Does Provision of Extrinsic Feedback Result in Improved Motor Learning in the Upper Limb Poststroke? A Systematic Review of the Evidence

Abstract

Background. Recovery of the upper limb (UL) after a stroke occurs well into the chronic stage. Stroke survivors can benefit from adaptive plasticity to improve UL movement through motor relearning. The provision of feedback has been shown to decrease the use of compensatory UL movement patterns. However, the effectiveness of feedback in improving UL motor recovery after a stroke has not yet been systematically reviewed. Objective.The objective of this review was to systematically examine the role of extrinsic feedback on implicit motor learning after stroke, focusing on UL movement and functional recovery. Results. The authors retrieved 9 studies that examined the role of feedback on UL motor recovery. Of these, 6 were randomized controlled trials (RCTs), 1 was a single-subject design, 1 was a pre—post design, and 1 was a cohort study. The studies were rated on the basis of Sackett’s levels of evidence and PEDro (Physiotherapy Evidence Database) scores for RCTs. Levels of evidence were limited (level 2b) for UL motor learning of the less-affected extremity and strong (level 1a) for the more-affected extremity. Discussion and conclusions. The results suggest that people with stroke may be capable of using extrinsic feedback for implicit motor learning and improving UL motor recovery. Emergent questions regarding the advantages of using different media for feedback delivery and the optimal type and schedule of feedback to enhance motor learning in patient populations still need to be addressed.