This just seems to confirm the recommendations written about by Margaret Yekutiel in the book, Sensory Re-Education of the Hand After Stroke in 2001. Better sensation leads to better motor recovery. What the hell will it take to write a simple fucking protocol on sensation and motor recovery? Is everyone in stroke that godammed lazy AND incompetent?
Short-Term Effect of Prosthesis Transforming Sensory Modalities on Walking in Stroke Patients with Hemiparesis
Dai Owaki,1 Yusuke Sekiguchi,2 Keita Honda,2 Akio Ishiguro,1 and Shin-ichi Izumi2,3
1Research Institute of Electrical Communication, Tohoku University, 2-2-1 Katahira, Aoba-ku, Sendai 980-8577, Japan
2Department of Physical Medicine and Rehabilitation, Tohoku University Graduate School of Medicine, 2-1 Seiryo-machi,
Sendai 980-8575, Japan
3Graduate School of Biomedical Engineering, Tohoku University, 2-1 Seiryo-machi, Sendai 980-8575, Japan
Correspondence should be addressed to Dai Owaki; owaki@riec.tohoku.ac.jp
Received 26 February 2016; Revised 23 June 2016; Accepted 3 July 2016
Academic Editor: Malgorzata Kossut
Copyright © 2016 Dai Owaki et al. This is an open access article distributed under the Creative Commons Attribution License,
which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Sensory impairments caused by neurological or physical disorders hamper kinesthesia, making rehabilitation difficult. In order to overcome this problem, we proposed and developed a novel biofeedback prosthesis called Auditory Foot for transforming sensory modalities, in which the sensor prosthesis transforms plantar sensations to auditory feedback signals. This study investigated
the short-term effect of the auditory feedback prosthesis on walking in stroke patients with hemiparesis. To evaluate the effect, we compared four conditions of auditory feedback from plantar sensors at the heel and fifth metatarsal. We found significant differences in the maximum hip extension angle and ankle plantar flexor moment on the affected side during the stance phase,
between conditions with and without auditory feedback signals. These results indicate that our sensory prosthesis could enhancewalking performance in stroke patients with hemiparesis, resulting in effective short-term rehabilitation.
1. Introduction
Rehabilitation includes physical therapy that enables longterm improvements through short-term efforts during daily interventions; it promotesmobility, improves functional ability,
and improves the quality of life. During physical therapy, kinesthesia, that is, motion perception that “I am moving,”
which is generated through the interaction dynamics between motor and sensory systems, that is, the “motor-sensory loop,” plays a crucial role in long-term motor learning as well as short-term motion generation. Thus, achievement of kinesthesia is essential for the rehabilitation of physical impairments and disabilities.However, sensory impairments caused by neurological or physical disorders hamper kinesthesia, making rehabilitation difficult. For the rehabilitation of sensory impairments, we proposed a novel biofeedback prosthesis [1] that transforms weak or deficient kinesthetic feedback into an alternative sensory modality. Fromthe viewpoint of systemengineering, sensory impairments in humans are considered as input failure in a system, leading to dysfunction of the entire system; the dysfunction can be corrected through repair or replacement
by another input component (Figure 1). In this situation,
enhancement of kinesthetic feedback or replacement with
another sensory modality allows intervention for the dysfunction
and enables reestablishment of motor-sensory loop
in patients undergoing rehabilitation.
Thus, the aim of this study was to verify the short-term
effect of the prosthesis in transforming sensorymodalities for
patients with sensory impairments. In particular, we focused
on an auditory feedback prosthesis that transformed plantar
sensation in walking rehabilitation [1] for the following four
reasons: plantar sensation, that is, the trajectory of the center
of pressure (COP) on the plantar region and the magnitude
of load, is an essential kinesthesia in walking [2–7]; in stroke
patients with hemiparesis, the range of COP trajectories
during walking is narrowed on the affected foot through
the change of gait [8]; the time required for the cognitive
resolution of auditory signals in the human brain (approximately
1ms) is shorter than that required for the resolution
of visual feedback signals (approximately 50–100ms); and
visual feedback systems, for example, a display showing visual
c of the proposed rehabilitation for sensory impairments: (a) from the viewpoint of system engineering, sensory
impairments are considered as input failure in a system, leading to dysfunction of the entire system. (b) The dysfunction can be corrected
through repair or replacement by another input component, where enhancement of kinesthetic feedback or replacement with another sensory
modality allows intervention for the dysfunction through reestablishment of motor-sensory loop.
feedback signals, constrains the posture of subjects, resulting
in limited rehabilitation spaces and approaches.
Previous studies have proposed auditory feedback systems
for walking rehabilitation; Miyake [10] proposed the
Walk-Mate system that utilizes the “mutual entrainment” of
the timing of footsteps of a subject and an agent modeled on a
computer system and showed that patients’ as well as healthy
subjects’ gait were restored to a stable and natural walking
state. Schauer and Mauritz [11] verified the timing effect of
auditory signals at touchdown during walking rehabilitation
for stroke patients. However, no previous studies focused on
transforming the spatiotemporal pattern of loading on a foot
to auditory feedback signals. Here, we applied our prosthesis,
called Auditory Foot [1], which transforms multipoint
cutaneous plantar sensations to auditory feedback signals
(Figure 2), to walking rehabilitation in stroke patients with
hemiparesis, and demonstrated the short-term effect of the
prosthesis on the intervention.
1Research Institute of Electrical Communication, Tohoku University, 2-2-1 Katahira, Aoba-ku, Sendai 980-8577, Japan
2Department of Physical Medicine and Rehabilitation, Tohoku University Graduate School of Medicine, 2-1 Seiryo-machi,
Sendai 980-8575, Japan
3Graduate School of Biomedical Engineering, Tohoku University, 2-1 Seiryo-machi, Sendai 980-8575, Japan
Correspondence should be addressed to Dai Owaki; owaki@riec.tohoku.ac.jp
Received 26 February 2016; Revised 23 June 2016; Accepted 3 July 2016
Academic Editor: Malgorzata Kossut
Copyright © 2016 Dai Owaki et al. This is an open access article distributed under the Creative Commons Attribution License,
which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Sensory impairments caused by neurological or physical disorders hamper kinesthesia, making rehabilitation difficult. In order to overcome this problem, we proposed and developed a novel biofeedback prosthesis called Auditory Foot for transforming sensory modalities, in which the sensor prosthesis transforms plantar sensations to auditory feedback signals. This study investigated
the short-term effect of the auditory feedback prosthesis on walking in stroke patients with hemiparesis. To evaluate the effect, we compared four conditions of auditory feedback from plantar sensors at the heel and fifth metatarsal. We found significant differences in the maximum hip extension angle and ankle plantar flexor moment on the affected side during the stance phase,
between conditions with and without auditory feedback signals. These results indicate that our sensory prosthesis could enhancewalking performance in stroke patients with hemiparesis, resulting in effective short-term rehabilitation.
1. Introduction
Rehabilitation includes physical therapy that enables longterm improvements through short-term efforts during daily interventions; it promotesmobility, improves functional ability,
and improves the quality of life. During physical therapy, kinesthesia, that is, motion perception that “I am moving,”
which is generated through the interaction dynamics between motor and sensory systems, that is, the “motor-sensory loop,” plays a crucial role in long-term motor learning as well as short-term motion generation. Thus, achievement of kinesthesia is essential for the rehabilitation of physical impairments and disabilities.However, sensory impairments caused by neurological or physical disorders hamper kinesthesia, making rehabilitation difficult. For the rehabilitation of sensory impairments, we proposed a novel biofeedback prosthesis [1] that transforms weak or deficient kinesthetic feedback into an alternative sensory modality. Fromthe viewpoint of systemengineering, sensory impairments in humans are considered as input failure in a system, leading to dysfunction of the entire system; the dysfunction can be corrected through repair or replacement
by another input component (Figure 1). In this situation,
enhancement of kinesthetic feedback or replacement with
another sensory modality allows intervention for the dysfunction
and enables reestablishment of motor-sensory loop
in patients undergoing rehabilitation.
Thus, the aim of this study was to verify the short-term
effect of the prosthesis in transforming sensorymodalities for
patients with sensory impairments. In particular, we focused
on an auditory feedback prosthesis that transformed plantar
sensation in walking rehabilitation [1] for the following four
reasons: plantar sensation, that is, the trajectory of the center
of pressure (COP) on the plantar region and the magnitude
of load, is an essential kinesthesia in walking [2–7]; in stroke
patients with hemiparesis, the range of COP trajectories
during walking is narrowed on the affected foot through
the change of gait [8]; the time required for the cognitive
resolution of auditory signals in the human brain (approximately
1ms) is shorter than that required for the resolution
of visual feedback signals (approximately 50–100ms); and
visual feedback systems, for example, a display showing visual
c of the proposed rehabilitation for sensory impairments: (a) from the viewpoint of system engineering, sensory
impairments are considered as input failure in a system, leading to dysfunction of the entire system. (b) The dysfunction can be corrected
through repair or replacement by another input component, where enhancement of kinesthetic feedback or replacement with another sensory
modality allows intervention for the dysfunction through reestablishment of motor-sensory loop.
feedback signals, constrains the posture of subjects, resulting
in limited rehabilitation spaces and approaches.
Previous studies have proposed auditory feedback systems
for walking rehabilitation; Miyake [10] proposed the
Walk-Mate system that utilizes the “mutual entrainment” of
the timing of footsteps of a subject and an agent modeled on a
computer system and showed that patients’ as well as healthy
subjects’ gait were restored to a stable and natural walking
state. Schauer and Mauritz [11] verified the timing effect of
auditory signals at touchdown during walking rehabilitation
for stroke patients. However, no previous studies focused on
transforming the spatiotemporal pattern of loading on a foot
to auditory feedback signals. Here, we applied our prosthesis,
called Auditory Foot [1], which transforms multipoint
cutaneous plantar sensations to auditory feedback signals
(Figure 2), to walking rehabilitation in stroke patients with
hemiparesis, and demonstrated the short-term effect of the
prosthesis on the intervention.
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