Date Presented 04/03/2025
This study investigated the effect of self-controlled practice (making choices during motor task practice) on motor learning and psychological outcomes for adults with upper limb impairment after stroke.
Primary Author and Speaker: Lauren Winterbottom
Additional Authors and Speakers: Dawn Nilsen, Glen Gillen
Contributing Authors: Lori Quinn, Daniel Geller, Michael Spinner, Joel Stein
PURPOSE: Stroke can cause persistent, debilitating impairments in upper limb (UL) function (Roby-Brami et al., 2021) necessitating extensive retraining. Self-controlled practice (SCP) involves making choices during motor skill practice and has been integrated into complex UL interventions for stroke (Kim et al., 2023; Lewthwaite et al., 2018). SCP improves motor learning (ML) in healthy adults and may improve psychological outcomes (Wulf & Lewthwaite, 2016). The purpose of this study was to investigate the effect of SCP on ML and psychological outcomes for adults with stroke.
DESIGN: Experimental.
METHOD: Sixteen adults aged 40-75 with chronic post-stroke UL impairment were paired and randomized into experimental (EG) and control (CG) groups. All subjects practiced a standardized simulated feeding task for two consecutive days. Each day, subjects practiced with both their more affected hand (10 blocks of 5 trials) and less affected hand (10 blocks of 2 trials). EG subjects chose the order they practiced blocks of trials. CG subjects followed the order chosen by the EG subject they were paired with. ML outcomes included retention of the trained task and transfer of learning to an untrained task 24 hours after practice completion. Psychological outcomes included the Intrinsic Motivation Inventory (IMI), self-efficacy, and mood.
RESULTS: Both groups improved significantly on trained and untrained tasks, with no significant differences between groups on ML or psychological measures. However, there was a strong significant association (r = .647, p = .007) between the ‘perceived choice’ IMI subscale following practice and improvement on the untrained transfer task.
CONCLUSION: While SCP did not have a significant effect on ML, perceived choice may be a relevant factor for ML after stroke. More research on SCP with the stroke population is needed.
IMPACT STATEMENT: Occupational therapists can consider incorporating SCP into motor practice based on individual preferences.
References
Kim, S., Shin, Y., Jeong, Y., Na, S., & Han, C. E. (2023). Autonomy support encourages use of more-affected arm post-stroke. Journal of Neuroengineering and Rehabilitation, 20(1), 116. https://doi.org/10.1186/s12984-023-01238-0
Lewthwaite, R., Winstein, C. J., Lane, C. J., Blanton, S., Wagenheim, B. R., Nelsen, M. A., Dromerick, A. W., & Wolf, S. L. (2018). Accelerating stroke recovery: body structures and functions, activities, participation, and quality of life outcomes from a large rehabilitation trial. Neurorehabilitation and Neural Repair, 32(2), 150–165. https://doi.org/10.1177/1545968318760726
Roby-Brami, A., Jarrassé, N., & Parry, R. (2021). Impairment and compensation in dexterous upper-limb function after stroke. From the direct consequences of pyramidal tract lesions to behavioral involvement of both upper-limbs in daily activities. Frontiers in Human Neuroscience, 15. https://doi.org/10.3389/fnhum.2021.662006
Wulf, G., & Lewthwaite, R. (2016). Optimizing performance through intrinsic motivation and attention for learning: The OPTIMAL theory of motor learning. Psychonomic Bulletin & Review, 23(5), 1382–1414. https://doi.org/10.3758/s13423-015-0999-9
