Division for Clinical and Cognitive Sciences, Department of Neurology, Medical Faculty, RWTH Aachen University, Germany.
Department of Neurobiology, University of Haifa, Israel.
Neuropsychologia. 2021 Aug 20;159:107921. doi: 10.1016/j.neuropsychologia.2021.107921. Epub 2021 Jun 25.
Recent studies show that limb apraxia is a quite frequent, yet often underdiagnosed, higher motor impairment following stroke. Because it adversely affects every-day life and personal independence, successful rehabilitation of apraxia is essential for personal well-being. Nevertheless, evidence of long-term efficacy of training schemes and generalization to untrained actions is still scarce. One possible reason for the tendency of this neurological disorder to persist may be a deficit in planning, conceptualisation and storage of complex motor acts. This pilot study aims at investigating explicit motor learning in apractic stroke patients. In particular, we addressed the ability of apractic patients to learn and to retain new explicit sequential finger movements across 10 training sessions over a 3-week interval. Nine stroke patients with ideomotor apraxia in its chronic stage participated in a multi-session training regimen and were included in data analyses. Patients performed an explicit finger sequence learning task (MSLT - motor sequence learning task), which is a well-established paradigm to investigate motor learning and memory processes. Patients improved task performance in terms of speed and accuracy across sessions. Specifically, they showed a noticeable reduction in the mean time needed to perform a correct sequence and the number of erroneous sequences. We found also a trend for improved performance at the Goldenberg apraxia test protocol: "imitation of meaningless hand and finger gestures" relative to when assessed before the MSLT training. Patients with ideomotor apraxia demonstrated the ability to acquire and maintain a novel sequence of movements; and, this training was associated with hints towards improvement of apraxia symptoms.
最近的研究表明，肢体失用症是中风后一种相当常见但经常被低估的高级运动障碍。由于它会对日常生活和个人独立性产生不利影响，因此失用症的成功康复对于个人幸福至关重要。然而，训练计划的长期疗效和对未训练动作的泛化的证据仍然很少。这种神经障碍持续存在的一个可能原因是复杂运动行为的计划、概念化和存储能力缺陷。这项初步研究旨在研究失用症中风患者的外显运动学习。特别是，我们研究了失用症患者在 3 周的间隔内通过 10 次训练课程学习和保留新的外显顺序手指运动的能力。9 名处于慢性期的意念运动失用症中风患者参加了多疗程训练方案，并纳入数据分析。患者执行了一个外显手指序列学习任务（MSLT-运动序列学习任务），这是一个用于研究运动学习和记忆过程的成熟范式。患者在整个课程中提高了任务表现的速度和准确性。具体来说，他们在执行正确序列所需的平均时间和错误序列的数量上都有明显减少。我们还发现，在与 MSLT 训练前相比，在 Goldberg 失用症测试方案“模仿无意义的手部和手指手势”中，患者的表现也有改善的趋势。患有意念运动失用症的患者表现出获得和维持新运动序列的能力；并且，这种训练与失用症症状改善的迹象有关。
