Effect of feedback on foot strike angle and forward propulsion in people with stroke

BackgroundEffective retraining of foot elevation and forward propulsion is essential in stroke survivors’ gait rehabilitation. However, home-based training often lacks valuable feedback. eHealth solutions based on inertial measurement units (IMUs) could offer real-time feedback on fundamental gait characteristics. This study aimed to investigate the effect of providing real-time feedback through an eHealth solution on foot strike angle (FSA) and forward propulsion in people with stroke.MethodsTwelve stroke survivors completed five walking trials on an instrumented treadmill: A) regular walking (1), B) feedback on FSA, C) feedback on propulsion, D) feedback on both FSA and propulsion, and E) regular walking (2). Visual feedback was presented through a green-to-red vertical slide bar on a screen in front of the participants. Linear mixed models evaluated the impact of feedback on FSA and propulsion, considering the sequence of feedback delivery, and potential learning or fatigue effects over the trials. Post-hoc pairwise comparisons were performed to assess the effect of different feedback types.ResultsLinear mixed models revealed a main effect on FSA and propulsion by feedback on FSA and propulsion, respectively. FSA significantly increased from 16.6⁰ in the initial regular walking trial to 24.0⁰ during FSA feedback and 23.6⁰ during combined FSA and propulsion feedback trials (p<0.001). Forward propulsion significantly improved by one third in the feedback on propulsion and combined feedback on both FSA and propulsion conditions compared to the first regular walking trial (p<0.001).ConclusionsThe positive effect of real-time feedback on FSA and forward propulsion highlight the potential of eHealth solutions in tailoring rehabilitation strategies in stroke survivors.

背景：对脑卒中幸存者的步态康复而言，有效复健足抬升动作与前向推进模式至关重要。然而，居家康复训练往往缺乏有效的反馈。基于惯性测量单元（Inertial Measurement Units, IMUs）的电子健康（eHealth）解决方案，能够为患者提供基础步态特征的实时反馈。本研究旨在探究基于电子健康解决方案的实时反馈，对脑卒中患者触地角（foot strike angle, FSA）与前向推进表现的影响。方法：12名脑卒中幸存者在配备测力装置的跑台（instrumented treadmill）上完成5组步行测试：A）常规步行（第1组）、B）触地角反馈组、C）推进反馈组、D）触地角与推进双重反馈组、E）常规步行（第2组）。视觉反馈通过参与者前方屏幕上的绿-红色垂直滑动条呈现。本研究采用线性混合模型（linear mixed models），在考量反馈递送顺序以及测试过程中潜在的学习效应与疲劳效应的前提下，评估反馈对触地角与前向推进表现的影响。此外，通过事后两两比较分析不同反馈类型的作用效果。结果：线性混合模型分析显示，触地角反馈与推进反馈分别对触地角与前向推进表现存在主效应。相较于初始常规步行测试中的16.6°，触地角反馈组与触地角-推进双重反馈组的触地角分别显著提升至24.0°与23.6°（p<0.001）。相较于第一组常规步行测试，推进反馈组与双重反馈组的前向推进表现均显著提升了三分之一（p<0.001）。结论：实时反馈对触地角与前向推进表现的积极作用，凸显了电子健康解决方案在为脑卒中幸存者定制个性化康复策略方面的应用潜力。