Shoulder rehabilitation exercises with kinematic biofeedback after arthroscopic rotator cuff repair: proposal for treatment (Preprint)

UNSTRUCTURED Background: The recovery of scapular and gleno-humeral physiological kinematic parameters, as well as sensorimotor control of movement, plays a primary role in the rehabilitation after arthroscopic rotator cuff repair. A highly customized rehabilitation approach is required to achieve this aim. Biofeedback can be a useful tool but there is poor evidence of its use in the rehabilitation after arthroscopic rotator cuff tear repair. Objective: This article describes an exercise-based program (ISEO-Program) for the recovery of scapular kinematics of patients arthroscopically treated for rotator cuff tear. Methods: The program integrates a conventional rehabilitation program with the use of the ISEO (INAIL Shoulder and Elbow Outpatient protocol), a motion analysis system based on inertial wearable sensors positioned over the thorax, scapula, humerus and forearm. ISEO can return a visual biofeedback of humerus angles over time or of the scapula-humeral coordination, with the possible overlap of patient-specific or asymptomatic subjects’ reference values. Results and conclusions: A set of 12 progressive exercises were defined, divided in four groups based on humerus and scapula movements, each comprising from two to four drills of increasing complexity. Exercises can require the use of ball, stick, rubber band and towels. For each drill, the neuromotor goal and type of visual biofeedback is specified.

Autonomic dysfunction in postoperative primitive neuroectodermal tumor of heart

We present a patient with a primitive neuroectodermal tumor arising from the right atrium who experienced multiple syncope episodes daily, which had first appeared 1 month after surgery. The symptoms continued to worsen over the course of chemotherapy, and the autonomic function test (AFT) was performed after the 14th chemotherapy cycle. The AFT revealed orthostatic hypotension and reduced baroreflex-dependent sympathetic reactivity. Physical counterpressure techniques were applied with a visual biofeedback intervention, and were found to be effective in reducing the syncope episodes.

Effect of an Intensified Combined Electromyography and Visual Feedback Training on Facial Grading in Patients With Post-paralytic Facial Synkinesis

Background: There is no current standard for facial synkinesis rehabilitation programs. The benefit and stability of effect of an intensified 10-day facial training combining electromyography and visual biofeedback training was evaluated.Methods: Fifty-four patients (77.8% female; median age: 49.5 years) with post-paralytic facial synkinesis (median time to onset of paralysis: 31.1 months) were included in retrospective longitudinal study between January 2013 and June 2016. Facial function was assesses at baseline (T0), first days of training (T1), last day of training (T2), and follow-up visit (T3) at a median time of 6 months later using the House-Brackmann (HB) facial nerve grading system, Stennert index (SI), Facial Nerve Grading System 2.0 (FNGS 2.0), and Sunnybrook Facial Grading System (SFGS). Pairwise comparisons between the time points with post-hoc Bonferroni correction were performed.Results: No significant changes of the gradings and subscores were seen between T0 and T1 (all p > 0.01). The 10-day combined and intensified feedback training between T1 and T2 improved facial symmetry and decreased synkinetic activity. Facial grading with the FNGS 2.0 or the SFGS were most suited to depict the training effect. FNGS 2.0, regional score, FNGS 2.0, synkinesis score, and FNGS 2.0 total score improved significantly (all p ≤ 0.0001). Both, the FNGS 2.0 and the SFGS showed the strongest improvement in the nasolabial fold/zygomatic and the oral region. Neither the age of the patient (r = 0.168; p = 0.224), the gender (r = 0.126; p = 0.363) nor the length of the interval between onset of the palsy and training start (r = 0.011; p = 0.886) correlated with the changes of the SFGS between T1 and T2. The results remained stable between T2 and T3 without any further significant change.Conclusion: Intensified daily combined electromyography and visual biofeedback training over 10 days was effective in patients with facial synkinesis and benefits were stable 6 months after therapy.

Visual Biofeedback Tool for Quantitative Pressure Monitoring in Lower-Limb Prosthetic Sockets

Obtaining a good socket fit is an iterative process dependent on the skill and experience of the prosthetist creating it, and requiring individualisation based on the size and shape. There is no standard measurement system used to aid prosthetic socket creation, despite the severe impacts on physical health and quality of life if one is ill-fitting. Pressure sensors embedded in a prosthetic socket were used to collect data at the socket-residuum interface. To choose an interpolation method, a 2D grid was used, with previously collected walking test pressure data, to simplify the sensor array with a border for extrapolation. Four multivariable interpolation methods were evaluated to create a colour map of the pressure data. Radial Basis Function interpolation was chosen as it produced a clear image with a graduated interpolation between data points and was used to create a colour map across the surface of a 3D prosthetic socket model. For the model to be accessible to clinical audiences, a desktop application was created using PyQt to view the model. The created application allowed for connection to the sensors via Bluetooth, with the pressure data updating the colour map on the 3D model in real-time. The created application shows the potential for a clinical product, however further development informed by feedback from rehabilitation clinicians and prosthesis users is required

Protocol for Sonospeech Cleft Pilot: A Pilot Randomised Control Trial of Ultrasound Visual Biofeedback Versus Standard Intervention for Children with Cleft Lip and Palate.

Background: Children with cleft lip and palate can continue to have problems producing clear speech after surgery. This can lead to social, emotional, and educational challenges. Typical treatment involves teaching children the correct tongue movements to produce speech sounds. This is known as articulation intervention. However, this intervention is challenging because the tongue is hidden from view and movements are difficult to see and describe. This pilot randomized control trial will try a new treatment, ultrasound visual biofeedback (U-VBF). Methods/Design: The Sonospeech project will enroll up to 40 children with cleft lip and palate aged 4;6 to 16 in a single-centre two-arm parallel group pilot randomized controlled trial with blinded assessors. Children will receive either six sessions of U-VBF or articulation intervention. The primary goals of this pilot are to determine recruitment/attrition rates; to measure pre-post follow up completion; and acceptability of the randomization and interventions to families.Discussion: Larger trials of speech interventions for children with cleft lip and palate are needed. This pilot/feasibility study will determine whether a larger randomized control trial comparing ultrasound and articulation interventions is feasible. Trial registration. ISRCTN, ISRCTN17441953. Registered 22 March 2021, http://isrctn.com/ISRCTN17441953. See Appendix 1 for all items.

Association between Anthropometric Variables, Sex, and Visual Biofeedback in Dynamic Postural Control Assessed on a Computerized Wobble Board

Anthropometrics and sex influence balance performances, and visual information can change anthropometrics’ relation and the postural sway. Therefore, the aim of the present study was to evaluate the effect of anthropometric characteristics, sex, and visual biofeedback and/or their interaction on a computerized wobble board. Twenty-seven (14 females, 13 males) young adults performed three 30-s double leg stance trials on a wobble board during two conditions: with visual and without visual biofeedback. Visual biofeedback improved (p = 0.010) balance on a wobble board with respect to the condition without visual biofeedback. Regardless of sex, no differences between conditions were found (p = 0.088). When investigating the effect of anthropometrics variables, sex, and their interactions on conditions, a significant main effect of the lower limb/height ratio, sex, and their interaction on the condition without visual biofeedback was found (p = 0.0008; R2 = 0.57). For the visual biofeedback condition, significant effects for sex and body mass (p = 0.0012; R2 = 0.43) and sex and whole-body moment of inertia (p = 0.0030; R2 = 0.39) were found. Results from the present study showed (1) visual biofeedback improved wobble board balance performance; (2) a significant main effect of lower limb/height ratio, sex, and their interaction on the wobble board performances without visual biofeedback emerged; (3) significant effects were found for sex and body mass and sex and moment of inertia in the visual biofeedback condition. Findings from the present study could have an impact on training and evaluations protocols, especially when several populations such as children, athletes, older adults and people with balance disorders are involved.

Therapeutic Effect of Tetrax based Visual Biofeedback Training for Balance Dysfunction in a Child with Ataxic Cerebral Palsy- A Case Report

Background and Purpose: The study investigated the effectiveness of Tetrax biofeedback training on balance of a child with ataxic Cerebral Palsy (ACP). Both Tetrax and conventional Occupational Therapy (COT) were performed. Each session of Tetrax and COT was carried out for 30 minutes, 3 times per week for 4 weeks. Primary outcome measure was Berg balance Scale (BBS) and fall index (FI). Secondary outcome measures were the stability index (ST) and the weight distribution index (WDI). Tetrax training has effectively aided in the recovery of balance when used in addition to the COT treatment, however further studies with larger populations are required for evidence of its effectiveness. Key words: Ataxia, Tetrax, Balance, Biofeedback, Rehabilitation.

Ultrasound Imaging as a Visual Biofeedback Tool in Rehabilitation: An Updated Systematic Review

Rehabilitative ultrasound imaging (RUSI) is used by physical therapists as a feedback tool for measuring changes in muscle morphology during therapeutic interventions such as motor control exercises (MCE). However, a structured overview of its efficacy is lacking. We aimed to systematically review the efficacy of RUSI for improving MCE programs compared with no feedback and other feedback methods. MEDLINE, PubMed, SCOPUS and Web of Science databases were searched for studies evaluating efficacy data of RUSI to improve muscular morphology, quality, and/or function of skeletal muscles and MCE success. Eleven studies analyzing RUSI feedback during MCE were included. Most studies showed acceptable methodological quality. Seven studies assessed abdominal wall muscles, one assessed pelvic floor muscles, one serratus anterior muscle, and two lumbar multifidi. Eight studies involved healthy subjects and three studies clinical populations. Eight studies assessed muscle thickness and pressure differences during MCE, two assessed the number of trials needed to successfully perform MCE, three assessed the retain success, seven assessed the muscle activity with electromyography and one assessed clinical severity outcomes. Visual RUSI feedback seems to be more effective than tactile and/or verbal biofeedback for improving MCE performance and retention success, but no differences with pressure unit biofeedback were found.