Differentiation among bio- and augmented- feedback in technologically assisted rehabilitation

Morone, Giovanni; Ghooshchy, Sheida Ghanbari; Palomba, Angela; Baricich, Alessio; Santamato, Andrea; Ciritella, Chiara; Ciancarelli, Irene; Molteni, Franco; Gimigliano, Francesca; Iolascon, Giovanni; Zoccolotti, Pierluigi; Paolucci, Stefano; Iosa, Marco

doi:10.1080/17434440.2021.1927704

Cited by 25 publications

(19 citation statements)

References 61 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…It should be noted that although the results indicate that the freezing and jerk mappings were sufficiently salient, the participants were young and cognitively unimpaired. Future studies will investigate whether patients with varied degrees of cognitive impairment can perceive and comprehend the sounds—particularly in the case of augmented feedback applications (Sigrist et al, 2012 ; Morone et al, 2021 ). It is also possible that these salient entities (e.g., bell sounds) cause unacceptable levels of alarm fatigue (Cvach, 2012 ) and sonic disturbance in clinical monitoring contexts (Roodaki et al, 2017 ; Aldana Blanco et al, 2020 ).…”

Section: Discussionmentioning

confidence: 99%

“…For this to occur reliably, the temporal structure of the sonified feedback must correlate well with that of the intrinsic feedback (Parise et al, 2012 ). If this is achieved, the sonified feedback can theoretically highlight task-relevant information already present in intrinsic channels, facilitating sensorimotor associative learning below the level of conscious perception (Makino et al, 2016 ; Morone et al, 2021 ). Alternatively, sonification can be used as a form of sensory substitution, filling in for another task-critical sensory stream that is either damaged or missing, such as vestibular, visual or somatosensory loss in balance training (Dozza et al, 2007 ; Costantini et al, 2018 ).…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

An Embodied Sonification Model for Sit-to-Stand Transfers

2022

View full text Add to dashboard Cite

Interactive sonification of biomechanical quantities is gaining relevance as a motor learning aid in movement rehabilitation, as well as a monitoring tool. However, existing gaps in sonification research (issues related to meaning, aesthetics, and clinical effects) have prevented its widespread recognition and adoption in such applications. The incorporation of embodied principles and musical structures in sonification design has gradually become popular, particularly in applications related to human movement. In this study, we propose a general sonification model for the sit-to-stand (STS) transfer, an important activity of daily living. The model contains a fixed component independent of the use-case, which represents the rising motion of the body as an ascending melody using the physical model of a flute. In addition, a flexible component concurrently sonifies STS features of clinical interest in a particular rehabilitative/monitoring situation. Here, we chose to represent shank angular jerk and movement stoppages (freezes), through perceptually salient pitch modulations and bell sounds. We outline the details of our technical implementation of the model. We evaluated the model by means of a listening test experiment with 25 healthy participants, who were asked to identify six normal and simulated impaired STS patterns from sonified versions containing various combinations of the constituent mappings of the model. Overall, we found that the participants were able to classify the patterns accurately (86.67 ± 14.69% correct responses with the full model, 71.56% overall), confidently (64.95 ± 16.52% self-reported rating), and in a timely manner (response time: 4.28 ± 1.52 s). The amount of sonified kinematic information significantly impacted classification accuracy. The six STS patterns were also classified with significantly different accuracy depending on their kinematic characteristics. Learning effects were seen in the form of increased accuracy and confidence with repeated exposure to the sound sequences. We found no significant accuracy differences based on the participants' level of music training. Overall, we see our model as a concrete conceptual and technical starting point for STS sonification design catering to rehabilitative and clinical monitoring applications.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

An Embodied Sonification Model for Sit-to-Stand Transfers

2022

View full text Add to dashboard Cite

show abstract

“…The FB can be provided in real-time during the execution of a task (concurrent FB) or soon after (terminal FB). Mainly two types of concurrent FBs are available for clinicians: "biofeedback, " that refers to biological signals about which the subject is partially/completely unaware, and "augmented feedback, " i.e., a FB given by a device on measures about which the subject is already directly aware (19). In this scenario, different signals can be used to feed FB information, but at present no indication exists for their specific effects on performance (17,19).…”

Section: Introductionmentioning

confidence: 99%

“…Mainly two types of concurrent FBs are available for clinicians: "biofeedback, " that refers to biological signals about which the subject is partially/completely unaware, and "augmented feedback, " i.e., a FB given by a device on measures about which the subject is already directly aware (19). In this scenario, different signals can be used to feed FB information, but at present no indication exists for their specific effects on performance (17,19). Nonetheless, it has been demonstrated that new technologies based on different FB modalities (19), such as visual (20)(21)(22), acoustic (23) and/or haptic (24,25), allow re-education of altered functions (26,27), and a consensus is forming on the role of FB to guide and improve patient-technological device interactions (16).…”

Section: Introductionmentioning

confidence: 99%

Load Auditory Feedback Boosts Crutch Usage in Subjects With Central Nervous System Lesions: A Pilot Study

et al. 2021

View full text Add to dashboard Cite

Background: Crutches are the most common walking aids prescribed to improve mobility in subjects with central nervous system (CNS) lesions. To increase adherence to the appropriate level of crutch usage, providing load-related auditory feedback (aFB) may be a useful approach. We sensorized forearm crutches and developed a custom software to provide aFB information to both user and physical therapist (PhT).Aim: Evaluate aFB effects on load control during gait by a self-controlled case series trial.Methods: A single experimental session was conducted enrolling 12 CNS lesioned participants. Load on crutch was recorded during 10 Meter Walk Test performed with and without aFB. In both cases, crutch load data, and gait speed were recorded. Usability and satisfaction questionnaires were administered to participants and PhTs involved.Results: Reliable data were obtained from eight participants. Results showed that compared to the no FB condition, aFB yielded a significant reduction in the mean load on the crutches during gait (p = 0.001). The FB did not influence gait speed or fatigue (p > 0.05). The experience questionnaire data indicated a positive experience regarding the use of aFB from both participants' and PhTs' perspectives.Conclusion: aFB significantly improves compliance with crutch use and does not affect gait speed or fatigue by improving the load placed on crutches. The FB is perceived by users as helpful, safe, and easy to learn, and does not interfere with attention or concentration while walking. Furthermore, the PhTs consider the system to be useful, easy to learn and reliable.

show abstract

“…Robotic therapy provides task-oriented, repetitive, high-intensity, and highly reproducible sensorimotor training to boost stroke plasticitydependent recovery [1,2]. Generally speaking, robotic UL devices provide augmented feedback and performance dueto a 2D monitor that increases subjects' attention, enjoyment, and motivation [3].…”

Section: Introductionmentioning

confidence: 99%

Robot-Assisted Training for Upper Limb in Stroke (ROBOTAS): An Observational, Multicenter Study to Identify Determinants of Efficacy

Calabrò

Morone

Naro

et al. 2021

JCM

Self Cite

View full text Add to dashboard Cite

Background: The loss of arm function is a common and disabling outcome after stroke. Robot-assisted upper limb (UL) training may improve outcomes. The aim of this study was to explore the effect of robot-assisted training using end-effector and exoskeleton robots on UL function following a stroke in real-life clinical practice. Methods: A total of 105 patients affected by a first-ever supratentorial stroke were enrolled in 18 neurorehabilitation centers and treated with electromechanically assisted arm training as an add-on to conventional therapy. Both interventions provided either an exoskeleton or an end-effector device (as per clinical practice) and consisted of 20 sessions (3/5 times per week; 6–8 weeks). Patients were assessed by validated UL scales at baseline (T0), post-treatment (T1), and at three-month follow-up (T2). The primary outcome was the Fugl-Meyer Assessment for the upper extremity (FMA-UE). Results: FMA-UE improved at T1 by 6 points on average in the end-effector group and 11 points on average in the exoskeleton group (p < 0.0001). Exoskeletons were more effective in the subacute phase, whereas the end-effectors were more effective in the chronic phase (p < 0.0001). Conclusions: robot-assisted training might help improve UL function in stroke patients as an add-on treatment in both subacute and chronic stages. Pragmatic and highmethodological studies are needed to confirm the showed effectiveness of the exoskeleton and end-effector devices.

show abstract

Differentiation among bio- and augmented- feedback in technologically assisted rehabilitation

Cited by 25 publications

References 61 publications

An Embodied Sonification Model for Sit-to-Stand Transfers

An Embodied Sonification Model for Sit-to-Stand Transfers

Load Auditory Feedback Boosts Crutch Usage in Subjects With Central Nervous System Lesions: A Pilot Study

Robot-Assisted Training for Upper Limb in Stroke (ROBOTAS): An Observational, Multicenter Study to Identify Determinants of Efficacy

Contact Info

Product

Resources

About