Abstract
BACKGROUND: Enhancing the efficacy of gait rehabilitation is an important area of need as most persons with a history of stroke continue to experience gait deficits following discharge from rehabilitation. Incorporating gamification and real-time biofeedback into gait retraining may provide benefits by increasing engagement and salience of stepping practice to target specific gait parameters, maximizing therapeutic impact on walking function. The objective of this study was to evaluate the feasibility and preliminary effects of a novel, customized, gamified gait biofeedback interface specifically designed to enhance propulsion during gait training. METHODS: A repeated-measures design was used to compare 3 speed-matched treadmill walking bouts: (1) walking without biofeedback (noBF); (2) walking while receiving simple, real-time audiovisual conventional biofeedback (cBF); and (3) walking while receiving gamified, real-time audiovisual biofeedback (gBF). Gait biomechanics, physiological intensity, and self-reports of task workload, user experience, and engagement were obtained from 15 participants (9 able-bodied, 6 post-stroke). RESULTS: Compared to noBF, both gBF and cBF showed significantly greater increases in peak anterior ground reaction force, trailing limb angle, and ankle moment of the targeted leg during biofeedback exposure (Min. 3) and during the post-test without biofeedback exposure (Post), with moderate to large effect sizes. Compared to walking without biofeedback, both biofeedback conditions induced significantly greater physiological intensity (heart rate and rating of perceived exertion). NASA-Task Load Index results showed that gBF induced a higher workload than cBF for mental demand, temporal demand, performance, frustration, and effort. Also, gBF was rated higher in the novelty component of the User Experience Questionnaire. CONCLUSIONS: This preliminary study confirmed the feasibility of real-time gamified gait biofeedback, suggesting that gBF can induce similar enhancements in gait biomechanics and physiological intensity as cBF, while promoting greater task load and mental demand during walking practice. This work lays foundations for future studies that further refine and customize the game design, as well as evaluate the effects of gBF in larger samples and greater training dosage. TRIAL REGISTRATION: This study was registered on ClinicalTrials.gov (NCT04013971) and all study procedures were approved by the human subjects review board (IRB00106866). The study started 04/04/2022 and ended 03/31/2023.