Does visual error augmentation offer advantages during bimanual therapy in individuals poststroke? A randomized controlled trial

Objective Reaching training with error augmentation has recently shown great promise for enhancing bimanual therapy training, using both robotic force feedback (haptics) and visually distorted display elements (graphics) to amplify motor learning. Methods In this two-arm, randomized controlled trial...

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Main Authors: Courtney Celian, Teresa Puzzi, Martina Verardi, Erica Olavarria, Federica Porta, Alessandra Pedrocchi, James L Patton
Format: Article
Language:English
Published: SAGE Publishing 2025-08-01
Series:Journal of International Medical Research
Online Access:https://doi.org/10.1177/03000605251361115
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author Courtney Celian
Teresa Puzzi
Martina Verardi
Erica Olavarria
Federica Porta
Alessandra Pedrocchi
James L Patton
author_facet Courtney Celian
Teresa Puzzi
Martina Verardi
Erica Olavarria
Federica Porta
Alessandra Pedrocchi
James L Patton
author_sort Courtney Celian
collection DOAJ
description Objective Reaching training with error augmentation has recently shown great promise for enhancing bimanual therapy training, using both robotic force feedback (haptics) and visually distorted display elements (graphics) to amplify motor learning. Methods In this two-arm, randomized controlled trial, we explored the effect of visual error augmentation alone by visually shifting the paretic limb’s cursor in the direction of error. We invited 38 chronic (>8 months postinjury) stroke survivors to practice bimanual reaching for approximately 40 min, 3 days per week for 3 weeks. Results The arm motor section of the Fugl–Meyer score (maximum score, 66 points) increased by an average of 2.2 and was retained at an average of 1.5 at a follow-up evaluation 7–9 weeks (approximately 2 months) later. For chronic stroke survivors, an improvement of ≥5.2 in the arm motor section of the Fugl–Meyer score is considered a clinically meaningful increase. No superiority was detected due to the error augmentation treatment, but other measures of composite abilities (range of motion, bimanual symmetry, and movement time) showed improvements favoring error augmentation. Conclusions Although removing robotic forces led to smaller gains than those reported previously, such touch-free bimanual therapy may prove to be an effective inexpensive automated rehabilitation tool for wider accessibility in therapeutic interventions. Trial registration: This study has been registered at ClinicalTrials.gov (ID#NCT03300141).
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spelling doaj-art-6bcb0bbef5024b4b9928a86cff474df22025-08-20T03:38:11ZengSAGE PublishingJournal of International Medical Research1473-23002025-08-015310.1177/03000605251361115Does visual error augmentation offer advantages during bimanual therapy in individuals poststroke? A randomized controlled trialCourtney CelianTeresa PuzziMartina VerardiErica OlavarriaFederica PortaAlessandra PedrocchiJames L PattonObjective Reaching training with error augmentation has recently shown great promise for enhancing bimanual therapy training, using both robotic force feedback (haptics) and visually distorted display elements (graphics) to amplify motor learning. Methods In this two-arm, randomized controlled trial, we explored the effect of visual error augmentation alone by visually shifting the paretic limb’s cursor in the direction of error. We invited 38 chronic (>8 months postinjury) stroke survivors to practice bimanual reaching for approximately 40 min, 3 days per week for 3 weeks. Results The arm motor section of the Fugl–Meyer score (maximum score, 66 points) increased by an average of 2.2 and was retained at an average of 1.5 at a follow-up evaluation 7–9 weeks (approximately 2 months) later. For chronic stroke survivors, an improvement of ≥5.2 in the arm motor section of the Fugl–Meyer score is considered a clinically meaningful increase. No superiority was detected due to the error augmentation treatment, but other measures of composite abilities (range of motion, bimanual symmetry, and movement time) showed improvements favoring error augmentation. Conclusions Although removing robotic forces led to smaller gains than those reported previously, such touch-free bimanual therapy may prove to be an effective inexpensive automated rehabilitation tool for wider accessibility in therapeutic interventions. Trial registration: This study has been registered at ClinicalTrials.gov (ID#NCT03300141).https://doi.org/10.1177/03000605251361115
spellingShingle Courtney Celian
Teresa Puzzi
Martina Verardi
Erica Olavarria
Federica Porta
Alessandra Pedrocchi
James L Patton
Does visual error augmentation offer advantages during bimanual therapy in individuals poststroke? A randomized controlled trial
Journal of International Medical Research
title Does visual error augmentation offer advantages during bimanual therapy in individuals poststroke? A randomized controlled trial
title_full Does visual error augmentation offer advantages during bimanual therapy in individuals poststroke? A randomized controlled trial
title_fullStr Does visual error augmentation offer advantages during bimanual therapy in individuals poststroke? A randomized controlled trial
title_full_unstemmed Does visual error augmentation offer advantages during bimanual therapy in individuals poststroke? A randomized controlled trial
title_short Does visual error augmentation offer advantages during bimanual therapy in individuals poststroke? A randomized controlled trial
title_sort does visual error augmentation offer advantages during bimanual therapy in individuals poststroke a randomized controlled trial
url https://doi.org/10.1177/03000605251361115
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