Quantifying gait DOES NOTHING TOWARDS RECOVERY! Create protocols that deliver recovery you blithering idiots!
Oops, I'm not playing by the polite rules of Dale Carnegie, 'How to Win Friends and Influence People'.
Telling stroke medical persons they know nothing about stroke is a no-no even if it is true.
Politeness will never solve anything in stroke. Yes, I'm a bomb thrower and proud of it. Someday a stroke 'leader' will try to ream me out for making them look bad by being truthful, I look forward to that day.
Wearable Activity Monitors to Quantify Gait During Stroke Rehabilitation: Data from a Pilot Randomised Controlled Trial Examining Auditory Rhythmical Cueing
by 
,,,
Christopher Buckley
1,*,Lisa Shaw
2,Patricia McCue
2,Philip Brown
3,Silvia Del Din
4,5,Richard Francis
2,Heather Hunter
3,Allen Lambert
2,Lynn Rochester
3,4,5 andSarah A. Moore
1,2,6,*1
Department of Sport, Exercise and Rehabilitation, Faculty of Health and Life Science, Northumbria University, Newcastle upon Tyne NE7 7YT, UK
2
Stroke Research Group, Faculty of Medical Sciences, Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne NE2 4HH, UK
3
The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne NE4 5PL, UK
4
Institute of Translational and Clinical Research, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne NE1 7RU, UK
5
National Institute for Health and Care Research (NIHR), Newcastle Biomedical Research Centre (BRC), Newcastle University, Newcastle upon Tyne NE4 5PL, UK
6
Stroke Northumbria, Northumbria Healthcare NHS Foundation Trust, Rake Lane, North Shields, Tyne and Wear NE29 8NH, UK
*
Authors to whom correspondence should be addressed.
Symmetry 2025, 17(10), 1640; https://doi.org/10.3390/sym17101640
Submission received: 14 July 2025 / Revised: 7 August 2025 / Accepted: 5 September 2025 / Published: 3 October 2025
(This article belongs to the Special Issue Symmetry/Asymmetry in Human Movement and Sensors Applied in Bioengineering)
Abstract
Hemiparesis is a disabling consequence of stroke, causing abnormal gait patterns with biomechanical asymmetries. Gait mechanics for stroke survivors appear resistant to conventional rehabilitation. Auditory rhythmical cueing (ARC) represents an emerging intervention option. To determine effective gait interventions, objective measures of gait collected from real-world environments may be required in addition to standard clinical outcomes to aid understanding of gait mechanics. This study reports on the ability of wearable activity monitors to quantify an ARC intervention for fifty-nine stroke survivors randomised into an ARC gait and balance training programme or an equivalent training programme without ARC. Gait assessments were undertaken at baseline and at 6 weeks for 4-metre walks and continuously for 7 days following each home assessment using a wearable activity monitor. The success rates of data collection using the wearable activity monitors ranged from 64 to 95%. Forty-eight Digital Mobility Outcomes representing a broad range of gait mechanics were calculated. Visualisation of all DMOs using radar plots indicated changes from baseline in both groups, with individual data indicating large variability in response to the intervention and control programme. Including wearable activity monitors to evaluate gait interventions for stroke survivors provides additional value to traditional methods and aids understanding of individual responses; as such, they should be used for future intervention-based research.
1. Introduction
Hemiparesis is a common disabling consequence of stroke that leads to abnormal gait patterns marked by biomechanical asymmetries that contribute to decreased gait velocity, increased susceptibility to falls, hospitalisations, and reduced independence and quality of life [1,2]. One of the main rehabilitation goals for stroke survivors is to regain the ability to ambulate independently in real-world settings [3,4]. Despite current rehabilitation efforts, gait problems are experienced by ≈80% of stroke survivors [5,6], and 50–70% of individuals are classified as household or limited community ambulators based on their walking function [1,7,8]. Given the disabling impacts of a stroke, more effective interventions to improve gait mechanics and, consequently, increase ambulation within the context of the participants’ own environments are required [1,9].
Stroke survivors would ideally benefit from practicing their gait rehabilitation outside the limited face-to-face therapy time available to them in real-world settings [8,10]. A potential low-cost method of enhancing the efficacy of gait rehabilitation post-stroke that can be practiced unsupervised is auditory rhythmical cueing (ARC). ARC is where a metronome beat (or music) is delivered during exercise training to normalise and train stepping. If the metronome is equally matched for each step, in theory, it should improve symmetry when walking [11]. The efficacy of ARC has been well established in Parkinson’s disease over the last 20 years [12], and there is evidence for its efficacy when applied in a clinic/laboratory setting for stroke survivors [13]. ARC is emerging as a feasible and acceptable method of targeting gait within and around the home after stroke, but ARC’s efficacy within real-world settings post-stroke has yet to be established [8,14,15].
To establish the efficacy of ARC in home and community settings, sensitive and specific measurements are required. During stroke rehabilitation, gait is conventionally assessed by measuring walking distance and speed using tests such as the 10 m walk test or the 6 min walk test (6MWT) [16]. Tests like these do not capture real-world walking behaviours or cardinal gait features of stroke survivors such as asymmetry and variability [2,17]. Although correlated to gait speed, these metrics are important as they are associated with several negative consequences, such as inefficiency, challenges to balance control, risk of musculoskeletal injury to the non-paretic lower limb, and loss of bone mass density in the paretic lower limb [18]. The lack of specific measures that capture gait asymmetry might explain why there is a current lack of evidence and effective interventions targeting gait asymmetry [8,19,20]. The same argument can be made for improvements in free-living walking performance (i.e., defined as what a person does in their own environment [17]), as this also lacks an objective and specific method to be quantified.
Wearable activity monitors are valid and reliable at capturing whole-body movement symmetry [21,22] and gait from real-world environments for stroke survivors [9,23]. A large variety of Digital Mobility Outcomes (DMOs) (defined as a digitally measured mobility parameter used to assess an individual’s health status, particularly in the context of movement and walking) can be calculated from wearable activity monitors [24]. Wearable activity monitors appear to be an ideal tool to objectively quantify the impact of interventions designed to improve specific gait mechanics for stroke survivors from real-world environments due to the increased specificity of measuring mechanical changes relative to conventional gait tests [2,6,9,25]. However, to our knowledge, they have yet to be tested for this purpose. Understanding effective gait interventions for stroke survivors is limited [26]. Interventions are still being developed by researchers and tested on relatively small single-site samples (N < 100), with variable methodological rigour undertaken in research laboratories with selected patient samples [6,27]. If wearable activity monitors can quantify specific changes in gait mechanics, it would help overcome these limitations while providing a step towards integrating wearable activity monitors to quantify the impact of future gait intervention-based research [10,25]. We have previously reported findings of a pilot RCT exploring the use of auditory rhythmical cueing to improve gait in community-dwelling stroke survivors [15]. The aim of this current paper is to report the data from wearable activity monitors collected within this pilot RCT and to visualise how, relative to a control group, the gait mechanics of stroke survivors may change following 6 weeks of ARC training. To achieve this aim, the objectives of this study are as follows:
- To quantify the success rate of integrating wearable activity monitors to collect data within a pilot RCT of ARC training post-stroke.
- Use 48 DMOs to visualise how, relative to a control group, the gait mechanics of stroke survivors are impacted following a 6-week ARC intervention,
- Provide DMO reference data recorded with the use of wearable activity monitors for both a control group and following 6 weeks of an ARC intervention.
- Discuss our findings with the purpose of informing future intervention studies aiming to integrate wearable activity monitors and quantify intervention impact for stroke survivors.
- More at link.
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