Evaluating the Effectiveness of Biofeedback Modalities for Lower Limb Amputee Gait Rehabilitation

Alexandria Michelini (1, 2), Jan Andrysek (1, 2)

1) Institute of Biomaterials and Biomedical Engineering, University of Toronto, 2) Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital

Most individuals with lower limb amputation (LLA) exhibit gait (walking pattern) deviations due, in part, to insufficient length of gait training and rehabilitation as well as atypical gait parameters (i.e. knee flexion/extension angles). This often leads to musculoskeletal conditions and joint degeneration, affecting their mobility and quality of life. Biomechanical biofeedback (BFB), the practice of providing real- time sensory feedback based on collected kinematic, kinetic and spatiotemporal data, has been shown to improve gait rehabilitation outcomes. As of yet, there is no clear consensus on the most effective BFB delivery modality (auditory or vibrotactile) for mobility applications. To overcome these current challenges, we will develop (AIM 1) a BFB prototype system and empirically evaluate (AIM 2) the effectiveness of single (auditory vs vibrotactile) vs multiple (auditory and vibrotactile) for improving gait deviations for individuals with LLA. Fifteen individuals with LLA will be recruited to participate in walking experiments with the proposed BFB system. This system will use a goniometer to collect knee flexion/extension angles and pressure sensors on the plantar surface of the foot (heel and toe) to collect stance/swing ratio. Vibrotactile feedback will be delivered using two vibrating motors and auditory feedback will be delivered using speakers. Participants will walk in a straight line at a self-selected speed under four modality conditions: 1) no feedback, 2) auditory, 3) vibrotactile, and 4) auditory and vibrotactile. Using a repeated measures ANOVA, pre and post-feedback kinematic and spatiotemporal parameters will be compared from each condition to determine which modality or combination of modalities is the most effective to improve gait deviations. Determining the most effective feedback modality is an integral step in creating an innovative BFB system for individuals with LLA. The adoption of a wearable BFB tool has the potential to improve the mobility and quality of life of amputees in Canada and worldwide.