In my opinion unexpected perturbations during walking will help balance and prevent falls much better than Kinect or regular Conventional
Balance Training. And I get a lot of perturbations walking thru crowded bars to the bathroom. But then I know nothing since I'm not medically trained. Is your doctor? Does s/he have 100% recovery protocols? No? Then not medically trained enough.
Kinect-based rapid movement training to improve balance recovery for stroke fall prevention: a randomized controlled trial
Journal of NeuroEngineering and Rehabilitation volume 18, Article number: 150 (2021)
Abstract
Background
Falls are more prevalent in stroke survivors than age-matched healthy older adults because of their functional impairment. Rapid balance recovery reaction with adequate range-of-motion and fast response and movement time are crucial to minimize fall risk and prevent serious injurious falls when postural disturbances occur. A Kinect-based Rapid Movement Training (RMT) program was developed to provide real-time feedback to promote faster and larger arm reaching and leg stepping distances toward targets in 22 different directions.
Objective
To evaluate the effectiveness of the interactive RMT and Conventional Balance Training (CBT) on chronic stroke survivors’ overall balance and balance recovery reaction.
Methods
In this assessor-blinded randomized controlled trial, chronic stroke survivors were randomized to receive twenty training sessions (60-min each) of either RMT or CBT. Pre- and post-training assessments included clinical tests, as well as kinematic measurements and electromyography during simulated forward fall through a “lean-and-release” perturbation system.
Results
Thirty participants were recruited (RMT = 16, CBT = 14). RMT led to significant improvement in balance control (Berg Balance Scale: pre = 49.13, post = 52.75; P = .001), gait control (Timed-Up-and-Go Test: pre = 14.66 s, post = 12.62 s; P = .011), and motor functions (Fugl-Meyer Assessment of Motor Recovery: pre = 60.63, post = 65.19; P = .015), which matched the effectiveness of CBT. Both groups preferred to use their non-paretic leg to take the initial step to restore stability, and their stepping leg’s rectus femoris reacted significantly faster post-training (P = .036).
Conclusion
The RMT was as effective as conventional balance training to provide beneficial effects on chronic stroke survivors’ overall balance, motor function and improving balance recovery with faster muscle response.
Trial registration: The study was registered at Clinicaltrials.gov (https://clinicaltrials.gov/ct2/show/NCT03183635, NCT03183635) on 12 June 2017.
Introduction
Telerehabilitation and interactive body motion detection technology using Kinect and Wii Fit have become more popular [1, 2]. The COVID-19 is a global pandemic started in the end of 2019 and is still ongoing at the preparation of this paper. Stroke survivors had limited access to the outpatient rehabilitation therapy during the COVID-19 pandemic. Telerehabilitation or computer-assisted training system using body motion detection technology can be applied for stroke rehabilitation during the COVID-19 pandemic by minimizing face-to-face interaction and the risk of infection. A recently published study in 2019 examined the effectiveness of an invention program which aimed to improve arm motor function in stroke survivors through 36 therapy sessions (70 min each) [1]. The program consisted of exercises, functional games, and stroke education. Their results showed home-based telerehabilitation was as effective as in-clinic rehabilitation and had significant improvements in arm motor function. Balance control and fall prevention are another important rehabilitation programs for stroke survivors. Healthcare professionals and stroke survivors are interested in the feasibility of using these computer-assisted training systems for balance training, and they would like to know the effectiveness when compared with conventional balance training (CBT) in the rehabilitation center.
Fall is more common in stroke survivors than age-matched healthy older adults [3]. Previous studies have reported that disturbances in muscle coordination [4] and between-limb synchronization [5], spasticity, and loss in dexterity from stroke [6] are the primary causes of falls [7] in adults with stroke, leading to an increased financial burden to the individual and the society [8]. To prevent falling and the severe injuries that may follow, it is vital to train the stroke survivors’ ability to maintain or recover their balance [9]. When experiencing postural disturbance, a person can perform a successful balance recovery by controlling the position and the motion of his/her body’s center-of-mass (COM) over the base-of-support (BOS) with mainly one of two strategies: fixed-support and change-in-support reactions. Fixed-support reactions rely on the generation of muscle torques from the ankle and/or hip joints to slow down or stop the movement of COM without changing the location and size of the BOS. In the change-in-support reactions, it involves rapid stepping and/or reaching-to-grasp a nearby object to increase the size of the BOS. Change-in support reactions can be very effective in providing the stabilizing force needed to restore postural balance when there is an unpredictable balance perturbation as they can arrest a much larger and faster COM motion [10]. Successful change-in-support balance recovery reactions require both fast response time (i.e. movement completion time) for rapid movement and adequate range-of-motion to prevent falls [7, 11]. These reactions are executed more rapidly than volitional limb movements but are often impaired in stroke survivors, researchers were investigated in reactive stepping related to falls in stroke rehabilitation [12].
Stroke survivors generally have a more prolonged reaction latency, slower movement speed, and less effective response to the external perturbation compared to non-stroke adults [13]. Specifically, it has been found that stroke survivors have delayed paretic muscle onset latencies compared to healthy older adults [14] and their own non-paretic limb in simulated falls. Previous studies have found that agility and perturbation training can effectively improve stroke survivors’ balance recovery reaction latency. Other than improving step reaction time, training can lower the prevalence of the stroke survivor’s fall incidents compared to conventional balance training (CBT) [14]. Similarly, Reactive Balance Training with fast and functional movements are beneficial for persons with fall risk [15, 16]. As a result, task-specific training could train faster response and movement times in chronic stroke survivors, and it is one of the potential training principles in fall prevention.
Balance exercises are typically prescribed by physiotherapists to chronic stroke survivors in clinical settings to reduce their fall risks [17, 18]. These exercises are usually emphasized in improving the range-of-motion and muscle strength in the paretic limbs to restore their physical ability. Moreover, similar to other stroke functional rehabilitation programs, the balance exercises require intensive and repetitive task-specific practice [19, 20]. Enormous social, emotional, health, and financial burden and strains are laid on the informal caregivers (spouse, children, siblings, or other family relations) as these caregivers are often called upon to administering exercises at home or sending the stroke survivors to rehabilitation centers [21]. Healthcare professionals (e.g., physiotherapists and occupational therapists), particularly those within the public healthcare system, may experience burn-out and stress, as they are often overwhelmed with the workload of stroke and other types of rehabilitations [22]. Telerehabilitation and interactive body motion detection technology using Kinect are having the potential to reduce the further increase of workload to the healthcare professionals. The system can provide guidance to users directly during the training and have training reports after the intervention for the clinical professional to follow up with each case.
Our study aimed to develop a Kinect-based guided balance training system for stroke rehabilitation and has the potential for home-based telerehabilitation. With the advancement of depth camera and body tracking technology and algorithm to identify body joint movements in 3D space (e.g. Realsense, Microsoft Kinect and Microsoft Azure Kinect, Wii Fit), many rehabilitation centers have adapted these affordable 3D motion capture technology to enhance their clinical practice [2, 13]. These technologies are being used to make rehabilitation methods more personalized, easy-to-use, and interactive than repetitive and high-intensity training in the traditional setting. Kinect-based physical therapy systems from a few established companies have obtained FDA 510(k) clearance (i.e. the medical device is safe and effective, and the device can be marketed for clinical use and is substantially equivalent to a legally marketed device), and previous studies have shown that Kinect and other technology-based systems could be used for both the training and assessment of reaching, gait analysis, stepping and balance [25,26,27]. They showed that technology-based rehabilitation was a suitable method for fall risk assessment and training to minimize fall risk. Previous studies utilized depth and tracking camera technology and virtual reality for balance and gait analysis purposes; however, their effectiveness has not been assessed for intensive balance training on chronic stroke survivors in a large-scale study nor in a randomised controlled trial [25,26,27,28,29,30,31,32,33,34,35,36,37]. Furthermore, previous studies did not assess its feasibility to improve the biomechanics and effectiveness of balance recovery reaction [10].
This study proposed a novel, task-specific Rapid Movement Training (RMT) program that would require stroke survivors to do rapid movement to reach out a target in different directions to minic the users can quickly reach an objects by hand or make a quick step to restore their balance during a fall incidence to minimize the severity of injury. Arm could reach forward and laterally, and foot could step forward, backward and laterally. We have considered all possible directions with both arms and legs with a total 22 directions. A virtual target was suddenly appeared to indicate different directions on a screen with his affected/unaffected arm/leg. By providing real-time visual feedback, this training was designed to promote both faster movement onset and completion time, as well as larger range-of-motion, to restore the users’ motor functions in balance control and recovery. It was designed to have an easy setup with a depth-sensing camera (Kinect), a mini PC/ laptop and a TV/computer screen, without the need to put any sensor on the users. We hypothesized that RMT could improve stroke survivor’s overall balance and balance recovery performance after training for 20 sessions with the system.
In this study, we aimed to investigate the RMT effectiveness after the 20-session training and compared with conventional balance training (CBT) on survivors with chronic stroke (> 1 year post-stroke. We used “lean-and-release” assessment [38] to provide a simulated falling environment; thus, we can measure the impact of RMT and CBT trainings had on the stroke survivors’ balance recovery reactions. We evaluated their response time on their foot on how they restore their balance during a sudden stimulated fall and their muscle response on 8 major lower limb muscles [i.e. kinematics of the body and electromyography (EMG) of leg muscles] and the clinical assessment scores related to balance. Our study is the only study known to have investigated the effects of both arms and legs with rapid movement training, and used the “lean-and-release” assessment to investigate the reaction and muscle response before and after the training on persons after stroke.
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