Does Walking to a Beat Improve Prosthetic Gait? Investigating Immediate Effects of Rhythmic Auditory Stimulation-Based Biofeedback

Abstract

Gait training is important for lower-limb prosthesis users (LLPUs) to regain mobility, however, traditional approaches often present challenges relating to time, cost, and accessibility. To overcome this, our team has been exploring wearable technology for out-of-clinic gait training. One promising biofeedback gait training approach, providing real-time feedback based on specific gait parameters, could be based on rhythmic auditory stimulation (RAS). Studies on the interaction between RAS and gait training have primarily used open-loop RAS without considering the user’s performance. Yet optimal gait training involves progressive, tailored practice and adaptable for goal-directed activities, suggesting the potential benefits of closed-loop RAS-based systems for modulating temporal symmetry and enhancing functional mobility outcomes. The aims of this study were threefold: to (1) examine whether, for LLPUs, RAS can improve the temporal symmetry and other spatiotemporal parameters (speed, cadence, etc.) (2) compare open- and closed-loop RAS strategies, and (3) evaluate symmetry usability and workload. RAS led to significant improvements in temporal symmetry outperforming open loop (5.5 ± 2.4% vs 3.3 ± 2.2%, respectively), thus suggesting the potential benefits of adaptive feedback training. Across both strategies, participants were able to maintain the set cadence and speed during biofeedback trials, and both strategies showed similar results in terms of workload, and overall usability was positively-rated. Future research should focus on adaptable systems tailored to individual needs and long-term assessments across more diverse gait symmetries. Finally, exploring progressive and adaptive gait training, and incorporating variations in step or stride length could optimize gait training protocols for enhanced outcomes.

Keywords

• Biofeedback
• gait analysis
• gait disabilities
• rhythmic stimulation
• wearable systems