Audiovisual biofeedback amplifies plantarflexor adaptation during walking among children with cerebral palsy.
Alyssa M Spomer, Benjamin C Conner, Michael H Schwartz and 2 others
PMID 38062454WHAT IT FOUND
Children and adolescents with cerebral palsy increased calf muscle activity during treadmill walking with every biofeedback type.
Audiovisual feedback, alone or with an exoskeleton, held the gain longest. Combined feedback was faster than audiovisual feedback, not larger. The gain stopped when feedback stopped.
Key findings
01When biofeedback was first turned on, participants significantly increased soleus activity from baseline using each modality.
02Audiovisual and combined feedback produced larger and more sustained soleus increases than sensorimotor feedback alone; combined feedback was faster than audiovisual feedback, but not larger.
03After acclimation and at two-week follow-up, audiovisual and combined feedback still raised soleus activity quickly, sensorimotor feedback did not, and activity returned to baseline when feedback was turned off.
STILL TO COME
How it was doneWhat they foundWhat it means for PTs
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What it does not show
Only eight participants were studied, and they varied in age, diagnosis, and GMFCS level, so the results cannot show how many patients would respond. The study tested short treadmill bouts, not a full rehabilitation programme, and it did not evaluate everyday walking. The muscle activity returned to baseline when feedback was turned off, so the study does not show lasting transfer. The order of conditions was changed, but the sample was small and individual responses varied widely. Speed was fixed for each participant, which may have limited how much soleus activity could increase. Audio and visual feedback were not compared separately, and gastrocnemius activity was not measured.
Declared interests
No author conflict-of-interest statement is provided in the supplied text. The publication metadata lists U.S. government and NIH extramural research support.
The easy way to misread this
Do not conclude that this biofeedback training improves everyday walking or that the exoskeleton alone caused the calf muscle change. The study had only eight participants, the muscle activity returned to baseline when feedback was turned off, and the combined condition included treadmill walking, instructions, visual feedback, audio feedback, and an exoskeleton together.