Compensatory cue-weighting strategies for the sense of agency in patients with poststroke motor deficits.

OBJECTIVE

Poststroke motor deficits often result in diminished or degraded sensorimotor input, potentially disrupting how patients attribute actions and affecting their sense of agency (SoA)-that is, the experience of controlling one's own actions. SoA emerges from the integration of sensorimotor cues (e.g., prediction errors between internal prediction and sensory feedback) and cognitive cues (e.g., thoughts or beliefs). However, the integration mechanism of these cues remains unclear.

METHOD: Twenty poststroke patients with sensorimotor deficits but no marked cognitive impairments, along with 10 healthy control participants, performed sinusoidal movements. During the movement, participants observed a cursor that either matched or deviated from their actual movements and judged whether the cursor reflected their own movement. We combined this task with questionnaires assessing reliance on cognitive cues and subjective SoA.

RESULTS

Patients with more severe motor deficits made more erroneous self-attributions (ps = .015, Cohen's ds = 1.27) and showed weaker correlation between pen-cursor distance and self-other judgment (βdif = .23, p = .017), suggesting lower sensitivity to prediction error. Erroneous self-attribution correlated with greater reliance on cognitive cues (r = .76, p = .010). Although SoA generally decreased with motor deficit severity (βs = .67, ps < .001), patients with more severe deficits exhibited higher SoA when showing higher cognitive cue reliance (β = .58, p = .010) or longer time since stroke (β = .62, p = .004).

CONCLUSIONS

Patients with more severe motor deficits may adopt compensatory cue-weighting strategies that rely more on cognitive than sensorimotor cues during agency registration. (PsycInfo Database Record (c) 2026 APA, all rights reserved).