Error-enhanced Learning for Stroke Recovery

Recruiting at 1 trial location

Overseen By Naveed Aghamohammadi

Age: 18+

Sex: Any

Trial Phase: Academic

Sponsor: Shirley Ryan AbilityLab

Must not be taking: Botox

Disqualifiers: Bilateral paresis, Severe spasticity, others

No Placebo Group All trial participants will receive the active study treatment (no placebo)

Compensation: Varies

Number of Visits: 9

Duration: 2 weeks

20 Participants Needed

What You Need to Know Before You Apply

What is the purpose of this trial?

This trial aims to improve movement in stroke survivors by analyzing and utilizing their reaching errors during exercises. Participants will receive a customized exercise program tailored to their specific movement mistakes, with the goal of enhancing their ability to reach with the affected arm. This study suits individuals who had a stroke over 8 months ago, experience weakness on one side, and can move their shoulder and elbow to some degree. As an unphased trial, it offers a unique opportunity to contribute to innovative research that could enhance rehabilitation techniques for stroke survivors.

Will I have to stop taking my current medications?

The trial protocol does not specify whether you need to stop taking your current medications. However, if you have had a Botox injection in the affected arm within the last 4 months, you cannot participate.

What prior data suggests that this exercise program is safe for stroke recovery?

Research has shown that the customized reaching exercise for stroke recovery has been well-received by participants in past studies. One study found that stroke survivors improved their reaching ability by doing exercises focused on their specific mistakes. This method used a robotic arm and virtual reality to help patients practice movements tailored to their errors. Importantly, no major negative effects or side effects were reported.

Another study emphasized using error signals during practice to improve arm coordination after a stroke. The exercises were adjusted based on participants' mistakes, leading to better movement without causing harm.

Overall, these findings suggest that the customized reaching exercise is safe for stroke survivors. Focusing on learning from mistakes helps improve movement without adding new risks. ^{1 2 3 4 5}

Why are researchers excited about this trial?

Researchers are excited about the Error-enhanced Learning approach for stroke recovery because it introduces a novel way to boost motor skill rehabilitation. Unlike traditional therapies that may focus on repetitive exercises, this technique uses customized reaching exercises that intentionally incorporate errors to enhance learning and adaptation in the brain. This innovative method aims to accelerate recovery by promoting neuroplasticity, allowing the brain to rewire more effectively after a stroke. By leveraging the brain’s natural ability to learn from mistakes, this approach has the potential to significantly improve motor function outcomes for stroke survivors.

What evidence suggests that this customized reaching exercise is effective for stroke recovery?

Research has shown that learning from mistakes can improve arm movement in stroke patients. Studies indicate that practicing with error signals enhances coordination after a stroke. In this trial, participants will divide into two groups to test different approaches. One study suggested that exercises focused on correcting mistakes are more effective than regular practice for improving movement and performance. Another trial used tools like a robotic arm and virtual reality to customize exercises based on each patient's errors, showing early promise in improving arm movement. Overall, tailoring exercises to mistakes is gaining attention for its potential to boost stroke recovery. ^{2 3 6 7 8}

Who Is on the Research Team?

James Patton, PhD

Principal Investigator

Shirley Ryan AbilityLab

Are You a Good Fit for This Trial?

This trial is for adults over 18 who have had a stroke at least 8 months ago, affecting the primary motor cortex but still retain some shoulder and elbow movement. It's not suitable for those with severe medical issues, recent Botox in the arm, bilateral paresis, multiple strokes or lesions, severe sensory deficits, high spasticity preventing movement, cognitive impairments that affect task performance or those already in upper extremity rehab.

Inclusion Criteria

I had a stroke over 8 months ago affecting my movement control area.

I have weakness on one side of my body.

I can move both my shoulders and elbows.

Exclusion Criteria

I have severe health issues right now.

I have weakness in both sides of my body.

You have participated in a similar study involving robotics before.

Timeline for a Trial Participant

Screening

Participants are screened for eligibility to participate in the trial

1 week

1 visit (in-person)

Treatment

Participants undergo reaching exercises using robotic arm and virtual reality display system

2 weeks

6 visits (in-person)

Post-Evaluation

Participants complete post-treatment evaluations to assess changes

1 week

1 visit (in-person)

Follow-up

Participants are monitored for safety and effectiveness after treatment

5 weeks

1 visit (in-person)

What Are the Treatments Tested in This Trial?

Interventions

• Customized Reaching Exercise

Trial Overview The study tests how making mistakes during exercises can help improve arm function after a stroke. Participants will reach for targets using their affected arm while researchers track errors to tailor an exercise program aimed at enhancing recovery based on individual error patterns.

How Is the Trial Designed?

Group I: Group 2 Experimental Treatment 2 Interventions

Group II: Group 1 Experimental Treatment 2 Interventions

Who Is Running the Clinical Trial?

Shirley Ryan AbilityLab

Lead Sponsor

Trials

212

Recruited

17,900+

Published Research Related to This Trial

A new technique for retraining reaching skills in poststroke hemiparesis patients involved temporarily magnifying errors, which showed immediate benefits in improving movement straightness during a 3-hour session with a robotic device.

Out of 10 patients, while all showed initial improvement, 3 did not retain the benefits after the training, suggesting that this method has potential but may require further refinement for consistent long-term results.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Custom-designed haptic training for restoring reaching ability to individuals with poststroke hemiparesis. Patton, JL., Kovic, M., Mussa-Ivaldi, FA.[2019]

A study aimed at improving motor recovery in chronic stroke patients showed that using real-time auditory feedback during upper extremity training significantly enhances reach trajectory performance compared to practice alone.

The research involved analyzing 20 reach parameters in two groups of stroke patients, demonstrating that while both methods can modify reach trajectories, auditory feedback is essential for achieving better performance outcomes.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Retraining reaching in chronic stroke with real-time auditory feedback. Maulucci, RA., Eckhouse, RH.[2016]

In a pilot study with 5 chronic stroke patients, position feedback during upper limb reach training led to improvements in kinematic variables, indicating enhanced motor learning.

Subjects required only a small percentage (7.4% to 14.7%) of training time for position feedback, yet all showed increased movement performance, suggesting that immediate feedback on errors can effectively aid rehabilitation.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Effect of position feedback during task-oriented upper-limb training after stroke: five-case pilot study. Molier, BI., Prange, GB., Krabben, T., et al.[2019]

A new visual distortion training method for stroke survivors, which simulates robot-assisted feedback without the actual robot, showed promising early results in improving motor skills during a bimanual virtual reality task.

Both treatment and control groups improved after three weeks of practice, with the treatment group showing a slight advantage, suggesting that visual feedback alone can be an effective and simpler alternative for rehabilitation.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Stroke Rehabilitation with Distorted Vision Perceived as Forces. Hajissa, E., Celian, C., Thielbar, KO., et al.[2020]

A pilot study involving three stroke survivors showed that customized error field training significantly reduced motor errors across multiple sessions, indicating potential effectiveness in rehabilitation.

The approach not only helps in tailoring therapy to individual motor impairments but also provides a way to characterize these deficits, suggesting a dual benefit for stroke recovery.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Customized therapy using distributions of reaching errors. Bittmann, MF., Patton, JL., Huang, FC.[2022]

In a pilot study involving 23 stroke patients, functional electrical stimulation (FES) training showed significant improvement in hand function compared to conventional training, although overall differences between the groups were not statistically significant.

Both groups demonstrated improvements in daily living activities and arm function, suggesting that while FES may be beneficial, more sessions and a larger sample size are needed to definitively assess its efficacy in severely impaired patients.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Motor training of upper extremity with functional electrical stimulation in early stroke rehabilitation. Mangold, S., Schuster, C., Keller, T., et al.[2019]

Robot-assisted reach training (RART) significantly improved upper extremity function and kinematic performance in chronic stroke survivors, with 38 participants involved in a randomized controlled trial over 6 weeks.

The group using an assist-as-needed protocol (RT-AAN) showed greater improvements in upper extremity function compared to the guidance force group (RT-G), indicating that this method may be more effective for rehabilitation.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Robot-Assisted Reach Training With an Active Assistant Protocol for Long-Term Upper Extremity Impairment Poststroke: A Randomized Controlled Trial. Cho, KH., Song, WK.[2019]

Augmented error feedback, specifically using a gain of 2 or an offset equal to the average error, significantly accelerated motor learning in healthy adults adapting to a 30° visuomotor rotation, with learning speed nearly twice that of control groups.

The group receiving the offset feedback not only learned faster but also showed a greater reduction in error, suggesting that these techniques could be beneficial for training in robotic teleoperation or rehabilitation for individuals with movement impairments.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Visuomotor learning enhanced by augmenting instantaneous trajectory error feedback during reaching. Patton, JL., Wei, YJ., Bajaj, P., et al.[2021]

In a study involving 158 recovering stroke patients, both trained and untrained movements showed improvements, indicating that motor learning allows for generalization of skills rather than requiring specific training for each task.

The results suggest that focusing on a smaller set of activities during rehabilitation may be more effective, as the brain appears to rebuild task representations through motor learning, which could optimize therapy design for stroke recovery.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Learning, not adaptation, characterizes stroke motor recovery: evidence from kinematic changes induced by robot-assisted therapy in trained and untrained task in the same workspace. Dipietro, L., Krebs, HI., Volpe, BT., et al.[2021]

Citations

1. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC8734943/

Error Augmentation Enhancing Arm Recovery in Individuals ... Neurorehabilitation studies suggest that manipulation of error signals during practice can stimulate improvement in coordination after stroke.

2. withpower.com withpower.com/trial/phase-1-stroke-1-2022-07d5d

Error-enhanced Learning for Stroke Recovery This trial uses a robotic arm and virtual reality to help stroke patients practice reaching exercises tailored to their specific mistakes.

3. clinicaltrials.gov clinicaltrials.gov/study/NCT07039006?lastUpdPost=2020-01-10_

Error Augmentation for Upper Limb Rehabilitation in Stroke ... This is a short, proof-of-concept study to evaluate whether EA feedback shows early promise for improving arm movement in people with upper limb motor ...

4. jneuroengrehab.biomedcentral.com jneuroengrehab.biomedcentral.com/articles/10.1186/s12984-018-0408-5

The effects of error-augmentation versus error-reduction ... Results suggest, with a moderate level of evidence, that EA is overall more effective than conventional repetitive practice (motor recovery and performance) ...

5. sciencedirect.com sciencedirect.com/science/article/pii/S2590109523000836

Feasibility of a Self-directed Upper Extremity Training ... Feasibility of a self-directed upper extremity training program to promote actual arm use for individuals living in the community with chronic stroke.

6. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC8734946/

Customized Therapy Using Distributions of Reaching Errors This study examined whether a customized training intervention that models error statistics can improve reaching for stroke survivors. We tested three ...

7. mdpi.com mdpi.com/1424-8220/24/11/3331

Mitigating Trunk Compensatory Movements in Post-Stroke ... The findings underscore the pivotal role of customized visual feedback in correcting aberrant upper limb movements among stroke survivors, ...

8. medrxiv.org medrxiv.org/content/10.1101/2025.06.04.25328824v1.full.pdf

Bimanual visual error augmentation We invited 38 chronic (> 8 months post injury) stroke survivors to practice bimanual reaching for approximately 40 minutes, 3 days per week, for ...