Dynamic coordination training with mobile robotic feedback to improve neuromuscular response and engagement in joint movement and balance therapy

Abstract

Balance decline with aging poses a serious threat to independence and quality of life. Challenging fall prevention programs focused on improving balance through training can mitigate fall risks, especially using an individualized approach with real-time biofeedback. However, compliance to standard rehabilitation routines is often poor because they require individuals to consistently perform repetitive, unsupervised training that lacks engagement and evidence to support effective treatment. Disparities between therapy challenge and individual capability can perpetuate boredom and frustration, which further diminish training adherence. To enhance therapy that addresses balance decline, we developed a goal-directed feedback training system that leverages human-in-the-loop motion control of a physical robot to promote motor learning, neuroplasticity, and engagement in unsupervised therapy. However, the specific requirements for this goal-directed movement coordination training remain unknown.

The purpose of this work was to (1) establish feasibility of gesture-controlled robotic feedback for engaging therapy, (2) validate a balance training system that provides visuospatial balance performance cues through wobble board motion control of a mobile robot, and (3) characterize age-specific biomechanics and engagement in dynamic balance training with goal-directed feedback to inform future at-home therapy. Through two human experiments that targeted coordinated wrist movements and balance training in healthy younger (18-39 years) and older (58-74 years) adults, we demonstrated that the robotic feedback training system can accurately quantify movement performance with a user-friendly, engaging, and challenging approach to standard training. A versatile, pocket-sized motion controller offered multipurpose training opportunities including high dose-rates of coordinated joint motion in young adults and challenging (e.g., greater muscle recruitment) balance coordination training in older adults. These studies collectively support the strong potential of robotic feedback for intrinsically motivating therapy through challenging and engaging goal-directed training, improving health awareness with accurate monitoring of at-home recovery progress, and advancing therapy practices to promote healthy and independent lifestyles.