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Upper limb motor impairment is one of the most debilitating sequelae after stroke, thus the aim of rehabilitation is to promote functional recovery and improve quality of life. Surface Electromyography Biofeedback (sEMG-BFB) is a therapeutic tool based on providing amplified neuromuscular information on motor performance to the patient, for enhancing motor learning and driving to a successful recovery. A preliminary pilot longitudinal study was carried out to preliminarily investigate any clinical and instrumental effect due to an innovative treatment based on sEMG-BFB, in stroke survivors. Fifteen stroke patients with impairment of hand function were enrolled for a 3-weeks- training with REcognition MOvement (REMO®), a sEMG-BFB armband, clinical and instrumental assessments were administered before and after the training. After training, statistically significant differences were observed at the Box and Block Test (BBT) and in the relation between changes at BBT and chMAX-chMIN of wrist extension movement. Our results indicated that improvement in the device control is associated to a better hand function. Further studies need to be conducted to investigate the feasibility of using REMO® to study motor behavior in both healthy and diseased subjects.

Key Clinical Message This study shows that neuromuscular taping improves gait, balance, pain and ability to walk and conduct daily activities in a multiple sclerosis patient. It is the first study to identify a panel of miRNAs modulated throughout rehabilitation using neuromuscular taping in a multiple sclerosis patient.

Enhanced feedback provided by virtual reality has been shown to promote motor learning both in healthy subjects and patients with motor impairments following lesions of the central nervous system. The aim of this study is to evaluate the effect of displaying a virtual teacher as visual feedback to promote the recovery of upper limb motor function after a stroke. The protocol reports the design of a single blind randomized controlled trial (RCT), blinded to outcome assessment. Two different treatments based on virtual reality will be compared: in the “Teacher” group, the patients receive treatment with continuous displaying of a virtual teacher, while in the “No-Teacher” group, the same exercises will be proposed without visualization of a virtual teacher. The Fugl-Meyer upper extremity scale will be considered as the primary outcome, while the Functional Independence Measure scale, Reaching Performance Scale and Modified Ashworth Scale will be considered as secondary outcomes. Moreover, kinematic parameters such as mean duration (seconds), mean linear velocity (cm/s) and smoothness (i.e. number of sub-movements) will be registered when performing standardised tasks. All tests will be performed before and after treatments. Both treatments will last four weeks with a daily session lasting one hour, five days a week (20 overall sessions). This study is designed to systematically assess the influence of using enhanced visual feedback for the recovery of upper limb motor function after a stroke. These findings will help to determine whether the use of a virtual teacher as enhanced visual feedback is effective for promoting better recovery of upper limb motor function over four weeks of post-stroke treatment. Current Controlled Trials registration number: NCT02234531 (registered on 29 August 2014, ClinicalTrials. gov) Kiper P., Zucconi C., Agostini M., Baba A., Dipalma F., Berlingieri C., Longhi C., Tonin P., Turolla A. Assessment of virtual teacher feedback for the recovery of the upper limb after a stroke. Study protocol for a randomized controlled trial. Med Rehabil 2016; 20(3): 13-20. DOI: 10.5604/01.3001.0009.5010