Somatosensory perceptual training enhances motor learning by observing

The Role of Sensory Impairments on Recovery and Rehabilitation After Stroke

PURPOSE OF REVIEW

The current review aims to address critical gaps in the field of stroke rehabilitation related to sensory impairment. Here, we examine the role and importance of sensation throughout recovery of neural injury, potential clinical and experimental approaches for improving sensory function, and mechanism-based theories that may facilitate the design of sensory-based approaches for the rehabilitation of somatosensation.

RECENT FINDINGS

Recently, the field of neurorehabilitation has shifted to using more quantitative and sensitive measures to more accurately capture sensory function in stroke and other neurological populations. These approaches have laid the groundwork for understanding how sensory impairments impact overall function after stroke. However, there is less consensus on which interventions are effective for remediating sensory function, with approaches that vary from clinical re-training, robotics, and sensory stimulation interventions. Current evidence has found that sensory and motor systems are interdependent, but commonly have independent recovery trajectories after stroke. Therefore, it is imperative to assess somatosensory function in order to guide rehabilitation outcomes and trajectory. Overall, considerable work in the field still remains, as there is limited evidence for purported mechanisms of sensory recovery, promising early-stage work that focuses on sensory training, and a considerable evidence-practice gap related to clinical sensory rehabilitation.

A systematic review of observational practice for adaptation of reaching movements

Observational practice is discussed as a substitute for physical practice for motor learning and adaptation. We systematically reviewed the literature on observational practice in reaching and aiming tasks. Our objectives were to identify (i) performance differences between observational and physical practice; (ii) factors that contribute to adaptation following observational practice; and (iii) the neural correlates of observational practice. We found 18 studies, all investigated adaptation of reaching in visuomotor rotations or force-field perturbations. Results of the studies showed that observational practice led to adaptation in both, visuomotor rotation and force-field paradigms (d = -2.16 as compared to no practice). However, direct effects were considerably smaller as compared to physical practice (d = 4.38) and aftereffects were absent, suggesting that observational practice informed inverse, but not forward modes. Contrarily, neurophysiological evidence in this review showed that observational and physical practice involved similar brain regions.

Somatosensory and dynamic balance improvement in older adults with diabetic peripheral neuropathy through sensorimotor exercise: A multisite randomized controlled trial

PURPOSE

To examine the effect of the Feldenkrais method on lower legs and foot somatosensory postural control-related function, dynamic balance, fear of falling and quality of life in adults with diabetic polyneuropathy in the short and mid-term.

METHODS

A single-blinded, parallel, multicentric randomized control trial was conducted in two health hospitals. Subjects with diabetic polyneuropathy and older than 55 years with a history of falls or dynamic balance dysfunction were recruited from the hospital databases and randomly allocated to the experimental or control group. The experimental group received 16 sessions of sensorimotor training based on the Feldenkrais method. Both groups received diabetic foot care instructions. The results were measured at the 3 and 6-month follow-up periods.

RESULTS

The mean age was 70 ± 8. A total of 44 participants were enrolled in the study, and 27 completed the process. No adverse events were reported. After the intervention, significant somatosensory results were obtained (p < 0.001). The results of the Up and Go and POMA tests were significant after the intervention (p < 0.001) and during the 3-month follow-up period for POMA (p = 0.018). The fear of falling showed significant results at the 3-month follow-up period (p = 0.03), and the quality of life in all measurements.

CONCLUSIONS

Significant short-term effects were obtained on somatosensory postural control-related function, dynamic balance, and fear of falling. Significant short and mid-term effects were achieved on quality of life. Older adults with diabetic polyneuropathy, dynamic balance impairment, or a history of falls can improve their abilities through the Feldenkrais method.

TRIAL REGISTRATION

Clinicaltrials.gov: NCT05262946.

Augmented action observation: Theory and practical applications in sensorimotor rehabilitation

Sensory feedback is a fundamental aspect of effective motor learning in sport and clinical contexts. One way to provide this is through sensory augmentation, where extrinsic sensory information are associated with, and modulated by, movement. Traditionally, sensory augmentation has been used as an online strategy, where feedback is provided during physical execution of an action. In this article, we argue that action observation can be an additional effective channel to provide augmented feedback, which would be complementary to other, more traditional, motor learning and sensory augmentation strategies. Given these similarities between observing and executing an action, action observation could be used when physical training is difficult or not feasible, for example during immobilization or during the initial stages of a rehabilitation protocol when peripheral fatigue is a common issue. We review the benefits of observational learning and preliminary evidence for the effectiveness of using augmented action observation to improve learning. We also highlight current knowledge gaps which make the transition from laboratory to practical contexts difficult. Finally, we highlight the key areas of focus for future research.

Enhance Kinesthetic Experience in Perceptual Learning for Welding Motor Skill Acquisition With Virtual Reality and Robot-Based Haptic Guidance

Welding is an important operation in many industries, including construction and manufacturing, which requires extensive training and practices. Although welding simulators have been used to accommodate welding training, it is still challenging to enable novice trainees to effectively understand the kinesthetic experience of the expert in an egocentric manner, such as the proper way of force exertion in complex welding operations. This study implements a robot-assisted perceptual learning system to transfer the expert welders' experience to trainees, including both the positional and force control actions. A human-subject experiment (N = 30) was performed to understand the motor skill acquisition process. Three conditions (control, robotic positional guidance with force visualization, and force perceptual learning with position visualization) were tested to evaluate the role of robotic guidance in welding motion control and force exertion. The results indicated various benefits related to task completion time and force control accuracy under the robotic guidance. The findings can inspire the design of future welding training systems enabled by external robotic systems.

Durability of motor learning by observing

Information about another person's movement kinematics obtained through visual observation activates brain regions involved in motor learning. Observation-related changes in these brain areas are associated with adaptive changes to feedforward neural control of muscle activation and behavioral improvements in limb movement control. However, little is known about the stability of these observation-related effects over time. Here, we used force channel trials to probe changes in lateral force production at various time points (1 min, 10 min, 30 min, 60 min, 24 h) after participants either physically performed, or observed another individual performing upper limb reaching movements that were perturbed by novel, robot-generated forces (a velocity-dependent force-field). Observers learned to predictively generate directionally and temporally specific compensatory forces during reaching, consistent with the idea that they acquired an internal representation of the novel dynamics. Participants who physically practiced in the force-field showed adaptation that was detectable at all time points, with some decay detected after 24 h. Observation-related adaptation was less temporally stable in comparison, decaying slightly after 1 h and undetectable at 24 h. Observation induced less adaptation overall than physical practice, which could explain differences in temporal stability. Visually acquired representations of movement dynamics are retained and continue to influence behavior for at least 1 h after observation.NEW & NOTEWORTHY We used force channel probes in an upper limb force-field reaching task in humans to compare the durability of learning-related changes that occurred through visual observation to those after physical movement practice. Visually acquired representations of movement dynamics continued to influence behavior for at least 1 h after observation. Our findings point to a 1-h window during which visual observation of another person could play a role in motor learning.

Motion state-dependent motor learning based on explicit visual feedback has limited spatiotemporal properties compared with adaptation to physical perturbations

We recently showed that subjects can learn motion state-dependent changes to motor output (temporal force patterns) based on explicit visual feedback of the equivalent force field (i.e., without the physical perturbation). Here, we examined the spatiotemporal properties of this learning compared with learning based on physical perturbations. There were two human subject groups and two experimental paradigms. One group (n = 40) experienced physical perturbations (i.e., a velocity-dependent force field, vFF), whereas the second (n = 40) was given explicit visual feedback (EVF) of the force-velocity relationship. In the latter, subjects moved in force channels and we provided visual feedback of the lateral force exerted during the movement, as well as the required force pattern based on movement velocity. In the first paradigm (spatial generalization), following vFF or EVF training, generalization of learning was tested by requiring subjects to move to 14 untrained target locations (0° to ±135° around the trained location). In the second paradigm (temporal stability), following training, we examined the decay of learning over eight delay periods (0 to 90 s). Results showed that learning based on EVF did not generalize to untrained directions, whereas the generalization for the vFF was significant for targets ≤ 45° away. In addition, the decay of learning for the EVF group was significantly faster than the FF group (a time constant of 2.72 ± 1.74 s vs. 12.53 ± 11.83 s). Collectively, our results suggest that recalibrating motor output based on explicit motion state information, in contrast to physical disturbances, uses learning mechanisms with limited spatiotemporal properties.NEW & NOTEWORTHY Adjustment of motor output based on limb motion state information can be achieved based on explicit information or from physical perturbations. Here, we investigated the spatiotemporal characteristics of short-term motor learning to determine the properties of the respective learning mechanisms. Our results suggest that adjustments based on physical perturbations are more temporally stable and applied over a greater spatial range than the learning based on explicit visual feedback, suggesting largely separate learning mechanisms.

Action observation plus motor imagery and somatosensory discrimination training are effective non-motor approaches to improve manual dexterity

BACKGROUND

Action observation plus motor imagery (AOMI) and somatosensory discrimination training (SSDT) represent sensory input-based approaches to train the motor system without necessarily asking subjects to perform active movements.

PURPOSE

To investigate AOMI and SSDT effects compared to no intervention on manual dexterity in healthy subjects.

STUDY DESIGN

Randomized controlled study.

METHODS

Sixty healthy right-handed participants were randomized into AOMI, SSDT or Control (CTRL) groups. AOMI observed video-clips including right-hand dexterity tasks and concurrently performed motor imagery, SSDT performed surfaces recognition and 2-point distance discrimination tasks with the right hand, whereas CTRL underwent no intervention. A blinded physiotherapist assessed participants for manual dexterity using the Purdue Pegboard Test (Right hand-R, Left hand-L, Both hands-B, R+L+B and assembly tasks) at baseline (T0) and training end (T1). A mixed-design Analysis of Variance with Time as within-subject factor and Group as between-subject factor was used to investigate between-group differences over time.

RESULTS

A Time by Group interaction and Time effect were found for R task, which increased from T0 to T1 in all groups with very large effect sizes for SSDT (d = 1.8, CI95 2.4-1.0, P < .001) and AOMI (d = 1.7, CI95 2.5-1.0, P < .001) and medium effect size for CTRL (d = 0.6, CI95 1.2-0.2, P < .001). Between-group post-hoc comparison for deltas (T1-T0) showed large effect size (d = 1.0, CI95 1.6-0.3, P = .003) in favor of SSDT and medium effect size (d = 0.7, CI95 1.4-0.1, P = .026) in favor of AOMI compared to CTRL. Time effects were found for L, B, R + L + B and assembly tasks (P < .001).

CONCLUSIONS

AOMI and SSDT induced greater manual dexterity improvements than no intervention. These findings supported the role of visual and somatosensory stimuli in building a motor plan and enhancing the accuracy of hand movements. These non-motor approaches may enhance motor performance in job or hobbies requiring marked manual dexterity.

Changes in excitability and GABAergic neuronal activity of the primary somatosensory cortex after motor learning

Introduction

It is widely known that motor learning changes the excitability of the primary motor cortex. More recently, it has been shown that the primary somatosensory cortex (S1) also plays an important role in motor learning, but the details have not been fully examined. Therefore, we investigated how motor skill training affects somatosensory evoked potential (SEP) in 30 neurologically healthy subjects.

Methods

SEP N20/P25_component and N20/P25 SEP paired-pulse depression (SEP-PPD) were assessed before and immediately after complex or simple visuomotor tasks.

Results

Motor learning was induced more efficiently by the complex visuomotor task than by the simple visuomotor task. Both the N20/P25 SEP amplitude and N20/P25 SEP-PPD increased significantly immediately after the complex visuomotor task, but not after the simple visuomotor task. Furthermore, the altered N20/P25 SEP amplitude was associated with an increase in motor learning efficiency.

Conclusion

These results suggest that motor learning modulated primary somatosensory cortex excitability.

Psychometric Properties of Lower Limb Somatosensory Function and Body Awareness Outcome Measures in Children with Upper Motor Neuron Lesions: A Systematic Review

PURPOSE

A systematic review of the psychometric properties and feasibility of outcome measures assessing lower limb somatosensory function and body awareness in children with upper motor neuron lesion.

METHODS

We followed the COnsensus-based Standards for the selection of health Measurement INstruments guidelines. Two raters independently judged the quality and risk of bias of each study. Data synthesis was performed, and aspects of feasibility were extracted.

RESULTS

Twelve studies investigated eleven somatosensory function measures quantifying four modalities and eight body awareness measures quantifying two modalities. The best evidence synthesis was very low to low for somatosensory function modalities and low for body awareness modalities. Few feasibility aspects were reported (e.g., the percentage or minimum age of participants able to perform the tests).

CONCLUSION

Current evidence on the psychometric characteristics of somatosensory function and body awareness outcome measures are relatively sparse. Further research on psychometric properties and practical application is needed.

Improved proprioception does not benefit visuomotor adaptation

Visuomotor adaptation arises when reaching in an altered visual environment, where one's seen hand position does not match their felt (i.e., proprioceptive) hand position in space. Here, we asked if proprioceptive training benefits visuomotor adaptation, and if these benefits arise due to implicit (unconscious) or explicit (conscious strategy) processes. Seventy-two participants were divided equally into 3 groups: proprioceptive training with feedback (PTWF), proprioceptive training no feedback (PTNF), and Control (CTRL). The PTWF and PTNF groups completed passive proprioceptive training, where a participant's hand was moved to an unknown reference location and they judged the felt position of their unseen hand relative to their body midline on every trial. The PTWF group received verbal feedback with respect to their response accuracy on the middle 60% of trials, whereas the PTNF did not receive any feedback during training. The CTRL group did not complete proprioceptive training and instead sat quietly during this time. Following proprioceptive training or time delay, all three groups reached when seeing a cursor that was rotated 30° clockwise relative to their hand motion. The experiment ended with participants completing a series of no-cursor reaches to assess implicit and explicit adaptation. Results indicated that the PTWF group improved the accuracy of their sense of felt hand position following proprioceptive training. However, this improved proprioceptive acuity (i.e., the accuracy of their sense of felt hand) did not benefit visuomotor adaptation, as all three groups showed similar visuomotor adaptation across rotated reach training trials. Visuomotor adaptation arose implicitly, with minimal explicit contribution for all three groups. Together, these results suggest that passive proprioceptive training does not benefit, nor hinder, the extent of implicit visuomotor adaptation established immediately following reach training with a 30° cursor rotation.

Synchronous vs. non-synchronous imitation: Using dance to explore interpersonal coordination during observational learning

Observational learning can enhance the acquisition and performance quality of complex motor skills. While an extensive body of research has focused on the benefits of synchronous (i.e., concurrent physical practice) and non-synchronous (i.e., delayed physical practice) observational learning strategies, the question remains as to whether these approaches differentially influence performance outcomes. Accordingly, we investigate the differential outcomes of synchronous and non-synchronous observational training contexts using a novel dance sequence. Using multidimensional cross-recurrence quantification analysis, movement time-series were recorded for novice dancers who either synchronised with (n = 22) or observed and then imitated (n = 20) an expert dancer. Participants performed a 16-count choreographed dance sequence for 20 trials assisted by the expert, followed by one final, unassisted performance trial. Although end-state performance did not significantly differ between synchronous and non-synchronous learners, a significant decline in performance quality from imitation to independent replication was shown for synchronous learners. A non-significant positive trend in performance accuracy was shown for non-synchronous learners. For all participants, better imitative performance across training trials led to better end-state performance, but only for the accuracy (and not timing) of movement reproduction. Collectively, the results suggest that synchronous learners came to rely on a real-time mapping process between visual input from the expert and their own visual and proprioceptive intrinsic feedback, to the detriment of learning. Thus, the act of synchronising alone does not ensure an appropriate training context for advanced sequence learning.

A tale of too many tasks: task fragmentation in motor learning and a call for model task paradigms

Motor learning encompasses a broad set of phenomena that requires a diverse set of experimental paradigms. However, excessive variation in tasks across studies creates fragmentation that can adversely affect the collective advancement of knowledge. Here, we show that motor learning studies tend toward extreme fragmentation in the choice of tasks, with almost no overlap between task paradigms across studies. We argue that this extreme level of task fragmentation poses serious theoretical and methodological barriers to advancing the field. To address these barriers, we propose the need for developing common 'model' task paradigms which could be widely used across labs. Combined with the open sharing of methods and data, we suggest that these model task paradigms could be an important step in increasing the robustness of the motor learning literature and facilitate the cumulative process of science.

Unilateral step training can drive faster learning of novel gait patterns

Humans are capable of learning many new walking patterns. People have learned to snowshoe up mountains, racewalk marathons, and march in precise synchrony. But what is required to learn a new walking pattern? Here, we demonstrate that people can learn new walking patterns without actually walking. Through a series of experiments, we observe that stepping with only one leg can facilitate learning of an entirely new walking pattern (i.e., split-belt treadmill walking). We find that the nervous system learns from the relative speed difference between the legs-whether or not both legs are moving-and can transfer this learning to novel gaits. We also show that locomotor learning requires active movement: observing another person adapt their gait did not result in significantly faster learning. These findings reveal that people can learn new walking patterns without bilateral gait training, as stepping with one leg can facilitate adaptive learning that transfers to novel gait patterns.

Dynamic task observation: A gaze-mediated complement to traditional action observation treatment?

Action observation elicits changes in primary motor cortex known as motor resonance, a phenomenon thought to underpin several functions, including our ability to understand and imitate others' actions. Motor resonance is modulated not only by the observer's motor expertise, but also their gaze behaviour. The aim of the present study was to investigate motor resonance and eye movements during observation of a dynamic goal-directed action, relative to an everyday one - a reach-grasp-lift (RGL) action, commonly used in action-observation-based neurorehabilitation protocols. Skilled and novice golfers watched videos of a golf swing and an RGL action as we recorded MEPs from three forearm muscles; gaze behaviour was concurrently monitored. Corticospinal excitability increased during golf swing observation, but it was not modulated by expertise, relative to baseline; no such changes were observed for the RGL task. MEP amplitudes were related to participants' gaze behaviour: in the RGL condition, target viewing was associated with lower MEP amplitudes; in the golf condition, MEP amplitudes were positively correlated with time spent looking at the effector or neighbouring regions. Viewing of a dynamic action such as the golf swing may enhance action observation treatment, especially when concurrent physical practice is not possible.

The role of sensory stimulation on motor learning via action observation: a mini review

Action observation involves the observation of an action followed by an attempt to replicate it. Recent studies show that increased sensorimotor cortical connectivity improves motor performance via observation and that priming the sensory system before observation enhances the effects of observation-based learning. Understanding the role of the sensory system is, therefore, critical for rehabilitation of movement disorders that have a sensory deficit.