Visual error augmentation during bimanual therapy in individuals post stroke

Research Objectives: To investigate the influence of visual error augmentation during bimanual upper extremity therapy in individuals’ post-stroke.

Design: Two-arm randomized clinical trial with blinded rater. Individuals were randomized into the treatment or control group. Individuals received 9 treatments across 3 weeks, and completed upper extremity evaluations before treatment, 1 week after treatment, and 8 weeks after treatment.

Setting: Translational research hospital in which clinicians and researchers are integrated in the same space.

Participants:The target population for the study was chronic stroke participants (at least 8 months post-injury), 18 years or older, with a history of a single stroke event, with mild-moderate upper extremity impairment (Fugl-Meyer Score 15-50) and residual active elbow flexion/extension when supported against gravity. 69 participants were assessed for eligibility, 38 participants met inclusion criteria and were randomized into the study. 19 subjects were allocated in each group, but 3 in each group were lost due to participant withdrawal. One participant in the control group was lost to follow-up. 16 participants in the treatment group, and 15 participants in the control group were analyzed in the results.

Interventions: Both groups completed a bimanual reaching and balancing exercise in a virtual reality environment. The treatment group received visual error augmentation, which visually shifted the cursor in the direction of error to enhance neuroplasticity associated with motor recovery.

Main Outcome Measures: Upper Extremity Fugl-Meyer, and bimanual asymmetry

Results: No clinically significant difference between treatment and control group for functional motor recovery (p=0.665) and no significant difference in the interaction between time and groups (p=0.069); however, both groups did improve over time (p=0.005).  For asymmetry of trajectory between paretic and non-paretic hand in the superior-inferior direction there is a significant difference between time instants (p < 0.001), while no significant difference was found in groups (p=0.266) or in the interaction between time and groups (p=0.066).

Conclusions: This is an example of supplemental treatment using interactive visual feedback for post-stroke upper extremity rehabilitation.

Author(s) Disclosures: n/a