Visual Biofeedback Research Articles

Enhancing speech adaptation to a palatal perturbation using ultrasound visual biofeedback

Prior clinical studies suggest that visual biofeedback of the tongue (e.g., ultrasound) may enhance the treatment of speech disorders, but outcomes have been mixed, likely due to variability in both the clinical profiles of participants and the way in which treatments have been carried out. Understanding the true potential of this clinical tool requires a clearer sense of how visual biofeedback interacts with speech motor control. Here, we present a novel experimental approach that mimics the conditions of clinical treatment for speech disorders while maintaining a high level of consistency and control over the speech-learning task. The procedure involves altering the vocal tract of typically developing talkers using a palatal prosthesis to perturb /s/-production in combination with the controlled application of ultrasound biofeedback. As participants practice and improve their speech, changes in articulatory movements are examined using acoustic and kinematic measures. The present study compared a control group (n = 10) receiving only auditory feedback during speech practice with a group receiving visual biofeedback (n = 10). Results indicate an effect of biofeedback, in particular in the retention of learned motor patterns, indicating that talkers integrate real-time visual feedback of tongue movement into the sensorimotor processes driving speech adaptation.Prior clinical studies suggest that visual biofeedback of the tongue (e.g., ultrasound) may enhance the treatment of speech disorders, but outcomes have been mixed, likely due to variability in both the clinical profiles of participants and the way in which treatments have been carried out. Understanding the true potential of this clinical tool requires a clearer sense of how visual biofeedback interacts with speech motor control. Here, we present a novel experimental approach that mimics the conditions of clinical treatment for speech disorders while maintaining a high level of consistency and control over the speech-learning task. The procedure involves altering the vocal tract of typically developing talkers using a palatal prosthesis to perturb /s/-production in combination with the controlled application of ultrasound biofeedback. As participants practice and improve their speech, changes in articulatory movements are examined using acoustic and kinematic measures. The present study compared a contro...

Perception-production relations in residual speech errors before and after biofeedback training

Rhotics are among the latest-emerging, most frequently misarticulated sounds in acquisition of American English (Smit et al., 1990). Children with residual speech errors (RSE) affecting rhotics may be unable to perceive differences between their own accurate and inaccurate productions (Shuster, 1998). Visual biofeedback may be an efficacious treatment approach for these children because it can bypass deficient auditory-perceptual channels (Shuster et al., 1995). Previous research has shown a relationship between accuracy in perceiving and producing rhotic targets in typically developing (TD) children (McAllister Byun & Tiede, 2017). We used the same methods to measure rhotic perception and production in a sample of 75 children with RSE. Based on previous literature (e.g., Hearnshaw et al., 2018; Rvachew & Jamieson, 1989), we hypothesize that children with RSE will show poorer perceptual abilities on average than TD children, but that they will show a similar degree of association between perception and production. Second, we will test whether changes in auditory acuity take place after a period of biofeedback treatment for RSE. Finding such changes would suggest that biofeedback may have its effect not only by retraining a target motor plan, but also by helping children update their auditory targets.Rhotics are among the latest-emerging, most frequently misarticulated sounds in acquisition of American English (Smit et al., 1990). Children with residual speech errors (RSE) affecting rhotics may be unable to perceive differences between their own accurate and inaccurate productions (Shuster, 1998). Visual biofeedback may be an efficacious treatment approach for these children because it can bypass deficient auditory-perceptual channels (Shuster et al., 1995). Previous research has shown a relationship between accuracy in perceiving and producing rhotic targets in typically developing (TD) children (McAllister Byun & Tiede, 2017). We used the same methods to measure rhotic perception and production in a sample of 75 children with RSE. Based on previous literature (e.g., Hearnshaw et al., 2018; Rvachew & Jamieson, 1989), we hypothesize that children with RSE will show poorer perceptual abilities on average than TD children, but that they will show a similar degree of association between perception and pr...

A novel sensor-based assessment of lower limb spasticity in children with cerebral palsy

BackgroundTo provide effective interventions for spasticity, accurate and reliable spasticity assessment is essential. For the assessment, the Modified Tardieu Scale (MTS) has been widely used owing to its simplicity and convenience. However, it has poor or moderate accuracy and reliability.MethodsWe proposed a novel inertial measurement unit (IMU)-based MTS assessment system to improve the accuracy and reliability of the MTS itself. The proposed system consists of a joint angle calculation algorithm, a function to detect abnormal muscle reaction (a catch and clonus), and a visual biofeedback mechanism. Through spastic knee and ankle joint assessment, the proposed IMU-based MTS assessment system was compared with the conventional MTS assessment system in 28 children with cerebral palsy by two raters.ResultsThe results showed that the proposed system has good accuracy (root mean square error < 3.2°) and test-retest and inter-rater reliabilities (ICC > 0.8), while the conventional MTS system has poor or moderate reliability. Moreover, we found that the deteriorated reliability of the conventional MTS system comes from its goniometric measurement as well as from irregular passive stretch velocity.ConclusionsThe proposed system, which is clinically relevant, can significantly improve the accuracy and reliability of the MTS in lower limbs for children with cerebral palsy.

Traditionally vs sonographically coached pushing in second stage of labor: a pilot randomized controlled trial

To investigate the usefulness of visual biofeedback using transperineal ultrasound to improve coached pushing during the active second stage of labor in nulliparous women. This was a randomized controlled trial of low-risk nulliparous women in the active second stage of labor. Patients were allocated to either coached pushing aided by visual demonstration on transperineal ultrasound of the progress of the fetal head (sonographic coaching) or traditional coaching. Patients in both groups were coached by an obstetrician for the first 20 min of the active second stage of labor and, subsequently, the labor was supervised by a midwife. Primary outcomes were duration of the active second stage and increase in the angle of progression at the end of the coaching process. Secondary outcomes included the incidence of operative delivery and complications of labor. Forty women were recruited into the study. Those who received sonographic coaching had a shorter active phase of the second stage (30 min (interquartile range (IQR), 24-42 min) vs 45 min (IQR, 39-55 min); P = 0.01) and a greater increase in the angle of progression (13.5° (IQR, 9-20°) vs 5° (IQR, 3-9.5°); P = 0.01) in the first 20 min of the active second stage of labor than did those who had traditional coaching. No differences were found in the secondary outcomes between the two groups. Our preliminary data suggest that transperineal ultrasound may be a useful adjunct to coached pushing during the active second stage of labor. Further studies are required to confirm these findings and better define the benefits of this approach. Copyright © 2018 ISUOG. Published by John Wiley & Sons Ltd.

Visual biofeedback using transperineal ultrasound in second stage of labor.

To assess the obstetric and psychological effects of visual biofeedback by transperineal ultrasound (TPU) during the second stage of labor. This was a prospective, single-center observational study of low-risk nulliparous women with epidural analgesia undergoing vaginal delivery. Visual biofeedback using TPU was provided to 26 women during the second stage of labor. Pushing efficacy was assessed by the change in the angle of progression (AoP) at rest and during pushing efforts, before and after biofeedback. Obstetric outcomes included incidence of perineal tearing, mode of delivery and length of second stage of labor. Psychological outcomes were assessed by self-reported measures obtained during the postnatal hospital stay and included measures of perceived control and maternal satisfaction with childbirth, as well as level of maternal feelings of connectedness with the newborn. Obstetric and psychological results were compared with those of a control group of 69 women who received standard obstetric coaching from midwives. Pushing efficacy increased significantly following visual biofeedback by TPU (P = 0.01), as indicated by a significantly lower delta AoP before (mean, 22.2° (95% CI, 13.9-31.7°)) compared with after (mean, 35.2° (95% CI, 25.9-45.3°)) biofeedback. A significant association was found between visual biofeedback and an intact perineum following delivery (P = 0.03). No significant differences were found between the two groups with regard to mode of delivery or length of the second stage. Feelings of maternal connectedness with the newborn were significantly stronger (P = 0.003) in women who received visual biofeedback than in those who did not. However, perceived control during childbirth and maternal satisfaction with childbirth did not differ significantly between the biofeedback and control groups. This pilot study suggests that biofeedback using TPU may serve as a complementary tool to coached maternal pushing during the second stage of labor, with obstetric as well as psychological benefits. Further studies are required to confirm our findings and define the optimal duration of the intervention. Copyright © 2017 ISUOG. Published by John Wiley & Sons Ltd.

COMplex Fracture Orthopedic Rehabilitation (COMFORT) - Real-time visual biofeedback on weight bearing versus standard training methods in the treatment of proximal femur fractures in the elderly: study protocol for a multicenter randomized controlled trial

BackgroundProximal femur fractures are a common injury after low energy trauma in the elderly. Most rehabilitation programs are based on restoring mobility and early resumption of weight-bearing. However, therapy compliance is low in patients following lower extremity fractures. Moreover, little is known about the relevance of gait parameters and how to steer the rehabilitation after proximal femur fractures in the elderly. Therefore, the aim of this prospective, randomized controlled trial is to gain insight in gait parameters and evaluate if real-time visual biofeedback can improve therapy compliance after proximal femur fractures in the elderly.MethodsThis is a two-arm, parallel-design, prospective, randomized controlled trial. Inclusion criteria are age ≥ 60 years, a proximal femur fracture following low energy trauma, and unrestricted-weight bearing. Exclusion criteria are cognitive impairment and limited mobility before trauma. Participants are randomized into either the control group, which receives care as usual, or the intervention group, which receives real-time visual biofeedback about weight-bearing during gait in addition to care as usual. Spatiotemporal gait parameters will be measured in 94 participants per group during a 30-m walk with an ambulatory biofeedback system (SensiStep). The progress of rehabilitation will be evaluated by the primary outcome parameters maximum peak load and step duration in relation to the discharge date. Secondary outcome parameters include other spatiotemporal gait parameters in relation to discharge date. Furthermore, the gait parameters will be related to three validated clinical tests: Elderly Mobility Scale; Functional Ambulation Categories; and Visual Analogue Scale. The primary hypothesis is that participants in the intervention group will show improved and faster rehabilitation compared to the control group.DiscussionThe first aim of this multicenter trial is to investigate the normal gait patterns after proximal femur fractures in the elderly. The use of biofeedback systems during rehabilitation after proximal femur fractures in the elderly is promising; therefore, the second aim is to investigate the effect of real-time visual biofeedback on gait after proximal femur fractures in the elderly. This could lead to improved outcome. In addition, analysis of the population may indicate characteristics of subgroups that benefit from feedback, making a differentiated approach in rehabilitation strategy possible.Trial registrationTrialRegister.nl, NTR6794. Registered on 31 October 2017.

Usability and Validation of the Smarter Balance System: An Unsupervised Dynamic Balance Exercises System for Individuals With Parkinson's Disease.

Conventional physical and balance rehabilitation programs to improve balance performance and increase postural stability are often limited due to cost, availability of physical therapists, and accessibility to rehabilitation facilities. Exercise compliance is also affected by a loss of memory and decline in motivation in prescribed home-based balance training. We have developed the smarter balance system (SBS) incorporating multimodal biofeedback (visual plus vibrotactile) intended for clinical and home-based balance rehabilitation and assessed its efficacy on physical therapists' recommended dynamic weight-shifting balance exercises (dynamic WSBE) in individuals with Parkinson's disease (PD). The SBS consists of a smartphone and custom belt housing a processing unit, miniaturized sensors, and vibrating actuators (tactors). Visual and vibrotactile biofeedback guidance during dynamic WSBE is generated by the SBS's custom app based on 90% of the user's limits of stability (LOS). Ten individuals with idiopathic PD having impaired postural stability participated in one unsupervised session comprising 24 trials of the dynamic WSBE in a laboratory setting. Participants' limits of stability (LOS) in the anterior-posterior (A/P) and medial-lateral (M/L) direction were measured at the pre- and post-session. To assess the efficacy of SBS to provide guidance during balance rehabilitation using dynamic WSBE, cross-correlation (XCOR), position error (PE), and percent of tactor activation (PTA) were measured. There was a significant increase in LOS between the pre- and post-training session in both A/P and M/L directions. The average XCOR across all participants were 0.87 (SD = 0.11) and 0.76 (SD = 0.11) for the A/P and M/L direction respectively. The average PE and PTA for the A/P direction was 1.17 deg (SD = 0.60) and 65.35% (SD = 15.1) respectively and 0.74 deg (SD = 0.28) and 31.3% (SD = 16.42) in the M/L direction respectively. There was no significant effect of trials for XCOR, PE, and PTA. Participants' LOS significantly increased after one session of the dynamic WSBE. Individuals with PD could accurately follow the target movements during the dynamic WSBE using the SBS. Future studies will assess the efficacy and acceptability of the SBS during long-term in-home rehabilitative training for balance-impaired individuals.

Development of real time abdominal compression force monitoring and visual biofeedback system

In this study, we developed and evaluated a system that could monitor abdominal compression force (ACF) in real time and provide a surrogating signal, even under abdominal compression. The system could also provide visual-biofeedback (VBF). The real-time ACF monitoring system developed consists of an abdominal compression device, an ACF monitoring unit and a control system including an in-house ACF management program.We anticipated that ACF variation information caused by respiratory abdominal motion could be used as a respiratory surrogate signal. Four volunteers participated in this test to obtain correlation coefficients between ACF variation and tidal volumes. A simulation study with another group of six volunteers was performed to evaluate the feasibility of the proposed system. In the simulation, we investigated the reproducibility of the compression setup and proposed a further enhanced shallow breathing (ESB) technique using VBF by intentionally reducing the amplitude of the breathing range under abdominal compression.The correlation coefficient between the ACF variation caused by the respiratory abdominal motion and the tidal volume signal for each volunteer was evaluated and R2 values ranged from 0.79 to 0.84. The ACF variation was similar to a respiratory pattern and slight variations of ACF ranges were observed among sessions. About 73–77% average ACF control rate (i.e. compliance) over five trials was observed in all volunteer subjects except one (64%) when there was no VBF. The targeted ACF range was intentionally reduced to achieve ESB for VBF simulation. With VBF, in spite of the reduced target range, overall ACF control rate improved by about 20% in all volunteers except one (4%), demonstrating the effectiveness of VBF.The developed monitoring system could help reduce the inter-fraction ACF set up error and the intra fraction ACF variation. With the capability of providing a real time surrogating signal and VBF under compression, it could improve the quality of respiratory tumor motion management in abdominal compression radiation therapy.

Effects of Biofeedback in Preventing Urinary Incontinence and Erectile Dysfunction after Radical Prostatectomy.

In this study, we present a biofeedback method for the strengthening of perineal muscles during the preoperative procedures for radical prostatectomy, and we evaluate this technique as a prevention measure against complications such as urinary incontinence (UI) and erectile dysfunction (ED), which affect prostatectomy patients after surgery. In the experimental protocol, the patients performed specific exercises with the help of a device that provided the patient with visual biofeedback, based on a plot of the anal pressure. For the experimental protocol, we selected 20 male patients, with an average age of 64.0 years, and submitted them to ten therapeutic sessions each. A control group consisting of 32 men with an average age of 66.3 years, who were treated with the same surgical procedure but not with the preoperative procedures, also took part in the experiment. To evaluate UI and ED after the surgery in both control and experimental groups, we used two validated questionnaires—to assess UI, we used the King’s Health Questionnaire (KHQ) and, for ED, we used the International Index of Erectile Function (IIEF-5) Questionnaire. We compared the variables associated with UI and ED after the surgery for the control and experimental groups. The occurrence of UI after radical prostatectomy in the control group (100% of the patients) was higher than that for the experimental group (5% of the patients), with p < 0.0001. Likewise, the occurrence of erectile dysfunction after prostatectomy in the control group (48.6% of the patients) was higher than that for the experimental group (5% of the patients), with p < 0.0001. The number of nocturia events also decreased as a consequence of the intervention (p < 0.0001), as did the number of disposable underwear units for urinary incontinence (p < 0.0001). Furthermore, we compared, only for the experimental group, the anal pressure before the biofeedback intervention and after the surgery, and we verified that the anal pressure after surgery was significantly higher (p < 0.0001). The results strongly suggest that the preoperative biofeedback procedure was effective in decreasing urinary incontinence and erectile dysfunction after radical prostatectomy. As future work, we intend to extend this analysis for larger samples and considering a broader age range.

Effects of real-time gait biofeedback on paretic propulsion and gait biomechanics in individuals post-stroke

ObjectivesGait training interventions that target paretic propulsion induce improvements in walking speed and function in individuals post-stroke. Previously, we demonstrated that able-bodied individuals increase propulsion unilaterally when provided real-time biofeedback targeting anterior ground reaction forces (AGRF). The purpose of this study was to, for the first time, investigate short-term effects of real-time AGRF gait biofeedback training on post-stroke gait.MethodsNine individuals with post-stroke hemiparesis (6 females, age = 54 ± 12.4 years 39.2 ± 24.4 months post-stroke) completed three 6-minute training bouts on an instrumented treadmill. During training, visual and auditory biofeedback were provided to increase paretic AGRF during terminal stance. Gait biomechanics were evaluated before training, and during retention tests conducted 2, 15, and 30 minutes post-training. Primary dependent variables were paretic and non-paretic peak AGRF; secondary variables included paretic and non-paretic peak trailing limb angle, plantarflexor moment, and step length. In addition to evaluating the effects of biofeedback training on these dependent variables, we compared effects of a 6-minute biofeedback training bout to a non-biofeedback control condition.ResultsCompared to pre-training, significantly greater paretic peak AGRFs were generated during the 2, 15, and 30-minute retention tests conducted after the 18-minute biofeedback training session. Biofeedback training induced no significant effects on the non-paretic leg. Comparison of a 6-minute biofeedback training bout with a speed-matched control bout without biofeedback demonstrated a main effect for training type, with greater peak AGRF generation during biofeedback.DiscussionOur results suggest that AGRF biofeedback may be a feasible and promising gait training strategy to target propulsive deficits in individuals post-stroke.

Real-time visual biofeedback to improve therapy compliance after total hip arthroplasty: A pilot randomized controlled trial

BackgroundPrevious studies have shown limited therapy compliance in weight-bearing in patients following total hip arthroplasty. Research questionThe purpose of this pilot RCT is to determine the immediate and late effect of real-time, visual biofeedback on weight-bearing during rehabilitation after THA in elderly. Methods24 participants who underwent THA were randomized to either the control or the intervention group. The intervention group received real-time, visual biofeedback on weight-bearing during training with the physical therapist during hospitalization and at twelve weeks follow up. ResultsWithout biofeedback, therapy compliance was limited. Significant improvement in peak load was found in the intervention group in the early postoperative phase. In contrast to the control group, the peak load at twelve weeks was significantly higher in the intervention group compared to the pre-operative peak load, indicating a lasting effect of early biofeedback. Other gait parameters were not significantly different in the early postoperative phase. In the intervention group a longer walking distance was observed and the use of walking aids was reduced at twelve weeks. SignificanceBiofeedback systems could be promising to improve outcomes and reduce costs in future rehabilitation programs after THA.

Abstract TP150: Kinematic Visual Biofeedback is Best When Training Novel Swallowing Behaviors in Dysphagic Patients After Stroke

Introduction: Dysphagia (swallowing impairment) is a common and often life threatening problem after stroke. Submental surface electromyography (ssEMG) visual feedback is a commonly used clinical tool to train novel swallowing maneuvers, even though its effectiveness has been questioned in studies of healthy adults. This study compares the effect of ssEMG and videofluoroscopy (VF) visual biofeedback on hyo-laryngeal accuracy when training the volitional laryngeal closure swallowing maneuver (vLVC) in post-stroke patients with dysphagia. The vLVC maneuver involves swallowing first, then maintaining laryngeal vestibule closure for at least 2 seconds. This study also examines the accuracy of clinician judgements about patient vLVC performance. Hypothesis: Accuracy will be reduced when only ssEMG (non-kinematic) versus VF (kinematic) visual feedback is used to teach the vLVC. Methods: Stroke participants (N=14) underwent 2 study phases. Phase 1: first demonstrated ability to perform the vLVC accurately. Phase 2 was vLVC training. Participants were randomized into three biofeedback groups including the ssEMG Group (ssEMG biofeedback in phases 1 and 2), the VF Group (VF biofeedback in phases 1 and 2), and the Mixed Group (VF phase 1, ssEMG phase 2). A clinician provided real-time, verbal cueing utilizing the assigned visual biofeedback to promote vLVC accuracy. The clinician could only see the assigned type of feedback also seen by the patient, although both VF and ssEMG were recorded for all participants. Results: Both accuracy of vLVC training performance and clinician feedback were worst in the ssEMG group compared to the VF and Mixed Groups (linear mixed models p&lt;0.001). Conclusions: Swallowing airway protection requires precisely timed movements of small, hidden laryngeal and pharyngeal structures. Kinematic feedback may be required to ensure that target swallowing movements are being trained in rehabilitation.

The Efficacy of Gait Training Using a Body Weight Support Treadmill and Visual Biofeedback in Patients with Subacute Stroke: A Randomized Controlled Trial.

Background This study was designed to determine whether or not gait training based on the use of treadmill with visual biofeedback and body weight support (BWS) would produce better effects in patients with subacute stroke compared to BWS treadmill training with no visual biofeedback. Materials and Methods 30 patients with subacute stroke were randomly assigned to do body weight supported treadmill training with visual biofeedback (BB group) or BWS treadmill training without visual biofeedback. Their gait was assessed with a 3D system (spatiotemporal gait parameters and symmetry index) and by means of 2-minute walk test (2 MWT), 10-metre walk test (10 MWT), and Timed Up & Go test. Subjects in both groups participated in 15 treadmill training sessions (30 minutes each). Results The participants from both groups achieved a statistically significant improvement in spatiotemporal gait parameters, walking speed, endurance, and mobility. The average change in the BB group after the end of the programme did not differ significantly compared to the change in the control group. The change in the symmetry index value of stance phase in the BB group was 0.03 (0.02) and in the control group was 0.02 (0.02). The difference was not statistically significant (p = 0.902). The statistically significantly higher improvement in the BB group was found in the range of walking speed (p = 0.003) and endurance (p = 0.012), but the difference between groups was of low clinical significance. Conclusions The findings do not confirm that BWS treadmill training with the function of visual biofeedback leads to significantly greater improvement in gait compared to BWS treadmill training with no visual biofeedback at an early stage after stroke. This study was registered at ClinicalTrials.gov, ID: ACTRN12616001283460.

Visual knee-kinetic biofeedback technique normalizes gait abnormalities during high-demand mobility after total knee arthroplasty

BackgroundAbnormal knee mechanics frequently follow total knee arthroplasty (TKA) surgery with these deficits amplifying as task demands increase. Knee-kinetic biofeedback could provide a means of attenuating gait abnormalities. The purposes of this study were as follows: (1) to describe the gait characteristic differences between patients with TKA and non-TKA adults during level (low-demand) and decline (high-demand) walking; and (2) where differences existed, to determine the impact of knee-kinetic biofeedback on normalizing these abnormalities. MethodsTwenty participants six months following a primary TKA and 15 non-TKA peers underwent gait analysis testing during level and decline walking. Knee-kinetic biofeedback was implemented to patients with TKA to correct abnormal gait characteristics if observed. ResultsPatients with TKA had lower knee extensor angular impulse (p<0.001), vGRF (p=0.001) and knee flexion motion (p=0.005) compared to the non-TKA group during decline walking without biofeedback. Patients with TKA normalized their knee extensor angular impulse (p=0.991) and peak vGRF (p=0.299) during decline walking when exposed to biofeedback. No between-group differences were observed during level walking. Groups were similar in age, gender, body mass index, physical activity level, pain interference and depression scores (p>0.05). ConclusionPatients with TKA demonstrate abnormal gait characteristics during a high-demand walking task when compared to non-TKA peers. Our findings indicate that knee-kinetic biofeedback can induce immediate improvements in gait characteristics during a high-demand walking task. There may be a potential role for the use of visual knee-kinetic biofeedback techniques to improve gait abnormalities during high-demand tasks following TKA.

Improvement of Praxis Skills in Children with Hemiplegic Cerebral Palsy by Using New Trend of Augmented Visual and Auditory Feedback Training: A Case Report

Aims: The aim of the study is to investigate if the new method of auditory and visual biofeedback as Upper Limb Exercise may improve praxis skills alone without any traditional physical therapy treatment or not and within three successive months of treatment in children with hemiplegic cerebral palsy. Methods: A 6-year-old hemiplegic cerebral palsied child was treated with Upper-Limb Exerciser as one of augmented visual and auditory feedback devices. Sensory Integration and Praxis test was used to measure a child’s ability to integrate sensory input for perception, motor planning, and spatial actions in; Space Visualization, Figure-Ground Perception, Standing and Walking Balance, Design Copying, Postural Praxis, Bilateral Motor Coordination, Constructional Praxis, Postrotary Nystagmus, Motor Accuracy, Sequencing Praxis, Oral Praxis, Manual Form Perception, Kinesthesia, Finger Identification, Graphethesia, Localization of Tactile Stimuli, and Praxis on Verbal Command. Results: The results revealed improvement of the major standard score for each of the 17 subtests of Sensory Integration and Praxis Test when compared after three successive treatment. Conclusion: The using upper limb exerciser as one method of augmented visual and auditory feedback can be used as one of the physical and occupational therapy programs aiming to improve praxis skills in hemiplegic cerebral palsied children.

Generating the Visual Biofeedback Signals Applicable to Reduction of Wrist Spasticity: A Pilot Study on Stroke Patients.

Introduction:Application of biofeedback techniques in rehabilitation has turned into an exciting research area during the recent decade. Providing an appropriate visual or auditory biofeedback signal is the most critical requirement of a biofeedback technique. In this regard, changes in Surface Electromyography (SEMG) signals during wrist movement can be used to generate an indictable visual biofeedback signal for wrist movement rehabilitation via SEMG biofeedback. This paper proposes a novel methodology for selecting the most appropriate features out of wrist muscle SEMG signals.Methods:To this end, the surface EMG signals from flexor and extensor muscle groups during wrist joint movements were recorded and analyzed. Some linear and nonlinear features in frequency, time, and time-frequency domains were extracted from the recorded surface EMG signals of the flexor and extensor muscles. Experiments and analyses were performed on ten healthy subjects and four stroke patients with wrist muscle spasticity as the movement disorder subjects. Some heuristic feature selection measures were applied. The main motivation behind choosing applied heuristic feature selection measures was meeting. In the first step, the designed visual biofeedback signal should indicate a healthy wrist motion profile as its successful tracking by the patient guarantees rehabilitation. In addition, the visual biofeedback signal should be a smooth curve thus preventing the patient from discomfort while tracking it on a monitor during the biofeedback therapy.Results:In this pilot study, after using the introduced feature selection measures, quantitative and qualitative analyses of the extracted features indicated that Shannon entropy is the most appropriate feature for generating a visual biofeedback signal as a healthy wrist motion profile to improve the ability of stroke patients in controlling wrist joint motion. In addition, it was shown that when the wrist joint moves between a flexed and rest position, the flexor muscle EMG signal should be used for generating a visual biofeedback signal. However when the wrist joint moves between a rest position and an extended position, the extensor muscle EMG signal is appropriate for providing a visual biofeedback signal. It is worth noting that the achieved pilot study results should be confirmed by the future studies with larger samples.Conclusion:According to the obtained results, it can be concluded that among the analyzed features, the Shannon entropy was the most appropriate feature. It can be employed for generating a visual biofeedback signal for reduction of spasticity in patients with stroke.

Biomechanical effects of augmented ankle power output during human walking.

The plantarflexor muscles are critical for forward propulsion and leg swing initiation during the push-off phase of walking, serving to modulate step length and walking speed. However, reduced ankle power output is common in aging and gait pathology, and is considered a root biomechanical cause of compensatory increases in hip power generation and increased metabolic energy cost. There is a critical need for mechanistic insight into the precise influence of ankle power output on patterns of mechanical power generation at the individual joint and limb levels during walking. We also posit that rehabilitative approaches to improve locomotor patterns should consider more direct means to elicit favorable changes in ankle power output. Thus, here we used real-time inverse dynamics in a visual biofeedback paradigm to test young adults' ability to modulate ankle power output during preferred speed treadmill walking, and the effects thereof on gait kinematics and kinetics. Subjects successfully modulated peak ankle power in response to biofeedback targets designed to elicit up to ±20% of normal walking values. Increasing ankle power output alleviated mechanical power demands at the hip and increased trailing limb positive work, propulsive ground reaction forces and step lengths. Decreasing ankle power had the opposite effects. We conclude that ankle power generation systematically influences the workload placed on more proximal leg muscles, trailing leg mechanical output and step length. Our findings also provide a promising benchmark for the application of biofeedback to restore ankle power in individuals with deficits thereof due to aging and gait pathology.

Innovative rehabilitative care models based on a multidisciplinary approach andnew technology in thermal setting

The aim of this work is to measure the movement in water and to store the data for the patient follow-up. It is based on the added value generated by the association of biofeedback with water rehabilitation, thanks to the instrumental prototype known as Biofeedback Scuba Suit (BFSS) suitable for water motion analysis and proper data transmission to both the biofeedback system and the therapist. The BFSS prototype is a hybrid motion capture system, portable and waterproof, coupled with a software that can analyze and reproduce on a virtual platform the kinematic data of the anatomical segments of the subject that wears it, generating a visual biofeedback by capturing and transmitting the data from the patient in the water. The algorithm allows the measurement of relative and absolute angular positions as well as axial rotary movements of the different anatomic segments to which the sensors are applied. In this study, the prototype was tested and validated by analyzing and comparing the movements of the upper left arm of healthy volunteers; being a pilot study, it was considered sufficient to analyze the movement of a single limb to demonstrate its accuracy. The results of the validation tests described in the results section, first performed out-ofwater and then in water, provided excellent results comparable with those obtained by the gold standard of kinematic measurement, represented by optokinetic systems. The potentials of BFSS for therapeutic purposes is vast: a) in aquatic rehabilitation; b) to improve the interaction with the patient and his motricity, as well as a basis for the continuous adaptation of the therapeutic program; c) allow to record, visualize and memorize the kinematic data during the aquatic rehabilitation.

DOSE THE USE OF VISUAL BIOFEEDBACK IN ELDERLY BALANCE TRAINING MINIMISE THEIR INCIDENCE OF FALLING?

18Dec 2017 DOSE THE USE OF VISUAL BIOFEEDBACK IN ELDERLY BALANCE TRAINING MINIMISE THEIR INCIDENCE OF FALLING? Abdullah Abbas Tobaigy and Mansour Abdullah Alshehri. College of Medicine and Health, University College Cork, Ireland. Physiotherapy Department, Faculty of Applied Medical Sciences, Umm Al-Qura University, Saudi Arabia.

Control of impact loading during distracted running before and after gait retraining in runners

ABSTRACTGait retraining using visual biofeedback has been reported to reduce impact loading in runners. However, most of the previous studies did not adequately examine the level of motor learning after training, as the modified gait pattern was not tested in a dual-task condition. Hence, this study sought to compare the landing peak positive acceleration (PPA) and vertical loading rates during distracted running before and after gait retraining. Sixteen recreational runners underwent a two-week visual biofeedback gait retraining program for impact loading reduction, with feedback on the PPA measured at heel. In the evaluation of PPA and vertical loading rates before and after the retraining, the participants performed a cognitive and verbal counting task while running. Repeated measures ANOVA indicated a significant interaction between feedback and training on PPA (F = 4.642; P = 0.048) but not vertical loading rates (F > 1.953; P > 0.067). Pairwise comparisons indicated a significantly lower PPA and vertical loading rates after gait retraining (P < 0.007; Cohen’s d > 0.68). Visual feedback after gait retraining reduced PPA and vertical loading rates during distracted running (P < 0.033; Cohen’s d > 0.36). Gait retraining is effective in lowering impact loading even when the runners are distracted. In dual-task situation, visual biofeedback provided beneficial influence on kinetics control after gait retraining.