Different kinds of feedbacks are used to help stroke patients in the upper limb recovery. Even that, is still not clear if feedback modalities represented a facilitation or an overload in the rehabilitation course after stroke. Aim of the study was to assess if the use of an on-line virtual teacher improved or decreased the motor impairment in stroke patients.

A randomized controlled trial was conduced enrolling 33 ischemic stroke in-patients, divided in three groups. The first two groups received a validated treatment based on virtual reality with or without the visualization of a virtual teacher (respectively EVER TEACHER and NO TEACHER groups). The third group (CONTROL) received only traditional rehabilitation. Before and after the treatment clinical (Fugl – Meyer Upper Extremity, F-M UE; Modified Asworth Scale; Reaching Performance Scale, RPS; Functional Independence Measure, FIM) and kinematics (duration and velocity of standardized reaching movements) outcomes were assessed. All the treatments
lasted four weeks with five sessions/week of 60 minutes.

Only the EVER TEACHER (respectively F-M UE, P=0.003; RPS, P=0.028; FIM, P=0.005) and NO TEACHER (respectively F-M UE, P=0.003; RPS, P=0.027; FIM, P=0.007) groups significantly increased the clinical outcomes after treatment. The Asworth Scale did not change significantly in neither groups. Only the velocity in the EVER TEACHER group significantly changed after the treatment.
Data suggested that this feedback may be useful to improve upper limb movements after stroke. Bigger sample size are needed to better understand the clinical effectiveness in using a virtual teacher.

The VR treatments in this study were made with our VRRS System.