Effects of Intrinsic Feedback-Based Gait Training Under Visual Deprivation on Balance and Gait in Stroke Survivors: A Randomized Controlled Study.

Abstract

Feedback is an essential component of motor learning and rehabilitation. Although extrinsic feedback is widely used in stroke rehabilitation, excessive dependence on external cues may limit opportunities for independent movement regulation. Training that emphasizes intrinsic feedback during visual deprivation (VD) may provide individuals with greater opportunities to perceive and regulate their movements using internally available sensory information. This study investigated the effects of gait training with intrinsic feedback on balance and gait abilities in individuals with stroke compared with extrinsic feedback training and conventional physical therapy. Thirty-six individuals with stroke were randomly assigned to the gait training with intrinsic feedback (GIF) group, gait training with extrinsic feedback (GEF) group, or control group (CG). The GIF performed forward and backward linear and curvilinear gait tasks on stable and unstable surfaces during VD without continuous verbal guidance. The GEF performed the same gait tasks during VD while receiving continuous verbal guidance, whereas the CG received conventional physical therapy. All interventions were conducted for 30 min, five times per week, for 8 weeks. Outcome measures included the Four Square Step Test (FSST), weight distribution, spatiotemporal gait variables, center of pressure (COP) variables, and the 10-Meter Walk Test (10 MWT). Significant group × time interactions were observed for the FSST, weight distribution, gait velocity, cadence, paretic stance phase, paretic swing phase, paretic step time, stride time, and the 10 MWT (p < 0.05). The GIF demonstrated significantly greater improvements than both the GEF and CG in the FSST, gait velocity, cadence, paretic step time, stride time, and the 10 MWT (p < 0.05). The GIF also showed greater improvement than the CG in weight distribution (p < 0.05). These findings suggest that gait training emphasizing intrinsic feedback during VD may provide additional benefits for selected aspects of balance and gait performance in individuals with stroke.