Development of a vibrotactile cueing device that implicitly increases walking speed during gait training in stroke patients: an observational case series study

Abstract

One of the main sequelae of stroke is difficulty walking, which is characterised by decreased walking speed and asymmetrical walking patterns. Physical therapists often rely on explicit motor learning strategies, i.e., providing mainly verbal instructions for how movements should be performed. However, the voluntary movement induced by explicit instruction may lead to associated unintended muscle contractions or higher cognitive demand, which could be detrimental. We introduce a vibrotactile cueing device that implicitly improves walking speed. The stroke patient walks while alternating vibrational cues are given to the left and right sides of their waist. At each specified step, cueing frequency increases in the cueing group without the patient’s awareness. The four patients in the cueing group did not notice the increase in walking speed during training; however, we observed an improvement in walking speed and cadence in patients using the proposed cueing system, which was maintained during the posttest phase. Additionally, patients using the cueing system were able to suppress excessive compensatory movements during training compared with patients who did not use the system. This case series study indicates that the proposed system for gait rehabilitation of stroke patients can enable an increase in walking speed without excessive effort.

Keywords:

• Stroke
• gait training
• cueing
• haptic device
• implicit motor learning cueing system

Acknowledgements

The authors express gratitude to Zenyuu Ogawa for assisting in hardware design.

Ethical approval: Ethical approval was granted by the Ethics Committee of Waseda University.

Consent for publication: Written informed consent for the publication of clinical details and/or clinical images was obtained from all patients.

Author contributions

KY and JL performed the design of this study, acquisition and analysis of data, and drafted the manuscript. YH and SI made contributions to the development and analysis of the data. HI was involved in the conception of the system and design of the study. All authors have read and concurred with the contents of the final manuscript.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Funding

This study was supported by the Japanese Society for the Promotion of Science (JSPS), Grant-in-Aid for Scientific Research (C) No. 17K01875, and Research Institute for Science and Engineering, Waseda University, Grant-in-Aid for Junior Researchers.