학술논문
Reward During Arm Training Improves Impairment and Activity After Stroke: A Randomized Controlled Trial.
Document Type
Academic Journal
Author
Widmer M; Division of Vascular Neurology and Neurorehabilitation, Department of Neurology, 27243University Hospital and University of Zurich, Zurich, Switzerland.; cereneo Center for Neurology and Rehabilitation, Vitznau, Switzerland.; cereneo Advanced Rehabilitation Institute (CARINg), Vitznau, Switzerland.; Department of Therapy, 60550Swiss Paraplegic Centre, Nottwil, Switzerland.; Held JPO; Division of Vascular Neurology and Neurorehabilitation, Department of Neurology, 27243University Hospital and University of Zurich, Zurich, Switzerland.; Wittmann F; Rehabilitation Engineering Laboratory, Department of Health Sciences and Technology, 27219ETH Zurich, Zurich, Switzerland.; Valladares B; Division of Vascular Neurology and Neurorehabilitation, Department of Neurology, 27243University Hospital and University of Zurich, Zurich, Switzerland.; cereneo Center for Neurology and Rehabilitation, Vitznau, Switzerland.; Lambercy O; Rehabilitation Engineering Laboratory, Department of Health Sciences and Technology, 27219ETH Zurich, Zurich, Switzerland.; Sturzenegger C; 386686Klinik Lengg, Zürcher RehaZentren, Zurich, Switzerland.; 60527Bellikon Rehabilitation Clinic, Bellikon, Switzerland.; Palla A; 30930Klinik Wald, Zürcher RehaZentren, Wald, Switzerland.; Swiss Concussion Center, 30699Schulthess Clinic, Zurich, Switzerland.; Lutz K; Division of Vascular Neurology and Neurorehabilitation, Department of Neurology, 27243University Hospital and University of Zurich, Zurich, Switzerland.; cereneo Center for Neurology and Rehabilitation, Vitznau, Switzerland.; squipe GmbH, Wädenswil, Switzerland.; Luft AR; Division of Vascular Neurology and Neurorehabilitation, Department of Neurology, 27243University Hospital and University of Zurich, Zurich, Switzerland.; cereneo Center for Neurology and Rehabilitation, Vitznau, Switzerland.
Source
Publisher: Sage Publications Country of Publication: United States NLM ID: 100892086 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1552-6844 (Electronic) Linking ISSN: 15459683 NLM ISO Abbreviation: Neurorehabil Neural Repair Subsets: MEDLINE
Subject
Language
English
Abstract
Background: Learning and learning-related neuroplasticity in motor cortex are potential mechanisms mediating recovery of movement abilities after stroke. These mechanisms depend on dopaminergic projections from midbrain that may encode reward information. Likewise, therapist experience confirms the role of feedback/reward for training efficacy after stroke.
Objective: To test the hypothesis that rehabilitative training can be enhanced by adding performance feedback and monetary rewards.
Methods: This multicentric, assessor-blinded, randomized controlled trial used the ArmeoSenso virtual reality rehabilitation system to train 37 first-ever subacute stroke patients in arm-reaching to moving targets. The rewarded group (n = 19) trained with performance feedback (gameplay) and contingent monetary reward. The control group (n = 18) used the same system without monetary reward and with graphically minimized performance feedback. Primary outcome was the change in the two-dimensional reaching space until the end of the intervention period. Secondary clinical assessments were performed at baseline, after 3 weeks of training (15 1-hour sessions), and at 3 month follow-up. Duration and intensity of the interventions as well as concomitant therapy were comparable between groups.
Results: The two-dimensional reaching space showed an overall improvement but no difference between groups. The rewarded group, however, showed significantly greater improvements from baseline in secondary outcomes assessing arm activity (Box and Block Test at post-training: 6.03±2.95, P = .046 and 3 months: 9.66±3.11, P = .003; Wolf Motor Function Test [Score] at 3 months: .63±.22, P = .007) and arm impairment (Fugl-Meyer Upper Extremity at 3 months: 8.22±3.11, P = .011).
Conclusions: Although neutral in its primary outcome, the trial signals a potential facilitating effect of reward on training-mediated improvement of arm paresis.
Trial Registration: ClinicalTrials.gov (ID: NCT02257125).
Objective: To test the hypothesis that rehabilitative training can be enhanced by adding performance feedback and monetary rewards.
Methods: This multicentric, assessor-blinded, randomized controlled trial used the ArmeoSenso virtual reality rehabilitation system to train 37 first-ever subacute stroke patients in arm-reaching to moving targets. The rewarded group (n = 19) trained with performance feedback (gameplay) and contingent monetary reward. The control group (n = 18) used the same system without monetary reward and with graphically minimized performance feedback. Primary outcome was the change in the two-dimensional reaching space until the end of the intervention period. Secondary clinical assessments were performed at baseline, after 3 weeks of training (15 1-hour sessions), and at 3 month follow-up. Duration and intensity of the interventions as well as concomitant therapy were comparable between groups.
Results: The two-dimensional reaching space showed an overall improvement but no difference between groups. The rewarded group, however, showed significantly greater improvements from baseline in secondary outcomes assessing arm activity (Box and Block Test at post-training: 6.03±2.95, P = .046 and 3 months: 9.66±3.11, P = .003; Wolf Motor Function Test [Score] at 3 months: .63±.22, P = .007) and arm impairment (Fugl-Meyer Upper Extremity at 3 months: 8.22±3.11, P = .011).
Conclusions: Although neutral in its primary outcome, the trial signals a potential facilitating effect of reward on training-mediated improvement of arm paresis.
Trial Registration: ClinicalTrials.gov (ID: NCT02257125).