Seeing the Errors You Feel Enhances Locomotor Performance but Not Learning

Explicit and implicit locomotor learning in individuals with chronic hemiparetic stroke

Motor learning involves both explicit and implicit processes that are fundamental for acquiring and adapting complex motor skills. However, stroke may damage the neural substrates underlying explicit and/or implicit learning, leading to deficits in overall motor performance. While both learning processes are typically used in concert in daily life and rehabilitation, no gait studies have determined how these processes function together after stroke when tested during a task that elicits dissociable contributions from both. Here, we compared explicit and implicit locomotor learning in individuals with chronic stroke to age- and sex-matched neurologically intact controls. We assessed implicit learning using split-belt adaptation (where two treadmill belts move at different speeds). We assessed explicit learning (i.e., strategy-use) using visual feedback during split-belt walking to help individuals explicitly correct for step length errors created by the split-belts. The removal of visual feedback after the first 40 strides of split-belt walking, combined with task instructions, minimized contributions from explicit learning for the remainder of the task. We utilized a multi-rate state-space model to characterize individual explicit and implicit process contributions to overall behavioral change. The computational and behavioral analyses revealed that, compared to controls, individuals with chronic stroke demonstrated deficits in both explicit and implicit contributions to locomotor learning, a result that runs counter to prior work testing each process individually during gait. Since post-stroke locomotor rehabilitation involves interventions that rely on both explicit and implicit motor learning, future work should determine how locomotor rehabilitation interventions can be structured to optimize overall motor learning.

Exploring Electrocortical Signatures of Gait Adaptation: Differential Neural Dynamics in Slow and Fast Gait Adapters

Individuals exhibit significant variability in their ability to adapt locomotor skills, with some adapting quickly and others more slowly. Differences in brain activity likely contribute to this variability, but direct neural evidence is lacking. We investigated individual differences in electrocortical activity that led to faster locomotor adaptation rates. We recorded high-density electroencephalography while young, neurotypical adults adapted their walking on a split-belt treadmill and grouped them based on how quickly they restored their gait symmetry. Results revealed unique spectral signatures within the posterior parietal, bilateral sensorimotor, and right visual cortices that differ between fast and slow adapters. Specifically, fast adapters exhibited lower alpha power in the posterior parietal and right visual cortices during early adaptation, associated with quicker attainment of steady-state step length symmetry. Decreased posterior parietal alpha may reflect enhanced spatial attention, sensory integration, and movement planning to facilitate faster locomotor adaptation. Conversely, slow adapters displayed greater alpha and beta power in the right visual cortex during late adaptation, suggesting potential differences in visuospatial processing. Additionally, fast adapters demonstrated reduced spectral power in the bilateral sensorimotor cortices compared with slow adapters, particularly in the theta band, which may suggest variations in perception of the split-belt perturbation. These findings suggest that alpha and beta oscillations in the posterior parietal and visual cortices and theta oscillations in the sensorimotor cortex are related to the rate of gait adaptation.

Perception of task duration affects metabolic cost during split-belt adaptation

Humans continuously adapt locomotor patterns. Whether metabolic cost reduction is the primary objective or a by-product of the observed biomechanical changes during adaptation is not known. The main goal of our study is to determine if perception of task duration affects the adaptation of locomotor patterns to reduce energetic cost during split-belt walking. We tested the hypothesis that individuals who believe they will sustain a locomotor adaptation task for a prolonged time will reduce metabolic cost by adapting toward a walking pattern associated with lower mechanical work. N=14 participants walked on a split-belt treadmill for 10 minutes with knowledge of task duration (group K), while N=15 participants performed the task under the assumption that they would walk for 30 minutes (group U). Both groups walked for 10 minutes with the belts moving at 1.5 and 0.5 m/s, followed by 6 minutes of walking with both belts at 1.0 m/s. We observed a significant main effect of Time (p<0.001, observed power 1.0) and the interaction of Time×Group (p=0.004, observed power 0.84) on metabolic cost. Participants in the U group had a metabolic cost that was 12% lower during adaptation compared to the K group, which did not reduce metabolic cost during adaptation. The metabolic cost reduction observed in group U was not associated with biomechanical changes during adaptation. Our results indicate that metabolic cost reduction has a primary role in tasks that need to be sustained for a prolonged time, and this reduction is not only related to biomechanical factors.

Reinforcement feedback impairs locomotor adaptation and retention

Introduction

Locomotor adaptation is a motor learning process used to alter spatiotemporal elements of walking that are driven by prediction errors, a discrepancy between the expected and actual outcomes of our actions. Sensory and reward prediction errors are two different types of prediction errors that can facilitate locomotor adaptation. Reward and punishment feedback generate reward prediction errors but have demonstrated mixed effects on upper extremity motor learning, with punishment enhancing adaptation, and reward supporting motor memory. However, an in-depth behavioral analysis of these distinct forms of feedback is sparse in locomotor tasks.

Methods

For this study, three groups of healthy young adults were divided into distinct feedback groups [Supervised, Reward, Punishment] and performed a novel locomotor adaptation task where each participant adapted their knee flexion to 30 degrees greater than baseline, guided by visual supervised or reinforcement feedback (Adaptation). Participants were then asked to recall the new walking pattern without feedback (Retention) and after a washout period with feedback restored (Savings).

Results

We found that all groups learned the adaptation task with external feedback. However, contrary to our initial hypothesis, enhancing sensory feedback with a visual representation of the knee angle (Supervised) accelerated the rate of learning and short-term retention in comparison to monetary reinforcement feedback. Reward and Punishment displayed similar rates of adaptation, short-term retention, and savings, suggesting both types of reinforcement feedback work similarly in locomotor adaptation. Moreover, all feedback enhanced the aftereffect of locomotor task indicating changes to implicit learning.

Discussion

These results demonstrate the multi-faceted nature of reinforcement feedback on locomotor adaptation and demonstrate the possible different neural substrates that underly reward and sensory prediction errors during different motor tasks.

Proportional sway-based electrotactile feedback improves lateral standing balance

Introduction

Plantar cutaneous augmentation is a promising approach in balance rehabilitation by enhancing motion-dependent sensory feedback. The effect of plantar cutaneous augmentation on balance has been mainly investigated in its passive form (e.g., textured insole) or on lower-limb amputees. In this study, we tested the effect of plantar cutaneous augmentation on balance in its active form (i.e., electrical stimulation) for individuals with intact limbs.

Methods

Ten healthy subjects participated in the study and were instructed to maintain their balance as long as possible on the balance board, with or without electrotactile feedback evoked on the medial side of the heel, synched with the lateral board sway. Electrotactile feedback was given in two different modes: 1) Discrete-mode E-stim as the stimulation on/off by a predefined threshold of lateral board sway and 2) Proportional-mode E-stim as the stimulation frequency proportional to the amount of lateral board sway. All subjects were distracted from the balancing task by the n-back counting task, to test subjects' balancing capability with minimal cognitive involvement.

Results

Proportional-mode E-stim, along with the n-back counting task, increased the balance time from 1.86 ± 0.03 s to 1.98 ± 0.04 s (p = 0.010). However, discrete-mode E-stim did not change the balance time (p = 0.669). Proportional-mode E-stim also increased the time duration per each swayed state (p = 0.035) while discrete-mode E-stim did not (p = 0.053).

Discussion

These results suggest that proportional-mode E-stim is more effective than discrete-mode E-stim on improving standing balance. It is perhaps because the proportional electrotactile feedback better mimics the natural tactile sensation of foot pressure than its discrete counterpart.

Reinforcement Learning during Locomotion

When learning a new motor skill, people often must use trial and error to discover which movement is best. In the reinforcement learning framework, this concept is known as exploration and has been linked to increased movement variability in motor tasks. For locomotor tasks, however, increased variability decreases upright stability. As such, exploration during gait may jeopardize balance and safety, making reinforcement learning less effective. Therefore, we set out to determine if humans could acquire and retain a novel locomotor pattern using reinforcement learning alone. Young healthy male and female participants walked on a treadmill and were provided with binary reward feedback (indicated by a green checkmark on the screen) that was tied to a fixed monetary bonus, to learn a novel stepping pattern. We also recruited a comparison group who walked with the same novel stepping pattern but did so by correcting for target error, induced by providing real-time veridical visual feedback of steps and a target. In two experiments, we compared learning, motor variability, and two forms of motor memories between the groups. We found that individuals in the binary reward group did, in fact, acquire the new walking pattern by exploring (increasing motor variability). Additionally, while reinforcement learning did not increase implicit motor memories, it resulted in more accurate explicit motor memories compared with the target error group. Overall, these results demonstrate that humans can acquire new walking patterns with reinforcement learning and retain much of the learning over 24 h.

Habitual exercise evokes fast and persistent adaptation during split-belt walking

Changing movement patterns in response to environmental perturbations is a critical aspect of gait and is related to reducing the energetic cost of the movement. Exercise improves energetic capacity for submaximal exercise and may affect how people adapt movement to reach an energetic minimum. The purpose of this study was to determine whether self-reported exercise behavior influences gait adaptation in young adults. Young adults who met the optimal volume of exercise according to the Physical Activity Guidelines for Americans (MOVE; n = 19) and young adults who did not meet the optimal volume of exercise (notMOVE; n = 13) walked on a split-belt treadmill with one belt moving twice the speed of the other belt for 10 minutes. Step length asymmetry (SLA) and mechanical work done by each leg were measured. Nonlinear mixed effects models compared the time course of adaptation between MOVE and notMOVE, and t-tests compared net work at the end of adaptation between MOVE and notMOVE. Compared to notMOVE, MOVE had a faster initial response to the split belt treadmill, and continued to adapt over the duration of split-belt treadmill walking. Young adults who engage in sufficient amounts of exercise responded more quickly to the onset of a perturbation, and throughout the perturbation they continued to explore movement strategies, which might be related to reduction of energetic cost. Our findings provide insights into the multisystem positive effects of exercise, including walking adaptation.

Joint-level coordination patterns for split-belt walking across different speed ratios

Locomotion is a highly flexible process, requiring rapid changes to gait due to changes in the environment or goals. Here, we used a split-belt treadmill to examine how the central nervous system coordinates a novel gait pattern. Existing research has focused on summary measures, most often step lengths, when describing changes induced while walking on the split-belt treadmill and during subsequent aftereffects. Here, we asked how the nervous system adjusts individual joint motions and the coordination pattern of the legs when people walk with one leg moving at either 2×, 3×, or 4× the speed of the other leg. We found that relative to tied-belt walking, split-belt perturbations change the timing relationships between the legs while most joint angle peaks and range of motion change little. The kinematic changes over the course of adaptation (i.e., from the beginning to end of a single split-belt walking bout) were subtle, particularly when comparing individual joint motions. The magnitude of the belt speed differences impacted intralimb coordination but did not produce consistent differences in most other measures. Most significant changes in kinematics occurred in the fast leg. Overall, interlimb timing changes drove a large proportion of the differences observed between tied-belt and split-belt gaits. Thus, it appears that the central nervous system can produce novel gait patterns through changes in coordination between legs that lead to new configurations at significant time points. These patterns can use within-limb and within-joint patterns that closely resemble those of normal walking.NEW & NOTEWORTHY We studied how the nervous system coordinates limb movements during asymmetric gait. Using a split-belt treadmill, we found that most changes in motion occurred when comparing motions between limbs, rather than among joints within a limb. Individual joint patterns resembled speed-matched comparisons, but this meant that joint movements became asymmetric during split-belt walking. These findings demonstrate that the nervous system can use consistent joint motions that are reconfigured in time to achieve new gait patterns.

Motion state-dependent motor learning based on explicit visual feedback is quickly recalled, but is less stable than adaptation to physical perturbations

Recent studies have shown that adaptation to visual feedback perturbations during arm reaching movements involves implicit and explicit learning components. Evidence also suggests that explicit, intentional learning mechanisms are largely responsible for savings—a faster recalibration compared with initial training. However, the extent explicit learning mechanisms facilitate learning and early savings (i.e., the rapid recall of previous performance) for motion state-dependent learning is generally unknown. To address this question, we compared the early savings/recall achieved by two groups of human subjects. One experienced physical perturbations (a velocity-dependent force-field, vFF) to promote adaptation that is thought to be a largely implicit process. The second was only given visual feedback of the required force-velocity relationship; subjects moved in force channels and we provided visual feedback of the lateral force exerted during the movement, as well as the required force pattern based on the movement velocity. Thus, subjects were shown explicit information on the extent the applied temporal pattern of force matched the required velocity-dependent force profile if the force-field perturbation had been applied. After training, both groups experienced a decay and washout period, which was followed by a reexposure block to assess early savings/recall. Although decay was faster for the explicit visual feedback group, the single-trial recall was similar to the physical perturbation group. Thus, compared with visual feedback perturbations, conscious modification of motor output based on motion state-dependent feedback demonstrates rapid recall, but this adjustment is less stable than adaptation based on experiencing the multisensory errors that accompany physical perturbations.

NEW & NOTEWORTHY The extent explicit feedback facilitates motion state-dependent changes to motor output is largely unknown. Here, we examined motor adaptation for subjects that experienced physical perturbations and another that made adjustments based on explicit visual feedback information of the required force-velocity relationship. Our results suggest that adjustment of motor output can be based on explicit motion state-dependent information and demonstrates rapid recall, but this learning is less stable than adaptation based on physical perturbations to movement.

Heksor: The CNS substrate of an adaptive behavior

Over the past half‐century, the largely hardwired central nervous system (CNS) of 1970 has become the ubiquitously plastic CNS of today, in which change is the rule not the exception. This transformation complicates a central question in neuroscience: how are adaptive behaviours – behaviours that serve the needs of the individual – acquired and maintained through life? It poses a more basic question: how do many adaptive behaviours share the ubiquitously plastic CNS? This question compels neuroscience to adopt a new paradigm. The core of this paradigm is a CNS entity with unique properties, here given the name heksor from the Greek hexis. A heksor is a distributed network of neurons and synapses that changes itself as needed to maintain the key features of an adaptive behaviour, the features that make the behaviour satisfactory. Through their concurrent changes, the numerous heksors that share the CNS negotiate the properties of the neurons and synapses that they all use. Heksors keep the CNS in a state of negotiated equilibrium that enables each heksor to maintain the key features of its behaviour. The new paradigm based on heksors and the negotiated equilibrium they create is supported by animal and human studies of interactions among new and old adaptive behaviours, explains otherwise inexplicable results, and underlies promising new approaches to restoring behaviours impaired by injury or disease. Furthermore, the paradigm offers new and potentially important answers to extant questions, such as the generation and function of spontaneous neuronal activity, the aetiology of muscle synergies, and the control of homeostatic plasticity.

Visuomotor Adaptation of Lower Extremity Movements During Virtual Ball-Kicking Task

Sophisticated soccer players can skillfully manipulate a ball with their feet depending on the external environment. This ability of goal-directed control in the lower limbs has not been fully elucidated, although upper limb movements have been studied extensively using motor adaptation tasks. The purpose of this study was to clarify how the goal-directed movements of the lower limbs is acquired by conducting an experiment of visuomotor adaptation in ball-kicking movements. In this study, healthy young participants with and without experience playing soccer or futsal performed ball-kicking movements. They were instructed to move a cursor representing the right foot position and shoot a virtual ball to a target on a display in front of them. During the learning trials, the trajectories of the virtual ball were rotated by 15° either clockwise or counterclockwise relative to the actual ball direction. As a result, participants adapted their lower limb movements to novel visuomotor perturbation regardless of the soccer playing experience, and changed their whole trajectories not just the kicking position during adaptation. These results indicate that the goal-directed lower limb movements can be adapted to the novel environment. Moreover, it was suggested that fundamental structure of visuomotor adaptation is common between goal-directed movements in the upper and lower limbs.

Effects of sensory manipulations on locomotor adaptation to split-belt treadmill walking in healthy younger and older adults

Locomotor adaptation relies on processes of both the peripheral and central nervous systems that may be compromised with advanced age (e.g., proprioception, sensorimotor integration). Age-related changes to these processes may result in reduced rates of locomotor adaptation under normal conditions and should cause older adults to be disproportionately more affected by sensory manipulations during adaptation compared to younger adults. 17 younger and 10 older adults completed five separate 5-minute split-belt walking trials: three under normal sensory conditions, one with 30% bodyweight support (meant to reduce proprioceptive input), and one with goggles that constrained the visual field (meant to reduce visual input). We fit step length symmetry data from each participant in each trial with a single exponential function and used the time constant to quantify locomotor adaption rate. Group by trial ANOVAs were used to test the effects of age, condition, and their interaction on adaptation rates. Contrary to our hypothesis, we found no evidence that sensory manipulations disproportionately affected older compared to younger adults, at least in our relatively small sample. In fact, in both groups, adaptation rates remained unaffected across all trials, including both normal and sensory manipulated trials. Our results provide evidence that both younger and older adults were able to adequately reweight sources of sensory information based on environmental constraints, indicative of well-functioning neural processes of motor adaptation.

General variability leads to specific adaptation toward optimal movement policies

Our nervous systems can learn optimal control policies in response to changes to our bodies, tasks, and movement contexts. For example, humans can learn to adapt their control policy in walking contexts where the energy-optimal policy is shifted along variables such as step frequency or step width. However, it is unclear how the nervous system determines which ways to adapt its control policy. Here, we asked how human participants explore through variations in their control policy to identify more optimal policies in new contexts. We created new contexts using exoskeletons that apply assistive torques to each ankle at each walking step. We analyzed four variables that spanned the levels of the whole movement, the joint, and the muscle: step frequency, ankle angle range, total soleus activity, and total medial gastrocnemius activity. We found that, across all of these analyzed variables, variability increased upon initial exposure to new contexts and then decreased with experience. This led to adaptive changes in the magnitude of specific variables, and these changes were correlated with reduced energetic cost. The timescales by which adaptive changes progressed and variability decreased were faster for some variables than others, suggesting a reduced search space within which the nervous system continues to optimize its policy. These collective findings support the principle that exploration through general variability leads to specific adaptation toward optimal movement policies.

Palatal Electrotactile Display Outperforms Visual Display in Tongue Motor learning

Incomplete tongue motor control is a common yet challenging issue among individuals with neurotraumas and neurological disorders. In development of the training protocols, multiple sensory modalities including visual, auditory, and tactile feedback have been employed. However, the effectiveness of each sensory modality in tongue motor learning is still in question. The object of this study was to test the effectiveness of visual and electrotactile assistance on tongue motor learning, respectively. Eight healthy subjects performed the tongue pointing task, in which they were visually instructed to touch the target on the palate by their tongue tip as accurately as possible. Each subject wore a custom-made dental retainer with 12 electrodes distributed over the palatal area. For visual training, 3×4 LED array on the computer screen, corresponding to the electrode layout, was turned on with different colors according to the tongue contact. For electrotactile training, electrical stimulation was applied to the tongue with frequencies depending on the distance between the tongue contact and the target, along with a small protrusion on the retainer as an indicator of the target. One baseline session, one training session, and three post-training sessions were conducted over four-day duration. Experimental result showed that the error was decreased after both visual and electrotactile trainings, from 3.56±0.11 (Mean±STE) to 1.27±0.16, and from 3.97±0.11 to 0.53±0.19, respectively. The result also showed that electrotactile training leads to stronger retention than visual training, as the improvement was retained as 62.68±1.81% after electrotactile training and 36.59±2.24% after visual training, at 3-day post training.

Younger and Late Middle-Aged Adults Exhibit Different Patterns of Cognitive-Motor Interference During Locomotor Adaptation, With No Disruption of Savings

It has been proposed that motor adaptation and subsequent savings (or faster relearning) of an adapted movement pattern are mediated by cognitive processes. Here, we evaluated the pattern of cognitive-motor interference that emerges when young and late middle-aged adults perform an executive working memory task during locomotor adaptation. We also asked if this interferes with savings of a newly learned walking pattern, as has been suggested by a study of reaching adaptation. We studied split-belt treadmill adaptation and savings in young (21 ± 2 y/o) and late middle-aged (56 ± 6 y/o) adults with or without a secondary 2-back task during adaptation. We found that young adults showed similar performance on the 2-back task during baseline and adaptation, suggesting no effect of the dual-task on cognitive performance; however, dual-tasking interfered with adaptation over the first few steps. Conversely, dual-tasking caused a decrement in cognitive performance in late middle-aged adults with no effect on adaptation. To determine if this effect was specific to adaptation, we also evaluated dual-task interference in late middle-aged adults that dual-tasked while walking in a complex environment that did not induce motor adaptation. This group exhibited less cognitive-motor interference than late middle-aged adults who dual-tasked during adaptation. Savings was unaffected by dual-tasking in both young and late middle-aged adults, which may indicate different underlying mechanisms for savings of reaching and walking. Collectively, our findings reveal an age-dependent effect of cognitive-motor interference during dual-task locomotor adaptation and no effect of dual-tasking on savings, regardless of age. Young adults maintain cognitive performance and show a mild decrement in locomotor adaptation, while late middle-aged adults adapt locomotion at the expense of cognitive performance.

Visuomotor errors drive step length and step time adaptation during 'virtual' split-belt walking: the effects of reinforcement feedback

Precise foot placement is dependent on changes in spatial and temporal coordination between two legs in response to a perturbation during walking. Here, we used a 'virtual' split-belt adaptation task to examine the effects of reinforcement (reward and punishment) feedback about foot placement on the changes in error, step length and step time asymmetry. Twenty-seven healthy adults (20 ± 2.5 years) walked on a treadmill with continuous feedback of the foot position and stepping targets projected on a screen, defined by a visuomotor gain for each leg. The paradigm consisted of a baseline period (same gain on both legs), visuomotor adaptation period (split: one high = 'fast', one low = 'slow' gain) and post-adaptation period (same gain). Participants were divided into 3 groups: control group received no score, reward group received increasing score for each target hit, and punishment group received decreasing score for each target missed. Re-adaptation was assessed 24 ± 2 h later. During early adaptation, the slow foot undershot and fast foot overshot the stepping target. Foot placement errors were gradually reduced by late adaptation, accompanied by increasing step length asymmetry (fast < slow step length) and step time asymmetry (fast > slow step time). Only the punishment group showed greater error reduction and step length re-adaptation on the next day. The results show that (1) explicit feedback of foot placement alone drives adaptation of both step length and step time asymmetry during virtual split-belt walking, and (2) specifically, step length re-adaptation driven by visuomotor errors may be enhanced by punishment feedback.

Updates in Motor Learning: Implications for Physical Therapist Practice and Education

Over the past 3 decades, the volume of human motor learning research has grown enormously. As such, the understanding of motor learning (ie, sustained change in motor behavior) has evolved. It has been learned that there are multiple mechanisms through which motor learning occurs, each with distinctive features. These mechanisms include use-dependent, instructive, reinforcement, and sensorimotor adaptation-based motor learning. It is now understood that these different motor learning mechanisms contribute in parallel or in isolation to drive desired changes in movement, and each mechanism is thought to be governed by distinct neural substrates. This expanded understanding of motor learning mechanisms has important implications for physical therapy. It has the potential to facilitate the development of new, more precise treatment approaches that physical therapists can leverage to improve human movement. This Perspective describes scientific advancements related to human motor learning mechanisms and discusses the practical implications of this work for physical therapist practice and education.

Incremental Visual Occlusion During Split-Belt Treadmill Walking Has No Gradient Effect on Adaptation or Retention

Split-belt treadmills have become an increasingly popular means of quantifying ambulation adaptability. Multiple sensory feedback mechanisms, including vision, contribute to task execution and adaptation success. No studies have yet explored visual feedback effects on locomotor adaptability across a spectrum of available visual information. In this study, we sought to better understand the effects of visual information on locomotor adaptation and retention by directly comparing incremental levels of visual occlusion. Sixty healthy young adults completed a split-belt adaptation protocol, including a baseline, asymmetric walking condition (adapt), a symmetric walking condition (de-adapt), and another asymmetric walking condition (re-adapt). We randomly assigned participants into conditions with varied visual occlusion (i.e., complete and lower visual field occlusion, or normal vision). We captured kinematic data, and outcome measures included magnitude of asymmetry, spatial and temporal contributions to step length asymmetry, variability of the final adapted pattern, and magnitude of adaptation. We used repeated measures and four-way MANOVAs to examine the influence of visual occlusion and walking condition. Participants with complete, compared to lower visual field visual occlusion displayed less consistency in their walking pattern, evident via increased step length standard deviation (p = .007, d = 0.89), and compared to normal vision groups (p = .003 d = 0.81). We found no other group differences, indicating that varying levels of visual occlusion did not significantly affect locomotor adaptation or retention. This study offers insight into the role vision plays in locomotor adaptation and retention with clinical utility for improving variability in step control.

The acute effects of aerobic exercise on sensorimotor adaptation in chronic stroke

Background:

Sensorimotor adaptation, or the capacity to adapt movement to changes in the moving body or environment, is a form of motor learning that is important for functional independence (e.g., regaining stability after slips or trips). Aerobic exercise can acutely improve many forms of motor learning in healthy adults. It is not known, however, whether acute aerobic exercise has similar positive effects on sensorimotor adaptation in stroke survivors as it does in healthy individuals.

Objective:

The aim of this study was to determine whether acute aerobic exercise promotes sensorimotor adaptation in people post stroke.

Methods:

A single-blinded crossover study. Participants attended two separate sessions, completing an aerobic exercise intervention in one session and a resting control condition in the other session. Sensorimotor adaptation was assessed before and after each session, as was brain derived neurotrophic factor. Twenty participants with chronic stroke completed treadmill exercise at moderate to high intensity for 30 minutes.

Results:

Acute aerobic exercise in chronic stroke survivors significantly increased sensorimotor adaptation from pre to post treadmill intervention. The 30-minute treadmill intervention resulted in an averaged 2.99 ng/ml increase in BDNF levels (BDNF pre-treadmill = 22.31 + /–2.85 ng/ml, post-treadmill was = 25.31 + /–2.46 pg/ml; t(16) = 2.146, p = 0.048, cohen’s d = 0.521, moderate effect size).

Conclusions:

These results indicate a potential role for aerobic exercise to promote the recovery of sensorimotor function in chronic stroke survivors.

Energy optimization during walking involves implicit processing

Gait adaptations, in response to novel environments, devices or changes to the body, can be driven by the continuous optimization of energy expenditure. However, whether energy optimization involves implicit processing (occurring automatically and with minimal cognitive attention), explicit processing (occurring consciously with an attention-demanding strategy) or both in combination remains unclear. Here, we used a dual-task paradigm to probe the contributions of implicit and explicit processes in energy optimization during walking. To create our primary energy optimization task, we used lower-limb exoskeletons to shift people's energetically optimal step frequency to frequencies lower than normally preferred. Our secondary task, designed to draw explicit attention from the optimization task, was an auditory tone discrimination task. We found that adding this secondary task did not prevent energy optimization during walking; participants in our dual-task experiment adapted their step frequency toward the optima by an amount and at a rate similar to participants in our previous single-task experiment. We also found that performance on the tone discrimination task did not worsen when participants were adapting toward energy optima; accuracy scores and reaction times remained unchanged when the exoskeleton altered the energy optimal gaits. Survey responses suggest that dual-task participants were largely unaware of the changes they made to their gait during adaptation, whereas single-task participants were more aware of their gait changes yet did not leverage this explicit awareness to improve gait adaptation. Collectively, our results suggest that energy optimization involves implicit processing, allowing attentional resources to be directed toward other cognitive and motor objectives during walking.

Neural Control of Human Locomotor Adaptation: Lessons about Changes with Aging

Walking patterns are adaptable in response to different environmental demands, which requires neural input from spinal and supraspinal structures. With an increase in age, there are changes in walking adaptation and in the neural control of locomotion, but the age-related changes in the neural control of locomotor adaptation is unclear. The purpose of this narrative review is to establish a framework where the age-related changes of neural control of human locomotor adaptation can be understood in terms of reactive feedback and predictive feedforward control driven by sensory feedback during locomotion. We parse out the effects of aging on (a) reactive adaptation to split-belt walking, (b) predictive adaptation to split-belt walking, (c) reactive visuomotor adaptation, and (d) predictive visuomotor adaptation, and hypothesize that specific neural circuits are influenced differentially with age, which influence locomotor adaptation. The differences observed in the age-related changes in walking adaptation across different locomotor adaptation paradigms will be discussed in light of the age-related changes in the neural mechanisms underlying locomotion.

Fluid Cognitive Abilities Are Important for Learning and Retention of a New, Explicitly Learned Walking Pattern in Individuals After Stroke

BACKGROUND

There is significant variability in poststroke locomotor learning that is poorly understood and affects individual responses to rehabilitation interventions. Cognitive abilities relate to upper extremity motor learning in neurologically intact adults, but have not been studied in poststroke locomotor learning.

OBJECTIVE

To understand the relationship between locomotor learning and retention and cognition after stroke.

METHODS

Participants with chronic (>6 months) stroke participated in 3 testing sessions. During the first session, participants walked on a treadmill and learned a new walking pattern through visual feedback about their step length. During the second session, participants walked on a treadmill and 24-hour retention was assessed. Physical and cognitive tests, including the Fugl-Meyer-Lower Extremity (FM-LE), Fluid Cognition Composite Score (FCCS) from the NIH Toolbox -Cognition Battery, and Spatial Addition from the Wechsler Memory Scale-IV, were completed in the third session. Two sequential regression models were completed: one with learning and one with retention as the dependent variables. Age, physical impairment (ie, FM-LE), and cognitive measures (ie, FCCS and Spatial Addition) were the independent variables.

RESULTS

Forty-nine and 34 participants were included in the learning and retention models, respectively. After accounting for age and FM-LE, cognitive measures explained a significant portion of variability in learning (R² = 0.17, P = .008; overall model R² = 0.31, P = .002) and retention (ΔR² = 0.17, P = .023; overall model R² = 0.44, P = .002).

CONCLUSIONS

Cognitive abilities appear to be an important factor for understanding locomotor learning and retention after stroke. This has significant implications for incorporating locomotor learning principles into the development of personalized rehabilitation interventions after stroke.

Locomotor Adaptation Is Associated with Microstructural Properties of the Inferior Cerebellar Peduncle

In sensorimotor adaptation paradigms, participants learn to adjust their behavior in response to an external perturbation. Locomotor adaptation and reaching adaptation depend on the cerebellum and are accompanied by changes in functional connectivity in cortico-cerebellar circuits. In order to gain a better understanding of the particular cerebellar projections involved in locomotor adaptation, we assessed the contribution of specific white matter pathways to the magnitude of locomotor adaptation and to long-term motor adaptation effects (recall and relearning). Diffusion magnetic resonance imaging with deterministic tractography was used to delineate the inferior and superior cerebellar peduncles (ICP, SCP) and the corticospinal tract (CST). Correlations were calculated to assess the association between the diffusivity values along the tracts and behavioral measures of locomotor adaptation. The results point to a significant correlation between the magnitude of adaptation and diffusivity values in the left ICP. Specifically, a higher magnitude of adaptation was associated with higher mean diffusivity and with lower anisotropy values in the left ICP, but not in other pathways. Post hoc analysis revealed that the effect stems from radial, not axial, diffusivity. The magnitude of adaptation was further associated with the degree of ICP lateralization, such that greater adaptation magnitude was correlated with increased rightward asymmetry of the ICP. Our findings suggest that the magnitude of locomotor adaptation depends on afferent signals to the cerebellum, transmitted via the ICP, and point to the contribution of error detection to locomotor adaptation rate.

Plantar or Palmar Tactile Augmentation Improves Lateral Postural Balance With Significant Influence from Cognitive Load

Although it seems intuitive to address the issue of reduced plantar cutaneous feedback by augmenting it, many approaches have adopted compensatory sensory cues, such as tactile input from another part of the body, for multiple reasons including easiness and accessibility. The efficacy of the compensatory approaches might be limited due to the cognitive involvement to interpret such compensatory sensory cues. The objective of this study is to test the hypothesis that the plantar cutaneous augmentation is more effective than providing compensatory sensory cues on improving postural regulation, when plantar cutaneous feedback is reduced. In our experiments, six healthy human subjects were asked to maintain their balance on a lateral balance board for as long as possible, until the balance board contacted the ground, for 240 trials with five interventions. During these experiments, subjects were instructed to close their eyes to increase dependency on plantar cutaneous feedback for balancing. Foam pad was also added on the board to emulate the condition of reduced plantar cutaneous feedback. The effects of tactile augmentation from the foot sole or the palm on standing balance were tested by applying transcutaneous electrical stimulation on calcaneal or ulnar nerve during the balance board tests, with and without a cognitively-challenging counting task. Experimental results indicate that the plantar cutaneous augmentation was effective on improving balance only with cognitive load, while the palmar cutaneous augmentation was effective only without cognitive load. This result suggests that the location of sensory augmentation should be carefully determined according to the attentional demands.

Adapting gait with asymmetric visual feedback affects deadaptation but not adaptation in healthy young adults

Split-belt treadmill walking allows researchers to understand how new gait patterns are acquired. Initially, the belts move at two different speeds, inducing asymmetric step lengths. As people adapt their gait on a split-belt treadmill, left and right step lengths become more symmetric over time. Upon returning to normal walking, step lengths become asymmetric in the opposite direction, indicating deadaptation. Then, upon re-exposure to the split belts, step length asymmetry is less than the asymmetry at the start of the initial exposure, indicating readaptation. Changes in step length symmetry are driven by changes in step timing and step position asymmetry. It is critical to understand what factors can promote step timing and position adaptation and therefore influence step length asymmetry. There is limited research regarding the role of visual feedback to improve gait adaptation. Using visual feedback to promote the adaptation of step timing or position may be useful of understanding temporal or spatial gait impairments. We measured gait adaptation, deadaptation, and readaptation in twenty-nine healthy young adults while they walked on a split-belt treadmill. One group received no feedback while adapting; one group received asymmetric real-time feedback about step timing while adapting; and the last group received asymmetric real-time feedback about step position while adapting. We measured step length difference (non-normalized asymmetry), step timing asymmetry, and step position asymmetry during adaptation, deadaptation, and readaptation on a split-belt treadmill. Regardless of feedback, participants adapted step length difference, indicating that walking with temporal or spatial visual feedback does not interfere with gait adaptation. Compared to the group that received no feedback, the group that received temporal feedback exhibited smaller early deadaptation step position asymmetry (p = 0.005). There was no effect of temporal or spatial feedback on step timing. The feedback groups adapted step timing and position similarly to walking without feedback. Future work should investigate whether asymmetric visual feedback also results in typical gait adaptation in populations with altered step timing or position control.

Using asymmetry to your advantage: learning to acquire and accept external assistance during prolonged split-belt walking

People can learn to exploit external assistance during walking to reduce energetic cost. For example, walking on a split-belt treadmill affords the opportunity for people to redistribute the mechanical work performed by the legs to gain assistance from the difference in belts' speed and reduce energetic cost. Though we know what people should do to acquire this assistance, this strategy is not observed during typical adaptation studies. We hypothesized that extending the time allotted for adaptation would result in participants adopting asymmetric step lengths to increase the assistance they can acquire from the treadmill. Here, participants walked on a split-belt treadmill for 45 min while we measured spatiotemporal gait variables, metabolic cost, and mechanical work. We show that when people are given sufficient time to adapt, they naturally learn to step further forward on the fast belt, acquire positive mechanical work from the treadmill, and reduce the positive work performed by the legs. We also show that spatiotemporal adaptation and energy optimization operate over different timescales: people continue to reduce energetic cost even after spatiotemporal changes have plateaued. Our findings support the idea that walking with symmetric step lengths, which is traditionally thought of as the endpoint of adaptation, is only a point in the process by which people learn to take advantage of the assistance provided by the treadmill. These results provide further evidence that reducing energetic cost is central in shaping adaptive locomotion, but this process occurs over more extended timescales than those used in typical studies.NEW & NOTEWORTHY Split-belt treadmill adaptation can be seen as a process where people learn to acquire positive work from the treadmill to reduce energetic cost. Though we know what people should do to reduce energetic cost, this strategy is not observed during adaptation studies. We extended the duration of adaptation and show that people continuously adapt their gait to acquire positive work from the treadmill to reduce energetic cost. This process requires longer exposure than traditionally allotted.

Use of explicit processes during a visually guided locomotor learning task predicts 24-h retention after stroke

Implicit and explicit processes can occur within a single locomotor learning task. The combination of these learning processes may impact how individuals acquire/retain the task. Because these learning processes rely on distinct neural pathways, neurological conditions may selectively impact the processes that occur, thus, impacting learning and retention. Thus, our purpose was to examine the contribution of implicit and explicit processes during a visually guided walking task and characterize the relationship between explicit processes and performance/retention in stroke survivors and age-matched healthy adults. Twenty chronic stroke survivors and twenty healthy adults participated in a 2-day treadmill study. Day 1 included baseline, acquisition1, catch, acquisition2, and immediate retention phases, and day 2 included 24-h retention. During acquisition phases, subjects learned to take a longer step with one leg through distorted visual feedback. During catch and retention phases, visual feedback was removed and subjects were instructed to walk normally (catch) or how they walked during the acquisition phases (retention). Change in step length from baseline to catch represented implicit processes. Change in step length from catch to the end of acquisition2 represented explicit processes. A mixed ANOVA found no difference in the type of learning between groups (P = 0.74). There was a significant relationship between explicit processes and 24-h retention in stroke survivors (r = 0.47, P = 0.04) but not in healthy adults (r = 0.34, P = 0.15). These results suggest that stroke may not affect the underlying learning mechanisms used during locomotor learning, but that these mechanisms impact how well stroke survivors retain the new walking pattern.NEW & NOTEWORTHY This study found that stroke survivors used implicit and explicit processes similar to age-matched healthy adults during a visually guided locomotion learning task. The amount of explicit processes was related to how well stroke survivors retained the new walking pattern but not to how well they performed during the task. This work illustrates the importance of understanding the underlying learning mechanisms to maximize retention of a newly learned motor behavior.

The Psychology of Reaching: Action Selection, Movement Implementation, and Sensorimotor Learning

The study of motor planning and learning in humans has undergone a dramatic transformation in the 20 years since this journal's last review of this topic. The behavioral analysis of movement, the foundational approach for psychology, has been complemented by ideas from control theory, computer science, statistics, and, most notably, neuroscience. The result of this interdisciplinary approach has been a focus on the computational level of analysis, leading to the development of mechanistic models at the psychological level to explain how humans plan, execute, and consolidate skilled reaching movements. This review emphasizes new perspectives on action selection and motor planning, research that stands in contrast to the previously dominant representation-based perspective of motor programming, as well as an emerging literature highlighting the convergent operation of multiple processes in sensorimotor learning.

Dissociated motor learning and de-adaptation in patients with functional gait disorders

Walking onto a stationary platform that had been previously experienced as moving generates a locomotor after-effect—the so-called ‘broken escalator’ phenomenon. The motor responses that occur during locomotor after-effects have been mapped theoretically using a hierarchal Bayesian model of brain function that takes into account current sensory information that is weighted according to prior contextually-relevant experiences; these in turn inform automatic motor responses. Here, we use the broken escalator phenomenon to explore motor learning in patients with functional gait disorders and probe whether abnormal postural mechanisms override ascending sensory information and conscious intention, leading to maladaptive and disabling gait abnormalities. Fourteen patients with functional gait disorders and 17 healthy control subjects walked onto a stationary sled (‘Before’ condition, five trials), then onto a moving sled (‘Moving’ condition, 10 trials) and then again onto the stationary sled (‘After’ condition, five trials). Subjects were warned of the change in conditions. Kinematic gait measures (trunk displacement, step timing, gait velocity), EMG responses, and subjective measures of state anxiety/instability were recorded per trial. Patients had slower gait velocities in the Before trials (P &lt; 0.05) but were able to increase this to accommodate the moving sled, with similar learning curves to control subjects (P = 0.87). Although trunk and gait velocity locomotor after-effects were present in both groups, there was a persistence of the locomotor after-effect only in patients (P &lt; 0.05). We observed an increase in gait velocity during After trials towards normal values in the patient group. Instability and state anxiety were greater in patients than controls (P &lt; 0.05) only during explicit phases (Before/After) of the task. Mean ‘final’ gait termination EMG activity (right gastrocnemius) was greater in the patient group than controls. Despite a dysfunctional locomotor system, patients show normal adaptive learning. The process of de-adaptation, however, is prolonged in patients indicating a tendency to perpetuate learned motor programmes. The trend to normalization of gait velocity following a period of implicit motor learning has implications for gait rehabilitation potential in patients with functional gait disorders and related disorders (e.g. fear of falling).

Persons post-stroke improve step length symmetry by walking asymmetrically

BACKGROUND AND PURPOSE

Restoration of step length symmetry is a common rehabilitation goal after stroke. Persons post-stroke often retain the ability to walk with symmetric step lengths ("symmetric steps"); however, the resulting walking pattern remains effortful. Two key questions with direct implications for rehabilitation have emerged: 1) how do persons post-stroke generate symmetric steps, and 2) why do symmetric steps remain so effortful? Here, we aimed to understand how persons post-stroke generate symmetric steps and explored how the resulting gait pattern may relate to the metabolic cost of transport.

METHODS

We recorded kinematic, kinetic, and metabolic data as nine persons post-stroke walked on an instrumented treadmill under two conditions: preferred walking and symmetric stepping (using visual feedback).

RESULTS

Gait kinematics and kinetics remained markedly asymmetric even when persons post-stroke improved step length symmetry. Impaired paretic propulsion and aberrant movement of the center of mass were evident during both preferred walking and symmetric stepping. These deficits contributed to diminished positive work performed by the paretic limb on the center of mass in both conditions. Within each condition, decreased positive paretic work correlated with increased metabolic cost of transport and decreased walking speed across participants.

CONCLUSIONS

It is critical to consider the mechanics used to restore symmetric steps when designing interventions to improve walking after stroke. Future research should consider the many dimensions of asymmetry in post-stroke gait, and additional within-participant manipulations of gait parameters are needed to improve our understanding of the elevated metabolic cost of walking after stroke.

Electrically-Evoked Proximity Sensation Can Enhance Fine Finger Control in Telerobotic Pinch

For teleoperation tasks requiring high control accuracy, it is essential to provide teleoperators with information on the interaction between the end effector and the remote environment. Real-time imaging devices have been widely adopted, but it delivers limited information, especially when the end effectors approach the target following the line-of-sight. In such situations, teleoperators rely on the perspective at the screen and can apply high force unintentionally at the initial contact. This research proposes to deliver the distance information at teleoperation to the fingertips of teleoperators, i.e., proximity sensation. Transcutaneous electrical stimulation was applied onto the fingertips of teleoperators, with the pulsing frequency inversely proportional to the distance. The efficacy of the proximity sensation was evaluated by the initial contact force during telerobotic pinch in three sensory conditions: vision only, vision + visual assistance (distance on the screen), and vision + proximity sensation. The experiments were repeated at two viewing angles: 30–60° and line-of-sight, for eleven healthy human subjects. For both cases, the initial contact force could be significantly reduced by either visual assistance (20–30%) or the proximity sensation (60–70%), without additional processing time. The proximity sensation is two-to-three times more effective than visual assistance regarding the amount of force reduction.

Does dual task placement and duration affect split-belt treadmill adaptation?

BACKGROUND

Dual tasking during prolonged split-belt adaptation (10-15 min) has shown to slow the adaptation process and prolong aftereffects. Therefore, dual tasks during split-belt adaptation are being explored for their potential in gait symmetry rehabilitation. However, the ideal paradigm configuration it is still not clear.

RESEARCH QUESTION

To determine whether split-belt adaptation and ensuing aftereffects are altered by dual task placement, specifically looking at onset of split-belt adaptation or later part way through Adaptation (Experiment 1) and dual task duration (Experiment 2).

METHODS

Healthy young adults (n = 40) performed 5 min of tied-belt walking, followed by 14 min of split-belts (Adaptation, 1:3 ratio) and 5 min of de-adaptation (both belts at same speed) to assess after effects (Post-Adaptation). Experiment 1: To assess the effects of dual task placement, an auditory version of an n-back task was presented during the first 8 min or last 8 min of Adaptation. Experiment 2: To assess the effects of dual task duration, the cognitive task was presented during the entire split-belt Adaptation phase (14 min) or during four 2-minute bouts (8 min). Cognitive task accuracy, dual support symmetry, and rates of adaptation and de-adaptation were compared.

RESULTS

When both the onset of the auditory cognitive task and the onset of Adaptation (split-belts) occurred simultaneously, participants prioritized split-belt adaptation and in doing so, cognitive task accuracy was reduced (Experiment 1). By prioritizing gait symmetry over cognitive performance, there were no differences in dual support symmetry adaptation (magnitude, variability or rate of Adaptation/De-adaptation) regardless of cognitive task placement or duration (Experiment 2).

SIGNIFICANCE

We believe the early portion of split-belt treadmill adaptation to be a cognitive interference period. These results support future work exploring the use of dual task in a rehabilitation setting with more complicated motor-cognitive dual task paradigms during this key period.

Providing low-dimensional feedback of a high-dimensional movement allows for improved performance of a skilled walking task

Learning a skilled movement often requires changing multiple dimensions of movement in a coordinated manner. Serial training is one common approach to learning a new movement pattern, where each feature is learned in isolation from the others. Once one feature is learned, we move on to the next. However, when learning a complex movement pattern, serial training is not only laborious but can also be ineffective. Often, movement features are linked such that they cannot simply be added together as we progress through training. Thus, the ability to learn multiple features in parallel could make training faster and more effective. When using visual feedback as the tool for changing movement, however, such parallel training may increase the attentional load of training and impair performance. Here, we developed a novel visual feedback system that uses principal component analysis to weight four features of movement to create a simple one-dimensional 'summary' of performance. We used this feedback to teach healthy, young participants a modified walking pattern and compared their performance to those who received four concurrent streams of visual information to learn the same goal walking pattern. We demonstrated that those who used the principal component-based visual feedback improved their performance faster and to a greater extent compared to those who received concurrent feedback of all features. These results suggest that our novel principal component-based visual feedback provides a method for altering multiple features of movement toward a prescribed goal in an intuitive, low-dimensional manner.

Individualized feedback to change multiple gait deficits in chronic stroke

Background

Walking deficits in people post-stroke are often multiple and idiosyncratic in nature. Limited patient and therapist resources necessitate prioritization of deficits such that some may be left unaddressed. More efficient delivery of therapy may alleviate this challenge. Here, we look to determine the utility of a novel principal component-based visual feedback system that targets multiple, patient-specific features of gait in people post-stroke.

Methods

Ten individuals with stroke received two sessions of visual feedback to attain a walking goal. This goal consisted of bilateral knee and hip joint angles of a typical ‘healthy’ walking pattern. The feedback system uses principal component analysis (PCA) to algorithmically weight each of the input features so that participants received one stream of performance feedback. In the first session, participants had to explore different patterns to achieve the goal, and in the second session they were informed of the goal walking pattern. Ten healthy, age-matched individuals received the same paradigm, but with a hemiparetic goal (i.e. to produce the pattern of an exemplar stroke participant). This was to distinguish the extent to which performance limitations in stroke were due neurological injury or the PCA based visual feedback itself.

Results

Principal component-based visual feedback can differentially bias multiple features of walking toward a prescribed goal. On average, individuals with stroke typically improved performance via increased paretic knee and hip flexion, and did not perform better with explicit instruction. In contrast, healthy people performed better (i.e. could produce the desired exemplar stroke pattern) in both sessions, and were best with explicit instruction. Importantly, the feedback for stroke participants accommodated a heterogeneous set of walking deficits by individually weighting each feature based on baseline walking.

Conclusions

People with and without stroke are able to use this novel visual feedback to train multiple, specific features of gait. Important for stroke, the PCA feedback allowed for targeting of patient-specific deficits. This feedback is flexible to any feature of walking in any plane of movement, thus providing a potential tool for therapists to simultaneously target multiple aberrant features of gait.

Effects of extended stance time on a powered knee prosthesis and gait symmetry on the lateral control of balance during walking in individuals with unilateral amputation

BACKGROUND

Individuals with lower limb amputation commonly exhibit large gait asymmetries that are associated with secondary health issues. It has been shown that they are capable of attaining improved temporal and propulsive symmetry when walking with a powered knee prosthesis and visual feedback, but they perceive this pattern of gait to be more difficult. Rather than improving the efficiency of gait, improved gait symmetry may be increasing individuals' effort associated with maintaining lateral balance.

METHODS

In this study, we used a simple visual feedback paradigm to increase the prosthesis-side stance time of six individuals with unilateral TFA or KD as they walked on a powered knee prosthesis at their self-selected speed. As they walked more symmetrically, we evaluated changes in medial-lateral center-of-mass excursion, lateral margin of stability, stride width, and hip abductor activity.

RESULTS

As the subjects increased their prosthesis-side stance time, their center-of-mass excursion and hip abductor activity significantly increased, while their lateral margin of stability significantly decreased on the prosthesis-side only. Stride width remained relatively unchanged with testing condition.

CONCLUSIONS

Extended stance time on a powered knee prosthesis (yielding more symmetric gait) challenged the lateral balance of individuals with lower limb amputation. Lateral stability may be a reason they prefer an asymmetric gait, even with more advanced technology. Hip muscular changes post-amputation may contribute to the decline in stability on the prosthesis side. Interventions and advancements in prosthesis control aimed at improving their control of lateral balance may ameliorate the difficulty in walking with improved gait symmetry.

A single high-intensity exercise bout during early consolidation does not influence retention or relearning of sensorimotor locomotor long-term memories

A single exercise bout has been found to improve the retention of a skill-based upper extremity motor task up to a week post-practice. This effect is the greatest when exercise intensity is high and exercise is administered immediately after motor practice (i.e., early in consolidation). Whether exercise can affect other motor learning types (e.g., sensorimotor adaptation) and tasks (e.g., walking) is still unclear as previous studies have not optimally refined the exercise parameters and long-term retention testing. Therefore, we investigated whether a single high-intensity exercise bout during early consolidation would improve the long-term retention and relearning of sensorimotor adaptation during split-belt treadmill walking. Twenty-six neurologically intact adults attended three sessions; sessions 2 and 3 were 1 day and 7 days after session 1, respectively. Participants were allocated either to Rest (REST) or to Exercise (EXE) group. In session 1, all groups walked on a split-belt treadmill in a 2:1 speed ratio (1.5:0.75 m/s). Then, half of the participants exercised for 5 min (EXE), while the other half rested for 5 min (REST). A short exercise bout during early consolidation did not improve retention or relearning of locomotor memories one or seven days after session 1. This result reinforces previous findings that the effect of exercise on motor learning may differ between sensorimotor locomotor adaptation and skilled-based upper extremity tasks; thus, the utility of exercise as a behavioral booster of motor learning may depend on the type of motor learning and task.

Taking advantage of external mechanical work to reduce metabolic cost: the mechanics and energetics of split-belt treadmill walking

KEY POINTS

The neuromotor system generates flexible motor patterns that can adapt to changes in our bodies or environment and also take advantage of assistance provided by the environment. We ask how energy minimization influences adaptive learning during human locomotion to improve economy when walking on a split-belt treadmill. We use a model-based approach to predict how people should adjust their walking pattern to take advantage of the assistance provided by the treadmill, and we validate these predictions empirically. We show that adaptation to a split-belt treadmill can be explained as a process by which people reduce step length asymmetry to take advantage of the work performed by the treadmill to reduce metabolic cost. Our results also have implications for the evaluation of devices designed to reduce effort during walking, as locomotor adaptation may serve as a model approach to understand how people learn to take advantage of external assistance.

ABSTRACT

In everyday tasks such as walking and running, we often exploit the work performed by external sources to reduce effort. Recent research has focused on designing assistive devices capable of performing mechanical work to reduce the work performed by muscles and improve walking function. The success of these devices relies on the user learning to take advantage of this external assistance. Although adaptation is central to this process, the study of adaptation is often done using approaches that seem to have little in common with the use of external assistance. We show in 16 young, healthy participants that a common approach for studying adaptation, split-belt treadmill walking, can be understood from a perspective in which people learn to take advantage of mechanical work performed by the treadmill. Initially, during split-belt walking, people step further forward on the slow belt than the fast belt which we measure as a negative step length asymmetry, but this asymmetry is reduced with practice. We demonstrate that reductions in asymmetry allow people to extract positive work from the treadmill, reduce the positive work performed by the legs, and reduce metabolic cost. We also show that walking with positive step length asymmetries, defined by longer steps on the fast belt, minimizes metabolic cost, and people choose this pattern after guided experience of a wide range of asymmetries. Our results suggest that split-belt adaptation can be interpreted as a process by which people learn to take advantage of mechanical work performed by an external device to improve economy.

Explicit Control of Step Timing During Split-Belt Walking Reveals Interdependent Recalibration of Movements in Space and Time

Split-belt treadmills that move the legs at different speeds are thought to update internal representations of the environment, such that this novel condition generates a new locomotor pattern with distinct spatio-temporal features compared to those of regular walking. It is unclear the degree to which such recalibration of movements in the spatial and temporal domains is interdependent. In this study, we explicitly altered subjects' limb motion in either space or time during split-belt walking to determine its impact on the adaptation of the other domain. Interestingly, we observed that motor adaptation in the spatial domain was susceptible to altering the temporal domain, whereas motor adaptation in the temporal domain was resilient to modifying the spatial domain. This non-reciprocal relation suggests a hierarchical organization such that the control of timing in locomotion has an effect on the control of limb position. This is of translational interest because clinical populations often have a greater deficit in one domain compared to the other. Our results suggest that explicit changes to temporal deficits cannot occur without modifying the spatial control of the limb.

Trading Symmetry for Energy Cost During Walking in Healthy Adults and Persons Poststroke

Background. Humans typically walk in ways that minimize energy cost. Recent work has found that healthy adults will even adopt new ways of walking when a new pattern costs less energy. This suggests potential for rehabilitation to drive changes in walking by altering the energy costs of walking patterns so that the desired pattern becomes energetically optimal (ie, costs least energy of all available patterns). Objective. We aimed to change gait symmetry in healthy adults and persons poststroke by creating environments where changing symmetry allowed the participants to save energy. Methods. Across 3 experiments, we tested healthy adults (n = 12 in experiment 1, n = 20 in experiment 2) and persons poststroke (n = 7 in experiment 3) in a novel treadmill environment that linked asymmetric stepping and gait speed-2 factors that influence energy cost-to create situations where walking with one's preferred gait symmetry (or asymmetry, in the case of the persons poststroke) was no longer the least energetically costly way to walk. Results. Across the 3 experiments, we found that most participants changed their gait when experiencing the new energy landscape. Healthy adults often adopted an asymmetric gait if it saved energy, and persons poststroke often began to step more symmetrically than they prefer to walk in daily life. Conclusions. We used a novel treadmill environment to show that people with and without stroke change clinically relevant features of walking to save energy. These findings suggest that rehabilitation approaches aimed at making symmetric walking energetically "easier" may promote gait symmetry after stroke.

Motor Control: No Constant but Change

We rely on predictions to rapidly select our walking gaits. New research suggests that the formation of these predictions is driven by the difference between the walk we expect and the walk we get.

Altered auditory feedback perception following an 8-week mindfulness meditation practice

Our own ongoing motor actions are perceived through sensory feedback pathways, and are integrated with neural processes to modulate further actions. This sensory feedback mechanism is known to contribute to the rehabilitation of impaired motor functions. Recent evidence also suggests that mindfulness meditation improves our awareness to sensation; therefore, enhancement of awareness to sensory feedback through mindfulness meditation training may have potential clinical applications. This study investigated an effect of eight-week practice of mindfulness meditation on speech perception/production processes. Among the thirty healthy participants, half of them engaged in regular meditation practice of 10 min per day for eight weeks, and the other half were not given any instructions for their daily life. The change of speech performance in sentence reading under 200 ms delayed auditory feedback (DAF) condition were assessed compared to without delay condition. Also, event-related potential response to the short sound of /a/, were measured. The result showed that, after the eight-week practice, the meditation group showed significantly improved speech fluency in the DAF condition, when 16-min meditation was introduced before the experiments. Furthermore, significantly increased auditory evoked potentials were observed in the central-parietal region when the participants listened to the delayed auditory feedback sound of their own voice. These findings provide the first glimpses into the possible relationship between mindfulness meditation and auditory feedback. Different instructions for daily activity between the meditation and control groups should be considered in further studies.

Walking through the looking glass: Adapting gait patterns with mirror feedback

Clinical locomotor research seeks to facilitate adaptation or retention of new walking patterns by providing feedback. Within a split-belt treadmill paradigm, sagittal plane feedback improves adaptation but does not affect retention. Representation of error in this manner is cognitively demanding. However, it is unknown in this paradigm how frontal plane feedback, which may utilize a unique learning process, impacts locomotor adaptation. Frontal plane movement feedback has been shown to impact retention of novel running mechanics but has yet to be evaluated in gait conditions widely applicable within neurorehabilitation, such as walking. The purpose of this study was to investigate the effects of frontal plane mirror feedback on gait adaptation and retention during split-belt treadmill walking. Forty healthy young adults were divided into two groups: one group received mirror feedback during the first split-belt exposure and the other received no mirror feedback. Individuals in the mirror feedback group were asked to look at their legs in the mirror, but no further instructions were given. Individuals with mirror feedback displayed more symmetric stance time during the first strides of adaptation and maintained this pattern into the second split-belt exposure when no feedback was provided. Individuals with mirror feedback also demonstrated more symmetric double support time upon returning to normal walking. Lastly, the mirror feedback also allowed individuals to walk with smaller gait variability during the final steps of both split-belt exposures. Overall, mirror feedback allowed individuals to reduce their stance time asymmetry and led to a more consistent adapted pattern, suggesting this type of feedback may have utility in gait training that targets symmetry and consistency in movement.

Movement and perception recalibrate differently across multiple days of locomotor learning

Learning a new movement through error-based adaptation leads to recalibration of movement and altered perception of that movement. Although presumed to be closely related, the relationship between adaptation-based motor and perceptual changes is not well understood. Here we investigated the changes in motor behavior and leg speed perception over 5 days of split-belt treadmill adaptation. We specifically wanted to know if changes in the perceptual domain would demonstrate savings-like behavior (i.e., less recalibration with more practice) and if these changes would parallel the savings observed in the motor domain. We found that the recalibration of leg speed perception decreased across days of training, indicating savings-like behavior in this domain. However, we observed that the magnitude of savings across days was different between motor and perceptual domains. These findings suggest a degree of independence between the motor and perceptual processes that occur with locomotor adaptation. NEW & NOTEWORTHY Error-based adaptation learning drives changes in movement and perception of movement. Are these changes across domains linked or simply coincidental? Here, we studied changes in movement and perception across 5 days of repeated locomotor adaptation. Savings-like behavior in the motor and perceptual domains developed with different magnitudes and over different timescales, leading us to conclude that motor and perceptual processes operate at least somewhat independently during locomotor adaptation.

A locomotor learning paradigm using distorted visual feedback elicits strategic learning

Distorted visual feedback (DVF) during locomotion has been suggested to result in the development of a new walking pattern in healthy individuals through implicit learning processes. Recent work in upper extremity visuomotor rotation paradigms suggest that these paradigms involve implicit and explicit learning. Additionally, in upper extremity visuomotor paradigms, the verbal cues provided appear to impact how a behavior is learned and when this learned behavior is used. Here, in two experiments in neurologically intact individuals, we tested how verbal instruction impacts learning a new locomotor pattern on a treadmill through DVF, the transfer of that pattern to overground walking, and what types of learning occur (i.e., implicit vs. explicit learning). In experiment 1, we found that the instructions provided impacted the amount learned through DVF, but not the size of the aftereffects or the amount of the pattern transferred to overground walking. Additionally, the aftereffects observed were significantly different from the baseline walking pattern, but smaller than the behavior changes observed during learning, which is uncharacteristic of implicit sensorimotor adaptation. Thus, experiment 2 aimed to determine the cause of these discrepancies. In this experiment, when VF was not provided, individuals continued using the learned walking pattern when instructed to do so and returned toward their baseline pattern when instructed to do so. Based on these results, we conclude that DVF during locomotion results in a large portion of explicit learning and a small portion of implicit learning. NEW & NOTEWORTHY The results of this study suggest that distorted visual feedback during locomotor learning involves the development of an explicit strategy with only a small component of implicit learning. This is important because previous studies using distorted visual feedback have suggested that locomotor learning relies primarily on implicit learning. This paradigm, therefore, provides a new way to examine a different form of learning in locomotion.

Independent voluntary correction and savings in locomotor learning

Humans can acquire new walking patterns in many different ways. For example, we can change our gait voluntarily in response to instruction or adapt by sensing our movement errors. Here, we investigated how acquisition of a new walking pattern through simultaneous voluntary correction and adaptive learning affected the resulting motor memory of the learned pattern. We studied adaptation to split-belt treadmill walking with and without visual feedback of stepping patterns. As expected, visual feedback enabled faster acquisition of the new walking pattern. However, upon later re-exposure to the same split-belt perturbation, participants exhibited similar motor memories whether they had learned with or without visual feedback. Participants who received feedback did not re-engage the mechanism used to accelerate initial acquisition of the new walking pattern to similarly accelerate subsequent relearning. These findings reveal that voluntary correction neither benefits nor interferes with the ability to save a new walking pattern over time.

A Dual-Learning Paradigm Simultaneously Improves Multiple Features of Gait Post-Stroke

BACKGROUND

Gait impairments after stroke arise from dysfunction of one or several features of the walking pattern. Traditional rehabilitation practice focuses on improving one component at a time, which may leave certain features unaddressed or prolong rehabilitation time. Recent work shows that neurologically intact adults can learn multiple movement components simultaneously.

OBJECTIVE

To determine whether a dual-learning paradigm, incorporating 2 distinct motor tasks, can simultaneously improve 2 impaired components of the gait pattern in people posttroke.

METHODS

Twelve individuals with stroke participated. Participants completed 2 sessions during which they received visual feedback reflecting paretic knee flexion during walking. During the learning phase of the experiment, an unseen offset was applied to this feedback, promoting increased paretic knee flexion. During the first session, this task was performed while walking on a split-belt treadmill intended to improve step length asymmetry. During the second session, it was performed during tied-belt walking.

RESULTS

The dual-learning task simultaneously increased paretic knee flexion and decreased step length asymmetry in the majority of people post-stroke. Split-belt treadmill walking did not significantly interfere with joint-angle learning: participants had similar rates and magnitudes of joint-angle learning during both single and dual-learning conditions. Participants also had significant changes in the amount of paretic hip flexion in both single and dual-learning conditions.

CONCLUSIONS

People with stroke can perform a dual-learning paradigm and change 2 clinically relevant gait impairments in a single session. Long-term studies are needed to determine if this strategy can be used to efficiently and permanently alter multiple gait impairments.

Closing the Loop: From Motor Neuroscience to Neurorehabilitation

The fields of human motor control, motor learning, and neurorehabilitation have long been linked by the intuition that understanding how we move (and learn to move) leads to better rehabilitation. In reality, these fields have remained largely separate. Our knowledge of the neural control of movement has expanded, but principles that can directly impact rehabilitation efficacy remain somewhat sparse. This raises two important questions: What can basic studies of motor learning really tell us about rehabilitation, and are we asking the right questions to improve the lives of patients? This review aims to contextualize recent advances in computational and behavioral studies of human motor learning within the framework of neurorehabilitation. We also discuss our views of the current challenges facing rehabilitation and outline potential clinical applications from recent theoretical and basic studies of motor learning and control.