Effects of a Personalized Exercise Rehabilitation Device on Dynamic Postural Balance for Scoliotic Patients: A Feasibility Study
Round 1
Reviewer 1 Report
The authors have reported a very good description of the "personalized exercise rehabilitation device". Based on a Physiotherapy technique widely used in clinical and research, they have developed a very interesting and highly useful device for clinical use. This type of tool, without replacing the physiotherapy treatment that has been shown to be effective, could complement said treatment, providing extra feedback to the patient and physiotherapist on the execution of the exercises. However, it is important to clarify how the "personalization" of the exercises was carried out, as well as the role of the physiotherapist in programming, guiding and monitoring these exercises.
I leave you some observations so that, as far as possible, they are taken into account. Congratulations for the work done.
Page 1. Line 4. It is recommended to add at the end of the title "A feasibility study".
Page 1. Line 18. “All subjects”. Please describe the number of participants.
Page 1. Line 27. The MeSH term is "Postural Balance". It is advisable to delete "dinamic". Could also include "Exercise Therapy". It is recommended to include the term "Physical Therapy Modalities" as MeSH term, since the professionals in charge of using the device with patients will be physiotherapists. Thus, the article will have a greater impact on these professionals.
Page 2. Line 46. The article does not speak of "exercise" in general, this term should be replaced by "physiotherapeutic scoliosis-specific exercises".
Page 2. Lines 47-48. Please clarify this statement. When the curve is less than 25 degrees, physical therapy and observation exercises without brazing would be indicated, but these exercises would also be indicated when the curve is greater in addition to brazing.
Page 2. Line 49. [5]. Please also include the reference 4 here.
Page 2. Line 54. “…types of exercise…”. It is recommended to replace by "physiotherapy techniques" and include the reference:
Berdishevsky H, Lebel VA, Bettany-Saltikov J, Rigo M, Lebel A, Hennes A, Romano M, Białek M, M'hango A, Betts T, de Mauroy JC, Durmala J. Physiotherapy scoliosis-specific exercises - a comprehensive review of seven major schools. Scoliosis Spinal Disord. 2016;11:20. doi: 10.1186/s13013-016-0076-9.
Page 3. Line 110. “…by conscious self-lengthening”. In this conscious lengthening, would it be possible for the patient to make undesirable compensations? Wouldn't the feedback and advice from the physiotherapist be necessary during the exercise?
For example, strengthening by isolated contraction of certain core stability muscles could prevent such compensations.
In this sense, the electromyographic feedback that includes the device and the choice of muscles that you have made is very interesting, such as multifidus, detailed later. In addition, it would be interesting to take into account other deep stabilizing muscles such as the transverse abdominis, which are essential in postural control. These parameters could be controlled by the physiotherapist.
Page 5. Line 167. “Electromyographyc (EMG) activity. Please specify that it is a Surface Electromyography (sEMG) device.
Page 5. Lines 172-173. Please specify if the SENIAM protocol was followed in the placement of the EMG sensors.
Page 5. Line 178. “presence of a doctor”. It would be interesting to include in this decision the physiotherapist who follows the rehabilitation treatment of the patient. Have you considered it?
Page 6. Line 195. “(MVC”). Please control the entire text the use of abbreviations. If they are only used once, as in this case, since the table abbreviations would be independent, it is not necessary to include them.
Page 6. Line 197. “concave side (CCS). It is necessary to associate abbreviations with the term the first time they are used in the text and to name them as abbreviations the rest of the time. Control the use of abbreviations throughout the text.
Page 6. Line 199. LPPT. It would be important to test whether the posterior pelvic tilt movement in the sagittal plane was performed actively by the abdominal muscles or passively.
Page 6. Line 209. Table 209. Table 3. I recommend including table 3 just after this sentence.
Page 7. Line 236. Notes. It is necessary to include the full terms referred to by the abbreviations LPT, LAPT, LPPT, CVS, CCS. To save space, an abbreviation for "difference in the inclination angle" can be used. For example, "(dia)" in Notes.
Page 8. Line 292. Please include larger boxes that include the color of each of the evaluation moments in order to better differentiate them.
Page8. Line 294. “… in the inclination angle…”. replace "inclination angles" with "muscle activities"?
Page 8. Line 311. “It means…”. I recommend replacing "means" with "could be related".
Page 8. Line 314. “since our bodies are connected organically”. Please could you replace the expression "since our bodies are connected organically" by a more explanatory one and include any reference that justifies it?
Page 9. Line 321. "... and muscle activity". In my opinion, the difficulty lies in the need to control so many parameters; thus, when the patient tries to correct one of them, he can compensate elsewhere. Please explain this sentence better as “muscle activity” in general does not cause this.
Page 9. Line 347. It would be important to explain this statement through references, why is this excess activity negative? Muscle imbalance? Increased energy expenditure?
Page 9. Line 348. “[31],[33]”. Please include both references within the same square brackets.
Page 9. Lines 348-351. Please, include reference.
Page 9. Line 352. “…a compensation mechanism…”. Would this compensatory mechanism be voluntary or involuntary?
Page 9. Line 353. “[34]”. Please, could you add a more updated reference?
Page 9. Line 354. In therapeutic stretching, some parameters such as breathing are essential, requiring the supervision of the physiotherapist. Please clarify if this supervision is carried out in the protocol.
Page 10. Lines 371-374. Very good deduction. To stabilize this eccentric work, the activation of the abdominal muscles is essential. Was this taken into account?
Page 10. Lines 378-379. Could it be because of weak abdominal muscles?
Page 10. Lines 382-384. Very good result the greater activation of multifidus. It could also be clarified that the excess of electromyographic activity of the spinal erectors is sometimes a compensation for the incorrect activation of multifidus.
Page 10. Line 393. “…weak side”. Please clarify convex or concave.
Author Response
Response to Reviewer 1 Comments
We thank you for your time and consideration on our submission (electronics-1006970). Below we address the reviewer comments and list of changes that we made to our manuscript according to the reports. The original reviewer comments are provided in black color, whereas our answers are given in red. The appropriate changes made in the revised manuscript are highlighted.
Comments
The authors have reported a very good description of the "personalized exercise rehabilitation device". Based on a Physiotherapy technique widely used in clinical and research, they have developed a very interesting and highly useful device for clinical use. This type of tool, without replacing the physiotherapy treatment that has been shown to be effective, could complement said treatment, providing extra feedback to the patient and physiotherapist on the execution of the exercises. However, it is important to clarify how the "personalization" of the exercises was carried out, as well as the role of the physiotherapist in programming, guiding and monitoring these exercises.
I leave you some observations so that, as far as possible, they are taken into account. Congratulations for the work done.
Point 1: Page 1. Line 4. It is recommended to add at the end of the title "A feasibility study".
Response 1: Thank you for your suggestion. As your recommendation, we have reflected this by adding “a feasibility study” at the end of the title (Page. 1. Line. 4.).
Point 2: Page 1. Line 18. “All subjects”. Please describe the number of participants.
Response 2: Thank you for your suggestion. We have reflected this by describing the number of participants in this study (Page. 1. Line. 18.).
Point 3: Page 1. Line 27. The MeSH term is "Postural Balance". It is advisable to delete "dinamic". Could also include "Exercise Therapy". It is recommended to include the term "Physical Therapy Modalities" as MeSH term, since the professionals in charge of using the device with patients will be physiotherapists. Thus, the article will have a greater impact on these professionals.
Response 3: Thank you for your suggestion. As your suggestion, we have reflected this by including the term “postural balance”, “exercise therapy”, and “physical therapy” (Page. 1. Line. 27-28.).
Point 4: Page 2. Line 46. The article does not speak of "exercise" in general, this term should be replaced by "physiotherapeutic scoliosis-specific exercises".
Response 4: Thank you for your suggestion. As your suggestion, we have reflected this by replacing the term “exercise” with “physiotherapeutic scoliosis-specific exercises” (Page. 2 Line. 47,48.).
Point 5: Page 2. Lines 47-48. Please clarify this statement. When the curve is less than 25 degrees, physical therapy and observation exercises without brazing would be indicated, but these exercises would also be indicated when the curve is greater in addition to brazing.
Response 5: Thank you for your suggestion. As your suggestion, we have clarified this by revising the manuscript as follows: (Page. 1. Line. 48-51.).
(1) Before: Typically, observation and exercise therapy is recommended when curves less than 25 degrees. Observation measures the curve on a regular schedule and bases treatment decisions on the rate of curvature progression [5]. If the spine curvature is greater than 25 degrees, it should be treated with bracing.
(2) After: Typically, observation and physiotherapeutic scoliosis-specific exercise therapy without bracing is recommended when curves less than 25 degrees. Observation measures the curve on a regular schedule and bases treatment decisions on the rate of curvature progression [5]. If the spine curvature is greater than 25 degrees, it should be treated with bracing in addition to these exercises.
Point 6: Page 2. Line 49. [5]. Please also include the reference 4 here.
Response 6: Thank you for your suggestion. As your suggestion, we have reflected this by including the reference [4] (Page. 2. Line 50.).
Point 7: Page 2. Line 54. “…types of exercise…”. It is recommended to replace by "physiotherapy techniques" and include the reference:
Response 7: Thank you for your suggestion. As your recommendation, we have reflected this by replacing “…types of exercise” as “physiotherapy techniques” and including the reference (Page. 2. Line 55.).
Point 8: Page 3. Line 110. “…by conscious self-lengthening”. In this conscious lengthening, would it be possible for the patient to make undesirable compensations? Wouldn't the feedback and advice from the physiotherapist be necessary during the exercise?
For example, strengthening by isolated contraction of certain core stability muscles could prevent such compensations.
In this sense, the electromyographic feedback that includes the device and the choice of muscles that you have made is very interesting, such as multifidus, detailed later. In addition, it would be interesting to take into account other deep stabilizing muscles such as the transverse abdominis, which are essential in postural control. These parameters could be controlled by the physiotherapist.
Response 8: We agree that an appropriate feedback and advice from the physiotherapist is necessary to avoid undesirable compensations. Therefore, the personalized exercise plans for the individuals were suggested according to the curve types and directions in the presence of a doctor. And, to avoid undesirable compensations, all patients were given enough time to understand their exercise sequence, intensity, and time before starting an exercise program.
Point 9: Page 5. Line 167. “Electromyographyc (EMG) activity. Please specify that it is a Surface Electromyography (sEMG) device.
Response 9: Thank you for your suggestion. As your suggestion, we have reflected this by revising “Surface electromyographic (sEMG)” (Page. 5. Line. 176.).
Point 10: Page 5. Lines 172-173. Please specify if the SENIAM protocol was followed in the placement of the EMG sensors.
Response 10: Thank you for your suggestion. The placement of the EMG sensors were referenced in previous studies. To clarify this, the references were included (Page. 6. Line. 184.).
Point 11: Page 5. Line 178. “presence of a doctor”. It would be interesting to include in this decision the physiotherapist who follows the rehabilitation treatment of the patient. Have you considered it?
Response 11: We agree with your assessment. The personalized exercise plans were suggested by considering the decision of doctor in the department of rehabilitation medicine. As your suggestion, in the future research, the decision from the physiotherapist who follows the rehabilitation treatment of the patient will be also included.
Point 12: Page 6. Line 195. “(MVC”). Please control the entire text the use of abbreviations. If they are only used once, as in this case, since the table abbreviations would be independent, it is not necessary to include them.
Response 12: Thank you for your suggestion. We agree with your assessment. In the case of “MVC”, since it was only used once, the abbreviation was not included in this manuscript (Page. 6. Line. 206.).
Point 13: Page 6. Line 197. “concave side (CCS). It is necessary to associate abbreviations with the term the first time they are used in the text and to name them as abbreviations the rest of the time. Control the use of abbreviations throughout the text.
Response 13: Thank you for your suggestion. We agree with your assessment. As your suggestion, we have reflected this by controlling the use of abbreviations throughout the text (Page. 6. Line. 219,220. / Page. 7. Line. 231,234,235,237,238,241,244,245,248,251,252,256,258,259,264,266,267,269,271,272,273. / Page. 8. Line. 274,277,281,282,283,286,288,291,295,297,303.).
Point 14: Page 6. Line 199. LPPT. It would be important to test whether the posterior pelvic tilt movement in the sagittal plane was performed actively by the abdominal muscles or passively.
Response 14: We agree with your assessment. Therefore, before starting an exercise program, to increase the effectiveness of exercise, all subjects were given enough time to understand how to perform the posterior pelvic tilt movement in the sagittal plane using the abdominal muscles actively. In the future research, it will be tested whether the posterior pelvic tilt movement in the sagittal plane is performed actively by the abdominal muscles or passively using sEMG signals.
Point 15: Page 6. Line 209. Table 209. Table 3. I recommend including table 3 just after this sentence.
Response 15: Thank you for your suggestion. As your recommendation, we have reflected this by including table 3 just after this sentence (Page. 6. Line. 219.).
Point 16: Page 7. Line 236. Notes. It is necessary to include the full terms referred to by the abbreviations LPT, LAPT, LPPT, CVS, CCS. To save space, an abbreviation for "difference in the inclination angle" can be used. For example, "(dia)" in Notes.
Response 16: Thank you for your suggestion. As your recommendation, we have reflected this by including the full terms referred to by the abbreviations LPT, LAPT, LPPT, CVS, CCS (Page. 7. Line. 222-223.).
Point 17: Page 8. Line 292. Please include larger boxes that include the color of each of the evaluation moments in order to better differentiate them.
Response 17: Thank you for your suggestion. As your suggestion, we have reflected this by including larger boxes that include the color of each of the evaluation moments in order to better differentiate them (Page. 8. Line. 302.).
Point 18: Page8. Line 294. “… in the inclination angle…”. replace "inclination angles" with "muscle activities"?
Response 18: Thank you for your suggestion. As your suggestion, we have reflected this by replacing “muscle activities” (Page. 8. Line. 303.).
Point 19: Page 8. Line 311. “It means…”. I recommend replacing "means" with "could be related".
Response 19: Thank you for your suggestion. As your recommendation, we have reflected this by replacing “could be related” (Page. 9. Line. 321.).
Point 20: Page 8. Line 314. “since our bodies are connected organically”. Please could you replace the expression "since our bodies are connected organically" by a more explanatory one and include any reference that justifies it?
Response 20: Thank you for your suggestion. As your suggestion, we have reflected this by replacing the expression with a more descriptive expression and including reference (Page. 9. Line. 324-325 / Page. 9. Line. 327.).
Point 21: Page 9. Line 321. "... and muscle activity". In my opinion, the difficulty lies in the need to control so many parameters; thus, when the patient tries to correct one of them, he can compensate elsewhere. Please explain this sentence better as “muscle activity” in general does not cause this.
Response 21: Thank you for your suggestion. As your suggestion, we have reflected this by replacing the sentence with a more descriptive expression and including reference (Page. 9. Line. 332-333.).
Point 22: Page 9. Line 347. It would be important to explain this statement through references, why is this excess activity negative? Muscle imbalance? Increased energy expenditure?
Response 22: Thank you for your suggestion. As your suggestion, we have reflected this by explaining why this excess activity negative thorough references (Page. 10. Line. 358-360.).
Point 23: Page 9. Line 348. “[31],[33]”. Please include both references within the same square brackets.
Response 23: Thank you for your suggestion. As your suggestion, we have reflected this by including both references within the same square brackets (Page. 10. Line. 360.).
Point 24: Page 9. Lines 348-351. Please, include reference.
Response 24: Thank you for your suggestion. As your suggestion, we have reflected this by including reference (Page. 10. Line. 364.).
Point 25: Page 9. Line 352. “…a compensation mechanism…”. Would this compensatory mechanism be voluntary or involuntary?
Response 25: That is an interesting perspective. It is thought that this compensatory mechanism is a voluntary reaction of our body.
Point 26: Page 9. Line 353. “[34]”. Please, could you add a more updated reference?
Response 26: Thank you for your suggestion. As your suggestion, we have reflected this by adding a more updated reference (Page. 10. Line. 365.).
Point 27: Page 9. Line 354. In therapeutic stretching, some parameters such as breathing are essential, requiring the supervision of the physiotherapist. Please clarify if this supervision is carried out in the protocol.
Response 27: Thank you for your suggestion. As your suggestion, we have reflected this by replacing the sentence with a more descriptive expression and including references (Page. 5. Line. 155-157.).
Point 28: Page 10. Lines 371-374. Very good deduction. To stabilize this eccentric work, the activation of the abdominal muscles is essential. Was this taken into account?
Response 28: You have raised an important question. Before starting an exercise program, to stabilize this eccentric work, all subjects were given enough time to understand how to perform the personalized exercise using the abdominal muscles actively. In the future research, it will be confirmed whether the abdominal muscles are performed actively using sEMG signals.
Point 29: Page 10. Lines 378-379. Could it be because of weak abdominal muscles?
Response 29: You have raised an important question. It is suggested that increased muscle activity in the erector spinae and lumbar multifidus muscle may be related to the weakness of abdominal muscles. It is also consistent with the previous study which suggest the weakness or improper functioning of abdominal muscles can lead to the development of scoliosis.
Point 30: Page 10. Lines 382-384. Very good result the greater activation of multifidus. It could also be clarified that the excess of electromyographic activity of the spinal erectors is sometimes a compensation for the incorrect activation of multifidus.
Response 30: Thank you for your suggestion. As your suggestion, we have reflected this by suggesting the association between excessive erector muscle and incorrect activation of multifidus muscle with meaningful results from this study (Page. 10. Line. 397-400.).
Point 31: Page 10. Line 393. “…weak side”. Please clarify convex or concave.
Response 31: Thank you for your suggestion. As your suggestion, we have reflected this by replacing “concave side” (Page. 11. Line. 409.).
Again, thank you for giving us the opportunity to strengthen our manuscript with your valuable comments and queries. We have worked hard to incorporate your feedback and hope that the revised manuscript is suitable for publication in Electronics.
Sincerely,
Jung-Ja Kim, PhD
Professor
Jeonbuk National University / Division of Biomedical Engineering; Research Center of Healthcare & Welfare Instrument of the Aged
567 Baekjae-daero, Deokjin-gu, Jeonju-si, Jeollabuk-do, Republic of Korea
Tel: 82-63-270-4102
Fax: 82-63-270-2247
Author Response File: 
Author Response.pdf
Reviewer 2 Report
The authors claimed in the abstract that "The aim of this study was to verify whether an exercise program using a personalized exercise rehabilitation device can influence the dynamic postural balance of scoliotic patients".
Indeed the paper describes some specific exercises using a commercial rehabilitation device, in order to investigate the biomechanical characteristics of subjects.
On the basis of these statements it is clear that the paper could be of some interest in a journal on rehabilitation medicine or biomedical engineering, however is out of the topics cover by Electronics, namely electrical circuits, microelectronics and so on.
Thus, I suggest the authors to submit the paper to a proper journal, so that the paper fits the scope of the journal.
Author Response
Response to Reviewer 2 Comments
We thank you for your time and consideration on our submission (electronics-1006970). Below we address the reviewer comments and list of changes that we made to our manuscript according to the reports. The original reviewer comments are provided in black color, whereas our answers are given in red.
Comments
The authors claimed in the abstract that "The aim of this study was to verify whether an exercise program using a personalized exercise rehabilitation device can influence the dynamic postural balance of scoliotic patients".
Indeed the paper describes some specific exercises using a commercial rehabilitation device, in order to investigate the biomechanical characteristics of subjects.
On the basis of these statements it is clear that the paper could be of some interest in a journal on rehabilitation medicine or biomedical engineering, however is out of the topics cover by Electronics, namely electrical circuits, microelectronics and so on.
Thus, I suggest the authors to submit the paper to a proper journal, so that the paper fits the scope of the journal.
Response
The authors agree to the reviewer’s indication because the submitted paper could be of some interest in a journal on rehabilitation medicine or biomedical engineering. However, the submitted paper is for suggesting a new rehabilitation system with electrical components and circuits required to perform the personalized exercise to improve the postural balance of patients with scoliosis. In the treatment of scoliosis, the manual therapy of a conventional physical therapists or the use of simple physical devices has many limitation in providing sophisticated treatments. The authors suggest that a rehabilitation system based on the electronic devices proposed in the paper is not irrelevant to the applied research in electronics because it enables more personalized treatment compared to the existing device.
The authors really would like to expect the reviewer’s positive consideration for the submitted paper.
Sincerely,
Jung-Ja Kim, PhD
Professor
Jeonbuk National University / Division of Biomedical Engineering; Research Center of Healthcare & Welfare Instrument of the Aged
567 Baekjae-daero, Deokjin-gu, Jeonju-si, Jeollabuk-do, Republic of Korea
Tel: 82-63-270-4102
Fax: 82-63-270-2247
Author Response File: Author Response.pdf
Reviewer 3 Report
The rehabilitation robot is one of the frontier directions in the field of advanced manufacturing. As a typical representative of the combination of medical and industrial, it has important scientific and social value. In this paper, authors proposed a rehabilitation device with personalized exercise for scoliotic patients. Different from the traditional rehabilitation devices, the personalized exercise rehabilitation device can provide the most appropriate exercise therapy and positively correct the asymmetrical postural balance patterns. And the experiment results show this strategy is effective and has the potential application in the clinic. However, as a scientific paper, authors should further revise and polish the manuscript before publishing.
The detailed design of the exercise rehabilitation device should be provided to help readers better understand the system. Authors are suggested to give the 2D or 3D design drawing and show the complex structure with section view or enlarging view.
The performance parameters of the personalized exercise rehabilitation device should be provided. Authors only introduce the motion limits of the different parts, while the motion speed and provided force are missing.
“The personalized exercise plans for the individuals were suggested according to the curve types and directions in the presence of a doctor.” This expression is too simple and difficult for reader to understand. Please explain with an example with specific parameters and cite the related references.
Since all patients are treated with personalized exercise plans, it’s difficult to show the superiority of the personalized exercise plans. If possible, authors should also set control group with the universal exercise plans.
The grammar of the writing has some errors throughout the manuscript and need to be checked and corrected. This will improve the work greatly and will make it more readable.
Line 59, “In general, scoliosis patients shows displaced blocks laterally with torsion.” It seems that the verb “shows” does not agree with the subject.
Line 127, “Table 1 shows a personalized exercise methods.”
Line 128, “Patients has to elongate the ….”
Line 143，“Patients has to maintain maximum pelvic tilt posture for 10 seconds …”
Line 144, “The trunk was derotated to …”. I didn’t find the “derotated” in the dictionary.
Line 184，“1 hours”
Author Response
Response to Reviewer 3 Comments
We thank you for your time and consideration on our submission (electronics-1006970). Below we address the reviewer comments and list of changes that we made to our manuscript according to the reports. The original reviewer comments are provided in black color, whereas our answers are given in red. The appropriate changes made in the revised manuscript are highlighted.
Comments
The rehabilitation robot is one of the frontier directions in the field of advanced manufacturing. As a typical representative of the combination of medical and industrial, it has important scientific and social value. In this paper, authors proposed a rehabilitation device with personalized exercise for scoliotic patients. Different from the traditional rehabilitation devices, the personalized exercise rehabilitation device can provide the most appropriate exercise therapy and positively correct the asymmetrical postural balance patterns. And the experiment results show this strategy is effective and has the potential application in the clinic. However, as a scientific paper, authors should further revise and polish the manuscript before publishing.
Point 1: The detailed design of the exercise rehabilitation device should be provided to help readers better understand the system. Authors are suggested to give the 2D or 3D design drawing and show the complex structure with section view or enlarging view.
Response 1: We agree that the detailed design of the exercise rehabilitation device can help readers better understand the system. Therefore, we have included a new Figure 1 to show the 3D design drawing with section view (Page. 2. Line 88. / Page. 3. Line. 100.).
Point 2: The performance parameters of the personalized exercise rehabilitation device should be provided. Authors only introduce the motion limits of the different parts, while the motion speed and provided force are missing.
Response 2: We agree that the performance parameters of the personalized exercise rehabilitation devices should be provided. Since seven electric actuators, which were used in this device, has same specifications, we have only included the maximum motion speed and load once in the manuscript (Page. 2. Line. 92-93.).
Point 3: “The personalized exercise plans for the individuals were suggested according to the curve types and directions in the presence of a doctor.” This expression is too simple and difficult for reader to understand. Please explain with an example with specific parameters and cite the related references.
Response 3: Thank you for providing these insights. As your suggestion, we have reflected this comment by explaining with an example with specific parameters and including related references. A specific protocols for personalized exercise methods were presented previously in Table 1 (Page. 6. Line. 188-192.).
Point 4: Since all patients are treated with personalized exercise plans, it’s difficult to show the superiority of the personalized exercise plans. If possible, authors should also set control group with the universal exercise plans.
Response 4: You have raised an important point. We agree with your assessment. In order to show the superiority of the personalized exercise plans, a study comparing the results with the control group to which the universal exercise plans were applied is currently being conducted. It is believed that the feasibility study could provide an indication for the effectiveness of developed device. Therefore, we have reflected this by adding “a feasibility study” at the end of the title (Page. 1. Line. 4.).
Point 5: The grammar of the writing has some errors throughout the manuscript and need to be checked and corrected. This will improve the work greatly and will make it more readable.
Response 5: Thank you for your suggestion. As your suggestion, to improve the work greatly, we have checked and corrected the grammar of our manuscript as follows:
Point 5.1: Line 59, “In general, scoliosis patients shows displaced blocks laterally with torsion.” It seems that the verb “shows” does not agree with the subject.
Response 5.1: As your suggestion, we have revised the manuscript accordingly (Page. 2. Line. 60-61.).
(1) Before revision: “In general, scoliosis patients shows displaced blocks laterally with torsion.”
(2) After revision: “In general, scoliosis patient shows displaced blocks laterally with torsion.”
Point 5.2: Line 127, “Table 1 shows a personalized exercise methods.”
Response 5.2: As your suggestion, we have revised the manuscript accordingly (Page. 4. Line. 134.).
(1) Before revision: “Table 1 shows a personalized exercise methods.”
(2) After revision: “Table 1 presents a personalized exercise methods.”
Point 5.3: Line 128, “Patients has to elongate the …”
Response 5.3: As your suggestion, we have revised the manuscript accordingly (Page. 4. Line. 135-136.).
(1) Before revision: “Patients has to elongate the …”
(2) After revision: “Patients were instructed to elongate the …”
Point 5.4: Line 143，“Patients has to maintain maximum pelvic tilt posture for 10 seconds …”
Response 5.4: As your suggestion, we have revised the manuscript accordingly (Page. 5. Line. 151-152.).
(1) Before revision: “Patients has to maintain maximum pelvic tilt posture for 10 seconds …”
(2) After revision: “Patients were instructed to maintain maximum pelvic tilt posture for 10 seconds …”
Point 5.5: Line 144, “The trunk was derotated to …”. I didn’t find the “derotated” in the dictionary.
Response 5.5: As your suggestion, we have revised the manuscript accordingly (Page. 5. Line. 153.).
(1) Before revision: “The trunk was derotated to …”
(2) After revision: “The trunk was rotated to …”
Point 5.6: Line 184，“1 hours”
Response 5.6: As your suggestion, we have revised the manuscript accordingly (Page. 6. Line. 194.).
(1) Before revision: “1 hours”
(2) After revision: “1 hour”
Again, thank you for giving us the opportunity to strengthen our manuscript with your valuable comments and queries. We have worked hard to incorporate your feedback and hope that the revised manuscript is suitable for publication in Electronics.
Sincerely,
Jung-Ja Kim, PhD
Professor
Jeonbuk National University / Division of Biomedical Engineering; Research Center of Healthcare & Welfare Instrument of the Aged
567 Baekjae-daero, Deokjin-gu, Jeonju-si, Jeollabuk-do, Republic of Korea
Tel: 82-63-270-4102
Fax: 82-63-270-2247
Author Response File: Author Response.pdf
Round 2
Reviewer 3 Report
The author partially addressed the questions. Here are the remaining issues.
- Authors are suggested to give the 2D or 3D design drawing and show the complex structure with section view or enlarging view. Please refer the figure in “Zi, Bin, Guangcai Yin, and Dan Zhang. "Design and optimization of a hybrid-driven waist rehabilitation robot." Sensors 16.12 (2016): 2121.”
- Since all patients are treated with personalized exercise plans, it’s difficult to show the superiority of the personalized exercise plans. I do understand the difficult to execute the additional experiments. If possible, please compare the results with the cases reported in previous literatures and published works.
- The grammar of the writing still has some errors. Line 133，“presents a …….methods”
- The article should also include more information related to the electronic area (circuit design, control method, data processing and so on), so that it can be suitable for publication in Electronics.
Author Response
Response to Reviewer 3 Comments
We thank you for your time and consideration on our submission (electronics-1006970). Below we address the reviewer comments and list of changes that we made to our manuscript according to the reports. The original reviewer comments are provided in black color, whereas our answers are given in red. The appropriate changes made in the revised manuscript are highlighted.
Comments
The author partially addressed the questions. Here are the remaining issues.
Point 1: Authors are suggested to give the 2D or 3D design drawing and show the complex structure with section view or enlarging view. Please refer the figure in “Zi, Bin, Guangcai Yin, and Dan Zhang. "Design and optimization of a hybrid-driven waist rehabilitation robot." Sensors 16.12 (2016): 2121.”
Response 1: As your suggestion, we have included a new Figure 1 to show the 3D design drawing with enlarging view by referring to the figure in other research (Page. 3. Line. 102).
Point 2: Since all patients are treated with personalized exercise plans, it’s difficult to show the superiority of the personalized exercise plans. I do understand the difficult to execute the additional experiments. If possible, please compare the results with the cases reported in previous literatures and published works.
Response 2: We agree that it is important to emphasize the superiority of the personalized exercise plans using developed device. Therefore, we have incorporated your comments by comparing the exercise efficiency between personalized exercise using developed device and previous exercises (Page. 9. Line. 334 - Page. 10. Line. 354.). In addition, we have reflected this by adding “personalized” “performed for a long time” and including the reference (Page. 10. Line. 391, Page. 11. Line. 393.).
Point 3: The grammar of the writing still has some errors. Line 133，“presents a …….methods”
Response 3: Thank you for your suggestion. As your suggestion, we have revised the manuscript accordingly (Page. 4. Line. 139 and 150.).
(1) Before revision: “Table 1 presents a personalized exercise methods.”
(2) After revision: “Table 1 presents a personalized exercise method.”
Point 4: The article should also include more information related to the electronic area (circuit design, control method, data processing and so on), so that it can be suitable for publication in Electronics.
Response 4: We agree with your assessment. Therefore, we have reflected your comment by adding a new Figure 2 that presents an overview of the device (Page. 3. Line. 105.).
Again, thank you for giving us the opportunity to strengthen our manuscript with your valuable comments and queries. We have worked hard to incorporate your feedback and hope that the revised manuscript is suitable for publication in Electronics.
Sincerely,
Jung-Ja Kim, PhD
Professor
Jeonbuk National University / Division of Biomedical Engineering; Research Center of Healthcare & Welfare Instrument of the Aged
567 Baekjae-daero, Deokjin-gu, Jeonju-si, Jeollabuk-do, Republic of Korea
Tel: 82-63-270-4102
Fax: 82-63-270-2247
Author Response File: 
Author Response.docx
