Effects of physical disability on the sensitivity and criterion of sense of agency

Effects of physical disability on the sensitivity and criterion of sense of agency | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Effects of physical disability on the sensitivity and criterion of sense of agency Yoshiki Ando, Kazuki Hayashida, Wen Wen, Shu Morioka This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7045962/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract The sense of agency—namely, the feeling that one’s actions are self-initiated and controllable—is fundamental to how individuals understand themselves and engage with the world. Although often taken for granted, this experience may be altered by physical disability. The present study examined differences in the sense of agency between healthy adults and individuals with physical impairments using a movement-based dot trajectory task. Two indices—sensitivity (slope) and decision criterion (point of subjective equality)—were derived from logistic regression modeling. The results showed that individuals with physical disabilities not only had blurred between self-other distinction, but also attributed actions to themselves without justification, indicating blurred self-other boundaries. Notably, the observed alteration was not attributable to age or physical activity levels, and no significant associations were observed with psychological state or caregiving needs. These findings suggest that physical limitations themselves, irrespective of mental health or daily activity, may reshape how individuals perceive control over their own actions. Understanding such shifts in self-perception could have important implications for rehabilitation strategies and for improving quality of life in populations with physical impairments. sense of agency physical disability slope point of subjective equality sensitivity criterion Figures Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 Introduction The mechanism behind the generation of sense of agency The sense of agency, a concept proposed by Gallagher ( 2000 ), refers to the subjective experience of controlling one’s own actions, and through them, the external events. The classic theory of comparator model suggests that the sense of agency is primarily based on sensorimotor information derived from the comparison between predicted and actual sensory feedback (Frith et al. 2000 ). When prediction errors are minimal—that is, when an action is executed as intended—individuals experience a strong sense of agency. For instance, when the sound expected after pressing a button is heard immediately, the sense of agency is typically strong. In contrast, the absence of the expected sound may reduce or eliminate this sense of agency. However, recent studies showed that besides the prediction error other information can also alter the sense of agency. Specifically, several cognitive factors can preserve the sense of agency even when prediction errors are large and the contribution of sensorimotor information is presumed to be minimal. Such cognitive factors include priori beliefs (Moore et al. 2009 ), social context (Lafleur et al. 2020 ), and outcome regularity (Wen & Haggard 2020 ). Recent studies suggest that the generation of the sense of agency involve both sensorimotor information (sensorimotor level) and cognitive information (cognitive level), and to result from the relative weighting of the reliability of these two sources of information (Haggard 2017 ; Synofzk et al. 2008; Wen et al. 2022). According to the cue integration theory (Synofzk et al. 2013; Moore et al. 2012), these weightings are adjusted based on the reliability of sensorimotor and cognitive information in a given situation. Understanding the mechanisms underlying the sense of agency has important implications for clinical rehabilitation practice. In individuals with physical disabilities, the sense of agency may be impaired due to motor and sensory impairments. The sense of agency has been shown to be closely associated with enhanced health and well-being (Moore 2016 ). Promoting this sense of agency is therefore considered essential for enabling individuals to lead better well-being. Among the various causes of a diminished sense of agency, three have been widely reported in the literature: physical impairments (Mirowsky 1995 ), aging (Cioffi et al. 2017 ), and mental or cognitive dysfunction (Vogel et al. 2024 ; Mehta et al. 2023 ). In the domain of physical functioning, Mirowsky ( 1995 ) reported that the average level of sense of agency remains high and stable between the ages of 18 and 50, but progressively declines with increasing age. This decline in older adults is largely attributed to physical impairments, such as reduced mobility, visual and auditory deterioration, and chronic pain. Cioffi (2017) found that older adults exhibit significantly lower levels of predictive judgment, bodily ownership, and sense of agency in response to bodily illusions compared to younger individuals. This reduction is thought to stem from a diminished ability to effectively utilize external sensory cues. Furthermore, individuals with psychiatric disorders have been shown to experience difficulties in identifying their own actions (Krugwasser et al. 2022 ). Furthermore, a recent study reported that across both major depressive disorder (MDD) and control groups, a stronger tendency toward depressive symptoms was associated with reduced sense of agency (Vogel et al. 2024 ). Specifically, people generally report an increased sense of agency in response to reward-contingent feedback (Kaiser et al. 2021 ). However, this effect was significantly attenuated in the depression and anxiety groups relative to healthy individuals (Mehta et al. 2023 ). Moreover, an increased tendency to attribute actions to oneself following negative loss feedback was associated with a worsening of anhedonia symptoms (Mehta et al. 2023 ). Assuming that the conventional sense of agency is influenced by reward-based processing, these findings suggest that individuals with depression and anxiety disorders—who are characterized by a tendency to internalize negative feedback and a diminished sensitivity to rewards—may experience impaired sense of agency. Although the above studies focus on distinct aspects, it is well established that physical function declines with age. Mental function is also known to be affected by both aging and deterioration in physical condition. Physical disability and sense of agency The present study focuses on the sense of agency in patients with physical disabilities. Japan’s Basic Law for Persons with Disabilities (the Act) defines that the term “disability” encompasses physical, intellectual, and mental disabilities (including developmental disorders), as well as any other impairment of mental or physical functions. Importantly, the Act defines a “person with a disability” not solely based on the presence of a functional impairment, but as someone who continuously experiences significant restrictions in daily or social life due to the interaction between their impairment and societal barriers. To alleviate the burdens faced by individuals with disabilities, Japan has implemented public support systems such as medical insurance and long-term care insurance. These systems aim to reduce the economic strain on individuals and ensure that society as a whole plays a role in supporting their daily lives and social participation. Previous research has shown that individuals with functional limitations or physical disabilities are generally at a disadvantage in terms of opportunities for social participation (Bickenbach et al. 1999 ). Notably, it has been reported that the social disadvantages is associated with reduced sense of agency. For example, one study demonstrated that the behavioral effect interval—a quantitative measure of the sense of agency—was significantly longer after participants recalled an episode of social exclusion, compared to when they recalled an episode of social inclusion or a baseline condition without priming stimuli (Malik et al. 2019). Furthermore, an fMRI study reported significant differences in the sense of agency between individuals with functional movement disorders (FMD) and healthy controls (Nahab et al., 2017 ). Importantly, some participants with FMD reported an exaggerated sense of agency in situations where motor control was clearly impaired, while others reported a lack of control even when motor function appeared intact (Nahab et al., 2017 ). These findings suggest that patients with FMD do not simply have a higher or lower sense of agency, but rather a less accurate sense of agency compared to healthy individuals. Recently, Wen et al. ( 2024 ) proposed that the sense of agency should be separated into two aspects, sensitivity and criterion. The former aspect measures how well one can distinguish between self- and other-caused sensory input, while the latter reflects the tendency to attribute sensory input to oneself. However, most previous studies on impaired sense of agency in various groups—such as individuals with physical disabilities or mental disorders—have not attempted to distinguish between these two aspects, making it difficult to understand the mechanisms underlying such impairments. In the case of physical disabilities, impaired effector organs may lead to reduced sensory feedback, resulting in mismatches between predicted and actual sensory information. This can potentially weaken the sensitivity of sense of agency. However, weakened sensorimotor-level sensitivities may be cognitively compensated for during self-attribution judgments. Therefore, using a single index of the sense of agency—such as rating, sensory attenuation, or intentional binding—is not sufficient to capture the full picture. In the present study, we aim to measure both the sensitivity and criterion of the sense of agency in patients with physical disabilities. Such research is vital for informing the development of medical, rehabilitative, and social support systems. Purpose of this study and research hypotheses The present study aims to empirically examine the characteristics of the sense of agency in individuals with physical disabilities and related factors. Two main hypotheses are proposed. First, it is likely that the sensitivity of sense of agency in individuals with physical disabilities is lower compared healthy adults due to the weakened sensorimotor input. Second, there may be a negative correlation between depression and sensitivity of the sense of agency in both the healthy adult group and the group with physical disabilities. This study presents two key novel contributions. First, by conducting a cross-sectional survey of individuals receiving services under Japan’s medical insurance and long-term care insurance systems, it enables the examination of the combined effects of physical function, aging, and mental health. Previous studies have tended to investigate these factors in isolation and have not comprehensively addressed their interaction in populations with multiple health conditions. Second, this study seeks to enhance existing measurement approaches. We plan to conduct assessment tasks that take individual characteristics into account, in addition to measuring the sense of agency, allowing for a more precise evaluation of how impairments in the sense of agency are linked to other factors. The findings of this study are expected to contribute to the optimization of medical and long-term care services, as well as to the refinement of criteria used in long-term care certification. By facilitating care that aligns more closely with patients’ intentions and goals, these improvements may help enhance health outcomes and overall well-being. Moreover, the results may offer valuable insights for the development of effective clinical intervention strategies. Methods Participants The participants were 27 homebound physically handicapped adults and 31 healthy controls in their 20s. Exclusion criteria were those who had difficulty performing or understanding the experimental tasks, those with visual impairments, those with upper limb functional impairments and those with Mini-Mental State Examination (MMSE) scores of 23 or less. Previous studies were unable to provide estimated effect sizes for group contrasts on sense of agency, and therefore we did not perform a priori power calculation. All participants were given a written explanation in accordance with the Declaration of Helsinki, and signed consent was obtained. The study was approved by the Kio University Research Ethics Committee (approval number: R5-35). Experimental tasks for capturing the sense of activity We employed the dot task developed by Wen et al. (2018, 2020 ) as a method to quantify the sense of agency and to test our hypothesis regarding the factors associated with its reduction in individuals with physical disabilities. In this task, participants use a laptop touchpad to manipulate dots on a screen (Fig. 1 ). The movement of the dots is interspersed with pre-recorded movements of others, with the proportion of the participant’s own input randomly varied in 10% increments from 0–100% across 11 conditions. Each condition consisted of ten 4-second trials (110 trials in total), and after each trial, participants answered “Yes” or “No” to whether they felt they were controlling the dots. This task is considered suitable for individuals with physical impairments due to its simplicity and accessibility. Moreover, it is regarded as a valid tool for assessing the sense of agency, as it minimizes biases arising from individual judgment criteria and allows for the investigation of inter-individual differences (Wen et al. 2024 ). Specifically, a logistic curve was fitted to the responses (i.e., the proportion of yes-response) across varying levels of stimulus control. This approach enables the calculation of two key indices: the slope, representing the sensitivity of the sense of agency, and the point of subjective equality (PSE), representing the criterion used to judge the sense of agency (Wen et al. 2024 ). Physical function Physical function of the participants was assessed using the Berg Balance Scale (BBS) for motor performance and the Functional Ambulation Categories (FAC) for walking independence. The BBS is a widely used tool for evaluating functional balance and has demonstrated high validity and reliability across diverse patient populations, including individuals with neurological disorders such as Parkinson’s disease, multiple sclerosis, and traumatic brain injury, as well as those with acquired conditions such as lower limb amputation (Meseguer et al. 2019). The BBS consists of three domains: seated balance, standing balance, and dynamic balance. Seated balance is assessed by the ability to sit unsupported. Standing balance includes tasks such as standing without support, standing with eyes closed, standing with feet together, standing on one leg, turning to look behind, picking up an object from the floor, reaching forward with an outstretched arm, and placing one foot in front of the other. Dynamic balance is evaluated through tasks including sit-to-stand, stand-to-sit, transfers, 360-degree turns, and stepping onto a platform (Azuma et al. 2019 ; Park et al. 2017; Neuls et al. 2011 ). Each item was rated on a 5-point ordinal scale from 0 to 4, with a maximum total score of 56. A score of 0 indicates inability to perform the task, while 4 indicates independent performance. Scoring may also consider the time taken, posture maintenance, and degree of supervision or use of assistive devices (Berg et al. 1992). The FAC assesses walking independence on a 6-point scale (0–5) based on the level of assistance required. A score of 0 indicates an inability to walk even with the help of two or more people, while a score of 5 reflects complete independence on level and uneven surfaces, including stairs. Activity level Activity level of the participants was measured using the Sedentary Lifestyle Questionnaire for Japanese (SLQ-J), a validated and reliable tool for assessing total sedentary time among individuals (Kai et al. 2017 ). Participants reported time spent sitting in six domains—work, commuting, television, computer use, reading, and other activities—on both working and non-working days. Caregiving burden Caregiving burden was assessed using two measures: the level of independence in daily living, and the Inclusion of Other in the Self Scale (IOS) to evaluate trust-based relationships with caregivers. The level of independence is defined by the Ministry of Health, Labour and Welfare (Japan), classifying individuals into four ranks: Rank J (independent), Rank A (semi-bedridden), and Ranks B and C (bedridden), each subdivided into two levels, resulting in eight total categories. Rank J includes J1 (uses public transport) and J2 (limited to neighborhood outings); Rank A includes A1 (assisted outings, active during the day) and A2 (rare outings, partial bedrest); Rank B includes B1 (wheelchair use for eating and toileting) and B2 (wheelchair use with assistance). The IOS is a simple and reliable tool for evaluating perceived closeness in interpersonal relationships (Gächter et al. 2015 ). Participants select from seven pairs of increasingly overlapping circles to indicate their perceived closeness with a caregiver (Aron et al. 1992 ). Psychological and psychiatric factors Psychological status was assessed using the Japanese versions of the Beck Depression Inventory-II (BDI-II) and the Schizotypal Personality Questionnaire (SPQ). The BDI-II is a 21-item self-report scale developed by Beck et al. to assess depressive symptoms over the previous two weeks (Beck et al. 1961). It is globally recognized for its high reliability, diagnostic sensitivity, and construct validity, and has been validated for use in Japanese populations (Kojima et al. 2002 ; Wang et al. 2013; McDowell 2006). The SPQ consists of 74 binary (yes/no) items covering the nine DSM-III-R criteria for schizotypal personality disorder and is widely used to evaluate schizotypal traits in non-clinical populations (Raine 1991 ). The Japanese version has demonstrated psychometric properties comparable to the original (Iijima et al. 2010 ). Initiative The Social Independence Outcome Scale (SIOS) was used to assess initiative. This scale evaluates outcomes of role acquisition and social participation in elderly individuals with declining functional abilities. It includes three subscales (11 items total) derived from the ICF “Activity and Participation” domain, and a “subjectivity” component reflecting self-empowerment. In this study, we focused on the “Initiative” subscale, which includes five items: self-efficacy, interpersonal interaction, knowledge and understanding, independent decision-making, and self-management. The SIOS has shown high internal consistency and test-retest reliability. Given our focus on sensorimotor-level ownership (as assessed by the dot task), the SIOS “Initiative” measure was used to evaluate participants’ subjective assessment of their own sense of agency. Data processing: sense of agency subjectivity From the dot task (Fig. 1 ), logistic regression curves were generated based on the percentage of yes-response at each control level. The logistic function was modeled as: $$\:y=\:\frac{1}{1+\text{e}\text{x}\text{p}(-a\left(x-PSE\right))}$$ where a denotes the slope of the curve and PSE represents the level of control at which participants responded “Yes” and “No” equally (Fig. 2 A) (Shimada et al. 2010 ). A steeper slope indicates greater sensitivity to self-agency, while a shallower slope indicates lower sensitivity. A higher PSE suggests a conservative criterion for self-attribution, whereas a lower PSE reflects a more liberal criterion (Wen et al. 2024 ). To ensure valid data interpretation, ambiguous responses were excluded based on area under the curve (AUC) values. For instance, Fig. 2 B shows clear response patterns (AUC = 0.93), while Fig. 3 B shows ambiguous patterns with frequent reversals (AUC = 0.79). Previous research classifies AUCs as follows: 0.70–0.80 (acceptable), 0.80–0.90 (high), and 0.90–1.00 (excellent) in discrimination performance (Hosmer et al. 2000). Based on this, trials with AUC ≤ 0.80 were excluded from further analysis due to poor model fit and unclear expression of action subjectivity. Statistical analysis Normality of each variable was assessed using the Shapiro–Wilk test. Between-group comparisons (healthy vs. physically disabled adults) were conducted using independent samples t -tests when normality was confirmed, and Mann–Whitney U tests otherwise. In addition, simple regression analysis was performed to confirm the effect of age in the group of with physical disabilities. Comparisons of slope and PSE between groups followed the same procedure. Correlations between slope/PSE and various factors—physical function, activity level, caregiving burden, psychological variables, and initiative—were evaluated using Spearman’s rank correlation coefficient. All statistical analyses were performed using RStudio (version 2023.06.0 + 421), with the significance level set at 5%. Results Results of each measurement item Figure 4 illustrates the participant flow throughout the study. Of the 27 service users registered at a home-visit rehabilitation station affiliated with the First author, and 31 healthy adults, 8 individuals were excluded for not meeting the inclusion criteria. As a result, 29 healthy adults and 21 individuals with physical disabilities were enrolled in the study. Among these, four participants did not meet the AUC criterion of 0.8. Two participants were excluded due to excessively steep logistic regression slopes (slope > 100), and two others either declined to complete the questionnaire or were unable to understand the questions. Ultimately, data from 50 participants were included in the final analysis. Basic demographic and measurement data for the participants are presented in Table 1 and Table 2 . The mean age of participants was 26.03 ± 1.4 years in the healthy adult group and 69.95 ± 11.9 years in the physically disabled group. Regarding diagnoses in the physically disabled group, 10 participants had orthopedic conditions, 2 had cerebrovascular disease (without notable paralysis), 3 had cancer, 1 had a spinal cord injury, and 5 had internal medical conditions. Levels of independence in activities of daily living were distributed as follows: 5 participants were classified as J1, 8 as J2, 7 as A2, and 1 as A1. While there were individual differences in walking ability due to use of assistive devices or the need for support, all participants in the physically disabled group were capable of ambulation. In comparisons between groups, the physically disabled group showed significantly lower scores than the healthy group on the Functional Ambulation Categories (FAC) and Berg Balance Scale (BBS). For the Schizotypal Personality Questionnaire (SPQ), healthy adults showed a non-significantly higher trend compared to the physically disabled group. However, no participants had a diagnosis of schizophrenia, and no clear positive or negative symptoms were observed. Table 2 Measurement results for physically disabled and healthy adults Physically disabled group (n = 21) Healthy adult group (n = 29) p -value Age 69.95 ± 11.98 26.03 ± 1.4 .999 MMSE 28.0 ± 2.0 29.9 ± 0.19 < .001 BDI-Ⅱ 8.04 ± 6.72 6.89 ± 5.65 .694 SPQ 6.33 ± 6.07 12.62 ± 7.37 < .001 SIOS 13.55 ± 4.19 13.65 ± 3.59 .867 BBS 39.81 ± 14.27 56 < .001 FAC 3.81 ± 0.93 5 < .001 IOS 4.95 ± 1.39 4.86 ± 1.19 .967 SLQ 484.2 ± 237.1 452.6 ± 230.1 .716 Note : The values are means ± standard deviations MMSE: Mini-Mental State Examination BDI-II: Beck Depression Inventory-Second Edition SPQ: Schizotypal Personality Questionnaire SIOS: Social Independence Outcome Scale BBS: Berg Balance Scale FAC: Functional Ambulation Categories IOS: Inclusion of Other in the Self Scale SLQ: Sedentary Lifestyle Questionnaire Group comparison of sense of agency measures Figure 5 Violin plots of slope and point of subjective equality (PSE) for each group. (Left) Slope values were broadly distributed in both groups. While healthy adults showed values concentrated around the median, the physically disabled group exhibited a more skewed distribution. (Right) The distribution of PSE values was considerably wider in the physically disabled group compared to the healthy adults. While most healthy adults did not judge movements with less than 50% control as self-generated, many individuals with physical disabilities judged such movements as their own. Significant group differences were observed in both slope and PSE. The results of the regression analysis for the physically disabled group showed that age was not a significant predictor of slope, β = 0.053, t (19) = 0.87, p = .393. The model accounted for only 3.9% of the variance ( R² = 0.039), and the overall model fit was not statistically significant, F (1, 19) = 0.76, p = .393. On the other hand, the analysis revealed a marginal, non-significant trend in which age positively predicted PSE, β = 0.006, t (19) = 1.98, p = .061. The model accounted for approximately 17.8% of the variance in PSE ( R² = 0.178). However, the overall regression did not reach statistical significance, F (1, 19) = 3.94, p = .061. Correlations between sense of agency and related factors The relationships between the sense of agency (slope and PSE) and various factors—physical function, activity level, caregiving burden, psychological status, and sense of agency—are presented in Table 3 and Table 4 for the physically disabled and healthy adult groups, respectively. No significant correlations were found for either slope or PSE with any of the measured factors. Table 3 Correlation Analysis of Slope, PSE, and Related Factors in the Physically Disabled Group BDI-Ⅱ SPQ Slope PSE SIOS FAC SLQ BBS MMSE *ADL BDI-Ⅱ ー SPQ 0.25 ー Slope -0.23 0.00 ー PSE -0.19 0.23 0.80*** ー SIOS -0.5* -0.19 -0.09 0.08 ー FAC -0.30 0.23 -0.32 -0.12 0.33 ー SLQ -0.20 0.16 -0.25 -0.26 0.02 0.22 ー BBS -0.43* 0.30 0.00 0.18 0.20 0.57 0.04 ー MMSE -0.38 -0.39 0.10 0.03 0.33 0.31 -0.02 -0.01 ー ADL* -0.19 0.13 -0.27 0.00 0.25 0.35 0.24 -0.11 0.19 ー IOS 0.07 -0.17 -0.08 -0.13 -0.01 -0.35 0.04 0.10 -0.08 -0.62 Note : * p < .05; ** p < .005, *** p < .001 BDI-II: Beck Depression Inventory-Second Edition SPQ: Schizotypal Personality Questionnaire PSE: Point of subjective equality SIOS: Social Independence Outcome Scale FAC: Functional Ambulation Categories SLQ: Sedentary Lifestyle Questionnaire BBS: Berg Balance Scale MMSE: Mini-Mental State Examination IOS: Inclusion of Other in the Self Scale *ADL: ADL independence of physically disabled individuals Table 4 Correlation Analysis of Slope, PSE, and Related Factors in the Healthy adult Group BDI-Ⅱ SPQ Slope PSE SIOS SLQ BDI-Ⅱ ー SPQ 0.46* ー Slope 0.00 0.01 ー PSE -0.04 -0.01 0.66*** ー SIOS -0.18 -0.11 -0.10 0.08 ー SLQ 0.15 0.09 0.24 -0.05 -0.12 ー IOS -0.33 -0.31 0.36 0.25 0.01 -0.11 Note : * p < .05; ** p < .005, *** p < .001 BDI-II: Beck Depression Inventory-Second Edition SPQ: Schizotypal Personality Questionnaire PSE: Point of subjective equality SIOS: Social Independence Outcome Scale SLQ: Sedentary Lifestyle Questionnaire IOS: Inclusion of Other in the Self Scale Discussion The aim of this study was to empirically investigate the characteristics of the sense of agency in individuals with physical disabilities and to explore related factors. A cross-sectional survey was conducted among individuals receiving services under Japan’s national health insurance and long-term care insurance systems. To assess the sense of agency, we employed a dot task that emphasizes cognitive characteristics over sensitivity to purely sensory or perceptual information. Additionally, we exploratorily examined potential associations between the sense of agency and factors such as physical function, activity level, caregiving demands, psychological state, and volition. The results showed that, compared to healthy controls, individuals with physical disabilities exhibited significantly lower slope values and significantly lower PSE, both of which are indicators of the sense of agency. In other words, individuals with physical disabilities are less sensitive to the relationship between their actions and the sensorimotor feedback, but are more likely to attribute the sensorimotor feedback to themselves without sufficient evidence. However, no significant correlations were found between sense of agency and any of the investigated factors in either group. These findings suggest that the presence of physical disability itself—rather than disease-specific characteristics—may contribute to alterations in the sense of agency. Regarding physical function, participants with physical disabilities demonstrated significantly reduced balance and gait performance compared to healthy individuals. Nevertheless, all participants with disabilities were ambulatory, maintaining a certain degree of motor ability. Their motor ability in the upper limb, which was necessary for the dot task, was not impaired. Despite this, they exhibited reduced sensitivity in distinguishing between self-generated and external movements. This indicates that such ability may not be limited to the body parts that are under the influence of physical disabilities, but rather may be a general cognitive function. On the other hand, individuals with physical disabilities showed a significantly lower PSE compared to healthy controls. This is likely to be a compensatory tendency to attribute movements to themselves even when their own motor input was insufficiently reflected. Importantly, our results showed that individuals with physical disabilities do not merely experience a reduced sense of agency, but rather a blurring of the criterion used to make agency judgments. Previous research has shown that active movement enhances perceptual sensitivity (Repp et al. 2007). The observed reduction in sensitivity among individuals with physical disabilities may stem from the narrowing of available behavioral options, which in turn reduces opportunities for active engagement, leading to impaired sensorimotor processing. On the other hand, the lower PSE may reflect a self-protective adaptation or changes in self-concept associated with the progression of physical limitations. However, the conclusion remains uncertain. Nonetheless, our findings highlight the changes both in sensitivity and criterion of the sense of agency in individuals with physical disabilities. Furthermore, while previous studies have reported misattributions of agency in clinical populations such as those with Parkinson’s disease, schizophrenia, stroke, and obsessive-compulsive disorder (Moore et al. 2010; Voss et al. 2010 ; Miyawaki et al. 2020 ; Gentsch et al. 2012 ), such findings have often been interpreted as disease-specific phenomena. In contrast, our study excluded individuals with those specific conditions and focused instead on users of medical or long-term care services, thereby providing findings that are potentially more generalizable. Notably, despite considerable heterogeneity in the backgrounds of individuals with disabilities, the only significant difference in basic characteristics between groups was physical function. This supports the notion that alterations in the sense of agency may stem not from specific diseases but from the broader condition of physical disability itself. Additionally, the present study did not find any significant correlations between the indices of sense of agency and various potential influencing factors in either group. Given that all participants in the current study were more than one year post-onset, it is possible that any initial changes in the sense of agency had stabilized over time. The results suggest that the sense of agency may not be strongly influenced by individual characteristics such as depression or care-receiving status. Instead, the observed differences in sensitivity and criterion between groups may stem from a fundamental impairment in sensorimotor functioning. In conclusion, a key strength of this study lies in its empirical examination of the sense of agency through two distinct components: sensitivity and criterion. We found that individuals with physical disabilities exhibited lower sensitivity in their sense of agency but a stronger tendency toward self-attribution compared to healthy controls. Physical disabilities may impair overall sensorimotor proceccing, even when the sensory and motor abilities of the limb used in the task remain intact. This impairment may lead to a compensatory tendency to attribute sensorimotor input to oneself without sufficient evidence. Further investigations are warranted to explore how this blurring of the self–other boundary impacts overall well-being. There are some limitations in our study. First, the participants with physical disabilities were older than the healthy controls in this study. Therefore, their attentional function and proficiency in using the computer mouse may also have affected task performance. Individual differences in cognitive functions such as attention and motor control ability when using a mouse may require further evaluation in order to understand their relationship with the sensitivity and criterion of the sense of agency. Furthermore, the individual differences in sensitivity and criterion in the physically disabled group were larger than those in the healthy control group. However, we were unable to identify specific factors that are linked to these individual differences. Further research is required to understand the individual differences in changes in the sense of agency in order to develop effective rehabilitation programs and to improve well-being for each individual. Declarations Competing interests The authors declare no competing interests. Funding This work was partially supported by JST FOREST Program (Grant Number: JPMJFR2144) to WW and JST CREST (Grant Number: JPMJCR23P1) to SM. Author Contribution Y.Ando wrote the main manuscript text. All authors reviewed the manuscript. Acknowledgement The authors would like to thank the users and staff of Utsunomiya Visiting Nurse Rehabilitation Station Nicot and the rehabilitation staff of Shin-Kaminokawa Hospital for their cooperation as survey subjects. Data availability All data collected for this study will be made available upon request. References Aron A, Aron EN, Smollan D. (1992). Inclusion of other in the self scale and the structure of interpersonal closeness. Journal of Personality and Social Psychology, 63, 596–612. doi:10.1037/0022-3514.63.4.596 Azuma Y, Chin T, Miura Y (2019) The relationship between balance ability and walking ability using the Berg Balance Scale in people with transfemoral amputation. Prosthet Orthot Int 43:396–401. https://doi.org/10.1177/0309364619846364 Beck AT. (1976). Cognitive therapy and the emotional disorder. New York: International University Press. 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Front Psychol 12 Kojima M, Furukawa TA, Takahashi H, et al (2002) Cross-cultural validation of the Beck Depression Inventory-II in Japan Krugwasser AR, Stern Y, Faivre N, et al (2022) Impaired sense of agency and associated confidence in psychosis. Schizophrenia 8:. https://doi.org/10.1038/s41537-022-00212-4 Lafleur A, Soulières I, Forgeot d’Arc B (2020) Sense of agency: Sensorimotor signals and social context are differentially weighed at implicit and explicit levels. Conscious Cogn 84:. https://doi.org/10.1016/j.concog.2020.103004 Malik RA, Obhi SS (2019) Social exclusion reduces the sense of agency: Evidence from intentional binding. Conscious Cogn 71:30–38. https://doi.org/10.1016/j.concog.2019.03.004 Mcdowell I Measuring Health: A Guide to Rating Scales and Questionnaires, Third Edition Mehta MM, Na S, Gu X, et al (2023) Reward-related self-agency is disturbed in depression and anxiety. PLoS One 18:. https://doi.org/10.1371/journal.pone.0282727 Meseguer-Henarejos AB, Rubio-Aparicio M, López-Pina JA, et al (2019) Characteristics that affect score reliability in the Berg Balance Scale: A meta-analytic reliability generalization study. Eur J Phys Rehabil Med 55:570–584 Mirowsky J. (1995). Age and the sense of control. Social Psychology Quarterly, 58:31–43. Miyawaki Y, Otani T, Morioka S (2020) Agency judgments in post-stroke patients with sensorimotor deficits. PLoS One 15:. https://doi.org/10.1371/journal.pone.0230603 Moore JW (2016) What is the sense of agency and why does it matter? Front Psychol 7:1272. Moore JW, Fletcher PC (2012) Sense of agency in health and disease: A review of cue integration approaches. Conscious Cogn 21:59–68. https://doi.org/10.1016/j.concog.2011.08.010 Moore JW, Lagnado D, Deal DC, Haggard P (2009) Feelings of control: Contingency determines experience of action. Cognition 110:279–283. https://doi.org/10.1016/j.cognition.2008.11.006 Moore JW, Schneider SA, Schwingenschuh P, et al Title: Dopaminergic medication boosts action-effect binding in Parkinson’s Disease Nahab FB, Kundu P, Maurer C, et al (2017) Impaired sense of agency in functional movement disorders: An fMRI study. PLoS One 12:. https://doi.org/10.1371/journal.pone.0172502 Neuls PD, Clark TL, Van Heuklon NC, Proctor JE, Kilker BJ, Bieber ME, Donlan AV, Carr-Jules SA, Neidel WH, Newton RA. (2011). Usefulness of the Berg Balance Scale to predict falls in the elderly. Journal of Geriatric Physical Therapy, 34(1):3–10. Park SH, Lee YS (2017) The Diagnostic Accuracy of the Berg Balance Scale in Predicting Falls. West J Nurs Res 39:1502–1525 Raine A, Raine A (1991) The SPQ: A Scale for the Assessment of Schizotypal Personality Based on DSM-III-R Criteria Downloaded from Repp BH, Knoblich G. (2007). Action can affect auditory perception. Psychological Science, 18(1):6–7. Shimada S, Qi Y, Hiraki K (2010) Detection of visual feedback delay in active and passive self-body movements. Exp Brain Res 201:359–364. https://doi.org/10.1007/s00221-009-2028-6 Synofzik M, Vosgerau G, Newen A (2008) Beyond the comparator model: A multifactorial two-step account of agency. Conscious Cogn 17:219–239. https://doi.org/10.1016/j.concog.2007.03.010 Synofzik M, Vosgerau G, Voss M (2013) The experience of agency: An interplay between prediction and postdiction. Front Psychol 4:. https://doi.org/10.3389/fpsyg.2013.00127 Vogel DHV, Jording M, Weiss PH, Vogeley K (2024) Temporal binding and sense of agency in major depression. Front Psychiatry 15:. https://doi.org/10.3389/fpsyt.2024.1288674 Voss M, Moore J, Hauser M, et al (2010) Altered awareness of action in schizophrenia: A specific deficit in predicting action consequences. Brain 133:3104–3112. https://doi.org/10.1093/brain/awq152 Wang YP, Gorenstein C (2013) Psychometric properties of the Beck Depression Inventory-II: A comprehensive review. Revista Brasileira de Psiquiatria 35:416–431 Wen W, Chang AYC, Imamizu H (2024) The sensitivity and criterion of sense of agency. Trends Cogn Sci 28:397–399 Wen W, Haggard P (2018) Control changes the way we look at the world. J Cogn Neurosci 30:603–619. https://doi.org/10.1162/jocn_a_01226 Wen W, Haggard P (2020) Prediction error and regularity detection underlie two dissociable mechanisms for computing the sense of agency. Cognition 195:. https://doi.org/10.1016/j.cognition.2019.104074 Wen W, Imamizu H (2022) The sense of agency in perception, behaviour and human–machine interactions. Nature Reviews Psychology 1:211–222 Wen W, Shimazaki N, Ohata R, et al (2020) Categorical perception of control. eNeuro 7:1–11. https://doi.org/10.1523/ENEURO.0258-20.2020 Kaede no Kaze Group. (n.d.). Home medical care and rehabilitation support . Retrieved from https://kaedenokaze.com/rehabiliday/sios/ Cabinet Office, Government of Japan. (n.d.). Basic Law for Persons with Disabilities . Retrieved from https://www8.cao.go.jp/shougai/whitepaper/h24hakusho/zenbun/pdf/h1/furoku01.pdf Ministry of Health, Labour and Welfare, Japan. (n.d.). Overview of the medical insurance system in Japan . Retrieved from https://www.mhlw.go.jp/stf/seisakunitsuite/bunya/kenkou_iryou/iryouhoken/iryouhoken01/index.html Iijima Y, Sasaki J, Bando N, Asai T, Mouri I, Tanno Y. (2010). Development of the Japanese version of the Schizotypal Personality Questionnaire and factor structure in schizotypal personality. Japanese Journal of Behavior Therapy , 36(1):29–41. Kai Y, et al. (2017). Reliability and validity of the Sedentary Lifestyle Questionnaire for Japanese (SLQ-J). Taiiku Kenkyu [Japan Journal of Physical Fitness and Sports Medicine], 115:23–29. Table 1 Table 1 is not available with this version. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7045962","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":484477480,"identity":"9be62445-bd22-4945-baf1-c68f952e4386","order_by":0,"name":"Yoshiki Ando","email":"data:image/png;base64,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","orcid":"","institution":"Kio University","correspondingAuthor":true,"prefix":"","firstName":"Yoshiki","middleName":"","lastName":"Ando","suffix":""},{"id":484477481,"identity":"4e042fba-3f14-477a-843b-5c0f1a384478","order_by":1,"name":"Kazuki Hayashida","email":"","orcid":"","institution":"Takarazuka University of Medical and Health Care","correspondingAuthor":false,"prefix":"","firstName":"Kazuki","middleName":"","lastName":"Hayashida","suffix":""},{"id":484477482,"identity":"38f875a7-1c9d-46c6-9eac-568108a4af28","order_by":2,"name":"Wen Wen","email":"","orcid":"","institution":"Rikkyo University","correspondingAuthor":false,"prefix":"","firstName":"Wen","middleName":"","lastName":"Wen","suffix":""},{"id":484477483,"identity":"f6dd8612-52ad-4f3e-8f68-62277f3ce85e","order_by":3,"name":"Shu Morioka","email":"","orcid":"","institution":"Kio University","correspondingAuthor":false,"prefix":"","firstName":"Shu","middleName":"","lastName":"Morioka","suffix":""}],"badges":[],"createdAt":"2025-07-04 10:53:04","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-7045962/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-7045962/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":86725770,"identity":"dd527bb4-7bf6-4097-9f1b-3d0c27d32e58","added_by":"auto","created_at":"2025-07-15 02:40:11","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":45982,"visible":true,"origin":"","legend":"\u003cp\u003eExperimental Task. Participants manipulated the dots on the screen using the laptop's touchpad for 4 seconds, and then answered whether they felt they had controlled the dot by selecting “yes” or “no.”\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-7045962/v1/33e096c969e6286cadd81c57.png"},{"id":86725967,"identity":"28a14ec2-b241-484f-b407-59de4e353f8c","added_by":"auto","created_at":"2025-07-15 02:48:11","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":55563,"visible":true,"origin":"","legend":"\u003cp\u003eExample of a typical logistic regression curve and AUC in a healthy adult. (A) A representative logistic regression curve from a healthy adult shows a gradual S-shaped pattern. The curve becomes steeper once the proportion of self-generated movement exceeds approximately 50%, indicating increased sensitivity to self-agency. (B) The corresponding area under the curve (AUC) for the same participant approximates a trapezoid with linear sides and features a large enclosed area, reflecting a consistent and confident judgment pattern.\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-7045962/v1/e2223774b1eb2c0baf12257d.png"},{"id":86725771,"identity":"5b79d566-5e10-4125-b944-25297c3f091d","added_by":"auto","created_at":"2025-07-15 02:40:11","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":52672,"visible":true,"origin":"","legend":"\u003cp\u003eExample of a poorly fitted logistic regression curve and AUC. (A) A logistic regression curve with a poor model fit, displaying a linear rather than an S-shaped form. Unlike the curve in Fig. 2A, there is no clear point at which the slope becomes steeper, indicating unclear sensitivity to self-agency. (B) The corresponding AUC for the same participant as in (A), showing an irregular trapezoidal shape. The area under the curve is smaller, and the line segments are discontinuous, reflecting inconsistent responses and poor model fit.\u003c/p\u003e","description":"","filename":"3.png","url":"https://assets-eu.researchsquare.com/files/rs-7045962/v1/07b2a5ead122d96ed7043e6b.png"},{"id":86725777,"identity":"107eb64d-942b-4128-9088-c4b31752541b","added_by":"auto","created_at":"2025-07-15 02:40:11","extension":"png","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":47658,"visible":true,"origin":"","legend":"\u003cp\u003eParticipant inclusion flowchart. Of the 58 individuals who initially agreed to participate, 8 were excluded due to not meeting the inclusion criteria. As a result, 29 healthy adults and 21 individuals with physical disabilities were enrolled in the study.\u003c/p\u003e","description":"","filename":"4.png","url":"https://assets-eu.researchsquare.com/files/rs-7045962/v1/458b6f8174d7a8dd86251595.png"},{"id":86725784,"identity":"00ff8bd3-b7e4-41de-9fb1-f4c8ae7be9ba","added_by":"auto","created_at":"2025-07-15 02:40:11","extension":"png","order_by":5,"title":"Figure 5","display":"","copyAsset":false,"role":"figure","size":65526,"visible":true,"origin":"","legend":"\u003cp\u003eViolin plots of slope and point of subjective equality (PSE) for each group. (Left) Slope values were broadly distributed in both groups. While healthy adults showed values concentrated around the median, the physically disabled group exhibited a more skewed distribution. (Right) The distribution of PSE values was considerably wider in the physically disabled group compared to the healthy adults. While most healthy adults did not judge movements with less than 50% control as self-generated, many individuals with physical disabilities judged such movements as their own. Significant group differences were observed in both slope and PSE.\u003c/p\u003e","description":"","filename":"5.png","url":"https://assets-eu.researchsquare.com/files/rs-7045962/v1/e0e11ab424b656d7e056e3ab.png"},{"id":88390534,"identity":"fe6c5d01-3bff-4a34-91d6-308a97ccb6f1","added_by":"auto","created_at":"2025-08-06 04:16:51","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1073052,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7045962/v1/87172742-48a8-4c19-9221-bcb02a57c0d6.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Effects of physical disability on the sensitivity and criterion of sense of agency","fulltext":[{"header":"Introduction","content":"\u003cp\u003e\u003cb\u003eThe mechanism behind the generation of sense of agency\u003c/b\u003e\u003c/p\u003e\u003cp\u003eThe sense of agency, a concept proposed by Gallagher (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e2000\u003c/span\u003e), refers to the subjective experience of controlling one’s own actions, and through them, the external events. The classic theory of comparator model suggests that the sense of agency is primarily based on sensorimotor information derived from the comparison between predicted and actual sensory feedback (Frith et al. \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e2000\u003c/span\u003e). When prediction errors are minimal—that is, when an action is executed as intended—individuals experience a strong sense of agency. For instance, when the sound expected after pressing a button is heard immediately, the sense of agency is typically strong. In contrast, the absence of the expected sound may reduce or eliminate this sense of agency. However, recent studies showed that besides the prediction error other information can also alter the sense of agency. Specifically, several cognitive factors can preserve the sense of agency even when prediction errors are large and the contribution of sensorimotor information is presumed to be minimal. Such cognitive factors include priori beliefs (Moore et al. \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e2009\u003c/span\u003e), social context (Lafleur et al. \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e2020\u003c/span\u003e), and outcome regularity (Wen \u0026amp; Haggard \u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e2020\u003c/span\u003e). Recent studies suggest that the generation of the sense of agency involve both sensorimotor information (sensorimotor level) and cognitive information (cognitive level), and to result from the relative weighting of the reliability of these two sources of information (Haggard \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e2017\u003c/span\u003e; Synofzk et al. 2008; Wen et al. 2022). According to the cue integration theory (Synofzk et al. 2013; Moore et al. 2012), these weightings are adjusted based on the reliability of sensorimotor and cognitive information in a given situation.\u003c/p\u003e\u003cp\u003eUnderstanding the mechanisms underlying the sense of agency has important implications for clinical rehabilitation practice. In individuals with physical disabilities, the sense of agency may be impaired due to motor and sensory impairments. The sense of agency has been shown to be closely associated with enhanced health and well-being (Moore \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e2016\u003c/span\u003e). Promoting this sense of agency is therefore considered essential for enabling individuals to lead better well-being. Among the various causes of a diminished sense of agency, three have been widely reported in the literature: physical impairments (Mirowsky \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e1995\u003c/span\u003e), aging (Cioffi et al. \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e2017\u003c/span\u003e), and mental or cognitive dysfunction (Vogel et al. \u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e2024\u003c/span\u003e; Mehta et al. \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e2023\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eIn the domain of physical functioning, Mirowsky (\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e1995\u003c/span\u003e) reported that the average level of sense of agency remains high and stable between the ages of 18 and 50, but progressively declines with increasing age. This decline in older adults is largely attributed to physical impairments, such as reduced mobility, visual and auditory deterioration, and chronic pain. Cioffi (2017) found that older adults exhibit significantly lower levels of predictive judgment, bodily ownership, and sense of agency in response to bodily illusions compared to younger individuals. This reduction is thought to stem from a diminished ability to effectively utilize external sensory cues.\u003c/p\u003e\u003cp\u003eFurthermore, individuals with psychiatric disorders have been shown to experience difficulties in identifying their own actions (Krugwasser et al. \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e2022\u003c/span\u003e). Furthermore, a recent study reported that across both major depressive disorder (MDD) and control groups, a stronger tendency toward depressive symptoms was associated with reduced sense of agency (Vogel et al. \u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e2024\u003c/span\u003e). Specifically, people generally report an increased sense of agency in response to reward-contingent feedback (Kaiser et al. \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e2021\u003c/span\u003e). However, this effect was significantly attenuated in the depression and anxiety groups relative to healthy individuals (Mehta et al. \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e2023\u003c/span\u003e). Moreover, an increased tendency to attribute actions to oneself following negative loss feedback was associated with a worsening of anhedonia symptoms (Mehta et al. \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e2023\u003c/span\u003e). Assuming that the conventional sense of agency is influenced by reward-based processing, these findings suggest that individuals with depression and anxiety disorders—who are characterized by a tendency to internalize negative feedback and a diminished sensitivity to rewards—may experience impaired sense of agency. Although the above studies focus on distinct aspects, it is well established that physical function declines with age. Mental function is also known to be affected by both aging and deterioration in physical condition.\u003c/p\u003e\u003cp\u003e\u003cb\u003ePhysical disability and sense of agency\u003c/b\u003e\u003c/p\u003e\u003cp\u003eThe present study focuses on the sense of agency in patients with physical disabilities. Japan’s Basic Law for Persons with Disabilities (the Act) defines that the term “disability” encompasses physical, intellectual, and mental disabilities (including developmental disorders), as well as any other impairment of mental or physical functions. Importantly, the Act defines a “person with a disability” not solely based on the presence of a functional impairment, but as someone who continuously experiences significant restrictions in daily or social life due to the interaction between their impairment and societal barriers. To alleviate the burdens faced by individuals with disabilities, Japan has implemented public support systems such as medical insurance and long-term care insurance. These systems aim to reduce the economic strain on individuals and ensure that society as a whole plays a role in supporting their daily lives and social participation.\u003c/p\u003e\u003cp\u003ePrevious research has shown that individuals with functional limitations or physical disabilities are generally at a disadvantage in terms of opportunities for social participation (Bickenbach et al. \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e1999\u003c/span\u003e). Notably, it has been reported that the social disadvantages is associated with reduced sense of agency. For example, one study demonstrated that the behavioral effect interval—a quantitative measure of the sense of agency—was significantly longer after participants recalled an episode of social exclusion, compared to when they recalled an episode of social inclusion or a baseline condition without priming stimuli (Malik et al. 2019). Furthermore, an fMRI study reported significant differences in the sense of agency between individuals with functional movement disorders (FMD) and healthy controls (Nahab et al., \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e2017\u003c/span\u003e). Importantly, some participants with FMD reported an exaggerated sense of agency in situations where motor control was clearly impaired, while others reported a lack of control even when motor function appeared intact (Nahab et al., \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e2017\u003c/span\u003e). These findings suggest that patients with FMD do not simply have a higher or lower sense of agency, but rather a less accurate sense of agency compared to healthy individuals. Recently, Wen et al. (\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e2024\u003c/span\u003e) proposed that the sense of agency should be separated into two aspects, sensitivity and criterion. The former aspect measures how well one can distinguish between self- and other-caused sensory input, while the latter reflects the tendency to attribute sensory input to oneself. However, most previous studies on impaired sense of agency in various groups—such as individuals with physical disabilities or mental disorders—have not attempted to distinguish between these two aspects, making it difficult to understand the mechanisms underlying such impairments.\u003c/p\u003e\u003cp\u003eIn the case of physical disabilities, impaired effector organs may lead to reduced sensory feedback, resulting in mismatches between predicted and actual sensory information. This can potentially weaken the sensitivity of sense of agency. However, weakened sensorimotor-level sensitivities may be cognitively compensated for during self-attribution judgments. Therefore, using a single index of the sense of agency—such as rating, sensory attenuation, or intentional binding—is not sufficient to capture the full picture. In the present study, we aim to measure both the sensitivity and criterion of the sense of agency in patients with physical disabilities. Such research is vital for informing the development of medical, rehabilitative, and social support systems.\u003c/p\u003e\u003cp\u003e\u003cb\u003ePurpose of this study and research hypotheses\u003c/b\u003e\u003c/p\u003e\u003cp\u003eThe present study aims to empirically examine the characteristics of the sense of agency in individuals with physical disabilities and related factors. Two main hypotheses are proposed. First, it is likely that the sensitivity of sense of agency in individuals with physical disabilities is lower compared healthy adults due to the weakened sensorimotor input. Second, there may be a negative correlation between depression and sensitivity of the sense of agency in both the healthy adult group and the group with physical disabilities.\u003c/p\u003e\u003cp\u003eThis study presents two key novel contributions. First, by conducting a cross-sectional survey of individuals receiving services under Japan’s medical insurance and long-term care insurance systems, it enables the examination of the combined effects of physical function, aging, and mental health. Previous studies have tended to investigate these factors in isolation and have not comprehensively addressed their interaction in populations with multiple health conditions. Second, this study seeks to enhance existing measurement approaches. We plan to conduct assessment tasks that take individual characteristics into account, in addition to measuring the sense of agency, allowing for a more precise evaluation of how impairments in the sense of agency are linked to other factors. The findings of this study are expected to contribute to the optimization of medical and long-term care services, as well as to the refinement of criteria used in long-term care certification. By facilitating care that aligns more closely with patients’ intentions and goals, these improvements may help enhance health outcomes and overall well-being. Moreover, the results may offer valuable insights for the development of effective clinical intervention strategies.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003e\u003cb\u003eParticipants\u003c/b\u003e\u003c/p\u003e\u003cp\u003eThe participants were 27 homebound physically handicapped adults and 31 healthy controls in their 20s. Exclusion criteria were those who had difficulty performing or understanding the experimental tasks, those with visual impairments, those with upper limb functional impairments and those with Mini-Mental State Examination (MMSE) scores of 23 or less. Previous studies were unable to provide estimated effect sizes for group contrasts on sense of agency, and therefore we did not perform a priori power calculation. All participants were given a written explanation in accordance with the Declaration of Helsinki, and signed consent was obtained. The study was approved by the Kio University Research Ethics Committee (approval number: R5-35).\u003c/p\u003e\u003cp\u003e\u003cb\u003eExperimental tasks for capturing the sense of activity\u003c/b\u003e\u003c/p\u003e\u003cp\u003eWe employed the dot task developed by Wen et al. (2018, \u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e2020\u003c/span\u003e) as a method to quantify the sense of agency and to test our hypothesis regarding the factors associated with its reduction in individuals with physical disabilities. In this task, participants use a laptop touchpad to manipulate dots on a screen (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). The movement of the dots is interspersed with pre-recorded movements of others, with the proportion of the participant’s own input randomly varied in 10% increments from 0–100% across 11 conditions. Each condition consisted of ten 4-second trials (110 trials in total), and after each trial, participants answered “Yes” or “No” to whether they felt they were controlling the dots.\u003c/p\u003e\u003cp\u003eThis task is considered suitable for individuals with physical impairments due to its simplicity and accessibility. Moreover, it is regarded as a valid tool for assessing the sense of agency, as it minimizes biases arising from individual judgment criteria and allows for the investigation of inter-individual differences (Wen et al. \u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e2024\u003c/span\u003e). Specifically, a logistic curve was fitted to the responses (i.e., the proportion of yes-response) across varying levels of stimulus control. This approach enables the calculation of two key indices: the slope, representing the sensitivity of the sense of agency, and the point of subjective equality (PSE), representing the criterion used to judge the sense of agency (Wen et al. \u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e2024\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003ePhysical function\u003c/b\u003e\u003c/p\u003e\u003cp\u003ePhysical function of the participants was assessed using the Berg Balance Scale (BBS) for motor performance and the Functional Ambulation Categories (FAC) for walking independence. The BBS is a widely used tool for evaluating functional balance and has demonstrated high validity and reliability across diverse patient populations, including individuals with neurological disorders such as Parkinson’s disease, multiple sclerosis, and traumatic brain injury, as well as those with acquired conditions such as lower limb amputation (Meseguer et al. 2019).\u003c/p\u003e\u003cp\u003eThe BBS consists of three domains: seated balance, standing balance, and dynamic balance. Seated balance is assessed by the ability to sit unsupported. Standing balance includes tasks such as standing without support, standing with eyes closed, standing with feet together, standing on one leg, turning to look behind, picking up an object from the floor, reaching forward with an outstretched arm, and placing one foot in front of the other. Dynamic balance is evaluated through tasks including sit-to-stand, stand-to-sit, transfers, 360-degree turns, and stepping onto a platform (Azuma et al. \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2019\u003c/span\u003e; Park et al. 2017; Neuls et al. \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e2011\u003c/span\u003e). Each item was rated on a 5-point ordinal scale from 0 to 4, with a maximum total score of 56. A score of 0 indicates inability to perform the task, while 4 indicates independent performance. Scoring may also consider the time taken, posture maintenance, and degree of supervision or use of assistive devices (Berg et al. 1992).\u003c/p\u003e\u003cp\u003eThe FAC assesses walking independence on a 6-point scale (0–5) based on the level of assistance required. A score of 0 indicates an inability to walk even with the help of two or more people, while a score of 5 reflects complete independence on level and uneven surfaces, including stairs.\u003c/p\u003e\u003cp\u003e\u003cb\u003eActivity level\u003c/b\u003e\u003c/p\u003e\u003cp\u003eActivity level of the participants was measured using the Sedentary Lifestyle Questionnaire for Japanese (SLQ-J), a validated and reliable tool for assessing total sedentary time among individuals (Kai et al. \u003cspan citationid=\"CR48\" class=\"CitationRef\"\u003e2017\u003c/span\u003e). Participants reported time spent sitting in six domains—work, commuting, television, computer use, reading, and other activities—on both working and non-working days.\u003c/p\u003e\u003cp\u003e\u003cb\u003eCaregiving burden\u003c/b\u003e\u003c/p\u003e\u003cp\u003eCaregiving burden was assessed using two measures: the level of independence in daily living, and the Inclusion of Other in the Self Scale (IOS) to evaluate trust-based relationships with caregivers.\u003c/p\u003e\u003cp\u003eThe level of independence is defined by the Ministry of Health, Labour and Welfare (Japan), classifying individuals into four ranks: Rank J (independent), Rank A (semi-bedridden), and Ranks B and C (bedridden), each subdivided into two levels, resulting in eight total categories. Rank J includes J1 (uses public transport) and J2 (limited to neighborhood outings); Rank A includes A1 (assisted outings, active during the day) and A2 (rare outings, partial bedrest); Rank B includes B1 (wheelchair use for eating and toileting) and B2 (wheelchair use with assistance). The IOS is a simple and reliable tool for evaluating perceived closeness in interpersonal relationships (Gächter et al. \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e2015\u003c/span\u003e). Participants select from seven pairs of increasingly overlapping circles to indicate their perceived closeness with a caregiver (Aron et al. \u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1992\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003cb\u003ePsychological and psychiatric factors\u003c/b\u003e\u003c/p\u003e\u003cp\u003ePsychological status was assessed using the Japanese versions of the Beck Depression Inventory-II (BDI-II) and the Schizotypal Personality Questionnaire (SPQ). The BDI-II is a 21-item self-report scale developed by Beck et al. to assess depressive symptoms over the previous two weeks (Beck et al. 1961). It is globally recognized for its high reliability, diagnostic sensitivity, and construct validity, and has been validated for use in Japanese populations (Kojima et al. \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e2002\u003c/span\u003e; Wang et al. 2013; McDowell 2006).\u003c/p\u003e\u003cp\u003eThe SPQ consists of 74 binary (yes/no) items covering the nine DSM-III-R criteria for schizotypal personality disorder and is widely used to evaluate schizotypal traits in non-clinical populations (Raine \u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e1991\u003c/span\u003e). The Japanese version has demonstrated psychometric properties comparable to the original (Iijima et al. \u003cspan citationid=\"CR47\" class=\"CitationRef\"\u003e2010\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003cb\u003eInitiative\u003c/b\u003e\u003c/p\u003e\u003cp\u003eThe Social Independence Outcome Scale (SIOS) was used to assess initiative. This scale evaluates outcomes of role acquisition and social participation in elderly individuals with declining functional abilities. It includes three subscales (11 items total) derived from the ICF “Activity and Participation” domain, and a “subjectivity” component reflecting self-empowerment. In this study, we focused on the “Initiative” subscale, which includes five items: self-efficacy, interpersonal interaction, knowledge and understanding, independent decision-making, and self-management. The SIOS has shown high internal consistency and test-retest reliability. Given our focus on sensorimotor-level ownership (as assessed by the dot task), the SIOS “Initiative” measure was used to evaluate participants’ subjective assessment of their own sense of agency.\u003c/p\u003e\u003cp\u003e\u003cb\u003eData processing: sense of agency subjectivity\u003c/b\u003e\u003c/p\u003e\u003cp\u003eFrom the dot task (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e), logistic regression curves were generated based on the percentage of yes-response at each control level. The logistic function was modeled as:\u003c/p\u003e\u003cdiv id=\"Equa\" class=\"Equation\"\u003e\u003cdiv format=\"TEX\" class=\"mathdisplay\" id=\"FileID_Equa\" name=\"EquationSource\"\u003e\n$$\\:y=\\:\\frac{1}{1+\\text{e}\\text{x}\\text{p}(-a\\left(x-PSE\\right))}$$\u003c/div\u003e\u003c/div\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003ewhere \u003cem\u003ea\u003c/em\u003e denotes the slope of the curve and PSE represents the level of control at which participants responded “Yes” and “No” equally (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003eA) (Shimada et al. \u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e2010\u003c/span\u003e). A steeper slope indicates greater sensitivity to self-agency, while a shallower slope indicates lower sensitivity. A higher PSE suggests a conservative criterion for self-attribution, whereas a lower PSE reflects a more liberal criterion (Wen et al. \u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e2024\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eTo ensure valid data interpretation, ambiguous responses were excluded based on area under the curve (AUC) values. For instance, Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003eB shows clear response patterns (AUC = 0.93), while Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003eB shows ambiguous patterns with frequent reversals (AUC = 0.79). Previous research classifies AUCs as follows: 0.70–0.80 (acceptable), 0.80–0.90 (high), and 0.90–1.00 (excellent) in discrimination performance (Hosmer et al. 2000). Based on this, trials with AUC ≤ 0.80 were excluded from further analysis due to poor model fit and unclear expression of action subjectivity.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003ch2\u003eStatistical analysis\u003c/h2\u003e\u003cp\u003eNormality of each variable was assessed using the Shapiro–Wilk test. Between-group comparisons (healthy vs. physically disabled adults) were conducted using independent samples \u003cem\u003et\u003c/em\u003e-tests when normality was confirmed, and Mann–Whitney U tests otherwise. In addition, simple regression analysis was performed to confirm the effect of age in the group of with physical disabilities.\u003c/p\u003e\u003cp\u003eComparisons of slope and PSE between groups followed the same procedure. Correlations between slope/PSE and various factors—physical function, activity level, caregiving burden, psychological variables, and initiative—were evaluated using Spearman’s rank correlation coefficient.\u003c/p\u003e\u003cp\u003eAll statistical analyses were performed using RStudio (version 2023.06.0 + 421), with the significance level set at 5%.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003e\u003cb\u003eResults of each measurement item\u003c/b\u003e\u003c/p\u003e\u003cp\u003eFigure\u0026nbsp;\u003cspan refid=\"Fig4\" class=\"InternalRef\"\u003e4\u003c/span\u003e illustrates the participant flow throughout the study. Of the 27 service users registered at a home-visit rehabilitation station affiliated with the First author, and 31 healthy adults, 8 individuals were excluded for not meeting the inclusion criteria. As a result, 29 healthy adults and 21 individuals with physical disabilities were enrolled in the study. Among these, four participants did not meet the AUC criterion of 0.8. Two participants were excluded due to excessively steep logistic regression slopes (slope\u0026thinsp;\u0026gt;\u0026thinsp;100), and two others either declined to complete the questionnaire or were unable to understand the questions. Ultimately, data from 50 participants were included in the final analysis.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003eBasic demographic and measurement data for the participants are presented in Table\u0026nbsp;1 and Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e2\u003c/span\u003e. The mean age of participants was 26.03\u0026thinsp;\u0026plusmn;\u0026thinsp;1.4 years in the healthy adult group and 69.95\u0026thinsp;\u0026plusmn;\u0026thinsp;11.9 years in the physically disabled group. Regarding diagnoses in the physically disabled group, 10 participants had orthopedic conditions, 2 had cerebrovascular disease (without notable paralysis), 3 had cancer, 1 had a spinal cord injury, and 5 had internal medical conditions.\u003c/p\u003e\u003cp\u003eLevels of independence in activities of daily living were distributed as follows: 5 participants were classified as J1, 8 as J2, 7 as A2, and 1 as A1. While there were individual differences in walking ability due to use of assistive devices or the need for support, all participants in the physically disabled group were capable of ambulation.\u003c/p\u003e\u003cp\u003eIn comparisons between groups, the physically disabled group showed significantly lower scores than the healthy group on the Functional Ambulation Categories (FAC) and Berg Balance Scale (BBS). For the Schizotypal Personality Questionnaire (SPQ), healthy adults showed a non-significantly higher trend compared to the physically disabled group. However, no participants had a diagnosis of schizophrenia, and no clear positive or negative symptoms were observed.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eMeasurement results for physically disabled and healthy adults\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"4\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePhysically disabled group (n\u0026thinsp;=\u0026thinsp;21)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eHealthy adult group (n\u0026thinsp;=\u0026thinsp;29)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cem\u003ep\u003c/em\u003e-value\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAge\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e69.95\u0026thinsp;\u0026plusmn;\u0026thinsp;11.98\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e26.03\u0026thinsp;\u0026plusmn;\u0026thinsp;1.4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSex(men/female)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e12/9\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e16/13\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u0026gt;\u0026thinsp;.999\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMMSE\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e28.0\u0026thinsp;\u0026plusmn;\u0026thinsp;2.0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e29.9\u0026thinsp;\u0026plusmn;\u0026thinsp;0.19\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eBDI-Ⅱ\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e8.04\u0026thinsp;\u0026plusmn;\u0026thinsp;6.72\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e6.89\u0026thinsp;\u0026plusmn;\u0026thinsp;5.65\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e.694\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSPQ\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e6.33\u0026thinsp;\u0026plusmn;\u0026thinsp;6.07\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e12.62\u0026thinsp;\u0026plusmn;\u0026thinsp;7.37\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSIOS\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e13.55\u0026thinsp;\u0026plusmn;\u0026thinsp;4.19\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e13.65\u0026thinsp;\u0026plusmn;\u0026thinsp;3.59\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e.867\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eBBS\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e39.81\u0026thinsp;\u0026plusmn;\u0026thinsp;14.27\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e56\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFAC\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e3.81\u0026thinsp;\u0026plusmn;\u0026thinsp;0.93\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eIOS\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e4.95\u0026thinsp;\u0026plusmn;\u0026thinsp;1.39\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e4.86\u0026thinsp;\u0026plusmn;\u0026thinsp;1.19\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e.967\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSLQ\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e484.2\u0026thinsp;\u0026plusmn;\u0026thinsp;237.1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e452.6\u0026thinsp;\u0026plusmn;\u0026thinsp;230.1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e.716\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"4\"\u003e\u003cem\u003eNote\u003c/em\u003e: The values are means\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviations\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colspan=\"4\"\u003eMMSE: Mini-Mental State Examination\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colspan=\"4\"\u003eBDI-II: Beck Depression Inventory-Second Edition\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colspan=\"4\"\u003eSPQ: Schizotypal Personality Questionnaire\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colspan=\"4\"\u003eSIOS: Social Independence Outcome Scale\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colspan=\"4\"\u003eBBS: Berg Balance Scale\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colspan=\"4\"\u003eFAC: Functional Ambulation Categories\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eIOS: Inclusion of Other in the Self Scale\u003c/p\u003e\u003cp\u003eSLQ: Sedentary Lifestyle Questionnaire\u003c/p\u003e\u003cp\u003e\u003cb\u003eGroup comparison of sense of agency measures\u003c/b\u003e\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003eFigure\u0026nbsp;\u003cspan refid=\"Fig5\" class=\"InternalRef\"\u003e5\u003c/span\u003e Violin plots of slope and point of subjective equality (PSE) for each group. (Left) Slope values were broadly distributed in both groups. While healthy adults showed values concentrated around the median, the physically disabled group exhibited a more skewed distribution. (Right) The distribution of PSE values was considerably wider in the physically disabled group compared to the healthy adults. While most healthy adults did not judge movements with less than 50% control as self-generated, many individuals with physical disabilities judged such movements as their own. Significant group differences were observed in both slope and PSE.\u003c/p\u003e\u003cp\u003eThe results of the regression analysis for the physically disabled group showed that age was not a significant predictor of slope, \u003cem\u003eβ\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.053, \u003cem\u003et\u003c/em\u003e(19)\u0026thinsp;=\u0026thinsp;0.87, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;.393. The model accounted for only 3.9% of the variance (\u003cem\u003eR\u0026sup2;\u003c/em\u003e = 0.039), and the overall model fit was not statistically significant, \u003cem\u003eF\u003c/em\u003e(1, 19)\u0026thinsp;=\u0026thinsp;0.76, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;.393. On the other hand, the analysis revealed a marginal, non-significant trend in which age positively predicted PSE, \u003cem\u003eβ\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.006, \u003cem\u003et\u003c/em\u003e(19)\u0026thinsp;=\u0026thinsp;1.98, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;.061. The model accounted for approximately 17.8% of the variance in PSE (\u003cem\u003eR\u0026sup2;\u003c/em\u003e = 0.178). However, the overall regression did not reach statistical significance, \u003cem\u003eF\u003c/em\u003e(1, 19)\u0026thinsp;=\u0026thinsp;3.94, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;.061.\u003c/p\u003e\u003cp\u003e\u003cb\u003eCorrelations between sense of agency and related factors\u003c/b\u003e\u003c/p\u003e\u003cp\u003eThe relationships between the sense of agency (slope and PSE) and various factors\u0026mdash;physical function, activity level, caregiving burden, psychological status, and sense of agency\u0026mdash;are presented in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e3\u003c/span\u003e and Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e4\u003c/span\u003e for the physically disabled and healthy adult groups, respectively. No significant correlations were found for either slope or PSE with any of the measured factors.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eCorrelation Analysis of Slope, PSE, and Related Factors in the Physically Disabled Group\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"11\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c10\" colnum=\"10\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c11\" colnum=\"11\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eBDI-Ⅱ\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eSPQ\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eSlope\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003ePSE\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003eSIOS\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c7\"\u003e\u003cp\u003eFAC\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c8\"\u003e\u003cp\u003eSLQ\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c9\"\u003e\u003cp\u003eBBS\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c10\"\u003e\u003cp\u003eMMSE\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c11\"\u003e\u003cp\u003e*ADL\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eBDI-Ⅱ\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eー\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSPQ\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.25\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eー\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSlope\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e-0.23\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.00\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eー\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePSE\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e-0.19\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.23\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.80***\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eー\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSIOS\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e-0.5*\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e-0.19\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e-0.09\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.08\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eー\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFAC\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e-0.30\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.23\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e-0.32\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e-0.12\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.33\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eー\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSLQ\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e-0.20\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.16\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e-0.25\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e-0.26\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.02\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.22\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003eー\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eBBS\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e-0.43*\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.30\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.00\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.18\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.20\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.57\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.04\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003eー\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMMSE\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e-0.38\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e-0.39\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.10\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.03\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.33\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.31\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e-0.02\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e-0.01\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003eー\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eADL*\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e-0.19\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.13\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e-0.27\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.00\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.25\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.35\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.24\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e-0.11\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e0.19\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003eー\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eIOS\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.07\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e-0.17\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e-0.08\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e-0.13\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e-0.01\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e-0.35\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.04\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e0.10\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e-0.08\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e-0.62\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"11\"\u003e\u003cem\u003eNote\u003c/em\u003e: *\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;.05; **\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;.005, ***\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;.001\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colspan=\"11\"\u003eBDI-II: Beck Depression Inventory-Second Edition\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colspan=\"11\"\u003eSPQ: Schizotypal Personality Questionnaire\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colspan=\"11\"\u003ePSE: Point of subjective equality\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colspan=\"11\"\u003eSIOS: Social Independence Outcome Scale\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colspan=\"11\"\u003eFAC: Functional Ambulation Categories\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colspan=\"11\"\u003eSLQ: Sedentary Lifestyle Questionnaire\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colspan=\"11\"\u003eBBS: Berg Balance Scale\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colspan=\"11\"\u003eMMSE: Mini-Mental State Examination\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eIOS: Inclusion of Other in the Self Scale\u003c/p\u003e\u003cp\u003e*ADL: ADL independence of physically disabled individuals\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eCorrelation Analysis of Slope, PSE, and Related Factors in the Healthy adult Group\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"7\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eBDI-Ⅱ\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eSPQ\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eSlope\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003ePSE\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003eSIOS\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c7\"\u003e\u003cp\u003eSLQ\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eBDI-Ⅱ\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eー\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSPQ\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.46*\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eー\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSlope\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.00\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.01\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eー\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePSE\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e-0.04\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e-0.01\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.66***\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eー\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSIOS\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e-0.18\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e-0.11\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e-0.10\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.08\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eー\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSLQ\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.15\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.09\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.24\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e-0.05\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e-0.12\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eー\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eIOS\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e-0.33\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e-0.31\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.36\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.25\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.01\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e-0.11\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"7\"\u003e\u003cem\u003eNote\u003c/em\u003e: *\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;.05; **\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;.005, ***\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;.001\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colspan=\"7\"\u003eBDI-II: Beck Depression Inventory-Second Edition\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colspan=\"7\"\u003eSPQ: Schizotypal Personality Questionnaire\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colspan=\"7\"\u003ePSE: Point of subjective equality\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colspan=\"7\"\u003eSIOS: Social Independence Outcome Scale\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colspan=\"7\"\u003eSLQ: Sedentary Lifestyle Questionnaire\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eIOS: Inclusion of Other in the Self Scale\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe aim of this study was to empirically investigate the characteristics of the sense of agency in individuals with physical disabilities and to explore related factors. A cross-sectional survey was conducted among individuals receiving services under Japan\u0026rsquo;s national health insurance and long-term care insurance systems. To assess the sense of agency, we employed a dot task that emphasizes cognitive characteristics over sensitivity to purely sensory or perceptual information. Additionally, we exploratorily examined potential associations between the sense of agency and factors such as physical function, activity level, caregiving demands, psychological state, and volition. The results showed that, compared to healthy controls, individuals with physical disabilities exhibited significantly lower slope values and significantly lower PSE, both of which are indicators of the sense of agency. In other words, individuals with physical disabilities are less sensitive to the relationship between their actions and the sensorimotor feedback, but are more likely to attribute the sensorimotor feedback to themselves without sufficient evidence. However, no significant correlations were found between sense of agency and any of the investigated factors in either group. These findings suggest that the presence of physical disability itself\u0026mdash;rather than disease-specific characteristics\u0026mdash;may contribute to alterations in the sense of agency.\u003c/p\u003e\u003cp\u003eRegarding physical function, participants with physical disabilities demonstrated significantly reduced balance and gait performance compared to healthy individuals. Nevertheless, all participants with disabilities were ambulatory, maintaining a certain degree of motor ability. Their motor ability in the upper limb, which was necessary for the dot task, was not impaired. Despite this, they exhibited reduced sensitivity in distinguishing between self-generated and external movements. This indicates that such ability may not be limited to the body parts that are under the influence of physical disabilities, but rather may be a general cognitive function. On the other hand, individuals with physical disabilities showed a significantly lower PSE compared to healthy controls. This is likely to be a compensatory tendency to attribute movements to themselves even when their own motor input was insufficiently reflected. Importantly, our results showed that individuals with physical disabilities do not merely experience a reduced sense of agency, but rather a blurring of the criterion used to make agency judgments. Previous research has shown that active movement enhances perceptual sensitivity (Repp et al. 2007). The observed reduction in sensitivity among individuals with physical disabilities may stem from the narrowing of available behavioral options, which in turn reduces opportunities for active engagement, leading to impaired sensorimotor processing. On the other hand, the lower PSE may reflect a self-protective adaptation or changes in self-concept associated with the progression of physical limitations. However, the conclusion remains uncertain. Nonetheless, our findings highlight the changes both in sensitivity and criterion of the sense of agency in individuals with physical disabilities.\u003c/p\u003e\u003cp\u003eFurthermore, while previous studies have reported misattributions of agency in clinical populations such as those with Parkinson\u0026rsquo;s disease, schizophrenia, stroke, and obsessive-compulsive disorder (Moore et al. 2010; Voss et al. \u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e2010\u003c/span\u003e; Miyawaki et al. \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e2020\u003c/span\u003e; Gentsch et al. \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e2012\u003c/span\u003e), such findings have often been interpreted as disease-specific phenomena. In contrast, our study excluded individuals with those specific conditions and focused instead on users of medical or long-term care services, thereby providing findings that are potentially more generalizable. Notably, despite considerable heterogeneity in the backgrounds of individuals with disabilities, the only significant difference in basic characteristics between groups was physical function. This supports the notion that alterations in the sense of agency may stem not from specific diseases but from the broader condition of physical disability itself.\u003c/p\u003e\u003cp\u003eAdditionally, the present study did not find any significant correlations between the indices of sense of agency and various potential influencing factors in either group. Given that all participants in the current study were more than one year post-onset, it is possible that any initial changes in the sense of agency had stabilized over time. The results suggest that the sense of agency may not be strongly influenced by individual characteristics such as depression or care-receiving status. Instead, the observed differences in sensitivity and criterion between groups may stem from a fundamental impairment in sensorimotor functioning.\u003c/p\u003e\u003cp\u003eIn conclusion, a key strength of this study lies in its empirical examination of the sense of agency through two distinct components: sensitivity and criterion. We found that individuals with physical disabilities exhibited lower sensitivity in their sense of agency but a stronger tendency toward self-attribution compared to healthy controls. Physical disabilities may impair overall sensorimotor proceccing, even when the sensory and motor abilities of the limb used in the task remain intact. This impairment may lead to a compensatory tendency to attribute sensorimotor input to oneself without sufficient evidence. Further investigations are warranted to explore how this blurring of the self\u0026ndash;other boundary impacts overall well-being. There are some limitations in our study. First, the participants with physical disabilities were older than the healthy controls in this study. Therefore, their attentional function and proficiency in using the computer mouse may also have affected task performance. Individual differences in cognitive functions such as attention and motor control ability when using a mouse may require further evaluation in order to understand their relationship with the sensitivity and criterion of the sense of agency. Furthermore, the individual differences in sensitivity and criterion in the physically disabled group were larger than those in the healthy control group. However, we were unable to identify specific factors that are linked to these individual differences. Further research is required to understand the individual differences in changes in the sense of agency in order to develop effective rehabilitation programs and to improve well-being for each individual.\u003c/p\u003e"},{"header":"Declarations","content":"\u003ch2\u003eCompeting interests\u003c/h2\u003e\n\u003cp\u003eThe authors declare no competing interests.\u003c/p\u003e\n\u003ch2\u003eFunding\u003c/h2\u003e\n\u003cp\u003eThis work was partially supported by JST FOREST Program (Grant Number: JPMJFR2144) to WW and\u003c/p\u003e\n\u003cp\u003eJST CREST (Grant Number: JPMJCR23P1) to SM.\u003c/p\u003e\n\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\n\u003cp\u003eY.Ando wrote the main manuscript text. All authors reviewed the manuscript.\u003c/p\u003e\n\u003ch2\u003eAcknowledgement\u003c/h2\u003e\n\u003cp\u003eThe authors would like to thank the users and staff of Utsunomiya Visiting Nurse Rehabilitation Station Nicot and the rehabilitation staff of Shin-Kaminokawa Hospital for their cooperation as survey subjects.\u003c/p\u003e\n\u003ch2\u003eData availability\u003c/h2\u003e\n\u003cp\u003eAll data collected for this study will be made available upon request.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n \u003cli\u003eAron A, Aron EN, Smollan D. (1992). Inclusion of other in the self scale and the structure of interpersonal closeness. Journal of Personality and Social Psychology, 63, 596\u0026ndash;612. doi:10.1037/0022-3514.63.4.596\u003c/li\u003e\n \u003cli\u003eAzuma Y, Chin T, Miura Y (2019) The relationship between balance ability and walking ability using the Berg Balance Scale in people with transfemoral amputation. 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The Japanese Journal of Psychonomic Science 42:1\u0026ndash;12. https://doi.org/10.14947/psychono.42.7\u003c/li\u003e\n \u003cli\u003eCioffi MC, Cocchini G, Banissy MJ, Moore JW (2017) Ageing and agency: Age-related changes in susceptibility to illusory experiences of control. R Soc Open Sci 4:. https://doi.org/10.1098/rsos.161065\u003c/li\u003e\n \u003cli\u003eFrith CD, Blakemore SJ, Wolpert DM (2000) Abnormalities in the awareness and control of action. Philosophical Transactions of the Royal Society B: Biological Sciences 355:1771\u0026ndash;1788\u003c/li\u003e\n \u003cli\u003eG\u0026auml;chter S, Starmer C, Tufano F (2015) Measuring the closeness of relationships: A comprehensive evaluation of the \u0026ldquo;inclusion of the other in the self\u0026rdquo; scale. PLoS One 10:. https://doi.org/10.1371/journal.pone.0129478\u003c/li\u003e\n \u003cli\u003eGallagher S (2000) Philosophical conceptions of the self: Implications for cognitive science. 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Front Psychol 12\u003c/li\u003e\n \u003cli\u003eKojima M, Furukawa TA, Takahashi H, et al (2002) Cross-cultural validation of the Beck Depression Inventory-II in Japan\u003c/li\u003e\n \u003cli\u003eKrugwasser AR, Stern Y, Faivre N, et al (2022) Impaired sense of agency and associated confidence in psychosis. Schizophrenia 8:. https://doi.org/10.1038/s41537-022-00212-4\u003c/li\u003e\n \u003cli\u003eLafleur A, Souli\u0026egrave;res I, Forgeot d\u0026rsquo;Arc B (2020) Sense of agency: Sensorimotor signals and social context are differentially weighed at implicit and explicit levels. Conscious Cogn 84:. https://doi.org/10.1016/j.concog.2020.103004\u003c/li\u003e\n \u003cli\u003eMalik RA, Obhi SS (2019) Social exclusion reduces the sense of agency: Evidence from intentional binding. 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PLoS One 15:. https://doi.org/10.1371/journal.pone.0230603\u003c/li\u003e\n \u003cli\u003eMoore JW (2016) What is the sense of agency and why does it matter? Front Psychol 7:1272.\u003c/li\u003e\n \u003cli\u003eMoore JW, Fletcher PC (2012) Sense of agency in health and disease: A review of cue integration approaches. Conscious Cogn 21:59\u0026ndash;68. https://doi.org/10.1016/j.concog.2011.08.010\u003c/li\u003e\n \u003cli\u003eMoore JW, Lagnado D, Deal DC, Haggard P (2009) Feelings of control: Contingency determines experience of action. Cognition 110:279\u0026ndash;283. https://doi.org/10.1016/j.cognition.2008.11.006\u003c/li\u003e\n \u003cli\u003eMoore JW, Schneider SA, Schwingenschuh P, et al Title: Dopaminergic medication boosts action-effect binding in Parkinson\u0026rsquo;s Disease\u003c/li\u003e\n \u003cli\u003eNahab FB, Kundu P, Maurer C, et al (2017) Impaired sense of agency in functional movement disorders: An fMRI study. PLoS One 12:. https://doi.org/10.1371/journal.pone.0172502\u003c/li\u003e\n \u003cli\u003eNeuls PD, Clark TL, Van Heuklon NC, Proctor JE, Kilker BJ, Bieber ME, Donlan AV, Carr-Jules SA, Neidel WH, Newton RA. (2011). Usefulness of the Berg Balance Scale to predict falls in the elderly. Journal of Geriatric Physical Therapy, 34(1):3\u0026ndash;10.\u003c/li\u003e\n \u003cli\u003ePark SH, Lee YS (2017) The Diagnostic Accuracy of the Berg Balance Scale in Predicting Falls. West J Nurs Res 39:1502\u0026ndash;1525\u003c/li\u003e\n \u003cli\u003eRaine A, Raine A (1991) The SPQ: A Scale for the Assessment of Schizotypal Personality Based on DSM-III-R Criteria Downloaded from\u003c/li\u003e\n \u003cli\u003eRepp BH, Knoblich G. (2007). Action can affect auditory perception. Psychological Science, 18(1):6\u0026ndash;7.\u003c/li\u003e\n \u003cli\u003eShimada S, Qi Y, Hiraki K (2010) Detection of visual feedback delay in active and passive self-body movements. Exp Brain Res 201:359\u0026ndash;364. https://doi.org/10.1007/s00221-009-2028-6\u003c/li\u003e\n \u003cli\u003eSynofzik M, Vosgerau G, Newen A (2008) Beyond the comparator model: A multifactorial two-step account of agency. Conscious Cogn 17:219\u0026ndash;239. https://doi.org/10.1016/j.concog.2007.03.010\u003c/li\u003e\n \u003cli\u003eSynofzik M, Vosgerau G, Voss M (2013) The experience of agency: An interplay between prediction and postdiction. Front Psychol 4:. https://doi.org/10.3389/fpsyg.2013.00127\u003c/li\u003e\n \u003cli\u003eVogel DHV, Jording M, Weiss PH, Vogeley K (2024) Temporal binding and sense of agency in major depression. Front Psychiatry 15:. https://doi.org/10.3389/fpsyt.2024.1288674\u003c/li\u003e\n \u003cli\u003eVoss M, Moore J, Hauser M, et al (2010) Altered awareness of action in schizophrenia: A specific deficit in predicting action consequences. 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Nature Reviews Psychology 1:211\u0026ndash;222\u003c/li\u003e\n \u003cli\u003eWen W, Shimazaki N, Ohata R, et al (2020) Categorical perception of control. eNeuro 7:1\u0026ndash;11. https://doi.org/10.1523/ENEURO.0258-20.2020\u003c/li\u003e\n \u003cli\u003eKaede no Kaze Group. (n.d.). \u003cem\u003eHome medical care and rehabilitation support\u003c/em\u003e. Retrieved from https://kaedenokaze.com/rehabiliday/sios/\u003c/li\u003e\n \u003cli\u003eCabinet Office, Government of Japan. (n.d.). \u003cem\u003eBasic Law for Persons with Disabilities\u003c/em\u003e. Retrieved from https://www8.cao.go.jp/shougai/whitepaper/h24hakusho/zenbun/pdf/h1/furoku01.pdf\u003c/li\u003e\n \u003cli\u003eMinistry of Health, Labour and Welfare, Japan. (n.d.). \u003cem\u003eOverview of the medical insurance system in Japan\u003c/em\u003e. Retrieved from https://www.mhlw.go.jp/stf/seisakunitsuite/bunya/kenkou_iryou/iryouhoken/iryouhoken01/index.html\u003c/li\u003e\n \u003cli\u003eIijima Y, Sasaki J, Bando N, Asai T, Mouri I, Tanno Y. (2010). Development of the Japanese version of the Schizotypal Personality Questionnaire and factor structure in schizotypal personality. \u003cem\u003eJapanese Journal of Behavior Therapy\u003c/em\u003e, 36(1):29\u0026ndash;41.\u003c/li\u003e\n \u003cli\u003eKai Y, et al. (2017). Reliability and validity of the Sedentary Lifestyle Questionnaire for Japanese (SLQ-J). Taiiku Kenkyu [Japan Journal of Physical Fitness and Sports Medicine], 115:23\u0026ndash;29.\u003c/li\u003e\n\u003c/ol\u003e"},{"header":"Table 1","content":"\u003cp\u003eTable 1 is not available with this version.\u003c/P\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"sense of agency, physical disability, slope, point of subjective equality, sensitivity, criterion","lastPublishedDoi":"10.21203/rs.3.rs-7045962/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7045962/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eThe sense of agency\u0026mdash;namely, the feeling that one\u0026rsquo;s actions are self-initiated and controllable\u0026mdash;is fundamental to how individuals understand themselves and engage with the world. Although often taken for granted, this experience may be altered by physical disability. The present study examined differences in the sense of agency between healthy adults and individuals with physical impairments using a movement-based dot trajectory task. Two indices\u0026mdash;sensitivity (slope) and decision criterion (point of subjective equality)\u0026mdash;were derived from logistic regression modeling. The results showed that individuals with physical disabilities not only had blurred between self-other distinction, but also attributed actions to themselves without justification, indicating blurred self-other boundaries. Notably, the observed alteration was not attributable to age or physical activity levels, and no significant associations were observed with psychological state or caregiving needs. These findings suggest that physical limitations themselves, irrespective of mental health or daily activity, may reshape how individuals perceive control over their own actions. Understanding such shifts in self-perception could have important implications for rehabilitation strategies and for improving quality of life in populations with physical impairments.\u003c/p\u003e","manuscriptTitle":"Effects of physical disability on the sensitivity and criterion of sense of agency","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-07-15 02:40:06","doi":"10.21203/rs.3.rs-7045962/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"410d1b3f-509d-4bd0-b4ce-7b07c379c8ce","owner":[],"postedDate":"July 15th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-08-06T04:08:44+00:00","versionOfRecord":[],"versionCreatedAt":"2025-07-15 02:40:06","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7045962","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7045962","identity":"rs-7045962","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}