Reward during arm training improves impairment and activity after stroke: A randomized controlled trial.

Are you that fucking clueless in not understanding that all you need is EXACT RECOVERY PROTOCOLS and your patient will gladly do millions of repetitions knowing the result will be recovery? No rewards needed. I'd have you all fired.

 Reward during arm training improves impairment and activity after stroke: A randomized controlled trial.

Neurorehabilitation and Neural Repair (NNR) , Volume 36(2) , Pgs. 140-150.

NARIC Accession Number: J88562.  What's this?
ISSN: 1545-9683.
Author(s): Widmer, Mario ; Held, Jeremia P. O.; Wittmann, Frieder; Valladares, Belen; Lambercy, Olivier; Sturzenegger, Christian; Palla, Antonella; Lutz, Kai; Luft, Andreas R. .
Publication Year: 2022.
Number of Pages: 11.

Abstract: 

Study evaluated the effect of enhanced feedback and reward on arm rehabilitative training following stroke. This multicenter, 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 trained with performance feedback (gameplay) and contingent monetary reward. The control group used the same system without monetary reward and with graphically minimized performance feedback. The 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 one-hour sessions), and at 3-month follow-up. Duration and intensity of the interventions as well as concomitant therapy were comparable between groups. The two-dimensional reaching space showed an overall improvement but no difference between groups. However, the rewarded group showed significantly greater improvements from baseline in secondary outcomes assessing arm activity and arm impairment. Although neutral in its primary outcome, the results of this study suggest a potential facilitating effect of reward on training-mediated improvement of arm paresis.
Descriptor Terms: FEEDBACK, LEARNING, LIMBS, MOTOR SKILLS, REHABILITATION SERVICES, STROKE.


Can this document be ordered through NARIC's document delivery service*?: Y.

Citation: Widmer, Mario , Held, Jeremia P. O., Wittmann, Frieder, Valladares, Belen, Lambercy, Olivier, Sturzenegger, Christian, Palla, Antonella, Lutz, Kai, Luft, Andreas R. . (2022). Reward during arm training improves impairment and activity after stroke: A randomized controlled trial.  Neurorehabilitation and Neural Repair (NNR) , 36(2), Pgs. 140-150. Retrieved 6/1/2022, from REHABDATA database. 

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

 Are you that blitheringly stupid that you can't see that EXACT PROTOCOLS LEADING TO 100% RECOVERY are all that is needed to motivate survivors? They would gladly do millions, even billions of reps to get that recovery. 

Oops, I'm not playing by the polite rules of Dale Carnegie,  'How to Win Friends and Influence People'. 

Telling stroke medical persons they know nothing about stroke is a no-no even if it is true. 

Politeness will never solve anything in stroke. Yes, I'm a bomb thrower and proud of it. Someday a stroke 'leader' will try to ream me out for making them look bad by being truthful , I look forward to that day.

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

Show all authors

Mario Widmer, Jeremia P. O. Held, Frieder Wittmann, ...

First Published December 22, 2021 Research Article Find in PubMed 

https://doi.org/10.1177/15459683211062898

Article information

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).

Keywords

rehabilitation, stroke, upper extremity, virtual reality, feedback, reward

Introduction

After stroke, 50% of survivors are left with upper extremity impairments,^1,2 a disability that lowers their health-related quality of life.³ Therapies to cure or ameliorate arm impairment are limited in their population efficacy, although some patients respond to therapy or recover spontaneously. Apart from training dose (ie, time spent training), it is unknown what makes training effective and in whom. When training dose is matched, most randomized controlled trials introducing new interventions (eg, robot-assisted therapy)⁴ showed no difference to control being routine care or conventional physical/occupational therapy. Assuming that currently available therapies do not fully exploit the biological recovery potential,⁵ there is urgent need for improvement.

Improvement may be achieved by identifying effective elements of therapy and boosting them. Reward during training may be one such element. In the rat, dopaminergic projections from the midbrain’s ventral tegmental area (VTA) to primary motor cortex (M1) are necessary for successful motor skill learning.⁶ Dopamine in M1 modulates excitability⁷ and enables long-term potentiation of cortico-cortical connections.⁸ Populations of dopaminergic VTA neurons respond to food rewards as well as to the combination of reward and training.⁹ In humans, reward enhances procedural¹⁰ and motor skill learning^11,12 and has a positive effect on motor adaptation.¹³ This is mainly the result of improved retention or consolidation.^11–13 In a functional magnetic resonance imaging study, we demonstrated that adding monetary rewards after good performance leads to better consolidation and higher ventral striatum activation than knowledge of performance alone,¹² the striatum being a key area of reward processing.^14,15

While motor skill learning is not the only mechanism mediating movement recovery after stroke, it certainly is an important factor.^16,17 It therefore seems likely that reward will also affect recovery, as it does skill learning. We thus hypothesized that augmenting reward improves recovery in response to training. Using the ArmeoSenso, a standardized virtual reality-based training system, allowed for delivery of intensive repetitive training of the upper limb¹⁸ while rewarding features like game scores (linked to a monetary reward), visual and sound special effects of the applied therapy game could be easily manipulated. Here we report a proof-of-concept, assessor-blinded, multicenter randomized controlled trial comparing the effect of enhanced feedback and reward vs unrewarded training matched in time and movement repetitions on arm activity and impairment.

 More at link.

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

 If you create 100% recovery protocols, the reward of recovery will be enough to get the therapy done,even if it requires 10 million repetitions. Use the correct reward structure and you'll get 100% compliance. This was not properly thought through.

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

Show all authors

Mario Widmer, Jeremia P. O. Held, Frieder Wittmann, ...

First Published December 22, 2021 Research Article 

https://doi.org/10.1177/15459683211062898

Article information

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).

Keywords

rehabilitation, stroke, upper extremity, virtual reality, feedback, reward

Introduction

After stroke, 50% of survivors are left with upper extremity impairments,^1,2 a disability that lowers their health-related quality of life.³ Therapies to cure or ameliorate arm impairment are limited in their population efficacy, although some patients respond to therapy or recover spontaneously. Apart from training dose (ie, time spent training), it is unknown what makes training effective and in whom. When training dose is matched, most randomized controlled trials introducing new interventions (eg, robot-assisted therapy)⁴ showed no difference to control being routine care or conventional physical/occupational therapy. Assuming that currently available therapies do not fully exploit the biological recovery potential,⁵ there is urgent need for improvement.

Improvement may be achieved by identifying effective elements of therapy and boosting them. Reward during training may be one such element. In the rat, dopaminergic projections from the midbrain’s ventral tegmental area (VTA) to primary motor cortex (M1) are necessary for successful motor skill learning.⁶ Dopamine in M1 modulates excitability⁷ and enables long-term potentiation of cortico-cortical connections.⁸ Populations of dopaminergic VTA neurons respond to food rewards as well as to the combination of reward and training.⁹ In humans, reward enhances procedural¹⁰ and motor skill learning^11,12 and has a positive effect on motor adaptation.¹³ This is mainly the result of improved retention or consolidation.^11–13 In a functional magnetic resonance imaging study, we demonstrated that adding monetary rewards after good performance leads to better consolidation and higher ventral striatum activation than knowledge of performance alone,¹² the striatum being a key area of reward processing.^14,15

While motor skill learning is not the only mechanism mediating movement recovery after stroke, it certainly is an important factor.^16,17 It therefore seems likely that reward will also affect recovery, as it does skill learning. We thus hypothesized that augmenting reward improves recovery in response to training. Using the ArmeoSenso, a standardized virtual reality-based training system, allowed for delivery of intensive repetitive training of the upper limb¹⁸ while rewarding features like game scores (linked to a monetary reward), visual and sound special effects of the applied therapy game could be easily manipulated. Here we report a proof-of-concept, assessor-blinded, multicenter randomized controlled trial comparing the effect of enhanced feedback and reward vs unrewarded training matched in time and movement repetitions on arm activity and impairment.

 

 

50 Per Cent More Motivation With This Way of Thinking About Rewards

How is your doctor helping motivate you to recover/do your exercises? ANYTHING AT ALL?
Has your doctor even thought about your resilience, motivation or emotional needs for recovery?
http://www.spring.org.uk/2016/02/reward-versus-loss.php?
The research shows that exactly the same financial rewards can produce markedly different levels of motivation when framed in different ways.

Professor Kevin G. Volpp, one of the study’s authors, said:

“Our findings demonstrate that the potential of losing a reward is a more powerful motivator and adds important knowledge to our understanding of how to use financial incentives to encourage employee participation in wellness programs.”

The study compared workplace rewards for physical activity.
Some people in the program were given $42 and then had $1.40 taken away for each day they didn’t exercise.
Others were told they would simply receive $1.40 for each day they exercised.
Both of these were compared with a control group.
Financially, it amounted to exactly the same thing, but the first framing emphasises a loss of money and the second framing emphasises the reward.
Fascinatingly, the reward-framing had no effect over and above offering no reward for exercise.
However, the loss-framed incentive increased by 50% the amount of times people reached their exercising goals compared with the control group and the reward-framed incentive.
The study was published in the journal Annals of Internal Medicine (Patel et al., 2016).

More at link.

Max Memory Boost By Combining Two Easy Methods

Is your doctor doing anything  for your memory problems? Or are you having to do your own research by reading my 136 posts on memory or

• Memory Self-efficacy (1)

or;

• Memory Self-efficacy training (1)

or;

• memory test (2)

Good luck on that.
http://www.spring.org.uk/2015/10/max-memory-boost-by-combining-two-easy-methods.php? 

Rewards combined with naps can help you learn, a new study finds.

When memories are linked to rewards, researchers found they stick better in the brain.

Adding a short nap afterwards can provide an extra boost.

Dr Kinga Igloi, who led the research, said:

“Rewards may act as a kind of tag, sealing information in the brain during learning.

During sleep, that information is favourably consolidated over information associated with a low reward and is transferred to areas of the brain associated with long-term memory.

Our findings are relevant for understanding the devastating effects that lack of sleep can have on achievement.”

In the study people were given pairs of pictures to try and remember.

Some took naps after learning, while others did not.

Sometimes participants were given small rewards after learning as well.

The study revealed that people remembered the pairs of pictures better when they received a reward.

But it was the group that slept after learning that performed the best overall.

Brain scans also showed that those who slept had higher activity in the hippocampus, an area vital to forming new memories.

People were asked back into the lab three months later for a surprise test.

Even three months later the group who were rewarded and slept after learning had the best recall.

Dr Igloi said:

“We already knew that sleep helps strengthens memories, but we now also know that it helps us select and retain those that have a rewarding value.

It makes adaptive sense that the consolidation of memory should work to prioritise information that is critical to our success and survival.”

The study was published in the journal eLife (Igloi et al., 2015)