Meaningful visual feedback for upper and lower limb rehabilitation early after stroke

Background: Key principles of stroke rehabilitation are practice and feedback. 3D motion capture has the potential to provide accurate kinematic data required for objective assessment and feedback. This study explored the use of a novel feedback aid in which patients, and their therapists, are presented with a stick figure visualisation that is able to mimic the user in real-time or post-hoc, dependent on the task and the patient’s ability to process information. Methods: Ethical committee approval was obtained. Case studies were undertaken to assess the effectiveness of a 6 week visual feedback programme consisting of 12 upper limb or gait training therapy sessions. A 54 year old male 9 days post-stroke and a 56 year old female 3 months post-stroke participated in the upper limb and gait training programme respectively. Outcome and 6 month follow-up measures used were the Action Research Arm Test (ARAT), 5 Metre Walk Test (5mWT) and the Stroke Impact Scale Recovery Level (SIS-R) and mobility score (SIS-16). Results: The male increased his ARAT score from 88% to 100% and reported an increase in SIS-R from 50% to 85% (90% at follow-up). The female demonstrated a reduction in the 5mWT from 14.8 to 10.34 seconds (7.16 seconds at follow-up) and reported an increase in SIS-16 from 59% to 85% (91% at follow-up). Moreover, participants commented on the system’s role in providing an increased sense of involvement and understanding of their rehabilitation, and in maintaining motivation levels. Conclusions: Findings suggested visual feedback to be a useful adjunct to stroke rehabilitation. Feasibility RCTs are currently being undertaken to further assess the effectiveness and feasibility of this intervention. Implications: Visual feedback has the potential to assist patients and their therapists in interpreting their movement performance, to encourage correct movements over compensatory patterns and enhance mobility outcomes after stroke