Lower Limb Table 16: Biofeedback for Gait Rehabilitation

Author Year; Country
Research Design
Sample Size



Villiger et al. 2015


Longitudinal Study

Level 2

N= 23

Population: 9 SCI individuals- 5 males and 4 females; incomplete SCI; all AIS D; Lesion level between C4 to T12; mean age= 55.1 ± 15.8y; years post injury= 1-5y; 14 healthy individuals were in the control group – 8 males and 7 females; mean age= 47.1 ± 14.4y

Treatment: Patients underwent 4 weeks of intensive VR-augmented lower limb training. The patients with iSCI were trained with the VR movement tasks 16–20 times during the 4 weeks (4–5 × 45 min. per week). The training used a VR-augmented therapy system for lower limbs combining action observation, imagination and execution. Before and after the training period a structural volumetric 3D MRI data set was acquired in patients. Retention of the performance improvements was assessed in a 3–4 month follow-up session.

Outcome Measures: 10 MWT, Berg Balance Scale (BBS), Lower Extremity motor Score (LEMS), Spinal Cord Independence Measure (SCIM mobility)

  1. The intense VR-augmented training of limb control improved significantly balance, walking speed, ambulation, and muscle strength in patients.
  2. Retention of clinical improvements was confirmed by the 3–4 months follow-up

Wall et al. 2015



Level 4

N= 5

Population: 5 males; incomplete SCI; mean age= 58.6y; years post injury >1y

Treatment: An interrupted time series design with three pre-tests over three weeks, a post-test within one week of the intervention, and a four-week follow up. Intervention consisted of one-hour sessions with varied games using the Nintendo Wii Fit twice per week for seven weeks. Survey data was also collected at post-test.

Outcome Measures: Gait speed, Timed up and Go (TUG), Forward Functional Reach Test (FFRT), Lateral Functional Reach Test (LFRT), RAND SF-36

  1. There were statistically significant changes found in gait speed and functional reach.
  2. The changes were also maintained at the four-week follow up post-test.
  3. Survey reports suggested improvements in balance, endurance, and mobility with daily tasks at home.

Govil and Noohu 2013;





Population: N=30 subjects with incomplete SCI; randomized to 2 groups.

For Group 1: mean (SD) age = 38.73 (10.75); DOI= 17.87 (8.37).

For Group 2: mean (SD) age=38.03 (7.45); DOI = 16.93 (7.10).

Treatment: Group 1 received EMG biofeedback to the gluteus maximus muscle, as well as traditional rehabilitation and gait training for 5 days/wk for 4 wks. Group 2 received traditional rehabilitation and gait training for 5 days/wk for 4 wks.

Outcome Measures: Walking speed, step length, cadence, EMG.

  1. Significant differences were found between the two groups in: walking velocity (m/s): Group 1 pre=0.12(0.11), post=0.27 (0.25); Group 2 pre=0.11(0.08), post=0.12(0.10); cadence: Group 1 pre=22.15(16.18), post=40.40(28.27); Group 2 pre=21.67 (20.71), post=22.04(21.71).
  2. Group 1 showed significant changes for EMG amplitude, step length, walking velocity and cadence pre and post.
  3. Group 2 showed significant changes for EMG amplitude, walking velocity and step length, but not cadence pre and post.
Effect Sizes

Tamburella et al. 2013;


Open-case study with retrospective matched control


Population: N=12 subjects with SCI; 6 in the vBFB group and 6 in control group (CTRL). vBFB group: mean (SD) age: 52 (11.74); 3M 3F. CTRL group: mean (SD) age: 53.5 (13.21); 3M 3F.

Treatment: 2 groups: vBFB and Rehab group (control). vFBF and CTRL groups underwent 8 wks of rehab 5 times/wk (CTRL: 60 minutes devoted to Rehab; vBFB: 40 minutes of rehab plus 20 of vBFB).

Outcome Measures: BBS; WISCI; 6MWT; 10MWT; TUG; balance performance and kinematic spatio-temporal gait parameters.

  1. Only the vBFB group experienced a significant improvement in balance and gait: BBS: 26 (10.69) at baseline to 41(7.8) at end of intervention; WISCI: 14.17(1.83) at baseline to 17.15(1.64) at end of intervention; 6MWT: 193.18(68.08) at baseline to 259.64(82.84) at end of intervention
  2. The improvement in balance and gait for the vBFB group was maintained at follow-up examinations.
  3. vBFB subjects experienced greater improvements than CTRL subjects for all measures, except for one balance measure.
  4. vBFB treatment demonstrated a significantly higher level of effectiveness than conventional rehabilitation.