Error Augmented Robotic Rehabilitation of the Upper Limb - A Review <s> INTRODUCTION <s> The effects of neurodevelopmental treatment on reaching in children with spastic quadriplegia were studied using a method of analysis to quantify the qualitative term "smoothness." Hand position in three-dimensional space was recorded during a simple reaching task using the WATSMART (Waterloo Spatial Motion Analysis and Recording Technique) system in conjunction with videotaping. The number of accelerations and decelerations (movement units) were measured in addition to movement time, distance of path (directedness), and associated reactions. Each subject performed several reaches before and following one treatment session. Following treatment, reaches were significantly faster, smoother (fewer movement units), and more mature. This study supports the hypotheses that neurodevelopmental treatment can produce immediate changes in the kinematic properties of reaching and that kinematic data can be used to quantitatively describe components of movement (eg, smoothness) that have traditionally been described qualitatively. <s> BIB001 </s> Error Augmented Robotic Rehabilitation of the Upper Limb - A Review <s> INTRODUCTION <s> On the basis of computational studies it has been proposed that the central nervous system internally simulates the dynamic behavior of the motor system in planning, control, and learning; the existence and use of such an internal model is still under debate. A sensorimotor integration task was investigated in which participants estimated the location of one of their hands at the end of movements made in the dark and under externally imposed forces. The temporal propagation of errors in this task was analyzed within the theoretical framework of optimal state estimation. These results provide direct support for the existence of an internal model. <s> BIB002 </s> Error Augmented Robotic Rehabilitation of the Upper Limb - A Review <s> INTRODUCTION <s> Abstract Wu C-Y, Trombly CA, Lin K-C, Tickle-Degnen L. A kinematic study of contextual effects on reaching performance in persons with and without stroke: influences of object availability. Arch Phys Med Rehabil 2000;81:95-101. Objective: To examine the effects of context on reaching performance in neurologically impaired and intact populations. Context was varied by the presence or absence of objects used to complete a task. Design: A counterbalanced repeated-measures design. Setting: A motor control laboratory in a university setting. Participants: Fourteen persons with stroke and 25 neurologically intact adults. Interventions: Each participant was tested under two conditions: the presence of the object, in which the participant reached forward with the impaired arm (or corresponding arm) to scoop coins off the table into the other hand; and the absence of the object, in which the participant reached forward to the place where the coins would be placed in the condition of object present. Main Outcome Measures: Kinematic variables of movement time, total displacement, peak velocity, percentage of reach where peak velocity occurs, and movement units (derived from acceleration data) for reaching tasks. Results: The condition of using real objects elicited kinematically better performance of reaching movements than the condition of performing movements without relevant objects present. Better performance was reflected by shorter movement time, less total displacement, higher peak velocity, greater percentage of reach where peak velocity occurs, and fewer movement units. Conclusion: The results of this study showed that the condition of object present elicited better performance of movements represented by kinematic variables than the condition of object absent. The clinical implication is that the use of real and functional objects might be an effective way of facilitating efficient, smooth, and coordinated movement with the impaired arm in persons with stroke. This study, however, should be replicated and extended to confirm the validity of its findings and to allow for generalization in various functional activities. © 2000 by the American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation <s> BIB003 </s> Error Augmented Robotic Rehabilitation of the Upper Limb - A Review <s> INTRODUCTION <s> Robotic devices are helping shed light on human motor control in health and injury. By using robots to apply novel force fields to the arm, investigators are gaining insight into how the nervous system models its external dynamic environment. The nervous system builds internal models gradually by experience and uses them in combination with impedance and feedback control strategies. Internal models are robust to environmental and neural noise, generalized across space, implemented in multiple brain regions, and developed in childhood. Robots are also being used to assist in repetitive movement practice following neurologic injury, providing insight into movement recovery. Robots can haptically assess sensorimotor performance, administer training, quantify amount of training, and improve motor recovery. In addition to providing insight into motor control, robotic paradigms may eventually enhance motor learning and rehabilitation beyond the levels possible with conventional training techniques. <s> BIB004 </s> Error Augmented Robotic Rehabilitation of the Upper Limb - A Review <s> INTRODUCTION <s> Objective: To determine whether progressive resistance strength training reduces impairments, activity limitations and participation restrictions after stroke.Methods: Electronic databases were searched to find trials conducted from 1966 to 2002. Articles were assessed independently by two reviewers according to the following inclusion criteria: (1) population: adults with stroke, (2) intervention: progressive resistive strength training in isolation, and (3) outcomes: changes in body function, physical activity or societal participation.Results: From the 350 articles initially identified, eight met the criteria for detailed review. Three were randomized controlled trials, with the remainder being single-case time-series analyses or pre–post trials. The five trials that measured impairments of muscle strength showed positive outcomes for progressive resistance strength training, with large effect sizes (d = 1.2–4.5). Few negative effects of strength training were reported, and these were minor. Only three... <s> BIB005 </s> Error Augmented Robotic Rehabilitation of the Upper Limb - A Review <s> INTRODUCTION <s> This investigation is one in a series of studies that address the possibility of stroke rehabilitation using robotic devices to facilitate “adaptive training.” Healthy subjects, after training in the presence of systematically applied forces, typically exhibit a predictable “after-effect.” A critical question is whether this adaptive characteristic is preserved following stroke so that it might be exploited for restoring function. Another important question is whether subjects benefit more from training forces that enhance their errors than from forces that reduce their errors. We exposed hemiparetic stroke survivors and healthy age-matched controls to a pattern of disturbing forces that have been found by previous studies to induce a dramatic adaptation in healthy individuals. Eighteen stroke survivors made 834 movements in the presence of a robot-generated force field that pushed their hands proportional to its speed and perpendicular to its direction of motion — either clockwise or counterclockwise. We found that subjects could adapt, as evidenced by significant after-effects. After-effects were not correlated with the clinical scores that we used for measuring motor impairment. Further examination revealed that significant improvements occurred only when the training forces magnified the original errors, and not when the training forces reduced the errors or were zero. Within this constrained experimental task we found that error-enhancing therapy (as opposed to guiding the limb closer to the correct path) to be more effective than therapy that assisted the subject. <s> BIB006 </s> Error Augmented Robotic Rehabilitation of the Upper Limb - A Review <s> INTRODUCTION <s> We developed a real-time controller for a 2 degree-of-freedom robotic system using xPC Target. This system was used to investigate how different methods of performance error feedback can lead to faster and more complete motor learning in individuals asked to compensate for a novel visuo-motor transformation (a 30 degree rotation). Four groups of normal human subjects were asked to reach with their unseen arm to visual targets surrounding a central starting location. A cursor tracking hand motion was provided during each reach. For one group of subjects, deviations from the "ideal" compensatory hand movement (i.e. trajectory errors) were amplified with a gain of 2 whereas another group was provided visual feedback with a gain of 3.1. Yet another group was provided cursor feedback wherein the cursor was rotated by an additional (constant) offset angle. We compared the rates at which the hand paths converged to the steady-state trajectories. Our results demonstrate that error-augmentation can improve the rate and extent of motor learning of visuomotor rotations in healthy subjects. We also tested this method on straightening the movements of stroke subjects, and our early results suggest that error amplification can facilitate neurorehabilitation strategies in brain injuries such as stroke. <s> BIB007 </s> Error Augmented Robotic Rehabilitation of the Upper Limb - A Review <s> INTRODUCTION <s> Spinal orthoses are common in the treatment of various conditions that affect the spine. They encompass both the spine and pelvis and thus have implications for pelvic and lower-limb motion during walking in addition to a direct effect on spinal motion. The role of the spine in walking is largely ill-defined, and the consequences of restricted spinal motion on walking have yet to be explored. This study investigated the effect of spinal restriction on gait in able-bodied persons. Gait analyses were performed on 10 able-bodied subjects as they walked at five different speeds that were distributed across their comfortable range of speeds. Data were collected during walking with and without spinal restriction by a fiberglass body jacket, which is similar to a thoracolumbosacral orthosis (TLSO). With spinal restriction, peak-to-peak (PP) pelvic obliquity and rotation were significantly reduced across all walking speeds (p < 0.001), while PP pelvic tilt was significantly reduced at only the fastest walking speeds (p = 0.017). PP hip abduction-adduction motion was significantly reduced with spinal restriction across all speeds (p < 0.001), while PP hip flexion-extension significantly increased at only the slow and very slow speeds (p < 0.001 and p = 0.023, respectively). A better understanding of the effects of restricted spinal motion on gait may help clinicians predict and avoid development of additional problems from TLSO use or surgical restriction of spinal motion. An awareness of these issues will enable clinicians to monitor patients for problems that may result from decreased spine and pelvic motion. <s> BIB008 </s> Error Augmented Robotic Rehabilitation of the Upper Limb - A Review <s> INTRODUCTION <s> Participation in regular physical activity (PA) provides health, psychological, and physiological benefits for people with and without a physical disability. This study investigated the physical and sedentary activity patterns of adolescents with cerebral palsy (CP). A cross-sectional, descriptive, postal survey was used, consisting of the Physical Activity Questionnaire for Adolescents (PAQ-A), self-reported level of gross motor function (based on the Gross Motor Function Classification System [GMFCS]), and specific questions regarding weekly sedentary activities. Following piloting to determine test-retest reliability (intraclass correlation [ICC] for PA=0.90; total weekly sedentary time=0.84) and concurrent validity (survey PA score vs pedometry, Pearson's r=0.24; survey PA score vs accelerometry, r=-0.21; survey weekly sedentary time vs logbook, r=0.38), the survey was mailed to all adolescents with CP in South Australia registered with Novita Children's Services (n=219). One hundred and twelve valid surveys were returned (76 males, 36 females; age range 11-17y, mean age 13y 11mo [SD 23mo]; GMFCS Level I, n=42; Level II, n=27; Level III, n=10; Level IV, n=17; Level V, n=15; level not reported, n=1). Results were compared with recent normative age- and sex-matched data sets. Key findings were that PA level of adolescents with CP was related to level of gross motor function and inversely related to age, and that adolescents with CP were less physically active than their peers without disability. Comparisons with normative data sets suggested that adolescents with CP tend to participate in less structured and lower intensity PA compared with non-disabled adolescents, though sedentary activity patterns (TV and computer use) of adolescents with and without CP were similar. <s> BIB009 </s> Error Augmented Robotic Rehabilitation of the Upper Limb - A Review <s> INTRODUCTION <s> BACKGROUND ::: The active practice of task-specific motor activities is a component of current approaches to stroke rehabilitation. ::: ::: ::: OBJECTIVES ::: To determine if repetitive task training after stroke improves global, upper or lower limb function, and if treatment effects are dependent on the amount, type or timing of practice. ::: ::: ::: SEARCH STRATEGY ::: We searched the Cochrane Stroke Trials Register (October 2006), The Cochrane Library, MEDLINE, EMBASE, CINAHL, AMED, SportDiscus, Science Citation Index, Index to Theses, ZETOC, PEDro, and OT Seeker (to September 2006), and OT search (to March 2006). We also searched for unpublished/non-English language trials, conference proceedings, combed reference lists, requested information on bulletin boards, and contacted trial authors. ::: ::: ::: SELECTION CRITERIA ::: Randomised/quasi-randomised trials in adults after stroke, where the intervention was an active motor sequence performed repetitively within a single training session, aimed towards a clear functional goal, and where the amount of practice could be quantified. ::: ::: ::: DATA COLLECTION AND ANALYSIS ::: Two authors independently screened abstracts, extracted data and appraised trials. Assessment of methodological quality was undertaken for allocation concealment, blinding, loss to follow up and equivalence of treatment. We contacted trial authors for additional information. ::: ::: ::: MAIN RESULTS ::: Fourteen trials with 17 intervention-control pairs and 659 participants were included. ::: ::: ::: PRIMARY OUTCOMES ::: results were statistically significant for walking distance (mean difference (MD) 54.6, 95% CI 17.5 to 91.7); walking speed (standardised mean difference (SMD) 0.29, 95% CI 0.04 to 0.53); sit-to-stand (standard effect estimate 0.35, 95% CI 0.13 to 0.56); and of borderline statistical significance for functional ambulation (SMD 0.25, 95% CI 0.00 to 0.51), and global motor function (SMD 0.32, 95% CI -0.01 to 0.66). There were no statistically significant differences for hand/arm function, or sitting balance/reach. ::: ::: ::: SECONDARY OUTCOMES ::: results were statistically significant for activities of daily living (SMD 0.29, 95% CI 0.07 to 0.51), but not for quality of life or impairment measures. There was no evidence of adverse effects. Follow-up measures were not significant for any outcome at six or twelve months. Treatment effects were not modified by intervention amount or timing, but were modified by intervention type for lower limbs. ::: ::: ::: AUTHORS' CONCLUSIONS ::: Repetitive task training resulted in modest improvement in lower limb function, but not upper limb function. Training may be sufficient to impact on daily living function. However, there is no evidence that improvements are sustained once training has ended. The review potentially investigates task specificity rather more than repetition. Further research should focus on the type and amount of training, and how to maintain functional gain. <s> BIB010 </s> Error Augmented Robotic Rehabilitation of the Upper Limb - A Review <s> INTRODUCTION <s> Purpose. To review research that examined the participation in activities of children who have cerebral palsy, in order to understand their extent of participation and the factors that influenced participation.Methods. A comprehensive search of seven databases retrieved 2,111 papers, 40 of which met criteria and were relevant for critique. As this paper intended to examine participation broadly, an ecological framework was used to organise the relevant papers into those studies that considered personal, environmental and occupational factors related to participation.Results. Children with cerebral palsy participated in a diverse array of activities across a range of occupational contexts. Their participation was not always a positive experience. Factors most commonly identified as barriers to participation were social attitudes and the physical environment. This review identified only emergent understandings of the naturally occurring changes in the participation of children with cerebral palsy that come ... <s> BIB011 </s> Error Augmented Robotic Rehabilitation of the Upper Limb - A Review <s> INTRODUCTION <s> OBJECTIVE ::: Our aim was to examine the feasibility and effects of robotic therapy for children with cerebral palsy and upper limb hemiplegia. ::: ::: ::: DESIGN ::: A single group within-subjects design was used. Twelve children aged 5-12 yrs with moderate to severe motor impairments participated in 1-hr robotic therapy sessions, 2 times per week for 8 wks. During each session, children used the paretic arm to perform 640 repetitive, goal-directed planar reaching movements, with robotic assistance as needed. Primary outcomes were the Quality of Upper Extremity Skills Test (QUEST) and the Fugl-Meyer Assessment upper limb subtest. Secondary outcomes were the Modified Ashworth Scale, peak isometric strength of shoulder and elbow muscles, and parent questionnaire scores. ::: ::: ::: RESULTS ::: We found significant gains in total QUEST and Fugl-Meyer Assessment scores at discharge and follow-up and in isometric strength of elbow extensors at discharge. The parent questionnaire showed significant improvements in "how much" and "how well" children used the paretic arm during daily functional tasks at home. ::: ::: ::: CONCLUSION ::: Robotic therapy can provide new opportunities for improving upper limb coordination and function in children with moderate to severe impairments due to cerebral palsy or stroke. <s> BIB012 </s> Error Augmented Robotic Rehabilitation of the Upper Limb - A Review <s> INTRODUCTION <s> There is increasing interest in using robotic devices to assist in movement training following neurologic injuries such as stroke and spinal cord injury. This paper reviews control strategies for robotic therapy devices. Several categories of strategies have been proposed, including, assistive, challenge-based, haptic simulation, and coaching. The greatest amount of work has been done on developing assistive strategies, and thus the majority of this review summarizes techniques for implementing assistive strategies, including impedance-, counterbalance-, and EMG- based controllers, as well as adaptive controllers that modify control parameters based on ongoing participant performance. Clinical evidence regarding the relative effectiveness of different types of robotic therapy controllers is limited, but there is initial evidence that some control strategies are more effective than others. It is also now apparent there may be mechanisms by which some robotic control approaches might actually decrease the recovery possible with comparable, non-robotic forms of training. In future research, there is a need for head-to-head comparison of control algorithms in randomized, controlled clinical trials, and for improved models of human motor recovery to provide a more rational framework for designing robotic therapy control strategies. <s> BIB013 </s> Error Augmented Robotic Rehabilitation of the Upper Limb - A Review <s> INTRODUCTION <s> Conventional neurorehabilitation appears to have little impact on impairment over and above that of spontaneous biological recovery. Robotic neurorehabilitation has the potential for a greater impact on impairment due to easy deployment, its applicability across of a wide range of motor impairment, its high measurement reliability, and the capacity to deliver high dosage and high intensity training protocols.We first describe current knowledge of the natural history of arm recovery after stroke and of outcome prediction in individual patients. Rehabilitation strategies and outcome measures for impairment versus function are compared. The topics of dosage, intensity, and time of rehabilitation are then discussed.Robots are particularly suitable for both rigorous testing and application of motor learning principles to neurorehabilitation. Computational motor control and learning principles derived from studies in healthy subjects are introduced in the context of robotic neurorehabilitation. Particular attention is paid to the idea of context, task generalization and training schedule. The assumptions that underlie the choice of both movement trajectory programmed into the robot and the degree of active participation required by subjects are examined. We consider rehabilitation as a general learning problem, and examine it from the perspective of theoretical learning frameworks such as supervised and unsupervised learning. We discuss the limitations of current robotic neurorehabilitation paradigms and suggest new research directions from the perspective of computational motor learning. <s> BIB014 </s> Error Augmented Robotic Rehabilitation of the Upper Limb - A Review <s> INTRODUCTION <s> There has been a rapid increase in the past decade in the number of robotic devices that are being developed to assist in movement rehabilitation of the upper extremity following stroke. Many of these devices have produced positive clinical results. Yet, it is still not well understood how these devices enhance movement recovery, and whether they have inherent therapeutic value that can be attributed to their robotic properties per se. This chapter reviews the history of robotic assistance for upper extremity training after stroke and the current state of the field. Future advances in the field will likely be driven by scientific studies focused on defining the behavioral factors that influence motor plasticity. <s> BIB015 </s> Error Augmented Robotic Rehabilitation of the Upper Limb - A Review <s> INTRODUCTION <s> Objective: To investigate the ability of the New Jersey Institute of Technology Robot Assisted Virtual Rehabilitation (NJIT-RAVR) system training to elicit changes in upper extremity (UE) function in children with hemiplegia secondary to cerebral palsy.Methods: Nine children (mean age 9 years, three males) participated in three pilots. Subjects trained 1 hour, 3 days a week for 3 weeks. Two groups performed this protocol as their only intervention. The third group also performed 5–6 hours of constraint-induced movement therapy.Results: All subjects participated in a short programme of nine, 60-minute training sessions without adverse effects. As a group, subjects demonstrated statistically significant improvements in Melbourne Assessment of Unilateral Upper Limb Function Test, a composite of three timed UE tasks and several measurements of reaching kinematics. Several subjects demonstrated clinically significant improvements in active shoulder abduction and flexion as well as forearm supination.Conclusion... <s> BIB016 </s> Error Augmented Robotic Rehabilitation of the Upper Limb - A Review <s> INTRODUCTION <s> OBJECTIVE ::: We developed a home-based rehabilitation exercise system incorporating a powered joystick linked to a computer game, to enable children with arm paresis to participate in independent home exercise. We investigated the feasibility and impact of using the system in the home setting. ::: ::: ::: METHODS ::: Eighteen children with cerebral palsy (median age 7.5 years, age range 5-16 years) were recruited from local National Health Service and the exercise system was installed in their home for approximately 4 weeks. Baseline and post-intervention assessments were taken: Canadian Occupational Performance Measure (COPM); kinematic measurement of movement quality (indexed by duration and smoothness) measured using a motion tracking system when performing a standardized computer task. ::: ::: ::: RESULTS ::: The system was used for a median time of 75 min (interquartile range (IQR) 17-271), equating to 606 outward and 734 inward movements. Pre-COPM, (median 4.2); post-COPM (median 6.0); obs=34; z=3.62, p<0.01). Kinematic analysis of pre- and post-intervention movements on the standardized task showed decreased duration and increased smoothness. ::: ::: ::: CONCLUSION ::: Some improvements in self-reported function and quality of movement are observed. This pilot study suggests that the system could be used to augment home-based arm exercise in an engaging way for children with cerebral palsy, although a controlled clinical trial is required to establish clinical efficacy. The feasibility of this technology has been demonstrated. <s> BIB017 </s> Error Augmented Robotic Rehabilitation of the Upper Limb - A Review <s> INTRODUCTION <s> INTRODUCTION Over the last 100 years, radical changes have occurred in the assessment and treatment of disease. Blood tests now provide a wealth of information on the function of many organs, genetic testing can predict some diseases, and imaging techniques provide detailed quantitative information on the anatomical structure of the body. Substantial changes have also occurred in the treatment of disease. These include advances in pharmacological interventions and biomedical devices such as cardiac pacemakers, prosthetic limbs, and cochlear implants to ameliorate the effects of dysfunction. These advances reflect the transfer of knowledge and increased use of technology from basic research to clinical practice. Not all fields of medicine have been equally influenced by technology. With the exception of advances in structural and functional imaging, neurological assessment is still largely based on a clinician's perceptual decisions when monitoring the behavioral performance of the patient, such as testing the briskness of the muscle stretch reflex with a hammer tap or observing the range of motion and movement of a joint. This reliance on subjective assessment tools reflects the keen ability of the human perceptual system to observe even subtle differences between normal and abnormal behavior and the difficulty to develop technologies to replicate this ability of human observation. Although assessment tools have evolved to quantify sensory, motor, and cognitive deficits using clinician-based measurement systems, these approaches remain inherently subjective. Correspondingly, rehabilitation approaches for neurological disorders such as for stroke or traumatic brain injury remain largely based on one-on-one interactions between patient and therapist. Rehabilitation approaches vary widely across practitioners with little evidence to support why one approach is better than another [1-3]. The result is a vicious circle between neurological assessment and neurorehabilitation: the lack of sensitive tools to quantify dysfunction makes demonstrating the effectiveness of novel therapeutic approaches difficult, and limited improvement by existing treatments as measured by current assessments implies no need for better assessment tools. Our purpose with this review is to suggest that the time may be right for a profound change in neurological assessment and neurorehabilitation, particularly related to stroke and traumatic brain injury. Our hypothesis is that robotic technologies can provide a radically new and effective approach to clinical assessment of brain function and rehabilitation. This approach also takes advantage of advances in our understanding of brain function to develop a range of behavioral tasks to assess the various brain circuits that support sensory, motor, and cognitive function. As well, it highlights how these same technologies can be used for rehabilitation in subjects following stroke. Over the last 40 years, our understanding of how the brain supports sensory, motor, and cognitive function has substantially increased [4-5]. Behavioral studies on humans have identified how we use sensory input to the brain to perceive the world around us, make decisions, and guide our highly skilled and flexible motor actions. Anatomical tracing techniques highlight the anatomical connectivity among different brain regions. Neurophysiological studies in awake, behaving animals have uncovered how neural activity in various brain regions correlates with various sensory, motor, and cognitive functions. In turn, clinical research on various patient groups have highlighted how damage in even small portions of the brain can have a profound impact on brain processing. The culmination of these studies forms several basic principles about brain function. First, sensory and motor systems work together to permit us to move and interact in the environment and create our perception of the world. … <s> BIB018 </s> Error Augmented Robotic Rehabilitation of the Upper Limb - A Review <s> INTRODUCTION <s> We systematically reviewed and analyzed the literature to find randomized controlled trials (RCTs) that employed robotic devices in upper-limb rehabilitation of people with stroke. Out of 574 studies, 12 matching the selection criteria were found. The Fugl-Meyer, Functional Independence Measure, Motor Power Scale, and Motor Status Scale outcome measures from the selected RCTs were pooled together, and the corresponding effect sizes were estimated. We found that when the duration/intensity of conventional therapy (CT) is matched with that of the robot-assisted therapy (RT), no difference exists between the intensive CT and RT groups in terms of motor recovery, activities of daily living, strength, and motor control. However, depending on the stage of recovery, extra sessions of RT in addition to regular CT are more beneficial than regular CT alone in motor recovery of the hemiparetic shoulder and elbow of patients with stroke; gains are similar to those that have been observed in intensive CT. <s> BIB019
Neurological impairments resulting from conditions such as stroke and cerebral palsy are common. For example, stroke affects 150 000 people in the UK each year (2005/2006 S.S.C.A., 2001 ) and cerebral palsy is the commonest cause of childhood disability in Europe BIB004 BIB014 BIB017 . Neurological impairment, resulting from these pathologies, often influences upper limb function causing weakness, spasticity and loss of selective muscle activation. These in turn, cause difficulties with voluntary movements and affect the ability to reach, grasp transport and manipulate objects. Movements in affected individuals are therefore characterized by increased duration, reduced peak velocity, increased variability and fewer straight hand trajectories BIB003 . Improvement in upper limb function can lead to better performance in activities of daily living, increased social integration and can thus produce a better quality of life BIB009 BIB011 . Exercise of an impaired limb is known to improve function BIB001 , with better performance observed with increased time and amount of practice devoted to learning a particular task BIB010 . Traditionally such exercises are monitored by a trained clinical therapist. However, researchers have (recently) begun to investigate the application of robotics as a potential modality to support such rehabilitation. The paradigm of upper limb rehabilitation robotics is a motivating computer environment, which promotes therapeutic movements of the impaired limb with a powered interface implementing a control algorithm to promote recovery BIB008 BIB018 . Such a system can provide patients with access to rehabilitation protocols, which do not require direct, time demanding, supervision of a clinical therapist. As such they can increase access to therapy with limited additional burden on healthcare provision. Furthermore, such systems enable the logging of valuable data regarding user's activity and performance for the therapist to closely monitor adaptation and provide feedback on progress to the user. Rehabilitation robotic therapy has demonstrated statistically significant benefits in improving upper limb function, with kinematic analysis revealing benefits in movement time, path and smoothness of reach BIB012 BIB014 BIB016 BIB017 BIB019 . Currently, three types of rehabilitation robot have been described: i) end point attachment; ii) multiple point attachment and iii) exoskeletons BIB004 Jackson et al., 2007, Scott and BIB018 BIB017 . End point attachment robots are limited in that they can only promote desirable trajectories (spatial and temporal characteristics) of the hand and cannot control the corresponding position of the elbow and shoulder. However, they are likely to be more cost effective than multiple point of attachment robots and exoskeletons. Multiple point of attachment robots and exoskeletons can control the full kinematics of the arm (end point, elbow, shoulder) but are usually significantly larger and more expensive and as such are less likely to be utilized outside the clinical environment; for example in home rehabilitation applications where size and price can be significant consideration factors for employing such technology. The control strategy i.e. the manner of interaction between user and the powered joysticks/robotics, implemented is critical for the promotion of improved upper limb function BIB004 BIB013 ) and different control strategies have been utilised in the current literature. BIB013 ) suggested they can broadly be divided into three groups. Firstly, assisting control strategies help to move the impaired upper limb in aiming type movements, this is similar to the "active assist" type exercises utilised by therapists BIB013 BIB017 . Secondly, challenge based control strategies can make movements more difficult, for example augmenting error between actual and desired trajectory or promoting increased effort (resistance training) from the participant. Thirdly, haptic simulation strategies involve the user practising activities of daily living within a virtual haptic environment (Montagner et al., 2007, Marchal-Crespo and BIB015 . Challenge based algorithms such as, error augmenting, are based on the concept that errors in performance and hence results of aiming and prehensile movements of the upper limb influence motor adaptation BIB002 BIB006 ). These strategies have been shown to improve motor function in adults suffering from stroke BIB005 BIB006 . Moreover, there have been early indications that error augmented visual feedback can induce motor learning in able bodied and possibly in impaired individuals BIB007 . In the last twenty years, substantial work has been done in robotic rehabilitation. Error augmentation seems to be a relatively new modality and to our knowledge there has not been an attempt to gather and collectively report the findings of such studies. Therefore, the purpose of this paper is to present a systematic literature review of research regarding the use of error augmented feedback in the robotic rehabilitation of the upper limb and determine its potential for promoting improved upper limb function in those who have suffered a neurological impairment.