The effect of videotape augmented feedback on drop jump landing strategy: Implications for anterior cruciate ligament and patellofemoral joint injury prevention. Combination transcranial direct current stimulation and virtual reality therapy for upper extremity training in patients with subacute stroke. Reinforced Feedback in Virtual Environment for Rehabilitation of Upper Extremity Dysfunction after Stroke: Preliminary Data from a Randomized Controlled Trial Simultaneous feedforward recruitment of the vasti in untrained postural tasks can be restored by physical therapy. Guidance hypothesis with verbal feedback in learning a palpation skill. Effectiveness of Two Forms of Feedback on Training of a Joint Mobilization Skill by Using a Joint Translation Simulator Effects of Constraint-Induced Therapy Versus Bilateral Arm Training on Motor Performance, Daily Functions, and Quality of Life in Stroke Survivors Feedback-Mediated Upper Extremities Exercise: Increasing Patient Motivation in Poststroke Rehabilitation Robot-assisted upper-limb therapy in acute rehabilitation setting following stroke: Department of Veterans Affairs multisite clinical trial. Effect of combined low-frequency repetitive transcranial magnetic stimulation and virtual reality training on upper limb function in subacute stroke: a double-blind randomized controlled trail Augmented Feedback for Enhanced Skill Acquisition in Individuals with Traumatic Brain Injury Virtual Reality Training for Upper Extremity in Subacute Stroke (VIRTUES) Effects of virtual reality on upper extremity function and activities of daily living performance in acute stroke: a double-blind randomized clinical trial. Effect of feedback on learning a vertebral joint mobilization skill. Effects of intensive arm training with an electromechanical orthosis in chronic stroke patients: a preliminary study. Influence of Combined Afferent Stimulation and Task-Specific Training Following Stroke: A Pilot Randomized Controlled Trial Transcranial direct current stimulation (tDCS) of the primary motor cortex and robot-assisted arm training in chronic incomplete cervical spinal cord injury: A proof of concept sham-randomized clinical study.
BACKGROUND Modification of high-risk movement strategies such as dynamic knee valgus is key to the reduction of anterior cruciate ligament ( ACL ) and patellofemoral joint ( PFJ ) injuries . Augmented feedback , which includes video and verbal feedback , could offer a quick , simple and effective alternative to training programs for altering high-risk movement patterns . It is not clear whether feedback can reduce dynamic knee valgus measured using frontal plane projection angle ( FPPA ) . METHODS Vertical ground reaction force ( vGRF ) , two-dimensional FPPA of the knee , contact time and jump height of 20 recreationally active university students were measured during a drop jump task pre- and post- an augmented feedback intervention .  A control group of eight recreationally active university students were also studied at baseline and repeat test . RESULTS There was a significant reduction in vGRF ( p=0.033 ) , FPPA ( p<0.001 ) and jump height ( p<0.001 ) and an increase in contact time ( p<0.001 ) post feedback in the intervention group . No changes were evident in the control group . CONCLUSION Augmented feedback leads to significant decreases in vGRF , FPPA and contact time which may help to reduce ACL and PFJ injury risk . However , these changes may result in decreased performance . CLINICAL RELEVANCE Augmented feedback reduces dynamic knee valgus , as measured via FPPA , and forces experienced during the drop jump task and therefore could be used as a tool for helping decrease ACL and PFJ injury risk prior to , or as part of , the implementation of injury prevention training programs OBJECTIVE To investigate the effects of combination cathodal transcranial direct current stimulation ( tDCS ) and virtual reality ( VR ) therapy for upper extremity ( UE ) training in patients with subacute stroke . DESIGN Pilot r and omized controlled trial . Patients were r and omly assigned to 1 of 3 groups : group A received cathodal tDCS , group B received VR , and group C received combination therapy ( cathodal tDCS was simultaneously applied during VR therapy ) . SETTING University hospital . PARTICIPANTS Patients ( N=59 ) with impaired unilateral UE motor function after stroke . INTERVENTION Fifteen sessions of treatment over a 3-week period . MAIN OUTCOME MEASURES The Modified Ashworth Scale , manual muscle test ( MMT ) , Manual Function Test ( MFT ) , Fugl-Meyer Scale ( FMS ) , and Box and Block Test were used to assess UE function . To evaluate activities of daily living , the Korean-Modified Barthel Index ( K-MBI ) was used . All outcomes were measured before and immediately after treatment . RESULTS After treatment , all groups demonstrated significant improvements in MMT , MFT , FMS , and K-MBI scores . The change in MFT and FMS scores was different between the 3 groups . Post hoc analysis revealed that the improvement of MFT and FMS scores in group C was significantly higher than those of the other 2 groups . CONCLUSIONS In the present pilot study , the combination of brain stimulation using tDCS and peripheral arm training using VR could facilitate a stronger beneficial effect on UE impairment than using each intervention alone . This combination therapy might be a helpful method to enhance recovery of the paretic UE in patients with stroke Objectives . To study whether the reinforced feedback in virtual environment ( RFVE ) is more effective than traditional rehabilitation ( TR ) for the treatment of upper limb motor function after stroke , regardless of stroke etiology ( i.e. , ischemic , hemorrhagic ) . Design . R and omized controlled trial . Participants . Forty-four patients affected by stroke . Intervention . The patients were r and omized into two groups : RFVE ( N = 23 ) and TR ( N = 21 ) , and stratified according to stroke etiology . The RFVE treatment consisted of multidirectional exercises providing augmented feedback provided by virtual reality , while in the TR treatment the same exercises were provided without augmented feedbacks . Outcome Measures . Fugl-Meyer upper extremity scale ( F-M UE ) , Functional Independence Measure scale ( FIM ) , and kinematics parameters ( speed , time , and peak ) . Results . The F-M UE ( P = 0.030 ) , FIM ( P = 0.021 ) , time ( P = 0.008 ) , and peak ( P = 0.018 ) , were significantly higher in the RFVE group after treatment , but not speed ( P = 0.140 ) . The patients affected by hemorrhagic stroke significantly improved FIM ( P = 0.031 ) , time ( P = 0.011 ) , and peak ( P = 0.020 ) after treatment , whereas the patients affected by ischemic stroke improved significantly only speed ( P = 0.005 ) when treated by RFVE . Conclusion . These results indicated that some poststroke patients may benefit from RFVE program for the recovery of upper limb motor function . This trial is registered with NCT01955291 BACKGROUND AND PURPOSE Physical therapy rehabilitation strategies are commonly directed at the alteration of muscle recruitment in functional movements . The aim of this study was to investigate whether feedforward strategies of the vasti in people with patellofemoral pain syndrome can be changed by a physical therapy treatment program in a r and omised , double blind , placebo controlled trial . SUBJECTS Forty ( 25 female , 15 male ) subjects aged 40 yrs or less ( 27.2+/-7.8 yrs ) . METHODS Subjects were allocated to either a placebo treatment or a physical therapy intervention program . The postural challenge used as the outcome measure was not included in the training program . Electromyography ( EMG ) onsets of vastus medialis obliquus ( VMO ) , vastus lateralis ( VL ) , tibialis anterior and soleus were assessed before and after the six week st and ardised treatment programs . RESULTS At baseline the EMG onset of VL occurred prior to that of VMO in both subject groups . Following physical therapy intervention there was a significant change in the time of onset of EMG of VMO compared to VL with the onsets occurring simultaneously . This change was associated with a reduction in symptoms . In contrast , following placebo intervention the EMG onset of VL still occurred prior to that of VMO . CONCLUSION AND DISCUSSION The results indicate that the feedforward strategy used by the central nervous system to control the patella can be restored . Importantly , the data suggest that this intervention produced a change that was transferred to a task that was not specifically included in the training program . Furthermore , the change in motor control was associated with clinical improvement in symptoms OBJECTIVE To investigate whether a force application of a novel motor skill was simple or complex and to determine the appropriate level of feedback during training . The objective was to determine the effects of various amounts of knowledge of results ( KR ) on learning a novel skill that is frequently taught in chiropractic for the assessment of vertebral motor unit dysfunction . METHODS Thirty-five active subjects were taught the novel skill of spring testing to a particular force range through 9 or 10 teaching sessions over a 2-week period ( a school holiday limited some to only 9 sessions ) . To determine the particular force range , an initial phase of the study involved a licensed and practicing clinician performing motion palpation spring testing of the thoracic spine of a prone subject . The data from a total of 47 pushes throughout the thoracic spine were recorded , and the mean force and st and ard deviation were calculated . The second phase of the study used the obtained mean and st and ard deviation for teaching the force of prone thoracic spine motion palpation to 35 active subjects by administering spring testing to 35 passive subjects . The active subjects were r and omly divided into 4 groups , with each receiving a varying amount of verbal feedback to move toward the target force of their learned skill . Each passive subject was laid prone on an instrumented adjusting table . Group 1 received the least amount of feedback while learning the novel skill . Groups 2 and 3 received more frequent , intermittent feedback while learning the skill , and group 4 received constant , frequent feedback during each of the 10 teaching sessions . All subjects returned within 2 weeks for 2 retention trials to determine the efficacy of the learned skill . RESULTS The mean force determined was 143 N with a st and ard deviation of 14 N. Each subject was taught spring testing within this target range . The 2 final retention trials showed group 3 to have demonstrated the most targeted retention of the learned motor skill . These subjects exhibited the closest force range to the target for the motor skill learned and fewer changes in st and ard deviation compared with their acquisition trials and thus the highest retention . Group 4 , receiving 100 % feedback , demonstrated the most accurate spring testing during the acquisition trials , but the subjects did not effectively demonstrate when compared on acquisition and retention trials . CONCLUSION The results of this study show data to be consistent with the guidance hypothesis in learning a novel motor skill . The constant KR feedback is beneficial for learning when used to reduce error during practice but detrimental when relied upon for retention and learning . These data suggest the necessity of using motor skill development learning theory in the teaching of chiropractic Background and Purpose Joint mobilization is a complicated task to learn and to teach and is characterized by great intersubject variability . This study 's purpose was to investigate whether quantitatively augmented feedback could enhance the learning of joint mobilization and , more specifically , to compare the effects of training with concurrent or terminal feedback by using a joint translation simulator ( JTS ) . Subjects Thirty-six undergraduate physical therapist students were r and omly assigned to control ( no feedback ) , concurrent feedback , and terminal feedback groups . Methods The JTS was design ed to simulate tissue resistance based on load-displacement relationships of glenohumeral joint specimens . Subjects applied specific mobilization grade s of force on the JTS while quantitative feedback was given to the feedback groups either during a trial ( ie , concurrent feedback ) or after a trial ( ie , terminal feedback ) . The skill acquisition phase lasted a total of 40 minutes , and a total of 75 repetitions were performed for each grade of each joint model . Pretest and no-feedback retention tests were conducted . Results During acquisition and retention , both feedback groups performed more accurately than did the control group . No obviously superior performance was shown by the terminal feedback group compared with concurrent feedback group during retention testing . Discussion and Conclusion Subjects who trained with augmented feedback had less variability , and thus more consistency , than the control group subjects who received no feedback . Augmented feedback provides the student with a reference force and the status of his or her performance . The effectiveness of the JTS feedback compared with no feedback was clearly demonstrated . Skill acquisition in mobilization can be enhanced by either concurrent or terminal feedback Background and Objective . This study investigated the relative effects of distributed constraint-induced therapy ( CIT ) and bilateral arm training ( BAT ) on motor performance , daily function , functional use of the affected arm , and quality of life in patients with hemiparetic stroke . Methods . A total of 60 patients were r and omized to  distributed CIT , BAT , or a control intervention of less specific but active therapy . Each group received intensive training for 2 hours/day , 5 days/week , for 3 weeks . Pretreatment and posttreatment measures included the Fugl — Meyer Assessment ( FMA ) , Functional Independence Measure ( FIM ) , Motor Activity Log ( MAL ) , and Stroke Impact Scale ( SIS ) . The proximal and distal scores of FMA were used to examine separate upper limb ( UL ) elements of movement . Results . The distributed CIT and BAT groups showed better performance in the overall and the distal part score of the FMA than the control group . The BAT group exhibited greater gains in the proximal part score of the FMA than the distributed CIT and control groups . Enhanced performance was found for the distributed CIT group in the MAL , the subtest of locomotion in the FIM , and certain domains of the SIS ( eg , ADL/IADL ) . Conclusion . BAT may uniquely improve proximal UL motor impairment . In contrast , distributed CIT may produce greater functional gains for the affected UL in subjects with mild to moderate chronic hemiparesis 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 in patients , r and omly 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 This r and omized , controlled , multisite Department of Veterans Affairs clinical trial assessed robot-assisted ( RA ) upper-limb therapy with the Mirror Image Movement Enabler ( MIME ) in the acute stroke rehabilitation setting . Hemiparetic subjects ( n = 54 ) received RA therapy using MIME for either up to 15 hours ( low-dose ) or 30 hours ( high-dose ) or received up to 15 hours of additional conventional therapy in addition to usual care ( control ) . The primary outcome measure was the Fugl-Meyer Assessment ( FMA ) . The secondary outcome measures were the Functional Independence Measure ( FIM ) , Wolf Motor Function Test , Motor Power , and Ashworth scores at intake , discharge , and 6-month follow-up . Mean duration of study treatment was 8.6 , 15.8 , and 9.4 hours for the low-dose , high-dose , and control groups , respectively . Gains in the primary outcome measure were not significantly different between groups at follow-up . Significant correlations were found at discharge between FMA gains and the dose and intensity of RA . Intensity also correlated with FMA gain at 6 months . The high-dose group had greater FIM gains than controls at discharge and greater tone but no difference in FIM changes compared with low-dose subjects at 6 months . As used during acute rehabilitation , motor-control changes at follow-up were no less with MIME than with additional conventional therapy . Intensity of training with MIME was positively correlated with motor-control gains Summary The effect of combined low-frequency repetitive transcranial magnetic stimulation ( LF rTMS ) and virtual reality ( VR ) training in patients after stroke was assessed . In a double-blind r and omized controlled trial , 112 patients with hemiplegia after stroke were r and omly divided into two groups : experimental and control . In experimental group , the patients received LF rTMS and VR training treatment , and those in control group received sham rTMS and VR training treatment . Participants in both groups received therapy of 6 days per week for 4 weeks . The primary endpoint including the upper limb motor function test of Fugl-meyer assessment ( U-FMA ) and wolf motor function test ( WMFT ) , and the secondary endpoint including modified Barthel index ( MBI ) and 36-item Short Form Health Survey Question naire ( SF-36 ) were assessed before and 4 weeks after treatment . Totally , 108 subjects completed the study ( 55 in experimental group and 53 in control group respectively ) . After 4-week treatment , the U-FMA scores [ mean difference of 13.2 , 95 % confidence interval ( CI ) 3.6 to 22.7 , P<0.01 ] , WMFT scores ( mean difference of 2.9 , 95 % CI 2.7 to 12.3 , P<0.01 ) , and MBI scores ( mean difference 16.1 , 95 % CI 3.8 to 9.4 , P<0.05 ) were significantly increased in the experimental group as compared with the control group . The results suggested the combined use of LF rTMS with VR training could effectively improve the upper limb function , the living activity , and the quality of life in patients with hemiplegia following subacute stroke , which may provide a better rehabilitation treatment for subacute stroke Coincident timing by individuals who exhibit traumatic brain injury was measured under conditions of no knowledge of results ( no KR ; n = 12 ) , KR on every trial ( n = 14 ) , summary KR ( n = 13 ) , and average KR ( n = 12 ) . Following acquisition trials , groups performed immediate and longer retention trials without KR . Absolute constant error and variable error , analyzed in separate repeated- measures analyses of variance , indicated that during acquisition trials subjects receiving KR on every trial were the most accurate and the most consistent in their responses ; however , subjects in groups receiving summary and average KR were the most accurate during immediate retention , with the group receiving summary KR being the most accurate during longer retention Objective : To compare the effectiveness of upper extremity virtual reality rehabilitation training ( VR ) to time-matched conventional training ( CT ) in the subacute phase after stroke . Methods : In this r and omized , controlled , single-blind phase III multicenter trial , 120 participants with upper extremity motor impairment within 12 weeks after stroke were consecutively included at 5 rehabilitation institutions . Participants were r and omized to either VR or CT as an adjunct to st and ard rehabilitation and stratified according to mild to moderate or severe h and paresis , defined as ≥20 degrees wrist and 10 degrees finger extension or less , respectively . The training comprised a minimum of sixteen 60-minute sessions over 4 weeks . The primary outcome measure was the Action Research Arm Test ( ARAT ) ; secondary outcome measures were the Box and Blocks Test and Functional Independence Measure . Patients were assessed at baseline , after intervention , and at the 3-month follow-up . Results : Mean time from stroke onset for the VR group was 35 ( SD 21 ) days and for the CT group was 34 ( SD 19 ) days . There were no between-group differences for any of the outcome measures . Improvement of upper extremity motor function assessed with ARAT was similar at the postintervention ( p = 0.714 ) and follow-up ( p = 0.777 ) assessment s. Patients in VR improved 12 ( SD 11 ) points from baseline to the postintervention assessment and 17 ( SD 13 ) points from baseline to follow-up , while patients in CT improved 13 ( SD 10 ) and 17 ( SD 13 ) points , respectively . Improvement was also similar for our subgroup analysis with mild to moderate and severe upper extremity paresis . Conclusions : Additional upper extremity VR training was not superior but equally as effective as additional CT in the subacute phase after stroke . VR may constitute a motivating training alternative as a supplement to st and ard rehabilitation . Clinical Trials.gov identifier : NCT02079103 . Classification of evidence : This study provides Class I evidence that for patients with upper extremity motor impairment after stroke , compared to conventional training , VR training did not lead to significant differences in upper extremity function improvement AIM To examine the effects of conventional therapy ( CT ) combined with intensive virtual reality ( VR ) program on upper extremity function and activities of daily living ( ADL ) in individuals in the acute stage of stroke . METHOD Twenty-six individuals were r and omly assigned to the control or experimental group . The control group received CT , while the experimental group received VR training in addition to CT on same day . The Fugl-Meyer Assessment ( FMA ) and the Manual Function Test ( MFT ) were used to measure improvement of functioning in the affected limb and the Korean version of the Modified Barthel Index ( K-MBI ) was conducted to evaluate ADL . RESULT In tests of upper extremity functioning , VR group showed significant improvement on FMA and MFT ( p < 0.05 ) . In the CT group , only FMA score showed significant change ( p < 0.05 ) . ADL performance improved significantly in both groups ( p < 0.05 ) . However , there were no significant differences between the two groups in upper extremity function and ADL performance ( p > 0.05 ) . CONCLUSION This study observed that VR training has the advantage of improving intended arm function during intensive training for individuals in the acute stage of stroke This study was design ed to investigate whether concurrent quantitative feedback of performance could improve the learning of a joint mobilization technique . A group of 110 physical therapy students had been r and omly divided into two groups for teaching purpose s. All students had previously learned mobilization of peripheral joints and were currently learning spinal mobilization .  From one of the groups , 22 students volunteered to comprise a control group , which was taught a spinal mobilization technique in the traditional way . Additional concurrent quantitative feedback of the level of force applied to the patient was given to 31 volunteers from the other group . These students formed the experimental group . A force plate was used for force measurement , and the feedback was given via an oscilloscope . The average force applied by the students ' instructors was taken as an " ideal " force . The oscilloscope showed both the applied force and the " ideal " force . Consistency was measured by the variance of the group 's performance . Accuracy was assessed by calculating the difference between the applied force and the " ideal " force . Results indicated that this feedback was associated with a significant improvement in accuracy and consistency in the application of the mobilizing force . This improvement was still present at a follow-up test conducted one week later . This result supports a greater use of such feedback in the teaching and practice of joint mobilization techniques , although the need for further research is emphasized OBJECTIVES To evaluate the use of an electromechanical device , comprising an exoskeleton , a static orthosis , and a glove , for functional rehabilitation of the elbow and h and in patients with hemiparesis , and to compare it with physical therapy rehabilitation . DESIGN Pretest-posttest design . SETTING Rehabilitation laboratory . PARTICIPANTS Volunteer sample of persons ( N=12 ) with persistent hemiparesis from a single , unilateral stroke within the past 3 to 36 months . INTERVENTIONS The volunteers were r and omly divided into 2 groups . One group was treated with a conventional program of physiotherapy , and another group participated in a training program in which an electromechanical orthosis was used . All volunteers received 24 sessions , held 3 times a week for 8 weeks . MAIN OUTCOME MEASURES Modified Ashworth Scale ( MAS ) , Fugl-Meyer Assessment ( FMA ) , and electromyogram ( EMG ) amplitude . RESULTS No statistical difference was found in the initial and final values of the MAS . Both groups showed a significant increase for the total scores of the FMA . However , only the group treated with the orthosis showed an increase in FMA scores related to the wrist and h and joint . The EMG analysis showed increased EMG amplitudes for all muscles in the group treated with the orthosis , whereas the group treated with physiotherapy showed gains in electromyographic activity only in the extensor digitorum communis . Intergroup comparison showed that the initial FMA scores of the wrist/h and were higher in the group treated with physiotherapy . However , after training , the scores in the group that used the orthosis were equivalent to those of the physiotherapy group . CONCLUSIONS The results suggest that this device can be an auxiliary tool to help the conventional rehabilitation program of motor function of the affected upper extremity Background . Reorganization of the human motor cortex can be induced by specific patterns of peripheral afferent stimulation . The potential for afferent stimulation to facilitate the functional recovery associated with conventional rehabilitative techniques has not previously been investigated . Objective . The authors sought to determine whether combining appropriate afferent stimulation with task-specific training result ed in greater improvements than training alone in patients with impaired upper limb function in the subacute phase following stroke . Method . Twenty patients with hemiparesis due to stroke were allocated r and omly to either a stimulation or control group . All received 9 sessions of task-specific physiotherapy training over 3 weeks . Prior to each training session , associative electrical stimulation of the motor point of 2 h and muscles was given in the stimulation group , whereas the control group received sham stimulation .  Changes in dexterity were assessed using a grip-lift task , and st and ard measures of upper-limb function were made before and following the intervention . Corticospinal excitability was examined using transcranial magnetic stimulation . Results . Both groups showed comparable improvements in functional measures of upper-limb function . Of the 20 patients , only 14 could perform the grip-lift task , which is an objective measure of dexterity . Patients in the stimulation group From the Research Centre for Human Movement Control , School of exhibited significantly greater improvements in this task than the control group . There was no significant change in corticospinal excitability in either group . Conclusion . This pilot study provides preliminary data suggesting that targeted afferent stimulation may facilitate the response to conventional rehabilitation in patients with hemiparesis due to stroke , but these results need to be confirmed in a larger scale study BACKGROUND After cervical spinal cord injury , current options for treatment of upper extremity motor functions have been limited to traditional approaches . However , there is a substantial need to explore more rigorous alternative treatments to facilitate motor recovery . OBJECTIVE To demonstrate whether anodal- primary motor cortex ( M1 ) excitability enhancement ( with cathodal-supra orbital area ) ( atDCS ) combined with robot-assisted arm training ( R-AAT ) will provide greater improvement in contralateral arm and h and motor functions compared to sham stimulation ( stDCS ) and R-AAT in patients with chronic , incomplete cervical spinal cord injury ( iCSCI ) . METHODS In this parallel-group , double-blinded , r and omized and sham-controlled trial , nine participants with chronic iCSCI ( AIS C and D level ) were r and omized to receive 10 sessions of atDCS or stDSC combined with R-AAT .  Feasibility and tolerability was assessed with attrition rate and occurrence of adverse events , Changes in arm and h and function were assessed with Jebson Taylor H and Function Test ( JTHFT ) . Amount of Use Scale of Motor Activity Log ( AOU-MAL ) , American Spinal Injury Association Upper Extremity Motor Score and Modified Ashworth Scale ( MAS ) at baseline , after treatment , and at two-month follow-up . RESULTS None of the participants missed a treatment session or dropped-out due to adverse events related to the treatment protocol . Participants tended to perform better in JTHFT and AOU-MAL after treatment . Active group at post-treatment and two-month follow-up demonstrated better arm and h and performance compared to sham group . CONCLUSION These preliminary findings support that modulating excitatory input of the corticospinal tracts on spinal circuits may be a promising strategy in improving arm and h and functions in persons with incomplete tetraplegia . Further study is needed to explore the underlying mechanisms of recovery
VAF should be considered in the rehabilitation of lower extremity musculoskeletal dysfunctions .
However , it can not be unequivocally confirmed that VAF is effective in this population , owing to study heterogeneity and a lack of high- quality evidence .
Nevertheless , positive effects on lower extremity biomechanics and postural control have been identified .
BACKGROUND Verbal augmented feedback ( VAF ) is commonly used in physiotherapy rehabilitation of individuals with lower extremity musculoskeletal dysfunction or to induce motor learning for injury prevention .
Its effectiveness for acquisition , retention and transfer of learning of new skills in this population is unknown .
OBJECTIVES First , to investigate the effect of VAF for rehabilitation and prevention of lower extremity musculoskeletal dysfunction .
Second , to determine its effect on motor learning and the stages of acquisition , retention and transfer in this population .