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Liu LY, Sangani S, Patterson KK, Fung J, Lamontagne A. Application of an Auditory-Based Feedback Distortion to Modify Gait Symmetry in Healthy Individuals. Brain Sci 2024; 14:798. [PMID: 39199490 PMCID: PMC11352473 DOI: 10.3390/brainsci14080798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2024] [Revised: 08/02/2024] [Accepted: 08/05/2024] [Indexed: 09/01/2024] Open
Abstract
BACKGROUND Augmenting auditory feedback through an error-augmentation paradigm could facilitate the perception and correction of gait asymmetry in stroke survivors, but how such a paradigm should be tailored to individual asymmetry profiles remains unclear. Before implementing the paradigm in rehabilitation, we need to investigate the instantaneous effects of distorted footstep sound feedback on gait symmetry in healthy young adults. METHODS Participants (n = 12) walked on a self-paced treadmill while listening to their footstep sounds, which were distorted unilaterally according to five conditions presented randomly: small delay; small advance; large delay; large advance; or unmodified (control). The primary outcomes were swing time ratio (SWR) and step length ratio (SLR). Secondary outcomes included walking speed, bilateral swing time, step length, and maximum toe height, as well as hip, knee, and ankle angle excursions. RESULTS SWR (p < 0.001) but not SLR (p ≥ 0.05) was increased in all distorted feedback conditions compared to the control condition. Increased swing time on the perturbed side ipsilateral to feedback distortion was observed in the advanced conditions (p < 0.001), while swing time increased bilaterally in the delayed conditions (p < 0.001) but to a larger extent on the unperturbed side contralateral to feedback distortion. Increases in swing time were accompanied by larger maximum toe height as well as larger hip and knee joint excursions (p < 0.05 to p < 0.001). No differences in any outcomes were observed between small and large feedback distortion magnitudes. CONCLUSIONS Distorted footstep sound feedback successfully elicits adaptation in temporal gait symmetry (SWR), with distinct modulation patterns for advanced vs. delayed footstep sounds. Spatial symmetry (SLR) remains unaltered, likely because auditory feedback primarily conveys temporal information. This research lays the groundwork to implement personalized augmented auditory feedback in neurorehabilitation.
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Affiliation(s)
- Le Yu Liu
- School of Physical and Occupational Therapy, McGill University, Montreal, QC H3G1Y5, Canada
- Feil and Oberfeld Research Centre, Jewish Rehabilitation Hospital Site of CISSS-Laval and Research Site of the Montreal Centre for Interdisciplinary Research in Rehabilitation (CRIR), Laval, QC H7V1R2, Canada
| | - Samir Sangani
- Feil and Oberfeld Research Centre, Jewish Rehabilitation Hospital Site of CISSS-Laval and Research Site of the Montreal Centre for Interdisciplinary Research in Rehabilitation (CRIR), Laval, QC H7V1R2, Canada
| | - Kara K. Patterson
- Department of Physical Therapy and Rehabilitation Science Institute, University of Toronto, Toronto, ON M5G1V7, Canada
- KITE-Toronto Rehabilitation Institute, Toronto, ON M5G2A2, Canada
| | - Joyce Fung
- School of Physical and Occupational Therapy, McGill University, Montreal, QC H3G1Y5, Canada
- Feil and Oberfeld Research Centre, Jewish Rehabilitation Hospital Site of CISSS-Laval and Research Site of the Montreal Centre for Interdisciplinary Research in Rehabilitation (CRIR), Laval, QC H7V1R2, Canada
| | - Anouk Lamontagne
- School of Physical and Occupational Therapy, McGill University, Montreal, QC H3G1Y5, Canada
- Feil and Oberfeld Research Centre, Jewish Rehabilitation Hospital Site of CISSS-Laval and Research Site of the Montreal Centre for Interdisciplinary Research in Rehabilitation (CRIR), Laval, QC H7V1R2, Canada
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Shoja O, Shojaei M, Hassanlouei H, Towhidkhah F, Zhang L. Quantifying Human Gait Symmetry During Blindfolded Treadmill Walking. Motor Control 2024; 28:225-240. [PMID: 38402881 DOI: 10.1123/mc.2023-0028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Revised: 12/20/2023] [Accepted: 01/05/2024] [Indexed: 02/27/2024]
Abstract
Bilateral gait symmetry is an essential requirement for normal walking since asymmetric gait patterns increase the risk of falls and injuries. While human gait control heavily relies on the contribution of sensory inputs, the role of sensory systems in producing symmetric gait has remained unclear. This study evaluated the influence of vision as a dominant sensory system on symmetric gait production. Ten healthy adults performed treadmill walking with and without vision. Twenty-two gait parameters including ground reaction forces, joint range of motion, and other spatial-temporal gait variables were evaluated to quantify gait symmetry and compared between both visual conditions. Visual block caused increased asymmetry in most parameters of ground reaction force, however mainly in the vertical direction. When vision was blocked, symmetry of the ankle and knee joint range of motion decreased, but this change did not occur in the hip joint. Stance and swing time symmetry decreased during no-vision walking while no significant difference was found for step length symmetry between the two conditions. This study provides a comprehensive analysis to reveal how the visual system influences bilateral gait symmetry and highlights the important role of vision in gait control. This approach could be applied to investigate how vision alters gait symmetry in patients with disorders to help better understand the role of vision in pathological gaits.
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Affiliation(s)
- Otella Shoja
- Faculty of Sport Sciences, Department of Motor Behavior, Alzahra University, Tehran, Iran
- Center for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR), Montreal, QC, Canada
- Department of Neuroscience, Institute of Biomedical Engineering, University of Montreal, Montreal, QC, Canada
| | - Masoumeh Shojaei
- Faculty of Sport Sciences, Department of Motor Behavior, Alzahra University, Tehran, Iran
| | - Hamidollah Hassanlouei
- Faculty of Sport Science and Health, Department of Motor Behavior, Shahid Beheshti University, Tehran, Iran
| | - Farzad Towhidkhah
- Department of Biomedical Engineering, Amirkabir University of Technology, Tehran, Iran
| | - Lei Zhang
- Institute for Neural Computation, Ruhr University Bochum, Bochum, Germany
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Galvão WR, Castro Silva LK, Viana RT, Oliveira PHA, Jucá RVBDM, Martins HR, Rabelo M, Fachin-Martins E, Lima LAO. Application of the participatory design in the testing of a baropodometric insole prototype for weight-bearing asymmetry after a stroke: A qualitative study. Hong Kong J Occup Ther 2024; 37:21-30. [PMID: 38912104 PMCID: PMC11192430 DOI: 10.1177/15691861241241776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Accepted: 03/10/2024] [Indexed: 06/25/2024] Open
Abstract
Introduction Currently studies indicate the need to incorporate the user`s perspective in the testing of new assistive technologies. The objective of this paper is to test a baropodometric insole prototype for monitoring and treatment weight-bearing asymmetry, according to the Participatory Design. Methods We used a qualitative case study approach during the testing phase of the baropodometric insole prototype. The focus group approach addressed topics related to the experience and accessibility of the potential user in conjunction with professionals, researchers, and physiotherapy students. Facilitators, barriers, and requirements for the device were collected through audio recordings of the discussions during and after prototype testing. Results Key steps in the prototype testing process were divided into (1) Test of the prototype according to the Participatory Design, divided into Who, When, How, and Why the potential user was involved in the study; and (2) Facilitators, barriers and requirements to improve the prototype. Conclusions The baropodometric insole prototype can be seen as a promising device for monitoring and treating weight-bearing asymmetry.
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Gouda A, Andrysek J. The Development of a Wearable Biofeedback System to Elicit Temporal Gait Asymmetry using Rhythmic Auditory Stimulation and an Assessment of Immediate Effects. SENSORS (BASEL, SWITZERLAND) 2024; 24:400. [PMID: 38257494 PMCID: PMC10819290 DOI: 10.3390/s24020400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Revised: 01/03/2024] [Accepted: 01/06/2024] [Indexed: 01/24/2024]
Abstract
Temporal gait asymmetry (TGA) is commonly observed in individuals facing mobility challenges. Rhythmic auditory stimulation (RAS) can improve temporal gait parameters by promoting synchronization with external cues. While biofeedback for gait training, providing real-time feedback based on specific gait parameters measured, has been proven to successfully elicit changes in gait patterns, RAS-based biofeedback as a treatment for TGA has not been explored. In this study, a wearable RAS-based biofeedback gait training system was developed to measure temporal gait symmetry in real time and deliver RAS accordingly. Three different RAS-based biofeedback strategies were compared: open- and closed-loop RAS at constant and variable target levels. The main objective was to assess the ability of the system to induce TGA with able-bodied (AB) participants and evaluate and compare each strategy. With all three strategies, temporal symmetry was significantly altered compared to the baseline, with the closed-loop strategy yielding the most significant changes when comparing at different target levels. Speed and cadence remained largely unchanged during RAS-based biofeedback gait training. Setting the metronome to a target beyond the intended target may potentially bring the individual closer to their symmetry target. These findings hold promise for developing personalized and effective gait training interventions to address TGA in patient populations with mobility limitations using RAS.
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Affiliation(s)
- Aliaa Gouda
- Institute of Biomedical Engineering, University of Toronto, Toronto, ON M5S 3G9, Canada;
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, ON M4G 1R8, Canada
| | - Jan Andrysek
- Institute of Biomedical Engineering, University of Toronto, Toronto, ON M5S 3G9, Canada;
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, ON M4G 1R8, Canada
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Johnson K, Liang H. Effect of unilateral ankle loading on gait symmetry in young adults. Gait Posture 2023; 104:120-125. [PMID: 37393845 DOI: 10.1016/j.gaitpost.2023.06.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Revised: 06/21/2023] [Accepted: 06/27/2023] [Indexed: 07/04/2023]
Abstract
BACKGROUND Walking requires constant adjustments to the changing environment. An asymmetrical perturbation can affect the gait symmetry, cause gait adaptations, and potentially induce retention of the adapted gait after removal of the perturbation. A unilateral ankle load has the potential to create asymmetry and facilitate the emergence of new gait patterns. However, few studies have examined the effect of unilateral loading on muscular adjustments during walking. The purpose of this study was to investigate gait adaptations and muscular adjustments after unilaterally loading or unloading the ankle. RESEARCH QUESTION What are the effects of unilateral loading and unloading on gait spatiotemporal parameters and muscle activation in young adults? METHODS Twenty young adults (10 M/10 F) walked on a treadmill at their preferred walking speeds in 3 conditions: 1) a 2-minute baseline trial; 2) three 5-minute trials with a load (3 % of bodyweight) on the dominant ankle (Loading); and 3) one 5-minute trial with the load removed (Unloading). Inertial measurement units (IMUs) and electromyography sensors (EMGs) were used for data collection. Early and late adaptation and post-adaptation were assessed using the first 5 strides and the last 30 strides of loading and unloading conditions. Outcome measures included symmetry index (SI) of spatiotemporal parameters, range-of-motion (ROM) of the lower body joints, and EMG integrals of leg muscles. Repeated measures ANOVA was conducted for statistical analysis (α = 0.05). RESULTS SI of swing phase percentage demonstrated rapid adaptation after unilateral loading or unloading. Stride length demonstrated an aftereffect following unloading. Young adults reduced ankle ROMs bilaterally in early adaptation and increased loaded-side knee and hip ROMs in late adaptation. Additionally, they increased the tibialis anterior activity bilaterally immediately after unilateral loading. SIGNIFICANCE Young adults showed an aftereffect in some variables after unilateral unloading, signifying that unilateral ankle loading can induce short term learning of a new gait pattern.
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Affiliation(s)
- Kaylan Johnson
- School of Physical Therapy, Marshall University, Huntington, WV, USA
| | - Huaqing Liang
- School of Physical Therapy, Marshall University, Huntington, WV, USA.
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Crosby LD, Chen JL, Grahn JA, Patterson KK. The Effect of Rhythm Abilities on Metronome-Cued Walking with an Induced Temporal Gait Asymmetry in Neurotypical Adults. J Mot Behav 2021; 54:267-280. [PMID: 34334109 DOI: 10.1080/00222895.2021.1953959] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
ABSRACT. Human gait is inherently rhythmical, thus walking to rhythmic auditory stimulation is a promising intervention to improve temporal gait asymmetry (TGA) following neurologic injury such as stroke. However, the degree of benefit may relate to an individual's underlying rhythmic ability. We conducted an initial investigation into the relationship between rhythm abilities and responsiveness of TGA when walking to a metronome. TGA was induced in neurotypical young adults with ankle and thigh cuff weights. Participants were grouped by strong or weak rhythm ability based on beat perception and production tests. TGA was induced using a unilateral load affixed to the non-dominant leg. Participants walked under three conditions: uncued baseline, metronome set to 100% of baseline cadence, and metronome set to 90% of baseline cadence. Repeated measures analysis using generalized estimating equations was conducted to determine how rhythm ability affected TGA response in each walking condition. Most participants improved TGA when walking to a metronome at either tempo compared to baseline; however, this improvement did not differ between strong and weak rhythm ability groups. Those who scored worse on the rhythm perception test also were poorer at synchronizing their steps to the beat. The induced TGA is smaller than what is commonly experienced after stroke. A larger induced TGA may be necessary to reveal subtle differences in responsiveness to rhythmical auditory stimulation between those with strong and weak rhythm abilities.
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Affiliation(s)
- Lucas D Crosby
- Rehabilitation Sciences Institute, University of Toronto, Toronto, Canada
| | - Joyce L Chen
- Rehabilitation Sciences Institute, University of Toronto, Toronto, Canada.,Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, Canada
| | - Jessica A Grahn
- Brain and Mind Institute, Department of Psychology, University of Western Ontario, London, Canada
| | - Kara K Patterson
- Rehabilitation Sciences Institute, University of Toronto, Toronto, Canada.,Department of Physical Therapy, University of Toronto, Toronto, Canada.,KITE Toronto Rehabilitation Institute, University Health Network, Toronto, Canada
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