Development and Assessment of a Wearable Biofeedback System to Elicit Gait Changes using Rhythmic Auditory Stimulation

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 extensively 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 objectives were to induce TGA in able-bodied individuals using RAS, characterize each strategy's impact on TGA, and assess the response and workload using NASA-TLX. Ten AB participants underwent gait training to induce TGA at different asymmetry levels. All three strategies enabled participants to achieve TGA compared to baseline. However, participants could not precisely match the target symmetry, suggesting the importance of setting RAS targets close to true symmetry in gait training for mobility-challenged populations. Notably, speed and cadence remained largely unchanged during RAS-based biofeedback gait training. Comparing all three strategies, participants' performance was similar. Future research should focus on long-term evaluations of RAS-based biofeedback gait training and explore these strategies with specific patient groups and gait disorders. These findings hold promise for developing personalized and effective gait training interventions to address TGA in patient populations with mobility limitations.