Rhythmic Haptic Cueing Using Wearable Devices as Physiotherapy for Huntington Disease: Case Study (Preprint)

Abstract

BACKGROUND Huntington’s Disease (HD) is an inherited genetic disorder that results in the death of brain cells. HD symptoms generally start with subtle changes in mood and mental abilities and degenerate progressively, ensuing a general lack of coordination and an unsteady gait, ultimately resulting in death. There is currently no cure for HD. Walking cued by an external (usually auditory) rhythm has been shown to steady gait and help with movement coordination in other neurological conditions. More recently, work with other neurological conditions has demonstrated that haptic (tactile) rhythmic cues, as opposed to audio cues, offer similar improvements when walking— with the added benefit of less intrusive, more private cues delivered by a wearable device that leave the ears free for conversation, situation awareness and safety. This paper presents a case study where rhythmic haptic cueing was applied to one person with Huntington’s disease. The case study has two elements: the data gait data we collected from our wearable devices; and the comments we received from a group of highly trained expert physiotherapists and specialists on Huntington’s disease. OBJECTIVE The objective of this case study was to investigate whether rhythmic haptic cueing can be applied to improve gait coordination and limb control in people living with Huntington’s disease. Whilst not offering a cure, therapeutic outcomes may delay the onset or severity of symptoms, with the potential to improve and prolong quality of life. METHODS The approach adopted for this study includes two elements, one quantitative and one qualitative. The first is a repeated measures design, with three conditions: “before” (baseline); “with haptic rhythm”; and “after exposure to haptic rhythm”. The second element is an in-depth interview with physiotherapists observing the session. RESULTS In comparison to the baseline, the physiotherapists noted a number of improvements to the participant’s kinematics during walk with the haptic cue. These improvements continued in the ‘after’ condition indicating some lasting effects. CONCLUSIONS The findings from this small case study, with a single participant, suggest that a haptic metronomic rhythm may have immediate therapeutic benefits for the walking kinematics of people living with Huntington’s disease and warrants further investigation.