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.

Figure 1

(a) The device setup: insoles connected to main unit of Walk-Even device that is worn around the waist. (b) Force sensor-embedded insoles that are placed under the sandals.

Figure 2

(a) Raw pressure data of the affected foot of participant #1 before and after intervention. Note the increased pressure on the affected foot after the intervention. (b) Heel and forefoot forces of the affected side across the averaged gait cycle are shown. Note the participant 1 transferred the body weight from heel to forefoot (crossing point) earlier after the intervention.