Sensor-based balance training with motion feedback in people with mild cognitive impairment.

Some individuals with mild cognitive impairment (MCI) experience not only cognitive deficits but also a decline in motor function, including postural balance. This pilot study sought to estimate the feasibility, user experience, and effects of a novel sensor-based balance training program. Patients with amnestic MCI (mean age 78.2 yr) were randomized to an intervention group (IG, n = 12) or control group (CG, n = 10). The IG underwent balance training (4 wk, twice a week) that included weight shifting and virtual obstacle crossing. Real-time visual/audio lower-limb motion feedback was provided from wearable sensors. The CG received no training. User experience was measured by a questionnaire. Postintervention effects on balance (center of mass sway during standing with eyes open [EO] and eyes closed), gait (speed, variability), cognition, and fear of falling were measured. Eleven participants (92%) completed the training and expressed fun, safety, and helpfulness of sensor feedback. Sway (EO, p = 0.04) and fear of falling (p = 0.02) were reduced in the IG compared to the CG. Changes in other measures were nonsignificant. Results suggest that the sensor-based training paradigm is well accepted in the target population and beneficial for improving postural control. Future studies should evaluate the added value of the sensor-based training compared to traditional training.

[1]  Cédric Annweiler,et al.  Postural control and cognitive decline in older adults: position versus velocity implicit motor strategy. , 2014, Gait & posture.

[2]  A. Bastian.  Understanding sensorimotor adaptation and learning for rehabilitation , 2008, Current opinion in neurology.

[3]  Maic Masuch,et al.  Exergaming for Elderly: Analyzing Player Experience and Performance , 2011 .

[4]  Jeffrey M. Hausdorff,et al.  Virtual reality for gait training: can it induce motor learning to enhance complex walking and reduce fall risk in patients with Parkinson's disease? , 2011, The journals of gerontology. Series A, Biological sciences and medical sciences.

[5]  C. Annweiler,et al.  Motor cortex and gait in mild cognitive impairment: a magnetic resonance spectroscopy and volumetric imaging study. , 2013, Brain : a journal of neurology.

[6]  Jan Stegenga,et al.  Exergaming for balance training of elderly: state of the art and future developments , 2013, Journal of NeuroEngineering and Rehabilitation.

[7]  Xiaonan Xue,et al.  Gait Dysfunction in Mild Cognitive Impairment Syndromes , 2008, Journal of the American Geriatrics Society.

[8]  R. Petersen.  Mild cognitive impairment as a diagnostic entity , 2004, Journal of internal medicine.

[9]  Michael Schwenk,et al.  Sensor-Based Interactive Balance Training with Visual Joint Movement Feedback for Improving Postural Stability in Diabetics with Peripheral Neuropathy: A Randomized Controlled Trial , 2015, Gerontology.

[10]  Mahoney Fi,et al.  FUNCTIONAL EVALUATION: THE BARTHEL INDEX. , 1965 .

[11]  Luigi Baratto,et al.  Balance features in Alzheimer's disease and amnestic mild cognitive impairment. , 2009, Journal of Alzheimer's disease : JAD.

[12]  W. van Mechelen,et al.  Adherence to exercise programs and determinants of maintenance in older adults with mild cognitive impairment. , 2012, Journal of aging and physical activity.

[13]  Klaus Hauer,et al.  Dual-task performances can be improved in patients with dementia , 2010, Neurology.

[14]  Cathy Craig,et al.  Assessing and training standing balance in older adults: a novel approach using the 'Nintendo Wii' Balance Board. , 2011, Gait & posture.

[15]  L. Radloff.  The CES-D Scale , 1977 .

[16]  O. Beauchet,et al.  Slow gait in MCI is associated with ventricular enlargement: results from the Gait and Brain Study , 2013, Journal of Neural Transmission.

[17]  Klaus Hauer,et al.  The Short FES-I: a shortened version of the falls efficacy scale-international to assess fear of falling. , 2007, Age and ageing.

[18]  J. Collins,et al.  Open-loop and closed-loop control of posture: A random-walk analysis of center-of-pressure trajectories , 2004, Experimental Brain Research.

[19]  S. Kuys,et al.  Is the Wii Fit™ a new-generation tool for improving balance, health and well-being? A pilot study , 2010, Climacteric : the journal of the International Menopause Society.

[20]  Wiebren Zijlstra,et al.  Biofeedback for training balance and mobility tasks in older populations: a systematic review , 2010, Journal of NeuroEngineering and Rehabilitation.

[21]  Cédric Annweiler,et al.  Association Between High Variability of Gait Speed and Mild Cognitive Impairment: A Cross‐Sectional Pilot Study , 2011, Journal of the American Geriatrics Society.

[22]  Bijan Najafi,et al.  Virtualizing the Assessment: A Novel Pragmatic Paradigm to Evaluate Lower Extremity Joint Perception in Diabetes , 2012, Gerontology.

[23]  M. Woollacott,et al.  Multisensory training of standing balance in older adults: I. Postural stability and one-leg stance balance. , 1994, Journal of gerontology.

[24]  Bijan Najafi,et al.  Assessing Postural Control and Postural Control Strategy in Diabetes Patients Using Innovative and Wearable Technology , 2010, Journal of diabetes science and technology.

[25]  K. Dodd,et al.  Effectiveness of balance training exercise in people with mild to moderate severity Alzheimer's disease: protocol for a randomised trial , 2009, BMC geriatrics.

[26]  David A. Winter,et al.  Human balance and posture control during standing and walking , 1995 .

[27]  M. Crowe,et al.  Changes in Everyday Function in Individuals with Psychometrically Defined Mild Cognitive Impairment in the Advanced Cognitive Training for Independent and Vital Elderly Study , 2007, Journal of the American Geriatrics Society.

[28]  C. Annweiler,et al.  Gait variability at fast-pace walking speed: A biomarker of mild cognitive impairment? , 2013, The journal of nutrition, health & aging.

[29]  Felipe Fregni,et al.  Effect of mild cognitive impairment on balance , 2011, Journal of the Neurological Sciences.

[30]  P. Era,et al.  Changes in Postural Balance in Frail Elderly Women during a 4-Week Visual Feedback Training: A Randomized Controlled Trial , 2004, Gerontology.

[31]  Marcia A Ciol,et al.  Exercise adherence following physical therapy intervention in older adults with impaired balance. , 2006, Physical therapy.

[32]  B. Reisberg,et al.  Mild cognitive impairment , 2005, The Lancet.

[33]  Cédric Annweiler,et al.  Motor Phenotype of Decline in Cognitive Performance among Community-Dwellers without Dementia: Population-Based Study and Meta-Analysis , 2014, PloS one.

[34]  Michael Schwenk,et al.  Interactive balance training integrating sensor-based visual feedback of movement performance: a pilot study in older adults , 2014, Journal of NeuroEngineering and Rehabilitation.

[35]  B. E. Maki,et al.  A prospective study of postural balance and risk of falling in an ambulatory and independent elderly population. , 1994, Journal of gerontology.

[36]  S. Hanneton,et al.  Coaching the Wii , 2009, 2009 IEEE International Workshop on Haptic Audio visual Environments and Games.

[37]  Mark Speechley,et al.  The Motor Signature of Mild Cognitive Impairment: Results From the Gait and Brain Study , 2014, The journals of gerontology. Series A, Biological sciences and medical sciences.

[38]  Britne A. Shabbott,et al.  Learning a visuomotor rotation: simultaneous visual and proprioceptive information is crucial for visuomotor remapping , 2010, Experimental Brain Research.

[39]  Michael Schwenk,et al.  Balance rehabilitation: promoting the role of virtual reality in patients with diabetic peripheral neuropathy. , 2013, Journal of the American Podiatric Medical Association.

[40]  R. Shadmehr,et al.  Interacting Adaptive Processes with Different Timescales Underlie Short-Term Motor Learning , 2006, PLoS biology.

[41]  J. V. van Dieën,et al.  Age Effects on Mediolateral Balance Control , 2014, PloS one.

[42]  Klaus Hauer,et al.  Improvements in gait characteristics after intensive resistance and functional training in people with dementia: a randomised controlled trial , 2014, BMC Geriatrics.

[43]  Barbara Williams,et al.  The Effect of Nintendo Wii on Balance: A Pilot Study Supporting the Use of the Wii in Occupational Therapy for the Well Elderly , 2011, Occupational therapy in health care.

[44]  R. Reitan.  Trail Making Test: Manual for Administration and Scoring , 1992 .

[45]  M. Montero‐Odasso,et al.  Dual-task complexity affects gait in people with mild cognitive impairment: the interplay between gait variability, dual tasking, and risk of falls. , 2012, Archives of physical medicine and rehabilitation.

[46]  E. Olsson,et al.  Motor Function in Subjects with Mild Cognitive Impairment and Early Alzheimer’s Disease , 2005, Dementia and Geriatric Cognitive Disorders.

[47]  L. Yardley,et al.  Validity and Sensitivity to Change of the Falls Efficacy Scales International to Assess Fear of Falling in Older Adults with and without Cognitive Impairment , 2010, Gerontology.

[48]  George F Borm,et al.  A simple sample size formula for analysis of covariance in randomized clinical trials. , 2007, Journal of clinical epidemiology.

[49]  G. Pichierri,et al.  Use of virtual reality technique for the training of motor control in the elderly , 2010, Zeitschrift für Gerontologie und Geriatrie.

[50]  Kevin J Black,et al.  The cognitive correlates of functional status: a review from the Committee on Research of the American Neuropsychiatric Association. , 2007, The Journal of neuropsychiatry and clinical neurosciences.

[51]  J. Kaye,et al.  Efficacy of Cognitive Rehabilitation Therapies for Mild Cognitive Impairment (MCI) in Older Adults: Working Toward a Theoretical Model and Evidence-Based Interventions , 2013, Neuropsychology Review.

[52]  Jacob Cohen.  Statistical Power Analysis for the Behavioral Sciences , 1969, The SAGE Encyclopedia of Research Design.

[53]  L. Ferrucci,et al.  A short physical performance battery assessing lower extremity function: association with self-reported disability and prediction of mortality and nursing home admission. , 1994, Journal of gerontology.

[54]  Kamiar Aminian,et al.  Spatio-temporal parameters of gait measured by an ambulatory system using miniature gyroscopes. , 2002, Journal of biomechanics.

[55]  J. Cummings,et al.  The Montreal Cognitive Assessment, MoCA: A Brief Screening Tool For Mild Cognitive Impairment , 2005, Journal of the American Geriatrics Society.