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 对卒中幸存者而言，有效开展足抬高与前向推进再训练是步态康复的核心环节。然而居家康复训练往往缺乏有效反馈机制。基于惯性测量单元（Inertial Measurement Unit, IMU）的电子健康（eHealth）解决方案，可针对步态核心特征提供实时反馈。本研究旨在探究通过eHealth方案提供实时反馈，对卒中患者足触地角（Foot Strike Angle, FSA）及前向推进效果的影响。
方法 12名卒中幸存者完成了5次仪器化跑台行走试验：A）常规行走（第1次），B）足触地角反馈训练，C）前向推进效果反馈训练，D）足触地角与前向推进效果联合反馈训练，E）常规行走（第2次）。受试者可通过前方屏幕上的绿-红垂直滑动条接收视觉反馈。本研究采用线性混合模型（Linear Mixed Models）评估反馈对足触地角与前向推进效果的影响，同时纳入反馈递送顺序、试验过程中潜在的学习或疲劳效应作为考量因素。随后开展事后两两比较，以分析不同反馈类型的干预效果。
结果 线性混合模型分析显示，针对足触地角与前向推进效果的反馈，分别对对应指标产生了显著主效应。与首次常规行走试验的16.6°相比，足触地角在单独足触地角反馈训练阶段提升至24.0°，在联合反馈训练阶段升至23.6°，差异具有统计学意义（p<0.001）。相较于首次常规行走试验，单独推进反馈训练与联合反馈训练组的前向推进效果均提升三分之一，差异具有统计学意义（p<0.001）。
结论 实时反馈对足触地角与前向推进效果的积极作用，凸显了eHealth解决方案在为卒中幸存者定制个性化康复策略方面的应用潜力。