Making training better: Error augmentation motor learning in stroke.

Many Canadians each year suffer stroke, and this number is increasing as the population ages. Although many people survive stroke, they still have significant problems recovering movement in their affected arm. We know that intensive exercise is important for the recovery of movement in people who have had a stroke. However, we do not fully understand what type of exercise and how much exercise is needed to get the best results. We also do not know whether people with different types of brain damage need the same type of exercise. We will address these questions in a study combining high intensity exercise tailored to the individual together with personalized feedback. Our objectives are to determine 1) the effectiveness of the new personalized treatment approach, 2) whether the amount of training affects the outcome, and 3) whether the amount of damage to brain regions that control movements can tell us about how well a person will recover arm movement using this approach. With technology experts in Israel, we designed a state-of-the-art training device using an arm support and virtual reality. The training uses a special type of error feedback to help the learner automatically use more elbow movement when reaching for objects. This is done by changing the type of feedback the learner receives. We will compare the effect of reaching training in three groups of people who have finished their rehabilitation but are within 12 months of their stroke. After evaluating the person's arm function and scanning their brain to measure how much damage there is from the stroke, individuals will be assigned to different practice groups. Exercise will be done 3 times/wk for 9 wk. We will measure progress after 3, 6 and 9 wk of practice to find out which exercise dose have the best results. We will also measure progress again 4 wks after the end of the training (wk 13) to see if improvements last. Research outcomes are important for guiding treatments for motor recovery.