Acoustic Feedback in Gait Rehabilitation-Pre-Post Effects in Patients With Unilateral Hip Arthroplasty.

Julia Reh,Gerd Schmitz,Tong-Hun Hwang,Alfred O Effenberg

doi:10.3389/fspor.2021.654546

Julia Reh, Gerd Schmitz + Show 2 more

Open Access

https://doi.org/10.3389/fspor.2021.654546

Copy DOI

Abstract

It is known that patients after unilateral hip arthroplasty still suffer from a deficient gait pattern compared to healthy individuals one year after surgery. Through the method of gait sonification, it may be possible to achieve a more efficient training and a more physiological gait pattern. Increased loads on the musculoskeletal system could thus be reduced and rehabilitation times shortened. In a previous investigation with this patient group, we found immediate gait pattern changes during training with dual mode acoustic feedback [real-time feedback (RTF) and instructive model sequences (IMS)]. To determine whether an effect persists without the immediate use of acoustic feedback, we analyze data from four times of testing. Following unilateral hip arthroplasty 22 patients participated in an intervention of ten gait training sessions of 20 min each. During gait training the sonification group (SG) (n = 11) received an acoustic feedback consisting of RTF and IMS compared to a control group (CG) (n = 11). Pre-test, intermediate test, post-test, and re-test were conducted using an inertial sensor-based motion analysis system. We found significant effects (α = 0.05) regarding step length and range of motion (RoM) of the hip joint. Step length of the affected leg increased in the SG from intermediate test to post-test but decreased in the CG [intermediate test: (SG) 0.63 m ± 0.12 m, (CG) 0.63 m ± 0.09 m; post-test: (SG) 0.66 m ± 0.11 m, (CG) 0.60 m ± 0.09 m]. However, from the post-test to the re-test a reverse development was observed [re-test: (SG) 0.63 m ± 0.10 m, (CG) 0.65 m ± 0.09 m]. Also, from post-test to re-test a decrease in the RoM of the unaffected hip for the SG but an increase for the CG could be observed [post-test: (SG) 44.10° ± 7.86°, (CG) 37.05° ± 7.21°; re-test: (SG) 41.73° ± 7.38°, (CG) 40.85° ± 9.28°]. Regarding further parameters, significant interactions in step duration as well as increases in stride length, gait speed, cadence, and a decrease in ground contact time from pre-test to re-test were observed for both groups.Clinical Trial Registration: https://www.drks.de/drks_web/, identifier DRKS00022570.

Highlights

After unilateral hip arthroplasty, many patients still suffer from an unphysiological gait pattern even after several years (Queen et al, 2011; Kolk et al, 2014; Leijendekkers et al, 2018; Cezarino et al, 2019)
To effectively use sonification for patients after hip arthroplasty we developed a new acoustic feedback approach, which is based on a combination of kinematic real-time feedback (RTF) and instructive model sequences (IMS)
The present study can only provide a first insight into the use of gait sonification for patients after unilateral hip arthroplasty, and the results only provide information about a short period after surgery, though, they do provide clues to future targeted applications of this method

Summary

Introduction

Many patients still suffer from an unphysiological gait pattern even after several years (Queen et al, 2011; Kolk et al, 2014; Leijendekkers et al, 2018; Cezarino et al, 2019). New technological developments that can be used independently by the patient could provide efficient support for training and recovery (Krishnan et al, 2016; Chamorro-Moriana et al, 2018; Escamilla-Nunez et al, 2020) In this context, new feedback technologies make use of the fact that the human nervous system continuously compares its own motion with incoming somatosensory information and adjusts . New feedback technologies make use of the fact that the human nervous system continuously compares its own motion with incoming somatosensory information and adjusts This is exploited by either amplifying or artificially generating relevant external stimuli so that a comparison between motor behavior and visual, tactile, kinaesthetic or auditory perception is enhanced. It can generally be assumed that augmented feedback can improve motor learning (Sigrist et al, 2013) as extended feedback for rehabilitation has already been investigated in various clinical and applied studies (Storberget et al, 2017; Kearney et al, 2019; Melero et al, 2019)

Methods

Results

Conclusion