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

Publication date: Available online 17 May 2017
Source:Archives of Physical Medicine and Rehabilitation
Author(s): Bulmaro Adolfo Valdés, Andrea Nicole Schneider, Hendrik Fridolijn Machiel Van der Loos
ObjectiveTo investigate whether the compensatory trunk movements of stroke survivors observed during reaching tasks can be decreased by force and visual feedback, and examine whether one of these feedback modalities is more efficacious than the other in reducing this compensatory tendency.DesignRandomized Crossover TrialSettingUniversity research laboratoryParticipants15 community dwelling older adults: 5 female, 64 ± 11 years old, with hemiplegia from non-traumatic hemorrhagic or ischemic stroke (> 3 months post-stroke), recruited from stroke recovery groups, the research group's website and the community.InterventionIn 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) through two robotic devices.Main Outcome MeasuresPrimary: Change in anterior trunk displacement measured by motion tracking camera. Secondary: trunk rotation; Index of curvature (measure of straightness of hands' path toward target); RMS error of hands' movement (differences between hands position on every iteration of the program); Completion time for each trial; Post-test questionnaire to evaluate users' experience and system's usability.ResultsBoth Visual (-45.6% (45.8) change from baseline, p=0.004) and Force (-41.1% (46.1), p=0.004) feedback were effective in reducing trunk compensation. Scores on secondary outcome measures did not improve with either feedback modality. Neither feedback condition was superior.ConclusionsVisual and force feedback show promise as two modalities that could be used to decrease trunk compensation in stroke survivors during reaching tasks. It remains to be established which one of these two feedback modalities is more efficacious than the other as a cue to reduce compensatory trunk movement.



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