Feasibility of visual instrumented movement feedback therapy in individuals with motor incomplete spinal cord injury walking on a treadmill

Abstract

Background: Incomplete spinal cord injury (iSCI) leads to motor and sensory deficits. Even in ambulatory persons with good motor function an impaired proprioception may result in an insecure gait. Limited internal afferent feedback (FB) can be compensated by provision of external FB by therapists or technical systems. Progress in computational power of motion analysis systems allows for implementation of instrumented real-time FB. The aim of this study was to test if individuals with iSCI can normalize their gait kinematics during FB and more importantly maintain an improvement after therapy.Methods: Individuals with chronic iSCI had to complete 6 days (1 day per week) of treadmill-based FB training with a 2 weeks pause after 3 days of training. Each day consists of an initial gait analysis followed by 2 blocks with FB/no-FB. During FB the deviation of the mean knee angle during swing from a speed matched reference (norm distance, ND) is visualized as a number. The task consists of lowering the ND, which was updated after every stride. Prior to the tests in patients the in-house developed FB implementation was tested in healthy subjects with an artificial movement task.Results: Four of five study participants benefited from FB in the short and medium term. Decrease of mean ND was highest during the first 3 sessions (from 3.93 ± 1.54 to 2.18 ± 1.04). After the pause mean ND stayed in the same range than before. In the last 3 sessions the mean ND decreased slower (2.40 ± 1.18 to 2.20 ± 0.90). Direct influences of FB ranged from 60 to 15% of reduction in mean ND compared to initial gait analysis and from 20 to 1% compared to no-FB sessions.Conclusions: Instrumented kinematic real-time FB may serve as an effective adjunct to established gait therapies in normalizing the gait pattern after incomplete spinal cord injury. Further studies with larger patient groups need to prove long term learning and the successful transfer of newly acquired skills to activities of daily living.

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

“…The limited portability of optical systems presents challenges for using such methods in a pediatric clinic. 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 limited portability of optical systems presents challenges for using such methods in a pediatric clinic. 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…”

“…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.…”

Editorial: Neuro-motor control and feed-forward models of locomotion in humans

“…As described by Scivoletto et al ( 2014 ), during the long and strenuous neurorehabilitation of patients with spinal cord injury, learning-dependent changes in CPG circuits can occur primarily through rhythmic peripheral influences imposed by the exercises. The gait training for these patients can also be improved through visual biofeedback, as reported by Schlieβmann et al ( 2014 ), or robotic devices as reported in the studies of Del-Ama et al ( 2014 ) and Sylos-Labini et al ( 2014 ). In the former study the muscle examination of patients with spinal cord injury revealed improvements at knee and hip sagittal muscle functioning, the same joints as those found impaired in the study of Awai and Curt ( 2014 ).…”

Developing a Low-Cost Force Treadmill via Dynamic Modeling

“…By using a force treadmill to quantitatively analyze gait patterns and detect gait abnormalities, medical therapists can adjust the intensity of treadmill training on an individual basis. In addition, previous studies have shown that the feedback of auditory, vibrotactile, and visual gait information can alter or improve gait features such as walking speed [ 30 , 31 ], gait coordination [ 32 ], trunk sway [ 33 ], stride length [ 31 ], hip mechanics [ 34 ], cadence [ 31 ], step length symmetry [ 35 ], knee movement [ 36 ], gait cycle length [ 37 ], duration of gait [ 37 ], and swing phase speed [ 37 ]. With the capability of generating many important gait features, force treadmills represent an ideal platform for implementing such biofeedback systems.…”