Posts Tagged biofeedback

[Abstract] Effects of ankle biofeedback training on strength, balance, and gait in patients with stroke – PEDro

Effects of ankle biofeedback training on strength, balance, and gait in patients with stroke
Kim S-J, Cho H-Y, Kim K-H, Lee S-M
Journal of Physical Therapy Science 2016 Sep;28(9):2596-2600
clinical trial
PURPOSE: This study aimed to investigate the effects of ankle biofeedback training on muscle strength of the ankle joint, balance, and gait in stroke patients. SUBJECTS AND METHODS: Twenty-seven subjects who had had a stroke were randomly allocated to either the ankle biofeedback training group (n = 14) or control group (n = 13). Conventional therapy, which adhered to the neurodevelopmental treatment approach, was administered to both groups for 30 minutes. Furthermore, ankle strengthening exercises were performed by the control group and ankle biofeedback training by the experimental group, each for 30 minutes, 5 days a week for 8 weeks. To test muscle strength, balance, and gait, the Biodex isokinetic dynamometer, functional reach test, and 10 m walk test, respectively, were used. RESULTS: After the intervention, both groups showed a significant increase in muscle strength on the affected side and improved balance and gait. Significantly greater improvements were observed in the balance and gait of the ankle biofeedback training group compared with the control group, but not in the strength of the dorsiflexor and plantar flexor muscles of the affected side. CONCLUSION: This study showed that ankle biofeedback training significantly improves muscle strength of the ankle joint, balance, and gait in patients with stroke.

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[Abstract] Biofeedback Signals for Robotic Rehabilitation: Assessment of Wrist Muscle Activation Patterns in Healthy Humans

Abstract:

Electrophysiological recordings from human muscles can serve as control signals for robotic rehabilitation devices. Given that many diseases affecting the human sensorimotor system are associated with abnormal patterns of muscle activation, such biofeedback can optimize human-robot interaction and ultimately enhance motor recovery. To understand how mechanical constraints and forces imposed by a robot affect muscle synergies, we mapped the muscle activity of 7 major arm muscles in healthy individuals performing goal-directed discrete wrist movements constrained by a wrist robot. We tested 6 movement directions and 4 force conditions typically experienced during robotic rehabilitation. We analyzed electromyographic (EMG) signals using a space-by-time decomposition and we identified a set of spatial and temporal modules that compactly described the EMG activity and were robust across subjects. For each trial, coefficients expressing the strength of each combination of modules and representing the underlying muscle recruitment, allowed for a highly reliable decoding of all experimental conditions. The decomposition provides compact representations of the observable muscle activation constrained by a robotic device. Results indicate that a low-dimensional control scheme incorporating EMG biofeedback could be an effective add-on for robotic rehabilitative protocols seeking to improve impaired motor function in humans.

Source: Biofeedback Signals for Robotic Rehabilitation: Assessment of Wrist Muscle Activation Patterns in Healthy Humans – IEEE Xplore Document

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[ARTICLE] Biofeedback improves performance in lower limb activities more than usual therapy in people following stroke: a systematic review – Full Text

Abstract

Question: Is biofeedback during the practice of lower limb activities after stroke more effective than usual therapy in improving those activities, and are any benefits maintained beyond the intervention?

Design: Systematic review with meta-analysis of randomised trials with a PEDro score > 4.

Participants: People who have had a stroke.

Intervention: Biofeedback (any type delivered by any signal or sense) delivered concurrently during practice of sitting, standing up, standing or walking compared with the same amount of practice without biofeedback.

Outcome measures: Measures of activity congruent with the activity trained.

Results: Eighteen trials including 429 participants met the inclusion criteria. The quality of the included trials was moderately high, with a mean PEDro score of 6.2 out of 10. The pooled effect size was calculated as a standardised mean difference (SMD) because different outcome measures were used. Biofeedback improved performance of activities more than usual therapy (SMD 0.50, 95% CI 0.30 to 0.70).

Conclusion: Biofeedback is more effective than usual therapy in improving performance of activities. Further research is required to determine the long-term effect on learning. Given that many biofeedback machines are relatively inexpensive, biofeedback could be utilised widely in clinical practice.

[Stanton R, Ada L, Dean CM, Preston E (2016) Biofeedback improves performance in lower limb activities more than usual therapy in people following stroke: a systematic review. Journal of Physiotherapy 63: 11–16]

Introduction

This is an update of a systematic review1 that examined the effect of biofeedback in training lower limb activities after stroke. Biofeedback is equipment that transforms biological signals into an output that can be understood by the learner, providing information to the learner that is not consciously available. That is, biofeedback takes intrinsic physiological signals and makes them extrinsic, giving the person immediate and accurate feedback of information about these body functions. Biofeedback can be delivered through various senses, such as visual, auditory and tactile systems, and can provide information about the kinematics, kinetics and/or electromyography of activities. Biofeedback is available from medical equipment (eg, electromyography, force platforms and positional devices traditionally used in clinical practice); or from non-medical equipment that is increasingly available and used in stroke rehabilitation (eg, recreational games such as the Nintendo® Wii™). Biofeedback can be used in addition to verbal content; however, it also has the advantage that it can be set up for the patient to use when left to practise alone. However, biofeedback is not commonly used in stroke rehabilitation.2

The previous version of this review,2 which was published in 2011, examined biofeedback broadly in training lower limb activities after stroke, including trials where any form of biofeedback was provided during practice of the whole activity (rather than part of the activity), with outcomes measured during the same activity. Twenty-two trials met the inclusion criteria and were included in the review; however, meta-analyses demonstrated significant heterogeneity that was best explained by the quality of the included trials. When analyses were limited to higher quality trials (PEDro score > 4), biofeedback had a moderate effect in the short term (10 trials, 241 participants, SMD 0.49, 95% CI 0.22 to 0.75) compared with usual therapy, which was maintained beyond intervention (five trials, 138 participants, SMD 0.41, 95% CI 0.06 to 0.75), suggesting that learning had occurred. For a direct comparison of the effect of biofeedback interventions and usual therapy (which includes therapist communication), a post hoc meta-analysis was conducted of those trials where the amount of practice was equal in each group. That is, trials where the control group practised the same activity for the same amount of time as the experimental group, with the only difference being the substitution of biofeedback for therapist communication (presumably including feedback) in the experimental group. This meta-analysis demonstrated a moderate effect of a similar magnitude to the overall analysis (eight trials, 170 participants, SMD 0.51, 95% CI 0.20 to 0.83), suggesting that biofeedback is superior to therapist communication.

Since that review1 was published in 2011, a number of additional trials have been published that investigated the effect of biofeedback, warranting an update of the review. In particular, the potential of using recreational games in stroke rehabilitation has gained attention. The inclusion criteria for this updated review incorporated findings from the previous review. Specifically, this meant that the updated review would include any randomised trial investigating biofeedback from any signal (position, force, EMG) via any sense (visual, auditory, tactile), delivered concurrently during whole activity practice, compared with usual therapy that was practice of the same activity for the same amount of time in the control group with no biofeedback (but presumably with therapist communication), with outcome measures at the activity level and congruent with the activity trained. This ensures a true comparison of the effect of biofeedback compared with usual therapist communication. For the biofeedback intervention, inclusion in this update was based on whether the biofeedback delivered was concurrent rather than terminal feedback. This meant that commercially available recreational games would be included if the majority of the games played within the study delivered concurrent biofeedback, rather than inclusion based on the equipment itself. In order to make recommendations based on the highest level of evidence, this review included only randomised trials with a PEDro score > 4.

Therefore, the research questions for this systematic review were:

  • 1. In adults following stroke, is biofeedback during the practice of lower limb activities more effective than usual therapy in improving those activities in the short term?
  • 2. Are any benefits maintained beyond the intervention?

Continue —> Biofeedback improves performance in lower limb activities more than usual therapy in people following stroke: a systematic review – Journal of Physiotherapy

 

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[Systematic Review] Biofeedback improves performance in lower limb activities more than usual therapy in people following stroke – Full Text

Abstract

Question: Is biofeedback during the practice of lower limb activities after stroke more effective than usual therapy in improving those activities, and are any benefits maintained beyond the intervention? Design: Systematic review with meta-analysis of randomised trials with a PEDro score > 4. Participants: People who have had a stroke. Intervention: Biofeedback (any type delivered by any signal or sense) delivered concurrently during practice of sitting, standing up, standing or walking compared with the same amount of practice without biofeedback. Outcome measures: Measures of activity congruent with the activity trained. Results: Eighteen trials including 429 participants met the inclusion criteria. The quality of the included trials was moderately high, with a mean PEDro score of 6.2 out of 10. The pooled effect size was calculated as a standardised mean difference (SMD) because different outcome measures were used. Biofeedback improved performance of activities more than usual therapy (SMD 0.50, 95% CI 0.30 to 0.70). Conclusion: Biofeedback is more effective than usual therapy in improving performance of activities. Further research is required to determine the long-term effect on learning. Given that many biofeedback machines are relatively inexpensive, biofeedback could be utilised widely in clinical practice. [Stanton R, Ada L, Dean CM, Preston E (2016) Biofeedback improves performance in lower limb activities more than usual therapy in people following stroke: a systematic review.Journal of PhysiotherapyXX: XX-XX]

Introduction

This is an update of a systematic review1 that examined the effect of biofeedback in training lower limb activities after stroke. Biofeedback is equipment that transforms biological signals into an output that can be understood by the learner, providing information to the learner that is not consciously available. That is, biofeedback takes intrinsic physiological signals and makes them extrinsic, giving the person immediate and accurate feedback of information about these body functions. Biofeedback can be delivered through various senses, such as visual, auditory and tactile systems, and can provide information about the kinematics, kinetics and/or electromyography of activities. Biofeedback is available from medical equipment (eg, electromyography, force platforms and positional devices traditionally used in clinical practice); or from non-medical equipment that is increasingly available and used in stroke rehabilitation (eg, recreational games such as the Nintendo® Wii™). Biofeedback can be used in addition to verbal content; however, it also has the advantage that it can be set up for the patient to use when left to practise alone. However, biofeedback is not commonly used in stroke rehabilitation.2

Continue —> Biofeedback improves performance in lower limb activities more than usual therapy in people following stroke: a systematic review

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[WEB SITE] Gait Trainer™ 3 – Biodex

More than just a treadmill…It is the most important improvement to gait training since the parallel bars.

The Gait Trainer 3 provides audio and visual biofeedback of step length and step speed

The Biodex Gait Trainer™ 3 is more than a treadmill. It is designed with an instrumented deck that issues both audio and visual real-time biofeedback to prompt patients into their correct gait pattern. Step length, step speed and right-to-left time distribution (step symmetry) are directly addressed; patient footfall is compared to desired footfall step after step, both on the display in real time and documented in an easy to read histogram.

The Biodex Gait Trainer is quiet, non-intimidating and allows the therapist to get in there and treat their patients. Real goals are monitored and progress reported. Objective documentation, with comparison to age- and gender-based normative data, helps prove need and document outcomes to family, referring physicians and insurance providers.

The Biodex Gait Trainer 3, with or without the Unweighing System or FreeStep for BWSTT, is suitable for all rehabilitation pathologies. Biodex has recently published Body Weight Support Treadmill Training (BWSTT) with Transition to Over Ground Ambulation: A Clinical Guideline for the Treatment of Patients with Neurological Conditions using Biodex Unweighing System and Gait Trainer. The document classifies the neurologically involved patient, then steps the user through the various phases of recovery for profound,moderate and minimal neurological impairments.

Treadmill Plus… The Gait Trainer 3 also serves as a traditional treadmill, with all the features and benefits of the Biodex RTM600 Rehabilitation Treadmill.

Gait Training SystemGAIT TRAINER 3 + UNWEIGHING
The Biodex Gait Training System

The Gait Trainer provides audio and visual biofeedback of step length and step speed. The Unweighing Support System provides assistance, helping patients regain their confidence, their strength and their stride. The Unweighing System, combined with the Gait Trainer 3 allows every patient the opportunity to get an early start on rehabilitation.

Source: Gait Trainer™ 3 – Treadmills – Physical Medicine | Biodex

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[Conference Paper] Haptic based Gait Rehabilitation System for Stroke Patients – Full Text PDF

Abstract
Among most existing gait rehabilitation robots, it
is difficult to find adequate devices for gait rehabilitation of
chronic stroke patients who can already stand and move but still
need to rehabilitate the affected lower limb through simple,
compact, and easy-to use devices. This paper presents a novel
haptic based gait rehabilitation system (HGRS) which has the
potential to provide over-ground gait training regimens for
post-stroke ambulatory subjects. It consists of a portable cane
for kinesthetic sensing and a wearable vibrotactor array for
tactile biofeedback. Contact of user with the handle provides
light grip force, it serves the purpose of balance assurance and
increased muscle activity through light touch concept and
vibrotactors contribute in enhancing the gait modification
through afferent signal of vibration. Walking trials conducted
with stroke patients indicate increased muscle activation and
balance, and improved temporal symmetry with use of HGRS.
HGRS is capable of assisting physical therapists in training
individuals with stroke suffering from gait abnormalities. In
addition, it is easy to use and low-cost which makes it reachable
to a vast domain of subjects suffering from gait abnormalities.

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[THESIS] AUGMENTED REALITY SYSTEM FOR REHABILITATION: NEW APPROACH BASED ON HUMAN INTERACTION AND BIOFEEDBACK – Full Text PDF

Abstract

Rehabilitation is the process of training for someone in order to recover or improve their lost functions caused by neurological deficits. The upper limb rehabilitation system provides relearning of motor skills that are lost due to any neurological injuries via motor rehabilitation training. The process of motor rehabilitation is a form of motor learning via practice or experience. It requires thorough understanding and examination of neural processes involved in producing movement and learning as well as the medical aspects that may affect the central nervous system (CNS) or peripheral nervous system (PNS) in order to develop an effective treatment system. Although there are numerous rehabilitation systems which have been proposed in literatures, a low cost upper limb rehabilitation system that maximizes the functional recovery by stimulating the neural plasticity is not widely available. This is due to lack of motivation during rehabilitation training, lack of real time biofeedback information with complete database, the requirement of one to one attention between physiotherapist and patient, the technique to stimulate human neural plasticity. Therefore, the main objective of this thesis is to develop a novel low cost rehabilitation system that helps recovery not only from loss of physical functions, but also from loss of cognitive functions to fulfill the aforementioned gaps via multimodal technologies such as augmented reality (AR), computer vision and signal processing. In order to fulfill such ambitious objectives, the following contributions have been implemented. Firstly, since improvements in physical functions are targeted, the Rehabilitation system with Biofeedback simulation (RehaBio) is developed. The system enhances user’s motivation via game based therapeutic exercises and biofeedback. For this, AR based therapeutic games are developed to provide eye-hand coordination with inspiration in motivation via immediate audio and visual feedback. All the exercises in RehaBio are developed in a safe training environment for paralyzed patients. In addition to that, realtime biofeedback simulation is developed and integrated to serve in two ways: (1) from the patient’s point of view, the biofeedback simulation motivates the user to execute the movements since it will animate the different muscles in different colors, and (2) from the therapist’s point of view, the muscle simulations and EMG threshold level can be evaluated as patient’s muscle performance throughout the rehabilitation process. Secondly, a new technique that stimulates the human neural plasticity is proposed. This is a virtual human arm (VHA) model that driven by proposed continuous joint angle prediction in real time based on human biological signal, Electromyogram (EMG). The VHA model simulation aims to create the illusion environment in Augmented Realitybased Illusion System (ARIS). Finally, a complete novel upper limb rehabilitation system, Augmented Reality-based Illusion System (ARIS) is developed. The system incorporates some of the developments in RehaBio and real time VHA model to develop the illusion environment. By conducting the rehabilitation training with ARIS, user’s neural plasticity will be stimulated to reestablish the neural pathways and synapses that are able to control mobility. This is achieved via an illusion concept where an illusion scene is created in AR environment to remove the impaired real arm virtually and replace it with VHA model to be perceived as part of the user’s own body. The job of the VHA model in ARIS is when the real arm cannot perform the required task, it will take over the job of the real one and will let the user perceive the sense that the user is still able to perform the reaching movement by their own effort to the destination point. Integration with AR based therapeutic exercises and motivated immediate intrinsic and extrinsic feedback in ARIS leads to serve as a novel upper limb rehabilitation system in a clinical setting. The usability tests and verification process of the proposed systems are conducted and provided with very encouraging results. Furthermore, the developments have been demonstrated to the clinical experts in the rehabilitation field at Port Kembla Hospital. The feedback from the professionals is very positive for both the RehaBio and ARIS systems and they have been recommended to be used in the clinical setting for paralyzed patients.

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[WEB PAGE] Biofeedback Reduces Seizures in Intractable Epilepsy – Medscape

Biofeedback Reduces Seizures in Intractable Epilepsy – Medscape

PHILADELPHIA — New research is showing that biofeedback, a technique using the mind to control physiologic responses, such as heart rate and respiration, can reduce seizure frequency.

The intervention is safe, easy to learn, and noninvasive, Yoko Nagai, PhD, Clinical Imaging Science Center, Brighton and Sussex Medical School, University of Sussex, United Kingdom, said at a press briefing during the American Epilepsy Association (AES) 69th Annual Meeting.

Dr Yoko Nagai

For the intervention — called electrodermal (EDA) biofeedback — patients attach small sensors to their two middle fingers. A small electrical current measures connectivity on the skin surface. Dr Nagai is named as the inventor on the patent of EDA biofeedback; this study was funded by the Wellcome Trust.
This therapeutic approach, called autonomic cognitive rehabilitation therapy, consists of both physiological and psychological components. “The idea is to build new habits or new reactions both from the psychological and physiological side,” she said.Patients sit at a computer with an animated program on the screen. Their increased skin conductivity drives the computer screen forward, changing the animation, while they strive to attain a final goal. Most patients enjoy the experience, which is similar to playing a video game, said Dr Nagai.

Over time, patients learn to anticipate and perceive seizure triggers and to respond effectively to them.

Dr Nagai’s earlier trial showed that 60% of 18 patients receiving the biofeedback reduced their seizure frequency by more than 50% after twelve 45-minute sessions over 4 weeks.

Her work has shown that increased skin conductivity can reduce electroencephalographic signatures of cortical excitability in patients with epilepsy. This effect, she said, is similar to that seen with some antiepileptic drugs.

Quantifying Connectivity

This new study quantified how functional neural connectivity is altered following the EDA biofeedback treatment. It included eight patients with treatment-resistant temporal lobe epilepsy, mean age 44.9 years, who had at least four seizures per month.

These patients received the biofeedback therapy three times a week for 4 weeks. They also underwent functional neuroimaging at the first and final therapy sessions.

The study found a significant reduction in seizure frequency (P = .002). One patient became seizure free. Two patients had greater than 50% seizure reduction. The average reduction in seizure frequency was 40.54%.

The smaller clinical effect compared to the earlier study is due to the more homogeneous study sample, said Dr Nagai.

There was increased functional neural connectivity to the orbitofrontal cortex (OFC) and the adjacent ventromedial prefrontal cortex (VMPFC) in the tempestas piriform cortex, inferior temporal gyrus, anterior cingulate, and precentral gyrus. There was decreased OFC/VMPFC connectivity with the superior temporal gyrus and angular gyrus.

“One of the most interesting findings is a weakened connection between this frontal part of the amygdala, which is responsible for stress and anxiety,” said Dr Nagai. “The implication of this result is that it seems that patients become less vulnerable to anxiety-related or stress-related seizures.”

Anyone can learn the biofeedback technique, said Dr Nagai. Although she has studied this only in adults, she said that children, even young ones, can learn to do it, and once learned, it’s a skill can be used in an ongoing way.

Dr. Ngai has trained other researchers — from as far away as Japan — on her technique. “They have gotten exactly the same results; it’s really promising,” she said. Currently, she’s working on a digital version of the therapy that can be more widely disseminated.

But she recognizes that in the grand scheme of epilepsy therapy, behavior therapy takes a back seat to pharmacologic approaches. “I didn’t see any lecture on this here,” at the AES meeting, she noted.

Dr Nagai’s project is “terrific,” said Joseph I. Sirven, MD, professor, neurology, Mayo Clinic, Phoenix, Arizona, said when asked to comment.

“It demonstrates that indeed biofeedback, a tool that has been at our disposal for some time, can have benefit.”

The study results are “similar to what a Cochrane review has suggested,” Dr Sirven told Medscape Medical News. “This adds yet another therapy that helps patient self-manage or empowers them with a therapy at their fingertips.”

Dr Nagai’s research was funded by the Welcome Trust. She is named as the inventor of EDA biofeedback therapy for epilepsy in the patent (US7734338).

American Epilepsy Society (AES) 69th Annual Meeting. Abstract 3.277.

Source: Biofeedback Reduces Seizures in Intractable Epilepsy

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[WEB SITE] KINECT REHABILITATION with Biofeedback – Virtual Reality Kinect Rehabilitation

News and case studies regarding Kinect rehabilitation, biofeedback systems and home rehabilitation

Source: KINECT REHABILITATION with Biofeedback | News, Healthcare, Research

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[WEB SITE] Neuroplasticity and the Use of Technology

Therapists Kristin Myers, OTR/L, CBIS and Meredith Nichols, DPT, CBIS were invited to spend a week in China to share their experience of using a computer feedback system with Chinese therapists and physicians. During their time in China, they also demonstrated the concept of active and functional retraining following brain injury, and the seemingly novel idea of neuroplastic recovery, especially years after injury.

Myers and Nichols work in a post-acute brain injury program at CORE Healthcare outside of Austin, Texas. This program utilizes aspects of forced use theories and technology to improve functional outcomes for their clients. Their facility was initially one of only six in the United States to acquire and utilize this specific interactive biofeedback equipment. This computer-aided biofeedback system is one of many tools used at their program to facilitate neuroplasticity following traumatic brain injury.

They are currently collecting preliminary data to evaluate the clinical use of this technology to motivate their patients through mass practice. To reverse learned non-use after stroke, practice that has been clustered together (aka mass practice) has improved functional outcomes, such as seen in Edward Taub’s clinical work using constraint induced therapy for stroke recovery.

The biofeedback computer system Nichols and Myers used combats the monotony of repetitive motions and encourages patients to work harder and move toward more complete recovery of function in less time. This work integrating mass practice and forced use theories using the computer system enabled them to be invited to spend a week in China earlier this year, where they shared their knowledge and expertise with Chinese physicians and therapists.

In a whirlwind tour, Myers and Nichols visited five hospitals, in five different major Chinese cities including Shanghai and Harbin, in five days.  They had the honor of providing a picture of rehabilitation in America to over 500 Chinese therapists, doctors, administrators, and government officials.

New Concepts in Therapy

Continue —>  Neuroplasticity and the Use of Technology.

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