Computer Assisted Rehabilitation Environment Research Articles

Might patients with cerebellar ataxia benefit from the Computer Assisted Rehabilitation ENvironment (CAREN)? A pilot study focusing on gait and balance.

Introduction: Ataxia is a neurological symptom that causes decreased balance, loss of coordination, and gait alterations. Innovative rehabilitation devices like virtual reality (VR) systems can provide task-oriented, repetitive and intensive training with multisensorial feedback, thus promoting neuroplastic processes. Among these VR technologies, the Computer Assisted Rehabilitation ENvironment (CAREN) associates a split belt treadmill on a 6-degrees of freedom platform with a 180° VR screen and a Vicon motion capture system to monitor patients' movements during training sessions. Methods: Eight patients affected by cerebellar ataxia were enrolled and received 20 sessions of CAREN training in addition to standard rehabilitation treatment. Each patient was evaluated at the beginning and at the end of the study with 3D gait analysis and clinical scales to assess balance, gait function and risk of falls. Results: We found improvements in kinematic, kinetic, and electromyographic parameters (as per pre-post- CAREN training), as well as in clinical outcomes, such as balance and risk of falls in ataxic patients. In addition, we found that trunk rotation improved, after CAREN intervention, approximating to the normative values. Discussion: Our results suggested that CAREN might be useful to improve specific biomechanical parameters of gait in ataxic patients.

Implementation in the Motek Caren system with virtual reality of an existing motor rehabilitation programme for people with Down’s syndrome in order to increase its effectiveness

IntroductionDown’s syndrome often requires specialized rehabilitation methods in order to effectively improve cognitive and motor functioning. The growing interest in technologies to support rehabilitation is opening up new and promising perspectives for improving the quality of life of people diagnosed with this syndrome. One of these technologies is the Computer Assisted Rehabilitation Environment (CAREN) system from Motek.ObjectivesThe aim of the planned research project is to explore the potential of using the CAREN system in the rehabilitation of people with Down’s syndrome.MethodsThe study included 10 participants with Down’s syndrome (men and women aged 18 to 50 years) without the presence of organic musculoskeletal disease or other somatic causes impairing motor performance. Before the training test, the participants were assessed by two psychological tests: 1) ACE III - Addenbrooke’s Cognitive Examination III Scale (ACE-III), which assesses attention and orientation, memory, verbal fluency, language and visuospatial functions and 2) the TONI 4 Non-Verbal Intelligence Test, which is a test used to measure general intelligence. The tests were carried out using the MOTEK CAREN device, which consists of a treadmill for motor training and a virtual reality screen on which different scenes are displayed for the participant to see during the test. Integrated motion capture technology was used to assess movement capabilities of the patients.. The screen displayed different types of applications in the form of virtual reality, in which the participant had to cope with various tasks accommodating different psychomotor skills, for example:crossing a virtual bridge, walking through a forest. The test took about 45 minutes per person. Two training sessions were conducted for each of the 10 patients with a one-month interval between them.ResultsThe Motek Caren System has proven to be a promising rehabilitation method for people with Down’s syndrome, compared to previous experience with different rehabilitation methods and existing research in the field.ConclusionsResults emphasize the necessity for further investigations and future research should involve more participants. The project has the potential to integrate modern technology with traditional forms of therapy to improve the quality of life and functioning of people affected by this syndrome.Disclosure of InterestNone Declared

Development of a multidimensional military readiness assessment.

There is a need to be able to accurately evaluate whether an injured service member is able to return to duty. An effective assessment would challenge and measures physical and cognitive performance in a military-relevant context. Current assessments are lacking in one or more of these aspects. The simulation and data capture abilities of virtual reality systems are promising for use as the basis of multidimensional assessments. The team has previously developed a military-specific assessment in the Computer Assisted Rehabilitation Environment (CAREN) called the Readiness Evaluation During simulated Dismounted Operations (REDOp). Due to notable limitations in the original assessment, we have developed the next iteration, REDOp2. The assessment is able to challenge and measure a broader range of physical and cognitive performance domains in a more streamlined fashion. While limited to facilities with a CAREN, REDOp2 has the potential to provide an effective tool for highly trained and experienced wounded service members that require thorough assessment prior to returning to duty to ensure the safety of the team and mission. This methods paper describes the specific limitations in REDOp, how they were addressed in REDOp2, and suggested next steps to prepare the assessment for implementation.

Machine Learning-Based Approach to Identifying Fall Risk in Seafarers Using Wearable Sensors

Falls on a ship cause severe injuries, and an accident falling off board, referred to as “man overboard” (MOB), can lead to death. Thus, it is crucial to accurately and timely detect the risk of falling. Wearable sensors, unlike camera and radar sensors, are affordable and easily accessible regardless of the weather conditions. This study aimed to identify the fall risk level (i.e., high and low risk) among individuals on board using wearable sensors. We collected walking data from accelerometers during the experiment by simulating the ship’s rolling motions using a computer-assisted rehabilitation environment (CAREN). With the best features selected by LASSO, eight machine learning (ML) models were implemented with a synthetic minority oversampling technique (SMOTE) and the best-tuned hyperparameters. In all ML models, the performance in classifying fall risk showed overall a good accuracy (0.7778 to 0.8519), sensitivity (0.7556 to 0.8667), specificity (0.7778 to 0.8889), and AUC (0.7673 to 0.9204). Logistic regression showed the best performance in terms of the AUC for both training (0.9483) and testing (0.9204). We anticipate that this study will effectively help identify the risk of falls on ships and aid in developing a monitoring system capable of averting falls and detecting MOB situations.

Coupling neurologic music therapy with immersive virtual reality to improve executive functions in individuals with Parkinson’s disease: A Quasi-Randomized Clinical Trial

IntroductionParkinson’s disease (PD) is one the most common neurodegenerative movement disorder, leading to motor and non-motor symptoms, including deficits in executive functions (EF), memory, visuospatial abilities, and psychomotor speed. Current treatments are primarily symptomatic, involving pharmacological, surgical strategies. Neurologic Music Therapy (NMT) has gained recognition for its effectiveness in neurorehabilitation of PD patients and improving motor and cognitive domains, such as EF. This study combines NMT with the virtual reality (VR) platform Computer-Assisted Rehabilitation Environment (CAREN), offering customizable environments for rhythmic cue practice to provide an innovative approach to Parkinson’s rehabilitation. MethodsIn our single-blind quasi-randomized controlled trial, forty patients were assigned to either an experimental group (EG = 20) or a control group (CG = 20). Both groups underwent two months of training with CAREN scenarios (three times a week for 24 sessions). The experimental group additionally received NMT applied to the selected scenarios. Participants were evaluated by a neuropsychologist at baseline and immediately after training. ResultsIntra-group analysis showed significant improvements in the EG for MOCA (p = 0.007), FAB (p = 0.008), Stroop Error (p = 0.003), Stroop Time (p < 0.001), and Visual Search (p < 0.001). The CG showed a significant difference only in Stroop Error (p = 0.02). ConclusionsThis pilot study is the first to combine NMT with CAREN in PD patients. Our findings suggest that NMT, within an immersive VR environment, effectively improves cognitive and EF in PD. Music structured within NMT techniques, coupled with advanced audio-visual feedback from VR, offers an innovative and potentially more effective approach for managing cognitive and executive deficits associated with PD.

Technology-based balance performance assessment can eliminate floor and ceiling effects

Many clinical measurement tools for balance have ceiling effects. Technology-based assessments using virtual reality systems such as the Computer-Assisted Rehabilitation Environment (CAREN) may provide a way to develop objective, quantitative measures that scale from low to high levels of difficulty. Our objective was to: (1) develop a performance assessment tool (PAT) for the CAREN; (2) quantify the reliability of the tool; (3) validate the scores against clinical balance measures; and (4) compare the scores from a population with balance impairments to those from able-bodied individuals in a cross-sectional validation study. Three games were developed on the CAREN and tested on 49 participants (36 able-bodied and 13 with impaired mobility). For each module, the corresponding measures were transformed into scores using a series of functions such that ceiling and flooring effects would be minimized. The results showed an association between scores and age, an overlap in scores from impaired high-performance individuals and able-bodied low performance individuals, and a correlation of PAT scores with other clinical tests. Several of the limitations of current clinical tools, including floor and ceiling effects, were overcome by the PAT, suggesting that the PAT can be used to monitor the effect of rehabilitation and training.

The use of the computer assisted rehabilitation environment in assessment and rehabilitation

Purpose. The purpose of this review article was to review and analyze the available literature regarding one of the most advanced virtual reality technologies. We reviewed and analyzed the use of the computer-assisted rehabilitation environment system in assessment and rehabilitation.&#x0D; Materials and methods. PubMed, Web of Science, Cochrane Library, Scopus, and Physiotherapy Evidence Database databases were searched from inception to October 2021. We used the search term “Computer Assisted Rehabilitation Environment” and included articles which directly or indirectly addressed the use of the computer assisted rehabilitation environment system in assessment, rehabilitation and on healthy people. We excluded articles not published in the English language, conference proceedings, reports of abstracts only, and duplicated articles. Also, articles addressing the use of other virtual reality technologies whether they used fully immersive, semi-immersive, or non-immersive interfaces or virtual reality devices such as the Wii or Xbox gaming technologies were also excluded. The relevant studies were collected and critically analyzed.&#x0D; Results. Our search retrieved 205 articles, with 119 duplicates identified and removed. Following screening 86 articles, we included 50 relevant articles which directly or indirectly addressed the computer-assisted rehabilitation environment system and were published in scientific journals. Twenty-two articles used the computer assisted rehabilitation environment for biomechanical analysis, 15 articles used the computer assisted rehabilitation environment for rehabilitation, 4 articles were reviews, and 9 articles addressed the computer assisted rehabilitation environment in other ways.&#x0D; Conclusion. The computer assisted rehabilitation environment system is a promising tool for assessment and rehabilitation. It can be used with different concepts to assist in diagnosis and treatment, can be used for healthy individuals and with patients, and basically follows biomechanical principles in operating. The high cost and complex infrastructure, however, may be the restriction to its use for research purposes and in clinical practice.

The effect of perturbation-based balance training on balance control and fear of falling in older adults: a single-blind randomised controlled trial

BackgroundPerturbation-based balance training (PBT) is an emerging intervention shown to improve balance recovery responses and reduce falls in everyday life in older adults. However, perturbation interventions were heterogeneous in nature and need improvement. This study aims to investigate the effects of a PBT protocol that was designed to address previously identified challenges of PBT, in addition to usual care, on balance control and fear of falling in older adults at increased risk of falling.MethodsCommunity-dwelling older adults (age ≥ 65 years) who visited the hospital outpatient clinic due to a fall incident were included. Participants received PBT in addition to usual care (referral to a physiotherapist) versus usual care alone. PBT consisted of three 30-minute sessions in three weeks. Unilateral treadmill belt accelerations and decelerations and platform perturbations (shifts and tilts) were applied during standing and walking on the Computer Assisted Rehabilitation Environment (CAREN, Motek Medical BV). This dual-belt treadmill embedded in a motion platform with 6 degrees of freedom is surrounded by a 180° screen on which virtual reality environments are projected. Duration and contents of the training were standardised, while training progression was individualised. Fear of falling (FES-I) and balance control (Mini-BESTest) were assessed at baseline and one week post-intervention. Primary analysis compared changes in outcome measures between groups using Mann-Whitney U tests.ResultsEighty-two participants were included (PBT group n = 39), with a median age of 73 years (IQR 8 years). Median Mini-BESTest scores did not clinically relevantly improve and were not significantly different between groups post-intervention (p = 0.87). FES-I scores did not change in either group.ConclusionsParticipation in a PBT program including multiple perturbation types and directions did not lead to different effects than usual care on clinical measures of balance control or fear of falling in community-dwelling older adults with a recent history of falls. More research is needed to explore how to modulate PBT training dose, and which clinical outcomes are most suitable to measure training effects on balance control.Trial registrationNederlands Trial Register NL7680. Registered 17-04-2019 – retrospectively registered. https://www.trialregister.nl/trial/7680.

EFFECTS OF TRIPS AND SLIPS ON AGONIST AND ANTAGONIST MUSCLE FORCES POST-PERTURBATION

Falls in adults are a major problem and can lead to injuries and death. In order to better understand falls and successful recoveries, identifying kinematics, kinetics, and muscle forces during recovery from loss of balance is crucial. To obtain reactive gait patterns, participants must be subjected to unexpected perturbations such as trips and slips. Previous researchers have reported kinetics recovery data following stumbling; however, the muscle force recovery patterns remain unknown. To better target exercises to reduce the risk of falls, we must first understand which muscles, their magnitude, and their coordination patterns, play a role in a successful recovery from a trip and a slip. Additionally, knowing the successful patterns of lower limb function can help with the diagnosis of faulty movements.A total of 20 healthy adults in their twenties with similar athletic backgrounds were perturbed on a split-belt treadmill using Computer-Assisted Rehabilitation Environment (Motkforce Link) at a preset speed of 1.1m/s. Two kinds of perturbations were administered: slip and trip. Slips were simulated by accelerating one belt, whereas trips were simulated by decelerating one belt. Both perturbations had similar intensity and only differed in the direction. Computational modeling was used to obtain lower-limb function during the compensatory step. SPM paired t-test was used to compare differences in recovery strategies between slip and trip through magnitude and patterns of joints.There were no significant differences in joint angles post tripping vs post-slipping. Results of net joint moments showed that compensating for the loss of balance due to tripping required a higher ankle plantarflexion moment than slipping (at 22-52%; 1.2± 0.3vs0.4±0.2, p&lt;0.001). Additionally, larger gluteus maximus (at 40-50%;8.7±3.8vs2.7±1.1N/kg, p=0.001), gluteus medius (at23~33%; 22.6±5.7vs6.8±3.6N/kg, p&lt;0.001) were generated than post-slipping, respectively.These findings suggested that greater GMAX and GMED forces are required post-trip recovery than slip. Future analysis of trip recovery showed the importance of ankle joint in recovering from forward and backward fall. These results can be used as references in remote diagnosis of joint and muscle weakness and assessment of the risk of falls with the use of accelerometers.

The effect of Computer Assisted Rehabilitation Environment (CAREN) in cognitive impairment and coping strategies in Parkinson's disease: a preliminary study

Parkinson’s disease is a neurodegenerative disorder characterized by different motor, vegetative, behavioral, and cognitive impairments, with worsening quality of life. Virtual reality devices have given promising results in neurorehabilitation as they can provide multisensory stimulation in a realistic environment. This study aims to test the efficacy of virtual reality training by using Computer Assisted Rehabilitation Environment in cognitive impairment in a sample of PD. 31 patients affected by PD were enrolled. All PD patients underwent 24 sessions of Computer Assisted Rehabilitation Environment training. The participants were assessed at baseline (T0) and after two months (T1). Our results suggested that Computer Assisted Rehabilitation Environment training may be effective in the cognitive and emotional domains, particularly by improving executive function, anxiety, and depressive symptoms. These changes have helped to improve self-efficacy and coping strategies. These results indicate greater cognitive and physical effort to overcome stressors. Our results show that Computer Assisted Rehabilitation Environment training was beneficial in improving cognitive functions. Longer duration training may be especially beneficial for patients with mild cognitive impairment. Our findings open the door to tailored personalized treatments based on the patient's motor and cognitive profiles.

Digital Intervention For The Management Of Alzheimer's Disease.

Alzheimer's disease (AD) is a progressive, multifactorial, chronic, neurodegenerative disease with high prevalence and limited therapeutic options, making it a global health crisis. Being the most common cause of dementia, AD erodes the cognitive, functional, and social abilities of the individual and causes escalating medical and psychosocial needs. As yet, this disorder has no cure and current treatment options are palliative in nature. There is an urgent need for novel therapy to address this pressing challenge. Digital therapeutics (Dtx) is one such novel therapy that is gaining popularity globally. Dtx provides evidence based therapeutic interventions driven by internet and software, employing tools such as mobile devices, computers, videogames, apps, sensors, virtual reality aiding in the prevention, management, and treatment of ailments like neurological abnormalities and chronic diseases. Dtx acts as a supportive tool for the optimization of patient care, individualized treatment and improved health outcomes. Dtx uses visual, sound and other non-invasive approaches for instance-consistent therapy, reminiscence therapy, computerised cognitive training, semantic and phonological assistance devices, wearables and computer-assisted rehabilitation environment to find applications in Alzheimer's disease for improving memory, cognition, functional abilities and managing motor symptom. A few of the Dtx-based tools employed in AD include "Memory Matters", "AlzSense", "Alzheimer Assistant", "smart robotic dog", "Immersive virtual reality (iVR)" and the most current gamma stimulation. The purpose of this review is to summarize the current trends in digital health in AD and explore the benefits, challenges, and impediments of using Dtx as an adjunctive therapy for the management of AD.

Prediction of Stability during Walking at Simulated Ship's Rolling Motion Using Accelerometers.

Due to a ship’s extreme motion, there is a risk of injuries and accidents as people may become unbalanced and be injured or fall from the ship. Thus, individuals must adjust their movements when walking in an unstable environment to avoid falling or losing balance. A person’s ability to control their center of mass (COM) during lateral motion is critical to maintaining balance when walking. Dynamic balancing is also crucial to maintain stability while walking. The margin of stability (MOS) is used to define this dynamic balancing. This study aimed to develop a model for predicting balance control and stability in walking on ships by estimating the peak COM excursion and MOS variability using accelerometers. We recruited 30 healthy individuals for this study. During the experiment, participants walked for two minutes at self-selected speeds, and we used a computer-assisted rehabilitation environment (CAREN) system to simulate the roll motion. The proposed prediction models in this study successfully predicted the peak COM excursion and MOS variability. This study may be used to protect and save seafarers or passengers by assessing the risk of balance loss.

Real-time feedback control of split-belt ratio to induce targeted step length asymmetry

IntroductionSplit-belt treadmill training has been used to assist with gait rehabilitation following stroke. This method modifies a patient’s step length asymmetry by adjusting left and right tread speeds individually during training. However, current split-belt training approaches pay little attention to the individuality of patients by applying set tread speed ratios (e.g., 2:1 or 3:1). This generalization results in unpredictable step length adjustments between the legs. To customize the training, this study explores the capabilities of a live feedback system that modulates split-belt tread speeds based on real-time step length asymmetry.Materials and methodsFourteen healthy individuals participated in two 1.5-h gait training sessions scheduled 1 week apart. They were asked to walk on the Computer Assisted Rehabilitation Environment (CAREN) split-belt treadmill system with a boot on one foot to impose asymmetrical gait patterns. Each training session consisted of a 3-min baseline, 10-min baseline with boot, 10-min feedback with boot (6% asymmetry exaggeration in the first session and personalized in the second), 5-min post feedback with boot, and 3-min post feedback without boot. A proportional-integral (PI) controller was used to maintain a specified step-length asymmetry by changing the tread speed ratios during the 10-min feedback period. After the first session, a linear model between baseline asymmetry exaggeration and post-intervention asymmetry improvement was utilized to develop a relationship between target exaggeration and target post-intervention asymmetry. In the second session, this model predicted a necessary target asymmetry exaggeration to replace the original 6%. This prediction was intended to result in a highly symmetric post-intervention step length.Results and discussionEleven out of 14 participants (78.6%) developed a successful relationship between asymmetry exaggeration and decreased asymmetry in the post-intervention period of the first session. Seven out of the 11 participants (63.6%) in this successful correlation group had second session post-intervention asymmetries of < 3.5%.ConclusionsThe use of a PI controller to modulate split-belt tread speeds demonstrated itself to be a viable method for individualizing split-belt treadmill training.

Multiview Video-Based 3-D Pose Estimation of Patients in Computer-Assisted Rehabilitation Environment (CAREN)

The computer-assisted rehabilitation environment (CAREN) system plays an important role in the training of rehabilitation patients, where the capture of the patient's 3-D pose and gait is critical for assessing the patient's requirements for effective training. Vision-based methods are highly effective for this task due to their low cost, high speed, and noninterference. Although various general vision-based pose estimation methods were developed recently, their performance is limited in the CAREN system due to the specific environment. To address these problems, we propose an improved framework for accurate 2-D and 3-D pose estimation for the CAREN system through using multiview videos. First, for 2-D pose estimation, we propose a coarse-to-fine heatmap shrinking (CFHS) strategy that gradually reduces the kernel size of the heatmap of joints during training to improve the performance. Second, to further obtain 3-D pose estimations, we propose a novel spatial-temporal perception network that fuses the 2-D results from multiple views and multiple moments; multiview early fusion uses complementary spatial information from different views, and multimoment late fusion leverages temporal information from the sequential input for higher accuracy. The experimental results, based on CAREN videos of 225 orthopedic patients, showed that the accuracy of 2-D human pose estimations with the CFHS training strategy reached 99.85% PCKh@0.5. For 3-D results, the mean per joint position error was 25.22 mm, and the 3DPCK reached 98.71%, which outperformed existing general video-based methods. The results showed that the proposed system is capable of estimating human poses with high accuracy for clinical applications.

The Effects of Ship’s Roll Motion on the Center of Mass and Margin of Stability During Walking: A Simulation Study

Walking strategies in an unstable environment like a ship differ from walking on stable ground. Extreme ship motions may endanger the safety of the crews. Notably, a loss of balance on board can lead to an injury or an accident of falling off a ship. Keeping one’s balance on board a ship is strongly influenced by the ship’s motion. Therefore, the objective of this study is to determine how walking on a ship differs from walking in a stable environment and explore the effects of the ship’s roll motion on balance control and stability while walking in sea environments. We hypothesized that step time variability, center of mass (COM), and margin of stability (MOS) would significantly differ between stable and unstable walking conditions. We also hypothesized that there would be an effect of rolling cycles and angles on increasing step time variability, COM excursion, and MOS variability. We recruited 30 healthy individuals between 21 and 39 years old for this study. Participants walked for two minutes at their self-selected speeds during the study with and without rolling on a computer-assisted rehabilitation environment (CAREN) system. The CAREN system was used to simulate the parametric roll motion of ships up to 20 degrees. This study quantified step time variability, peak COM excursion, and MOS variability in different rolling conditions. We found a significant difference in step time variability (p < 0.001), lateral peak COM excursion (p < 0.001), and MOS variability (p < 0.001) between waking on land and walking at sea.

Effects of arm swing amplitude and lower limb asymmetry on motor variability patterns during treadmill gait

Motor variability is a fundamental feature of gait. Altered arm swing and lower limb asymmetry (LLA) may be contributing factors having been shown to affect the magnitude and dynamics of variability in spatiotemporal and trunk motion. However, the effects on lower limb joints remain unclear.Full-body kinematics of 15 healthy young adults were recorded during treadmill walking using the Computer-Assisted Rehabilitation Environment system. Participants completed six trials, combining three arm swing (AS) amplitude (normal, active, held) and two LLA (symmetrical, asymmetrical) conditions. The mean standard deviation (meanSD), maximum Lyapunov exponent (λmax), detrended fluctuation analysis scaling exponent of range of motion (DFAα), and sample entropy (SaEn) were computed for tridimensional trunk, pelvis, and lower limb joint angles, and compared using repeated-measures ANOVAs.Relative to normal AS, active AS increased meanSD of all joint angles, λmax of frontal plane hip and ankle angles, and SaEn of sagittal plane ankle angles. Active AS, however, did not affect λmax or SaEn of trunk or pelvis angles. LLA increased meanSD of sagittal plane joint angles, λmax of Euclidean norm trunk angle and of lower limb joint angles, and SaEn of ankle dorsiflexion/ plantarflexion, but decreased SaEn of tridimensional trunk angles and hip rotation in the slower moving leg.Alterations in lower limb variability with active AS and LLA suggest that young adults actively exploit their lower limb redundancies to maintain gait. This appears to preserve trunk stability and regularity during active AS but not during LLA.

Overground and Virtual Reality Gait Speed Are Associated With Atypical Symptom Reporting in Active Duty Service Members With a History of Mild to Moderate Traumatic Brain Injury.

Physical therapy following traumatic brain injury (TBI) can be negatively impacted by psychological symptoms, atypical symptom reporting, and response bias. We examined rates of Symptom Validity Test (SVT) failure in active duty military service members with a history of mild-moderate TBI and its impact on gait speed. Intensive Outpatient Program at the National Intrepid Center of Excellence at Walter Reed National Military Medical Center. Participants were 84 active duty service members with a history of mild-moderate TBI classified as SVT pass ( n = 49) or SVT fail ( n = 35). Retrospective study. Overground preferred and fast walking speed as well as Computer Assisted Rehabilitation Environment (CAREN) gait speed were recorded. Participants completed the Neurobehavioral Symptom Inventory and the Validity-10 was used to assign patients into the SVT pass and SVT fail groups. Gait speed metrics were compared across these groups and test operating characteristics were calculated. Approximately 42% of the sample was classified into the SVT fail group. All 3 gait speed measures were significantly slower in the SVT fail group than in the SVT pass group ( P s < .001, d s = 0.60-0.80). Gait speed cutoffs for screeners or indicators of atypical reporting were identified. The potential for response bias is a critical area for the clinician to consider when conducting physical therapy evaluations. Participants in the SVT fail group had slower walking speed on all 3 measures assessed. Several useful cutoffs were identified to serve as screeners or indicators of SVT failure, though these preliminary findings have limitations and need to be replicated.

Adaptations in muscle architecture complement the gastrocnemius operating ranges during gait in children who idiopathically toe-walk

Kinetic data acquired from force plates embedded in moving platforms naturally contain artifacts due to platform acceleration, called force plate inertial components. While they can be estimated and removed from the measured signals, the system's inertial properties need to be known. Our objective was to: (1) develop a method for estimating the inertial properties and force plate inertial components for any instrumented platform; (2) estimate the inertial properties specifically for the Computer-Assisted Rehabilitation Environment (CAREN); and (3) validate the estimates with new experimental data. Unloaded ramp-and-hold perturbations (for estimation) and unloaded random perturbations (for validation) were executed to obtain the force, moment, and motion of the CAREN platform. Inertial properties were estimated by minimizing the error between the measured and computed inertial forces and moments. Obtained estimates were validated by calculating the coefficient of determination (R2) between the measured and computed forces or moments when keeping the inertial properties fixed. The estimates of the CAREN's inertial properties exhibited low variability across trials, and R2 for the validation trials was 0.90 ± 0.08 (mean ± standard deviation). The developed method can be used for removing inertial components from force plate signals, yielding reliable estimates of ground reactions in dynamic biomechanical research and clinical assessments.

Assessment of Computer Assisted Rehabilitation Environment (CAREN) System Use and Mood in Patients With Multiple Sclerosis.

Depression is a common comorbidity in patients with multiple sclerosis (MS) and is associated with decreased quality of life. Identifying treatments that aid psychological and physical rehabilitation in patients with MS provides valuable information for interdisciplinary teams. Seventy-five adults with MS who completed the Patient Health Questionnaire-9 (PHQ-9) and Patient-Reported Outcomes Measurement Information System (PROMIS) Global Health scale during routine physical therapy appointments where the (CAREN) system was used were studied. Data were retrospective and collected via patient-reported outcomes. Group comparisons used 2-sample t tests or Mann-Whitney U tests for continuous variables and Fisher exact tests for categorical variables. To examine self-reported depression, mean ± SD baseline scores were computed and stratified by number of CAREN sessions. Patients with 5 or more sessions seemed to have lower baseline PHQ-9 and PROMIS Mental Health scores; however, no significant differences were found at the univariate level. There were no statistically significant differences in follow-up scores for the outcome measures. Current research evaluating the rehabilitation of patients with MS using the CAREN system is scarce. This pilot study is important to inform prospective studies exploring use of the CAREN system for psychological rehabilitation. Patients with 5 or more CAREN sessions had lower baseline PHQ-9 scores, which may suggest that mood plays a role in the selection of patients for CAREN system use. This study shows that mood is not affected by the CAREN system. More specific research needs to be completed with a more robust sample.

Examining the Relationship Between Conventional Outcomes and Immersive Balance Task Performance in Service Members With Mild Traumatic Brain Injury.

Mild traumatic brain injury (mTBI) is associated with significant financial cost and reduced military readiness and impacts quality of life for active duty service members (SMs). Post-concussive symptoms can include vestibular impairments, such as chronic dizziness and postural instability, which can be compounded by psychological comorbidities like PTSD. Comprehensive vestibular evaluations are required to assess symptoms and guide clinical decision-making. At the National Intrepid Center of Excellence (NICoE), in addition to traditional vestibular assessments, clinicians can also leverage virtual environments (VEs) in the Computer-Assisted Rehabilitation Environment (CAREN) to further evaluate balance. The objective of this study was to examine the relationship between conventional outcomes and VE performance on immersive balance tasks in the CAREN, determine whether VE performance could predict conventional outcomes, and explore the impact of PTSD. This retrospective analysis included 112 SMs from the NICoE Intensive Outpatient Program who provided informed consent for their clinical data to be used for research purposes. All had a history of mTBI, underwent vestibular evaluations, and completed immersive balance tasks on the CAREN. Conventional outcomes included the Sensory Organization Test (SOT), Functional Gait Assessment (FGA), Activities Balance Confidence (ABC) Scale, and Dizziness Handicap Inventory (DHI). The PTSD Checklist-Military Version was added to account for behavioral symptoms. Computer-Assisted Rehabilitation Environment outcomes included total time to complete the Balance Cubes VE, with the platform static (BC-Static) and with random platform motion (BC-PM) as well as composite scores for the Shark Hunt VE, with (SH-Recall) and without a recall task (SH-Standard). Statistical analyses included independent t-tests to determine group differences, Pearson's correlations to examine relationships between conventional outcomes and VE performance, and binary logistic regressions to determine if VE performance predicted conventional outcomes based on clinically relevant cutoffs. SMs who took less time to complete BC-Static had better overall balance, indicated by higher ABC, SOT, and FGA scores (P <.001). Those with greater self-reported dizziness, higher DHI scores, took longer to complete BC-Static (P < .05). FGA and SOT, objective gait and balance, were similarly correlated to BC-PM performance (P <.001). SMs with higher SOT scores, better balance, also tended to have higher SH-Standard scores (P <.1). SMs, who were above normative SOT, FGA, and ABC cutoffs, completed BC-Static significantly faster than those below (P <.05). This remained true for BC-PM but was only significant for SOT (P = .004). Performance on BC-Static, BC-PM, and SH-Standard was significant predictors of SOT score. For SMs with comorbid mTBI and PTSD, increased functional disability was observed in conventional outcomes and diminished VE performance was noted. Objective balance and gait, SOT and FGA, demonstrated the strongest relationships to immersive VE performance in the CAREN. Our findings suggest that these immersive balance tasks may be effective as an adjunct assessment to examine balance. Future work will focus on moving these VEs from the CAREN to a portable system, which could be more readily utilized in a variety of clinical settings, increasing accessibility.