A massively successful experience is needed for spontaneous use in post-stroke: a randomized controlled trial

Abstract Background: Motivation to use the more-affected arm is an essential indicator of recovery in stroke survivors. This study aimed to investigate whether personal mastery experience via intensive repetitive reaching movements with autonomy support may increase self-efficacy and thus increase performance and use of the more-affected arm in mild-to-moderate subacute to chronic stroke patients. Methods: Twenty-six participants with stroke were divided into two groups: a motivation group (with autonomy support) and a control group (without autonomy support). Five weeks of training and test sessions were administered using the individualized motivation enhancement system that we developed. The task difficulty parameter modulated the time limit for attaining targets to provide autonomy support. We analyzed various clinical and behavioral measures using mixed-effect models. Results: Successful experiences did not change in the control group (p = .129),but dramatically increased in the motivation group (p < .0001). Performance significantly improved in the retention test for both groups (p < .0001), without any group differences (p = .329). However, the motivation group exhibited a dramatic increase in the use of the more-affected arm (p < .0001), whereas the control group did not (p Conclusions: The successful experience of personal mastery accomplished by autonomy support increased the use of the affected arm. Autonomy support in the motivation group may make a participant aware of the training goal: to use the more-affected arm as much as possible or make the affected arm use more habitual. Trial registration: The study was registered with The Clinical Research Information Service (CRIS), KCT0008117. Registered retrospectively on January 13, 2023, at https://cris.nih.go.kr/cris/search/detailSearch.do/23875