Abstract
Biofeedback (BFB), the practice of providing real-time sensory feedback has been shown to improve gait rehabilitation outcomes. BFB training through rhythmic stimulation has the potential to improve spatiotemporal gait asymmetries while minimizing cognitive load by encouraging a synchronization between the user's gait cycle and an external rhythm. The purpose of this work was to evaluate if rhythmic stimulation can improve the stance time symmetry ratio (STSR) and to compare vibrotactile to auditory stimulation. Gait parameters including velocity, cadence, stride length, double support time, and step length symmetry, were also examined. An experimental rhythmic stimulation system was developed, and twelve healthy adults (5 males), age 28.42 ± 10.93 years, were recruited to participate in walking trials. A unilateral ankle weight was used to induce a gait asymmetry to simulate asymmetry as commonly exhibited by individuals with lower limb amputation and other clinical disorders. Four conditions were evaluated: 1) No ankle weight baseline, 2) ankle weight without rhythmic stimulation, 3) ankle weight + rhythmic vibrotactile stimulation (RVS) using alternating motors and 4) ankle weight + rhythmic auditory stimulation (RAS) using a singletone metronome at the participant's self-selected cadence. As expected the STSR became significantly more asymmetrical with the ankle weight (i.e. induced asymmetry condition). STSR improved significantly with RVS and RAS when compared to the ankle weight without rhythmic stimulation. Cadence also significantly improved with RVS and RAS compared to ankle weight without rhythmic stimulation. With the exception of double support time, the other gait parameters were unchanged from the ankle weight condition. There were no statistically significant differences between RVS and RAS. This study found that rhythmic stimulation can improve the STSR when an asymmetry is induced. Moreover, RVS is at least as effective as auditory stimulation in improving STSR in healthy adults with an induced gait asymmetry. Future work should be extended to populations with mobility impairments and outside of laboratory settings.
Highlights
Spatiotemporal gait asymmetry is a condition commonly exhibited in clinical populations with mobility difficulties including individuals with lower limb amputation (LLA), Parkinson’s disease, and cerebral palsy
The purpose of this work was to evaluate if rhythmic stimulation can improve the stance time symmetry ratio (STSR) and to compare vibrotactile to auditory stimulation
This study found that rhythmic stimulation can improve the STSR when an asymmetry is induced
Summary
Spatiotemporal gait asymmetry is a condition commonly exhibited in clinical populations with mobility difficulties including individuals with lower limb amputation (LLA), Parkinson’s disease, and cerebral palsy. BFB is the practice of providing real-time feedback to an individual based on collected information from that user.[5] BFB can be used to supplement traditional gait training using various modalities – most commonly through visual, auditory, and vibrotactile. In the case of gait rehabilitation, auditory or tactile stimulation modalities indirectly provide information about gait movements and events. While both modalities act to augment sensory feedback, they do so by utilizing different neural physiology and pathways.[6,7] This can manifest into unique responses or levels of biofeedback effectiveness. BFB training through rhythmic stimulation has the potential to improve spatiotemporal gait asymmetries while minimizing cognitive load by encouraging a synchronization between the user’s gait cycle and an external rhythm
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