Effect of position feedback during task-oriented upper-limb training after stroke: Five-case pilot study

Abstract

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.

Parameters and Measures in Assessment of Motor Learning in Neurorehabilitation; A Systematic Review of the Literature

“…Molier et al ( 2011 ) examined the effect of position resistance feedback, provided when a deviation from a predefined path occurred, during three reaching task trainings (moving hand; making a curve; lifting hand to shelf). The average use of the feedback was calculated, and the difficultly level was established by measurement of the reached height and diameter of predefined path.…”

Effect of Virtual Reality‐based Bilateral Upper Extremity Training on Upper Extremity Function after Stroke: A Randomized Controlled Clinical Trial

“…VR has several advantages, including the elicitation of an independent life in a real environment (You et al ., ), which provides motivation stemming from interest (Flynn et al ., ) as well as induction of active participation, which increase the desire to exercise (Merians et al ., ). In addition, in a VR environment, the extent of motor learning is increased by auditory and/or visual feedback (Molier et al ., ) as well as by improved concentration (Hashimoto et al ., ).…”

“…Loss of upper extremity control is the most common type of neurologic disability associated with stroke (Trombly et al ., ); 30–66% of patients do not have normal upper extremity function at 6 months after stroke (Molier et al ., ). A paretic upper limb shows a noticeable decrease in motor ability owing to paralysis, abnormal muscle tone, associative reaction and reduced coordination capability (Trombly et al ., ).…”

Error Augmentation: The Alternative Approach to Treat Brain Injury

“…Moreover, bigger errors are expected to enhance motivation to learn by making even little errors seem great [12]. In addition, rising error can guide to larger signal-to-noise ratios for sensory feedback and selfevaluation.…”