Influence of visual and auditory biofeedback on partial body weight support treadmill training of individuals with chronic hemiparesis: a randomized controlled clinical trial. Evidence for physiotherapy practice: a survey of the Physiotherapy Evidence Database (PEDro). Effects of a novel walking training program with postural correction and visual feedback on walking function in patients with post-stroke hemiparesis Gait improvement in patients with cerebral palsy by visual and auditory feedback The Impact of Different Types of Assistive Devices on Gait Measures and Safety in Huntington's Disease Gait training in subacute non-ambulatory stroke patients using a full weight-bearing gait-assistance robot: A prospective, randomized, open, blinded-endpoint trial Effect of Task Specific Exercises, Gait Training, and Visual Biofeedback on Equinovarus Gait among Individuals with Stroke: Randomized Controlled Study Effectiveness of knowledge of result and knowledge of performance in the learning of a skilled motor activity by healthy young adults Augmented visual feedback of movement performance to enhance walking recovery after stroke: study protocol for a pilot randomised controlled trial Efficacy of Feedback-Controlled Robotics-Assisted Treadmill Exercise to Improve Cardiovascular Fitness Early After Stroke: A Randomized Controlled Pilot Trial Haptic biofeedback for improving compliance with lower-extremity partial weight bearing. Balance and Gait Training With Augmented Feedback Improves Balance Confidence in People With Parkinson’s Disease Effects of auditory feedback during gait training on hemiplegic patients’ weight bearing and dynamic balance ability The effect of different corrective feedback methods on the outcome and self confidence of young athletes. The PEDro scale is a valid measure of the methodological quality of clinical trials: a demographic study. The effectiveness of robotic-assisted gait training for paediatric gait disorders: systematic review The Relative Importance of Visual, Auditory, and Haptic Information for the User's Experience of Mechanical Switches A pilot study of post-total knee replacement gait rehabilitation using lower limbs robot-assisted training system Effects of gait training with a cane and an augmented pressure sensor for enhancement of weight bearing over the affected lower limb in patients with stroke: a randomized controlled pilot study A shoe insole delivering subsensory vibratory noise improves balance and gait in healthy elderly people. Comparison of mirror, raw video, and real-time visual biofeedback for training toe-out gait in individuals with knee osteoarthritis. Reliability of the PEDro scale for rating quality of randomized controlled trials. Effects of augmented proprioceptive cues on the parameters of gait of individuals with Parkinson's disease Efficacy of an insole shoe wedge and augmented pressure sensor for gait training in individuals with stroke: a randomized controlled trial Clinical impact of gait training enhanced with visual kinematic biofeedback: Patients with Parkinson’s disease and patients stable post stroke Feasibility and effects of home-based smartphone-delivered automated feedback training for gait in people with Parkinson's disease: A pilot randomized controlled trial. PEDro. A database of randomized trials and systematic reviews in physiotherapy. Gait rehabilitation: a new biofeedback device for monitoring and enhancing weight-bearing over the affected lower limb. Effects of Complementary Auditory Feedback in Robot-Assisted Lower Extremity Motor Adaptation The PEDro scale had acceptably high convergent validity, construct validity, and interrater reliability in evaluating methodological quality of pharmaceutical trials. Intensive Gait Training for Older Adults with Symptomatic Knee Osteoarthritis Efficacy of gait training using a treadmill with and without visual biofeedback in patients after stroke: A randomized study.
BACKGROUND Stroke is an important causal factor of deficiency and functional dependence worldwide . OBJECTIVE To determine the immediate effects of visual and auditory biofeedback , combined with partial body weight supported ( PBWS ) treadmill training on the gait of individuals with chronic hemiparesis . DESIGN R and omized controlled trial . SETTING Outpatient rehabilitation hospital . POPULATION S Thirty subjects with chronic hemiparesis and ability to walk with some help . METHODS Participants were r and omized to a control group that underwent only PBWS treadmill training ; or experimental I group with visual biofeedback from the display monitor , in the form of symbolic feet as the subject took a step ; or experimental group II with auditory biofeedback associated display , using a metronome at 115 % of the individual 's preferred cadence . They trained for 20 minutes and were evaluated before and after training . Spatio-temporal and angular gait variables were obtained by kinematics from the Qualisys Motion Analysis system . RESULTS Increases in speed and stride length were observed for all groups over time ( speed : F=25.63 ; P<0.001 ; stride length : F=27.18 ; P<0.001 ) , as well as changes in hip and ankle range of motion - ROM ( hip ROM : F=14.43 ; P=0.001 ; ankle ROM : F=4.76 ; P=0.038 ) , with no time*groups interaction . Other spatio-temporal and angular parameters remain unchanged . CONCLUSIONS Visual biofeedback and auditory biofeedback had no influence on PBWS treadmill training of individuals with chronic hemiparesis , in short term . Additional studies are needed to determine whether , in long term , the biofeedback will promote additional benefit to the PBWS treadmill training . CLINICAL REHABILITATION IMPACT The findings of this study indicate that visual and auditory biofeedback does not bring immediate benefits on PBWS treadmill training of individuals with chronic hemiparesis . This suggest that , for additional benefits are achieved with biofeedback , effects should be investigated after long-term training , which may determine if some kind of biofeedback is superior to another to improve the hemiparetic gait Evidence -based practice involves the use of evidence from systematic review s and r and omised controlled trials , but the extent of this evidence in physiotherapy has not previously been surveyed . The aim of this survey is to describe the quantity and quality of r and omised controlled trials and the quantity of systematic review s relevant to physiotherapy . The Physiotherapy Evidence Data base ( PEDro ) was search ed . The quality of trials was assessed with the PEDro scale . The search identified a total of 2,376 r and omised controlled trials and 332 systematic review s. The first trial was published in 1955 and the first review was published in 1982 . Since that time , the number of trials and review s has grown exponentially . The mean PEDro quality score has increased from 2.8 in trials published between 1955 and 1959 to 5.0 for trials published between 1995 and 1999 . There is a substantial body of evidence about the effects of physiotherapy . However , there remains scope for improvements in the quality of the conduct and reporting of clinical trials [ Purpose ] This study aim ed to eluci date the effects of a novel walking training program with postural correction and visual feedback on walking function in patients with post-stroke hemiparesis . [ Subjects ] Sixteen subjects were r and omly allocated to either the experimental group ( EG ) or the control group ( CG ) , with eight subjects in each . [ Methods ] EG and CG subjects performed a 30-min treadmill walking training exercise twice daily for 2 weeks . EG subjects also underwent postural correction using elastic b and s and received visual feedback during walking . The 10-m walk test was performed , and gait parameters were measured using a gait analysis system . [ Results ] All parameters showed significant main effects for the group factor and time-by-group interactions . Significant main effects for the time factor were found in the stride length and stance phase ratios . [ Conclusion ] The novel walking training program with postural correction and visual feedback may improve walking function in patients with post-stroke hemiparesis Visual and auditory feedback cues have been shown to improve gait and balance in patients with movement disorders , such as Parkinson 's disease and multiple sclerosis . Subsequently , closed-loop virtual reality was used to enhance the gait improvement effect of such cues . Objectives : To study the effects of gait training with visual and auditory feedback cues on the walking abilities of patients with gait disorders due to cerebral palsy . Methods : Visual and auditory feedback cues were generated by a wearable accelerometry-driven device . Ten r and omly selected patients with gait disorders due to cerebral palsy trained with visual feedback cues while ten such patients trained with auditory feedback cues . Baseline performance ( walking speed and stride length along a 10 m straight track ) was measured before device use . Following 20min training with the device , performance without the device was measured again and compared to the baseline performance . Results : For patients training with visual feedback , the average improvement in walking speed was 21.70%+/−36.06 % and in stride length 8.72%±9.47 % . For patients training with auditory feedback , average improvement in walking speed was 25.43%±28.65 % and in stride length 13.58%±13.10 % . Conclusion : Visual and auditory feedback cues can improve gait parameters in patients with gait disorders due to cerebral palsy Background Gait and balance impairments lead to frequent falls and injuries in individuals with Huntington 's disease ( HD ) .  Assistive devices ( ADs ) such as canes and walkers are often prescribed to prevent falls , but their efficacy is unknown . We systematic ally examined the effects of different types of ADs on quantitative gait measures during walking in a straight path and around obstacles . Methods Spatial and temporal gait parameters were measured in 21 subjects with HD as they walked across a GAITRite walkway under 7 conditions ( i.e. , using no AD and 6  commonly prescribed ADs : a cane , a weighted cane , a st and ard walker , and a 2 , 3 or 4 wheeled walker ) . Subjects also were timed and observed for number of stumbles and falls while walking around two obstacles in a figure-of-eight pattern . Results Gait measure variability ( i.e. , coefficient of variation ) , an indicator of fall risk , was consistently better when using the 4WW compared to other ADs . Subjects also walked the fastest and had the fewest number of stumbles and falls when using the 4WW in the figure-of-eight course . Subjects walked significantly slower using ADs compared to no AD both across the GAITRite and in the figure-of-eight . Measures reflecting gait stability and safety improved with the 4WW but were made worse by some other ADs BACKGROUND This study was a prospect i ve , r and omized , open , blinded-endpoint trial with the aim of examining whether gait training with a gait-assistance robot ( GAR ) improves gait disturbances in subacute non-ambulatory hemiplegic stroke patients more than overground conventional gait training . The GAR adopts a robot arm control system with full weight bearing and foot pressure visual biofeedback . METHODS Twenty-six hemiplegic patients were r and omly assigned to either the  GAR-assisted gait training ( GAGT ) group or the  overground conventional gait training ( OCGT ) group . Both groups underwent 60 min of st and ard physical therapy and 20 min of GAGT or OCGT 5 days a week for 4 weeks . The primary outcome measure was the Functional Ambulation Classification ( FAC ) . The secondary outcome measures were the peak torque of the extensor muscles in the lower extremities and a 10-m walking test . The lower extremity function was evaluated using the Fugl-Meyer Assessment , and activities of daily living were assessed using the Functional Independence Measure . RESULTS The GAGT group demonstrated significantly greater improvements in FAC and peak torque on the unaffected side ( p=0.02 ) than the OCGT group . Additionally , gait speed tended to be faster ( p=0.07 ) in the GAGT group . CONCLUSIONS GAGT combined with st and ard physical therapy in subacute non-ambulatory hemiplegic patients led to significant improvements in gait and peak torque on the unaffected side compared to OCGT Background and Purpose . Equinovarus foot is a common sign after stroke . The aim of this study is to investigate the effect of task specific exercises , gait training , and visual biofeedback on correcting equinovarus gait among individuals with stroke . Subjects and Methods . Sixteen subjects with ischemic stroke were r and omly assigned to two equal groups ( G1 and G2 ) . All the patients were at stage 4 of motor recovery of foot according to Chedoke-McMaster Stroke Assessment without any cognitive dysfunction . E-med pedography was used to measure contact time , as well as force underneath hind and forefoot during walking . Outcome measures were collected before r and omization , one week after the last session , and four weeks later . Participants in G1 received task specific exercises , gait training , and visual biofeedback and a traditional physical therapy program was applied for participants in G2 for 8 weeks . Results . Significant improvement was observed among G1 patients ( P ≤ 0.05 ) which lasts one month after therapy termination . On the other h and , there were no significant differences between measurements of the participants in G2 . Between groups comparison also revealed a significant improvement in G1 with long lasting effect . Conclusion . The results of this study showed a positive long lasting effect of the task specific exercises , gait training , and visual biofeedback on equinovarus gait pattern among individuals with stroke [ Purpose ] The acquisition of motor skills are fundamental to human life . There is a lack of research on whether knowledge of performance or knowledge of result as augmented feedback is more effective . The objective of this study was to compare the effectiveness of knowledge of result and knowledge of performance in the learning of a skilled motor activity by healthy young adults . [ Subjects and Methods ] A total of thirty healthy young adult males and females without any neurological or musculoskeletal impairment , between the age of 18–30 years were the subjects of the study . They were r and omly allocated to 2 groups : group 1 was given knowledge of result as feedback , and knowledge of performance was given as feedback to group 2 . Both the groups practice d the task of throwing a soft spongy ball for 6 days per week for 4 weeks , with 40 trials each day . The outcome measure used was the distance of the throw . [ Results ] The results were analyzed using the t-test . The mean distances thrown by both the groups showed highly significant improvements and throwing distance of group 2 showed better improvement than that of group 1 . [ Conclusion ] Both types of augmented feedback were effective at improving skilled motor activity , but the knowledge of performance group showed better improvement than the knowledge of result group Background Increasing evidence suggests that use of augmented visual feedback could be a useful approach to stroke rehabilitation . In current clinical practice , visual feedback of movement performance is often limited to the use of mirrors or video . However , neither approach is optimal since cognitive and self-image issues can distract or distress patients and their movement can be obscured by clothing or limited viewpoints . Three-dimensional motion capture has the potential to provide accurate kinematic data required for objective assessment and feedback in the clinical environment . However , such data are currently presented in numerical or graphical format , which is often impractical in a clinical setting . Our hypothesis is that presenting this kinematic data using bespoke visualisation software , which is tailored for gait rehabilitation after stroke , will provide a means whereby feedback of movement performance can be communicated in a more meaningful way to patients . This will result in increased patient underst and ing of their rehabilitation and will enable progress to be tracked in a more accessible way . Methods The hypothesis will be assessed using an exploratory ( phase II ) r and omised controlled trial . Stroke survivors eligible for this trial will be in the subacute stage of stroke and have impaired walking ability ( Functional Ambulation Classification of 1 or more ) . Participants ( n = 45 ) will be r and omised into three groups to compare the use of the visualisation software during overground physical therapy gait training against an intensity-matched and attention-matched placebo group and a usual care control group . The primary outcome measure will be walking speed . Secondary measures will be Functional Ambulation Category , Timed Up and Go , Rivermead Visual Gait Assessment , Stroke Impact Scale-16 and spatiotemporal parameters associated with walking . Additional qualitative measures will be used to assess the participant ’s experience of the visual feedback provided in the study . Discussion Results from the trial will explore whether the early provision of visual feedback of biomechanical movement performance during gait rehabilitation demonstrates improved mobility outcomes after stroke and increased patient underst and ing of their rehabilitation . Trial registration Current Controlled Trials IS RCT Background and Purpose : Cardiovascular fitness is greatly reduced after stroke . Although individuals with mild to moderate impairments benefit from conventional cardiovascular exercise interventions , there is a lack of effective approaches for persons with severely impaired physical function . This r and omized controlled pilot trial investigated efficacy and feasibility of feedback-controlled robotics-assisted treadmill exercise ( FC-RATE ) for cardiovascular rehabilitation in persons with severe impairments early after stroke . Methods : Twenty individuals ( age 61 ± 11 years ; 52 ± 31 days poststroke ) with severe motor limitations ( Functional Ambulation Classification 0 - 2 ) were recruited for FC-RATE or conventional robotics-assisted treadmill exercise ( RATE ) ( 4 weeks , 3 × 30-minute sessions/wk ) . Outcome measures focused on peak cardiopulmonary performance parameters , training intensity , and feasibility , with examiners blinded to allocation . Results : All 14 allocated participants ( 70 % of recruited ) completed the intervention ( 7/group , withdrawals unrelated to intervention ) , without serious adverse events occurring . Cardiovascular fitness increased significantly in both groups , with peak oxygen uptake increasing from 14.6 to 17.7 mL · kg−1 · min−1 ( + 17.8 % ) after 4 weeks ( 45.8%-55.7 % of predicted maximal aerobic capacity ; time effect P = 0.01 ; no group-time interaction ) . Training intensity ( % heart rate reserve ) was significantly higher for FC-RATE ( 40 % ± 3 % ) than for conventional RATE ( 14 % ± 2 % ) ( P = 0.001 ) . Discussion and Conclusions : Substantive overall increases in the main cardiopulmonary performance parameters were observed , but there were no significant between-group differences when comparing FC-RATE and conventional RATE . Feedback-controlled robotics-assisted treadmill exercise significantly increased exercise intensity , but recommended intensity levels for cardiovascular training were not consistently achieved . Future research should focus on appropriate algorithms within advanced robotic systems to promote optimal cardiovascular stress . Video abstract available for more insights from the authors ( Supplemental Digital Content 1 , http://links.lww.com/JNPT/A107 ) After lower-extremity orthopedic trauma and surgery , patients are often advised to restrict weight bearing on the affected limb . Conventional training methods are not effective at enabling patients to comply with recommendations for partial weight bearing . The current study assessed a novel method of using real-time haptic ( vibratory/vibrotactile ) biofeedback to improve compliance with instructions for partial weight bearing . Thirty healthy , asymptomatic participants were r and omized into 1 of 3 groups : verbal instruction , bathroom scale training , and haptic biofeedback . Participants were instructed to restrict lower-extremity weight bearing in a walking boot with crutches to 25 lb , with an acceptable range of 15 to 35 lb . A custom weight bearing sensor and biofeedback system was attached to all participants , but only those in the haptic biofeedback group were given a vibrotactile signal if they exceeded the acceptable range . Weight bearing in all groups was measured with a separate vali date d commercial system . The verbal instruction group bore an average of 60.3±30.5 lb ( mean±st and ard deviation ) . The bathroom scale group averaged 43.8±17.2 lb , whereas the haptic biofeedback group averaged 22.4±9.1 lb ( P<.05 ) . As a percentage of body weight , the verbal instruction group averaged 40.2±19.3 % , the bathroom scale group averaged 32.5±16.9 % , and the haptic biofeedback group averaged 14.5±6.3 % ( P<.05 ) . In this initial evaluation of the use of  haptic biofeedback  to improve compliance with lower-extremity partial weight bearing , haptic biofeedback was superior to conventional physical therapy methods . Further studies in patients with clinical orthopedic trauma are warranted Background . Fear of falling has been identified as an important and independent fall-risk predictor in patients with Parkinson ’s disease ( PD ) . However , there are inconsistent findings on the effects of balance and gait training on balance confidence . Objective . To explore whether balance and gait training with augmented feedback can enhance balance confidence in PD patients immediately after treatment and at 3- and 12-month follow-ups . Methods . A total of 51 PD patients were r and omly assigned to a balance and gait training ( BAL ) group or to an active control ( CON ) group . The BAL group received balance and gait training with augmented feedback , whereas CON participants received lower-limb strength training for 12 weeks . Outcome measures included Activities-Specific Balance Confidence ( ABC ) Scale , limits-of-stability test , single-leg-stance test , and spatiotemporal gait characteristics . All tests were administered before intervention ( Pre ) , immediately after training ( Post ) , and at 3 months ( Post3 m ) and 12 months ( Post12 m ) after treatment completion . Results . The ABC score improved marginally at Post and significantly at Post3 m and Post12 m only in the BAL group ( P < .017 ) . Both participant groups increased their end point excursion at Post , but only the BAL group maintained the improvement at Post3 m . The BAL group maintained significantly longer time-to-loss-of-balance during the single-leg stance test than the CON group at Post3 m and Post12 m ( P < .05 ) . For gait characteristics , both participant groups increased gait velocity , but only the BAL group increased stride length at Post , Post3 m , and Post12 m ( P < .017 ) . Conclusions . Positive findings from this study provide evidence that BAL with augmented feedback could enhance balance confidence and balance and gait performance in patients with PD [ Purpose ] This study examined the effects of auditory feedback during gait on the weight bearing of patients with hemiplegia result ing from a stroke . [ Subjects ] Thirty hemiplegic patients participated in this experiment and they were r and omly allocated to an experimental group and a control group . [ Methods ] Both groups received neuro-developmental treatment for four weeks and the experimental group additionally received auditory feedback during gait training . In order to examine auditory feedback effects on weight bearing during gait , a motion analysis system GAITRite was used to measure the duration of the stance phase and single limb stance phase of the subjects . [ Results ] The experimental group showed statistically significant improvements in the duration of the stance phase and single limb stance phase of the paretic side and the results of the Timed Up and Go Test after the training . [ Conclusion ] Auditory feedback during gait training significantly improved the duration of the stance phase and single limb stance phase of hemiplegic stroke patients This experiment investigated the effects of three corrective feedback methods , using different combinations of correction , or error cues and positive feedback for learning two badminton skills with different difficulty ( foreh and clear - low difficulty , backh and clear - high difficulty ) .  Outcome and self-confidence scores were used as dependent variables . The 48 participants were r and omly assigned into four groups . Group A received correction cues and positive feedback . Group B received cues on errors of execution . Group C received positive feedback , correction cues and error cues . Group D was the control group . A pre , post and a retention test was conducted . A three way analysis of variance ANOVA ( 4 groups X 2 task difficulty X 3 measures ) with repeated measures on the last factor revealed significant interactions for each depended variable . All the corrective feedback methods groups , increased their outcome scores over time for the easy skill , but only groups A and C for the difficult skill . Groups A and B had significantly better outcome scores than group C and the control group for the easy skill on the retention test . However , for the difficult skill , group C was better than groups A , B and D. The self confidence scores of groups A and C improved over time for the easy skill but not for group B and D. Again , for the difficult skill , only group C improved over time . Finally a regression analysis depicted that the improvement in performance predicted a proportion of the improvement in self confidence for both the easy and the difficult skill . It was concluded that when young athletes are taught skills of different difficulty , different type of instruction , might be more appropriate in order to improve outcome and self confidence . A more integrated approach on teaching will assist coaches or physical education teachers to be more efficient and effective . Key pointsThe type of the skill is a critical factor in determining the effectiveness of the feedback types . Different instructional methods of corrective feedback could have beneficial effects in the outcome and self-confidence of young athletesInstructions focusing on the correct cues or errors increase performance of easy skills . Positive feedback or correction cues increase self-confidence of easy skills but only the combination of error and correction cues increase self confidence and outcome scores of difficult skills QUESTIONS Does the PEDro scale measure only one construct ie , the method ological quality of clinical trials ? What is the hierarchy of items of the PEDro scale from least to most adhered to ? Is there any effect of year of publication of trials on item adherence ? Are PEDro scale ordinal scores equivalent to interval data ? DESIGN Rasch analysis of two independent sample s of 100 clinical trials from the PEDro data base scored using the PEDro scale . RESULTS Both sample s of PEDro data showed fit to the Rasch model with no item misfit . The  PEDro scale item hierarchy was the same in both sample s , ranging from the most adhered to item r and om allocation , to the least adhered to item therapist blinding . There was no differential item functioning by year of publication . Original PEDro ordinal scores were highly correlated with transformed PEDro interval scores ( r = 0.99 ) . CONCLUSION The PEDro scale is a valid measure of the method ological quality of clinical trials . It is valid to sum PEDro scale item scores to obtain a total score that can be treated as interval level measurement and subjected to parametric statistical analysis Background Robotic-assisted gait training ( RAGT ) affords an opportunity to increase walking practice with mechanical assistance from robotic devices , rather than therapists , where the child may not be able to generate a sufficient or correct motion with enough repetitions to promote improvement . However the devices are expensive and clinicians and families need to underst and if the approach is worthwhile for their children , and how it may be best delivered . Methods The objective of this review was to identify and appraise the existing evidence for the effectiveness of RAGT for paediatric gait disorders , including modes of delivery and potential benefit . Six data bases were search ed from 1980 to October 2016 , using relevant search terms . Any clinical trial that evaluated a clinical aspect of RAGT for children/adolescents with altered gait was selected for inclusion . Data were extracted following the PRISMA approach . Seventeen trials were identified , assessed for level of evidence and risk of bias , and appropriate data extracted for reporting . Results Three r and omized controlled trials were identified , with the remainder of lower level design . Most individual trials reported some positive benefits for RAGT with children with cerebral palsy ( CP ) , on activity parameters such as st and ing ability , walking speed and distance . However a meta- analysis of the two eligible RCTs did not confirm this finding ( p = 0.72 ) . Training schedules were highly variable in duration and frequency and adverse events were either not reported or were minimal . There was a paucity of evidence for diagnoses other than CP . Conclusion There is weak and inconsistent evidence regarding the use of RAGT for children with gait disorders . If clinicians ( and their clients ) choose to use RAGT , they should monitor individual progress closely with appropriate outcome measures including monitoring of adverse events . Further research is required using higher level trial design , increased numbers , in specific population s and with relevant outcome measures to both confirm effectiveness and clarify training schedules While the use of h and tools and other everyday manually controlled devices is naturally accompanied by multisensory feedback , the deployment of fully multimodal virtual interfaces requires that haptic , acoustic , and visual cues be synthesis ed . The complexity and character of this synthesis will depend on a thorough underst and ing of the multimodal perceptual experience , including the interrelations between the individual sensory channels during manual interaction . In this study seventy participants were asked to rank the manual operation of ten electromechanical switches according to preference . The participants were r and omly assigned in groups of ten to one of seven sensory presentation conditions . These conditions comprised six bimodal and unimodal sensory combinations created by selectively restricting the flow of haptic , auditory , and visual information , plus one condition in which ful sensory information was available . A principal components analysis on the obtained ranking data indicated that the sensory conditions with unimpeded haptic information were clearly distinct from those in which the haptic cues were impeded . The analysis also showed that , for switch use , the unimodal haptic condition most closely approached the condition with combined haptic , auditory , and visual feedback , compared with all of the conditions where haptic feedback was restricted The aim of this study was to explore the application value of the lower limbs robot-assisted training system for post-total knee replacement ( TKR ) gait rehabilitation . A total of 60 patients with osteoarthritis of the knee were equally r and omized into the traditional and robot-assisted rehabilitation training groups within 1 week after TKR . All patients received 2-week training . Scores of hospital for special surgery ( HSS ) , knee kinesthesia grade s , knee proprioception grade s , functional ambulation ( FAC ) scores , Berg balance scores , 10-m sitting – st and ing time , and 6-min walking distances were compared between the groups . The HSS score , Berg score , 10-m sitting – st and ing time , and 6-min walking distance of the robot-assisted training group were significantly higher than the control group ( P < 0.05 ) . Its knee kinesthesia grade , knee proprioception grade , and FAC score were better than the control group but not significantly ( P > 0.05 ) . Lower limbs robot-assisted rehabilitation training  improves post-TKR patients ’ knee proprioception and stability more effectively compared with the traditional method . It improves patients ’ gait and symptoms , increases their walking speed , and prolongs their walking distances , which benefit their return to family and society Objective : The purpose of this study was to examine the effect of gait training when using a cane with an augmented pressure sensor for enhancement of weight-bearing over the affected lower limb on the peak pressure force of the cane , muscle activation , and gait in patients with stroke . Design : R and omized controlled pilot study . Setting : Inpatient rehabilitation center . Participants : A total of 22 hemiparetic stroke patients were recruited and r and omly divided into an experimental group ( n = 11 ) and control group , which later had a drop-out ( n = 10 ) . Interventions : Subjects in the experimental group participated in gait training with auditory feedback for 30 minutes , five times a week for four weeks , whereas those in the control group received gait training without auditory feedback for the same amount of time . Main measures : The peak force of cane , muscle activation of gluteus medius , and vastus medialis oblique , single limb support phase of the affected leg , and gait speed before and after training were collected . Results : Significant improvement in the peak force of cane , muscle activation of gluteus medius and vastus medialis oblique , single limb support phase of the affected leg , and gait speed were observed in the experimental group ( 13.5 ±9.5 cm/s ) compared with the control group ( 3.7 ±8.4 cm/s ) ( p < 0.05 ) . Conclusion : Gait training using a cane with an augmented pressure sensor to enhance weight bearing over the affected lower limb is beneficial and effective in improving the peak force of cane , muscle activation , and gait in stroke patients OBJECTIVES To test whether subsensory vibratory noise applied to the sole of the foot using a novel piezoelectric vibratory insole can significantly improve sensation , enhance balance , and reduce gait variability in elderly people , as well as to determine the optimal level of vibratory noise and whether the therapeutic effect would endure and the user 's sensory threshold would remain constant during the course of a day . DESIGN A r and omized , single-blind , crossover study of 3 subsensory noise stimulation levels on 3 days . SETTING Balance and gait laboratory . PARTICIPANTS Healthy community-dwelling elderly volunteers ( N=12 ; age , 65 - 90y ) who could feel the maximum insole vibration . INTERVENTIONS A urethane foam insole with the piezoelectric actuators delivering subsensory vibratory noise stimulation to the soles of the feet . MAIN OUTCOME MEASURES Balance , gait , and timed Up and Go ( TUG ) test . RESULTS The vibratory insoles significantly improved performance on the TUG test , reduced the area of postural sway , and reduced the temporal variability of walking at both 70 % and 85 % of the sensory threshold and during the course of a day . Vibratory sensation thresholds remained relatively stable within and across study days . CONCLUSIONS This study provides proof of concept that the application of the principle of stochastic resonance to the foot sole sensory system using a new low-voltage piezoelectric technology can improve measures of balance and gait that are associated with falls . Effective vibratory noise amplitudes range from 70 % to 85 % of the sensory threshold and can be set once daily OBJECTIVE To compare performance error and perceived difficulty during toe-out gait modification in people with knee osteoarthritis ( OA ) across 3 different types of visual feedback : mirror , raw video , and real-time biofeedback of toe-out angle . DESIGN Repeated- measures , within-subject trial . SETTING University motion analysis laboratory . PARTICIPANTS Individuals with knee OA ( N=20 ; 11 women ; mean age , 65.4±9.8y ) participated in this study . Seven participants had mild knee OA , 9 had moderate knee OA , and 4 had severe knee OA . INTERVENTIONS Participants were trained to walk on a treadmill while matching a target indicating a 10 ° increase in stance phase toe-out compared with toe-out angle measured during self-selected walking . The target was provided visually via the 3 types of feedback listed above and were presented in a r and om order . MAIN OUTCOME MEASURES Kinematic data were collected and used to calculate the difference between the target angle and the actual performed angle for each condition ( toe-out performance error ) . Difficulty was assessed using a numerical rating scale ( 0 - 10 ) provided verbally by participants . RESULTS Toe-out performance error was significantly less when using the real-time biofeedback method than when using the other 2 methods ( P=.025 ; mean difference vs mirror=2.05 ° ; mean difference vs raw video=1.51 ° ) . Perceived difficulty was not statistically different between the groups ( P=.51 ) . CONCLUSIONS Although statistically significant , the 2 ° difference in toe-out gait performance error may not necessitate the large economic and personnel costs of real-time biofeedback as a means to modify movement in clinical or research setting BACKGROUND AND PURPOSE Assessment of the quality of r and omized controlled trials ( RCTs ) is common practice in systematic review s. However , the reliability of data obtained with most quality assessment scales has not been established . This report describes 2 studies design ed to investigate the reliability of data obtained with the Physiotherapy Evidence Data base ( PEDro ) scale developed to rate the quality of RCTs evaluating physical therapist interventions . METHOD In the first study , 11 raters independently rated 25 RCTs r and omly selected from the PEDro data base . In the second study , 2 raters rated 120 RCTs r and omly selected from the PEDro data base , and disagreements were resolved by a third rater ; this generated a set of individual rater and consensus ratings . The process was repeated by independent raters to create a second set of individual and consensus ratings . Reliability of ratings of PEDro scale items was calculated using multirater kappas , and reliability of the total ( summed ) score was calculated using intraclass correlation coefficients ( ICC [ 1,1 ] ) . RESULTS The kappa value for each of the 11 items ranged from.36 to.80 for individual assessors and from.50 to.79 for consensus ratings generated by groups of 2 or 3 raters . The ICC for the total score was.56 ( 95 % confidence interval=.47-.65 ) for ratings by individuals , and the ICC for consensus ratings was.68 ( 95 % confidence interval=.57-.76 ) . DISCUSSION AND CONCLUSION The reliability of ratings of PEDro scale items varied from " fair " to " substantial , " and the reliability of the total PEDro score was " fair " to " good . Context : Impairment of initiating sequential movements and processing of proprioception contribute to characteristic Parkinson 's disease ( PD ) gait abnormalities . Many studies have used a single external cue or 2 different cues to correct PD gait . Aim : An aim of this study was to determine the influence of paired proprioceptive cues on gait parameters of individuals with PD . Setting and Design : Double-blind r and omized controlled trial . Material s and Methods : Subjects were 30 PD patients who had mild to moderate impairment according to the United Parkinson 's Disease Rating Scale ( UPDRS ) . They were r and omly assigned to either a routine physiotherapy program or treadmill training with vibratory stimuli applied to the feet plantar surfaces and proprioceptive neuromuscular facilitation ( PNF ) as well as the same physiotherapy program . All Participants received a 45-minutes session of low intensity physiotherapy program , 3 times a week , for 8 weeks . The duration of treadmill training was 5 minutes at baseline and 25 minutes at the end of treatment . Walking speed and distance were recorded from the treadmill control panel for both groups before and immediately after the end of treatment . The Qualysis ProReflex motion analysis system was used to measure cadence , stride length , hip , knee , and ankle joints ’ angular excursion . Results : The cadence , stride length , and lower limb joints ’ angular excursion showed a significant improvement in both groups ( P ≤ 0.05 ) . These improvements in spatio-temporal parameters and angular excursion were higher in the study group than in the control group ( P ≤ 0.05 ) . Conclusion : Potentiated proprioceptive feedback improves parkinsonian gait kinematics , the hip , knee , and ankle joints ’ angular excursion Objective : To determine whether external feedback to promote symmetrical weight distribution during st and ing and walking would improve gait performance and balance in people with stroke . Design : R and omized , controlled , assessor-blinded trial . Setting : Rehabilitation unit and physical therapy department . Subjects : Thirty-five individuals with stroke ( mean ( SD ) age = 53.0 ( 9.3 ) years ) were r and omly assigned to an experimental ( n = 17 ) or control group ( n = 18 ) . Time post stroke was less than six months for most subjects ( n = 27 , 77 % ) . Interventions : Subjects participated in 15 rehabilitation sessions including 30 minutes of gait retraining per session . During gait retraining , the experimental group used an insole shoe wedge and sensors set-up ( I-ShoWS ) while the control group received a conventional programme . The I-ShoWS set-up consisted of a wedge insole and a footswitch for the non-paretic leg and a pressure sensor on the paretic leg . Outcome measures : Gait speed , step length and single support time asymmetry ratio , balance and amount of load on paretic leg during stance were evaluated twice : one day before and after training . Results : The experimental group demonstrated significant increase in st and ing and gait symmetry compared with the control group ( P < 0.05 ) . They demonstrated 3 times greater improvement in gait speed than the control group ( P = 0.02 ) . Balance improvement was significantly greater for the experimental than for the control group ( P < 0.05 ) . Conclusion : Gait retraining using the I-ShoWS set-up was more effective in restoration of gait speed , st and ing and walking symmetry and balance than a conventional treatment programme . These results indicate the benefit of implementing feedback during gait retraining As the world 's population ages , falls , physical inactivity , decreased attention and impairments in balance and gait arise as a consequence of decreased sensation , weakness , trauma and degenerative disease . Progressive balance and gait training can facilitate postural righting , safe ambulation and community participation . This small r and omized clinical trial evaluated if visual and kinematic feedback provided during supervised gait training would interfere or enhance mobility , endurance , balance , strength and flexibility in older individuals greater than one year post stroke ( Gobbi et al. , 2009 ) or Parkinson 's disease ( PD ) ( Gobbi et al. , 2009 ) . Twenty-four individuals consented to participate . The participants were stratified by diagnosis and r and omly assigned to a control ( usual gait training ( Gobbi et al. , 2009 ) ) or an experimental group ( usual gait training plus kinematic feedback ( Gobbi et al. , 2009 ) ) . At baseline and 6 weeks post training ( 18 h ) , subjects completed st and ardized tests ( mobility , balance , strength , range of motion ) . Gains were described across all subjects , by treatment group and by diagnosis . Then they were compared for significance using nonparametric statistics . Twenty-three subjects completed the study with no adverse events . Across all subjects , by diagnosis ( stroke and PD ) and by training group ( control and experimental ) , there were significant gains in mobility ( gait speed , step length , endurance , and quality ) , balance ( Berg Balance ) , range of motion and strength . There were no significant differences in the gain scores between the control and experimental groups . Subjects chronic post stroke made greater strength gains on the affected side than subjects with PD but otherwise there were no significant differences . In summary , during supervised gait training , dynamic visual kinematic feedback from wireless pressure and motion sensors had similar , positive effects as verbal , therapist feedback . A wireless kinematic feedback system could be used at home , to provide feedback and motivation for self correction of gait while simultaneously providing data to the therapist ( at a distance ) BACKGROUND Inertial measurement units combined with a smartphone application ( CuPiD-system ) were developed to provide people with Parkinson 's disease ( PD ) real-time feedback on gait performance . This study investigated the CuPiD-system 's feasibility and effectiveness compared with conventional gait training when applied in the home environment . METHODS Forty persons with PD undertook gait training for 30 min , three times per week for six weeks . Participants were r and omly assigned to i ) CuPiD , in which a smartphone application offered positive and corrective feedback on gait , or ii ) an active control , in which personalized gait advice was provided  . Gait , balance , endurance and quality of life were assessed before and after training and at four weeks follow-up using st and ardized tests . RESULTS Both groups improved significantly on the primary outcomes ( single and dual task gait speed ) at post-test and follow-up . The CuPiD group improved significantly more on balance ( MiniBESTest ) at post-test ( from 24.8 to 26.1 , SD ∼ 5 ) and maintained quality of life ( SF-36 physical health ) at follow-up whereas the control group deteriorated ( from 50.4 to 48.3 , SD ∼ 16 ) . No other statistically significant differences were found between the two groups . The CuPiD system was well-tolerated and participants found the tool user-friendly . CONCLUSION CuPiD was feasible , well-accepted and seemed to be an effective approach to promote gait training , as participants improved equally to controls . This benefit may be ascribed to the real-time feedback , stimulating corrective actions and promoting self-efficacy to achieve optimal performance . Further optimization of the system and adequately-powered studies are warranted to corroborate these findings and determine cost-effectiveness This paper describes PEDro , the Physiotherapy Evidence Data base . PEDro is a web-based data base of r and omized controlled trials and systematic review s in physiotherapy . It can be accessed free of charge at http://ptwww.cchs.usyd.edu.au/pedro . The data base contains bibliographic details and abstract s of most English- language r and omized trials and systematic review s in physiotherapy , and of many trials and review s in other language s. Trials on the data base are rated on the basis of their method ological quality so that users of the data base can quickly identify trials of high quality . Trials and systematic review s are extensively indexed to facilitate search ing . PEDro provides an important information re source to support evidence -based clinical practice AIM Gait rehabilitation programs often require either partial weight-bearing ( PWB ) or encourage full weight-bearing ( FWB ) on the affected limb . Until recently , there was no objective and practical way to measure correct weight-bearing during ambulation . The present study evaluates a new in-shoe device ( SmartStep , And ante Medical Devices Ltd. ) for measuring the amount of weight on the affected limb and for biofeedback gait training . METHODS The first part of the study aim ed to establish the validity of the SmartStep by comparing the results obtained from this device with the results obtained from a force plate . The second part aim ed to evaluate the effectiveness of the SmartStep  as a biofeedback method in patients who have been referred for FWB gait rehabilitation . Analysis was based on independent sample s t-test and chi squared test for evaluating statistically significant differences between the 2 gait rehabilitation modes . RESULTS The SmartStep could repeat the same results with 0.53 kg error of mean . Statistically significant correlation was found between results obtained from the SmartStep and from the force plate ( R2=0.9067 and P=0.004 ) . The use of the SmartStep auditory biofeedback , significantly ( P=0.00031 ) improved patients ' weight-bearing over the affected limb in the experimental group ( 7.9 kg + /-5.28 ) as compared to the control group ( 0.7+/-2.41 kg ) . CONCLUSIONS The SmartStep proved to be very reliable since it generated significant repeatable results which correlated significantly with those obtained from a force plate . Patients recommended for FWB gait can significantly improve body weight loading over the affected limb by the use of the SmartStep auditory biofeedback This study investigates how complementary auditory feedback may affect short-term gait modifications induced by four training sessions with a robotic exoskeleton .  Healthy subjects walked on a treadmill and were instructed to match a modified gait pattern derived from their natural one , while receiving assistance by the robot ( kinetic guidance ) . The main question we wanted to answer is whether the most commonly used combination of feedback ( i.e. , haptic and visual ) could be either enhanced by adding auditory feedback or successfully substituted with a combination of kinetic guidance and auditory feedback .  Participants were r and omly assigned to one of four groups , all of which received kinetic guidance . The control group received additional visual feedback , while the three experimental groups were each provided with a different modality of auditory feedback . The third experimental group also received the same visual feedback as the control group . Differences among the training modalities in gait kinematics , timing and symmetry were assessed in three post-training sessions BACKGROUND AND OBJECTIVE The Physiotherapy Evidence Data base ( PEDro ) scale has been widely used to investigate method ological quality in physiotherapy r and omized controlled trials ; however , its validity has not been tested for pharmaceutical trials . The aim of this study was to investigate the validity and interrater reliability of the PEDro scale for pharmaceutical trials . The reliability was also examined for the Cochrane Back and Neck ( CBN ) Group risk of bias tool . METHODS This is a secondary analysis of data from a previous study . We considered r and omized placebo controlled trials evaluating any pain medication for chronic spinal pain or osteoarthritis .  Convergent validity was evaluated by correlating the PEDro score with the summary score of the CBN risk of bias tool . The construct validity was tested using a linear regression analysis to determine the degree to which the total PEDro score is associated with treatment effect sizes , journal impact factor , and the summary score for the CBN risk of bias tool . The interrater reliability was estimated using the Prevalence and Bias Adjusted Kappa coefficient and 95 % confidence interval ( CI ) for the PEDro scale and CBN risk of bias tool . RESULTS Fifty-three trials were included , with 91 treatment effect sizes included in the analyses . The correlation between PEDro scale and CBN risk of bias tool was 0.83 ( 95 % CI 0.76 - 0.88 ) after adjusting for reliability , indicating strong convergence . The PEDro score was inversely associated with effect sizes , significantly associated with the summary score for the CBN risk of bias tool , and not associated with the journal impact factor . The interrater reliability for each item of the PEDro scale and CBN risk of bias tool was at least substantial for most items ( > 0.60 ) . The intraclass correlation coefficient for the PEDro score was 0.80 ( 95 % CI 0.68 - 0.88 ) , and for the CBN , risk of bias tool was 0.81 ( 95 % CI 0.69 - 0.88 ) . CONCLUSION There was evidence for the convergent and construct validity for the PEDro scale when used to evaluate method ological quality of pharmacological trials . Both risk of bias tools have acceptably high interrater reliability Objective The objective of this study was to determine whether individualized gait training is more effective than usual care for reducing mobility disability and pain in individuals with symptomatic knee osteoarthritis . Design Adults aged 60 yrs or older with symptomatic knee osteoarthritis and mobility limitations were r and omized to physical therapist – directed gait training on an instrumented treadmill , with biofeedback individualized to optimize knee movements , biweekly for 3 mos or usual care ( control ) . Mobility disability was defined using Late Life Function and Disability Index Basic Lower Limb Function score ( primary ) ; mobility limitations , using timed 400-m walk , chair-st and , and stair-climb tests ; and symptoms , using the Knee Injury/Osteoarthritis Outcome Score at baseline , as well as at 3 , 6 , and 12 mos . The analyses used longitudinal mixed models . Results There were no significant intergroup differences between the  35 gait-training ( 74.3 % women ; age , 69.7 ± 8.2 yrs ) and 21 control ( 57.1 % women ; age , 68.9 ± 6.5 yrs ) participants at baseline . At 3 mos , the gait-training participants had greater improvement in mobility disability ( 4.3 ± 1.7 ; P = 0.0162 ) and symptoms ( 8.6 ± 4.1 ; P = 0.0420 ) . However , there were no intergroup differences detected for pain , 400-m walk , chair-st and , or stair-climb times at 3 mos or for any outcomes at 6 or 12 mos . Conclusions Compared with usual care , individualized gait training result ed in immediate improvements in mobility disability knee symptoms in adults with symptomatic knee osteoarthritis , but these effects were not sustained OBJECTIVES To evaluate the effects of gait training using a treadmill with and without visual biofeedback in patients in the late period after stroke , and to compare both training methods . DESIGN A r and omized , controlled study . SUBJECTS Fifty people at least 6 months after stroke , r and omly enrolled into groups with a rehabilitation programme of treadmill training with or without visual biofeedback . METHODS Spatio-temporal gait parameters , walking speed , walking distance , self-reliant mobility and functional capacity were evaluated during a programme of 10 sessions over 2 weeks . RESULTS Patients in both groups achieved statistically significant improvement . Participants in the intervention group revealed a significantly greater improvement in the shortening of the stance phase ( p = 0.0045 ) and lengthening of the swing phase of the unaffected limb ( p = 0.0042 ) and an increase in the unaffected limb cycle length ( p = 0.0021 ) . There were no significant differences between groups in other spatio-temporal parameters of gait or additionally assessed parameters . CONCLUSION Gait training using a treadmill result ed in improvements in the gait and functional capacity of patients . The use of biofeedback gives better results in improving gait cycle length , duration of gait phases and swing phase speed compared with exercise on a treadmill alone
This systematic review synthesized and analyzed clinical findings related to the effectiveness of innovative technological feedback for tackling functional gait recovery .