Extrinsic feedback for motor learning after stroke: what is the evidence?

Purpose: There is little guidance on using extrinsic feedback to enhance motor learning after stroke. This narrative review synthesises research findings and identifies questions remaining to be answered. Method: A summary is given relating to the use of extrinsic feedback in healthy subjects. Then, research concerning content of feedback, feedback scheduling, and attentional focus is discussed in relation to patients with stroke. Results: Though research is scarce, preliminary key findings were as follows: Patients' balance performance can improve from receiving visual feedback about weight distribution during practice; auditory feedback of force production may improve performance of sit-to-stand; providing feedback on less than 100% of trials, and giving summary or average feedback may enhance learning; instructions or feedback inducing an external focus may be more effective than those with an internal focus. Further research is needed concerning the relative benefits of verbal, visual, video and kinematic feedback; reduced feedback frequencies and summary feedback schedules; feedback delays, error estimation, and self-controlled feedback; and attentional focus of feedback. Conclusions: Although there are some indications that feedback might enhance motor learning after stroke, there are many areas as yet not examined and there is clearly a need for considerable research in this area.