Sleep promotes offline enhancement of an explicitly learned discrete but not an explicitly learned continuous task

Visuomotor skill learning in young adults with Down syndrome

BACKGROUND

Individuals with Down syndrome (DS) have impaired general motor skills compared to typically developed (TD) individuals.

AIMS

To gain knowledge on how young adults with DS learn and retain new motor skills.

METHODS AND PROCEDURES

A DS-group (mean age = 23.9 ± 3 years, N = 11), and an age-matched TD-group (mean age 22.8 ± 1.8, N = 14) were recruited. The participants practiced a visuomotor accuracy tracking task (VATT) in seven blocks (10.6 min). Online and offline effects of practice were assessed based on tests of motor performance at baseline immediate and 7-day retention.

OUTCOMES AND RESULTS

The TD-group performed better than the DS-group on all blocks (all P < 0.001). Both groups improved VATT-performance online from baseline to immediate retention, (all P < 0.001) with no difference in online effect between groups. A significant between-group difference was observed in the offline effect (∆TD - ∆DS, P = 0.04), as the DS-group's performance at 7-day retention was equal to their performance at immediate retention (∆DS, P > 0.05), whereas an offline decrease in performance was found in the TD-group (∆TD, P < 0.001).

CONCLUSIONS AND IMPLICATIONS

Visuomotor pinch force accuracy is lower for adults with DS compared to TD. However, adults with DS display significant online improvements in performance with motor practice similar to changes observed for TD. Additionally, adults with DS demonstrate offline consolidation following motor learning leading to significant retention effects.

The Relationship Between Sleep Quality, Sleep-Related Biomarkers, and Motor Skill Acquisition in People With Multiple Sclerosis: A Pilot Study

OBJECTIVE

Neurorehabilitation that involves learning new motor skills is one of the promising clinical methods for motor recovery in people with multiple sclerosis (PwMS); therefore, factors that influence the acquisition of motor skills in PwMS need to be investigated. Sleep disturbances are common in PwMS; however, no study has investigated the effect of sleep and sleep-related biomarkers on skill acquisition in PwMS. This study aimed to examine the effect of sleep and sleep-related biomarkers on motor acquisition in PwMS.

METHODS

Forty participants with MS and 40 controls were recruited in this study. To assess motor acquisition, each participant was asked to perform a novel game through a virtual reality (VR) system 5 times (blocks). The main outcome measures for each block were the required time to complete the VR game and the recorded errors. The difference in scores between Block 5 and Block 1 for both outcomes were considered to represent motor skill acquisition. Sleep was assessed by self-report using the Pittsburgh Sleep Quality Index (PSQI) and objectively using sleep monitor technology. Serotonin level was assessed using means of enzyme-linked immunosorbent assay using plasma samples.

RESULTS

There were significant positive correlations in both groups between motor skill acquisition and PSQI score. In PwMS, significant negative correlation between motor skill acquisition and sleep efficiency and significant positive correlation between motor skill acquisition and sleep latency were also observed. Interestingly, a significant negative correlation was observed between motor skill acquisition and the plasma serotonin level in both groups. Most of these correlations remained significant after controlling for disease severity, fatigue, baseline performance, and cognitive status.

CONCLUSION

Sleep quality may influence motor skill acquisition in PwMS. Circulatory serotonin level might explain this relationship.

IMPACT

Physical therapists are encouraged to be aware of sleep quality and sleep assessment. Sleep management strategies should be considered when treating PwMS.

Sleep-dependent motor memory consolidation in healthy adults: A meta-analysis

It is widely accepted that sleep better facilitates the consolidation of motor memories than does a corresponding wake interval (King et al., 2017). However, no in-depth analysis of the various motor tasks and their relative sleep gain has been conducted so far. Therefore, the present meta-analysis considered 48 studies with a total of 53 sleep (n = 829) and 53 wake (n = 825) groups. An overall comparison between all sleep and wake groups resulted in a small effect for the relative sleep gain in motor memory consolidation (g = 0.43). While no subgroup differences were identified for differing designs, a small effect for the finger tapping task (g = 0.47) and a medium effect for the mirror tracing task (g = 0.62) were found. In summary, the meta-analysis substantiates that sleep generally benefits the consolidation of motor memories. However, to further our understanding of the mechanisms underlying this effect, examining certain task dimensions and their relative sleep gain would be a promising direction for future research.

Selective improvements in balancing associated with offline periods of spaced training

Benefits from post-training memory processing have been observed in learning many procedural skills. Here, we show that appropriate offline periods produce a performance gain during learning to stand on a multiaxial balance board. The tilt angle and the area of sway motion of the board were much more reduced in participants performing a training spaced by an interval of one day with respect to participants executing the same amount of practice over a concentrated period. In particular, offline memory encoding was specifically associated with the motion along the anterior-posterior direction, the spatio-temporal dynamics, and the frequency contents of the board sway. Overall, quantification of spaced learning in a whole-body postural task reveals that offline memory processes enhance the performance by encoding single movement components. From a practical perspective, we believe that the amount of practice and the length of inter-session interval, adopted in this study, may provide objective insights to develop appropriate programs of postural training.

The effect of sleep on motor learning in the aging and stroke population - a systematic review

There is extensive evidence for positive effects of sleep on motor learning in young individuals; however, the effects of sleep on motor learning in people with stroke and in healthy older individuals are not well understood. The aim of this systematic review was to quantify the association between sleep and procedural memory performance - a marker for motor learning - in healthy older people and people with stroke. After searches in PubMed, Medline and Embase fourteen studies, including 44 subjects after stroke and 339 healthy older participants were included. Overall, sleep was found to enhance motor performance in people after stroke in comparison to an equivalent time of wakefulness. In addition, although evidence is limited, sleep only enhanced motor performance in people after stroke and not in age-matched healthy older adults. In older adults the effect of a sleep intervention did - in general - not differ from equivalent periods of wakefulness. Tasks with whole hand or whole body movements could show significant changes. The results suggest a delayed retention effect after longer breaks including sleep, hinting towards a changed learning strategy as a result of aging. Current evidence for sleep dependent learning in people after stroke is promising, however sparse.

Sleep and memory consolidation: motor performance and proactive interference effects in sequence learning

That post-training sleep supports the consolidation of sequential motor skills remains debated. Performance improvement and sensitivity to proactive interference are both putative measures of long-term memory consolidation. We tested sleep-dependent memory consolidation for visuo-motor sequence learning using a proactive interference paradigm. Thirty-three young adults were trained on sequence A on Day 1, then had Regular Sleep (RS) or were Sleep Deprived (SD) on the night after learning. After two recovery nights, they were tested on the same sequence A, then had to learn a novel, potentially competing sequence B. We hypothesized that proactive interference effects on sequence B due to the prior learning of sequence A would be higher in the RS condition, considering that proactive interference is an indirect marker of the robustness of sequence A, which should be better consolidated over post-training sleep. Results highlighted sleep-dependent improvement for sequence A, with faster RTs overnight for RS participants only. Moreover, the beneficial impact of sleep was specific to the consolidation of motor but not sequential skills. Proactive interference effects on learning a new material at Day 4 were similar between RS and SD participants. These results suggest that post-training sleep contributes to optimizing motor but not sequential components of performance in visuo-motor sequence learning.

Time rather than sleep appears to enhance off-line learning and transfer of learning of an implicit continuous task

There is increasing evidence that sleep promotes off-line enhancement of a variety of explicitly learned motor tasks in young adults. However, whether sleep promotes off-line consolidation of implicitly learned motor tasks is still under question. Furthermore, the role of sleep in promoting transfer of learning remains unknown. This study examined the role of sleep in learning and transfer of learning of an implicit continuous motor task. Twenty-three neurologically intact individuals (mean age 26.4 years) were randomly assigned to either a sleep group or a no-sleep group. The sleep group practiced a continuous tracking task in the evening and underwent retention and transfer testing the following morning, while the no-sleep group practiced the tracking task in the morning and underwent retention and transfer testing in the evening. The results show that in both the sleep and no-sleep groups, performance improved off-line without further practice for both the general skill and the sequence-specific skill. The results also indicate that sleep and time promote transfer of learning of both sequence-specific and general skill learning to a spatial and temporal variation of the motor task. These findings demonstrate that sleep does not play a critical role in promoting off-line learning and transfer of learning of an implicit continuous motor task.

Sleep enhances learning of a functional motor task in young adults

BACKGROUND

Sleep has been demonstrated to enhance simple motor skill learning "offline" in young adults. "Offline learning" refers to either the stabilization or the enhancement of a memory through the passage of time without additional practice. It remains unclear whether a functional motor task will benefit from sleep to produce offline motor skill enhancement. Physical therapists often teach clients functional motor skills; therefore, it is important to understand how sleep affects learning of these skills.

OBJECTIVE

The purpose of this study was to determine whether sleep enhances the learning of a functional motor task.

DESIGN

A prospective, cross-sectional, repeated-measures design was used.

METHODS

Young participants who were healthy (N=24) were randomly assigned to either a sleep group or a no-sleep group. The sleep group practiced a novel walking task in the evening and underwent retention testing the following morning, and the no-sleep group practiced the task in the morning and underwent retention testing in the evening. Outcome measures included time around the walking path and spatiotemporal gait parameters.

RESULTS

Only participants who slept after practicing the novel walking task demonstrated a significant offline improvement in performance. Compared with the no-sleep group, participants in the sleep group demonstrated a significant decrease in the time around the walking path, an increase in tandem velocity, an increase in tandem step length, and a decline in tandem step time.

LIMITATIONS

Time-of-day effect and inability to ensure a certain amount of sleep quantity and quality of participants were limitations of the study.

CONCLUSIONS

This study is the first to provide evidence that sleep facilitates learning clinically relevant functional motor tasks. Sleep is an important factor that physical therapists should consider when teaching clients motor skills.