Rhythmic Haptic Cueing Using Wearable Devices as Physiotherapy for Huntington Disease: Case Study

Using rhythm for rehabilitation: the acceptability of a novel haptic cueing device in extended stroke rehabilitation

Purpose

Restoration of walking ability is a key goal to both stroke survivors and their therapists. However, the intensity and duration of rehabilitation available after stroke can be limited by service constraints, despite the potential for improvement which could reduce health service demands in the long run. The purpose of this paper is to present qualitative findings from a study that explored the acceptability of a haptic device aimed at improving walking as part of an extended intervention in stroke rehabilitation.

Design/methodology/approach

Pre-trial focus groups and post-trial interviews to assess the acceptability of Haptic Bracelets were undertaken with seven stroke survivors.

Findings

Five themes were identified as impacting on the acceptability of the Haptic Bracelet: potential for improving quality of life; relationships with technology; important features; concerns; response to trial and concentration. Participants were interested in the haptic bracelet and hoped it would provide them with more confidence making them: feel safer when walking; have greater ability to take bigger strides rather than little steps; a way to combat mistakes participants reported making due to tiredness and reduced pain in knees and hips.

Originality/value

Haptic Bracelets are an innovative development in the field of rhythmic cueing and stroke rehabilitation. The haptic bracelets also overcome problems encountered with established audio-based cueing, as their use is not affected by external environmental noise.

Peer review

The peer review history for this article is available at: https://publons.com/publon 10.1108/JET-01-2021-0003

Recent Trends and Practices Toward Assessment and Rehabilitation of Neurodegenerative Disorders: Insights From Human Gait

The study of human movement and biomechanics forms an integral part of various clinical assessments and provides valuable information toward diagnosing neurodegenerative disorders where the motor symptoms predominate. Conventional gait and postural balance analysis techniques like force platforms, motion cameras, etc., are complex, expensive equipment requiring specialist operators, thereby posing a significant challenge toward translation to the clinics. The current manuscript presents an overview and relevant literature summarizing the umbrella of factors associated with neurodegenerative disorder management: from the pathogenesis and motor symptoms of commonly occurring disorders to current alternate practices toward its quantification and mitigation. This article reviews recent advances in technologies and methodologies for managing important neurodegenerative gait and balance disorders, emphasizing assessment and rehabilitation/assistance. The review predominantly focuses on the application of inertial sensors toward various facets of gait analysis, including event detection, spatiotemporal gait parameter measurement, estimation of joint kinematics, and postural balance analysis. In addition, the use of other sensing principles such as foot-force interaction measurement, electromyography techniques, electrogoniometers, force-myography, ultrasonic, piezoelectric, and microphone sensors has also been explored. The review also examined the commercially available wearable gait analysis systems. Additionally, a summary of recent progress in therapeutic approaches, viz., wearables, virtual reality (VR), and phytochemical compounds, has also been presented, explicitly targeting the neuro-motor and functional impairments associated with these disorders. Efforts toward therapeutic and functional rehabilitation through VR, wearables, and different phytochemical compounds are presented using recent examples of research across the commonly occurring neurodegenerative conditions [viz., Parkinson's disease (PD), Alzheimer's disease (AD), multiple sclerosis, Huntington's disease (HD), and amyotrophic lateral sclerosis (ALS)]. Studies exploring the potential role of Phyto compounds in mitigating commonly associated neurodegenerative pathologies such as mitochondrial dysfunction, α-synuclein accumulation, imbalance of free radicals, etc., are also discussed in breadth. Parameters such as joint angles, plantar pressure, and muscle force can be measured using portable and wearable sensors like accelerometers, gyroscopes, footswitches, force sensors, etc. Kinetic foot insoles and inertial measurement tools are widely explored for studying kinematic and kinetic parameters associated with gait. With advanced correlation algorithms and extensive RCTs, such measurement techniques can be an effective clinical and home-based monitoring and rehabilitation tool for neuro-impaired gait. As evident from the present literature, although the vast majority of works reported are not clinically and extensively validated to derive a firm conclusion about the effectiveness of such techniques, wearable sensors present a promising impact toward dealing with neurodegenerative motor disorders.

Rhythmic Haptic Cueing for Gait Rehabilitation of People With Hemiparesis: Quantitative Gait Study

Background

Rhythm, brain, and body are closely linked. Humans can synchronize their movement to auditory rhythms in ways that can improve the regularity of movement while reducing perceived effort. However, the ability to perform rhythmic movement may be disrupted by various neurological conditions. Many such conditions impair mechanisms that control movement, such as gait, but typically without rhythmic perception being affected. This paper focuses on hemiparetic stroke, a neurological condition that affects one side of the body. Hemiparetic stroke can cause severe asymmetries in gait, leading to numerous physical problems ranging from muscle degeneration to bone fractures. Movement synchronization via entrainment to auditory metronomes is known to improve asymmetry and related gait problems; this paper presents the first systematic study of entrainment for gait rehabilitation via the haptic modality.

Objective

This paper explores the gait rehabilitation of people with hemiparesis following a stroke or brain injury, by a process of haptic entrainment to rhythmic cues. Various objective measures, such as stride length and stride time, are considered.

Methods

This study is a quantitative gait study combining temporal and spatial data on haptically cued participants with hemiparetic stroke and brain injury. We designed wearable devices to deliver the haptic rhythm, called Haptic Bracelets, which were placed on the leg near the knee. Spatial data were recorded using a Qualisys optical motion capturing system, consisting of 8 optoelectronic cameras, and 20 markers placed on anatomical lower limb landmarks and 4 additional tracking clusters placed on the right and left shank and thigh. Gait characteristics were measured before, during, and after cueing.

Results

All 11 successfully screened participants were able to synchronize their steps to a haptically presented rhythm. Specifically, 6 participants demonstrated immediate improvements regarding their temporal gait characteristics, and 3 of the 6 improved their gait in terms of spatial characteristics.

Conclusions

Considering the great variability between survivors of stroke and brain injury and the limited number of available participants in our study, there is no claim of statistical evidence that supports a formal experimental result of improved gait. However, viewing this empirical gait investigation as a set of 11 case studies, more modest empirical claims can be made. All participants were able to synchronize 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 after, 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.