A Portable Gait Asymmetry Rehabilitation System for Individuals with Stroke Using a Vibrotactile Feedback

Gait asymmetry caused by hemiparesis results in reduced gait efficiency and reduced activity levels. In this paper, a portable rehabilitation device is proposed that can serve as a tool in diagnosing gait abnormalities in individuals with stroke and has the capability of providing vibration feedback to help compensate for the asymmetric gait. Force-sensitive resistor (FSR) based insoles are used to detect ground contact and estimate stance time. A controller (Arduino) provides different vibration feedback based on the gait phase measurement. It also allows wireless interaction with a personal computer (PC) workstation using the XBee transceiver module, featuring data logging capabilities for subsequent analysis. Walking trials conducted with healthy young subjects allowed us to observe that the system can influence abnormality in the gait. The results of trials showed that a vibration cue based on temporal information was more effective than intensity information. With clinical experiments conducted for individuals with stroke, significant improvement in gait symmetry was observed with minimal disturbance caused to the balance and gait speed as an effect of the biofeedback. Future studies of the long-term rehabilitation effects of the proposed system and further improvements to the system will result in an inexpensive, easy-to-use, and effective rehabilitation device.

[1]  C. Wall,et al.  The effect of vibrotactile feedback on postural sway during locomotor activities , 2013, Journal of NeuroEngineering and Rehabilitation.

[2]  E R Draper,et al.  A treadmill-based system for measuring symmetry of gait. , 2000, Medical engineering & physics.

[3]  J. Allum,et al.  The effects of vibrotactile biofeedback training on trunk sway in Parkinson's disease patients. , 2012, Parkinsonism & related disorders.

[4]  Kara K. Patterson,et al.  Evaluation of gait symmetry after stroke: a comparison of current methods and recommendations for standardization. , 2010, Gait & posture.

[5]  H J Stam,et al.  Validity of the Pedar Mobile system for vertical force measurement during a seven-hour period. , 2006, Journal of biomechanics.

[6]  B. Espiau,et al.  A Wearable Sensor Network for Gait Analysis: A Six-Day Experiment of Running Through the Desert , 2011, IEEE/ASME Transactions on Mechatronics.

[7]  L. Berglund,et al.  Validation of F-Scan pressure sensor system: a technical note. , 1998, Journal of rehabilitation research and development.

[8]  A. Lees,et al.  Adjustments in gait symmetry with walking speed in trans-femoral and trans-tibial amputees. , 2003, Gait & posture.

[9]  Peter J Beek,et al.  Rhythm Perturbations in Acoustically Paced Treadmill Walking After Stroke , 2009, Neurorehabilitation and neural repair.

[10]  Danny Rafferty,et al.  Metabolic Cost of Overground Gait in Younger Stroke Patients and Healthy Controls , 2006 .

[11]  P. Friedman,et al.  Gait recovery after hemiplegic stroke. , 1990, International disability studies.

[12]  Yijung Chung,et al.  Functional electrical stimulation applied to gluteus medius and tibialis anterior corresponding gait cycle for stroke. , 2012, Gait & posture.

[13]  David Ewins,et al.  An evaluation of patient perceptions to the value of the gait laboratory as part of the rehabilitation of primary lower limb amputees , 2008, Prosthetics and orthotics international.

[14]  A. A. Gopalai,et al.  A Wearable Real-Time Intelligent Posture Corrective System Using Vibrotactile Feedback , 2011, IEEE/ASME Transactions on Mechatronics.

[15]  Brian L. Davis,et al.  Realtime Visual Feedback Diminishes Energy Consumption of Amputee Subjects During Treadmill Locomotion , 2004 .

[16]  C. Wall,et al.  Vibrotactile tilt feedback improves dynamic gait index: a fall risk indicator in older adults. , 2009, Gait & posture.

[17]  Lynn Rochester,et al.  Measurement of Community Ambulation After Stroke: Current Status and Future Developments , 2005, Stroke.

[18]  L. Rochester,et al.  Community ambulation after stroke: how important and obtainable is it and what measures appear predictive? , 2004, Archives of physical medicine and rehabilitation.

[19]  J. Czerniecki,et al.  The prevalence of knee pain and symptomatic knee osteoarthritis among veteran traumatic amputees and nonamputees. , 2005, Archives of physical medicine and rehabilitation.

[20]  Conrad Wall,et al.  Application of Vibrotactile Feedback of Body Motion to Improve Rehabilitation in Individuals With Imbalance , 2010, Journal of neurologic physical therapy : JNPT.

[21]  M. Tomizuka,et al.  A Gait Monitoring System Based on Air Pressure Sensors Embedded in a Shoe , 2009, IEEE/ASME Transactions on Mechatronics.

[22]  Masayoshi Tomizuka,et al.  A mobile gait monitoring system for gait analysis , 2009, 2009 IEEE International Conference on Rehabilitation Robotics.

[23]  Mary C Whitton,et al.  Use of Visual and Proprioceptive Feedback to Improve Gait Speed and Spatiotemporal Symmetry Following Chronic Stroke: A Case Series , 2012, Physical Therapy.

[24]  F Lacquaniti,et al.  Influence of leg muscle vibration on human walking. , 2000, Journal of neurophysiology.

[25]  Luca Benini,et al.  A wireless system for gait and posture analysis based on pressure insoles and Inertial Measurement Units , 2009, 2009 3rd International Conference on Pervasive Computing Technologies for Healthcare.

[26]  Rai-Chi Chan,et al.  Turning-Based Treadmill Training Improves Turning Performance and Gait Symmetry After Stroke , 2014, Neurorehabilitation and neural repair.

[27]  S. Simon Gait Analysis, Normal and Pathological Function. , 1993 .

[28]  Jeonghee Kim,et al.  Cell phone based balance trainer , 2012, Journal of NeuroEngineering and Rehabilitation.

[29]  R. Macko,et al.  Reduced ambulatory activity after stroke: the role of balance, gait, and cardiovascular fitness. , 2005, Archives of physical medicine and rehabilitation.

[30]  P. Novak,et al.  Effect of step-synchronized vibration stimulation of soles on gait in Parkinson's disease: a pilot study , 2006, Journal of NeuroEngineering and Rehabilitation.

[31]  J. Eng,et al.  Symmetry in vertical ground reaction force is accompanied by symmetry in temporal but not distance variables of gait in persons with stroke. , 2003, Gait & posture.

[32]  A. Randolph,et al.  Reliability of measurements of pressures applied on the foot during walking by a computerized insole sensor system. , 2000, Archives of physical medicine and rehabilitation.

[33]  Kok Soon Soon,et al.  New Foot Pressure Activated Sensory Compensation System for Posture-Control Enhancement in Amputees , 2007, IEEE/ASME Transactions on Mechatronics.

[34]  Abhishek Srivastava,et al.  Post-stroke balance training: Role of force platform with visual feedback technique , 2009, Journal of the Neurological Sciences.

[35]  B. E. Maki,et al.  Measuring balance in the elderly: validation of an instrument. , 1992, Canadian journal of public health = Revue canadienne de sante publique.

[36]  Bart Nienhuis,et al.  Restoration of weight-shifting capacity in patients with postacute stroke: a rehabilitation cohort study. , 2005, Archives of physical medicine and rehabilitation.

[37]  Kathleen H. Sienko,et al.  Assessment of Vibrotactile Feedback on Postural Stability During Pseudorandom Multidirectional Platform Motion , 2010, IEEE Transactions on Biomedical Engineering.

[38]  Gert Kwakkel,et al.  Predicting mobility outcome one year after stroke: a prospective cohort study. , 2006, Journal of rehabilitation medicine.

[39]  F. Horak,et al.  Vibrotactile Biofeedback Improves Tandem Gait in Patients with Unilateral Vestibular Loss , 2009, Annals of the New York Academy of Sciences.

[40]  S.M.N.A. Senanayake,et al.  A Real-Time System With Assistive Feedback for Postural Control in Rehabilitation , 2010, IEEE/ASME Transactions on Mechatronics.

[41]  R. Riener,et al.  Towards more effective robotic gait training for stroke rehabilitation: a review , 2012, Journal of NeuroEngineering and Rehabilitation.

[42]  F. Prince,et al.  Symmetry and limb dominance in able-bodied gait: a review. , 2000, Gait & posture.

[43]  Linfang Yang,et al.  Lower extremity ambulatory feedback system for people with amputations gait asymmetry training , 2013 .

[44]  V. Gurfinkel,et al.  Locomotor‐like movements evoked by leg muscle vibration in humans , 1998, The European journal of neuroscience.

[45]  Paolo Bonato,et al.  Noise‐enhanced balance control in patients with diabetes and patients with stroke , 2006, Annals of neurology.

[46]  Kara K. Patterson,et al.  Gait asymmetry in community-ambulating stroke survivors. , 2008, Archives of physical medicine and rehabilitation.

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

[48]  Lorna Paul,et al.  Metabolic cost of over ground gait in younger stroke patients and healthy controls. , 2006, Medicine and science in sports and exercise.

[49]  C R Cantor,et al.  Gait disorders. , 1999, Clinics in podiatric medicine and surgery.

[50]  J. V. Erp,et al.  Vibrotactile in-vehicle navigation system , 2004 .

[51]  Richard W. Bohannon,et al.  Rehabilitation goals of patients with hemiplegia , 1988 .

[52]  Shu Chen,et al.  A Wearable Device for Real-Time Motion Error Detection and Vibrotactile Instructional Cuing , 2011, IEEE Transactions on Neural Systems and Rehabilitation Engineering.

[53]  Jungwon Yoon,et al.  Effects of kinesthetic haptic feedback on standing stability of young healthy subjects and stroke patients , 2015, Journal of NeuroEngineering and Rehabilitation.

[54]  S. J. M. Bamberg,et al.  A Wireless Sensory Feedback Device for Real-Time Gait Feedback and Training , 2012, IEEE/ASME Transactions on Mechatronics.

[55]  C. Bard,et al.  Contribution of proprioception for calibrating and updating the motor space. , 1995, Canadian journal of physiology and pharmacology.

[56]  V. Dietz,et al.  Computerized Visual Feedback: An Adjunct to Robotic-Assisted Gait Training , 2008, Physical Therapy.

[57]  J. Krakauer Motor learning: its relevance to stroke recovery and neurorehabilitation. , 2006, Current opinion in neurology.

[58]  E. Isakov Gait rehabilitation: a new biofeedback device for monitoring and enhancing weight-bearing over the affected lower limb. , 2007, Europa medicophysica.