Explicit motor sequence learning with the paretic arm after stroke

Characterizing practice-dependent motor learning after a stroke

BACKGROUND

After stroke, patients must learn to use residual motor function correctly. Consistently, motor learning is crucial in stroke motor recovery. We assessed motor performance, practice-dependent on-line motor learning, and factors potentially affecting them in stroke patients.

METHODS

This is a cross-sectional observational study. Twenty-six patients with first brain stroke leading to upper limb motor deficit in the subacute or chronic timeframe were enrolled. They performed a Finger Tapping Task (FTT) with both the affected and unaffected limbs. We assessed how patients learn to perform motor tasks despite the motor deficit and the differences in performance between the unaffected and affected limbs. Furthermore, by randomizing the order, we evaluated the possible inter-limb transfer of motor learning (i.e. transfer of a motor skill learned in one limb to the opposite one). Moreover, sleep, attention, anxiety, and depression were assessed through specific tests and questionnaires.

RESULTS

Improved FTT accuracy and completed sequences for the affected limb were observed, even if lower than for the unaffected one. Furthermore, when patients initially performed the FTT with the unaffected limb, they showed higher accuracy in subsequent task completion with the affected limb than subjects who started with the affected limb. Only anxiety and attentional abilities showed significant correlations with motor performance.

CONCLUSIONS

This work provides relevant insights into motor learning in stroke. Practice-dependent on-line motor learning is preserved in stroke survivors, and an inter-limb transfer effect can be observed. Attentional abilities and anxiety can affect learning after stroke, even if the effect of other factors cannot be excluded.

Effectiveness of Physiotherapy for Improving Functionality, Participation, and Quality of Life after a Stroke: Study Protocol for a Randomized Controlled Clinical Trial

BACKGROUND

Stroke survivors experience significant alterations in their daily functionality that has a negative impact on their functionality, participation, and quality of life. Person-centered approaches in Physical Therapy interventions that are focused on functional and meaningful goals help to minimize the impact of the alterations. Therefore, the aim of this study is to assess the effectiveness of a Physical Therapy intervention based on a goal-oriented approach with task-specific training for improving functionality, participation, and quality of life for people with Stroke.

METHODS

A single-blinded randomized controlled clinical trial will be developed. Adults over 50 years old diagnosed with Stroke over 6 months will be included in this study. Participants (n = 62) will be randomly allocated into two groups: The experimental group (n = 31) will receive 30 sessions, three per week during 10 weeks, of Physical Therapy sessions of goal-directed and task-specific training. The control group (n = 31) will follow the same intervention intensity of their usual Physical Therapy treatment. The primary outcome variables quality of life (NewsQol), participation (Ox-PAQ), and gait functionality (FAC) and the secondary outcome variables functional disability (BI), postural control (PASS), dynamic trunk balance (TIS), and functional goals (GAS) will be measured at baseline, after group interventions (10 weeks), and 6 months after the baseline. Statistical analyses will include repeated-measures ANOVA, Student's t-test, or the Mann-Whitney U-test, with a 95% confidence interval and significance level of p < 0.05.

CONCLUSION

Person-centered approaches in Physical Therapy interventions may yield better outcomes in functionality, participation, and quality of life for Stroke patients compared to standardized interventions.

TRIAL REGISTRATION

ClinicalTrials.gov: NCT06165666 (December 2023).

Analysis of Motor Learning Principles Applied in Tasks or Motor Skills Trained by Stroke Patients

Objective:

To analyze the principles applied to promote and evaluate motor learning in tasks or motor skills trained by stroke patients.

Methods:

Articles were included if they used motor learning principles in tasks or motor skills trained by stroke patients.

Results:

Twelve studies were included in this review. Quality was good for the included studies. Articles used motor learning principle based on practice (N = 12), repetitive training (N = 9), and feedback (N = 5).

Conclusions:

There are different motor learning principles to promote and evaluate motor learning in stroke patients. These findings could guide clinicians during training of tasks or motor skills.

Sleep and motor learning in stroke (SMiLES): a longitudinal study investigating sleep-dependent consolidation of motor sequence learning in the context of recovery after stroke

INTRODUCTION

There is growing evidence that sleep is disrupted after stroke, with worse sleep relating to poorer motor outcomes. It is also widely acknowledged that consolidation of motor learning, a critical component of poststroke recovery, is sleep-dependent. However, whether the relationship between disrupted sleep and poor outcomes after stroke is related to direct interference of sleep-dependent motor consolidation processes, is currently unknown. Therefore, the aim of the present study is to understand whether measures of motor consolidation mediate the relationship between sleep and clinical motor outcomes post stroke.

METHODS AND ANALYSIS

We will conduct a longitudinal observational study of up to 150 participants diagnosed with stroke affecting the upper limb. Participants will be recruited and assessed within 7 days of their stroke and followed up at approximately 1 and 6 months. The primary objective of the study is to determine whether sleep in the subacute phase of recovery explains the variability in upper limb motor outcomes after stroke (over and above predicted recovery potential from the Predict Recovery Potential algorithm) and whether this relationship is dependent on consolidation of motor learning. We will also test whether motor consolidation mediates the relationship between sleep and whole-body clinical motor outcomes, whether motor consolidation is associated with specific electrophysiological sleep signals and sleep alterations during subacute recovery.

ETHICS AND DISSEMINATION

This trial has received both Health Research Authority, Health and Care Research Wales and National Research Ethics Service approval (IRAS: 304135; REC: 22/LO/0353). The results of this trial will help to enhance our understanding of the role of sleep in recovery of motor function after stroke and will be disseminated via presentations at scientific conferences, peer-reviewed publication, public engagement events, stakeholder organisations and other forms of media where appropriate.

TRIAL REGISTRATION NUMBER

ClinicalTrials.gov: NCT05746260, registered on 27 February 2023.

Decreased thalamo-cortico connectivity during an implicit sequence motor learning task and 7 days escitalopram intake

Evidence suggests that selective serotonin reuptake inhibitors (SSRIs) reorganize neural networks via a transient window of neuroplasticity. While previous findings support an effect of SSRIs on intrinsic functional connectivity, little is known regarding the influence of SSRI-administration on connectivity during sequence motor learning. To investigate this, we administered 20 mg escitalopram or placebo for 1-week to 60 healthy female participants undergoing concurrent functional magnetic resonance imaging and sequence motor training in a double-blind randomized controlled design. We assessed task-modulated functional connectivity with a psycho-physiological interaction (PPI) analysis in the thalamus, putamen, cerebellum, dorsal premotor, primary motor, supplementary motor, and dorsolateral prefrontal cortices. Comparing an implicit sequence learning condition to a control learning condition, we observed decreased connectivity between the thalamus and bilateral motor regions after 7 days of escitalopram intake. Additionally, we observed a negative correlation between plasma escitalopram levels and PPI connectivity changes, with higher escitalopram levels being associated with greater thalamo-cortico decreases. Our results suggest that escitalopram enhances network-level processing efficiency during sequence motor learning, despite no changes in behaviour. Future studies in more diverse samples, however, with quantitative imaging of neurochemical markers of excitation and inhibition, are necessary to further assess neural responses to escitalopram.

Neurophysiology of motor skill learning in chronic stroke

OBJECTIVE

Motor learning is relevant in chronic stroke for acquiring compensatory strategies to motor control deficits. However, the neurophysiological mechanisms underlying motor skill acquisition with the paretic upper limb have received little systematic investigation. The aim of this study was to assess the modulation of corticomotor excitability and intracortical inhibition within ipsilesional primary motor cortex (M1) during motor skill learning.

METHODS

Ten people at the chronic stage after stroke and twelve healthy controls trained on a sequential visuomotor isometric wrist extension task. Skill was quantified before, immediately after, 24 hours and 7 days post-training. Transcranial magnetic stimulation was used to examine corticomotor excitability and short- and long-interval intracortical inhibition (SICI and LICI) pre- and post-training.

RESULTS

The patient group exhibited successful skill acquisition and retention, although absolute skill level was lower compared with controls. In contrast to controls, patients' ipsilesional corticomotor excitability was not modulated during skill acquisition, which may be attributed to excessive ipsilesional LICI relative to controls. SICI decreased after training for both patient and control groups.

CONCLUSIONS

Our findings indicate distinct inhibitory networks within M1 that may be relevant for motor learning after stroke.

SIGNIFICANCE

These findings have potential clinical relevance for neurorehabilitation adjuvants aimed at augmenting the recovery of motor function.

The importance of different learning stages for motor sequence learning after stroke

The task of learning predefined sequences of interrelated motor actions is of everyday importance and has also strong clinical importance for regaining motor function after brain lesions. A solid understanding of sequence learning in stroke patients can help clinicians to optimize and individualize rehabilitation strategies. Moreover, to investigate the impact of a focal lesion on the ability to successfully perform motor sequence learning can enhance our comprehension of the underlying physiological principles of motor sequence learning. In this article, we will first provide an overview of current concepts related to motor sequence learning in healthy subjects with focus on the involved brain areas and their assumed functions according to the temporal stage model. Subsequently, we will consider the question of what we can learn from studies investigating motor sequence learning in stroke patients. We will first focus on the implications of lesion location. Then, we will analyze whether distinct lesion locations affect specific learning stages. Finally, we will discuss the implications for clinical rehabilitation and suggest directions for further research.