The association between functional impairment, propensity for reinvestment, and time spent in rehabilitation indicates that exclusive reliance on conscious motor processing strategies in the rehabilitation setting may be an impediment to regaining functional independence. There is a need to develop motor learning strategies for rehabilitation that restrain the propensity for reinvestment.

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Background and Purpose. After a stroke, people often attempt to consciously control their motor actions, which, paradoxically, disrupts optimal performance. A learning strategy that minimizes the accrual of explicit knowledge may circumvent attempts to consciously control motor actions, thereby resulting in better performance. The purpose of this study was to examine the implicit learning of a dynamic balancing task after stroke by use of 1 of 2 motor learning strategies: learning without errors and discovery learning. Participants and Methods. Ten adults with stroke and 12 older adults practiced a dynamic balancing task on a stabilometer under single-task (balance only) and concurrent-task conditions. Root-mean-square error (in degrees) from horizontal was used to measure balance performance. Results. The balance performance of the discovery (explicit) learners after stroke was impaired by the imposition of a concurrent cognitive task load. In contrast, the performance of the errorless (implicit) learners (stroke and control groups) and the discovery learning control group was not impaired. Discussion and Conclusion. The provision of explicit information during rehabilitation may be detrimental to the learning/relearning and execution of motor skills in some people with stroke. The application of implicit motor learning techniques in the rehabilitation setting may be beneficial. [Orrell AJ, Eves FF, Masters RSW. Motor learning of a dynamic balancing task after stroke: implicit implications for stroke rehabilitation. Phys Ther. 2006;86:369–380.]

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Implicit learning is durable over time, robust under psychological stress and shows specificity of transfer; characteristics that may be beneficial in stroke rehabilitation. The purpose of this study was to investigate implicit sequence learning processes in unilateral stroke using an extended number of trial blocks in a serial reaction time task (SRTT). Previous research, using a SRTT, has produced equivocal results that may be associated with the small number of trial blocks used. Seven adults, at least one year after stroke, and eight controls performed 54 blocks of a modified SRTT over two weeks. Participants responded with a finger key press during acquisition and retention and with a whole arm movement during transfer. Response times in milliseconds were used to measure learning. The stroke group performed more slowly than the controls during all experimental phases. Response times for both groups decreased with practice of the repeating sequence, increased with introduction of a random sequence, and decreased when reintroduced to the repeating sequence of the SRTT. Both groups demonstrated delayed retention of knowledge of the sequence over a two-week period and exhibited specificity of transfer. These data suggest that with extended practice people with unilateral stroke are able to learn implicitly.