Workplace pedometer interventions for increasing physical activity.

BACKGROUND: The World Health Organization (WHO) recommends undertaking 150 minutes of moderate-intensity physical activity per week, but most people do not. Workplaces present opportunities to influence behaviour and encourage physical activity, as well as other aspects of a healthy lifestyle. A pedometer is an inexpensive device that encourages physical activity by providing feedback on daily steps, although pedometers are now being largely replaced by more sophisticated devices such as accelerometers and Smartphone apps. For this reason, this is the final update of this review. OBJECTIVES: To assess the effectiveness of pedometer interventions in the workplace for increasing physical activity and improving long-term health outcomes. SEARCH METHODS: We searched the Cochrane Central Register of Controlled Trials, MEDLINE, Embase, the Cumulative Index to Nursing and Allied Health Literature (CINAHL), Occupational Safety and Health (OSH) UPDATE, Web of Science, ClinicalTrials.gov, and the WHO International Clinical Trials Registry Platform from the earliest record to December 2016. We also consulted the reference lists of included studies and contacted study authors to identify additional records. We updated this search in May 2019, but these results have not yet been incorporated. One more study, previously identified as an ongoing study, was placed in 'Studies awaiting classification'. SELECTION CRITERIA: We included randomised controlled trials (RCTs) of workplace interventions with a pedometer component for employed adults, compared to no or minimal interventions, or to alternative physical activity interventions. We excluded athletes and interventions using accelerometers. The primary outcome was physical activity. Studies were excluded if physical activity was not measured. DATA COLLECTION AND ANALYSIS: We used standard methodological procedures expected by Cochrane. When studies presented more than one physical activity measure, we used a pre-specified list of preferred measures to select one measure and up to three time points for analysis. When possible, follow-up measures were taken after completion of the intervention to identify lasting effects once the intervention had ceased. Given the diversity of measures found, we used ratios of means (RoMs) as standardised effect measures for physical activity. MAIN RESULTS: We included 14 studies, recruiting a total of 4762 participants. These studies were conducted in various high-income countries and in diverse workplaces (from offices to physical workplaces). Participants included both healthy populations and those at risk of chronic disease (e.g. through inactivity or overweight), with a mean age of 41 years. All studies used multi-component health promotion interventions. Eleven studies used minimal intervention controls, and four used alternative physical activity interventions. Intervention duration ranged from one week to two years, and follow-up after completion of the intervention ranged from three to ten months. Most studies and outcomes were rated at overall unclear or high risk of bias, and only one study was rated at low risk of bias. The most frequent concerns were absence of blinding and high rates of attrition. When pedometer interventions are compared to minimal interventions at follow-up points at least one month after completion of the intervention, pedometers may have no effect on physical activity (6 studies; very low-certainty evidence; no meta-analysis due to very high heterogeneity), but the effect is very uncertain. Pedometers may have effects on sedentary behaviour and on quality of life (mental health component), but these effects were very uncertain (1 study; very low-certainty evidence). Pedometer interventions may slightly reduce anthropometry (body mass index (BMI) -0.64, 95% confidence interval (CI) -1.45 to 0.18; 3 studies; low-certainty evidence). Pedometer interventions probably had little to no effect on blood pressure (systolic: -0.08 mmHg, 95% CI -3.26 to 3.11; 2 studies; moderate-certainty evidence) and may have reduced adverse effects (such as injuries; from 24 to 10 per 100 people in populations experiencing relatively frequent events; odds ratio (OR) 0.50, 95% CI 0.30 to 0.84; low-certainty evidence). No studies compared biochemical measures or disease risk scores at follow-up after completion of the intervention versus a minimal intervention. Comparison of pedometer interventions to alternative physical activity interventions at follow-up points at least one month after completion of the intervention revealed that pedometers may have an effect on physical activity, but the effect is very uncertain (1 study; very low-certainty evidence). Sedentary behaviour, anthropometry (BMI or waist circumference), blood pressure (systolic or diastolic), biochemistry (low-density lipoprotein (LDL) cholesterol, total cholesterol, or triglycerides), disease risk scores, quality of life (mental or physical health components), and adverse effects at follow-up after completion of the intervention were not compared to an alternative physical activity intervention. Some positive effects were observed immediately at completion of the intervention periods, but these effects were not consistent, and overall certainty of evidence was insufficient to assess the effectiveness of workplace pedometer interventions. AUTHORS' CONCLUSIONS: Exercise interventions can have positive effects on employee physical activity and health, although current evidence is insufficient to suggest that a pedometer-based intervention would be more effective than other options. It is important to note that over the past decade, technological advancement in accelerometers as commercial products, often freely available in Smartphones, has in many ways rendered the use of pedometers outdated. Future studies aiming to test the impact of either pedometers or accelerometers would likely find any control arm highly contaminated. Decision-makers considering allocating resources to large-scale programmes of this kind should be cautious about the expected benefits of incorporating a pedometer and should note that these effects may not be sustained over the longer term. Future studies should be designed to identify the effective components of multi-component interventions, although pedometers may not be given the highest priority (especially considering the increased availability of accelerometers). Approaches to increase the sustainability of intervention effects and behaviours over a longer term should be considered, as should more consistent measures of physical activity and health outcomes.

Buying time: a proof-of-concept randomized controlled trial to improve sleep quality and cognitive function among older adults with mild cognitive impairment.

BACKGROUND: Current evidence suggests that good quality sleep is associated with preserved cognitive function and reduced dementia risk in older adults. Sleep complaints are especially common among older adults with mild cognitive impairment (MCI), and this may contribute to their increased risk for progression to dementia. Thus, improving their sleep may be important for maintaining their cognitive health. Chronotherapy is a set of intervention strategies that can improve sleep quality through strengthening the entrainment of the biological clock to the solar light-dark cycle, and includes strategies such as (1) bright light therapy (BLT); (2) physical activity (PA); and (3) good sleep hygiene. Of these strategies, BLT is the most potent and is based on providing individualized timing to entrain circadian rhythms. Thus, a personalized chronotherapy intervention of individually timed BLT and individually tailored PA promotion, in conjunction with general sleep hygiene education may promote older adult sleep quality. We therefore aim to carry out a proof-of-concept randomized controlled trial (RCT) to examine the efficacy of such a personalized chronotherapy intervention to improve sleep quality among older adults with MCI. METHODS/DESIGN: This was a 24-week RCT of a personalized chronotherapy intervention aimed to primarily improve sleep quality as measured by the MotionWatch8©. Participants in the personalized chronotherapy group (INT) will receive four once-weekly, general sleep hygiene education classes, followed by 20 weeks of (1) individually timed BLT and (2) bi-weekly, individually tailored PA counseling phone calls in conjunction with receiving a consumer-available PA tracker-the Fitbit® Flex™. Ninety-six adults (aged 65-85 years) classified as having MCI (i.e., Mini-Mental State Exam (MMSE) ≥ 24; Montreal Cognitive Assessment (MoCA) ≤ 26; without dementia or significant functional impairment) will be randomized to either INT or a waitlist control group (CON). DISCUSSION: The results of this trial will help determine if a personalized chronotherapy intervention that includes individually timed BLT and individually tailored PA promotion, along with general sleep hygiene education can promote sleep quality among older adults at increased risk for dementia. Our results will help inform best practices for promoting sleep quality among older adults with MCI. TRIAL REGISTRATION: ClinicalTrials.gov , NCT02926157 . Registered on 6 October 2016.

Does feedback on daily activity level from a Smart watch during inpatient stroke rehabilitation increase physical activity levels? Study protocol for a randomized controlled trial.

BACKGROUND: Practicing activities improves recovery after stroke, but many people in hospital do little activity. Feedback on activity using an accelerometer is a potential method to increase activity in hospital inpatients. This study's goal is to investigate the effect of feedback, enabled by a Smart watch, on daily physical activity levels during inpatient stroke rehabilitation and the short-term effects on simple functional activities, primarily mobility. METHODS/DESIGN: A randomized controlled trial will be undertaken within the stroke rehabilitation wards of the Second Affiliated hospital of Anhui University of Traditional Chinese Medicine, Hefei, China. The study participants will be stroke survivors who meet inclusion criteria for the study, primarily: able to participate, no more than 4 months after stroke and walking independently before stroke. Participants will all receive standard local rehabilitation and will be randomly assigned either to receive regular feedback about activity levels, relative to a daily goal tailored by the smart watch over five time periods throughout a working day, or to no feedback, but still wearing the Smart watch. The intervention will last up to 3 weeks, ending sooner if discharged. The data to be collected in all participants include measures of daily activity (Smart watch measure); mobility (Rivermead Mobility Index and 10-metre walking time); independence in personal care (Barthel Activities of Daily Living (ADL) Index); overall activities (the World Health Organization (WHO) Disability Assessment Scale, 12-item version); and quality of life (the Euro-Qol 5L5D). Data will be collected by assessors blinded to allocation of the intervention at baseline, 3 weeks or at discharge (whichever is the sooner); and a reduced data set will be collected at 12 weeks by telephone interview. The primary outcome will be change in daily accelerometer activity scores. Secondary outcomes are compliance and adherence to wearing the watch, and changes in mobility, independence in personal care activities, and health-related quality of life. DISCUSSION: This project is being implemented in a large city hospital with limited resources and limited research experience. There has been a pilot feasibility study using the Smart watch, which highlighted some areas needing change and these are incorporated in this protocol. TRIAL REGISTRATION: ClinicalTrials.gov, NCT02587585 . Registered on 30 September 2015. Chinese Clinical Trial Registry, ChiCTR-IOR-15007179 . Registered on 8 August 2015.

An Initial Evaluation of the Impact of Pokémon GO on Physical Activity.

BACKGROUND: Pokémon GO is a location-based augmented reality game. Using GPS and the camera on a smartphone, the game requires players to travel in real world to capture animated creatures, called Pokémon. We examined the impact of Pokémon GO on physical activity (PA). METHODS AND RESULTS: A pre-post observational study of 167 Pokémon GO players who were self-enrolled through recruitment flyers or online social media was performed. Participants were instructed to provide screenshots of their step counts recorded by the iPhone Health app between June 15 and July 31, 2016, which was 3 weeks before and 3 weeks after the Pokémon GO release date. Of 167 participants, the median age was 25 years (interquartile range, 21-29 years). The daily average steps of participants at baseline was 5678 (SD, 2833; median, 5718 [interquartile range, 3675-7279]). After initiation of Pokémon GO, daily activity rose to 7654 steps (SD, 3616; median, 7232 [interquartile range, 5041-9744], pre-post change: 1976; 95% CI, 1494-2458, or a 34.8% relative increase [P<0.001]). On average, 10 000 "XP" points (a measure of game progression) was associated with 2134 additional steps per day (95% CI, 1673-2595), suggesting a potential dose-response relationship. The number of participants achieving a goal of 10 000+ steps per day increased from 15.3% before to 27.5% after (odds ratio, 2.06; 95% CI, 1.70-2.50). Increased PA was also observed in subgroups, with the largest increases seen in participants who spent more time playing Pokémon GO, those who were overweight/obese, or those with a lower baseline PA level. CONCLUSIONS: Pokémon GO participation was associated with a significant increase in PA among young adults. Incorporating PA into gameplay may provide an alternative way to promote PA in persons who are attracted to the game. CLINICAL TRIAL REGISTRATION: URL: http://www.clinicaltrials.gov. Unique identifier: NCT02888314.

Children's Experiences Wearing Pedometers in a Telephone-Delivered Imagery Intervention Aimed at Increasing Active Play.

PURPOSE: Much of what we know about pedometer interventions and imagery interventions with children is grounded in quantitative data. The general purpose of the present study was to qualitatively explore the experiences of children who had participated in a 4-week imagery intervention designed to increase active play. Specifically, the current study investigated children's experiences with (a) wearing pedometers and (b) listening to audio recordings (imagery scripts and short stories) via an automated telephone system. METHOD: Two focus-group interviews were conducted with a subsample of children (aged 9-10 years) who had completed the imagery intervention: 1 interview with children from the imagery group (n = 7) and 1 with children from the control group (n = 5). RESULTS: Findings indicated that children enjoyed wearing pedometers. At the same time, children reported some complaints about wearing these devices (e.g., they are uncomfortable). Children also described that the automated telephone system was fun to use, despite the fact that it was difficult to remember to call the system 3 times each week. Finally, children in the imagery group noted that the imagery scripts were easy to imagine and motivated them to engage in active play, while children in the control group found the short stories interesting. CONCLUSION: The results of the current study can help researchers and practitioners develop and implement effective pedometer and imagery interventions with children.

Trastorno de retraso de la fase del sueño y del despertar. Síndrome de retraso de fase / Delayed sleep wake phase disorder (DSWPD)

El trastorno de retraso de la fase del sueño y del despertar o síndrome de retraso de fase (SRF) es la alteración del ritmo circadiano de sueño más frecuente y suele manifestarse en la adolescencia. Se caracteriza por un retraso estable, habitualmente de más de dos horas, del inicio y del final del sueño respecto a los horarios convencionales. Clínicamente los pacientes presentan insomnio a la hora de acostarse, con gran dificultad para levantarse por la mañana en la hora deseada. Entre semana, debido a las obligaciones escolares o sociales, los niños con SRF duermen pocas horas, generándose una privación crónica de sueño que se manifestará con somnolencia diurna, fatiga, falta de atención, afectación del rendimiento escolar o absentismo escolar. Característicamente, el fin de semana o durante las vacaciones, cuando están libres de horarios, retrasan el sueño, siendo este de características normales y levantándose descansados. Es importante realizar un diagnóstico precoz para iniciar un tratamiento temprano que minimice las consecuencias del SRF. Por la imposibilidad de seguir unos horarios regulares de estudio ni de trabajo, son jóvenes a los que se califica de noctámbulos o de vagos, a pesar de sus esfuerzos repetidos por adaptarse a unos horarios convencionales, lo que aboca en altos índices de depresión, ansiedad y abuso de sustancias. El retraso de fase de sueño se confirma mediante las agendas de sueño, la actigrafía y los marcadores de fase circadianos. La higiene del sueño, la cronoterapia, la fototerapia y la administración de melatonina son los posibles tratamientos del SRF (AU)

Delayed sleep wake phase disorder (DSWPD) or delayed sleep phase disorder is the most frequent circadian rhythm sleep disorder and is commonly seen in adolescents. DSWPD is characterized by habitual by sleep onset and wake times that are usually delayed more than two hours relative to conventional sleep-wake times. Clinically, affected subjects experience difficulty falling asleep and arising at socially acceptable wake time. Enforced conventional wake times (during the school or working days), may result in chronically insufficient sleep manifested as excessive daytime sleepiness, fatigue, repetitive school absences with negative impact on their attention and academic performance. When allowed to follow their preferred schedule (during the weekends or vacation periods), the patient’s timing of sleep is delayed with normal and restoring sleep. It is very important to make an early diagnosis to initiate treatments that minimize consequences of DSWPD. Although their repetitive attempts to adapt to conventional times, their difficulties to maintain regular school or work timings leads these adolescents to be seen as lazy and not motivated, which usually results in an increase in mood disorders and drug abuse. Delay sleep phase is demonstrated by sleep log, actigraphy monitoring and in the timing of other circadian rhythms. Sleep hygiene, chronotherapy, bright light therapy or melatonin administration are the most habitual treatment of the DSWPD (AU)

Development of an integral assessment approach of health status in patients with obstructive airway diseases: the CORONA study.

BACKGROUND: Traditional assessment of patients with obstructive lung diseases (asthma and chronic obstructive pulmonary disease; COPD) relies on physiological tests. The COPD and Asthma Rotterdam Integrated Care Approach (CORONA) study aims to develop a diagnostic pathway with a more comprehensive approach to the assessment of patients with asthma and COPD in secondary care. METHODS: An eight-step method was used to develop and implement the pathway for patients with asthma or COPD referred to an outpatient hospital setting. RESULTS: The diagnostic pathway consists of an evidence-based set of measurements prioritized by a Delphi procedure. The pathway incorporates three innovative diagnostics: the metronome-paced hyperventilation test to measure dynamic hyperinflation, an activity monitor to objectively evaluate physical activity in daily life, and the Nijmegen Clinical Screening Instrument as a comprehensive assessment tool to acquire detailed insight into symptoms, functional limitations, and quality of life. CONCLUSION: An innovative diagnostic pathway was developed and implemented for patients with obstructive lung diseases referred to secondary care. As this pathway aims to provide a comprehensive analysis of health status, it focuses on biomedical aspects and also reviews behavioral aspects that further elucidate the patient's health status. The added value of the diagnostic pathway needs to be determined from both an organizational perspective and from the individual patient's viewpoint.

Effectiveness of internet-supported cognitive behavioral and chronobiological interventions and effect moderation by insomnia subtype: study protocol of a randomized controlled trial.

BACKGROUND: DSM-V criteria for insomnia disorder are met by 6 to 10% of the adult population. Insomnia has severe consequences for health and society. One of the most common treatments provided by primary caregivers is pharmacological treatment, which is far from optimal and has not been recommended since a 2005 consensus report of the National Institutes of Health. The recommended treatment is Cognitive Behavioral Therapy for Insomnia. Effectiveness, however, is still limited. Only a few studies have evaluated the effectiveness of chronobiological treatments, including the timed application of bright light, physical activity and body warming. Another opportunity for optimization of treatment is based on the idea that the people suffering from insomnia most likely represent a heterogeneous mix of subtypes, with different underlying causes and expected treatment responses. The present study aims to evaluate the possibility for optimizing insomnia treatment along the principles of personalized and stratified medicine. It evaluates the following: 1. The relative effectiveness of internet-supported cognitive behavioral therapy, bright light, physical activity and body warming; 2. Whether the effectiveness of internet-supported cognitive behavioral therapy for insomnia can be augmented by simultaneous or prior application of bright light, physical activity and body warming; and 3. Whether the effectiveness of the interventions and their combination are moderated by the insomnia subtype. METHODS/DESIGN: In a repeated measures, placebo-controlled, randomized clinical trial that included 160 people diagnosed with insomnia disorder, we are evaluating the relative effectiveness of 4 intervention weeks. Primary outcome is subjective sleep efficiency, quantified using a sleep diary. Secondary outcomes include other complaints of sleep and daytime functioning, health-related cost estimates and actigraphic objective sleep estimates. Compliance will be monitored both subjectively and objectively using activity, light and temperature sensors. Insomnia subtypes will be assessed using questionnaires. Mixed effect models will be used to evaluate intervention effects and moderation by insomnia subtype ratings. DISCUSSION: The current study addresses multiple opportunities to optimize and personalize treatment of insomnia disorder. TRIAL REGISTRATION: Netherlands National Trial Register NTR4010, 4 June 2013.

Physical activity, sedentary behavior and total wellness changes among sedentary adults: a 4-week randomized controlled trial.

BACKGROUND: The construct of total wellness includes a holistic approach to the body, mind and spirit components of life. While the health benefits of reducing sedentary behavior and increasing physical activity are well documented, little is known about the influence on total wellness of an internet-based physical activity monitor designed to help people to achieve higher physical activity levels. PURPOSE: The purpose of this four-week, personal activity monitor-based intervention program was to reduce sedentary behavior and increase physical activity levels in daily living for sedentary adults and to determine if these changes would also be associated with improvement in total wellness. METHODS: Twenty-two men and 11 women (27 years ± 4.0) were randomly assigned to either an intervention (n = 18) or control group (n = 15). The intervention group interacted with an online personal activity monitor (Gruve Solution™) designed to reduce sedentary time and increase physical activity during activities of daily living. The control group did not interact with the monitor, as they were asked to follow their normal daily physical activities and sedentary behavior routines. The Wellness Evaluation of Lifestyle (WEL) inventory was used to assess total wellness. Sedentary time, light, walking, moderate and vigorous intensity physical activities were assessed for both intervention and control groups at baseline and at week-4 by the 7-day Sedentary and Light Intensity Physical Activity Log (7-day SLIPA Log) and the International Physical Activity Questionnaire (IPAQ). RESULTS: Significant increases in pre-post total wellness scores (from 64% ± 5.7 to 75% ± 8.5) (t(17) = -6.5, p < 0.001) were observed in the intervention group by the end of week four. Intervention participants decreased their sedentary time (21%, 2.3 hours/day) and increased their light (36.7%, 2.5 hours/day), walking (65%, 1057 MET-min/week), moderate (67%, 455 MET-min/week) and vigorous intensity (60%, 442 MET-min/week) physical activity (all p < 0.001). No significant differences for total wellness were observed between the groups at baseline and no pre-post significant differences were observed for any outcome variable in the control group. CONCLUSION: Total wellness is improved when sedentary, but sufficiently physically active adults, reduce sedentary time and increase physical activity levels (i.e. light, waking, moderate and vigorous).

Kinect-based posture tracking for correcting positions during exercise.

The Kinect sensor has opened the path for developing numerous applications in several different areas. Medical and health applications are benefiting from the Kinect as it allows non-invasive body motion capture that can be used in motor rehabilitation and phobia treatment. A major advantage of the Kinect is that allows developing solutions that can be used at home or even the office thus, expanding the user freedom for interacting with complementary solutions to its physical activities without requiring any traveling. This paper present a Kinect-based posture tracking software for assisting the user in successfully match postures required in some exercises for strengthen body muscles. Unlike several video games available, this tool offers a user interface for customizing posture parameters, so it can be enhanced by healthcare professionals or by their guidance through the user.

A portable immersive surgery training system using RGB-D sensors.

Surgical training plays an important role in assisting residents to develop critical skills. Providing effective surgical training, however, remains as a challenging task. Existing videotaped training instructions can only show imagery from a fixed viewpoint that lacks both depth perception and interactivity. We present a new portable immersive surgical training system that is capable of acquiring and displaying high fidelity 3D reconstructions of actual surgical procedures. Our solution utilizes a set of Microsoft Kinect sensors to simultaneously recover the participants, the surgical environment, and the surgical scene itself. We then develop a space-time navigator to allow the trainees to witness and explore a prior procedure as if they were there. Preliminary feedback from residents shows that our system is much more effective than conventional videotaped system.

Virtual umra: an interdisciplinary faith-based pedometer intervention for increasing steps at school.

BACKGROUND: Curriculum interventions aimed at increasing physical activity in schools may prove useful in contexts where changes in policy/environment are not feasible. Design/evaluation of interventions targeting minority groups is important in light of well-publicized health disparities. Religious minorities represent a special subset that may positively respond to interventions tailored to their unique beliefs, which to date have been relatively underreported. METHODS: Muslim American youth (n = 45) attending a parochial middle school participated in a religiously- and culturally-tailored 8-wk, interdisciplinary pedometer intervention. School-time ambulatory activity was quantified using a delayed multiple-baseline across subjects ABA design. Visual analysis of graphic data as well as repeated-measures ANOVA and ANCOVA and post hoc contrasts were used to analyze step counts including the moderating effects of day type (PE, no-PE), gender, BMI classification, grade, and time. RESULTS: The intervention elicited modest increases in males' steps only with effect decay beginning midintervention. BMI classification and grade were not associated with changes in steps. CONCLUSIONS: Full curricular integration by affected classroom teachers, staff modeling of PA behavior, and alternative curriculum for girls' PE classes may further potentiate the intervention.

Cell phone based balance trainer.

BACKGROUND: In their current laboratory-based form, existing vibrotactile sensory augmentation technologies that provide cues of body motion are impractical for home-based rehabilitation use due to their size, weight, complexity, calibration procedures, cost, and fragility. METHODS: We have designed and developed a cell phone based vibrotactile feedback system for potential use in balance rehabilitation training in clinical and home environments. It comprises an iPhone with an embedded tri-axial linear accelerometer, custom software to estimate body tilt, a "tactor bud" accessory that plugs into the headphone jack to provide vibrotactile cues of body tilt, and a battery. Five young healthy subjects (24 ± 2.8 yrs, 3 females and 2 males) and four subjects with vestibular deficits (42.25 ± 13.5 yrs, 2 females and 2 males) participated in a proof-of-concept study to evaluate the effectiveness of the system. Healthy subjects used the system with eyes closed during Romberg, semi-tandem Romberg, and tandem Romberg stances. Subjects with vestibular deficits used the system with both eyes-open and eyes-closed conditions during semi-tandem Romberg stance. Vibrotactile feedback was provided when the subject exceeded either an anterior-posterior (A/P) or a medial-lateral (M/L) body tilt threshold. Subjects were instructed to move away from the vibration. RESULTS: The system was capable of providing real-time vibrotactile cues that informed corrective postural responses. When feedback was available, both healthy subjects and those with vestibular deficits significantly reduced their A/P or M/L RMS sway (depending on the direction of feedback), had significantly smaller elliptical area fits to their sway trajectory, spent a significantly greater mean percentage time within the no feedback zone, and showed a significantly greater A/P or M/L mean power frequency. CONCLUSION: The results suggest that the real-time feedback provided by this system can be used to reduce body sway. Its advantages over more complex laboratory-based and commercial balance training systems in terms of cost, size, weight, functionality, flexibility, and accessibility make it a good candidate for further home-based balance training evaluation.

A balance control model predicts how vestibular loss subjects benefit from a vibrotactile balance prosthesis.

A balance control model was applied to interpret how subjects with a severe vestibular loss (VL) used vibrotactile information from a balance prosthesis to enhance balance control. Experimental data were from 5 VL subjects standing with eyes closed and responding to continuous pseudorandom surface tilts of the stance platform. Results showed that vibrotactile feedback information reduced sway at frequencies below ~0.6 Hz, but vibrotactile feedback was less effective in reducing sway as stimulus amplitude increased. This experimental pattern was accurately predicted by the model, which was based on time-delayed sensory feedback control. The model predicted that changes to the vibrotactor activation scheme could improve performance of the prosthesis and demonstrated that further improvements might be possible if motor learning, acquired by practice and training, could increase VL subjects' reliance on the prosthesis.

Designing vibrotactile balance feedback for desired body sway reductions.

Vibrotactile feedback about body position and velocity has been shown to be effective at reducing low frequency body sway (below about 0.5 Hz) in response to balance perturbations while standing. However, current devices cause an undesirable increase in high frequency body sway. In addition, unlike other sensory prostheses such as hearing aids, which are fine-tuned to the user, current vibrotactile balance prostheses largely employ a "one size fits all" approach, in that they use the same settings (i.e. parameter values) for all subjects. Rather than using a fixed design consisting of position and velocity feedback for all subjects, we propose a "custom design" approach that employs system identification methods to identify the feedback required to achieve a desired body sway frequency response for the subject. Our derivations and simulations show that in order to accomplish this objective, feedback consisting of a subject-specific filtered combination of body position, velocity and acceleration is required. Simulation results are provided to illustrate the results.

An integrated vestibular-cochlear prosthesis for restoring balance and hearing.

An integrated vestibular-cochlear implant can be rapidly prototyped and clinically tested by modifying an existing modern cochlear implant. The modifications include addition of gyroscope sensors and reallocation of several electrodes that are normally used for auditory nerve stimulation to the semicircular canals, while sharing the external DSP processor and the internal receiver/stimulator. This paper discusses the validation issues related to hardware and software design that arise in integrating electric hearing and balance onto a single device. The device's initially targeted population will be deaf individuals who also have vestibular impairment since there is a strong ethical justification for vestibular implantation along with minimal additional surgical risk. Because of widespread usage of ototoxic drugs and unique genetic mutations, the patient population with both impaired hearing and balance function is especially prevalent in Asian countries such as China and India. Should such an integrated vestibular-cochlear implant be verified, it could be used to restore balance or treat a wide array of vestibular disorders.

Us'em: the user-centered design of a device for motivating stroke patients to use their impaired arm-hand in daily life activities.

Stroke leaves the majority of its survivors with an impairment of the upper extremity that affects their ability to live independently and their quality of life. Rehabilitation research shows that practice of everyday life activities in a natural context may sustain or even improve arm-hand performance, even during chronic stages after stroke. Based on this insight we designed, developed and evaluated Us'em; this consists of two watch-like accelerometry devices that provide feedback to stroke patients regarding the usage of their impaired versus their non-affected upper extremity. System usability and treatment credibility/expectancy were evaluated positively by therapists and patients.

Development of a self-contained accelerometry based system for control of functional electrical stimulation in hemiplegia.

For stroke patients, functional electrical stimulation (FES) has been shown in the past to greatly reduce gait impairments. A critical element of the success of this intervention is accurate and reliable triggering of the stimulation for step initiation. Foot switches are the most commonly used devices for triggering hemiplegic FES gait, but they have been known to produce unreliable results and degrade over time. This paper outlines the development of a self-contained accelerometry-based gait stimulation system that can be worn around the waist and unlike other systems, adds no additional hardware or equipment to don or doff. An acceleration algorithm was developed and shown to have significantly shorter heel strike detection delays than when detecting with a heel sensor which could lead to improved stimulation timing for step initiation.

A clinical trial of a prototype of wireless surface fes rehabilitation system in foot drop correction.

The purpose of this study is to develop a wireless FES rehabilitation system to assist effective improvement of the lower limbs. In this report, a prototype system combined with foot drop correction and gait evaluation using wireless surface electrical stimulator and the wireless inertial sensors was developed and tested with a right hemiplegic subject. For gait evaluation, lower limb joint angles and segment angles were estimated by the Kalman filter from the data measured with wireless inertial sensors. Electrical stimulation was applied to the common peroneal nerve or the tibialis anterior muscle by detecting stimulus timing automatically from the data of wireless inertial sensor attached on the shank of the hemiplegic side. The maximum joint angle of ankle dorsiflexion of the paralyzed side at the swing phase was increased approximately to the value of the healthy side by applying the electrical stimulation. The developed system was performed well in foot drop correction and the measured data of the inertial sensors showed the characteristics and difference of paralyzed side with and without electrical stimulation using the segment angles and joint angles.

Foot worn inertial sensors for gait assessment and rehabilitation based on motorized shoes.

Fall prevention in elderly subjects is often based on training and rehabilitation programs that include mostly traditional balance and strength exercises. By applying such conventional interventions to improve gait performance and decrease fall risk, some important factors are neglected such as the dynamics of the gait and the motor learning processes. The EU project "Self Mobility Improvement in the eLderly by counteractING falls" (SMILING project) aimed to improve age-related gait and balance performance by using unpredicted external perturbations during walking through motorized shoes that change insole inclination at each stance. This paper describes the shoe-worn inertial module and the gait analysis method needed to control in real-time the shoe insole inclination during training, as well as gait spatio-temporal parameters obtained during long distance walking before and after the 8-week training program that assessed the efficacy of training with these motorized shoes.