Chih-Feng Lin

Balance control enhancement using sub-sensory stimulation and visual-auditory biofeedback strategies for amputee subjects

Sub-sensory electrical or mechanical stimulation can enhance the sensitivity of the human somatosensory system to improve the balance control capabilities of elderly. In addition, clinical studies suggest that visual-auditory biofeedback can improve sensory compensation for the elderly. This study hypothesizes that the static balance and gait performance of single leg quiet standing and treadmill walking could be improved for providing proprioceptive neuromuscular facilitation using sub-sensory stimulation and visual-auditory biofeedback in amputee subjects. To test this, a computerized foot pressure biofeedback sensory compensation system using sub-threshold low-level electrical stimulation combined with visual-auditory biofeedback was developed. Seven unilateral trans-tibial amputees who wore prostheses over 2 years were recruited. The subjects performed multiple single leg quiet standing trials with sub-sensory electrical stimulation applied at the quadriceps muscle during half of the trials. Static balance performance was characterized by using a Zebris motion analysis system to measure the sway distance and duration of the centre of mass on the second sacral (S2) of the subjects. In addition, multiple treadmill ambulatory trials with or without visual-auditory biofeedback was performed. Dynamic gait performance was characterized with a Zebris instrumented insole to measure the temporal responses of foot pressure sensors. Experimental results showed an improvement in three balance performance indices (Holding Time Index, HTI, Maximum Sway Distance Index, MSDI, and Average Sway Distance Index, ASDI) during single leg quiet standing by applying sub-sensory stimulation. The improvement ratio of these balance performance indices across subjects for single leg quiet standing tests resulted in 132.34% in HTI, 44.61% in MSDI, and 61.45% in ASDI. With visual-auditory biofeedback as a cue for heel contact and toe push-off condition during treadmill ambulation, the improvement of four dynamic gait performance measures (Double Support Period, DSP, Constant Time Cadence, CTC, Single Support Period, SSP, and Stance/Swing Ratio, SSR) in amputees was verified. This resulted in 7.89% in DSP (affected side), 5.09% in CTC, 16.67% in SSP (sound side), 45.30% in SSR (sound side), and 40.30% in SSR (affected side) respectively. These findings suggest that sub-threshold electrical stimulation and visual-auditory biofeedback rehabilitation strategies may be effective in compensating sensory loss and improving static balance and dynamic ambulation performance for amputees.

The Effectiveness of Kinesio Taping for Athletes with Medial Elbow Epicondylar Tendinopathy

Kinesio taping has also been used for athletes with Medial Elbow Epicondylar Tendinopathy (MET) as an additional treatment method. The purpose of this study was to determine the clinical effectiveness of Kinesio tape on maximal grip strength and absolute and related force sense in athletes with MET when applied to the medial forearm. 27 male athletes who voluntarily participated in this study were divided into a healthy group (n=17) and a MET group (n=10). All subjects were assessed for the maximal grip strength and grip force sense (absolute and related force sense) under 3 taping conditions: 1) without taping; 2) with placebo Kinesio taping; and 3) with Kinesio taping. No significant interaction was found between groups and taping condition in maximal grip force and related force sense error, except for absolute force sense error (p=0.04). Both groups with absolute force sense measurements had significantly decreased errors in the placebo Kinesio taping and Kinesio taping conditions. Both taping may enhance discrimination of magnitude of grip force control (absolute force sense) in both groups when applied to the forearm. However, Kinesio taping did not change maximal grip strength in either group. The effects of Kinesio taping on other muscle functions remain to be studied.

DESIGN OF A NEW BIOFEEDBACK PROPRIOCEPTIVE NEUROMUSCULAR FACILITATION SYSTEM FOR BELOW-KNEE AMPUTEES

Proprioceptive neuromuscular facilitation and foot sensory compensation are critical to balance control and ambulatory performance in below-knee amputees. Sub-sensory stimulation has been shown to be effective in enhancing the sensitivity of the human somatosensory system. In addition, visual-auditory biofeedback to improve foot sensory compensation for amputees was suggested in recent articles. The purpose of this study is to develop a new biofeedback proprioceptive neuromuscular facilitation system for improving balance control and foot sensory compensation in below-knee amputees. The proposed system functioned with sub-threshold electrical stimulation and visual-auditory biofeedback was developed for clinical study. Two unilateral trans-tibial amputees who consecutively wore prosthetics over 10 years were participated in this study. Subjects performed multiple single leg quite standing trails with sub-sensory electrical stimulation applied at the quadriceps muscle during half of the trails. Four static balance performance indices (i.e. Holding Time Index, HTI; Sway Length Index, SLI; Max Sway Distance Index, MSDI; Average Sway Distance Index, ASDI) were characterized using Zebris motion analysis system. The improvement ratio of these static balance performance indices across subjects for single leg quiet standing tests were resulted in a 209.7% in HTI, 39.1% in SLI, 24.3% in MSDI, and 65.4% in ASDI respectively. In addition, multiple treadmill ambulatory trails with or without visual-auditory biofeedback were evaluated. Four dynamic gait performance indices (i.e. Double Support Time Index, DSTI; Constant Time Cadence Index, CTCI; Single Support Time Index, SSTI; Stance/Swing Phase Index, SSPI) were characterized with Zebris instrumented insole and associated FMS analysis software. With visual-auditory biofeedback, the improvement of all four dynamic gait performance indices in below-knee amputees was verified. The improvement ratio of four gait performance indices across subjects resulted in a 14.81% in DSTI (sound side), 14.29% in DSTI (affected side), 14% in CTCI, 13.00% in SSTI (sound side), 6.02% in SSTI (affected side), 45.17% in SSPI (sound side), and 27.49% in SSPI (affected side) respectively. These findings suggest that sub-threshold electrical stimulation and visual-auditory biofeedback proprioceptive neuromuscular facilitation strategies may be effective in compensating foot sensory loss and improving balance control for below-knee amputees.

New Computer Protocol with Subsensory Stimulation and Visual/Auditory Biofeedback for Balance Assessment in Amputees

In this study, we hypothesized that the static standing weight bearing steadiness and dynamic walking weight shifting stability could be improved by providing neuromuscular facilitation using subsensory stimulation and visual–auditory biofeedback in amputee respectively. To test this hypothesis, a computer protocol with sensory feedback neuromuscular facilitation system was developed and used for clinical assessment. Seven unilateral transtibial amputees who consecutively worn prosthetics over two years were recruited. Experimental results show a reduction in all of the postural sway related indices and increase in single-leg holding time index during static quiet standing by applying subsensory stimulation. With visual–auditory biofeedback for providing clue for heel contact and toe push-off condition during dynamic ambulation, an improvement in all four dynamic walking weight shifting stability indices in amputees was verified. This study provided evidence that sensory feedback neuromuscular stimulation may put amputees at better balance capability.

A new trunk sway assessment protocol using biofeedback inertial-based sensing modality for stroke patients

The ability to control postural steadiness is an important determinant of overcoming the internal and external environmental stimulus across the falls for stoke patients. Traditionally, assessments of postural steadiness are based on patients ability to control the angular deviation of the center of mass (COM) within the base of support. In this study, a wireless inertial-based sensing modality with augmented biofeedback training protocol was developed and used for clinical evaluation. Eighteen cerebral vascular accident patients were recruited for the assessment. The experimental results revealed that biofeedback strategy together with motor skill learning protocol appears to be an important variable for improving postural steadiness during tandem stance.

A NEW TRUNK SWAY ASSESSMENT PROTOCOL FOR STROKE PATIENTS USING A BIOFEEDBACK INERTIAL-BASED SENSING MODALITY

Brain damage pathology can generate an irrelevant motor program leading to abnormal posture. Given this observation, we tested the hypothesis that postural control deficits are present in individuals with postural disorders. A new trunk sway assessment protocol evaluation system using an inertial-based sensing technique combined with visual-biofeedback strategies was developed. The proposed system was used to assess the angular deviation of the center of mass and enhanced balance control in patients with stroke. Twelve participants with hemiplegia were randomly divided into a visual-biofeedback group (experimental) and a without visual-biofeedback group (control), and were asked to stand as still as possible for 30 s. Postural sway data were submitted to conventional quantitative analyses of sway magnitude using a center of mass measurement. Additionally, group means were compared using parametric tests. Parameters in both the anterior-posterior and medio-lateral directions within the stroke patients were compared using paired t-tests. The experimental group showed increased postural control, indicative of reduced postural sway. Decreased complexity in the medio-lateral direction was also observed in the experimental group, suggesting both a reduction in the dynamic range available for postural control, and that their postural corrections were dominated primarily by longer-term scales. Significant interactions between the diagnostic group and visual condition were also observed for both of these measures, suggesting that the control group participants were impaired in their ability to make corrections to their sway pattern when no visual biofeedback was available. Greater sway magnitude and reduced complexity suggest that individuals with hemiplegia have deficits in sensorimotor integration and a reduced range of timescales available within which to make postural corrections.

Sports Injuries amongst Athletes with Disabilities in Taiwan: Wheelchair Basketball

The purpose of this study was to analyze the incidence of sports injuries amongst disabled athletes who joined the wheelchair basketball competition series in Taiwan. Wheelchair basketball has been identified as one of the high injury-risk sports, although limited information regarding the incidence or type of injury sustained by disabled athletes in Taiwan appears to be available. The Sports Injuries Registry is a sports injury data-collection instrumentality that is administered during the wheelchair basketball competitive period, the focus of this registry being on any injury sustained by wheelchair basketball players and that occurred during the competitive sporting period. Data pertaining to one hundred and sixty-five participants who joined the 2001 wheelchair-basketball competition season were collected, seventy injuries being registered from this pool of 165 players. The most-common injuries were located at the finger/wrist/hand (30%), upper arm/shoulder (30%), and forearm/elbow (15.7%). Cervical injuries constituted 11.4% of all injuries, followed by thoracic injuries (5.7%), head/face injuries (2.9%), leg/ankle/foot injuries (2.9%), and knee/thigh injuries (1.4%). Muscle injuries (including muscle strain, muscle soreness/spasm, tendonitis) featured in 51.4% of total injuries, followed by ligament injuries (14.3%), blisters (11.4%), concussion (8.6%), and lacerations/abrasion/cutting injuries (12.9%). The upper extremities accounted for 75.7% of the total injuries for these athletes, repetitive motion of the upper extremity possibly constituting the most-serious problem for studied disabled athletes, for whom it appears necessary to improve overall muscle endurance and strength and to increase the duration of resting intervals in order to attempt to reduce injury frequency. As regards the specific type of injury arising, 50% of injured athletes sustained a muscle injury, good muscle flexibility being emphasized for the upper extremity. Further steps are needed to educate athletes as regards muscle-stretch and -strengthening programs in order to attempt to reduce the incidence of future injuries.