Rafael Escamilla and IBBME UofT

February 26, 2020 @ 12:00 pm – 12:30 pm
Red Seminar Room
Donnelly Building

Event Name: Graduate Seminar Series: Clinical Stream

Graduate Seminar Series for the Institute of Biomaterials and Biomedical Engineering (IBBME). This day is for clinical stream presenters.

Location: Red Seminar Room – Donnelly Building

Presentation Title: TITLE: Development and Assessment of a Wearable Biofeedback System to Improve Gait of Individuals with Lower-Limb Amputation
BACKGROUND: Lower-limb amputations (LLA) are associated with major rehabilitation challenges and lifelong mobility limitations [1]. Limb loss not only hinders aspects of motor control, but it also reduces sensory feedback information (e.g., foot sole ground contact information) [2]. Consequently, prosthetic users must rely on alternative senses and information, such as vision, hearing and residual limb/socket interaction to re-learn how to ambulate safely [3], to perform complex mobility tasks effectively [4], and to maintain balance [5],[6]. Technology-driven approaches, such as virtual reality, therapy-focused videogames and biofeedback (BFB) systems, are promising modalities for augmenting rehabilitation in the clinical facility and at home [7]–[9], taking advantage of motor learning strategies to potentially accelerate the learning process. A major benefit of BFB systems, and wearable systems in particular, is the ability to provide real-time, continuous or continual feedback to reinforce PT goals and good gait habits [10],[11]. Accordingly, the overarching AIM of this project is to develop and test a wearable vibrotactile biofeedback (BFB) system as a clinical tool for decreasing gait deviations and improving gait patterns in individuals with LLA. RESEARCH QUESTIONS: 1) Can a BFB system improve gait patterns (i.e., gait symmetry index -SI- and knee flexion angle at swing phase) in individuals with amputations exhibiting gait deviations? And 2) What are the secondary gait parameters (i.e., spatiotemporal, kinetics and kinematics parameters) improved/altered when BFB is incorporated into the walking scheme of prosthetic users?
METHODS: A BFB system was developed to track the selected gait parameters (i.e., SI and knee flexion angle), based on measurements of spatiotemporal events (i.e., heel strike and toe-off). A variety of algorithms were developed and used to determine if the gait parameters fall within the ‘desired’ ranges, and real-time vibrotactile feedback is provided accordingly to promote corrective actions. The study design involved ten (N=10) healthy subjects and six (N=6) prosthetic users. All participants were tested under three different conditions: i) No stimulation “NF”, ii) Single stimulation “S” (one motor vibrating at the front of the thigh), and iii) Multiple stimulation “M” (two motors vibrating, one at the front and one at the back of the thigh). In total, 40 trials per participant within a single 2.5-hour session. Each trial consisted of a 20 meters walking in straight line at self-selected speed, wearing the BFB system. SI and knee angle are measured in real-time during each trial (RQ1). For RQ2, a GaitRite Mat is utilized at each trial, and a Motion Capture System before and after each session to assess spatiotemporal, kinetics and kinematics parameters, respectively.
PRELIMINARY RESULTS: The study design is assessing how well participants are able to achieve target gait parameters, and which BFB strategies and algorithms most effectively achieve the results (most accurately achieve desired target value of gait parameter in the least amount of time). A statistically analysis (repeated measure of ANOVA with a post-hoc Tukey analysis) shown that this augmented training experience using the wearable BFB system (either with S or M stimulation) is sufficient to alter/improve gait performance (i.e., SI, and knee flexion angle) of healthy subjects and individuals with LLA.
CLINICAL RELEVANCE: To advancing global impact of childhood disability. The proposed research will provide insights for developing innovative interventions including an effective and user-friendly wearable BFB system to improve patient outcomes and, to decrease the burden of limb amputations and ultimately other physical and neurological disabilities. As prosthetic users are among the main clients of Holland Bloorview Hospital, they would benefit from such BFB device in diverse mobility conditions during the rehabilitation process. The system is also hoped to reduce rehabilitation time and cost by preventing further musculoskeletal problems due to an inadequate posture and gait.
Supervisor Name: Jan Andrysek
Year of Study: 4
Program of Study: PhD

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