Wearable Devices for Biofeedback Rehabilitation: A Systematic Review and Meta-Analysis to Design Application Rules and Estimate the Effectiveness on Balance and Gait Outcomes in Neurological Diseases

Abstract

Wearable devices are used in rehabilitation to provide biofeedback about biomechanical or physiological body parameters to improve outcomes in people with neurological diseases. This is a promising approach that influences motor learning and patients’ engagement. Nevertheless, it is not yet clear what the most commonly used sensor configurations are, and it is also not clear which biofeedback components are used for which pathology. To explore these aspects and estimate the effectiveness of wearable device biofeedback rehabilitation on balance and gait, we conducted a systematic review by electronic search on MEDLINE, PubMed, Web of Science, PEDro, and the Cochrane CENTRAL from inception to January 2020. Nineteen randomized controlled trials were included (Parkinson’s n = 6; stroke n = 13; mild cognitive impairment n = 1). Wearable devices mostly provided real-time biofeedback during exercise, using biomechanical sensors and a positive reinforcement feedback strategy through auditory or visual modes. Some notable points that could be improved were identified in the included studies; these were helpful in providing practical design rules to maximize the prospective of wearable device biofeedback rehabilitation. Due to the current quality of the literature, it was not possible to achieve firm conclusions about the effectiveness of wearable device biofeedback rehabilitation. However, wearable device biofeedback rehabilitation seems to provide positive effects on dynamic balance and gait for PwND, but higher-quality RCTs with larger sample sizes are needed for stronger conclusions.

Targeted walking training of patients in the early recovery period of cerebral stroke (preliminary research)

“…Мы применяли БОС-тренировку исходя из тех возможностей, которые были посильны пациентам и технически осуществимы в течение их трехне-дельного пребывания в стационаре. Таким образом, можно было осуществить 10 тренировок, в среднем число процедур составило 10±0,58 (9)(10)(11).…”

“…При выполнении ходьбы и других упражнений больными с последствиями церебрального инсульта или болезнью Паркинсона в качестве БОС активно используется технология носимых сенсоров [11]. Применяются, в частности, сенсоры на инерционной технологии, которые регистрируют различные биомеханические показатели, что позволяет потенциально перейти к более селективному выбору параметров ходьбы для тренировки.…”

A Study of Biofeedback Gait Training in Cerebral Stroke Patients in the Early Recovery Phase with Stance Phase as Target Parameter

“…Attempts are being made to automatically classify post-stroke walking abnormalities using IMUs and neural networks [15]. Some authors report using this technology for BFB therapy in patients with the sequelae of cerebral stroke and Parkinson's disease [16]. However, according to a systematic review [16], IMU-based BFB systems showed good results only for balance training.…”

“…Some authors report using this technology for BFB therapy in patients with the sequelae of cerebral stroke and Parkinson's disease [16]. However, according to a systematic review [16], IMU-based BFB systems showed good results only for balance training. There is still little information regarding other motor skills.…”

Gait Disorder Detection and Classification Method Using Inertia Measurement Unit for Augmented Feedback Training in Wearable Devices

“…However, many researchers are currently studying wearable devices using augmented feedback training or related rehabilitation methods to relieve motor symptoms and maximize the treatment effects of neurodegenerative diseases, particularly PD [28]. For example, Byl et al [29] researched Smart Shoes to evaluate and observe the effectiveness of visual kinematic feedback on gait training by using Inertia Measurement Unit (IMU) and pressure sensor.…”