Error augmentation enhancing arm recovery in individuals with chronic stroke: a randomized crossover design.
BACKGROUND
Neurorehabilitation studies suggest that manipulation of error signals during practice can stimulate improvement in coordination after stroke.


OBJECTIVE
To test visual display and robotic technology that delivers augmented error signals during training, in participants with stroke.


METHODS
A total of 26 participants with chronic hemiparesis were trained with haptic (via robot-rendered forces) and graphic (via a virtual environment) distortions to amplify upper-extremity (UE) tracking error. In a randomized crossover design, the intervention was compared with an equivalent amount of practice without error augmentation (EA). Interventions involved three 45-minute sessions per week for 2 weeks, then 1 week of no treatment, and then 2 additional weeks of the alternate treatment. A therapist provided a visual cursor using a tracking device, and participants were instructed to match it with their hand. Haptic and visual EA was used with blinding of participant, therapist, technician-operator, and evaluator. Clinical measures of impairment were obtained at the beginning and end of each 2-week treatment phase as well as at 1 week and at 45 days after the last treatment.


RESULTS
Outcomes showed a small, but significant benefit to EA training over simple repetitive practice, with a mean 2-week improvement in Fugl-Meyer UE motor score of 2.08 and Wolf Motor Function Test of timed tasks of 1.48 s.


CONCLUSIONS
This interactive technology may improve UE motor recovery of stroke-related hemiparesis.
1University of Illinois at Chicago, IL, USA.
Farnaz
F
Abdollahi
Emily D
ED
Case Lazarro
Molly
M
Listenberger
Robert V
RV
Kenyon
Mark
M
Kovic
Ross A
RA
Bogey
Donald
D
Hedeker
Borko D
BD
Jovanovic
James L
JL
Patton
D000328:Adult; D000368:Aged; D001132:Arm / Q000503:physiopathology; D002908:Chronic Disease; D018592:Cross-Over Studies; D056228:Feedback, Sensory; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010291:Paresis / Q000628:therapy; D011214:Practice, Psychological; D012371:Robotics; D020521:Stroke / Q000628:therapy*; D016896:Treatment Outcome
error augmentation; haptic technology; physical therapy; robotics; stroke rehabilitation; upper extremity