Abstract
Walking rehabilitation is challenging in stroke patients with sensory impairments. In this study, we examined the two-week effect of an auditory biofeedback prosthesis, Auditory Foot (AF), on the change in the frontal whole body angular momentum (WBAM) range, before and after a two-week walking rehabilitation. We conducted a pilot randomized controlled trial (RCT). We employed statistical Bayesian modeling to understand the mechanism of the rehabilitation effect and predict the expected effect in new patients. The best-performing model indicated that the frontal WBAM range was reduced in the AF group by 12.9–28.7%. This suggests that the use of kinesthetic biofeedback in gait rehabilitation contributes to the suppression of frontal WBAM, resulting in an improved walking balance function in stroke patients.
Highlights
The main symptom of stroke due to brain damage is motor paralysis, e.g., gait disorder, which is the main cause of disability [1]
We focused on an auditory biofeedback from cutaneous plantar sensation for the following reasons: (i) plantar sensation, that is, the trajectory of the center of pressure (COP) on the plantar region and the magnitude of load, is an essential kinesthesia in walking [15,16]; (ii) in stroke patients with hemiparesis, the range of COP trajectories during walking is narrowed on the affected foot through the change of gait [17]; (iii) the time required for the cognitive resolution of auditory signals in the human brain is shorter than that required for the resolution of visual feedback signals; and (iv) visual feedback systems, that is, a display showing visual feedback signals, constrains the posture of subjects, resulting in limited rehabilitation spaces and approaches
Our statistical analysis using a Bayesian model showed that the whole body angular momentum (WBAM) range was reduced in the Auditory Foot (AF) group by 12.9–28.7% (95% prediction interval, mean 20.9%) compared with the CT group
Summary
The main symptom of stroke due to brain damage is motor paralysis, e.g., gait disorder, which is the main cause of disability [1]. Patients with stroke require rehabilitation to regain functional capacity and to return to work [2]. Achieving kinesthesia is essential for the rehabilitation of physical impairments and disabilities. Sensory impairments caused by neurological or physical disorders hamper kinesthesia, making walking rehabilitation difficult. Most studies have reported the effect of impaired plantar sensation on gait plasticity due to aging [3] or diseases, such as diabetes mellitus [4] or congenital insensitivity to pain with anhidrosis (CIPA) [5], and stroke [6,7,8]
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