Interpersonal interactions for haptic guidance during balance exercises.

BACKGROUND: Caregiver-patient interaction relies on interpersonal coordination during support provided by a therapist to a patient with impaired control of body balance. RESEARCH QUESTION: The purpose of this study was to investigate in a therapeutic context active and passive participant involvement during interpersonal support in balancing tasks of increasing sensorimotor difficulty. METHODS: Ten older adults stood in semi-tandem stance and received support from a physical therapist (PT) in two support conditions: 1) physical support provided by the PT to the participant's back via an instrumented handle affixed to a harness worn by the participant ("passive" interpersonal touch; IPT) or 2) support by PT and participant jointly holding a handle instrumented with a force-torque transducer while facing each other ("active" IPT). The postural stability of both support conditions was measured using the root-mean-square (RMS) of the Centre-of-Pressure velocity (RMS dCOP) in the antero-posterior (AP) and medio-lateral (ML) directions. Interpersonal postural coordination (IPC) was characterized in terms of cross-correlations between both individuals' sway fluctuations as well as the measured interaction forces. RESULTS: Active involvement of the participant decreased the participant's postural variability to a greater extent, especially under challenging stance conditions, than receiving support passively. In the passive support condition, however, stronger in-phase IPC between both partners was observed in the antero-posterior direction, possibly caused by a more critical (visual or tactile) observation of participants' body sway dynamics by the therapist. In-phase cross-correlation time lags indicated that the therapist tended to respond to participants' body sway fluctuations in a reactive follower mode, which could indicate visual dominance affecting the therapist during the provision of haptic support. SIGNIFICANCE: Our paradigm implies that in balance rehabilitation more partnership-based methods promote greater postural steadiness. The implications of this finding with regard to motor learning and rehabilitation need to be investigated.

Interpersonal interactions for haptic guidance during maximum forward reaching.

Caregiver-patient interactions rely on interpersonal coordination (IPC) involving the haptic and visual modalities. We investigated in healthy individuals spontaneous IPC during joint maximum forward reaching. A 'contact-provider' (CP; n=2) kept light interpersonal touch (IPT) laterally with the wrist of the extended arm of a forward reaching, blind-folded 'contact-receiver' (CR; n=22). Due to the stance configuration, CP was intrinsically more stable. CR received haptic feedback during forward reaching in two ways: (1) presence of a light object (OBT) at the fingertips, (2) provision of IPT. CP delivered IPT with or without vision or tracked manually with vision but without IPT. CR's variabilities of Centre-of-Pressure velocity (CoP) and wrist velocity, interpersonal cross-correlations and time lags served as outcome variables. OBT presence increased CR's reaching amplitude and reduced postural variability in the reach end-state. CR's variability was lowest when CP applied IPT without vision. OBT decreased the strength of IPC. Correlation time lags indicated that CP retained a predominantly reactive mode with CR taking the lead. When CP had no vision, presumably preventing an effect of visual dominance, OBT presence made a qualitative difference: with OBT absent, CP was leading CR. This observation might indicate a switch in CR's coordinative strategy by attending mainly to CP's haptic 'anchor'. Our paradigm implies that in clinical settings the sensorimotor states of both interacting partners need to be considered. We speculate that haptic guidance by a caregiver is more effective when IPT resembles the only link between both partners.