Research Centre for Nutrition, Lifestyle and Exercise, Zuyd University of Applied Sciences, Heerlen, Netherlands.
Department of Family Medicine, CAPHRI School for Public Health and Primary Care, Maastricht University, Maastricht, Netherlands.
Phys Ther. 2021 May 4;101(5). doi: 10.1093/ptj/pzab017.
Clinicians may use implicit or explicit motor learning approaches to facilitate motor learning of patients with stroke. Implicit motor learning approaches have shown promising results in healthy populations. The purpose of this study was to assess whether an implicit motor learning walking intervention is more effective compared with an explicit motor learning walking intervention delivered at home regarding walking speed in people after stroke in the chronic phase of recovery.
This randomized, controlled, single-blind trial was conducted in the home environment. The 79 participants, who were in the chronic phase after stroke (age = 66.4 [SD = 11.0] years; time poststroke = 70.1 [SD = 64.3] months; walking speed = 0.7 [SD = 0.3] m/s; Berg Balance Scale score = 44.5 [SD = 9.5]), were randomly assigned to an implicit (n = 38) or explicit (n = 41) group. Analogy learning was used as the implicit motor learning walking intervention, whereas the explicit motor learning walking intervention consisted of detailed verbal instructions. Both groups received 9 training sessions (30 minutes each), for a period of 3 weeks, targeted at improving quality of walking. The primary outcome was walking speed measured by the 10-Meter Walk Test at a comfortable walking pace. Outcomes were assessed at baseline, immediately after intervention, and 1 month postintervention.
No statistically or clinically relevant differences between groups were obtained postintervention (between-group difference was estimated at 0.02 m/s [95% CI = -0.04 to 0.08] and at follow-up (between-group difference estimated at -0.02 m/s [95% CI = -0.09 to 0.05]).
Implicit motor learning was not superior to explicit motor learning to improve walking speed in people after stroke in the chronic phase of recovery.
To our knowledge, this is the first study to examine the effects of implicit compared with explicit motor learning on a functional task in people after stroke. Results indicate that physical therapists can use (tailored) implicit and explicit motor learning strategies to improve walking speed in people after stroke who are in the chronic phase of recovery.
临床医生可能会使用内隐或外显的运动学习方法来促进脑卒中患者的运动学习。内隐运动学习方法在健康人群中显示出良好的效果。本研究的目的是评估在脑卒中慢性恢复期，与家庭环境中提供的外显运动学习步行干预相比，内隐运动学习步行干预是否更能有效提高患者的步行速度。
这是一项在家庭环境中进行的随机、对照、单盲试验。79 名参与者在脑卒中后慢性期（年龄=66.4 [标准差=11.0]岁；脑卒中后时间=70.1 [标准差=64.3]个月；步行速度=0.7 [标准差=0.3]m/s；伯格平衡量表评分为 44.5 [标准差=9.5]），被随机分配到内隐（n=38）或外显（n=41）组。类比学习被用作内隐运动学习步行干预，而外显运动学习步行干预则包括详细的口头指导。两组均接受 9 次训练（每次 30 分钟），为期 3 周，旨在提高步行质量。主要结局指标是 10 米步行测试的步行速度，以舒适的步行速度进行测量。结果在基线、干预后即刻和干预后 1 个月进行评估。
干预后两组之间没有统计学上或临床上显著的差异（组间差异估计为 0.02 m/s [95%置信区间= -0.04 至 0.08]，随访时为 -0.02 m/s [95%置信区间= -0.09 至 0.05]）。
内隐运动学习在改善脑卒中慢性恢复期患者的步行速度方面并不优于外显运动学习。
据我们所知，这是第一项比较内隐和外显运动学习对脑卒中后患者功能任务影响的研究。结果表明，物理治疗师可以使用（定制的）内隐和外显运动学习策略来提高脑卒中慢性恢复期患者的步行速度。
