Designing wearable haptic cueing for neurological gait rehabilitation: user requirements across residential care and community settings

Abstract

Wearable haptic cueing offers rhythmic prompts for neurological gait rehabilitation while leaving hearing available for communication and environmental awareness. We investigated the user, design, and implementation requirements needed to make these systems usable in practice. We analysed six linked studies involving 17 people with neurological conditions affecting gait and three physiotherapists across formative sessions, residential care, and community self-management. Wearable devices served as technology probes. Observations, interviews, diaries, physiotherapist records, gait analysis, and activity logs informed thematic analysis and cross-study comparison. Seven recurring requirement areas concerned haptic perceptibility and placement, wearability and fastening, interaction burden, rhythm personalisation, real-world walking contexts, supported use, and perceived value beyond gait outcomes. Requirements interacted: perceptible cue locations could be difficult to access for fastening or control, while fixed rhythms did not always accommodate terrain, fatigue, interruptions, or changing pace. Carers and clinicians supported configuration, operation, safety, and interpretation. Participants described confidence, routine formation, and willingness to walk; these accounts were interpreted as perceived value rather than evidence of therapeutic efficacy. Low sensation, cognitive burden, and mobility limitations could make wearable cueing impractical. Future systems should offer adjustable haptic output, flexible placement, accessible fastening, simple controls, personalised rhythms, and robustness during everyday walking. Design should accommodate support from carers and clinicians and consider trade-offs between requirements. These findings inform wearable rehabilitation design rather than establish clinical efficacy.