The effects of different sensory augmentation on weight-shifting balance exercises in Parkinson’s disease and healthy elderly people: a proof-of-concept study

Abstract

BackgroundEarlier versions of biofeedback systems for balance-related applications were intended primarily to provide “alarm” signals about body tilt rather than to guide rehabilitation exercise motion. Additionally, there have been few attempts to evaluate guidance modalities for balance rehabilitation exercises. The purpose of this proof-of-concept study is to evaluate the effects of guidance modalities during common dynamic weight-shifting exercises used in clinical settings.MethodsA motion guidance system providing visual biofeedback, vibrotactile biofeedback, or both, was used during weight-shifting exercises. Eleven people with idiopathic Parkinson’s disease (PD) and nine healthy elderly people participated. Each participant wore a six-degree-of-freedom inertial measurement unit (IMU) located near the sacrum and four linear vibrating actuators (Tactors) attached to the skin over the front, back, and right and left sides of the abdomen. The IMU measured angular displacements and velocities of body tilt in anterior-posterior (A/P) and medial-lateral (M/L) directions. Participants were instructed to follow a slow moving target by shifting their weight in either the A/P or M/L direction up to 90 % of their limits of stability (LOS). Real-time position error was provided to participants in one of three sensory modalities: visual, vibrotactile, or both. Participants performed 5 trials for each biofeedback modality and movement direction (A/P and M/L) for a total of 30 trials in a random order. To characterize performance, position error was defined as the average absolute difference between the target and participant movements in degrees.ResultsSimultaneous delivery of visual and vibrotactile biofeedback resulted in significantly lower position error compared to either visual or vibrotactile biofeedback alone regardless of the movement direction for both participant cohorts. The pairwise comparisons were not significantly different between visual and vibrotactile biofeedback.ConclusionThe study is the first attempt to assess the effects of guidance modalities on common balance rehabilitation exercises in people with PD and healthy elderly people. The results suggest that combined visual and vibrotactile biofeedback can improve volitional responses during postural tracking tasks.Index Terms – sensory augmentation, weight-shifting balance exercise, guidance modality, vibrotactile biofeedback, visual biofeedback, Parkinson’s disease.

The Effects of a Wearable Sensory Prosthesis on Gait and Balance Function After 10 Weeks of Use in Persons With Peripheral Neuropathy and High Fall Risk – The walk2Wellness Trial

“…The concept of sensory substitution related to brain plasticity was laid out by Bach-y-Rita and colleagues, initially for vision and the vestibular system ( Bach-y-Rita et al, 1969 ; Bach-y-Rita, 2004 ) and other sensory systems ( Tyler et al, 2003 ; Bach-y-Rita, 2004 ). Recent efforts include wearable systems showing benefits to patients with vestibular loss ( Hegeman et al, 2005 ; Wall et al, 2009 ; Basta et al, 2011 ; Yamanaka et al, 2016 ), PN ( Wall et al, 2012 ; Wrisley et al, 2018 , 2020 ) and Parkinson’s Disease ( Rossi-Izquierdo et al, 2013 ; Lee et al, 2015 ). Combining wearable neurostimulation with balance therapy has shown benefits in patients with multiple sclerosis ( Leonard et al, 2017 ), cerebellar ataxia ( Cakrt et al, 2012 ), stroke ( Badke et al, 2011 ) traumatic brain injury ( Ptito et al, 2020 ) and in-home balance therapy ( Bao et al, 2018 ).…”

Effects of a balance-based exergaming intervention using the Kinect sensor on posture stability in individuals with Parkinson’s disease: a single-blinded randomized controlled trial

“…PD-related balance impairment is associated with a loss of mobility and increased likelihood of falls, and can cause marked disability [ 2 , 3 ]. To ameliorate postural instability, techniques using external feedback with cueing or sensory stimuli have been investigated [ 4 , 5 ]. Several studies suggest that external feedback may initiate other neural pathways and play a significant role in the volitional control of movements for people with PD [ 6 , 7 ].…”

Vibrotactile-Based Rehabilitation on Balance and Gait in Patients with Neurological Diseases: A Systematic Review and Metanalysis

“…Moreover, not only one body application was used. Vibrotactile effectors were used mounted on belts or directly in contact with the patient’s skin and placed in different body areas: head [ 35 , 41 , 42 ], sternum [ 43 ], waist level [ 44 ], at L4/L5 level [ 45 , 46 , 47 ], hip [ 48 , 49 ]; lower limb [ 50 , 51 , 52 ], anklets [ 32 ] and foot [ 53 ]. The experimental interventions lasted several days (maximum of 4 weeks) [ 54 ] or one single day and were mostly conducted in a hospital or laboratory setting.…”