Gait Training With Visual Feedback and Proprioceptive Input to Reduce Gait Asymmetry in Adults With Cerebral Palsy: A Case Series

Levin, Ilana; Lewek, Michael D.; Feasel, Jeff; Thorpe, Deborah

doi:10.1097/pep.0000000000000362

Cited by 19 publications

(10 citation statements)

References 28 publications

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“…The hardware requirements and setup time of the IMU-based feedback platform are much lower than those for motion analysis systems 5 or virtual reality environments. 6 Our study demonstrated strong convergent validity of the IMU measurement with established optical motion capture measurement methods (the overall R 2 correlations approximating 1). The study indicated a greater rate of joint excursion for the IMU system than the optical system, and we believe that this is caused by movement of the IMUs relative to the overall limb segments because they overlie muscles which contract during gait.…”

Section: Discussionsupporting

confidence: 61%

“…2 Some gait deviations in children with CP can persist and be recalcitrant to retraining even after pharmacologic or surgical management of spasticity and contracture. The potential for computational biofeedback modalities to augment gait retraining have been explored, [3][4][5][6][7][8] in recognition of the consistency and objectivity of feedback provided.…”

Section: Introductionmentioning

confidence: 99%

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Feasibility of a real-time pattern-based kinematic feedback system for gait retraining in pediatric cerebral palsy

Liu

Oliveira

Ehrenberg

et al. 2021

Journal of Rehabilitation and Assistive Technologies Engineerin

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Introduction Visual biofeedback of lower extremity kinematics has the potential to enhance retraining of pathological gait patterns. We describe a system that uses wearable inertial measurement units to provide kinematic feedback on error measures generated during periods of gait in which the knee is predominantly extended (‘extension period’) and flexed (‘flexion period’). Methods We describe the principles of operation of the system, a validation study on the inertial measurement unit derived knee flexion angle on which the system is based, and a feasibility study to assess the ability of a child with cerebral palsy to modify a gait deviation (decreased swing phase knee flexion) in response to the feedback. Results The validation study demonstrated strong convergent validity with an independent measurement of knee flexion angle. The gait pattern observed during training with the system exhibited increased flexion in the flexion period with maintenance of appropriate extension in the extension period. Conclusions Inertial measurement units can provide robust feedback during gait training. A child with cerebral palsy was able to interpret the novel two phase visual feedback and respond with rapid gait adaptation in a single training session. With further development, the system has the potential to support clinical retraining of deviated gait patterns.

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Section: Discussionsupporting

confidence: 61%

Section: Introductionmentioning

confidence: 99%

Feasibility of a real-time pattern-based kinematic feedback system for gait retraining in pediatric cerebral palsy

Liu

Oliveira

Ehrenberg

et al. 2021

Journal of Rehabilitation and Assistive Technologies Engineerin

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show abstract

“…Young and older adults had reduced A/P and M/L tilt and A/P tilt velocity during normal walking ( 41 ). Cues have also been used to reduce knee adduction moments in people with knee osteoarthritis ( 42 ), alter plantar foot loading in people with stroke ( 43 ), and reduce gait asymmetry in people with cerebral palsy ( 44 ). When provided with combined auditory and vibrotactile SA, people with bilateral vestibular loss demonstrated decreased EMG amplitudes and less EMG background activity when standing on a compliant surface with their eyes closed ( 29 ).…”

Section: Real-time Use Findingsmentioning

confidence: 99%

“…Persons with compromised sensory systems (visual, vestibular, proprioceptive) may be able to use SA via a rehabilitation device to “upweight” ( 67 ) the available accurate information from the non-compromised system(s), or possibly enhance the “weakened signal” resulting in improved postural control. It appears that longer duration training with SA has better potential to enhance sensory reweighting ( 44 ). Persons with more severe sensory impairment have been found to benefit more from SA compared to those with moderate deficits, thus supporting the use of SA in acute stages of rehabilitation ( 47 ).…”

Section: Rehabilitation Using Augmented Sensory Feedbackmentioning

confidence: 99%

Potential Mechanisms of Sensory Augmentation Systems on Human Balance Control

et al. 2018

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Numerous studies have demonstrated the real-time use of visual, vibrotactile, auditory, and multimodal sensory augmentation technologies for reducing postural sway during static tasks and improving balance during dynamic tasks. The mechanism by which sensory augmentation information is processed and used by the CNS is not well understood. The dominant hypothesis, which has not been supported by rigorous experimental evidence, posits that observed reductions in postural sway are due to sensory reweighting: feedback of body motion provides the CNS with a correlate to the inputs from its intact sensory channels (e.g., vision, proprioception), so individuals receiving sensory augmentation learn to increasingly depend on these intact systems. Other possible mechanisms for observed postural sway reductions include: cognition (processing of sensory augmentation information is solely cognitive with no selective adjustment of sensory weights by the CNS), “sixth” sense (CNS interprets sensory augmentation information as a new and distinct sensory channel), context-specific adaptation (new sensorimotor program is developed through repeated interaction with the device and accessible only when the device is used), and combined volitional and non-volitional responses. This critical review summarizes the reported sensory augmentation findings spanning postural control models, clinical rehabilitation, laboratory-based real-time usage, and neuroimaging to critically evaluate each of the aforementioned mechanistic theories. Cognition and sensory re-weighting are identified as two mechanisms supported by the existing literature.

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“…CP presents with positive and negative motor signs including: spasticity, weakness, impaired selective motor control and sensory deficits [4]. ICP has been used to improve balance [5], gait symmetry [6], upper limb strength [7] and other functional abilities in people with CP. Perhaps the largest study to date in this field is the 'Move it to improve it' (MITII) randomized controlled trial that used web-based therapy at home to improve occupational performance and visual perception in children with unilateral CP [8].…”

Section: Introductionmentioning

confidence: 99%

A biofeedback-enhanced therapeutic exercise video game intervention for young people with cerebral palsy: A randomized single-case experimental design feasibility study

MacIntosh

Desailly²,

Vignais

et al. 2020

PLoS ONE

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Importance/Background Movement-controlled video games have potential to promote home-based practice of therapy activities. The success of therapy gaming interventions depends on the quality of the technology used and the presence of effective support structures. Aim This study assesses the feasibility of a novel intervention that combines a co-created gaming technology integrating evidence-based biofeedback and solution-focused coaching (SFC) strategies to support therapy engagement and efficacy at home. Methods Following feasibility and single-case reporting standards (CONSORT and SCRIBE), this was a non-blind, randomized, multiple-baseline, AB, design. Nineteen (19) young people with cerebral palsy (8-18 years old) completed the 4-week home-based intervention in France and Canada. Participant motivations, personalized practice goals, and relevance of the intervention to daily activities were discussed in a Solution Focused Coaching-style conversation pre-, post-intervention and during weekly check-ins. Participants controlled a video game by completing therapeutic gestures (wrist extension, pinching) detected via electromyography and inertial sensors on the forearm (Myo Armband and custom software). Process feasibility success criteria for recruitment response, completion and adherence rates, and frequency of technical issues were established a priori. Scientific feasibility, effect

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Gait Training With Visual Feedback and Proprioceptive Input to Reduce Gait Asymmetry in Adults With Cerebral Palsy: A Case Series

Abstract: Outcome measures and training protocols were feasible in this sample of convenience of adults with CP who were ambulatory and who did not have visual impairment. The adults with CP in this study demonstrated individual improvements in gait and balance following training.

Cited by 19 publications

References 28 publications

Feasibility of a real-time pattern-based kinematic feedback system for gait retraining in pediatric cerebral palsy

Feasibility of a real-time pattern-based kinematic feedback system for gait retraining in pediatric cerebral palsy

Potential Mechanisms of Sensory Augmentation Systems on Human Balance Control

A biofeedback-enhanced therapeutic exercise video game intervention for young people with cerebral palsy: A randomized single-case experimental design feasibility study

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