Abstract
Objective
To investigate whether the compensatory trunk movements of stroke survivors observed
during reaching tasks can be decreased by force and visual feedback, and to examine
whether one of these feedback modalities is more efficacious than the other in reducing
this compensatory tendency.
Design
Randomized crossover trial.
Setting
University research laboratory.
Participants
Community-dwelling older adults (N=15; 5 women; mean age, 64±11y) with hemiplegia
from nontraumatic hemorrhagic or ischemic stroke (>3mo poststroke), recruited from
stroke recovery groups, the research group's website, and the community.
Interventions
In a single session, participants received augmented feedback about their trunk compensation
during a bimanual reaching task. Visual feedback (60 trials) was delivered through
a computer monitor, and force feedback (60 trials) was delivered through 2 robotic
devices.
Main Outcome Measures
Primary outcome measure included change in anterior trunk displacement measured by
motion tracking camera. Secondary outcomes included trunk rotation, index of curvature
(measure of straightness of hands' path toward target), root mean square error of
hands' movement (differences between hand position on every iteration of the program),
completion time for each trial, and posttest questionnaire to evaluate users' experience
and system's usability.
Results
Both visual (−45.6% [45.8 SD] change from baseline, P=.004) and force (−41.1% [46.1 SD], P=.004) feedback were effective in reducing trunk compensation. Scores on secondary
outcome measures did not improve with either feedback modality. Neither feedback condition
was superior.
Conclusions
Visual and force feedback show promise as 2 modalities that could be used to decrease
trunk compensation in stroke survivors during reaching tasks. It remains to be established
which one of these 2 feedback modalities is more efficacious than the other as a cue
to reduce compensatory trunk movement.
Keywords
List of abbreviations:
ANCOVA (analysis of covariance), FMA (Fugl-Meyer assessment), RPS (Reaching Performance Scale), UE (upper extremity)To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Archives of Physical Medicine and RehabilitationAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Motor compensation and recovery for reaching in stroke patients.Acta Neurol Scand. 2003; 107: 369-381
- Compensation for distal impairments of grasping in adults with hemiparesis.Exp Brain Res. 2004; 157: 162-173
- Trunk compensation during bimanual reaching at different heights by healthy and hemiparetic adults.J Mot Behav. 2016 Dec 9; ([E-pub ahead of print])
- What do motor “recovery” and “compensation” mean in patients following stroke?.Neurorehabil Neural Repair. 2009; 23: 313-319
- Task-specific training with trunk restraint on arm recovery in stroke: randomized control trial.Stroke. 2006; 37: 186-192
- Effects of trunk restraint combined with intensive task practice on poststroke upper extremity reach and function: a pilot study.Neurorehabil Neural Repair. 2009; 23: 78-91
- Pilot trial of distributed constraint-induced therapy with trunk restraint to improve poststroke reach to grasp and trunk kinematics.Neurorehabil Neural Repair. 2012; 26: 247-255
- Trunk restraint: physical intervention for improvement of upper-limb motor impairment and function.in: Söderback I. International handbook of occupational therapy interventions. Springer New York, New York2009: 295-300
- Rehabilitation of reaching poststroke: a randomized pilot investigation of tactile versus auditory feedback for trunk control.J Neurol Phys Ther. 2010; 34: 138-144
- Reducing compensatory motions in video games for stroke rehabilitation.(Proceedings of the SIGCHI Conference on Human Factors in Computing Systems; 2012 May 5-10) ACM, Austin, TX2012: 2049-2058
- Short-term effects of practice with trunk restraint on reaching movements in patients with chronic stroke: a controlled trial.Stroke. 2004; 35: 1914-1919
- Fugl-Meyer assessment of sensorimotor function after stroke: standardized training procedure for clinical practice and clinical trials.Stroke. 2011; 42: 427-432
- Development and validation of a scale for rating motor compensations used for reaching in patients with hemiparesis: the reaching performance scale.Phys Ther. 2004; 84: 8-22
- Validity of movement pattern kinematics as measures of arm motor impairment poststroke.Stroke. 2010; 41: 2303-2308
- Variable admittance control of a four-degree-of-freedom intelligent assist device.(In: Proceedings IEEE International Conference on Robotics and Automation; 2012 May 14-18; St Paul, MN) IEEE, New York, NY2012: 3903-3908
- Neuromechanics of human movement.Human Kinetics, Champaign, IL2008
- Accuracy and reliability of the Kinect version 2 for clinical measurement of motor function.PLoS One. 2016; 11: 1-17
- SUS-A quick and dirty usability scale.in: Usability evaluation in industry. CRC Press, London, UK1996: 189-194
- A simple sequentially rejective multiple test procedure.Scand J Stat. 1979; 6: 65-70
- Statistical power analysis for the behavioral sciences.2nd ed. L. Erlbaum Associates, Hillsdale1988
- Does provision of extrinsic feedback result in improved motor learning in the upper limb poststroke? A systematic review of the evidence.Neurorehabil Neural Repair. 2010; 24: 113-124
- Nature, timing, frequency and type of augmented feedback; does it influence motor relearning of the hemiparetic arm after stroke? A systematic review.Disabil Rehabil. 2010; 32: 1799-1809
- Physical guidance research: assisting principles and supporting evidence.in: Skill acquisition in sport: research, theory and practice. Taylor & Francis, Milton Park, UK2012: 150-169
- Frequent augmented feedback can degrade learning: evidence and interpretations.in: Tutorials in motor neuroscience. Springer Science+Business Media Dordrecht, Dordrecht, Netherlands1991: 59-75
- Applying principles of motor learning and control to upper extremity rehabilitation.J Hand Ther. 2013; 26: 94-103
- Usability testing of gaming and social media applications for stroke and cerebral palsy upper limb rehabilitation.(In: 36th Annual International Conference of the IEEE Engineering in Medicine and Biology Society (EMBC). 2014 Aug 26-30; Chicago IL. New York, NY)2014: 3602-3605
Article Info
Publication History
Published online: May 16, 2017
Footnotes
Supported by the Peter Wall Solutions Initiative (grant no. 11-079), Vancouver, Canada; Consejo Nacional de Ciencia y Tecnología Mexico (grant no. 311462); and Canada Foundation for Innovation.
Clinical Trial Registration No.: NCT02654951.
Disclosures: none.
Identification
Copyright
© 2017 by the American Congress of Rehabilitation Medicine
