Evidence of Motor Skill Learning in Acute Stroke Patients Without Lesions to the Thalamus and Internal Capsule

Abstract

Background: It is currently unknown whether motor skill learning (MSkL) with the paretic upper limb is possible during the acute phase after stroke and whether lesion localization impacts MSkL. Here, we investigated MSkL in acute (1–7 days post) stroke patients compared with healthy individuals (HIs) and in relation to voxel-based lesion symptom mapping. Methods: Twenty patients with acute stroke and 35 HIs were trained over 3 consecutive days on a neurorehabilitation robot measuring speed, accuracy, and movement smoothness variables. Patients used their paretic upper limb and HI used their nondominant upper limb on an MSkL task involving a speed/accuracy trade-off. Generalization was evaluated on day 3. All patients underwent a 3-dimensional magnetic resonance imaging used for VSLM. Results: Most patients achieved MSkL demonstrated by day-to-day retention and generalization of the newly learned skill on day 3. When comparing raw speed/accuracy trade-off values, HI achieved larger MSkL than patients. However, relative speed/accuracy trade-off values showed no significant differences in MSkL between patients and HI on day 3. In patients, MSkL progression correlated with acute motor and cognitive impairments. The voxel-based lesion symptom mapping showed that acute vascular damage to the thalamus or the posterior limb of the internal capsule reduced MSkL. Conclusions: Despite worse motor performance for acute stroke patients compared with HI, most patients were able to achieve MSkL with their paretic upper limb. Damage to the thalamus and posterior limb of the internal capsule, however, reduced MSkL. These data show that MSkL could be implemented into neurorehabilitation during the acute phase of stroke, particularly for patients without lesions to the thalamus and posterior limb of the internal capsule. Registration: URL: https://www.clinicaltrials.gov ; Unique identifier: NCT01519843.

Rest the Brain to Learn New Gait Patterns after Stroke

“…This finding indicates that stroke survivors have online motor learning deficits when compared with neurologically intact adults, which agrees with some prior studies 27,28 but differs to some extent from other existing motor learning literature. [14][15][16][17]29 It is likely that this divergence from previous literature results from our examination of mildly impaired individuals using a multi-DOF, functionally relevant motor acuity task during gait. For example, recent research suggests that reinforcement learning was impaired early after the stroke but not in the chronic phase, whereas error-based learning was unaffected after stroke at either time point when compared with controls.…”

“…For example, some studies suggest that stroke primarily affects the processes underlying motor control and execution, while leaving the learning of motor skills intact. [14][15][16][17] However, a recent study revealed that the extent of motor learning deficits following a stroke is dependent on the severity of motor impairment. 18 It is important to note that a major challenge in establishing evidence of learning deficits is that performance deficits can be misinterpreted as learning deficits.…”

The stratified effects of repetitive transcranial magnetic stimulation in upper limb motor impairment recovery after stroke: a meta-analysis

“…Additionally, the potential for recovery varies between chronic and non-chronic stroke cases. The optimal recovery period is within 3 months after stroke, particularly within 4 weeks of its onset ( 47 ). Therefore, when selecting rTMS parameters, it is crucial to consider the different stroke stages and hemiplegia severities in order to develop individualized rehabilitation programs in clinical practice.…”

Moving toward elucidating alternative motor pathway structures post-stroke: the value of spinal cord neuroimaging

“…In addition, Byblow et al ( 12 ) have further suggested that acute stroke patients show ~70% resolution of motor impairment if corticospinal tracts are functional. Overall, neuroimaging studies have confirmed that amount, connectivity, and neurophysiologic function of CST is related to impairment and functional recovery post-stroke ( 13 – 16 ).…”