In clinical practice, therapists often encounter cases of unilateral spatial neglect (USN) observed in far and near space. In this case report, immersive virtual reality (VR) technology was adopted as a therapy tool in a patient with stroke with severe near and far space neglect. Neuropsychological tests in near and far space as well as the Catherine Bergego Scale (CBS), as an index of neglect in daily living, were measured preintervention and postintervention. Improvement of neuropsychological tests, particularly in far space, was clearly demonstrated postintervention. However, CBS score did not change postintervention. This may be because the patient unsuccessfully translated these visual search task skills used in far space to activities of daily living. Our findings suggest the potential use of immersive VR technology in patients with USN and highlight the VR programme's limited ability to fully recover a patient's disability in natural settings.
Falls and fall-induced injuries are major global public health problems, and sensory input impairment in older adults results in significant limitations in feedback-type postural control. A haptic-based biofeedback (BF) system can be used for augmenting somatosensory input in older adults, and the application of this BF system can increase the objectivity of the feedback and encourage comparison with that provided by a trainer. Nevertheless, an optimal BF system that focuses on interpersonal feedback for balance training in older adults has not been proposed. Thus, we proposed a haptic-based perception-empathy BF system that provides information regarding the older adult's center-of-foot pressure pattern to the trainee and trainer for refining the motor learning effect. The first objective of this study was to examine the effect of this balance training regimen in healthy older adults performing a postural learning task. Second, this study aimed to determine whether BF training required high cognitive load to clarify its practicability in real-life settings. Twenty older adults were assigned to two groups: BF and control groups. Participants in both groups tried balance training in the single-leg stance while performing a cognitive task (i.e., serial subtraction task). Retention was tested 24 h later. Testing comprised balance performance measures (i.e., 95% confidence ellipse area and mean velocity of sway) and dual-task performance (number of responses and correct answers). Measurements of postural control using a force plate revealed that the stability of the single-leg stance was significantly lower in the BF group than in the control group during the balance task. The BF group retained the improvement in the 95% confidence ellipse area 24 h after the retention test. Results of dual-task performance during the balance task were not different between the two groups. These results confirmed the potential benefit of the proposed balance training regimen in designing successful motor learning programs for preventing falls in older adults.
Recent studies have shown that haptic feedback on the body, either at or away from the desired gait parameter to be changed, can improve gait performance. Here we introduced a haptic-based biofeedback device to supplement the foot pressure information of a paretic foot with a wearable vibrotactile biofeedback device attached to the back. This system provides information regarding a patient's foot pressure pattern to the patient and physical therapist. Therefore, the biofeedback system can share information regarding abnormal gait patterns between patients and therapists. This pilot study showed that the device immediately improved the stride length during walking, but not walking speed. Furthermore, subjective reports indicated that synchronizing foot pressure pattern information between the patient and therapist induced higher patient motivation for gait rehabilitation.
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