PRS Conference abstracts

Creating a SPARK: Investigating An investigation into the use The learning of higher order
exercise behaviour and preferences of inertial sensors to quantify manual therapy through
in patients with chronic kidney joint position sense real-time feedback
disease to aid the design of Bewes R, Williams JM Williams JM
exercise programmes [email protected] [email protected]
MacKinnon HJ, Clarke AL, Young HL, Background/Aims: The literature presents Background/Aims: The learning of
Hull KL, Burton JO, Smith AC the importance of the sensorimotor system higher order manual therapy skills
[email protected] to the injured and/or painful shoulder, is complex. One reason may be the
Background/Aims: Chronic kidney advocating sensorimotor rehabilitation. lack of intrinsic feedback enabling
disease (CKD) is a progressive condition Evidence for this rehabilitative approach is self-correction. Specific skills, such as
that increases the risk of all-cause limited as a functional, clinically useful manipulation, also present a risk for the
mortality and reduces quality of life. outcome measure is lacking. Inertial sensors novice practitioner. Therefore, the aim
National guidelines recommend exercise are increasingly used in biomechanics of this series of studies was to develop a
to manage co-morbidities and improve research. Application of inertial sensors feedback tool to enhance the learning of
functional ability, yet the majority of to measure shoulder Joint Position Error spinal manual therapy.
people with CKD are inactive. This (JPE) is explored as an easily quantifiable Methods: An instrumentation method
project aimed to understand the patient's aspect of sensorimotor control. was developed, first on a skeleton,
perspective on exercise and physical to determine feasibility, then on the
Methods: Thirty participants with non-
activity to inform the development of a human to provide real-time feedback
painful shoulders completed 15 active
self-directed intervention to encourage of performance of spinal manipulation.
position-matching tasks using 3AMG
people to be more active (SPARK). This Expert practitioners completed a series
inertial sensors (THETAmetrix). Sensors
approach has been shown to be effective of manipulations to identify important
were attached immediately inferior to
in the management of other long-term metrics to denote performance. The
the deltoid tubercle and superior to the
conditions and hence represents an area feedback device and these metrics
acromial arch. A sternal sensor allowed
for development in CKD to improve were then used to target the learning of
calculation of relative angles using
quality of life and health outcomes. manipulation in a prospective study.
direction cosine matrices. JPE was
Methods: Questionnaire data was calculated as the difference between Results: The inertial sensor
collected in general nephrology and pre- start and finish positions and determined instrumentation was feasible and could
dialysis outpatient clinics on three sites for elevation, horizontal abduction and quantify important metrics denoting
(Leicester, Northampton and Kettering). rotation planes using resultant Euler performance of spinal manipulation. The
This included the Leisure Time Exercise angles. Variation in visual input and time use of real-time feedback for learning
Questionnaire (LTEQ) and free text delay to position matching explored sensor cervical manipulation demonstrated
comments regarding preferred activities ability to detect variation in performance. significant increases in thrust velocity
and barriers/motivators to engaging in Results: Non-parametric statistical (pre = 49o/sec; post = 97o/sec, p = 0.003).
exercise. Clinical data was obtained from analysis using Friedman’s two-way Despite the increase in velocity, there was
the participants' medical records. ANOVA by ranks and post-hoc analysis of no change in the magnitude of range of
Results: Patients with CKD not requiring pairs using the Wilcoxon signed-rank test motion (p = 0.247 for rotation; p = 0.314
renal replacement were sampled showed inertial sensors were able to detect for side-bending). The magnitude of
(n=1357; 722 male; median age 68 years; significant differences in ability (n=147, range of motion during the thrust is
median eGFR 29 ml/min/1.73 m2); p<0.001). JPE was significantly better important with regards to the arterial
1104 participants were inactive (81.4%) with visual input (mean±SD=3.5±2.0o) system. Therefore, the method appears
as defined by the LTEQ. Analysis of free and significantly worse with longer to be able to not only monitor this in
text comments from 333 participants time delays to position matching real-time but also the feedback during
generated themes regarding barriers and (mean±=5.7±3.0o). These results suggest learning seems to result in the specific
motivators to exercise. Barriers identified the ability to detect differences development of other aspects of the
were physical (fatigue, non-specific, resulting from altered visual input and time motor skill (velocity) without affecting
co-morbidities), psychological (reduced delay, demonstrating potential for a this important metric. This is important
motivation, anxiety) and social (time and clinically useful quantifiable measurement. for safety when learning this skill.
cost), while motivating factors included Conclusions: JPE measured using inertial Implications: This study describes the
support, education and gentle exercise. sensors can quantify and detect variation in process of development of a novel real-
Conclusions: The preferred exercise performance for position matching in the time feedback device that can facilitate
modality identified was walking, and non-painful shoulder. A quantifiable method the learning of higher order manual
© 2015 MA Healthcare Ltd

results show that a walking intervention, of measuring JPE aspects of shoulder therapy skills. Manipulation can be
combined with an educational manual, sensorimotor control allows further quantified and aspects of performance
has the potential to facilitate people with research into the role of sensorimotor enhanced through feedback provided by
CKD to become more active. control in the painful shoulder. a single inertial sensor.

S2 International Journal of Therapy and Rehabilitation, August 2015, Vol 22, No 8

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