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

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

Booth, Adam T. (Amsterdam UMC; Motek Medical B.V.)
Buizer, Annemieke I. (Amsterdam UMC)
Harlaar, J. (TU Delft Biomechatronics & Human-Machine Control; Amsterdam UMC)
Steenbrink, Frans (Motek Medical B.V.)
van der Krogt, Marjolein M. (Amsterdam UMC)

2019

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 (7.4^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.

Biofeedback, psychology
Cerebral palsy
Rehabilitation
Virtual reality
Walking

http://resolver.tudelft.nl/uuid:de250829-ff76-4706-aba3-bbd883d84022

https://doi.org/10.1016/j.apmr.2018.10.013

2019-05-14

0003-9993

Archives of Physical Medicine and Rehabilitation, 100 (4), 598-605

Green Open Access added to TU Delft Institutional Repository 'You share, we take care!' - Taverne project https://www.openaccess.nl/en/you-share-we-take-care Otherwise as indicated in the copyright section: the publisher is the copyright holder of this work and the author uses the Dutch legislation to make this work

Institutional Repository

journal article

© 2019 Adam T. Booth, Annemieke I. Buizer, J. Harlaar, Frans Steenbrink, Marjolein M. van der Krogt