HearWalk: Co-designing and Building a Sound Feedback System for Hemiparetic Gait Training

Background
Sound feedback has been increasingly explored as a tool to enhance motor learning during gait training by augmenting patient self-awareness. Hemiparetic patients (e.g., after stroke or traumatic brain injury) exhibit a large intra-group variability, making it important for assistive technology to be patient-tailored. It is recommended that patients and professionals are involved in development processes to increase usability and user acceptance.

Objective
To develop and test a sound feedback system with multiple feedback possibilities compatible with conventional gait training protocols.

Methods
In developing an auditory feedback system for gait training, our research employed a user-centric co-design approach in four iterative cycles of design, development, and evaluation. A focus group of therapists defined clinical scenarios, general patients’ needs, and proposed sound feedback ideas. After development, these strategies underwent scrutiny by the focus group. Feasibility studies with patient-therapist pairs assessed the clinical practicality and usability of the system. Subsequent iterations were shaped by patient and therapists’ insights, leading to a final portable wireless prototype made of inexpensive motion sensors, a mobile app, and a sound playback system.

Takeaways and Perspectives
We developed three use-case scenarios integrable with conventional gait training protocols. Patients exhibited variability in physical and cognitive abilities, auditory comprehension, and preferences, confirming that the system needs to be adjustable to individual patients. Further research will focus on specific patient subgroups and movement impairments. Despite the resource-intensive nature of user-centered design, this project adds evidence to that clinical stakeholder perspectives are crucial for the effective development of rehabilitation technology.