811 research outputs found
Recommended from our members
A longitudinal rehabilitation case study for hemiparetic gait using outdoor rhythmic haptic cueing via a wearable device
Introduction
Improvement of gait is a high priority for hemiparetic stroke survivors. Auditory rhythmic cueing is a proven method for improving gait via entrainment but use is limited outside the lab. The lack of use in outdoor settings seems to reflect the problem that auditory cueing can be distracting and isolating out of doors, where survivors typically need to remain safe, aware of the environment. In such settings, haptic cueing offers an unobtrusive, invisible, sociable, safe alternative.
Research Question
Existing studies have demonstrated improvements in temporal symmetry, increase in stride length and walking speed by means of post-stroke gait rehabilitation using wearable haptic devices in the lab. However, previous studies have been limited to laboratory settings and have focused on short-term improvements. By contrast, we present the first case study on the self-managed use of wearable haptics for gait rehabilitation via entrainment in outdoor settings, and the first findings from applying this technique over a number of days.
Methods
A longitudinal pilot study was conducted with a single hemiparetic participant providing rhythmic haptic cueing using a wearable haptic device for a two-week period. The participant was asked to walk in synchrony to the haptic rhythm at a suitable outdoor setting for a minimum of 10 minutes each day. Gait data was measured before and after the two-week intervention using lab-based IMU sensors.
Results
On comparing before and after gait characteristics, preliminary results showed substantial improvement in temporal symmetry and walking speed.
Conclusions
There is implications for potential long-term benefits for stroke survivors in gait rehabilitation using rhythmic haptic cueing. Improvements in temporal symmetry, increase in stride length and walking speed could improve confidence, independence and overall quality of life for stroke survivors, with implications for reduction of costs associated with care and rehabilitation
Wearable Haptic Devices for Gait Re-education by Rhythmic Haptic Cueing
This research explores the development and evaluation of wearable haptic devices for gait sensing and rhythmic haptic cueing in the context of gait re-education for people with neurological and neurodegenerative conditions. Many people with long-term neurological and neurodegenerative conditions such as Stroke, Brain Injury, Multiple Sclerosis or Parkinson’s disease suffer from 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 for in-the-wild applications with people having such conditions. This work aims to investigate the research question of how wearable haptic devices can help in long-term gait re-education using rhythmic haptic cueing. A longitudinal pilot study has been conducted with a brain trauma survivor, providing rhythmic haptic cueing using a wearable haptic device as a therapeutic intervention for a two-week period. Preliminary results comparing pre and post-intervention gait measurements have shown improvements in walking speed, temporal asymmetry, and stride length. The pilot study has raised an array of issues that require further study. This work aims to develop and evaluate prototype systems through an iterative design process to make possible the self-managed use of such devices in-the-wild. These systems will directly provide therapeutic intervention for gait re-education, offer enhanced information for therapists, remotely monitor dosage adherence and inform treatment and prognoses over the long-term. This research will evaluate the use of technology from the perspective of multiple stakeholders, including clinicians, carers and patients. This work has the potential to impact clinical practice nationwide and worldwide in neuro-physiotherapy
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
Recommended from our members
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
Recommended from our members
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
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
Recommended from our members
How can rhythmic haptic cueing using wearable haptic devices help gait rehabilitation for stroke survivors: a longitudinal pilot study
Stroke is one of the leading causes for long-term adult disabilities. More than half of all stroke survivors depend on others for everyday activities after they are discharged from hospital. One of the conditions a stroke survivor may experience is hemiparetic gait. Typical characteristics of hemiparetic gait are: reduced speed, increased step variability, spatial and temporal asymmetry. These, in turn, lead to joint pain, bone degeneration, higher risk of falls, and fracture. To improve health and daily activities, rehabilitation, and physiotherapy is an integral part of the recovery plan. Rehabilitation is commonly performed in a clinical setting however this kind of long-term care is expensive. Therefore, reliable in-house rehabilitation techniques are highly desirable. In addition, there is evidence in the literature to suggest home-based rehabilitation is often more beneficial to the patients.
Numerous studies have shown rhythmic cueing as a promising technique for post-stroke gait rehabilitation. Auditory rhythmic cueing has shown improvement in gait patterns. Specifically, auditory cueing can assist with improvements in temporal and spatial symmetry, along with increases in walking speed, step and stride length. However, auditory cueing may be obstructive in an outdoor setting while trying to listen for alerts or having a conversation with others.
In such settings, haptic (touch based) cueing can be highly effective as means of covert, unobstructive rhythmic cueing. Recent studies have shown promising results for rhythmic haptic cueing using wearable haptic devices for post-stroke gait rehabilitation with improvement in temporal symmetry, increase in stride length and walking speed. This could improve confidence, independence and overall quality of life for the stroke survivors, with implications for reduction of costs associated with care and rehabilitation. Long-term benefits are yet to be determined empirically. Therefore, a longitudinal, in-the-wild pilot study, has been conducted with a single brain trauma survivor, providing rhythmic haptic cueing using a wearable haptic device. Gait characteristics have been analysed by comparing before and after in-lab measurements from a two-week intervention. This study aims to provide insights into potential long-term benefits of rhythmic haptic cueing for a range of neurological conditions affecting gait
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
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
Recommended from our members
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
- …