Clinical Integration of a Goal-Specific Virtual-Reality Biofeedback Treadmill Training Program for Children with Cerebral Palsy

Aims: To conduct a preliminary evaluation of the effectiveness of a clinical virtual-reality (VR) treadmill-based biofeedback treatment program in children and adolescents with cerebral-palsy (CP). Methods: This study included preliminary retrospective data from 17 children with CP (mean ± SD age 11.3 ± 3.1 years, Gross-Motor-Function-Classification System level I/II = 8/9). All participants were referred to a series of VR treadmill-based biofeedback training in the Gait Real-time Analysis Interactive Lab system (7–12 treatments for 3–6 wk), adhering to a clinical paradigm. One of the treatment aims for all participants was to increase the knee extension angle during initial contact. Outcome measures included spatiotemporal parameters, dimensionless walking speed (DWS), Gait-Profile-Score (GPS), Gait-Variable-Score (GVS), and kinematics waveforms. Results: All but one participant completed all treatments in their series. There was a significant improvement in DWS (p = 0.008), step-length in the more-involved leg (p < 0.001) and reduction in variance in most spatiotemporal parameters (p < 0.05), in addition to small changes in the less-involved leg kinematic waveforms (p < 0.05). Conclusions: Overall reductions in spatiotemporal gait deviations were observed following the VR treadmill-based biofeedback series, with strong participant adherence, although no consistent increase in knee extension angle was found. VR biofeedback may be a promising intervention within a clinical paradigm for individuals with CP.