StimuLOOP – Advances and Perspectives in Precision Rehabilitation

StimuLOOP is an innovative project designed to help people with gait disorders, such as those caused by strokes or Parkinson’s disease, improve their walking. What makes StimuLOOP unique is its combination of precision approaches with modern technologies, including motion measurement and real-time motion feedback, virtual reality, and sleep optimization, all integrated into a mutually reinforcing cycle. The goal is to make rehabilitation particularly effective for each individual. To achieve this, patients recovering from strokes or living with Parkinson’s are recruited and randomized into groups with or without sleep optimization.

To obtain a precise picture of the gait disorder, patients’ walking patterns are analyzed in a state-of-the-art gait laboratory at ETH Zurich. Deviations from normal gait patterns are characterized in detail. This data is then evaluated in a clinical decision-making process involving multiple experts, leading to the identification of a specific gait parameter that serves as a metric for a tailored rehabilitation program. To sustainably alter this individual parameter, a personalized three-week training program is developed.

The training takes place in a cutting-edge training laboratory at the Lake Lucerne Institute in Vitznau. Patients walk on a treadmill within a virtual environment projected onto a large screen in front of them. Their current gait pattern is meticulously analyzed, and real-time feedback on the selected gait parameter enables them to adapt their movement step-by-step to meet the target. Throughout the three-week training period, progress is continuously monitored, and the training program is adjusted and optimized accordingly.

To ensure the learned patterns are firmly anchored in memory between sessions, StimuLOOP employs an innovative technique from sleep research developed at the University Hospital Zurich. During the training sessions patients will hear acoustic cues. At night, these cues are played through headphones to the sleeping individual in synchrony with slow waves in the EEG representative of deep sleep. These soft tones tailored to the individuals’ brainwaves help the brain consolidate what has been learned without disrupting sleep.

This 5-year project began in 2021 and has now reached midterm. During the initial phase, project partners have already achieved major milestones, and the work has resulted in numerous scientific publications, and preliminary study results have been presented at international conferences in fields such as medicine, movement science, rehabilitation, sleep research, health, and data science. Early follow-up projects are emerging in research and innovation to deepen understanding and facilitate clinical applications. Critical to the project’s success are the patients who voluntarily dedicate their time to participate in the main study. Approximately a quarter of the total cohort has already been recruited, with initial feedback being very positive. However, a scientific conclusion on the effectiveness of this personalized rehabilitation training approach will only be possible once the study is completed.

The project’s comprehensive data is analyzed by data scientists at ETH Zurich. The aim is to understand how motor learning can be optimized for each individual across various conditions. The data will also be used to create models capable of predicting treatment outcomes and continuously optimizing therapy in a data-driven manner. StimuLOOP makes an important societal contribution by improving movement and mobility for people with neurological impairments, enabling them to lead more active and independent lives.