Improving Foot Rocker via Robot-Resisted Gait Training With Self-Awareness Biofeedback in Adults With Cerebral Palsy

Cerebral palsy (CP) is a non-progressive neurological disorder that impairs motor control and coordination due to brain injury or abnormalities before, during, or shortly after birth. Although robotic gait training can improve overall gait patterns in CP, interventions targeting the ‘foot rockers’ motion, essential for stable weight transfer and effective push-off, have received limited attention. In this study, five adults with CP were recruited to train on a robotic treadmill system in which controlled downward forces were applied to the pelvis during walking, promoting implicit motor learning to develop an improved foot rockers strategy. Following this, during overground walking, participants received distinct real-time auditory cues at heel strike and push-off, providing self-awareness feedback to reinforce and maintain the foot rockers pattern acquired during treadmill training. Post-training analyses reported increased Tibialis Anterior activation during early stance, enhancing dorsiflexion and heel strike, and greater Soleus and Gastrocnemius engagement in late stance for stronger push-offs (p <0.05). These functional gains were reflected in key spatiotemporal metrics: longer step length, greater toe clearance, a reduced stance percentage, and a shorter double stance time (p <0.05). Participants also exhibited increased range of motion of the foot and increased knee and hip extension throughout stance, reflecting a more upright lower limb (p <0.05). Survey responses confirmed that participants acknowledged the resistive treadmill training for strengthening their muscles and influencing their walking patterns, and reported that the auditory biofeedback enhanced their awareness of heel-to-toe contact. Participants emphasized the necessity of incorporating both interventions, highlighting its potential as a promising approach to improving foot rockers and overall gait pattern in adults with CP.