Error augmentation enhancing arm recovery in individuals with chronic stroke: A randomized crossover design

Farnaz Abdollahi, Emily D. Case Lazarro, Molly Listenberger, Robert V. Kenyon, Mark Kovic, Ross A. Bogey, Donald Hedeker, Borko D. Jovanovic, James L. Patton*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

87 Scopus citations


Background. Neurorehabilitation studies suggest that manipulation of error signals during practice can stimulate improvement in coordination after stroke. Objective. To test visual display and robotic technology that delivers augmented error signals during training, in participants with stroke. Methods. A total of 26 participants with chronic hemiparesis were trained with haptic (via robot-rendered forces) and graphic (via a virtual environment) distortions to amplify upper-extremity (UE) tracking error. In a randomized crossover design, the intervention was compared with an equivalent amount of practice without error augmentation (EA). Interventions involved three 45-minute sessions per week for 2 weeks, then 1 week of no treatment, and then 2 additional weeks of the alternate treatment. A therapist provided a visual cursor using a tracking device, and participants were instructed to match it with their hand. Haptic and visual EA was used with blinding of participant, therapist, technician-operator, and evaluator. Clinical measures of impairment were obtained at the beginning and end of each 2-week treatment phase as well as at 1 week and at 45 days after the last treatment. Results. Outcomes showed a small, but significant benefit to EA training over simple repetitive practice, with a mean 2-week improvement in Fugl-Meyer UE motor score of 2.08 and Wolf Motor Function Test of timed tasks of 1.48 s. Conclusions. This interactive technology may improve UE motor recovery of stroke-related hemiparesis.

Original languageEnglish (US)
Pages (from-to)120-128
Number of pages9
JournalNeurorehabilitation and Neural Repair
Issue number2
StatePublished - Feb 2014


  • error augmentation
  • haptic technology
  • physical therapy
  • robotics
  • stroke rehabilitation
  • upper extremity

ASJC Scopus subject areas

  • Rehabilitation
  • Neurology
  • Clinical Neurology


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