Background: Many patients after a stroke sustain a significant disability of the upper extremity that limits their daily independence. Using a robotic interface enables the application of high-intensity repetitive training.

Objectives: To investigate the effectiveness of robotic error enhancement (EE) training on motor recovery at sub-acute and chronic stroke.

Methods: Three separated studies were conducted in the last 8 years using EE method. Study 1: (n =41), healthy subjects, 2weeks of training consisting of three 20-min sessions per week. Study 2: Sub-acute phase, an experimental group (n=9) and a control group (n=7), 2weeks of training consisting of three 20-min sessions per week. Study 3: Chronic Phase: (n =22), 3-5 years post stroke, 5 days of 1 hour each of training. A 3D of DeXtreme Robot intervention applying error enhancement forces, whereas control groups carried out the same protocol in null-field conditions.  The robotic rehabilitation intervention was applied in addition to the standard rehabilitation protocol of the rehabilitation center. All participants were assessed at baseline and after training, collecting (1) clinical, (2) patient-reported, and (3) kinematic outcome measures. Motor performance using the DeXtreme robotic device was measured as the Motor error, Number of Movement Units, and the Normalized Jerk Score. Clinical outcome assessments included Motor Assessment Scale (MAS) and Fugl-Meyer (FM).

Results: In all 3 studies, following EE training, the clinical self-reported, clinical scores (Motor Assessment Scale, and Fugl-Meyer scale) and kinematic components (quantification of movement errors, magnitude of movement errors across game-sets, and jerkiness) were improved. 

Conclusions: We conclude that practicing hand-reaching movement in multiple random directions, using the error-enhancement technique, decreases the deviation of the hand trajectory from a straight line, and improves clinical/functional outcomes.

Eli Carmeli was born in Haifa, Israel, in 1955. He received the License Diploma in physical therapy from the Wingate Institute in 1980, the B.PT. degree in physical therapy from Tel Aviv University in 1987, and the Ph.D. degree in medical of Sciences from the Technion–Israel Institute of Technology in 1993. He performed post-doctoral research at the University of Florida in Gainesville, USA. 

After 30 years of a professional career, as a researcher and lecturer in an academic settingת, he is currently a Professor Emeritus. His publications and research interests investigate the aging process both on the cellular and clinical level, physical activity with people with intellectual and developmental disabilities and post stroke individuals. Prof. Carmeli is also serving as a research consultant for Rehabilitative Technologies.