Feedback-mediated upper extremities exercise: increasing patient motivation in poststroke rehabilitation

Maša D Popović, Miloš D Kostić, Sindi Z Rodić, Ljubica M Konstantinović, Maša D Popović, Miloš D Kostić, Sindi Z Rodić, Ljubica M Konstantinović

Abstract

Purpose: This proof-of-concept study investigated whether feedback-mediated exercise (FME) of the affected arm of hemiplegic patients increases patient motivation and promotes greater improvement of motor function, compared to no-feedback exercise (NFE).

Method: We developed a feedback-mediated treatment that uses gaming scenarios and allows online and offline monitoring of both temporal and spatial characteristics of planar movements. Twenty poststroke hemiplegic inpatients, randomly assigned to the FME and NFE group, received therapy five days a week for three weeks. The outcome measures were evaluated from the following: (1) the modified drawing test (mDT), (2) received therapy time-RTT, and (3) intrinsic motivation inventory-IMI.

Results: The FME group patients showed significantly higher improvement in the speed metric (P < 0.01), and smoothness metric (P < 0.01), as well as higher RTT (P < 0.01). Significantly higher patient motivation is observed in the FME group (interest/enjoyment subscale (P < 0.01) and perceived competence subscale (P < 0.01)).

Conclusion: Prolonged endurance in training and greater improvement in certain areas of motor function, as well as very high patient motivation and strong positive impressions about the treatment, suggest the positive effects of feedback-mediated treatment and its high level of acceptance by patients.

Figures

Figure 1
Figure 1
FME session (a) with screen shots of the first (b), second (c), and third (d) game, and NFE session (e) with photos of the first (f), second (g), and third (h) exercise. Examples of required movements are indicated with white arrows in each game or black arrows in each exercise.
Figure 2
Figure 2
Consort diagram of study participant selection (feedback-mediated exercise—FME, no-feedback exercise—NFE).
Figure 3
Figure 3
Box and whiskers plot of smoothness, speed, and precision improvement coefficients for FME and NFE groups. The black line denotes the improvement coefficient of 1 (equal result before and after treatment). Data with statistically significant difference is marked by *.
Figure 4
Figure 4
Box and whiskers plot of IMI subscale scores for FME and NFE groups; score range from 1 = not at all true to 7 = very true. Data with statistically significant difference is marked by *. Outliers are marked with a red +.
Figure 5
Figure 5
Box and whiskers plot of average RTT for FME and NFE groups; maximum RTT is 15 min. Outliers are marked with a red +.

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