Clinical impact of gait training enhanced with visual kinematic biofeedback: Patients with Parkinson’s disease and patients stable post stroke

Abstract

As the world's population ages, falls, physical inactivity, decreased attention and impairments in balance and gait arise as a consequence of decreased sensation, weakness, trauma and degenerative disease. Progressive balance and gait training can facilitate postural righting, safe ambulation and community participation. This small randomized clinical trial evaluated if visual and kinematic feedback provided during supervised gait training would interfere or enhance mobility, endurance, balance, strength and flexibility in older individuals greater than one year post stroke (Gobbi et al., 2009) or Parkinson's disease (PD) (Gobbi et al., 2009). Twenty-four individuals consented to participate. The participants were stratified by diagnosis and randomly assigned to a control (usual gait training (Gobbi et al., 2009)) or an experimental group (usual gait training plus kinematic feedback (Gobbi et al., 2009)). At baseline and 6 weeks post training (18 h), subjects completed standardized tests (mobility, balance, strength, range of motion). Gains were described across all subjects, by treatment group and by diagnosis. Then they were compared for significance using nonparametric statistics. Twenty-three subjects completed the study with no adverse events. Across all subjects, by diagnosis (stroke and PD) and by training group (control and experimental), there were significant gains in mobility (gait speed, step length, endurance, and quality), balance (Berg Balance), range of motion and strength. There were no significant differences in the gain scores between the control and experimental groups. Subjects chronic post stroke made greater strength gains on the affected side than subjects with PD but otherwise there were no significant differences. In summary, during supervised gait training, dynamic visual kinematic feedback from wireless pressure and motion sensors had similar, positive effects as verbal, therapist feedback. A wireless kinematic feedback system could be used at home, to provide feedback and motivation for self correction of gait while simultaneously providing data to the therapist (at a distance).

Effects of Wearable Sensor-Based Balance and Gait Training on Balance, Gait, and Functional Performance in Healthy and Patient Populations: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

“…RCTs were performed in patients with PD ( n = 2) [27,28] , stroke ( n = 1) [29] , PD/stroke ( n = 1) [30] , peripheral neuropathy, either relating to diabetes ( n = 1) [31] or chemotherapy ( n = 1) [32] , and healthy ( n = 1) [33] , or frail older adults with confirmed fall risk ( n = 1) [14] . The average age of the samples ranged from 52.1 to 84.9 years.…”

“…IMUs were used for measuring kinematic data of body segments in order to provide feedback about center of mass [14,28,[31][32][33] or lower extremity movement [14,27,[30][31][32] . Wearable plantar pressure sensors were used to cue weight symmetry distribution between feet while standing (i.e., % body weight loading on the paretic leg) or weight variation during stance phase while walking (i.e., single support time asymmetry ratio) [29,30] . In all studies, the information from sensors was translated into a visual, audio, vibratory, or combination of 2 or more feedbacks.…”

“…Training frequency ranged from 2 to 5 times per week. In 5 studies, the controls received the same training as the intervention group, however without WS feedback [27][28][29][30]33] . In 3 studies, the controls received routine care only [14,31,32] .…”

A New Method towards Achieving FES-Induced Movement

“…It can also be used for gait restoration and for remedy purposes. Others include: lowering maintenance costs maintenance and improvement of physical and mental health, making the patients more self-reliance and sociable [29,30].…”

Motor Task Performance under Visual and Auditory Feedback Post Stroke: A Randomised Crossover Trial

“…Despite the high precision [18][19][20], IMUs have only been used so far to quantify and characterize movement patterns and effects of interventions in post-stroke patients [19][20][21], with only anecdotal evidence of their use in rehabilitation tools [22][23][24].…”