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Background  Gait rehabilitation often utilizes correction of stepping movements, and visual feedback is one of the interactive forms that can be used for rehabilitation. We presented a paradigm called visual feedback distortion in which we manipulated the visual representation of step length. Our previous work showed that an implicit distortion of visual feedback of step length entails unintentional modulations in the subjects’ gait spatial pattern. Even in the presence of cognitive load through a distraction task, distortion of visual feedback still induced modulation of gait step length. In the current study, subjects were aware of the imposed distortion of visual feedback and they were instructed to maintain their natural gait symmetric pattern during trials. We then studied whether such an explicit “visual feedback distortion” would still influence gait spatial pattern.    Methods  Nine healthy subjects participated in the treadmill walking trial. The step length was defined as the distance between each foot. The on-line visual feedback showing right and left step length information as bar graphs was displayed on a computer screen. When distorting the visual feedback, the height of the bar for only one side was manipulated, so that subjects perceived their step length as being asymmetric. Actual step lengths were measured during trial and analyzed to see the effects of visual feedback distortion.    Results  Our results showed that a gradual distortion of visual feedback systematically modulated gait step length away from symmetry even at the expense of an opposing apparent task goal. It was also observed that the amount of induced gait modulation was reduced during the explicit condition compared to the implicit condition where subjects were not aware of distortion.    Conclusions  Our study demonstrated that although the visual feedback display used in this study did not alter visual space or evoke illusions of motion, perturbation of visual information about subjects’ movement can cause unintentional motor functions. This suggests that the effect of visual feedback distortion is spontaneous and a gait training involving the visual distortion paradigm may provide an effective way to help subjects correct gait patterns by driving implicit motor functions, thereby bringing benefits to rehabilitation.

Effect of explicit visual feedback distortion on human gait