Benchmarking System for Assessing Balance (BeStABle) during gait using visual stepping cues

Abstract

Background: The ability to characterise balance capacity through clinical assessment procedures is often limited by a focus on movement tasks substantially more predictable than those experienced in the real world. Consequently, assessment protocols may not sufficiently elicit and characterise the full range of sensory, cognitive and physical challenges present in daily life. Methods: A task-specific procedure for assessing balance control during gait via a treadmill-based augmented-reality environment called the ‘Benchmarking System for Assessing Balance’ (BeStABle) is proposed. The apparatus utilises unpredictable visual cues that prescribe discrete changes to foot placement patterns, requiring rapid stimulus perception, decision-making, and modification of body dynamics, followed by compensatory corrections to return to steady gait. This is representative of a wide variety of situations in community living and many reported circumstances of real-world falls. This assessment procedure is demonstrated with a case study comparing three high-functioning users of transtibial (below-knee) prostheses with a group of 19 able-bodied persons. Results: The BeStABle successfully discriminates the prosthesis users from the normative group in multiple outcomes, and most prominently when participants are cued to narrow their steps. The finding that certain gait adaptations are not realisable by the prosthesis users may help to refine future protocols for assessing gait and balance impairment with the BeStABle. Conclusion: The BeStABle treadmill-based augmented-reality environment enables the repeatable and objective assessment of gait adaptations through a process that is safe for subjects and efficient for clinicians.