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      A heel-strike real-time auditory feedback device to promote motor learning in children who have cerebral palsy: a pilot study to test device accuracy and feasibility to use a music and dance-based learning paradigm


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          Cerebral palsy (CP) is a developmental disorder of movement and posture that occurs due to damage to the developing nervous system. As part of therapy, wearable sensors that trigger interactive feedback may provide multi-sensory guidance and motivation. A prototype of a heel-strike real-time feedback system has been developed which records the number of heel strikes during gait and indicates successful heel contact through real-time auditory feedback. The first aim of this feasibility study was to test the prototype accuracy.

          Since the end user for this device is a child, the device should be esthetically appealing and sufficiently motivating for children to perform repetitive challenging therapeutic movements. The second aim of this study was to collect feedback from the subjects with regard to the device usability and understand if the bell sound used as feedback used was motivating enough for children to continue using the prototype. This would help us in developing the next generation of the device.


          The prototype was tested with typically developing children and children who have CP. The accuracy in detecting heel strikes was calculated. As part of the study, the subjects were also asked questions to test the device compliance and acceptability of the musical beats with the pediatric population.


          The device accuracy in identifying heel strikes is 97.44% (95% CI 96.31, 98.88%). The subjects did not show any hesitation to put on the device and the sound feedback motivated them to move. Based on this pilot study, a minimum age limit of 5 years is appropriate and the intervention study should be conducted for no more than 30 min per week.


          The pilot study showed that a main study can be conducted to test auditory feedback as an intervention to promote motor learning in children who have cerebral palsy. No adverse event or safety issues were reported in the feasibility study.

          Electronic supplementary material

          The online version of this article (10.1186/s40814-018-0229-0) contains supplementary material, which is available to authorized users.

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          Most cited references 18

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          Proposed definition and classification of cerebral palsy, April 2005

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            Prognosis for gross motor function in cerebral palsy: creation of motor development curves.

            Lack of a valid classification of severity of cerebral palsy and the absence of longitudinal data on which to base an opinion have made it difficult to consider prognostic issues accurately. To describe patterns of gross motor development of children with cerebral palsy by severity, using longitudinal observations, as a basis for prognostic counseling with parents and for planning clinical management. Longitudinal cohort study of children with cerebral palsy, stratified by age and severity of motor function and observed serially for up to 4 years during the period from 1996 to 2001. Nineteen publicly funded regional children's ambulatory rehabilitation programs in Ontario. A total of 657 children aged 1 to 13 years at study onset, representing the full spectrum of clinical severity of motor impairment in children with cerebral palsy. Severity of cerebral palsy, classified with the 5-level Gross Motor Function Classification System; function, formally assessed with the Gross Motor Function Measure (GMFM). Based on a total of 2632 GMFM assessments, 5 distinct motor development curves were created; these describe important and significant differences in the rates and limits of gross motor development among children with cerebral palsy by severity. There is substantial within-stratum variation in gross motor development. Evidence-based prognostication about gross motor progress in children with cerebral palsy is now possible, providing parents and clinicians with a means to plan interventions and to judge progress over time. Further work is needed to describe motor function of adolescents with cerebral palsy.
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              Gait analysis using a shoe-integrated wireless sensor system.

              We describe a wireless wearable system that was developed to provide quantitative gait analysis outside the confines of the traditional motion laboratory. The sensor suite includes three orthogonal accelerometers, three orthogonal gyroscopes, four force sensors, two bidirectional bend sensors, two dynamic pressure sensors, as well as electric field height sensors. The "GaitShoe" was built to be worn in any shoe, without interfering with gait and was designed to collect data unobtrusively, in any environment, and over long periods. The calibrated sensor outputs were analyzed and validated with results obtained simultaneously from the Massachusetts General Hospital, Biomotion Laboratory. The GaitShoe proved highly capable of detecting heel-strike and toe-off, as well as estimating foot orientation and position, inter alia.

                Author and article information

                Pilot Feasibility Stud
                Pilot Feasibility Stud
                Pilot and Feasibility Studies
                BioMed Central (London )
                29 January 2018
                29 January 2018
                : 4
                [1 ]ISNI 0000 0001 2285 7943, GRID grid.261331.4, The Ohio State University, ; Columbus, OH 43210 USA
                [2 ]GRID grid.432757.0, Bertec Corporation, ; Columbus, OH 43229 USA
                © The Author(s). 2018

                Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

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