Thursday, April 15, 2010

Discussions with Dr. Rosen

I have spent the past few weeks in discussions with Dr. Rosen regarding the WiiCane, and being educated in the biomechanical and sensory aspects of veering. I will summarize some of our discussions and end with some implications for product design and teaching approaches with the device.

Sandy has reviewed a few hours of video and I have sent her the recordings of two more students. I should note that the data are not ideal for analysis so Sandy’s comments were based on what was possible to glean from the images.

It is highly improbable that training with the WiiCane is influencing students’ gait. Sandy said, “Gait patterns stabilize around age 6-7 according to all medical research.. . . gait is a very hard one to change long term.” As for posture (particularly pelvis-trunk alignment), which is more “fluid,” we probably are not effectively influencing this either, but we could.

So why is it that we see improvement in some students using the device? First, I’ve come to believe that early and dramatic improvement in straight-line travel is probably just becoming adjusted to using the feedback system. But the long-term changes in walking a straight-line is most likely from the training’s (exercise) impact on proprioceptive awareness. The proprioceptive system is a balance system The one that is not vestibular) — that makes normal, slight adjustments to balance. It is (as Gene understands it) neurologically related to muscle systems and tone. Individuals can be trained throughout life (not like gait patterns) to fine tune this system; effective training is active exercise. What might be happening with the Wii is that the repeated feedback influences this system’s patterns.

So, what are the product and training implications? I will simply bullet some of the more salient points that Sandy makes:

- We must eliminate any incorrect feedback that the system issues now – there is plenty of it evident. We need to use the body orientation data and create a better feedback logic. We should not be giving feedback that causes ping-pong patterns of walking.

- We should be including instructions for the teachers and users to make adjustment to the line of travel by using trunk movement, not feet movement. We need to look at the words/text we use for the feedback and the advice in the user guide.

- We should begin at each end of the course with the student aligned from the floor to the pelvis, then ask the student to align their trunk forward. This need serious consideration, and an effective and easy squaring-off platform that reaches from the floor to around the pelvis.

If all this works perfectly there is one part of the assessment of the device that we have not yet looked at. Sandy and I will talk about how I will do this when I return to the Bronx for final testing in June. THE BIG QUESTION: how much will the proprioceptive changes generalize, and will they be effective in the real world when the student does not travel on an ideal surface. Changes in the travel surfaces are inevitable. These will interpret the new patterns achieved with training, and student will revert to their old patterns. How much training and the degree of benefit in the real world need to be looked at. On this topic I have my single experience (n=1) with a student I trained with the equivalent of over 100 trails on a WiiCane at HKNC. He learned to walk in a straight line indoors, and has demonstrated this in the real world consistently since training. We are looking to see if this will be typical.

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