Abstract
BackgroundEarlier versions of biofeedback systems for balance-related applications were intended primarily to provide “alarm” signals about body tilt rather than to guide rehabilitation exercise motion. Additionally, there have been few attempts to evaluate guidance modalities for balance rehabilitation exercises. The purpose of this proof-of-concept study is to evaluate the effects of guidance modalities during common dynamic weight-shifting exercises used in clinical settings.MethodsA motion guidance system providing visual biofeedback, vibrotactile biofeedback, or both, was used during weight-shifting exercises. Eleven people with idiopathic Parkinson’s disease (PD) and nine healthy elderly people participated. Each participant wore a six-degree-of-freedom inertial measurement unit (IMU) located near the sacrum and four linear vibrating actuators (Tactors) attached to the skin over the front, back, and right and left sides of the abdomen. The IMU measured angular displacements and velocities of body tilt in anterior-posterior (A/P) and medial-lateral (M/L) directions. Participants were instructed to follow a slow moving target by shifting their weight in either the A/P or M/L direction up to 90 % of their limits of stability (LOS). Real-time position error was provided to participants in one of three sensory modalities: visual, vibrotactile, or both. Participants performed 5 trials for each biofeedback modality and movement direction (A/P and M/L) for a total of 30 trials in a random order. To characterize performance, position error was defined as the average absolute difference between the target and participant movements in degrees.ResultsSimultaneous delivery of visual and vibrotactile biofeedback resulted in significantly lower position error compared to either visual or vibrotactile biofeedback alone regardless of the movement direction for both participant cohorts. The pairwise comparisons were not significantly different between visual and vibrotactile biofeedback.ConclusionThe study is the first attempt to assess the effects of guidance modalities on common balance rehabilitation exercises in people with PD and healthy elderly people. The results suggest that combined visual and vibrotactile biofeedback can improve volitional responses during postural tracking tasks.Index Terms – sensory augmentation, weight-shifting balance exercise, guidance modality, vibrotactile biofeedback, visual biofeedback, Parkinson’s disease.
Highlights
Earlier versions of biofeedback systems for balance-related applications were intended primarily to provide “alarm” signals about body tilt rather than to guide rehabilitation exercise motion
Our key finding is that both groups had the smallest position error between the target and participant movements when performing weight-shifting balance exercises accompanied by simultaneous delivery of visual and vibrotactile biofeedback regardless of A/P and M/L directions; the increased range of limits of stability (LOS) in both directions occurred after the completion of 30 experimental trials
This study describes the effects of guidance modalities during dynamic weight-shifting exercises, which are commonly used in balance rehabilitation, in people with Parkinson’s disease (PD) and healthy elderly people
Summary
Earlier versions of biofeedback systems for balance-related applications were intended primarily to provide “alarm” signals about body tilt rather than to guide rehabilitation exercise motion. There have been few attempts to evaluate guidance modalities for balance rehabilitation exercises The purpose of this proof-of-concept study is to evaluate the effects of guidance modalities during common dynamic weight-shifting exercises used in clinical settings. Several studies have shown that physical and balance rehabilitation regimens can improve postural stability in people with PD for short (hours to days) and long (weeks to months) periods [13,14,15,16,17]. Smania et al [13] evaluated the effect of intensive balance training sessions on postural stability in 64 people with idiopathic PD during conventional balance training (e.g., dynamic weight-shifting balance exercise and destabilization of the body’s center of mass (COM)) under the supervision of a physical therapist. For these and other reasons, there is growing interest in assistive device design and development with sensory augmentation
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