Musical Biofeedback Paradigms to Promote High-Intensity Gait Training

High-intensity gait training (HIGT) is a well documented post-stroke rehabilitative approach that can improve balance and gait by tapping into plasticity principles that focus on training intensity, specificity, and salience. Listening to music during high-intensity endurance-type exercise activities can enhance energy efficiency, increase work output, and reduce perceived exertion, promoting motivation and psychological benefits. Research has also shown that musical agency resulting from real-time control over music through movement can further reduce perceived exertion and pain relative to passive listening. Despite the potential of musical interactive systems to promote exercise and support HIGT approaches, these are not commonplace in rehabilitation centers conducting HIGT, probably due to the added cost and personnel training necessary to integrate them into HIGT protocols. To address this gap, we first conducted an expert interview with three HIGT-trained physiotherapists to understand HIGT praxis, challenges, and the scope for musical interactive systems to support HIGT goals. We learned that the main clinical challenge in HIGT delivery, i.e. getting patients to exercise at a certain intensity for a sufficient duration, could potentially be addressed through real-time musical biofeedback that encourages patients to attain the desired exercise intensity and quantity over time. We then developed three separate musical biofeedback concepts (video demos: https://shorturl.at/cyzW5) wherein gait is measured using a single lightweight wireless inertial sensor (like in cell phones). When patients achieve training goals during HIGT (e.g. total step count, approximate distance covered, step cadence), they are rewarded through the addition of musical layers to multitrack compositions in multiple genres (new age, acoustic pop, metal). Future work includes assessing the feasibility and clinical potential of these feedback concepts within current HIGT protocols. Overall, this work lays the foundation for systematically leveraging the ability of musical interaction to facilitate long-term motor benefits for brain-injured patients.