Cortical and Kinematic Correlates of Feedback-Based Head Stabilization During Treadmill Walking.

Human motor control relies on the integration of sensory information to ensure stable and efficient movement. Augmented feedback (aFB) provides external cues that can enhance movement execution, yet little is known about its neural correlates during walking, particularly regarding head stabilization, a key component for visual and postural control. This cross-sectional study examined the effects of visual aFB on head stability and prefrontal cortex activation during treadmill walking in 25 healthy adults (median age: 31 years; 60% female). Participants walked under two visual feedback conditions: walking with a laser (WL), in which a head-mounted laser projected their head trajectory onto a wall without specific instruction, and walking with a head stabilization task (HST), where they were explicitly asked to keep the laser trace within an individualized horizontal target band, thus requiring active control of head motion. Head accelerations were recorded via a tri-axial accelerometer, and cortical activity in Brodmann areas 9, 10, 45, and 46 was assessed using functional near-infrared spectroscopy (fNIRS). Compared to WL, HST resulted in reduced head accelerations, especially along the vertical axis (p<0.001), and increased prefrontal activation in BA10 (p<0.001) and BA46 (p= 0.017). Stronger activation in these regions correlated with lower head accelerations, suggesting enhanced cognitive control of stability. These findings indicate that embedding goal-directed feedback in walking tasks engages prefrontal networks and improves motor performance, supporting its potential application in feedback-based gait rehabilitation. Clinical Trial Registration: ClinicalTrials.gov NCT06826638.