Spinal cord injury (SCI) is associated with multiple motor problems leading to the alteration and... more Spinal cord injury (SCI) is associated with multiple motor problems leading to the alteration and limited adaptation in the walking and postural behavior. This review addresses recent findings on locomotor and postural adaptations after spinal cord injury. The adaptation of the locomotor behavior to behavioral goals and external constraints constitute important functional prerequisites in the recovery of locomotion after spinal cord injury. Functional prerequisites in locomotion include coping with changes in speed, slope obstacle, weight support, interaction with walking aids, energy consumption and attentional demands. Various treatment approaches such as locomotor training using body weight support (BWS) and functional electrical stimulation (FES) will be discussed, in the context of functional prerequisites necessary in the recovery of locomotion. Understanding locomotor and postural adaptations will lead to a better appreciation of the normal and dysfunctional mechanisms, and culminate eventually in the development of appropriate rehabilitation assessment and treatment strategies.
To test the efficacy and acceptance of a footdrop stimulator controlled by a tilt sensor. A nonra... more To test the efficacy and acceptance of a footdrop stimulator controlled by a tilt sensor. A nonrandomized, test-retest study of 26 subjects with footdrop of more than 1 year's duration, resulting from various central nervous system disorders, was performed in 4 centers for at least 3 months. Speed of walking in a straight line, speed around a figure of 8, and physiological cost index (PCI) were measured with and without the device. Hours/day and steps/day using the device were recorded. All but 2 subjects used the tilt sensor at home, rather than a foot switch. Walking speed increased by 15% after 3 months (n = 26; P < 0.01), 32% after 6 months (n = 16; P < 0.01), and 47% after 12 months (n = 8; P < 0.05), while PCI decreased. The number of steps taken per day of use increased significantly over time, and increased speed was directly correlated with usage. Walking speed also increased with the stimulator off, but to a lesser extent, indicating a training effect. Subject...
The task of stepping over obstacles is known to be particularly risky for persons post stroke. A ... more The task of stepping over obstacles is known to be particularly risky for persons post stroke. A kinetic analysis informing on the movement strategies used to ensure clearance of the leading limb over an obstacle is, however, lacking. We examined obstacle avoidance strategies in six community dwelling stroke survivors comparing the use of paretic and non-paretic limb as the leading limb for clearance over obstacles measuring 7.5% and 15% of their total leg length. Subjects were able to increase foot clearance height in both limbs in order to avoid the two obstacles. Obstacle clearance with the non-paretic limb leading was associated with positive knee flexor work that increased when stepping over each obstacle, thus showing a normal knee strategy that flexes both the knee and the hip for foot clearance. There was also slightly increased hip flexor contribution for non-paretic obstacle clearance that was the same for both obstacle heights. When the paretic limb led during obstacle clearance, there was also evidence of an increased knee flexor moment, suggesting a residual knee strategy, but it was less pronounced than for the non-paretic limb and was assisted by greater vertical hip elevation and additional positive hip flexor work that both gained greater importance with increased obstacle height. These findings suggest that rehabilitation should explore the ability to improve the residual, but less powerful, knee flexor strategy in the paretic limb in specific patients, with further promotion of a hip flexor and limb elevation strategy depending on patient deficits and obstacle height.
Journal of neuroengineering and rehabilitation, 2015
Rehabilitation interventions involving virtual reality (VR) technology have been developed for th... more Rehabilitation interventions involving virtual reality (VR) technology have been developed for the promotion of functional independence post stroke. A scoping review was performed to examine the efficacy of VR-based interventions on balance and mobility disorders post stroke. Twenty-four articles in the English language examining VR game-based interventions and outcomes directed at balance and mobility disorders were included. Various VR systems (customized and commercially available) were used as rehabilitation tools. Outcome measures included laboratory and clinical measures of balance and gait. Outcome measures of dynamic balance showed significant improvements following VR-based interventions as compared to other interventions. Further, it was observed that VR-based intervention may have favorable effects in improving walking speed and the ability to deal with environmental challenges, which may also facilitate independent community ambulation. VR-based therapy thus has the pote...
Conference proceedings : ... Annual International Conference of the IEEE Engineering in Medicine and Biology Society. IEEE Engineering in Medicine and Biology Society. Annual Conference, 2004
Virtual reality (VR) technology offers a new and safe way to increase practice time and provide t... more Virtual reality (VR) technology offers a new and safe way to increase practice time and provide the varied environments and constraints needed to optimize locomotor training. Our specific objectives are (1) to create a virtual environment (VE) coupled with a self-paced treadmill for locomotor training; (2) to compare temporal and distance measurements of gait during treadmill walking while looking at different scenarios of VE; and (3) to develop a protocol optimized for the training of locomotor disorders after stroke. A motorized treadmill was mounted on a six-degree-of-freedom motion platform. VEs were created using commercial software (SoftImage) and projected on a large screen, while system control was administered through the CAREN software (Motek BV). The instantaneous treadmill speed and scene progression were servo-controlled. Preliminary results show that healthy subjects are able to have full control of their own walking speed both on the treadmill and within the virtual s...
The Journal of neuroscience : the official journal of the Society for Neuroscience, 1995
The purpose of this study was to investigate the determinants of postural orientation by examinin... more The purpose of this study was to investigate the determinants of postural orientation by examining stance kinematics and kinetics at various interpaw distances. Four adult cats were trained to stand, unrestrained, on a force platform. Three-dimensional ground reaction forces and kinematics, as well as EMG activities, were recorded during stance at five different anteroposterior (AP) distances and two widths. Stance distance was varied by changing the distance between the four force plates mounted on the platform. All cats used a strategy of maintaining a constant horizontal orientation of the trunk and levering the limbs at the girdles while maintaining constant intralimb geometry to accommodate the changes in stance distance. The direction of the ground reaction forces covaried with the limb axes. As a result, the joint torques were conserved in the forelimb, and varied within small ranges in the hind. Increased tonic activity in the extensors of the back, the hip, and the ankle wa...
jou rn al homepage: www.elsevier.com /locate/humo v differently to different avoidance behaviors.... more jou rn al homepage: www.elsevier.com /locate/humo v differently to different avoidance behaviors. Such a measure can be beneficial in contrasting obstacle avoidance behaviors in different populations with mobility problems.
2009 Virtual Rehabilitation International Conference, 2009
ABSTRACT We have developed a novel cane device to be used in conjunction with a treadmill-based v... more ABSTRACT We have developed a novel cane device to be used in conjunction with a treadmill-based virtual reality (VR) locomotor system. The instrumentation of such a cane device is described and results examining its use and feasibility as a proof of principle are provided in this preliminary study involving five persons with stroke and 5 healthy participants. Average walking speeds with and without the cane are compared between the overground physical environment (PE) and the treadmill-based virtual environment (VE). Gait variability quantified as the % coefficient of variation (CV) for stride duration with and without the cane in the VE is also examined. Furthermore, the vertical loading forces exerted on the cane during level walking in the VE are reported and discussed. Results reveal that walking with the treadmill cane is feasible for use in both healthy and stroke populations. It is evident that people who normally rely on a walking cane benefit more from the instrumented cane than those people who normally walk unaided. This work represents the first instrumented cane for use with a treadmill-based locomotor system.
The ability to use haptic input through light contact to improve stability while walking post-str... more The ability to use haptic input through light contact to improve stability while walking post-stroke is investigated in a virtual environment (VE). Persons with stroke and healthy participants walk in a VE where they encounter changes in the slope of the support surface. Kinematic, kinetic, and electromyographic data analyses will be used to show the anticipatory postural adjustments made leading up to and after a transition to a sloped surface. Pilot testing shows that the transition to sloped surface is more challenging for the stroke participant tested, as compared to an age-matched control. Modifications to the current protocol will improve the feasibility of not only task completion by both healthy and neurologically impaired participants, but also the ability to use and evaluate the use of haptic information for stability while walking in a VE with slope changes.
To characterize navigation errors made by patients with the absence of vestibular function on one... more To characterize navigation errors made by patients with the absence of vestibular function on one side owing to surgical resection of an acoustic neuroma. Seventeen young (18-38 years) and 9 older healthy individuals (67-83 years), as well as 5 patients 2 to 20 months following surgery (37-61 years), were studied. They sidestepped laterally with eyes closed toward memorized targets located 1.25 m to their right or left. They stopped when they judged that they were in front of the target. The position of head and body markers was recorded in three dimensions with a six-camera Vicon 512 system (Oxford Metrics Ltd., Oxford, UK). Navigation errors were (1) distance error, the distance between the end target and a perpendicular line drawn from the sternum to the plane of targets, and (2) deviation, the angle formed between the line joining the initial and end targets and the line joining the subject&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s shoulders. Mean distance error was 20.9 +/- 22.0 degrees cm in patients, 29.6 +/- 30.3 cm in young healthy subjects, and -1.7 +/- 18.4 cm in older subjects (p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; .01 compared with young subjects). Mean deviation was symmetric and 8 degrees and -3 degrees in healthy young and older subjects, respectively. In contrast, patients had a significantly larger deviation when navigating toward the side of their lesion than the intact side (13 degrees +/- 9 degrees versus 3 degrees +/- 9 degrees; p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; .01). Our results suggest that patients with vestibular deficits have impaired ability to control body rotations when walking sideways without vision toward the side of their vestibular lesion.
To evaluate the benefits of a vestibular rehabilitation program (VRP) in the Montreal-Laval area.... more To evaluate the benefits of a vestibular rehabilitation program (VRP) in the Montreal-Laval area. The VRP was conceptualized by a panel of experts including otolaryngologists, physiotherapists, and researchers from McGill University and its teaching hospitals. From February 1999 to December 2001, 117 patients were seen, and 88 of them completed the VRP. The VRP has been established at the Jewish Rehabilitation Hospital in Laval, PQ, to provide specialized rehabilitation to clients suffering from vertigo, dizziness, and/or impaired balance owing to lesions or disorders of the vestibular system. Presence or absence of nystagmus or vertigo during the Dix-Hallpike test, Dizziness Handicap Inventory (DHI), and Dynamic Gait Index (DGI). Thirty-five patients with benign paroxysmal positional vertigo of the posterior canal were treated with canalith repositioning manoeuvres. All of the patients (100%) had absence of nystagmus or vertigo after one to four treatment sessions. Forty-six patients with vestibular deficits or dizziness-disequilibrium completed the VRP, which consisted mainly of individualized eye-head and balance home exercise programs. At the end of the VRP, there was a significant decrease in DHI score (31 vs 57; p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; .01) and a significant increase in DGI score (18.4 vs 22.6; p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; .01). A range of modest to major improvements was shown by comparing initial and discharge scores of patients who had completed vestibular rehabilitation. The VRP appears to be beneficial for patients with a variety of vestibular disorders. Further research is needed to continue optimizing vestibular rehabilitation.
This study investigated the postural strategies to adapt to uphill and downhill treadmill inclina... more This study investigated the postural strategies to adapt to uphill and downhill treadmill inclination (0, 5 and 10%) during walking and standing in eight healthy subjects. Increasing the treadmill grade from 0 to 10% induced an increasingly flexed posture of the hip, knee and ankle at initial foot contact as well as a progressive forward tilt of pelvis and trunk.
2011 International Conference on Virtual Rehabilitation, 2011
Abstract The ability to accurately judge distance and time to collision is an important perceptua... more Abstract The ability to accurately judge distance and time to collision is an important perceptual determinant in shaping obstacle circumvention strategies for functional locomotion. In addition, deficits in planning and execution, as well as biomechanical ...
Most daily occupations require the ability to perform two or more activities simultaneously (i.e.... more Most daily occupations require the ability to perform two or more activities simultaneously (i.e. dual tasking) while adapting to unexpected changes in the environment. When a person has neurological deficits, this ability is usually impaired. Moreover, recent evidence supports a relationship between executive function deficits and dual task performance. Most of the studies that examine the effect of dual tasking
Abstract The purpose of this study is to examine dual task performance during locomotion in a fun... more Abstract The purpose of this study is to examine dual task performance during locomotion in a functional virtual setting. A virtual reality-based paradigm was developed in order to achieve this goal. To date, four participants who had a stroke completed the study protocol ...
Balance and locomotion involve multi-sensory integration while meeting environmental demands. In ... more Balance and locomotion involve multi-sensory integration while meeting environmental demands. In addition, increased task complexity negatively affects postural control in aging and patient populations. The goal of this pilot study was to examine the effects of aging and cognitive load on the visual perception of vertical. Four young and 3 older individuals participated. Subjective visual vertical (SVV) performance deteriorated more
Gait and cognitive functions can deteriorate during dual tasking, especially in people with neuro... more Gait and cognitive functions can deteriorate during dual tasking, especially in people with neurological deficits. Most studies examining the simultaneous effects of dual tasking on motor and cognitive aspects were not performed in ecological environments. Using virtual reality technology, functional environments can be simulated to study dual tasking. The aims of this study were to test the feasibility of using a virtual functional environment for the examination of dual tasking and to determine the effects of dual tasking on gait parameters in people with stroke and age-matched controls who were healthy. This was a cross-sectional observational study. Twelve community-dwelling older adults with stroke and 10 age-matched older adults who were healthy participated in the study. Participants walked on a self-paced treadmill while viewing a virtual grocery aisle projected onto a screen placed in front of them. They were asked to walk through the aisle (single task) or to walk and select (&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot;shop for&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot;) items according to instructions delivered before or during walking (dual tasking). Overall, the stroke group walked slower than the control group in both conditions, whereas both groups walked faster overground than on the treadmill. The stroke group also showed larger variability in gait speed and shorter stride length than the control group. There was a general tendency to increase gait speed and stride length during dual-task conditions; however, a significant effect of dual tasking was found only in one dual-task condition for gait speed and stride duration variability. All participants were able to complete the task with minimal mistakes. The small size and heterogeneity of the sample were limitations of the study. It is feasible to use a functional virtual environment for investigation of dual tasking. Different gait strategies, including an increase or decrease in gait speed, can be used to cope with the increase in cognitive demands required for dual tasking.
Spinal cord injury (SCI) is associated with multiple motor problems leading to the alteration and... more Spinal cord injury (SCI) is associated with multiple motor problems leading to the alteration and limited adaptation in the walking and postural behavior. This review addresses recent findings on locomotor and postural adaptations after spinal cord injury. The adaptation of the locomotor behavior to behavioral goals and external constraints constitute important functional prerequisites in the recovery of locomotion after spinal cord injury. Functional prerequisites in locomotion include coping with changes in speed, slope obstacle, weight support, interaction with walking aids, energy consumption and attentional demands. Various treatment approaches such as locomotor training using body weight support (BWS) and functional electrical stimulation (FES) will be discussed, in the context of functional prerequisites necessary in the recovery of locomotion. Understanding locomotor and postural adaptations will lead to a better appreciation of the normal and dysfunctional mechanisms, and culminate eventually in the development of appropriate rehabilitation assessment and treatment strategies.
To test the efficacy and acceptance of a footdrop stimulator controlled by a tilt sensor. A nonra... more To test the efficacy and acceptance of a footdrop stimulator controlled by a tilt sensor. A nonrandomized, test-retest study of 26 subjects with footdrop of more than 1 year's duration, resulting from various central nervous system disorders, was performed in 4 centers for at least 3 months. Speed of walking in a straight line, speed around a figure of 8, and physiological cost index (PCI) were measured with and without the device. Hours/day and steps/day using the device were recorded. All but 2 subjects used the tilt sensor at home, rather than a foot switch. Walking speed increased by 15% after 3 months (n = 26; P < 0.01), 32% after 6 months (n = 16; P < 0.01), and 47% after 12 months (n = 8; P < 0.05), while PCI decreased. The number of steps taken per day of use increased significantly over time, and increased speed was directly correlated with usage. Walking speed also increased with the stimulator off, but to a lesser extent, indicating a training effect. Subject...
The task of stepping over obstacles is known to be particularly risky for persons post stroke. A ... more The task of stepping over obstacles is known to be particularly risky for persons post stroke. A kinetic analysis informing on the movement strategies used to ensure clearance of the leading limb over an obstacle is, however, lacking. We examined obstacle avoidance strategies in six community dwelling stroke survivors comparing the use of paretic and non-paretic limb as the leading limb for clearance over obstacles measuring 7.5% and 15% of their total leg length. Subjects were able to increase foot clearance height in both limbs in order to avoid the two obstacles. Obstacle clearance with the non-paretic limb leading was associated with positive knee flexor work that increased when stepping over each obstacle, thus showing a normal knee strategy that flexes both the knee and the hip for foot clearance. There was also slightly increased hip flexor contribution for non-paretic obstacle clearance that was the same for both obstacle heights. When the paretic limb led during obstacle clearance, there was also evidence of an increased knee flexor moment, suggesting a residual knee strategy, but it was less pronounced than for the non-paretic limb and was assisted by greater vertical hip elevation and additional positive hip flexor work that both gained greater importance with increased obstacle height. These findings suggest that rehabilitation should explore the ability to improve the residual, but less powerful, knee flexor strategy in the paretic limb in specific patients, with further promotion of a hip flexor and limb elevation strategy depending on patient deficits and obstacle height.
Journal of neuroengineering and rehabilitation, 2015
Rehabilitation interventions involving virtual reality (VR) technology have been developed for th... more Rehabilitation interventions involving virtual reality (VR) technology have been developed for the promotion of functional independence post stroke. A scoping review was performed to examine the efficacy of VR-based interventions on balance and mobility disorders post stroke. Twenty-four articles in the English language examining VR game-based interventions and outcomes directed at balance and mobility disorders were included. Various VR systems (customized and commercially available) were used as rehabilitation tools. Outcome measures included laboratory and clinical measures of balance and gait. Outcome measures of dynamic balance showed significant improvements following VR-based interventions as compared to other interventions. Further, it was observed that VR-based intervention may have favorable effects in improving walking speed and the ability to deal with environmental challenges, which may also facilitate independent community ambulation. VR-based therapy thus has the pote...
Conference proceedings : ... Annual International Conference of the IEEE Engineering in Medicine and Biology Society. IEEE Engineering in Medicine and Biology Society. Annual Conference, 2004
Virtual reality (VR) technology offers a new and safe way to increase practice time and provide t... more Virtual reality (VR) technology offers a new and safe way to increase practice time and provide the varied environments and constraints needed to optimize locomotor training. Our specific objectives are (1) to create a virtual environment (VE) coupled with a self-paced treadmill for locomotor training; (2) to compare temporal and distance measurements of gait during treadmill walking while looking at different scenarios of VE; and (3) to develop a protocol optimized for the training of locomotor disorders after stroke. A motorized treadmill was mounted on a six-degree-of-freedom motion platform. VEs were created using commercial software (SoftImage) and projected on a large screen, while system control was administered through the CAREN software (Motek BV). The instantaneous treadmill speed and scene progression were servo-controlled. Preliminary results show that healthy subjects are able to have full control of their own walking speed both on the treadmill and within the virtual s...
The Journal of neuroscience : the official journal of the Society for Neuroscience, 1995
The purpose of this study was to investigate the determinants of postural orientation by examinin... more The purpose of this study was to investigate the determinants of postural orientation by examining stance kinematics and kinetics at various interpaw distances. Four adult cats were trained to stand, unrestrained, on a force platform. Three-dimensional ground reaction forces and kinematics, as well as EMG activities, were recorded during stance at five different anteroposterior (AP) distances and two widths. Stance distance was varied by changing the distance between the four force plates mounted on the platform. All cats used a strategy of maintaining a constant horizontal orientation of the trunk and levering the limbs at the girdles while maintaining constant intralimb geometry to accommodate the changes in stance distance. The direction of the ground reaction forces covaried with the limb axes. As a result, the joint torques were conserved in the forelimb, and varied within small ranges in the hind. Increased tonic activity in the extensors of the back, the hip, and the ankle wa...
jou rn al homepage: www.elsevier.com /locate/humo v differently to different avoidance behaviors.... more jou rn al homepage: www.elsevier.com /locate/humo v differently to different avoidance behaviors. Such a measure can be beneficial in contrasting obstacle avoidance behaviors in different populations with mobility problems.
2009 Virtual Rehabilitation International Conference, 2009
ABSTRACT We have developed a novel cane device to be used in conjunction with a treadmill-based v... more ABSTRACT We have developed a novel cane device to be used in conjunction with a treadmill-based virtual reality (VR) locomotor system. The instrumentation of such a cane device is described and results examining its use and feasibility as a proof of principle are provided in this preliminary study involving five persons with stroke and 5 healthy participants. Average walking speeds with and without the cane are compared between the overground physical environment (PE) and the treadmill-based virtual environment (VE). Gait variability quantified as the % coefficient of variation (CV) for stride duration with and without the cane in the VE is also examined. Furthermore, the vertical loading forces exerted on the cane during level walking in the VE are reported and discussed. Results reveal that walking with the treadmill cane is feasible for use in both healthy and stroke populations. It is evident that people who normally rely on a walking cane benefit more from the instrumented cane than those people who normally walk unaided. This work represents the first instrumented cane for use with a treadmill-based locomotor system.
The ability to use haptic input through light contact to improve stability while walking post-str... more The ability to use haptic input through light contact to improve stability while walking post-stroke is investigated in a virtual environment (VE). Persons with stroke and healthy participants walk in a VE where they encounter changes in the slope of the support surface. Kinematic, kinetic, and electromyographic data analyses will be used to show the anticipatory postural adjustments made leading up to and after a transition to a sloped surface. Pilot testing shows that the transition to sloped surface is more challenging for the stroke participant tested, as compared to an age-matched control. Modifications to the current protocol will improve the feasibility of not only task completion by both healthy and neurologically impaired participants, but also the ability to use and evaluate the use of haptic information for stability while walking in a VE with slope changes.
To characterize navigation errors made by patients with the absence of vestibular function on one... more To characterize navigation errors made by patients with the absence of vestibular function on one side owing to surgical resection of an acoustic neuroma. Seventeen young (18-38 years) and 9 older healthy individuals (67-83 years), as well as 5 patients 2 to 20 months following surgery (37-61 years), were studied. They sidestepped laterally with eyes closed toward memorized targets located 1.25 m to their right or left. They stopped when they judged that they were in front of the target. The position of head and body markers was recorded in three dimensions with a six-camera Vicon 512 system (Oxford Metrics Ltd., Oxford, UK). Navigation errors were (1) distance error, the distance between the end target and a perpendicular line drawn from the sternum to the plane of targets, and (2) deviation, the angle formed between the line joining the initial and end targets and the line joining the subject&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s shoulders. Mean distance error was 20.9 +/- 22.0 degrees cm in patients, 29.6 +/- 30.3 cm in young healthy subjects, and -1.7 +/- 18.4 cm in older subjects (p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; .01 compared with young subjects). Mean deviation was symmetric and 8 degrees and -3 degrees in healthy young and older subjects, respectively. In contrast, patients had a significantly larger deviation when navigating toward the side of their lesion than the intact side (13 degrees +/- 9 degrees versus 3 degrees +/- 9 degrees; p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; .01). Our results suggest that patients with vestibular deficits have impaired ability to control body rotations when walking sideways without vision toward the side of their vestibular lesion.
To evaluate the benefits of a vestibular rehabilitation program (VRP) in the Montreal-Laval area.... more To evaluate the benefits of a vestibular rehabilitation program (VRP) in the Montreal-Laval area. The VRP was conceptualized by a panel of experts including otolaryngologists, physiotherapists, and researchers from McGill University and its teaching hospitals. From February 1999 to December 2001, 117 patients were seen, and 88 of them completed the VRP. The VRP has been established at the Jewish Rehabilitation Hospital in Laval, PQ, to provide specialized rehabilitation to clients suffering from vertigo, dizziness, and/or impaired balance owing to lesions or disorders of the vestibular system. Presence or absence of nystagmus or vertigo during the Dix-Hallpike test, Dizziness Handicap Inventory (DHI), and Dynamic Gait Index (DGI). Thirty-five patients with benign paroxysmal positional vertigo of the posterior canal were treated with canalith repositioning manoeuvres. All of the patients (100%) had absence of nystagmus or vertigo after one to four treatment sessions. Forty-six patients with vestibular deficits or dizziness-disequilibrium completed the VRP, which consisted mainly of individualized eye-head and balance home exercise programs. At the end of the VRP, there was a significant decrease in DHI score (31 vs 57; p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; .01) and a significant increase in DGI score (18.4 vs 22.6; p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; .01). A range of modest to major improvements was shown by comparing initial and discharge scores of patients who had completed vestibular rehabilitation. The VRP appears to be beneficial for patients with a variety of vestibular disorders. Further research is needed to continue optimizing vestibular rehabilitation.
This study investigated the postural strategies to adapt to uphill and downhill treadmill inclina... more This study investigated the postural strategies to adapt to uphill and downhill treadmill inclination (0, 5 and 10%) during walking and standing in eight healthy subjects. Increasing the treadmill grade from 0 to 10% induced an increasingly flexed posture of the hip, knee and ankle at initial foot contact as well as a progressive forward tilt of pelvis and trunk.
2011 International Conference on Virtual Rehabilitation, 2011
Abstract The ability to accurately judge distance and time to collision is an important perceptua... more Abstract The ability to accurately judge distance and time to collision is an important perceptual determinant in shaping obstacle circumvention strategies for functional locomotion. In addition, deficits in planning and execution, as well as biomechanical ...
Most daily occupations require the ability to perform two or more activities simultaneously (i.e.... more Most daily occupations require the ability to perform two or more activities simultaneously (i.e. dual tasking) while adapting to unexpected changes in the environment. When a person has neurological deficits, this ability is usually impaired. Moreover, recent evidence supports a relationship between executive function deficits and dual task performance. Most of the studies that examine the effect of dual tasking
Abstract The purpose of this study is to examine dual task performance during locomotion in a fun... more Abstract The purpose of this study is to examine dual task performance during locomotion in a functional virtual setting. A virtual reality-based paradigm was developed in order to achieve this goal. To date, four participants who had a stroke completed the study protocol ...
Balance and locomotion involve multi-sensory integration while meeting environmental demands. In ... more Balance and locomotion involve multi-sensory integration while meeting environmental demands. In addition, increased task complexity negatively affects postural control in aging and patient populations. The goal of this pilot study was to examine the effects of aging and cognitive load on the visual perception of vertical. Four young and 3 older individuals participated. Subjective visual vertical (SVV) performance deteriorated more
Gait and cognitive functions can deteriorate during dual tasking, especially in people with neuro... more Gait and cognitive functions can deteriorate during dual tasking, especially in people with neurological deficits. Most studies examining the simultaneous effects of dual tasking on motor and cognitive aspects were not performed in ecological environments. Using virtual reality technology, functional environments can be simulated to study dual tasking. The aims of this study were to test the feasibility of using a virtual functional environment for the examination of dual tasking and to determine the effects of dual tasking on gait parameters in people with stroke and age-matched controls who were healthy. This was a cross-sectional observational study. Twelve community-dwelling older adults with stroke and 10 age-matched older adults who were healthy participated in the study. Participants walked on a self-paced treadmill while viewing a virtual grocery aisle projected onto a screen placed in front of them. They were asked to walk through the aisle (single task) or to walk and select (&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot;shop for&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot;) items according to instructions delivered before or during walking (dual tasking). Overall, the stroke group walked slower than the control group in both conditions, whereas both groups walked faster overground than on the treadmill. The stroke group also showed larger variability in gait speed and shorter stride length than the control group. There was a general tendency to increase gait speed and stride length during dual-task conditions; however, a significant effect of dual tasking was found only in one dual-task condition for gait speed and stride duration variability. All participants were able to complete the task with minimal mistakes. The small size and heterogeneity of the sample were limitations of the study. It is feasible to use a functional virtual environment for investigation of dual tasking. Different gait strategies, including an increase or decrease in gait speed, can be used to cope with the increase in cognitive demands required for dual tasking.
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