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Arch Phys Med Rehabil. 2019 Apr;100(4):598-605. doi: 10.1016/j.apmr.2018.10.013. Epub 2018 Nov 14.

Immediate Effects of Immersive Biofeedback on Gait in Children With Cerebral Palsy.

Author information

1
Department of Rehabilitation Medicine, Amsterdam UMC, VU University Medical Center, Amsterdam Movement Sciences, the Netherlands; Department of Clinical Applications and Research, Motek Medical BV, Amsterdam, the Netherlands. Electronic address: a.booth@vumc.nl.
2
Department of Rehabilitation Medicine, Amsterdam UMC, VU University Medical Center, Amsterdam Movement Sciences, the Netherlands.
3
Department of Rehabilitation Medicine, Amsterdam UMC, VU University Medical Center, Amsterdam Movement Sciences, the Netherlands; Department of Biomechanical Engineering, Delft University of Technology, Delft, the Netherlands.
4
Department of Clinical Applications and Research, Motek Medical BV, Amsterdam, the Netherlands.

Abstract

OBJECTIVE:

To investigate the immediate response to avatar-based biofeedback on 3 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:

Children with spastic paresis (N=22; 10.5±3.1y), able to walk without assistive devices.

INTERVENTION:

Children walked on a treadmill with a 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 2-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 avatar alone with 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 (7.4o) 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.

KEYWORDS:

Biofeedback, psychology; Cerebral palsy; Rehabilitation; Virtual reality; Walking

PMID:
30447196
DOI:
10.1016/j.apmr.2018.10.013

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