Depressive symptoms influence use of feedback for motor learning and recovery in chronic stroke

Purpose: Sensorimotor impairments and depressive symptoms (PSD) influence arm motor recovery post-stroke. Feedback provision improves upper limb motor learning in patients with chronic stroke but factors including PSD may affect ability to use feedback. We evaluated the influence of PSD on the ability to use auditory feedback for upper limb recovery and motor learning in patients with chronic stroke. Methods: Participants (n = 24) practiced 72 pointing movements/session (6 targets, 12 sessions, randomized) with auditory feedback on movement speed and trunk displacement. The presence of PSD (Beck's Depression Inventory; BDI-II) was assessed at pre-intervention (PRE). Arm motor impairment (Fugl-Meyer Assessment, shoulder horizontal adduction, shoulder flexion, elbow extension ranges, trunk displacement) and arm use (Motor Activity Log) were assessed at PRE, immediately after (POST) and retention (3mos; RET). Participants were divided into two groups based on BDI-II scores: >= 14/63 (DEP group; n = 8; score: 20.5+/-7.5) and <= 13/63 (no PSD (ND) group; n = 16; score: 5.0+/-3.8). Changes in impairment and arm use levels were assessed (mixed-model ANOVAs). Results: All participants improved arm use. DEP had lower Fugl-Meyer scores, used more compensatory trunk displacement and had lower shoulder horizontal adduction range compared to ND. Conclusion: The presence of PSD diminished the ability to use auditory feedback for arm motor recovery and motor learning.