Task-dependent performance of wearable multimodal biofeedback in physical rehabilitation: A longitudinal post-stroke case ctudy

Abstract

Background/Objectives: Wearable technology is increasingly used to provide biofeedback in physical rehabilitation; however, there is no consensus on which biofeedback parameter is most appropriate for clinical use, as most studies evaluate only one arbitrarily selected parameter. This study presents a wearable multimodal biofeedback system integrating multiple parameters selected based on the prior literature and evaluates its feasibility, usability, and implementation within a rehabilitation context through a longitudinal post-stroke case study. Methods: The system integrates inertial and electromyographic sensors to monitor centre of mass (CoM-B), joint angle (ANG-B), and muscle activity (EMG-B), delivering real-time sensory cues based on the monitored parameters. Feasibility was assessed in a post-stroke participant (male, 32 years, 29 months post-stroke, left hemiparesis, Fugl-Meyer Lower Extremity Score = 27) across 15 sessions involving stand-to-sit, split-stance weight shifting, and walking tasks. Each task was practiced with all three biofeedback parameters, with five sessions per parameter. Results: The motor performance varied across biofeedback parameters and tasks. CoM-B was associated with favourable trends in motor performance during stand-to-sit, showing improvements in medio-lateral displacement (0.03/session); ANG-B during walking, showing increased ankle dorsiflexion (1 deg/session); and EMG-B during split-stance weight shifting, showing increased tibialis anterior activation (5 µV/session). Conclusions: The findings generate the hypothesis that the ability of biofeedback to elicit favourable motor performance is task-dependent, suggesting that the choice of biofeedback parameters may need to be adapted to task demands. The system demonstrated high usability and feasibility, supporting its potential for post-stroke rehabilitation. Further studies are needed to test the generated hypothesis and evaluate the system efficacy.