The use of visual feedback in upper limb stroke rehabilitation: a pilot randomized controlled trial

Background and objectives: For a significant proportion of stroke survivors arm function is limited. Visual feedback (VF) using 3D motion capture may enhance understanding of correct movement patterns and encourage motor relearning, however clinically this is predominantly limited to gait analysis laboratories. This study assessed the feasibility and preliminary effects of 3D VF of upper limb movement during stroke rehabilitation. Methods: Adults within 3 months of stroke onset and with limited arm function consented to being recruited into a pilot RCT consisting of: (1) an Intervention Group (IG) receiving additional upper limb therapy with VF, (2) a dose-matched Placebo Group and (3) a Control Group receiving standard care only. Additional therapy was 12 one-hour sessions over six weeks in a community-based setting. Measures evaluated the feasibility (adverse events and drop-out rates) and outcomes (Action Research Arm Test (ARAT), 9 Hole Peg Test (9HPT), Stroke Impact Scale, (SIS)). Results: Eleven of 72 (15%) participants screened were recruited. No adverse events observed and only one drop-out from IG. No participants received all 12 sessions although non-attendance was lowest in IG. Functional improvement (ARAT) was seen across all groups immediately post intervention although dexterity remained reduced (9HPT). Those in IG reported the greatest increases in function (SIS). [Low numbers prevent significance testing] Conclusions: VF in upper limb stroke rehabilitation is feasible. Preliminary outcomes suggest it may improve gross movement but has less impact on dexterity, limiting fuller functional recovery. Further modifications are required to optimize the intervention before embarking on a larger RCT.