Biofeedback Based Physical Rehabilitation in Parkinson's Disease Aimed at Self-Enhancement

Parkinson’s disease (PD) is a progressive neuromotor disorder that results in a progressive deterioration of balance and motor abilities with a consequent increase of the risk of falls and a reduction of quality of life. Physical therapy revealed to be fit for the symptomatic treatment of the disease and the adoption of biofeedback signals showed to be effective in prolonging the benefits of the therapy. Thus, this doctoral project has been designed to assess the benefits that wearable technologies for biofeedback generation could have in physical therapy. To further improve the developed biofeedback-based system, the assessment of new methods for the objective evaluation of balance control was included into the study. The dissertation is divided into three different set of studies, respectively aimed at: 1) presenting new wearable systems specifically designed for biofeedback-based rehabilitation; 2) assessing proprioceptive impairments in PD subjects through the adoption of a robotic platform to destabilize the base of support; 3) discussing new methods for the evaluation of balance preceding the execution of voluntary movements. The efficacy of the main proposed solution was assessed in a 6-months RCT study by comparison of subjects with PD trained with the biofeedback system and patients that received usual care. Both clinical and instrumental outcomes supported the higher efficacy of the biofeedback-based approach. The developed instrumented tests showed good sensitivity in discriminating patients and in detecting changes induced by physical therapy. The results reported in this thesis lead to the conclusion that the adoption of biofeedback based physical rehabilitation systems is promising in the treatment of Parkinson’s disease. The availability of a set of fast, easy-to-manage tests for the evaluation of balance and motor control might be useful in the design of home-delivered, user-tailored exercises for both healthy elderly and neurological subjects.