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Recognizing the growing interests and benefits of technology-assisted interactive telerehabilitation in various populations, the aim of this review is to systematically review the effects of interactive telerehabilitation with remote monitoring and guidance for improving balance and gait performance in older adults and individuals with neurological conditions. The study protocol for this systematic review was registered with the international prospective register of systematic reviews (PROSPERO) with the unique identifier CRD42024509646. Studies written in English published from January 2014 to February 2024 in Web of Science, Pubmed, Scopus, and Google Scholar were examined. Of the 247 identified, 17 were selected after initial and eligibility screening, and their methodological quality was assessed with the National Institutes of Health Quality Assessment Tool for Observational Cohort and Cross-sectional Studies. All 17 studies demonstrated balance and gait performance improvement in older adults and in individuals with stroke, Parkinson's disease, and multiple sclerosis following 4 or more weeks of interactive telerehabilitation via virtual reality, smartphone or tablet apps, or videoconferencing. The findings of this systematic review can inform the future design and implementation of interactive telerehabilitation technology and improve balance and gait training exercise regimens for older adults and individuals with neurological conditions. [ABSTRACT FROM AUTHOR]

Abstract 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.

Cutaneous information from joints has been attributed proprioceptive properties similar to those of muscle spindles. This study aimed to assess whether vibration-induced changes in torso cutaneous information contribute to whole-body postural reorganization in humans. Ten healthy young adults stood in normal and Romberg stances with six vibrating actuators positioned on the torso in contact with the skin over the left and right external oblique, internal oblique, and erector spinae muscle locations at the L4/L5 vertebrae level. Vibrations around the torso were randomly applied at two locations simultaneously (covibration) or at all locations simultaneously. Kinematic analysis of the body segments indicated that covibration applied to the skin over the internal oblique muscles induced shifts of both the head and torso in the anterior direction (torso flexion) while the hips shifted in the posterior direction (ankle plantar flexion). Conversely, covibration applied to the skin over the erector spinae muscle locations produced opposite effects. However, covibration applied to the skin over the left internal oblique and left erector spinae, the right internal oblique and right erector spinae, or at all locations simultaneously did not induce any significant postural changes. In addition, the center of pressure position as measured by the force plate was unaffected by all covibration conditions tested. These results were independent of stance and suggest an integrated and coordinated reorganization of posture in response to vibration-induced changes in cutaneous information. In addition, combinations of vibrotactile stimuli over multiple locations exhibit directional summation properties in contrast to the individual responses we observed in our previous work. [ABSTRACT FROM AUTHOR]

Introduction: Recent advancements in functional near-infrared spectroscopy technology have offered a portable, wireless, wearable solution to measure the activity of the prefrontal cortex (PFC) in the human neuroscience field. This study is the first to validate the different contributions made by the PFC's eight subregions in healthy young adults to the reactive recovery responses following treadmill-induced unpredictable slip perturbations and vibrotactile cueing (i.e., precues)., Methods: Our fall-inducing technology platform equipped with a split-belt treadmill provided unpredictable slip perturbations to healthy young adults while walking at their self-selected walking speed. A portable, wireless, wearable, and multi-channel (48 channels) functional near-infrared spectroscopy system evaluated the activity of PFC's eight subregions [i.e., right and left dorsolateral prefrontal cortex (DLPFC), ventrolateral prefrontal cortex (VLPFC), frontopolar prefrontal cortex (FPFC), and orbitofrontal cortex (OFC)] as quantified by oxyhemoglobin and deoxyhemoglobin concentrations. A motion capture system and two force plates beneath the split-belt treadmill were used to quantify participants' kinematic and kinetic behavior. All participants completed 6 trials: 2 consecutive trials without vibrotactile cueing and with a slip perturbation (control trials); 3 trials with vibrotactile cueing [2 trials with the slip perturbation (cueing trial) and 1 trial without the slip perturbation (catch trial)], and 1 trial without vibrotactile cueing and with a slip perturbation (post-control trial). The PFC subregions' activity and kinematic behavior were assessed during the three periods (i.e., standing, walking, and recovery periods)., Results: Compared to the walkers' standing and walking periods, recovery periods showed significantly higher and lower levels of oxyhemoglobin and deoxyhemoglobin concentrations, respectively, in the right and left DLPFC, VLPFC, and FPFC, regardless of the presence of vibrotactile cueing. However, there was no significant difference in the right and left OFC between the three periods. Kinematic analyses confirmed that vibrotactile cueing significantly improved reactive recovery responses without requiring more involvement by the PFC subregions, which suggests that the sum of attentional resources is similar in cued and non-cued motor responses., Discussion: The results could inform the design of wearable technologies that alert their users to the risks of falling and assist with the development of new gait perturbation paradigms that prompt reactive responses., Competing Interests: JC was employed by OBELAB Inc. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 Lee, Choi, Ahn and Martin.)