The use of biofeedback for gait retraining: A mapping review

Background: Biofeedback seems to be a promising tool to improve gait outcomes for both healthy individuals and patient groups. However, due to differences in study designs and outcome measurements, it remains uncertain how different forms of feedback affect gait outcomes. Therefore, the aim of this study is to review primary biomechanical literature which has used biofeedback to alter gait-related outcomes in human participants. Methods: Medline, Cinahl, Cochrane, SPORTDiscus and Pubmed were searched from inception to December 2017 using various keywords and the following MeSHterms: biofeedback, feedback, gait, walking and running. From the included studies, sixteen different study characteristics were extracted. Findings: In this mapping review 173 studies were included. The most common feedback mode used was visual feedback (42%, n=73) and the majority fed-back kinematic parameters (36%, n=62). The design of the studies were poor: only 8% (n=13) of the studies had both a control group and a retention test; 69% (n=120) of the studies had neither. A retention test after 6 months was performed in 3% (n=5) of the studies, feedback was faded in 9% (n=15) and feedback was given in the field rather than the laboratory in 4% (n=8) of the studies. Interpretation: Further work on biofeedback and gait should focus on the direct comparison between different modes of feedback or feedback parameters, along with better designed and field based studies

Using Music to Modify Step-Rate and Running Biomechanics in Healthy Runners

Context: Running-related injury (RRI) is a significant public health issue that may be caused by injurious running biomechanics. Increasing step-rate (SR) using gait retraining may prevent and treat RRI. The Optimizing Performance Through Intrinsic Motivation and Attention for Learning (OPTIMAL) theory indicates enhanced expectancies, autonomy, and external focus of attention will optimize motor learning. Music has been shown to create enhanced expectancies, can provide incidental choices (autonomy), directs attention externally, and may increase compliance. No studies have investigated if music can be used to alter SR and running biomechanics or strategies that may improve compliance to gait retraining. Objective: The purpose of this study was to 1) compare differences in SR and running biomechanics between those who use music auditory cueing (MUS) and those who use metronome auditory cueing (MET) during the phases of a temporospatial gait retraining protocol, 2) compare differences in RPE change scores across four temporospatial gait retraining sessions between the MUS and MET group, and 3) determine if there is an association between groups (MUS and MET) and compliance to a self-administered, temporospatial gait retraining protocol and describe the likelihood of compliance between groups (MUS and MET). Methods: Thirty, healthy recreational runners were included and randomly placed in either the MET or MUS group. Inertial measurement unit motion analysis collected SR, peak positive tibial acceleration (PPA), and peak stance phase hip adduction (peakHIPADD) during the stance phase of running. A cellular device application collected running volume and SR data when participants ran outside of the lab, which defined compliance. The Borg’s rate of perceived exertion (RPE) scale was used to compare change in RPE between groups. A multivariate repeated measures ANOVA was used to compare SR, PPA, and peakHIPADD from the introductory pretest (INTROpre) and the three posttests (INTROpost, LABpost, SELFpost). Change scores between baseline RPE and RPE after each gait retraining session were calculated and analyzed using a mixed repeated measures ANOVA. SR and running volume were derived from the cellular application exports and compliance was defined as 1) maintaining an average SR within +/- two steps per minute of the target SR throughout each run and 2) maintaining the average running volume. Runners were assigned as “compliant” and “noncompliant”. A Fischer’s exact test was performed, and an odds ratio was calculated to determine association and likelihood of compliance between groups. Results: Both groups increased SR between the INTROpre and introductory posttest (INTROpost) (p \u3c.001), and the increase in SR was maintained at all other posttest timepoints (LABpost and SELFpost). There were no differences in PPA or peakHIPADD at any posttest timepoints regardless of group. No significant differences in RPE change scores between groups across time were found. There was a significant association between group and compliance (p = .05) and the MUS group was ~6 times as likely to comply with the self-administered gait retraining program. Conclusions: SR can be altered using either a metronome or music tempo. Both a metronome and music can be used as an auditory cue without creating increased perception of exertion. Runners using the music auditory cueing may continue to practice their new target SR more than runners assigned a metronome cueing, which provides rationale to use music to retrain SR within a self-administered gait retraining protocol. Running biomechanics may not have changed since SR was only increased by 5% so future research should repeat the current study methods using larger increases in SR

Drone-Driven Running:Exploring the Opportunities for Drones to Support Running Well-being through a Review of Running and Drone Interaction Technologies

There is an underexplored interaction space for drones that can be utilised as running interaction technology, distinct from human drone interaction that warrants foregrounding. This paper consolidates the current state of art in running interaction technology through a review of relevant studies and commercial technologies in a framework positioned using dimensions related to the form of interaction as identified in the sports ITECH framework. Our analysis highlights the unmet opportunities in running interaction technology and presents the potential of drones to further support runners. The potential of drones to support various forms of interaction are supported using exemplar research done in human-drone interaction. Through our findings, we hope to inform and expedite future research and practice in the field of running interaction technology and runner drone interaction by supporting researchers in defining and situating their contributions.</p

Robotic biofeedback for post-stroke gait rehabilitation: a scoping review

This review aims to recommend directions for future research on robotic biofeedback towards prompt post-stroke gait rehabilitation by investigating the technical and clinical specifications of biofeedback systems (BSs), including the complementary use with assistive devices and/or physiotherapist-oriented cues. A literature search was conducted from January 2019 to September 2022 on Cochrane, Embase, PubMed, PEDro, Scopus, and Web of Science databases. Data regarding technical (sensors, biofeedback parameters, actuators, control strategies, assistive devices, physiotherapist-oriented cues) and clinical (participants’ characteristics, protocols, outcome measures, BSs’ effects) specifications of BSs were extracted from the relevant studies. A total of 31 studies were reviewed, which included 660 stroke survivors. Most studies reported visual biofeedback driven according to the comparison between real-time kinetic or spatiotemporal data from wearable sensors and a threshold. Most studies achieved statistically significant improvements on sensor-based and clinical outcomes between at least two evaluation time points. Future research should study the effectiveness of using multiple wearable sensors and actuators to provide personalized biofeedback to users with multiple sensorimotor deficits. There is space to explore BSs complementing different assistive devices and physiotherapist-oriented cues according to their needs. There is a lack of randomized-controlled studies to explore post-stroke stage, mental and sensory effects of BSs.This work has been supported in part by the FEDER Funds through the COMPETE 2020—Programa Operacional Competitividade e Internacionalização (POCI) and P2020 with the Reference Project SmartOs Grant POCI-01-0247-FEDER-039868, and by FCT national funds, under the national support to R&D units grant, through the reference project UIDB/04436/2020 and UIDP/04436/2020, under scholarship reference 2020.05709.BD, and under Stimulus of Scientific Employment with the grant 2020.03393.CEECIND

The effect of changing mediolateral center of pressure on rearfoot eversion during treadmill running

INTRODUCTION: Atypical rearfoot eversion is an important kinematic risk factor in running-related injuries. Prominent interventions for atypical rearfoot eversion include foot orthoses, footwear, and taping, yet a running gait retraining is lacking. Therefore, the aim was to investigate the effects of changing mediolateral center of pressure (COP) on rearfoot eversion, subtalar pronation, medial longitudinal arch angle (MLAA), hip kinematics and vertical ground reaction force (vGRF). METHODS: Fifteen healthy female runners underwent gait retraining under three conditions. Participants were instructed to run normally, on the lateral (COP lateral) and medial (COP medial) side of the foot. Foot progression angle (FPA) was controlled using real-time visual feedback. 3D measurements of rearfoot eversion, subtalar pronation, MLAA, FPA, hip kinematics, vGRF and COP were analyzed. A repeated-measures ANOVA followed by pairwise comparisons was used to analyze changes in outcome between three conditions. Data were also analyzed using statistic parameter mapping. RESULTS: Running on the lateral side of the foot compared to normal running and running on the medial side of the foot reduced peak rearfoot eversion (mean difference (MD) with normal 3.3°, p < 0.001, MD with COP medial 6°, p < 0.001), peak pronation (MD with normal 5°, p < 0.001, MD with COP medial 9.6°, p=<0.001), peak MLAA (MD with normal 2.3°, p < 0.001, MD with COP medial 4.1°, p < 0.001), peak hip internal rotation (MD with normal 1.8°, p < 0.001), and peak hip adduction (MD with normal running 1°, p = 0.011). Running on the medial side of the foot significantly increased peak rearfoot eversion, pronation and MLAA compared to normal running. SIGNIFICANCE: This study demonstrated that COP translation along the mediolateral foot axis significantly influences rearfoot eversion, MLAA, and subtalar pronation during running. Running with either more lateral or medial COP reduced or increased peak rearfoot eversion, peak subtalar pronation, and peak MLAA, respectively, compared to normal running. These results might use as a basis to help clinicians and researchers prescribe running gait retraining by changing mediolateral COP for runners with atypical rearfoot eversion or MLAA

Optimizing beat synchronized running to music

The use of music and specifically tempo-matched music has been shown to affect running performance. But can we maximize the synchronization of movements to music and does maximum synchronization influence kinematics and motivation? In this study, we explore the effect of different types of music-to-movement alignment strategies on phase coherence, cadence and motivation. These strategies were compared to a control condition where the music tempo was deliberately not aligned to the running cadence. Results show that without relative phase alignment, a negative mean asynchrony (NMA) of footfall timings with respect to the beats is obtained. This means that footfalls occurred slightly before the beat and that beats were anticipated. Convergence towards this NMA or preferred relative phase angle was facilitated when the first music beat of a new song started close to the step, which means that entrainment occurred. The results also show that using tempo and phase alignment, the relative phase can be manipulated or forced in a certain angle with a high degree of accuracy. Ensuring negative angles larger than NMA (step before beat) results in increased motivation and decreasing cadence. Running in NMA or preferred relative phase angles results in a null effect on cadence. Ensuring a positive phase angle with respect to NMA results in higher motivation and higher cadence. None of the manipulations resulted in change in perceived exhaustion or a change in velocity. Results also indicate that gender plays an important role when using forced phase algorithms: effects were more pronounced for the female population than for the male population. The implementation of the proposed alignment strategies and control of beat timing while running opens possibilities optimizing the individual running cadence and motivation

Effects of Auditory Rhythm and Music on Gait Disturbances in Parkinson’s Disease

Gait abnormalities such as shuffling steps, start hesitation, and freezing are common and often incapacitating symptoms of Parkinson’s disease (PD) and other parkinsonian disorders. Pharmacological and surgical approaches have only limited efficacy in treating these gait disorders. Rhythmic auditory stimulation (RAS), such as playing marching music or dance therapy, has been shown to be a safe, inexpensive, and an effective method in improving gait in PD patients. However, RAS that adapts to patients’ movements may be more effective than rigid, fixed-tempo RAS used in most studies. In addition to auditory cueing, immersive virtual reality technologies that utilize interactive computer-generated systems through wearable devices are increasingly used for improving brain-body interaction and sensory-motor integration. Using multisensory cues, these therapies may be particularly suitable for the treatment of parkinsonian freezing and other gait disorders. In this review, we examine the affected neurological circuits underlying gait and temporal processing in PD patients and summarize the current studies demonstrating the effects of RAS on improving these gait deficits