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

2006 ◽  
Vol 18 (04) ◽  
pp. 190-197 ◽  
Author(s):  
MING-YIH LEE ◽  
CHIH-FENG LIN ◽  
KOK-SOON SOON
Keyword(s):  
Electrical Stimulation ◽  
Balance Control ◽  
Balance Performance ◽  
Performance Indices ◽  
Gait Performance ◽  
Time Index ◽  
Affected Side ◽  
Proprioceptive Neuromuscular Facilitation ◽  
Sound Side ◽  
Sensory Compensation

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.

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

2007 ◽  
Vol 31 (4) ◽  
pp. 342-352 ◽  
Author(s):  
Ming-Yih Lee ◽  
Chih-Feng Lin ◽  
Kok-Soon Soon
Keyword(s):  
Electrical Stimulation ◽  
Balance Control ◽  
Sensory Stimulation ◽  
Quiet Standing ◽  
Static Balance ◽  
Balance Performance ◽  
Foot Pressure ◽  
Gait Performance ◽  
Sound Side ◽  
Dynamic Gait

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.

scholarly journals Static Standing Trunk Sway Assessment in Amputees – Effects of Sub-Threshold Stimulation

2007 ◽  
Vol 4 (1) ◽  
pp. 37-40 ◽  
Author(s):  
L. Ming-Yih ◽  
S. Kok-Soon ◽  
L. Chih-Feng
Keyword(s):  
Electrical Stimulation ◽  
Postural Sway ◽  
Balance Control ◽  
Somatosensory System ◽  
Sensory Stimulation ◽  
Quiet Standing ◽  
Static Balance ◽  
Balance Performance ◽  
Standing Test ◽  
Postural Steadiness

Sub-threshold electrical stimulation can enhance the sensitivity of the human somatosensory system to improve the balance control capability of elderly was shown in recent rehabilitation articles. The purpose of this study was to evaluate the postural sway of trans-tibial amputees when performing single leg quiet standing on firm surface. Four unilateral trans-tibial amputees who consecutively wore prosthetics over 2 years were recruited in this study. Subjects performed single leg quiet standing trails with sub-threshold electrical stimulation applied at the quadriceps muscle during the trails. Spatial co-ordinates for the determination kinematic data (sway distance) of the center of mass (COM) on second sacral (S2) were collected using an ultrasound-based Zebris CMS-HS system. The single leg quiet standing test is measure considered to assess postural steadiness in a static position by a spatial measurement. The common notion is that a better postural steadiness, i.e. less postural sway, allows for longer time single leg quiet standing. However, there is lack of evidence how postural steadiness during single leg quiet standing changes over time. In this article, we hypothesized that the static balance of single leg quiet standing could be improved for providing proprioceptive neuromuscular facilitation using sub-sensory stimulation in amputees. To test this hypothesis, a computerized sub-threshold low-level electrical stimulation device was developed and proposed for clinical study. Experimental results show that reduction in all of the postural sway indices (constant time sway length, max sway distance and average sway distance) and increase in single leg support time index during single leg quiet standing by applying sub-sensory stimulation. The single leg quiet standing test findings suggest that sub-threshold electrical stimulation rehabilitation strategies may be effective in improving static balance performance for amputees.

scholarly journals The Role of Clinical and Instrumented Outcome Measures in Balance Control of Individuals with Multiple Sclerosis

2013 ◽  
Vol 2013 ◽  
pp. 1-10 ◽  
Author(s):  
Neeta Kanekar ◽  
Alexander S. Aruin
Keyword(s):  
Multiple Sclerosis ◽  
Balance Control ◽  
Clinical Test ◽  
Balance Performance ◽  
Performance Deficits ◽  
Clinical Scales ◽  
Balance Confidence ◽  
High Fatigue ◽  
Healthy Control ◽  
Stability Limits

Purpose. The aim of the study was to investigate differences in balance control between individuals with multiple sclerosis (MS) and healthy control subjects using clinical scales and instrumented measures of balance and determine relationships between balance measures, fatigue, and disability levels in individuals with MS with and without a history of falls.Method. Twelve individuals with MS and twelve healthy controls were evaluated using the Berg Balance and Activities-specific Balance Confidence Scales, Modified Clinical Test of Sensory Interaction on Balance, and Limits of Stability Tests as well as Fatigue Severity Scale and Barthel Index.Results. Mildly affected individuals with MS had significant balance performance deficits and poor balance confidence levels (P<0.05). MS group had higher sway velocities and diminished stability limits (P<0.05), significant sensory impairments, high fatigue and disability levels (P<0.05). Sway velocity was a significant predictor of balance performance and the ability to move towards stability limits for the MS group. For the MS-fallers group, those with lower disability levels had faster movement velocities and better balance performance.Conclusion. Implementation of both clinical and instrumented tests of balance is important for the planning and evaluation of treatment outcomes in balance rehabilitation of people with MS.

scholarly journals The underlying mechanisms of improved balance after short- and long-term training in older adults

2020 ◽  
Author(s):  
Leila Alizadehsaravi ◽  
Ruud Koster ◽  
Wouter Muijres ◽  
Huub Maas ◽  
Sjoerd M. Bruijn ◽  
...  
Keyword(s):  
Older Adults ◽  
Time Course ◽  
Balance Control ◽  
H Reflex ◽  
Balance Performance ◽  
Unipedal Standing ◽  
Ankle Muscles ◽  
Reflex Gain ◽  
And Performance

AbstractWith training older adults can improve balance control, but the time course and neural mechanisms underlying these improvements are unclear. We studied changes in balance (robustness and performance), as well as in H-reflex gains, paired reflex depression (PRD) and co-contraction duration (CCI) in ankle muscles after short-term (1 session; STT) and long-term (3 weeks; LTT) balance training in 22 older adults. Mediolateral balance robustness during unipedal stance (time to balance loss in unipedal standing on a robotic platform with decreasing rotational stiffness) improved (33%) after STT, with no further improvement after LTT. Balance performance (mean absolute mediolateral center of mass velocity) improved (18.75%) after STT in perturbed unipedal standing and after LTT (18.18%) in unperturbed unipedal standing. CCI of soleus/tibialis anterior did not change after STT but increased (16%) after LTT. H-reflex gain and PRD excitability did not change with training. Cross-correlations showed that H-reflex gains in unipedal stance were lower and CCI was higher in participants with a more robust balance at the last time-point measurement and, CCI was higher in participants with better balance performance at several time-points. However, changes in robustness and performance were uncorrelated with changes in CCI, H-reflex gain, or PRD. Our results indicate that balance robustness improves over a single session, while balance performance improves more gradually over multiple sessions. Changes in co-contraction and motor neuron excitability of ankle muscles are not exclusive causes of improved balance performance and robustness.

scholarly journals The effect of Estonian folk dance practice on static balance performance in young females

2020 ◽  
Vol 26 ◽  
pp. 61-71
Author(s):  
Leili Väisa ◽  
Jaan Ereline ◽  
Mati Pääsuke ◽  
Tatjana Kums
Keyword(s):  
Balance Control ◽  
Young Female ◽  
Support Surface ◽  
Movement Trajectory ◽  
Folk Dance ◽  
Balance Performance ◽  
Body Balance ◽  
Eyes Closed ◽  
Unstable Support ◽  
Static Body

The aim of the present study was to establish the changes that occur in dancers’ static body balance indicators during rest, in case of interfering factors and in stress condition. The sample consisted of 14 advanced female folk dancers at the age of 16–20 years. The participants’ static body balance was measured at the beginning (in the autumn) and at the end (in the spring) of the eight-month dancing period. Static body balance indicators were registered on a dynamographic platform within 30 seconds, standing on bipedal on stable and unstable support surface in eyes-open (EO) and eyes-closed (EC) conditions. The Flamingo test balance control, the balance control after spinning around and jumping tests were conducted only in EO condition. The following parameters were registered: the movements of the centre of pressure (CoP) in the anterior-posterior (AP) and medio-lateral (ML) dimensions; the length, speed and area of the trajectory. According to the study, folk dancers’ CoP movements in the AP and ML dimensions, measured in different conditions (EO, EC), on stable and unstable support surface, did not change significantly after the eight-month dancing practice. The young folk dancers’ static body balance, assessed by CoP movement trajectory, speed and area, improved considerably over the eight-month training period. Flamingo test results indicate that practising folk dance develops the young female folk dancers’ right and left side static stability equally. In the context of Estonian folk dance practice, including preparation for performing at dance festival, the young female folk dancers’ balance performance improved both in vestibular instability (spins, standing on unstable support surface and in EO condition) and fatigue (jumping test) conditions.

scholarly journals Functional Electrical Stimulation of Peroneal Muscles on Balance in Healthy Females

2021 ◽  
Vol 2021 ◽  
pp. 1-8
Author(s):  
Zoe A. Bamber ◽  
Wei Sun ◽  
Rhea S. Menon ◽  
Patrick C. Wheeler ◽  
Ian D. Swain ◽  
...  
Keyword(s):  
Electrical Stimulation ◽  
Functional Electrical Stimulation ◽  
Balance Control ◽  
Standing Balance ◽  
Treadmill Running ◽  
Eyes Closed ◽  
Significant Difference ◽  
Single Leg Stance ◽  
Eyes Open ◽  
Healthy Females

Balance improvement could contribute to ankle stability for the prevention of ankle sprains. Functional electrical stimulation (FES) is an effective way of augmenting muscle activity and improving balance. This study investigated the effect of FES of peroneal muscles on single-and double-leg balance. Fifteen healthy females (age=23.1±1.6 years, height=1.63±0.07 m, and weight=63.7±9.9 kg) performed single- and double-leg standing balance tests with eyes open and closed before and after 15-minute FES intervention during treadmill running at a comfortable, self-selected pace. FES of peroneal muscles was provided bilaterally, using an Odstock Dropped Foot Stimulator. The total excursion of the centre of pressure (COP) was calculated to assess the standing balance control ability. The total excursion of COP in single- and double-leg stance with eyes open reduced significantly after FES intervention by 14.7% (p<0.001) and 5.9% (p=0.031), respectively. The eyes-closed condition exhibited a 12.7% (p=0.002) reduction in single-leg stance but did not significantly change in double-leg stance (p>0.05). Limb preference did not account for balance postintervention. No significant difference in total excursion of COP was found between preferred and less preferred limbs with both visual conditions (p>0.05). FES of peroneal muscles improved standing balance control with eyes open in double-leg and single-leg stance and with eyes closed in double-leg stance. The improvements in balance control with FES treatment did not vary concerning limb preference.

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