Promote Motor Learning Research Articles

Effect of habitual physical activity on motor performance and prefrontal cortex activity during implicit motor learning.

Acute bouts of exercise have been shown to improve motor learning. However, whether these benefits can be observed from habitual physical activity (PA) levels remains unclear and has important implications around PA guidelines to promote motor learning across the lifespan. This study investigated the effect of habitual PA levels on brain activity within the dorsolateral prefrontal cortex (DLPFC) during procedural motor skill acquisition. Twenty-six right-handed healthy young adults had physical activity levels quantified by calculating the metabolic equivalent of task (METs) in minutes per week, derived from the International Physical Activity Questionnaire (IPAQ). Functional near-infrared spectroscopy (fNIRS) over the DLPFC was recorded to measure neural activation during a serial reaction time task (SRTT). Behavioural indicators of procedural motor skill acquisition were quantified as reaction time and accuracy of correct trials during the SRTT. DLPFC activation was characterised as task-related changes in oxyhaemoglobin (∆[HbO2]). Findings showed that higher PA levels were associated with improvements in reaction time during procedural motor skill acquisition (p = 0.03). However, no significant effects of PA levels on accuracy or ∆[HbO2] during procedural motor skill acquisition were observed. These findings show that while habitual PA may promote motor performance in young adults, this is not reflected by changes in the DLPFC area of the brain.

Immersive virtual reality for learning exoskeleton-like virtual walking: a feasibility study

PurposeVirtual Reality (VR) has proven to be an effective tool for motor (re)learning. Furthermore, with the current commercialization of low-cost head-mounted displays (HMDs), immersive virtual reality (IVR) has become a viable rehabilitation tool. Nonetheless, it is still an open question how immersive virtual environments should be designed to enhance motor learning, especially to support the learning of complex motor tasks. An example of such a complex task is triggering steps while wearing lower-limb exoskeletons as it requires the learning of several sub-tasks, e.g., shifting the weight from one leg to the other, keeping the trunk upright, and initiating steps. This study aims to find the necessary elements in VR to promote motor learning of complex virtual gait tasks.MethodsIn this study, we developed an HMD-IVR-based system for training to control wearable lower-limb exoskeletons for people with sensorimotor disorders. The system simulates a virtual walking task of an avatar resembling the sub-tasks needed to trigger steps with an exoskeleton. We ran an experiment with forty healthy participants to investigate the effects of first- (1PP) vs. third-person perspective (3PP) and the provision (or not) of concurrent visual feedback of participants’ movements on the walking performance – namely number of steps, trunk inclination, and stride length –, as well as the effects on embodiment, usability, cybersickness, and perceived workload.ResultsWe found that all participants learned to execute the virtual walking task. However, no clear interaction of perspective and visual feedback improved the learning of all sub-tasks concurrently. Instead, the key seems to lie in selecting the appropriate perspective and visual feedback for each sub-task. Notably, participants embodied the avatar across all training modalities with low cybersickness levels. Still, participants’ cognitive load remained high, leading to marginally acceptable usability scores.ConclusionsOur findings suggest that to maximize learning, users should train sub-tasks sequentially using the most suitable combination of person’s perspective and visual feedback for each sub-task. This research offers valuable insights for future developments in IVR to support individuals with sensorimotor disorders in improving the learning of walking with wearable exoskeletons

The affective response to positive performance feedback is associated with motor learning.

Motor skill learning and performance are improved when successful actions are paired with extrinsic rewards, such as money. Positive feedback indicating successful task performance is thought to induce intrinsic reward associated with goal attainment, evidenced by increases in positive affect that correlate with neural reward signaling. However, it is not clear whether the subjective, internal reward processes elicited by positive feedback promote motor learning and performance.Here, we tested the hypothesis that intrinsic reward elicited by positive feedback promotes motor learning and performance. Participants practiced a visuomotor interception task using a joystick, and received feedback during practice indicating success or failure depending on their accuracy. During practice, the accuracy demands were adapted to control and vary the frequency of positive feedback across randomly ordered blocks of practice at either 50%, 70%, or 90%. Performance was measured for each condition as the average accuracy during practice. Learning was estimated by measuring the accuracy pre and post practice in the absence of feedback. We queried participants periodically on their enjoyment of the task to index affective responses to performance feedback.The intrinsic reward elicited by positive feedback, operationalized by the increase in enjoyment immediately following positive versus negative feedback, was positively correlated with learning from pre to post practice. However, increasing the overall amount of positive feedback by lower accuracy demands did not improve performance. These results suggest that experiencing intrinsic reward due to positive feedback benefits motor learning only when it is contingent on good performance.

An external focus promotes motor learning of an aiming task in individuals with hearing impairments.

Research has shown that external relative to internal focus (IF) instructions may improve motor performance as well as cognitive function (e.g., attentional stability and task-focus). The aim of the study was to examine the influence of attentional focus instructions on skill acquisition and learning of an aiming task in individuals with hearing impairments. The participants (N=39, Mage=17.87±1.88years) performed a bowling task with their dominant hand to knock down as many pins as possible. On day 1, they were randomly divided into three attentional focus groups; IF (focus on your throwing hand), external focus (EF) (focus on the pins), and control (no-focus) instructions. Each participant performed 36 trials, divided into 3 blocks of 12 trials. Attentional focus instructions were given before each block, with a brief reminder provided after each 3 trials. On day 2, retention and transfer (further distance) tests were performed. Results showed that while there were no significant differences between groups in the pre-test, the EF group outperformed both IF and control groups in retention and transfer tests. No significant difference was found between the control and IF. The findings suggest that the advantages of the external relative to the IF and no-focus instructions may generalize to individuals with hearing impairments.

Hebbian priming of human motor learning

Motor learning relies on experience-dependent plasticity in relevant neural circuits. In four experiments, we provide initial evidence and a double-blinded, sham-controlled replication (Experiment I-II) demonstrating that motor learning involving ballistic index finger movements is improved by preceding paired corticospinal-motoneuronal stimulation (PCMS), a human model for exogenous induction of spike-timing-dependent plasticity. Behavioral effects of PCMS targeting corticomotoneuronal (CM) synapses are order- and timing-specific and partially bidirectional (Experiment III). PCMS with a 2 ms inter-arrival interval at CM-synapses enhances learning and increases corticospinal excitability compared to control protocols. Unpaired stimulations did not increase corticospinal excitability (Experiment IV). Our findings demonstrate that non-invasively induced plasticity interacts positively with experience-dependent plasticity to promote motor learning. The effects of PCMS on motor learning approximate Hebbian learning rules, while the effects on corticospinal excitability demonstrate timing-specificity but not bidirectionality. These findings offer a mechanistic rationale to enhance motor practice effects by priming sensorimotor training with individualized PCMS.

Investigation of Motor Learning Effects Using a Hybrid Rehabilitation System Based on Motion Estimation.

Upper-limb paralysis requires extensive rehabilitation to recover functionality for everyday living, and such assistance can be supported with robot technology. Against such a background, we have proposed an electromyography (EMG)-driven hybrid rehabilitation system based on motion estimation using a probabilistic neural network. The system controls a robot and functional electrical stimulation (FES) from movement estimation using EMG signals based on the user's intention, enabling intuitive learning of joint motion and muscle contraction capacity even for multiple motions. In this study, hybrid and visual-feedback training were conducted with pointing movements involving the non-dominant wrist, and the motor learning effect was examined via quantitative evaluation of accuracy, stability, and smoothness. The results show that hybrid instruction was as effective as visual feedback training in all aspects. Accordingly, passive hybrid instruction using the proposed system can be considered effective in promoting motor learning and rehabilitation for paralysis with inability to perform voluntary movements.

Lesion-specific cortical activation following sensory stimulation in patients with subacute stroke

BackgroundSensory stimulation can play a fundamental role in the activation of the primary sensorimotor cortex (S1-M1), which can promote motor learning and M1 plasticity in stroke patients. However, studies have focused mainly on investigating the influence of brain lesion profiles on the activation patterns of S1-M1 during motor tasks instead of sensory tasks. Therefore, the objective of this study is to explore the lesion-specific activation patterns due to different brain lesion profiles and types during focal vibration (FV).MethodsIn total 52 subacute stroke patients were recruited in this clinical experiment, including patients with basal ganglia hemorrhage/ischemia, brainstem ischemia, other subcortical ischemia, cortical ischemia, and mixed cortical–subcortical ischemia. Electroencephalograms (EEG) were recorded following a resting state lasting for 4 min and three sessions of FV. FV was applied over the muscle belly of the affected limb’s biceps for 3 min each session. Beta motor-related EEG power desynchronization overlying S1-M1 was used to indicate the activation of S1-M1, while the laterality coefficient (LC) of the activation of S1-M1 was used to assess the interhemispheric asymmetry of brain activation.Results(1) Regarding brain lesion profiles, FV could lead to the significant activation of bilateral S1-M1 in patients with basal ganglia ischemia and other subcortical ischemia. The activation of ipsilesional S1-M1 in patients with brainstem ischemia was higher than that in patients with cortical ischemia. No activation of S1-M1 was observed in patients with lesions involving cortical regions. (2) Regarding brain lesion types, FV could induce the activation of bilateral S1-M1 in patients with basal ganglia hemorrhage, which was significantly higher than that in patients with basal ganglia ischemia. Additionally, LC showed no significant correlation with the modified Barthel index (MBI) in all patients, but a positive correlation with MBI in patients with basal ganglia lesions.ConclusionsThese results reveal that sensory stimulation can induce lesion-specific activation patterns of S1-M1. This indicates FV could be applied in a personalized manner based on the lesion-specific activation of S1-M1 in stroke patients with different lesion profiles and types. Our study may contribute to a better understanding of the underlying mechanisms of cortical reorganization.

Examining Learner-Controlled Role-Switching in Dyad Practice for the Learning of a Speed Cup-Stacking Task

Dyad practice has proven to be an efficient, and in some cases, a more effective method of promoting motor learning compared to individual practice. Further, providing individuals control over their own or another learner’s practice environment has also been shown to be superior for skill learning relative to individuals without control. The purpose of the experiment was to assess learner-controlled role-switching in dyad practice conditions. In dyads, partners either alternated actor and observer roles on a trial-to-trial basis, or under novel learner-controlled conditions wherein either the actor or the observer was given control over when the partners should switch roles. Participants practiced a speed cup-stacking task and learning was assessed in 24-h retention and transfer tests. Although there were no learning differences between dyad conditions, paired learners effectively chose when to switch roles with their partner, without undermining learning. The results also highlight the dynamic nature of dyad practice as the observers chose to switch roles more frequently than the actors, yet both dyad groups adopted comparable switching strategies by alternating roles following relatively ‘good’ and ‘bad’ trials. This experiment provides further support for dyad practice as an efficient and effective method of skill learning.

A Review of Actuators in Ankle-Foot Rehabilitation Therapy

Ankle injury is one of the physical injuries that commonly occur during physical related activities, especially in sports. Currently, there are established treatments for ankle rehabilitation at the hospital. This treatment involves range of motion exercises and endurance exercises. However, current treatment requires patients to visit to hospital frequently which is very repetitive in nature. Ankle rehabilitation robots are developed to enhance ankle strength, flexibility and proprioception after injury and promote motor learning and ankle plasticity in patients with drop foot. This article reviews the types of actuators used in ankle rehabilitation and discusses the evolution of industrial robotics towards rehabilitation.

Imagery training of motor actions in children and adolescents: a meta-analysis

ABSTRACT Imagery training is well-established in sports, rehabilitation, and work settings. Both classic and recent meta-analyses confirm that it can improve motor performance and promote motor learning in adults. Findings from studies focusing on children and adolescents, however, are ambiguous, and it is not clear whether imagery training has an impact on performance and learning in individuals of younger ages. Given that the potential impact of imagery training in children and adolescents has yet to be determined, we conducted a meta-analysis to extend knowledge on the effectiveness of imagery training in this population. We included imagery training studies investigating healthy children or adolescents at an age of 6–18 and focusing on a motor task, which resulted in 19 studies and 110 effect sizes. Our analysis revealed an overall medium positive effect for imagery training of Cohen’s d = 0.494, 95% CI [0.287, 0.701]. The results demonstrate that imagery training can improve motor performance in children and adolescents. Future research is needed to further differentiate the effects across age, task, or developmental aspects, and to provide more elaborate recommendations for applied settings such as physical education, rehabilitation, or competitive sports.

The value of corticospinal excitability and intracortical inhibition in predicting motor skill improvement driven by action observation

The observation of other's actions represents an essential element for the acquisition of motor skills. While action observation is known to induce changes in the excitability of the motor cortices, whether such modulations may explain the amount of motor improvement driven by action observation training (AOT) remains to be addressed. Using transcranial magnetic stimulation (TMS), we first assessed in 41 volunteers the effect of action observation on corticospinal excitability, intracortical inhibition, and transcallosal inhibition. Subsequently, half of the participants (AOT-group) were asked to observe and then execute a right-hand dexterity task, while the controls had to observe a no-action video before practicing the same task. AOT participants showed greater performance improvement relative to controls. More importantly, the amount of improvement in the AOT group was predicted by the amplitude of corticospinal modulation during action observation and, even more, by the amount of intracortical inhibition induced by action observation. These relations were specific for the AOT group, while the same patterns were not found in controls. Taken together, our findings demonstrate that the efficacy of AOT in promoting motor learning is rooted in the capacity of action observation to modulate the trainee's motor system excitability, especially its intracortical inhibition. Our study not only enriches the picture of the neurophysiological effects induced by action observation onto the observer's motor excitability, but linking them to the efficacy of AOT, it also paves the way for the development of models predicting the outcome of training procedures based on the observation of other's actions.

Biomechanical Task-Based Gait Analysis Suggests ReWalk Gait Resembles Crutch Gait

Current gait rehabilitation strategies rely heavily on motor learning principles, which involve facilitating active patient participation, high-doses of biomechanical task-related motor activities and accurate feedback. Furthermore, appropriate muscle groups need to be recruited for the joint movements that constitute the biomechanical task-related activities in order to effectively promote motor learning. Recently, exoskeleton-type robots utilizing crutches have been incorporated into overground gait rehabilitation programs. However, it is unclear which gait-related tasks are being trained because the joint movements and muscle recruitment patterns deviate from those of natural gait. This raises concerns because repetitive training with these devices may not lead to desirable rehabilitative gains. In this study, we compare the lower limb joint angles and electromyography patterns of healthy subjects walking with and without ReWalk in accordance with the three major biomechanical tasks required by bipedal gait: weight acceptance (WA), single-limb support, and limb advancement. Furthermore, we investigate whether the physical constraints of ReWalk, most noticeably the use of crutches and fixed ankle joints, were responsible for the specific changes by conducting additional walking sessions with either crutches or ankle foot orthoses. The results from the six healthy male volunteers suggest that the gait patterns observed with ReWalk deviate significantly from those of natural gait, particularly during the WA, and closely resemble those of crutch gait.

Experience-based functional gains in gait and stability with torso-weighting in people with multiple sclerosis: Randomized pilot study

BACKGROUND: Balance-based torso-weighting has improved gait and balance performance in people with multiple sclerosis (MS) in a single session with torso-weights on, demonstrating an orthotic effect. Daily use of torso-weighting may promote motor learning and more enduring therapeutic effects but has not yet been studied. PURPOSE: Confirm orthotic effects and compare therapeutic effects of daily torso-weighting versus shape/sham-weighting or no weighting. We hypothesized that daily torso-weighting would result in positive effects on gait and balance, tested without weights. METHODS: Five participants with MS experienced three conditions for 2-4 weeks each: no weights first, then double-blinded randomization to torso-weighting or shape-weighting first then cross-over to the alternate condition. Personalized torso-weighting on a vest-like garment countered individual reactive balance responses following manual perturbations. Postural sway recorded orthotic effects with/without torso-weights while standing on a force plate with eyes open/closed. Clinical measures recorded therapeutic effects while unweighted: gait parameters, 6-Minute Walk Test (6MWT), and Sensory Organization Test (SOT). Weighting conditions were compared using paired t-tests with one-tailed alpha at 0.05. RESULTS: Postural sway decreased significantly with torso-weights. Cadence and step width improved significantly after torso-weighting versus shape-weight periods. Average gait parameters showed no improvement after shape-weight periods. Velocity, 6MWT, and SOT tended to improve with torso-weighting, averaging improvements of+15%,+16%, and+13.8%, respectively. CONCLUSIONS: Findings support both orthotic and therapeutic effects of torso-weighting. Daily use of torso-weights for multiple weeks may promote motor learning of gait parameters and balance. Further research is warranted to examine sensory augmentation as a potential mechanism.

A Control Framework for Adaptation of Training Task and Robotic Assistance for Promoting Motor Learning With an Upper Limb Rehabilitation Robot

Robot-assisted rehabilitation has been a promising solution to improve motor learning of neurologically impaired patients. State-of-the-art control strategies are typically limited to the ignorance of heterogeneous motor capabilities of poststroke patients and therefore intervene suboptimally. In this article, we propose a control framework for robot-assisted motor learning, emphasizing the detection of human intention, generation of reference trajectories, and modification of robotic assistance. A real-time trajectory generation algorithm is presented to extract the high-level features in active arm movements using an adaptive frequency oscillator (AFO) and then integrate the movement rhythm with the minimum-jerk principle to generate an optimal reference trajectory, which synchronizes with the motion intention in the patient as well as the motion pattern in healthy humans. In addition, a subject-adaptive assistance modification algorithm is presented to model the patient’s residual motor capabilities employing spatially dependent radial basis function (RBF) networks and then combining the RBF-based feedforward controller with the impedance feedback controller to provide only necessary assistance while simultaneously regulating the maximum-tolerated error during trajectory tracking tasks. We conduct simulation and experimental studies based on an upper limb rehabilitation robot to evaluate the overall performance of the motor-learning framework. A series of results showed that the difficulty level of reference trajectories was modulated to meet the requirements of subjects’ intended motion, furthermore, the robotic assistance was compliantly optimized in response to the changing performance of subjects’ motor abilities, highlighting the potential of adopting our framework into clinical application to promote patient-led motor learning.

Criticisms and perspectives of heuristic learning in physical education

Background and study aim. The ecological-dynamic approach promotes motor learning through task variability, modification of environmental constraints and appropriate use of feedback, original and creative motor solutions. This study wants to open a critical perspective on the didactics of physical activity selecting a methodological perspective adherent to ecological-dynamic approach. The aim is to highlight the significant aspects and the uniqueness and unrepeatability of heuristic learning, starting from theoretical lines.
 Material and Methods. For this purpose, an accurate survey of the scientific literature has been analyzed, highlighting the points of contact and contrast of cognitive and ecological-dynamic approach.
 Results. In the context of physical education, the most used pedagogical approach is the linear one. Teaching is influenced by spatial and temporal constraints, spaces and equipment, with reproduction styles and with predefined tasks and motor responses. This modality promotes awareness of motor skills and not transferability to other subject areas, as indicated by ministerial documents. Non-linear pedagogy, while promoting motor learning as a consequence of the interaction between the subject and the context, shows some limits. The first concerns the learning of transversal skills and, the second concerns the use of prescriptive teaching, absent in the ecological-dynamic approach, through heuristic learning. It is necessary to overcome the areas of prescriptiveness that still resist in the paradigm most recognized by the scientific community, the Constraints Led Approach, closely related to nonlinear pedagogy. They do not favor completely a heuristic learning as the anthropometric constraints suffer from the limitation of biomechanics. Also, goal constraints are prescriptively determined by the physical education teacher, which is not compatible with heuristic learning.
 Conclusions. This analysis highlights the need, usefulness and usability of heuristic learning in different professional fields. The study aims to offer a new perspective on physical education objectives in the National Indications, projecting them towards a social and transversal purpose.

Habilitation Improves Mouse Gait Development Following Neonatal Brain Injury.

Neonatal brain injury during gait development disrupts neural circuits and causes permanent gait dysfunction. Rehabilitation as an intervention to improve impaired gait function has been used in adults as a treatment for stroke and spinal cord injury. However, although neonates have greater neuroplasticity and regenerative capacity than adults, normal gait development and the effects of habilitation on gait function following neonatal brain injury are largely unknown. In this study, we generated cryogenic injury in mice at postnatal day 2 and subsequently performed habilitative training to promote autonomous limb movement for 4 weeks. We also quantitatively analyzed the gait acquisition process in developing mice using the Catwalk XT system. Using quantitative gait analyses, we showed that during normal gait development in mice, stance phase function matures later than swing phase function. We also demonstrated that habilitation in which active limb movements were enhanced by suspending mice with a rubber band with no floor grounding promotes motor learning, including gait function, in mice with impaired acquisition of gait function resulting from neonatal brain injury. Our findings provide a basis for research on gait development in mice and suggest new habilitation strategies for patients with impaired gait development caused by perinatal brain diseases such as hypoxic-ischemic encephalopathy and periventricular leukomalacia.

Novelty exposure induces stronger sensorimotor representations during a manual adaptation task.

Active exploration of novel spatial environments enhances memory for subsequently presented explicit, declarative information in humans. These effects have been attributed to novelty promoting dopamine release via mesolimbic dopaminergic pathways in the brain. As procedural motor learning has been linked to dopamine as well, we predict that novelty effects extend to this domain. To test this hypothesis, the present study examined whether spatial novelty exploration benefits subsequent sensorimotor adaptation. Participants explored either two different virtual environments (i.e., novelty condition; n = 210) or two identical environments (i.e., familiar condition; n = 253). They then performed a manual adaptation task in which they had to adapt joystick movements to a visual perturbation. We assessed the rate of adaptation following the introduction of this perturbation, and the rate of deadaptation following its removal. While results showed reliable adaptation patterns and similar adaptation rates across both conditions, individuals in the novelty condition showed slower deadaptation. This suggests that exposure to spatial novelty induced stronger sensorimotor representations during adaptation, potentially through novelty‐induced dopaminergic effects in mesocortical and/or nigrostriatal pathways. Novelty exposure may be employed to promote motor learning on tasks that require precision movements in altered sensory contexts, for example, in astronauts moving in microgravity or patients with impaired motor processing.

From simulation to motor execution: a review of the impact of dynamic motor imagery on performance

ABSTRACT There is now ample evidence that motor imagery contributes to improve motor performance and promote motor learning and recovery. During the last decades, a large number of experimental studies and imagery frameworks were designed to determine the critical key components for effective imagery interventions. The extent to which athletes often move slightly during motor imagery has spawned specific interest in imagery research from a conceptual perspective, hence challenging the traditional idea that imagery requires to remain motionless. While a wealth of research has extensively decoupled motor imagery from action, more recent imagery theories specifically considered that athletes can perform a dynamic form of imagery, by adopting a congruent body position and embodying spatial and/or temporal features of the movement without entirely performing it. Spurred by the wide use of this form of imagery by athletes and the promising related experimental research, the present paper aims at reviewing the impact and predictive positive effects of dynamic motor imagery on motor performance. Direct implications for applied work, including specific instructions that dynamic motor imagery might have during different stages of the coaching process of athletes, are further considered. A framework for the appropriate timing for delivering dynamic imagery interventions is finally proposed.

Real-time feedback using extended reality: A current overview and further integration into sports

The learning process in humans is reinforced with feedback on actions. In sports, feedback plays an important role in optimizing motion techniques. Athletes can learn and internalize correct motion executions in order to improve their performance. The most widely used feedback method in sports is response advice by experts (coaches). Meanwhile, technical devices are useful for promoting motor learning. With the help of extended reality, such as virtual reality, augmented reality and mixed reality, it is possible to receive visual feedback through (head-mounted) displays during motion execution for real-time corrections in motor learning. The use of extended reality real-time feedback is becoming increasingly common in many application fields of motor learning. So far, forms of real-time feedback have mainly been used in the health and medical sector. In sports, the increasing exploration of real-time feedback could provide a useful supplement to conventional feedback methods. Real-time feedback using extended reality could enable a better self-motion perception and faster learning success, consequently, having a positive effect on the performance development of athletes. This article summarizes the current use of real-time feedback ( Prior application of real-time XR feedback in various research fields section), presents the useful addition of extended reality real-time feedback to common feedback methods in sports ( Framework of the addition of real-time XR feedback in sports section), and recommends a possible integration of real-time feedback in sports training with the help of a model ( Concept development section). Overall, the benefits of using extended reality technologies are presented, and a human-system-interaction in sports is proposed.

The Effect of Virtual Reality-Based Therapy on Improving Upper Limb Functions in Individuals With Stroke: A Randomized Control Trial.

Background: Stroke is a common cause of motor disability. The recovery of upper limb after stroke is poor, with few stroke survivors regaining some functional use of the affected upper limb. This is further complicated by the fact that the prolonged rehabilitation is accompanied by multiple challenges in using and identifying meaningful and motivated treatment tasks that may be adapted and graded to facilitate the rehabilitation program. Virtual reality-based therapy is one of the most innovative approaches in rehabilitation technology and virtual reality systems can provide enhanced feedback to promote motor learning in individuals with neurological or musculoskeletal diseases.Purpose: This study investigated the effect of virtual reality-based therapy on improving upper limb functions in individuals with chronic stroke.Methods: Forty Saudi individuals with chronic stroke (6–24 months following stroke incidence) and degree of spasticity ranged between 1, 1 + and 2 according to Modified Ashworth Scale were included in this study. Participants were randomly assigned into two groups, experimental and control, with the experimental group undertaking a conventional 1-h functional training program, followed by another hour of virtual reality-based therapy using Armeo Spring equipment and the control group received 2 h of a conventional functional training program. The treatment program was conducted three times per week for three successive months. The change in the scores of Action Research Arm Test (ARAT), Wolf Motor Function Test (WMFT), WMFT-Time (time required to complete the test) and Hand Grip Strength (HGS) were recorded at baseline and after completion of the treatment. Parametric (paired and unpaired t-tests) non-parametric (Wilcoxon and Mann–Whitney tests) statistical tests were used to identify the differences within and between groups (experimental group and control group) and evaluation times (pre- and immediately post-treatment).Results: Both groups showed significant differences (all, P < 0.05) in all measured variables after 3 months of the treatment. Individuals with stoke in the experimental group had a better improvement in ARAT (P < 0.01), WMFT (P < 0.01) and WMFT-Time (P < 0.01) scores after completion of the treatment compared to the control group. No significant difference in HGS scores was detected between groups after completion of the treatment (P = 0.252).Conclusion: The use of combined treatment of virtual reality-based therapy and conventional functional training program is more effective for improving upper limb functions in individuals with chronic stroke than the use of the conventional program alone.