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+sense: sensory biofeedback devices for Parkinson’s disease

Helena R. Gonçalves (PhD Student)

Our motivation

Parkinson’s disease is the second most common worldwide disease, for which there is still no cure. Patients present slowness and lower automaticity gait, with shorter steps, episodes of freezing, feeling their feet completely glued to the ground during long seconds and consequents major complications at balance level. With disease progression, these motor symptoms became immune to the traditional levodopa-based treatments, which boosted us to develop technological-based solutions to overcome the pharmacological barrier.

Proposed solution

+sense (plusSense) proposes front-end personalized high-tech solutions based on biofeedback devices which relies on acquisition, interpretation, and feedback of patients’ sensorimotor information. It is expected to increase the somatosensory awareness, promoting the bypass of nerve messages that may be at the origin of motor symptoms in PD.

Further, it envisions to provide digital biomarkers to complement clinic PD management combining wearable sensory information with artificial intelligence algorithms, following a user-centered approach.

As main goal, it is expected to improve patients’ quality of lite, being less dependence on third parties by promoting their motor autonomy.

There are four +sense intervention areas:

(1) +sBiofeedback was the first sub-system developed in this project.  It comprises an instrumented waistband, adaptable to different users’ physiognomies. The waistband was instrumented with sensors, as inertial units and cameras to capture users’ motion and context. From real-time processing of the acquired sensory data, it is returned vibrotactile and visual sensory information through actuators integrated in the instrumented waistband.  Personalized biofeedback strategies are implemented based on the PD disease degree, making the device suitable for moderate, mild and severe stages of patients’ mobility. The assistive and rehabilitative medical device helps patients to maintain a regular, fluid gait cadence, avoiding episodes of freezing and promoting the management of balance. Patients feels more comfortable walking and more autonomous to perform their daily tasks.

(2) +sMotion module is responsible to acquire and monitor lower trunk inertial signal, provide real-time gait segmentation, post-processing gait analysis and gait-associated metrics estimation. This module is linked with +sBiofeedback, since also comprises the same instrumented waistband. Thus, +sMotion includes a wearable gait analysis LAB which is a part of the instrumented waistband. Through the miniaturized inertial sensors integrated into the waistband, several motor metrics are estimated, acting as an indicator of patients’ motor status. +sMotion ensures long-term monitoring in non-controlled sets, as quotidian environments. By providing this information to clinicians, it is delivered objective, reliable and continuous assessments about their patients’ motor function. During routine consultations, it is possible to complement the information indicated by patients about their condition and the observed by neurologists.

(3) +sC-support modules aims to serve as digital biomarker on PD management. Applying +sMotion outcomes as data input of AI-based algorithms enabled to correlate motor metrics with clinical scales which allowed to assess disease progression, motor status and quality of life levels. +SC-support includes a user-friendly application, +S APP, for neurologists use during routine consultations. The AI-based APP suggests the patients’ disease level based on the + SMotion measurements, working as a complement diagnosis tools, aiming to help clinicians in a more personalized treatment prescription. Also, as a clinical decision support tool during consultations, +sC-support includes a software based on augmented reality glasses, worn by clinicians, to provide an assessment of the patients’ postural alignment.


(4) +sImmersive. This module started by using mixed reality APP as a complementary tool of motor monitoring and training, using Hololens 2.0. The virtual environment allows to immerse patient on home scenarios and daily tasks aiming to achieve a more feasible assessing and rehabilitation.

Further, by combining patients’ immersion on virtual environments through augmented reality glasses with brain activity decoding tools via EEG, + sImmersive is a new front-end tool that enables patients’ motor assessment and training with +sense technologies.

Application Scenarios

+sense tech solutions are specially designed to be used by patients with PD and related physicians. +sBiofeedback, +sMotion and +sImmerssive systems are developed to be used in home scenarios, hospitalsrehabilitation centerslong-term care units, and nursing homes. +sC-support was also designed to be used in hospitals, rehabilitation centers, long-term care units, and nursing homes, but to be used by physicians, nurses, researchers and health care-related persons.

Alought +sense solutions have been developed to promote consequent quality of life in PD, the application of each +sense module can be extended to other applications. Thinking out of the box:

+sBiofeedback can be customized to provide the sensory cueing biofeedback to other neurological diseases or target population.

+sMotion besides to provide lower trunk Lower trunk kinematic data, estimates gait & postural parameters metrics, recognize human activities recognition in several settings, which can be applied in sports and industry.

+sC-support module can be extended to  other scales, to measure levels of stress or even detect constraints in motion during work.

On + sImmersive module, other virtual scenarios or tasks can be used to train users from different domains, e.g. in sports.


Our Team

+sense team follows a holistic approach with the end-users broadly included in the development and research loop, through a closed partnership with clinicians from the neurology service of Braga hospital, via Academic Clinical Center. We are a multidisciplinary team, who intend to put engineering at the service of health. Currently, +sense team involves a PhD student and six MSc students in several areas of Engineering:

  • Helena R. Gonçalves –PhD Student in Doctoral Program of Biomedical Engineering
  • André Branquinho – MSc Student in Biomedical Engineering
  • Beatriz Miranda – MSc Student in Biomedical Engineering
  • Luís Abreu – MSc Student in Informatics Engineering
  • Marta Cardoso – MSc Student in Biomedical Engineering
  • Pedro Pinheiro – MSc Student in Informatics Engineering
  • MD Margarida Rodrigues – Neurologist of Braga Hospital


+sense team work was recognized by an honorable mention and the 2nd prize on 17th edition of Technological Innovation Award Engineer Jaime Filipe issued by Instituto Nacional de Reabilitação.

Further, a patent request was submitted on National Instute of Patents with reference PT PAT-110910U.

Our Partners

+sense has the support of a medical team from the Clinical Academic Center of Braga (2CA-Braga, a partnership between U.Minho and Hospital of Braga), which allows us to test our solutions with real patients who need a walking aid.


Our Publications

Journal Papers:

  • H. R. Gonçalves, A.M. Rodrigues and C.P. Santos, “Gait monitoring system for patients with Parkinson’s disease,” Expert Systems with Applications, vol. 185, pp. 115653, 2021,
  • R. Gonçalves, A.M. Rodrigues and C.P. Santos, “Vibrotactile biofeedback devices in Parkinson’s disease: a narrative review,” Medical & Biological Engineering, vol. 59, pp. 1185–1199, 2021.
  • Helena R Gonçalves Rui Moreira, Ana Rodrigues and Cristina P Santos, “Finding Parameters around the Abdomen for a Vibrotactile System Healthy and Patients with Parkinson’s Disease”, J. Med. Syst (2018), 42:232.

Conference Papers:

  • Branquinho, H. R. Gonçalves, J. F. Pinto, A. M. Rodrigues and C. P. Santos, “Wearable gait Analysis LAB as a biomarker of Parkinson’s disease motor stages and Quality of life: a preliminary study,” 2021 IEEE International Conference on Autonomous Robot Systems and Competitions (ICARSC), 2021, pp. 234-239.
  • Rui Moreira, Helena R Gonçalves Ana Rodrigues and Cristina P Santos, “The Potential of Visual Cues to Overcome Freezing of Gait in Parkinson’s Disease”, IEEE 6th Portuguese Meeting on Bioengineering (ENBENG), 2019, Lisbon, Portugal.
  • Helena R. Gonçalves, Rui Moreira, Ana Rodrigues, Graça Minas, Luís P. Reis and Cristina P Santos, “Real time Tool for Human Gait Detection from Lower Trunk Acceleration”, 20th International Conference on Climbing and Walking Robots and Support Technologies for Mobile Machines (WORLDCIST 2018), Naples, Italy.
  • Helena R Gonçalves, Ana Rodrigues, Graça Minas and Cristina P Santos, “Functional Feedback Vibrotactile System for Patients with Parkinson’s Disease Freezing of Gait”, Proceedings Book of IEEE 5th Portuguese Meeting on Bioengineering (ENBENG), 2017, Coimbra, Portugal.
  • Helena R Gonçalves, Ana Rodrigues, Graça Minas and Cristina P Santos, “Literature Review of Vibrotactile Systems Addressing Freezing of Gait in Parkinsonians”, IEEE International Conference on Autonomous Robot Systems and Competitions (ICARSC 2017), Coimbra, Portugal.
  • Helena R. Gonçalves, Ana Rodrigues, Graça Minas and Cristina P Santos, “Neurofeedback Vibrotactile System for Parkinsonians Overcome Freezing of Gait First Steps in Detecting the most Perceived Frequency”, 20th International Conference on Climbing and Walking Robots and Support Technologies for Mobile Machines (CLAWAR 2017), Porto, Portugal.

Oral presentations:

  • Helena Gonçalves, Ana Rodrigues, Cristina Santos and Rui Moreira, “Sistemas de biofeedback vibrotátil e visual orientados às condições motoras”, Congresso da Sociedade Portuguesa das Doenças do Movimento 2018 – Genética das Doenças do Movimento. Curia, 2-3/03/2018.
  • Helena R. Gonçalves and Cristina P. Santos, “Cinta de Biofeedback Vibrotátil: uma contribuição para Pacientes com Doença de Parkinson” in 2018 Workshop Robótica na Medicina (Serviço de Saúde Nacional)
  • Helena Gonçalves, Rui Moreira, Cristina Santos and Margarida Rodrigues, “Cinta de Biofeedback Vibrotátil: utilidade na Doença de Parkinson”, 1º Congresso CNS – Será que a tecnologia pode tratar a doença Parkinson? Torres Vedras, 07/04/2018.
  • Helena Gonçalves, Rui Moreira, Cristina Santos and Margarida Rodrigues, “Cinta de Biofeedback Vibrotátil para doentes com a DPI”, Congresso da Sociedade Portuguesa das Doenças do Movimento 2018 – Genética das Doenças do Movimento. Curia, 2-3/03/2018.