Analyzes of Inﬂuencing Factors to the Sensorimotor Training

Technical Support Systems in the Physiotherapy

Angelina Thiers

, Annett l’Orteye

, Katja Orlowski

, Kerstin Schrader

and Thomas Schrader

Brandenburg University of Applied Sciences, Department of Informatics and Media, Brandenburg an der Havel, Germany

adtisches Klinikum Brandenburg GmbH Akademisches Lehrkrankenhaus der Charit

e, Abteilung Medizinische Schule,

Brandenburg, Germany

SAfP Spektrum Akademie f

ur Physiotherapie, Berlin, Germany

Keywords:

Sensorimotor Training, EMG Data, Technical Support Systems.

Abstract:

The popularity of the sensorimotor training is still growing. Nonetheless, the training is not yet fully inves-

tigated. Information given by the manufacturers, in the literature and the experience of physiotherapists will

form the basis of physiotherapeutic interventions. For an integration of evidence based decision making a

change in the approach of the therapy planning is needed. This can be achieved by the use of technical support

systems. Therefore, the behavior of 32 test persons was investigated. Within two different setups several in-

vestigation scopes were analyzed. One scope was the inﬂuence of the laterality to the muscular activity during

the training on the exerciser. Furthermore, the effects of the different equipment with regard to the information

of the literature and the manufacturers were analyzed. Additionally, a detailed investigation of the muscular

activity during the realization of tasks given by the physiotherapist was made. Also, a survey regarding the

muscular strain during the training as well as the acceptance of the sensors was fulﬁlled. Finally, factors which

have an inﬂuence on the progress of the training were identiﬁed and analyzed. The beneﬁt and the necessity

of technical support systems in the sensorimotor training was shown.

1 INTRODUCTION

Across the health care professions the use of evidence

is extensively promoted. The physical therapy pro-

fession goes along with this progress. One aim of the

American Physical Therapy Association is that up to

the year 2020 physiotherapists will use evidence in

practice (Jewell, 2010).

The necessity of evidence is caused by a couple

of reasons. On the one hand, there are many different

ways to achieve an improvement within a special dis-

ease pattern. This variety of treatment options leads

to a critical consideration of the therapy by the thera-

pist and by the patient. Consequently, a detailed doc-

umentation of the therapy is needed. This documen-

tation should contain essential information to provide

evidence. This requirement can be achieved by the

usage of technical support systems (Jewell, 2010; von

Eisenhart-Rothe et al., 2007).

One therapy method, which is often used for pre-

vention purposes, therapy, rehabilitation as well as

for the improvement of the athletic performance is

the sensorimotor training. Its huge popularity en-

sures that there is a great variety of equipment, which

should support and improve the training. Despite its

popularity, the training itself is not completely inves-

tigated until now (R

uhl and Laubach, 2012).

Actually, the therapy planing is based on the fol-

lowing facts: the experience of the physiotherapist,

the information given in the literature, the productin-

formation given by the manufacturers as well as on

the possibilities in the physiotherapy practices. De-

pending on the information given by the manufac-

turer, the therapist is planing the usage of the equip-

ment in the training. For example, the Balance Board

should strengthen the musculature of the buttocks,

the legs, the back and the abdomen (Sport-Thieme,

2012). Furthermore the literature documents addi-

tional effects. The ﬁrst one is the improvement of the

inter- and intramuscular coordination of the muscles

of the feet and the legs. The second effect, staying

with both feed on the Balance Board, is the enhance-

ment of the stabilization in the region of the lumbar

spine, the pelvis and the hip. Additionally, the opti-

mization of the inter- and intramuscular coordination

of muscles of the lumbar spine, the thoracic spine and

Thiers A., l’Orteye A., Orlowski K., Schrader K. and Schrader T..

Analyzes of Inﬂuencing Factors to the Sensorimotor Training - Technical Support Systems in the Physiotherapy.

DOI: 10.5220/0005093000450052

In Proceedings of the 2nd International Congress on Sports Sciences Research and Technology Support (icSPORTS-2014), pages 45-52

ISBN: 978-989-758-057-4

 2014 SCITEPRESS (Science and Technology Publications, Lda.)

the cervical spine should also be a beneﬁt (Bertram

and Laube, 2008).

For the usage of evidence a more detailed look at

the sensorimotor training is needed. The aim of the

current study was to identify and analyze all kinds of

factors which have an inﬂuence on the progress of the

therapy. Therefore, the behavior patterns of 32 test

persons were investigated during their training on the

exercisers. Finally, the necessity and the beneﬁt of

using supporting systems in the sensorimotor training

should be shown.

2 MATERIAL & METHODS

2.1 Measurements

The usage of Shimmer

measuring units is one ap-

proach for a noninvasive patient monitoring. Next

to the mentioned feature of monitoring, the sensors

assist diagnostics with their given functions. One

of their beneﬁts is the small form factor of the sen-

sor. Additionally, the characteristic of wireless com-

munication is a further advantage of the measure-

ment units. The Bluetooth technology enables data to

stream online and in real-time. All used sensors were

a combination of a baseboard and a special daughter-

board. For the current investigation the electromyo-

gram (EMG) as well as the gyroscope daughterboards

were used (Shimmer Research, 2011).

The EMG daughterboard allows the user to mea-

sure one channel of the electrical activity of a mus-

cle. Furthermore the sensor also provides a pre-

ampliﬁcation of the EMG signal. Hence, the non-

invasive method visualizes the whole activity of a

muscle (Shimmer Research Support, 2012).

The gyroscope daughterboard consists of a single

and a dual axis angular rate gyroscope and is able to

measure three axis of angular velocity (Kuris, 2010).

2.2 Exercisers

Within the experimental setups the behavior of the test

persons on three different exercisers was investigated.

The ﬁrst one is the Balance Board. The last two exer-

cisers were two types of a special Rocker Board. The

only difference is the direction of the deﬂection of the

Rocker Board.

2.2.1 Balance Board

The Balance Board is characterized by its multidi-

mensional instability, ﬁgure 1. The exerciser offers

different ﬁelds of application. The Balance Board

supports the strengthening of the musculature of the

buttocks, the legs, the back as well as the abdomen

(Sport-Thieme, 2012). The dimensions of the Bal-

ance Board are given in table 1.

2.2.2 Rocker Board

One feature of the Rocker Board is its one-

dimensional instability, ﬁgure 1. The board can be

used in two different ways. It offers either a forward-

backward or a left-right instability. The Rocker Board

is made to train the coordination, the stamina, the

strength as well as the motor skills (Bad-Company,

2013).

In case of the left-right deﬂection it requires spe-

cial movement patterns performed by the extension

and the ﬂexion of the knee joints. In contrast, the

forward-backward deﬂection demands the reaction of

the ankle joints.

Figure 1: Balance and Rocker Board.

Table 1: Dimensions of the Exercisers.

Balance Board Rocker Board

Height 9.0 cm 7.5 cm

Dimension 41.5 cm 45.0 cm

Deﬂection ∼ 18

◦

∼ 16

◦

Material Plastic Wood

Surface smooth smooth and ﬁrm

2.3 Experimental Setups

The investigation obtains its data from two different

experimental setups. The data from the ﬁrst setup

originates from a previous study (Thiers et al., 2014).

The collected data prove the assumption that the train-

ing on an exerciser with a multidimensional instabil-

ity causes a higher muscular activity than the train-

ing on an exerciser with an one-dimensional instabil-

ity (Grifka and Dullien, 2008). The second setup was

developed to have a closer look at the sensorimotor

training. Additionally, the effects of the interventions

given by the physiotherapist were analyzed.

To develop an user-oriented experimental setup

the design of both studies was made in coopera-

tion with experienced physiotherapists of a medical

school. One requirement of the physiotherapists was

the transferability of the setups into a training, which

can also be performed by patients. Hence, this causes

the drop out of the maximum voluntary contraction

icSPORTS2014-InternationalCongressonSportSciencesResearchandTechnologySupport

measurement. Alternatively, the normalization of the

data was made by a reference measurement in front of

the exerciser.

2.3.1 Setup 1

The ﬁrst setup includes the data of 13 test persons.

All of them were young and healthy students. For

participating in the study all test persons have to gave

their written consent.

The ﬁrst setup comprised of three different parts.

The ﬁrst one was the test of the laterality of each

proband. The second part contains measurements on

the three exercisers. Finally, a survey regarding the

acceptance of the sensors was made.

The investigations of the laterality were made by

multiple tests. At the beginning six tests for the deter-

mination of the handedness were made. For instance,

the hand which opens a bottle was identiﬁed. For the

investigation of the dominance of the feet, ten differ-

ent tests were made. For example, the establishment

of the takeoff leg and shooting foot. Finally, a scales

test was made. For this reason the test person has to

stand with each leg on one scale. The distribution of

the bodyweight on the two scales was documented.

For the second part of the setup two different types

of Shimmer

measurement units were used. A pair

of gyroscope sensors were centrally placed on the dif-

ferent exercisers. On the one hand this placement

enables to synchronize all recorded data and on the

other hand the intensity of deﬂection of the exercis-

ers was documented. For the veriﬁcation of the as-

sumption that a higher muscular activity is achieved

when using exercisers with a multidimensional insta-

bility compared to the training with exercisers with

an one-dimensional instability (Grifka and Dullien,

2008), the EMG data of four pairs of muscles were

recorded. The voltage values of the M. tibialis ante-

rior, the M. soleus, the M. vastus lateralis as well as

the values of the M. biceps femoris of both body sides

were measured. The skin preparation and the place-

ment of the electrodes followed the recommendations

of the SENIAM project (SENIAM project, 2012).

The test persons had to perform the test sequence

for each of the three exercisers. One iteration of the

test sequence comprised a reference measurement in

front of the exerciser with a duration of 15 s as well as

a measurement on the equipment. This part of the pro-

cedure consists of four consecutive phases of chang-

ing difﬁculty, table 2. All phases have in common,

that they were characterized by symmetrical require-

ments to both body sides. All recordings have been

done without shoes. The subjects stand on both legs

for the whole time. In addition, the instructions and

the supervision of the correct execution were made by

an experienced physiotherapist.

The last part of the setup was a survey regarding

the subjective impressions of the training and the ac-

ceptance of the sensors. The questions regarding the

subjective impressions comprised the content of the

degree of the felt strain in general and in special body

areas. Additionally, the supervisor documents her im-

pressions, too. The following topics were addressed

by the questions of the sensor acceptance (examples):

if wearing the sensors caused restrictions during the

execution, if wearing the measurement units induced

an unpleasant feeling, if the test persons would use

the technology again as well as the usefulness and ap-

plicability of the sensors in everyday life. The options

for the answers were the choice of yes/ no as well as

free text.

Table 2: Setup 1 - Test procedure.

Phase Task Duration

1 Eyes open 30 s

2 Eyes closed 30 s

3 Throwing a medicine ball 60 s

4 Eyes open 30 s

2.3.2 Setup 2

19 healthy and young students took part in the second

setup. The participants were not the same than in the

ﬁrst trial.

The second setup also consisted of three different

parts. These parts were executed subsequently: deter-

mination of the laterality, measurement on only one

exerciser and the survey regarding the acceptance of

the sensors. The ﬁrst and the last part were identical

to the ﬁrst setup.

On the contrary, the second setup only investi-

gated the behavior of the test persons on one exer-

ciser, the forward-backward Rocker Board. The test

sequence was composed of a reference measurement

in front of the exerciser and a measurement on the

exerciser. The overall duration of the training on the

Rocker Board was eight minutes, table 3. The ﬁrst

phase had a duration of 60 s and during that phase

the test person should get familiar with equipment.

The second and the third phase were characterized

by the intervention of the physiotherapist. She re-

quested the subject to either focus on the right or left

body side. Immediately after that, their was again a

phase without any intervention. The aim of the ﬁfth

phase was an individual intervention by the physio-

therapist. She gave different instructions regarding

the stance and the posture as well as the performance.

AnalyzesofInfluencingFactorstotheSensorimotorTraining-TechnicalSupportSystemsinthePhysiotherapy

The ﬁnal phase should document, if the subjects have

adopted the behavior of the previous phase or not. For

a detailed investigation the deﬂection of the Rocker

Board and the muscular activity were recorded. The

EMG values were derived from both sides of the M.

peroneus longus, the M. tibialis anterior and the M.

vastus lateralis. Again, the skin preparation and the

placement of the electrodes followed the recommen-

dations of the SENIAM project (SENIAM project,

2012). The measurements of both setups had also in

common, that the test persons had to stand the whole

time without shoes on both feet. The study was su-

pervised by an experienced physiotherapist.

Table 3: Setup 2 - Test procedure.

Phase Task Duration

1 Without Intervention 60 s

2 Right Intervention 30 s

3 Left Intervention 30 s

4 Without Intervention 120 s

5 Physiotherapists Intervention 120 s

6 Without Intervention 120 s

2.4 Data Analyzes

Before starting the signal processing, the data sets

were synchronized. The ﬁrst step of signal process-

ing was the application of a notch ﬁlter to EMG data

with a blocking frequency of 50 Hz. Secondly a ﬁr

band-pass ﬁlter was applied to the data (Merletti and

Parker, 2004). Afterwards, the normalization of the

EMG data took place. Therefore the average muscu-

lar activity when staying in front of the exerciser was

calculated and used as normalization value. Subse-

quently, the absolute values of the measurement on

the exercisers were transformed into relative values

by using the normalization value. Finally, all EMG

values were presented as a percentage value of the

stance.

The next step regarding the EMG processing im-

plies the full-wave rectiﬁcation of the EMG data

(Merletti and Parker, 2004). For the evaluation of

the muscular activity in the time domain different sta-

tistical parameters were calculated. For instance the

maximum and mean values for the whole signal over

a time window of 512 ms (Gu et al., 2010). These sta-

tistical parameters were evaluated within further cal-

culations. Namely, on the one hand the course of the

maximum values over time was documented. On the

other hand the mean value of the maximum voltage

values for each phase as well as for the complete pro-

cedure were calculated. Besides that, the accumulated

EMG activity (iEMG) was analyzed. Therefore, the

EMG was integrated over time. Consequently, the to-

tal accumulated activity was computed by the calcula-

tion of the area under the EMG for a chosen time pe-

riod (Robertson and Caldwell, 2004; Medved, 2000).

This calculation was performed for each phase as well

as for the complete test procedure. For a more de-

tailed investigation, the course of the iEMG over the

time was calculated and plotted.

3 RESULTS

3.1 Setup 1

Figure 2 provides an overview of the overall muscular

activity of all test persons during the complete test

procedure on each exerciser.

The complete accumulated EMG activity during

the individual test sequences of each test person were

computed. The data were normalized for each sub-

ject. Therefore, the muscle with the highest strain

during all trials of each person was identiﬁed. This

muscles represents 100 %. The values of the remain-

ing muscles of the different trials were presented in

relation to the 100 %. This data was collected for all

of the 13 subjects. Finally, the whole data was aver-

aged and visualized in ﬁgure 2.

The investigation of the EMG data had revealed,

that it is useful to distinguish between the process of

the compensation of the instability caused by the ex-

erciser and the process of the maintenance of the body

stability. The ﬁrst part is mainly realized by the mus-

culature of the lower legs. However, the maintenance

of the body balance is linked to the stability of the

knee joints. Due to that, the musculature of the thigh

has to produce the major part of the performance. Ac-

cordingly, the patterns of the M. biceps femoris and

the M. vastus lateralis show for all of the three exer-

cisers a similar intensity.

On the basis of this approach, the evaluation of

the musculature of the M. tibialis anterior and the

M. soleus shows individual results for the equip-

ment. The instability caused by the different Boards

is mainly compensated by the ankle sprains. Conse-

quently, a higher intensity of the instability induces a

higher muscular activity. One assumption in the lit-

erature is, that an exerciser with a multidimensional

instability requires a higher muscles strain in compar-

ison to an exerciser with an one-dimensional insta-

bility (Grifka and Dullien, 2008). This assumption

can not be validated by the measured EMG activity in

this study. Both types of the one-dimensional Rocker

icSPORTS2014-InternationalCongressonSportSciencesResearchandTechnologySupport

Board have produced a higher strain in the muscula-

ture of the lower legs. Consequently, in this case the

Rocker Board has a comparatively higher degree of

difﬁculty.

Figure 2: Comparison: Exerciser.

3.2 Setup 2

3.2.1 Intervention: Right/ Left

One type of intervention is to advise the patient to fo-

cus on one special body side. During the second phase

the physiotherapist instructed the subjects to focus on

their right body side. Immediately afterwards, in the

third phase the task was to burden especially the mus-

culature of the left body side.

The accumulated EMG activity was computed for

the duration of both phases separately. The data were

normalized. The muscle with the highest strain rep-

resents the 100 %. The remaining muscles were set

in relation to the 100 %. The data of all test persons

of setup two were collected and summarized in the

boxplots of ﬁgure 3.

The upper graphic of ﬁgure 3 shows the interven-

tion data for the M. peroneus longus. The visualiza-

tion ﬁgures out, that the realization of the right inter-

vention is made in a more correct way. Accordingly,

the range of the boxplots is smaller during the right

intervention. Notwithstanding the left muscle is more

active during the left phase. In contrast, the results

of the M. tibialis anterior show a different outcome.

During both phases the right muscle is the more ac-

tive one. Nonetheless, the median of the left mus-

cle raises during the phase of the left intervention. In

contrast, the right one is nearly the same. The most

successful realization of the requirement to focus on

one body side was documented for the M. vastus lat-

eralis, lower graphic in ﬁgure 3. The measured ac-

tivity during each phase corresponds to the expected

ratio of the body sides. There is a clear difference of

the amount of activation of the left and right muscles

during the individual phases.

Figure 3: Intervention Right-Left.

3.2.2 Intervention: Physiotherapist

The ﬁfth phase of the measurement on the Rocker

Board comprised the intervention of the physiother-

apist. Figure 4 represents the muscular activity of one

test person during this phase.

The physiotherapist analyzed the behavior of the

test person on the exerciser and gave immediate in-

structions for a better behavior. The current ﬁgure

documents six instructions, red lines in ﬁgure 4. The

ﬁrst and the second intervention addressed the posi-

tion of the pelvis. The physiotherapist advised the

test person to rotate the left part of the pelvis into the

front. The expected reaction in the muscular activity

was an increase in the intensity of the EMG values

of the left body side. Except the M. tibialis anterior,

there were no changes in the EMG values of the left

body side recorded. Especially after the repetition of

the instruction, the left M. tibialis anterior increased

its activity. The same effects were documented for

the right side of the muscle. Within the third inter-

vention the order was to lean the torso to the right.

Again, the physiotherapists expects more activity in

the EMG values of the right body side. Both mus-

cles of the lower leg showed a slight activation. In

contrast, the activity of the right M. vastus lateralis

stayed the same. Again, the documented EMG values

only meet in a limited way the exceptions of the phys-

iotherapist. The instruction to improve the ﬂexion of

the knee joints was given during the fourth interven-

tion. The realization of this task could only be occu-

pied by the increased activity of the right M. vastus

lateralis and the right M. tibialis anterior. Both mus-

cles had fulﬁlled the expectations. In contrast, this

result was not achieved by the left side. The physio-

therapist addressed this instruction again for the left

knee joint during the ﬁfth intervention. Only the left

M. tibialis anterior showed higher voltage values. The

participation of the left M. vastus lateralis is needed

for a correct ﬂexion of the knee joint. Unexpectedly,

the right muscle side produced higher values. In con-

AnalyzesofInfluencingFactorstotheSensorimotorTraining-TechnicalSupportSystemsinthePhysiotherapy

trast to the previous interventions, the last one was an

improvement of the performance. The physiothera-

pist advised the test person to burden both body sides

equally. The expectation was the compensation of the

muscular activity. Although, the left M. tibialis an-

terior produced higher voltage values, the right body

side was still the more dominant one. Referring to the

EMG values, the test person was not able to fulﬁll the

requirement completely.

Figure 4: Intervention Physiotherapist.

3.3 All Subjects

3.3.1 Laterality

To determine whether there is a correlation between

the laterality and the dominance of one body side in

the muscular activity or not, different tests for the

identiﬁcation of the laterality were made.

The six tests for the handedness and the ten test

for the dominance of the feet were analyzed sepa-

rately. The ﬁrst step comprised of the counting of

the frequency, how often one body side was used

within the test. The next step included the conversa-

tion of the frequency values from absolute values into

percentage-values. Immediately afterwards, it was

determined which body side was the dominant one.

Within the actual investigation the concrete body side

only plays a minor role. Only the percentage values

of the dominant side of the hands and the feet were of

interest. The difference between the two values was

calculated. The results were visualized for each of

the 32 (setup 1 and setup 2) test persons in the illus-

tration of ﬁgure 5. The beneﬁt of this calculation is

to develop assumptions regarding the relationship of

the dominance of the hands and the dominance of the

feet.

A detailed look at the concrete dominance values

shows that only ﬁve out of 32 subjects achieved 100 %

while determining the intensity of the dominance of

one hand. In contrast, no test person achieved 100 %

regarding the dominance of one feet. This observa-

tion is supported by ﬁgure 5. Only 31.25% of the test

persons have a more dominant body side regarding

the feet than the hands (Test persons achieve a nega-

tive difference value). Additionally, it is obvious that

there is a great variance in the plotted values. Hence,

the intensity of the dominance of the feet is not di-

rectly linked to the intensity of the dominance of the

hands. Furthermore, it is not possible to make general

assumptions on how large the deviation of these two

values might be for an individual subject.

The overall analyzes of the laterality data ﬁgures

out, that by the majority of people the handedness

tend to be more pronounced than the dominance of

the lower extremities.

Figure 5: Laterality.

3.3.2 Subjective Impressions

All test persons had to comment the intensity of strain

which they felt during the training. They had to

choose between zero (nothing) and ten (very much

exhausting). Depending on her point of view the su-

pervisor also had to rate each training and had to doc-

ument the level of strain for each test person indepen-

dently. To evaluate if there is a correlation between

the subjective impressions of the test persons and the

impressions of the physiotherapist both ratings were

paired and were plotted dependency on each other in

graphic 6.

The investigation of the correlation revealed a co-

variance greater than two. Consequently, a positive

correlation between the ranking of the test person and

the ranking of the physiotherapist exists. The major

outcome of ﬁgure 6 is, that there is rarely an accor-

dance regarding the impressions of the physiothera-

pist and the impressions of the test persons. Only in

9.7 % of the training sessions an agreement was doc-

umented. In contrast, in 25.8 % of the sessions the

icSPORTS2014-InternationalCongressonSportSciencesResearchandTechnologySupport

test persons thought the training was more exhaust-

ing than the physiotherapist documented. In 64.5 %

of the cases the test persons ranking of the strain was

lower than the ranking of the strain of the experienced

physiotherapist. Figure 6 visualizes the partially great

differences in the ranking of the intensity of the strain

during the trails. In one case, the physiotherapists im-

pression was a ranking of ten. In contrast, the test

person only documents a ranking of four.

Figure 6: Subjective Impressions.

3.3.3 Acceptance

In addition to the survey of the intensity of the strain,

the test persons had to answer a questionnaire regard-

ing the acceptance of the measurement units. The re-

sults of this survey where documented in ﬁgure 7.

The ﬁrst question discusses, if there are any re-

strictions during the execution of the trail when wear-

ing the sensors. Three out of 29 test persons docu-

mented a restriction. The problem was the ﬁxing of

the sensors. To avoid a drop of the sensors, they were

ﬁxed with tape. In some cases the tape was too tight.

A similar result was achieved by the question, if

the sensors caused an uncomfortable feeling. The

tight ﬁxation was a problem. Furthermore, the place-

ment of the sensors at the M. vastus lateralis and the

M. biceps femoris in setup one was slightly difﬁcult.

For some test persons it caused some problems to sit

on a chair during the pauses in a comfortable way.

Only one out of 32 test persons would not use the

measurement units again. Unfortunately, the person

does not document a reason for this decision. One

explanation for the fact, that nearly all persons agree

to the question, might be, that they see the beneﬁt of

the sensors.

100 % of the test persons have answered the ques-

tion, if they see a beneﬁt in the usage of the sensors,

with yes. Additionally, there was the possibility to

give a more detailed answer. Most of them recog-

nized the beneﬁt in the ﬁelds of documentation of the

training and the opportunity to have a detailed

look at the behavior of the muscles.

One question addressed the usefulness of the

transferability of the technology into physiotherapists

everyday life. More than 80 % gave a positive feed-

back. A few test persons mentioned that it would be

more useful for training and rehabilitation of patients,

who were competitive athletes.

The greatest deﬁcit of the current technology is

that the application of the sensors took so much time.

Therefore, the transfer of the technology into every-

day life is difﬁcult.

Figure 7: Acceptance of the Sensors.

4 DISCUSSION

The current study reveals different ﬁndings. The ﬁrst

setup points out, that each Board requires different

skills of the test persons. Additionally, the assump-

tion of the literature, that exerciser with a multidimen-

sional instability cause a higher muscle strain than the

one with an one-dimensional instability (Grifka and

Dullien, 2008), could not be proven. Furthermore the

distribution of the muscle activity of the individual

muscles of the lower extremities ﬁgures out, that the

body stability is maintained by the musculature of the

upper legs. In contrast, the muscles of the lower legs

try to compensate the instability caused by the exer-

ciser.

This ﬁnding is also supported by the outcome of

the investigation of the muscle behavior when the test

persons were asked to focus on a special body side.

The analyzes shows the clearest realization within the

EMG values of the M. vastus lateralis. This is associ-

ated to the procedure, that in most cases the test per-

sons move their body’s center. The M. vastus lateralis

is one of the muscles, which participates especially in

the maintenance of the body stability. Consequently,

the shift of the body’s center has effects to the mus-

cular activity. The muscles of the lower legs mainly

AnalyzesofInfluencingFactorstotheSensorimotorTraining-TechnicalSupportSystemsinthePhysiotherapy

participate in the process of the compensation of the

instability of the exerciser. The task to focus to one

body side is subordinated.

The detailed exemplary investigation of the phys-

iotherapist reveals, that the subjects were able to un-

derstand instructions. However, sometimes their way

to fulﬁll the tasks differs from the expectations of the

physiotherapist. Unfortunately, it is not always pos-

sible to identify these differences without any tech-

nical support. An additional argument for the usage

of technical support systems is given by the varying

ratings regarding the difﬁculty of the exercises.

The last major ﬁnding of the investigation is the

acceptance of the sensors. Although a few improve-

ments of the technical arrangement should be made,

the test persons were open-minded and would use the

sensors again.

5 CONCLUSION

The investigation of the different questions regarding

the sensorimotor training ﬁgures out, that technical

support systems are a good opportunity to improve

the quality of the training. It is not possible to make

general assumptions regarding the effects of the indi-

vidual exerciser. Each patient has its own character-

istics and procedures to handle the given challenges.

Therefore, it is necessary to analyze each test per-

son, depending on his behavior, one exerciser could

be chosen.

Next, the laterality of the test persons should be

analyzed. The dominance of one body side is de-

pending on the socialization and on other factors like

sports. If the subject prefers bilaterally sports the

dominance will be less signiﬁcant or its behavior is

correlating with situations which were typical for the

sport. This laterality inﬂuences the behavior on the

exerciser in general and the realization of special tasks

given by he physiotherapists. Unfortunately, it is not

always possible to give an objective evaluation of the

quality of the execution of the patient. Aggravating

this situation, the impressions of the patients does

not always correlate with the physiotherapists impres-

sions or the measured muscle activity.

To sum up, there are many factors which inﬂuence

the quality of the sensorimotor training. To improve

the efﬁciency and to objectively document the effec-

tiveness of the training the usage of technical support

systems would be a beneﬁt.

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