IEEE Transactions on Neural Systems and Rehabilitation Engineering

The most prominent signature associated with motor execution and motor imagery is the event-related desynchronisation and synchronisation (ERD/S) in the mu and beta bands (8-30 Hz). In the context of brain-computer interfaces (BCI), this ERD/S signature is helpful for binary decisions, such as left vs. right imagery, but it is not a robust biomarker for continuous prediction, such as precisely decoding different levels of force application. This is essential for developing better BCI applications with precise dynamic force outputs. Recent studies have revealed that sensorimotor beta bursts have a stronger relationship with motor control, even at a single-trial level, than beta band power. We, therefore, investigated whether the transient nature of beta bursts provide an alternative, but robust biomarker for BCI force decoding. Here, we designed an experiment where human participants (N = 16) performed both motor execution (ME) at four force levels (10%, 25%, 50%, and 75% of maximum voluntary contraction) and imagined exerting the same, i.e. a motor imagery (MI) task, as their electroencephalogram was recorded. We observed a clear and classical ERD pattern in the motor cortex during the ME task, whereas it was less pronounced during the MI task. After extracting sensorimotor beta bursts, we observed differences in spectral burst features between motor execution and imagery including burst amplitude, spectral width, and temporal width. Moreover, different force levels were correlated with changes in the burst amplitude and burst spectral width, specifically during motor execution. Interestingly, we found that different beta burst waveforms are associated with the different force levels and conditions. This suggests that the bursts-level features could be driven by changes in the underlying beta burst waveforms. Overall, our study shows that sensorimotor beta burst can be an important piece of the puzzle to implementing precise force control in brain-computer interface-based prosthetics.

This study aims to predict human intentions during intense sports activities, specifically in table tennis. Using a publicly available Real World Table Tennis dataset containing simultaneous EEG and video recordings, we developed a series of participant-specific classifiers for nine players (7 males and 2 females; age range 18-30), based on pose features and EEG signals. The pose-based classifier used a stochastic gradient descent model with logistic loss, whereas the EEG-based classifier employed a modified convolutional neural network architecture (EEGNet). Both classifiers successfully predicted left-right attack intentions from the time windows preceding racket-ball impact, with optimal decoding occurring at -100 ms for pose features and -500 ms for EEG signals. EEG-based decoding achieved higher performance than pose-based decoding, and a multi-modal ensemble further improved prediction, reaching a mean macro F1 score of 0.563 (bootstrapped 95% CI: 0.523-0.603), corresponding to gains of +0.03 over pose-only and +0.02 over EEG-only classifiers. Because each classifier is trained independently, the ensemble can be feasibly extended to incorporate additional modalities in the future. These results suggest potential applications in neural prosthetic systems and neurofeedback tools for sports training.

Recent advancements in wearable sensors and machine learning show promise for estimating lower-body joint torques outside of laboratory settings. Inertial Measurement Units combined with Convolutional Neural Networks have proven effective for this task. However, the impact of different input data types and formats remains underexplored. This study investigates how variations in input data influence the prediction of lower-body joint torques during walking. Results indicate that while dataset choice causes only minor differences in prediction performance, the overall quality of the dataset plays a more critical role than the specific input variables in achieving accurate torque predictions using wearable sensors.

This paper presents experimental evidence that alpha-band EEG signals can be reliably detected from an in-ear electrode during physical activity, enabling fatigue monitoring in dynamic, real-world conditions such as sports. We collected an EEG dataset using a custom-designed, compact wearable system measuring only 20 mm in diameter, integrated inside the earphone. It supports five channels, four head electrodes (T3, C3, C4, T4) and one in-ear electrode, allowing simultaneous multi-site recordings. Recordings were made while a participant engaged in a controlled cycling protocol designed to induce physical fatigue. We demonstrated a direct relationship between alpha power and entropy in EEG data recorded from both the head and ear, during both activity and rest. To our knowledge, this is the first study to demonstrate in-ear alpha power tracking during active physical movement for sports-related fatigue monitoring. These findings open new possibilities for compact, wearable EEG systems in athletic and high-performance settings, where traditional EEG setups are impractical

BackgroundEar-EEG-based brain-computer interfaces (BCIs) provide improved wearability and comfort compared to traditional scalp-EEG systems. However, their performance is constrained by low signal-to-noise ratios (SNRs) and high rates of BCI illiteracy under conventional luminance-modulated steady-state visual evoked potential (SSVEP) paradigms. MethodsThis study introduces a text-sequence stimulation paradigm to address these limitations by leveraging ventral visual pathway responses that are more accessible to electrodes near the ear. Using offline frequency-sweeping experiments across 4-8 Hz, we identified optimal stimulus parameters (4.6-6.8 Hz with 0.25{pi} phase shifts) and integrated them into a 12-target BCI system. We further conducted online experiments to compare the response characteristics and real-time spelling performance between the proposed text-sequence paradigm and conventional luminance stimulation. ResultsComparative experiments with 14 participants demonstrate that text sequence stimuli achieve an average information transfer rate (ITR) of 44.59 {+/-} 10.50 bits/min, outperforming luminance modulation by 76.18% in ITR. Notably, text sequence stimulation effectively mitigated BCI illiteracy, with all participants achieving near or above 70% accuracy (mean: 86.37 {+/-} 9.61%). This represents a significant improvement over luminance modulation, where 50% of users fell below 70% accuracy. ConclusionsBy reducing the flicker area by 14% and mimicking the natural luminance variations that occur during reading, the proposed method enhanced visual comfort. The online results further validate text-sequence stimulation as a high-performance and user-friendly paradigm for ear-EEG BCIs, supporting their practicality for assistive applications.

Purposeto characterize the dynamic postural control during weight load shifting with and without support surface reduction with temporal metrics commonly used in linear control systems identification. MethodsFrom the COP coordinates temporal, global and structural parameters were calculated. Reliability of derived parameters were determined using Bland-Altman analysis. ResultsFor the observed population, temporal variables tend to decrease when the complexity of the task is increased with the reduction in the support surface and the non dominance. ConclusionDelay and rise times were significantly shorter for the non-dominant limb in the anteroposterior direction when volunteers performed the same task with different limbs. In the mediolateral direction, delay and rise times were shorter in both unipodal stances with respect to their bipodal homologues. An increase in COP path length, velocity and sample entropy was observed when the support area was reduced. All parameters showed good reliability in both directions at all stances. This framework could be used in the clinical practice to assess dynamic postural control capabilities in patients whose balance is pathologically affected. The trial was evaluated and approved by the Central Committee of Bioethics in Biomedical Practice and Research of the province of Entre Rios.

The opportunity to collect movement data from smartphones for prolonged periods has opened new perspectives in the field of clinical movement analysis. However, when monitoring peoples mobility in free-living conditions, smartphone placement can influence the validity of the extracted digital mobility outcome. This study aimed to develop and validate an automatic smartphone placement recognition classifier and to investigate potential critical factors that can influence performance. The classifier was trained on data from 15 healthy participants using inertial signals collected from smartphones placed at six body placements during free-living walking and externally validated on over 3,000 individuals from external datasets, including blind participants and patients with cardiovascular or Parkinsons disease. A decision-tree ensemble model was developed using feature subsets of increasing dimensionality, with the optimal subset comprising 50 features. Classification accuracy increased consistently when front and back pocket placements were aggregated (81.1%) and further improved when coat pocket was also included in the pocket class (88.5%), underscoring the challenge of distinguishing between fine-grained pocket placements. The best-recognized placements across the external datasets were lower back (precision: 100%, recall: 72.5%), hand (precision: 94.2%, recall: 94.5%), and the aggregated pocket class (precision: 86.7%, recall: 90.2%). Recognition accuracy changed across cohorts (0.73 - 0.85), activities (0.63 - 0.94) and speed (0.79 - 0.87), however it stayed consistent across various technological and environmental factors. Overall, this study demonstrates the feasibility of robust placement recognition in walking and underscores the importance of accounting for key influencing factors when designing frameworks intended for deployment in heterogeneous real-world or clinical contexts. HighlightsO_LIMachine learning accurately identifies smartphone placement during real-world gait C_LIO_LISix on-body placements recognized, including pockets, hand, bag, and lower-back C_LIO_LIFree-living data used for training, ensuring robust performance across conditions C_LIO_LIFeature selection and hyperparameter tuning optimize classification accuracy C_LIO_LIExternal validation confirms generalizability across >3,000 healthy and diseased adults C_LI

Background: Accurate evaluation of fine motor abilities is a key aspect of neurological rehabilitation. However, conventional approaches like goniometry are limited by variations among raters and their difficulty in detecting active movement. On the other hand, computer vision-based software delivers non-invasive and quantitative analysis of hand movements. An innovative computer-vision-based software tool, F.A.I.R. Chance(C), was developed to track and analyze individual finger joint movements on a camera-equipped laptop and give real-time numerical feedback. However, its metrics require validation in a healthy population before the tool can be used for clinical purposes. Objective: To assess the reliability and validity of finger movement assessment by the F.A.I.R. Chance computer vision-based tool in healthy adult participants. Methods: An observational cross-sectional study was done at MGM School of Physiotherapy, comprising 30 healthy participants between 18 and 60 years of age. Finger movements like flexion, extension, abduction, and adduction were measured with a standard handheld goniometer. These same finger movements were then measured with the tool at two time points separated by a 30-minute interval to determine the test-retest reliability. The tool's measurements were compared with the goniometric measurements to determine its concurrent validity. Test retest reliability was checked by the Intra-class Correlation Coefficient ICC (2,1), while concurrent validity was tested through Pearson's correlation coefficients. Results: Metacarpophalangeal and proximal interphalangeal joint motions demonstrated moderate to good test-retest reliability (ICC: 0.716-0.953) for the F.A.I.R. Chance tool. However, distal interphalangeal joint movements had lower consistency. Good reliability (ICC: 0.754-0.908) was seen for movements of abduction and adduction in the fingers. Strong concurrent validity for extension movements of the metacarpophalangeal joints (r=0.760-0.914) and moderate concurrent validity for flexion movements of the metacarpophalangeal joints (r=0.427-0.604) was demonstrated for all fingers for the F.A.I.R. Chance tool. Concurrent validity for adduction and abduction movements demonstrated a low to fair correlation with goniometric measurements (r=0.210-0.440). This is consistent with previous research showing poor agreement between goniometry and adduction-abduction movements of the fingers. Conclusion: The F.A.I.R. Chance tool shows good reliability and acceptable concurrent validity to assess fine motor movements in the healthy adult population. This sets a basis for further clinical study of the tool in the target population with fine motor impairments. Keywords: artificial intelligence; assistive technology; computer vision; fine motor evaluation; hand function;

PurposeWe present a large-scale (N=120) comparative study of gel-based and dry electroencephalography systems for cognitive load analysis in tasks involving information visualization stimuli. Although dry systems are increasingly adopted owing to their portability and fast setup, their sensitivity to cognitive-related measurements (as compared to gel-based systems) remains debated. This limits the understanding of whether dry systems provide sufficient sensitivity for cognitive load assessment under controlled task conditions. MethodsWe analyzed a diverse set of signal quality metrics, such as signal-to-noise ratio and channel retention, combined with spectral features across frequency bands to evaluate the ability for each device to capture workload-related neural markers during information visualization tasks. ResultsAlthough the gel-based device showed consistently better quality results than the dry one, the effect sizes suggest a small practical significance of the differences between systems. These results demonstrate that dry systems can provide adequate physiological sensitivity for cognitive load assessments. ConclusionOur findings highlight the trade-off between usability (setup, calibration, etc.) and data fidelity, providing practical guidance for choosing electroencephalography systems for cognitive workload monitoring and applied neuroengineering research. Overall, the results suggest that dry systems can support coarse-grained cognitive load assessment, while gel-based systems remain advantageous when greater sensitivity is required.

Biomechanical simulations of complex hand motions remain scarce, due to challenges that span computation and data acquisition. Using a computer vision-based motion capture approach, a 23-degree of freedom musculoskeletal model, and direct collocation optimization, we performed muscle-driven simulations to track hand kinematics from 7 participants performing American Sign Language gestures. While proximal joints were tracked accurately, interphalangeal joint tracking was significantly worse, with a consistent flexion bias. Modifications to finger extensor muscle paths that incorporated the dual-inserting nature of the extensors improved accuracy, suggesting better representation of extensor force distribution across distal joints may be necessary for accurate hand simulations.

Background and ObjectiveThe foot-ankle complex is a highly articulated and mechanically constrained system, often simplified as a chain of few rigid segments, neglecting many bone-to-bone motions and raising questions about the accurate representation of interaction with ground. This study proposes a new reduced-order multibody formulation that captures intrinsic kinematic constraints of the foot through motion synergies. MethodsBones kinematic coupling, or motion synergies, were experimentally derived from weight-bearing CT scans using principal component analysis. These couplings were embedded in a synergy-based multibody kinematic optimization framework describing the foot-ankle with five degrees of freedom: ankle flexion; foot adduction, pronation, and arching; and toe flexion. Model accuracy was evaluated against bone-level experimental kinematics. The model was applied to gait data from healthy, flat, and diabetic feet and compared with a standard multi-segment foot model, assessing robustness by progressively reducing the number of skin markers. ResultsAverage errors were about 1{degrees} and 0.5 mm when using subject-specific synergies and below 7{degrees} and 4 mm when scaling the generic model, matching or exceeding the accuracy of existing models. Reliable reconstruction was obtained using only four foot markers. In clinical gait analysis, the model showed superior discrimination between populations and enabled assessment of transverse arch deformation, not accessible with conventional models. ConclusionThe proposed synergy-based model provides an accurate, low-complexity framework for reconstructing bone-level foot and ankle kinematics, substantially simplifying gait analysis while improving biomechanical interpretability. This framework supports future integration with dynamic models aimed at studying load transmission in the foot.

Major depressive disorder (MDD) is a common psychiatric disorder that requires reliable and objective assessment for early clinical intervention. Electroencephalography (EEG) is widely used for this purpose because it provides a non-invasive and low-cost measure of brain activity with high temporal resolution. However, EEG-based depression detection remains challenging due to the nonlinear nature of EEG signals, inter-subject variability, and the limited availability of subject-independent evaluation. To address these issues, this paper proposes a hybrid quantum-classical multiscale long short-term memory with parameterized quantum circuit branches (MS-LSTM-PQC) framework for subject-level EEG-based depression detection. The proposed model extracts temporal representations at multiple scales using parallel LSTM branches and incorporates eyes-closed (EC) and eyes-open (EO) condition information through condition-aware feature fusion. To further enhance the learned representations, scale-specific LSTM features are processed using PQC-based quantum branches implemented with TensorFlow Quantum (TFQ), providing an additional nonlinear feature transformation before classification. Experiments were conducted on the Mumtaz EEG depression dataset using EC-only, EO-only, and merged EC+EO conditions with 1-s, 2-s, and 3-s EEG windows. To reduce subject-level data leakage, all experiments were evaluated using 5-fold and 10-fold GroupKFold validation. The best overall accuracies across the evaluated settings were 92.05% and 95.08% under 5-fold and 10-fold GroupKFold validation, respectively. The 2-s merged EC+EO setting provided the most stable performance across validation protocols. In addition, Integrated Gradients (IG)-based explainability analysis showed that frontal and fronto-central channels, especially Fz, showed higher contributions to the model decision. These results suggest that multiscale temporal learning with quantum-enhanced feature transformation can support subject-level EEG-based depression detection under leakage-controlled evaluation.

Tissue-level mechanical stimuli are primary drivers of tissue adaptation and can be optimised during conservative treatments to improve treatment outcomes for many highly prevalent musculoskeletal conditions. Current laboratory-based technologies limit our ability to connect conservative interventions such as exercise and movement modification with muscle, joint, and tissue-level mechanics, in natural environments. We introduce a physics-informed neural network (PINN) to estimate clinically relevant biomechanics from smart garments. By accounting for physiological dynamics of neural activation and muscle contraction, the PINN accurately predicted hip joint angles (RMSE <6 degrees), moments (RMSE 0.12 N*m/kg to 0.30 N*m/kg), and joint forces (RMSE 6 to 16%) from three inertial measurement units and four electromyographic sensors. We demonstrated that the trained PINN can be combined with a smart garment to estimate hip biomechanics, in real-time, during a gait retraining intervention aimed at modifying joint loading to treat hip osteoarthritis. The developed PINN and smart garment system may be adapted and generalised for personalised management or rehabilitation of a broad range of musculoskeletal diseases and injuries, in clinical, home, workplace, and sporting environments.

Millimeter-wave radar can quietly monitor health and behavior at home, which is vital for supporting people living with dementia. Most studies, however, remain limited to short-term testing in controlled spaces. Real-world deployment requires robust activity classification as a prerequisite: vital-sign and behavioral sensing require fundamentally different processing pipelines, and absent periods need to be reliably distinguished from stationary states. Bridging the critical gap between controlled laboratory demonstrations and continuous home monitoring, this paper introduces a self-adapting radar framework that extracts meaningful behavioral segments from massive, unconstrained real-world data. The system performs continuous real-time activity classification (stationary, walking, and absent) and target localization, selectively directing downstream processing to the most informative segments. It addresses key real-world deployment challenges including adaptive thresholding across subjects and environments, and walking detection under naturalistic activity conditions. Prior to integration with the Minder platform, the system was validated in a fully instrumented studio apartment against ground truth. Across 12 subjects, the system achieved an overall classification accuracy of 0.98, with F1 scores of 0.99 for absence and stationary states, and 0.95 for walking. Event-based evaluation yielded a per-subject walking sensitivity of 0.916{+/-} 0.058 and F1 score of 0.935 {+/-}0.030. Localization root mean square error during movement was 0.40 m. The results demonstrate reliable performance suitable for transitioning to long-term real-world home deployment.

Various ankle-foot conditions (e.g., fractures, diabetic foot ulcers, and post-surgical recovery) require periods of complete non-weightbearing followed by gradually increasing partial loadings. However, existing assistive devices often provide inconsistent or uncomfortable offloading during gait. Additionally, prolonged proximal leg offloading can contribute to muscle atrophy, reduced bone density, and overuse of other body segments. We present a novel offloading ankle-foot orthosis (OLAFO) designed to overcome these limitations. The OLAFO features a patient-specific load-bearing shank brace, designed through a digital workflow and fabricated from a 3D-printed core reinforced with carbon-fiber composite lamination. Interlocking serrated side struts, adjustable in 2 mm increments, modulate load sharing between the shank and plantar surfaces. Furthermore, the OLAFO incorporates contact plates with a rocker profile informed by roll-over-shape measurements to support forward progression and gait symmetry. Proof-of-concept biomechanical verification in one able-bodied participant evaluated complete offloading, five partial-loading levels, and normal gait using a pressure walkway to compute vertical ground reaction forces and impulses. In complete offloading, the affected foot generated no contact pressures. Across partial-loading levels, the foot impulse increased from 14% to 53% of the total load and scaled linearly with strut height adjustments, supporting clinician-prescribed loading increments. Contralateral stance duration increased only modestly compared to commonly used assistive devices, indicating reduced compensatory loading on the intact limb. These findings demonstrate the proof-of-concept feasibility of the OLAFO, highlighting its potential for verifying full offloading and prescribing partial-loading targets during rehabilitation. Future research will evaluate performance across patient populations and clinical rehabilitation tasks.

PurposeThe para-cycling classification system aims to minimize the impact of impairments on competition outcomes with the help of scientific evidence. This study investigated the impact of unilateral and bilateral ankle immobility on cycling performance, quantified by the maximal average mechanical power output (AMPO) over one revolution relative to that without ankle immobility. MethodsTen well-trained non-disabled cyclists performed all-out 6-second sprints on a cycle ergometer at 120 rpm under three conditions: without ankle foot orthoses (AFOs), with 1 AFO and with 2 AFOs immobilizing the ankle joint(s). Mechanical power output, pedal forces, cycling kinematics and surface-electromyography were measured. Maximal AMPO; ankle, knee and hip joint AMPO; and the amount of muscle excitation were calculated. ResultsWith 1 AFO and 2 AFOs, respectively, maximal AMPO was 96% (p<0.05) and 91% (p<0.001) of that without AFOs (1188 W). The decrease in maximal AMPO with ankle immobilization was less than the decrease in ankle joint AMPO (126 W decrease with 2 AFOs; p<0.001), due to an increase in hip joint AMPO (69 W increase with 2 AFOs; p<0.05). The amount of muscle excitation was not significantly different across conditions. ConclusionsThese findings provide a first quantitative and mechanistic indication of the impact of ankle immobility on cycling performance, which may offer valuable evidence to support the development of an evidence-based para-cycling classification system.

Purpose: To identify, through iterative user-centered design, the auditory biofeedback requirements and sound preferences supporting gait training in children with cerebral palsy (CP), and to determine which feedback variables, sound mappings, and sound types yield clinically viable and movement-interpretable paradigms. Methods: The iterative process spanned two prototype phases. Prototype A comprised seven paradigms demonstrated to two experienced physiotherapists (Workshop 1A). Two of these were subsequently discarded owing to poor sound-movement interpretability and two were modified. Six paradigms were added to Prototype B, demonstrated to four children, five parents, and one therapist (Workshop 1B) and two therapists (Workshop 2B). Data were analyzed using systematic text condensation. Results: Within-child sound preferences varied with energy level and sensory state on a given day. Sound-movement interpretability tended to suffer for paradigms with greater acoustic complexity (e.g. computer-generated music). Therapists endorsed a repertoire spanning both movement quality and movement quantity targets. Participants independently proposed paradigms rewarding restrained and controlled movement, a feedback category absent from the current prototype. Conclusions: Session-level calibration is preferable to fixed sound profiles, requiring real-time interface support for paradigm adjustment. Acoustic complexity must remain subordinate to movement-sound interpretability. Paradigms targeting movement restraint are a development priority unaddressed in the literature.

PurposeTranscranial direct current stimulation (tDCS) can noninvasively modulate activity in targeted brain regions. It is well established that the excitability of motor-related regions can increase when the target region is located beneath the anode (anodal tDCS), suggesting its potential to increase motor performance. Although such attempts have been widely examined, the results remain inconclusive. The purpose of this study was to assess the conditions under which anodal tDCS may improve motor performance in healthy adults. MethodsWe conducted a systematic review of studies on the use of anodal tDCS for improving motor performance in healthy adults. A computerized search was performed using the Web of Science, Scopus, PubMed, JDreamIII, and Ichushi-Web to identify relevant studies published between January 1, 1990 and May 25, 2022. ResultsTwenty-five studies were included in the qualitative synthesis. For the meta-analysis, 25 trials (N=885) were extracted from 23 studies. There were significant effects of anodal tDCS on motor performance improvement, but with evidence of publication bias and substantial heterogeneity among the trials. Post-hoc analysis revealed that motor performance 24 hours after the application of anodal tDCS may benefit from stimulation. There was no marked effect related to stimulation intensity, duration, or whether stimulation was provided during motor performance. ConclusionsOur study clarified the current state of anodal tDCS use for motor performance enhancement and indicates that there is currently no reliable evidence to support its effectiveness. Further studies, particularly randomized controlled trials, are necessary to establish the reliability of these effects for future applications.

Brain-machine interfaces (BMIs) for vision restoration require models that accurately simulate the anatomy and electrical properties of visual pathways. However, current models focus only on isolated structures, such as the retina or brain, and overlook surrounding tissues. Here, we present a comprehensive computational model of the human head, incorporating the entire visual pathway--including the eye, optic nerve, and brain--along with critical neighboring tissues such as the orbit, paranasal sinuses, enabling precise simulations. Validation using human and large animal data demonstrated a strong correlation between the simulated and measured electrical potentials. Component elimination analysis revealed that the optimized comprehensive model outperformed simplified versions. The models utility was demonstrated through multiple applications: (1) comparative analysis of electrical neuromodulation technologies for optic neuropathy, revealing the filed intensity limitations of noninvasive approaches and the safety concerns of invasive intraorbital approach; (2) identification of optimal stimulation site, revealing that transnasal stimulation at the optic chiasm outperformed traditional approaches; and (3) in silico design of electrode arrays for optic nerve prosthetics, demonstrating theoretical advantages in invasiveness and visual field coverage compared to existing retinal and cortical prosthetics. This validated and versatile computational resource supports the development of neuromodulation strategies and visual BMI technologies.

Gait asymmetry is a common manifestation of walking impairment among clinical populations. We recently developed a novel treadmill walking approach called dynamic treadmill walking that can provide asymmetric gait training by changing the treadmill speed between fast and slow speeds within a single stride. Here, we studied the energy expenditure associated with a variety of dynamic treadmill walking conditions. We hypothesized that the metabolic power required for dynamic treadmill walking in all conditions would approximate the metabolic power associated with conventional walking at the mean of the fast and slow speeds employed in the task. Eleven young adults without gait impairment walked on an instrumented treadmill and breathed into a metabolic measurement system. During dynamic treadmill walking, the treadmill fluctuated between 0.75m/s and 1.50m/s, each for 50% of an individuals stride time. We used a metronome to synchronize participants right heel-strikes with four different timing conditions. Net metabolic power during dynamic treadmill walking was significantly greater than normal walking at the mean speed of the task (1.125m/s) and generally lower than walking at the fast speed (1.5m/s). We did not observe any significant associations between net metabolic power and several measures of gait asymmetry during dynamic treadmill walking. These findings establish dynamic treadmill walking as a promising technique for improving gait symmetry in individuals who cannot tolerate fast treadmill walking, a common gait rehabilitation approach. Future work will assess the feasibility, metabolic demands, and clinical efficacy of using dynamic treadmill walking to improve gait symmetry in clinical populations. Key Points SummaryO_LIDynamic treadmill walking (i.e., walking with oscillating treadmill speeds) has previously been shown to drive gait asymmetries, but little is known about the energy expenditure required to complete the task. C_LIO_LIOur hypothesis was that dynamic treadmill walking would have similar metabolic power requirements to normal walking at a speed that is intermediate between the two dynamic treadmill walking speeds. C_LIO_LIWe found that dynamic treadmill walking actually requires metabolic power that is greater than the average of the two belt speeds, but less than that used for fast walking. C_LIO_LIDynamic treadmill walking is a promising and clinically translatable technique for rehabilitating populations with gait asymmetries that is not more energetically costly than fast treadmill walking, a common gait rehabilitation approach. C_LI