Real-time biofeedback device for gait rehabilitation of post-stroke patients

Abstract

In this work, we develop a device, called 'Walk-Even', that can provide real-time feedback to correct gait asymmetry commonly exhibited in post-stroke survivors and persons with certain neurological disorders. The device computes gait parameters, including gait time, swing time, and stance time of each leg, to detect gait asymmetry and provide corresponding real-time biofeedback by means of auditory and electrotactile stimulation to actively correct the user's gait. The system consists of customized forcesensor-embedded insoles adjustable to fit any shoe size, electrotactile and auditory feedback circuits, microcontroller, and wireless XBee transceivers. The device also offers data saving capability. To validate its accuracy and reliability, we compared the gait measurements from our device with a commercial gait and balance assessment device, Zeno Walkway. The results show good correlation and agreement in a validity study with six healthy subjects and reliability study with seventeen healthy subjects. In addition, preliminary testing on six post-stroke patients after an 8-week training shows that the Walk-Even device helps to improve gait symmetry, foot pressure and forefoot loading of the affected side. Thus, initial testing indicates that the device is accurate in measuring the gait parameters and effective in improving gait symmetry using real-time feedback. The device is portable and low cost and has the potential for use in a non-clinical setting for patients that can walk independently without assistance. A more extensive testing with stroke patients is still ongoing.

Systematic review on wearable lower-limb exoskeletons for gait training in neuromuscular impairments

“…They found that the average number of sessions (2 hours per session) for walking and developing sit-stand transitions with contact guard assistance (i.e., helper maintains touch or near-touch contact, but provides no assistance) and close supervision were 15 and 18 sessions, respectively. In this regard, there are few studies that showed that the use of biofeedback could accelerate the learning process and reduce the time and effort devoted to learn how to use an exoskeleton [101][102][103][104].…”

The Effects of Auditory Feedback Gait Training Using Smart Insole on Stroke Patients

“…During the study, patients who could no longer participate in the intervention program due to change of medical state, who had less than 80% participation rate were excluded. The patients and the assessing therapist were blinded to the group allocation [ 21 ].…”

“…Ma and his colleagues revealed the tactile feedback can be used for the gait symmetry [ 19 ]. We also observed the auditory feedback can be effective to achieve gait symmetry for stroke patients [ 21 ]. Our previous study applied auditory feedback with pneumatic-pressure insole to chronic stroke survivors.…”

Design of multi‐pad electrotactile system envisioned as a feedback channel for supernumerary robotic limbs

“…Research investigating electrotactile feedback on the lower limb in closed‐loop systems intended for other application scenarios was also mostly directed toward single‐channel systems 17,18 . Multi‐channel feedback interfaces are superior to single‐channel systems in terms of usability, setup, donning, and doffing time 19,20 .…”

“…16 Research investigating electrotactile feedback on the lower limb in closed-loop systems intended for other application scenarios was also mostly directed toward single-channel systems. 17,18 Multi-channel feedback interfaces are superior to single-channel systems in terms of usability, setup, donning, and doffing time. 19,20 The requirement for the use of tactile feedback with state-of-the art robotic hands in transmitting high bandwidth information or even multimodal information to the user.…”