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Korte JA, Weakley A, Donjuan Fernandez K, Joiner WM, Fan AP. Neural Underpinnings of Learning in Dementia Populations: A Review of Motor Learning Studies Combined with Neuroimaging. J Cogn Neurosci 2024; 36:734-755. [PMID: 38285732 DOI: 10.1162/jocn_a_02116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2024]
Abstract
The intent of this review article is to serve as an overview of current research regarding the neural characteristics of motor learning in Alzheimer disease (AD) as well as prodromal phases of AD: at-risk populations, and mild cognitive impairment. This review seeks to provide a cognitive framework to compare various motor tasks. We will highlight the neural characteristics related to cognitive domains that, through imaging, display functional or structural changes because of AD progression. In turn, this motivates the use of motor learning paradigms as possible screening techniques for AD and will build upon our current understanding of learning abilities in AD populations.
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Mychajliw C, Holz H, Minuth N, Dawidowsky K, Eschweiler GW, Metzger FG, Wortha F. Performance Differences of a Touch-Based Serial Reaction Time Task in Healthy Older Participants and Older Participants With Cognitive Impairment on a Tablet: Experimental Study. JMIR Aging 2024; 7:e48265. [PMID: 38512340 PMCID: PMC10995790 DOI: 10.2196/48265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 11/30/2023] [Accepted: 12/08/2023] [Indexed: 03/22/2024] Open
Abstract
BACKGROUND Digital neuropsychological tools for diagnosing neurodegenerative diseases in the older population are becoming more relevant and widely adopted because of their diagnostic capabilities. In this context, explicit memory is mainly examined. The assessment of implicit memory occurs to a lesser extent. A common measure for this assessment is the serial reaction time task (SRTT). OBJECTIVE This study aims to develop and empirically test a digital tablet-based SRTT in older participants with cognitive impairment (CoI) and healthy control (HC) participants. On the basis of the parameters of response accuracy, reaction time, and learning curve, we measure implicit learning and compare the HC and CoI groups. METHODS A total of 45 individuals (n=27, 60% HCs and n=18, 40% participants with CoI-diagnosed by an interdisciplinary team) completed a tablet-based SRTT. They were presented with 4 blocks of stimuli in sequence and a fifth block that consisted of stimuli appearing in random order. Statistical and machine learning modeling approaches were used to investigate how healthy individuals and individuals with CoI differed in their task performance and implicit learning. RESULTS Linear mixed-effects models showed that individuals with CoI had significantly higher error rates (b=-3.64, SE 0.86; z=-4.25; P<.001); higher reaction times (F1,41=22.32; P<.001); and lower implicit learning, measured via the response increase between sequence blocks and the random block (β=-0.34; SE 0.12; t=-2.81; P=.007). Furthermore, machine learning models based on these findings were able to reliably and accurately predict whether an individual was in the HC or CoI group, with an average prediction accuracy of 77.13% (95% CI 74.67%-81.33%). CONCLUSIONS Our results showed that the HC and CoI groups differed substantially in their performance in the SRTT. This highlights the promising potential of implicit learning paradigms in the detection of CoI. The short testing paradigm based on these results is easy to use in clinical practice.
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Affiliation(s)
- Christian Mychajliw
- Geriatric Center, University Hospital for Psychiatry and Psychotherapy, University of Tübingen, Tübingen, Germany
- TuCAN, Tübingen Cognitive Assessment for Neuropsychiatric Disorders, Tübingen, Germany
| | - Heiko Holz
- TuCAN, Tübingen Cognitive Assessment for Neuropsychiatric Disorders, Tübingen, Germany
- Institute of Computer Science, Ludwigsburg University of Education, Ludwigsburg, Germany
- LEAD Graduate School & Research Network, University of Tübingen, Tübingen, Germany
| | - Nathalie Minuth
- Geriatric Center, University Hospital for Psychiatry and Psychotherapy, University of Tübingen, Tübingen, Germany
- TuCAN, Tübingen Cognitive Assessment for Neuropsychiatric Disorders, Tübingen, Germany
| | - Kristina Dawidowsky
- Geriatric Center, University Hospital for Psychiatry and Psychotherapy, University of Tübingen, Tübingen, Germany
- TuCAN, Tübingen Cognitive Assessment for Neuropsychiatric Disorders, Tübingen, Germany
| | - Gerhard Wilhelm Eschweiler
- Geriatric Center, University Hospital for Psychiatry and Psychotherapy, University of Tübingen, Tübingen, Germany
| | - Florian Gerhard Metzger
- Geriatric Center, University Hospital for Psychiatry and Psychotherapy, University of Tübingen, Tübingen, Germany
- Vitos Hospital for Psychiatry and Psychotherapy Haina, Klinik für Psychiatrie und Psychotherapie, Vitos Haina gGmbH, Haina, Germany
| | - Franz Wortha
- TuCAN, Tübingen Cognitive Assessment for Neuropsychiatric Disorders, Tübingen, Germany
- LEAD Graduate School & Research Network, University of Tübingen, Tübingen, Germany
- Centre for Early Mathematics Learning, School of Science, Loughborough University, Loughborough, United Kingdom
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Palma GCS, Freitas TB, Bonuzzi GMG, Torriani-Pasin C. Does Cognitive Impairment Impact Motor Learning? A Scoping Review of Elderly Individuals With Alzheimer's Disease and Mild Cognitive Impairment. Percept Mot Skills 2023; 130:1924-1951. [PMID: 37337358 DOI: 10.1177/00315125231182732] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/21/2023]
Abstract
Individuals with cognitive impairment may have motor learning deficits due to the high engagement of cognitive mechanisms during motor skill acquisition. We conducted a scoping review to address the quality of current research on the relationship between cognitive impairments (i.e., deficits in attention, memory, planning and executive functions) and motor learning among older adults with Alzheimer's Disease or Mild Cognitive Impairment. After screening thousands of articles, we selected 15 studies describing cognitive assessment tools, experimental designs, and the severity of cognitive impairment. Although seven studies reported that cognitive impairment impaired motor learning, most studies included a high risk of bias. We identified multiple assessment tools across these studies that make comparisons among findings difficult. Future research in this area should focus on the influence of increased practice days during motor learning acquisition and incorporate both retention and transfer tests. Cognitive assessments should target the specific cognitive skills or deficits most closely related to the motor learning process.
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Affiliation(s)
- Gisele C S Palma
- Motor Behavior Research in Neurorehabilitation (GEPENEURO), Laboratory of Motor Behavior (LACOM), University of São Paulo, São Paulo, Brazil
| | - Tatiana B Freitas
- Motor Behavior Research in Neurorehabilitation (GEPENEURO), Laboratory of Motor Behavior (LACOM), University of São Paulo, São Paulo, Brazil
| | - Giordano Márcio G Bonuzzi
- Department of Physical Education, State University of Piauí, Picos, Piauí, Brazil
- Department of Physical Education, Federal University of Vale do São Francisco, Petrolina, Pernambuco, Brazil
| | - Camila Torriani-Pasin
- Motor Behavior Research in Neurorehabilitation (GEPENEURO), Laboratory of Motor Behavior (LACOM), University of São Paulo, São Paulo, Brazil
- Neurorehabilitation, Exercise Science and Learning (NEUROEXCEL), Department of Physical Therapy and Movement Sciences, The University of Texas at El Paso, El Paso, Texas, USA
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Martin E, Scotté-Barranoff C, Tallet J. What neurological diseases tell us about procedural perceptual-motor learning? A systematic review of the literature. Neurol Sci 2023:10.1007/s10072-023-06724-w. [PMID: 36973591 DOI: 10.1007/s10072-023-06724-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Accepted: 03/01/2023] [Indexed: 03/29/2023]
Abstract
INTRODUCTION Procedural perceptual-motor learning of sequences (PPMLS) provides perceptual-motor skills in many activities of daily living. Based on behavioral and neuroimaging results, theoretical models of PPMLS postulate that the cortico-striatal loop, the cortico-cerebellar loop and the hippocampus are specifically involved in the early stage of PPMLS while the cortico-striatal loop would be specifically involved in the late stage of PPMLS. Hence, current models predict that the early stage of PPMLS should be impaired in Parkinson's disease (PD: lesion of the cortico-striatal loop), in cerebellar disease (CD: lesion of the cortico-cerebellar loop) and in Alzheimer's disease (AD: lesion of the hippocampus), whereas the late stage of PPMLS should be specifically impaired in PD. OBJECTIVE The aim of the study is (1) to draw a complete picture of experimental results on PPMLS in PD, CD and AD (2) to understand heterogeneity of results as regard to participant and task characteristics. METHOD This review is based on the guideline proposed by the PRISMA statement. RESULTS Our review reveals (1) that the experimental results clarify the theoretical models and (2) that the impairment of PPMLS depends on both the personal characteristics of the participants and the characteristics of the task to-be-learnt rather than on the disease itself. CONCLUSION Our results highlight that these characteristics should be more carefully considered to understand the heterogeneity of results across studies on PPMLS and the effects of rehabilitation programs.
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Affiliation(s)
- Elodie Martin
- ToNIC, Toulouse NeuroImaging Center, Université de Toulouse, Inserm, UPS, Toulouse, France.
- Institut de Formation en Psychomotricité, Université Toulouse, UPS, Toulouse, France.
| | | | - Jessica Tallet
- ToNIC, Toulouse NeuroImaging Center, Université de Toulouse, Inserm, UPS, Toulouse, France
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De Wit L, Marsiske M, O'Shea D, Kessels RPC, Kurasz AM, DeFeis B, Schaefer N, Smith GE. Procedural Learning in Individuals with Amnestic Mild Cognitive Impairment and Alzheimer's Dementia: a Systematic Review and Meta-analysis. Neuropsychol Rev 2020; 31:103-114. [PMID: 32897482 PMCID: PMC7889687 DOI: 10.1007/s11065-020-09449-1] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Accepted: 07/30/2020] [Indexed: 11/24/2022]
Abstract
The notion that procedural learning and memory is spared in Alzheimer's disease (AD) has important implications for interventions aiming to build on intact cognitive functions. However, despite these clinical implications, there are mixed findings in the literature about whether or not procedural learning remains intact. This meta-analysis examines the standard mean difference of all published studies regarding procedural learning in AD dementia or amnestic Mild Cognitive Impairment (aMCI) compared to cognitively healthy older adults. Additionally, we conducted statistical equivalence analyses. Our systematic review showed that only a limited number of studies (k = 17) have compared procedural learning between individuals with aMCI or AD dementia and healthy controls. Our meta-analysis, which synthesized these studies, demonstrated that while procedural learning performance was not statistically equivalent between individuals with aMCI or AD dementia, and healthy older adults, the difference was clinically and statistically trivial. Although larger studies are needed, the present findings suggest that procedural learning does appear to remain spared in aMCI and AD dementia.
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Affiliation(s)
- Liselotte De Wit
- Department of Clinical and Health Psychology, University of Florida, P.O. Box 100165, Gainesville, FL, 32610-0165, USA. .,Donders Institute for Brain, Cognition and Behaviour, Radboud University, Montessorilaan 3, 6525, HR, Nijmegen, The Netherlands.
| | - Michael Marsiske
- Department of Clinical and Health Psychology, University of Florida, P.O. Box 100165, Gainesville, FL, 32610-0165, USA
| | - Deirdre O'Shea
- Department of Clinical and Health Psychology, University of Florida, P.O. Box 100165, Gainesville, FL, 32610-0165, USA
| | - Roy P C Kessels
- Donders Institute for Brain, Cognition and Behaviour, Radboud University, Montessorilaan 3, 6525, HR, Nijmegen, The Netherlands. .,Department of Medical Psychology & Radboudumc Alzheimer Center, Radboud University Medical Center, Postbus 9101, 6500, HB, Nijmegen, The Netherlands.
| | - Andrea M Kurasz
- Department of Clinical and Health Psychology, University of Florida, P.O. Box 100165, Gainesville, FL, 32610-0165, USA
| | - Brittany DeFeis
- Department of Clinical and Health Psychology, University of Florida, P.O. Box 100165, Gainesville, FL, 32610-0165, USA
| | - Nancy Schaefer
- University of Florida Health Science Center Libraries, University of Florida, SW Archer Rd, Gainesville, FL, 32610, USA
| | - Glenn E Smith
- Department of Clinical and Health Psychology, University of Florida, P.O. Box 100165, Gainesville, FL, 32610-0165, USA.
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Brown SR, Yoward S. The effectiveness of home-based exercise programmes on mobility and functional independence in community-dwelling adults with Alzheimer's disease: a critical review. INTERNATIONAL JOURNAL OF THERAPY AND REHABILITATION 2019. [DOI: 10.12968/ijtr.2017.0168] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Background/AimsIn the UK, two-thirds of people with dementia are community-dwelling. Guidelines recommend exercise to promote independence among this population, however evidence to support this is scarce. This study aimed to evaluate the effectiveness of home-based exercise programmes on mobility and functional independence in people with Alzheimer's disease living in the community.MethodsThe following electronic databases were searched: AMED, CINAHL, EMBASE, Medline, SPORTsDiscus, The Cochrane Library, PEDro, OpenGrey and Online Thesis. All included trials were assessed for methodological quality using PEDro bias scores and McMaster's Critical Appraisal Tool and Guideline. English language restrictions were applied.ResultsA total of seven trials were included within the review. Trial quality was mixed. All trials reported measures for mobility, while five trials included measures of functional independence. Results for the effectiveness of home-based exercise on mobility were mixed, with only two studies reporting significant improvements. Functional independence significantly improved in all trials.ConclusionsThe effectiveness of home-based exercise programmes on mobility in community-dwelling people with Alzheimer's disease remains inconclusive, while a growing body of evidence indicates its effectiveness in improving functional independence. However, high quality trials are scarce. Larger, randomised, controlled trials specific to this population are thus warranted.
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Affiliation(s)
- Samantha Rachael Brown
- Senior Physiotherapist in Older Person's Medicine, Newcastle-upon-Tyne, Hospitals NHS Foundation Trust, Newcastle-upon-Tyne, UK
| | - Samantha Yoward
- Senior Lecturer, School of Health Sciences, York St John University, York, UK
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Motor deficits in 16-month-old male and female 3xTg-AD mice. Behav Brain Res 2019; 356:305-313. [DOI: 10.1016/j.bbr.2018.09.006] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Revised: 09/07/2018] [Accepted: 09/08/2018] [Indexed: 11/22/2022]
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Chauvel G, Maquestiaux F, Gemonet E, Hartley A, Didierjean A, Masters R, Dieudonné B, Verny M, Bier N, Joubert S. Intact Procedural Knowledge in Patients with Alzheimer's Disease: Evidence from Golf Putting. J Mot Behav 2017; 50:268-274. [PMID: 28850319 DOI: 10.1080/00222895.2017.1341376] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Can Alzheimer's disease (AD) patients efficiently learn to perform a complex motor skill when relying on procedural knowledge? To address this question, the authors compared the golf-putting performance of AD patients, older adults, and younger adults in 2 different learning situations: one that promotes high error rates (thus increasing the reliance on declarative knowledge) or one that promotes low error rates (thus increasing the reliance on procedural knowledge). Motor performance was poorer overall for AD patients and older adults relative to younger adults in the high-error condition but equivalent between similar groups in the low-error condition. Also, AD patients in the low-error condition had better performance at the final putting distance relative to those in the high-error condition. This performance facilitation for AD patients likely stems from intact procedural knowledge.
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Affiliation(s)
- Guillaume Chauvel
- a Department of Psychology , Université de Franche-Comté , Besançon , France
| | - François Maquestiaux
- a Department of Psychology , Université de Franche-Comté , Besançon , France.,b Institut Universitaire de France , Paris , France
| | - Elise Gemonet
- c Department of Sport Sciences , Aix-Marseille Université , Marseille , France
| | - Alan Hartley
- d Psychology, Scripps College , Claremont , California
| | - André Didierjean
- a Department of Psychology , Université de Franche-Comté , Besançon , France
| | - Rich Masters
- e Sport and Leisure Studies Department , University of Waikato , Hamilton , New Zealand
| | - Bénédicte Dieudonné
- f Hôpital de la Pitié Salpêtrière , Université Pierre et Marie Curie , Paris , France
| | - Marc Verny
- f Hôpital de la Pitié Salpêtrière , Université Pierre et Marie Curie , Paris , France
| | - Nathalie Bier
- g Institut Universitaire de Geriatrie de Montreal , Universite de Montreal , Canada
| | - Sven Joubert
- g Institut Universitaire de Geriatrie de Montreal , Universite de Montreal , Canada
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9
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Werner C, Wiloth S, Lemke NC, Kronbach F, Jansen CP, Oster P, Bauer JM, Hauer K. People with Dementia Can Learn Compensatory Movement Maneuvers for the Sit-to-Stand Task: A Randomized Controlled Trial. J Alzheimers Dis 2017; 60:107-120. [PMID: 28759967 DOI: 10.3233/jad-170258] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND A complex motor skill highly relevant to mobility in everyday life (e.g., sit-to-stand [STS] transfer) has not yet been addressed in studies on motor learning in people with dementia (PwD). OBJECTIVE To determine whether a dementia-specific motor learning exercise program enables PwD to learn compensatory STS maneuvers commonly taught in geriatric rehabilitation therapy to enhance patients' STS ability. METHODS Ninety-seven patients with mild-to-moderate dementia (Mini-Mental State Examination: 21.9±2.9 points) participated in a double-blinded, randomized, placebo-controlled trial with 10-week intervention and 3-month follow-up period. The intervention group (IG, n = 51) underwent a motor learning exercise program on compensatory STS maneuvers specifically designed for PwD. The control group (CG, n = 46) performed a low-intensity motor placebo activity. Primary outcomes were scores of the Assessment of Compensatory Sit-to-stand Maneuvers in People with Dementia (ACSID), which covers the number of recalled and initiated, and of effectively performed compensatory STS maneuvers. Secondary outcomes included temporal and kinematic STS characteristics measured by a body-fixed motion sensor (BFS, DynaPort® Hybrid). RESULTS The IG significantly improved in all ACSID scores compared to the CG (p < 0.001). Secondary analysis confirmed learning effects for all BFS-based outcomes (p < 0.001-0.006). Learning gains were sustained during follow-up for most outcomes. CONCLUSION People with mild-to-moderate dementia can learn and retain compensatory STS maneuvers in response to a dementia-specific motor learning exercise program. This is the first study that demonstrated preserved motor learning abilities in PwD by using a motor skill highly relevant to everyday life.
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Affiliation(s)
- Christian Werner
- Department of Geriatric Research, Agaplesion Bethanien Hospital Heidelberg, Geriatric Center at the University of Heidelberg, Heidelberg, Germany
| | - Stefanie Wiloth
- Department of Geriatric Research, Agaplesion Bethanien Hospital Heidelberg, Geriatric Center at the University of Heidelberg, Heidelberg, Germany.,Institute for the Study of Christian Social Service, University of Heidelberg, Heidelberg, Germany
| | - Nele Christin Lemke
- Institute for the Study of Christian Social Service, University of Heidelberg, Heidelberg, Germany.,Network of Aging Research (NAR), University of Heidelberg, Heidelberg, Germany
| | - Florian Kronbach
- Department of Interdisciplinary Emergency Medicine, Katharinenhospital Stuttgart, Stuttgart, Germany
| | - Carl-Philipp Jansen
- Department of Psychological Aging Research, Institute of Psychology, University of Heidelberg, Heidelberg, Germany
| | - Peter Oster
- Department of Geriatric Research, Agaplesion Bethanien Hospital Heidelberg, Geriatric Center at the University of Heidelberg, Heidelberg, Germany
| | - Jürgen M Bauer
- Department of Geriatric Research, Agaplesion Bethanien Hospital Heidelberg, Geriatric Center at the University of Heidelberg, Heidelberg, Germany.,Center of Geriatric Medicine, University of Heidelberg, Heidelberg, Germany
| | - Klaus Hauer
- Department of Geriatric Research, Agaplesion Bethanien Hospital Heidelberg, Geriatric Center at the University of Heidelberg, Heidelberg, Germany
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Schaefer SY, Duff K. Within-session and one-week practice effects on a motor task in amnestic mild cognitive impairment. J Clin Exp Neuropsychol 2016; 39:473-484. [PMID: 27690745 DOI: 10.1080/13803395.2016.1236905] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Practice effects on neuropsychological tests, which are improvements in test scores due to repeated exposure to testing materials, are robust in healthy elders, but muted in older adults with cognitive disorders. Conversely, few studies have investigated practice effects on motor tasks involving procedural memory, particularly across test-retest periods exceeding 24 hours. The current study examined one-week practice effects on a novel upper extremity motor task in 54 older adults with amnestic mild cognitive impairment. Results indicate that these individuals with primary memory deficits did improve on this motor task within a brief training session as well as across one week. These practice effects were unrelated to demographic characteristics or global cognition. One-week practice effects were, however, negatively related to delayed memory function, with larger practice effects being associated with poorer delayed memory and potentially better visuospatial ability. The presence of longer term practice effects on a procedural motor task not only has implications for how longitudinal assessments with similar measures involving implicit memory might be interpreted, but may also inform future rehabilitative strategies for patients with more severe declarative memory deficits.
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Affiliation(s)
- Sydney Y Schaefer
- a School of Biological and Health Systems Engineering , Arizona State University , Tempe , AZ , USA.,b Center on Aging , University of Utah , Salt Lake City , UT , USA
| | - Kevin Duff
- b Center on Aging , University of Utah , Salt Lake City , UT , USA.,c Department of Neurology , University of Utah , Salt Lake City , UT , USA.,d Center for Alzheimer's Care, Imaging and Research , University of Utah , Salt Lake City , UT , USA
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Lynch B, Beukema P, Verstynen T. Differentiating Visual from Response Sequencing during Long-term Skill Learning. J Cogn Neurosci 2016; 29:125-136. [PMID: 27626233 DOI: 10.1162/jocn_a_01037] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
The dual-system model of sequence learning posits that during early learning there is an advantage for encoding sequences in sensory frames; however, it remains unclear whether this advantage extends to long-term consolidation. Using the serial RT task, we set out to distinguish the dynamics of learning sequential orders of visual cues from learning sequential responses. On each day, most participants learned a new mapping between a set of symbolic cues and responses made with one of four fingers, after which they were exposed to trial blocks of either randomly ordered cues or deterministic ordered cues (12-item sequence). Participants were randomly assigned to one of four groups (n = 15 per group): Visual sequences (same sequence of visual cues across training days), Response sequences (same order of key presses across training days), Combined (same serial order of cues and responses on all training days), and a Control group (a novel sequence each training day). Across 5 days of training, sequence-specific measures of response speed and accuracy improved faster in the Visual group than any of the other three groups, despite no group differences in explicit awareness of the sequence. The two groups that were exposed to the same visual sequence across days showed a marginal improvement in response binding that was not found in the other groups. These results indicate that there is an advantage, in terms of rate of consolidation across multiple days of training, for learning sequences of actions in a sensory representational space, rather than as motoric representations.
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12
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Kim HF, Hikosaka O. Parallel basal ganglia circuits for voluntary and automatic behaviour to reach rewards. Brain 2015; 138:1776-800. [PMID: 25981958 DOI: 10.1093/brain/awv134] [Citation(s) in RCA: 101] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2014] [Accepted: 04/14/2015] [Indexed: 11/13/2022] Open
Abstract
The basal ganglia control body movements, value processing and decision-making. Many studies have shown that the inputs and outputs of each basal ganglia structure are topographically organized, which suggests that the basal ganglia consist of separate circuits that serve distinct functions. A notable example is the circuits that originate from the rostral (head) and caudal (tail) regions of the caudate nucleus, both of which target the superior colliculus. These two caudate regions encode the reward values of visual objects differently: flexible (short-term) values by the caudate head and stable (long-term) values by the caudate tail. These value signals in the caudate guide the orienting of gaze differently: voluntary saccades by the caudate head circuit and automatic saccades by the caudate tail circuit. Moreover, separate groups of dopamine neurons innervate the caudate head and tail and may selectively guide the flexible and stable learning/memory in the caudate regions. Studies focusing on manual handling of objects also suggest that rostrocaudally separated circuits in the basal ganglia control the action differently. These results suggest that the basal ganglia contain parallel circuits for two steps of goal-directed behaviour: finding valuable objects and manipulating the valuable objects. These parallel circuits may underlie voluntary behaviour and automatic skills, enabling animals (including humans) to adapt to both volatile and stable environments. This understanding of the functions and mechanisms of the basal ganglia parallel circuits may inform the differential diagnosis and treatment of basal ganglia disorders.
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Affiliation(s)
- Hyoung F Kim
- Laboratory of Sensorimotor Research, National Eye Institute, National Institutes of Health, Bethesda, MD 20892, USA
| | - Okihide Hikosaka
- Laboratory of Sensorimotor Research, National Eye Institute, National Institutes of Health, Bethesda, MD 20892, USA
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13
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White L, Ford MP, Brown CJ, Peel C, Triebel KL. Facilitating the use of implicit memory and learning in the physical therapy management of individuals with Alzheimer disease: a case series. J Geriatr Phys Ther 2014; 37:35-44. [PMID: 23459238 DOI: 10.1519/jpt.0b013e3182862d2c] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND AND PURPOSE Physical rehabilitation of individuals with Alzheimer disease (AD) is often complicated by impairments in explicit memory and learning. Rehabilitation strategies that facilitate the use of the preserved implicit memory system may be effective in treating patients with AD. The purpose of this case series is to describe the application of these strategies, including high-repetition practice, errorless learning (EL), and spaced retrieval, to the physical therapy management of individuals with moderate AD. CASE DESCRIPTION Three women aged 89 to 95 years with moderate AD who resided in an assisted living facility participated in physical therapy to address their mobility limitations. INTERVENTION Twelve physical therapy sessions were scheduled over a period of 4 weeks. Interventions were individually designed to address the mobility needs of each patient, and rehabilitation strategies based on implicit learning principles were integrated into the interventions. OUTCOMES All patients participated in at least 10 of the 12 physical therapy sessions. Improvements in performance of objective measures of balance were observed in all patients, although only 1 patient's balance score exceeded the minimal detectable change. No significant clinical change was observed in any patients on the Timed Up and Go Test or self-selected gait speed. DISCUSSION Principles of implicit learning were integrated into the interventions for these patients with moderate AD. However, the feasibility of applying the EL paradigm was limited. Further research on the effectiveness of EL, spaced retrieval, and other rehabilitation strategies that facilitate implicit learning of mobility skills in patients with AD is needed to promote optimal physical therapy outcomes in this patient population.
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Affiliation(s)
- Laura White
- 1University of South Alabama, Mobile. 2University of Alabama at Birmingham
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Gidley Larson JC, Suchy Y. The contribution of verbalization to action. PSYCHOLOGICAL RESEARCH 2014; 79:590-608. [DOI: 10.1007/s00426-014-0586-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2013] [Accepted: 06/04/2014] [Indexed: 11/28/2022]
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15
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Evidence of altered corticomotor system connectivity in early-stage Alzheimer's disease. J Neurol Phys Ther 2012; 36:8-16. [PMID: 22333920 DOI: 10.1097/npt.0b013e3182462ea6] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND AND PURPOSE There is increasing evidence for subtle motor dysfunction early in Alzheimer disease (AD), including common motor behaviors that were once considered unaffected early in the disease process. Our objective was to assess whether functional neural networks underlying motor behavior are altered by AD. METHODS We investigated AD-related differences in regional brain activation during motor performance. Nine older adults with early-stage AD and 10 without dementia underwent functional magnetic resonance imaging while performing a visually directed simple motor task (hand squeeze). RESULTS Despite some similarity in brain activation during motor performance, we found that individuals without dementia exhibited greater activation in accessory motor regions, supplementary motor area, and cerebellum compared with those with AD. We also assessed disease-related differences in regions where activity was functionally integrated with primary motor cortex. Using a psychophysiological interaction analysis, we found that those with AD displayed increased coactivation with primary motor cortex of bilateral motor and visual regions. DISCUSSION AND CONCLUSIONS These AD-related differences in regional coactivation during motor execution may represent inefficiency in the motor network as a consequence of the disease process. Alternatively, they may represent compensatory activation. These findings provide further evidence that in early stages of AD, neuromotor function is altered even during simple motor behaviors. The results may have implications for performance of more complex tasks and may be associated with the well-characterized decline in dual-task performance in those with AD.
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Borich MR, Kimberley TJ. Both sleep and wakefulness support consolidation of continuous, goal-directed, visuomotor skill. Exp Brain Res 2011; 214:619-30. [PMID: 21912927 DOI: 10.1007/s00221-011-2863-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2011] [Accepted: 09/01/2011] [Indexed: 11/26/2022]
Abstract
Sleep has been shown to benefit memory consolidation for certain motor skills, but it remains unclear if this relationship exists for motor skills with direct rehabilitation applications. We aimed to determine the neurobehavioral relationship between finger-tracking skill development and sleep following skill training in young, healthy subjects. Forty subjects received tracking training in the morning (n = 20) or the evening (n = 20). Measures of tracking skill and cortical excitability were collected before and after training. Following training, tracking skill and measures of cortical excitability were assessed at two additional follow-up visits (12 and 24 h post-training) for each subject following an episode of sleep or waking activity. Two-way repeated-measures ANOVAs with Bonferroni-adjusted post hoc tests were conducted for tracking accuracy and measures of cortical excitability. Skill performance improved after training and continued to develop offline during the first post-training interval (12 h). This development was not further enhanced by sleep during this interval. Level of skill improvement was maintained for at least one day in both training groups. Cortical excitability was reduced following training and was related to level of skill performance at follow-up assessment. These data suggest offline memory consolidation of a continuous, visuospatial, finger-tracking skill is not dependent on sleep. These findings are in agreement with recent literature, indicating characteristics of a motor skill may be sensitive to the beneficial effect of sleep on post-training information processing.
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Affiliation(s)
- Michael R Borich
- Department of Physical Medicine and Rehabilitation, Program in Physical Therapy/Rehabilitation Science, University of Minnesota, Minneapolis, MN, USA.
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Learning to perceive structure from motion and neural plasticity in patients with Alzheimer's disease. Neuropsychologia 2010; 48:1464-71. [DOI: 10.1016/j.neuropsychologia.2010.01.016] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2009] [Revised: 01/21/2010] [Accepted: 01/21/2010] [Indexed: 11/19/2022]
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Wångblad C, Ekblad M, Wijk H, Ivanoff SD. Experiences of physical strain during person transfer situations in dementia care units. Scand J Caring Sci 2009; 23:644-50. [DOI: 10.1111/j.1471-6712.2008.00655.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Machado S, Cunha M, Minc D, Portella CE, Velasques B, Basile LF, Cagy M, Piedade R, Ribeiro P. Alzheimer's disease and implicit memory. ARQUIVOS DE NEURO-PSIQUIATRIA 2009; 67:334-42. [DOI: 10.1590/s0004-282x2009000200034] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/27/2008] [Accepted: 02/21/2009] [Indexed: 11/21/2022]
Abstract
Specific neuropsychiatric disorders, such as Alzheimer's disease (AD) affect some forms of memory while leaving others relatively intact. In this review, we investigate particularities of the relationship between explicit and implicit memories in AD. It was found that implicit memory is preserved in AD, irrespective of the task used; in other words, there was not interference from explicit memory. In addition, it was verified that is possible through implicit memory compensatory strategies such as, activities of daily living (ADL) to compensate for the explicit memory deficits. In this sense, cognitive rehabilitation (CR) demonstrates reasonable results in the process of compensation of explicit memory deficits. Concluding, the decline in explicit memory suggests that both systems are functionally independent even if the other is compromised. We expect that when explicit memory system is not involved in competition with the implicit system, the final effect of learning is better, because all of the implicit memory capacity is engaged in learning and not in competition with the explicit system.
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Affiliation(s)
- Sergio Machado
- Federal University of Rio de Janeiro, Brazil; Brazilian Institute of Neural Bioscience, Brazil
| | - Marlo Cunha
- Federal University of Rio de Janeiro, Brazil; Brazilian Institute of Neural Bioscience, Brazil
| | - Daniel Minc
- Federal University of Rio de Janeiro, Brazil
| | | | - Bruna Velasques
- Federal University of Rio de Janeiro, Brazil; Brazilian Institute of Neural Bioscience, Brazil
| | - Luis F. Basile
- University of São Paulo Medical School, Brazil; UMESP, Brazil
| | | | | | - Pedro Ribeiro
- Federal University of Rio de Janeiro, Brazil; UFRJ, Brazil; Brazilian Institute of Neural Bioscience, Brazil
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van Halteren-van Tilborg IADA, Scherder EJA, Hulstijn W. Motor-skill learning in Alzheimer's disease: a review with an eye to the clinical practice. Neuropsychol Rev 2007; 17:203-12. [PMID: 17680369 PMCID: PMC2039835 DOI: 10.1007/s11065-007-9030-1] [Citation(s) in RCA: 111] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Since elderly people suffering from dementia want to go on living independently for as long as possible, they need to be able to maintain familiar and learn new practical skills. Although explicit or declarative learning methods are mostly used to train new skills, it is hypothesized that implicit or procedural techniques may be more effective in this population. The present review discusses 23 experimental studies on implicit motor-skill learning in patients with Alzheimer's disease (AD). All studies found intact implicit motor-learning capacities. Subsequently, it is elaborated how these intact learning abilities can be exploited in the patients' rehabilitation with respect to the variables 'practice' and 'feedback.' Recommendations for future research are provided, and it is concluded that if training programs are adjusted to specific needs and abilities, older people with AD are well able to (re)learn practical motor skills, which may enhance their autonomy.
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Lafosse JM, Corboy JR, Leehey MA, Seeberger LC, Filley CM. MS vs. HD: can white matter and subcortical gray matter pathology be distinguished neuropsychologically? J Clin Exp Neuropsychol 2007; 29:142-54. [PMID: 17365249 DOI: 10.1080/13803390600582438] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
This study was conducted to examine the neuropsychological effects of white matter and subcortical gray matter pathology. Nineteen patients with multiple sclerosis (MS), 16 with Huntington's disease (HD), and 17 normal controls (NC) participated. Participants completed the California Verbal Learning Test (CVLT), Rotary Pursuit (RP) and Mirror Tracing (MT) tasks, and the Symbol Digit Modalities Test (SDMT). The principal findings pertain to a dissociation in procedural memory: on RP, the HD group demonstrated impaired sequence learning compared to the MS group, which performed similarly to the NC group, yet on MT, the MS and HD groups demonstrated normal perceptual-motor integration learning. On the CVLT, both patient groups performed better on recognition than on recall. On the SDMT, both patient groups performed worse than the NC group, with the HD group performing more poorly than the MS and NC groups. These results suggest that involvement of white and subcortical gray matter may produce different neuropsychological effects.
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Affiliation(s)
- Jose M Lafosse
- Regis University, Department of Psychology and Neuroscience Program, Denver, CO 80221-1099, USA.
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Hauer K, Becker C, Lindemann U, Beyer N. Effectiveness of Physical Training on Motor Performance and Fall Prevention in Cognitively Impaired Older Persons. Am J Phys Med Rehabil 2006; 85:847-57. [PMID: 16998433 DOI: 10.1097/01.phm.0000228539.99682.32] [Citation(s) in RCA: 78] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To determine whether older cognitively impaired people benefit from physical training with regard to motor performance or fall risk reduction and to critically evaluate the methodologic approach in identified randomized controlled intervention trials. DESIGN Published randomized controlled intervention trials from 1966 through 2004 were identified in PubMed, CINAHL, Gerolit, and the Cochrane Central Register of Controlled Trials according to predefined inclusion criteria and evaluated by two independent reviewers using a modified rating system for randomized controlled intervention trials developed by the Cochrane Library. RESULTS There were 11 randomized controlled intervention trials that met the predefined inclusion criteria. There was a large heterogeneity regarding methodology, sample size, type of intervention, study outcomes, and analyses. We found conflicting evidence regarding the effect of physical training on motor performance and falls in older people with cognitive impairment. However, a considerable number of the studies had methodologic limitations, which hampered the evaluation of the effectiveness of training. CONCLUSIONS The randomized controlled intervention trials showed only limited effectiveness of physical training in patients with cognitive impairment. More studies with adequate sample size, sensitive and validated measurements, and higher specificity for the types of intervention targeting subgroups of patients with different degrees of cognitive impairment are required to give evidence-based recommendations.
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Affiliation(s)
- K Hauer
- Department of Geriatric Rehabilitation, Research Institute, Robert Bosch Foundation, Stuttgart, Germany
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Hochhalter AK, Overmier JB, Gasper SM, Bakke BL, Holub RJ. A COMPARISON OF SPACED RETRIEVAL TO OTHER SCHEDULES OF PRACTICE FOR PEOPLE WITH DEMENTIA. Exp Aging Res 2005; 31:101-18. [PMID: 15981792 DOI: 10.1080/03610730590914976] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Spaced retrieval training uses a schedule of practice trials distributed according to a learner's performance. The authors compared spaced retrieval to four alternative schedules of practice to determine whether it is more effective than other schedules for people with dementia. Participants practiced (a) pill names or (b) nonverbal sequences. Spaced retrieval did not produce long-term retention more often than other schedules of practice on either task. Participants with higher scores on one portion of the Hopkins Verbal Learning Test-Revised were more likely to show long-term retention of pill names regardless of schedule of practice (Experiment 1).
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Affiliation(s)
- Angela K Hochhalter
- Department of Psychology, University of Minnesota, Minneapolis, Minnesota, USA.
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Dick MB, Hsieh S, Bricker J, Dick-Muehlke C. Facilitating acquisition and transfer of a continuous motor task in healthy older adults and patients with Alzheimer's disease. Neuropsychology 2003; 17:202-12. [PMID: 12803425 DOI: 10.1037/0894-4105.17.2.202] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
This study examined the acquisition and transfer of a fine motor skill, namely the rotary pursuit, in 99 patients with Alzheimer's disease (AD) and 100 normal controls (NCs). To identify optimal learning strategies, the authors had participants practice the rotary pursuit under constant, blocked, random, or no training conditions. Transfer was assessed using speeds that were different from those practiced during acquisition. AD patients and NCs receiving constant practice outperformed their peers in the blocked and random conditions during acquisition. Whereas all 3 types of practice facilitated transfer in the NCs, AD patients only benefited from constant practice. The inability of the AD patients to benefit from variable practice suggests that these individuals may have difficulty accessing and/or forming motor schemas.
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Affiliation(s)
- Malcolm B Dick
- Institute for Brain Aging & Dementia, University of California, Irvine 92697-4285, USA.
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Dick MB, Hsieh S, Dick-Muehlke C, Davis DS, Cotman CW. The variability of practice hypothesis in motor learning: does it apply to Alzheimer's disease? Brain Cogn 2000; 44:470-89. [PMID: 11104538 DOI: 10.1006/brcg.2000.1206] [Citation(s) in RCA: 39] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Based on Schmidt's (1975) variability of practice hypothesis, this study examined acquisition and transfer of a gross motor skill, namely tossing, in 58 patients with Alzheimer's disease (AD) and 58 healthy older adults under constant, blocked, and random practice conditions. While healthy older adults were able to learn the tossing task equally well under the three practice conditions, only AD patients receiving constant practice showed significant improvements. Tests of intermediate transfer yielded the expected random practice advantage in healthy controls but not AD patients. None of the practice conditions facilitated intermediate transfer in AD patients; however, constant practice did benefit these impaired individuals on tests of near transfer. These results indicate that the variability of practice hypothesis does not extend to AD patients. As motor learning and transfer were clearly a function of constant practice, future attempts to retrain basic activities of daily living in AD patients should emphasize consistency in training.
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Affiliation(s)
- M B Dick
- University of California, Irvine, CA 92697-4285, USA.
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Richardson J, Law M, Wishart L, Guyatt G. The use of a simulated environment (easy street) to retrain independent living skills in elderly persons: a randomized controlled trial. J Gerontol A Biol Sci Med Sci 2000; 55:M578-84. [PMID: 11034230 DOI: 10.1093/gerona/55.10.m578] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Older adults who receive training for functional skills in contextually appropriate environments may show greater functional improvement than persons trained in a traditional environment. Functionally limited older adults receiving training in contextually appropriate environments (simulated home and community settings) may show greater improvement in activities of daily living (ADL) than persons trained in a traditional manner. METHODS Eighty-eight patients from a day hospital, aged 65 years or older, were randomized to either receive rehabilitation in a simulated environment (Easy Street) or in a gymnasium setting. Rehabilitation focused on retraining functional skills in a contextually appropriate environment (Easy Street) or in a traditional setting (gymnasium) using motor learning principles for a period of 16 weeks. Outcome measures included the Structured Assessment of Instrumental Living Skills (SAILS), a performance measure with criterion and timed components; a self-report health status questionnaire, the Short Form-36 (SF-36); and the patient-orientated goal-directed Canadian Occupational Performance Measure (COPM). RESULTS There were no group differences on any of the outcome measures: SAILS (p = .3); the SF-36 physical (p = .83) and mental (p = .51); and the COPM performance scale (p = .94) and satisfaction scale (p = .40). CONCLUSIONS Although we have not excluded benefits of contextually appropriate rehabilitation environments with different intervention approaches, at different stages of rehabilitation or with patients at higher functional levels, our results suggest the appropriateness of a moratorium on these expensive interventions pending demonstration of clear positive effects determined from further study.
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Affiliation(s)
- J Richardson
- Research Department, St. Peter's Hospital, Hamilton, Ontario, Canada.
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Buchner A, Frensch PA. Wie nützlich sind Sequenzlernaufgaben? Zum theoretischen Status und der empirischen Befundlage eines Forschungsparadigmas. PSYCHOLOGISCHE RUNDSCHAU 2000. [DOI: 10.1026//0033-3042.51.1.10] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Zusammenfassung. Sequenzlernaufgaben sind äußerst einfache Wahlreaktionsaufgaben, die in der kognitionspsychologischen Lernforschung inzwischen erstaunlich populär geworden sind. Wir analysieren mögliche Ursachen dieser Popularität, indem wir den theoretischen Status dieses Aufgabentyps betrachten, und skizzieren überblicksartig die einschlägigen Forschungsbemühungen. Letztere lassen sich grob in zwei Kategorien einteilen. Zum einen sollen mit Sequenzlernaufgaben Dissoziationen zwischen qualitativ verschiedenen expliziten (oft als “bewußt” bezeichneten) und impliziten (oft als “unbewußt” bezeichneten) Lernprozessen untersucht werden. Zum anderen wird versucht, durch direkte Manipulationen der Lernbedingungen Hypothesen über Mechanismen zu prüfen, die dem Sequenzlernen zugrunde liegen sollen. Wir resümieren, daß der Dissoziationsanspruch bis heute nicht überzeugend eingelöst worden ist, daß aber die Beschäftigung mit Sequenzlernaufgaben unabhängig davon wertvolle Beiträge zum Verständnis von Sequenzlernen per se erbringt.
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