A Novel Core Strengthening Intervention for Improving Trunk Function, Balance and Mobility after Stroke.

This paper a novel core-strengthening intervention (CSI) delivered using the AllCore360°, a device that targets trunk muscles through a systematic, high-intensity rotating-plank exercise. Three individuals (age: 61.7 ± 3.2 years; range: 58-64 years) with post-stroke hemiplegia participated in 12-sessions of the CSI. The participants completed up to 142 rotating planks at inclination angles (IAs) that ranged from 40° to 65°, over 12 sessions. The interventional effects on the functional outcomes of trunk performance, balance and mobility were assessed using the Trunk Impairment Scale (TIS), the Berg Balance Scale (BBS), the Timed-Up and Go (TUG) test, the 10-m walk test (10MWT), and the 6-min walk test (6MWT). Postural outcomes were assessed using the center of pressure (CoP) data recorded during quiet standing on a balance platform, and neuromuscular outcomes were assessed using electromyography (EMG) during AllCore360° rotations. All participants completed the CSI (minimum of 120 rotations), demonstrating the feasibility of the CSI in chronic stroke. The CoP data suggested improved lateral control of posture during standing across participants (averaging an over 30% reduction in lateral sway), while the EMG data revealed the ability of the CSI to systematically modulate trunk muscle responses. In summary, the current investigation presents the feasibility of a novel delivery method for core strengthening to maximize rehabilitation outcomes in the chronic phase of stroke.

Objective evaluation of the risk of falls in individuals with traumatic brain injury: feasibility and preliminary validation.

Falls are a significant health concern for individuals with traumatic brain injury (TBI). For developing effective preemptive strategies to reduce falls, it is essential to get an accurate and objective assessment of fall-risk. The current investigation evaluates the feasibility of a robotic, posturography-based fall-risk assessment to objectively quantify the risk of falls in individuals with TBI. Five individuals with chronic TBI (age: 56.2 ± 4.7 years, time since injury: 13.09±11.95 years) performed the fall-risk assessment on hunova- a commercial robotic platform for assessing and training balance. The unique assessment considers multifaceted fall-driving components, including static and dynamic balance, sit-to-stand, limits of stability, responses to perturbations, gait speed, and history of previous falls and provides a composite score for risk of falls, called silver index (SI), a number between 0 (no risk) and 100 (high risk) based on a machine learning-based predictive model. The SI score for individuals with TBI was 66±32.1 (min: 32, max: 100) - categorized as medium-to-high risk of falls. The construct validity of SI outcome was performed by evaluating its relationship with clinical outcomes of functional balance and mobility (Berg Balance Scale (BBS), Timed-Up and Go (TUG), and gait speed) as well as posturography outcomes (Center of Pressure (CoP) area and velocity). The bivariate Pearson correlation coefficient, although not statistically significant, suggested the presence of linear relationships (0.52 > r > 0.84) between SI and functional and posturography outcomes, supporting the construct validity of SI. A large sample is needed to further prove the validity of the SI outcome before it is used for meaningful interpretations of the risk of falls in individuals with TBI.Clinical Relevance- Clinical assessments of risk of falls are traditionally based on questionnaires that may lack objectivity, consistency, and accuracy. The current work tests the feasibility of using a robotic platform-based assessment to objectively quantify the risk of falls in individuals with TBI.

A Novel Core-Strengthening Program for Improving Trunk Function, Balance and Mobility after Stroke: a Case Study.

The objective of the current investigation was to evaluate the feasibility of a core-strengthening program delivered to a chronic stroke participant using a novel robotic device, AllCore360°, which targets trunk muscles through a systematic, consistent, high-intensity exercise. A 58-year old male with hemiplegia post stroke (time since injury: 18 years) was enrolled and performed 12-sessions of the core-strengthening program on AllCore360°. The participant completed a total of 142 360°-rotating-planks (called as 'spins') at four inclination angles, over 12 sessions. Assessments at baseline and follow up included posturography during quiet standing, electromyography (EMG) during AllCore360° spins, and assessments for trunk function (Trunk Impairment Scale (TIS)), balance (Berg Balance Scale (BBS) and mobility (Timed-Up and Go (TUG), 10-meter Walk test (10MWT), 6-minute Walk Test (6MWT)). Clinically meaningful improvements were observed in the TIS (73%), the BBS (45.2%), and the TUG test (22.7%). Medial-lateral Center of Pressure (MLCoP) data showed reduced RMS and range by 32.3% and 29.2%, respectively. EMG data from left and right rectus abdominis (RAB) muscles showed increased levels of activations for both inclination angles, 65° (LRAB: 74%, RRAB: 48.4%) and 55° (LRAB: 22.3%, RRAB: 28.7%). The participant rated the core-strengthening program 71 (scale: 0-126) on Physical ACtivity Enjoyment Scale at the follow up, showing a high level of satisfaction and engagement toward the training program. The preliminary results suggest that the novel robotic design and enhanced engagement of neuromuscular mechanisms features of AllCore360° core-strengthening program could facilitate improvements in trunk function, balance and mobility post stroke. A study with a large sample and an appropriate control group needs to be performed in the future.Clinical Relevance- The majority of clinical programs include core-stability exercises for improving trunk function. The current investigation presents a novel robotic-device based core-strengthening program that can provide systematic, consistent, and repetitive practice for optimal functional gains.

Balance Control Strategies during Perturbed Standing after a Traumatic Brain Injury: Kinematic Analysis.

The objective of the current investigation was to examine the presence, absence or alteration of fundamental postural control strategies in individuals post traumatic brain injury (TBI) in response to base of support perturbations in the anterior-posterior (AP) direction. Four age-matched healthy controls (age: 46.50 ± 5.45 years) and four individuals diagnosed with TBI (age: 48.50 ± 9.47 years, time since injury: 6.02 ± 4.47 years) performed standing on instrumented balance platform with integrated force plates while 3D motion capture data was collected at 60 Hz. The platform was programmed to move in the AP direction, during a sequence of 5 perturbations delivered in a sinusoidal pattern at a frequency of 1 Hz, with decreasing amplitudes of 10, 8, 6, 4, and 2 mm respectively. The sagittal plane peak-to-peak range and root mean square (RMS) of the hip, knee, and ankle joint angles during the 5 seconds of perturbation were computed from optical motion capture data. The TBI group had a higher mean range (5.17 ± 1.91°) about the ankle compared to the HC group (4.17 ± 0.81°) for the 10mm perturbation, but their mean range was smaller than the HCs for the other 4 conditions. About the hip, the TBI group's mean range was larger than the HC's for all conditions. For both groups, the mean range decreased with perturbation amplitude for all conditions. The TBI group showed larger changes in mean range and RMS values as the amplitude of the perturbation changed, while the HC group showed smaller intertrial changes. The results suggest that the TBI group was substantially more reliant on the hip strategy to maintain balance during the perturbations and this reliance was well linked with perturbation amplitude.Clinical Relevance- Existing information regarding changes in postural control strategies in individuals post TBI is limited. The current work demonstrates lower limb kinematic differences between HC and TBI and some preliminary evidence on increased hip movement in the TBI group.

Accuracy comparison of machine learning algorithms at various wear-locations for activity identification post stroke: A pilot analysis.

Objective and accurate activity identification of physical activities in everyday life is an important aspect in assessing the impact of various post-stroke rehabilitation therapies and interventions. Since post-stroke hemiparesis affects gait and balance in individuals with stroke, activity identification algorithms that consider stroke-specific movement irregularities are needed. While wearable physical activity monitors provide the means to detect activities in the free-living, algorithms using their data are specific to the wear location of the device. This pilot study builds, validates, and compares three machine learning algorithms (linear support vector machine, Random Forest, and RUSBoosted trees) at three popular wear locations (wrist, waist, and ankle) to identify and accurately distinguish mobility-related activities (sitting, standing and walking) in individuals with chronic stroke. A total of 102 minutes of data from two lab visits of three-stroke participants was used to build the classifiers. A 5-fold cross-validation technique was used to validate and compare the accuracy of classifiers. RUSBoosted trees using data from waist and ankle activity monitors, with an accuracy of 99.1%, outperformed other classifiers in detecting three activities of interest.Clinical Relevance- One of the major aims of post-stroke rehabilitation is improving mobility, which may be facilitated by understanding the structure and pattern of everyday mobility through real-world, objective outcomes. Accurate activity identification, as shown in this pilot investigation, is an essential first step before developing objective outcomes for monitoring mobility and balance in everyday life of these individuals.

Feasibility of a real-time pattern-based kinematic feedback system for gait retraining in pediatric cerebral palsy.

INTRODUCTION: Visual biofeedback of lower extremity kinematics has the potential to enhance retraining of pathological gait patterns. We describe a system that uses wearable inertial measurement units to provide kinematic feedback on error measures generated during periods of gait in which the knee is predominantly extended ('extension period') and flexed ('flexion period'). METHODS: We describe the principles of operation of the system, a validation study on the inertial measurement unit derived knee flexion angle on which the system is based, and a feasibility study to assess the ability of a child with cerebral palsy to modify a gait deviation (decreased swing phase knee flexion) in response to the feedback. RESULTS: The validation study demonstrated strong convergent validity with an independent measurement of knee flexion angle. The gait pattern observed during training with the system exhibited increased flexion in the flexion period with maintenance of appropriate extension in the extension period. CONCLUSIONS: Inertial measurement units can provide robust feedback during gait training. A child with cerebral palsy was able to interpret the novel two phase visual feedback and respond with rapid gait adaptation in a single training session. With further development, the system has the potential to support clinical retraining of deviated gait patterns.

Enhancing sensory acuity and balance function using near-sensory biofeedback-based perturbation intervention for individuals with traumatic brain injury.

BACGROUND: Interventions addressing balance dysfunction after traumatic brain injury (TBI) only target compensatory aspects and do not investigate perceptual mechanisms such as sensory acuity. OBJECTIVE: To evaluate the efficacy of a novel intervention that integrates sensory acuity with a perturbation-based approach for improving the perception and functional balance after TBI. METHODS: A two-group design was implemented to evaluate the effect of a novel, perturbation-based balance intervention. The intervention group (n = 5) performed the intervention with the sinusoidal (0.33, 0.5, and 1 Hz) perturbations to the base of support with amplitudes derived using our novel outcome of sensory acuity - perturbation perception threshold (PPT). The efficacy is evaluated using changes in PPT and functional outcomes (Berg Balance Scale (BBS), Timed-up and Go (TUG), 5-meter walk test (5MWT), and 10-meter walk test (10MWT)). RESULTS: There was a significant post-intervention change in PPT for 0.33 Hz (p = 0.021). Additionally, clinically and statistically significant improvements in TUG (p = 0.03), 5MWT (p = 0.05), and 10MWT (p = 0.04) were observed. CONCLUSIONS: This study provides preliminary efficacy of a novel, near-sensory balance intervention for individuals with TBI. The use of PPT is suggested for a comprehensive understanding and treatment of balance dysfunction. The promising results support the investigation in a larger cohort.

Augmented-reality guided treadmill training as a modality to improve functional mobility post-stroke: A proof-of-concept case series.

Objective: To provide a proof-of-concept for a novel stroke-gait-specific augmented reality (AR)-guided treadmill intervention by evaluating its effect on temporospatial and functional outcomes of mobility.Methods: Two females with hemiplegia post stroke were recruited for participation in a 4-week intervention, and a single healthy control was recruited for baseline comparisons. The stroke-intervention (SI) participant (aged 54-years), completed 12 sessions of AR-guided treadmill intervention. The stroke-control (SC) participant (aged 59-years) completed 12 sessions of conventional treadmill intervention. Temporospatial and functional mobility were assessed pre-intervention, post-intervention, and at 1-month follow-up. Physical ACtivity Enjoyment Scale (PACES) was administered post-intervention.Results: The SI participant showed clinically meaningful improvements in functional outcomes post-intervention and at 1-month follow-up (Berg balance score (BBS): +6 and +10 points; Dynamic Gait Index (DGI): +2 at post-intervention only; walking speed: +0.19 and +0.24 m/s; 6-minute walk test (6MWT): +51.9 and +38.9) respectively. The SC showed clinically meaningful improvements in BBS (+3 and +3) and walking speed (+0.06 at post-intervention). The PACES scores showed that the SI participant had a significantly higher (23 points) enjoyment level during the intervention compared to the SC participant. The SI participant was more asymmetric compared to the SC participant at pre and post-intervention visits.Conclusions: The SI participant showed greater improvement in functional assessments compared to the SC participant post intervention. The AR-guided approach may have added benefits compared to traditional treadmill training, while providing better customization, patient enjoyment, and engagement. Further investigation with a larger sample is warranted.

Kinetic Gait Changes after Robotic Exoskeleton Training in Adolescents and Young Adults with Acquired Brain Injury.

BACKGROUND: Acquired brain injury (ABI) is one of the leading causes of motor deficits in children and adults and often results in motor control and balance impairments. Motor deficits include abnormal loading and unloading, increased double support time, decreased walking speed, control, and coordination. These deficits lead to diminished functional ambulation and reduced quality of life. Robotic exoskeletons (RE) for motor rehabilitation can provide the user with consistent, symmetrical, goal-directed repetition of movement, as well as balance and stability. PURPOSE: The goal of this preliminary prospective before and after study is to evaluate the therapeutic effect of RE training on the loading/unloading and spatial-temporal characteristics in adolescents and young adults with chronic ABI. METHOD: Seven participants diagnosed with ABI between the ages of 14 and 27 years participated in the study. All participants received twelve 45 minute sessions of RE gait training. The bilateral loading (linearity of loading and rate of loading), speed, step length, swing time, stance time, and total time were collected using Zeno™ walkway (ProtoKinetics, Havertown, PA, USA) before and after RE training. RESULTS: Results from the study showed improved step length, speed, and an overall progression towards healthy bilateral loading, with linearity of loading showing a significant therapeutic effect (p < 0.05). CONCLUSION: These preliminary results suggest that high dose, repetitive, consistent gait training using RE has the potential to induce recovery of function in adolescents and young adults diagnosed with ABI.

Evaluating Sensory Acuity as a Marker of Balance Dysfunction After a Traumatic Brain Injury: A Psychophysical Approach.

There is limited research on sensory acuity i.e., ability to perceive external perturbations via body-sway during standing in individuals with a traumatic brain injury (TBI). It is unclear whether sensory acuity diminishes after a TBI and if it is a contributing factor to balance dysfunction. The objective of this investigation is to first objectively quantify the sensory acuity in terms of perturbation perception threshold (PPT) and determine if it is related to functional outcomes of static and dynamic balance. Ten individuals with chronic TBI and 11 age-matched healthy controls (HC) performed PPT assessments at 0.33, 0.5, and 1 Hz horizontal perturbations to the base of support in the anterior-posterior direction, and a battery of functional assessments of static and dynamic balance and mobility [Berg balance scale (BBS), timed-up and go (TUG) and 5-m (5MWT) and 10-m walk test (10MWT)]. A psychophysical approach based on Single Interval Adjustment Matrix Protocol (SIAM), i.e., a yes-no task, was used to quantify the multi-sensory thresholds of perceived external perturbations to calculate PPT. A mixed-design analysis of variance (ANOVA) and post-hoc analyses were performed using independent and paired t-tests to evaluate within and between-group differences. Pearson correlation was computed to determine the relationship between the PPT and functional measures. The PPT values were significantly higher for the TBI group (0.33 Hz: 2.97 ± 1.0, 0.5 Hz: 2.39 ± 0.7, 1 Hz: 1.22 ± 0.4) compared to the HC group (0.33 Hz: 1.03 ± 0.6, 0.5 Hz: 0.89 ± 0.4, 1 Hz: 0.42 ± 0.2) for all three perturbation frequencies (p < 0.006 post Bonferroni correction). For the TBI group, the PPT for 1 Hz perturbations showed significant correlation with the functional measures of balance (BBS: r = -0.66, p = 0.037; TUG: r = 0.78, p = 0.008; 5MWT: r = 0.67, p = 0.034, 10MWT: r = 0.76, p = 0.012). These findings demonstrate that individuals with TBI have diminished sensory acuity during standing which may be linked to impaired balance function after TBI.

Visual kinematic feedback enhances the execution of a novel knee flexion gait pattern in children and adolescents.

BACKGROUND: Altered knee motion is one of the most common gait deviations in pediatric populations with gait disorders. The potential for pediatric gait retraining using visual feedback based on knee kinematic patterns is under-explored. RESEARCH QUESTION: This study investigated whether pediatric participants could successfully modify knee flexion patterns in response to a visual kinematic feedback system (VKFS). METHODS: Knee flexion angles from twelve typically developing children and adolescents (6 M, 6 F; 11.9 ±â€¯2.7 years) were calculated using wearable inertial measurement units. Participants were tested while walking on a treadmill using pattern based visual feedback (FB). Four novel target patterns which amplified or attenuated swing phase peak knee flexion were tested. No feedback (NFB) tests assessed the participant's ability to independently reproduce the patterns. Mean absolute cycle error (MACE) and magnitude of peak knee flexion error (PK) were calculated during the last 10 strides of FB and NFB trials. Pre-exposure reference values (R) were also calculated. RESULTS AND SIGNIFICANCE: PK-FB was significantly smaller (p < 0.05) than PK-R for all targets. Average values for PK-NFB were higher than for PK-FB, although PK-NFB remained significantly lower than PK-R for two targets. Contrary to one of the study's hypotheses, MACE-FB and MACE-NFB were larger than MACE-R. The study provided evidence that pediatric participants were able to modify peak knee flexion during gait in the sense targeted by the VKFS. Analysis suggested that MACE increases were explained by increases in gait cycle deviation outside of the changed region.

Kinematic and Functional Gait Changes After the Utilization of a Foot Drop Stimulator in Pediatrics.

Foot drop is one of the most common secondary conditions associated with hemiplegia post stroke and cerebral palsy (CP) in children, and is characterized by the inability to lift the foot (dorsiflexion) about the ankle. This investigation focuses on children and adolescents diagnosed with brain injury and aims to evaluate the orthotic and therapeutic effects due to continuous use of a foot drop stimulator (FDS). Seven children (10 ± 3.89 years) with foot drop and hemiplegia secondary to brain injury (stroke or CP) were evaluated at baseline and after 3 months of FDS usage during community ambulation. Primary outcome measures included using mechanistic (joint kinematics, toe displacement, temporal-spatial asymmetry), and functional gait parameters (speed, step length, time) to evaluate the orthotic and therapeutic effects. There was a significant correlation between spatial asymmetry and speed without FDS at 3 months (r = 0.76, p < 0.05, df = 5) and no correlation between temporal asymmetry and speed for all conditions. The results show orthotic effects including significant increase in toe displacement (p < 0.025 N = 7) during the swing phase of gait while using the FDS. A positive correlation exists between toe displacement and speed (with FDS at 3 months: r = 0.62, p > 0.05, without FDS at 3 months: r = 0.44, p > 0.05). The results indicate an orthotic effect of increased dorsiflexion and toe displacement during swing with the use of the FDS in children with hemiplegia. Further, the study suggests that there could be a potential long-term effect of increased dorsiflexion during swing with continuous use of FDS.

Effects of Robotic Exoskeleton Gait Training on an Adolescent with Brain Injury.

Brain injury is one of the leading causes of motor deficits in children and adults, and it often results in motor control and balance impairments. Motor deficits include decreased walking speed, increased double support time, increased temporal and spatial asymmetry, and decreased control and coordination; leading to compromised functional ambulation and reduced quality of life. Robotic exoskeletons for motor rehabilitation can provide the user with consistent, symmetrical, goal-directed repetition of movement as well as balance and stability. The goal of this case study was to evaluate the efficacy of high dose robotic training on dynamic gait using functional and neuromechanical outcome measures in an adolescent with chronic brain injury. The results from this study demonstrated improved spatial symmetry, swing time, stance time, step length and an overall progression towards healthy bilateral loading. These preliminary results suggest that high dose, repetitive, consistent gait training using robotic exoskeletons has the potential to induce recovery of function in adolescents diagnosed with brain injury.

Anticipatory and Compensatory Postural Responses during Perturbed Standing in Individuals with Traumatic Brain Injury.

Anticipatory postural adjustments (APA) and compensatory postural adjustments (CPA) are neuromuscular responses generated to stabilize the body and achieve balance during perturbations. The impaired sensory integration after a traumatic brain injury (TBI) can limit the ability to perceive perturbations and potentially affect the ability to generate APA and CPA responses. The main objective of this investigation is to explore the existence of APA and CPA generation in tibialis anterior (TA) and gastrocnemius (GAST) muscles during base of support perturbations in healthy controls (HC) as well as individuals with TBI. The secondary objective is to explore the effectiveness of a novel computerized biofeedback based intervention (CBBI) at improving APA and CPA responses in individuals with TBI. We observed that all three groups - HC (n=5), TBI-control (n=5), and TBI-Intervention (n=4) showed the presence of only CPA responses for the TA muscle, however, these responses were longer and variable for both TBI groups, compared to the short and consistent responses of the HC group. The GAST was involved in both APA and CPA for all groups. After the 4-week CBBI period, the TBI-I group showed increased APA responses for both TA and GAST. Further, the TBI-I group showed reduced CPA responses for both TA and GAST after the intervention. The elevated and longer CPA responses of TA and GAST and lower APA responses of GAST could suggest impaired postural control. Due to their significance and potential link to the balance dysfunction, these mechanisms need to be studied comprehensively in larger samples in order to effectively optimize the rehabilitation approaches for improving balance and avoiding falls in individuals with TBI.

Kinematics and pushrim kinetics in adolescents propelling high-strength lightweight and ultra-lightweight manual wheelchairs.

PURPOSE: The purpose of this study is to describe and compare pushrim forces, propulsive work cost, and upper body kinematics in adolescents propelling (1) a standard high strength lightweight wheelchair, and (2) an ultra-lightweight wheelchair with adjustable main axle positioning, on a level tiled floor ("Tile"), ascending a ramp ("Ramp"), and across a foam mat ("Mat"). METHODS: A within-subjects repeated measures study design was used. Eight adolescent manual wheelchair users propelled the standard and ultra-lightweight wheelchairs across the three conditions. Average pushrim tangential force, propulsive power and work per unit distance travelled, as well as upper body kinematic angles, were analyzed. RESULTS: Average pushrim tangential force (1.80 ± 0.7 N, p = .042) and propulsive work per unit distance travelled (8.3 ± 1.7 J·m- 1, p = .002) were higher for the standard lightweight wheelchair, whereas average speed was lower (0.12 ± 0.03 m/s, p = .006). Maximum shoulder (9.2 ± 2.0°, p = .003) and elbow flexion (8.0 ± 2.2°, p = .009) were higher for the ultra-lightweight wheelchair. Compared with Tile, propulsion on Mat and Ramp was associated with higher average tangential force, work per unit distance, power, and maximum flexion of the neck and trunk, whereas shoulder extension and average speed were lower for Mat and Ramp. CONCLUSIONS: Compared with the standard lightweight wheelchair, ultra-lightweight wheelchair propulsion was associated with lower pushrim forces, lower energy costs, higher self-selected speeds, and increased shoulder and elbow flexion. These variables have been linked to injury risk and mobility efficiency, and the results provided evidence that differences in weight and configuration options are both contributors. Findings can inform decision-making in the prescription of manual wheelchairs for pre-adult populations. Implications for Rehabilitation A significant proportion of manual wheelchair users are children and adolescents, and due to the early onset of use they may be especially predisposed to the development of chronic overuse injuries. The study reports differences in energy costs, pushrim forces, and upper body kinematics measured when adolescents propelled standard and ultra-lightweight wheelchairs across three trial conditions. In the ultra-lightweight wheelchair, reduced energy cost is linked to more efficient mobility, and lower forces may be linked to lower risk of chronic injury. Significant differences in elbow and shoulder kinematics are also reported, and the findings support the importance of both weight and setup options in the selection of manual wheelchairs.

Robotic Exoskeleton Gait Training for Inpatient Rehabilitation in a Young Adult with Traumatic Brain Injury.

Severe and moderate traumatic brain injury (TBI) causes motor deficits leading to impairments in functional ambulation. Motor recovery involves intensive rehabilitation through physical therapy. Current practices in rehabilitation results in variable recovery of motor function and may result in residual gait deviations. Wearable robotic exoskeletons can provide the user with intensive, goal-directed repetition of movement as well as provide the user with stability and balance during gait, compared to conventional physical therapy. During the acute stage of recovery, the brain is healing and relearning and increased intensive motor rehabilitation throughout this stage could result in improved functional ambulation, especially in individuals with severe impairments who are not independent ambulators. This pilot study evaluates the effect of early intervention robotic exoskeleton gait training on lower extremity biomechanics on a 21 year old young adult with TBI.

Haptic proprioception in a virtual locomotor task.

Normal gait needs both proprioceptive and visual feedback to the nervous system to effectively control the rhythmicity of motor movement. Current preprogrammed exoskeletons provide only visual feedback with no user control over the foot trajectory. We propose an intuitive controller where hand trajectories are mapped to control contralateral foot movement. Our study shows that proprioceptive feedback provided to the users hand in addition to visual feedback result in better control during virtual ambulation than visual feedback alone. Hand trajectories resembled normal foot trajectories when both proprioceptive and visual feedback was present. Our study concludes that haptic feedback is essential for both temporal and spatial aspects of motor control in rhythmic movements.