Abstract— Previous studies have shown that the motor training in a virtual-environment with the augmented feedback promotes motor learning in normal subjects and in long-term post-stroke patients. We evaluated whether this approach could be useful also for treating patients with arm motor deficits due to a recent stroke. Thirty-eight patients were included in the study within 3 months from an ischemic stroke in the territory of the middle cerebral artery. Twenty-five subjects received training with the Reinforced Feedback in Virtual Environment (RFVE) therapy for the arm, and thirteen patients received an equal amount of a conventional rehabilitation (CR) therapy focused to the upper limb. Before and after therapy, the autonomy of daily living activities were assessed with the Functional Independence Measure (FIM) and the degree of motor impairment was measured with the Fugl-Meyer scale for the upper extremity (FM-UE). The RFVE therapy group showed significant improvements in the FM-UE and the FIM scale mean scores. The conventional therapy determined smaller and not statistically significant scores improvements. These data indicate that the recovery of arm motor function in patients after a recent stroke appear to be speeded up by an augmented feedback provided in a virtual-environment. I. INTRODUCTION REVIOUS evidence on healthy subjects has demonstrated that appropriate feedback on the nature of the movement (knowledge of performance) and some variables of outcome (knowledge of results) may help to temporarily or permanently improve motor performance [1] – [6]. In this regard, computer-based systems can provide subjects with artificially-enhanced feedback that may facilitate the acquisition of new motor skills. Todorov and co-workers reported that training in virtual environments Manuscript received April 23, 2007. L. Piron is with the IRCCS San Camillo Hospital, via Alberoni 70, 30126 Lido di Venezia, Venezia, Italy (+39 041 2207214; fax: +39 041 731330; e-mail: lab.neuroscienze@ospedalesancamillo.net ). P. Tombolini as Ordinary Associate of A.I.FI. (Associazione Italiana Fisioterapisti)) (e-mail: ptombolini@libero.it ). A. Turolla is with the IRCCS San Camillo Hospital, via Alberoni 70, 30126 Lido di Venezia, Venezia, Italy (e-mail: andreaturolla@tin.it ). C. Zucconi is with the IRCCS San Camillo Hospital, via Alberoni 70, 30126 Lido di Venezia, Venezia, Italy (e-mail: silvazu@hotmail.com ). M. Agostini is with the IRCCS San Camillo Hospital, via Alberoni 70, 30126 Lido di Venezia, Venezia, Italy (e-mail: miki.ago@libero.it ). M. Dam is with the Dept. of Neurology and Psychiatry, University of Padova, via Giustiniani 5, 35218 Padova, Italy (mauro.dam@unipd.it ). G. Santarello is with the IRCCS San Camillo Hospital, via Alberoni 70, 30126 Lido di Venezia, Italy (e-mail: giosantarello@hotmail.com ). F. Piccione is with the IRCCS San Camillo Hospital, via Alberoni 70, 30126 Lido di Venezia, Italy (e-mail: piccioneparinello@aliceposta.it ). P. Tonin is with the IRCCS San Camillo Hospital, via Alberoni 70, 30126 Lido di Venezia, Venezia, Italy (e-mail: patonin@tin.it ). with enhanced feedback promotes the learning of complex multi-join motor task, better than conventional methods [7]. Preliminary reports have indicated that a virtual-reality based therapy improves upper-limb motor performance in the chronic phase after stroke [8] – [11]. Along this line, we evaluated whether this approach could be useful also for treating patients with arm motor deficits due to a recent stroke. II. METHODS Thirty-eight patients were included in the study; they were suffering from mild/intermediate arm motor impairments due to an ischemic stroke, occurring within three months before the study. All patients presented a mild to intermediate arm impairment. The demographic characteristics of the 38 patients are summarized in Table I. TABLE I GROUPS’ DEMOGRAPHIC CHARACTERISTICS All patients (n.=38) RFVE Group Age, years ± SD Sex, M/F Stroke to rehabilitation interval, months ± SD 61.5 ± 9.4 17/8 2.5 ± 1.5 Control Group Age, years ± SD Sex, M/F Stroke to rehabilitation interval, months ± SD 61.2 ± 6.6 8/5 2.6 ± 1.6 Twenty-five subjects (RFVE Group) received Reinforced Feedback in Virtual Environment (RFVE) therapy for the arm, and thirteen patients (Control Group) received an equal amount of a conventional rehabilitation (CR) therapy focused to the upper limb. Before and after therapy, the autonomy of daily living activities were assessed with the Functional Independence Measure (FIM) and the degree of motor impairment was measured with the Fugl-Meyer scale for the upper extremity (FM-UE). For both groups the therapy lasted from 5 to 7 weeks, 1 hour daily for five days a week. The equipment used for the RFVE therapy consisted of a PC workstation, a high-resolution LCD projector, a 3D motion-capture system (Polhemus 3Space Fastrack, Vermont, U.S.A.), and a dedicated software, developed at Massachusetts Institute of Technology U.S.A., for processing data and creating the virtual environment. Reinforced Feedback in Virtual Environment Facilitates the Arm Motor Recovery in Patients after a Recent Stroke Lamberto Piron, Paolo Tombolini, Andrea Turolla, Carla Zucconi, Michela Agostini, Mauro Dam, Giovanna Santarello, Francesco Piccione and Paolo Tonin P 121 1-4244-1204-8/07/$25.00 ©2007 IEEE