Diploma the 'is deals wi th the research of effect of biofeedback in the form of electrotactile stimulation of tongue in the patients with balance disorders eaused by the cerebellar lesion. For the therapeutic program 4 patients with cerebellar ataxia at the age of38 - 74 years were chosen. Subjects have partieipated in the therapeutic program with the application of biofeedback, they were training postural stability while visual control was excluded and they were using electrotacti le signal on the tongue for orientation. I used neurological tests BESTest and Dynamic Oait Index, questionnaire The Activities- Specific Balance Confidence (ABC) Scale, Dizziness I Tandicap Inventory (D ll) a Visual Analogue Scale (VAS), and examination by stati posturography for evaluation of postural stability in the patients. I supposed that therapy by biofeedback in the form of electrotactile stimulation of tongue improves postural stability in the patients with balance disorders caused by cerebellar lesion. Powered by TCPDF (www.tcpdf.org)

INTRODUCTION This graduation theses considers with the influence of rehabilitation by electrotactile stimulation of the tongue on stability of stance and gait in patients with degenerative cerebellar ataxia. Electrotactile stimulation of the tongue is an innovative method based on biofeedback principle, which uses additive sensory information about the position of the head to train the postural stability METHOD We used this method in six patients (four men and two women) with this disease. Patients went through intensive twelve-day therapy. The duration of the lessons was 30 minutes twice a day. We examined postural stability of the patients by using clinical evaluations (Balance Evaluation Systems Test, Dynamic Gait Index), posturography (modified Clinical Test of Sensory Interaction for Balance) and questionnaires (Activities -specific Balance Confidence, Dizziness Handicap Inventory) before and after the therapy. RESULTS The patients showed significant improvement in both clinical tests after the therapy. The results of posturography measurement are not so definite - the significant improvement was achieved only in some measured parameters. Both questionnaires did not show significant improvement. CONCLUSION The results of this study show, that electrotactile stimulation tongue could have a...

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Introduction: Biofeedback based on sensory substitution is a new method to treat patients with postural disorders. BrainPort provides tongue electrotactile stimulation. This innovative technique was developed for vestibular dysfunction of peripheral origin. Primarily for patients who had no benefits from conventional rehabilitation. Tongue electrotactile stimulation seems to be useful for central vestibula dysfunction as well. We are dealing with effect of BrainPort in therapy of degenerative cerebellar ataxia. We are interested in whether the effects persist for one month after the rehabilitation program. Methods: The methods are applied in 6 patients with degenerative cerebellar ataxia, verified by clinical testing, posturography, and genetic testing or verification of cerebellar lesions by MRI. Patients underwent an 12-day intensive rehabilitation program with BrainPort. Treatment was carried out 2 times a day. Patients were learning appropriate postural corrections to maintain signal in the middle of the tongue. To assess the effect of therapy we used posturography, standardized clinical tests - BESTest, Dynamic Gait Index (DGI) and standardized questionnaires - The Activities-Specific Balance Confidence Scale (ABC) and Dizzines Inventroy Handicap (DHI). The examination was performed before...

The graduation thesis deals with the issue of balance disorders due to a cerebellar damage. It deals in detail with the treatment of patients suffering from degenerative cerebellar ataxia and with the use of biofeedback technologies as means of postural stability treatment. The aim of practical part of this work was to investigate the effectiveness of therapy using biofeedback for patients suffering from progressive ataxia due to cerebellar neurodegeneration. The research sample consisted of 8 patients. The patients underwent a total of 18 therapy sessions within a twelve-day rehabilitative program. The therapy contained a training of stability in various positions with the elimination of visual control. A device provided an additive information about head sways for the patients via a tongue electrotactile stimulation. The effects were assessed by means of posturography, functional clinical tests (BESTest, Dynamic Gait Index) and questionnaires (Activities-specific Balance Confidence Scale, Dizziness Handicap Inventory). Three assessments were performed: immediately before, immediately after, and 30 days after the rehabilitative program. A statistical analysis of the data showed significant improvement in all observed parameters. In addition, there was no loss of the benefits in the interval of 30...

Sensory feedback possesses the possibility of adding a new dimension to many applications, including, but not limited to, prosthetics and surgical robots for improved control, virtual reality for incorporation of another sense, and phantom limb pain reduction for amputees. Electrotactile stimulation provides a compact, light-weight, energy efficient, highly responsive, and non-invasive option for sensory feedback; however, it has been found to commonly elicit unnatural or uncomfortable sensations for the user. To address this issue, this thesis was designed to test the impact of the different electrotactile stimulus parameters – current amplitude and polarity, pulse width, frequency, and waveform – on the user’s perceived sensation and afferent neural response. The relationship between sensation and neural response was also analysed. The aim of this thesis was to create guidelines to assist in the design and use of electrotactile stimulation. Neural data and matching psychophysical data from one healthy subject and purely psychophysical data from three others were gathered while applying electrotactile stimulations of different parameter combinations on the dorsal side of the hand or lower arm. Significant (p < 0.05) correlations and differences were found in all three relationships between electrotactile stimulus parameters, primary afferent response, and perceived sensation. Current (specifically negative) or pulse width control in monophasic waveforms were deemed most appropriate in applications that relay information through varying intensity. However, monophasic waveforms produced more discomfort, rendering biphasic waveforms more suitable when mild, local, and more natural sensations are of greater importance. Surprisingly, the data also suggested higher sensitivity to positive currents. While lower values of current amplitude and pulse width increased neural spike count, stimulus frequency could reliably control neural firing at all tested frequencies. Spike counts were moderately to strongly correlated with perceived intensity; however, practically identical neural responses could elicit different sensations. High current pulses at low frequencies induced spikes with the shortest latency – but with greater risk of discomfort. Due to limitations in sample size, generalisability is limited, and this thesis should be considered a pilot study to guide future investigations. The results suggest that recording from single and multiple afferent nerve fibres simultaneously would improve the understanding of the neural population response to electrotactile stimuli. Moreover, the one-to-one neural response to electrotactile stimuli raised the question of whether an electrotactile stimulation based on a natural spike pattern could replicate the original sensation. A future study testing this hypothesis may find a new approach to designing painless electrotactile stimulations for sensory feedback use. / Sensorisk återkoppling har möjlighet att drastiskt förbättra många användningsområden, t.ex. genom att bidra till enklare kontroll av proteser och kirurgiska robotar, mer verklighetstrogna VR-spel, och minskade fantomsmärtor hos patienter med amputeringar. Elektrisk hudstimulering erbjuder ett kompakt, lätt, energisnålt, hög-responsivt och icke-invasivt alternativ för sensorisk återkoppling – dock framkallar denna metod ofta onaturliga och obehagliga förnimmelser för användaren. Detta examensarbete bemöter detta problem genom att undersöka effekten av stimuleringsparametrar som strömstyrka, pulsbredd, frekvens och vågform på försökspersonens upplevda förnimmelse samt den afferenta nervresponsen. Även relationen mellan förnimmelse och nervrespons analyserades. Examensarbetets ändamål var att skapa riktlinjer för att förenkla designen och användandet av elektrisk hudstimulering. Nervdata med matchande psykofysiska data samlades från en frisk försöksperson, samt enbart psykofysiska data från tre andra, under olika elektriska hudstimuleringar (med varierande parametervärden) på handens dorsala sida eller på underarmen. Signifikanta (p < 0.05) korrelationer och skillnader fanns i alla tre relationer mellan parametrarna för elektrisk hudstimulering, primärafferent respons och upplevd förnimmelse. Kontroll av ström (i synnerhet negativ) eller pulsbredd i monofasisk vågform visade sig vara mest fördelaktigt i applikationer där information kommuniceras till användaren genom att variera den upplevda intensiteten. Dock skapade denna vågform mer obehag, och bifasiska vågformer bedömdes mer passande då milda, lokala, och mer naturliga förnimmelser är av högre värde. Positiv ström upplevdes, förvånande, starkare än negativ. Vid låga värden på ström och pulsbredd var dessa faktorer viktiga gällande antalet aktionspotentialer (AP), men stimuleringsfrekvensen kunde kontrollera antalet AP vid alla frekvenser. Mängden AP var måttligt till starkt korrelaterad med upplevd intensitet – samtidigt kunde praktiskt taget identiska nervresponser vara kopplade till olika förnimmelser. Lågfrekvent stimulering med hög ström hade kortast latenstid, men högre risk för obehag. P.g.a. lågt antal försökspersoner är generaliserbarheten begränsad och detta examensarbete bör beaktas som en förstudie för att guida framtida forskning. Resultaten från denna studie antyder att en tydligare bild av populationsresponsen skulle kunna skapas genom samtidig läsning av ett flertal enskilda nervfibrer samtidigt. Det faktum att varje stimulering kunde ge upphov till en AP väckte frågan: kan ett stimuleringsmönster baserat på en naturlig nervrespons återskapa den ursprungliga förnimmelsen? En studie som testar denna hypotes har möjligheten att finna ett nytt tillvägagångssätt för att skapa smärtfri elektrisk hudstimulering för sensorisk återkoppling.