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These data suggest that ensuring adequate sleep between rehabilitation therapy sessions and normalizing sleep cycles following stroke may be important variables that can positively influence implicit motor learning after stroke-related brain damage.

This study provides the first evidence that sleep enhances motor learning through both improved spatial tracking accuracy and anticipation of upcoming movements, as demonstrated by a reduction in the time lag of tracking in individuals following stroke. We propose that the cerebellum and hippocampus are likely important neural correlates associated with sleep-dependent off-line motor skill learning.

Our analysis extends recent work by revealing specific benefits for instrumental activities of daily living for individuals in the early stages of AD and supports the value of exercise for individuals with cognitive impairment.

Fitts' law predicts that there is an essential trade-off between speed and accuracy during movement. Past investigations of Fitts' law have not characterized whether advance planning of upcoming fast and accurate movements impacts either behavior or patterns of brain activation. With an event-related functional magnetic resonance imaging (fMRI) paradigm, we investigated the neural correlates of advance planning and movement difficulty of rapid, goal-directed aimed movements using a discrete version of the classic Fitts' task. Our behavioral data revealed strong differences in response time, initial movement velocity, and end-point accuracy based on manipulation of both time to plan movements and response difficulty. We discovered a modulation of the neural network associated with executing the Fitts' task that was dependent on the availability of time to plan the upcoming movement and motor difficulty. Specifically, when time to plan for the upcoming movement was available, medial frontal gyrus (BA 10), pre-SMA (BA 6), putamen and cerebellar lobule VI were uniquely active to plan movements. Further, their activation correlated with behavioral measures of movement. In contrast, manipulating movement difficulty invoked a different pattern of brain activations in regions that are known to participate in motor control, including supplementary motor area (BA 6), sensory motor cortex (BA 4, 3, 2) and putamen. Our finding that medial frontal gyrus (BA 10) was important for discrete, fast and accurate movements expands the known role of this brain region, which in the past has been identified as a cognitive processing system supporting stimulus-oriented attending. We now extend this conceptualization to include motor functions such as those employed for processing for rapid, goal-directed aimed movements.

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BackgroundMounting evidence demonstrates that individuals with stroke benefit from sleep to enhance learning of a motor task. While stage NREM2 sleep and REM sleep have been associated with offline motor skill learning in neurologically intact individuals, it remains unknown which sleep parameters or specific sleep stages are associated with offline motor skill learning in individuals with stroke.MethodsTwenty individuals with chronic stroke (>6 months following stroke) and 10 control participants slept for three consecutive nights in a sleep laboratory with polysomnography. Participants practiced a tracking task the morning before the third night and underwent a retention test the morning following the third night. Offline learning on the tracking task was assessed. Pearson’s correlations assessed for associations between the magnitude of offline learning and sleep variables, age, upper-extremity motor function, stroke severity, depression, and time since stroke occurrence.ResultsIndividuals with stroke performed with significantly less error on the tracking task following a night of sleep (p = 0.006) while the control participants did not (p = 0.816). Increased sleep efficiency (r = −0.285), less time spent in stage NREM3 sleep (r = 0.260), and more time spent in stage REM sleep (r = −0.266) were weakly-to-moderately associated with increased magnitude of offline motor learning. Furthermore, higher upper-extremity motor function (r = −0.400), lower stroke severity (r = 0.360), and less time since stroke occurrence (r = 0.311) were moderately associated with increased magnitude of offline motor learning.ConclusionThis study is the first study to provide insight into which sleep stages and individual characteristics may be associated with offline learning in people with stroke. Further research is needed to delineate which factors or combination of factors promote offline motor learning in people with neurologic injury to best promote motor recovery in these individuals.

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.