Reward enhances motor adaptation learning in acute stroke patients
Paul, T.; Wiemer, V. M.; Guenther, J.; Lehnberg, F. M.; Grafton, S. T.; Fink, G. R.; Volz, L. J.
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The majority of motor recovery occurs within the first weeks after stroke and partially relies on similar mechanisms as motor learning in the healthy brain. Given that motor learning can result from both error- and reinforcement-based mechanisms, we investigated whether complementing error-based adaptation with reinforcement feedback enhances motor learning early after stroke. Here, we show for the first time that acute stroke patients exhibit successful error-based visuomotor adaptation with their paretic hand. Reward and punishment feedback exerted opposite modulatory effects on motor adaptation: while performance-dependent punishment feedback hampered adaptation, reward enhanced both initial learning and retention. Mechanistically, reward provided a complementary teaching signal when sensory prediction errors were compromised by sensorimotor deficits resulting in a systematic reduction of motor noise. Our results emphasize that combining reward feedback with motor adaptation facilitates relearning of motor control after stroke and may thus be critical to enhance motor recovery in future therapeutic settings.
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