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

 I consider this Self-controlled practice pretty much useless since there is nothing specific about what needs to be done to get recovered. You give survivors EXACT PROTOCOLS for recovery and they'll gladly do the millions of reps needed because they are looking forward to 100% recovery. Yeah, this is just a thesis, but the advisors incompetently didn't inform her of the flaws in her analysis.

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

Lauren Beth Winterbottom

Submitted in partial fulfillment of the

requirements for the degree of Doctor of Education in

Teachers College, Columbia University

2024

© 2024

Lauren Beth Winterbottom

All Rights Reserved

Abstract

Lauren Beth Winterbottom

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