and Gait Training
DAVID E. KREBS
TIMOTHY L. FAGERSON
Biofeedback is increasingly used in neuromuscular reeducation and gait training, largely because of the growing consensus in rehabilitation about the importance of motor learning. The two key ingredients in motor learning are practice and feedback (Schmidt, 1988). Properly understood and applied, biofeedback is an excellent tool for enhancing practice and performance of motor skills. The purpose of this chapter is to review the rationale and methods for using biofeedback to augment neuromuscular reeducation and gait training. (As in other chapters with glossaries, italics on first use of a term in this chapter indicate that the term is included in the glossary.)
Feedback must be relevant in order to enhance learning. Therapists are well aware that providing verbal cues can improve motor performance. This feedback may, for example, be in the form of verbal cues to focus attention on agonist muscles, praise for the patient who has just mastered straight-leg raising after knee arthrotomy, or congratulations to the child who has for the first time gained control of a prosthetic myoelectric hand.
Studies of specificity of information, in which, for example, subjects are asked to pitch a ball at a target, demonstrate that performance decrements can occur with each piece of lost information. However, the converse may not be true; that is, more feedback is not necessarily better. The timing and type of feedback, whether exogenous or endogenous, may be as important as the amount of feedback. General verbal encouragement is often a relatively nonspecific and inefficient means of aiding motor performance. In addition, there are the frequent long delays (i.e., latency) between completion of tasks by patients and the provision