Tung-Wu Lu

Effects of Virtual Reality-Augmented Balance Training on Sensory Organization and Attentional Demand for Postural Control in People With Parkinson Disease: A Randomized Controlled Trial

Background There is a lack of studies related to virtual reality (VR)–augmented balance training on postural control in people with Parkinson disease (PD). Objective The purposes of this study were: (1) to examine the effects of VR-augmented balance training on the sensory integration of postural control under varying attentional demands and (2) to compare the results with those of a conventional balance training (CB) group and an untrained control group. Design A longitudinal, randomized controlled trial was used. Setting The intervention was conducted in the clinic, and the assessment was performed in a research laboratory. Patients Forty-two people with PD (Hoehn and Yahr stages II–III) were recruited. Intervention The VR and CB groups received a 6-week balance training program. Measurements The sensory organization tests (SOTs) of computerized posturography with single- and dual-task conditions were conducted prior to training, after training, and at follow-up. Equilibrium scores, sensory ratios, and verbal reaction times (VRTs) were recorded. Results There were no significant differences in equilibrium scores or VRTs between the VR and CB groups. However, the equilibrium scores in SOT-6 (ie, unreliable vision and somatosensation) of the VR group increased significantly more than that of the control group after training. The equilibrium scores in SOT-5 (ie, unreliable somatosensation with eyes closed) of the CB group also increased significantly more than that of the control group after training. Limitations The functional significance of the improvements in equilibrium scores in the SOTs was not known, and the sample size was small. Conclusions Both VR and CB training improved sensory integration for postural control in people with PD, especially when they were deprived of sensory redundancy. However, the attentional demand for postural control was not changed after either VR or CB training.

Effects of severity of degeneration on gait patterns in patients with medial knee osteoarthritis

This study tested the hypothesis that patients with mild and severe medial knee osteoarthritis (OA) adopt different compensatory gait patterns to unload the deseased knee, in not only the frontal plane but also the sagittal plane. Fifteen patients with mild and 15 with severe bilateral medial knee OA, and 15 normal controls walked while the kinematic and kinetic data were measured. Compared to the normal group, both OA groups had significantly greater pelvic anterior tilt, swing-pelvis list, smaller standing knee abduction, as well as smaller standing hip flexor and knee extensor moments during stance. The severe group also had greater hip abduction, knee extension and ankle plantarflexion. The mild group successfully reduced the extensor moment and maintained normal abductor moment at the diseased knee mainly through listing and anterior tilting the pelvis. With extra compensatory changes at other joints and increased hip abductor moment, the severe group successfully reduced the knee extensor moment but failed to reduce the abductor moment. These results suggest that, apart from training of the knee muscles, training of the hip muscles and pelvic control are essential in the rehabilitative intervention of patients with knee OA, especially for more severe patients.

In vivo three-dimensional kinematics of the normal knee during active extension under unloaded and loaded conditions using single-plane fluoroscopy

Measurement of the changes of the three-dimensional (3D) motion and surface kinematics of the knee under different external loading conditions is essential for the understanding and evaluation of the function of the joint, as well as for relevant clinical applications. Knee extension exercise (KEE) has been applied extensively in the rehabilitation programs of patients with various knee disorders. This study measured the 3D knee kinematics of eight normal subjects during active knee extension for unloaded and loaded conditions using a voxel-based method for the registration of fluoroscopic images with CT bone data. The knee kinematics during unloaded conditions were found to be similar to previous findings. A mass of 5 kg at the ankle did not affect the joint angles but significantly altered the lateral contact positions during knee extension, especially at knee flexion angles higher than 75 degrees, and also reduced the asymmetry of the surface kinematics between the medial and lateral condyles. The results of the current study may be useful for knee replacement design and for developing guidelines for the use of KEEs for the rehabilitation of patients with knee disorders.

Age and height effects on the center of mass and center of pressure inclination angles during obstacle-crossing

Tripping over obstacles has been reported as one of the most frequent causes of falls in the elderly. Maintenance of the bodys balance and precise swing foot control is essential for successful obstacle-crossing. The aim of this study was thus to investigate the height and age effects on the center of mass (COM) and center of pressure (COP) inclination angles and angular velocities during obstacle-crossing. Ten healthy young and 15 healthy older adults were recruited to walk and cross obstacles of heights of 10%, 20% and 30% of their leg lengths. The COM and COP position data were calculated using data measured from a three-dimensional (3D) motion analysis system and forceplates. Smaller medial COM-COP inclination angles were found in the older group, suggesting that the neuromusculoskeletal system may have more room to control the swing foot with sufficient foot clearance. Decreased inclination angles with increasing obstacle height suggest that the subjects tended to keep their COM position close to the COP position to increase the bodys stability. Greater anterior inclination angular velocities were found in the older group to maintain the same inclination angles as the young. Not only inclination angles, but also COM-COP angular velocity, were useful for assessing ones ability to control the bodys dynamic stability.

A volumetric model-based 2D to 3D registration method for measuring kinematics of natural knees with single-plane fluoroscopy.

PURPOSE Accurate measurement of the three-dimensional (3D) rigid body and surface kinematics of the natural human knee is essential for many clinical applications. Existing techniques are limited either in their accuracy or lack more realistic experimental evaluation of the measurement errors. The purposes of the study were to develop a volumetric model-based 2D to 3D registration method, called the weighted edge-matching score (WEMS) method, for measuring natural knee kinematics with single-plane fluoroscopy to determine experimentally the measurement errors and to compare its performance with that of pattern intensity (PI) and gradient difference (GD) methods. METHODS The WEMS method gives higher priority to matching of longer edges of the digitally reconstructed radiograph and fluoroscopic images. The measurement errors of the methods were evaluated based on a human cadaveric knee at 11 flexion positions. RESULTS The accuracy of the WEMS method was determined experimentally to be less than 0.77 mm for the in-plane translations, 3.06 mm for out-of-plane translation, and 1.13 degrees for all rotations, which is better than that of the PI and GD methods. CONCLUSIONS A new volumetric model-based 2D to 3D registration method has been developed for measuring 3D in vivo kinematics of natural knee joints with single-plane fluoroscopy. With the equipment used in the current study, the accuracy of the WEMS method is considered acceptable for the measurement of the 3D kinematics of the natural knee in clinical applications.

A method for estimating subject-specific body segment inertial parameters in human movement analysis.

An optimization-based, non-invasive, radiation-free method was developed for estimating subject-specific body segment inertial properties (BSIPs) using a motion capture system and two forceplates. The method works with accurate descriptions of the geometry of the body segments, subject-specific center of pressure (COP) and kinematic data captured during stationary standing, and an optimization procedure. Twelve healthy subjects performed stationary standing in different postures, level walking and squatting while kinematic and forceplate data were measured. The performance of the current method was compared to three commonly used predictive methods in terms of the errors of the calculated ground reaction force, COP and joint moments using the corresponding predicted BSIPs. The current method was found to be capable of producing estimates of subject-specific BSIPs that predicted accurately the important variables in human motion analysis during static and dynamic activities. With the differences in the BSIPs from the current method, the mean COP errors were less than 5 mm during stationary standing postures, while those from the existing comparative methods ranged from 11 to 25 mm. During dynamic activities, the existing methods gave COP errors three times as large as the proposed method, with up to 2.5 times RMSE in joint moments during walking. Being non-invasive and using standard motion laboratory equipment, the current method will be useful for routine clinical gait analysis and relevant clinical applications, particularly in patient populations that are not targeted by the existing predictive methods.

Enhancing the examiner's resisting force improves the reliability of manual muscle strength measurements: comparison of a new device with hand-held dynamometry.

OBJECTIVE To develop and determine the reliability of a newly -designed resistance-enhanced dynamometer for muscle strength measurement, and to test the hypothesis that enhancing the examiners resisting force improves the reliability of manual muscle strength measurements. DESIGN An intra-examiner, inter-examiner, intra-session and inter-session reliability study. SUBJECTS Twenty-five men (mean age 22.5 (standard deviation (SD) 1.7) years) were tested separately by 2 examiners using the resistance-enhanced dynamometer and a traditional hand-held dynamometer for an intra- and inter-examiner reliability study. Twenty-seven volunteers (mean age 22.1 (SD 0.8) years) were tested by a female examiner using the resistance-enhanced dynamometer for an intra- and inter-session reliability study. METHODS Maximum resisting forces for the knee flexors and extensors were measured using the resistance-enhanced dynamometer and the traditional hand-held dynamometer. RESULTS The traditional hand-held dynamometer had good intra-examiner reliability (intra-class correlation coefficient (ICC) = 0.79-0.93) but poor inter-examiner reliability (ICC = 0.11-0.28). The resistance-enhanced dynamo meter had very good intra-examiner (ICC = 0.91-0.94), inter-examiner (ICC = 0.98), intra-session (ICC = 0.93-0.99) and inter-session (ICC = 0.91-0.92) reliability. The resistance-enhanced dynamometer also had better inter-examiner agreement (smallest real difference (SRD) 9-16% for resistance-enhanced dynamometer, 21-43% for traditional hand-held dynamometer). CONCLUSION The resistance-enhanced dynamometer had very good reliability. Enhancing the examiners resisting force appeared to improve the reliability of manual muscle strength measurements. The resistance-enhanced dynamometer is useful for muscle strength measurements in clinical practice.

QUANTIFICATION OF THREE-DIMENSIONAL MOVEMENT OF SKIN MARKERS RELATIVE TO THE UNDERLYING BONES DURING FUNCTIONAL ACTIVITIES

Skin marker-based stereophotogrammetry has been widely used in the in vivo, noninvasive measurement of three-dimensional (3D) joint kinematics in many clinical applications. However, the measured poses of body segments are subject to errors called soft tissue artifacts (STA). No study has reported the unrestricted STA of markers on the thigh and shank in normal subjects during functional activities. The purpose of this study was to assess the 3D movement of skin markers relative to the underlying bones in normal subjects during functional activities using a noninvasive method based on the integration of 3D fluoroscopy and stereophotogrammetry. Generally, thigh markers had greater STA than shank ones and the STA of the markers were in nonlinear relationships with knee flexion angles. The STA of a marker also appeared to vary among subjects and were affected by activities. This suggests that correction of STA in human motion analysis may have to consider the multijoint nature of functional activities such as using a global compensation approach with individual anthropometric data. The results of the current study may be helpful for establishing guidelines of marker location selection and for developing STA compensation methods in human motion analysis.

Altered inter-joint coordination during walking in patients with total hip arthroplasty

The purpose of this study was to investigate the pattern and variability of inter-joint coordination for both surgical and non-surgical limbs during walking in patients before and after total hip arthroplasty (THA). Gait analysis of THA patients (n=20) and age-matched controls (n=10) was performed. THA patients were tested at pre-surgery, 6-week and 16-week post surgery. Continuous relative phase (CRP) was used to assess the inter-joint coordination pattern and variability. Variability of coordination for each subject was calculated over a gait cycle with the deviation phase (DP). Between-subject group differences in CRP patterns were examined with cross-correlation measures and root-mean-square (RMS) differences. The surgical limb demonstrated significantly higher DP values comparing to the controls at pre-surgery. Compared to pre-surgery, significant time effects on THA patients were detected in hip-knee DP values at 16-week post surgery for both limbs, and in knee-ankle DP values at 16-week post surgery for the surgical limb. RMS differences for hip-knee and knee-ankle CRP decreased gradually after surgery for both limbs. Cross-correlation measures were overall strong for CRP patterns of both limbs, with r(2) values greater than 0.94. Our results suggested that both hip-knee and knee-ankle coordination, especially the surgical limb, were altered with a higher variability to compromise the deteriorated hip joint. Asymmetric changes in accommodations and variability of bilateral lower extremities may contribute to the residual gait problems observed in THA patients. Therefore, clinical efforts may exert to improve the inter-joint coordination in this population.

Carryover effects alter FMRI statistical analysis in an acupuncture study.

Carryover effects can contaminate ON/OFF BOLD contrasts designated in an fMRI experiment. Yet, the ON/OFF contrasts are essential to facilitate statistical analysis based on the significance of contrast levels. Here, we conducted an fMRI experiment with acupuncture stimulation applied on ST42 acupoint as well as with tactile stimulation on its skin surface. Experiment consisted of three two-block acupuncture and one two-block tactile fMRI runs. Each block started with 26-sec OFF period followed by either 26-sec needle manipulation in the acupuncture runs or by scratching skin surface with sand paper in the tactile. To test if carryover effects could alter the BOLD contrasts, we analyzed different portions of fMRI data using GLM method. Our results showed analyses on different portions of acupuncture fMRI data gave significantly different results. Statistical parametric maps of group random effects resulted from the analysis on the very first fMRI trial formed the broadest coverage of the active brain areas. BOLD model time course also best explained the adjusted raw time course at peak active voxel (coefficient of determination = 0.88). Analyses on other portions of fMRI data only selected subset of the active brain areas delineated by the analysis on the very first data trial and the BOLD model only mildly accounted for the adjusted raw time courses. In tactile runs, results were more consistent across analyses. Therefore, in fMRI experiments with strong carryover effects, a single-block experimental design with multiple repetitions, separated by long enough periods of time, should be more suitable to extract task BOLD effects.