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In general, performance improvement of tasks depends on the amount of practice. Practice can be achieved in several ways, including:

• Massed practice where the patient repeats the exact same task or movement many times
• Distributed practice where there are rest periods of increasing frequency and duration during a practice session
• Variability of the practice tasks where there are variations of different intensities in the practice session - e.g. reaching randomly for a few different items in a random order instead of focusing on one target object. The introduction of variability into practice session has been shown to improve "retention" of the skill being practiced on subsequent sessions. In addition, variability of practice is thought to increase "generalization" of the movement being practiced to new tasks, meaning that the patient is able to transfer the skill of what they are practicing to other situation, hopefully involving activities of daily living (ADL).

These elements of practice are all incorporated into the various applications and techniques which have been developed based on the motor learning theory.

Other Rehabilitation Techniques

• Arm ability training for patients with mild hemiparesis. The mild deficits experienced by these patients are most likely to affect their return to work after their stroke. Training tasks include arm-hand steadiness, hand grip, aimed reaching, tracking, and wrist-finger speed.
• Neuromuscular stimulation, also called functional electric stimulation, may significantly increase motor recovery
• Interactive robotic therapy where the patient initiates a movement and a robot then assists them in completing the movement or provides resistance either to an improper movement or as progressive resistance training for the affected arm. Use of robotic therapy, in additional to conventional rehabilitation, has been shown in a limited number of subjects to have significantly greater benefit on measurements of impairment and on ADLs than conventional therapy alone.
• Bilateral movement training based on the theory of interlimb coordination, meaning that voluntary movements of the healthy, unaffected limb may facilitate movement in the affected limb. Cumulative evidence from a review of several studies that investigated results from bilateral movement training for paretic arms indicates that bilateral movement training, with or without auditory cuing or sensory feedback, is effective in improving motor capabilities and functional outcome for poststroke patients with a paretic limb in the sub-acute or chronic (6 months or longer from stroke onset) phase of recovery. This applies when the training is used either as a single protocol or combined with other training.
• Virtual reality training has been used in small pilot studies but has not undergone controlled clinical trials. A simulated environment is created for retraining exercises for motor function. The extent to which training carries over from the simulated environment to an actual physical environment is not clear.
• Transcutaneous electrical nerve stimulation (TENS) may increase motor function without affecting pain or spasticity.
• Electromyographic (EMG) biofeedback may significantly improve motor recovery in the arm, but not in the leg. To date, studies examining the efficacy of EMG biofeedback are inconclusive. It may be more effective when combined with other training such as robotic training and other types of feedback such as positional biofeedback which helps patients orient themselves in space. EMG biofeedback may also be combined with neuromuscular stimulation.