Trainer in a pocket - proof-of-concept of mobile, real-time, foot kinematics feedback for gait pattern normalization in individuals after stroke, incomplete spinal cord injury and elderly patients

Background Walking disabilities negatively affect inclusion in society and quality of life and increase the risk for secondary complications. It has been shown that external feedback applied by therapists and/or robotic training devices enables individuals with gait abnormalities to consciously normalize their gait pattern. However, little is known about the effects of a technically-assisted over ground feedback therapy. The aim of this study was to assess whether automatic real-time feedback provided by a shoe-mounted inertial-sensor-based gait therapy system is feasible in individuals with gait impairments after incomplete spinal cord injury (iSCI), stroke and in the elderly. Methods In a non-controlled proof-of-concept study, feedback by tablet computer-generated verbalized instructions was given to individuals with iSCI, stroke and old age for normalization of an individually selected gait parameter (stride length, stance or swing duration, or foot-to-ground angle). The training phase consisted of 3 consecutive visits. Four weeks post training a follow-up visit was performed. Visits started with an initial gait analysis (iGA) without feedback, followed by 5 feedback training sessions of 2–3 min and a gait analysis at the end. A universal evaluation and FB scheme based on equidistant levels of deviations from the mean normal value (1 level = 1 standard deviation (SD) of the physiological reference for the feedback parameter) was used for assessment of gait quality as well as for automated adaptation of training difficulty. Overall changes in level over iGAs were detected using a Friedman’s Test. Post-hoc testing was achieved with paired Wilcoxon Tests. The users’ satisfaction was assessed by a customized questionnaire. Results Fifteen individuals with iSCI, 11 after stroke and 15 elderly completed the training. The average level at iGA significantly decreased over the visits in all groups (Friedman’s test, p < 0.0001), with the biggest decrease between the first and second training visit (4.78 ± 2.84 to 3.02 ± 2.43, p < 0.0001, paired Wilcoxon test). Overall, users rated the system’s usability and its therapeutic effect as positive. Conclusions Mobile, real-time, verbalized feedback is feasible and results in a normalization of the feedback gait parameter. The results form a first basis for using real-time feedback in task-specific motor rehabilitation programs. Trial registration DRKS00011853, retrospectively registered on 2017/03/23. Electronic supplementary material The online version of this article (10.1186/s12984-018-0389-4) contains supplementary material, which is available to authorized users.

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PID https://www.doi.org/10.1186/s12984-018-0389-4
PID pmc:PMC5975685
PID pmid:29843763
URL http://archiv.ub.uni-heidelberg.de/volltextserver/24634/
URL https://rd.springer.com/article/10.1186/s12984-018-0389-4
URL http://link.springer.com/article/10.1186/s12984-018-0389-4
URL http://link.springer.com/content/pdf/10.1186/s12984-018-0389-4.pdf
URL https://link.springer.com/article/10.1186/s12984-018-0389-4
URL https://doaj.org/toc/1743-0003
URL https://jneuroengrehab.biomedcentral.com/articles/10.1186/s12984-018-0389-4
URL https://katalog.ub.uni-heidelberg.de/cgi-bin/titel.cgi?katkey=68263809
URL http://dx.doi.org/10.1186/s12984-018-0389-4
URL http://link.springer.com/article/10.1186/s12984-018-0389-4/fulltext.html
URL https://www.ncbi.nlm.nih.gov/pubmed/29843763
URL https://academic.microsoft.com/#/detail/2807362762
URL https://jneuroengrehab.biomedcentral.com/track/pdf/10.1186/s12984-018-0389-4
URL https://dx.doi.org/10.1186/s12984-018-0389-4
URL http://europepmc.org/articles/PMC5975685
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Author Schließmann, Daniel
Author Nisser, Maria
Author Schuld, Christian
Author Gladow, Till
Author Derlien, Steffen
Author Heutehaus, Laura
Author Weidner, Norbert
Author Smolenski, Ulrich
Author Rupp, Rüdiger, 0000-0002-3873-1023
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Collected From Europe PubMed Central; OpenAPC Initiative; PubMed Central; Datacite; UnpayWall; Heidelberger Dokumentenserver; DOAJ-Articles; Crossref; Microsoft Academic Graph
Hosted By Europe PubMed Central; OpenAPC Initiative; Heidelberger Dokumentenserver; Journal of NeuroEngineering and Rehabilitation
Journal Journal of NeuroEngineering and Rehabilitation, 15,
Publication Date 2018-05-29
Publisher BioMed Central
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Country Germany
Format application/pdf
Language English
Resource Type Other literature type; Conference object; Article; UNKNOWN
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Source https://science-innovation-policy.openaire.eu/search/publication?articleId=dedup_wf_001::4f3539d2f52d6701b1764fa4e429c659
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Last Updated 25 December 2020, 18:38 (CET)
Created 25 December 2020, 18:38 (CET)