Balance Rehabilitation Training Research Articles

Emotional Models for the Estimation of Arousal and Pleasure in Older Adults During Balance Rehabilitation Training.

Emotional computing has been previously applied to assess physiological behavior in a wide variety of tasks and activities. This study extends for the first time the use of emotional computing in the field of balance rehabilitation training. A proof-of-concept study was conducted to assess arousal and pleasure response to a range of physical exercises from the OTAGO and HOLOBALANCE balance rehabilitation programs with varying levels of difficulty and physical demand. Eleven participants were enrolled and performed a set of exercises wearing an ECG sensor, reporting arousal and pleasure at the end of each session. A dataset of 264 unique sessions was collected and used to extract heart rate variability (HRV) features from the measured RR intervals and automatically assess user arousal and pleasure, evaluating different classification algorithms. The results suggested that assessment of both emotions is feasible, reaching an accuracy of 72% and 74% for arousal and pleasure estimation, resnectively. Clinical Relevance- Arousal and pleasure are clinically useful indicators of patient's experience and engagement while performing balance rehabilitation exercises with novel sensing technologies and monitoring platforms.

Prognosis of traumatic spinal cord injury in children: Follow-up of 86 patients

PurposeThe long-term situation of children with spinal cord injury (SCI) was investigated, and suggestions for helping them better return to the society were provided. MethodsSCI patients less than 18 years old hospitalized in Beijing Boai Hospital from January 2011 to December 2020 were retrospectively analyzed. Information including motor function, complications, characteristic changes, self-care abilities, school attendance and social participation were collected by telephone interview and electronic questionnaire. All the answers were statistically analyzed. ResultsA total of 86 cases were enrolled, 77 girls and 9 boys, with a median injury age of 6 years and 2 months. The follow-up time was 3–130 months. The main cause of trauma in these children was sport injury (66.3%), the thoracic spinal cord was involved the most (91.9%), and complete SCIs accounted for the majority (76.7%). In terms of complications, children with complete SCIs were more likely to have urinary incontinence, constipation and characteristic changes (p < 0.05); whereas the incomplete SCIs often have spasticity (p < 0.05). As to the daily living abilities, children with incomplete lumbar SCIs were more capable to accomplish personal hygiene, transfer, and bathing independently than those with complete injuries, or cervical/thoracic SCIs, respectively (p < 0.05). Moreover, children older than 9 years care more able to dress and transfer independently than the youngers (p < 0.05). Wheelchair users accounted for 84.9% and more than half of them were able to propel wheelchair independently, and those who move passively in wheelchairs were mostly introverted kids (p < 0.05). Almost all (93.8%) children with incomplete injuries were able to walk independently. Most (79.1%) children continued to attending school, and 41.9% participated in interest classes. Unfortunately, 67.4% of the children spent less time playing with their peers than before the injury. ConclusionSCIs impair physical structures and function of children, affect their independence in daily living, and restrict school attendance and social interaction. Comprehensive rehabilitation after injury is a systematic work. Medical staff and caregivers should not only pay attention to neurological function, but also help them improve self-care abilities. It is also important to balance rehabilitation training and school work and social participation.

Analysis of Physiological Signals of Individuals with Eyes Closed Subjected to Unexpected Direction-Specific Stimuli Causing Instability

Research regarding the cerebral cortex and muscle activity patterns of the body used for postural balance control when sudden instability stimuli occur is lacking. This study analyzed individuals' physiological signals when direction-specific instability stimuli were applied while their eyes were closed. Healthy adults in their 20s maintained their postural balance while looking at the center of gravity provided by a monitor with a three-dimensional dynamic postural balance training system. We performed electroencephalography (EEG) and measured trunk and lower extremity muscle activity of participants with their eyes closed when subjected to four direction-specific instability stimuli (anterior, posterior, left, and right). EEG results showed that gamma waves increased significantly with an unbalanced stimulus when the participant's eyes were open and closed. The increased gamma wave rate with eyes closed was low in the exercise planning area, where information is relatively integrated and exercise is planned without visual information. EMG results showed fewer gamma waves on EEG due to the low focus on postural control because participants could not observe the center of gravity, which is the basis for balance. The trunk and lower extremity muscles tended to be used more due to the larger body perturbation angle. These outcomes can be used as basic data regarding how the human brain and muscles maintain postural balance when an unexpected external instability stimulus occurs. Quantitative postural balance rehabilitation training protocols for the elderly and those with disabilities can be created based on these outcomes.

RETRACTED ARTICLE: Test and simulation of health balance training equipment based on medical multimedia image for exercise balance ability

The lack of balance ability and lumbar muscle strain caused by asymmetric lower limb function have become the studied hot topics of many kinematics disciplines recently. The strength asymmetry of lower limbs of young tennis players is considered to be an intrinsic risk factor for lumbar muscle injury. Therefore, using dynamic balance instrument to scientifically evaluate the balance ability of tennis players’ lower limbs and evaluate the balance rehabilitation training method is of great significance to the recovery effect of tennis players with lumbar muscle strain and to improve their sports performance. At present, the balanced rehabilitation training method used in clinical practice is mainly based on medical multimedia images, relying on the doctor’s artificial rehabilitation treatment mode. Due to lack of manpower and lack of experience, doctors may need some rehabilitation equipment to assist the patient. This paper mainly focuses on the mechanical body design of the dynamic balance instrument. After analyzing the medical image of the patient’s diseased part, it completes a set of motion balance table with 2 degrees of freedom. Through the simulation and actual test, it detects the help of the balance table to the rehabilitation of human exercise balance ability effect. Finally, the rehabilitation test was performed on the tennis players with lumbar muscle strain, and the effect was good. It is a training equipment with high application value.

Effects of Tai Chi Yunshou exercise on community-based stroke patients: a cluster randomized controlled trial

BackgroudTai Chi Chuan was used for stroke survivors with balance impairments. However, even a short-form of Tai Chi Chuan includes forms that make the exercise challenging for the stroke survivors. Tai Chi Yunshou (wave hands in the cloud) is the “mother” form and the fundamental form of all Tai Chi Chuan styles, which is considered more suitable and feasible for stroke survivors with balance impairments. So this study was designed to evaluate the effects of Tai Chi Yunshou exercise on community-based stroke patients with balance dysfunctions.MethodsA total of 250 participants from 10 community health centers (5 per arm) were selected and randomly allocated into Tai Chi Yunshou exercise group (TC group) or a balance rehabilitation training group (control group) in an equal ratio. Participants in the TC group were received Tai Chi Yunshou exercise training five times per week for 12 weeks and those in control group were received balance rehabilitation training five times per week for 12 weeks. Outcome assessments including Berg Balance Scale (BBS), Time up to go test (TUGT), Modified Barthel Index (MBI) were measured at baseline, 4 weeks, 8 weeks, 12 weeks and followed-up 6 weeks (18 weeks), 12 weeks (24 weeks). Intention-to-treat analysis was performed. Analysis of variance of repeated measures was used to assess between-group differences.ResultsA total of 244 participants, 120 in the TC group and 124 in the rehabilitation group, were included in final analysis. There was no siginificant difference in Tai Chi Yunshou and balance rehabilitation training on the improvement of balance ability and mobility (P = 0.531 and P = 0.839, respectively) after adjustment for baseline. However, there was significant difference between two groups on improvement of motor funtion (P = 0.022), fear of falling (P < 0.001) and depression (P = 0.035) for the post stroke patients. No adverse events were reported during the study.ConclusionTai Chi Yunshou and balance rehabilitation training led to improved balance ability and functional mobility, and both are suitable community-based programs that may benefit for stroke recovery and community reintegration. Our data demonstrated that a 12-week Tai Chi Yunshou intervention was more effective in motor function, fear of falling and depression than balance rehabilitation training. Future studies examining the effectiveness of Tai Chi Yunahou as a balance ability improvement strategy for community-dwelling survivors of stroke are recommended.Trial registrationChinese Clinical Trail Registry: ChiCRT-TRC-13003641. Registration date: 22 August, 2013.

Structural analysis of a rehabilitative training system based on a ceiling rail for safety of hemiplegia patients.

The body-weight support (BWS) function, which helps to decrease load stresses on a user, is an effective tool for gait and balance rehabilitation training for elderly people with weakened lower-extremity muscular strength, hemiplegic patients, etc. This study conducts structural analysis to secure user safety in order to develop a rail-type gait and balance rehabilitation training system (RRTS). The RRTS comprises a rail, trolley, and brain-machine interface. The rail (platform) is connected to the ceiling structure, bearing the loads of the RRTS and of the user and allowing locomobility. The trolley consists of a smart drive unit (SDU) that assists the user with forward and backward mobility and a body-weight support (BWS) unit that helps the user to control his/her body-weight load, depending on the severity of his/her hemiplegia. The brain-machine interface estimates and measures on a real-time basis the body-weight (load) of the user and the intended direction of his/her movement. Considering the weight of the system and the user, the mechanical safety performance of the system frame under an applied 250-kg static load is verified through structural analysis using ABAQUS (6.14-3) software. The maximum stresses applied on the rail and trolley under the given gravity load of 250 kg, respectively, are 18.52 MPa and 48.44 MPa. The respective safety factors are computed to be 7.83 and 5.26, confirming the RRTS’s mechanical safety. An RRTS with verified structural safety could be utilized for gait movement and balance rehabilitation and training for patients with hemiplegia.

The Effects of Coding Schemes on Vibrotactile Biofeedback for Dynamic Balance Training in Parkinson's Disease and Healthy Elderly Individuals.

Coding scheme for earlier versions of vibrotactile biofeedback systems for balance-related applications was primarily binary in nature, either on or off at a given threshold (range of postural tilt), making it unable to convey information about error magnitude. The purpose of this paper was to explore the effects of two coding schemes (binary versus continuous) for vibrotactile biofeedback during dynamic weight-shifting exercises that are common physical therapists' recommended balance exercises used in clinical settings. Nine individuals with idiopathic Parkinson's disease and nine healthy elderly individuals participated in this paper. All participants performed dynamic weight-shifting exercises assisted with either the binary or continuous vibrotactile biofeedback delivered using with vibrating actuators (tactors) in either the anterior-posterior or medial-lateral direction. Participants' limits of stability at pre and post exercises were compared to evaluate the effects of the exercises on their range of motion. The continuous coding scheme produced significantly better performance than the binary scheme when both groups were performing dynamic weight-shifting balance exercises with assistive vibrotactile biofeedback. The results have implications in terms of maximizing the effects of error-driven motor learning and increasing performance on balance rehabilitation training combined with vibrotactile biofeedback.

균형 재활 훈련을 위한 특정 회전 움직임에서 피검자 동작 분석을 위한 깊이 센서 기반 키넥트 시스템의 정확성 및 부정확성 평가

Abstract: The balance ability significantly decreased in the elderly because of deterioration of the neural muscu-lature regulatory mechanisms. Several studies have investigated methods of improving balance ability using real-timesystems, but it is limited by the expensive test equipment and specialized resources. Recently, Kinect system basedon depth data has been applied to address these limitations. Little information about accuracy/inaccuracy of Kinectsystem is, however, available, particular in motion analysis for evaluation of effectiveness in rehabilitation training.Therefore, the aim of the current study was to evaluate accuracy/inaccuracy of Kinect system in specific rotationalmovement for balance rehabilitation training. Six healthy male adults with no musculoskeletal disorder were selectedto participate in the experiment. Movements of the participants were induced by controlling the base plane of thebalance training equipment in directions of AP (anterior-posterior), ML (medial-lateral), right and left diagonal direc-tion. The dynamic motions of the subjects were measured using two Kinect depth sensor systems and a three-dimen-sional motion capture system with eight infrared cameras for comparative evaluation. The results of the error ratefor hip and knee joint alteration of Kinect system comparison with infrared camera based motion capture systemoccurred smaller values in the ML direction (Hip joint: 10.9~57.3%, Knee joint: 26.0~74.8%). Therefore, the accu-racy of Kinect system for measuring balance rehabilitation traning could improve by using adapted algorithm whichis based on hip joint movement in medial-lateral direction.Key words: Balance Ability, Balance Training, Motion Capture System, Kinect System, Base Plane

Optimized balance rehabilitation training strategy for the elderly through an evaluation of balance characteristics in response to dynamic motions.

Balance is important in daily activities and essential for maintaining an independent lifestyle in the elderly. Recent studies have shown that balance rehabilitation training can improve the balance ability of the elderly, and diverse balance rehabilitation training equipment has been developed. However, there has been little research into optimized strategies for balance rehabilitation training. To provide an optimized strategy, we analyzed the balance characteristics of participants in response to the rotation of a base plate on multiple axes. Seven male adults with no musculoskeletal or nervous system-related diseases (age: 25.5±1.7 years; height: 173.9±6.4 cm; body mass: 71.3±6.5 kg; body mass index: 23.6±2.4 kg/m2) were selected to investigate the balance rehabilitation training using customized rehabilitation equipment. Rotation of the base plate of the equipment was controlled to induce dynamic rotation of participants in the anterior–posterior, right-diagonal, medial–lateral, and left-diagonal directions. We used a three-dimensional motion capture system employing infrared cameras and the Pedar Flexible Insoles System to characterize the major lower-extremity joint angles, center of body mass, and center of pressure. We found statistically significant differences between the changes in joint angles in the lower extremities in response to dynamic rotation of the participants (P<0.05). The maximum was greater with anterior–posterior and medial–lateral dynamic rotation than with that in other directions (P<0.05). However, there were no statistically significant differences in the frequency of center of body mass deviations from the base of support (P>0.05). These results indicate that optimizing rotation control of the base plate of balance rehabilitation training equipment to induce anterior–posterior and medial–lateral dynamic rotation preferentially can lead to effective balance training. Additional tests with varied speeds and ranges of angles of base plate rotation are expected to be useful as well as an analysis of the balance characteristics considering a balance index that reflects the muscle activity and cooperative characteristics.

Characteristics of center of body mass trajectory and lower extremity joint motion responded by dynamic motions of balance training system

Purpose To provide an optimized strategy for balance rehabilitation training, we identified the change of joint angles in lower-extremity and trajectory of center of body mass (COM) in response to rotation of base plate of balance training equipment.

Evaluation of Tai Chi Yunshou exercises on community-based stroke patients with balance dysfunction: a study protocol of a cluster randomized controlled trial.

BackgroundBalance dysfunction after stroke limits patients’ general function and participation in daily life. Previous researches have suggested that Tai Chi exercise could offer a positive improvement in older individuals’ balance function and reduce the risk of falls. But convincing evidence for the effectiveness of enhancing balance function after stroke with Tai Chi exercise is still inadequate. Considering the difficulties for stroke patients to complete the whole exercise, the current trial evaluates the benefit of Tai Chi Yunshou exercise for patients with balance dysfunction after stroke through a cluster randomization, parallel-controlled design.Methods/DesignA single-blind, cluster-randomized, parallel-controlled trial will be conducted. A total of 10 community health centers (5 per arm) will be selected and randomly allocated into Tai Chi Yunshou exercise group or balance rehabilitation training group. Each community health centers will be asked to enroll 25 eligible patients into the trial. 60 minutes per each session, 1 session per day, 5 times per week and the total training round is 12 weeks. Primary and secondary outcomes will be measured at baseline and 4-weeks, 8-weeks, 12-weeks, 6-week follow-up, 12-week follow-up after randomization. Safety and economic evaluation will also be assessed.DiscussionThis protocol aims to evaluate the effectiveness of Tai Chi Yunshou exercise for the balance function of patients after stroke. If the outcome is positive, this project will provide an appropriate and economic balance rehabilitation technology for community-based stroke patients.Trial registrationChinese Clinical Trial Registry: ChiCTR-TRC-13003641. Registration date: 22 August, 2013 http://www.chictr.org/usercenter/project/listbycreater.aspx.

Dynamic Control of Gait and Posture Training on Robot

In the research, a robot with gait and posture training functions is developed as an interactive balance rehabilitation training system for balance control impaired people to use. The system uses an action control tool with braking and monitoring functions to obtain the dynamic posture and gravity position of the body of the trainee, followed by subsequent process with software which is developed and designed completely to generate related feedback instructions for the trainee. Moreover, the instructions are presented in image, audio and tactile feedback manners, such that the trainee is provided with multiple message instructions to perform training activities according to the action request actually. Clinically, the research may provide training contents oriented according to task need. Compared to the decomposed action approach emphasized in conventional rehabilitation, it does allow the trainee to focus on the activity and obtains more significant effect. Furthermore, the goal of falling prevention function is also achievable after trained by the robot with gait and posture training functions developed in the research.

시각차단 균형훈련이 뇌졸중 환자의 보행기능에 미치는 영향

PURPOSE: The purpose of this study was to investigate the effect of balance rehabilitation training with the visual cue deprivation on gait function in stroke patients in comparison with balance training without the visual cue deprivation. METHODS: Twenty two stroke patients participated in this study. Patients were randomly assigned to one of the two balance training program with and without the visual cue deprivation. Balance training session for each group lasted 50 minutes, 3 times a week for a total of 6 weeks. Gait function was measured with the Functional Gait Assessment (FGA), the self-selective comfortable gait speed (CGS), the maximal gait speed (MGS), and the Gait Analysis System. Temporal and spatial gait parameters of each evaluation were measured before and after the balance training program respectively. RESULTS: After the program, the visual cue deprivation group improved significantly in the FGA, the CGS, the gait velocity, the step time, the step length, the stride length, and the Functional Ambulation Performance (FAP) in comparison with the balance training group with the visual cue (p<.05). CONCLUSION: The gait function of the participants with the visual cue deprivation showed more improvement after the balance training program compared to the patients group without the visual cue deprivation, Therefore, the balance training program with the visual cue deprivation may be useful for rehabilitation of patients with chronic stroke.

Cell phone based balance trainer

BackgroundIn their current laboratory-based form, existing vibrotactile sensory augmentation technologies that provide cues of body motion are impractical for home-based rehabilitation use due to their size, weight, complexity, calibration procedures, cost, and fragility.MethodsWe have designed and developed a cell phone based vibrotactile feedback system for potential use in balance rehabilitation training in clinical and home environments. It comprises an iPhone with an embedded tri-axial linear accelerometer, custom software to estimate body tilt, a "tactor bud" accessory that plugs into the headphone jack to provide vibrotactile cues of body tilt, and a battery. Five young healthy subjects (24 ± 2.8 yrs, 3 females and 2 males) and four subjects with vestibular deficits (42.25 ± 13.5 yrs, 2 females and 2 males) participated in a proof-of-concept study to evaluate the effectiveness of the system. Healthy subjects used the system with eyes closed during Romberg, semi-tandem Romberg, and tandem Romberg stances. Subjects with vestibular deficits used the system with both eyes-open and eyes-closed conditions during semi-tandem Romberg stance. Vibrotactile feedback was provided when the subject exceeded either an anterior-posterior (A/P) or a medial-lateral (M/L) body tilt threshold. Subjects were instructed to move away from the vibration.ResultsThe system was capable of providing real-time vibrotactile cues that informed corrective postural responses. When feedback was available, both healthy subjects and those with vestibular deficits significantly reduced their A/P or M/L RMS sway (depending on the direction of feedback), had significantly smaller elliptical area fits to their sway trajectory, spent a significantly greater mean percentage time within the no feedback zone, and showed a significantly greater A/P or M/L mean power frequency.ConclusionThe results suggest that the real-time feedback provided by this system can be used to reduce body sway. Its advantages over more complex laboratory-based and commercial balance training systems in terms of cost, size, weight, functionality, flexibility, and accessibility make it a good candidate for further home-based balance training evaluation.