Immediate effects of immersive biofeedback on gait in children with cerebral palsy

Publication date: Available online 14 November 2018

Source: Archives of Physical Medicine and Rehabilitation

Author(s): Adam T.C. Booth, Annemieke I. Buizer, Jaap Harlaar, Frans Steenbrink, Marjolein M. van der Krogt

Objective

To investigate the immediate response to avatar-based biofeedback on three clinically important gait parameters; step length, knee extension and ankle power, in children with cerebral palsy (CP).

Design

Repeated measures design.

Setting

Rehabilitation clinic.

Participants

Twenty-two children with spastic paresis (10y4m±3y1m), able to walk without assistive devices.

Intervention

Children walked on a treadmill with virtual reality environment. Following baseline gait analysis, they were challenged to improve aspects of gait. Children visualized themselves as an avatar, representing movement in real-time. They underwent a series of two-minute trials receiving avatar based biofeedback on step length, knee extension and ankle power. To investigate optimization of biofeedback visualization, additional trials in which knee extension was visualized as a simple bar with no avatar; and a further trial with avatar alone, and no specific biofeedback were carried out.

Main outcome measures

Gait pattern, as measured by joint angles, powers and spatiotemporal parameters, were compared between baseline and biofeedback trials.

Results

Participants were able to adapt gait pattern with biofeedback, in an immediate response, reaching large increases in ankle power generation at push-off (37.7%) and clinically important improvements in knee extension (7.4^o) and step length (12.7%). Biofeedback on one parameter had indirect influence on other aspects of gait.

Conclusion

Children with CP show capacity in motor function to achieve improvements in clinically important aspects of gait. Visualizing biofeedback with an avatar was subjectively preferential compared to a simplified bar presentation of knee angle. Future studies are required to investigate if observed transient effects of biofeedback can be retained with prolonged training to test whether biofeedback-based gait training may be implemented as a therapy tool.

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