{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T01:55:28Z","timestamp":1787018128896,"version":"build-2736575974"},"reference-count":66,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"8","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["Stroke"],"published-print":{"date-parts":[[2025,8]]},"abstract":"<jats:sec>\n                    <jats:title>BACKGROUND:<\/jats:title>\n                    <jats:p>After stroke, impairment of hand sensorimotor control leads to improperly scaled and directed fingertip forces that disrupt object manipulation. The objective of this study was to determine the efficacy of finger force magnitude and direction training using 3-dimensional versus 1-dimensional biofeedback to enhance poststroke upper extremity motor recovery.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>METHODS:<\/jats:title>\n                    <jats:p>A double-blind randomized controlled trial took place in the Veterans Affairs laboratory from 2020 to 2023. Forty-five stroke survivors were randomly assigned to the experimental or control group. Both groups received 18 training sessions to generate digit force in the target magnitude and direction. The experimental group trained with visual feedback on the digit force magnitude in 3 dimensions. The control group trained with 1-dimensional visual feedback on the digit force magnitude along the target direction only. The primary outcome was the change in upper extremity function assessed using the Action Research Arm Test post-intervention.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS:<\/jats:title>\n                    <jats:p>\n                      Baseline characteristics were comparable between the groups (mean age, 59 years, 60% male, 40% Black people). The change between pretraining and posttraining Action Research Arm Test scores was significantly greater for the experimental group than for the control group (experimental mean, 3.5 [CI, 2.2\u20134.8] versus control mean, 0.8 [CI, \u22120.5 to 2.1];\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      =0.005). This difference was maintained at 1-month follow-up. Secondary analysis showed that individuals in the experimental group whose stroke occurred within a year prior improved more (mean, 6.1 [CI, 4.0\u20138.3]) than others (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt;0.003).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSIONS:<\/jats:title>\n                    <jats:p>Force direction feedback led to improved upper extremity motor recovery in stroke survivors. This biofeedback-based treatment may provide the needed explicit training in force direction control for more effective hand rehabilitation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>REGISTRATION:<\/jats:title>\n                    <jats:p>\n                      URL:\n                      <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"uri\" xlink:href=\"https:\/\/www.clinicaltrials.gov\">https:\/\/www.clinicaltrials.gov<\/jats:ext-link>\n                      ; Unique identifier: NCT03995069.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1161\/strokeaha.125.050965","type":"journal-article","created":{"date-parts":[[2025,5,22]],"date-time":"2025-05-22T05:01:32Z","timestamp":1747890092000},"page":"2266-2276","update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":3,"title":["Biofeedback Training for 3-Dimensional Finger Force Control to Improve Upper Limb Function Poststroke: An RCT"],"prefix":"10.1161","volume":"56","clinical-trial-number":[{"clinical-trial-number":"nct03995069","registry":"10.18810\/clinical-trials-gov"}],"author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6446-5905","authenticated-orcid":true,"given":"Na Jin","family":"Seo","sequence":"first","affiliation":[{"name":"Ralph H. Johnson Veterans Affairs Health Care System, Charleston, SC (N.J.S., C.S., K.C., J.B., G.S., C.F., A.B., J.G., A.A., K.H., D.T., V.R.)."},{"name":"Division of Occupation Therapy, Department of Rehabilitation Sciences (N.J.S), Medical University of South Carolina, Charleston."},{"name":"Department of Health Sciences and Research (N.J.S., C.S., K.C., J.B., G.S., C.F., A.B., J.G., A.A., K.H., D.T.), Medical University of South Carolina, Charleston."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1102-7180","authenticated-orcid":true,"given":"Christian","family":"Schranz","sequence":"additional","affiliation":[{"name":"Ralph H. Johnson Veterans Affairs Health Care System, Charleston, SC (N.J.S., C.S., K.C., J.B., G.S., C.F., A.B., J.G., A.A., K.H., D.T., V.R.)."},{"name":"Department of Health Sciences and Research (N.J.S., C.S., K.C., J.B., G.S., C.F., A.B., J.G., A.A., K.H., D.T.), Medical University of South Carolina, Charleston."},{"name":"Department of Psychology, University of Innsbruck, Austria (C.S.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kristen","family":"Coupland","sequence":"additional","affiliation":[{"name":"Ralph H. Johnson Veterans Affairs Health Care System, Charleston, SC (N.J.S., C.S., K.C., J.B., G.S., C.F., A.B., J.G., A.A., K.H., D.T., V.R.)."},{"name":"Department of Health Sciences and Research (N.J.S., C.S., K.C., J.B., G.S., C.F., A.B., J.G., A.A., K.H., D.T.), Medical University of South Carolina, Charleston."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3785-3472","authenticated-orcid":true,"given":"Jenna","family":"Blaschke","sequence":"additional","affiliation":[{"name":"Ralph H. Johnson Veterans Affairs Health Care System, Charleston, SC (N.J.S., C.S., K.C., J.B., G.S., C.F., A.B., J.G., A.A., K.H., D.T., V.R.)."},{"name":"Department of Health Sciences and Research (N.J.S., C.S., K.C., J.B., G.S., C.F., A.B., J.G., A.A., K.H., D.T.), Medical University of South Carolina, Charleston."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3861-1371","authenticated-orcid":true,"given":"Gabrielle","family":"Scronce","sequence":"additional","affiliation":[{"name":"Ralph H. Johnson Veterans Affairs Health Care System, Charleston, SC (N.J.S., C.S., K.C., J.B., G.S., C.F., A.B., J.G., A.A., K.H., D.T., V.R.)."},{"name":"Department of Health Sciences and Research (N.J.S., C.S., K.C., J.B., G.S., C.F., A.B., J.G., A.A., K.H., D.T.), Medical University of South Carolina, Charleston."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0520-2034","authenticated-orcid":true,"given":"Christian","family":"Finetto","sequence":"additional","affiliation":[{"name":"Ralph H. Johnson Veterans Affairs Health Care System, Charleston, SC (N.J.S., C.S., K.C., J.B., G.S., C.F., A.B., J.G., A.A., K.H., D.T., V.R.)."},{"name":"Department of Health Sciences and Research (N.J.S., C.S., K.C., J.B., G.S., C.F., A.B., J.G., A.A., K.H., D.T.), Medical University of South Carolina, Charleston."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7483-0360","authenticated-orcid":true,"given":"Adam","family":"Baker","sequence":"additional","affiliation":[{"name":"Ralph H. Johnson Veterans Affairs Health Care System, Charleston, SC (N.J.S., C.S., K.C., J.B., G.S., C.F., A.B., J.G., A.A., K.H., D.T., V.R.)."},{"name":"Department of Health Sciences and Research (N.J.S., C.S., K.C., J.B., G.S., C.F., A.B., J.G., A.A., K.H., D.T.), Medical University of South Carolina, Charleston."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-5200-4433","authenticated-orcid":true,"given":"Ja\u2019Quann","family":"Gallant","sequence":"additional","affiliation":[{"name":"Ralph H. Johnson Veterans Affairs Health Care System, Charleston, SC (N.J.S., C.S., K.C., J.B., G.S., C.F., A.B., J.G., A.A., K.H., D.T., V.R.)."},{"name":"Department of Health Sciences and Research (N.J.S., C.S., K.C., J.B., G.S., C.F., A.B., J.G., A.A., K.H., D.T.), Medical University of South Carolina, Charleston."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Arianna","family":"Alston","sequence":"additional","affiliation":[{"name":"Ralph H. Johnson Veterans Affairs Health Care System, Charleston, SC (N.J.S., C.S., K.C., J.B., G.S., C.F., A.B., J.G., A.A., K.H., D.T., V.R.)."},{"name":"Department of Health Sciences and Research (N.J.S., C.S., K.C., J.B., G.S., C.F., A.B., J.G., A.A., K.H., D.T.), Medical University of South Carolina, Charleston."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-8604-9081","authenticated-orcid":true,"given":"Keith","family":"Howard","sequence":"additional","affiliation":[{"name":"Ralph H. Johnson Veterans Affairs Health Care System, Charleston, SC (N.J.S., C.S., K.C., J.B., G.S., C.F., A.B., J.G., A.A., K.H., D.T., V.R.)."},{"name":"Department of Health Sciences and Research (N.J.S., C.S., K.C., J.B., G.S., C.F., A.B., J.G., A.A., K.H., D.T.), Medical University of South Carolina, Charleston."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5224-1098","authenticated-orcid":true,"given":"Devin","family":"Thompson","sequence":"additional","affiliation":[{"name":"Ralph H. Johnson Veterans Affairs Health Care System, Charleston, SC (N.J.S., C.S., K.C., J.B., G.S., C.F., A.B., J.G., A.A., K.H., D.T., V.R.)."},{"name":"Department of Health Sciences and Research (N.J.S., C.S., K.C., J.B., G.S., C.F., A.B., J.G., A.A., K.H., D.T.), Medical University of South Carolina, Charleston."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4098-0539","authenticated-orcid":true,"given":"Viswanathan","family":"Ramakrishnan","sequence":"additional","affiliation":[{"name":"Ralph H. Johnson Veterans Affairs Health Care System, Charleston, SC (N.J.S., C.S., K.C., J.B., G.S., C.F., A.B., J.G., A.A., K.H., D.T., V.R.)."},{"name":"Department of Public Health Sciences (V.R.), Medical University of South Carolina, Charleston."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5269-9632","authenticated-orcid":true,"given":"Christine A.","family":"Holmstedt","sequence":"additional","affiliation":[{"name":"Department of Neurology (C.A.H.), Medical University of South Carolina, Charleston."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9048-4106","authenticated-orcid":true,"given":"Derek G.","family":"Kamper","sequence":"additional","affiliation":[{"name":"Lampe Joint Department of Biomedical Engineering, North Carolina State University, University of North Carolina at Chapel Hill, Raleigh (D.G.K.)."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"key":"e_1_3_3_2_2","doi-asserted-by":"publisher","DOI":"10.1007\/s12975-015-0435-5"},{"key":"e_1_3_3_3_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.gaitpost.2008.12.015"},{"key":"e_1_3_3_4_2","doi-asserted-by":"publisher","DOI":"10.13066\/kspm.2022.17.4.45"},{"key":"e_1_3_3_5_2","doi-asserted-by":"publisher","DOI":"10.1161\/01.STR.0000204063.75779.8d"},{"key":"e_1_3_3_6_2","doi-asserted-by":"publisher","DOI":"10.1518\/001872008X250692"},{"key":"e_1_3_3_7_2","doi-asserted-by":"publisher","DOI":"10.1080\/00140130802578555"},{"key":"e_1_3_3_8_2","doi-asserted-by":"publisher","DOI":"10.1152\/jn.00088.2020"},{"key":"e_1_3_3_9_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jbiomech.2011.03.020"},{"key":"e_1_3_3_10_2","doi-asserted-by":"publisher","DOI":"10.1080\/00140139.2011.606923"},{"key":"e_1_3_3_11_2","doi-asserted-by":"publisher","DOI":"10.1177\/0018720811420256"},{"key":"e_1_3_3_12_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jbiomech.2014.11.046"},{"key":"e_1_3_3_13_2","doi-asserted-by":"publisher","DOI":"10.1080\/00222895.1994.9941688"},{"key":"e_1_3_3_14_2","volume-title":"The Grasping Hand","author":"MacKenzie CL","year":"1994","unstructured":"MacKenzie CL, Iberall T. The Grasping Hand. 1st ed. Elsevier Science; 1994.","edition":"1"},{"key":"e_1_3_3_15_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.conb.2008.11.006"},{"key":"e_1_3_3_16_2","doi-asserted-by":"publisher","DOI":"10.1161\/01.str.32.6.1279"},{"key":"e_1_3_3_17_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIR.0000000000001123"},{"key":"e_1_3_3_18_2","doi-asserted-by":"publisher","DOI":"10.1161\/STROKEAHA.111.674671"},{"key":"e_1_3_3_19_2","doi-asserted-by":"publisher","DOI":"10.1152\/jn.00130.2003"},{"key":"e_1_3_3_20_2","doi-asserted-by":"publisher","DOI":"10.1152\/jn.00936.2009"},{"key":"e_1_3_3_21_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.apergo.2013.10.014"},{"key":"e_1_3_3_22_2","doi-asserted-by":"publisher","DOI":"10.1093\/brain\/awh432"},{"key":"e_1_3_3_23_2","doi-asserted-by":"publisher","DOI":"10.3389\/fnhum.2021.662006"},{"key":"e_1_3_3_24_2","doi-asserted-by":"publisher","DOI":"10.1186\/s12984-023-01213-9"},{"key":"e_1_3_3_25_2","doi-asserted-by":"publisher","DOI":"10.1097\/00002060-200212000-00002"},{"key":"e_1_3_3_26_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jht.2009.10.004"},{"key":"e_1_3_3_27_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jbiomech.2007.04.023"},{"key":"e_1_3_3_28_2","doi-asserted-by":"publisher","DOI":"10.1518\/001872008X250610"},{"key":"e_1_3_3_29_2","doi-asserted-by":"publisher","DOI":"10.1518\/001872008X354192"},{"key":"e_1_3_3_30_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00221-010-2193-7"},{"key":"e_1_3_3_31_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00221-015-4241-9"},{"key":"e_1_3_3_32_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.apmr.2010.08.016"},{"key":"e_1_3_3_33_2","doi-asserted-by":"publisher","DOI":"10.1186\/s13063-022-06224-w"},{"key":"e_1_3_3_34_2","doi-asserted-by":"publisher","DOI":"10.1161\/01.str.24.1.58"},{"key":"e_1_3_3_35_2","doi-asserted-by":"publisher","DOI":"10.1161\/str.23.6.919a"},{"key":"e_1_3_3_36_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.apmr.2013.03.007"},{"key":"e_1_3_3_37_2","doi-asserted-by":"publisher","DOI":"10.1310\/tsr2104-319"},{"key":"e_1_3_3_38_2","doi-asserted-by":"publisher","DOI":"10.3200\/JMBR.36.2.212-224"},{"key":"e_1_3_3_39_2","doi-asserted-by":"publisher","DOI":"10.1080\/00140130903287999"},{"key":"e_1_3_3_40_2","doi-asserted-by":"publisher","DOI":"10.1038\/nn.2596"},{"key":"e_1_3_3_41_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.clinph.2017.04.028"},{"key":"e_1_3_3_42_2","doi-asserted-by":"publisher","DOI":"10.1177\/1545968317697033"},{"key":"e_1_3_3_43_2","doi-asserted-by":"publisher","DOI":"10.1152\/jn.91108.2008"},{"key":"e_1_3_3_44_2","doi-asserted-by":"publisher","DOI":"10.1093\/brain\/awl278"},{"key":"e_1_3_3_45_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.clinph.2010.10.035"},{"key":"e_1_3_3_46_2","doi-asserted-by":"publisher","DOI":"10.1080\/00140130903389035"},{"key":"e_1_3_3_47_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jht.2013.04.006"},{"key":"e_1_3_3_48_2","doi-asserted-by":"publisher","DOI":"10.1080\/00222895.2016.1191416"},{"key":"e_1_3_3_49_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.pain.2011.06.003"},{"key":"e_1_3_3_50_2","unstructured":"National Institute of Neurological Disorders and Stroke. Adverse event relatedness scale. Accessed March 18 2022. https:\/\/cde.nlm.nih.gov\/deView?tinyId=XrsKeH6EJCC"},{"key":"e_1_3_3_51_2","unstructured":"US Department of Health and Human Services National Institutes of Health National Cancer Institute. Common Terminology Criteria for Adverse Events (CTCAE) version 5.0. Accessed March 18 2022. https:\/\/ctep.cancer.gov\/protocolDevelopment\/electronic_applications\/ctc.htm#ctc_50"},{"key":"e_1_3_3_52_2","doi-asserted-by":"publisher","DOI":"10.1080\/165019701750165916"},{"key":"e_1_3_3_53_2","doi-asserted-by":"publisher","DOI":"10.1177\/1545968307305353"},{"key":"e_1_3_3_54_2","doi-asserted-by":"publisher","DOI":"10.1191\/0269215505cr832oa"},{"key":"e_1_3_3_55_2","doi-asserted-by":"publisher","DOI":"10.1682\/jrrd.2009.09.0155"},{"key":"e_1_3_3_56_2","doi-asserted-by":"publisher","DOI":"10.1177\/1545968308331146"},{"key":"e_1_3_3_57_2","doi-asserted-by":"publisher","DOI":"10.1177\/1545968309356295"},{"key":"e_1_3_3_58_2","doi-asserted-by":"publisher","DOI":"10.2522\/ptj.20110009"},{"key":"e_1_3_3_59_2","doi-asserted-by":"publisher","DOI":"10.1152\/jn.00762.2018"},{"key":"e_1_3_3_60_2","doi-asserted-by":"publisher","DOI":"10.1177\/1539449218757740"},{"key":"e_1_3_3_61_2","doi-asserted-by":"publisher","DOI":"10.1002\/ana.24734"},{"key":"e_1_3_3_62_2","doi-asserted-by":"publisher","DOI":"10.3389\/fneur.2021.667340"},{"key":"e_1_3_3_63_2","doi-asserted-by":"publisher","DOI":"10.1186\/s12984-017-0252-z"},{"key":"e_1_3_3_64_2","doi-asserted-by":"publisher","DOI":"10.1177\/2055668318793585"},{"key":"e_1_3_3_65_2","doi-asserted-by":"publisher","DOI":"10.1109\/TNSRE.2021.3090571"},{"key":"e_1_3_3_66_2","doi-asserted-by":"publisher","DOI":"10.1523\/JNEUROSCI.4993-07.2008"},{"key":"e_1_3_3_67_2","doi-asserted-by":"publisher","DOI":"10.1152\/jn.00123.2017"}],"container-title":["Stroke"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ahajournals.org\/doi\/full\/10.1161\/STROKEAHA.125.050965","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,8,7]],"date-time":"2025-08-07T15:08:40Z","timestamp":1754579320000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ahajournals.org\/doi\/10.1161\/STROKEAHA.125.050965"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,8]]},"references-count":66,"journal-issue":{"issue":"8","published-print":{"date-parts":[[2025,8]]}},"alternative-id":["10.1161\/STROKEAHA.125.050965"],"URL":"https:\/\/doi.org\/10.1161\/strokeaha.125.050965","relation":{},"ISSN":["0039-2499","1524-4628"],"issn-type":[{"value":"0039-2499","type":"print"},{"value":"1524-4628","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,8]]},"assertion":[{"value":"2025-02-03","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-04-23","order":1,"name":"revised","label":"Revised","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-04-28","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-05-22","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}