2024 Theses Doctoral

Impact of Self-Controlled Practice on Motor Learning for Individuals with Post-Stroke Upper Limb Hemiparesis

Winterbottom, Lauren

Upper limb (UL) impairments are common after stroke and can lead to loss of independence and long-term disability. Motor learning interventions for individuals with stroke can improve UL function and engagement in daily activities. Self-controlled practice (SCP) involves allowing choice during motor skill practice and has been shown to improve motor learning in healthy adults as well as individuals with Parkinson's disease. Additionally, SCP may impact psychological outcomes, including intrinsic motivation, self-efficacy, and positive affect. Although SCP has been incorporated into complex stroke rehabilitation interventions, little is known about its specific impact on motor learning for individuals with stroke. The purpose of this study is to investigate the effect of SCP on motor learning and psychological outcomes for adults with chronic UL impairment after stroke.

Sixteen participants with chronic UL impairment due to stroke were paired and randomized into two groups. All participants practiced a standardized motor task with both their more affected and less affected hands for two consecutive days. During each day of practice, participants completed 50 30-second trials (10 blocks of 5 trials each) with their more affected hand and 20 30-second trials (10 blocks of 2 trials each) with their less affected hand. The experimental group was given control over their practice schedule and chose the order they practiced blocks of trials. Participants in the control group followed a pre-determined practice schedule based on the choices made by the participant they were paired with in the experimental group. Outcome measures were assessed on Day 1 before practice (Pre-Test), Day 2 after practice (Post-Test), and Day 3 (Follow-up). Motor learning outcomes included 24-hour retention of the trained motor task and immediate (10-minute) and delayed (24-hour) transfer of learning to an untrained motor task. Psychological outcomes including intrinsic motivation, self-efficacy, and positive affect were also assessed.

Both groups demonstrated significant improvements from baseline on both the trained task and the untrained task at the Day 3 follow-up assessment. There were no significant between-group differences on any motor learning or psychological outcome measures. However, there was a significant association between perceived choice that was assessed on Day 2 following practice and amount of change on the untrained transfer task at Day 3. This suggests that perception of choice may be a relevant factor for motor learning after stroke. However, more research with larger sample sizes is needed to further investigate this finding.