# Augmented feedback as a therapeutic approach for gait rehabilitation in patients with cerebral palsy: a systematic review

## TL;DR

This systematic review evaluates how augmented feedback can improve gait in cerebral palsy patients, finding strong evidence for velocity and ankle function improvements.

## Contribution

The study provides a systematic evaluation of augmented feedback's effectiveness in gait rehabilitation for cerebral palsy, highlighting key parameters with strong evidence.

## Key findings

- Augmented feedback shows strong evidence for improving gait velocity and ankle kinematics in cerebral palsy patients.
- Visual feedback is most effective for kinematic outcomes, but evidence for other gait parameters remains inconclusive.
- High variability in study protocols and quality prevents meta-analysis and limits conclusions about long-term effects.

## Abstract

To evaluate the effectiveness of augmented feedback (AF) in improving gait function in individuals with cerebral palsy (CP) and assess the strength of evidence across different gait parameters.

We included peer-reviewed interventional studies involving children or adults with CP who received AF during gait training, with gait-related outcomes assessed.

A systematic search was conducted in July 2025 across PubMed, Cochrane Library, IEEE Xplore, and PEDro database.

Risk of bias was assessed using the Cochrane Risk of Bias tool for RCTs and MINORS criteria for other study designs.

Of 477 screened records, 25 studies met inclusion criteria, comprising 612 total participants (409 intervention, 203 control). Studies included 13 single-session and 12 multi-session interventions.

Using systematic evidence synthesis, velocity improvements showed strong evidencial support for AF, while ankle kinematics demonstrated moderate to strong evidence. Visual feedback had the most consistent effects across parameters, particularly for kinematic outcomes. Most other gait parameters (step length, stride length, cadence) showed inconclusive evidence due to conflicting findings across studies of varying quality.

High heterogeneity in protocols, outcome measures, and study quality (32% high, 52% moderate, 16% low quality) prevented a meta-analysis. Limited long-term follow-up data (only 5 studies) restricts conclusions about sustained effects.

AF shows promise for enhancing gait velocity and ankle function in CP, particularly for spastic subtypes. However, evidence remains insufficient for widespread clinical adoption. Standardized protocols, larger sample sizes, and long-term follow-ups are essential for evidence-based implementation.