{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,27]],"date-time":"2026-06-27T06:58:11Z","timestamp":1782543491832,"version":"3.54.5"},"reference-count":30,"publisher":"MDPI AG","issue":"2","license":[{"start":{"date-parts":[[2024,1,9]],"date-time":"2024-01-09T00:00:00Z","timestamp":1704758400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Natural Sciences and Engineering Research Council of Canada (NSERC) Postgraduate Scholarship","award":["461469827"],"award-info":[{"award-number":["461469827"]}]},{"name":"Natural Sciences and Engineering Research Council of Canada (NSERC) Postgraduate Scholarship","award":["CPG-163967"],"award-info":[{"award-number":["CPG-163967"]}]},{"name":"Natural Sciences and Engineering Research Council of Canada (NSERC) Postgraduate Scholarship","award":["RGPIN 2018-05046"],"award-info":[{"award-number":["RGPIN 2018-05046"]}]},{"name":"Canadian Institutes of Health Research","award":["461469827"],"award-info":[{"award-number":["461469827"]}]},{"name":"Canadian Institutes of Health Research","award":["CPG-163967"],"award-info":[{"award-number":["CPG-163967"]}]},{"name":"Canadian Institutes of Health Research","award":["RGPIN 2018-05046"],"award-info":[{"award-number":["RGPIN 2018-05046"]}]},{"DOI":"10.13039\/501100000038","name":"Natural Sciences and Engineering Research Council (NSERC) Discovery","doi-asserted-by":"publisher","award":["461469827"],"award-info":[{"award-number":["461469827"]}],"id":[{"id":"10.13039\/501100000038","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100000038","name":"Natural Sciences and Engineering Research Council (NSERC) Discovery","doi-asserted-by":"publisher","award":["CPG-163967"],"award-info":[{"award-number":["CPG-163967"]}],"id":[{"id":"10.13039\/501100000038","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100000038","name":"Natural Sciences and Engineering Research Council (NSERC) Discovery","doi-asserted-by":"publisher","award":["RGPIN 2018-05046"],"award-info":[{"award-number":["RGPIN 2018-05046"]}],"id":[{"id":"10.13039\/501100000038","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Sensors"],"abstract":"<jats:p>Temporal gait asymmetry (TGA) is commonly observed in individuals facing mobility challenges. Rhythmic auditory stimulation (RAS) can improve temporal gait parameters by promoting synchronization with external cues. While biofeedback for gait training, providing real-time feedback based on specific gait parameters measured, has been proven to successfully elicit changes in gait patterns, RAS-based biofeedback as a treatment for TGA has not been explored. In this study, a wearable RAS-based biofeedback gait training system was developed to measure temporal gait symmetry in real time and deliver RAS accordingly. Three different RAS-based biofeedback strategies were compared: open- and closed-loop RAS at constant and variable target levels. The main objective was to assess the ability of the system to induce TGA with able-bodied (AB) participants and evaluate and compare each strategy. With all three strategies, temporal symmetry was significantly altered compared to the baseline, with the closed-loop strategy yielding the most significant changes when comparing at different target levels. Speed and cadence remained largely unchanged during RAS-based biofeedback gait training. Setting the metronome to a target beyond the intended target may potentially bring the individual closer to their symmetry target. These findings hold promise for developing personalized and effective gait training interventions to address TGA in patient populations with mobility limitations using RAS.<\/jats:p>","DOI":"10.3390\/s24020400","type":"journal-article","created":{"date-parts":[[2024,1,9]],"date-time":"2024-01-09T09:43:24Z","timestamp":1704793404000},"page":"400","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":9,"title":["The Development of a Wearable Biofeedback System to Elicit Temporal Gait Asymmetry using Rhythmic Auditory Stimulation and an Assessment of Immediate Effects"],"prefix":"10.3390","volume":"24","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8452-401X","authenticated-orcid":false,"given":"Aliaa","family":"Gouda","sequence":"first","affiliation":[{"name":"Institute of Biomedical Engineering, University of Toronto, Toronto, ON M5S 3G9, Canada"},{"name":"Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, ON M4G 1R8, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4976-1228","authenticated-orcid":false,"given":"Jan","family":"Andrysek","sequence":"additional","affiliation":[{"name":"Institute of Biomedical Engineering, University of Toronto, Toronto, ON M5S 3G9, Canada"},{"name":"Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, ON M4G 1R8, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2024,1,9]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"763","DOI":"10.1093\/ptj\/76.7.763","article-title":"Temporal Stability of Gait in Parkinson\u2019s Disease","volume":"76","author":"Morris","year":"1996","journal-title":"Phys. Ther."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"304","DOI":"10.1016\/j.apmr.2007.08.142","article-title":"Gait Asymmetry in Community-Ambulating Stroke Survivors","volume":"89","author":"Patterson","year":"2008","journal-title":"Arch. Phys. Med. Rehabil."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"776","DOI":"10.1109\/TNSRE.2014.2356722","article-title":"Mechanisms of Gait Asymmetry Due to Push-off Deficiency in Unilateral Amputees","volume":"23","author":"Adamczyk","year":"2015","journal-title":"IEEE Trans. Neural Syst. Rehabil. Eng."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"99","DOI":"10.21300\/18.2-3.2016.99","article-title":"Gait Training Interventions for Lower Extremity Amputees: A Systematic Literature Review","volume":"18","author":"Highsmith","year":"2016","journal-title":"Technol. Innov."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"322","DOI":"10.1016\/j.gaitpost.2011.10.003","article-title":"Gait Asymmetries in Children with Cerebral Palsy: Do They Deteriorate with Running?","volume":"35","year":"2012","journal-title":"Gait Posture"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1617","DOI":"10.1109\/TNSRE.2019.2924682","article-title":"Effects of Vibrotactile Biofeedback Coding Schemes on Gait Symmetry Training of Individuals with Stroke","volume":"27","author":"Afzal","year":"2019","journal-title":"IEEE Trans. Neural Syst. Rehabil. Eng."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"33","DOI":"10.1080\/23335432.2022.2142160","article-title":"Walking Asymmetry and Its Relation to Patient-Reported and Performance-Based Outcome Measures in Individuals with Unilateral Lower Limb Loss","volume":"9","author":"Wong","year":"2022","journal-title":"Int. Biomech."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"27","DOI":"10.1186\/1743-0003-6-27","article-title":"Changes in Spatiotemporal Gait Variables over Time during a Test of Functional Capacity after Stroke","volume":"6","author":"Sibley","year":"2009","journal-title":"J. Neuroeng. Rehabil."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"267","DOI":"10.1080\/00222895.2021.1953959","article-title":"The Effect of Rhythm Abilities on Metronome-Cued Walking with an Induced Temporal Gait Asymmetry in Neurotypical Adults","volume":"54","author":"Crosby","year":"2022","journal-title":"J. Mot. Behav."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"1009","DOI":"10.2522\/ptj.20050394","article-title":"Gait Coordination after Stroke: Benefits of Acoustically Paced Treadmill Walking","volume":"87","author":"Roerdink","year":"2007","journal-title":"Phys. Ther."},{"key":"ref_11","doi-asserted-by":"crossref","unstructured":"Michelini, A., Sivasambu, H., and Andrysek, J. (2022). The Short-Term Effects of Rhythmic Vibrotactile and Auditory Biofeedback on the Gait of Individuals After Weight-Induced Asymmetry. Can. Prosthet. Orthot. J., 5.","DOI":"10.33137\/cpoj.v5i1.36223"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"517028","DOI":"10.3389\/fneur.2020.517028","article-title":"An Initial Investigation of the Responsiveness of Temporal Gait Asymmetry to Rhythmic Auditory Stimulation and the Relationship to Rhythm Ability Following Stroke","volume":"11","author":"Crosby","year":"2020","journal-title":"Front. Neurol."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"1417","DOI":"10.1586\/14737175.7.10.1417","article-title":"Gait Training Strategies to Optimize Walking Ability in People with Stroke: A Synthesis of the Evidence","volume":"7","author":"Eng","year":"2011","journal-title":"Expert Rev. Neurother."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"2581","DOI":"10.1109\/TNSRE.2023.3282216","article-title":"Evaluation of a Vibrotactile Biofeedback System Targeting Stance Time Symmetry Ratio of Individuals With Lower-Limb Amputation: A Pilot Study","volume":"31","author":"Gouda","year":"2023","journal-title":"IEEE Trans. Neural Syst. Rehabil. Eng."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"198","DOI":"10.2522\/ptj.20150441","article-title":"Time-Discrete Vibrotactile Feedback Contributes to Improved Gait Symmetry in Patients with Lower Limb Amputations: Case Series","volume":"97","author":"Crea","year":"2017","journal-title":"Phys. Ther."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"1337","DOI":"10.1080\/02640414.2010.507252","article-title":"Exercise, Music, and the Brain: Is There a Central Pattern Generator?","volume":"28","author":"Stefan","year":"2010","journal-title":"J. Sports Sci."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"67","DOI":"10.1186\/s12984-021-00863-x","article-title":"Utilization of Wearable Technology to Assess Gait and Mobility Post-Stroke: A Systematic Review","volume":"18","author":"Peters","year":"2021","journal-title":"J. Neuroeng. Rehabil."},{"key":"ref_18","doi-asserted-by":"crossref","unstructured":"Bowman, T., Gervasoni, E., Arienti, C., Lazzerini, S.G., Negrini, S., Crea, S., Cattaneo, D., and Carrozza, M.C. (2021). Wearable Devices for Biofeedback Rehabilitation: A Systematic Review and Meta-Analysis to Design Application Rules and Estimate the Effectiveness on Balance and Gait Outcomes in Neurological Diseases. Sensors, 21.","DOI":"10.3390\/s21103444"},{"key":"ref_19","doi-asserted-by":"crossref","unstructured":"Pinheiro, C., Lopes, J.M., Figueiredo, J., Goncalves, L.M., and Santos, C.P. (2020, January 15\u201317). Design and Technical Validation of a Wearable Biofeedback System for Robotic Gait Rehabilitation. Proceedings of the 2020 IEEE International Conference on Autonomous Robot Systems and Competitions, ICARSC 2020, Ponta Delgada, Portugal.","DOI":"10.1109\/ICARSC49921.2020.9096105"},{"key":"ref_20","doi-asserted-by":"crossref","unstructured":"Gouda, A., and Andrysek, J. (2022). Rules-Based Real-Time Gait Event Detection Algorithm for Lower-Limb Prosthesis Users during Level-Ground and Ramp Walking. Sensors, 22.","DOI":"10.3390\/s22228888"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"34","DOI":"10.1016\/S0966-6362(00)00070-9","article-title":"Symmetry and Limb Dominance in Able-Bodied Gait: A Review","volume":"12","author":"Sadeghi","year":"2000","journal-title":"Gait Posture"},{"key":"ref_22","doi-asserted-by":"crossref","unstructured":"Al-Juaid, R., and Al-Amri, M. (2020). An Evaluation of Symmetries in Ground Reaction Forces during Self-Paced Single-and Dual-Task Treadmill Walking in the Able-Bodied Men. Symmetry, 12.","DOI":"10.3390\/sym12122101"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"102806","DOI":"10.1016\/j.humov.2021.102806","article-title":"Perceptions of an Over-Ground Induced Temporal Gait Asymmetry by Healthy Young Adults","volume":"78","author":"Crosby","year":"2021","journal-title":"Hum. Mov. Sci."},{"key":"ref_24","unstructured":"Hart, S.G., and Staveland, L.E. (1988). Advances in Psychology, Elsevier."},{"key":"ref_25","doi-asserted-by":"crossref","unstructured":"Zhang, H., Yin, Y., Chen, Z., Zhang, Y., Rao, A.K., Guo, Y., and Zanotto, D. (2020). Wearable Biofeedback System to Induce Desired Walking Speed in Overground Gait Training. Sensors, 20.","DOI":"10.3390\/s20144002"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"80","DOI":"10.1016\/j.gaitpost.2017.02.029","article-title":"Accuracy and Repeatability of Single-Pose Calibration of Inertial Measurement Units for Whole-Body Motion Analysis","volume":"54","author":"Mecheri","year":"2017","journal-title":"Gait Posture"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"497","DOI":"10.5194\/isprs-archives-XLII-4-W4-497-2017","article-title":"Experimental Comparison between Mahoney and Complementary Sensor Fusion Algorithm for Attitude Determination by Raw Sensor Data of Xsens IMU on Buoy","volume":"42","author":"Jouybari","year":"2017","journal-title":"Int. Arch. Photogramm. Remote Sens. Spat. Inf. Sci.\u2014ISPRS Arch."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"261","DOI":"10.1038\/s41592-019-0686-2","article-title":"SciPy 1.0: Fundamental Algorithms for Scientific Computing in Python","volume":"17","author":"Virtanen","year":"2020","journal-title":"Nat. Methods"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"311","DOI":"10.1589\/jpts.24.311","article-title":"Effects of Rhythmic Auditory Stimulation (RAS) on Gait Ability and Symmetry after Stroke","volume":"24","year":"2012","journal-title":"J. Phys. Ther. Sci."},{"key":"ref_30","doi-asserted-by":"crossref","unstructured":"Escamilla-Nunez, R., Sivasambu, H., and Andrysek, J. (2022). Exlporation of Vibrotactile Biofeedback Strategies to Induce Stance Time Asymmetries. Can. Prosthet. Orthot. J., 5.","DOI":"10.33137\/cpoj.v5i1.36744"}],"container-title":["Sensors"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1424-8220\/24\/2\/400\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T13:43:05Z","timestamp":1760103785000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1424-8220\/24\/2\/400"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,1,9]]},"references-count":30,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2024,1]]}},"alternative-id":["s24020400"],"URL":"https:\/\/doi.org\/10.3390\/s24020400","relation":{},"ISSN":["1424-8220"],"issn-type":[{"value":"1424-8220","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,1,9]]}}}