Augmented multisensory feedback enhances locomotor adaptation in humans with incomplete spinal cord injury

Different forms of augmented feedback may engage different motor learning pathways, but it is unclear how these pathways interact with each other, especially in patients with incomplete spinal cord injury (SCI). The purpose of this study was to test whether augmented multisensory feedback could enhance aftereffects following short term locomotor training (i.e., adaptation) in patients with incomplete SCI. A total of 10 subjects with incomplete SCI were recruited to perform locomotor adaptation. Three types of augmented feedback were provided during the adaptation: (a) computerized visual cues showing the actual and target stride length (augmented visual feedback); (b) a swing resistance applied to the leg (augmented proprioceptive feedback); (c) a combination of the visual cues and resistance (augmented multisensory feedback). The results showed that subjects' stride length increased in all conditions following the adaptation, but the increase was greater and retained longer in the multisensory feedback condition. The multisensory feedback provided in this study may engage both explicit and implicit learning pathways during the adaptation and in turn enhance the aftereffect. The results implied that multisensory feedback may be used as an adjunctive approach to enhance gait recovery in humans with SCI.