Department of Physical Medicine and Rehabilitation, Neuromuscular and Rehabilitation Robotics Laboratory (NeuRRo Lab), Michigan Medicine, University of Michigan, 325 E Eisenhower Parkway (Room 3013), Ann Arbor, MI, 48108, USA.
Department of Robotics, University of Michigan, Ann Arbor, MI, USA.
J Neuroeng Rehabil. 2024 Oct 29;21(1):192. doi: 10.1186/s12984-024-01494-8.
The ability to relearn a lost skill is critical to motor recovery after a stroke. Previous studies indicate that stroke typically affects the processes underlying motor control and execution but not the learning of those skills. However, these studies could be confounded by the presence of significant motor impairments. Furthermore, prior research involving the upper extremity indicates that stroke survivors have an advantage in offline motor learning when compared with controls. However, this has not been examined using motor acuity tasks (i.e., tasks focusing on the quality of executed actions) that have direct functional relevance to rehabilitation.
Investigate how stroke affects leg motor skill learning during walking in stroke survivors.
Twenty-five participants (10 stroke; 15 controls) were recruited for this prospective, case-control study. Participants learned a novel foot-trajectory tracking task on two consecutive days while walking on a treadmill. The task necessitated greater hip and knee flexion during the swing phase of the gait. Online learning was measured by comparing tracking error at the beginning and end of each practice session, offline (rest-driven) learning was measured by comparing the end of the first practice session to the beginning of the second, and retention was measured by comparing the beginning of the first practice session to the beginning of the second. Online learning, offline learning, and retention were compared between the stroke survivors and uninjured controls.
Stroke survivors improved their tracking performance on the first day (p = 0.033); however, the amount of learning in stroke survivors was lower in comparison with the control group on both days (p ≤ 0.05). Interestingly, stroke survivors showed higher offline learning gains when compared with uninjured controls (p = 0.011).
Even stroke survivors with no perceivable motor impairments have difficulty acquiring new motor skills related to walking, which may be related to the underlying neural damage caused at the time of stroke. Furthermore, stroke survivors may require longer training with adequate rest to acquire new motor skills.
在中风后恢复运动能力，重新学习丧失的技能至关重要。先前的研究表明，中风通常会影响运动控制和执行的基础过程，但不会影响这些技能的学习。然而，这些研究可能因存在显著的运动障碍而受到混淆。此外，涉及上肢的先前研究表明，与对照组相比，中风幸存者在线下运动学习方面具有优势。然而，这尚未通过使用与康复具有直接功能相关性的运动敏锐度任务（即专注于执行动作质量的任务）进行检查。
研究中风如何影响中风幸存者在行走时的腿部运动技能学习。
这项前瞻性病例对照研究招募了 25 名参与者（10 名中风患者；15 名对照组）。参与者在跑步机上行走时连续两天学习一项新的足部轨迹跟踪任务。该任务在步态的摆动阶段需要更大的髋关节和膝关节弯曲。在线学习通过比较每个练习阶段开始和结束时的跟踪误差来测量，离线（休息驱动）学习通过比较第一次练习阶段结束时和第二次练习阶段开始时来测量，保留通过比较第一次练习阶段开始时和第二次练习阶段开始时来测量。比较中风幸存者和未受伤对照组之间的在线学习、离线学习和保留。
中风幸存者在第一天（p=0.033）提高了他们的跟踪表现；然而，与对照组相比，中风幸存者在两天内的学习量都较低（p≤0.05）。有趣的是，中风幸存者的离线学习增益高于未受伤的对照组（p=0.011）。
即使是没有明显运动障碍的中风幸存者，也难以获得与行走相关的新运动技能，这可能与中风时的潜在神经损伤有关。此外，中风幸存者可能需要更长的训练和充分的休息才能获得新的运动技能。
