So no protocols from this research, useless for survivors to get 100% recovery on walking.
Autonomous Control of Music to Retrain Walking After Stroke
Abstract
Background
Post-stroke
care(We need RECOVERY AND RESULTS instead of this lazy 'care'!) guidelines(WE NEED EXACT PROTOCOLS, not useless guidelines!) highlight continued rehabilitation as essential;
however, many stroke survivors cannot participate in outpatient
rehabilitation. Technological advances in wearable sensing, treatment
algorithms, and care delivery interfaces have created new opportunities
for high-efficacy rehabilitation interventions to be delivered
autonomously in any setting (ie, clinic, community, or home).
Methods
We
developed an autonomous rehabilitation system that combines the
closed-loop control of music with real-time gait analysis to fully
automate patient-tailored walking rehabilitation. Specifically, the
mechanism-of-action of auditory-motor entrainment is applied to induce
targeted changes in the post-stroke gait pattern by way of targeted
changes in music. Using speed-controlled biomechanical and physiological
assessments, we evaluate in 10 individuals with chronic post-stroke
hemiparesis the effects of a fully-automated gait training session on
gait asymmetry and the energetic cost of walking.
Results
Post-treatment reductions in step time (Δ: −12 ± 26%, P = .027), stance time (Δ: −22 ± 10%, P = .004), and swing time (Δ: −15 ± 10%, P = .006) asymmetries were observed together with a 9 ± 5% reduction (P = .027)
in the energetic cost of walking. Changes in the energetic cost of
walking were highly dependent on the degree of baseline energetic
impairment (r =− .90, P < .001). Among the 7
individuals with a baseline energetic cost of walking larger than the
normative value of healthy older adults, a 13 ± 4% reduction was
observed after training.
Conclusions
The
closed-loop control of music can fully automate walking rehabilitation
that markedly improves walking after stroke. Autonomous rehabilitation
delivery systems that can safely provide high-efficacy rehabilitation in
any setting have the potential to alleviate access-related care gaps
and improve long-term outcomes after stroke.
Introduction
Post-stroke neuromotor deficits result in gait asymmetries and an increased energetic cost of walking.1-3 Such deficits in walking quality often persist beyond standard rehabilitation efforts and result in reduced physical activity.4,5
Care guidelines highlight continued rehabilitation as essential to
improve mobility and function and mitigate costly future morbidities6;
however, most stroke survivors do not participate in outpatient
rehabilitation, in part due to limited access to skilled care and
disparities in transportation availability and time.7
Technological developments in high fidelity wearable sensing, automated treatment algorithms, and novel care delivery interfaces8,9
have created new opportunities for high-efficacy interventions to be
delivered autonomously in any setting (ie, clinic, home, or community).
We present the closed-loop control of music (Figure 1)
as a novel approach to leveraging such advancements to autonomously
provide highly salient and targeted, patient-tailored. Here,
“closed-loop” refers to the autonomous control of music, driven by input
from foot sensors as the participant walks. More specifically, the
autonomous rehabilitation system integrates real-time gait sensing with
music-based treatment algorithms to enable the application of
auditory-motor entrainment for enhancing post-stroke walking.10
Plainly,
auditory-motor entrainment is why people can effortlessly synchronize
their movements (ie, entrain) to the beat of an external rhythm.11-15
Indeed, auditory-motor neural circuits cause rhythmic motor output to
be attracted to, and eventually lock on to, the frequency of an external
rhythmic auditory signal.16-19
Our autonomous rehabilitation system applies the neurobiological
process of auditory-motor entrainment to induce targeted and
personalized changes in the post-stroke gait pattern. More specifically,
the rhythm of music is purposefully modulated based on continuous,
real-time gait assessments, resulting in gait training autonomously
tailored to each user’s gait.
The profound effect that rhythmic auditory stimuli have on neuromotor control12,15,20-23
has led to development and study of numerous clinical interventions
centered on auditory-motor entrainment. The efficacy of these
interventions has been extensively studied in people post-stroke, with
their ability to improve walking well-established,24-36 resulting in their recommendation37 and inclusion38
in published clinical practice guidelines. However, as with any skilled
intervention, clinical benefits can only be realized if the
intervention is readily accessible. The objective of this foundational
study is to determine if gait training autonomously delivered by way of
the closed-loop control of music has potential to improve walking
quality after stroke, as measured by improvements in the energetic cost
of walking and gait asymmetry.
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