An international group of scientists including researchers from HSE University has proposed a novel approach to rehabilitating patients with motor disorders. According to the researchers, more effective recovery can be achieved by granting patients the freedom to choose their movements and providing an appropriate system of rewards for engaging in the prescribed exercises. The opinion paper has been published in Neurorehabilitation and Neural Repair.
Motor function disruptions can arise due to a variety of diseases. For example, following a stroke, individuals frequently experience immobilisation in one half of the body or one limb, with the affected side typically being opposite to the side of the haemorrhage. The rehabilitation of patients with motor disorders can be a lengthy and challenging process. For instance, to regain limb mobility after a stroke and resume a normal lifestyle, extensive daily training, akin to that undertaken by professional athletes, is essential. During their clinic stay, patients undergo supervised training sessions, with medical professionals overseeing the correctness and consistency of their exercises. However, this training must continue at home after the patient is discharged from the clinic, and during this phase, many individuals tend to lose motivation.
A mnemonic technique can help recognise the symptoms of a stroke and recall the specific steps that need to be taken. Remember the F.A.S.T.4.5 acronym:
F stands for facial drooping,
A for arm or leg weakness,
S for speech difficulties, and
T serves as a reminder to call the ambulance immediately, as time is short, with only
4.5 hours left to save a life.
There is a rationale behind the reluctance to exercise a weakened limb: for instance, if someone intends to grab a cup of coffee and their left arm is not functioning properly, they are likely to resort to their right hand to accomplish the task. The person will find it easier and safer, as the coffee is less likely to spill. Each time individuals decide between their weakened and healthy limbs, they assess the resources required and the eventual benefits they will gain. The choice is typically made in favour of the option with the least costs and the greatest benefits, based on a subjective assessment by the patient.
An international team including researchers from the HSE Institute for Cognitive Neuroscience have proposed using the neuroeconomic approach to facilitate the rehabilitation of patients with motor disorders. Neuroeconomics is the scientific study of decision-making by examining the processes and motivations behind the choices people make. According to scientists, every physical movement is intricately linked to the decision-making process. However, while a healthy individual promptly and unconsciously decides which arm or leg to use, the process is far more deliberate for a stroke survivor. The study authors suggest that neuroeconomic games can serve as a motivating tool, encouraging patients to use their weakened limb more often and thus facilitate a faster recovery after illnesses.
The advantage of the neuroeconomic approach lies in the availability of proven tools for examining an individual's preferences and tendencies, such as their risk appetite, propensity for prosocial or selfish behaviour, and ability to defer immediate rewards for greater long-term benefits. This information indicates which reward could outweigh the cost of opting to use an impaired arm or leg.
Neuroeconomic models have been tested on healthy volunteers for more than a decade. In a neuroeconomic game, participants are prompted to make choices under various conditions. Pick up 100 coins now or 200 in a week from now? What if you could pick up 150 now? What if you could get 200 in three days rather than after a week? By manipulating the task conditions, including the size and nature of the reward, researchers investigate the factors influencing an individual's decision-making. In the rehabilitation of patients with motor disorders, a computer game is used where the person is required to reach for a specific object. If they employ their weakened limb, they accrue points, which can subsequently be exchanged for money or other rewards.
The primary aspect of what we offer to the patient is the opportunity to make a choice. In contrast to conventional rehabilitation approaches, we do not just issue commands, e.g. 'you must use your left hand.' Instead, we suggest that while they are free to reach for the cup with either hand, doing so with their left hand will yield a larger reward. Our aim is to provide individuals with an incentive which makes a challenging goal more appealing.
Neuroeconomic games can be applied not only in the rehabilitation of stroke patients but also in the recovery process of individuals dealing with mental disorders. Numerous neurological conditions, such as depression or anxiety disorders, are linked to motor disfunctions, including obsessive movements, heightened or inhibited mobility. The neuroeconomic approach makes it possible to align the conditions required for recovery as closely as possible with everyday life.