Infusing Motor Learning Research Into Neurorehabilitation Practice

Abstract

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.

The use of augmented auditory feedback to improve arm reaching in stroke: a case series

“…There are a variety of therapeutic techniques to treat the upper extremity post-stroke, though currently no regime is the gold standard [2–4]. However, the application of motor learning principles is one approach that may support and enhance therapeutic gains during rehabilitation [5,6]. Specifically, augmented feedback is one of the most potent factors that can influence motor learning [7,8].…”

Functional Test of the Hemiparetic Upper Extremity: A Rasch Analysis With Theoretical Implications

“…1 However, today, post-stroke rehabilitation emphasizes behavioral re-learning, challenging practice, and improved capacity to accomplish increasingly more difficult movement tasks. 15 Ideally, the FTHUE score would specify exactly where the patient is located on the measurement metric thereby clarifying which functional tasks are easy, difficult, and “just-right”. 15 The FTHUE measured UE function by whether or not a task was performed but does not detail skilled behavior.…”

“…14 However, in contemporary rehabilitation practice, ideally, the score should inform design of repetitive and progressively more challenging task-practice sessions to engage behavioral and neural-cognitive motor learning processes. 15 It would be advantageous if the mapping of the FTHUE to stages of recovery 14 were aligned with contemporary treatment theory. For example, within the Rehabilitation Treatment Taxonomy (RTT) framework, treatment or ingredients exert forces of change on a treatment target through a known or hypothesized mechanism of action 16 .…”

“…15,17 The Interdisciplinary Comprehensive Arm Rehabilitation Evaluation (ICARE) Stroke Initiative which implemented the Accelerated Skill Acquisition Program (ASAP) 18 provided an opportunity to examine the FTHUE in the context of a contemporary intervention program. ASAP is a task-oriented, principle-based approach intended to improve functional skills and is consistent with current evidence-based rehabilitation guidelines.…”

“…ASAP is a task-oriented, principle-based approach intended to improve functional skills and is consistent with current evidence-based rehabilitation guidelines. 15,18,19 The approach aims to improve upper extremity coordination during performance of meaningful tasks while reducing reach-to-grasp impairments and the need for movement compensations.…”