Gait Training in Chronic Stroke Using Walk-Even Feedback Device: A Pilot Study

Abstract

Asymmetrical gait and a reduction in weight bearing on the affected side are a common finding in chronic stroke survivors. The purpose of this pilot study was to determine the effectiveness of a shoe insole device that we developed, called Walk-Even, in correcting asymmetric gait in chronic stroke survivors. Six individuals with chronic (>6 months) stroke underwent 8 weeks of intervention with 2 sessions/week, each consisting of 20 minutes of gait training and 20 minutes of lower-extremity strength training. The 2 control participants underwent conventional gait training, while 4 participants underwent gait training using the Walk-Even. Following intervention, all the participants improved on most of the gait measures: peak pressure of the foot, time of transfer of weight from heel-to-forefoot, center of pressure (COP) trajectory, COP velocity, asymmetry ratio of stance, mean-force-heel, mean-force-metatarsals, Timed “Up and Go,” and Activities-specific Balance Scale. The improvement was more pronounced in the 4 participants that underwent training with Walk-Even compared to the control participants. This pilot study suggests that a combination of strength and gait training with real-time feedback may reduce temporal asymmetry and enhance weight-bearing on the affected side in chronic stroke survivors. A large randomized controlled study is needed to confirm its efficacy.

Wearable Movement Sensors for Rehabilitation: A Focused Review of Technological and Clinical Advances

“…A single sensor attached to the heel allows detection of heel strike and heel off phases of gait, while multiple sensors within an insole enable examination of walking strategies 10 , center of pressure translations 11 , and the estimation of vertical ground reaction forces throughout the gait cycle 12 . Force-based sensors are also used to drive auditory 13 and visual 14 biofeedback during gait training 13,14 . Limitations of force-based sensors include their susceptibility to mechanical wear over time, limited direct measurements to events during stance phase 9 , and potential drift secondary to humidity and temperature inside the shoe 15 that may influence data quality.…”

Assessment Methods of Post-stroke Gait: A Scoping Review of Technology-Driven Approaches to Gait Characterization and Analysis

“…These systems are designed to allow for the recording of both dynamic plantar pressure and spatiotemporal data. F-scan (Tekscan Inc., South Boston, USA) is an ultra-thin in-shoe pressure measurement system utilizing Force-Sensitive Resistive films (FSR) technology ( 100 ). Focusing on portability, cost-effectiveness, and applicability to outdoor setting, Solanki and Lahiri ( 88 ) developed FSR-based shoes ( Shoes FSR ) that offered detailed gait characterization including abnormal gait, such as observed in post-stroke.…”

Explicit Control of Step Timing During Split-Belt Walking Reveals Interdependent Recalibration of Movements in Space and Time

“…However, the opposite has not been demonstrated. For example, altering intra-limb measures (i.e., characterizing single leg motion) of timing, such as stance time duration (Afzal et al, 2015; Krishnan et al, 2016) also leads to changes in intra-limb spatial features, such as stride lengths. In sum, the spatial and temporal control of the limb is thought to be dissociable, but it remains unclear if the adaptation of internal representations of timing can be altered and what is the impact of such manipulation in the temporal domain on the spatial control of the limb.…”