Does visual error augmentation offer advantages during bimanual therapy in individuals post stroke? A randomized controlled trial

OBJECTIVE

Reaching training with error augmentation (EA) has recently shown great promise for enhancing bimanual therapeutic training, using both robotic forces feedback (haptics) and a visually distorted display elements (graphics) to amplify motor learning.

METHODS

Here in a two-arm, randomized controlled trial we explored the effect of visual EA alone by visually shifting the paretic limb’s cursor in the direction of error. We invited 38 chronic (> 8 months post injury) stroke survivors to practice bimanual reaching for approximately 40 minutes, 3 days per week, for three weeks.

RESULTS

Arm motor section of the Fugl-Meyer (AMFM; maximum score 66 points) increased an average of 2.2 and retained to a follow-up evaluation 7-9 weeks (about 2 months) later (average 1.5). Clinically meaningful increase for AMFM for chronic stroke survivors is 5.2 points. No superiority was detected due to the EA treatment, but other measures on the composite abilities (range of motion, bimanual symmetry, and movement time) showed improvements favoring EA.

CONCLUSIONS

While removing robot forces led to smaller gains than previous work, such touch-free bimanual therapy may still prove to be an effective inexpensive automated rehabilitation tool for wider accessibility in therapy interventions.

This study was registered at<ext-link xmlns:xlink="http://www.w3.org/1999/xlink" ext-link-type="uri" xlink:href="https://ClinicalTrials.gov">ClinicalTrials.gov</ext-link>(ID#<ext-link xmlns:xlink="http://www.w3.org/1999/xlink" ext-link-type="clintrialgov" xlink:href="NCT03300141">NCT03300141</ext-link>).