Tony Szturm

Effects of an Interactive Computer Game Exercise Regimen on Balance Impairment in Frail Community-Dwelling Older Adults: A Randomized Controlled Trial

Background Due to the many problems associated with reduced balance and mobility, providing an effective and engaging rehabilitation regimen is essential to progress recovery from impairments and to help prevent further degradation of motor skills. Objectives The purpose of this study was to examine the feasibility and benefits of physical therapy based on a task-oriented approach delivered via an engaging, interactive video game paradigm. The intervention focused on performing targeted dynamic tasks, which included reactive balance controls and environmental interaction. Design This study was a randomized controlled trial. Setting The study was conducted in a geriatric day hospital. Participants Thirty community-dwelling and ambulatory older adults attending the day hospital for treatment of balance and mobility limitations participated in the study. Interventions Participants were randomly assigned to either a control group or an experimental group. The control group received the typical rehabilitation program consisting of strengthening and balance exercises provided at the day hospital. The experimental group received a program of dynamic balance exercises coupled with video game play, using a center-of-pressure position signal as the computer mouse. The tasks were performed while standing on a fixed floor surface, with progression to a compliant sponge pad. Each group received 16 sessions, scheduled 2 per week, with each session lasting 45 minutes. Measurements Data for the following measures were obtained before and after treatment: Berg Balance Scale, Timed “Up & Go” Test, Activities-specific Balance Confidence Scale, modified Clinical Test of Sensory Interaction and Balance, and spatiotemporal gait variables assessed in an instrumented carpet system test. Results Findings demonstrated significant improvements in posttreatment balance performance scores for both groups, and change scores were significantly greater in the experimental group compared with the control group. No significant treatment effect was observed in either group for the Timed “Up & Go” Test or spatiotemporal gait variables. Limitations The sample size was small, and there were group differences at baseline in some performance measures. Conclusion Dynamic balance exercises on fixed and compliant sponge surfaces were feasibly coupled to interactive game-based exercise. This coupling, in turn, resulted in a greater improvement in dynamic standing balance control compared with the typical exercise program. However, there was no transfer of effect to gait function.

Task-Specific Rehabilitation of Finger-Hand Function Using Interactive Computer Gaming

The present case study assessed the feasibility of using an interactive gaming system, coupled with the manipulation of common objects, as a form of repetitive, task-specific movement therapy. Three adults with moderate chronic motor impairments of the fingers and hand participated: one 36-year-old man with an incomplete cervical spinal cord injury, one 60-year-old man with a left cortical cerebro-vascular accident, and one 38-year-old woman with left hemiplegic cerebral palsy. Each subject received an intervention of 15 one-hour sessions, which consisted solely of interactive exercise gaming using a diverse range of objects. The objects provided graded and challenging training levels, which emulated the functional properties of objects used in daily life. This in turn produced positive effects on the recovery of active finger range of motion and hand function.

The interacting effect of cognitive and motor task demands on performance of gait, balance and cognition in young adults.

Mobility limitations and cognitive impairments, each common with aging, reduce levels of physical and mental activity, are prognostic of future adverse health events, and are associated with an increased fall risk. The purpose of this study was to examine whether divided attention during walking at a constant speed would decrease locomotor rhythm, stability, and cognitive performance. Young healthy participants (n=20) performed a visuo-spatial cognitive task in sitting and while treadmill walking at 2 speeds (0.7 and 1.0 m/s).Treadmill speed had a significant effect on temporal gait variables and ML-COP excursion. Cognitive load did not have a significant effect on average temporal gait variables or COP excursion, but variation of gait variables increased during dual-task walking. ML and AP trunk motion was found to decrease during dual-task walking. There was a significant decrease in cognitive performance (success rate, response time and movement time) while walking, but no effect due to treadmill speed. In conclusion walking speed is an important variable to be controlled in studies that are designed to examine effects of concurrent cognitive tasks on locomotor rhythm, pacing and stability. Divided attention during walking at a constant speed did result in decreased performance of a visuo-spatial cognitive task and an increased variability in locomotor rhythm.

A Randomized, Double-Blinded, Crossover Pilot Study Assessing the Effect of Nabilone on Spasticity in Persons With Spinal Cord Injury

OBJECTIVES To determine whether nabilone, a synthetic cannabinoid, alleviates spasticity in people with spinal cord injury (SCI). DESIGN A double-blind, placebo-controlled crossover study. SETTING Outpatient rehabilitation clinics. PARTICIPANTS We recruited volunteers (N=12) with SCI and spasticity. One subject, a paraplegic man, dropped out of the study because of an unrelated cause. Eleven subjects completed the study; all subjects were men with an average age of 42.36 years; 6 of them were persons with tetraplegia, and 5 were persons with paraplegia. INTERVENTIONS The subjects received either nabilone or placebo during the first 4-week period (0.5mg once a day with option to increase to 0.5mg twice a day), and then outcome measures were assessed. After a 2-week washout, subjects were crossed over to the opposite arm. MAIN OUTCOME MEASURES The primary outcome was the Ashworth Scale for spasticity in the most involved muscle group, in either the upper or lower extremities, chosen by the subject and clinician. The secondary outcomes included the sum of the Ashworth Scale in 8 muscle groups of each side of the body measured by the clinician; Spasm Frequency Scale and visual analog scale, reported by the subject; Wartenberg Pendulum Test, in order to quantify severity of spasticity; and the Clinicians and Subjects Global Impression of Change. RESULTS One subject dropped out during the placebo arm because of an unrelated urinary stricture, and 11 subjects completed the study. There was a significant decrease on active treatment for the Ashworth in the most involved muscle (mean difference +/- SD, .909+/-.85; P=.003), as well as the total Ashworth score (P=.001). There was no significant difference in other measures. Side effects were mild and tolerable. CONCLUSIONS Nabilone may be beneficial to reduce spasticity in people with SCI. We recommend a larger trial with a more prolonged treatment period and an option to slowly increase the dosage further.

On modeling center of foot pressure distortion through a medium

The center of foot pressure (COP) is a commonly used output measure of the postural control system as it is indicative of the systems stability. A dense piece of foam, i.e., a sponge, can be used to emulate random environmental conditions that distort the ground reaction forces received and interpreted by the cutaneous sensors in the feet; thus introducing uncertainty into the control system. In this paper, the density and size of the sponge was selected such that a subjects weight did not cause full compression. In general, the COP is measured from the bottom of the sponge. As the sponge is used to distort ground reaction forces, it is reasonable then to assume that the COP signal would also be distorted. The use of other sensory information to identify state of balance, and compute necessary balance adjustments, is therefore required. In addition to a sponge, many different types of specialized footwear and inserts are used for people with peripheral neuropathy, such as diabetics. However, it is difficult to design diabetic footwear without a better understanding of the mechanical and physiological effects that different surfaces typical of outdoor terrains, such as a sponge, which cannot be predicted without the sense of the foot, have on balance. Therefore, the goal of this study was to investigate the change of the COP signal from the top and bottom of the sponge. Portable force sensing mats from Vista Medical were used to obtain the COP from the top and bottom of the sponge. The COP measured on the bottom of the sponge is not the same as the COP measured on the top, particularly in the medial-lateral direction. Several linear and nonlinear models were used to identify the unknown plant; i.e., the sponge. Overall, the nonlinear neural network method had superior performance when compared with the linear models. Thus, the results indicate that the signals from the top and bottom of the sponge are in fact different, and furthermore, they are nonlinearly related. A nonlinear mathematical model is proposed which describes COP distortion through a medium such as a sponge. Although the values for the model parameters determined were for a particular sponge, this study suggests that a neural network plant identification model may be applied to any medium other than the sponge; the information can then be used to determine how the balance control model is affected given the sensory information received.

Application of feedforward backpropagation neural network to center of mass estimation for use in a clinical environment

In this paper, a feedforward backpropagation neural network model is developed to estimate the resultant center of mass (COM) trajectory in the sagittal plane. The COM trajectory is one of the primary outputs of the human postural control system, and is indicative of the systems stability. However, currently available systems that calculate the COM are not clinically available, making it difficult to widely assess balance problems. The inputs to the neural network model developed in this paper are obtained using equipment that is inexpensive, easy to use and portable. The results indicate that neural network models show promising results for obtaining COM estimates that have clinical applications.

Store-and-Feedforward Adaptive Gaming System for Hand-Finger Motion Tracking in Telerehabilitation

This paper presents a telerehabilitation system that encompasses a webcam and store-and-feedforward adaptive gaming system for tracking finger-hand movement of patients during local and remote therapy sessions. Gaming-event signals and webcam images are recorded as part of a gaming session and then forwarded to an online healthcare content management system (CMS) that separates incoming information into individual patient records. The CMS makes it possible for clinicians to log in remotely and review gathered data using online reports that are provided to help with signal and image analysis using various numerical measures and plotting functions. Signals from a 6 degree-of-freedom magnetic motion tracking system provide a basis for video-game sprite control. The MMT provides a path for motion signals between common objects manipulated by a patient and a computer game. During a therapy session, a webcam that captures images of the hand together with a number of performance metrics provides insight into the quality, efficiency, and skill of a patient.

Biologically-Inspired Adaptive Learning: A Near Set Approach

The problem considered in this paper is how learning by machines can be influenced beneficially by various forms of learning by biological organisms. The solution to this problem is partially solved by considering considering a model of perception that is at the level of classes in a partition defined by a particular equivalence relation in an approximation space. This form of perception provides a basis for adaptive learning that has surprising acuity. Viewing approximation spaces as the formal counterpart of perception was suggested by Ewa Ortowska in 1982. This view of perception grew out the discovery of rough sets by Zdzistaw Pawlak during the early 1980s. The particular model of perception that underlies biologically-inspired learning is based on a near set approach, which considers classes of organisms with similar behaviours. In this paper, the focus is on learning by tropical fish called glowlight tetra (Hemigarmmus erythrozonus). Ethology (study of the comparative behaviour of organisms), in particular, provides a basis for the design of an artificial ecosystem useful in simulating the behaviour of fish. The contribution of this paper is a complete framework for an ethology-based study of adaptive learning defined in the context of nearness approximation spaces.

Center of mass approximation and prediction as a function of body acceleration

In order to maintain postural stability, the central nervous system must maintain equilibrium of the total center of body mass (COM) in relation to its base of support. Thus, the trajectory of the COM provides an important measure of postural stability. Three different models were developed to estimate the COM and the results tested on 16 subjects: namely a neural network, an adaptive fuzzy interface system and a hybrid genetic algorithm sum-of-sines model. The inputs to the models were acquired via two accelerometers, one representing the trunk segment placed on T2 and the second representing the limb segment placed on the shank below the knee joint. The portability, ease of use and low cost (compared with video motion analysis systems) of the accelerometers increases the range of clinics to which the system will be available. The subjects performed a multisegmental movement task on fixed and foam surfaces, thus covering a relatively wide dynamic scope. The results are encouraging for obtaining COM estimates that have clinical applications; the genetic sum-of-sines model was found to be superior when compared to the other two models.

Center of Mass Approximation During Walking as a Function of Trunk and Swing Leg Acceleration

The 3D center of body mass (COM) trajectory provides us with a measure of movement performance and level of stability while walking. As an alternative to directly calculating the COM from motion trajectories and anthropometric data, we propose developing models to estimate the COM trajectory during walking on irregular surfaces. The inputs to the models were acquired via two accelerometers, one representing the trunk segment placed on T2 and the second representing the swing leg placed on the lateral malleolus. The subjects walked on a fixed surface and encountered an uneven, irregular surface, causing instability in the balance system. The results were encouraging, providing an estimate of the COM trajectory with a low error of 4.17plusmn1.94%. The reasonable accuracy, portability, ease of use and low cost (compared with video motion analysis systems) of the accelerometers increases the range of clinical applications of the proposed method