Effects of gait training with auditory feedback on walking and balancing ability in adults after hemiplegic stroke: a preliminary, randomized, controlled study

Cha, Yong-Jun; Kim, Jung-Doo; Choi, Yu-Ran; Kim, Nan-Hyang; Son, Sung Min

doi:10.1097/mrr.0000000000000295

Cited by 16 publications

(18 citation statements)

References 18 publications

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“…Following the white noise intervention, both the paretic and non-paretic sides demonstrated no statistically significant change in A-P/M-L CoP range and velocity and M-L inclination angle. Previous studies affirming the effectiveness of continuous white noise and auditory feedback 33,19,20 reported a post-feedback decrease in CoP range and improvement in balance, which contradicts our findings.…”

Section: Discussioncontrasting

confidence: 99%

Auditory feedback alters postural control and functional ability in patients with chronic stroke

Lim

Ryu

2020

Preprint

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Background: This study aimed to investigate the effect of white noise on dynamic balance in patients with stroke and the pre- and post-intervention changes in dynamic balance during walking by analyzing the anterior-posterior (A-P) and medial-lateral (M-L) center of pressure (CoP) range and velocity, center of mass (CoM), and A-P/M-L inclination angle using CoM-CoP and to establish the basis for using auditory feedback as an effective means of exercise intervention by bringing changes in dynamic balance abilities of patients with chronic stroke and retain the necessary abilities for maintaining independent and functional daily living.Methods: Nineteen patients with chronic stroke (age: 61.2±9.8 years, height: 164.4±7.4 cm, weight: 61.1±9.4 kg, paretic side (R/L): 11/8, duration: 11.6±4.9 years) were included as study participants. Auditory feedback used white noise, and all participants listened for 20 minutes mixing six types of natural sounds with random sounds. The dynamic balancing ability was evaluated during the walking, and the variables were the center of pressure (CoP), the center of mass (CoM), CoP-CoM inclined angle.Results: There is a significant increase in the A-P CoP range, A-P inclination angle, and gait speed on the paretic and non-paretic sides following white noise intervention (p<.05). In addition, the changes in CoP velocity on the paretic and non-paretic sides increased in both the A-P and M-L directions but not significantly.Conclusion: Our findings confirmed the positive effect of using white noise as auditory feedback through a more objective and quantitative assessment using CoP-CoM inclination angle as an evaluation indicator for assessing dynamic balance in patients with chronic stroke. The A-P and M-L inclination angle can be employed as a useful indicator for evaluating other exercise programs and intervention methods for functional enhancement of patients with chronic stroke in terms of their effects on dynamic balance and effectiveness.

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Section: Discussioncontrasting

confidence: 99%

Auditory feedback alters postural control and functional ability in patients with chronic stroke

Lim

Ryu

2020

Preprint

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“…Table 2 shows participant characteristics, wearable devices, type of sensors and placement, experimental and control intervention, timing of the intervention, balance and gait outcomes, and finally time points of the included studies. The selected RCTs were performed in people with PD (n = 6) [ 40 , 41 , 42 , 43 , 44 , 45 ], stroke (n = 13) [ 41 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 ] and mild cognitive impairment (MCI) (n = 1) [ 58 ]. The total sample consists of 513 PwND with mean age ranging from 46 to 79 years.…”

Section: Resultsmentioning

confidence: 99%

“…Considering biomechanical measurements, five studies [ 43 , 46 , 48 , 52 , 53 ] used pressure sensors and one study [ 57 ] combined a pressure sensor with a foot switch. Pressure sensors were positioned under the foot of the paretic leg and were activated considering the % body weight loading [ 53 , 57 ] or by the combination of body weight loading and specific gait cycle phase ( Figure 3 ) [ 46 , 48 ]. In Jung et al [ 52 ], pressure sensors were embedded into a cane used on the nonparetic side and activated by body weight %.…”

Section: Resultsmentioning

confidence: 99%

“…In addition, studies [ 41 , 42 , 45 , 55 ] also provided knowledge of results, presenting a scoring point or a number representing the outcome of the performance. In eight of the studies [ 44 , 46 , 48 , 50 , 51 , 52 , 53 , 57 ], the modality exploited to transmit the signal to users’ devices was auditory. Four studies [ 40 , 41 , 45 , 47 , 54 ] used visual signal, while in the other five studies [ 42 , 49 , 55 , 56 , 58 ] a combination of auditory and visual biofeedback was applied.…”

Section: Resultsmentioning

confidence: 99%

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Wearable Devices for Biofeedback Rehabilitation: A Systematic Review and Meta-Analysis to Design Application Rules and Estimate the Effectiveness on Balance and Gait Outcomes in Neurological Diseases

Bowman

Gervasoni

Arienti

et al. 2021

Sensors

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Wearable devices are used in rehabilitation to provide biofeedback about biomechanical or physiological body parameters to improve outcomes in people with neurological diseases. This is a promising approach that influences motor learning and patients’ engagement. Nevertheless, it is not yet clear what the most commonly used sensor configurations are, and it is also not clear which biofeedback components are used for which pathology. To explore these aspects and estimate the effectiveness of wearable device biofeedback rehabilitation on balance and gait, we conducted a systematic review by electronic search on MEDLINE, PubMed, Web of Science, PEDro, and the Cochrane CENTRAL from inception to January 2020. Nineteen randomized controlled trials were included (Parkinson’s n = 6; stroke n = 13; mild cognitive impairment n = 1). Wearable devices mostly provided real-time biofeedback during exercise, using biomechanical sensors and a positive reinforcement feedback strategy through auditory or visual modes. Some notable points that could be improved were identified in the included studies; these were helpful in providing practical design rules to maximize the prospective of wearable device biofeedback rehabilitation. Due to the current quality of the literature, it was not possible to achieve firm conclusions about the effectiveness of wearable device biofeedback rehabilitation. However, wearable device biofeedback rehabilitation seems to provide positive effects on dynamic balance and gait for PwND, but higher-quality RCTs with larger sample sizes are needed for stronger conclusions.

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“…In contrast, ipsilesional cortical activity was more widespread in stroke participants than controls during the visuomotor task. While auditory feedback has been shown to improve weight bearing and gait characteristics in stroke survivors (57), individuals with stroke have been shown to rely on visual feedback for posturing (58). Additionally, visual feedback during grip-force control increases activation in the visual cortex, premotor cortex, supplementary motor areas, and the ipsilateral cerebellum in stroke participants (59), and limb apraxia has been associated with a deficit in visuo-motor integration due to lesions in the fronto-parietal motor network (60).…”

Section: Discussionmentioning

confidence: 99%

Tasked-Based Functional Brain Connectivity in Multisensory Control of Wrist Movement After Stroke

et al. 2019

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In this study we documented brain connectivity associated with multisensory integration during wrist control in healthy young adults, aged matched controls and stroke survivors. A novel functional MRI task paradigm involving wrist movement was developed to gain insight into the effects of multimodal sensory feedback on brain functional networks in stroke participants. This paradigm consisted of an intermittent position search task using the wrist during fMRI signal acquisition with visual and auditory feedback of proximity to a target position. We enrolled 12 young adults, 10 participants with chronic post-stroke hemiparesis, and nine age-matched controls. Activation maps were obtained, and functional connectivity networks were calculated using an independent component analysis (ICA) approach. Task-based networks were identified using activation maps, and nodes were obtained from the ICA components. These nodes were subsequently used for connectivity analyses. Stroke participants demonstrated significantly greater contralesional activation than controls during the visual feedback condition and less ipsilesional activity than controls during the auditory feedback condition. The sensorimotor component obtained from the ICA differed between rest and task for control and stroke participants: task-related lateralization to the contralateral cortex was observed in controls, but not in stroke participants. Connectivity analyses between the lesioned sensorimotor cortex and the contralesional cerebellum demonstrated decreased functional connectivity in stroke participants (p < 0.005), which was positively correlated the Box and Blocks arm function test (r 2 = 0.59). These results suggest that task-based functional connectivity provides detail on changes in brain networks in stroke survivors. The data also highlight the importance of cerebellar connections for recovery of arm function after stroke.

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Effects of gait training with auditory feedback on walking and balancing ability in adults after hemiplegic stroke: a preliminary, randomized, controlled study

Cited by 16 publications

References 18 publications

Auditory feedback alters postural control and functional ability in patients with chronic stroke

Auditory feedback alters postural control and functional ability in patients with chronic stroke

Wearable Devices for Biofeedback Rehabilitation: A Systematic Review and Meta-Analysis to Design Application Rules and Estimate the Effectiveness on Balance and Gait Outcomes in Neurological Diseases

Tasked-Based Functional Brain Connectivity in Multisensory Control of Wrist Movement After Stroke

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