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      Rhythmic Haptic Cueing Using Wearable Devices as Physiotherapy for Huntington Disease: Case Study

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        , BSc, MSc, PhD 1 , , , BSc, MSc 2 , , PhD 2 , , PhD 2 , , BSc, MSc 2 , , BSc, MSc, PhD 3 , , BSc, DClinPsy, CPsychol 4
      (Reviewer), (Reviewer), (Reviewer)
      JMIR Rehabilitation and Assistive Technologies
      JMIR Publications
      physiotherapy, rhythm, haptic, tactile, wearable, cueing, Huntington, gait

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          Abstract

          Background

          Huntington disease (HD) is an inherited genetic disorder that results in the death of brain cells. HD symptoms generally start with subtle changes in mood and mental abilities; they then degenerate progressively, ensuing a general lack of coordination and an unsteady gait, ultimately resulting in death. There is currently no cure for HD. Walking cued by an external, usually auditory, rhythm has been shown to steady gait and help with movement coordination in other neurological conditions. More recently, work with other neurological conditions has demonstrated that haptic (ie, tactile) rhythmic cues, as opposed to audio cues, offer similar improvements when walking. An added benefit is that less intrusive, more private cues are delivered by a wearable device that leaves the ears free for conversation, situation awareness, and safety. This paper presents a case study where rhythmic haptic cueing (RHC) was applied to one person with HD. The case study has two elements: the gait data we collected from our wearable devices and the comments we received from a group of highly trained expert physiotherapists and specialists in HD.

          Objective

          The objective of this case study was to investigate whether RHC can be applied to improve gait coordination and limb control in people living with HD. While not offering a cure, therapeutic outcomes may delay the onset or severity of symptoms, with the potential to improve and prolong quality of life.

          Methods

          The approach adopted for this study includes two elements, one quantitative and one qualitative. The first is a repeated-measures design with three conditions: before haptic rhythm (ie, baseline), with haptic rhythm, and after exposure to haptic rhythm. The second element is an in-depth interview with physiotherapists observing the session.

          Results

          In comparison to the baseline, the physiotherapists noted a number of improvements to the participant’s kinematics during her walk with the haptic cues. These improvements continued in the after-cue condition, indicating some lasting effects. The quantitative data obtained support the physiotherapists’ observations.

          Conclusions

          The findings from this small case study, with a single participant, suggest that a haptic metronomic rhythm may have immediate, potentially therapeutic benefits for the walking kinematics of people living with HD and warrants further investigation.

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          Most cited references29

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          Huntington's disease

          Huntington's disease is an autosomal-dominant, progressive neurodegenerative disorder with a distinct phenotype, including chorea and dystonia, incoordination, cognitive decline, and behavioural difficulties. Typically, onset of symptoms is in middle-age after affected individuals have had children, but the disorder can manifest at any time between infancy and senescence. The mutant protein in Huntington's disease--huntingtin--results from an expanded CAG repeat leading to a polyglutamine strand of variable length at the N-terminus. Evidence suggests that this tail confers a toxic gain of function. The precise pathophysiological mechanisms of Huntington's disease are poorly understood, but research in transgenic animal models of the disorder is providing insight into causative factors and potential treatments.
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            Cueing training in the home improves gait-related mobility in Parkinson's disease: the RESCUE trial.

            Gait and mobility problems are difficult to treat in people with Parkinson's disease. The Rehabilitation in Parkinson's Disease: Strategies for Cueing (RESCUE) trial investigated the effects of a home physiotherapy programme based on rhythmical cueing on gait and gait-related activity. A single-blind randomised crossover trial was set up, including 153 patients with Parkinson's disease aged between 41 and 80 years and in Hoehn and Yahr stage II-IV. Subjects allocated to early intervention (n = 76) received a 3-week home cueing programme using a prototype cueing device, followed by 3 weeks without training. Patients allocated to late intervention (n = 77) underwent the same intervention and control period in reverse order. After the initial 6 weeks, both groups had a 6-week follow-up without training. Posture and gait scores (PG scores) measured at 3, 6 and 12 weeks by blinded testers were the primary outcome measure. Secondary outcomes included specific measures on gait, freezing and balance, functional activities, quality of life and carer strain. Small but significant improvements were found after intervention of 4.2% on the PG scores (p = 0.005). Severity of freezing was reduced by 5.5% in freezers only (p = 0.007). Gait speed (p = 0.005), step length (p<0.001) and timed balance tests (p = 0.003) improved in the full cohort. Other than a greater confidence to carry out functional activities (Falls Efficacy Scale, p = 0.04), no carry-over effects were observed in functional and quality of life domains. Effects of intervention had reduced considerably at 6-week follow-up. Cueing training in the home has specific effects on gait, freezing and balance. The decline in effectiveness of intervention effects underscores the need for permanent cueing devices and follow-up treatment. Cueing training may be a useful therapeutic adjunct to the overall management of gait disturbance in Parkinson's disease.
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              Wearable Inertial Sensor Systems for Lower Limb Exercise Detection and Evaluation: A Systematic Review

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                Author and article information

                Contributors
                Journal
                JMIR Rehabil Assist Technol
                JRAT
                JMIR Rehabilitation and Assistive Technologies
                JMIR Publications (Toronto, Canada )
                2369-2529
                Jul-Dec 2020
                14 September 2020
                : 7
                : 2
                : e18589
                Affiliations
                [1 ] School of Mathematical and Computer Sciences Heriot-Watt University Edinburgh United Kingdom
                [2 ] School of Computing and Communications The Open University Milton Keynes United Kingdom
                [3 ] Knowledge Media Institute The Open University Milton Keynes United Kingdom
                [4 ] PJ Care Limited Peterborough United Kingdom
                Author notes
                Corresponding Author: Theodoros Georgiou t.georgiou@ 123456hw.ac.uk
                Author information
                https://orcid.org/0000-0001-8211-0569
                https://orcid.org/0000-0002-1419-8068
                https://orcid.org/0000-0001-5930-519X
                https://orcid.org/0000-0001-8490-3730
                https://orcid.org/0000-0002-2247-9804
                https://orcid.org/0000-0001-6598-0757
                https://orcid.org/0000-0001-5777-0450
                Article
                v7i2e18589
                10.2196/18589
                7522730
                32924955
                43ae546d-3fb4-4997-a12f-e4c7f5826341
                ©Theodoros Georgiou, Riasat Islam, Simon Holland, Janet van der Linden, Blaine Price, Paul Mulholland, Allan Perry. Originally published in JMIR Rehabilitation and Assistive Technology (http://rehab.jmir.org), 14.09.2020.

                This is an open-access article distributed under the terms of the Creative Commons Attribution License ( https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in JMIR Rehabilitation and Assistive Technology, is properly cited. The complete bibliographic information, a link to the original publication on http://rehab.jmir.org/, as well as this copyright and license information must be included.

                History
                : 6 March 2020
                : 30 April 2020
                : 15 June 2020
                : 11 August 2020
                Categories
                Original Paper
                Original Paper

                physiotherapy,rhythm,haptic,tactile,wearable,cueing,huntington,gait
                physiotherapy, rhythm, haptic, tactile, wearable, cueing, huntington, gait

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