Improvement of Arm Movement Patterns and Endpoint Control Depends on Type of Feedback During Practice in Stroke Survivors

BACKGROUND: A major challenge in stroke rehabilitation is restoration of arm motor function. Therapy-induced improvements in arm function may occur via restoration of premorbid movement patterns (recovery) or development of compensatory movement strategies. However, it is unclear whether the learning benefits of practice might be enhanced by incorporating different forms of feedback, focusing on movement outcomes or on specific arm movement patterns. OBJECTIVE: To determine if manipulation of attentional focus by providing either knowledge of results (KR) feedback, focusing on movement outcomes, or knowledge of performance (KP) feedback, focusing on arm movement patterns during repetitive practice of a pointing movement, may lead to arm motor recovery. METHODS: Twenty-eight chronic stroke survivors were randomly assigned to 2 groups that practiced 10 sessions of 75 pointing movements. During practice, groups received either 20% KR about movement precision or faded (26.6% average) KP about arm joint movements. A nondisabled control group (n = 5) practiced the same task with KR. RESULTS: Motor patterns recovered only in KP, as evidenced by immediate and long-term increases in joint range, better interjoint coordination in early movement phases, and generalization of gains. Improvements in clinical impairment and function were related to decreases in compensation (trunk rotation) and recovery of interjoint coordination in mid-movement phases. CONCLUSIONS: In stroke survivors, when the learners' attention was directed to the movements themselves (KP), motor improvements reflect recovery compared to when attention was directed toward movement outcomes (KR).