The Use of Extrinsic Performance Feedback and Reward to Enhance Upper Limb Motor Behavior and Recovery Post-Stroke: A Scoping Review.

The included studies were small. Between-group studies ranged from N = 11 to 45 participants, and within-participant studies, excluding case series, ranged from N = 5 to 43. Many studies excluded participants with cognitive impairment, aphasia, or neglect, so the results may not apply to patients with these common stroke-related problems. Stroke type, lesion location, vascular territory, and chronicity were often not reported, and no study analyzed whether these factors changed feedback effects. Clinical benefits were inconsistent. Only 4 studies showed benefits exceeding minimum clinically important difference thresholds, and those thresholds were not available for several measures. The review included pilots, case series, and small crossover experiments, so it maps evidence rather than proving that a feedback system works. Direct comparisons of feedback modality, timing, frequency, valence, and motivational elements were rare, so therapists cannot know which feedback design to choose. Motor learning and compensation effects were often measured in simple reaching tasks, and only limited evidence tested generalization to daily activities or long-term recovery.

The authors declared no potential conflicts of interest. The paper disclosed that DJP was supported by a postdoctoral fellowship from the Canadian Institutes of Health Research.

Do not conclude that gamified or reward feedback is proven to improve upper-limb recovery. The review included small, heterogeneous studies, and only four clinical-outcome studies exceeded minimum clinically important difference thresholds.