Rhythmic Haptic Cueing for Gait Rehabilitation of People With Hemiparesis: Quantitative Gait Study

Georgiou, Theodoros; Holland, Simon and van der Linden, Janet (2020). Rhythmic Haptic Cueing for Gait Rehabilitation of People With Hemiparesis: Quantitative Gait Study. JMIR Biomedical Engineering, 5(1), article no. e18649.

DOI: https://doi.org/10.2196/18649

Abstract

Background: Rhythm, brain and body are closely linked. Humans can synchronise their movement to auditory rhythms in ways that can improve regularity of movement while reducing perceived effort. However, the ability to perform rhythmic movement may be disrupted by various neurological conditions. Many such conditions impair mechanisms that control movement, such as gait – but typically without rhythmic perception being affected. This paper focuses on hemiparetic stroke – a neurological condition which affects one side of the body. Hemiparetic stroke can cause severe asymmetries in gait, leading to numerous physical problems – ranging from muscle degeneration to bone fractures. Movement synchronisation via entrainment to auditory metronomes is known to improve asymmetry and related gait problems; this paper presents the first systematic study of entrainment for gait rehabilitation via the haptic modality.

Objective: This paper explores the gait rehabilitation of people with hemiparesis following a stroke or brain injury, by a process of haptic entrainment to rhythmic cues. Various objective measures such as stride length and stride time are considered. Methods: The study presented here is a quantitative gait study combining temporal and spatial data on haptically cued participants with hemiparetic stroke and brain injury. Gait characteristics were measured before, during, and after cueing.

Results: All eleven successfully screened participants were able to synchronise their steps to a haptically presented rhythm. Specifically, six participants demonstrated immediate improvements regarding their temporal gait characteristics, and three out of six improved their gait in terms of spatial characteristics.

Conclusions: Considering the great variability between stroke and brain injury survivors, and the limited number of available participants in our study, there is no claim here of statistical evidence able to support a formal experimental result of improved gait. However, viewing this empirical gait investigation as a set of eleven case studies, more modest empirical claims can be made. All participants were able to synchronise their steps to a haptically presented rhythm. For a substantial proportion of participants, an immediate (though not necessarily lasting) improvement of temporal gait characteristics was found during cueing. Some improvements over baseline occurred immediately afterwards, rather than during, haptic cueing. Design issues and trade-offs are identified, and interactions between perception, sensory deficit, attention, memory, cognitive load and haptic entrainment are noted.

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