Does Provision of Extrinsic Feedback Result in Improved Motor Learning in the Upper Limb Poststroke? A Systematic Review of the Evidence

Background. Recovery of the upper limb (UL) after a stroke occurs well into the chronic stage. Stroke survivors can benefit from adaptive plasticity to improve UL movement through motor relearning. The provision of feedback has been shown to decrease the use of compensatory UL movement patterns. However, the effectiveness of feedback in improving UL motor recovery after a stroke has not yet been systematically reviewed. Objective.The objective of this review was to systematically examine the role of extrinsic feedback on implicit motor learning after stroke, focusing on UL movement and functional recovery. Results. The authors retrieved 9 studies that examined the role of feedback on UL motor recovery. Of these, 6 were randomized controlled trials (RCTs), 1 was a single-subject design, 1 was a pre—post design, and 1 was a cohort study. The studies were rated on the basis of Sackett’s levels of evidence and PEDro (Physiotherapy Evidence Database) scores for RCTs. Levels of evidence were limited (level 2b) for UL motor learning of the less-affected extremity and strong (level 1a) for the more-affected extremity. Discussion and conclusions. The results suggest that people with stroke may be capable of using extrinsic feedback for implicit motor learning and improving UL motor recovery. Emergent questions regarding the advantages of using different media for feedback delivery and the optimal type and schedule of feedback to enhance motor learning in patient populations still need to be addressed.

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Role of the somatosensory cortex in motor memory consolidation

Journal of Neurophysiology ◽

10.1152/jn.00770.2019 ◽

2020 ◽

Vol 124 (3) ◽

pp. 648-651

Author(s):

Manasi Wali

Keyword(s):

Motor Learning ◽

Somatosensory Cortex ◽

Memory Consolidation ◽

Motor Memory ◽

Implicit Motor Learning ◽

Implicit Motor ◽

Human Motor ◽

Plos Biol

Motor memories become resistant to interference by the process of consolidation, which leads to long-term retention. Studies have shown involvement of the somatosensory cortex in motor learning-related plasticity, but not directly in motor memory consolidation. This Neuro Forum article reviews evidence from a continuous theta-burst transcranial magnetic stimulation (cTBS) study by Kumar and colleagues (Kumar N, Manning TF, Ostry DJ. PLoS Biol 17: e3000469, 2019) that demonstrates the role of somatosensory, rather than motor, cortex in human motor memory consolidation during implicit motor learning.

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Explicit motor sequence learning after stroke: a neuropsychological study

Experimental Brain Research ◽

10.1007/s00221-021-06141-5 ◽

2021 ◽

Author(s):

Cristina Russo ◽

Laura Veronelli ◽

Carlotta Casati ◽

Alessia Monti ◽

Laura Perucca ◽

...

Keyword(s):

Basal Ganglia ◽

Motor Learning ◽

Upper Limb ◽

Motor Recovery ◽

Finger Tapping ◽

Control Group ◽

Stroke Severity ◽

Motor Sequence ◽

Stroke Patients ◽

Motor Practice

AbstractMotor learning interacts with and shapes experience-dependent cerebral plasticity. In stroke patients with paresis of the upper limb, motor recovery was proposed to reflect a process of re-learning the lost/impaired skill, which interacts with rehabilitation. However, to what extent stroke patients with hemiparesis may retain the ability of learning with their affected limb remains an unsolved issue, that was addressed by this study. Nineteen patients, with a cerebrovascular lesion affecting the right or the left hemisphere, underwent an explicit motor learning task (finger tapping task, FTT), which was performed with the paretic hand. Eighteen age-matched healthy participants served as controls. Motor performance was assessed during the learning phase (i.e., online learning), as well as immediately at the end of practice, and after 90 min and 24 h (i.e., retention). Results show that overall, as compared to the control group, stroke patients, regardless of the side (left/right) of the hemispheric lesion, do not show a reliable practice-dependent improvement; consequently, no retention could be detected in the long-term (after 90 min and 24 h). The motor learning impairment was associated with subcortical damage, predominantly affecting the basal ganglia; conversely, it was not associated with age, time elapsed from stroke, severity of upper-limb motor and sensory deficits, and the general neurological condition. This evidence expands our understanding regarding the potential of post-stroke motor recovery through motor practice, suggesting a potential key role of basal ganglia, not only in implicit motor learning as previously pointed out, but also in explicit finger tapping motor tasks.

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Non-linear effects of cathodal transcranial direct current stimulation (tDCS) of the primary motor cortex on implicit motor learning

Experimental Brain Research ◽

10.1007/s00221-019-05477-3 ◽

2019 ◽

Vol 237 (4) ◽

pp. 919-925 ◽

Cited By ~ 4

Author(s):

Gali Shilo ◽

Michal Lavidor

Keyword(s):

Motor Cortex ◽

Motor Learning ◽

Direct Current ◽

Transcranial Direct Current Stimulation ◽

Primary Motor Cortex ◽

Direct Current Stimulation ◽

Implicit Motor Learning ◽

Non Linear ◽

Implicit Motor ◽

Linear Effects

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Implicit motor learning in primary school children: A systematic review

Journal of Sports Sciences ◽

10.1080/02640414.2021.1947010 ◽

2021 ◽

pp. 1-19

Author(s):

Femke van Abswoude ◽

Remo Mombarg ◽

Wouter de Groot ◽

Gwennyth Eileen Spruijtenburg ◽

Bert Steenbergen

Keyword(s):

Systematic Review ◽

Motor Learning ◽

Primary School ◽

School Children ◽

Primary School Children ◽

Implicit Motor Learning ◽

Implicit Motor

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Implicit motor learning within three trials

Scientific Reports ◽

10.1038/s41598-021-81031-y ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Jennifer E. Ruttle ◽

Bernard Marius ’t Hart ◽

Denise Y. P. Henriques

Keyword(s):

Motor Learning ◽

Implicit Learning ◽

Time Course ◽

Skills Training ◽

Implicit Processes ◽

Training Performance ◽

Slow Development ◽

Implicit Motor Learning ◽

Implicit Motor ◽

And Shifts

AbstractIn motor learning, the slow development of implicit learning is traditionally taken for granted. While much is known about training performance during adaptation to a perturbation in reaches, saccades and locomotion, little is known about the time course of the underlying implicit processes during normal motor adaptation. Implicit learning is characterized by both changes in internal models and state estimates of limb position. Here, we measure both as reach aftereffects and shifts in hand localization in our participants, after every training trial. The observed implicit changes were near asymptote after only one to three perturbed training trials and were not predicted by a two-rate model’s slow process that is supposed to capture implicit learning. Hence, we show that implicit learning is much faster than conventionally believed, which has implications for rehabilitation and skills training.

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