BiofeedbBiofeedback diagramack's working principle is based on information from the body coded into an appropriate signal and provided back to the user in real time. Brain and muscle activities that are not normally controlled voluntarily may be changed according to the new available information (Ref: 1, 2).

The neurological mechanisms underlying the effectiveness of biofeedback training are still debated. Biofeedback may enhance neural plasticity by engaging auxiliary sensory inputs, thus making it a plausible tool for neurorehabilitation and for a variety of population.

The concept of task-oriented (functional) repetitive training suggests that biofeedback should be delivered during a functionally-related movement to optimize motor function (Ref: 3).

The interest in biofeedback design is moving from the visualbiofeedback of force plate measurements to audio- (Ref: 4) and tactile-biofeedback (Ref: 5) of inertial sensors measurements, with the intent of producing new cost-effective and portable systems for functional rehabilitation. Only a few studies have evaluated different types of biofeedback in subjects with Parkinson’s disease (PD). Scientific evidence, and preliminary validation, on effects of cueing and rhythm for gait improvement with important results in patients show freezing of gait (Ref: 6, 7).

No studies involving PD have been performed outside the clinical centres.

Cupid will identify and evaluate novel strategies for biofeedback rehabilitation in PD. The consortium will
•    design and test novel body sensor network for biofeedback restitution
•    design and test new algorithms and signal processing
•    implement biofeedback multi-sensory restitution channels and methods

Scenario of useBiofeedback picture

Mrs Jane has suffered from PD for 6 years. Her major motor symptoms include: movement start hesitation, slow gait characterized by short step, and poor balance control. Her clinician recommends her a rehabilitative program to be performed at home, by means of a new service and system based on recent technology.

The clinician and patient decide that the main exercises should aim to ameliorate her gait, by increasing step length, and to improve balance, by correcting trunk posture, the preferred feedback is the audio one, to be modulated according to trunk position. She is trained for a couple of hours in the clinical center, and then she is assured with on-site technical assistance if necessary. She performs the therapy at home, without need of assistance. Before each training session starts, she records a self-assigned score about her motor status. The clinician is so able to see if her evaluation (which can be strongly affected by mood and cognition) is in accordance to the objectivity that the system can measure. The at-home rehabilitation exercise (consisting of 20 minutes walking with the audio biofeedback, and balance exercise with music on a daily base) will last for 6 weeks, after which a new medical examination will be performed in the neurological care center. Medical examination will be done after a wash out, and then results evaluated to possibly perform a further stage of the rehabilitation protocol.

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1 Nicolai S et al.. Improvement of balance after audio-biofeedback. A 6-week intervention study in patients with progressive supranuclear palsy. Z Gerontol Geriatr. 2010
2 Fernando, C.K., J.V Basmajian. Biofeedback in physical medicine and rehabilitation. Biofeed. Self Regul., 1978
3 Huang H, Wolf SL, He J. Recent developments in biofeedback for neuromotor rehabilitation. J Neuroeng Rehabil. 2006
4 Dozza et al. Auditory biofeedback substitutes for loss of sensory information in maintaining stance. Exp.Brain Res., 2007
5 Wall, C., III, et al., Vestibular prostheses: the engineering and biomedical issues. J.Vestib.Res., 2002
6 McIntosh, G.C., et al., Rhythmic auditory-motor facilitation of gait patterns in patients with Parkinson's disease. J.Neurol.Neurosurg.Psychiatry,1997
7 Nieuwboer, A., et al., Cueing training in the home improves gait-related mobility in Parkinson's disease: the RESCUE trial.
J.Neurol.Neurosurg.Psychiatry, 2007