A preliminary investigation of error enhancement of the velocity component in stroke patients’ reaching movements

Abstract

Background/aim: Patients with stroke who are suffering from impaired reaching movement experience insufficient spatial and temporal coordination, affecting upper limb functions and everyday life tasks. This study examines a new robot-assisted rehabilitation method for ameliorating arm reaching movements through velocity error enhancement training. The authors hypothesised that this robot-assisted rehabilitation training may encourage restoration of arm reaching abilities among post-stroke hemiparesis patients. Methods: Several clinical and kinematic measures were used to evaluate outcomes. Subjects were assigned either to an experimental group that underwent 5-week treatments with error enhanced forces, or to a control group that received passive treatment. The control group undertook reaching tasks over the same period while they were connected to the robot but without it applying any error enhancement forces to their upper limb. The robotic system was programmed based on previous kinematic data from healthy subjects, so any deviation from the relatively smooth, calculated, optimal trajectory, and velocity profile mean encountered error enhancing external forces. Results: The results showed an appreciable effect on smoothness and regularity of movement. After 5 weeks of velocity error enhancement treatment, all subjects in the experimental group displayed movements converging towards their optimal profiles, together with decreased variability in path trajectory. In contrast to the control group, their mean deviation was also significantly reduced. These positive changes in motor control patterns were paralleled by gains in functional capacity, as reflected by the Motor Assessment Scale test results. However, those results should be carefully inspected in regard to small sample size and un-matching of motor performance at the beginning of the trial between groups. Conclusion: The study demonstrates the potential of robotic rehabilitation that combines error enhancement and velocity component training to help stroke patients.

The effects of error-augmentation versus error-reduction paradigms in robotic therapy to enhance upper extremity performance and recovery post-stroke: a systematic review

“…Table 1 (EA only), Table 2 (ER only) and Table 3 (EA and ER) described all 13 studies as well as their results. Among the 13 selected studies, there are six randomized controlled trials (RCT) [ 52 – 57 ], five crossover studies [ 52 , 54 , 58 – 60 ], one quasi-experimental study [ 24 ], two randomized comparative study [ 61 , 62 ] and one pilot study [ 63 ]. Among all thirteen studies, only four could be found in clinical trials registry [ 52 , 56 , 57 , 63 ].…”

“… WMFT FAS: first phase 0.51 (medium effect). second phase 0.52 (medium effect) WMFT time: First phase 0.28 (small effect) Second phase 0.14 (very small effect) 7/10, high quality Givon-Mayo et al [ 63 ] Pilot study. Trial registered NCT02017093 7 in total, E = 4 and C = 3 Ages: 45–78 (mean = 59.14 ± 9.77), 8 males and 1 female.…”

“…Besides two studies that included healthy subjects in their control groups [ 24 , 60 ], all other studies only included stroke survivors [ 52 – 59 , 61 – 63 ]. Eleven out of thirteen selected studies [ 24 , 52 – 57 , 59 – 62 ] recruited participants with a chronic stroke (i.e.…”

“…Eleven out of thirteen selected studies [ 24 , 52 – 57 , 59 – 62 ] recruited participants with a chronic stroke (i.e. more than six months post-stroke’ [ 64 ]) with a mean value of 74.5 ± 46.8 months, one study [ 63 ] recruited participants with an acute stroke (i.e. less than a month post-stroke [ 65 ]), and one study did not specify in which stage of stroke the participants were situated [ 58 ].…”

Neurorehabilitation - To Facilitate or to Impede

“…Moreover, researchers have recently begun to investigate a novel application of robotics [4,5] as a potential modality to enhance neuro rehabilitation that leverages the power of neuro-plasticity but using error augmentation approach [6].…”