A Comparison of the Immediate Effects of Verbal and Virtual Reality Feedback on Gait in Children with Cerebral Palsy

Abstract

Different types of feedback are used during gait training in children with cerebral palsy (CP), including verbal (VB) and virtual reality (VR) feedback. Previous studies on VR feedback showed positive effects on the targeted gait parameter. However, both positive and negative side effects on other parameters were seen as well. The literature on the effect of VB feedback is lacking and, to our knowledge, both feedback methods have not yet been compared. In this monocentric study with a single-session intervention protocol, children with CP completed a training session on the Gait Real-Time Analysis Interactive Lab (GRAIL) and received both VB and VR feedback on hip extension, in randomized order. Outcome parameters were continuous gait curves of sagittal kinematics and hip kinetics, specific features of hip angle and moment, sagittal gait variable scores and gait profile scores. Improvement of the targeted gait parameter was seen both after VB and VR feedback, with a small advantage for VR over VB feedback. Furthermore, positive side effects on knee and ankle sagittal kinematics were seen. However, the overall gait profile score did not improve, most likely due to negative compensatory strategies. In conclusion, children with CP can adapt gait in response to both VB and VR feedback, with VR feedback producing a slightly better effect. Due to secondary effects on parameters other than the targeted parameter, the overall gait did not improve.