Effectiveness of Telerehabilitation Programs in Elderly with Hip or Knee Arthroplasty: A Systematic Review.

Background: Lower limb osteoarthritis (OA) often generates musculoskeletal pain causing functional impairment and decreasing mobility, autonomy, and quality of life. Patients with OA are commonly prescribed specific care for total hip arthroplasty or total knee arthroplasty (THA or TKA), when patients present symptoms that are refractory to nondrug treatments. Currently, when patients are discharged from orthopedic surgery, they are either referred to a rehabilitation department, or sent directly home with assistance such as remote monitoring by teleconsultation or a mobile application. In recent years, there has been an evolution in digital health and in particular telerehabilitation. To determine utility and effectiveness, the aim of this systematic review was to highlight and evaluate different telerehabilitation programs using new information and communication technologies. Methods: Five databases, ScienceDirect, PubMed, Web of Sciences, Scopus, and Google scholar, were searched until 30 June 30, 2023. All studies written in English and meeting our inclusion criteria were included. Databases were screened for "Total Hip Arthroplasty," "Total Knee Arthroplasty," "Total Hip Replacement," "Total Knee Replacement," "Rehabilitation," "Physical Activity," "Physiotherapy," "Telerehabilitation," "Telecommunication*," "Senior*," and "Elderly" in accordance with PRISMA-ScR guideline. Results: Fourteen articles were selected according to inclusion criteria. Telerehabilitation was offered in seven different ways (video call, applications smartphones, website, etc.). Assessments included were mainly quality of life questionnaires, perceived effort after exercises, field surveys on the tool experience, and physical tests to assess motor functions. Conclusion: This review highlights the importance and relevance of evaluating the contributions and limits of new health technologies to improve patient monitoring and thus enable better remote clinical care.

Sensorimotor Time Delay Estimation by EMG Signal Processing in People Living with Spinal Cord Injury.

Neuro mechanical time delay is inevitable in the sensorimotor control of the body due to sensory, transmission, signal processing and muscle activation delays. In essence, time delay reduces stabilization efficiency, leading to system instability (e.g., falls). For this reason, estimation of time delay in patients such as people living with spinal cord injury (SCI) can help therapists and biomechanics to design more appropriate exercise or assistive technologies in the rehabilitation procedure. In this study, we aim to estimate the muscle onset activation in SCI people by four strategies on EMG data. Seven complete SCI individuals participated in this study, and they maintained their stability during seated balance after a mechanical perturbation exerting at the level of the third thoracic vertebra between the scapulas. EMG activity of eight upper limb muscles were recorded during the stability. Two strategies based on the simple filtering (first strategy) approach and TKEO technique (second strategy) in the time domain and two other approaches of cepstral analysis (third strategy) and power spectrum (fourth strategy) in the time-frequency domain were performed in order to estimate the muscle onset. The results demonstrated that the TKEO technique could efficiently remove the electrocardiogram (ECG) and motion artifacts compared with the simple classical filtering approach. However, the first and second strategies failed to find muscle onset in several trials, which shows the weakness of these two strategies. The time-frequency techniques (cepstral analysis and power spectrum) estimated longer activation onset compared with the other two strategies in the time domain, which we associate with lower-frequency movement in the maintaining of sitting stability. In addition, no correlation was found for the muscle activation sequence nor for the estimated delay value, which is most likely caused by motion redundancy and different stabilization strategies in each participant. The estimated time delay can be used in developing a sensory motor control model of the body. It not only can help therapists and biomechanics to understand the underlying mechanisms of body, but also can be useful in developing assistive technologies based on their stability mechanism.

Time-delay estimation in biomechanical stability: a scoping review.

Despite its high-level of robustness and versatility, the human sensorimotor control system regularly encounters and manages various noises, non-linearities, uncertainties, redundancies, and delays. These delays, which are critical to biomechanical stability, occur in various parts of the system and include sensory, signal transmission, CNS processing, as well as muscle activation delays. Despite the relevance of accurate estimation and prediction of the various time delays, the current literature reflects major discrepancy with regards to existing prediction and estimation methods. This scoping review was conducted with the aim of characterizing and categorizing various approaches for estimation of physiological time delays based on PRISMA guidelines. Five data bases (EMBASE, PubMed, Scopus, IEEE and Web of Science) were consulted between the years of 2000 and 2022, with a combination of four related categories of keywords. Scientific articles estimating at least one physiological time delay, experimentally or through simulations, were included. Eventually, 46 articles were identified and analyzed with 20 quantification and 16 qualification questions by two separate reviewers. Overall, the reviewed studies, experimental and analytical, employing both linear and non-linear models, reflected heterogeneity in the definition of time delay and demonstrated high variability in experimental protocols as well as the estimation of delay values. Most of the summarized articles were classified in the high-quality category, where multiple sound analytical approaches, including optimization, regression, Kalman filter and neural network in time domain or frequency domain were used. Importantly, more than 50% of the reviewed articles did not clearly define the nature of the estimated delays. This review presents and summarizes these issues and calls for a standardization of future scientific works for estimation of physiological time-delay.

Does an outdoor virtual environment projected in a head-mounted display affect balance in healthy young adults?

BACKGROUND: Virtual reality head-mounted display (VR-HMD) is increasingly used for balance evaluation and rehabilitation. However, more studies must be conducted on virtual environments (VE) effects. This study aimed to assess the impact of an outdoor VE projected in a high-quality VR-HMD and of the VR-HMD mass on postural stability, postural control and leaning. METHODS: This study involved ten healthy young men who performed five 30-s stabilometric trials. Four experimental conditions were randomly performed: eyes open (EO) or eyes closed (EC), with (VR) or without (No VR) VR-HMD. Postural stability (antero-posterior (AP) and medio-lateral (ML) ranges of the center of pressure (CoP), 90% confidence ellipse area), postural control (CoP velocity (global, AP and ML)) and standard deviation of the CoP mean position), and postural leaning (AP/ML CoP mean position) were assessed. The comparisons between EO VR and EO No VR were used to analyze the VE effects and comparisons between EC VR and EC No VR for the VR-HMD mass effects. RESULTS: Spatiotemporal parameters that characterised postural stability and postural control, except ML velocity (p > 0.05), were significantly influenced by the simulated VE with higher values in EO VR than EO No VR (p < 0.05), but not by the VR-HMD mass. The mean position of the CoP showed no significant differences between conditions. SIGNIFICANCE: Postural stability and postural control modification due to the VE used in this study revealed that this VE could be interesting for VR-HMD rehabilitation and assessment. VR-HMD is not a factor to be considered for stabilometric analysis.

Testing Usability of a Medical Device Using Virtual Reality.

Before commercialization of a medical device, it is important to evaluate its usability. Traditional methods such as user testing to evaluate usability of medical device encountered difficulties to put participants in simulation conditions that are sufficiently realistic to be representative of real life. Virtual reality can be used to immerse participants in a high-fidelity simulation at a lower cost, but is not widely used today. This feasibility study aims to compare the results obtained between user tests in a real simulated environment and in a virtual reality environment, with feedback on the advantages and disadvantages of both conditions.

The rehabilitation robot: factors influencing its use, advantages and limitations in clinical rehabilitation.

PURPOSE: Despite the proven effectiveness of rehabilitation robots (RR) in the literature, they are still little used in clinical rehabilitation. The aim of this study was to analyse the factors influencing the use of RR and the perception of therapists who used RR. METHOD: In order to characterize the factors influencing the use of RR by therapists, a semi-structured interview was conducted with 18 therapists. These interviews are based on an interview guide inspired by the Unified Theory of Acceptance and Use of Technology model. The interviews were recorded and then transcribed, summarized and finally synthesized cross-sectionally. In addition and in parallel, the System Usability Scale (SUS) was also proposed to clinicians in order to collect quantitative data. RESULTS: The interviews highlight the facilitators perceived by the therapists, such as the intensity of the movement, the complementarity with conventional rehabilitation. The results also showed the possible barriers perceived, these can be sometimes inconclusive (e.g., bugs). The SUS results show no effect, either on the gender of the users, their therapists, or the duration of use of the tool. CONCLUSION: Better communication on the functionality of the robot and the construction of achievable goals would lead to more results that are conclusive but also better patient care. To date, and despite the evidence for the effectiveness of RRs, therapists believe that there are still many barriers to their use. They agree, however, that if changes are made, RRs will become an integral part of therapy.IMPLICATIONS FOR REHABILITATIONThe study idenfied and highlighted the factors influencing the use of the rehabilitation robot in the clinics through metric and ergonomic evaluations.The study allowed to quantify the level of acceptance of the Lokomat among therapists.This study allowed to identify negative factors that could be resolved through the implementation of a structured and generalized protocol for patients and thus improve their care.

Is treadmill walking biomechanically comparable to overground walking? A systematic review.

BACKGROUND: The equivalency of treadmill and overground walking has been investigated in a large number of studies. However, no systematic review has been performed on this topic. RESEARCH QUESTION: The aim of this study was to compare the biomechanical, electromyographical and energy consumption outcomes of motorized treadmill and overground walking. METHODS: Five databases, ScienceDirect, SpringerLink, Web of Science, PubMed, and Scopus, were searched until January 13, 2021. Studies written in English comparing lower limb biomechanics, electromyography and energy consumption during treadmill and overground walking in healthy young adults (20-40 years) were included. RESULTS: Twenty-two studies (n = 409 participants) were included and evaluated via the Cochrane Collaboration's tool. These 22 studies showed that some kinematic (reduced pelvic ROM, maximum hip flexion angle for females, maximum knee flexion angle for males and cautious gait pattern), kinetic (sagittal plane joint moments: dorsiflexor moments, knee extensor moments and hip extensor moments and sagittal plane joint powers at the knee and hip joints, peak backwards, lateral and medial COP velocities and propulsive forces during late stance) and electromyographic (lower limbs muscles activities) outcome measures were significantly different for motorized treadmill and overground walking. SIGNIFICANCE: Spatiotemporal, kinematic, kinetic, electromyographic and energy consumption outcome measures were largely comparable for motorized treadmill and overground walking. However, the differences in kinematic, kinetic and electromyographic parameters should be taken into consideration by clinicians, trainers, and researchers when working on new protocols related to patient rehabilitation, fitness rooms or research as to be as close as possible to the outcome measures of overground walking. The protocol registration number is CRD42021236335 (PROSPERO International Prospective Register of Systematic Reviews).

Variations in Patterns of Muscle Activity Observed in Participants Walking in Everyday Environments: Effect of Different Surfaces.

Purpose: The purpose of this study was to examine variations in lower limb surface electromyography (EMG) activity when individuals walked on different outdoor surfaces and to characterize the different potential motor strategies. Method: Forty healthy adult participants walked at a self-selected speed over asphalt, grass, and pavement. They then walked on an indoor treadmill at the same gait speed as observed for each outdoor condition. The EMG activity of the vastus lateralis (VL), tibialis anterior (TA), biceps femoris (BF), and gastrocnemius lateralis (GL) muscles was recorded, and the duration and intensity (root mean square) of EMG burst activity was calculated. Results: Walking on grass resulted in a longer TA burst duration than walking on other outdoor surfaces. Walking on pavement was associated with increased intensity of TA and VL activation compared with the indoor treadmill condition. The variability of EMG intensity for all muscle groups tested (TA, GL, BF, VL) was greatest on grass and lowest on asphalt. Conclusions: The muscle activity patterns of healthy adult participants vary in response to the different qualities of outdoor walking surfaces. Ongoing development of ambulatory EMG methods will be required to support gait retraining programmes that are tailored to the environment.

Objectif : examiner les variations de l'activité électromyographique (EMG) de surface des membres inférieurs lorsqu'une personne marche sur différentes surfaces extérieures et caractériser les diverses stratégies motrices potentielles. Méthodologie : au total, 40 participants adultes en bonne santé ont marché à vitesse spontanée sur de l'asphalte, du gazon et des pavés. Ils ont ensuite dû marcher sur un tapis roulant à la même vitesse que sur chaque surface extérieure. Les chercheurs ont enregistré l'activité EMG des muscles vaste latéral (VL), tibial antérieur (TA), biceps fémoral (BF) et gastrocnémien latéral (GL) durant la marche. Ils ont ensuite calculé la durée et l'intensité (moyenne quadratique) de la bouffée d'activité EMG. Résultats : la marche sur le gazon provoque principalement une bouffée d'activité du muscle TA plus longue que la marche sur les autres surfaces extérieures. La marche sur les pavés est liée à une augmentation de l'intensité d'activation des muscles TA et VL par rapport à celle sur le tapis roulant. La variabilité de l'intensité EMG de tous les muscles testés (TA, GL, BF, VL) était plus élevée sur le gazon et plus faible sur l'asphalte. Conclusion : les tracés d'activité musculaire des participants varient selon la nature des surfaces de marche extérieure. Les méthodes d'enregistrement de l'EMG devront être améliorées de façon à valider les programmes de rééducation de la marche adaptés à l'environnement.

Intersegmental kinematics coordination in unilateral peripheral and central origin: Effect on gait mechanism?

BACKGROUND: The gait mechanism requires an efficient intersegmental coordination in order to ensure the displacement of the body while simultaneously maintaining the postural stability. However, intersegmental coordination may be disrupted by neurological or orthopaedic involvement, this increasing the metabolic cost associated with excessive or prolonged muscle co-contraction. RESEARCH QUESTION: Our aim was to evaluate and to understand how hip OA affects lower limbs coordination during gait by using the kinematic segmental covariation law method and predict the energy expenditure. METHODS: In order to evaluate the influence of unilateral alteration of the lower limbs on the gait mechanism, three groups namely 63 hip osteoarthritis patients, 65 chronic hemiparetic stroke patients and 72 healthy subjects performed an instrumented gait analysis. The subjects had to walk barefoot for at least 3 min at a self-selected speed on a force measuring motor-driven treadmill. The biomechanical variables (kinematic, kinetic and energetical cost) were simultaneously recorded. RESULTS: The comparison between the three groups was tested using a repeated measure ANOVA. All biomechanical parameters show significant differences between the 3 groups highlighting the gait alteration for the patients groups. However, the energetic cost remains normal in the hip osteoarthritis group despite of the alteration of the other variables. A multivariate analysis allowed to identify the independent variables affecting more specifically their gait mechanisms. SIGNIFICANCE: This study showed the importance of quantitative functional evaluation in order to better understand the impact of hip osteoarthritis on the gait mechanism. The biomechanical analysis provides objective evidence of the altered gait mechanism and more particularly of the intersegmental coordination in these patients. This gait analysis is therefore an interesting tool in the functional evaluation of the patient to better guide the diagnosis.