Autonomous Control of Music to Retrain Walking After Stroke

Abstract

Background Post-stroke care guidelines highlight continued rehabilitation as essential; however, many stroke survivors cannot participate in outpatient rehabilitation. Technological advances in wearable sensing, treatment algorithms, and care delivery interfaces have created new opportunities for high-efficacy rehabilitation interventions to be delivered autonomously in any setting (ie, clinic, community, or home). Methods We developed an autonomous rehabilitation system that combines the closed-loop control of music with real-time gait analysis to fully automate patient-tailored walking rehabilitation. Specifically, the mechanism-of-action of auditory-motor entrainment is applied to induce targeted changes in the post-stroke gait pattern by way of targeted changes in music. Using speed-controlled biomechanical and physiological assessments, we evaluate in 10 individuals with chronic post-stroke hemiparesis the effects of a fully-automated gait training session on gait asymmetry and the energetic cost of walking. Results Post-treatment reductions in step time (Δ: −12 ± 26%, P = .027), stance time (Δ: −22 ± 10%, P = .004), and swing time (Δ: −15 ± 10%, P = .006) asymmetries were observed together with a 9 ± 5% reduction ( P = .027) in the energetic cost of walking. Changes in the energetic cost of walking were highly dependent on the degree of baseline energetic impairment ( r =− .90, P < .001). Among the 7 individuals with a baseline energetic cost of walking larger than the normative value of healthy older adults, a 13 ± 4% reduction was observed after training. Conclusions The closed-loop control of music can fully automate walking rehabilitation that markedly improves walking after stroke. Autonomous rehabilitation delivery systems that can safely provide high-efficacy rehabilitation in any setting have the potential to alleviate access-related care gaps and improve long-term outcomes after stroke.

Validating the Safe and Effective Use of a Neurorehabilitation System (InTandem) to Improve Walking in the Chronic Stroke Population: Usability Study

“…These strengths add to the compounding evidence for InTandem to be used by the intended population in the intended environment for use. The accumulated evidence for InTandem includes a feasibility study that resulted in clinically relevant improvements in speed over 1 and multiple sessions [ 30 ] and a reduction in the energetic cost of walking along with improved gait asymmetries [ 31 ]; a longitudinal RCT of safety and clinical efficacy of InTandem [ 32 ]; and a budget impact model that estimates cost savings to payers [ 33 ]. Furthermore, MR-001 (InTandem) was designated as a breakthrough device by the FDA in 2020 [ 34 ], which underscores both the unmet need to address persistent walking deficits of people who are in the chronic stroke phase of recovery in an accessible and effective manner and the merit and opportunity that InTandem offers them.…”