Arm choice post-stroke is habitual rather than optimal in right-, but not in left-paretic individuals

In non-disabled individuals, arm choice in pointing movements depends on expected biomechanical effort, expected success, and a handedness bias. Following a stroke, is arm choice re-optimized to account for the decreased motor performance, or does it follow a pre-injury habitual pattern? Because premorbidly right-handed individuals with left hemiparesis generally use their affected arm less than those with right hemiparesis, we hypothesized that arm choice follows a more habitual pattern in right-than in left-hemiparetic individuals. Participants with mild to moderate chronic stroke who were right-handed before stroke performed pointing movements in both free- and forced-choice blocks, both under a no-time constraint condition and under a fast-time constraint condition designed to promote habitual choice. Mixed-effects models of arm choice revealed that expected effort and side of stroke predicted choices overall. However, expected success predicted choice in left-, but not of right-hemiparetic individuals. Furthermore, while left-hemiparetic individuals tended to avoid unsuccessful movements in the fast condition by selecting their non-paretic arm, right-hemiparetic individuals persevered in choosing their more affected arm. In addition, reaction times decreased in left-hemiparetic individuals between the no-time and the fast condition but showed no changes in right-hemiparetic individuals. Finally, arm choice in the no-time condition correlated with a clinical measure of spontaneous arm use for right-, but not for left-hemiparetic individuals. Our results thus show that, in premorbidly right-handed individuals with mild to moderate chronic stroke, arm choice is habitual in right-hemiparetic individuals, but shows a greater degree of optimality by taking account expected success in left-hemiparetic individuals. New & Noteworthy Although we are seldom aware of it, we constantly make decisions to use one arm or the other in our daily activities. Here, we study whether these decisions change following a chronic mild to moderate stroke that affects motor control. Our results show that chronic stroke survivors with a right hemiparesis make arm choice using a habitual strategy, while those with left hemiparesis re-optimize their choices to account for their impaired motor performance.