On the basis of this study, it was not possible to determine which combinations of aspects and types of augmented feedback are most essential for a beneficial effect on motor activities and motor functions of the hemiparetic arm after stroke. This was due to the combination of multiple aspects and types of augmented feedback in the included studies. This systematic review indicates that augmented feedback in general has an added value for stroke rehabilitation.

BackgroundThe majority of stroke survivors have to cope with deficits in arm function, which is often measured with subjective clinical scales. The objective of this study is to examine whether circle drawing metrics are suitable objective outcome measures for measuring upper extremity function of stroke survivors.MethodsStroke survivors (n = 16) and healthy subjects (n = 20) drew circles, as big and as round as possible, above a table top. Joint angles and positions were measured. Circle area and roundness were calculated, and synergistic movement patterns were identified based on simultaneous changes of the elevation angle and elbow angle.ResultsStroke survivors had statistically significant lower values for circle area, roundness and joint excursions, compared to healthy subjects. Stroke survivors moved significantly more within synergistic movement patterns, compared to healthy subjects. Strong correlations between the proximal upper extremity part of the Fugl-Meyer scale and circle area, roundness, joint excursions and the use of synergistic movement patterns were found.ConclusionsThe present study showed statistically significant differences in circle area, roundness and the use of synergistic movement patterns between healthy subjects and stroke survivors. These circle metrics are strongly correlated to stroke severity, as indicated by the proximal upper extremity part of the FM score.In clinical practice, circle area and roundness can give useful objective information regarding arm function of stroke survivors. In a research setting, outcome measures addressing the occurrence of synergistic movement patterns can help to increase understanding of mechanisms involved in restoration of post stroke upper extremity function.

Background: The majority of stroke patients have to cope with impaired arm function. Gravity compensation of the arm instantaneously affects abnormal synergistic movement patterns. The goal of the present study is to examine whether gravity compensated training improves unsupported arm function. Methods: Seven chronic stroke patients received 18 half-hour sessions of gravity compensated reach training, in a period of six weeks. During training a motivating computer game was played. Before and after training arm function was assessed with the Fugl-Meyer assessment and a standardized, unsupported circle drawing task. Synergistic movement patterns were identified based on concurrent changes in shoulder elevation and elbow flexion/extension angles. Results: Median increase of Fugl-Meyer scores was 3 points after training. The training led to significantly increased work area of the hemiparetic arm, as indicated by the normalized circle area. Roundness of the drawn circles and the occurrence of synergistic movement patterns remained similar after the training. Conclusions: A decreased strength of involuntary coupling might contribute to the increased arm function after training. More research is needed to study working mechanisms involved in post stroke rehabilitation training. The used training setup is simple and affordable and is therefore suitable to use in clinical settings.

The majority of stroke survivors have to cope with deficits in arm function, which is often monitored with subjective clinical scales during stroke rehabilitation. The aim of this study is to examine whether robotic outcome measures obtained during circle drawing are suitable to objectively measure upper extremity function of stroke survivors, especially regarding synergistic movement patterns. Stroke survivors (n = 16) and healthy subjects (n = 20) drew circles, as big and as round as possible, above a table top. Joint angles and positions of the shoulder and elbow were measured. Synergistic movement patterns were identified based on simultaneous changes of the shoulder elevation angle and elbow angle. Stroke survivors moved significantly more within synergistic movement patterns, compared to healthy subjects. Strong correlations between the proximal upper extremity part of the Fugl-Meyer (FM) scale and the use of synergistic movement patterns were found. The proposed outcome measures seem to be suitable measures to objectively quantify the occurrence of synergistic movement patterns of the upper extremity following stroke.

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Feedback is an important element in motor learning during rehabilitation therapy following stroke. The objective of this pilot study was to better understand the effect of position feedback during task-oriented reach training of the upper limb in people with chronic stroke. Five subjects participated in the training for 30 minutes three times a week for 6 weeks. During training, subjects performed reaching movements over a predefined path. When deviation from this path occurred, shoulder and elbow joints received position feedback using restraining forces. We recorded the amount of position feedback used by each subject. During pre-and posttraining assessments, we collected data from clinical scales, isometric strength, and workspace of the arm. All subjects showed improvement on one or several kinematic variables during a circular motion task after training. One subject showed improvement on all clinical scales. Subjects required position feedback between 7.4% and 14.7% of training time. Although augmented feedback use was limited, kinematic outcome measures and movement performance during training increased in all subjects, which was comparable with other studies. Emphasis on movement errors at the moment they occur may possibly stimulate motor learning when movement tasks with sufficiently high levels of difficulty are applied. Abbreviations: AR = axial rotation, ARAT = Action Research Arm Test, CCW = counterclockwise, CW = clockwise, EA = elevation angle, EE = elbow excursion, EF = elbow flexion, EP = plane of elevation, FMA-UL = Fugl-Meyer Assessment Upper-Limb (subscale), MI = Motricity Index, MVT = maximal voluntary torque.

Robotics is increasingly used in rehabilitation therapy of the hemiparetic arm after stroke. Several studies performed adaptation experiments to gain more insight in the underlying learning processes. In these studies adaptation during reaching movements in different directions is assessed. No information about influence of direction on the amount of learning to these separate directions is present. In this paper we assessed the effect of reaching direction on visuomotor learning. Forty healthy subjects performed 48 movements to five different directions during adaptation to a 30 degrees visuomotor rotation. The execution error was defined as the initial direction error at peak velocity and after 100 ms after onset of the movement. The amount of learning was defined as the difference between the start value and the end value of the execution error. A significant higher amount of adaptation in the movement towards the contralateral part of the body (-72) compared to reaching towards other directions was observed. When possible feedback and corrections mechanisms are taken into account; results indicate that subjects adapt most towards -72 direction and least towards -144 direction. Data of healthy elderly and stroke survivors would be essential to test whether observed results are present in these populations as well, which could have implications for motor relearning in rehabilitation therapy.

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