Institute of Clinical Neuroscience and Medical Psychology, Medical Faculty, University of Düsseldorf, Düsseldorf, Germany.
Department of Neurology, Mauritius Hospital Meerbusch, Meerbusch, Germany.
Brain. 2021 Jul 28;144(6):1764-1773. doi: 10.1093/brain/awab128.
Functional recovery after stroke is dose-dependent on the amount of rehabilitative training. However, rehabilitative training is subject to motivational hurdles. Decision neuroscience formalizes drivers and dampers of behaviour and provides strategies for tipping motivational trade-offs and behaviour change. Here, we used one such strategy, upfront voluntary choice restriction ('precommitment'), and tested if it can increase the amount of self-directed rehabilitative training in severely impaired stroke patients. In this randomized controlled study, stroke patients with working memory deficits (n = 83) were prescribed daily self-directed gamified cognitive training as an add-on to standard therapy during post-acute inpatient neurorehabilitation. Patients allocated to the precommitment intervention could choose to restrict competing options to self-directed training, specifically the possibility to meet visitors. This upfront choice restriction was opted for by all patients in the intervention group and highly effective. Patients in the precommitment group performed the prescribed self-directed gamified cognitive training twice as often as control group patients who were not offered precommitment [on 50% versus 21% of days, Pcorr = 0.004, d = 0.87, 95% confidence interval (CI95%) = 0.31 to 1.42], and, as a consequence, reached a 3-fold higher total training dose (90.21 versus 33.60 min, Pcorr = 0.004, d = 0.83, CI95% = 0.27 to 1.38). Moreover, add-on self-directed cognitive training was associated with stronger improvements in visuospatial and verbal working memory performance (Pcorr = 0.002, d = 0.72 and Pcorr = 0.036, d = 0.62). Our neuroscientific decision add-on intervention strongly increased the amount of effective cognitive training performed by severely impaired stroke patients. These results warrant a full clinical trial to link decision-based neuroscientific interventions directly with clinical outcome.
脑卒中后的功能恢复程度与康复训练的量呈正相关。然而，康复训练受到动机障碍的影响。决策神经科学将行为的驱动因素和抑制因素形式化，并提供了改变动机权衡和行为的策略。在这里，我们使用了其中一种策略，即提前自愿选择限制（“预先承诺”），并测试其是否可以增加严重受损的脑卒中患者的自我导向康复训练量。在这项随机对照研究中，患有工作记忆缺陷的脑卒中患者（n=83）在急性后住院神经康复期间被规定每天进行自我导向的游戏化认知训练作为标准治疗的附加治疗。被分配到预先承诺干预组的患者可以选择限制竞争性选项，即自我导向的训练，特别是与访客见面的可能性。干预组的所有患者都选择了这种预先的选择限制，而且效果非常显著。与未提供预先承诺的对照组患者相比，预先承诺组患者进行规定的自我导向的游戏化认知训练的频率高出两倍[在 50%的天数与 21%的天数之间，Pcorr=0.004，d=0.87，95%置信区间（CI95%）=0.31 至 1.42]，因此，达到了三倍更高的总训练剂量（90.21 分钟与 33.60 分钟，Pcorr=0.004，d=0.83，CI95%=0.27 至 1.38）。此外，附加的自我导向认知训练与视空间和言语工作记忆表现的更强改善相关（Pcorr=0.002，d=0.72 和 Pcorr=0.036，d=0.62）。我们的神经科学决策附加干预措施显著增加了严重受损的脑卒中患者进行的有效认知训练量。这些结果需要进行全面的临床试验，将基于决策的神经科学干预措施与临床结果直接联系起来。
