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Instantaneous effect of real-time avatar visual feedback on interlimb coordination during walking post-stroke

  • Le Yu Liu
    Correspondence
    Corresponding author at: School of Physical and Occupational Therapy, McGill University, 3654 Promenade Sir-William-Osler, Montreal, QC H7V 1R2, Canada.
    Affiliations
    School of Physical and Occupational Therapy of McGill University, 3654 Promenade Sir-William-Osler, Montreal H3G1Y5, Canada

    Feil and Oberfeld Research Centre, Jewish Rehabilitation Hospital site of CISSS-Laval and research site of the Montreal Centre for Interdisciplinary Research in Rehabilitation (CRIR), 3205 Pl. Alton-Goldbloom, Laval H7V 1R2, Canada
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  • Samir Sangani
    Affiliations
    Feil and Oberfeld Research Centre, Jewish Rehabilitation Hospital site of CISSS-Laval and research site of the Montreal Centre for Interdisciplinary Research in Rehabilitation (CRIR), 3205 Pl. Alton-Goldbloom, Laval H7V 1R2, Canada
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  • Kara K. Patterson
    Affiliations
    Department of Physical Therapy of University of Toronto, 160-500 University Ave, Toronto M5G 1V7, Canada

    KITE-University Health Network, 550 University Ave #12-165, Toronto M5G 2A2, Canada
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  • Joyce Fung
    Affiliations
    School of Physical and Occupational Therapy of McGill University, 3654 Promenade Sir-William-Osler, Montreal H3G1Y5, Canada

    Feil and Oberfeld Research Centre, Jewish Rehabilitation Hospital site of CISSS-Laval and research site of the Montreal Centre for Interdisciplinary Research in Rehabilitation (CRIR), 3205 Pl. Alton-Goldbloom, Laval H7V 1R2, Canada
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  • Anouk Lamontagne
    Affiliations
    School of Physical and Occupational Therapy of McGill University, 3654 Promenade Sir-William-Osler, Montreal H3G1Y5, Canada

    Feil and Oberfeld Research Centre, Jewish Rehabilitation Hospital site of CISSS-Laval and research site of the Montreal Centre for Interdisciplinary Research in Rehabilitation (CRIR), 3205 Pl. Alton-Goldbloom, Laval H7V 1R2, Canada
    Search for articles by this author

      Highlights

      • Real-time avatar feedback improves post-stroke gait symmetry and coordination
      • Improvements in gait symmetry correlate with improvements in interlimb coordination
      • Observed improvements appear largely driven by adaptations on the non-paretic side

      Abstract

      Background

      Gait asymmetry, which is common after stroke, is typically characterized using spatiotemporal parameters of gait that do not consider the aspect of movement coordination. In this manuscript, we examined whether an avatar-based feedback provided as a single-session intervention to improve gait symmetry also improved inter-limb coordination among people with stroke and we examined the relationship between changes in coordination and step length symmetry.

      Methods

      Twelve stroke participants walked on a self-paced treadmill with and without a self-avatar that replicated their locomotor movements in real time. Continuous relative phase and angular coefficient of correspondence calculated using bilateral sagittal hip movements were used to quantify temporal and spatial interlimb coordination, respectively. Spatial gait symmetry, previously shown to improve with the avatar feedback, was quantified using step length ratio between both limbs, with the largest value as numerator.

      Findings

      Participants who improved their spatial symmetry during avatar exposure also improved their temporal coordination, while spatial coordination remained unchanged. Overall, improvements in spatial symmetry correlated positively with improvements in temporal coordination. The non-paretic hip and paretic ankle angle excursion in the sagittal plane also significantly increased during avatar exposure.

      Interpretation

      Improvements in gait symmetry may be explained by changes in interlimb coordination. Current data and existing literature further suggest that such improvements are largely driven by adaptations in non-paretic leg movements, notably at the hip. By providing real-time information on walking movements not affordable in other ways, avatar-based feedback shows great potential to improve gait symmetry and interlimb coordination post-stroke.

      Keywords

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