Advertisement

Reducing Trunk Compensation in Stroke Survivors: A Randomized Crossover Trial Comparing Visual and Force Feedback Modalities

  • Bulmaro Adolfo Valdés
    Correspondence
    Corresponding author Bulmaro Adolfo Valdés, MPE, Robotics for Rehabilitation Exercise and Assessment in Collaborative Healthcare Lab, Department of Mechanical Engineering, 6250 Applied Science Lane, The University of British Columbia, Vancouver, BC V6T 1Z4, Canada.
    Affiliations
    Robotics for Rehabilitation Exercise and Assessment in Collaborative Healthcare Lab, Department of Mechanical Engineering, The University of British Columbia, Vancouver, BC, Canada
    Search for articles by this author
  • Andrea Nicole Schneider
    Affiliations
    Abilities Neurological Rehabilitation, Surrey, BC, Canada
    Search for articles by this author
  • H.F. Machiel Van der Loos
    Affiliations
    Robotics for Rehabilitation Exercise and Assessment in Collaborative Healthcare Lab, Department of Mechanical Engineering, The University of British Columbia, Vancouver, BC, Canada
    Search for articles by this author

      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 access
      One-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 Rehabilitation
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Roby-Brami A.
        • Feydy A.
        • Combeaud M.
        • Biryukova E.V.
        • Bussel B.
        • Levin M.F.
        Motor compensation and recovery for reaching in stroke patients.
        Acta Neurol Scand. 2003; 107: 369-381
        • Michaelsen S.M.
        • Jacobs S.
        • Roby-Brami A.
        • Levin M.F.
        Compensation for distal impairments of grasping in adults with hemiparesis.
        Exp Brain Res. 2004; 157: 162-173
        • Valdés B.A.
        • Glegg S.M.
        • Van der Loos H.F.
        Trunk compensation during bimanual reaching at different heights by healthy and hemiparetic adults.
        J Mot Behav. 2016 Dec 9; ([E-pub ahead of print])
        • Levin M.F.
        • Kleim J.A.
        • Wolf S.L.
        What do motor “recovery” and “compensation” mean in patients following stroke?.
        Neurorehabil Neural Repair. 2009; 23: 313-319
        • Michaelsen S.M.
        • Dannenbaum R.
        • Levin M.F.
        Task-specific training with trunk restraint on arm recovery in stroke: randomized control trial.
        Stroke. 2006; 37: 186-192
        • Woodbury M.L.
        • Howland D.R.
        • McGuirk T.E.
        • et al.
        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
        • Wu C.
        • Chen Y.
        • Chen H.
        • Lin K.
        • Yeh I.
        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
        • Levin M.F.
        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
        • Thielman G.
        Rehabilitation of reaching poststroke: a randomized pilot investigation of tactile versus auditory feedback for trunk control.
        J Neurol Phys Ther. 2010; 34: 138-144
        • Alankus G.
        • Kelleher C.
        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
        • Michaelsen S.M.
        • Levin M.F.
        Short-term effects of practice with trunk restraint on reaching movements in patients with chronic stroke: a controlled trial.
        Stroke. 2004; 35: 1914-1919
        • Sullivan K.J.
        • Tilson J.K.
        • Cen S.Y.
        • et al.
        Fugl-Meyer assessment of sensorimotor function after stroke: standardized training procedure for clinical practice and clinical trials.
        Stroke. 2011; 42: 427-432
        • Levin M.
        • Desrosiers J.
        • Beauchemin D.
        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
        • Subramanian S.K.
        • Yamanaka J.
        • Chilingaryan G.
        • Levin M.F.
        Validity of movement pattern kinematics as measures of arm motor impairment poststroke.
        Stroke. 2010; 41: 2303-2308
        • Lecours A.
        • Mayer-St-Onge B.
        • Gosselin C.
        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
        • Enoka R.M.
        Neuromechanics of human movement.
        Human Kinetics, Champaign, IL2008
        • Otte K.
        • Kayser B.
        • Mansow-Model S.
        • et al.
        Accuracy and reliability of the Kinect version 2 for clinical measurement of motor function.
        PLoS One. 2016; 11: 1-17
        • Brooke J.
        SUS-A quick and dirty usability scale.
        in: Usability evaluation in industry. CRC Press, London, UK1996: 189-194
        • Holm S.
        A simple sequentially rejective multiple test procedure.
        Scand J Stat. 1979; 6: 65-70
        • Cohen J.
        Statistical power analysis for the behavioral sciences.
        2nd ed. L. Erlbaum Associates, Hillsdale1988
        • Subramanian S.K.
        • Massie C.L.
        • Malcolm M.P.
        • Levin M.F.
        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
        • Molier B.I.
        • Van Asseldonk E.H.
        • Hermens H.J.
        • Jannink M.J.
        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
        • Hodges N.
        • Campagnaro P.
        Physical guidance research: assisting principles and supporting evidence.
        in: Skill acquisition in sport: research, theory and practice. Taylor & Francis, Milton Park, UK2012: 150-169
        • Schmidt R.
        Frequent augmented feedback can degrade learning: evidence and interpretations.
        in: Tutorials in motor neuroscience. Springer Science+Business Media Dordrecht, Dordrecht, Netherlands1991: 59-75
        • Muratori L.M.
        • Lamberg E.M.
        • Quinn L.
        • Duff S.V.
        Applying principles of motor learning and control to upper extremity rehabilitation.
        J Hand Ther. 2013; 26: 94-103
        • Valdés B.A.
        • Hilderman C.G.E.
        • Hung C.T.
        • Shirzad N.
        • Van der Loos H.F.M.
        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