A Wearable Mixed Reality Platform to Augment Overground Walking: A Feasibility Study

Abstract

Humans routinely modify their walking speed to adapt to functional goals and physical demands. However, damage to the central nervous system (CNS) often results in abnormal modulation of walking speed and increased risk of falls. There is considerable interest in treatment modalities that can provide safe and salient training opportunities, feedback about walking performance, and that may augment less reliable sensory feedback within the CNS after injury or disease. Fully immersive virtual reality technologies show benefits in boosting training-related gains in walking performance; however, they lack views of the real world that may limit functional carryover. Augmented reality and mixed reality head-mount displays (MR-HMD) provide partially immersive environments to extend the virtual reality benefits of interacting with virtual objects but within an unobstructed view of the real world. Despite this potential advantage, the feasibility of using MR-HMD visual feedback to promote goal-directed changes in overground walking speed remains unclear. Thus, we developed and evaluated a novel mixed reality application using the Microsoft HoloLens MR-HMD that provided real-time walking speed targets and augmented visual feedback during overground walking. We tested the application in a group of adults not living with disability and examined if they could use the targets and visual feedback to walk at 85%, 100%, and 115% of each individual’s self-selected speed. We examined whether individuals were able to meet each target gait speed and explored differences in accuracy across repeated trials and at the different speeds. Additionally, given the importance of task-specificity to therapeutic interventions, we examined if walking speed adjustment strategies were consistent with those observed during usual overground walking, and if walking with the MR-HMD resulted in increased variability in gait parameters. Overall, participants matched their overground walking speed to the target speed of the MR-HMD visual feedback conditions (all p-values > 0.05). The percent inaccuracy was approximately 5% across all speed matching conditions and remained consistent across walking trials after the first overall walking trial. Walking with the MR-HMD did not result in more variability in walking speed, however, we observed more variability in stride length and time when walking with feedback from the MR-HMD compared to walking without feedback. The findings offer support for mixed reality-based visual feedback as a method to provoke goal-specific changes in overground walking behavior. Further studies are necessary to determine the clinical safety and efficacy of this MR-HMD technology to provide extrinsic sensory feedback in combination with traditional treatments in rehabilitation.

Gait-modifying effects of augmented-reality cueing in people with Parkinson’s disease

“…We therefore conclude that people with PD can adjust various aspects of their gait to variations in AR cues, and that they do this as effectively as to real-world cues. These findings, corroborating related work in healthy adults ( 29 , 44 ), are relevant for recent studies that have already implemented AR cues in training interventions like dual-task training for people with PD, which showed promising results ( 20 , 45 ).…”

“…Even though early AR cueing research in people with PD with the first-generation AR headsets did not find any significant improvements on FoG, the results were still encouraging as subjective benefits of AR cueing are often reported ( 23 – 25 ). The lack of positive findings may be related to the limited AR field of view (AR-FOV) of the AR headsets ( 18 , 23 , 26 , 27 ), an insufficient familiarization period to AR headsets ( 23 ), the fact that only one specific visual cue was implemented ( 1 , 17 ), or the emphasis on FoG as an outcome measure instead of other valuable gait characteristics like gait speed and step length, susceptible to improvement with AR cueing ( 20 , 25 , 28 , 29 ). In the present study we address these issues.…”