The Effect of Video Game Biofeedback on Propulsion Biomechanics: A Preliminary Investigation Open Access
Alam, Zahin (Spring 2022)
Abstract
Introduction: Hemiparesis is characterized by decreased motor control and consequential muscle weakness on one side of the body, often termed the “paretic” side. Hemiparesis leads to biomechanical deficits in the paretic leg and inter-limb asymmetry, reducing walking function and mobility. One concomitant effect of hemiparesis is the reduction of propulsion in the paretic leg of stroke survivors. Gait interventions have targeted the paretic leg to increase paretic propulsion to be closer in magnitude relative to the non-paretic leg propulsion, reducing inter-limb propulsive asymmetry between the paretic and non-paretic limbs. Along with reduced propulsion, hemiparesis may alter the timing of propulsion. This thesis explores the utilization of real-time video game-based biofeedback as a gait rehabilitative strategy targeting paretic propulsion. Video games have been shown to create a more engaging and motivating training session and may help to distract users from fatigue or boredom. Our premise is that by taking advantage of game-based elements, video game biofeedback may make gait rehabilitation more fun and more engaging, thus maximizing therapeutic efficiency of restoring proper propulsion.
Methods: During a gait analysis session, three able-bodied participants (1 female, age 21.3 ± .58 y) and one post-stroke participant (69 y) were exposed to 3 walking conditions - no biofeedback, conventional biofeedback (Motion Monitor), and video game biofeedback (RockWalk). In addition to propulsion, measured using anteriorly directed ground reaction forces (AGRFs), we also recorded heart rate (using a chest-mounted monitor) and skin impedance (using a portable sensing device attached to the fingertips). Additionally, after each trial, participants were asked to report their rating of perceived exertion and score on an engagement questionnaire.
Outcome/measurements: The primary outcome measures were peak AGRF magnitude, coefficient of variance (CoV) of peak AGRF magnitude, timing latency of peak AGRF during the gait cycle, and CoV of peak AGRF timing. Secondary outcomes included average heart rate, skin conductance response (SCR), rating of perceived exertion (RPE), and engagement questionnaire scores.
Results: Compared to no biofeedback, video game biofeedback (RockWalk) induced a significantly greater peak AGRF magnitude and an increase in stride-to-stride variability of peak AGRF magnitude. There was no significant change in timing of peak AGRF, but RockWalk induced a small decrease in the latency of peak AGRF relative to ipsilateral toe-off. Moreover, there was a decrease in the stride-to-stride variability of peak AGRF timing. For able-bodied participants, RockWalk induced the highest skin conductance response, average heart rate, and average RPE. The engagement questionnaire showed that RockWalk was found to be more creative and faster-paced than Motion Monitor, though both Motion Monitor and RockWalk were found to be similarly enjoyable and engaging. Our case-study on one stroke survivor also demonstrated the feasibility and immediate effects of the video game biofeedback for improving propulsion in people with post-stroke hemiparesis.
Discussion: Our preliminary results show that video game biofeedback can increase the magnitude of propulsion of the targeted leg without changing propulsion magnitude in the non-targeted leg of healthy individuals. Timing analysis suggests that timing of peak AGRF may be tightly controlled despite changes in walking conditions (e.g. different speeds, with biofeedback) in healthy individuals, though biofeedback may induce greater stride-to-stride consistency in timing of peak AGRF. Lastly, video game biofeedback induced greater exercise intensity (average heart rate), perceived effort (RPE), and was reported to be more creative and fast-paced, though engagement was subjectively similar to a basic biofeedback interface. Taken together, these results support the feasibility of utilizing our novel video game biofeedback interface as a gait rehabilitative tool, and pave the way for future studies exploring the effects of video game biofeedback in individuals post-stroke with propulsive gait deficits.
Table of Contents
Chapter 1. THE EFFECT OF DIFFERENT MODES OF BIOFEEDBACK INTERFACES ON THE GENERATION OF PROPULSION……………………………………………………………….1
1.1 Introduction……………………………………………………………………………………2
1.2 Methods………………………………………………………………………………………..5
1.3 Results………………………………………………………………………………………..13
1.4 Discussion……………………………………………………………………………………18
Chapter 2. ANALYSIS OF TIMING OF PROPULSION RELATED BIOMECHANICAL VARIABLES……………………………………………………………………………………………..21
2.1. Timing of Propulsion-Related Biomechanical Variables Is Impaired in Individuals with Post-Stroke Hemiparesis………………………………………………………………………………………..22
2.1.1 Abstract……………………………………………………………………………...22
2.1.2 Introduction………………………………………………………………………….23
2.1.3 Methods……………………………………………………………………………...24
2.1.4 Results……………………………………………………………………………….26
2.1.5 Discussion…………………………………………………………………………...29
2.2 The Effect of Propulsion Biofeedback on the Timing of Propulsion-Related Biomechanical Variables………………………………………………………………………………………32
2.2.1 Introduction………………………………………………………………………….32
2.2.2 Methods……………………………………………………………………………...33
2.2.3 Results……………………………………………………………………………….33
2.2.4 Discussion…………………………………………………………………………...35
2.3 The Effect of Different Modes of Biofeedback Interfaces on The Timing of Propulsion……………………………………………………………………………………..36
2.3.1 Introduction………………………………………………………………………….36
2.3.2 Methods……………………………………………………………………………...37
2.3.3 Results……………………………………………………………………………….42
2.3.4 Discussion…………………………………………………………………………...47
Chapter 3. THE EFFECT OF DIFFERENT MODES OF BIOFEEDBACK INTERFACE ON AROUSAL STATE AND ENGAGEMENT……………………………………………………………50
3.1 Introduction…………………………………………………………………………………..50
3.2 Methods…………………………………………………………………………....................52
3.3 Results………………………………………………………………………………………..59
3.4 Discussion……………………………………………………………………………………70
4. CASE STUDY: FEASIBILITY AND EFFECTS OF GAME-BASED BIOFEEDBACK IN A POST-STROKE PARTICIPANT………………………………………………………………………73
5. List Figures and Tables………………………………………………………………………………..0
6. References……………………………………………………………………………………………..78
7. Appendix……………………………………………………………………………………………….83
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