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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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Asmussen L, Frey BM, Frontzkowski LK, Wróbel PP, Grigutsch LS, Choe CU, Bönstrup M, Cheng B, Thomalla G, Quandt F, Gerloff C, Schulz R. Dopaminergic mesolimbic structural reserve is positively linked to better outcome after severe stroke. Brain Commun 2024; 6:fcae122. [PMID: 38712322 PMCID: PMC11073754 DOI: 10.1093/braincomms/fcae122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2023] [Revised: 02/26/2024] [Accepted: 04/08/2024] [Indexed: 05/08/2024] Open
Abstract
The concept of brain reserve capacity has emerged in stroke recovery research in recent years. Imaging-based biomarkers of brain health have helped to better understand outcome variability in clinical cohorts. Still, outcome inferences are far from being satisfactory, particularly in patients with severe initial deficits. Neurorehabilitation after stroke is a complex process, comprising adaption and learning processes, which, on their part, are critically influenced by motivational and reward-related cognitive processes. Amongst others, dopaminergic neurotransmission is a key contributor to these mechanisms. The question arises, whether the amount of structural reserve capacity in the dopaminergic system might inform about outcome variability after severe stroke. For this purpose, this study analysed imaging and clinical data of 42 severely impaired acute stroke patients. Brain volumetry was performed within the first 2 weeks after the event using the Computational Anatomy Toolbox CAT12, grey matter volume estimates were collected for seven key areas of the human dopaminergic system along the mesocortical, mesolimbic and nigrostriatal pathways. Ordinal logistic regression models related regional volumes to the functional outcome, operationalized by the modified Rankin Scale, obtained 3-6 months after stroke. Models were adjusted for age, lesion volume and initial impairment. The main finding was that larger volumes of the amygdala and the nucleus accumbens at baseline were positively associated with a more favourable outcome. These data suggest a link between the structural state of mesolimbic key areas contributing to motor learning, motivational and reward-related brain networks and potentially the success of neurorehabilitation. They might also provide novel evidence to reconsider dopaminergic interventions particularly in severely impaired stroke patients to enhance recovery after stroke.
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Affiliation(s)
- Liv Asmussen
- University Medical Center Hamburg-Eppendorf, Department of Neurology, 20246 Hamburg, Germany
| | - Benedikt M Frey
- University Medical Center Hamburg-Eppendorf, Department of Neurology, 20246 Hamburg, Germany
| | - Lukas K Frontzkowski
- University Medical Center Hamburg-Eppendorf, Department of Neurology, 20246 Hamburg, Germany
| | - Paweł P Wróbel
- University Medical Center Hamburg-Eppendorf, Department of Neurology, 20246 Hamburg, Germany
| | - L Sophie Grigutsch
- University Medical Center Hamburg-Eppendorf, Department of Neurology, 20246 Hamburg, Germany
| | - Chi-un Choe
- University Medical Center Hamburg-Eppendorf, Department of Neurology, 20246 Hamburg, Germany
| | - Marlene Bönstrup
- University Medical Center Hamburg-Eppendorf, Department of Neurology, 20246 Hamburg, Germany
- University Medical Center Leipzig, Department of Neurology, 04103 Leipzig, Germany
| | - Bastian Cheng
- University Medical Center Hamburg-Eppendorf, Department of Neurology, 20246 Hamburg, Germany
| | - Götz Thomalla
- University Medical Center Hamburg-Eppendorf, Department of Neurology, 20246 Hamburg, Germany
| | - Fanny Quandt
- University Medical Center Hamburg-Eppendorf, Department of Neurology, 20246 Hamburg, Germany
| | - Christian Gerloff
- University Medical Center Hamburg-Eppendorf, Department of Neurology, 20246 Hamburg, Germany
| | - Robert Schulz
- University Medical Center Hamburg-Eppendorf, Department of Neurology, 20246 Hamburg, Germany
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Gerardin E, Regnier M, Dricot L, Lambert J, van Ravestyn C, De Coene B, Bihin B, Lindberg P, Vandermeeren Y. Dexterity in the Acute Phase of Stroke: Impairments and Neural Substrates. Neurorehabil Neural Repair 2024; 38:229-239. [PMID: 38329006 DOI: 10.1177/15459683241230029] [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] [Indexed: 02/09/2024]
Abstract
BACKGROUND Stroke can impair manual dexterity, leading to loss of independence following incomplete recovery. Enhancing our understanding of dexterity impairment may improve neurorehabilitation. OBJECTIVES The study aimed to measure dexterity components in acute stroke patients with and without hand motor deficits, compare them to those of healthy controls (HC), and to explore the neural substrates involved in specific components of dexterity. METHODS We used the Dextrain Manipulandum to quantify fine finger force control, finger selection accuracy, coactivation, and reaction time (RT). Dexterity was evaluated twice (2 days apart) in 74 patients and 14 HC. Voxel-Lesion-Symptom-Mapping (VLSM) was used to analyze the relationship between tissue damage and dexterity. Results. Due to severe paresis or fatigue, 24 patients could not perform these tasks. In 50 patients (included 4.6 ± 3.3 days post-stroke), finger force control improved (P < .001), as it did in HC (P = .03) who performed better than patients on both evaluations. Accuracy of finger selection did not improve significantly in any group, but the HC performed better on both evaluations. Unexpectedly, coactivation was better in patients than in HC at D3 (P = .03). There were no between-group differences in RT. VLSM showed that damage to the superior temporal gyrus (STG) impaired finger force control while damage to the posterior limb of the internal capsule (PLIC) impaired finger selectivity. CONCLUSIONS Acute stroke affecting the STG or PLIC impaired selective components of dexterity. Patients with mild to moderate impairment showed better finger force control and accuracy selection within 48 hours, suggesting the feasibility of detecting early dexterity improvements.
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Affiliation(s)
- Eloïse Gerardin
- UCLouvain/CHU UCL Namur (Godinne), Neurology Department, Stroke Unit, Yvoir, Belgium
- UClouvain, Louvain Bionics, Louvain-la-Neuve, Belgium
- UCLouvain, Institute of NeuroScience (IoNS), NEUR Division, Brussels, Belgium
| | - Maxime Regnier
- UCLouvain, CHU UCL Namur (Godinne), Scientific Support Unit (USS), Yvoir, Belgium
| | - Laurence Dricot
- UCLouvain, Institute of NeuroScience (IoNS), NEUR Division, Brussels, Belgium
| | - Julien Lambert
- UCLouvain, Institute of NeuroScience (IoNS), COSY Division, Brussels, Belgium
| | - Coralie van Ravestyn
- UCLouvain/CHU UCL Namur (Godinne), Neurology Department, Stroke Unit, Yvoir, Belgium
- UClouvain, Louvain Bionics, Louvain-la-Neuve, Belgium
- UCLouvain, Institute of NeuroScience (IoNS), NEUR Division, Brussels, Belgium
| | - Béatrice De Coene
- UCLouvain/CHU UCL Namur (Godinne), Radiology Department, Yvoir, Belgium
| | - Benoît Bihin
- UCLouvain, CHU UCL Namur (Godinne), Scientific Support Unit (USS), Yvoir, Belgium
| | - Påvel Lindberg
- Université Paris Cité, Institute of Psychiatry and Neuroscience of Paris (IPNP), INSERM U1266, Paris, France
| | - Yves Vandermeeren
- UCLouvain/CHU UCL Namur (Godinne), Neurology Department, Stroke Unit, Yvoir, Belgium
- UClouvain, Louvain Bionics, Louvain-la-Neuve, Belgium
- UCLouvain, Institute of NeuroScience (IoNS), NEUR Division, Brussels, Belgium
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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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Bonuzzi GMG, Bastos FH, Schweighofer N, Wade E, Winstein CJ, Torriani-Pasin C. Moderate-intensity cardiovascular exercise performed before motor practice attenuates offline implicit motor learning in stroke survivors but not age-matched neurotypical adults. Exp Brain Res 2023:10.1007/s00221-023-06659-w. [PMID: 37395857 DOI: 10.1007/s00221-023-06659-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Accepted: 06/26/2023] [Indexed: 07/04/2023]
Abstract
The acute impact of cardiovascular exercise on implicit motor learning of stroke survivors is still unknown. We investigated the effects of cardiovascular exercise on implicit motor learning of mild-moderately impaired chronic stroke survivors and neurotypical adults. We addressed whether exercise priming effects are time-dependent (e.g., exercise before or after practice) in the encoding (acquisition) and recall (retention) phases. Forty-five stroke survivors and 45 age-matched neurotypical adults were randomized into three sub-groups: BEFORE (exercise, then motor practice), AFTER (motor practice, then exercise), and No-EX (motor practice alone). All sub-groups practiced a serial reaction time task (five repeated and two pseudorandom sequences per day) on three consecutive days, followed 7 days later by a retention test (one repeated sequence). Exercise was performed on a stationary bike, (one 20-min bout per day) at 50% to 70% heart rate reserve. Implicit motor learning was measured as a difference score (repeated-pseudorandom sequence response time) during practice (acquisition) and recall (delayed retention). Separate analyses were performed on the stroke and neurotypical groups using linear mixed-effects models (participant ID was a random effect). There was no exercise-induced benefit on implicit motor learning for any sub-group. However, exercise performed before practice impaired encoding in neurotypical adults and attenuated retention performance of stroke survivors. There is no benefit to implicit motor learning of moderately intense cardiovascular exercise for stroke survivors or age-matched neurotypical adults, regardless of timing. Practice under a high arousal state and exercise-induced fatigue may have attenuated offline learning in stroke survivors.
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Affiliation(s)
- Giordano Marcio Gatinho Bonuzzi
- Department of Physical Education, State University of Piauí, Professor Barros Araújo Campus, BR-316, KM 299, Altamira, Picos, Piaui, 64602-000, Brazil.
- Department of Physical Education, Federal University of Vale Do São Francisco, Petrolina, Pernambuco, Brazil.
- School of Physical Education and Sport, University of Sao Paulo, São Paulo, São Paulo, Brazil.
| | - Flavio Henrique Bastos
- School of Physical Education and Sport, University of Sao Paulo, São Paulo, São Paulo, Brazil
| | - Nicolas Schweighofer
- Division of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles, CA, USA
| | - Eric Wade
- Department of Mechanical Engineering, California Polytechnic State University, San Luis Obispo, CA, USA
| | - Carolee Joyce Winstein
- Division of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles, CA, USA
| | - Camila Torriani-Pasin
- School of Physical Education and Sport, University of Sao Paulo, São Paulo, São Paulo, Brazil
- Neurorehabilitation, Exercise Science and Learning (NEUROEXCEL), Department of Physical Therapy and Movement Sciences, The University of Texas at El Paso, El Paso, TX, USA
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Cao N, Pi Y, Qiu F, Wang Y, Xia X, Liu Y, Zhang J. Plasticity changes in dorsolateral prefrontal cortex associated with procedural sequence learning are hemisphere-specific. Neuroimage 2022; 259:119406. [PMID: 35752417 DOI: 10.1016/j.neuroimage.2022.119406] [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: 03/06/2022] [Revised: 05/31/2022] [Accepted: 06/21/2022] [Indexed: 11/19/2022] Open
Abstract
Corticocortical neuroplastic changes from higher-order cortices to primary motor cortex (M1) have been described for procedural sequence learning. The dorsolateral prefrontal cortex (DLPFC) plays critical roles in cognition, including in motor learning and memory. However, neuroplastic changes in the DLPFC and their influence on M1 and on motor learning are not well understood. The present study examined bilateral DLPFC-M1 changes in plasticity induced by procedural motor sequence learning in a serial reaction time task. DLPFC plasticity induced by procedural sequence learning was examined by comparing before vs. after training assessments of ipsilateral/contralateral DLPFC-M1 interactions between sequence order and random order trials performed using either the left or right hand. Intra-hemispheric (inter-stimulus interval [ISI] = 10 ms) and inter-hemispheric (ISI = 10 or 50 ms) DLPFC-M1 interactions and single-pulse motor-evoked potentials (MEPs) were measured with transcranial magnetic stimulation (TMS). The reaction times of participants measured during motor training were faster for sequence learning than for random learning with either hand. Paired-pulse TMS induced DLPFC-M1 interactions that were disinhibited after motor sequence learning, especially for left DLPFC-left M1 interactions with right hand task performance and for left DLPFC-right M1 interactions with left hand task performance. These findings indicate that motor sequence learning induces neuroplastic changes to enhance DLPFC-M1 interactions. This manifestation of plasticity showed hemispheric specificity, favoring the left DLPFC. DLPFC plasticity may be a useful index of DLPFC function and may be a treatment target for enhancing DLPFC function and motor learning.
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Affiliation(s)
- Na Cao
- School of Psychology, Shanghai University of Sport, Shanghai, China; Department of Life Sciences, Graduate School of Arts and Sciences, University of Tokyo, Tokyo, Japan; Japan Society for the Promotion of Science, Tokyo, Japan
| | - Yanling Pi
- Shanghai Punan Hospital of Pudong New District, Shanghai, China
| | - Fanghui Qiu
- School of Physical Education, Qingdao University, Qingdao, China
| | - Yanqiu Wang
- School of Psychology, Shanghai University of Sport, Shanghai, China
| | - Xue Xia
- School of Psychology, Shanghai University of Sport, Shanghai, China
| | - Yu Liu
- School of Kinesiology, Shanghai University of Sport, Shanghai, China
| | - Jian Zhang
- School of Psychology, Shanghai University of Sport, Shanghai, China.
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Hassett J, Carlson H, Babwani A, Kirton A. Bihemispheric developmental alterations in basal ganglia volumes following unilateral perinatal stroke. NEUROIMAGE: CLINICAL 2022; 35:103143. [PMID: 36002972 PMCID: PMC9421529 DOI: 10.1016/j.nicl.2022.103143] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2022] [Revised: 06/25/2022] [Accepted: 08/01/2022] [Indexed: 12/02/2022] Open
Abstract
Basal ganglia segmentation appears reliable in children with perinatal stroke. Alterations from perinatal stroke to basal ganglia development may be bihemispheric. Stroke type may dictate nucleus-specific differences in basal ganglia development. Putamen volume is associated with motor function in children with perinatal stroke.
Introduction Perinatal stroke affects millions of children and results in lifelong disability. Two forms prevail: arterial ischemic stroke (AIS), and periventricular venous infarction (PVI). With such focal damage early in life, neural structures may reorganize during development to determine clinical function, particularly in the contralesional hemisphere. Such processes are increasingly understood in the motor system, however, the role of the basal ganglia, a group of subcortical nuclei that are critical to movement, behaviour, and learning, remain relatively unexplored. Perinatal strokes that directly damage the basal ganglia have been associated with worse motor outcomes, but how developmental plasticity affects bilateral basal ganglia structure is unknown. We hypothesized that children with perinatal stroke have alterations in bilateral basal ganglia volumes, the degree of which correlates with clinical motor function. Methods Children with AIS or PVI, and controls, aged 6–19 years, were recruited from a population-based cohort. MRIs were acquired on a 3 T GE MR750w scanner. High-resolution T1-weighted images (166 slices, 1 mm isotropic voxels) underwent manual segmentations of bilateral caudate and putamen. Extracted volumes were corrected for total intracranial volume. A structure volume ratio quantified hemispheric asymmetry of caudate and putamen (non-dominant/dominant hemisphere structure volume) with ratios closer to 1 reflecting a greater degree of symmetry between structures. Participants were additionally dichotomized by volume ratios into two groups, those with values above the group mean (0.8) and those below. Motor function was assessed using the Assisting Hand Assessment (AHA) and the Box and Blocks test in affected (BBTA) and unaffected (BBTU) hands. Group differences in volumes were explored using Kruskal-Wallis tests, and interhemispheric differences using Wilcoxon. Partial Spearman correlations explored associations between volumes and motor function (factoring out age, and whole-brain white matter volume, a proxy for lesion extent). Results In the dominant (non-lesioned) hemisphere, volumes were larger in AIS compared to PVI for both the caudate (p < 0.05) and putamen (p < 0.01) but comparable between stroke groups and controls. Non-dominant (lesioned) hemisphere volumes were larger for controls than AIS for the putamen (p < 0.05), and for the caudate in PVI (p = 0.001). Interhemispheric differences showed greater dominant hemisphere volumes for the putamen in controls (p < 0.01), for both the caudate (p < 0.01) and putamen (p < 0.001) in AIS, and for the caudate (p = 0.01) in PVI. Motor scores did not differ between AIS and PVI thus groups were combined to increase statistical power. Better motor scores were associated with larger non-dominant putamen volumes (BBTA: r = 0.40, p = 0.011), and larger putamen volume ratios (BBTA: r = 0.52, p < 0.001, AHA: r = 0.43, p < 0.01). For those with relatively symmetrical putamen volume ratios (ratio > group mean of 0.8), age was positively correlated with BBTA (r = 0.54, p < 0.01) and BBTU (r = 0.69, p < 0.001). For those with more asymmetrical putamen volume ratios, associations with motor function and age were not seen (BBTA: r = 0.21, p = 0.40, BBTU: r = 0.37, p = 0.13). Conclusion Specific perinatal stroke lesions affect different elements of basal ganglia development. PVI primarily affected the caudate, while AIS primarily affected the putamen. Putamen volumes in the lesioned hemisphere are associated with clinical motor function. The basal ganglia should be included in evolving models of developmental plasticity after perinatal stroke.
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Affiliation(s)
- Jordan Hassett
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Helen Carlson
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada; Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada; Alberta Children's Hospital Research Institute (ACHRI), Calgary, AB, Canada
| | - Ali Babwani
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Adam Kirton
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada; Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada; Alberta Children's Hospital Research Institute (ACHRI), Calgary, AB, Canada.
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8
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Levin MF, Demers M. Motor learning in neurological rehabilitation. Disabil Rehabil 2021; 43:3445-3453. [PMID: 32320305 DOI: 10.1080/09638288.2020.1752317] [Citation(s) in RCA: 52] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Revised: 03/14/2020] [Accepted: 04/02/2020] [Indexed: 12/27/2022]
Abstract
While most upper limb training interventions in neurological rehabilitation are based on established principles of motor learning and neural plasticity, recovery potential may be improved if the focus includes remediating an individual's specific motor impairment within the framework of a motor control theory. This paper reviews current theories of motor control and motor learning and describes how they can be incorporated into training programs to enhance sensorimotor recovery in patients with neurological lesions. An emphasis is placed on dynamical systems theory and the use of new technologies such as virtual, augmented and mixed reality applications for rehabilitation to facilitate learning.Implications for RehabilitationKinematic abundance allows the healthy nervous system to produce different combinations of joint rotations to perform a desired task.The structure of practice to improve the movement repertoire in rehabilitation should take into account the kinematic abundance of the system.Learning can be enhanced by varied practice with feedback about key movement elements.Virtual reality environments provide opportunities to manipulate the structure and schedule of practice and feedback.
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Affiliation(s)
- Mindy F Levin
- School of Physical and Occupational Therapy, McGill University, Montreal, Canada
- Feil and Oberfeld Research Center, Jewish Rehabilitation Hospital, Center for Interdisciplinary Research in Rehabilitation of Greater Montreal, Montreal, Canada
| | - Marika Demers
- School of Physical and Occupational Therapy, McGill University, Montreal, Canada
- Feil and Oberfeld Research Center, Jewish Rehabilitation Hospital, Center for Interdisciplinary Research in Rehabilitation of Greater Montreal, Montreal, Canada
- USA Division of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles, CA, USA
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9
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Liew SL, Zavaliangos-Petropulu A, Schweighofer N, Jahanshad N, Lang CE, Lohse KR, Banaj N, Barisano G, Baugh LA, Bhattacharya AK, Bigjahan B, Borich MR, Boyd LA, Brodtmann A, Buetefisch CM, Byblow WD, Cassidy JM, Charalambous CC, Ciullo V, Conforto AB, Craddock RC, Dula AN, Egorova N, Feng W, Fercho KA, Gregory CM, Hanlon CA, Hayward KS, Holguin JA, Hordacre B, Hwang DH, Kautz SA, Khlif MS, Kim B, Kim H, Kuceyeski A, Lo B, Liu J, Lin D, Lotze M, MacIntosh BJ, Margetis JL, Mohamed FB, Nordvik JE, Petoe MA, Piras F, Raju S, Ramos-Murguialday A, Revill KP, Roberts P, Robertson AD, Schambra HM, Seo NJ, Shiroishi MS, Soekadar SR, Spalletta G, Stinear CM, Suri A, Tang WK, Thielman GT, Thijs VN, Vecchio D, Ward NS, Westlye LT, Winstein CJ, Wittenberg GF, Wong KA, Yu C, Wolf SL, Cramer SC, Thompson PM. Smaller spared subcortical nuclei are associated with worse post-stroke sensorimotor outcomes in 28 cohorts worldwide. Brain Commun 2021; 3:fcab254. [PMID: 34805997 PMCID: PMC8598999 DOI: 10.1093/braincomms/fcab254] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Revised: 08/06/2021] [Accepted: 09/06/2021] [Indexed: 11/17/2022] Open
Abstract
Up to two-thirds of stroke survivors experience persistent sensorimotor impairments. Recovery relies on the integrity of spared brain areas to compensate for damaged tissue. Deep grey matter structures play a critical role in the control and regulation of sensorimotor circuits. The goal of this work is to identify associations between volumes of spared subcortical nuclei and sensorimotor behaviour at different timepoints after stroke. We pooled high-resolution T1-weighted MRI brain scans and behavioural data in 828 individuals with unilateral stroke from 28 cohorts worldwide. Cross-sectional analyses using linear mixed-effects models related post-stroke sensorimotor behaviour to non-lesioned subcortical volumes (Bonferroni-corrected, P < 0.004). We tested subacute (≤90 days) and chronic (≥180 days) stroke subgroups separately, with exploratory analyses in early stroke (≤21 days) and across all time. Sub-analyses in chronic stroke were also performed based on class of sensorimotor deficits (impairment, activity limitations) and side of lesioned hemisphere. Worse sensorimotor behaviour was associated with a smaller ipsilesional thalamic volume in both early (n = 179; d = 0.68) and subacute (n = 274, d = 0.46) stroke. In chronic stroke (n = 404), worse sensorimotor behaviour was associated with smaller ipsilesional putamen (d = 0.52) and nucleus accumbens (d = 0.39) volumes, and a larger ipsilesional lateral ventricle (d = -0.42). Worse chronic sensorimotor impairment specifically (measured by the Fugl-Meyer Assessment; n = 256) was associated with smaller ipsilesional putamen (d = 0.72) and larger lateral ventricle (d = -0.41) volumes, while several measures of activity limitations (n = 116) showed no significant relationships. In the full cohort across all time (n = 828), sensorimotor behaviour was associated with the volumes of the ipsilesional nucleus accumbens (d = 0.23), putamen (d = 0.33), thalamus (d = 0.33) and lateral ventricle (d = -0.23). We demonstrate significant relationships between post-stroke sensorimotor behaviour and reduced volumes of deep grey matter structures that were spared by stroke, which differ by time and class of sensorimotor measure. These findings provide additional insight into how different cortico-thalamo-striatal circuits support post-stroke sensorimotor outcomes.
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Affiliation(s)
- Sook-Lei Liew
- Chan Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles, CA, USA
- Keck School of Medicine, Mark and Mary Stevens Neuroimaging and Informatics Institute, University of Southern California, Los Angeles, CA, USA
| | - Artemis Zavaliangos-Petropulu
- Neuroscience Graduate Program, University of Southern California, Los Angeles, CA, USA
- Imaging Genetics Center, Mark and Mary Stevens Neuroimaging and Informatics Institute, Keck School of Medicine, University of Southern California, Marina del Rey, CA, USA
| | - Nicolas Schweighofer
- Biokinesiology and Physical Therapy, Ostrow School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Neda Jahanshad
- Imaging Genetics Center, Mark and Mary Stevens Neuroimaging and Informatics Institute, Keck School of Medicine, University of Southern California, Marina del Rey, CA, USA
| | - Catherine E Lang
- Departments of Physical Therapy, Washington University School of Medicine, St. Louis, MO, USA
- Department of Occupational Therapy, Washington University School of Medicine, St. Louis, MO, USA
- Department of Neurology, Washington University School of Medicine, St. Louis, MO, USA
| | - Keith R Lohse
- Department of Health and Kinesiology, University of Utah, Salt Lake City, UT, USA
| | - Nerisa Banaj
- Laboratory of Neuropsychiatry, IRCCS Santa Lucia Foundation, Rome, Italy
| | - Giuseppe Barisano
- Neuroscience Graduate Program, University of Southern California, Los Angeles, CA, USA
- Laboratory of Neuro Imaging, Mark and Mary Stevens Neuroimaging and Informatics Institute, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Lee A Baugh
- Basic Biomedical Sciences, Sanford School of Medicine, University of South Dakota, Vermillion, SD, USA
- Sioux Falls VA Health Care System, Sioux Falls, SD, USA
- Center for Brain and Behavior Research, Vermillion, SD, USA
- Sanford Research, Sioux Falls, SD, USA
| | - Anup K Bhattacharya
- Mallinckrodt Institute of Radiology, Washington University School of Medicine in St. Louis, St. Louis, MO, USA
| | - Bavrina Bigjahan
- Department of Radiology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Michael R Borich
- Department of Rehabilitation Medicine, Emory University, Atlanta, GA, USA
| | - Lara A Boyd
- Department of Physical Therapy & the Djavad Mowafaghian Centre for Brain Health, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Amy Brodtmann
- Florey Institute of Neuroscience and Mental Health, University of Melbourne, Heidelberg, VIC, Australia
- Eastern Cognitive Disorders Clinic, Monash University, Melbourne, VIC, Australia
| | - Cathrin M Buetefisch
- Department of Rehabilitation Medicine, Emory University, Atlanta, GA, USA
- Department of Neurology, School of Medicine, Emory University, Atlanta, GA, USA
- Department of Radiology, Emory University, Atlanta, GA, USA
| | - Winston D Byblow
- Department of Exercise Sciences and Centre for Brain Research, University of Auckland, Auckland, New Zealand
| | - Jessica M Cassidy
- Allied Health Science, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Charalambos C Charalambous
- Department of Basic and Clinical Sciences, University of Nicosia Medical School, Nicosia, Cyprus
- Center for Neuroscience and Integrative Brain Research (CENIBRE), University of Nicosia Medical School, Nicosia, Cyprus
| | - Valentina Ciullo
- Laboratory of Neuropsychiatry, IRCCS Santa Lucia Foundation, Rome, Italy
| | - Adriana B Conforto
- Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil
- Hospital Israelita Albert Einstein, São Paulo, SP, Brazil
| | - Richard C Craddock
- Department of Neurology, Dell Medical School, University of Texas at Austin, Austin, TX, USA
| | - Adrienne N Dula
- Department of Neurology, Dell Medical School, University of Texas at Austin, Austin, TX, USA
| | - Natalia Egorova
- Florey Institute of Neuroscience and Mental Health, University of Melbourne, Heidelberg, VIC, Australia
- Melbourne School of Psychological Sciences, University of Melbourne, Melbourne, VIC, Australia
| | - Wuwei Feng
- Department of Health Sciences & Research, Medical University of South Carolina, Charleston, SC, USA
| | - Kelene A Fercho
- Civil Aerospace Medical Institute, US Federal Aviation Administration, Oklahoma City, OK, USA
- Division of Basic Biomedical Sciences, Sanford School of Medicine, University of South Dakota, Vermillion, SD, USA
| | - Chris M Gregory
- Department of Health Sciences & Research, Medical University of South Carolina, Charleston, SC, USA
| | - Colleen A Hanlon
- Cancer Biology, Wake Forest School of Medicine, Winston Salem, NC, USA
- College of Health Professions, Medical University of South Carolina, Charleston, SC, USA
| | - Kathryn S Hayward
- Florey Institute of Neuroscience and Mental Health, University of Melbourne, Heidelberg, VIC, Australia
- Department of Physiotherapy, University of Melbourne, Heidelberg, VIC, Australia
- NHMRC CRE in Stroke Rehabilitation and Brain Recovery, University of Melbourne, Heidelberg, VIC, Australia
| | - Jess A Holguin
- Chan Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles, CA, USA
| | - Brenton Hordacre
- Innovation, IMPlementation and Clinical Translation (IIMPACT) in Health, Allied Health and Human Performance, University of South Australia, Adelaide, SA, Australia
| | - Darryl H Hwang
- Department of Radiology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
- Department of Biomedical Engineering, Viterbi School of Engineering, University of Southern California, Los Angeles, CA, USA
| | - Steven A Kautz
- Department of Health Sciences & Research, Medical University of South Carolina, Charleston, SC, USA
- Ralph H. Johnson VA Medical Center, Charleston, SC, USA
| | - Mohamed Salah Khlif
- Florey Institute of Neuroscience and Mental Health, University of Melbourne, Heidelberg, VIC, Australia
| | - Bokkyu Kim
- Department of Physical Therapy Education, College of Health Professions, SUNY Upstate Medical University, Syracuse, NY, USA
| | - Hosung Kim
- Keck School of Medicine, Mark and Mary Stevens Neuroimaging and Informatics Institute, University of Southern California, Los Angeles, CA, USA
| | - Amy Kuceyeski
- Department of Radiology, Weill Cornell Medicine, New York, NY, USA
| | - Bethany Lo
- Chan Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles, CA, USA
| | - Jingchun Liu
- Department of Radiology, Tianjin Medical University General Hospital, Tianjin, China
| | - David Lin
- Center for Neurotechnology and Neurorecovery, Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
| | - Martin Lotze
- Department of Diagnostic Radiology, University Medicine Greifswald, Greifswald, Germany
| | - Bradley J MacIntosh
- Hurvitz Brain Sciences, Sunnybrook Research Institute, Toronto, ON, Canada
- Department of Medical Biophysics, University of Toronto, Toronto, ON, Canada
| | - John L Margetis
- Chan Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles, CA, USA
| | - Feroze B Mohamed
- Jefferson Integrated Magnetic Resonance Imaging Center, Department of Radiology, Thomas Jefferson University, Philadelphia, PA, USA
| | | | - Matthew A Petoe
- Bionics Institute, Melbourne, VIC, Australia
- Department of Medicine and Centre for Brain Research, University of Auckland, Auckland, New Zealand
| | - Fabrizio Piras
- Laboratory of Neuropsychiatry, IRCCS Santa Lucia Foundation, Rome, Italy
| | - Sharmila Raju
- Department of Neurology, New York University Langone, New York, NY, USA
| | - Ander Ramos-Murguialday
- TECNALIA, Basque Research and Technology Alliance (BRTA), Health Division, San Sebastian Donostia, Spain
- Institute of Medical Psychology and Behavioral Neurobiology, University of Tübingen, Tübingen, Germany
| | - Kate P Revill
- Facility for Education and Research in Neuroscience, Emory University, Atlanta, GA, USA
| | - Pamela Roberts
- Chan Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles, CA, USA
- Department of Physical Medicine and Rehabilitation, Cedars-Sinai, Los Angeles, CA, USA
- California Rehabilitation Institute, Los Angeles, CA, USA
| | - Andrew D Robertson
- Canadian Partnership for Stroke Recovery, Sunnybrook Research Institute, University of Toronto, Toronto, ON, Canada
- Department of Kinesiology, University of Waterloo, Waterloo, ON, Canada
| | - Heidi M Schambra
- Department of Neurology, New York University Langone, New York, NY, USA
| | - Na Jin Seo
- Department of Health Sciences & Research, Medical University of South Carolina, Charleston, SC, USA
- Ralph H. Johnson VA Medical Center, Charleston, SC, USA
- Department of Rehabilitation Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - Mark S Shiroishi
- Imaging Genetics Center, Mark and Mary Stevens Neuroimaging and Informatics Institute, Keck School of Medicine, University of Southern California, Marina del Rey, CA, USA
- Department of Radiology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Surjo R Soekadar
- Clinical Neurotechnology Laboratory, Department of Psychiatry and Psychotherapy, Charité - University Medicine Berlin, Berlin, Germany
| | - Gianfranco Spalletta
- Laboratory of Neuropsychiatry, IRCCS Santa Lucia Foundation, Rome, Italy
- Division of Neuropsychiatry, Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
| | - Cathy M Stinear
- Department of Medicine, University of Auckland, Auckland, New Zealand
| | - Anisha Suri
- Department of Electrical and Computer Engineering, Swanson School of Engineering, University of Pittsburgh, Pittsburgh, PA, USA
| | - Wai Kwong Tang
- Department of Psychiatry, Faculty of Medicine, the Chinese University of Hong Kong, Hong Kong, China
| | - Gregory T Thielman
- Department of Physical Therapy and Neuroscience, University of the Sciences, Philadelphia, PA, USA
| | - Vincent N Thijs
- Florey Institute of Neuroscience and Mental Health, University of Melbourne, Heidelberg, VIC, Australia
- Department of Neurology, Austin Health, Heidelberg, VIC, Australia
| | - Daniela Vecchio
- Laboratory of Neuropsychiatry, IRCCS Santa Lucia Foundation, Rome, Italy
| | - Nick S Ward
- UCL Queen Square Institute of Neurology, London, UK
| | - Lars T Westlye
- Department of Psychology, University of Oslo, Oslo, Norway
- NORMENT, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - Carolee J Winstein
- Biokinesiology and Physical Therapy, Ostrow School of Medicine, University of Southern California, Los Angeles, CA, USA
- Department of Neurology, University of California, Los Angeles, Los Angeles, CA, USA
| | - George F Wittenberg
- Department of Neurology, University of Pittsburgh, Pittsburgh, PA, USA
- Neurology, Department of Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, PA, USA
| | - Kristin A Wong
- Department of Physical Medicine & Rehabilitation, Dell Medical School, University of Texas at Austin, Austin, TX, USA
| | - Chunshui Yu
- Department of Radiology, Tianjin Medical University General Hospital, Tianjin, China
- Tianjin Key Laboratory of Functional Imaging, Tianjin Medical University General Hospital, Tianjin, China
| | - Steven L Wolf
- Division of Physical Therapy Education, Department of Rehabilitation Medicine, Emory University School of Medicine, Atlanta, GA, USA
- Division of Physical Therapy Education, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
- Division of Physical Therapy Education, Department of Cell Biology, Emory University School of Medicine, Atlanta, GA, USA
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA, USA
- Center for Visual and Neurocognitive Rehabilitation, Atlanta VA Health Care System, Decatur, GA, USA
| | - Steven C Cramer
- California Rehabilitation Institute, Los Angeles, CA, USA
- Department of Neurology, University of California, Los Angeles, Los Angeles, CA, USA
| | - Paul M Thompson
- Imaging Genetics Center, Mark and Mary Stevens Neuroimaging and Informatics Institute, Keck School of Medicine, University of Southern California, Marina del Rey, CA, USA
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10
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Clark B, Whitall J, Kwakkel G, Mehrholz J, Ewings S, Burridge J. The effect of time spent in rehabilitation on activity limitation and impairment after stroke. Cochrane Database Syst Rev 2021; 10:CD012612. [PMID: 34695300 PMCID: PMC8545241 DOI: 10.1002/14651858.cd012612.pub2] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
BACKGROUND Stroke affects millions of people every year and is a leading cause of disability, resulting in significant financial cost and reduction in quality of life. Rehabilitation after stroke aims to reduce disability by facilitating recovery of impairment, activity, or participation. One aspect of stroke rehabilitation that may affect outcomes is the amount of time spent in rehabilitation, including minutes provided, frequency (i.e. days per week of rehabilitation), and duration (i.e. time period over which rehabilitation is provided). Effect of time spent in rehabilitation after stroke has been explored extensively in the literature, but findings are inconsistent. Previous systematic reviews with meta-analyses have included studies that differ not only in the amount provided, but also type of rehabilitation. OBJECTIVES To assess the effect of 1. more time spent in the same type of rehabilitation on activity measures in people with stroke; 2. difference in total rehabilitation time (in minutes) on recovery of activity in people with stroke; and 3. rehabilitation schedule on activity in terms of: a. average time (minutes) per week undergoing rehabilitation, b. frequency (number of sessions per week) of rehabilitation, and c. total duration of rehabilitation. SEARCH METHODS We searched the Cochrane Stroke Group trials register, CENTRAL, MEDLINE, Embase, eight other databases, and five trials registers to June 2021. We searched reference lists of identified studies, contacted key authors, and undertook reference searching using Web of Science Cited Reference Search. SELECTION CRITERIA We included randomised controlled trials (RCTs) of adults with stroke that compared different amounts of time spent, greater than zero, in rehabilitation (any non-pharmacological, non-surgical intervention aimed to improve activity after stroke). Studies varied only in the amount of time in rehabilitation between experimental and control conditions. Primary outcome was activities of daily living (ADLs); secondary outcomes were activity measures of upper and lower limbs, motor impairment measures of upper and lower limbs, and serious adverse events (SAE)/death. DATA COLLECTION AND ANALYSIS Two review authors independently screened studies, extracted data, assessed methodological quality using the Cochrane RoB 2 tool, and assessed certainty of the evidence using GRADE. For continuous outcomes using different scales, we calculated pooled standardised mean difference (SMDs) and 95% confidence intervals (CIs). We expressed dichotomous outcomes as risk ratios (RR) with 95% CIs. MAIN RESULTS The quantitative synthesis of this review comprised 21 parallel RCTs, involving analysed data from 1412 participants. Time in rehabilitation varied between studies. Minutes provided per week were 90 to 1288. Days per week of rehabilitation were three to seven. Duration of rehabilitation was two weeks to six months. Thirteen studies provided upper limb rehabilitation, five general rehabilitation, two mobilisation training, and one lower limb training. Sixteen studies examined participants in the first six months following stroke; the remaining five included participants more than six months poststroke. Comparison of stroke severity or level of impairment was limited due to variations in measurement. The risk of bias assessment suggests there were issues with the methodological quality of the included studies. There were 76 outcome-level risk of bias assessments: 15 low risk, 37 some concerns, and 24 high risk. When comparing groups that spent more time versus less time in rehabilitation immediately after intervention, we found no difference in rehabilitation for ADL outcomes (SMD 0.13, 95% CI -0.02 to 0.28; P = 0.09; I2 = 7%; 14 studies, 864 participants; very low-certainty evidence), activity measures of the upper limb (SMD 0.09, 95% CI -0.11 to 0.29; P = 0.36; I2 = 0%; 12 studies, 426 participants; very low-certainty evidence), and activity measures of the lower limb (SMD 0.25, 95% CI -0.03 to 0.53; P = 0.08; I2 = 48%; 5 studies, 425 participants; very low-certainty evidence). We found an effect in favour of more time in rehabilitation for motor impairment measures of the upper limb (SMD 0.32, 95% CI 0.06 to 0.58; P = 0.01; I2 = 10%; 9 studies, 287 participants; low-certainty evidence) and of the lower limb (SMD 0.71, 95% CI 0.15 to 1.28; P = 0.01; 1 study, 51 participants; very low-certainty evidence). There were no intervention-related SAEs. More time in rehabilitation did not affect the risk of SAEs/death (RR 1.20, 95% CI 0.51 to 2.85; P = 0.68; I2 = 0%; 2 studies, 379 participants; low-certainty evidence), but few studies measured these outcomes. Predefined subgroup analyses comparing studies with a larger difference of total time spent in rehabilitation between intervention groups to studies with a smaller difference found greater improvements for studies with a larger difference. This was statistically significant for ADL outcomes (P = 0.02) and activity measures of the upper limb (P = 0.04), but not for activity measures of the lower limb (P = 0.41) or motor impairment measures of the upper limb (P = 0.06). AUTHORS' CONCLUSIONS An increase in time spent in the same type of rehabilitation after stroke results in little to no difference in meaningful activities such as activities of daily living and activities of the upper and lower limb but a small benefit in measures of motor impairment (low- to very low-certainty evidence for all findings). If the increase in time spent in rehabilitation exceeds a threshold, this may lead to improved outcomes. There is currently insufficient evidence to recommend a minimum beneficial daily amount in clinical practice. The findings of this study are limited by a lack of studies with a significant contrast in amount of additional rehabilitation provided between control and intervention groups. Large, well-designed, high-quality RCTs that measure time spent in all rehabilitation activities (not just interventional) and provide a large contrast (minimum of 1000 minutes) in amount of rehabilitation between groups would provide further evidence for effect of time spent in rehabilitation.
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Affiliation(s)
- Beth Clark
- School of Health Sciences, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, UK
| | - Jill Whitall
- Department of Physical Therapy and Rehabilitation Science, University of Maryland, Baltimore, Maryland, USA
| | - Gert Kwakkel
- Department of Rehabilitation Medicine, Amsterdam Movement Sciences and Amsterdam, Amsterdam Neurosciences, VU University Medical Center, Amsterdam, Netherlands
| | - Jan Mehrholz
- Department of Public Health, Dresden Medical School, Technical University Dresden, Dresden, Germany
| | - Sean Ewings
- Southampton Statistical Sciences Research Institute, University of Southampton, Southampton, UK
| | - Jane Burridge
- Research Group, Faculty of Health Sciences, University of Southampton, Southampton, UK
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11
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Critically appraised paper: Implicit motor learning is not superior to explicit motor learning for improving gait speed in chronic stroke [commentary]. J Physiother 2021; 67:311. [PMID: 34535414 DOI: 10.1016/j.jphys.2021.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Accepted: 09/03/2021] [Indexed: 11/21/2022] Open
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12
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Abstract
Compared to blocked practice, interleaved practice of different tasks leads to superior long-term retention despite poorer initial acquisition performance. This phenomenon, the contextual interference effect, is well documented in various domains but it is not yet clear if it persists in the absence of explicit knowledge in terms of fine motor sequence learning. Additionally, while there is some evidence that interleaved practice leads to improved transfer of learning to similar actions, transfer of implicit motor sequence learning has not been explored. The present studies used a serial reaction time task where participants practiced three different eight-item sequences that were either interleaved or blocked on Day 1 (training) and Day 2 (testing). In Experiment 1, the retention of the three training sequences was tested on Day 2 and in Experiment 2, three novel sequences were performed on Day 2 to measure transfer. We assessed whether subjects were aware of the sequences to determine whether the benefit of interleaved practice extends to implicitly learned sequences. Even for participants who reported no awareness of the sequences, interleaving led to a benefit for both retention and transfer compared to participants who practiced blocked sequences. Those who trained with blocked sequences were left unprepared for interleaved sequences at test, while those who trained with interleaved sequences were unaffected by testing condition, revealing that learning resulting from blocked practice may be less flexible and more vulnerable to testing conditions. These results indicate that the benefit of interleaved practice extends to implicit motor sequence learning and transfer.
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Affiliation(s)
- Julia M Schorn
- Department of Psychology, University of California, Los Angeles, Los Angeles, CA, 90095, USA.
| | - Barbara J Knowlton
- Department of Psychology, University of California, Los Angeles, Los Angeles, CA, 90095, USA
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13
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Dias da Silva MR, Postma M. Straying Off Course: The Negative Impact of Mind Wandering on Fine Motor Movements. J Mot Behav 2021; 54:186-202. [PMID: 34346297 DOI: 10.1080/00222895.2021.1937032] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
The goal of this study was to examine how various degrees of perceptual decoupling during mind wandering affect fine motor control. We hypothesized that while under normal circumstances attention ensures an optimal control strategy that leads to accurate motor performance, during mind wandering the process becomes disrupted. In this study, we conducted a computer-based experiment with a tracking task. During mind wandering, motor movements were more erratic and less variable, indicative of reduced attentiveness to the continuous demands of the external task. Importantly, the deeper the reported mind wandering, the less accurate and less variable were the mouse movements, suggesting that perceptual decoupling may take place in a graded rather than in an all or nothing manner. Greater movement intermittency was associated with higher tracking accuracy, suggesting that more corrective movements toward a moving target were functional to task performance. Moreover, greater variance in velocity was negatively correlated with tracking accuracy. These findings suggest that periods of inattention to the task have a negative impact on fine motor movement control by making behavior unpredictable, providing support for the idea that there is a decoupling of sensory-motor processes during mind wandering.
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Affiliation(s)
| | - Marie Postma
- Cognitive Science and Artificial Intelligence Department, Tilburg University, Tilburg, The Netherlands
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14
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Russo C, Veronelli L, Casati C, Monti A, Perucca L, Ferraro F, Corbo M, Vallar G, Bolognini N. Explicit motor sequence learning after stroke: a neuropsychological study. Exp Brain Res 2021; 239:2303-2316. [PMID: 34091696 PMCID: PMC8282572 DOI: 10.1007/s00221-021-06141-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Accepted: 05/23/2021] [Indexed: 11/30/2022]
Abstract
Motor learning interacts with and shapes experience-dependent cerebral plasticity. In stroke patients with paresis of the upper limb, motor recovery was proposed to reflect a process of re-learning the lost/impaired skill, which interacts with rehabilitation. However, to what extent stroke patients with hemiparesis may retain the ability of learning with their affected limb remains an unsolved issue, that was addressed by this study. Nineteen patients, with a cerebrovascular lesion affecting the right or the left hemisphere, underwent an explicit motor learning task (finger tapping task, FTT), which was performed with the paretic hand. Eighteen age-matched healthy participants served as controls. Motor performance was assessed during the learning phase (i.e., online learning), as well as immediately at the end of practice, and after 90 min and 24 h (i.e., retention). Results show that overall, as compared to the control group, stroke patients, regardless of the side (left/right) of the hemispheric lesion, do not show a reliable practice-dependent improvement; consequently, no retention could be detected in the long-term (after 90 min and 24 h). The motor learning impairment was associated with subcortical damage, predominantly affecting the basal ganglia; conversely, it was not associated with age, time elapsed from stroke, severity of upper-limb motor and sensory deficits, and the general neurological condition. This evidence expands our understanding regarding the potential of post-stroke motor recovery through motor practice, suggesting a potential key role of basal ganglia, not only in implicit motor learning as previously pointed out, but also in explicit finger tapping motor tasks.
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Affiliation(s)
- Cristina Russo
- Department of Psychology and Milan Center for Neuroscience-NeuroMi, University of Milano-Bicocca, Milan, Italy.
| | - Laura Veronelli
- Department of Neurorehabilitation Sciences, Casa di Cura Policlinico, Milan, Italy
| | - Carlotta Casati
- Laboratory of Neuropsychology, IRCCS Istituto Auxologico Italiano, Milan, Italy.,Department of Neurorehabilitation Sciences, IRCCS Istituto Auxologico Italiano, Milan, Italy
| | - Alessia Monti
- Department of Neurorehabilitation Sciences, Casa di Cura Policlinico, Milan, Italy
| | - Laura Perucca
- Department of Neurorehabilitation Sciences, IRCCS Istituto Auxologico Italiano, Milan, Italy.,Department of Biomedical Sciences for Health, Università Degli Studi di Milano, Milan, Italy
| | - Francesco Ferraro
- Riabilitazione Specialistica Neuromotoria - Dipartimento di Neuroscienze, ASST "Carlo Poma" di Mantova - Presidio di Riabilitazione Multifunzionale di Bozzolo, Mantua, Italy
| | - Massimo Corbo
- Department of Neurorehabilitation Sciences, Casa di Cura Policlinico, Milan, Italy
| | - Giuseppe Vallar
- Department of Psychology and Milan Center for Neuroscience-NeuroMi, University of Milano-Bicocca, Milan, Italy.,Laboratory of Neuropsychology, IRCCS Istituto Auxologico Italiano, Milan, Italy
| | - Nadia Bolognini
- Department of Psychology and Milan Center for Neuroscience-NeuroMi, University of Milano-Bicocca, Milan, Italy.,Laboratory of Neuropsychology, IRCCS Istituto Auxologico Italiano, Milan, Italy
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15
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Gregor S, Saumur TM, Crosby LD, Powers J, Patterson KK. Study Paradigms and Principles Investigated in Motor Learning Research After Stroke: A Scoping Review. Arch Rehabil Res Clin Transl 2021; 3:100111. [PMID: 34179749 PMCID: PMC8211998 DOI: 10.1016/j.arrct.2021.100111] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVES To (1) characterize study paradigms used to investigate motor learning (ML) poststroke and (2) summarize the effects of different ML principles in promoting skill acquisition and retention. Our secondary objective is to evaluate the clinical utility of ML principles on stroke rehabilitation. DATA SOURCES Medline, Excerpta Medica Database, Allied and Complementary Medicine, Cumulative Index to Nursing and Allied Health Literature, and Cochrane Central Register of Controlled Trials were searched from inception on October 24, 2018 and repeated on June 23, 2020. Scopus was searched on January 24, 2019 and July 22, 2020 to identify additional studies. STUDY SELECTION Our search included keywords and concepts to represent stroke and "motor learning. An iterative process was used to generate study selection criteria. Three authors independently completed title, abstract, and full-text screening. DATA EXTRACTION Three reviewers independently completed data extraction. DATA SYNTHESIS The Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension guidelines for scoping reviews were used to guide our synthesis. Thirty-nine studies were included. Study designs were heterogeneous, including variability in tasks practiced, acquisition parameters, and retention intervals. ML principles investigated included practice complexity, feedback, motor imagery, mental practice, action observation, implicit and explicit information, aerobic exercise, and neurostimulation. An additional 2 patient-related factors that influence ML were included: stroke characteristics and sleep. Practice complexity, feedback, and mental practice/action observation most consistently promoted ML, while provision of explicit information and more severe strokes were detrimental to ML. Other factors (ie, sleep, practice structure, aerobic exercise, neurostimulation) had a less clear influence on learning. CONCLUSIONS Improved consistency of reporting in ML studies is needed to improve study comparability and facilitate meta-analyses to better understand the influence of ML principles on learning poststroke. Knowledge of ML principles and patient-related factors that influence ML, with clinical judgment can guide neurologic rehabilitation delivery to improve patient motor outcomes.
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Affiliation(s)
- Sarah Gregor
- KITE, Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario
- Rehabilitation Sciences Institute, University of Toronto, Toronto, Ontario
| | - Tyler M. Saumur
- KITE, Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario
- Rehabilitation Sciences Institute, University of Toronto, Toronto, Ontario
| | - Lucas D. Crosby
- KITE, Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario
- Rehabilitation Sciences Institute, University of Toronto, Toronto, Ontario
| | - Jessica Powers
- KITE, Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario
- Rehabilitation Sciences Institute, University of Toronto, Toronto, Ontario
| | - Kara K. Patterson
- KITE, Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario
- Rehabilitation Sciences Institute, University of Toronto, Toronto, Ontario
- Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada
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16
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Sombric CJ, Torres-Oviedo G. Cognitive and Motor Perseveration Are Associated in Older Adults. Front Aging Neurosci 2021; 13:610359. [PMID: 33986654 PMCID: PMC8110726 DOI: 10.3389/fnagi.2021.610359] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Accepted: 03/22/2021] [Indexed: 11/13/2022] Open
Abstract
Aging causes perseveration (difficulty to switch between actions) in motor and cognitive tasks, suggesting that the same neural processes could govern these abilities in older adults. To test this, we evaluated the relation between independently measured motor and cognitive perseveration in young (21.4 ± 3.7 y/o) and older participants (76.5 ± 2.9 y/o). Motor perseveration was measured with a locomotor task in which participants had to transition between distinct walking patterns. Cognitive perseveration was measured with a card matching task in which participants had to switch between distinct matching rules. We found that perseveration in the cognitive and motor domains were positively related in older, but not younger individuals, such that participants exhibiting greater perseveration in the motor task also perseverated more in the cognitive task. Additionally, exposure reduces motor perseveration: older adults who had practiced the motor task could transition between walking patterns as proficiently as naïve, young individuals. Our results suggest an overlap in neural processes governing cognitive and motor perseveration with aging and that exposure can counteract the age-related motor perseveration.
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Affiliation(s)
| | - Gelsy Torres-Oviedo
- Sensorimotor Learning Laboratory, Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, United States
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Moliterno AH, Bezerra FV, Pires LA, Roncolato SS, da Silva TD, Massetti T, Fernani DCGL, Magalhães FH, de Mello Monteiro CB, Dantas MTAP. Effect of Contextual Interference in the Practicing of a Computer Task in Individuals Poststroke. BIOMED RESEARCH INTERNATIONAL 2020; 2020:2937285. [PMID: 32775414 PMCID: PMC7396124 DOI: 10.1155/2020/2937285] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Accepted: 07/07/2020] [Indexed: 11/17/2022]
Abstract
OBJECTIVES Sensory and motor alterations resulting from stroke often impair the performance and learning of motor skills. The present study is aimed at investigating whether and how poststroke individuals and age- and sex-matched healthy controls benefit from a contextual interference effect on the practice of a maze task (i.e., constant vs. random practice) performed on the computer. METHODS Participants included 21 poststroke individuals and 21 healthy controls, matched by sex and age (30 to 80 years). Both groups were divided according to the type of the practice (constant or random) presented in the acquisition phase of the learning protocol. For comparison between the groups, types of practice, and blocks of attempts, the analysis of variance with Tukey's post hoc test (p < 0.05) was used. RESULTS Poststroke individuals presented longer movement times as compared with the control group. In addition, only poststroke individuals who performed the task with random practice showed improved performance at the transfer phase. Moreover, randomized practice enabled poststroke individuals to perform the transfer task similarly to individuals without any neurological impairment. CONCLUSION The present findings indicated a significant effect of contextual interference of practice in poststroke individuals, suggesting that applying randomized training must be considered when designing rehabilitation protocols for this population.
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Affiliation(s)
- Alice Haniuda Moliterno
- University of West Paulista-UNOESTE-Presidente Prudente, SP, Brazil
- São Paulo State University (Unesp) "Júlio de Mesquita Filho"-Presidente Prudente, SP, Brazil
| | - Fernanda Vieira Bezerra
- University of West Paulista-UNOESTE-Presidente Prudente, SP, Brazil
- São Paulo State University (Unesp) "Júlio de Mesquita Filho"-Presidente Prudente, SP, Brazil
| | | | | | - Talita Dias da Silva
- Grupo de Pesquisa em Aplicações Tecnológicas em Reabilitação School of Arts, Sciences and Humanities-EACH-University of São Paulo, São Paulo, SP, Brazil
| | - Thais Massetti
- Grupo de Pesquisa em Aplicações Tecnológicas em Reabilitação School of Arts, Sciences and Humanities-EACH-University of São Paulo, São Paulo, SP, Brazil
| | - Deborah Cristina Gonçalves Luiz Fernani
- University of West Paulista-UNOESTE-Presidente Prudente, SP, Brazil
- Grupo de Pesquisa em Aplicações Tecnológicas em Reabilitação School of Arts, Sciences and Humanities-EACH-University of São Paulo, São Paulo, SP, Brazil
- Laboratory Design and Scientific Writing. Department of Basic Sciences, ABC Faculty of Medicine-Santo André, SP, Brazil
| | - Fernando Henrique Magalhães
- Grupo de Pesquisa em Aplicações Tecnológicas em Reabilitação School of Arts, Sciences and Humanities-EACH-University of São Paulo, São Paulo, SP, Brazil
| | - Carlos Bandeira de Mello Monteiro
- Grupo de Pesquisa em Aplicações Tecnológicas em Reabilitação School of Arts, Sciences and Humanities-EACH-University of São Paulo, São Paulo, SP, Brazil
- Laboratory Design and Scientific Writing. Department of Basic Sciences, ABC Faculty of Medicine-Santo André, SP, Brazil
| | - Maria Tereza Artero Prado Dantas
- University of West Paulista-UNOESTE-Presidente Prudente, SP, Brazil
- Grupo de Pesquisa em Aplicações Tecnológicas em Reabilitação School of Arts, Sciences and Humanities-EACH-University of São Paulo, São Paulo, SP, Brazil
- Laboratory Design and Scientific Writing. Department of Basic Sciences, ABC Faculty of Medicine-Santo André, SP, Brazil
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Miyamoto YR, Wang S, Smith MA. Implicit adaptation compensates for erratic explicit strategy in human motor learning. Nat Neurosci 2020; 23:443-455. [PMID: 32112061 DOI: 10.1038/s41593-020-0600-3] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2017] [Accepted: 01/28/2020] [Indexed: 11/09/2022]
Abstract
Sports are replete with strategies, yet coaching lore often emphasizes 'quieting the mind', 'trusting the body' and 'avoiding overthinking' in referring to the importance of relying less on high-level explicit strategies in favor of low-level implicit motor learning. We investigated the interactions between explicit strategy and implicit motor adaptation by designing a sensorimotor learning paradigm that drives adaptive changes in some dimensions but not others. We find that strategy and implicit adaptation synergize in driven dimensions, but effectively cancel each other in undriven dimensions. Independent analyses-based on time lags, the correlational structure in the data and computational modeling-demonstrate that this cancellation occurs because implicit adaptation effectively compensates for noise in explicit strategy rather than the converse, acting to clean up the motor noise resulting from low-fidelity explicit strategy during motor learning. These results provide new insight into why implicit learning increasingly takes over from explicit strategy as skill learning proceeds.
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Affiliation(s)
- Yohsuke R Miyamoto
- John A. Paulson School of Engineering and Applied Sciences, Harvard University, Cambridge, MA, USA
| | - Shengxin Wang
- Department of Mechatronics Engineering, Harbin Institute of Technology, Harbin, China
| | - Maurice A Smith
- John A. Paulson School of Engineering and Applied Sciences, Harvard University, Cambridge, MA, USA. .,Center for Brain Science, Harvard University, Cambridge, MA, USA.
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Dahms C, Brodoehl S, Witte OW, Klingner CM. The importance of different learning stages for motor sequence learning after stroke. Hum Brain Mapp 2020; 41:270-286. [PMID: 31520506 PMCID: PMC7268039 DOI: 10.1002/hbm.24793] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Revised: 07/31/2019] [Accepted: 09/02/2019] [Indexed: 11/12/2022] Open
Abstract
The task of learning predefined sequences of interrelated motor actions is of everyday importance and has also strong clinical importance for regaining motor function after brain lesions. A solid understanding of sequence learning in stroke patients can help clinicians to optimize and individualize rehabilitation strategies. Moreover, to investigate the impact of a focal lesion on the ability to successfully perform motor sequence learning can enhance our comprehension of the underlying physiological principles of motor sequence learning. In this article, we will first provide an overview of current concepts related to motor sequence learning in healthy subjects with focus on the involved brain areas and their assumed functions according to the temporal stage model. Subsequently, we will consider the question of what we can learn from studies investigating motor sequence learning in stroke patients. We will first focus on the implications of lesion location. Then, we will analyze whether distinct lesion locations affect specific learning stages. Finally, we will discuss the implications for clinical rehabilitation and suggest directions for further research.
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Affiliation(s)
- Christiane Dahms
- Hans Berger Department of NeurologyJena University HospitalJenaGermany
| | - Stefan Brodoehl
- Hans Berger Department of NeurologyJena University HospitalJenaGermany
- Biomagnetic CenterJena University HospitalJenaGermany
| | - Otto W. Witte
- Hans Berger Department of NeurologyJena University HospitalJenaGermany
| | - Carsten M. Klingner
- Hans Berger Department of NeurologyJena University HospitalJenaGermany
- Biomagnetic CenterJena University HospitalJenaGermany
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20
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Johnson L, Burridge J, Demain S, Ewings S. Comparing the Impact of an Implicit Learning Approach With Standard Care on Recovery of Mobility Following Stroke: Protocol for a Pilot Cluster Randomized Controlled Trial. JMIR Res Protoc 2019; 8:e14222. [PMID: 31687935 PMCID: PMC6864481 DOI: 10.2196/14222] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Revised: 06/17/2019] [Accepted: 07/16/2019] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Although implicit and explicit learning approaches have been well investigated in healthy populations, there is less evidence regarding the relative benefits of each approach in clinical practice. Studies in stroke typically investigate single elements of an implicit learning approach (ILA; eg, reduced quantity feedback or an external focus of attention) within controlled environments. These studies predominantly evaluate performance, with few measuring this over time (ie, learning). The relevance and transferability of current research evidence into stroke rehabilitation is therefore limited. OBJECTIVE The objective of this study was to compare the ILA with standard care in the acute phase following stroke, to generate data and insights to inform the design of a definitive trial, and to understand patient and therapist perceptions of the ILA. METHODS This is a multicenter, assessor-blind, cluster randomized controlled pilot trial with nested qualitative evaluation. Stroke units (clusters) will be randomized to either ILA (intervention) or standard care (control) arms. Therapy teams at the intervention sites will be trained in the ILA and provided with an intervention manual. Those at the control sites will have minimal input from the research team, other than for data collection. Consent will be provided at the individual participant level. Once enrolled, participants will receive rehabilitation that focuses on lower limb recovery, using the designated approach. Measures will be taken at baseline, every 2 weeks until the point of discharge from hospital, and at 3 months post stroke onset. Measures include the Fugl Meyer Assessment (motor leg subsection), modified Rivermead Mobility Index, Swedish Postural Adjustment in Stroke Scale, and achievement of mobility milestones. Fidelity of the treatment approach will be monitored using observational video analysis. Focus groups and interviews will be used to gain insight into the perceptions of trial participants and clinical teams. RESULTS The first site opened to recruitment in February 2019. The opening of a further 5 sites will be staggered throughout 2019. Results are expected in early 2021. CONCLUSIONS The findings from this mixed methods pilot study will be used to inform the design of a definitive study, comparing the ILA with standard care in acute stroke rehabilitation. TRIAL REGISTRATION ClinicalTrials.gov NCT03792126; https://clinicaltrials.gov/ct2/show/NCT03792126. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/14222.
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Affiliation(s)
- Louise Johnson
- Stroke Unit, Royal Bournemouth and Christchurch Hospitals NHS Foundation Trust, Bournemouth, United Kingdom
| | - Jane Burridge
- University of Southampton, Southampton, United Kingdom
| | - Sara Demain
- University of Plymouth, Plymouth, United Kingdom
| | - Sean Ewings
- University of Southampton, Southampton, United Kingdom
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21
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Backhaus W, Braass H, Gerloff C, Hummel FC. Can Daytime Napping Assist the Process of Skills Acquisition After Stroke? Front Neurol 2018; 9:1002. [PMID: 30524365 PMCID: PMC6262055 DOI: 10.3389/fneur.2018.01002] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Accepted: 11/06/2018] [Indexed: 01/14/2023] Open
Abstract
Acquisition and reacquisition of skills is a main pillar of functional recovery after stroke. Nighttime sleep has a positive influence on motor learning in healthy individuals, whereas the effect of daytime sleep on neuro-rehabilitative training and relearning of the trained skills is often neglected. The aim of this study was to investigate the relationship between daytime sleep (napping) and the ability to learn a new visuomotor task in chronic stroke patients. The main hypothesis was that sleep enhances motor memory consolidation after training resulting in better motor performance after a period of daytime sleep. Thirty stroke survivors completed the study. They were randomized to one of three different conditions (i) wakeful resting, (ii) short nap (10-20 min), or (iii) long nap (50-80 min). All individuals trained the task with the contralesional, stroke-impaired hand, behavioral evaluation was performed after the break time (wake, nap), and 24 h later. Patients demonstrated a significant task-related behavioral improvement throughout the training. In contrast to the main hypothesis, there was no evidence for sleep-dependent motor consolidation early after the initial, diurnal break, or after an additional full night of sleep. In a secondary analysis, the performance changes of stroke survivors were compared with those of a group of healthy older adults who performed the identical task within the same experimental setup with their non-dominant hand. Performance levels were comparable between both cohorts at all time points. Stroke-related difficulties in motor control did not impact on the degree of performance improvement through training and daytime sleep did not impact on the behavioral gains in the two groups. In summary, the current study indicates that one-time daytime sleep after motor training does not influence behavioral gains.
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Affiliation(s)
- Winifried Backhaus
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Defitech Chair of Clinical Neuroengineering, Brain Mind Institute and Center for Neuroprosthetics, Swiss Federal Institute of Technology (EPFL), Geneva, Switzerland
- Defitech Chair of Clinical Neuroengineering, Brain Mind Institute and Center for Neuroprosthetics, Swiss Federal Institute of Technology Valais (EPFL Valais), Clinique Romande de Réadaptation, Sion, Switzerland
| | - Hanna Braass
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Christian Gerloff
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Friedhelm C. Hummel
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Defitech Chair of Clinical Neuroengineering, Brain Mind Institute and Center for Neuroprosthetics, Swiss Federal Institute of Technology (EPFL), Geneva, Switzerland
- Defitech Chair of Clinical Neuroengineering, Brain Mind Institute and Center for Neuroprosthetics, Swiss Federal Institute of Technology Valais (EPFL Valais), Clinique Romande de Réadaptation, Sion, Switzerland
- Clinical Neuroscience, Medical School University of Geneva, Geneva, Switzerland
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Wadden KP, Hodges NJ, De Asis KL, Neva JL, Boyd LA. Individualized Challenge Point Practice as a Method to Aid Motor Sequence Learning. J Mot Behav 2018; 51:467-485. [PMID: 30395786 DOI: 10.1080/00222895.2018.1518310] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
We conducted two studies to investigate if and how: (1) the rate of skill acquisition was related to motor performance at retention of a serial RT task (Study 1); and (2) whether rate of skill acquisition and baseline performance could be used to design schedules of practice related to contextual interference (CI) to enhance motor learning (Study 2). In Study 1, a slower rate of skill acquisition of repeating sequences in practice was related to faster response times at retention. Based on performance in Study 1, three levels of individualized CI were created for Study 2. Compared to low and moderate levels of CI, the higher CI practice condition led to faster response times in retention. We conclude that an individualized 'challenge point', which generates high CI enhances motor learning by optimizing challenge.
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Affiliation(s)
- Katie P Wadden
- a Rehabilitation Sciences , University of British Columbia , Vancouver , Canada
| | - Nicola J Hodges
- b School of Kinesiology , University of British Columbia , Vancouver , Canada
| | - Kristopher L De Asis
- c Department of Mechanical Engineering , University of British Columbia , Vancouver , Canada
| | - Jason L Neva
- d Department of Physical Therapy , University of British Columbia , Vancouver , Canada
| | - Lara A Boyd
- d Department of Physical Therapy , University of British Columbia , Vancouver , Canada .,e Centre for Brain Health , University of British Columbia , Vancouver , Canada
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23
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Bui KD, Johnson MJ. Designing robot-assisted neurorehabilitation strategies for people with both HIV and stroke. J Neuroeng Rehabil 2018; 15:75. [PMID: 30107849 PMCID: PMC6092818 DOI: 10.1186/s12984-018-0418-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2017] [Accepted: 07/27/2018] [Indexed: 01/01/2023] Open
Abstract
There is increasing evidence that HIV is an independent risk factor for stroke, resulting in an emerging population of people living with both HIV and stroke all over the world. However, neurorehabilitation strategies for the HIV-stroke population are distinctly lacking, which poses an enormous global health challenge. In order to address this gap, a better understanding of the HIV-stroke population is needed, as well as potential approaches to design effective neurorehabilitation strategies for this population. This review goes into the mechanisms, manifestations, and treatment options of neurologic injury in stroke and HIV, the additional challenges posed by the HIV-stroke population, and rehabilitation engineering approaches for both high and low resource areas. The aim of this review is to connect the underlying neurologic properties in both HIV and stroke to rehabilitation engineering. It reviews what is currently known about the association between HIV and stroke and gaps in current treatment strategies for the HIV-stroke population. We highlight relevant current areas of research that can help advance neurorehabilitation strategies specifically for the HIV-stroke population. We then explore how robot-assisted rehabilitation combined with community-based rehabilitation could be used as a potential approach to meet the challenges posed by the HIV-stroke population. We include some of our own work exploring a community-based robotic rehabilitation exercise system. The most relevant strategies will be ones that not only take into account the individual status of the patient but also the cultural and economic considerations of their respective environment.
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Affiliation(s)
- Kevin D. Bui
- Department of Bioengineering, University of Pennsylvania, Philadelphia, USA
- Rehabilitation Robotics Lab (a GRASP Lab), University of Pennsylvania, 1800 Lombard Street, Philadelphia, 19146 USA
| | - Michelle J. Johnson
- Department of Bioengineering, University of Pennsylvania, Philadelphia, USA
- Rehabilitation Robotics Lab (a GRASP Lab), University of Pennsylvania, 1800 Lombard Street, Philadelphia, 19146 USA
- Department of Physical Medicine and Rehabilitation, Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA
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Hamoudi M, Schambra HM, Fritsch B, Schoechlin-Marx A, Weiller C, Cohen LG, Reis J. Transcranial Direct Current Stimulation Enhances Motor Skill Learning but Not Generalization in Chronic Stroke. Neurorehabil Neural Repair 2018; 32:295-308. [PMID: 29683030 DOI: 10.1177/1545968318769164] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Motor training alone or combined with transcranial direct current stimulation (tDCS) positioned over the motor cortex (M1) improves motor function in chronic stroke. Currently, understanding of how tDCS influences the process of motor skill learning after stroke is lacking. OBJECTIVE To assess the effects of tDCS on the stages of motor skill learning and on generalization to untrained motor function. METHODS In this randomized, sham-controlled, blinded study of 56 mildly impaired chronic stroke patients, tDCS (anode over the ipsilesional M1 and cathode on the contralesional forehead) was applied during 5 days of training on an unfamiliar, challenging fine motor skill task (sequential visual isometric pinch force task). We assessed online and offline learning during the training period and retention over the following 4 months. We additionally assessed the generalization to untrained tasks. RESULTS With training alone (sham tDCS group), patients acquired a novel motor skill. This skill improved online, remained stable during the offline periods and was largely retained at follow-up. When tDCS was added to training (real tDCS group), motor skill significantly increased relative to sham, mostly in the online stage. Long-term retention was not affected by tDCS. Training effects generalized to untrained tasks, but those performance gains were not enhanced further by tDCS. CONCLUSIONS Training of an unfamiliar skill task represents a strategy to improve fine motor function in chronic stroke. tDCS augments motor skill learning, but its additive effect is restricted to the trained skill.
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Affiliation(s)
| | - Heidi M Schambra
- 2 New York University, NY, USA.,3 National Institute of Neurological Disorders and Stroke, Bethesda, MD, USA
| | | | | | | | - Leonardo G Cohen
- 3 National Institute of Neurological Disorders and Stroke, Bethesda, MD, USA
| | - Janine Reis
- 1 University Hospital Freiburg, Freiburg, Germany.,3 National Institute of Neurological Disorders and Stroke, Bethesda, MD, USA
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Pavol MA, Bassile CC, Lehman JR, Harmon E, Ferreira N, Shinn B, St James N, Callender J, Stein J. Modified Approach to Stroke Rehabilitation (MAStR): feasibility study of a method to apply procedural memory concepts to transfer training. Top Stroke Rehabil 2018; 25:351-358. [PMID: 29609504 DOI: 10.1080/10749357.2018.1458462] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
OBJECTIVE Training and implementation for a multidisciplinary stroke rehabilitation method emphasizing procedural memory. BACKGROUND Current practice in stroke rehabilitation relies on explicit memory, often compromised by stroke, failing to capitalize on better-preserved procedural memory skills. Recruitment of procedural memory requires consistency and practice, characteristics difficulty to promote on inpatient rehabilitation units. We designed a method Modified Approach to Stroke Rehabilitation (MAStR) to maximize consistency and practice for transfer training with stroke patients. DESIGN Phase I, single-group study. MAStR has two innovations: (1) simplification of instructions to only three words, other direction provided non-verbally; (2) having all rehabilitation staff apply the same approach for transfers. Staff training in MAStR included review of written material describing the rationale for MAStR and demonstration of a transfer using MAStR. Enrolled patients completed each transfer with MAStR in addition to standard rehabilitation therapy. RESULTS The MAStR method was taught to a large, multidisciplinary rehabilitation staff (n = 31). Training and certification required 15 min per staff member. Five stroke patients were enrolled. No transfers with MAStR resulted in injury, no negative feedback was received from staff or patients. Staff reported satisfaction with the brief MAStR training and reported transfers were easier to complete with the MAStR method. CONCLUSIONS Feasibility was demonstrated for an innovative application of procedural memory concepts to stroke rehabilitation. All rehabilitation disciplines were successfully trained. MAStR was well-tolerated and liked by rehabilitation staff and patients. These results support pursuit of a Phase II pilot study.
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Affiliation(s)
- Marykay A Pavol
- a Cerebral Localization Lab, Stroke Division, Department of Neurology, Neurological Institute, Columbia University Medical Center , Columbia University College of Physicians & Surgeons , New York , NY , USA
| | - Clare C Bassile
- b Department of Rehabilitation and Regenerative Medicine , Columbia University College of Physicians & Surgeons , New York , NY , USA
| | - Jennifer R Lehman
- c Department of Rehabilitation Medicine (Physical Therapy) , New York Presbyterian Hospital-Columbia University , New York , NY , USA
| | - Emma Harmon
- d Department of Rehabilitation Medicine (Occupational Therapy) , New York Presbyterian Hospital-Columbia University , New York , NY , USA
| | - Nancy Ferreira
- c Department of Rehabilitation Medicine (Physical Therapy) , New York Presbyterian Hospital-Columbia University , New York , NY , USA
| | - Brittany Shinn
- d Department of Rehabilitation Medicine (Occupational Therapy) , New York Presbyterian Hospital-Columbia University , New York , NY , USA
| | - Nancy St James
- e Department of Nursing (Inpatient Rehabilitation Unit) , New York Presbyterian Hospital-Columbia University , New York , NY , USA
| | - Jacqueline Callender
- f Department of Rehabilitation Medicine (Recreation Therapy) , New York Presbyterian Hospital-Columbia University , New York , NY , USA
| | - Joel Stein
- b Department of Rehabilitation and Regenerative Medicine , Columbia University College of Physicians & Surgeons , New York , NY , USA
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Yang L, Wan F, Nan W, Zhu F, Hu Y. Reliable Detection of Implicit Waveform-Specific Learning in Continuous Tracking Task Paradigm. Sci Rep 2017; 7:12333. [PMID: 28951576 PMCID: PMC5615060 DOI: 10.1038/s41598-017-11977-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2016] [Accepted: 08/30/2017] [Indexed: 11/09/2022] Open
Abstract
Implicit waveform-specific (IWS) learning during a typical continuous tracking task paradigm has been reported for decades, as evidenced by better tracking improvement on the repeated segment of a specific target waveform than random segments. However, the occurrence of the IWS learning in such a task paradigm has been challenged by several unsuccessful results in recent literature. This research concerns reliable detection of the induced IWS learning and to this end, proposes to use the similarity between the cursor and the target along the direction corresponding to the waveform pattern as the performance measure. A 3-day experiment designed with full examination on IWS learning including a practice phase, an immediate test phase and a consolidation test phase after 24 hours was conducted to validate the feasibility and sensitivity of the Pearson's correlation coefficient on the vertical movement r v in this study. Experiment results indicate that r v is more sensitive in detecting the IWS learning in all phases compared to the conventional root mean square error (RMSE) performance measure. The findings confirm the importance of the performance measure in implicit learning research and the similarity measure in accordance with the waveform could be promising for waveform-specific learning detection in this paradigm.
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Affiliation(s)
- Limin Yang
- Department of Electrical and Computer Engineering, University of Macau, Macau S.A.R., China
| | - Feng Wan
- Department of Electrical and Computer Engineering, University of Macau, Macau S.A.R., China.
| | - Wenya Nan
- Department of Electrical and Computer Engineering, University of Macau, Macau S.A.R., China.,Department of Psychology, College of Education, Shanghai Normal University, Shanghai, China
| | - Frank Zhu
- Faculty of Education, The University of Hong Kong, Hong Kong S.A.R., China.,Department of Surgery, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong S.A.R., China
| | - Yong Hu
- Department of Orthopaedics and Traumatology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong S.A.R., China
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Zahiri N, Abollahi I, Nabavi SM, Ehsani F, Arab AM, Shaw I, Shariat A, Shaw BS, Dastoorpoor M, Danaee M, Sangelaji B. Interference Effect of Prior Explicit Information on Motor Sequence Learning in Relapsing-Remitting Multiple Sclerosis Patients. Malays J Med Sci 2017; 24:69-80. [PMID: 28381930 DOI: 10.21315/mjms2017.24.1.8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2016] [Accepted: 11/07/2016] [Indexed: 10/20/2022] Open
Abstract
BACKGROUND Multiple sclerosis (MS) is the most widespread disabling neurological condition in young adults around the world. The purpose of this study was to investigate the impact of explicit information (EI) on motor-sequence learning in MS patients. METHODS Thirty patients with relapsing-remitting MS (RRMS), age: 29.5 (SD = 5.6) years and 30 healthy gender-, age-, and education-matched control group participants, age: 28.8 (SD = 6.0) years, were recruited for this study. The participants in the healthy group were then randomly assigned into an EI (n = 15) group and a no-EI (n = 15) group. Similarly, the participants in the control group were then randomly assigned into EI (n = 15) and no-EI (n = 15) groups. The participants performed a serial reaction time (SRT) task and reaction times. A retention test was performed after 48 hours. RESULTS All participants reduced their reaction times across acquisition (MS group: 46.4 (SD = 3.3) minutes, P < 0.001, and healthy group: 39.4 (SD = 3.3) minutes, P < 0.001). The findings for the within-participants effect of repeated measures of time were significant (F(5.06, 283.7) = 71.33. P < 0.001). These results indicate that the interaction between group and time was significant (F(5.06, 283.7) = 6.44. P < 0.001), which indicated that the reaction time in both groups was significantly changed between the MS and healthy groups across times (B1 to B10). The main effect of the group (MS and healthy) (F(1, 56) = 22.78. P < 0.001) and also the main effect of no-EI vs EI (F(1, 56) = 4.71. P < 0.001) were significant. CONCLUSION This study demonstrated that that RRMS patients are capable of learning new skills, but the provision of EI prior to physical practice is deleterious to implicit learning. It is sufficient to educate MS patients on the aim and general content of the training and only to provide feedback at the end of the rehabilitative session.
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Affiliation(s)
- Nahid Zahiri
- Department of Physiotherapy, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Iraj Abollahi
- Department of Physiotherapy, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | | | - Fatemeh Ehsani
- Neuromuscular Rehabilitation Research Center, Semnan University of Medical Sciences, Semnan, Iran
| | - Amir Masoud Arab
- Department of Physiotherapy, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Ina Shaw
- Department of Sport and Movement Studies, University of Johannesburg, Doornfontein, Johannesburg, Republic of South Africa
| | - Ardalan Shariat
- Department of Occupational Health, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Malaysia
| | - Brandon S Shaw
- Department of Sport and Movement Studies, University of Johannesburg, Doornfontein, Johannesburg, Republic of South Africa
| | - Maryam Dastoorpoor
- Department of Epidemiology and Biostatistics, Faculty of Public Health, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Mahmoud Danaee
- University of Malaya Centre of Addiction Sciences (UMCAS), Malaysia
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Clark B, Whitall J, Kwakkel G, Mehrholz J, Ewings S, Burridge J. Time spent in rehabilitation and effect on measures of activity after stroke. Hippokratia 2017. [DOI: 10.1002/14651858.cd012612] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Affiliation(s)
- Beth Clark
- Poole Hospital NHS Foundation Trust; Stroke Care Unit; Poole Dorset UK BH15 2JB
| | - Jill Whitall
- University of Maryland; Department of Physical Therapy and Rehabilitation Science; Baltimore MD USA 21403
| | - Gert Kwakkel
- VU University Medical Center; Department of Rehabilitation Medicine, MOVE Research Institute Amsterdam, Amsterdam Neurosciences; De Boelelaan 1118 Amsterdam Netherlands 1007 MB
| | - Jan Mehrholz
- Technical University Dresden; Department of Public Health, Dresden Medical School; Fetscherstr. 74 Dresden Germany 01307
| | - Sean Ewings
- University of Southampton; Southampton Statistical Sciences Research Institute; Southampton Hampshire UK SO17 1BJ
| | - Jane Burridge
- University of Southampton; Research Group, Faculty of Health Sciences; Building 45, University of Southampton Southampton UK SO17 1BJ
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30
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Sombric CJ, Harker HM, Sparto PJ, Torres-Oviedo G. Explicit Action Switching Interferes with the Context-Specificity of Motor Memories in Older Adults. Front Aging Neurosci 2017; 9:40. [PMID: 28321188 PMCID: PMC5337495 DOI: 10.3389/fnagi.2017.00040] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2016] [Accepted: 02/14/2017] [Indexed: 12/17/2022] Open
Abstract
Healthy aging impairs the ability to adapt movements to novel situations and to switch choices according to the context in cognitive tasks, indicating resistance to changes in motor and cognitive behaviors. Here we examined if this lack of “flexibility” in old subjects observed in motor and cognitive domains were related. To this end, we evaluated subjects' performance in a motor task that required switching walking patterns and its relation to performance in a cognitive switching task. Specifically, a group of old (>73 years old) and young subjects learned a new locomotor pattern on a split-belt treadmill, which drives the legs at different speeds. In both groups, we assessed the ability to disengage the walking pattern learned on the treadmill when walking overground. Then, we determined if this motor context-specificity was related to subjects' cognitive ability to switch actions in a set-shift task. Motor and cognitive behaviors were tested twice on separate visits to determine if age-related differences were maintained with exposure. Consistent with previous studies, we found that old adults adapted slower and had deficits in retention. Most importantly, we found that older subjects could not switch locomotor patterns when transitioning across walking contexts. Interestingly, cognitive switching performance was inversely related to subjects' ability to switch walking patterns. Thus, cognitive mediated switching interfered with locomotor switching. These findings were maintained across testing sessions. Our results suggest that distinct neural substrates mediate motor and cognitive action selection, and that these processes interfere with each other as we age.
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Affiliation(s)
- Carly J Sombric
- Department of Bioengineering, University of Pittsburgh Pittsburgh, PA, USA
| | - Harrison M Harker
- Department of Bioengineering, University of Pittsburgh Pittsburgh, PA, USA
| | - Patrick J Sparto
- Department of Physical Therapy, University of Pittsburgh Pittsburgh, PA, USA
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31
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Shishov N, Melzer I, Bar-Haim S. Parameters and Measures in Assessment of Motor Learning in Neurorehabilitation; A Systematic Review of the Literature. Front Hum Neurosci 2017; 11:82. [PMID: 28286474 PMCID: PMC5324661 DOI: 10.3389/fnhum.2017.00082] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2016] [Accepted: 02/09/2017] [Indexed: 12/21/2022] Open
Abstract
Upper limb function, essential for daily life, is often impaired in individuals after stroke and cerebral palsy (CP). For an improved upper limb function, learning should occur, and therefore training with motor learning principles is included in many rehabilitation interventions. Despite accurate measurement being an important aspect for examination and optimization of treatment outcomes, there are no standard algorithms for outcome measures selection. Moreover, the ability of the chosen measures to identify learning is not well established. We aimed to review and categorize the parameters and measures utilized for identification of motor learning in stroke and CP populations. PubMed, Pedro, and Web of Science databases were systematically searched between January 2000 and March 2016 for studies assessing a form of motor learning following upper extremity training using motor control measures. Thirty-two studies in persons after stroke and 10 studies in CP of any methodological quality were included. Identified outcome measures were sorted into two categories, “parameters,” defined as identifying a form of learning, and “measures,” as tools measuring the parameter. Review's results were organized as a narrative synthesis focusing on the outcome measures. The included studies were heterogeneous in their study designs, parameters and measures. Parameters included adaptation (n = 6), anticipatory control (n = 2), after-effects (n = 3), de-adaptation (n = 4), performance (n = 24), acquisition (n = 8), retention (n = 8), and transfer (n = 14). Despite motor learning theory's emphasis on long-lasting changes and generalization, the majority of studies did not assess the retention and transfer parameters. Underlying measures included kinematic analyses in terms of speed, geometry or both (n = 39), dynamic metrics, measures of accuracy, consistency, and coordination. There is no exclusivity of measures to a specific parameter. Many factors affect task performance and the ability to measure it—necessitating the use of several metrics to examine different features of movement and learning. Motor learning measures' applicability to clinical setting can benefit from a treatment-focused approach, currently lacking. The complexity of motor learning results in various metrics, utilized to assess its occurrence, making it difficult to synthesize findings across studies. Further research is desirable for development of an outcome measures selection algorithm, while considering the quality of such measurements.
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Affiliation(s)
- Nataliya Shishov
- Department of Physical Therapy, Recanati School for Community Health Professions, Faculty of Health Sciences, Ben-Gurion University of the Negev Beer-Sheva, Israel
| | - Itshak Melzer
- Department of Physical Therapy, Recanati School for Community Health Professions, Faculty of Health Sciences, Ben-Gurion University of the Negev Beer-Sheva, Israel
| | - Simona Bar-Haim
- Department of Physical Therapy, Recanati School for Community Health Professions, Faculty of Health Sciences, Ben-Gurion University of the Negev Beer-Sheva, Israel
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32
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Kal E, Winters M, van der Kamp J, Houdijk H, Groet E, van Bennekom C, Scherder E. Is Implicit Motor Learning Preserved after Stroke? A Systematic Review with Meta-Analysis. PLoS One 2016; 11:e0166376. [PMID: 27992442 PMCID: PMC5161313 DOI: 10.1371/journal.pone.0166376] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2016] [Accepted: 10/27/2016] [Indexed: 11/19/2022] Open
Abstract
Many stroke patients experience difficulty with performing dual-tasks. A promising intervention to target this issue is implicit motor learning, as it should enhance patients’ automaticity of movement. Yet, although it is often thought that implicit motor learning is preserved post-stroke, evidence for this claim has not been systematically analysed yet. Therefore, we systematically reviewed whether implicit motor learning is preserved post-stroke, and whether patients benefit more from implicit than from explicit motor learning. We comprehensively searched conventional (MEDLINE, Cochrane, Embase, PEDro, PsycINFO) and grey literature databases (BIOSIS, Web of Science, OpenGrey, British Library, trial registries) for relevant reports. Two independent reviewers screened reports, extracted data, and performed a risk of bias assessment. Overall, we included 20 out of the 2177 identified reports that allow for a succinct evaluation of implicit motor learning. Of these, only 1 study investigated learning on a relatively complex, whole-body (balance board) task. All 19 other studies concerned variants of the serial-reaction time paradigm, with most of these focusing on learning with the unaffected hand (N = 13) rather than the affected hand or both hands (both: N = 4). Four of the 20 studies compared explicit and implicit motor learning post-stroke. Meta-analyses suggest that patients with stroke can learn implicitly with their unaffected side (mean difference (MD) = 69 ms, 95% CI[45.1, 92.9], p < .00001), but not with their affected side (standardized MD = -.11, 95% CI[-.45, .25], p = .56). Finally, implicit motor learning seemed equally effective as explicit motor learning post-stroke (SMD = -.54, 95% CI[-1.37, .29], p = .20). However, overall, the high risk of bias, small samples, and limited clinical relevance of most studies make it impossible to draw reliable conclusions regarding the effect of implicit motor learning strategies post-stroke. High quality studies with larger samples are warranted to test implicit motor learning in clinically relevant contexts.
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Affiliation(s)
- E. Kal
- Department of Research & Development, Heliomare Rehabilitation Centre, Wijk aan Zee, The Netherlands
- Department of Human Movement Sciences, Faculty of Behavioural and Movement Sciences, VU University Amsterdam, MOVE Research Institute, Amsterdam, The Netherlands
- Department of Clinical Neuropsychology, Faculty of Behavioural and Movement Sciences, VU University Amsterdam, Amsterdam, The Netherlands
- * E-mail:
| | - M. Winters
- Department of Rehabilitation, Nursing Science & Sports, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - J. van der Kamp
- Department of Human Movement Sciences, Faculty of Behavioural and Movement Sciences, VU University Amsterdam, MOVE Research Institute, Amsterdam, The Netherlands
- Institute of Human Performance, University of Hong Kong, Hong Kong, Hong Kong
| | - H. Houdijk
- Department of Research & Development, Heliomare Rehabilitation Centre, Wijk aan Zee, The Netherlands
- Department of Human Movement Sciences, Faculty of Behavioural and Movement Sciences, VU University Amsterdam, MOVE Research Institute, Amsterdam, The Netherlands
| | - E. Groet
- Department of Research & Development, Heliomare Rehabilitation Centre, Wijk aan Zee, The Netherlands
| | - C. van Bennekom
- Department of Research & Development, Heliomare Rehabilitation Centre, Wijk aan Zee, The Netherlands
- Coronel Institute for Occupational and Environmental Health, Academic Medical Centre/University of Amsterdam, Amsterdam, The Netherlands
| | - E. Scherder
- Department of Clinical Neuropsychology, Faculty of Behavioural and Movement Sciences, VU University Amsterdam, Amsterdam, The Netherlands
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Fleming MK, Newham DJ, Rothwell JC. Explicit motor sequence learning with the paretic arm after stroke. Disabil Rehabil 2016; 40:323-328. [PMID: 27927022 DOI: 10.1080/09638288.2016.1258091] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
PURPOSE Motor sequence learning is important for stroke recovery, but experimental tasks require dexterous movements, which are impossible for people with upper limb impairment. This makes it difficult to draw conclusions about the impact of stroke on learning motor sequences. We aimed to test a paradigm requiring gross arm movements to determine whether stroke survivors with upper limb impairment were capable of learning a movement sequence as effectively as age-matched controls. MATERIALS AND METHODS In this case-control study, 12 stroke survivors (10-138 months post-stroke, mean age 64 years) attempted the task once using their affected arm. Ten healthy controls (mean 66 years) used their non-dominant arm. A sequence of 10 movements was repeated 25 times. The variables were: time from target illumination until the cursor left the central square (onset time; OT), accuracy (path length), and movement speed. RESULTS OT reduced with training (p < 0.05) for both groups, with no change in movement speed or accuracy (p > 0.1). We quantified learning as the OT difference between the end of training and a random sequence; this was smaller for stroke survivors than controls (p = 0.015). CONCLUSIONS Stroke survivors can learn a movement sequence with their paretic arm, but demonstrate impairments in sequence specific learning. Implications for Rehabilitation Motor sequence learning is important for recovery of movement after stroke. Stroke survivors were found to be capable of learning a movement sequence with their paretic arm, supporting the concept of repetitive task training for recovery of movement. Stroke survivors showed impaired sequence specific learning in comparison with age-matched controls, indicating that they may need more repetitions of a sequence in order to re-learn movements. Further research is required into the effect of lesion location, time since stroke, hand dominance and gender on learning of motor sequences after stroke.
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Affiliation(s)
- Melanie K Fleming
- a Centre of Human and Aerospace Physiological Sciences , King's College London , London , UK
| | - Di J Newham
- a Centre of Human and Aerospace Physiological Sciences , King's College London , London , UK
| | - John C Rothwell
- b Institute of Neurology , University College London , London , UK
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Grimm F, Naros G, Gharabaghi A. Closed-Loop Task Difficulty Adaptation during Virtual Reality Reach-to-Grasp Training Assisted with an Exoskeleton for Stroke Rehabilitation. Front Neurosci 2016; 10:518. [PMID: 27895550 PMCID: PMC5108796 DOI: 10.3389/fnins.2016.00518] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2015] [Accepted: 10/26/2016] [Indexed: 11/23/2022] Open
Abstract
Stroke patients with severe motor deficits of the upper extremity may practice rehabilitation exercises with the assistance of a multi-joint exoskeleton. Although this technology enables intensive task-oriented training, it may also lead to slacking when the assistance is too supportive. Preserving the engagement of the patients while providing “assistance-as-needed” during the exercises, therefore remains an ongoing challenge. We applied a commercially available seven degree-of-freedom arm exoskeleton to provide passive gravity compensation during task-oriented training in a virtual environment. During this 4-week pilot study, five severely affected chronic stroke patients performed reach-to-grasp exercises resembling activities of daily living. The subjects received virtual reality feedback from their three-dimensional movements. The level of difficulty for the exercise was adjusted by a performance-dependent real-time adaptation algorithm. The goal of this algorithm was the automated improvement of the range of motion. In the course of 20 training and feedback sessions, this unsupervised adaptive training concept led to a progressive increase of the virtual training space (p < 0.001) in accordance with the subjects' abilities. This learning curve was paralleled by a concurrent improvement of real world kinematic parameters, i.e., range of motion (p = 0.008), accuracy of movement (p = 0.01), and movement velocity (p < 0.001). Notably, these kinematic gains were paralleled by motor improvements such as increased elbow movement (p = 0.001), grip force (p < 0.001), and upper extremity Fugl-Meyer-Assessment score from 14.3 ± 5 to 16.9 ± 6.1 (p = 0.026). Combining gravity-compensating assistance with adaptive closed-loop feedback in virtual reality provides customized rehabilitation environments for severely affected stroke patients. This approach may facilitate motor learning by progressively challenging the subject in accordance with the individual capacity for functional restoration. It might be necessary to apply concurrent restorative interventions to translate these improvements into relevant functional gains of severely motor impaired patients in activities of daily living.
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Affiliation(s)
- Florian Grimm
- Division of Functional and Restorative Neurosurgery, and Centre for Integrative Neuroscience, Eberhard Karls University of Tuebingen Tuebingen, Germany
| | - Georgios Naros
- Division of Functional and Restorative Neurosurgery, and Centre for Integrative Neuroscience, Eberhard Karls University of Tuebingen Tuebingen, Germany
| | - Alireza Gharabaghi
- Division of Functional and Restorative Neurosurgery, and Centre for Integrative Neuroscience, Eberhard Karls University of Tuebingen Tuebingen, Germany
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Skidmore ER, Butters M, Whyte E, Grattan E, Shen J, Terhorst L. Guided Training Relative to Direct Skill Training for Individuals With Cognitive Impairments After Stroke: A Pilot Randomized Trial. Arch Phys Med Rehabil 2016; 98:673-680. [PMID: 27794487 DOI: 10.1016/j.apmr.2016.10.004] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2016] [Accepted: 10/03/2016] [Indexed: 10/20/2022]
Abstract
OBJECTIVE To examine the effects of direct skill training and guided training for promoting independence after stroke. DESIGN Single-blind randomized pilot study. SETTING Inpatient rehabilitation facility. PARTICIPANTS Participants in inpatient rehabilitation with acute stroke and cognitive impairments (N=43). INTERVENTIONS Participants were randomized to receive direct skill training (n=22, 10 sessions as adjunct to usual inpatient rehabilitation) or guided training (n=21, same dose). MAIN OUTCOME MEASURE The FIM assessed independence at baseline, rehabilitation discharge, and months 3, 6, and 12. RESULTS Linear mixed models (random intercept, other effects fixed) revealed a significant intervention by time interaction (F4,150=5.11, P<.001), a significant main effect of time (F4,150=49.25, P<.001), and a significant effect of stroke severity (F1,150=34.46, P<.001). There was no main effect of intervention (F1,150=.07, P=.79). Change in FIM scores was greater for the direct group at rehabilitation discharge (effect size of between-group differences, d=.28) and greater for the guide group at months 3 (d=.16), 6 (d=.39), and 12 (d=.53). The difference between groups in mean 12-month change scores was 10.57 points. CONCLUSIONS Guided training, provided in addition to usual care, offered a small advantage in the recovery of independence, relative to direct skill training. Future studies examining guided training in combination with other potentially potent intervention elements may further advise best practices in rehabilitation for individuals with cognitive impairments after acute stroke.
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Affiliation(s)
- Elizabeth R Skidmore
- Department of Occupational Therapy, School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, PA; Department of Physical Medicine and Rehabilitation, School of Medicine, University of Pittsburgh, Pittsburgh, PA.
| | - Meryl Butters
- Department of Psychiatry, School of Medicine, University of Pittsburgh, Pittsburgh, PA
| | - Ellen Whyte
- Department of Psychiatry, School of Medicine, University of Pittsburgh, Pittsburgh, PA
| | - Emily Grattan
- Department of Health Science and Research, Medical University of South Carolina, Charleston, SC
| | - Jennifer Shen
- Department of Physical Medicine and Rehabilitation, School of Medicine, University of Pittsburgh, Pittsburgh, PA
| | - Lauren Terhorst
- Department of Occupational Therapy, School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, PA
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Wadden KP, Asis KD, Mang CS, Neva JL, Peters S, Lakhani B, Boyd LA. Predicting Motor Sequence Learning in Individuals With Chronic Stroke. Neurorehabil Neural Repair 2016; 31:95-104. [PMID: 27511047 DOI: 10.1177/1545968316662526] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
BACKGROUND Conventionally, change in motor performance is quantified with discrete measures of behavior taken pre- and postpractice. As a high degree of movement variability exists in motor performance after stroke, pre- and posttesting of motor skill may lack sensitivity to predict potential for motor recovery. OBJECTIVE Evaluate the use of predictive models of motor learning based on individual performance curves and clinical characteristics of motor function in individuals with stroke. METHODS Ten healthy and fourteen individuals with chronic stroke performed a continuous joystick-based tracking task over 6 days, and at a 24-hour delayed retention test, to assess implicit motor sequence learning. RESULTS Individuals with chronic stroke demonstrated significantly slower rates of improvements in implicit sequence-specific motor performance compared with a healthy control (HC) group when root mean squared error performance data were fit to an exponential function. The HC group showed a positive relationship between a faster rate of change in implicit sequence-specific motor performance during practice and superior performance at the delayed retention test. The same relationship was shown for individuals with stroke only after accounting for overall motor function by including Wolf Motor Function Test rate in our model. CONCLUSION Nonlinear information extracted from multiple time points across practice, specifically the rate of motor skill acquisition during practice, relates strongly with changes in motor behavior at the retention test following practice and could be used to predict optimal doses of practice on an individual basis.
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Affiliation(s)
- Katie P Wadden
- University of British Columbia, Vancouver, British Columbia, Canada
| | | | - Cameron S Mang
- University of British Columbia, Vancouver, British Columbia, Canada
| | - Jason L Neva
- University of British Columbia, Vancouver, British Columbia, Canada
| | - Sue Peters
- University of British Columbia, Vancouver, British Columbia, Canada
| | - Bimal Lakhani
- University of British Columbia, Vancouver, British Columbia, Canada
| | - Lara A Boyd
- University of British Columbia, Vancouver, British Columbia, Canada
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37
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Greenwood R, Caine D, Hammerbeck U, Leff A, Playford D, Stevenson V, Ward N. Restorative Neurology, Rehabilitation and Brain Injury. Neurology 2016. [DOI: 10.1002/9781118486160.ch18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Affiliation(s)
| | - Diana Caine
- National Hospital for Neurology & Neurosurgery
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Hayes HA, Hunsaker N, Dibble LE. Implicit Motor Sequence Learning in Individuals with Parkinson Disease: A Meta-Analysis. JOURNAL OF PARKINSONS DISEASE 2016; 5:549-60. [PMID: 26406135 DOI: 10.3233/jpd-140441] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Deficits in implicit motor sequence learning (IMSL) in individuals with Parkinson disease (PD) compared to age matched healthy controls (HC) are unclear. OBJECTIVE The purpose of this paper is to present results of a systematic review with a meta-analysis examining the hypothesis that IMSL is impaired in individuals with PD when compared to HC. METHODS Fifteen articles met our final criteria and assessed 299 individuals with PD and 244 HC. Raw mean and standard deviation data for the final block of repeated and final block of random practice trials were obtained to calculate sequence-specific learning (SSL) for individuals with PD and HC. Forest plots were used to depict the comparison of the groups by assessing standardized mean difference with random effect size. RESULTS A significant and moderate effect size, 0.83 was found suggesting that individuals with PD demonstrated impaired SSL of motor sequences compared to HC. CONCLUSIONS Individuals with PD demonstrate a deficit compared with HC in their ability to implicitly learn motor tasks. Existing research lacks detail on the factors which may alter IMSL, either negatively or positively, such as the design features of current IMSL paradigms utilized and disease-specific characteristics. Successful motor rehabilitation of functional tasks in persons with PD is highly dependent on IMSL; therefore, an improved knowledge of the influence of these additional variables is critical.
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Grimm F, Gharabaghi A. Closed-Loop Neuroprosthesis for Reach-to-Grasp Assistance: Combining Adaptive Multi-channel Neuromuscular Stimulation with a Multi-joint Arm Exoskeleton. Front Neurosci 2016; 10:284. [PMID: 27445658 PMCID: PMC4917563 DOI: 10.3389/fnins.2016.00284] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2016] [Accepted: 06/07/2016] [Indexed: 11/25/2022] Open
Abstract
Stroke patients with severe motor deficits cannot execute task-oriented rehabilitation exercises with their affected upper extremity. Advanced rehabilitation technology may support them in performing such reach-to-grasp movements. The challenge is, however, to provide assistance as needed, while maintaining the participants' commitment during the exercises. In this feasibility study, we introduced a closed-loop neuroprosthesis for reach-to-grasp assistance which combines adaptive multi-channel neuromuscular stimulation with a multi-joint arm exoskeleton. Eighteen severely affected chronic stroke patients were assisted by a gravity-compensating, seven-degree-of-freedom exoskeleton which was attached to the paretic arm for performing reach-to-grasp exercises resembling activities of daily living in a virtual environment. During the exercises, adaptive electrical stimulation was applied to seven different muscles of the upper extremity in a performance-dependent way to enhance the task-oriented movement trajectory. The stimulation intensity was individualized for each targeted muscle and remained subthreshold, i.e., induced no overt support. Closed-loop neuromuscular stimulation could be well integrated into the exoskeleton-based training, and increased the task-related range of motion (p = 0.0004) and movement velocity (p = 0.015), while preserving accuracy. The highest relative stimulation intensity was required to facilitate the grasping function. The facilitated range of motion correlated with the upper extremity Fugl-Meyer Assessment score of the patients (p = 0.028). Combining adaptive multi-channel neuromuscular stimulation with antigravity assistance amplifies the residual motor capabilities of severely affected stroke patients during rehabilitation exercises and may thus provide a customized training environment for patient-tailored support while preserving the participants' engagement.
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Affiliation(s)
- Florian Grimm
- Division of Functional and Restorative Neurosurgery, Department of Neurosurgery, and Centre for Integrative Neuroscience, Eberhard Karls University Tuebingen Tuebingen, Germany
| | - Alireza Gharabaghi
- Division of Functional and Restorative Neurosurgery, Department of Neurosurgery, and Centre for Integrative Neuroscience, Eberhard Karls University Tuebingen Tuebingen, Germany
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40
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Grimm F, Naros G, Gharabaghi A. Compensation or Restoration: Closed-Loop Feedback of Movement Quality for Assisted Reach-to-Grasp Exercises with a Multi-Joint Arm Exoskeleton. Front Neurosci 2016; 10:280. [PMID: 27445655 PMCID: PMC4914560 DOI: 10.3389/fnins.2016.00280] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2016] [Accepted: 06/06/2016] [Indexed: 11/13/2022] Open
Abstract
Assistive technology allows for intensive practice and kinematic measurements during rehabilitation exercises. More recent approaches attach a gravity-compensating multi-joint exoskeleton to the upper extremity to facilitate task-oriented training in three-dimensional space with virtual reality feedback. The movement quality, however, is mostly captured through end-point measures that lack information on proximal inter-joint coordination. This limits the differentiation between compensation strategies and genuine restoration both during the exercise and in the course of rehabilitation. We extended in this proof-of-concept study a commercially available seven degree-of-freedom arm exoskeleton by using the real-time sensor data to display a three-dimensional multi-joint visualization of the user's arm. Ten healthy subjects and three severely affected chronic stroke patients performed reach-to-grasp exercises resembling activities of daily living assisted by the attached exoskeleton and received closed-loop online feedback of the three-dimensional movement in virtual reality. Patients in this pilot study differed significantly with regard to motor performance (accuracy, temporal efficiency, range of motion) and movement quality (proximal inter-joint coordination) from the healthy control group. In the course of 20 training and feedback sessions over 4 weeks, these pathological measures improved significantly toward the reference parameters of healthy participants. It was moreover feasible to capture the evolution of movement pattern kinematics of the shoulder and elbow and to quantify the individual degree of natural movement restoration for each patient. The virtual reality visualization and closed-loop feedback of joint-specific movement kinematics makes it possible to detect compensation strategies and may provide a tool to achieve the rehabilitation goals in accordance with the individual capacity for genuine functional restoration; a proposal that warrants further investigation in controlled studies with a larger cohort of stroke patients.
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Affiliation(s)
- Florian Grimm
- Division of Functional and Restorative Neurosurgery, and Centre for Integrative Neuroscience, Eberhard Karls University Tuebingen, Germany
| | - Georgios Naros
- Division of Functional and Restorative Neurosurgery, and Centre for Integrative Neuroscience, Eberhard Karls University Tuebingen, Germany
| | - Alireza Gharabaghi
- Division of Functional and Restorative Neurosurgery, and Centre for Integrative Neuroscience, Eberhard Karls University Tuebingen, Germany
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Snow NJ, Mang CS, Roig M, McDonnell MN, Campbell KL, Boyd LA. The Effect of an Acute Bout of Moderate-Intensity Aerobic Exercise on Motor Learning of a Continuous Tracking Task. PLoS One 2016; 11:e0150039. [PMID: 26901664 PMCID: PMC4764690 DOI: 10.1371/journal.pone.0150039] [Citation(s) in RCA: 61] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2015] [Accepted: 02/08/2016] [Indexed: 12/03/2022] Open
Abstract
INTRODUCTION There is evidence for beneficial effects of acute and long-term exercise interventions on several forms of memory, including procedural motor learning. In the present study we examined how performing a single bout of continuous moderate intensity aerobic exercise would impact motor skill acquisition and retention in young healthy adults, compared to a period of rest. We hypothesized that exercise would improve motor skill acquisition and retention, compared to motor practice alone. MATERIALS AND METHODS Sixteen healthy adults completed sessions of aerobic exercise or seated rest that were immediately followed by practice of a novel motor task (practice). Exercise consisted of 30 minutes of continuous cycling at 60% peak O2 uptake. Twenty-four hours after practice, we assessed motor learning with a no-exercise retention test (retention). We also quantified changes in offline motor memory consolidation, which occurred between practice and retention (offline). Tracking error was separated into indices of temporal precision and spatial accuracy. RESULTS There were no differences between conditions in the timing of movements during practice (p = 0.066), at retention (p = 0.761), or offline (p = 0.966). However, the exercise condition enabled participants to maintain spatial accuracy during practice (p = 0.477); whereas, following rest performance diminished (p = 0.050). There were no significant differences between conditions at retention (p = 0.532) or offline (p = 0.246). DISCUSSION An acute bout of moderate-intensity aerobic exercise facilitated the maintenance of motor performance during skill acquisition, but did not influence motor learning. Given past work showing that pairing high intensity exercise with skilled motor practice benefits learning, it seems plausible that intensity is a key modulator of the effects of acute aerobic exercise on changes in complex motor behavior. Further work is necessary to establish a dose-response relationship between aerobic exercise and motor learning.
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Affiliation(s)
- Nicholas J. Snow
- Graduate Program in Rehabilitation Sciences, Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Cameron S. Mang
- Graduate Program in Rehabilitation Sciences, Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Marc Roig
- School of Physical and Occupational Therapy, McGill University, Montréal, Canada
- Memory and Motor Rehabilitation Laboratory (MEMORY-LAB), Feil and Oberfeld Research Centre, Jewish Rehabilitation Hospital, Montréal Centre for Interdisciplinary Research in Rehabilitation (CRIR), Laval, QC, Canada
| | - Michelle N. McDonnell
- International Centre for Allied Health Evidence and Alliance for Research in Exercise, Nutrition and Activity (ARENA), Sansom Institute for Health Research, School of Health Sciences, University of South Australia, Adelaide, Australia
| | - Kristin L. Campbell
- Graduate Program in Rehabilitation Sciences, Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Lara A. Boyd
- Graduate Program in Rehabilitation Sciences, Faculty of Medicine, University of British Columbia, Vancouver, Canada
- Graduate Program in Neuroscience, Faculty of Medicine, University of British Columbia, Vancouver, Canada
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Ackerley R, Borich M, Oddo CM, Ionta S. Insights and Perspectives on Sensory-Motor Integration and Rehabilitation. Multisens Res 2016. [DOI: 10.1163/22134808-00002530] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
The present review focuses on the flow and interaction of somatosensory-motor signals in the central and peripheral nervous system. Specifically, where incoming sensory signals from the periphery are processed and interpreted to initiate behaviors, and how ongoing behaviors produce sensory consequences encoded and used to fine-tune subsequent actions. We describe the structure–function relations of this loop, how these relations can be modeled and aspects of somatosensory-motor rehabilitation. The work reviewed here shows that it is imperative to understand the fundamental mechanisms of the somatosensory-motor system to restore accurate motor abilities and appropriate somatosensory feedback. Knowledge of the salient neural mechanisms of sensory-motor integration has begun to generate innovative approaches to improve rehabilitation training following neurological impairments such as stroke. The present work supports the integration of basic science principles of sensory-motor integration into rehabilitation procedures to create new solutions for sensory-motor disorders.
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Affiliation(s)
- Rochelle Ackerley
- Department of Physiology, University of Gothenburg, Göteborg, Sweden
- Laboratoire Neurosciences Intégratives et Adaptatives (UMR 7260), CNRS — Aix-Marseille Université, Marseille, France
| | - Michael Borich
- Neural Plasticity Research Laboratory, Division of Physical Therapy, Dept of Rehabilitation Medicine, Emory University, Atlanta, GA, USA
| | | | - Silvio Ionta
- The Laboratory for Investigative Neurophysiology, Dept of Radiology and Dept of Clinical Neurosciences, University Hospital Center and University of Lausanne, Lausanne, Switzerland
- Rehabilitation Engineering Laboratory, Department of Health Sciences and Technology, ETH Zürich, Zurich, Switzerland
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Gudberg C, Johansen-Berg H. Sleep and Motor Learning: Implications for Physical Rehabilitation After Stroke. Front Neurol 2015; 6:241. [PMID: 26635718 PMCID: PMC4656813 DOI: 10.3389/fneur.2015.00241] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2015] [Accepted: 10/30/2015] [Indexed: 12/22/2022] Open
Abstract
Sleep is essential for healthy brain function and plasticity underlying learning and memory. In the context of physical impairment such as following a stroke, sleep may be particularly important for supporting critical recovery of motor function through similar processes of reorganization in the brain. Despite a link between stroke and poor sleep, current approaches to rehabilitative care often neglect the importance of sleep in clinical assessment and treatment. This review assimilates current evidence on the role of sleep in motor learning, with a focus on the implications for physical rehabilitation after stroke. We further outline practical considerations for integrating sleep assessment as a vital part of clinical care.
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Affiliation(s)
- Christel Gudberg
- Oxford Centre for Functional MRI of the Brain (FMRIB), Nuffield Department of Clinical Neurosciences, University of Oxford, John Radcliffe Hospital , Oxford , UK ; Sleep and Circadian Neuroscience Institute (SCNi), Nuffield Department of Clinical Neurosciences, University of Oxford, Sir William Dunn School of Pathology , Oxford , UK
| | - Heidi Johansen-Berg
- Oxford Centre for Functional MRI of the Brain (FMRIB), Nuffield Department of Clinical Neurosciences, University of Oxford, John Radcliffe Hospital , Oxford , UK
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Auriat AM, Neva JL, Peters S, Ferris JK, Boyd LA. A Review of Transcranial Magnetic Stimulation and Multimodal Neuroimaging to Characterize Post-Stroke Neuroplasticity. Front Neurol 2015; 6:226. [PMID: 26579069 PMCID: PMC4625082 DOI: 10.3389/fneur.2015.00226] [Citation(s) in RCA: 81] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2015] [Accepted: 10/12/2015] [Indexed: 01/09/2023] Open
Abstract
Following stroke, the brain undergoes various stages of recovery where the central nervous system can reorganize neural circuitry (neuroplasticity) both spontaneously and with the aid of behavioral rehabilitation and non-invasive brain stimulation. Multiple neuroimaging techniques can characterize common structural and functional stroke-related deficits, and importantly, help predict recovery of function. Diffusion tensor imaging (DTI) typically reveals increased overall diffusivity throughout the brain following stroke, and is capable of indexing the extent of white matter damage. Magnetic resonance spectroscopy (MRS) provides an index of metabolic changes in surviving neural tissue after stroke, serving as a marker of brain function. The neural correlates of altered brain activity after stroke have been demonstrated by abnormal activation of sensorimotor cortices during task performance, and at rest, using functional magnetic resonance imaging (fMRI). Electroencephalography (EEG) has been used to characterize motor dysfunction in terms of increased cortical amplitude in the sensorimotor regions when performing upper limb movement, indicating abnormally increased cognitive effort and planning in individuals with stroke. Transcranial magnetic stimulation (TMS) work reveals changes in ipsilesional and contralesional cortical excitability in the sensorimotor cortices. The severity of motor deficits indexed using TMS has been linked to the magnitude of activity imbalance between the sensorimotor cortices. In this paper, we will provide a narrative review of data from studies utilizing DTI, MRS, fMRI, EEG, and brain stimulation techniques focusing on TMS and its combination with uni- and multimodal neuroimaging methods to assess recovery after stroke. Approaches that delineate the best measures with which to predict or positively alter outcomes will be highlighted.
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Affiliation(s)
- Angela M Auriat
- Department of Physical Therapy, Faculty of Medicine, University of British Columbia , Vancouver, BC , Canada
| | - Jason L Neva
- Department of Physical Therapy, Faculty of Medicine, University of British Columbia , Vancouver, BC , Canada
| | - Sue Peters
- Department of Physical Therapy, Faculty of Medicine, University of British Columbia , Vancouver, BC , Canada
| | - Jennifer K Ferris
- Graduate Program in Neuroscience, Faculty of Medicine, University of British Columbia , Vancouver, BC , Canada
| | - Lara A Boyd
- Department of Physical Therapy, Faculty of Medicine, University of British Columbia , Vancouver, BC , Canada ; Graduate Program in Neuroscience, Faculty of Medicine, University of British Columbia , Vancouver, BC , Canada
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Graham JV, Eustace C, Brock K, Swain E, Irwin-Carruthers S. The Bobath Concept in Contemporary Clinical Practice. Top Stroke Rehabil 2015; 16:57-68. [DOI: 10.1310/tsr1601-57] [Citation(s) in RCA: 97] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Skidmore ER. Training to Optimize Learning after Traumatic Brain Injury. CURRENT PHYSICAL MEDICINE AND REHABILITATION REPORTS 2015; 3:99-105. [PMID: 26217546 PMCID: PMC4514532 DOI: 10.1007/s40141-015-0081-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
One of the major foci of rehabilitation after traumatic brain injury is the design and implementation of interventions to train individuals to learn new knowledge and skills or new ways to access and execute previously acquired knowledge and skills. To optimize these interventions, rehabilitation professionals require a clear understanding of how traumatic brain injury impacts learning, and how specific approaches may enhance learning after traumatic brain injury. This brief conceptual review provides an overview of learning, the impact of traumatic brain injury on explicit and implicit learning, and the current state of the science examining selected training approaches designed to advance learning after traumatic brain injury. Potential directions for future scientific inquiry are discussed throughout the review.
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Affiliation(s)
- Elizabeth R. Skidmore
- Department of Occupational Therapy, University of Pittsburgh, 5012 Forbes Tower, Pittsburgh, PA 15260, Telephone: (412) 383-6617, Telefax: (412) 383-6613
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Compensatory motor network connectivity is associated with motor sequence learning after subcortical stroke. Behav Brain Res 2015; 286:136-45. [PMID: 25757996 DOI: 10.1016/j.bbr.2015.02.054] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2014] [Revised: 02/13/2015] [Accepted: 02/17/2015] [Indexed: 12/31/2022]
Abstract
Following stroke, functional networks reorganize and the brain demonstrates widespread alterations in cortical activity. Implicit motor learning is preserved after stroke. However the manner in which brain reorganization occurs, and how it supports behavior within the damaged brain remains unclear. In this functional magnetic resonance imaging (fMRI) study, we evaluated whole brain patterns of functional connectivity during the performance of an implicit tracking task at baseline and retention, following 5 days of practice. Following motor practice, a significant difference in connectivity within a motor network, consisting of bihemispheric activation of the sensory and motor cortices, parietal lobules, cerebellar and occipital lobules, was observed at retention. Healthy subjects demonstrated greater activity within this motor network during sequence learning compared to random practice. The stroke group did not show the same level of functional network integration, presumably due to the heterogeneity of functional reorganization following stroke. In a secondary analysis, a binary mask of the functional network activated from the aforementioned whole brain analyses was created to assess within-network connectivity, decreasing the spatial distribution and large variability of activation that exists within the lesioned brain. The stroke group demonstrated reduced clusters of connectivity within the masked brain regions as compared to the whole brain approach. Connectivity within this smaller motor network correlated with repeated sequence performance on the retention test. Increased functional integration within the motor network may be an important neurophysiological predictor of motor learning-related change in individuals with stroke.
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Motor skill learning is associated with diffusion characteristics of white matter in individuals with chronic stroke. J Neurol Phys Ther 2015; 38:151-60. [PMID: 23934017 DOI: 10.1097/npt.0b013e3182a3d353] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND AND PURPOSE Imaging advances allow investigation of white matter after stroke; a growing body of literature has shown links between diffusion-based measures of white matter microstructure and motor function. However, the relationship between these measures and motor skill learning has not been considered in individuals with stroke. The aim of this study was to investigate the relationships between posttraining white matter microstructural status, as indexed by diffusion tensor imaging within the ipsilesional posterior limb of the internal capsule (PLIC), and learning of a novel motor task in individuals with chronic stroke. METHODS A total of 13 participants with chronic stroke and 9 healthy controls practiced a visuomotor pursuit task across 5 sessions. Change in motor behavior associated with learning was indexed by comparing baseline performance with a delayed retention test. Fractional anisotropy (FA) indexed at the retention test was the primary diffusion tensor imaging-derived outcome measure. RESULTS In individuals with chronic stroke, we discovered an association between posttraining ipsilesional PLIC FA and the magnitude of change associated with motor learning; hierarchical multiple linear regression analyses revealed that the combination of age, time poststroke, and ipsilesional PLIC FA posttraining was associated with motor learning-related change (R = 0.649; P = 0.02). Baseline motor performance was not related to posttraining ipsilesional PLIC FA. DISCUSSION AND CONCLUSIONS Diffusion characteristics of posttraining ipsilesional PLIC were linked to the magnitude of change in skilled motor behavior. These results imply that the microstructural properties of regional white matter indexed by diffusion behavior may be an important factor to consider when determining potential response to rehabilitation in persons with stroke. VIDEO ABSTRACT AVAILABLE (see Video, Supplemental Digital Content 1, http://links.lww.com/JNPT/A59) for more insights from the authors.
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Infusing motor learning research into neurorehabilitation practice: a historical perspective with case exemplar from the accelerated skill acquisition program. J Neurol Phys Ther 2015; 38:190-200. [PMID: 24828523 DOI: 10.1097/npt.0000000000000046] [Citation(s) in RCA: 98] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
UNLABELLED : This special interest article provides a historical framework with a contemporary case example that traces the infusion of the science of motor learning into neurorehabilitation practice. The revolution in neuroscience provided the first evidence for learning-dependent neuroplasticity and presaged the role of motor learning as critical for restorative therapies after stroke. The scientific underpinnings of motor learning have continued to evolve from a dominance of cognitive or information processing perspectives to a blend with neural science and contemporary social-cognitive psychological science. Furthermore, advances in the science of behavior change have contributed insights into influences on sustainable and generalizable gains in motor skills and associated behaviors, including physical activity and other recovery-promoting habits. For neurorehabilitation, these insights have tremendous relevance for the therapist-patient interactions and relationships. We describe a principle-based intervention for neurorehabilitation termed the Accelerated Skill Acquisition Program that we developed. This approach emphasizes integration from a broad set of scientific lines of inquiry including the contemporary fields of motor learning, neuroscience, and the psychological science of behavior change. Three overlapping essential elements-skill acquisition, impairment mitigation, and motivational enhancements-are integrated. VIDEO ABSTRACT AVAILABLE (See Video, Supplemental Digital Content 1, http://links.lww.com/JNPT/A71) for more insights from the authors.
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Siengsukon CF, Boyd LA. Sleep Enhances Implicit Motor Skill Learning in Individuals Poststroke. Top Stroke Rehabil 2015; 15:1-12. [DOI: 10.1310/tsr1501-1] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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