Cueing Changes in Peak Vertical Ground Reaction Force to Improve Coordination Dynamics in Walking

Biofeedback has been effectively implemented to improve the mediation and distribution of joint loads during gait, however, the inability to effectively coordinate lower limb movement by altering loading patterns may increase pathological stress and risk of injury and deleterious joint changes. This study examined the influence cueing an increase or decrease in lower extremity loading has on inter- and intralimb joint coordination during gait, applied herein for 12 persons following anterior cruciate ligament reconstruction across three loading conditions (control, high, and low). Visual biofeedback was presented on a screen via a force-measuring treadmill with targeted changes prescribed based on stride-to-stride peak vertical ground reaction forces bilaterally. The pattern and stability of coordination dynamics among each of the ankle, hip and knee joint pairs were assessed via discrete relative phase and cross-recurrence quantification analyses for each condition. High and low loading altered the pattern and stability of intralimb coordination; low loading led to decreased coordination stability (20 degrees greater than control condition) and high loading resulted in a more tightly coupled coordination pattern (higher %CDET). With thoughtful consideration for movement control, biofeedback can be used to target mechanisms leading to long-term deleterious joint adaptations.