Haptic Biofeedback for Improving Compliance With Lower-Extremity Partial Weight Bearing

Abstract

After lower-extremity orthopedic trauma and surgery, patients are often advised to restrict weight bearing on the affected limb. Conventional training methods are not effective at enabling patients to comply with recommendations for partial weight bearing. The current study assessed a novel method of using real-time haptic (vibratory/vibrotactile) biofeedback to improve compliance with instructions for partial weight bearing. Thirty healthy, asymptomatic participants were randomized into 1 of 3 groups: verbal instruction, bathroom scale training, and haptic biofeedback. Participants were instructed to restrict lower-extremity weight bearing in a walking boot with crutches to 25 lb, with an acceptable range of 15 to 35 lb. A custom weight bearing sensor and biofeedback system was attached to all participants, but only those in the haptic biofeedback group were given a vibrotactile signal if they exceeded the acceptable range. Weight bearing in all groups was measured with a separate validated commercial system. The verbal instruction group bore an average of 60.3±30.5 lb (mean±standard deviation). The bathroom scale group averaged 43.8±17.2 lb, whereas the haptic biofeedback group averaged 22.4±9.1 lb (P<.05). As a percentage of body weight, the verbal instruction group averaged 40.2±19.3%, the bathroom scale group averaged 32.5±16.9%, and the haptic biofeedback group averaged 14.5±6.3% (P<.05). In this initial evaluation of the use of haptic biofeedback to improve compliance with lower-extremity partial weight bearing, haptic biofeedback was superior to conventional physical therapy methods. Further studies in patients with clinical orthopedic trauma are warranted.

Measuring movement symmetry using tibial-mounted accelerometers for people recovering from total knee arthroplasty

“…Previous studies have provided promising results of movement training strategies to improve symmetry of movement for select patient populations 8,10,31 . In regard to TKA rehabilitation, McClelland and colleagues 8 have demonstrated use of a force plate system to provide feedback on lower limb weight-bearing during exercise and activity.…”

“…In addition, motion analysis systems have been used for providing feedback to patients during movement pattern re-training after lower limb joint surgeries 8–10 . However, the equipment used to measure movement asymmetry and provide patients feedback during rehabilitation is not practical for common clinical use and difficult to use in community settings that patients encounter during daily living.…”

Biofeedback in partial weight bearing: usability of two different devices from patient's and physical therapist's perspective

“…walking) and are not accurate in training patients to comply with partial weight-bearing (PWB) instructions [5][6][7][8][9]. Previous research shows that it is difficult for patients to comply with WB instructions [1,5,7,[9][10][11][12][13]. Reasons for non-compliance include [1] the difficulty to judge the load placed on the lower-limb, and [2] the use of inadequate training methods to achieve controlled PWB [1,7,11,13].…”

“…However, these methods do not represent dynamic activities (e.g. walking) and are not accurate in training patients to comply with partial weight-bearing (PWB) instructions [5][6][7][8][9]. Previous research shows that it is difficult for patients to comply with WB instructions [1,5,7,[9][10][11][12][13].…”

“…Conversely, the rationale for gradually advancing WB is that repetitive loads can stimulate bone growth and healing [1][2][3]. Therefore, it is commonly recommended that a rehabilitation program should include WB restrictions, which are gradually reduced as healing occurs [1,5].…”