Automatized, Standardized, and Patient-Tailored Progressive Walking-Adaptability Training: A Proof-of-Concept Study

Abstract

Background Treadmill training augmented with visual images projected on the belt's surface can help improve walking adaptability. Moreover, patient-tailored automatization and standardization can increase the feasibility of walking-adaptability therapy. We developed C-Gait, a treadmill protocol consisting of a baseline walking-adaptability assessment involving 7 putatively distinct walking-adaptability tasks and a decision algorithm, to automatically update training content and execution parameters to a patients’ performance and perceived challenge. Objectives The main objective was to examine the feasibility, acceptability, and clinical potential of C-Gait training. The secondary objective was to evaluate the validity of the baseline assessment. Design This was a longitudinal proof-of-concept study with pretraining, posttraining, and retention tests encompassing baseline assessment and walking-related clinical measures. Methods Twenty-four healthy adults, 12 healthy older persons, and 28 patients with gait and/or balance deficits performed the baseline assessment; the gait deficit group received 10 C-Gait training sessions over a 5-week period. Baseline assessment scores and walking-related clinical measures served as outcome measures. Results C-Gait training exhibited significant progression in training content and execution, with considerable between-patient variation and minimal overruling by therapists. C-Gait training was well accepted and led to improvements in walking adaptability and general walking ability, which persisted after training cessation. Baseline assessment scores differed over groups and difficulty levels, had no-to-moderate correlations with walking-related clinical measures, and had limited correlations among walking-adaptability tasks. Limitations C-Gait was evaluated in a small yet diverse cohort. More encompassing studies are required to further establish its apparent merits. The validity of treadmill-based walking-adaptability assessment against an overground standard remains to be established. Conclusions C-Gait offers automatized, standardized, and patient-tailored walking-adaptability training that is feasible and well accepted, with good potential for improving task-specific and generic measures of walking.

Avoiding 3D Obstacles in Mixed Reality: Does It Differ from Negotiating Real Obstacles?

“…In walking, it is important to be able to adapt to environmental circumstances, including the ability to avoid obstacles. Currently, walking-adaptability training is done with real obstacles or with 2D projections onto the walking surface [50][51][52][53][54][55]. Compared to 2D projections, the HoloLens offers the possibility to go beyond 2D by presenting 3D holographic obstacles.…”

“…Compared to real obstacles, 3D holographic obstacles are safer and can be made to suddenly appear, which could prove beneficial for obstacle-avoidance training. Furthermore, holographic obstacles can be easily adapted and customized, and be part of an automatically administered protocol in which obstacle characteristics (timing, number, size) can be varied depending on the participant's progress (see for a related example [55]). Moreover, holographic obstacles offer a mobile setup.…”

C-Gait for Detecting Freezing of Gait in the Early to Middle Stages of Parkinson’s Disease: A Model Prediction Study

“…“C-Gait” is an automatized and standardized assessment program supported by C-Mill (Motek, Netherlands) ( Supplementary Figure 1A ), comprising seven distinct items ( Timmermans et al, 2019 ). Here, six items were applied, including Visually guided stepping, Tandem walking, Obstacle avoidance, Slalom walking, Reaction to unexpected perturbation, and Speed of adaptation ( Supplementary Figure 1B and Supplementary Table 1 ).…”

“…Outcome measures of the C-Gait baseline assessment comprised its belt speed and the composite score, performance per walking adaptability task, and overall performance averaged over the seven walking adaptability tasks, as detailed here ( Timmermans et al, 2019 ). Task performance of slalom walking, tandem walking, speed adaptations, goal-directed stepping, obstacle avoidance, and walking with suddenly shifting obstacles and targets was defined as the percentage of correctly performed steps relative to the projected visual objects [based on center of pressure (COP) at mid-stance].…”

“…C-Gait assessment, designed for walking adaptability measurement with augmented-reality technology, can recreate the various complex tasks of walking and simulate real-life situations provoking FOG. It has good surface validity in individuals with different walking abilities, and most task items capture unique aspects of walking adaptability ( Timmermans et al, 2019 ). However, the latter was a small-sample study not including PD cases, indicating that various domains in walking adaptability need to be further clarified.…”