as compared with the reference group (n = 79). Conclusions. Clinically manifested symptoms in otherwise healthy children with generalized joint hypermobility are accompanied by increases in the laxity of other body tissues. Thus, generalized joint hypermobility with musculoskeletal symptoms does not seem to be restricted to joint tissues. In symptomatic hypermobile children, a more systemic derangement was also present as compared with asymptomatic hypermobile children

A relation between blood pressure and stiffness of joints and skin

Background. Blood pressure, particularly pulse pressure, is associated with arterial wall stiffness, but little is known about its relation to stiffness of other parts of the body. We examined the extent to which blood pressure levels in young healthy children are related to stiffness of various tissues. Methods. In November 2000, we studied 95 healthy prepubertal children (41 boys and 54 girls, within age range 8-10 years) from two primary schools in the city of Zeist, The Netherlands. Systolic and diastolic blood pressure and pulse pressure were analyzed in relation to various tissue indicators of stiffness, including active joint mobility and skin extensibility. All results were adjusted forage, sex, body height, body weight and muscle strength as possible confounders. Results. Diastolic blood pressure was lower with increased active joint mobility (multivariate generalized linear regression coefficient = -4.5 mmHg per standard deviation [SDI joint mobility; 95% confidence interval [CI] = -.7.8 to -1.2). Pulse pressure was lower with increased skin extensibility (-3.2 mmHg per SD skin extensibility; CI = -5.2 to -1.1), through a higher diastolic blood pressure (2.0 mmHg per SD skin extensibility; CI = 0.2-3.9) and possibly lower systolic blood pressure (-0.8 mmHg per SD skin extensibility; CI = -3.5 to 1.9). These associations were mutually independent. Additional adjustment for reported musculoskeletal problems or physical activity levels did not materially change the findings. Conclusions. Our findings support the hypothesis that constitutional stiffness of body tissues may be associated with blood pressure levels and eventually cardiovascular risk

Serious Gaming in Augmented Reality using HMDs for Assessment of Upper Extremity Motor Dysfunctions: User Studies for Engagement and Usability

For a better understanding of how different disorders affect motor function, a uniform, standardized and objective evaluation is a desirable goal for the clinical community. We explore the potential of Augmented Reality (AR) combined with serious gaming and free hand tracking to facilitate objective, cost-effective and patient-friendly methods for evaluation of upper extremity motor dysfunction in different patient groups. In this paper, we describe the design process of the game and the system architecture of the AR framework to meet these requirements. Furthermore, we report our findings from two pilot studies we conducted with healthy people aged over 50. First, we present a usability study (n = 5) on three different modalities of visual feedback for natural hand interaction with AR objects (i. e., no augmented hand, partial augmented hand and a full augmented hand model). The results show that a virtual representation of the fingertips or hand improves the usability of natural hand interaction. Secondly, a study about game engagement is presented. The results of this experiment (n = 8) show that there might be potential for engagement, but usability needs to be improved before it can emerge.System EngineeringPolicy Analysi

A Haptic Serious Augmented Reality Game for Motor Assessment of Parkinson's Disease Patients

n the clinical community there is a need for assessment tools that allow for objective, quantitative and valid measures of motor dysfunction. In this paper, we report on the design and evaluation of a serious game that engages patients with Parkinson's disease in upper extremity (hand/arm) movements. The game employs augmented reality to show virtual movement targets, i.e. candies falling from a conveyor belt, and a haptic game controller to catch the candies, that is able to acquire quantitative data about the patient's movement. This paper first describes the design process of the game and the system components. Secondly, we present results of our small quantitative evaluation study (N11, age: 26–60, healthy persons) regarding the usability of the system, the task load and user experience of the game. Our findings show that the system has a relatively good usability and the game is engaging, but there is still need for technical improvement with regard to tracking the controller in 3D space.System EngineeringDesign Conceptualization and CommunicationDesign Aesthetic