Augmented feedback for manual wheelchair propulsion technique training in a virtual reality simulator

Background: Motor learning of appropriate manual wheelchair propulsion is critical, as incorrect technique elevates risk for upper extremity pain. Virtual reality simulators allow users to practice this complex task in a safe and realistic environment. Additionally, augmented feedback (AF) may be provided in order to optimize learning. The purpose of this study was to investigate the effects of providing AF with various delivery schedules on motor learning and transfer of this skill to over-ground propulsion. Methods: Thirty healthy young adults were randomly assigned to three groups. During a virtual reality propulsion training session, the high-frequency AF group received AF in the form of knowledge of performance throughout all propulsion training; the faded AF group received this AF in a faded schedule (high relative frequency of AF early in practice, with relative frequency of AF provision diminishing throughout practice); and the control group underwent training with no AF. Propulsion assessments were performed at baseline and 48 h after practice in both virtual and real environments to measure retention and transfer, respectively. Results: Compared to the control group, both feedback groups exhibited significant improvements in contact angle and push frequency in both environments after training. Small, non-significant between-group differences were also found between the high-frequency and faded feedback groups. Conclusion: Virtual reality training is an effective learning intervention for acquisition, retention, and transfer of appropriate manual wheelchair propulsion technique when such training includes AF regarding propulsion biomechanics.