“Trust - M ”Balance System"

The Balance system is evaluation of both postural function and rehabilitation by the BFB (biofeedback) method.

 
 

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The balance system “Trust-M” is designed for the diagnosis of balance disorders, objective evaluation of the treatment efficacy and the balance function recovery by means of the biofeedback method (BFB).

Stabilometry, is a diagnostics method for postural disordersanda standard study is included in the orders, protocols and standards of care. The order of the Ministry of Healthcare of the Russian Federation of 29.12.12.#1705 n “On the Medical Rehabilitation Management”.

 

Application

 

Neurology – diagnostics and rehabilitation of patients with earlier stroke consequences, brain concussion, Parkinson’s disease, vascular encephalopathy, hyperkinetic disorders , Limbs pareses\paralysis and CP patients.

Posturology – objective evaluation of postural function.

Traumatology - Orthopedics allows detecting the asymmetries of the locomotor system, anomaly of joints and spine, correctly to select orthoses and prostheses.

Otorhinolaryngology – study of vestibular system function.

Ophthalmology – assessment of the functional result of vision correction.

Stomatology– control of intervention success in the maxillofacial system.

Pharmacology– drug effect assessment.

Addictilogy – determination of alcoholic Intoxication.

Physiotherapi – assessment of the treatment efficacy.

Sports medicine– diagnostics and rehabilitation in sports medicine, study of sportspeople balance function, their static and dynamical stability (SDS), exercise training quality control, assessment of exercise tolerance.

 Advantages

 

The stabilometric platform “Trust-M” Stabilometry allows to perform a full-fledged posturological study using stabilometry with synchronous recording of muscle tone (EMG, tremor).

Biofeedback – play media, for increase of patient engagement, allow performing highly efficient rehabilitation of patient with the locomotor system and postural disorders.

The platform’s distinctive feature is the virtual memory module which allows creating unique diagnostic and rehabilitation BFB methods. It is possible to simulate media with the effect of ship motion, horizon distortion samples, room movement effect etc.

The stabilometric platform “Trust-M” Stabilometry along with standard stabilometric trainings and tests (Romberg test, optokinetic test, stability limit tests), allows accomplishmentof combined methods using biomechanical sensors which detect the movements and tremor of separate body parts in three mutually perpendicular planes.

The sum of information on the centre of mass projection fluctuations and the fluctuation of the separate segments of the patient allows the positive identificationof the pathological processes.

For comfortable viewing during use , a convenient and balustered access rampis included.

To ensure the patient’s safety at all times there is a mobile rolling fall arrest system with patient weight unloading function..

 

 

Main technical characteristics

 

Balance system

50x50 mm

Accuracy of reduced pressure centre coordinates calculations

1 mm

Balustered access ramp

availability

Patient fall arrest system

mobile

Biomechanical sensors for recording EMG, tremor, motion kinematics.

Up to 2 pcs

Number of EMG recording channels

Up to 4 channels

Recording of tremors in 3 coordinates

Up to 6 channels

Diagnostic tests

Romberg test, optokinetic testing, stability limit test, vestibular- sensory, user technique creating wizard

BFB with balance training device

LCD display, projector, VR helmet

Play motivational scenarios

3-D virtual media with stereo effect

PC connection interface

USB, telemetry

Diagnostic parameters of balance system

Stabilogram, statokinesiogram, power spectrum, Romberg ratio, expended energy ratio

 

 

The balance system “Trust-M” is designed for the diagnosis of balance disorders, objective evaluation of the treatment efficacy and the balance of functional recovery by means of the biofeedback method (BFB).

 

Stabilometrics, is a standardized method for postural disorders diagnostics, and is included in the orders, protocols and standards of care. The order of the Ministry of Healthcare of the Russian Federation of 29.12.12.#1705 n “On the Medical Rehabilitation Management”. 

Рис.1 Комплекс «Траст-М» Стабилометрия
“Trust-M” Stabilometry Platform

The method becomes increasingly important in widely differing areas of clinical medicine allowing Healthcare Professionals to assess the efficiency of the whole balance system and perform topical and

nosological diagnostics of the patient’s balance system disorders. 

In neurological practice the stabilometrics application range comprises such areas as cerebrovascular pathology (diagnostics and rehabilitation of patients with earlier stroke consequences, vascular encephalopathies etc.), degenerative-dystrophic diseases of the central and peripheral nervous system (Parkinson’s disease,various types of ataxia, osteochondrosis), myodystrophies, CP, brain injury etc.   

In traumatology and orthopedicsstabilometrics allows  the detection of the asymmetries of the locomotor system, anomaly of joints and column, perform posture correction and correctly to select orthoses and prostheses. Currently,stabilometrics is the only objective tool for postural function evaluation.

The method is widely used in sports medicine for diagnostics and rehabilitation allowing the study of the balance function of sportspeople, their static and dynamical stability (SDS), exercise training quality control and assess their exercise tolerance.

In stomatology the installation of dental prosthesis, brackets and other interventions in the maxillofacial apparatus can affect the patient’s balance function. Stabilometry is used to monitor the success of interventions conducted (including the absence of any impairment of the balance control).

By means of stabilometry in otorhinolaryngology the vestibular system functions are studied, in ophthalmology – this allows the assessment of the functional results of vision correction possible. In addition, a pharmacological drug effects assessment is performed, thereby revealing in addictology, how alcoholic Intoxication severity is. In Physiotherapy stabilometry makes it possible to assess the treatment efficacy.

 

Stabilometry and 3D Stabilometry

The classical stabilometrics method (which literally means stability measurement), is an objective estimation method of posturology function, which has been  known since the 70s. In the 80s  with the appearance of  personal computers, computer analysis and signal visualization methods, stabilometric platforms became widely used in medical practice which allowed recording the pressure centre projections on the bearing area in 2 coordinates (2D Stabilometry). Such measurements can hugely restrict the objective evaluation of posturological functions. 

Рис.2. «Траст-М». Стабилометрия 3D.
3D Stabilometry

But medical progress does not stand still! The “Trust-M” Stabilometry Platform is accomplishing three-dimensional stabilometry 3D linked with the classical methods of 2D stabilometry. Using biomechanical sensors together with a stabilometric platform allows recording the fluctuations of the common pressure centre (CPC) in sagittal and frontal plane as well as the motions of any

body segments in 3 directions (forward – backward, right – left, up-down), assessing segment rotations, tremor and myoelectrical activity.

The total information on fluctuations of CPC and fluctuations of separate body segments allows the medical practitioner to accurately determine the pathological process level. The capability to record fluctuations in the whole frequency range, including high frequencies, significantly increases the methods sensitivity, which allows detecting even insignificant increases of muscle tone. Combined use of the stabilometric platform with biomechanical sensors makes it possible to study infants thereby facilitating early prenosological diagnostics whereas using only a stabilometric platform has age limit to 4-5 years.

Рис. 3.ПО Стабилометрия-Неврокор
"Neurocor" Stabilometry Software

Assessing tremors is a substantial advantage to the physician. Tremorsare frequently reported by  neurological patients. Practice motion syndrome can be present in many diseases as well as in healthy people. Sensors “Trust-M” allows medical professionals to perform a tremor analysis and evaluate its frequency, amplitude and spectral characteristics which significantly lightens differential diagnostics of diseases accompanied by shaking (essential tremor, Parkinson’s disease).

Synchronous myographic examination of the lower limb muscles or trunk during stabilogram recording makes it possible to define the internal strategy for maintaining balance in the main posture.

 

 

 

BFB Stabilometry

BFB or Biofeedback –  is a method of medical rehabilitation comprising a package of diagnostic, treatment and preventive procedures whilstthe patient continuously receives information about the state of his physiological processes in a form easy for a lay persons level of understanding.

Рис. 4. «Траст-М» Стабилометрия – БОС
BFB Stabilometry

The  output of biofeedback canbe compared with a “physiological mirror”. The task of the procedure – to teach This involves the patient receiving information in real-time to adapt and control and thereby change his physiological parameters.
 

The “Trust-M” Stabilometry platform makes it possible to perform a highly efficient BFB method of rehabilitation inpatients diagnosed with locomotor system and postural disorders. Exciting play media with a possibility of “particiapting” in a virtual reality increase a patient’s motivation and consequently, the treatment process becomes much more pleasant and interesting.

When conducting the BFB procedure on the “Trust-M” Stabilometry platform the following physiological parameters are employed:

•    Support reaction (per CPC plane coordinates)
•    Movements in segments
•    Joints and segments rotations
•    Tremor monitoring
•    Myoelectrical activity.


The Stabilometry-Neurocor’s computer software has a customized interface Wizard to help the doctor quickly and easily to adjust the parameters of BFB action for a specific patient with the necessary amplitude and sensitivity. The standard software bundle comes complete with a set of a various playful interactive scenarios including “Target”, “Boat”, “Snowboarder”, “Delta Plane”, “Rally”, “Labyrinth”, “Paper Plane”, “Rocket”, “Forest Walk”, “Virtual Joystick”.

These interactive scenarios have various tuned techniques that allow a patient to train their individual centre of gravity whilst retaining their centre of gravity so as to perform a temporary fixing of theircentre of gravity in a certain place, control muscle tone and train angle contractures in joints etc.

As BFB visualization tools in the Trust-M Stabilometry platform an LCD-Panel, projection screen, virtual reality glasses suitable for stereo image.
 

Virtual reality

One of the features of the Trust-M Stabilometry Platform is the virtual reality module (VR) which allows the physician to create unique diagnostics tests and BFB rehabilitation methods. The use of the technology significantly expands the possibilities for conducting clinical tests of sensor interaction in different virtually simulated conditions for determining the type and the degree of balance disorder.

Рис.5. «Траст-М» Стабилометрия – Виртуальная реальность
Stabilometry TRUST-M "Virtual Reality"

A special test of Sensory Interaction was developed for the “Trust-M” Stabilometry Platform in virtual reality environment. Using the test it is possible to evaluate the condition/stability of the somatosensory system in the presence of a disturbing action on the visual perceptual system.

The test is based upon the recording and analysis of a patient’s postural fluctuations in the presence of preprogrammed sensory loads (optokinetic testing in virtual environment, blurred image, receding room, “sea rolling effect”).

For rehabilitation methods, the BFB virtual reality technology allows creating exiting playful and interactive environments thereby enhancing a patient’s motivation and transforming training into an amusing and enjoyable time.

Virtual reality has several advantages in treatment of patients requiring physical rehabilitation. The method is particularly useful for individuals with disabilities. Spine injured patients in wheelchairs can again feel as if they are standing on their feet.
 

 

Postural tests and parameters

The stabilometric platform “Trust-M” Stabilometry allows to perform a full-fledged posturological study in accordance with international standards with calculation of the main diagnostic criteria:

Рис.6. Отчет ПО Стабилометрия-Неврокор
Neurocor "Stabilometry" Report
  • Average velocity of the centre of pressure travel;
  • statokinesiogram area;
  • mid position of the centre of pressure in X and Y direction;
  • maximum values of the pressure centre fluctuations amplitude along the axis;
  • standard quadratic deviation of the pressure centre mid position along the axis;
  • basic frequency of pressure centre fluctuations along the axis;
  • level of fluctuation spectrum power baseband along the axis;
  • statokinesiogram length;
  • mean direction of the centre of pressure fluctuations;
  • Romberg ratio;
  • energy expenditure ratio;
  • evaluation of the effectiveness of the specified action in BFB tests

 

Thereby the quality of the posturology study results, the possibility to easily use, compare data received, compare them with research and practice literature and other sources.
    
The platform supports accepted research methods of the main posture balance when changing different external conditions. The following tests are used most frequently in medical practice: 

•    Romberg test, the point of which is that during studies,a visual analyzer impact is excluded; the upright position is kept only thanks to proprioception;
•    Optokinetic testing allows the evaluationof the reaction of the sensorimotor system on a visual stimulation, for example, on black and white moving bands;
•    Stability limit test consists of a series of consecutive changes of a patient’s body positions and allowing to vividly evaluate the travels of the centre of pressure in the maximum possible leaning either left-right and forward - back when patient is capable of  keeping their balance;
•    sensory-vestibular test reflects on a stabilogram the response of the balance control system to a provocative action of head rotation to either the left and right.

 

 

 

 

 

Technical capabilities of the stabilometric platform “Trust-M”

 

Capabilities of the stabilometric platform

 

Size of stabilometric platform Maximum 500х500 mm
Power type From USB bus
Load range (tested person weight) From 10 to 150 kg
Possibility of automatic or hand change of platform coordinate origin Available
Positioning error of reduced pressure centre Maximum 1 mm
Stabilometry sampling rate Maximum 400 hz
PC connection interface USB

 

Capabilities of biomechanical sensors

 

Number of tremor recording channels in 3 axis Up to 2
Number of movement recording channels in 3 coordinates Up to 2
Number of cumulative EMG recording channels Up to 4
Angular movements measurement accuracy Maximum 0.5 deg.
Noise in EMG channels Max. 0.5 µV RMS
In-phase rejection in EMG channels Maximum 100 dB
PC connection interface Telemetry, wireless
Built in battery Li-ion 3.7 V
Battery life Up to 6 hours

 

Functional capabilities of the platform

 

Diagnostic studies and trainings fulfillment on the balance system when the position of the examined person is “standing”, “sitting” and “march in place”. Available

Conducting of conventional stabilometric studies with calculating of diagnostic criteria:

 

-Average velocity of the centre of pressure travel;

- statokinesiogram area;

- mid position of the centre of pressure in X and Y direction;

- maximum values of the pressure centre fluctuations amplitude along the axis;

 

- standard quadratic deviation of the pressure centre mid position along the axis;

 

- basic frequency of pressure centre fluctuations along the axis;

 

-level of fluctuation spectrum power baselinealong the axis;

-statokinesiogram length;

-mean direction of the fluctuations;

-Romberg ratio;

 

-energy expenditure ratio;

 

-evaluation of the effectiveness of the specified action in BFB tests.

Available
Built-in tests for postural studies (Romberg test, optokinetic testing, stability limit test, sensory-vestibular test) Available
Wizard of test methods Available
Virtual reality tests Available
Support of BFB via support reaction based on stabilometry or biomechanical sensors using visual and acoustic channels Available
Conducting of individual rehabilitation trainings (controllable load) Available
Built in exercise machines (in BFB mode) Available
Use of additional movement sensors and movement myography “Trust-M” Available
Quantitative movement detection Available

 

Capabilities of software

 

Russified interface Available
Compatibility with OS Windows version “7”, “8”, “10” Available
Availability of separate screens for training control (expert) and visual channel(tested person) Available
Possibility of individualization of load degree and executions condition of the training task when performing rehabilitation class Available
Possibility of database management with saving of individual examination results Available
Capability of automatic generation of a study report Available
BFB virtual reality Available
Capability of exporting the conclusion to Microsoft Word Available

 

Supply package

Balance system

Balance system 1
Handrails for a patient stabilization with an access ramp Optionally
Rolling fall arrest system Optionally
Intel-based PC with a professional graphics adapter 1
LCD panel for BFB 1
Biomechanical Sensors “Trust-M” 1-2
Charging device 1-2
EMG Electrodes Optionally
Connecting EMG cables Optionally
Fixing cuff package 1
SW Stabilometry-Neurocor 1
SW BFG Game Application 1
SW Biomechanics-Neurocor Optionally
Operating Instructions 1
User’s Guide 1

 

*At the request of the customer and by agreement with the customer the technical capabilities and the supply package may be changed.