Self-rehabilitation of acquired brain injury patients including neglect and attention deficit disorder with a tablet game in a clinical setting

We designed and evaluated a whack-a-mole (WAM) style game (see Figure 1) in a clinical randomized controlled trial (RCT) with reminder-assisted but self-initiated use over the period of a month with 43 participants from a post-lesion pool. While game play did not moderate rehabilitative progress indices of standard neuropsychological control tests, it did significantly improve in-game performance when compared to the control group. Its performance indicators and interaction data were highly accurate in predicting neglect and which hand the patients used for input. Patients found playing beneficial to their rehabilitation and attributed gains in the attention training properties of the game. The game showed potential for bedside assessment, insight support, and motivation by providing knowledge about rehabilitative progress

HearWalk: Co-designing and Building a Sound Feedback System for Hemiparetic Gait Training

BackgroundSound feedback has been increasingly explored as a tool to enhance motor learning during gait training by augmenting patient self-awareness. Hemiparetic patients (e.g., after stroke or traumatic brain injury) exhibit a large intra-group variability, making it important for assistive technology to be patient-tailored. It is recommended that patients and professionals are involved in development processes to increase usability and user acceptance.ObjectiveTo develop and test a sound feedback system with multiple feedback possibilities compatible with conventional gait training protocols.MethodsIn developing an auditory feedback system for gait training, our research employed a user-centric co-design approach in four iterative cycles of design, development, and evaluation. A focus group of therapists defined clinical scenarios, general patients’ needs, and proposed sound feedback ideas. After development, these strategies underwent scrutiny by the focus group. Feasibility studies with patient-therapist pairs assessed the clinical practicality and usability of the system. Subsequent iterations were shaped by patient and therapists’ insights, leading to a final portable wireless prototype made of inexpensive motion sensors, a mobile app, and a sound playback system.Takeaways and PerspectivesWe developed three use-case scenarios integrable with conventional gait training protocols. Patients exhibited variability in physical and cognitive abilities, auditory comprehension, and preferences, confirming that the system needs to be adjustable to individual patients. Further research will focus on specific patient subgroups and movement impairments. Despite the resource-intensive nature of user-centered design, this project adds evidence to that clinical stakeholder perspectives are crucial for the effective development of rehabilitation technology.<br/

Applying Concurrent Auditory Feedback on Swing Phase Kinematics in Hemiparetic Gait Training

Objective: Our goal was to develop and test a novel method to provide concurrent auditory feedback on limb angular velocity during the swing phase of walking in the context of hemiparetic gait rehabilitation. Design: The feedback stimulus was the sound of wading through water - a real-life situation where the swing phase generates sound. We achieved this using thigh and shank angular velocity signals to control pre-recorded flowing water sounds, and evaluated it in a feasibility test involving patients and physiotherapists. The feedback was applied as an add-on to conventional gait therapy in a case-by-case manner determined by the physiotherapists.Setting: Patients performed overground walking training in a 20 m hospital corridor using their preferred assistive devices.Participants: Nine hemiparetic stroke patients (5M, 4F, aged 55.44 ± 16.08 y/o) along with seven physiotherapists (13 ± 10.5 years of clinical experience).Interventions: Three feedback variants were tested in a user-adjustable format: Plain wading sound - A direct translation of their movements to a wading sound.Negative reinforcement - A urinating sound if the forward limb rotation was not fast enough.Positive reinforcement - A splash if a target forward rotation velocity was achieved.https://drive.google.com/drive/folders/1LWHEXB1K9ZZsX9zDFKkhVOesTqoP1Gg2?usp=share_linkMain Outcome Measure(s): Kinematic characterizations with and without feedback.Results: The patients exhibited substantial variability in their response to the feedback but three of them exhibited immediately observable improvements in kinematic quality (cadence, step periodicity, knee extension control) and most reported positive subjective experiences. Most therapists expressed that the core idea had potential for everyday adoption, while some found the positive and negative feedback variants too complex for the users.Conclusions: We believe that the clinical potential of this form of swing phase feedback is worthy of further investigation.<br/

Designing Sonified Feedback on Knee Kinematics in Hemiparetic Gait Based on Inertial Sensor Data

In recent years, interactive sonification based on data from wearable sensors has been explored as a feedback tool in movement rehabilitation. However, it is yet to be routinely adopted as part of physiotherapy protocols, partly due to challenges with designing solutions tailored to diverse patients. In this work, we propose a set of adaptable feedback paradigms on knee kinematics for hemiparetic stroke patients undergoing gait training. We first collected inertial data and video footage from 15 hemiparetic patients during overground walking. The video footage was then analyzed by a physiotherapist, who identified three main knee related movement impairments - reduced range of motion, dysregulated extension, and hyperextension. Using a custombuilt software architecture, we devised two music-based paradigms for providing tailored concurrent feedback on knee movement and the impairments identified by the physiotherapist based on inertial data. The paradigms will be clinically tested with patients as part of a future study, and we believe that their impairment-specificity and individual adjustability will make them an advancement of existing auditory feedback designs.In: Pauletto, S., Delle Monache, S. and Selfridge, R. (Eds) Proceedings of the Conference on Sonification of Health and Environmental Data (SoniHED 2022). ISBN: 978-91-8040-358-

User-Centered Design of Auditory Feedback for Hemiparetic Gait Rehabilitation

Auditory biofeedback has been increasingly explored as a tool to enhance motor learning during gait rehabilitation by augmenting patient self-awareness of their kinematics [3]. Hemiparetic patients (e.g. after stroke or traumatic brain injury) exhibit considerable intra-group variability in terms of impairment types and mobility level. Therefore, it is important for assistive technological systems to be patient-tailored and flexible in order to cater to the inherent diversity of individual therapy needs [2]. To achieve this, it has long been recommended that patients and professionals be systematically and meaningfully involved in the development process, which typically involves several iterations of design and testing with the ultimate goal of increasing usability and user acceptance [1]. However, this type of methodology is not the norm due to time/budget constraints and challenges in working with interdisciplinary groups [1,2]. We have, together with physiotherapists and hemiparetic patients, developed and tested a range of novel auditory feedback paradigms targeting hemiparetic gait using a novel technological system. We explored specific use-cases in which real-time feedback was provided on stance and swing phase kinematic characteristics such as limb and joint rotation, sometimes in combination with rhythmic cueing. The feedback stimuli have been designed to be goal-oriented, ecologically meaningful, and aesthetically acceptable to patients. Feasibility tests have been conducted with relevant patients. We showcase a hand-picked set of feedback types to demonstrate the devised use-cases and feedback design philosophy. We believe that this work is an important step in the realization of clinically usable auditory feedback systems for hemiparetic gait rehabilitation.ReferencesDabbs, A. D. V., Myers, B. A., Mc Curry, K. R., Dunbar-Jacob, J., Hawkins, R. P., Begey, A., &amp; Dew, M. A. (2009). User-centered design and interactive health technologies for patients. Computers, informatics, nursing: CIN, 27(3), 175.Lesaffre, M. (2018). Investigating embodied music cognition for health and well-being. Springer handbook of systematic musicology, 779-791.Linnhoff, D., Alizadeh, S., Schaffert, N., &amp; Mattes, K. (2020). Use of acoustic feedback to change gait patterns: Implementation and transfer to motor learning theory—A scoping review. Journal of Motor Learning and Development, 8(3), 598-618.<br/