To promote autonomous stage motor learning in a patient using bilateral carbon fiber dorsiflexion-assist ankle-foot orthoses, which progression would be MOST appropriate?

• A. Have the patient ambulate on a treadmill at a pace slightly faster than comfortable.
• B. Limit distractions in the practice setting.
• C. Ask the patient to perform a cognitive task during ambulation over level surfaces.
• D. Increase distance of ambulation practice trials.

Answer: (C)

Promoting autonomous stage motor learning means getting the walking pattern to run with little conscious effort, even when the person’s attention is divided. Introducing a cognitive task during ambulation, especially on level surfaces, pushes the nervous system to automate the gait pattern so it can continue smoothly while thinking or multitasking. The bilateral carbon fiber dorsiflexion-assist AFOs provide a stable, consistent dorsiflexion assist, and adding a cognitive demand helps the patient practice maintaining gait automatically under dual-task conditions. This combination strengthens automatic control more effectively than just walking faster, walking farther, or practicing with fewer distractions, which don’t specifically foster automaticity.