Patent Publication Number: US-2021183263-A1

Title: Gait facilitation and feedback method and system

Description:
CROSS-REFERENCE TO RELATED APPLICATIONS 
     This application claims the benefit of U.S. Provisional Application No. 62/778,047 filed Dec. 11, 2018, the contents of which are incorporated herein by reference. 
    
    
     BACKGROUND OF THE INVENTION 
     The present invention generally relates to a gait facilitation and feedback system capable of providing automatic external cues to facilitate improved gait patterns and increased safety with ambulation. 
     Currently, commercial systems exist that are intended to improve ambulation in people with parkinsonian symptoms. These systems include walkers and canes with a laser line perpendicular to the user&#39;s progression, metronomes to provide auditory cues for stepping tempo, and walking programs that are either independent without cues or feedback or are manually guided walking sessions. Physical therapy also plays a large role in working with individuals with parkinsonian symptoms and often uses different cuing and feedback mechanisms in the clinic to improve gait pattern and ambulation. Some strategies used are: auditory clapping, tape lines on the floor, large exaggerated movements with verbal cues, stepping toward or over objects, or treadmill training. These techniques are beneficial in the clinic, but unfortunately do not carry over well into the individual&#39;s ambulation once the external stimulus is removed. Currently, it is common for patients to put tape lines on the floor of their home as external cues to assist with ambulation therapy, but tape may not be effective in times of low lighting such as in the middle of the night. 
     BRIEF DESCRIPTION OF THE INVENTION 
     The present invention provides gait facilitation and feedback methods and systems capable of providing automatic external cues to facilitate improved gait patterns and increased safety with ambulation. 
     According to one aspect of the invention, a gait facilitation and feedback method is provided that includes, during ambulation of a user over a surface, generating and simultaneously projecting multiple light beams on the surface in front of the user&#39;s line of progression during ambulation, the light beams projecting multiple illuminated lines in front of and perpendicular to the user&#39;s line of progression during ambulation to thereby project a field projection on the surface that is continuously seen by the user during ambulation and is not dependent on stepping of the user during ambulation. 
     Another aspect of the invention is a gait facilitation and feedback system equipped with means for generating and simultaneously projecting multiple light beams on a surface in front of a user&#39;s line of progression during ambulation by the user over the surface so that multiple illuminated lines are illuminated that are parallel to each other in front of and perpendicular to the user&#39;s line of progression during ambulation to thereby project a field projection on the surface that is continuously seen by the user during ambulation and is not dependent on stepping of the user during ambulation. 
     Technical aspects of the methods and systems described above preferably include the ability to continuously provide gait facilitation and feedback by continuously providing visual cuing for proper gait sequencing, and in preferred embodiments also provide real time feedback to track gait pattern performance. The methods and systems may utilize different options for visual and auditory feedback, with the general intent of providing visual cues along a user&#39;s walking path, optionally while recording and providing auditory cues and/or feedback on gait pattern performance based on heel and forefoot weight bearing. The methods and systems can be used as a training and management tool for individuals that benefit form external cues, such as individuals that suffer from parkinsonian symptoms, but can be used by essentially any individual undergoing gait training or rehabilitation. 
     Other aspects and advantages of this invention will be appreciated from the following detailed description. 
    
    
     
       BRIEF DESCRIPTION OF THE DRAWINGS 
         FIGS. 1A and 1B  schematically represent front and rear views showing a gait facilitation and feedback system in use by a user during ambulation in accordance with a nonlimiting embodiment of this invention, wherein the system continuously provides visual cues to the user by generating and projecting light beams on a surface in front of the user&#39;s line of progression during ambulation, and the light beams project multiple illuminated lines that are in front of and perpendicular to the user&#39;s line of progression to thereby project a field projection on the surface that can be continuously seen by the user during ambulation to facilitate stepping and to reduce the tendency for freezing of gait. 
         FIG. 2  schematically represents the gait facilitation and feedback system of  FIG. 1  further equipped with means for sensing weight bearing at the heel and forefoot of a shoe of the user to detect weight bearing at areas of the user&#39;s foot at heel contact and mid to late stance phase of a gait cycle during ambulation of the user, and means for generating and transmitting an auditory cue to the user to notify the user that the user has accomplished heel strike and forefoot weight transfer. 
         FIGS. 3A and 3B  schematically represent, respectively, front and rear views of a laser and hologram unit adapted for generating and projecting the light beams of any of the systems of  FIGS. 1 and 2 . 
         FIG. 4  schematically represents gait facilitation and feedback systems deployed in rooms in accordance with another nonlimiting embodiment of this invention. 
         FIG. 5  schematically represents the laser/hologram unit of  FIGS. 4A and 4B  as a component of a user&#39;s belt consistent with the gait facilitation and feedback system of  FIGS. 1 and 2 . 
         FIG. 6  schematically represents locations of heel and forefoot sensor pads adapted to be placed in a user&#39;s shoe in accordance with an optional aspect of this invention. 
         FIGS. 7A and 7B  schematically represent the laser/hologram unit of  FIGS. 4A and 4B  as a component of a user&#39;s shoe in accordance with an optional aspect of this invention. 
     
    
    
     DETAILED DESCRIPTION OF THE INVENTION 
     The invention will be described below as encompassing gait facilitation and feedback methods and systems capable of providing visual cues (optionally in combination with other automatic external cues) that can be continuously seen by a user of the system to facilitate stepping, reduce the tendency for freezing of gait, facilitate improved gait patterns, and increase safety of the user during ambulation. In certain embodiments, the system may also provide feedback on real-time performance, as well as objective information that can be used for goal setting and provide a reward system to the user. The system may have a high benefit for individuals with Parkinson&#39;s or parkinsonian symptoms, as it provides external cues adapted to make up for the loss of internal cuing for motor planning that is seen in these individuals. The reward system is particularly beneficial for this population due to the lack of dopamine in the brain providing reward satisfaction and motivation. 
     The system is also useful for balance and gait training within different therapeutic regimens. The system may be beneficial for anyone who is working on their gait pattern, ambulation, and balance, as it provides cuing for stepping and feedback on appropriate weight shift. Such use is not limited to the adult or neurologically involved populations, but may be beneficial to pediatric populations as well. The system may be used to help facilitate proper gait patterns in individuals who are working toward decreasing “toe walking,” as this system has the capability of providing a programable visual stimulus in front of the user, can control auditory stimuli (songs, sounds, etc.), and provide weight bearing feedback in real time. The system can be offered with different components and variations of complexities and feedback systems that allow for more affordability across a given demographic and varied use in different environments and situations. The system can be individually used and owned by the user, as well as can be owned and used by an organization, such as a therapy clinic, for in-clinic training, as well as renting to patients for long-term home training. 
     Nonlimiting embodiments of gait facilitation and feedback systems and the use thereof by an individual are represented in  FIGS. 1 and 2 . In each case, the system comprises a wearable light-generating unit  10  as a means for generating and simultaneously projecting multiple light beams  12  during ambulation of a user/wearer over a surface. Such a unit  10  may be, for example, a laser and hologram device that simultaneously generates multiple laser light beams. In the embodiments of  FIGS. 1 and 2 , the light beams  12  project multiple illuminated lines  14  on a surface that are parallel to each other and in front of and perpendicular to the user&#39;s line of progression  16  during ambulation to thereby project a field projection  18  on the surface that can be continuously seen by the user during ambulation. The operation of the light-generating unit  10  and the generation of the illuminated lines  14  are not dependent on stepping of the user during ambulation, but instead continuous during operation of the unit  10 . As a result of comprising multiple illuminated lines  14 , the field projection  18  provides a visual cue that the user steps toward or over to improve step length, foot clearance, and heel strike, so that the field projection  18  is able to facilitate stepping by the user and reduce the user&#39;s tendency for freezing of gait. Though a laser/hologram unit that generates laser light beams is believed to be preferred as the light-generating unit  10 , the use of other light generating devices and other forms of light are foreseeable as long as the illuminated lines  14  are sufficiently visible and distinct to the particular user. 
     In  FIG. 1 , the light-generating unit  10  is attached to a belt  20  at or near the center of the belt  20 . A battery pack  22  is attached to the belt  20  and is connected to the light-generating unit  10  via a wire connection. In  FIG. 2 , the system is further equipped with means for sensing weight bearing at the heel and forefoot of a shoe of a user to detect weight bearing at areas of the user&#39;s foot at heel contact and mid to late stance phase of a gait cycle during ambulation of the user, and a sound-generating unit for generating and transmitting an auditory cue to the user to notify the user that the user has accomplished heel strike and forefoot weight transfer as sensed by the sensing means. The sensing means are represented in  FIG. 2  as placed in the users shoes at the heel and forefoot, and are represented in  FIG. 6  as sensor pads  24  that conform to the shape of the heel and forefoot insole and may be attached to the insole of the user&#39;s shoes with adhesive. Sensing elements  26  and  28  carried by the sensor pads  24  can be shaped and designed to detect weight bearing at the appropriate areas of the foot at heel contact and mid to late stance phase of the gait cycle. The sensing elements  26  and  28  detect a percent weight bearing at the heel strike and late midstance portions of the gait cycle. When enough weight is detected, the outputs of the sensor elements  26  and  28  may be used by the sound-generating unit to generate and transmit an auditory cue (sound) to the user to identify a successful heel strike and successful midfoot weight transfer during the stance portion of the gait cycle. In the example of  FIG. 2 , the outputs of the sensor elements  26  and  28  are wirelessly transmitted to earbuds  30  to generate an auditory sound, though the use of other forms of speakers is foreseeable. With this approach, the outputs of the sensor elements  26  and  28  may be directly wirelessly transmitted to the earbuds  30 , or the belt  20  may carry a sound generating unit that converts the outputs of the sensor elements  26  and  28  to an auditory signal that is then relayed to the earbuds  30 . The auditory cue may be programed into the system through an online application to allow the user to customize the sounds that are generated. This may be a click or something such as music or sounds that could be used as motivation in pediatric users. Alternatively or in addition, the heel and forefoot sensor pads  24  may be adapted to directly provide a mechanical auditory function, for example, a mechanic audible feedback (e.g., “pop” or “click”) when sufficient weight bearing is sensed at the heel and midfoot. 
       FIGS. 3A and 3B  schematically represent front and rear views of a nonlimiting example of the light-generating unit  10 .  FIG. 3A  schematically depicts areas  50  and  52  of the unit  10  from which, respectively, the laser and hologram fields are emitted from the unit  10 . The unit  10  is able to be worn on the belt  20  of the user ( FIGS. 1 and 2 ) or mounted on a floor in a desired location ( FIG. 4 ). The unit  10  may be attached to the belt  20  via a click-in ball and socket joint, of which  FIG. 3B  shows the ball (male end)  38  of such a joint on the back side of the unit  10 . With custom design options of the unit  10 , a user or clinician can design different patterns of field projections that can be used for exercises, in addition to ambulation therapy. The field projection  18  generated with the unit  10  is preferably controllable independent of the optional sensor pads  24 , and though intended for use with the sensor pads  24  could be used separately. 
     It is also foreseeable that the light-generating unit  10  of  FIGS. 3A and 3B  could be mounted within any given environment (e.g., the user&#39;s hallway from bed to bathroom, doorways to prevent mobility freezing, or even in therapy clinics) to provide functions such as targets, agility ladders, or other field patterns that are commonly created by applying tape to a floor.  FIG. 4  is a schematic plan view showing light-generating units  10  in a freestanding form for use in a therapeutic environment or the user&#39;s home. In  FIG. 4 , two units  10  are individually mounted on tripods  32  that can be set up to project the multiple light beams  12  to generate multiple illuminated lines  14  on the floor of a desired location. The resulting projection field  18  may be programable through an online application to allow for various options, such as perpendicular lines from the user&#39;s bed  34  to the bathroom  36 , or a star pattern  36  projected on the floor of a therapy clinic. 
       FIG. 5  schematically represents a more detailed view of the belt  20  of  FIGS. 1 and 2 . The belt  20  is preferably formed of an elastic material and adapted to be worn and attached around the user&#39;s waist. The belt  20  is shown as having an anchoring site comprising a socket (female end)  40  of a ball and socket joint for coupling with the complementary ball  38  of the unit  10  in  FIG. 3B . The anchoring site may include a built-in gyroscope within the socket  40  to prevent the user&#39;s movements from moving the light-generating unit  10  and its field projection  18 . The belt  20  is also schematically represented as storing batteries  42  that can be interchanged with those of the light-generating unit  10 . Alternatively, the belt  20  and light-generating unit  10  can be equipped with wiring that allows the light-generating unit  10  to be selectively connected to the batteries  42  carried on the belt  20 , as shown in  FIG. 2 . The belt  20  may optionally also mount other components of the system, for example, a previously-noted sound-generating unit that may relay or produce an auditory sound to identify a successful heel strike and midfoot weight transfer. 
       FIGS. 7A and 7B  schematically represent the light-generating unit  10  as a component of a shoe attachment  46  adapted to be attached to the top of a user&#39;s shoes  44  near the toe. In this embodiment, the laser beam  12  (or another form of narrow light beam) is generated at the level of the toe perpendicular to the user&#39;s line of progression  16 . Shoe attachments of the type represented in  FIGS. 7A and 7B  are preferably attached to both of the user&#39;s shoes. 
     As noted previously, the system may operate in combination with an online application that can be accessed on the user&#39;s phone or other mobile electronic device. The application can be configured to provide feedback on total steps versus heel strikes and adequate forefoot weight transfer, and allow the user to set goals such as daily heel strike goals that could potentially provide a reward system for the user. 
     In view of the above, the gait facilitation and feedback system is adapted to detect heel strike and forefoot weight transfer during the gait cycle of a user and have an option to provide auditory feedback to the user, for example, via a mechanical “click” or “pop” sound generated with the sensor pads, or an electric signal generated by the sensor pads (or another sound generating unit) and transmitted to earbuds worn by the user when those tasks are accomplished. Within an online application and/or wireless earbuds or speaker, it is also an option to program music or a metronome to provide auditory cuing rather than feedback or to trigger such cues based on weight bearing inputs from the sensor pads. The system also provides visual cues by means of field projections that contain targets perpendicular to the user&#39;s progression for stepping cues and motor freezing prevention. The user&#39;s performance can be tracked on an electronic application providing objective information of number of heel strikes and forefoot weight transfers versus total steps that can also be used for goal setting, providing a reward system for the user. 
     In contrast to conventional commercial ambulation therapy systems, gait facilitation and feedback systems of the present invention are preferably capable of providing comprehensive external cuing and gait feedback wherever the user may be, e.g., whether at a clinic or at home. Such a system can provide visuals cues, auditory feedback/cues, and objective measures/rewards, that can be used personally or as a training tool by therapists. The light-generating unit  10  can also provide several functions, whether it is used at the user&#39;s belt buckle for ambulation or exercises, or to provide designs in the clinic or an individual&#39;s household. 
     Gait facilitation and feedback systems of the present invention provide means for using current strategies independently and long-term. With the given evidence of the benefits of prolonged ambulation, use of external cues and providing reward systems for the given population, potential for this system to be highly beneficial is great. 
     While the invention has been described in terms of a particular embodiment, it should be apparent that alternatives could be adopted by one skilled in the art. For example, the system and its components could differ in appearance and construction from the embodiment described herein and shown in the drawings, and functions of certain components of the system could be performed by components of different construction but capable of a similar (though not necessarily equivalent) function. As such, it should be understood that the above detailed description is intended to describe the particular embodiment represented in the drawings and certain but not necessarily all features and aspects thereof, and to identify certain but not necessarily all alternatives to the represented embodiment and described features and aspects. As a nonlimiting example, the invention encompasses additional or alternative embodiments in which one or more features or aspects of the disclosed embodiment could be eliminated. Accordingly, it should be understood that the invention is not necessarily limited to any embodiment described herein or illustrated in the drawings, and the phraseology and terminology employed above are for the purpose of describing the illustrated embodiment and do not necessarily serve as limitations to the scope of the invention. Therefore, the scope of the invention is to be limited only by the following claims.