A pilot study using tactile cueing for gait rehabilitation following stroke

Recovery of walking function is a vital goal of post-stroke rehabilitation. Cueing using audio metronomes has been shown to improve gait, but can be impractical when interacting with others, particularly outdoors where awareness of vehicles and bicycles is essential. Audio is also unsuitable in environments with high background noise, or for those with a hearing impairment. If successful, lightweight portable tactile cueing has the potential to take the benefits of cueing out of the laboratory and into everyday life. The Haptic Bracelets are lightweight wireless devices containing a computer, accelerometers and low-latency vibrotactiles with a wide dynamic range. In this paper we review gait rehabilitation problems and existing solutions, and present an early pilot in which the Haptic Bracelets were applied to post-stroke gait rehabilitation. Tactile cueing during walking was well received in the pilot, and analysis of motion capture data showed immediate improvements in gait

A Gait Rehabilitation pilot study using tactile cueing following Hemiparetic Stroke

Recovery of walking function is a major goal of post-stroke rehabilitation. Audio metronomic cueing has been shown to improve gait, but can be impractical and inconvenient to use in a community setting, for example outdoors where awareness of traffic is needed, as well as being unsuitable in environments with high background noise, or for those with a hearing impairment. Silent lightweight portable tactile cueing, if similarly successful, has the potential to take the benefits out of the lab and into everyday life. The Haptic Bracelets, designed and built at the Open University originally for musical purposes, are self- contained lightweight wireless devices containing a computer, Wi-Fi chip, accelerometers and low-latency vibrotactiles with a wide dynamic range. In this paper we outline gait rehabilitation problems and existing solutions, and present an early pilot in which the Haptic Bracelets were applied to post-stroke gait rehabilitation

Rhythmic Haptic Cueing for Gait Rehabilitation of Hemiparetic Stroke and Brain Injury Survivors

This thesis explores the gait rehabilitation of hemiparetic stroke and brain injury survivors by a process of haptic entrainment to rhythmic cues. Entrainment to auditory metronomes is known to improve gait; this thesis presents the first systematic study of entrainment for gait rehabilitation via the haptic modality. To investigate this approach, a multi-limb metronome capable of delivering a steady, isochronous haptic rhythm to alternating legs was developed, purpose-built for gait rehabilitation, together with appropriate software for monitoring and assessing gait. A formative observational study, carried out at a specialised neurological centre, supplemented by discussions with physiotherapists and neuropsychologists, was used to focus the scope on hemiparetic stroke and brain injury. A second formative study used a technology probe approach to explore the behaviour of hemiparetic participants under haptic cueing using a pre-existing prototype. Qualitative data was collected by observation of, and discussion with, participants and health professionals. In preparation for a quantitative gait study, a formal experiment was carried out to identify a workable range for haptic entrainment. This led to the creation of a procedure to screen out those with cognitive difficulties entraining to a rhythm, regardless of their walking ability. The final study was a quantitative gait study combining temporal and spatial data on haptically cued participants with hemiparetic stroke and brain injury. Gait characteristics were measured before, during and after cueing. All successfully screened participants were able to synchronise their steps to a haptically presented rhythm. For a substantial proportion of participants, an immediate (though not necessarily lasting) improvement of temporal gait characteristics was found during cueing. Some improvements over baseline occurred immediately afterwards, rather than during, haptic cueing. Design issues and trade-offs are identified, and interactions between perception, sensory deficit, attention, memory, cognitive load and haptic entrainment are noted

A blended user centred design study for wearable haptic gait rehabilitation following hemiparetic stroke

Restoring mobility and rehabilitation of gait are high priorities for post-stroke rehabilitation. Cueing using metronomic rhythmic sensory stimulation has been shown to improve gait, but most versions of this approach have used auditory and visual cues. In contrast, we developed a prototype wearable system for rhythmic cueing based on haptics, which was shown to be highly effective in an early pilot study. In this paper we describe a follow-up study with four stroke survivors to inform design, and to identify issues and requirements for such devices to be used in home-based or out-door settings. To this end, we present a blended user-centred design study of a wearable haptic gait rehabilitation system. This study draws on the combined views of physiotherapists, nurses, interaction designers and stroke survivors. Many of the findings were unanticipated, identifying issues outside the scope of initial designs, with important implications for future design and appropriate use

Wearables for Long Term Gait Rehabilitation of Neurological Conditions

Many people with long-term neurological and neurodegenerative conditions such as stroke, brain injury, multiple sclerosis or Parkinson’s disease suffer from an impaired walking gait pattern. Gait improvement can lead to better fluidity in walking, improved health outcomes, greater independence, and enhanced quality of life. Existing lab-based studies with wearable devices have shown that rhythmic haptic cueing can cause immediate improvements to gait features such as temporal symmetry, stride length and walking speed. However, current wearable systems are unsuitable for self-managed use, and to move this approach from out of the lab into long-term sustained usage, numerous design challenges need to be addressed. We are designing, developing, and testing a closed-loop system to provide adaptive haptic rhythmic cues for sustainable self-managed long-term use outside the lab by survivors of stroke, and other neurological conditions, in their everyday lives

Questioning Classic Patient Classification Techniques in Gait Rehabilitation: Insights from Wearable Haptic Technology

Classifying stroke survivors based on their walking abilities is an important part of the gait rehabilitation process. It can act as powerful indicator of function and prognosis in both the early days after a stroke and long after a survivor receives rehabilitation. This classification often relies solely on walking speed; a quick and easy measure, with only a stopwatch needed. However, walking speed may not be the most accurate way of judging individual’s walking ability. Advances in technology mean we are now in a position where ubiquitous and wearable technologies can be used to elicit much richer measures to characterise gait. In this paper we present a case study from one of our studies, where within a homogenous group of stroke survivors (based on walking speed classification) important differences in individual results and the way they responded to rhythmic haptic cueing were identified during the piloting of a novel gait rehabilitation technique

Wearable Haptic Devices For Post- Stroke Gait Rehabilitation

Wearable technologies, in the form of small, light and inconspicuous devices, can be designed to help individuals suffering from neurological conditions carry out regular rehabilitation exercises. Current research has shown that walking to a rhythm can lead to significant improvements in various aspects of gait. Our primary aim is to provide a suitable, technology based intervention to enhance gait rehabilitation of people with chronic and degenerative neurological health conditions (such as stroke). This intervention will be in the form of small, lightweight, wireless, wearable devices the user can take out of the clinic, extending their rehabilitation to their own home setting. The devices can deliver a series of vibrations at a steady rhythm giving the patient a more stable and symmetric pace of walking. The simplest version of this approach typically comprise of a very small network of just two nodes and a central controller. The existing prototypes (called the Haptic Bracelets) capture and analyse motion data in real time to provide adaptive haptic (through vibrations) cueing. In the future and after more refinement, the system could allow a single therapist to monitor and advise groups of stroke survivors undergoing therapy sessions

Wearable Haptic Devices for Long-Term Gait Re-education for Neurological Conditions

Many people with long-term neurological and neurodegenerative conditions such as stroke, brain injury, multiple sclerosis or Parkinson’s disease suffer from an impaired walking gait pattern. Gait improvement can lead to better fluidity in walking, improved health outcomes, greater independence, and enhanced quality of life. Existing lab-based studies with wearable haptic devices have shown that rhythmic haptic cueing can cause immediate improvements to gait features such as temporal symmetry, stride length and walking speed. However, such wearable haptic devices are unsuitable for self-managed use, and to move this approach from out of the lab into long-term sustained usage, numerous design challenges need to be addressed. We are designing, developing, and testing a closed-loop system to provide adaptive haptic rhythmic cues for sustainable self-managed long-term use outside the lab by survivors of stroke, and other neurological conditions, in their everyday lives

Effects of sensory cueing in virtual motor rehabilitation. A review.

Objectives To critically identify studies that evaluate the effects of cueing in virtual motor rehabilitation in patients having different neurological disorders and to make recommendations for future studies. Methods Data from MEDLINE®, IEEExplore, Science Direct, Cochrane library and Web of Science was searched until February 2015. We included studies that investigate the effects of cueing in virtual motor rehabilitation related to interventions for upper or lower extremities using auditory, visual, and tactile cues on motor performance in non-immersive, semi-immersive, or fully immersive virtual environments. These studies compared virtual cueing with an alternative or no intervention. Results Ten studies with a total number of 153 patients were included in the review. All of them refer to the impact of cueing in virtual motor rehabilitation, regardless of the pathological condition. After selecting the articles, the following variables were extracted: year of publication, sample size, study design, type of cueing, intervention procedures, outcome measures, and main findings. The outcome evaluation was done at baseline and end of the treatment in most of the studies. All of studies except one showed improvements in some or all outcomes after intervention, or, in some cases, in favor of the virtual rehabilitation group compared to the control group. Conclusions Virtual cueing seems to be a promising approach to improve motor learning, providing a channel for non-pharmacological therapeutic intervention in different neurological disorders. However, further studies using larger and more homogeneous groups of patients are required to confirm these findings

Two kinds of entrainment in gait rehabilitation using haptic metronomic cues

There are currently over 1.2 million stroke survivors in the UK, and with more than 100,000 new incidents each year, stroke is a leading cause of adult disability. Almost three quarters of stroke survivors suffer from gait deficiencies. In the case of hemiparetic stroke and related brain injuries, gait deficiencies typically take the form of bilateral spatial and temporal asymmetries. This can lead to overuse of the non-paretic (unaffected) leg, exposing it to higher vertical forces, and underuse of the paretic ( affected ) leg leading to loss of muscle tone and reduction of bone mineral density. This increases the risk of knee and joint problems together with hip and bone fractures, and the likelihood of falls. Restoring mobility and rehabilitation of gait are thus high priorities for post-stroke rehabilitation