Gamification as a Sustainable Source of Enjoyment During Balance and Gait Exercises

We may be motivated to engage in a certain motor activity because it is instrumental to obtaining reward (e.g., money) or because we enjoy the activity, making it intrinsically rewarding. Enjoyment is related to intrinsic motivation which is considered to be a durable form of motivation. Therefore, many rehabilitation programs aim to increase task enjoyment by adding game elements (“gamification”). Here we ask how the influence of game elements on motivation develops over time and additionally explore whether enjoyment influences motor performance. We describe two different studies that varied game elements in different exercises. Experiment 1 compared the durability of enjoyment for a gamified and a conventional balance exercise in elderly. Experiment 2 addressed the question whether adding game elements to a gait adaptability exercise enhances the durability of enjoyment and additionally tested whether the game elements influenced movement vigor and accuracy (motor performance). The results show that the game elements enhanced enjoyment. Enjoyment faded over time, but this decrease tended to be less pronounced in gamified exercises. There was no evidence that the game elements affected movement vigor or accuracy

A real-time system for biomechanical analysis of human movement and muscle function

Mechanical analysis of movement plays an important role in clinical management of neurological and orthopedic conditions. There has been increasing interest in performing movement analysis in real-time, to provide immediate feedback to both therapist and patient. However, such work to date has been limited to single-joint kinematics and kinetics. Here we present a software system, named human body model (HBM), to compute joint kinematics and kinetics for a full body model with 44 degrees of freedom, in real-time, and to estimate length changes and forces in 300 muscle elements. HBM was used to analyze lower extremity function during gait in 12 able-bodied subjects. Processing speed exceeded 120 samples per second on standard PC hardware. Joint angles and moments were consistent within the group, and consistent with other studies in the literature. Estimated muscle force patterns were consistent among subjects and agreed qualitatively with electromyography, to the extent that can be expected from a biomechanical model. The real-time analysis was integrated into the D-Flow system for development of custom real-time feedback applications and into the gait real-time analysis interactive lab system for gait analysis and gait retraining. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1007/s11517-013-1076-z) contains supplementary material, which is available to authorized users

Getting the best out of advanced rehabilitation technology for the lower limbs : minding motor learning principles

Advanced technology, including gait-training devices, is increasingly being integrated into neurorehabilitation. However, to use gait-training devices to their optimal potential, it is important that they are applied in accordance with motor learning and locomotor training principles. In this article, we outline the most important principles and explain how advanced gait-training devices are best used to improve therapy outcome

Feasibility of a perturbation protocol to quantify dynamic stability

Previously deposited in University of Strathclyde repository on 21 Sep 2017 at: https://strathprints.strath.ac.uk/61837/Item not available in this repository.Falls in elderly are the leading cause of injury and therefore considered a major health problem in our ageing society [1]. A fall is the result of an inadequate restoration of balance when it is compromised. The use of external perturbations to evoke loss of balance in a standardized and safe manner is an increasingly popular approach to measur e dynamic stability, offering opp ortunities for fall prevention research [2]. Although a perturbation - paradigm is promising, little is known about the type of perturbation that is most informative to quantify dynamic stability. Therefore, the first aim of this feasibility study was to evaluate whether mechanical, visual and auditory perturbations can be used to affect dynamic stability. The second aim was to evaluate whether we can distinguish between younger and older adults using the response to external perturbations.http://www.gcmas.org/pubpu

Development of a perturbation protocol to quantity gait resilience using mechanical, visual and auditory perturbations: A case study

Item not available in this repository.Falls are the leading cause of death due to injury in the elderly and therefore a major problem in our aging society. In order to prevent falls it is of great importance that clinicians are able to identify those who are at risk of falling and intervene early. However, capturing gait instability is difficult as the human body is well capable of compensating for impairments and hence it is difficult to distinguish fallers from non-fallers during steady state walking using currently available stability measures1. Most falls in the elderly occur during locomotion as gait resilience is compromised due to aging and therefore the ability to resist external perturbations during walking is also decreased. Measuring the response to external perturbations has been proposed to quantify dynamic stability and to identify fall-risk. However, perturbations used in these studies are unlikely to occur in everyday life and are dangerous and difficult to monitor. Little is known about the type of experimental perturbations that could be used for diagnosis of fallers . Therefore, the aim of this study is to evaluate the feasibility of a protocol that mimics perturbations encountered in daily life like, a push, a trip, a slip, sudden darkness or a loud noisehttps://isbweb.org/https://isbweb.org/images/conferences/isb-congresses/2015/isb_2015_abstract_book_final.pdfpubpu

Perturbation-based gait training to improve daily life gait stability in older adults at risk of falling:Protocol for the REACT randomized controlled trial

Background: The European population is rapidly ageing. There is an urgent need for innovative solutions to reduce fall risk in older adults. Perturbation-based gait training is a promising new method to improve reactive balance responses. Whereas positive effects on task-specific dynamic balance recovery during gait have been shown in clinical or laboratory settings, translation of these effects to daily life gait function and fall risk is limited. We aim to evaluate the effect of a 4-week perturbation-based treadmill training on daily-life dynamic gait stability, assessed with inertial sensor data. Secondary outcomes are balance recovery performance, clinical balance and gait assessment scores, the amount of physical activity in daily life and falls incidence during 6 months follow-up. Methods: The study is a monocenter assessor-blinded randomized controlled trial. The target study sample consists of 70 older adults of 65 years and older, living in the community and with an elevated risk of falling. A block-randomization to avoid seasonal effects will be used to allocate the participants into two groups. The experimental group receives a 4-week, two times per week perturbation-based gait training programme on a treadmill, with simulated slips and trips, in combination with cognitive dual tasks. The control group receives a 4-week, two times per week treadmill training programme under cognitive dual-task conditions without perturbations. Participants will be assessed at baseline and after the 4-weeks intervention period on their daily-life gait stability by wearing an inertial sensor on the lower back for seven consecutive days. In addition, clinical balance and gait assessments as well as questionnaires on falls- and gait-efficacy will be taken. Daily life falls will be followed up over 6 months by a fall calendar. Discussion: Whereas perturbation-based training has shown positive effects in improving balance recovery strategies and in reducing laboratory falls, this study will contribute to investigate the translation of perturbation-based treadmill training effects in a clinical setting towards improving daily life gait stability and reducing fall risk and falls. Trial registration: NTR7703 / NL66322.028.18, Registered: January 8, 2019; Enrolment of the first participant April 8, 2019

Development of a Balance Recovery Performance Measure for Gait Perturbation Training Based on the Center of Pressure

Background: The availability of instrumented treadmills that can apply unexpected perturbations during walking has made gait perturbation training more popular in clinical practice. To quantify and monitor balance recovery while training, easy to use measures are needed and may be based on integrated force plate data. Therefore, we aimed to quantify and evaluate different implementations of the recovery performance measure based on center of pressure data. Methods: Recovery performance was calculated based on differences in center of pressure trajectories between unperturbed walking and balance recovery after a perturbation. Five methodological choices leading to 36 different implementations were evaluated. Test-retest reliability, effect sizes, and concurrent validity were evaluated against trunk velocity measures. Results: Differences in measures of (dis-)similarity, time normalization and reference data affected reliability, sensitivity and validity and none of the performance measure implementations based on center of pressure trajectories was superior on all criteria. Measures assessing perturbation effects on trunk velocities provided more reliable and sensitive recovery outcomes. Discussion: Different implementations of the recovery performance measure can be chosen dependent on constraints imposed in the clinical setting. Conclusion: Quantifying recovery performance based on center of pressure data is possible and may be suitable to monitor improvement in recovery performance after gait perturbations in specific clinical setups. Validity of performance measures in general requires further attention

Effects of Perturbation-Based Treadmill Training on Balance Performance, Daily Life Gait, and Falls in Older Adults:REACT Randomized Controlled Trial

OBJECTIVE: The aim of this study was to evaluate the effect of perturbation-based treadmill training on gait quality in daily life, a predictor of fall risk that was used as the primary outcome. An additional aim was to evaluate the effects on secondary outcomes, including balance, gait performance, self-efficacy, daily life physical activity, and falls. METHODS: Seventy community-dwelling older adults (mean age = 74.73 [SD = 5.69] years; 46 women) at risk of falling were randomized and received 4 weeks of dual-task treadmill training, either with or without treadmill perturbations. Balance, gait performance, self-efficacy, and daily life trunk accelerometry at baseline, after intervention, and at a 6-month follow-up were assessed and compared within group over time and between groups for each time point, and their change rates between groups over time were also assessed. RESULTS: Both groups improved in their balance, gait performance, and self-efficacy; the experimental group showed a significantly larger decrease in concern of falling and an increase in physical performance than the controls. These training effects did not translate into significant improvements in daily life gait quality or physical activity. However, the number of daily life falls and the percentage of fallers decreased significantly more in the experimental group. CONCLUSION: A 4-week perturbation-based dual-task treadmill training program can improve self-efficacy, balance, and gait performance in a controlled setting and reduce daily life falls, although not through changes in quantity or quality of daily life gait. IMPACT: Perturbation-based treadmill training is a safe and efficient way to train older adults' balance recovery and gait performance, increase self-efficacy, and prevent falls.</p

Gait perturbations to discriminate between older adults with and without history of falls

Item not available in this repository.BACKGROUND AND AIM: While falls among older adults are considered a major health problem, the sensitivity of conventional fall risk assessments to identify individuals at risk is poor [1]. Among the main risk factors for falls are balance and gait impairments [2]. The ability to resist or recover from gait perturbations to prevent falling requires fast and accurate responses and might discriminate between fallers and non-fallers. We therefore investigated the ability to discriminate between older adults with and without history of falls using medio-lateral and anterior-posterior gait perturbations. METHODS: Twenty-five older adults (14 females; 74.0±11.1 years of age) walked at a fixed treadmill speed (1.03±0.20 m/s) on the GRAIL (Motekforce Link BV, Amsterdam, The Netherlands). Trunk and lower limb kinematics were collected (Vicon, Oxford, UK) during steady state walking and in response to four types of perturbations: ipsi-lateral and contra-lateral platform sway and unilateral belt acceleration and deceleration. Maximum pelvic velocity per step in the medio-lateral and anterior-posterior direction was calculated during baseline walking and the first step after each perturbation. Participants were categorized as fallers or non-fallers based on their self-reported fall history over the past 12 months. Additionally, falls efficacy score (FES), physical activity questionnaire (PAQ), one-legged stance test (OLST) and the timed up and go (TUG) test were assessed. Differences between fallers and non-fallers were analysed using one-way ANOVAs. RESULTS: Seven participants (28%) reported at least one fall in the past 12 months and were categorized as fallers. Fallers showed significantly lower maximum pelvic velocity in response to the deceleration perturbation compared to non-fallers (F=5.651; p=0.026). No significant differences in maximum pelvic velocity were found during baseline walking and for the other perturbation types (Figure 1). Moreover, no significant differences were found between fallers and nonfallers for the conventional measures (i.e. the FES, PAQ, OLST and TUG). CONCLUSIONS: We successfully discriminated fallers from non-fallers based on the recovery from deceleration perturbations, while we were not able to do so by means of the conventional measures. Fallers had more difficulties in maintaining walking speed as indicated by the lower maximum pelvic velocity. On average, their maximum pelvic velocity was negative, meaning that their position on the treadmill became more rearward after the deceleration perturbation. Therefore, assessing the ability to recover from deceleration perturbations may be used to identify fall risk in older adults. The added value of other perturbation outcomes and strategies to recover from perturbations will be discussed. [1] Gates S. et al. (2008). J Rehabil Res Dev, 45(8): 1105-16. [2] Ambrose, AF et al. (2013). Maturitas, 75(1): 51-61.https://ispgr.org/wp-content/uploads/2018/10/2017Abstracts.pdfhttps://ispgr.org/past-congresses/pubpu