Brief research report 309 Base of support feedback in gait rehabilitation Alexander S. Aruin 1,2,* , Timothy A. Hanke 1 and Asha Sharma 1 The purpose of this study was to investigate the effect of feedback information about base of support in gait rehabilitation. Sixteen individuals with hemiparesis resulting in narrow base of support, were randomly placed into two equal groups, experimental and control. The experimental group was provided with a portable device that provided extrinsic auditory feedback infor- mation about base of support incorporated in the functional context of conventional gait therapy, whereas the control group received a conventional gait therapy only. Changes in step width with treatment were assessed with step print technique. The experimental group of subjects improved their step width with treatment from 0.09 ± 0.003 m to 0.16 ± 0.006 m while individuals assigned to the control group showed smaller improvement from 0.099 ± 0.004 m to 0.13 ± 0.003 m. While both groups demonstrated statistically significant improvement (p < 0.05), the level of recovery of step width seen in the experimental group was greater. International Journal of Rehabilitation Research 26:309–312  c 2003 Lippincott Williams & Wilkins. International Journal of Rehabilitation Research 2003, 26:309–312 Keywords: feedback, gait, rehabilitation 1 Marianjoy Rehabilitation Hospital, Wheaton, Illinois and 2 Department of Physical Therapy, University of Illinois at Chicago, USA. Correspondence to: Alexander S. Aruin, Department of Physical Therapy, College of Applied Health Sciences, University of Illinois at Chicago, USA. Tel: + 1 312 355 0904; fax: + 1 312 356 4583; e-mail: aaruin@uic.edu Introduction It has been demonstrated in the literature that treatment based on feedback training benefit individuals with central nervous system (CNS) deficits (Basmajian, 1981; Wolf, 1983; Montoya et al., 1993; Peterson et al., 1996; Glanz et al., 1997; Hanke, 1999; Aruin et al., 2000; Walker et al., 2000). By providing special information about the accuracy of studied movement, these indivi- duals may gain better control over their motor system. Specifically, the usefulness of feedback was shown in the gait training of children with various forms of cerebral palsy (Conrad and Bleck, 1980; Flodmark, 1986) and spastic diplegia (Kassover et al., 1986) as well as in improvement of the hand-eye coordination of individuals with cerebral palsy (Talbot et al., 1981). Feedback-based systems may be effective in improvement of stance symmetry of patients with hemiplegia (Shumway-Cook, 1988; Winstein et al., 1989; Wing et al., 1993; Nichols, 1997; Walker et al., 2000) and reduction of the movement time while rising and sitting down (Engardt, 1994a, 1994b). The importance of walking in activities of daily living makes motor re-education an important part of rehabili- tation. The control of the body mass about its center in the frontal plane during walking is a function of lateral foot placement (MacKinnon and Winter, 1993). This foot placement dictates the base of support (BOS) during the stance phases of the gait cycle. Step or stride width, which is reflective of the limits of the BOS in the frontal plane during walking depends on several factors including age, gender, fall status and body dimensions. Impairment of lateral foot placement due to a neurological disease or trauma could significantly reduce BOS. Consequently, reduced BOS during walking may lead to postural instability and increased metabolic cost (Donelan et al., 1999). There are several techniques used in gait therapy directed towards modifying a patient’s base of support. The first is based on providing a verbal guidance to the patient when a clinician instructs a patient to move his or her leg out to the side. Another technique, which continues to be used by rehabilitation professionals, is manually providing tactile cues to selected individual muscles or handling the foot of the patient in order to physically assist with placement (Bobath, 1978). Other approaches are based on using mechanical devices that prevent the patient from putting the legs together such as colored markers taped to the floor or a wooden balance beam. These methods however, suffer, respectively, from being too cognitively focused (i.e., specifically trying to have the patient consciously control a single muscle during a complex task or allowing the patient to become a passive recipient of the therapist-induced foot place- ment), or ecologically obtrusive in the case of walking with a balance beam placed on the floor and between the patient’s feet. In contrast to these drawbacks, extrinsic auditory feedback could stimulate more active involve- ment of the patients in the process of restoring existing or learning new skills. The purpose of the present study was to explore the effectiveness of providing auditory feed- back of the BOS offered in addition to conventional gait rehabilitation. Materials and methods Sixteen subjects with a narrow base of support due to a recent single unilateral cerebrovascular accident 0342-5282  c 2003 Lippincott Williams & Wilkins DOI: 10.1097/01.mrr.0000102059.48781.a8 Copyright © Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.