Adaptive Gaze Strategies to Reduce Environmental Uncertainty During a Sequential Visuomotor Behaviour

Fork in the road: How self-efficacy related to walking across terrain influences gaze behavior and path choice

Decisions about where to move occur throughout the day and are essential to life. Different movements may present different challenges and affect the likelihood of achieving a goal. Certain choices may have unintended consequences, some of which may cause harm and bias the decision. Movement decisions rely on a person gathering necessary visual information via shifts in gaze. Here we sought to understand what influences this information-seeking gaze behavior. Participants chose between walking across one of two paths that consisted of terrain images found in either hiking or urban environments. We manipulated the number and type of terrain of each path, which altered the amount of available visual information. We recorded gaze behavior during the approach to the paths and had participants rate the confidence in their ability to walk across each terrain type (i.e., self-efficacy) as though it was real. Participants did not direct gaze more to the path with greater visual information, regardless of how we quantified information. Rather, we show that a person's perception of their motor abilities predicts how they visually explore the environment with their eyes as well as their choice of action. The greater the self-efficacy in walking across one path, the more they directed gaze to it and the more likely they chose to walk across it.

Seeing does not mean processing: where we look and the visual information we rely on change independently as we learn a novel walking task

People use vision to inform motor control strategies during walking. With practice performing a target stepping task, people shift their gaze farther ahead, transitioning from watching their feet contact the target to looking for future target locations. The shift in gaze focus suggests the role of vision in motor control changes from emphasizing feedback to feedforward control. The present study examines whether changing visual fixation location is accompanied by a similar change in reliance upon visual information. Twenty healthy young adults practiced stepping on moving targets projected on the surface of a treadmill. Periodically, participants' visual reliance was probed by hiding stepping targets which inform feedback or feedforward (targets < or > 1.5 steps ahead, respectively) motor control strategies. We calculated visual reliance as the increase in step error when targets were hidden. We hypothesized that with practice, participant reliance on feedback visual information would decrease and their reliance on feedforward visual information would increase. Contrary to our hypothesis, participants became significantly more reliant on feedback visual information with practice (p < 0.001) but their reliance on feedforward visual information did not change (p = 0.49). Participants' reliance on visual information increased despite looking significantly farther ahead with practice (p < 0.016). Together, these results suggest that participants fixated on feedback information less. However, changes in fixation pattern did not reduce their reliance upon feedback information as stepping performance still significantly decreased when feedback information was removed after training. These findings provide important context for how the role of vision in controlling walking changes with practice.

Multisensory cues for walking in virtual reality: humans combine conflicting visual and self-motion information to reproduce distances

When humans walk, it is important for them to have some measure of the distance they have traveled. Typically, many cues from different modalities are available, as humans perceive both the environment around them (for example, through vision and haptics) and their own walking. Here, we investigate the contribution of visual cues and nonvisual self-motion cues to distance reproduction when walking on a treadmill through a virtual environment by separately manipulating the speed of a treadmill belt and of the virtual environment. Using mobile eye tracking, we also investigate how our participants sampled the visual information through gaze. We show that, as predicted, both modalities affected how participants (N = 28) reproduced a distance. Participants weighed nonvisual self-motion cues more strongly than visual cues, corresponding also to their respective reliabilities, but with some interindividual variability. Those who looked more toward those parts of the visual scene that contained cues to speed and distance tended also to weigh visual information more strongly, although this correlation was nonsignificant, and participants generally directed their gaze toward visually informative areas of the scene less than expected. As measured by motion capture, participants adjusted their gait patterns to the treadmill speed but not to walked distance. In sum, we show in a naturalistic virtual environment how humans use different sensory modalities when reproducing distances and how the use of these cues differs between participants and depends on information sampling.NEW & NOTEWORTHY Combining virtual reality with treadmill walking, we measured the relative importance of visual cues and nonvisual self-motion cues for distance reproduction. Participants used both cues but put more weight on self-motion; weight on visual cues had a trend to correlate with looking at visually informative areas. Participants overshot distances, especially when self-motion was slow; they adjusted steps to self-motion cues but not to visual cues. Our work thus quantifies the multimodal contributions to distance reproduction.

A Method of Detecting Human Movement Intentions in Real Environments

Accurate and timely movement intention detection can facilitate exoskeleton control during transitions between different locomotion modes. Detecting movement intentions in real environments remains a challenge due to unavoidable environmental uncertainties. False movement intention detection may also induce risks of falling and general danger for exoskeleton users. To this end, in this study, we developed a method for detecting human movement intentions in real environments. The proposed method is capable of online self-correcting by implementing a decision fusion layer. Gaze data from an eye tracker and inertial measurement unit (IMU) signals were fused at the feature extraction level and used to predict movement intentions using 2 different methods. Images from the scene camera embedded on the eye tracker were used to identify terrains using a convolutional neural network. The decision fusion was made based on the predicted movement intentions and identified terrains. Four able-bodied participants wearing the eye tracker and 7 IMU sensors took part in the experiments to complete the tasks of level ground walking, ramp ascending, ramp descending, stairs ascending, and stair descending. The recorded experimental data were used to test the feasibility of the proposed method. An overall accuracy of 93.4% was achieved when both feature fusion and decision fusion were used. Fusing gaze data with IMU signals improved the prediction accuracy.

The visual control of locomotion when stepping onto moving surfaces: A comparison of younger and older adults

Stepping between static and moving surfaces presents a locomotor challenge associated with increased injury frequency and severity in older adults. The current study evaluates younger and older adults' behaviours when overcoming challenges sampling moving walkway and escalator environments. Twelve younger adults (18-40 years, Male = 8) and 15 older adults (60-81 years, Male = 5) were examined using an integration of optoelectronic motion capture and mobile eye-tracking. Participants were investigated approaching and stepping onto a flat conveyor belt (static or moving; with or without surface (demarcation) lines). Specifically, the four conditions were: (i) static surface without demarcation lines; (ii) static surface with demarcation lines; (iii) moving surface without demarcation lines; and (iv) moving surface with demarcation lines. A two (age group) x two (surface-condition) x two (demarcation-condition) linear mixed-model revealed no main or interaction effects (p > .05) for perturbation magnitude, indicating participants maintained successful locomotion. However, different adaptive behaviours were identified between conditions with moving and accuracy demands (e.g., moving surfaces increased step length, demarcations reduced step length). Between subject effects identified differences between age groups. Older adults utilised different behaviours, such as earlier gaze transfer from the final approach walkway step location. Overall, the current study suggests that adaptive behaviours emerge relative to the environment's specific demands and the individual's action capabilities.

Probing the deployment of peripheral visual attention during obstacle-crossing planning

Gaze is directed to one location at a time, making peripheral visual input important for planning how to negotiate different terrain during walking. Whether and how the brain attends to this input is unclear. We developed a novel paradigm to probe the deployment of sustained covert visual attention by testing orientation discrimination of a Gabor patch at stepping and non-stepping locations during obstacle-crossing planning. Compared to remaining stationary, obstacle-crossing planning decreased visual performance (percent correct) and sensitivity (d') at only the first of two stepping locations. Given the timing of the first and second steps before obstacle crossing relative to the Gabor patch presentation, the results suggest the brain uses peripheral vision to plan one step at a time during obstacle crossing, in contrast to how it uses central vision to plan two or more steps in advance. We propose that this protocol, along with multiple possible variations, presents a novel behavioral approach to identify the role of covert visual attention during obstacle-crossing planning and other goal-directed walking tasks.

Evaluating the integration of eye-tracking and motion capture technologies: Quantifying the accuracy and precision of gaze measures

Integrating mobile eye tracking and optoelectronic motion capture enables point of gaze to be expressed within the laboratory co-ordinate system and presents a method not commonly applied during research examining dynamic behaviors, such as locomotion. This paper examines the quality of gaze data collected through the integration. Based on research suggesting increased viewing distances are associated with reduced data quality; the accuracy and precision of gaze data as participants (N = 11) viewed floor-based targets at distances of 1–6 m was investigated. A mean accuracy of 2.55 ± 1.12° was identified, however, accuracy and precision measures (relative to targets) were significantly (p < .05) reduced at greater viewing distances. We then consider if signal processing techniques may improve accuracy and precision, and overcome issues associated with missing data. A 4th-order Butterworth lowpass filter with cut-off frequencies determined via autocorrelation did not significantly improve data quality, however, interpolation via Quintic spline was sufficient to overcome gaps of up to 0.1 s. We conclude the integration of gaze and motion capture presents a viable methodology in the study of human behavior and presents advantages for data collection, treatment, and analysis. We provide considerations for the collection, analysis, and treatment of gaze data that may help inform future methodological decisions.

Don't watch your step: gaze behavior adapts with practice of a target stepping task

Vision plays a vital role in locomotor learning, providing feedback information to correct movement errors, and feedforward information to inform learned movement plans. Gaze behavior, or the distribution of fixation locations, can quantify how visual information is used during the motor learning process. How gaze behavior adapts during motor learning and in response to changing motor performance is poorly understood. This study examines if and how an individual's gaze behavior adapts during a sequence learning, target stepping task. We monitored the gaze behavior of 12 healthy young adults while they walked on a treadmill and attempted to precisely step on moving targets that were separated by variable distances (80%, 100%, and 120% of preferred step length). Participants completed a total of 11 trial blocks of 102 steps each. We hypothesized that both mean fixation distance would increase (participants would look farther ahead), and step error would decrease with experience. Following practice, participants significantly increased their fixation distance (P < 0.001) by 0.27 ± 0.18 steps and decreased their step error (P < 0.001) by 4.0 ± 1.7 cm, supporting our hypothesis. Our results suggest that early in the learning process, participants gaze behavior emphasized gathering visual information necessary for feedback motor control. As motor performance improved with experience, participants shifted their gaze fixation farther ahead placing greater emphasis on the visual information used for feedforward motor control. These findings provide important information about how gaze behavior changes in parallel with improvements in walking performance.NEW & NOTEWORTHY People consistently vary how they use visual information to inform walking. However, what drives this variation and how sampled visual information changes with locomotor learning is not well understood. Here, we find that gaze fixation locations moved farther ahead while step error decreases as participants practice a target stepping task. The results suggest that participants increasingly used a feedforward locomotor control strategy with practice.

The influence of the motor command accuracy on the prediction error and the automatic corrective response

The online control system allows for automatic corrective response to unexpected perturbation. This corrective response may involve a prediction error between the sensory prediction by the motor command and the actual feedback signal. Therefore, we attempted to investigate the effect of motor command accuracy on the automatic corrective response. Participants were asked to move a cursor displayed on a monitor and required to reach the center of a Gaussian blob target as accurately as possible for small and large Gaussian blob conditions. The accuracy of the motor command was manipulated by the size of the Gaussian blob. In half of the trials, a perturbation occurred in which the cursor position jumped 10 mm to either the left or right from the actual position, which induced an automatic corrective response. This corrective response was detected by the acceleration signal on the lateral axis. In addition, the prediction error was estimated by the amplitude of the N1 event-related potential (ERP) of the EEG signal. We found that the automatic response and N1 ERP were significantly larger in the small Gaussian blob conditions than in the large one. This result indicates that the automatic corrective response is affected by the certainty of the motor command manipulated by the Gaussian blob. Furthermore, the linear mixed-effect model (LME) indicated that the response is associated with the N1 ERP. Therefore, we suggest that the motor command accuracy affects the prediction error, which in turn modulates the automatic corrective response.

Quiet Eye as a Mechanism for Table Tennis Performance under Fatigue and Complexity

QE is the final ocular fixation that precedes critical athletic movements and that enables athletes to gather relevant information and organize their subsequent movement. Although little is known about the factors sustaining performance in table tennis, to date there has been no investigation to assess QE as a contributor to table tennis performance. Furthermore, there is limited research regarding the influence on QE of factors that are known to impact performance, such as task complexity and fatigue. In a within-subjects experimental design, we manipulated fatigue (high vs low) and task complexity (high vs low). Eleven elite table tennis players (m_age =14.72 years, m_experience = 7.27 years) underwent each of the four resulting conditions. Athletes made longer QE before hit versus missed shots (p <.001, η²p = .795) and QE and performance decreased under fatigue (p = 0.02, η²_p = .628; p = .002, η²_p = .62), but we did not detect a significant effect of complexity on QE (p = .352, η²_p = .087). This study is one of the first to show that QE sustains performance in a dynamic sport, that is table tennis, and that QE is affected by fatigue.

Altered Spatiotemporal Gaze Dynamics During Unexpected Obstacle Negotiation in a Fatigued State

Humans use their peripheral vision during locomotion to perceive an approaching obstacle in their path, while also focusing central gaze on steps ahead of them. However, certain physiological and psychological factors may change this strategy, such as when a walker is physically fatigued. In this study, 21 healthy participants walked through a dark room while wearing eye tracking glasses before and following intense exercise. Obstacles were placed in random locations along their path and became illuminated when participants approached them. Results indicate that, when fatigued, participants had altered spatial gaze strategies, including more frequent use of central gaze to perceive obstacles and an increased gaze angular displacement. However, there were no changes in temporal gaze strategies following exercise. These findings reveal how physical fatigue alters one's visual perception of their environment during locomotion, and may partially explain why people are at greater risk of trips and falls while fatigued.

Binocular vision and the control of foot placement during walking in natural terrain

Coordination between visual and motor processes is critical for the selection of stable footholds when walking in uneven terrains. While recent work (Matthis et al. in Curr Biol 8(28):1224–1233, 2018) demonstrates a tight link between gaze (visual) and gait (motor), it remains unclear which aspects of visual information play a role in this visuomotor control loop, and how the loss of this information affects that relationship. Here we examine the role of binocular information in the visuomotor control of walking over complex terrain. We recorded eye and body movements while normally-sighted participants walked over terrains of varying difficulty, with intact vision or with vision in one eye blurred to disrupt binocular vision. Gaze strategy was highly sensitive to the complexity of the terrain, with more fixations dedicated to foothold selection as the terrain became more difficult. The primary effect of increased sensory uncertainty due to disrupted binocular vision was a small bias in gaze towards closer footholds, indicating greater pressure on the visuomotor control process. Participants with binocular vision losses due to developmental disorders (i.e., amblyopia, strabismus), who have had the opportunity to develop alternative strategies, also biased their gaze towards closer footholds. Across all participants, we observed a relationship between an individual’s typical level of binocular visual function and the degree to which gaze is shifted toward the body. Thus the gaze–gait relationship is sensitive to the level of sensory uncertainty, and deficits in binocular visual function (whether transient or long-standing) have systematic effects on gaze strategy in complex terrains. We conclude that binocular vision provides useful information for locating footholds during locomotion. Furthermore, we have demonstrated that combined eye/body tracking in natural environments can be used to provide a more detailed understanding of the impact of a type of vision loss on the visuomotor control process of walking, a vital everyday task.

Predictive eye movements are adjusted in a Bayes-optimal fashion in response to unexpectedly changing environmental probabilities

This study examined the application of active inference to dynamic visuomotor control. Active inference proposes that actions are dynamically planned according to uncertainty about sensory information, prior expectations, and the environment, with motor adjustments serving to minimise future prediction errors. We investigated whether predictive gaze behaviours are indeed adjusted in this Bayes-optimal fashion during a virtual racquetball task. In this task, participants intercepted bouncing balls with varying levels of elasticity, under conditions of higher or lower environmental volatility. Participants' gaze patterns differed between stable and volatile conditions in a manner consistent with generative models of Bayes-optimal behaviour. Partially observable Markov models also revealed an increased rate of associative learning in response to unpredictable shifts in environmental probabilities, although there was no overall effect of volatility on this parameter. Findings extend active inference frameworks into complex and unconstrained visuomotor tasks and present important implications for a neurocomputational understanding of the visual guidance of action.

Icy road ahead-rapid adjustments of gaze-gait interactions during perturbed naturalistic walking

Most humans can walk effortlessly across uniform terrain even when they do not pay much attention to it. However, most natural terrain is far from uniform, and we need visual information to maintain stable gait. Recent advances in mobile eye-tracking technology have made it possible to study, in natural environments, how terrain affects gaze and thus the sampling of visual information. However, natural environments provide only limited experimental control, and some conditions cannot safely be tested. Typical laboratory setups, in contrast, are far from natural settings for walking. We used a setup consisting of a dual-belt treadmill, 240∘ projection screen, floor projection, three-dimensional optical motion tracking, and mobile eye tracking to investigate eye, head, and body movements during perturbed and unperturbed walking in a controlled yet naturalistic environment. In two experiments (N = 22 each), we simulated terrain difficulty by repeatedly inducing slipping through accelerating either of the two belts rapidly and unpredictably (Experiment 1) or sometimes following visual cues (Experiment 2). We quantified the distinct roles of eye and head movements for adjusting gaze on different time scales. While motor perturbations mainly influenced head movements, eye movements were primarily affected by the presence of visual cues. This was true both immediately following slips and—to a lesser extent—over the course of entire 5-min blocks. We find adapted gaze parameters already after the first perturbation in each block, with little transfer between blocks. In conclusion, gaze–gait interactions in experimentally perturbed yet naturalistic walking are adaptive, flexible, and effector specific.

Target position and avoidance margin effects on path planning in obstacle avoidance

This study examined how people choose their path to a target, and the visual information they use for path planning. Participants avoided stepping outside an avoidance margin between a stationary obstacle and the edge of a walkway as they walked to a bookcase and picked up a target from different locations on a shelf. We provided an integrated explanation for path selection by combining avoidance margin, deviation angle, and distance to the obstacle. We found that the combination of right and left avoidance margins accounted for 26%, deviation angle accounted for 39%, and distance to the obstacle accounted for 35% of the variability in decisions about the direction taken to circumvent an obstacle on the way to a target. Gaze analysis findings showed that participants directed their gaze to minimize the uncertainty involved in successful task performance and that gaze sequence changed with obstacle location. In some cases, participants chose to circumvent the obstacle on a side for which the gaze time was shorter, and the path was longer than for the opposite side. Our results of a path selection judgment test showed that the threshold for participants abandoning their preferred side for circumventing the obstacle was a target location of 15 cm to the left of the bookcase shelf center.

Gazing down increases standing and walking postural steadiness

When walking on an uneven surface or complex terrain, humans tend to gaze downward. This behaviour is usually interpreted as an attempt to acquire useful information to guide locomotion. Visual information, however, is not used exclusively for guiding locomotion; it is also useful for postural control. Both locomotive and postural control have been shown to be sensitive to the visual flow arising from the respective motion of the individual and the three-dimensional environment. This flow changes when a person gazes downward and may present information that is more appropriate for postural control. To investigate whether downward gazing can be used for postural control, rather than exclusively for guiding locomotion, we quantified the dynamics of standing and walking posture in healthy adults, under several visual conditions. Through these experiments we were able to demonstrate that gazing downward, just a few steps ahead, resulted in a steadier standing and walking posture. These experiments indicate that gazing downward may serve more than one purpose and provide sufficient evidence of the possible interplay between the visual information used for guiding locomotion and that used for postural control. These findings contribute to our understanding of the control mechanism/s underlying gait and posture and have possible clinical implications.

Motives driving gaze and walking decisions

To navigate complex environments, people must decide how to direct gaze to acquire relevant information and decide where, when, and how to move the body. Recent work supports the idea that gaze may be directed to reduce task-relevant environmental uncertainty and to ensure movement accuracy based on the cost (or effort) to move the body and maintain balance. During walking, these two factors may compete for gaze allocation and explain how we make decisions about where to step. Using a forced-choice walking paradigm, where we manipulated the visual uncertainty (simulating uncertain terrain characteristics) and motor cost associated with specific step-target choices, we examined the motives driving gaze and step decisions. We characterized each individual's distinct gaze behavior based on their sensitivity to changes in visual uncertainty, which predicted step-choice behavior when foot-placement accuracy was important to the task. We show that individuals who tended to look at both target choices as visual uncertainty increased prioritized stepping onto the more certain location after looking at it longer, even at the expense of increased motor cost. In contrast, individuals who tended to look at only one of the target choices as visual uncertainty increased preferred to step on the target that minimized motor cost. Overall, we demonstrate that how a person explores the environment with their eyes dictates where they step. These gaze and step decisions may relate to the value a person assigns to information gain, being certain of their actions, and conserving energy.

An exploratory study of gaze behaviour in young adults with developmental coordination disorder

Developmental Coordination Disorder (DCD) is characterized by substantial difficulties with motor coordination to the extent that it has a clear impact on the daily functioning of those who suffer from the disorder. Laboratory-based research indicated impaired oculomotor control in individuals with DCD. However, it is not clear how these oculomotor problems contribute to control and coordination in daily tasks. This study explored differences and similarities in gaze behaviour during reading and cup stacking between young adults with DCD and their matched typically developing counterparts (TD; aged 20-23 years). Gaze behaviour was recorded using eye-tracking, and hand movements were registered using a digital camera. Results of the reading tasks demonstrated similar behaviour between the groups, apart from a lower number of characters recorded per fixation in the DCD group. In cup stacking, the individuals with DCD were slower than their counterparts when three cups had to be displaced to a central target using the dominant hand. The gaze strategy of individuals with DCD involved systematic fixations on the cup or target prior to the hand movement to that cup or target, whereas these alternating saccades between cup and target were less obvious in the TD group. In the bimanual stacking task, where a pyramid of six cups had to be built on a central target using both hands, both groups mainly fixated the central target for the whole duration of the task, without distinct differences in gaze behaviour and duration of performance between individuals with and those without DCD. In conclusion, gaze behaviour of young adults with DCD shows differences from that of their typically developing counterparts that may be related to underlying oculomotor deficits in some but not all daily tasks.

Gaze behaviour during walking in young adults with developmental coordination disorder

BACKGROUND

Individuals with Developmental Coordination Disorder (DCD) experience difficulty with motor coordination and this affects their daily functioning. Research indicated inferior visuospatial processing and oculomotor control in DCD. As visual information is essential for locomotor control, more insight in the gaze behaviour of this population during walking is required and crucial for gaze training interventions as a possible means to improve daily functioning of children and adults with DCD.

AIM

This study explored differences and similarities in gaze behaviour during walking between typically developing young adults and those with DCD.

METHODS AND PROCEDURES

Ten young adults with DCD (age: 22.13 ± 0.64) and ten typically developing individuals (age: 22.00 ± 1.05) completed a walking task in which they had to place their feet on irregularly placed targets wearing eye tracking glasses.

OUTCOMES AND RESULTS

Individuals with DCD walked slower and demonstrated a different gaze strategy compared to their neurotypical peers as they fixated almost each and every target sequentially. Typically developing individuals, on the other hand, directed gaze further along the path and often fixated areas around the targets.

CONCLUSIONS AND IMPLICATIONS

Despite adequate walking performance in daily situations in young adults with DCD, fundamental control deficits persist into adulthood. WHAT THIS PAPER ADDS?: This paper is the first to demonstrate differences in gaze behaviour between young adults with DCD and typically developing individuals in a task that resembles a task of daily living, as previous research focused on laboratory tasks. This is a valuable finding as DCD has a clear impact on the daily life. Furthermore, this study demonstrated that the fundamental control deficits of DCD persist into adulthood despite frequent performance and practice of these daily tasks. Lastly, these findings might contribute to the therapeutic potential of gaze training interventions to improve the daily functioning of children and adults with DCD.

Age-related changes in gaze sampling strategies during obstacle navigation

BACKGROUND

Appropriate coordination of gaze behavior and body motion is essential for navigating cluttered environments. This is often complicated by having to contend with a concurrent secondary task, like engaging in a conversation or looking for relevant landmarks. However, there is little evidence of how aging and multitasking affects how gaze is deployed during obstacle navigation to guide our movements.

RESEARCH QUESTION

How do gaze patterns differ between young and older adults when navigating around a series of obstacles under dual-task conditions?

METHODS

17 young adults and 17 older adults navigated around vertically-oriented obstacles in isolation (i.e., single-task condition) and while engaging in a concurrent backward-counting or visual search task (i.e., dual-task conditions). In the visual search condition, participants had to identify the location of an object (i.e., a black shape on a tile) along the perimeter of the pathway, simulating a landmark. We quantified the spatial-temporal pattern of gaze to obstacles relative to body position, as well as the frequency and duration of gaze fixations to obstacles, route-planning features, and landmarks.

RESULTS

We found that older adults transferred gaze away from obstacles earlier and contacted obstacles more frequently than young adults. However, the proportion of fixation number and duration to obstacles did not differ between groups in any condition. In addition, older adults had to allocate gaze to landmarks to a greater extent in the visual search condition-at the expense of fixating route-planning areas-to maintain similar search performance in the dual-task condition compared to the single-task condition.

SIGNIFICANCE

Older adults use different gaze strategies and have greater difficulty under dual-tasking conditions than young adults when navigating around a series of obstacles. We suggest that deficits in visual working memory and/or divided attention may explain these results.

Enriching footsteps sounds in gait rehabilitation in chronic stroke patients: a pilot study

In the context of neurorehabilitation, sound is being increasingly applied for facilitating sensorimotor learning. In this study, we aimed to test the potential value of auditory stimulation for improving gait in chronic stroke patients by inducing alterations of the frequency spectra of walking sounds via a sound system that selectively amplifies and equalizes the signal in order to produce distorted auditory feedback. Twenty-two patients with lower extremity paresis were exposed to real-time alterations of their footstep sounds while walking. Changes in body perception, emotion, and gait were quantified. Our results suggest that by altering footsteps sounds, several gait parameters can be modified in terms of left-right foot asymmetry. We observed that augmenting low-frequency bands or amplifying the natural walking sounds led to a reduction in the asymmetry index of stance and stride times, whereas it inverted the asymmetry pattern in heel-ground exerted force. By contrast, augmenting high-frequency bands led to opposite results. These gait changes might be related to updating of internal forward models, signaling the need for adjustment of the motor system to reduce the perceived discrepancies between predicted-actual sensory feedbacks. Our findings may have the potential to enhance gait awareness in stroke patients and other clinical conditions, supporting gait rehabilitation.

Mobility-Related Gaze Training in Individuals With Glaucoma: A Proof-of-Concept Study

Purpose

Older adults with glaucoma show inappropriate gaze strategies during routine mobility tasks. Furthermore, glaucoma is a risk factor for falling and colliding with objects when walking. However, effective interventions to rectify these strategies and prevent these adverse events are scarce. We designed a gaze training program with the goal of providing proof-of-concept that we could modify mobility-related gaze behavior in this population.

Methods

A total of 13 individuals with moderate glaucoma participated in this study. We taught participants general and task-specific gaze strategies over two 1-hour sessions. To determine the efficacy of this gaze training program, participants performed walking tasks that required accurate foot placement onto targets and circumventing obstacles before and after training. We used a mobile eye tracker to quantify gaze and a motion-capture system to quantify body movement.

Results

After training, we found changes in the timing between gaze shifts away from targets relative to stepping on them (P < 0.05). In the obstacle negotiation task, we found a greater range of gaze shifts early in walking trials and changes in the timing between gaze shifts away from obstacles after training (P < 0.05), each suggesting better route planning. A posttraining reduction in foot-placement error and obstacle collisions accompanied these changes (P < 0.05).

Conclusions

Our results demonstrated that it is possible to modify mobility-related gaze behavior and mobility performance in older adults with glaucoma.

Translational Relevance

This study provides proof-of-concept for a gaze training program for glaucoma. A larger, randomized controlled trial is warranted.

Motor cost affects the decision of when to shift gaze for guiding movement

Frequent gait modifications are often required to navigate our world. These can involve long or wide steps or changes in direction. People generally prefer to minimize the motor cost (or effort) of a movement, although with changes in gait this is not always possible. The decision of when and where to shift gaze is critical for controlling motor actions, since vision informs the brain about the available choices for movement-in this case, where to step. Here we asked how motor cost influences the allocation of gaze. To address this, we had participants walk and step to the center of sequential targets on the ground. We manipulated the motor cost associated with controlling foot placement by varying the location of one target in the lateral direction on a trial-to-trial basis within environments with different numbers of targets. Costlier steps caused a switch from a gaze strategy of planning future steps to one favoring visual feedback of the current foot placement when participants had to negotiate another target immediately after. Specifically, costlier steps delayed gaze shifts away from the manipulated target. We show that this relates to the cost of moving the leg and redirecting the body's center of mass from target to target. Overall, our results suggest that temporal gaze decisions are affected by motor costs associated with step-to-step demands of the environment. Moreover, they provide insight into what affects the coordination between the eyes and feet for the control of stable and accurate foot placement while walking. NEW & NOTEWORTHY Changes in gait allow us to navigate our world. For instance, one may step long or wide to avoid a spilled drink. The brain can direct gaze to gather relevant information for making these types of motor decisions; however, the factors affecting gaze allocation in natural behaviors are poorly understood. We show how the motor cost associated with a step influences the decision of when to redirect gaze to ensure accurate foot placement while walking.