5th Edition of International Neurology Conference 2026

Abstract

Early mobilization after acute stroke remains a debated topic in stroke rehabilitation literature. Some studies indicate that early mobilization is safe and beneficial in this population^1-3, while others have suggested that very early physical activity worsens neurologic injury^4,5. A study similar to our Phase 1 trial, performed in Taiwan in 2021, demonstrated that survivors of acute stroke who receive up to 2 rehabilitation sessions per day for 5 days per week early in their hospitalization have better functional recovery at 3 months post-stroke⁶. The AVERT Phase II trial was a large, multi-center randomized control trial which concluded that early mobilization within 24 hours of symptom onset of a stroke was both feasible and safe². However, in AVERT Phase III, the very early mobilization group had reduced odds of a favorable outcome 3 months post-stroke compared to the control group⁷. Some argue that this trial has its own limitations, pointing to the fact that the time difference between groups to first mobilization was only 4 hours, likely due to an overall trend of usual care practices moving towards earlier mobility in general⁸. The results of the AVERT trial raised concern that very early mobilization may cause changes in cerebral blood flow and blood pressure leading to worsened stroke outcomes, increased mortality, and increased rate of falls during early mobility.

Motor learning strategies may play a critical role in optimizing rehabilitation during the early post-stroke period. Error augmentation training is a motor learning technique that enhances implicit learning by deliberately amplifying movement errors. Instead of guiding patients toward correct movement patterns, therapists increase task difficulty to promote self-correction and motor adaptation. Error augmentation training in patients with stroke has been shown to improve long-term step length symmetry⁹ and improve hemiparetic upper extremity function^9,10. However, very little research has been performed regarding error augmentation in the acute phase following a stroke, as most of the literature focuses on patients in the subacute or chronic phase of stroke recovery.

Our Phase I pilot trial evaluated the effects of frequent, high-intensity physical therapy incorporating error augmentation during acute stroke hospitalization. Participants receiving frequent error augmentation therapy demonstrated greater improvements in mobility and disability outcomes compared with those receiving standard-of-care therapy.¹¹ Improvements in PASS and AM-PAC scores were notably greater in the experimental group. These findings suggested that early intensive therapy can be safely implemented in shorter sessions during the acute phase following stroke. However, several limitations remained. The pilot study was conducted at a single site with a relatively small sample size, and it was unclear whether improvements were driven by therapy frequency, the intensity of error augmentation training, or the combination of both.

Therefore, the purpose of this study is to compare the effects of frequent early mobilization, intense error augmentation training, the combination of frequent, intense error augmentation therapy, and standard-of-care-therapy. We hypothesize that seeing these patients for early mobility in the acute care setting with shorter, more frequent physical therapy sessions with an emphasis on motor learning through error augmentation training will yield superior functional outcomes. Additionally, we aim to determine whether the improvement in functional gains can be attributed to increased frequency of PT sessions, error augmentation training, or if it is the combination of these two interventions that results in improved functional outcomes. We further hypothesize that increasing treatment frequency while incorporating error augmentation will enhance motor learning and promote better carryover of functional gains.