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Jack PS, Austin JH, Sarah NK, Tony GJI, Shaun GB. A kinematically complex multi-articular motor skill for investigating implicit motor learning. PSYCHOLOGICAL RESEARCH 2024:10.1007/s00426-024-01987-0. [PMID: 38940820 DOI: 10.1007/s00426-024-01987-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Accepted: 06/06/2024] [Indexed: 06/29/2024]
Abstract
Here we present a task developed to probe implicit learning of a complex motor skill. This task addresses limitations related to task complexity noted in the literature for methods investigating implicit motor learning, namely the serial reaction time task and continuous tracking task. Specifically, the serial reaction time task is limited by the kinematic simplicity of the required movement and the continuous tracing task faces time-on-task confounds and limitations in the control of task difficulty. The task presented herein addresses these issues by employing a kinematically complex multi-articular movement that controls factors that contribute to task difficulty: stimulus animation velocity and trajectory complexity. Accordingly, our objective was to validate the use of this task in probing implicit motor learning, hypothesizing that participants would learn one of the repeating stimuli implicitly. Participants engaged in six blocks of training whereby they first observed and then reproduced a seemingly random complex trajectory. Repeated trajectories were embedded amongst random trajectories. In line with the hypothesis, error for the repeated trajectories was decreased in comparison to that observed for the random trajectories and 73% of participants were unable to identify one of the repeated trajectories, demonstrating the occurrence of implicit learning. While the task requires minor alteration to optimize learning, ultimately the findings underline the task's potential to investigate implicit learning of a complex motor skill.
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Affiliation(s)
- P Solomon Jack
- Laboratory for Brain Recovery and Function, School of Physiotherapy, Dalhousie University, Rm 407, 4th Floor Forrest Building, 5869 University Avenue, PO Box 15000, Halifax, NS, B3H 4R2, Canada
- Department of Psychology and Neuroscience, Dalhousie University, Halifax, Canada
| | - J Hurst Austin
- Laboratory for Brain Recovery and Function, School of Physiotherapy, Dalhousie University, Rm 407, 4th Floor Forrest Building, 5869 University Avenue, PO Box 15000, Halifax, NS, B3H 4R2, Canada
- PhD Health Program, Faculty of Health, Dalhousie University, Halifax, Canada
| | - N Kraeutner Sarah
- Neuroplasticity, Imagery, and Motor Behaviour Laboratory, Department of Psychology, University of British Columbia, Okanagan Campus, Vancouver, Canada
| | - G J Ingram Tony
- Laboratory for Brain Recovery and Function, School of Physiotherapy, Dalhousie University, Rm 407, 4th Floor Forrest Building, 5869 University Avenue, PO Box 15000, Halifax, NS, B3H 4R2, Canada
| | - G Boe Shaun
- Laboratory for Brain Recovery and Function, School of Physiotherapy, Dalhousie University, Rm 407, 4th Floor Forrest Building, 5869 University Avenue, PO Box 15000, Halifax, NS, B3H 4R2, Canada.
- Department of Psychology and Neuroscience, Dalhousie University, Halifax, Canada.
- PhD Health Program, Faculty of Health, Dalhousie University, Halifax, Canada.
- School of Health and Human Performance, Dalhousie University, Halifax, Canada.
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Ben M, Glinsky JV, Chu J, Spooren AI, Roberts S, Chen LW, Denis S, Lorusso M, Jorgensen V, Gollan EJ, Agostinello J, Van Laake-Geelen CCM, Lincoln C, Stolwijk JM, Bell C, Paddison S, Rainey D, Tranter K, Ilha J, Oostra K, Sherrington C, Harvey LA. Early and intensive Motor Training for people with spinal cord injuries (the SCI-MT Trial): description of the intervention. Spinal Cord 2023; 61:600-607. [PMID: 37468607 PMCID: PMC10645584 DOI: 10.1038/s41393-023-00911-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Revised: 06/23/2023] [Accepted: 06/27/2023] [Indexed: 07/21/2023]
Abstract
STUDY DESIGN Descriptive. OBJECTIVES The primary objective is to describe the intervention that will be provided in a large multi-centre randomised controlled trial titled: Early and Intensive Motor Training for people with Spinal Cord Injuries (the SCI-MT Trial). The secondary objective is to describe the strategies that will be used to operationalise and standardise the Motor Training provided to participants while keeping the intervention person-centred. METHODS The paper focuses on the rationale and principles of Motor Training for people with spinal cord injuries (SCI). The description of the intervention is based on the Template for Intervention Description and Replication (TIDieR) checklist. Specifically, it addresses the following 6 criteria of the TIDieR checklist: why the effectiveness of Motor Training is being examined; what, how, where and when the Motor Training will be administered; and how much Motor Training will be provided. RESULTS A detailed intervention manual has been developed to help standardise the delivery of the intervention. CONCLUSIONS This paper describes the details of a complex intervention administered as part of a large randomised controlled trial. It will facilitate the subsequent interpretation of the trial results and enable the intervention to be reproduced in clinical practice and future trials.
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Affiliation(s)
- M Ben
- Kolling Institute, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
- John Walsh Centre for Rehabilitation Research, Northern Sydney Local Health District, St Leonards, Sydney, NSW, Australia
| | - J V Glinsky
- Kolling Institute, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
- John Walsh Centre for Rehabilitation Research, Northern Sydney Local Health District, St Leonards, Sydney, NSW, Australia
| | - J Chu
- Kolling Institute, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
- John Walsh Centre for Rehabilitation Research, Northern Sydney Local Health District, St Leonards, Sydney, NSW, Australia
| | | | - S Roberts
- Fiona Stanley Hospital, Murdoch, WA, Australia
| | - L W Chen
- Royal North Shore Hospital, St Leonards, NSW, Australia
| | - S Denis
- The Prince of Wales Hospital, Wales, NSW, Australia
| | - M Lorusso
- I.R.C.C.S. Foundation Santa Lucia, Rome, Italy
| | - V Jorgensen
- Sunnaas Rehabilitation Hospital, Nesodden, Norway
| | - E J Gollan
- The Princess Alexandra Hospital, Harlow, QLD, Australia
| | - J Agostinello
- The Royal Talbot Rehabilitation Centre, Kew Vic, VIC, Australia
| | - C C M Van Laake-Geelen
- Adelante Centre of Expertise in Rehabilitation and Audiology, Hoensbroek, The Netherlands
- Department of Rehabilitation Medicine, Research School CAPHRI, Maastricht University, Maastricht, The Netherlands
| | - C Lincoln
- Queen Elizabeth National Spinal Injures Unit, Glasgow, Scotland
| | - J M Stolwijk
- Center of Excellence for Rehabilitation Medicine, University Medical Center Utrecht Brain Center, University Medical Center Utrecht and De Hoogstraat Rehabilitation, Utrecht, The Netherlands
| | - C Bell
- Spinal Cord Injury Rehabilitation, Repat Health Precinct, Daw Park, SA, Australia
| | - S Paddison
- London Spinal Cord Injury Centre, Royal National Orthopaedic Hospital Trust, Middlesex, UK
| | - D Rainey
- Royal Rehab, Ryde, NSW, Australia
| | - K Tranter
- Kolling Institute, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
- John Walsh Centre for Rehabilitation Research, Northern Sydney Local Health District, St Leonards, Sydney, NSW, Australia
| | - J Ilha
- Universidade do Estado de Santa Catarina - UDESC, College of Health and Sport Science, Florianopolis, SC, Brazil
| | - K Oostra
- Ghent University Hospital, Ghent, Belgium
| | - C Sherrington
- Sydney School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - L A Harvey
- Kolling Institute, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia.
- John Walsh Centre for Rehabilitation Research, Northern Sydney Local Health District, St Leonards, Sydney, NSW, Australia.
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Arikawa E, Kubota M, Haraguchi T, Takata M, Natsugoe S. Implicit Motor Learning Strategies Benefit Dual-Task Performance in Patients with Stroke. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1673. [PMID: 37763792 PMCID: PMC10536444 DOI: 10.3390/medicina59091673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/26/2023] [Revised: 09/12/2023] [Accepted: 09/13/2023] [Indexed: 09/29/2023]
Abstract
Background and Objectives: In stroke rehabilitation, the use of either implicit or explicit learning as a motor learning approach during dual tasks is common, but it is unclear which strategy is more beneficial. This study aims to determine the benefits of implicit versus explicit motor learning approaches in patients with stroke. Materials and Methods: Seventeen patients with stroke and 21 control participants were included. Motor learning was evaluated using the Serial Reaction Time Task (SRTT) in the context of dual-task conditions. The SRTT was conducted on two separate days: one day for implicit learning conditions and the other day for explicit learning conditions. Under the explicit learning conditions, a task rule was given to the participants before they started the task, but not under the implicit learning conditions. Learning scores were calculated for both implicit and explicit learning, and these scores were then compared within groups for patients with stroke and controls. We calculated the difference in learning scores between implicit and explicit learning and conducted a correlation analysis with the Trail Making Test (TMT) Parts A and B. Results: Learning scores on the SRTT were not different between implicit and explicit learning in controls but were significantly greater in patients with stroke for implicit learning than for explicit learning. The difference in learning scores between implicit and explicit learning in patients with stroke was correlated with TMT-A and showed a correlation trend with TMT-B. Conclusions: Implicit learning approaches may be effective in the acquisition of motor skills with dual-task demands in post-stroke patients with deficits in attention and working memory.
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Affiliation(s)
- Eito Arikawa
- Graduate School of Health Sciences, Kagoshima University, 8-35-1, Sakuragaoka, Kagoshima 890-8544, Japan;
- General Rehabilitation Center, Kajikionsen Hospital, 4714, Kida, Kajiki, Aira City, Kagoshima 899-5241, Japan
| | - Masatomo Kubota
- Department of Occupational Therapy, School of Health Science, Factory of Medicine, Kagoshima University, 8-35-1, Sakuragaoka, Kagoshima 890-8544, Japan
| | - Tomoko Haraguchi
- General Rehabilitation Center, Kajikionsen Hospital, 4714, Kida, Kajiki, Aira City, Kagoshima 899-5241, Japan
| | - Masachika Takata
- General Rehabilitation Center, Kajikionsen Hospital, 4714, Kida, Kajiki, Aira City, Kagoshima 899-5241, Japan
| | - Shoji Natsugoe
- General Rehabilitation Center, Kajikionsen Hospital, 4714, Kida, Kajiki, Aira City, Kagoshima 899-5241, Japan
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Ofek H, Alperin M, Knoll T, Livne D, Laufer Y. Explicit versus implicit lower extremity sensory retraining for post-stroke chronic sensory deficits: a randomized controlled trial. Disabil Rehabil 2022:1-7. [PMID: 35649684 DOI: 10.1080/09638288.2022.2080288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
PURPOSE Sensory impairment post-stroke limits rehabilitation of balance and gait. This study aims to compare the effect of explicit sensory retraining (ESR) versus implicit repeated exposure (IRE) to stimuli of the lower extremity, assessing their effects on sensation, balance, and gait in individuals with chronic post-stroke sensory impairment. MATERIALS AND METHODS A two-arm parallel double-blind multicenter randomized controlled trial was conducted in physical therapy outpatient clinics. Volunteers with chronic sensory impairment post-stroke participated in 10 sessions of 45 min ESR or IRE, according to a detailed protocol. Outcome measures assessed sensation, balance, mobility, and participation. RESULTS A total of 64 participants were recruited (ESR, n = 34; IRE, n = 30). The intention-to-treat pre-post analysis demonstrated clinically meaningful changes for both interventions (10-31% improvement for the various measures), with no between-group difference or time × group interaction. The effect size for the time effect varied, with the largest being 0.63 for the miniBEST. CONCLUSIONS Sensory rehabilitation treatment by either ESR or IRE led to similar clinically significant changes in the performance of the lower extremity and participation in subjects with sensory loss post-stroke. Both treatment protocols are easy to implement in an outpatient clinic. . CLINICALTRIALS.GOV REGISTRATION NCT01988220. Implications for rehabilitationStandardized, structured, sensory-focused training can improve balance and gait in subjects with chronic post-stroke sensory impairment.Both explicit and implicit learning-based sensory protocols focused on the lower extremity effectively improved balance, mobility, and gait abilities, resulting in enhanced participation of individuals in the chronic post-stroke phase.A series of ten 45-minute treatment sessions in outpatient clinics lead to clinically significant improvements.
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Affiliation(s)
- Hadas Ofek
- Department of Physical Therapy, School of Social Welfare and Health Sciences, University of Haifa, Haifa, Israel.,Department of Physical Therapy, Zefat Academic College, Safed, Israel
| | | | - Tsipi Knoll
- Clalit Health Services, Haifa and Western Galilee, Haifa, Israel
| | - Daphna Livne
- Department of Physical Therapy, Zefat Academic College, Safed, Israel.,Clalit Health Services, Haifa and Western Galilee, Haifa, Israel
| | - Yocheved Laufer
- Department of Physical Therapy, School of Social Welfare and Health Sciences, University of Haifa, Haifa, Israel
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Nieboer M, Jie LJ, Willemse L, Peek S, Braun S, Wouters E. Attitudes towards a sensor-feedback technology in gait rehabilitation of patients after stroke. Disabil Rehabil Assist Technol 2021:1-7. [PMID: 34263711 DOI: 10.1080/17483107.2021.1936664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Intensive gait training is important for effective rehabilitation of people after stroke. "Stappy" is a sensor-feedback system that provides real-time feedback on the persons gait pattern/performance during training. The main aim of this study was to assess attitudes towards "Stappy" in people after stroke to practise walking performance independently at home. METHODS Demographics were collected. Frequency of practice with "Stappy" was monitored through the system. Participants used "Stappy" at home for two weeks. Semi-structured interviews were conducted to explore patient experiences with "Stappy" afterwards. Interviews were analysed using thematic analysis. RESULTS Seventeen people after stroke (13 males, mean age 65, 17 to 172 months after stroke) were interviewed. There was a large variability (ranging from 0 to 14 days) in frequency of use over the two-week period. Although, thirty-eight percent were non-users, participants seemed satisfied about the option of feedback of the system on people's gait pattern. Moderate to frequent users reported the ability to integrate "Stappy" into daily walking and the presence of support by the social environment as important factors for use. CONCLUSION In a sub sample of stroke patients the ability to receive real-time feedback during practice about walking performance at home was viewed positively. Six participants did not or hardly used the sensor-feedback technology, even though they were positive about potential benefits. This implies that mHealth is not eligible for all individuals. To improve adherence various considerations were derived from this study, that may further optimise the frequency and personalise the use of the technology.IMPLICATIONS FOR REHABILITATIONThe frequency of use of a sensor-feedback technology in gait rehabilitation varied a lot in a cross-sectional sample of people after stroke.Patients after stroke seemed to have a positive attitude towards a sensor-feedback technology to support unsupervised practice of walking. However, this was unrelated to whether they had used or had not used the technology.Moderate and frequent users of the sensor-feedback technology reported the ability to integrate sensor-feedback technology in daily life and social support as important factors for use.For clinical practice in gait rehabilitation it is important to screen which patients are capable to use and may benefit from a technology as the one used in this study.
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Affiliation(s)
- Marianne Nieboer
- Department Health Innovations andTechnology, Fontys University of Applied Sciences, Eindhoven, the Netherlands
| | - Li-Juan Jie
- Research Centre for Nutrition, Lifestyle and Exercise, Zuyd University of Applied Sciences, Heerlen, the Netherlands.,NUTRIM school for Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, the Netherlands.,CAPRHI School for Public Health and Primary Care, Maastricht University, Maastricht, the Netherlands
| | - Lydia Willemse
- Department Health Innovations andTechnology, Fontys University of Applied Sciences, Eindhoven, the Netherlands.,School of Social and Behavioral Sciences, Department of Tranzo, Tilburg University, the Netherlands
| | - Sebastiaan Peek
- School of Social and Behavioral Sciences, Department of Tranzo, Tilburg University, the Netherlands
| | - Susy Braun
- Research Centre for Nutrition, Lifestyle and Exercise, Zuyd University of Applied Sciences, Heerlen, the Netherlands.,CAPRHI School for Public Health and Primary Care, Maastricht University, Maastricht, the Netherlands
| | - Eveline Wouters
- Department Health Innovations andTechnology, Fontys University of Applied Sciences, Eindhoven, the Netherlands.,School of Social and Behavioral Sciences, Department of Tranzo, Tilburg University, the Netherlands
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