Examination of effect and responder to real-time auditory feedback during overground gait for stroke: a randomized cross-over study

Real-time auditory feedback for overground gait was developed to simulate realistic gait practice. This study aimed to assess the effects of different auditory feedback conditions and identify patients with stroke who might benefit from auditory feedback based on physical function. Twenty patients with stroke participated in three 6-min gait trials: no feedback (control), auditory feedback focused on increasing ankle plantar flexion (ankle trial), and auditory feedback on increasing lower-leg extension angle (leg trial). Physical function was evaluated using the Short Physical Performance Battery (SPPB); gait function was assessed through gait speed, cadence, stride length, and joint motion using inertial sensors before and after each trial. Gait speed (P = 0.001), stride length (P < 0.001), ankle plantar flexion (P = 0.014), and leg extension angles (P = 0.020) improved significantly over time. Interaction effects between time and trial were observed for stride length (P = 0.001) and leg extension angle (P = 0.003). Among the auditory feedback trials, stride length (P = 0.012), length-time difference (P = 0.003), and leg extension angle (P = 0.008) increased significantly in the leg trial compared with the control trial. SPPB scores were independently associated with the benefit from the leg trial (odds ratio: 2.217, 95% confidence interval: 1.152-4.266, P = 0.017). Real-time auditory feedback focused on leg extension angle during gait may enhance gait speed by improving leg extension and optimizing spatial gait strategies.