Developing Enjoyable Auditory Feedback Paradigms to Alleviate Toe Walking in Children with Cerebral Palsy

Movement sonification has great potential as an auditory feedback tool to enhance motor learning. A user group that has received relatively little attention is children with cerebral palsy, who commonly exhibit ‘toe walking’, which is characterized by lacking heel contact with the ground during stepping. Sonification designs aiming to alleviate this commonly employ simplistic feedback sounds (e.g. buzzing or clicking), which not only are unsuitable for sustained use with children, but also undershoot the potential of the auditory medium to promote motivation, engagement, and meaningful perception-action coupling during training. To address this, we established an overall feedback design direction based on past literature and discussions with stakeholders. Accordingly, we built a technological framework for lightweight wireless motion sensing, sonification prototyping, and real-time testing. Next, we developed and showcased five novel feedback paradigms to inform on toe walking and reward heel strike through a combination of rich ecological sounds aimed at promoting playfulness and engagement while providing salient and meaningful positive reinforcement. Future work will test the feasibility and motor learning effects of these (and similar) paradigms while also investigating their optimal application in clinical and home environments. We believe that this work can serve as an important step towards countering the long term effects of toe walking in many children with cerebral palsy through sonic interaction.