Nature, timing, and type of augmented feedback in motor skill relearning

Abstract

With upcoming innovative technologies more possibilities arise in the application of augmented feedback in rehabilitation therapy of the hemiparetic arm after stroke. The effect of different aspects and types of augmented feedback on motor functions and motor activities of the hemiparetic arm after stroke are studied in a systematic literature review. Based on current literature it was not possible to determine which combinations of aspects and types of augmented feedback are most essential for a beneficial effect on motor activities and motor functions of the hemiparetic arm after stroke. This was due to the combination of multiple aspects and types of augmented feedback in the included studies. Knowledge about the actual use of position feedback during practice in reaching training after stroke is obtained from a training experiment in five stroke survivors. During training, subjects performed reaching movements over a predefined path, when deviating shoulder and elbow joints received position feedback using restraining forces. Although augmented feedback use was limited, kinematic outcome measures and movement performance during training increased in all subjects. In an experimental study knowledge about the influence of different feedback conditions on motor learning in healthy elderly and stroke survivors was obtained. Repetitive reaching movements were performed with a visual distortion of hand movements in three feedback conditions: concurrent (cKP) and terminal knowledge of performance (tKP), and terminal knowledge of results (tKR). The highest potential for learning and consolidation was achieved with cKP in both groups. Remarkable was the presence of several subjects showing limited amounts of learning, independent of the provided feedback. The effect of reaching direction on visuomotor learning was studied in healthy young and elderly subjects, and stroke survivors. Repetitive reaching movements to five directions during an adaptation to a visuomotor rotation were performed. Significant higher amount of adaptation in the movement towards the contralateral part of the body compared to reaching towards other directions was observed for the young subjects. No significant differences in learning between directions was observed for the elderly, and only a higher deviation at the start of the learning phase for stroke survivors in one direction were found.