Updates in Motor Learning: Implications for Physical Therapist Practice and Education

Leech, Kristan A.; Roemmich, Ryan T.; Gordon, James; Reisman, Darcy S.; Cherry‐Allen, Kendra M.

doi:10.1093/ptj/pzab250

Cited by 55 publications

(48 citation statements)

References 73 publications

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“…Motor adaptation is thought to be important for understanding the health and function of the nervous system across a variety of contexts including stroke rehabilitation. 1 , 3 , 4 We used a robotic task to profile impairments in individuals ranging from 14 days to roughly 4 years post-stroke (median = 53 days). The task imposed a systematic discrepancy between hand motion and a feedback cursor displayed in the participant’s workspace.…”

Section: Discussionmentioning

confidence: 99%

“…This is perhaps unsurprising as we lack empirical data linking motor adaptation, learning, and improvements in motor function in human participants with stroke. 3 Recent work has reported a lack of confidence amongst therapists who incorporate principles of motor adaptation and learning into clinical practice. 54 – 56 Despite growing consensus surrounding the importance and clinical utility of motor learning principles, experts still lack consensus regarding what principles best promote improvements in motor performance.…”

Section: Discussionmentioning

confidence: 99%

“…It is assumed that individuals with stroke are capable of modifying their arm movements using error feedback that arises from movement or is provided by a therapist. [3][4][5][6] This may be problematic as motor adaptation is reduced, on average, in chronic stroke and impedes the ability to use error feedback to interact with different objects and environments. [7][8][9][10][11] Visuomotor rotations are a common method for assessing how the nervous system uses error feedback to adapt arm movements.…”

Section: Introductionmentioning

confidence: 99%

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Assessing Impairments in Visuomotor Adaptation After Stroke

Moore

Piitz

Singh

et al. 2022

Neurorehabil Neural Repair

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Background: Motor impairment in the arms is common after stroke and many individuals participate in therapy to improve function. It is assumed that individuals with stroke can adapt and improve their movements using feedback that arises from movement or is provided by a therapist. Here we investigated visuomotor adaptation in individuals with sub-acute and chronic stroke. Objective: We examined the impact of the stroke-affected arm (dominant or non-dominant), time post-stroke, and relationships with clinical measures of motor impairment and functional independence. Methods: Participants performed reaching movements with their arm supported in a robotic exoskeleton. We rotated the relationship between the motion of the participant’s hand and a feedback cursor displayed in their workspace. Outcome measures included the amount that participants adapted their arm movements and the number of trials they required to adapt. Results: Participants with stroke (n = 36) adapted less and required more trials to adapt than controls (n = 29). Stroke affecting the dominant arm impaired the amount of adaptation more than stroke affecting the non-dominant arm. Overall, 53% of participants with stroke were impaired in one or more measures of visuomotor adaptation. Initial adaptation was weakly correlated with time post-stroke, and the amount of adaptation correlated moderately with clinical measures of motor impairment and functional independence. Conclusion: Our findings reveal impairments in visuomotor adaptation that are associated with motor impairment and function after stroke. Longitudinal studies are needed to understand the relationship between adaptation and recovery attained in a therapy setting.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Assessing Impairments in Visuomotor Adaptation After Stroke

Moore

Piitz

Singh

et al. 2022

Neurorehabil Neural Repair

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“…This understanding may be crucial for the development of interventions to promote motor recovery in populations with neurological disorders. Given that recovery-supportive neuroplasticity, motor learning and task practice are fundamental to neurorehabilitation ( Winstein et al, 2014 ) understanding how to engage the neural substrates associated with contemporary motor learning mechanisms will serve to begin to translate this new science into actionable practice through evidence-based clinical decision making (e.g., Leech et al, 2022 ). Our study findings provide beginning evidence to inform the design of interventions that incorporate task practice paradigms in light of the neural substrates engaged in motor learning.…”

Section: Discussionmentioning

confidence: 99%

Different Patterns of Neural Activity Characterize Motor Skill Performance During Acquisition and Retention

Beroukhim-Kay

Kim

Monterosso

et al. 2022

Front. Hum. Neurosci.

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Motor performance and learning have distinct behavioral and neural signatures and can be uniquely modulated by various informational and motivational factors. Contemporary frameworks describe four different motor learning mechanisms mapped onto specific neural regions which are key for motor skill acquisition: error-based learning (cerebellum), reinforcement learning (basal ganglia), cognitive strategies (prefrontal cortex), and use-dependent learning (motor cortex). However, little is known about the neural circuits engaged during skill acquisition that are modulated specifically by practice-based performance improvement and those that predict recall performance. Based on previous work, we hypothesize that brain activity during practice in primary motor cortex and basal ganglia (1) is associated with trial-by-trial practice performance and (2) is predictive of immediate recall performance. Leveraging the contemporary framework, we use a well-known task paradigm that primarily relies upon cognitive strategy, reinforcement, and use-based learning mechanisms to test our hypotheses. Forty neurotypical young adults were asked to practice a pinch force tracking task. Participants received performance feedback after each trial during practice. We used whole brain analysis of functional magnetic resonance imaging (fMRI) and behavioral performance measures (i.e., time-on-target and self-efficacy) during the practice phase to determine which brain activation patterns are (1) associated with trial-by-trial tracking performance and (2) predictive of immediate no-feedback retention performance. We observed brain activations in the frontal orbital cortex, putamen, amygdala, and insula correlated with tracking performance improvement during practice. In contrast, a different set of performance-related activated regions were observed that were associated with immediate retention performance that included the primary motor cortex, superior frontal gyrus, somatosensory cortex, angular gyrus, and parietal gyrus. Our findings demonstrate that improved practice performance and recall of a sensorimotor skill are correlated with distinct neural activity patterns during acquisition, drawing on different motor learning mechanisms during encoding. While motor performance improvements depend on both cortical and subcortical regions, motor skill recall depends primarily on prefrontal and motor cortices. We discuss possible interpretations for why our hypothesis regarding basal ganglia activity and retention performance was not supported. Understanding the different neural mechanisms engaged in motor performance and learning may inform novel interventions to enhance motor skill learning.

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“…Gait training interventions based on the principles of motor learning (ML) can improve the gait pattern [ 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 ]. Motor learning is an efficacious rehabilitation approach based on a high repetition of task-oriented exercises that can be incrementally progressed to ensure adequate challenge [ 15 , 16 ]. However, these successful interventions call for intensive and long-duration treatments that are not financially practical in the current health care milieu.…”

Section: Introductionmentioning

confidence: 99%

Stance Phase Gait Training Post Stroke Using Simultaneous Transcranial Direct Current Stimulation and Motor Learning-Based Virtual Reality-Assisted Therapy: Protocol Development and Initial Testing

et al. 2022

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Gait deficits are often persistent after stroke, and current rehabilitation methods do not restore normal gait for everyone. Targeted methods of focused gait therapy that meet the individual needs of each stroke survivor are needed. Our objective was to develop and test a combination protocol of simultaneous brain stimulation and focused stance phase training for people with chronic stroke (>6 months). We combined Transcranial Direct Current Stimulation (tDCS) with targeted stance phase therapy using Virtual Reality (VR)-assisted treadmill training and overground practice. The training was guided by motor learning principles. Five users (>6 months post-stroke with stance phase gait deficits) completed 10 treatment sessions. Each session began with 30 min of VR-assisted treadmill training designed to apply motor learning (ML)-based stance phase targeted practice. During the first 15 min of the treadmill training, bihemispheric tDCS was simultaneously delivered. Immediately after, users completed 30 min of overground (ML)-based gait training. The outcomes included the feasibility of protocol administration, gait speed, Timed Up and Go (TUG), Functional Gait Assessment (FGA), paretic limb stance phase control capability, and the Fugl–Meyer for lower extremity coordination (FMLE). The changes in the outcome measures (except the assessments of stance phase control capability) were calculated as the difference from baseline. Statistically and clinically significant improvements were observed after 10 treatment sessions in gait speed (0.25 ± 0.11 m/s) and FGA (4.55 ± 3.08 points). Statistically significant improvements were observed in TUG (2.36 ± 3.81 s) and FMLE (4.08 ± 1.82 points). A 10-session intervention combining tDCS and ML-based task-specific gait rehabilitation was feasible and produced clinically meaningful improvements in lower limb function in people with chronic gait deficits after stroke. Because only five users tested the new protocol, the results cannot be generalized to the whole population. As a contribution to the field, we developed and tested a protocol combining brain stimulation and ML-based stance phase training for individuals with chronic stance phase deficits after stroke. The protocol was feasible to administer; statistically and/or clinically significant improvements in gait function across an array of gait performance measures were observed with this relatively short treatment protocol.

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Updates in Motor Learning: Implications for Physical Therapist Practice and Education

Cited by 55 publications

References 73 publications

Assessing Impairments in Visuomotor Adaptation After Stroke

Assessing Impairments in Visuomotor Adaptation After Stroke

Different Patterns of Neural Activity Characterize Motor Skill Performance During Acquisition and Retention

Stance Phase Gait Training Post Stroke Using Simultaneous Transcranial Direct Current Stimulation and Motor Learning-Based Virtual Reality-Assisted Therapy: Protocol Development and Initial Testing

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