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Benchmarking System for Assessing Balance (BeStABle) during gait using visual stepping cues
Andrew Berry1, Nathan Fopma1, Matjaž Zadravec2
1Department of Biomechanical Engineering, Delft University of Technology, Delft, The Netherlands.
Gait & Posture
|July 21, 2026
Summary
The Benchmarking System for Assessing Balance (BeStABle) uses virtual reality to objectively assess gait and balance. It effectively differentiates individuals with lower-limb prostheses from able-bodied individuals, particularly when gait adaptations are required.
Area of Science:
- Biomechanics
- Rehabilitation Engineering
- Human Movement Science
Background:
- Clinical balance assessments often lack real-world predictability, failing to capture diverse sensory, cognitive, and physical challenges.
- Current protocols may not adequately assess balance capacity in dynamic, unpredictable environments.
- This limits the characterization of balance control relevant to daily life activities.
Purpose of the Study:
- To introduce a novel task-specific procedure for assessing balance control during gait using an augmented reality treadmill system.
- To evaluate the system's ability to simulate real-world balance challenges.
- To compare balance control between individuals using transtibial prostheses and able-bodied individuals.
Main Methods:
- Development of the Benchmarking System for Assessing Balance (BeStABle), an augmented reality treadmill environment.
- Implementation of unpredictable visual cues to alter foot placement patterns during gait.
- Assessment of stimulus perception, decision-making, and compensatory corrections in participants.
- Case study comparing three transtibial prosthesis users with 19 able-bodied individuals.
Main Results:
- The BeStABle system demonstrated significant discrimination between prosthesis users and the control group across multiple outcome measures.
- The most prominent differences were observed when participants were prompted to narrow their step width.
- Findings suggest specific gait adaptations may be challenging for individuals with transtibial prostheses, informing future assessment protocols.
Conclusions:
- The BeStABle provides a safe, repeatable, and objective method for assessing gait adaptations in a controlled environment.
- This augmented reality system offers an efficient tool for clinicians to evaluate balance control.
- The system aids in refining protocols for assessing gait and balance impairments, particularly in populations with lower-limb loss.