Gait complexity is acutely restored in older adults when walking to a fractal-like visual stimulus

Typically, gait rehabilitation uses an invariant stimulus paradigm to improve gait related deficiencies. However, this approach may not be optimal as it does not incorporate gait complexity, or in more precise words, the variable fractal-like nature found in the gait fluctuations commonly observed in healthy populations. Aging which also affects gait complexity, resulting in a loss of adaptability to the surrounding environment, could benefit from gait rehabilitation that incorporates a variable fractal-like stimulus paradigm. Therefore, the present study aimed to investigate the effect of a variable fractal-like visual stimulus on the stride-to-stride fluctuations of older adults during overground walking. Additionally, our study aimed to investigate potential retention effects by instructing the participants to continue walking after turning off the stimulus. Older adults walked 8 min with i) no stimulus (self-paced), ii) a variable fractal-like visual stimulus and iii) an invariant visual stimulus. In the two visual stimuli conditions, the participants walked 8 additional minutes after the stimulus was turned off. Gait complexity was evaluated with the widely used fractal scaling exponent calculated through the detrended fluctuation analysis of the stride time intervals. We found a significant ~20% increase in the scaling exponent from the no stimulus to the variable fractal-like stimulus condition. However, no differences were found when the older adults walked to the invariant stimulus. The observed increase was towards the values found in the past to characterize healthy young adults. We have also observed that these positive effects were retained even when the stimulus was turned off for the fractal condition, practically, acutely restoring gait complexity of older adults. These very promising results should motivate researchers and clinicians to perform clinical trials in order to investigate the potential of visual variable fractal-like stimulus for gait rehabilitation.