Augmented feedback is typically defined as performance- or outcome-related information presented to a motor skill learner in a practice environment (Schmidt & Lee, 2001). This information, which supplements naturally-occurring, task-intrinsic information, has been found to facilitate motor skill learning (Salmoni, et al., 1984). These benefits to motor learning, however, are mediated by several factors including the sensory channel (modality) in which feedback is presented. While augmented feedback presented visually does not typically produce lasting benefits to skilled performance (Sigrist et al, 2013), research in related areas suggests that augmented feedback presented in an audiovisual fashion may benefit motor learning in ways that overcome the limitations of unimodal visual research. Building off this research, the current series of experiments examined how augmented feedback presented audiovisually influenced motor learning of a simple motor task relative to augmented feedback presented either visually or aurally. The first experiment, subjects performed a novel steering task with their non-dominant hand and were tasked with staying within a pre-established boundary. During the practice phase, participants received concurrent feedback regarding their performance. Participants were then tested 24-hours post-practice to examine how feedback presented during practice would affect performance on no-feedback retention and transfer tests. Results from this study indicated that both audiovisual and aural feedback presented during practice facilitate motor learning, whereas feedback presented visually does not. In the second experiment, participants completed the steering task used in experiment one but with an additional timing component added. During practice participants were given two simultaneous streams of concurrent feedback presented either multimodally (e.g. timing information presented aurally, spatial information presented visually) or unimodally (e.g. both timing and spatial information presented aurally). Results from the second study indicated that modally-appropriate multimodal feedback facilitated motor learning to a greater degree than unimodal feedback even when multiple streams of information are presented within the augmented feedback. Theoretical and practical implications are further discussed.

Transforming human movement into live sound can be used as a method to enhance motor skill learning via the provision of augmented perceptual feedback. A small but growing number of studies hint at the substantial efficacy of this approach, termed 'movement sonification'. However there has been sparse discussion in Psychology about how movement should be mapped onto sound to best facilitate learning. The current thesis draws on contemporary research conducted in Psychology and theoretical debates in other disciplines more directly concerned with sonic interaction - including Auditory Display and Electronic Music-Making - to propose an embodied account of sonification as feedback. The empirical portion of the thesis both informs and tests some of the assumptions of this approach with the use of a custom bimanual coordination paradigm. Four motor skill learning studies were conducted with the use of optical motion-capture. Findings support the general assumption that effective mappings aid learning by making task-intrinsic perceptual information more readily available and meaningful, and that the relationship between task demands and sonic information structure (or, between action and perception) should be complementary. Both the theoretical and empirical treatments of sonification for skill learning in this thesis suggest the value of an approach which addresses learner experience of sonified interaction while grounding discussion in the links between perception and action.

Stroke is a chronic, lifelong illness, and full recovery requires continuous physical and cognitive rehabilitation. Such long-term rehabilitation is cost-prohibitive; however an approach to providing long-term therapy that has recently gained traction is the use of socially assistive agent (SAA) systems. These systems make use of non-contact communication devices and can be used to guide people through a variety of rehabilitative tasks. They have the potential supplement current rehabilitation practices by providing motivation during intense exercises, and can extend the reach of the therapist into remote and home settings. Though SAA systems have been used in a variety of rehabilitative and assistive contexts, there remain questions regarding the best design for such systems. Currently there is a lack of detail on what type of feedback optimizes user performance, and the role that the delivery medium (e.g., a human coach, a tablet, or a robot) plays in user performance. The purpose of this thesis is the design of a system to investigate the interaction between feedback and medium type when implemented for a novel motor task. The selected task is modeled on the shuffleboard game, with the delivery medium including a human coach and tablet and two types of augmented feedback. The designed system incorporates various hardware and software components. A vision system communicates with a laptop to record and analyze motor task data, with a program that also interfaces with a control circuit. The control circuit may transmit data through Bluetooth to a custom-built app on the tablet, which then provides augmented feedback with audio dialogue. Otherwise, the human coach is provided designed feedback from the laptop. An initial system evaluation was performed with this constructed system using pilot participants to validate the design. The initial system evaluation demonstrated the ability to improve participant performance; however, it also demonstrated a high level of task difficulty. Several changes may need to be incorporated to the system to ensure better learning for participants. This includes changes to the physical setup, as well as changes to the frequency of the augmented feedback. This thesis may be used as the foundation for future experimentation with different delivery media or types of augmented feedback to discover how to best optimize user performance for a novel motor task.

No / Modification of high-risk movement strategies such as dynamic knee valgus is key to the reduction of anterior cruciate ligament (ACL) and patellofemoral joint (PFJ) injuries. Augmented feedback, which includes video and verbal feedback, could offer a quick, simple and effective alternative to training programs for altering high-risk movement patterns. It is not clear whether feedback can reduce dynamic knee valgus measured using frontal plane projection angle (FPPA). Methods Vertical ground reaction force (vGRF), two-dimensional FPPA of the knee, contact time and jump height of 20 recreationally active university students were measured during a drop jump task pre- and post- an augmented feedback intervention. A control group of eight recreationally active university students were also studied at baseline and repeat test. Results There was a significant reduction in vGRF (p = 0.033), FPPA (p < 0.001) and jump height (p < 0.001) and an increase in contact time (p < 0.001) post feedback in the intervention group. No changes were evident in the control group. Conclusion Augmented feedback leads to significant decreases in vGRF, FPPA and contact time which may help to reduce ACL and PFJ injury risk. However, these changes may result in decreased performance. Clinical relevance Augmented feedback reduces dynamic knee valgus, as measured via FPPA, and forces experienced during the drop jump task and therefore could be used as a tool for helping decrease ACL and PFJ injury risk prior to, or as part of, the implementation of injury prevention training programs.

Environ 75 % des personnes ayant eu un accident vasculaire cérébral (AVC) sont atteintes de déficiences sensorimotrices à la main qui persistent après la réadaptation fonctionnelle intensive. Pour optimiser la récupération de ces personnes, un programme de réadaptation basé sur la pratique intensive de tâches spécifiques inspirées de la vie quotidienne (ex : la préhension) et couplée avec différentes rétroactions, est recommandé. Ces tâches doivent contenir un certain niveau de difficulté, doivent être progressivement adaptées, et impliquer une participation active de la personne. Toutefois, la mise en œuvre d’un tel programme est parfois entravée par des contraintes clinico-administratives. Dans cette perspective, l'utilisation de gants souples robotisés couplés à un environnement de réalité virtuelle, en complément à la thérapie conventionnelle et supervisée de manière indirecte par des professionnels, représente une solution prometteuse. L'objectif général de cette thèse vise la poursuite du développement d’une intervention technologique émergente utilisant un gant souple robotisé pour intensifier la réadaptation sensorimotrice de la main après un AVC. Pour ce faire, trois étapes ont été déployées dans le présent doctorat : La première visait, par l’intermédiaire d’une étude mixte, à évaluer la facilité d'utilisation et l'utilité perçue d'un prototype de gant souple robotisé pour optimiser la fonction de la main post-AVC auprès de 14 ergothérapeutes experts. Cette première étude confirme que les ergothérapeutes perçoivent positivement le gant souple robotisé en tant qu'outil de réadaptation et suggère de tenir compte de certains facteurs, se rattachant notamment aux différents domaines de la Théorie unifiée de l'acceptation et de l'utilisation des technologies (UTAUT) (c.-à-d. utilité perçue, facilité d’utilisation perçue, influence sociale, conditions facilitantes) dans la poursuite de son développement. La deuxième visait, par l’intermédiaire d’une étude mixte avec approche de conception centrée sur l’utilisateur, à co-développer une interface d'exploitation supportant l'utilisation d'un gant souple robotisé couplé à un environnement virtuel, et d’en évaluer sa facilité d'utilisation auprès de 14 personnes atteintes d’hémiparésie de la main à la suite d’un AVC. Cette deuxième étude confirme que cette interface d'exploitation présente un haut niveau d’utilisabilité (moyenne=87,0/100; SD=11,6) au « System Usability Scale ». De plus, 74 recommandations visant à améliorer l'interface d'exploitation, ses 3 fonctionnalités, et ses exercices ont été formulés au cours de deux cycles itératifs, aboutissant à des améliorations subséquentes à la version préliminaire. La troisième visait, par l’intermédiaire d’une étude préliminaire de faisabilité, à évaluer la faisabilité, la sécurité, les effets préliminaires et la satisfaction du nouveau programme d'exercices co-développé à l’étape précédente combinant le gant souple robotisé et l'environnement de réalité virtuelle auprès de 11 personnes atteintes d’hémiparésie de la main à la suite d’un AVC récent. Cette troisième étude confirme la faisabilité du programme, avec des taux d'assiduité et de conformité atteignant respectivement 96 % et 95 %. Elle démontre également une augmentation notable du nombre de répétitions de mouvement de la main dépassant les 2543 répétitions sur deux semaines (médiane des répétitions/séance = 260) avec un soutien professionnel minimal (indépendance médiane acquise en six séances). De plus, des améliorations individuelles, allant au-delà des changements minimaux détectables ou importants sur le plan clinique de différents tests fonctionnels (ex : ARAT, FMA-UE, BBT et ABILHAND), sont mesurées, ainsi qu’un niveau de satisfaction élevé vis-à- vis du programme (médiane = 5/5). L’engagement dans un processus d'amélioration continu est essentiel pour maximiser l'utilité et la facilité d'utilisation du nouveau programme d’exercices. La combinaison du gant souple robotisé et de son environnement de réalité virtuelle, développée dans le cadre de cette thèse, est perçue par les ergothérapeutes et les personnes ayant eu un AVC comme acceptable et utile pour intensifier la neuroréadaptation. De plus, ce nouveau programme d'exercices est faisable, sécuritaire, bénéfique et satisfaisant pour les utilisateurs finaux ciblés. Un futur essai contrôlé randomisé multicentrique est suggéré pour évaluer son efficacité (effet de supériorité) et envisager son intégration dans les milieux cliniques. / Approximately 75% of individuals who have had a stroke experience sensorimotor impairments in their hand that persist beyond their discharge from intensive functional rehabilitation. To optimize recovery, a program based on repetition, intensity, task specificity and the combination of various sensory feedback mechanisms is recommended. However, implementing these recommendations in clinical practice is often hindered by clinical and administrative constraints. From this perspective, the use of soft robotic gloves, coupled with a virtual reality environment as an adjunct to conventional therapy and indirectly supervised by professionals, represents a promising intervention. The overarching goal of this thesis is to further develop an emerging technological intervention, based on key neuroplasticity principles, to enhance sensorimotor hand rehabilitation post-stroke. To achieve this, three phases were deployed in this doctoral research program. The first phase aimed to assess the ease of use and perceived utility of a soft robotic glove prototype for post-stroke hand function recovery among 14 expert occupational therapists (OTs) via a mixed-method study. This initial study confirmed positive perceptions towards the soft robotic glove among OTs and suggested considering factors related to the Unified Theory of Acceptance and Use of Technology (UTAUT) (i.e. performance expectancy, effort expectancy, social influence, facilitating conditions) in its ongoing development. The second phase aimed to co-develop an operating interface supporting the use of a soft robotic glove coupled with a virtual environment and assess its usability among 14 individuals with hand hemiparesis post-stroke through a mixed-method study using a user-centered design approach. This study confirmed the high usability of the co-developed operating interface (mean=87.0; SD=11.6) on the System Usability Scale. Additionally, from two iterative cycles, 74 recommendations for interface, functionality, and exercise improvements were formulated, leading to subsequent enhancements to the preliminary version of the glove and software. 5 The third phase aimed to evaluate the feasibility, safety, preliminary effects, and security of the newly co-developed exercise program involving a soft robotic glove and a virtual reality environment among 11 individuals with hand hemiparesis following a recent stroke through a randomized feasibility study. This study confirmed the feasibility of the program, with attendance and compliance rates reaching 96% and 95%, respectively. It also demonstrates a significant increase in the number of hand movement repetitions performed by participants (exceeding 2543 over two weeks (median repetitions/session = 260) with minimal professional supervision (median independence achieved in six sessions). Furthermore, individual improvements beyond minimal detectable or clinically important changes were detected on various functional tests (e.g., ARAT, FMA-UE, BBT, and ABILHAND), along with high satisfaction levels regarding the intervention (median = 5/5). Commitment to a continuous improvement process is crucial to maximize the utility and ease of use of this technological intervention. The combination of the soft robotic glove and virtual reality environment developed in this thesis were perceived as acceptable and useful by both OTs and individuals who had a recent stroke for enhancing neurorehabilitation. Moreover, the exercise program associated with this technology is feasible, safe, beneficial, and satisfying for individuals recently affected by a stroke. A future multicenter randomized controlled trial is suggested to evaluate its effectiveness and consider its integration into clinical settings.