Reward During Arm Training Improves Impairment and Activity After Stroke: A Randomized Controlled Trial

Area of Science:

• Neurorehabilitation
• Motor learning
• Stroke recovery

Background:

• Motor cortex neuroplasticity is key for movement recovery after stroke.
• Dopaminergic pathways in the midbrain may encode reward signals influencing learning.
• Therapist experience suggests feedback and reward enhance training efficacy post-stroke.

Purpose of the Study:

• To investigate if adding performance feedback and monetary rewards can enhance rehabilitative training for stroke patients.
• To test the hypothesis that reward-based interventions improve motor function recovery.

Main Methods:

• A multicenter, assessor-blinded, randomized controlled trial involving 37 subacute stroke patients.
• Utilized the ArmeoSenso virtual reality system for arm-reaching training.
• Compared a group receiving performance feedback and monetary rewards against a control group with minimal feedback.

Main Results:

• No significant difference was observed in the primary outcome (2D reaching space).
• The rewarded group showed significantly greater improvements in secondary outcomes for arm activity (Box and Block Test, Wolf Motor Function Test).
• Significant improvements in arm impairment (Fugl-Meyer Upper Extremity) were noted in the rewarded group at 3-month follow-up.

Conclusions:

• While the primary outcome was neutral, the study suggests a potential facilitating effect of reward on training-mediated improvements in arm paresis.
• Monetary rewards may enhance the efficacy of virtual reality-based neurorehabilitation for stroke survivors.
• Further research is warranted to explore the role of reward in optimizing motor recovery.