Wearable sensor-based biofeedback training for balance and gait in Parkinson’s disease: a pilot randomized controlled trial

Publication date: Available online 10 December 2016
Source:Archives of Physical Medicine and Rehabilitation
Author(s): Ilaria Carpinella, Davide Cattaneo, Gianluca Bonora, Thomas Bowman, Laura Martina, Angelo Montesano, Maurizio Ferrarin
ObjectivesTo analyze the feasibility and efficacy of a novel system (Gamepad) for biofeedback rehabilitation in Parkinson's Disease (PD). It is hypothesized that Gamepad-based training is feasible and provides larger improvements of balance and gait, compared to physiotherapy without biofeedback.DesignRandomized controlled trial.SettingsClinical rehabilitation gym.ParticipantsForty-two PD subjects randomized into Experimental (EG) and Control Group (CG).InterventionsBoth groups underwent a 20-session training for balance and gait. EG performed tailored functional tasks using Gamepad. The system, based on wearable inertial sensors, provided users with real-time visual and acoustic feedback about their movement during the exercises. CG underwent individually structured physiotherapy without feedback.Main Outcome MeasuresAssessments were performed by a blinded examiner pre-, post-intervention and at 1-month follow-up. Primary outcomes were Berg Balance Scale (BBS) and 10-meter Walk Test (10MWT). Secondary outcomes included instrumental stabilometric indexes and the Tele-healthcare Satisfaction Questionnaire.ResultsGamepad was well-accepted by participants. Statistically significant between-group differences in BBS suggested better balance performances of EG compared to CG both post-training [EG-CG mean (SD): 2.3 (3.4) points, p=0.047] and at follow-up [EG-CG: 2.7 (3.3) points, p=0.018]. Post-training stabilometric indexes showed that medio-lateral body sway during upright stance was significantly reduced in EG compared to CG [EG-CG: -1.6 (1.5) mm, p=0.003). No significant between-group differences were found in the other outcomes.ConclusionsGamepad-based training was feasible and superior to physiotherapy without feedback in improving BBS performance and retaining it for one month. Following training, 10MWT data were comparable between groups. Further development of the system is warranted to allow the autonomous use of Gamepad outside clinical settings, enhance gait improvements, and increase transfer of training effects to real-life contexts.



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