Walking representation and simulation based on multi-source image fusion and multi-agent reinforcement learning for gait rehabilitation.

In the formulation of strategies for walking rehabilitation, achieving precise identification of the current state and making rational predictions about the future state are crucial but often unrealized. To tackle this challenge, our study introduces a unified framework that integrates a novel 3D walking motion capture method using multi-source image fusion and a walking rehabilitation simulation approach based on multi-agent reinforcement learning. We found that, (i) the proposal achieved an accurate 3D walking motion capture and outperforms other advanced methods. Experimental evidence indicates that, compared to similar visual skeleton tracking methods, the proposed approach yields results with higher Pearson correlation (r=0.93), intra-class correlation coefficient (ICC(2,1)=0.91), and narrower confidence intervals ([0.90,0.95] for r, [0.88,0.94] for ICC(2,1)) when compared to standard results. The outcomes of the proposed approach also exhibit commendable correlation and concurrence with those obtained through the IMU-based skeleton tracking method in the assessment of gait parameters ([0.85,0.89] for r, [0.75,0.81] for ICC(2,1)); (ii) multi-agent reinforcement learning has the potential to be used to solve the simulation task of gait rehabilitation. In mimicry experiment, our proposed simulation method for gait rehabilitation not only enables the intelligent agent to converge from the initial state to the target state, but also observes evolutionary patterns similar to those observed in clinical practice through motor state resolution. This study offers valuable contributions to walking rehabilitation, enabling precise assessment and simulation-based interventions, with potential implications for clinical practice and patient outcomes.

Theory of Biomechanical Evolution of the Rheumatoid Foot: A Narrative Review.

BACKGROUND: In patients with rheumatoid arthritis (RA), the pathological progression of lower limb biomechanics is established. Although specific aspects of RA gait patterns have been studied and described, we are aware of no studies of gait pattern compensations over the entire disease course. This study aimed to describe a model that could predict the evolution of lower limb pathomechanics in patients with RA. METHODS: A literature review was conducted of electronic databases (MEDLINE, PEDro, Trip Database, DOAJ, BioMed Central, PLOS clinical trial, ScienceDirect, and CRD York University, AHRQ, NICE, Cochrane Library) to October 3, 2023. RESULTS: A theory was developed that all people with RA induce or augment gait evolution syndromes following the same biomechanical course. Specifically, we postulate the "rheumatoid equinus syndrome," the "rheumatoid abnormal pronation syndrome" and the "rheumatoid shuffle syndrome," which have never been described before. CONCLUSIONS: A new model of the evolution of gait compensation in RA is proposed. An important challenge of RA is that it increases the risk of ulcerative lesions, falls, pain, fractures, and healthcare costs. The proposed model can be used to reduce morbidity in this patient group by helping to explain and reduce the pain, deformity, and ankylosis of foot RA.

A gamified virtual environment intervention for gait rehabilitation in Parkinson's Disease: co-creation and feasibility study.

BACKGROUND: Treadmill gait training has been shown to improve gait performance in People with Parkinson's Disease (PwPD), and in combination with Virtual Reality, it can be an effective tool for gait rehabilitation. The addition of gamification elements can create a more stimulating and adherent intervention. However, implementation of new technologies in healthcare can be challenging. This study aimed to develop and evaluate the feasibility of a treadmill rehabilitation program in a Gamified Virtual Reality Environment (GVRE) for PwPD. METHODS: The GVRE was developed following a user-centered design approach, involving both PwPD and physiotherapists in the development and evaluation of the intervention. The intervention consisted of a walking simulation in three different environments (countryside, city, and park), which had a progressive increase in difficulty. To test its feasibility, three sessions were carried out with four PwPD and four physiotherapists. To assess the usability, the System Usability Scale (SUS), Assistive Technology Usability Questionnaire for people with Neurological diseases (NATU Quest) and Simulator Sickness Questionnaire (SSQ) were used. To assess the intervention's acceptability, feedback and in-game performance was collected from participants. RESULTS: Results showed the feasibility of the intervention, with a SUS score of 74.82 ± 12.62, and a NATU Quest score of 4.49 ± 0.62, and positive acceptability feedback. Participants showed clear preferences for naturalistic environments, and gamification elements were seen as positive. Difficulty settings worked as intended, but lowered enjoyment of the experience in some cases. CONCLUSIONS: This intervention was successfully shown as a feasible option for the training of gait under Dual Task conditions for PwPD. It offers a safe and replicable environment in which complex situations can be trained. However, further iterations of the intervention need to be improved in order to guarantee accurate tracking and a more realistic training progression. TRIAL REGISTRATION NUMBER: NCT05243394-01/20/2022.

Effects of flexor reflex stimulation on gait aspects in stroke patients: randomized clinical trial.

BACKGROUND: Gait deficits are very common after stroke and therefore an important aspect in poststroke rehabilitation. A currently little used method in gait rehabilitation after stroke is the activation of the flexor reflex (FR) by electrical stimulation of the sole of foot while walking. The aim of this study was to investigate the effect of FR stimulation on gait performance and gait parameters in participants with stroke within a single session of flexor reflex stimulation using Incedo™. METHODS: Twenty-five participants with subacute (n = 14) and chronic (n = 11) stroke were enrolled in the study. Motor functions were tested with a 10-m walk test (10mWT), a 2-min walk test (2minWT), and a gait analysis. These tests were performed with and without Incedo™ within a single session in randomized order. RESULTS: In the 10mWT, a significant difference was found between walking with Incedo™ (15.0 ± 8.5 s) versus without Incedo™ (17.0 ± 11.4 s, p = 0.01). Similarly, the 2minWT showed a significant improvement with Incedo™ use (90.0 ± 36.4 m) compared to without Incedo™ (86.3 ± 36.8 m, p = 0.03). These results indicate that while the improvements are statistically significant, they are modest and should be considered in the context of their clinical relevance. The gait parameters remained unchanged except for the step length. A subgroup analysis indicated that participants with subacute and chronic stroke responded similarly to the stimulation. There was a correlation between the degree of response to electrostimulation while walking and degree of improvement in 2minWT (r = 0.50, p = 0.01). CONCLUSIONS: This study is the first to examine FR activation effects in chronic stroke patients and suggests that stimulation effects are independent of the time since stroke. A larger controlled clinical trial is warranted that addresses issues as the necessary number of therapeutical sessions and for how long stimulation-induced improvements outlast the treatment period. TRIAL REGISTRATION: The trial was retrospectively registered in German Clinical Trials Register. CLINICAL TRIAL REGISTRATION NUMBER: DRKS00021457. Date of registration: 29 June 2020.

Proprioceptive Neuromuscular Facilitation (PNF)-Integrated Gait Rehabilitation Following Total Hip Arthroplasty.

As a type of aseptic osteonecrosis, femoral head avascular necrosis (AVN) is characterized by abnormal blood flow that results in osteocyte death and femoral head degradation. Trauma, alcohol abuse, corticosteroid usage, and a few underlying medical disorders are common reasons. A 46-year-old farmer who had acute femoral head damage and left hip pain is described in this case study as having undergone total hip arthroplasty (THA). The systematic plan of the physiotherapy intervention included patient education, joint restoration, pain management, prevention of complications, strengthening, proprioception, endurance, and task-oriented motor relearning activities. Over the course of four weeks, the patient demonstrated improvements in functional outcomes and pain levels, highlighting the significance of a thorough physiotherapy approach in the management of AVN following THA. For the best possible patient results, this case study emphasizes the importance of early detection, diagnosis, and a well-coordinated rehabilitation program.

Walking with unilateral ankle-foot unloading: a comparative biomechanical analysis of three assistive devices.

BACKGROUND: Foot and ankle unloading is essential in various clinical contexts, including ulcers, tendon ruptures, and fractures. Choosing the right assistive device is crucial for functionality and recovery. Yet, research on the impact of devices beyond crutches, particularly ankle-foot orthoses (AFOs) designed to unload the ankle and foot, is limited. This study investigates the effects of three types of devices-forearm crutches, knee crutch, and AFO-on biomechanical, metabolic, and subjective parameters during walking with unilateral ankle-foot unloading. METHODS: Twenty healthy participants walked at a self-selected speed in four conditions: unassisted able-bodied gait, and using three unloading devices, namely forearm crutches, iWalk knee crutch, and ZeroG AFO. Comprehensive measurements, including motion capture, force plates, and metabolic system, were used to assess various spatiotemporal, kinematic, kinetic, and metabolic parameters. Additionally, participants provided subjective feedback through questionnaires. The conditions were compared using a within-subject crossover study design with repeated measures ANOVA. RESULTS: Significant differences were found between the three devices and able-bodied gait. Among the devices, ZeroG exhibited significantly faster walking speed and lower metabolic cost. For the weight-bearing leg, ZeroG exhibited the shortest stance phase, lowest braking forces, and hip and knee angles most similar to normal gait. However, ankle plantarflexion after push-off using ZeroG was most different from normal gait. IWalk and crutches caused significantly larger center-of-mass mediolateral and vertical fluctuations, respectively. Participants rated the ZeroG as the most stable, but more participants complained it caused excessive pressure and pain. Crutches were rated with the highest perceived exertion and lowest comfort, whereas no significant differences between ZeroG and iWalk were found for these parameters. CONCLUSIONS: Significant differences among the devices were identified across all measurements, aligning with previous studies for crutches and iWalk. ZeroG demonstrated favorable performance in most aspects, highlighting the potential of AFOs in enhancing gait rehabilitation when unloading is necessary. However, poor comfort and atypical sound-side ankle kinematics were evident with ZeroG. These findings can assist clinicians in making educated decisions about prescribing ankle-foot unloading devices and guide the design of improved devices that overcome the limitations of existing solutions.

Investigating the Effects of a Kinematic Gait Parameter-Based Haptic Cue on Toe Clearance in Parkinson's Patients.

Recurrent falls pose a significant challenge for Parkinson's disease (PD) patients and are a leading cause of disability in this population. One contributing factor to these recurring falls is the reduced minimum toe clearance (mTC). Preventing such falls by enhancing mTC has become an important goal in gait training among PD patients. In this paper, we propose a wearable cueing-based novel gait training device in anticipation of improved mTC. The cueing device records the foot strike angle (FSA) and cues the participants if the FSA is observed above a threshold. The patients with PD (n = 8) were recruited and asked to walk under two conditions: (a) with cue and (b) without cue at a self-selected speed during the ON medication state. Kinetic and kinematic gait parameters such as vertical ground reaction force, center of pressure, toe clearance, and FSA were recorded. A Mann-Whitney U test showed a significant increase (p < 0.001) in the toe clearance (within 34% to 64% of the swing phase from the toe-off instance) and FSA, from 87.60 mm and - 5.43degrees respectively during without cue to 94.29 mm and 2.93degrees respectively during with cue walking condition except in one subject. These findings support the potential incorporation of an FSA-based cueing device for toe clearance improvement among PD patients. In addition, the wearable setup supports the cueing device applicability outside laboratory and home settings.

Adaptive auditory assistance for stride length cadence modification in older adults and people with Parkinson's.

Gait rehabilitation using auditory cues can help older adults and people with Parkinson's improve walking performance. While auditory cues are convenient and can reliably modify gait cadence, it is not clear if auditory cues can reliably modify stride length (SL), another key gait performance metric. Existing algorithms also do not address habituation or fluctuation in motor capability, and have not been evaluated with target populations or under dual-task conditions. In this study, we develop an adaptive auditory cueing framework that aims to modulate SL and cadence. The framework monitors the gait parameters and learns a personalized cue-response model to relate the gait parameters to the input cues. The cue-response model is represented using a multi-output Gaussian Process (MOGP) and is used during optimization to select the cue to provide. The adaptive cueing approach is benchmarked against the fixed approach, where cues are provided at a fixed cadence. The two approaches are tested under single and dual-task conditions with 13 older adults (OA) and 8 people with Parkinson's (PwP). The results show that more than half of the OA and PwP in the study can change both SL and cadence using auditory cues. The fixed approach is best at changing people's gait without secondary task, however, the addition of the secondary task significantly degrades effectiveness at changing SL. The adaptive approach can maintain the same level of SL change regardless of the presence of the secondary task. A separate analysis is conducted to identify factors that influence the performance of the adaptive framework. Gait information from the previous time step, along with the previous input cue, can improve its prediction accuracy. More diversity in the initialization data can also improve the GP model. Finally, we did not find a strong correlation between stride length and cadence when the parameters are contingent upon input cues.

Boosting lower-limb motor imagery performance through an ensemble method for gait rehabilitation.

Lower-limb exoskeletons have been used extensively in many rehabilitation applications to assist disabled people with their therapies. Brain-machine interfaces (BMIs) further provide effective and natural control schemes. However, the limited performance of brain signal decoding from lower-limb kinematics restricts the broad growth of both BMI and rehabilitation industry. To address these challenges, we propose an ensemble method for lower-limb motor imagery (MI) classification. The proposed model employs multiple techniques to boost performance, including deep and shallow parts. Traditional wavelet transformation followed by filter-bank common spatial pattern (CSP) employs neurophysiologically reasonable patterns, while multi-head self-attention (MSA) followed by temporal convolutional network (TCN) extracts deeper encoded generalized patterns. Experimental results in a customized lower-limb exoskeleton on 8 subjects in 3 consecutive sessions showed that the proposed method achieved 60.27% and 64.20% for three (MI of left leg, MI of right leg, and rest) and two classes (lower-limb MI vs. rest), respectively. Besides, the proposed model achieves improvements of up to 4% and 2% accuracy for the subject-specific and subject-independent modes compared to the current state-of-the-art (SOTA) techniques, respectively. Finally, feature analysis was conducted to show discriminative brain patterns in each MI task and sessions with different feedback modalities. The proposed models integrated in the brain-actuated lower-limb exoskeleton established a potential BMI for gait training and neuroprosthesis.

Biomechanical Effects of Manipulating Preferred Cadence During Treadmill Walking in Patients With ACL Reconstruction.

BACKGROUND: Abnormal gait is common after anterior cruciate ligament reconstruction (ACLR) which may influence osteoarthritis risk in this population. Yet few gait retraining options currently exist in ACLR rehabilitation. Cueing cadence changes is a simple, low-cost method that can alter walking mechanics in healthy adults, but few studies have tested its effectiveness in an ACLR population. Here, we evaluated the acute effects of altering cadence on knee mechanics in patients 9 to 12 months post ACLR. HYPOTHESIS: Cueing larger steps will facilitate larger knee angles and moments, while cueing smaller steps would induce smaller knee angles and moments. STUDY DESIGN: Randomized cross-sectional design. LEVEL OF EVIDENCE: Level 3. METHODS: Twenty-eight patients with unilateral ACLR underwent gait assessments on a treadmill at preferred pace. Preferred walking gait was assessed first to obtain preferred cadence. Participants then completed trials while matching an audible beat set to 90% and 110% of preferred cadence in a randomized order. Three-dimensional sagittal and frontal plane biomechanics were evaluated bilaterally. RESULTS: Compared with preferred cadence, cueing larger steps induced larger peak knee flexion moments (KFMs) and knee extension excursions bilaterally (P < 0.01), whereas cueing smaller steps only reduced knee flexion excursions (P < 0.01). Knee adduction moments remain unchanged across conditions and were similar between limbs (P > 0.05). Peak KFMs and excursions were smaller in the injured compared with uninjured limb (P < 0.01). CONCLUSION: Frontal plane gait outcomes were unchanged across conditions suggesting acute cadence manipulations result in mainly sagittal plane adaptations. Follow-up studies using a longitudinal cadence biofeedback paradigm may be warranted to elucidate the utility of this gait retraining strategy after ACLR. CLINICAL RELEVANCE: Cueing changes in walking cadence can target sagittal plane knee loading and joint range of motion in ACLR participants. This strategy may offer high clinical translatability given it requires relatively minimal equipment (ie, free metronome app) outside of a treadmill.

Defining characteristics of independent walking persons after stroke presenting with different arm swing coordination patterns.

BACKGROUND: Persons after stroke present with an altered arm swing during walking. Given the known influence of the arm swing on gait, it is important to identify the characteristics of persons with stroke with different arm-to-leg coordination patterns during walking. METHODS: Twenty-five persons after stroke walked on a self-paced treadmill at comfortable walking speed. The frequency of shoulder movements per stride was detected by Fast Fourier transform analysis on the kinematic data for hemiplegic shoulder movements in the sagittal plane. An independent-sample t-test or Mann-Whitney U test was used to compare clinical and biomechanical parameters between identified subgroups. RESULTS: Two earlier described subgroups based on the number of shoulder flexion-extension movements during one stride could be confirmed. Participants in the 1:1 ratio subgroup (one arm swing during one stride, N = 15) presented with a less upper limb impairment and less spasticity of the elbow extensors (p = 0.012) than the participants in the 2:1 ratio subgroup (two arm swings during one stride, N = 9). Although not significant, the participants in the 1:1 subgroup also seemed to have less spasticity of the shoulder internal rotators (p = 0.06) and a less walking variability based on the standard deviation of the step width. Further research on a greater sample should confirm these findings. CONCLUSION: Fast Fourier transform analysis was used to identify subgroups based on sagittal shoulder kinematics during walking. The clinical and gait related differences between the identified subgroups can be taken into account in future research investigating post-stroke gait interventions aiming to improve the arm swing.

Audiovisual biofeedback amplifies plantarflexor adaptation during walking among children with cerebral palsy.

BACKGROUND: Biofeedback is a promising noninvasive strategy to enhance gait training among individuals with cerebral palsy (CP). Commonly, biofeedback systems are designed to guide movement correction using audio, visual, or sensorimotor (i.e., tactile or proprioceptive) cues, each of which has demonstrated measurable success in CP. However, it is currently unclear how the modality of biofeedback may influence user response which has significant implications if systems are to be consistently adopted into clinical care. METHODS: In this study, we evaluated the extent to which adolescents with CP (7M/1F; 14 [12.5,15.5] years) adapted their gait patterns during treadmill walking (6 min/modality) with audiovisual (AV), sensorimotor (SM), and combined AV + SM biofeedback before and after four acclimation sessions (20 min/session) and at a two-week follow-up. Both biofeedback systems were designed to target plantarflexor activity on the more-affected limb, as these muscles are commonly impaired in CP and impact walking function. SM biofeedback was administered using a resistive ankle exoskeleton and AV biofeedback displayed soleus activity from electromyography recordings during gait. At every visit, we measured the time-course response to each biofeedback modality to understand how the rate and magnitude of gait adaptation differed between modalities and following acclimation. RESULTS: Participants significantly increased soleus activity from baseline using AV + SM (42.8% [15.1, 59.6]), AV (28.5% [19.2, 58.5]), and SM (10.3% [3.2, 15.2]) biofeedback, but the rate of soleus adaptation was faster using AV + SM biofeedback than either modality alone. Further, SM-only biofeedback produced small initial increases in plantarflexor activity, but these responses were transient within and across sessions (p > 0.11). Following multi-session acclimation and at the two-week follow-up, responses to AV and AV + SM biofeedback were maintained. CONCLUSIONS: This study demonstrated that AV biofeedback was critical to increase plantarflexor engagement during walking, but that combining AV and SM modalities further amplified the rate of gait adaptation. Beyond improving our understanding of how individuals may differentially prioritize distinct forms of afferent information, outcomes from this study may inform the design and selection of biofeedback systems for use in clinical care.

Biomechanical comparison of human trunk and thigh muscle activity during walking and horseback riding activity.

INTRODUCTION: Hippotherapy is a physical therapy tool that utilizes horseback riding to improve strength, coordination, gait, and balance. These benefits may be linked to similarities in kinematics and muscle activation between horseback riding and normal human gait, but this is not well represented in the literature, especially for muscle activation. The purpose of this study was to investigate the relationships between muscle activation of horseback riding and healthy human gait. METHODS: The muscle activation of nine healthy female participants (age 18-22) were recorded during walking and horseback riding trials using surface electromyography (EMG). Muscles analyzed include rectus abdominis, lumbar erector spinae, rectus femoris and biceps femoris. Activation waveforms during walking and riding were generated, and from this average and maximum contraction magnitudes were recorded. RESULTS: Average muscle activation was significantly greater in riding for the left (p = 0.008) and right (p = 0.04) biceps femoris. Additionally, average and maximal activation of the left erector spinae were significantly greater in riding (W = 4; critical value for W at n = 9 is 5). Remaining differences in muscle activation between walking and riding were non-significant. DISCUSSION: Peak and average muscle activation magnitude across the gait cycle were similar for most muscle groups. When present, differences were greater in riding. Despite these similarities, EMG waveforms displayed more predictable temporal patterns in walking. CONCLUSION: These findings suggest that hippotherapy could be used to elicit muscle excitation similar to that of normal gait, which may have promising implications for rehabilitation targeting gait correction.

Gait adaptation to asymmetric hip stiffness applied by a robotic exoskeleton.

Wearable exoskeletons show significant potential for improving gait impairments, such as interlimb asymmetry. However, a more profound understanding of whether exoskeletons are capable of eliciting neural adaptation is needed. This study aimed to characterize how individuals adapt to bilateral asymmetric joint stiffness applied by a hip exoskeleton, similar to split-belt treadmill training. Thirteen unimpaired individuals performed a walking trial on the treadmill while wearing the exoskeleton. The right side of the exoskeleton acted as a positive stiffness torsional spring, pulling the thigh towards the neutral standing position, while the left acted as a negative stiffness spring pulling the thigh away from the neutral standing position. The results showed that this intervention applied by a hip exoskeleton elicited adaptation in spatiotemporal and kinetic gait measures similar to split-belt treadmill training. These results demonstrate the potential of the proposed intervention for retraining symmetric gait.

Combined Ankle Robot Training and Robot-assisted Gait Training Improved the Gait Pattern of a Patient with Chronic Traumatic Brain Injury.

Background: : Walking disability caused by central nervous system injury often lingers. In the chronic phase, there is great need to improve walking speed and gait, even for patients who walk independently. Robot-assisted gait training (RAGT) has been widely used, but few studies have focused on improving gait patterns, and its effectiveness for motor function has been limited. This report describes the combination of "RAGT to learn the gait pattern" and "ankle robot training to improve motor function" in a patient with chronic stage brain injury. Case: : A 34-year-old woman suffered a traumatic brain injury 5 years ago. She had residual right hemiplegia [Fugl-Meyer Assessment-Lower Extremity (FMA-LE): 18 points] and mild sensory impairment, but she walked independently with a short leg brace and a cane. Her comfortable gait speed was 0.57 m/s without an orthosis, and her 6-m walk test distance was 240 m. The Gait Assessment and Intervention Tool (G.A.I.T.) score was 35 points. After hospitalization, ankle robot training was performed daily, with RAGT performed 10 times in total. Post-intervention evaluation performed on Day 28 showed: FMA-LE, 23 points; comfortable walking speed, 0.69 m/s; G.A.I.T., 27 points; and three-dimensional motion analysis showed ankle dorsiflexion improved from 3.22° to 12.59° and knee flexion improved from 1.75° to 16.54° in the swing phase. Discussion: : This is one of few studies to have examined the combination of two robots. Combining the features of each robot improved the gait pattern and motor function, even in the chronic phase.

A robotic treadmill system to mimic overground walking training with body weight support.

Introduction: Body weight support overground walking training (BWSOWT) is widely used in gait rehabilitation. However, existing systems require large workspace, complex structure, and substantial installation cost for the actuator, which make those systems inappropriate for the clinical environment. For wide clinical use, the proposed system is based on a self-paced treadmill, and uses an optimized body weight support with frame-based two-wire mechanism. Method: The Interactive treadmill was used to mimic overground walking. We opted the conventional DC motors to partially unload the body weight and modified pelvic type harness to allow natural pelvic motion. The performance of the proposed system on the measurement of anterior/posterior position, force control, and pelvic motion was evaluated with 8 healthy subjects during walking training. Results: We verified that the proposed system was the cost/space-effective and showed the more accurate anterior/posterior position than motion sensor, comparable force control performance, and natural pelvic motion. Discussion: The proposed system is cost/space effective, and able to mimic overground walking training with body weight support. In future work, we will improve the force control performance and optimize the training protocol for wide clinical use.

Designing Ecological Auditory Feedback on Lower Limb Kinematics for Hemiparetic Gait Training.

Auditory feedback has earlier been explored as a tool to enhance patient awareness of gait kinematics during rehabilitation. In this study, we devised and tested a novel set of concurrent feedback paradigms on swing phase kinematics in hemiparetic gait training. We adopted a user-centered design approach, where kinematic data recorded from 15 hemiparetic patients was used to design three feedback algorithms (wading sounds, abstract, musical) based on filtered gyroscopic data from four inexpensive wireless inertial units. The algorithms were tested (hands-on) by a focus group of five physiotherapists. They recommended that the abstract and musical algorithms be discarded due to sound quality and informational ambiguity. After modifying the wading algorithm (as per their feedback), we conducted a feasibility test involving nine hemiparetic patients and seven physiotherapists, where variants of the algorithm were applied to a conventional overground training session. Most patients found the feedback meaningful, enjoyable to use, natural-sounding, and tolerable for the typical training duration. Three patients exhibited immediate improvements in gait quality when the feedback was applied. However, minor gait asymmetries were found to be difficult to perceive in the feedback, and there was variability in receptiveness and motor change among the patients. We believe that our findings can advance current research in inertial sensor-based auditory feedback for motor learning enhancement during neurorehabilitation.

Immediate improvements in post-stroke gait biomechanics are induced with both real-time limb position and propulsive force biofeedback.

BACKGROUND: Paretic propulsion [measured as anteriorly-directed ground reaction forces (AGRF)] and trailing limb angle (TLA) show robust inter-relationships, and represent two key modifiable post-stroke gait variables that have biomechanical and clinical relevance. Our recent work demonstrated that real-time biofeedback is a feasible paradigm for modulating AGRF and TLA in able-bodied participants. However, the effects of TLA biofeedback on gait biomechanics of post-stroke individuals are poorly understood. Thus, our objective was to investigate the effects of unilateral, real-time, audiovisual TLA versus AGRF biofeedback on gait biomechanics in post-stroke individuals. METHODS: Nine post-stroke individuals (6 males, age 63 ± 9.8 years, 44.9 months post-stroke) participated in a single session of gait analysis comprised of three types of walking trials: no biofeedback, AGRF biofeedback, and TLA biofeedback. Biofeedback unilaterally targeted deficits on the paretic limb. Dependent variables included peak AGRF, TLA, and ankle plantarflexor moment. One-way repeated measures ANOVA with Bonferroni-corrected post-hoc comparisons were conducted to detect the effect of biofeedback on gait biomechanics variables. RESULTS: Compared to no-biofeedback, both AGRF and TLA biofeedback induced unilateral increases in paretic AGRF. TLA biofeedback induced significantly larger increases in paretic TLA than AGRF biofeedback. AGRF biofeedback increased ankle moment, and both feedback conditions increased non-paretic step length. Both types of biofeedback specifically targeted the paretic limb without inducing changes in the non-paretic limb. CONCLUSIONS: By showing comparable increases in paretic limb gait biomechanics in response to both TLA and AGRF biofeedback, our novel findings provide the rationale and feasibility of paretic TLA as a gait biofeedback target for post-stroke individuals. Additionally, our results provide preliminary insights into divergent biomechanical mechanisms underlying improvements in post-stroke gait induced by these two biofeedback targets. We lay the groundwork for future investigations incorporating greater dosages and longer-term therapeutic effects of TLA biofeedback as a stroke gait rehabilitation strategy. Trial registration NCT03466372.

Potential of the omnidirectional walking platform with virtual reality as a rehabilitation tool.

Introduction: The combination of virtual reality (VR) with an omnidirectional walking platform (ODWP) may have potential in rehabilitation settings. However, its use, acceptance, safety, and effectiveness are unclear. This preliminary study aims to understand the feasibility, safety, and user experience (including investigating the onset of cybersickness) while walking on the ODWP with fully immersive VR. Methods: Participants engaged with eight immersive VR walking scenarios. The scenarios were created using 360-degree videos and were programmed to run with the ODWP. Safety modifications for the ODWP were made, with the addition of parallel bars. Quantitative feedback on the perceived safety and acceptance of using VR with an ODWP for rehabilitation was collected. Cybersickness was evaluated using the Simulation Symptoms Questionnaire (SSQ). Results: Thirty-five participants (n = 8 physiotherapists, n = 27 healthy adults) were recruited for this study. The mean perceived safety score was 78.9/100 and acceptance was 64.5/100. Seventy-one percent of participants experienced mild to moderate symptoms of cybersickness as reported on the SSQ. The SSQ scores were not correlated to participant age or simulation exposure time. Conclusion: VR while using ODWP has the potential for rehabilitation, however, more consideration is needed to address acceptance and cybersickness.

Data on a novel approach examining the role of the cerebellum in gait performance improvement in patients with Parkinson disease receiving neurologic music therapy.

Individuals with idiopathic Parkinson's disease (PD) benefit from Rhythmic Auditory Stimulation (RAS) concerning gait impairment recovery. In PD, RAS may help eliciting rhythmic and automatized motor responses, including gait, by bypassing the deteriorated internal "clock" within basal ganglia for automatic and rhythmic motricity. We aimed at exploring the contribution of the cerebellum to this "bypass effect" in response to RAS. To this end, we examined the cerebellum-cerebral connectivity indices using conventional EEG recording to assess whether the cerebellum contributes to RAS-based post-training effects in persons with PD. Fifty PD patients were randomly assigned to an 8-week training program using Gait-Trainer3 with or without RAS. We measured the Functional Gait Assessment, the Unified Parkinson's Disease Rating Scale, the Berg Balance Scale, the Tinetti Falls Efficacy Scale, the 10-meter walking test, the timed up-and-go test, and the gait quality index derived from gait analysis before and after the end of the training. A standard EEG during gait on the GT3 was also recorded and submitted to eLORETA analysis. Particularly, we focused on the time course of the gait-related activities (which were characterized using the maximum amplitude vertex across the gait cycles) within each brain region of interest. These clinical and electrophysiological measures could be used to monitor the improvement in gait performance in standard clinical settings and to develop new rehabilitation protocols focusing on a holistic functional recovery approach.