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Balthazard P.,University of Applied Sciences and Arts Western Switzerland | De Goumoens P.,University of Lausanne | Rivier G.,Clinique Romande de Readaptation SUVACare | Demeulenaere P.,University of Applied Sciences and Arts Western Switzerland | And 3 more authors.
BMC Musculoskeletal Disorders | Year: 2012

Background: Recent clinical recommendations still propose active exercises (AE) for CNSLBP. However, acceptance of exercises by patients may be limited by pain-related manifestations. Current evidences suggest that manual therapy (MT) induces an immediate analgesic effect through neurophysiologic mechanisms at peripheral, spinal and cortical levels. The aim of this pilot study was first, to assess whether MT has an immediate analgesic effect, and second, to compare the lasting effect on functional disability of MT plus AE to sham therapy (ST) plus AE. Methods. Forty-two CNSLBP patients without co-morbidities, randomly distributed into 2 treatment groups, received either spinal manipulation/ mobilization (first intervention) plus AE (MT group; n = 22), or detuned ultrasound (first intervention) plus AE (ST group; n = 20). Eight therapeutic sessions were delivered over 4 to 8weeks. Immediate analgesic effect was obtained by measuring pain intensity (Visual Analogue Scale) before and immediately after the first intervention of each therapeutic session. Pain intensity, disability (Oswestry Disability Index), fear-avoidance beliefs (Fear-Avoidance Beliefs Questionnaire), erector spinae and abdominal muscles endurance (Sorensen and Shirado tests) were assessed before treatment, after the 8th therapeutic session, and at 3- and 6-month follow-ups. Results: Thirty-seven subjects completed the study. MT intervention induced a better immediate analgesic effect that was independent from the therapeutic session (VAS mean difference between interventions: -0.8; 95% CI: -1.2 to -0.3). Independently from time after treatment, MT + AE induced lower disability (ODI mean group difference: -7.1; 95% CI: -12.8 to -1.5) and a trend to lower pain (VAS mean group difference: -1.2; 95% CI: -2.4 to -0.30). Six months after treatment, Shirado test was better for the ST group (Shirado mean group difference: -61.6; 95% CI: -117.5 to -5.7). Insufficient evidence for group differences was found in remaining outcomes. Conclusions: This study confirmed the immediate analgesic effect of MT over ST. Followed by specific active exercises, it reduces significantly functional disability and tends to induce a larger decrease in pain intensity, compared to a control group. These results confirm the clinical relevance of MT as an appropriate treatment for CNSLBP. Its neurophysiologic mechanisms at cortical level should be investigated more thoroughly. Trial registration. Trial registration number: NCT01496144. © 2012 althazard et al.; licensee BioMed Central Ltd. Source


Perdikis S.,Center for Neuroprosthetics | Leeb R.,Center for Neuroprosthetics | Williamson J.,University of Glasgow | Ramsay A.,University of Glasgow | And 6 more authors.
Journal of Neural Engineering | Year: 2014

Objective. While brain-computer interfaces (BCIs) for communication have reached considerable technical maturity, there is still a great need for state-of-the-art evaluation by the end-users outside laboratory environments. To achieve this primary objective, it is necessary to augment a BCI with a series of components that allow end-users to type text effectively. Approach. This work presents the clinical evaluation of a motor imagery (MI) BCI text-speller, called BrainTree, by six severely disabled end-users and ten able-bodied users. Additionally, we define a generic model of code-based BCI applications, which serves as an analytical tool for evaluation and design. Main results. We show that all users achieved remarkable usability and efficiency outcomes in spelling. Furthermore, our model-based analysis highlights the added value of human-computer interaction techniques and hybrid BCI error-handling mechanisms, and reveals the effects of BCI performances on usability and efficiency in code-based applications. Significance. This study demonstrates the usability potential of code-based MI spellers, with BrainTree being the first to be evaluated by a substantial number of end-users, establishing them as a viable, competitive alternative to other popular BCI spellers. Another major outcome of our model-based analysis is the derivation of a 80% minimum command accuracy requirement for successful code-based application control, revising upwards previous estimates attempted in the literature. © 2014 IOP Publishing Ltd. Source


Reynard F.,Clinique Romande de Readaptation SUVACare | Terrier P.,Institute for Research in Rehabilitation
Journal of Biomechanics | Year: 2014

Repetitive falls degrade the quality of life of elderly people and of patients suffering of various neurological disorders. In order to prevent falls while walking, one should rely on relevant early indicators of impaired dynamic balance. The local dynamic stability (LDS) represents the sensitivity of gait to small perturbations: divergence exponents (maximal Lyapunov exponents) assess how fast a dynamical system diverges from neighbor points. Although numerous findings attest the validity of LDS as a fall risk index, reliability results are still sparse. The present study explores the intrasession and intersession repeatability of gait LDS using intraclass correlation coefficients (ICC) and standard error of measurement (SEM). Ninety-five healthy individuals performed 5min treadmill walking in two sessions separated by 9 days. Trunk acceleration was measured with a 3D accelerometer. Three time scales were used to estimate LDS: over 4-10 strides (λ4-10), over one stride (λ1) and over one step (λ0.5). The intrasession repeatability was assessed from three repetitions of either 35 strides or 70 strides taken within the 5min tests. The intersession repeatability compared the two sessions, which totalized 210 strides. The intrasession ICCs (70-strides estimates/35-strides estimates) were 0.52/0.18 for λ4-10 and 0.84/0.77 for λ1 and λ0.5. The intersession ICCs were around 0.60. The SEM results revealed that λ0.5 measured in medio-lateral direction exhibited the best reliability, sufficient to detect moderate changes at individual level (20%). However, due to the low intersession repeatability, one should average several measurements taken on different days in order to better approximate the true LDS. © 2013 Elsevier Ltd. Source


Leeb R.,Ecole Polytechnique Federale de Lausanne | Perdikis S.,Ecole Polytechnique Federale de Lausanne | Tonin L.,Ecole Polytechnique Federale de Lausanne | Biasiucci A.,Ecole Polytechnique Federale de Lausanne | And 6 more authors.
Artificial Intelligence in Medicine | Year: 2013

Objectives: Brain-computer interfaces (BCIs) are no longer only used by healthy participants under controlled conditions in laboratory environments, but also by patients and end-users, controlling applications in their homes or clinics, without the BCI experts around. But are the technology and the field mature enough for this? Especially the successful operation of applications - like text entry systems or assistive mobility devices such as tele-presence robots - requires a good level of BCI control. How much training is needed to achieve such a level? Is it possible to train naïve end-users in 10 days to successfully control such applications? Materials and methods: In this work, we report our experiences of training 24 motor-disabled participants at rehabilitation clinics or at the end-users' homes, without BCI experts present. We also share the lessons that we have learned through transferring BCI technologies from the lab to the user's home or clinics. Results: The most important outcome is that 50% of the participants achieved good BCI performance and could successfully control the applications (tele-presence robot and text-entry system). In the case of the tele-presence robot the participants achieved an average performance ratio of 0.87 (max. 0.97) and for the text entry application a mean of 0.93 (max. 1.0). The lessons learned and the gathered user feedback range from pure BCI problems (technical and handling), to common communication issues among the different people involved, and issues encountered while controlling the applications. Conclusion: The points raised in this paper are very widely applicable and we anticipate that they might be faced similarly by other groups, if they move on to bringing the BCI technology to the end-user, to home environments and towards application prototype control. © 2013 Elsevier B.V. Source


Terrier P.,Institute for Research in Rehabilitation | Reynard F.,Clinique Romande de Readaptation SUVACare
Gait and Posture | Year: 2015

Falls during walking are a major health issue in the elderly population. Older individuals are usually more cautious, walk more slowly, take shorter steps, and exhibit increased step-to-step variability. They often have impaired dynamic balance, which explains their increased falling risk. Those locomotor characteristics might be the result of the neurological/musculoskeletal degenerative processes typical of advanced age or of a decline that began earlier in life. In order to help determine between the two possibilities, we analyzed the relationship between age and gait features among 100 individuals aged 20-69. Trunk acceleration was measured during a 5-min treadmill session using a 3D accelerometer. The following dependent variables were assessed: preferred walking speed, walk ratio (step length normalized by step frequency), gait instability (local dynamic stability, Lyapunov exponent method), and acceleration variability (root mean square [RMS]). Using age as a predictor, linear regressions were performed for each dependent variable. The results indicated that walking speed, walk ratio and trunk acceleration variability were not dependent on age (R2<2%). However, there was a significant quadratic association between age and gait instability in the mediolateral direction (R2=15%). We concluded that most of the typical gait features of older age do not result from a slow evolution over the life course. On the other hand, gait instability likely begins to increase at an accelerated rate as early as age 40-50. This finding supports the premise that local dynamic stability is likely a relevant early indicator of falling risk. © 2014 Elsevier B.V. Source

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