Boyd Lara, Winstein Carolee
Department of Physical Therapy and Rehabilitation Sciences, University of Kansas Medical Center, Kansas City, KS, USA.
J Neurol Phys Ther. 2006 Jun;30(2):46-57; discussion 58-9. doi: 10.1097/01.npt.0000282566.48050.9b.
A large portion of the rehabilitation experience after stroke relies on implicit learning. However, our understanding of how best to facilitate motor learning after stroke is limited by a paucity of research that has explored the interaction between explicit information and implicit learning across various task domains. Previously we reported that the delivery of explicit instructions disrupted implicit motor learning after stroke that involved the sensorimotor cortical areas or basal ganglia. The purpose of this study was to determine the robustness of these findings by determining whether they could be replicated with 2 motor tasks, one discrete and one continuous, employed by the same group of participants. Ten individuals with stroke in the sensorimotor cortical areas (SMC), 10 with stroke in the basal ganglia (BG), and 10 age-matched healthy controls (HC) participated in this study. Each completed 3 days of practice of both a discrete implicit motor task (the serial reaction time task) and a continuous motor task (the continuous tracking task); all returned on a fourth day for retention tests. By random designation, participants were divided into either the explicit information (EI) or no explicit information (No-EI) groups. Consistent with previous results, we found that the response to explicit information after stroke was uniformly negative regardless of task or lesion location; both stroke groups demonstrated an interference effect of explicit information while the healthy control group did not. Strengthening these findings is the fact that the interference effect of explicit information was not task dependent. This point is particularly important for rehabilitation scientists as they instruct clients during various therapeutic tasks after stroke. Our data suggest that certain forms of explicit information delivered before task practice may not be as useful for learning as discovering the solution to the motor task with practice alone, and this is regardless of the type of task being learned.
中风后的康复过程很大程度上依赖于内隐学习。然而,我们对于如何在中风后最佳地促进运动学习的理解,受到了相关研究匮乏的限制,这些研究本应探索明确信息与跨各种任务领域的内隐学习之间的相互作用。此前我们报告称,明确指令的传递会干扰中风后的内隐运动学习,这种学习涉及感觉运动皮层区域或基底神经节。本研究的目的是通过确定这些发现能否在同一组参与者所采用的两项运动任务(一项离散任务和一项连续任务)中得到重复,来确定这些发现的稳健性。十名感觉运动皮层区域(SMC)中风患者、十名基底神经节(BG)中风患者以及十名年龄匹配的健康对照者(HC)参与了本研究。每个人都完成了一项离散内隐运动任务(序列反应时任务)和一项连续运动任务(连续跟踪任务)的三天练习;所有人在第四天返回进行保持测试。通过随机指定,参与者被分为明确信息(EI)组或无明确信息(No-EI)组。与之前的结果一致,我们发现中风后对明确信息的反应无论任务或损伤位置如何均一致为负面;两个中风组均表现出明确信息的干扰效应,而健康对照组则没有。明确信息的干扰效应不依赖于任务这一事实进一步强化了这些发现。这一点对于康复科学家来说尤为重要,因为他们在中风后的各种治疗任务中指导患者。我们的数据表明,在任务练习前传递的某些形式的明确信息,可能并不像仅通过练习来发现运动任务的解决方案那样对学习有用,而且这与所学习任务的类型无关。