Auditory rhythmic cueing (ARC) has been used to provide auditory feedback and shows promise in improving a variety of walking parameters following stroke. Mobility problems are present in 70-80% of stroke survivors and can result in impaired gait and reduced physical activity limiting independent living. Design issues and trade-offs are identified, and interactions between perception, sensory deficit, attention, memory, cognitive load, and haptic entrainment are noted. Some improvements over baseline occurred immediately after, rather than during, haptic cueing. For a substantial proportion of participants, an immediate (though not necessarily lasting) improvement of temporal gait characteristics was found during cueing. All participants were able to synchronize their steps to a haptically presented rhythm. However, viewing this empirical gait investigation as a set of 11 case studies, more modest empirical claims can be made. Specifically, 6 participants demonstrated immediate improvements regarding their temporal gait characteristics, and 3 of the 6 improved their gait in terms of spatial characteristics.Ĭonclusions: Considering the great variability between survivors of stroke and brain injury and the limited number of available participants in our study, there is no claim of statistical evidence that supports a formal experimental result of improved gait. Results: All 11 successfully screened participants were able to synchronize their steps to a haptically presented rhythm. Gait characteristics were measured before, during, and after cueing. Spatial data were recorded using a Qualisys optical motion capturing system, consisting of 8 optoelectronic cameras, and 20 markers placed on anatomical lower limb landmarks and 4 additional tracking clusters placed on the right and left shank and thigh. We designed wearable devices to deliver the haptic rhythm, called Haptic Bracelets, which were placed on the leg near the knee. Methods: This study is a quantitative gait study combining temporal and spatial data on haptically cued participants with hemiparetic stroke and brain injury. Various objective measures, such as stride length and stride time, are considered. 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. Movement synchronization 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. Hemiparetic stroke can cause severe asymmetries in gait, leading to numerous physical problems ranging from muscle degeneration to bone fractures. This paper focuses on hemiparetic stroke, a neurological condition that affects one side of the body. Many such conditions impair mechanisms that control movement, such as gait, but typically without rhythmic perception being affected. However, the ability to perform rhythmic movement may be disrupted by various neurological conditions. Humans can synchronize their movement to auditory rhythms in ways that can improve the regularity of movement while reducing perceived effort. Provider and participant session written records and feedback questionnaires confirmed programme deliverability and acceptability.Īn ARC gait and balance training programme refined by key stakeholders was feasible to deliver and acceptable to participants and providers.īackground: Rhythm, brain, and body are closely linked. All 12 participants completed the six supervised sessions and 10/12 completed the 12 self-managed sessions. The training programme consisted of 18 sessions (six supervised, 12 self-managed) of exercises and ARC delivered by a low-cost commercially available metronome. Programme provider written notes, participant exercise and fall diaries, adverse event monitoring and feedback questionnaires captured data about deliverability, safety and acceptability of the programmes. Twelve patients post-stroke with a gait related mobility impairment received either the ARC gait and balance training programme or the gait and balance training programme without ARC. A two-group acceptability and deliverability study was then undertaken. Programme design and content were refined during stakeholder workshops involving physiotherapists and stroke survivors. This manuscript reports stakeholder refinement of an ARC gait and balance training programme for use at home and outdoors, and a study which assessed acceptability and deliverability of this programme. Although laboratory studies demonstrate that training programmes using auditory rhythmical cueing (ARC) may improve gait post-stroke, few studies have evaluated this intervention in the home and outdoors where deployment may be more appropriate.
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