Design and pilot study of a Gait Enhancing Mobile Shoe

Hemiparesis is a frequent and disabling consequence of stroke and can lead to asymmetric and ineffcient walking patterns. Training on a split-belt treadmill, which has two separate treads driving each leg at a different speed, can correct such asymmetries post-stroke. However, the effects of split-belt treadmill training only partially transfer to everyday walking over ground and extended training sessions are required to achieve long-lasting effects. Our aim is to develop an alternative device, the Gait Enhancing Mobile Shoe (GEMS), that mimics the actions of the split-belt treadmill, but can be used during over-ground walking and in one’s own home, thus enabling long-term training. The GEMS does not require any external power and is completely passive; all necessary forces are redirected from the natural forces present during walking. Three healthy subjects walked on the shoes for twenty minutes during which one GEMS generated a backward motion and the other GEMS generated a forward motion. Our preliminary experiments suggest that wearing the GEMS did cause subjects to modify coordination between the legs and these changes persisted when subjects returned to normal over-ground walking. The largest effects were observed in measures of temporal coordination (e.g., duration of double-support). These results suggest that the GEMS is capable of altering overground walking coordination in healthy controls and could potentially be used to correct gait asymmetries post-stroke.

[1]  A. Bastian,et al.  Thinking about walking: effects of conscious correction versus distraction on locomotor adaptation. , 2010, Journal of neurophysiology.

[2]  Julia T. Choi,et al.  Adaptation reveals independent control networks for human walking , 2007, Nature Neuroscience.

[3]  S. Olney,et al.  Temporal, kinematic, and kinetic variables related to gait speed in subjects with hemiplegia: a regression approach. , 1994, Physical therapy.

[4]  Chitralakshmi K. Balasubramanian,et al.  Relationship between step length asymmetry and walking performance in subjects with chronic hemiparesis. , 2007, Archives of physical medicine and rehabilitation.

[5]  Erin V. L. Vasudevan,et al.  Younger Is Not Always Better: Development of Locomotor Adaptation from Childhood to Adulthood , 2011, The Journal of Neuroscience.

[6]  N. Spear Retrieval of memory in animals. , 1973 .

[7]  W. T. Thach,et al.  Throwing while looking through prisms. II. Specificity and storage of multiple gaze-throw calibrations. , 1996, Brain : a journal of neurology.

[8]  Chitralakshmi K. Balasubramanian,et al.  Anterior-Posterior Ground Reaction Forces as a Measure of Paretic Leg Contribution in Hemiparetic Walking , 2006, Stroke.

[9]  V. Dietz,et al.  Contribution of feedback and feedforward strategies to locomotor adaptations. , 2006, Journal of neurophysiology.

[10]  R F Reynolds,et al.  The broken escalator phenomenon. Aftereffect of walking onto a moving platform. , 2003, Experimental brain research.

[11]  Adolfo M Bronstein,et al.  What the “Broken Escalator” Phenomenon Teaches Us about Balance , 2009, Annals of the New York Academy of Sciences.

[12]  Amy J Bastian,et al.  Split-belt treadmill adaptation shows different functional networks for fast and slow human walking. , 2010, Journal of neurophysiology.

[13]  D. Reisman,et al.  Locomotor adaptation on a split-belt treadmill can improve walking symmetry post-stroke. , 2007, Brain : a journal of neurology.

[14]  Claire Wolstenholme,et al.  How do infants adapt to loading of the limb during the swing phase of stepping? , 2003, Journal of neurophysiology.

[15]  W. Marsden I and J , 2012 .

[16]  M E Bouton,et al.  Stimulus generalization, context change, and forgetting. , 1999, Psychological bulletin.

[17]  John W. Krakauer,et al.  Independent learning of internal models for kinematic and dynamic control of reaching , 1999, Nature Neuroscience.

[18]  Kyle B. Reed,et al.  Asymmetric passive dynamic walker , 2011, 2011 IEEE International Conference on Rehabilitation Robotics.

[19]  W. T. Thach,et al.  Throwing while looking through prisms. I. Focal olivocerebellar lesions impair adaptation. , 1996, Brain : a journal of neurology.

[20]  Ismet Handzic,et al.  Motion controlled gait enhancing mobile shoe for rehabilitation , 2011, 2011 IEEE International Conference on Rehabilitation Robotics.

[21]  C. Gowland,et al.  Hemiplegic gait: analysis of temporal variables. , 1983, Archives of physical medicine and rehabilitation.

[22]  Amy J Bastian,et al.  Split-Belt Treadmill Training Poststroke: A Case Study , 2010, Journal of neurologic physical therapy : JNPT.

[23]  F A Mussa-Ivaldi,et al.  Adaptive representation of dynamics during learning of a motor task , 1994, The Journal of neuroscience : the official journal of the Society for Neuroscience.

[24]  Amy J Bastian,et al.  Seeing Is Believing: Effects of Visual Contextual Cues on Learning and Transfer of Locomotor Adaptation , 2010, The Journal of Neuroscience.

[25]  Kyle B. Reed,et al.  Gait enhancing mobile shoe (GEMS) for rehabilitation , 2009, World Haptics 2009 - Third Joint EuroHaptics conference and Symposium on Haptic Interfaces for Virtual Environment and Teleoperator Systems.

[26]  Steven C Cramer,et al.  Robotics, motor learning, and neurologic recovery. , 2004, Annual review of biomedical engineering.

[27]  J. Kahn,et al.  Rapid and Long-term Adaptations in Gait Symmetry Following Unilateral Step Training in People With Hemiparesis , 2009, Physical Therapy.

[28]  Endel Tulving,et al.  Encoding specificity and retrieval processes in episodic memory. , 1973 .

[29]  J. Perry,et al.  Gait Analysis , 2024 .

[30]  Darcy S. Reisman,et al.  SPLIT-BELT TREADMILL ADAPTATION and GAIT SYMMETRY POST-STROKE. , 2005 .

[31]  D. Mozaffarian,et al.  Heart disease and stroke statistics--2010 update: a report from the American Heart Association. , 2010, Circulation.

[32]  S. M. Morton,et al.  Cerebellar Contributions to Locomotor Adaptations during Splitbelt Treadmill Walking , 2006, The Journal of Neuroscience.

[33]  R. Macko,et al.  Cardiovascular Health and Fitness After Stroke , 2005, Topics in stroke rehabilitation.

[34]  S. Olney,et al.  A comparison of gait biomechanics and metabolic requirements of overground and treadmill walking in people with stroke. , 2009, Clinical biomechanics.

[35]  James U. Korein,et al.  Robotics , 2018, IBM Syst. J..

[36]  Alfred D. Grant Gait Analysis: Normal and Pathological Function , 2010 .

[37]  J. Bloedel,et al.  A new conditioning paradigm: Conditioned limb movements in locomoting decerebrate ferrets , 1988, Neuroscience Letters.

[38]  Titianova Eb,et al.  Asymmetry in walking performance and postural sway in patients with chronic unilateral cerebral infarction. , 1995 .

[39]  W. T. Thach,et al.  Throwing while looking through prisms , 2005 .

[40]  A. Bronstein,et al.  The broken escalator phenomenon , 2003, Experimental Brain Research.

[41]  C. Winstein,et al.  Neurorehabilitation and Neural Repair Cerebellar Stroke Impairs Temporal but Not Spatial Accuracy during Implicit Motor Learning Neurorehabilitation and Neural Repair Additional Services and Information For , 2022 .

[42]  D. Reisman,et al.  Split-Belt Treadmill Adaptation Transfers to Overground Walking in Persons Poststroke , 2009, Neurorehabilitation and neural repair.

[43]  Adolfo M Bronstein,et al.  Visuo-vestibular influences on the moving platform locomotor aftereffect. , 2008, Journal of neurophysiology.