Effects of unilateral real-time biofeedback on propulsive forces during gait

Abstract

BackgroundIn individuals with post-stroke hemiparesis, reduced push-off force generation in the paretic leg negatively impacts walking function. Gait training interventions that increase paretic push-off can improve walking function in individuals with neurologic impairment. During normal locomotion, push-off forces are modulated with variations in gait speed and slope. However, it is unknown whether able-bodied individuals can selectively modulate push-off forces from one leg in response to biofeedback. Here, in a group of young, neurologically-unimpaired individuals, we determined the effects of a real-time visual and auditory biofeedback gait training paradigm aimed at unilaterally increasing anteriorly-directed ground reaction force (AGRF) in the targeted leg.MethodsGround reaction force data during were collected from 7 able-bodied individuals as they walked at a self-selected pace on a dual-belt treadmill instrumented with force platforms. During 11-min of gait training, study participants were provided real-time AGRF biofeedback encouraging a 20–30% increase in peak AGRF generated by their right (targeted) leg compared to their baseline (pre-training) AGRF. AGRF data were collected before, during, and after the biofeedback training period, as well as during two retention tests performed without biofeedback and after standing breaks.ResultsCompared to AGRFs generated during the pre-training gait trials, participants demonstrated a significantly greater AGRF in the targeted leg during and immediately after training, indicating that biofeedback training was successful at inducing increased AGRF production in the targeted leg. Additionally, participants continued to demonstrate greater AGRF production in the targeted leg after two standing breaks, showing short-term recall of the gait pattern learned during the biofeedback training. No significant effects of training were observed on the AGRF in the non-targeted limb, showing the specificity of the effects of biofeedback toward the targeted limb.ConclusionsThese results demonstrate the short-term effects of using unilateral AGRF biofeedback to target propulsion in a specific leg, which may have utility as a training tool for individuals with gait deficits such as post-stroke hemiparesis. Future studies are needed to investigate the effects of real-time AGRF biofeedback as a gait training tool in neurologically-impaired individuals.Electronic supplementary materialThe online version of this article (doi:10.1186/s12984-017-0252-z) contains supplementary material, which is available to authorized users.

Effects of extended powered knee prosthesis stance time via visual feedback on gait symmetry of individuals with unilateral amputation: a preliminary study

“…An increase in absolute swing time and overall stride time seemed to be necessary consequences when increasing absolute stance time with feedback. Previous studies have demonstrated unilateral propulsive biofeedback induces changes in the targeted limb only for both people with and without stroke [35, 36], but a prosthesis presents different challenges. Additionally, amputees may have less control over the prosthesis timing because the control parameters (related to swing flexion/extension timing) were fixed in this study.…”

Validity of Measurement for Trailing Limb Angle and Propulsion Force during Gait Using a Magnetic Inertial Measurement Unit

“…On a further note, several previous studies investigate the collection of key kinematics and kinematic information, including joint angle, trajectory of center of mass, ground reaction force, during gait, and so on using the smallest possible inertial sensors [41,45]. Meanwhile, gait training using biofeedback of propulsion force on gait velocity and TLA could improve gait performance [18,[46][47][48]; however, these methods are not easily reproduced in clinical practice due to their complicated environmental restrictions. e ndings of this study can contribute towards establishing a more clinically friendly method for gait assessment as well as biofeedback gait training in clinical practice.…”

Computational Design of FastFES Treatment to Improve Propulsive Force Symmetry During Post-stroke Gait: A Feasibility Study

“…Third, it is possible that the subject did not try to minimize propulsive force asymmetry when relearning to walk. A potentially insightful experiment would be to provide the subject with real-time feedback of his propulsive force asymmetry and instruct him to attempt to minimize it, similar to recent studies performed on healthy individuals (Schenck and Kesar, 2017) and individuals post-stroke (Genthe et al, 2018). Such an experiment could elucidate whether the subject's propulsive force asymmetry is primarily due to neural control limitations, biomechanical constraints, or a subconscious decision to optimize other quantities (e.g., metabolic cost Zarrugh et al, 1974; Bertram, 2005).…”