The Development of a Wearable Biofeedback System to Elicit Temporal Gait Asymmetry using Rhythmic Auditory Stimulation and an Assessment of Immediate Effects

Abstract

Temporal gait asymmetry (TGA) is commonly observed in individuals facing mobility challenges. Rhythmic auditory stimulation (RAS) can improve temporal gait parameters by promoting synchronization with external cues. While biofeedback for gait training, providing real-time feedback based on specific gait parameters measured, has been proven to successfully elicit changes in gait patterns, RAS-based biofeedback as a treatment for TGA has not been explored. In this study, a wearable RAS-based biofeedback gait training system was developed to measure temporal gait symmetry in real time and deliver RAS accordingly. Three different RAS-based biofeedback strategies were compared: open- and closed-loop RAS at constant and variable target levels. The main objective was to assess the ability of the system to induce TGA with able-bodied (AB) participants and evaluate and compare each strategy. With all three strategies, temporal symmetry was significantly altered compared to the baseline, with the closed-loop strategy yielding the most significant changes when comparing at different target levels. Speed and cadence remained largely unchanged during RAS-based biofeedback gait training. Setting the metronome to a target beyond the intended target may potentially bring the individual closer to their symmetry target. These findings hold promise for developing personalized and effective gait training interventions to address TGA in patient populations with mobility limitations using RAS.

Keywords: biofeedback; gait training; rhythmic auditory stimulation; temporal gait asymmetry; wearable systems.

Figure 1

(Left) Flow diagram illustrating the developed wearable BFB system. (Right) A participant equipped with (red boxes) the developed BFB and (green boxes) wearable motion capture systems.

Figure 2

Example of the different metronomes generated based on different STSRs: (top) STSR = 1 and (bottom) STSR = 0.82. Green regions represent the duration of the beat sound (100 ms) and blue regions represent the duration with no beat sound (varying time (ms)).

Figure 3

(Top) Outline of the sequence of tasks/trials for the sessions. (Bottom) Illustration of a single lap.

Figure 4

Right (blue) and left (green) orientation signals from the lower leg inertial sensors. Start (solid red) and end (dashed red) of the turn detected.

Figure 5

Box plot figures for each strategy at each target STSR level (dashed red) across all participants. The horizontal solid grey line indicates a perfect symmetry ratio. Black plus (+) represents mean values.