Walking through the looking glass: Adapting gait patterns with mirror feedback

Persons with Parkinson's disease show impaired interlimb coordination during backward walking

INTRODUCTION

Although there is growing literature supporting the implementation of backward walking as a potential rehabilitation tool, moving backwards may precipitate falls for persons with Parkinson's disease. We sought to better understand interlimb coordination during backward walking in comparison to forward walking in persons with Parkinson's disease and healthy controls.

METHODS

We assessed coordination using point estimate of relative phase at each participant's preferred walking speed.

RESULTS

Persons with Parkinson's disease demonstrated impaired interlimb coordination between the more affected arm and each leg compared to controls, which worsened during backward walking.

CONCLUSION

For those with Parkinson's disease, inability to output smooth coordinated movement of the more affected shoulder may impair coordination during forward and, especially, backward walking. Our findings provide new information about backward walking that can allow clinicians to make safer, more effective therapeutic recommendations for persons with Parkinson's disease.

Incremental Visual Occlusion During Split-Belt Treadmill Walking Has No Gradient Effect on Adaptation or Retention

Split-belt treadmills have become an increasingly popular means of quantifying ambulation adaptability. Multiple sensory feedback mechanisms, including vision, contribute to task execution and adaptation success. No studies have yet explored visual feedback effects on locomotor adaptability across a spectrum of available visual information. In this study, we sought to better understand the effects of visual information on locomotor adaptation and retention by directly comparing incremental levels of visual occlusion. Sixty healthy young adults completed a split-belt adaptation protocol, including a baseline, asymmetric walking condition (adapt), a symmetric walking condition (de-adapt), and another asymmetric walking condition (re-adapt). We randomly assigned participants into conditions with varied visual occlusion (i.e., complete and lower visual field occlusion, or normal vision). We captured kinematic data, and outcome measures included magnitude of asymmetry, spatial and temporal contributions to step length asymmetry, variability of the final adapted pattern, and magnitude of adaptation. We used repeated measures and four-way MANOVAs to examine the influence of visual occlusion and walking condition. Participants with complete, compared to lower visual field visual occlusion displayed less consistency in their walking pattern, evident via increased step length standard deviation (p = .007, d = 0.89), and compared to normal vision groups (p = .003 d = 0.81). We found no other group differences, indicating that varying levels of visual occlusion did not significantly affect locomotor adaptation or retention. This study offers insight into the role vision plays in locomotor adaptation and retention with clinical utility for improving variability in step control.

Can Exergames Be Improved to Better Enhance Behavioral Adaptability in Older Adults? An Ecological Dynamics Perspective

Finding effective training solutions to attenuate the alterations of behavior and cognition in the growing number of older adults is an important challenge for Science and Society. By offering 3D computer-simulated environments to combine perceptual-motor and cognitive exercise, exergames are promising in this respect. However, a careful analysis of meta-analytic reviews suggests that they failed to be more effective than conventional motor-cognitive training. We analyzed the reasons for this situation, and we proposed new directions to design new, conceptually grounded, exergames. Consistent with the evolutionary neuroscience approach, we contend that new solutions should better combine high level of metabolic activity with (neuro)muscular, physical, perceptual-motor, and cognitive stimulations. According to the Ecological Dynamics rationale, we assume that new exergames should act at the agent-environment scale to allow individuals to explore, discover, and adapt to immersive and informationally rich environments that should include cognitively challenging tasks, while being representative of daily living situations.