Article Text

Download PDFPDF
Research paper
Reward and punishment enhance motor adaptation in stroke
  1. Graziella Quattrocchi1,2,
  2. Richard Greenwood2,
  3. John C Rothwell1,
  4. Joseph M Galea3,
  5. Sven Bestmann1
  1. 1 Sobell Department of Motor Neuroscience and Movement Disorders, UCL Institute of Neurology, University College London, London, UK
  2. 2 National Hospital for Neurology and Neurosurgery, UCLH NHS Trust, London, UK
  3. 3 School of Psychology, University of Birmingham, Birmingham, UK
  1. Correspondence to Dr Graziella Quattrocchi, Sobell Department of Motor Neuroscience and Movement Disorders, 33 Queen Square, London WC1N3BG, UK; g.quattrocchi{at}


Background and objective The effects of motor learning, such as motor adaptation, in stroke rehabilitation are often transient, thus mandating approaches that enhance the amount of learning and retention. Previously, we showed in young individuals that reward and punishment feedback have dissociable effects on motor adaptation, with punishment improving adaptation and reward enhancing retention. If these findings were able to generalise to patients with stroke, they would provide a way to optimise motor learning in these patients. Therefore, we tested this in 45 patients with chronic stroke allocated in three groups.

Methods Patients performed reaching movements with their paretic arm with a robotic manipulandum. After training (day 1), day 2 involved adaptation to a novel force field. During the adaptation phase, patients received performance-based feedback according to the group they were allocated: reward, punishment or no feedback (neutral). On day 3, patients readapted to the force field but all groups now received neutral feedback.

Results All patients adapted, with reward and punishment groups displaying greater adaptation and readaptation than the neutral group, irrespective of demographic, cognitive or functional differences. Remarkably, the reward and punishment groups adapted to similar degree as healthy controls. Finally, the reward group showed greater retention.

Conclusions This study provides, for the first time, evidence that reward and punishment can enhance motor adaptation in patients with stroke. Further research on reinforcement-based motor learning regimes is warranted to translate these promising results into clinical practice and improve motor rehabilitation outcomes in patients with stroke.

  • Adaptation
  • Motivation
  • Motor Learning
  • Reaching
  • Stroke

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.


  • Funding This work was supported by a European Research Council Starter Grant (ActSelectContext, 260424 to SB) and Starter Grant (MotMotLearn, 637488 to JG).

  • Competing interests None to be declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

Linked Articles