RESUMEN
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.
Asunto(s)
Trastornos Neurológicos de la Marcha , Rehabilitación Neurológica , Paresia , Humanos , Fenómenos Biomecánicos , Retroalimentación , Marcha , Trastornos Neurológicos de la Marcha/rehabilitación , Extremidad Inferior , Paresia/rehabilitación , Rehabilitación Neurológica/métodosRESUMEN
BACKGROUND: Gait deficits are very common after stroke and improved therapeutic interventions are needed. The objective of this study was therefore to investigate the therapeutic use of the nociceptive withdrawal reflex to support gait training in the subacute post-stroke phase. METHODS: Individuals were randomly allocated to a treatment group that received physiotherapy-based gait training supported by withdrawal reflex stimulation and a control group that received physiotherapy-based gait training alone. Electrical stimuli delivered to the arch of the foot elicited the withdrawal reflex at heel-off with the purpose of facilitating the initiation and execution of the swing phase. Gait was assessed before and immediately after finishing treatment, and one month and six months after finishing treatment. Assessments included the Functional Ambulation Category (FAC) test, the preferred and maximum gait velocities, the duration of the stance phase in the hemiparetic side, the duration of the gait cycle, and the stance time symmetry ratio. RESULTS: The treatment group showed an improved post treatment preferred walking velocity (p < 0.001) and fast walking velocity (p < 0.001) compared to the control group. Furthermore, subjects in the treatment group with severe walking impairment at inclusion time showed the best improvement as assessed by a longer duration of the stance phase in the hemiparetic side (p < 0.002) and a shorter duration of the gait cycle (p < 0.002). The stance time symmetry ratio was significantly better for the treatment than the control group after finishing training (p < 0.02). No differences between groups were detected with the FAC test after finishing training (p = 0.09). CONCLUSION: Withdrawal reflex-based functional electrical therapy was useful in the rehabilitation of the hemiparetic gait of severely impaired patients.