评估帕金森病患者步态特征和改善步态模式的可穿戴生物反馈装置:病例系列。

IF 5.2 2区 医学 Q1 ENGINEERING, BIOMEDICAL Journal of NeuroEngineering and Rehabilitation Pub Date : 2024-06-26 DOI:10.1186/s12984-024-01403-z
Thomas Bowman, Andrea Pergolini, Maria Chiara Carrozza, Tiziana Lencioni, Alberto Marzegan, Mario Meloni, Nicola Vitiello, Simona Crea, Davide Cattaneo
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引用次数: 0

摘要

简介帕金森病(PD)患者表现出异常步态,影响了他们的独立性和生活质量。在帕金森病引起的所有步态改变中,最常见的是步长缩短、步幅增大以及在加载反应和推离阶段地面反作用力减小。可穿戴生物反馈技术可提供与特定步态事件或步态表现相关的单模态或多模态刺激,从而提高受试者对步态障碍的认识。此外,步态康复技术的便携性和在临床和家庭环境中的适用性也提高了步态障碍管理的效率。可穿戴振动触觉双向界面(BI)是一种生物反馈设备,旨在实时提取步态特征,并在特定步态阶段同步向帕金森病受试者腰部提供定制的振动触觉刺激。本研究的目的是测量生物反馈仪对通常受典型缓动步态影响的步态参数的影响,并评估其在临床实践中的可用性和安全性:在本病例系列中,七名受试者(年龄:70.4 ± 8.1 岁;H&Y:2.7 ± 0.3)使用了 BI,并进行了 10 米步行道测试(10mWT)和两分钟步行测试(2MWT),作为训练前(Pre-trn)和训练后(Post-trn)评估。步态测试在有生物反馈刺激(Bf)和无生物反馈刺激(No-Bf)的情况下随机进行。所有受试者都进行了三次为期 40 分钟的训练,以便在行走活动中熟悉生物反馈技术。对步态参数(即步速、步长、步幅、行走距离、双支撑阶段)进行了描述性分析。采用双侧 Wilcoxon 符号检验来评估 Bf 和 No-Bf 评估之间的差异(p 结果):训练后,受试者的步速有所提高(Pre-trn_No-Bf:0.72(0.59,0.72) 米/秒;Post-trn_Bf:0.95(0.69,0.98) 米/秒;p = 0.043)和步长(Pre-trn_No-Bf:0.87(0.81,0.96)米;后-trn_Bf:1.05(0.96,1.14) 米;p = 0.023)。同样,受试者的步行距离也得到了改善(Pre-trn_No-Bf:97.5 (80.3,110.8) 米;Post-trn_Bf:118.5(99.3,129.3)米;p = 0.028),而在 2MWT 期间,双支撑阶段的持续时间缩短了(trn_No-Bf 前:29.7(26.8,31.7) %;trn_Bf 后:27.2(24.6,28.7) %;p = 0.018)。BI 对步频有立竿见影的效果(Pre-trn_No-Bf:108(103.8,116.7)步/分钟;Pre-trn_Bf:101.4(96.3,111.4)步/分钟;p = 0.028),以及trn后的步行距离(post-trn_No-Bf:112.5(97.5,124.5)米;Post-trn_Bf:118.5(99.3,129.3)米;p = 0.043)。五名受试者的 SUS 评分为 77.5 分,两名受试者的 SUS 评分为 80.3 分。在安全性方面,所有受试者都完成了方案,没有发生任何不良事件:结论:对于肢体残疾用户来说,BI 似乎是可用和安全的。在临床行走测试中测量的时间步态参数提供了详细的结果。使用 BI 的短期培训表明,帕金森病患者的步态模式有所改善。这项研究为今后将 BI 作为临床评估和康复工具整合到医院和偏远地区的帕金森病患者中提供了初步支持:研究方案已注册(DGDMF.VI/P/I.5.i.m.2/2019/1297),并获得了意大利卫生部医疗器械和药品服务总局以及伦巴第大区(意大利米兰)伦理委员会的批准。
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Wearable biofeedback device to assess gait features and improve gait pattern in people with parkinson's disease: a case series.

Introduction: People with Parkinson's Disease (PD) show abnormal gait patterns compromising their independence and quality of life. Among all gait alterations due to PD, reduced step length, increased cadence, and decreased ground-reaction force during the loading response and push-off phases are the most common. Wearable biofeedback technologies offer the possibility to provide correlated single or multi-modal stimuli associated with specific gait events or gait performance, hence promoting subjects' awareness of their gait disturbances. Moreover, the portability and applicability in clinical and home settings for gait rehabilitation increase the efficiency in the management of PD. The Wearable Vibrotactile Bidirectional Interface (BI) is a biofeedback device designed to extract gait features in real-time and deliver a customized vibrotactile stimulus at the waist of PD subjects synchronously with specific gait phases. The aims of this study were to measure the effect of the BI on gait parameters usually compromised by the typical bradykinetic gait and to assess its usability and safety in clinical practice.

Methods: In this case series, seven subjects (age: 70.4 ± 8.1 years; H&Y: 2.7 ± 0.3) used the BI and performed a test on a 10-meter walkway (10mWT) and a two-minute walk test (2MWT) as pre-training (Pre-trn) and post-training (Post-trn) assessments. Gait tests were executed in random order with (Bf) and without (No-Bf) the activation of the biofeedback stimulus. All subjects performed three training sessions of 40 min to familiarize themselves with the BI during walking activities. A descriptive analysis of gait parameters (i.e., gait speed, step length, cadence, walking distance, double-support phase) was carried out. The 2-sided Wilcoxon sign-test was used to assess differences between Bf and No-Bf assessments (p < 0.05).

Results: After training subjects improved gait speed (Pre-trn_No-Bf: 0.72(0.59,0.72) m/sec; Post-trn_Bf: 0.95(0.69,0.98) m/sec; p = 0.043) and step length (Pre-trn_No-Bf: 0.87(0.81,0.96) meters; Post-trn_Bf: 1.05(0.96,1.14) meters; p = 0.023) using the biofeedback during the 10mWT. Similarly, subjects' walking distance improved (Pre-trn_No-Bf: 97.5 (80.3,110.8) meters; Post-trn_Bf: 118.5(99.3,129.3) meters; p = 0.028) and the duration of the double-support phase decreased (Pre-trn_No-Bf: 29.7(26.8,31.7) %; Post-trn_Bf: 27.2(24.6,28.7) %; p = 0.018) during the 2MWT. An immediate effect of the BI was detected in cadence (Pre-trn_No-Bf: 108(103.8,116.7) step/min; Pre-trn_Bf: 101.4(96.3,111.4) step/min; p = 0.028) at Pre-trn, and in walking distance at Post-trn (Post-trn_No-Bf: 112.5(97.5,124.5) meters; Post-trn_Bf: 118.5(99.3,129.3) meters; p = 0.043). SUS scores were 77.5 in five subjects and 80.3 in two subjects. In terms of safety, all subjects completed the protocol without any adverse events.

Conclusion: The BI seems to be usable and safe for PD users. Temporal gait parameters have been measured during clinical walking tests providing detailed outcomes. A short period of training with the BI suggests improvements in the gait patterns of people with PD. This research serves as preliminary support for future integration of the BI as an instrument for clinical assessment and rehabilitation in people with PD, both in hospital and remote environments.

Trial registration: The study protocol was registered (DGDMF.VI/P/I.5.i.m.2/2019/1297) and approved by the General Directorate of Medical Devices and Pharmaceutical Service of the Italian Ministry of Health and by the ethics committee of the Lombardy region (Milan, Italy).

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来源期刊
Journal of NeuroEngineering and Rehabilitation
Journal of NeuroEngineering and Rehabilitation 工程技术-工程:生物医学
CiteScore
9.60
自引率
3.90%
发文量
122
审稿时长
24 months
期刊介绍: Journal of NeuroEngineering and Rehabilitation considers manuscripts on all aspects of research that result from cross-fertilization of the fields of neuroscience, biomedical engineering, and physical medicine & rehabilitation.
期刊最新文献
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