Pieter Ginis

A Wearable System for Gait Training in Subjects with Parkinson’s Disease

In this paper, a system for gait training and rehabilitation for Parkinsons disease (PD) patients in a daily life setting is presented. It is based on a wearable architecture aimed at the provision of real-time auditory feedback. Recent studies have, in fact, shown that PD patients can receive benefit from a motor therapy based on auditory cueing and feedback, as happens in traditional rehabilitation contexts with verbal instructions given by clinical operators. To this extent, a system based on a wireless body sensor network and a smartphone has been developed. The system enables real-time extraction of gait spatio-temporal features and their comparison with a patients reference walking parameters captured in the lab under clinical operator supervision. Feedback is returned to the user in form of vocal messages, encouraging the user to keep her/his walking behavior or to correct it. This paper describes the overall concept, the proposed usage scenario and the parameters estimated for the gait analysis. It also presents, in detail, the hardware-software architecture of the system and the evaluation of system reliability by testing it on a few subjects.

A Mobile Kalman-Filter Based Solution for the Real-Time Estimation of Spatio-Temporal Gait Parameters

Gait impairments are among the most disabling symptoms in several musculoskeletal and neurological conditions, severely limiting personal autonomy. Wearable gait sensors have been attracting attention as diagnostic tool for gait and are emerging as promising tool for tutoring and guiding gait execution. If their popularity is continuously growing, still there is room for improvement, especially towards more accurate solutions for spatio-temporal gait parameters estimation. We present an implementation of a zero-velocity-update gait analysis system based on a Kalman filter and off-the-shelf shoe-worn inertial sensors. The algorithms for gait events and step length estimation were specifically designed to comply with pathological gait patterns. More so, an Android app was deployed to support fully wearable and stand-alone real-time gait analysis. Twelve healthy subjects were enrolled to preliminarily tune the algorithms; afterwards sixteen persons with Parkinsons disease were enrolled for a validation study. Over the 1314 strides collected on patients at three different speeds, the total root mean square difference on step length estimation between this system and a gold standard was 2.9%. This shows that the proposed method allows for an accurate gait analysis and paves the way to a new generation of mobile devices usable anywhere for monitoring and intervention.

Cueing for people with Parkinson's disease with freezing of gait: A narrative review of the state-of-the-art and novel perspectives

Freezing, which manifests during gait and other movements, is an incapacitating motor symptom experienced by many patients with Parkinsons disease (PD). In rehabilitation, auditory and visual cueing methods are commonly applied to evoke a more goal-directed type of motor control and, as such, reduce freezing severity in patients with PD. In this narrative review, we summarize the current evidence regarding the effects of external cueing in patients with PD with freezing of gait (FOG) and provide suggestions on how to further improve cueing effectiveness with emerging technological developments. For this paper, we reviewed 24 articles describing the assessment of the effects of cues in patients with FOG (n=354). Because these studies mostly involved quasi-experimental designs, no methodological analysis was undertaken. In general, the evidence suggests that cue-augmented training can reduce FOG severity, improve gait parameters and improve upper-limb movements immediately after training. However, findings were not univocal, and long-term consolidation and transfer of the effects appear to be hampered specifically in this subgroup. With the increasing use of wearable technology, new possibilities are allowing for adapting the cue type, cue content and dose of cues to the needs of individual patients, which may boost the clinical use and efficiency of cued training in PD patients with FOG.

Prolonged Walking with a Wearable System Providing Intelligent Auditory Input in People with Parkinson’s Disease

Rhythmic auditory cueing is a well-accepted tool for gait rehabilitation in Parkinson’s disease (PD), which can now be applied in a performance-adapted fashion due to technological advance. This study investigated the immediate differences on gait during a prolonged, 30 min, walk with performance-adapted (intelligent) auditory cueing and verbal feedback provided by a wearable sensor-based system as alternatives for traditional cueing. Additionally, potential effects on self-perceived fatigue were assessed. Twenty-eight people with PD and 13 age-matched healthy elderly (HE) performed four 30 min walks with a wearable cue and feedback system. In randomized order, participants received: (1) continuous auditory cueing; (2) intelligent cueing (10 metronome beats triggered by a deviating walking rhythm); (3) intelligent feedback (verbal instructions triggered by a deviating walking rhythm); and (4) no external input. Fatigue was self-scored at rest and after walking during each session. The results showed that while HE were able to maintain cadence for 30 min during all conditions, cadence in PD significantly declined without input. With continuous cueing and intelligent feedback people with PD were able to maintain cadence (p = 0.04), although they were more physically fatigued than HE. Furthermore, cadence deviated significantly more in people with PD than in HE without input and particularly with intelligent feedback (both: p = 0.04). In PD, continuous and intelligent cueing induced significantly less deviations of cadence (p = 0.006). Altogether, this suggests that intelligent cueing is a suitable alternative for the continuous mode during prolonged walking in PD, as it induced similar effects on gait without generating levels of fatigue beyond that of HE.

Fall-prone older people's attitudes towards the use of virtual reality technology for fall prevention

Background: Virtual reality (VR) technology is a relatively new rehabilitation tool that can deliver a combination of cognitive and motor training for fall prevention. The attitudes of older people to such training are currently unclear. Objective: This study aimed to investigate: (1) the attitudes of fall-prone older people towards fall prevention exercise with and without VR; (2) attitudinal changes after intervention with and without VR; and (3) user satisfaction following fall prevention exercise with and without VR. Methods: A total of 281 fall-prone older people were randomly assigned to an experimental group receiving treadmill training augmented by VR (TT+VR, n = 144) or a control group receiving treadmill training alone (TT, n = 137). Two questionnaires were used to measure (1) attitudes towards fall prevention exercise with and without VR (AQ); and (2) user satisfaction (USQ). AQ was evaluated at baseline and after intervention. USQ was measured after intervention only. Results: The AQ revealed that most participants had positive attitudes towards fall prevention exercise at baseline (82.2%) and after intervention (80.6%; p = 0.144). In contrast, only 53.6% were enthusiastic about fall prevention exercise with VR at baseline. These attitudes positively changed after intervention (83.1%; p < 0.001), and 99.2% indicated that they enjoyed TT+VR. Correlation analyses showed that postintervention attitudes were strongly related to user satisfaction (USQ: r = 0.503; p < 0.001). Conclusions: Older peoples attitudes towards fall prevention exercise with VR were positively influenced by their experience. From the perspective of the user, VR is an attractive training mode, and thus improving service provision for older people is important.

Judges in judo conform to the referee because of the reactive feedback system

Abstract This experiment tested whether the conformism observed among panels of judges in aesthetic sports also occurs among judges in judo. Similar to aesthetic sports, judo judging relies upon a form of open feedback. However, in judo, this system is reactive (i.e. two judges have to publicly ‘correct’ the score given by the higher-status referee), whereas it is active in aesthetic sports (i.e. judges with equal status report their score simultaneously and can use the feedback about the scores of their colleagues for evaluating later performances). In order to test whether such reactive open-feedback system leads to conformism among judges in judo, we designed an experiment in which this feedback was manipulated. Participants were 20 certified Flemish judges, who had to score two sets of 11 ambiguous video sequences that are used during formation and training of judo judges: one set with feedback about the referees score and one set without feedback. The results revealed that when participants knew the referees score, their scores were significantly more in line with this score than when they did not know this score. More specifically, for both sets of sequences at least 10% less deviations from the referee were observed when participants were given feedback about the score of the referee. These results suggest that preventable conformism can occur in typical judo judging, that is with reactive open feedback.

Analysis of Biofeedback Effects in Parkinson’s Disease at Multiple Time-Scales

In this study we investigate the effects of motor adaptation and motor learning in persons with Parkinson’s disease during an home-based gait training program built on auditory biofeedback (BF). For this purpose, we assessed the motor response produced immediately after auditory BF messages and analysed it at multiple time-scales, within and between all training sessions. The findings indicate that motor adaptation is possible in a home-based training context for persons with PD using a wearable BF system.

Focusing on heel strike improves toe clearance in people with Parkinson’s disease: an observational pilot study

OBJECTIVES To investigate differences in toe clearance between people with PD and age-matched healthy elderly (HE) during comfortable walking and to study the effects of dual-tasking and the use of an attentional strategy emphasizing heel strike on toe clearance. DESIGN Observational cross-sectional study. SETTING Camera-based 3D gait laboratory. PARTICIPANTS Ten persons with PD (Hoehn and Yahr I to III) having mild gait disturbances and 10 HE. INTERVENTIONS Participants walked for two minutes under three conditions at comfortable pace: single-task walking, attending to heel strike during single-task walking, and dual-task walking. MAIN OUTCOME MEASURES Minimal and maximal toe clearance; foot strike angle with the ground. RESULTS People with PD had less maximal toe clearance in the end of the swing phase and a smaller foot strike angle than HE during all three walking conditions. Impairments significantly diminished during heel strike focused walking improving performance to equal the HE. Heel strike focused walking resulted in an increased minimal toe clearance and a longer duration of end swing phase when compared to walking with and without a dual-task. The attentional strategy to focus on heel strike improved the stride length when compared to dual-task walking. Surprisingly, minimal toe clearance did not differ between PD and HE in any of the conditions and there were no dual-task effects on toe clearance. CONCLUSION These findings provide evidence favoring the potential incorporation of an attentional strategy focusing on the heel strike in PD gait rehabilitation.