Motor Learning Task Research Articles

Blinding of transcranial direct current stimulation is compromised in typically developing children compared to young adults.

Achieving successful blinding is a persistent challenge for clinical trials involving transcranial direct current stimulation. Studies involving populations with increased sensory sensitivity, such as children, could be at risk for increased bias from inadequate blinding due to unique sensation of stimulation relative to adults. The objectives of this study were 1) To examine differences in transcranial stimulation blinding between children and young adults and its relationship to sensory sensitivity. 2) To test the efficacy of an ActiSham protocol for participant blinding, compared to a traditional sham protocol. Typically developing right-handed children (N = 12, 5-14 yr) and young adults (N = 15, 15-25 yr) completed a single-session study to test transcranial stimulation blinding after three conditions counterbalanced across participants: Active, Sham and ActiSham. Stimulation was paired with a motor learning task to simulate a combinatory neurorehabilitation intervention. After each condition, participants reported if they received real or fake stimulation and their response confidence. To quantify sensory sensitivity, participants completed the Sensory Profile (second edition). Compared to a chance level, 1) children and young adults correctly identified Active stimulation, 2) children incorrectly identified Sham and ActiSham stimulation and 3) young adults identified Sham and ActiSham stimulation at chance-level. Blinding accuracy was not related to sensory sensitivity. Children report stimulation as real stimulation with higher confidence for almost all conditions, indicating unsuccessful blinding compared to young adults. Future studies should consider alternative sham protocols or methods to improve blinding in child participants.

Immersive virtual reality for learning exoskeleton-like virtual walking: a feasibility study

PurposeVirtual Reality (VR) has proven to be an effective tool for motor (re)learning. Furthermore, with the current commercialization of low-cost head-mounted displays (HMDs), immersive virtual reality (IVR) has become a viable rehabilitation tool. Nonetheless, it is still an open question how immersive virtual environments should be designed to enhance motor learning, especially to support the learning of complex motor tasks. An example of such a complex task is triggering steps while wearing lower-limb exoskeletons as it requires the learning of several sub-tasks, e.g., shifting the weight from one leg to the other, keeping the trunk upright, and initiating steps. This study aims to find the necessary elements in VR to promote motor learning of complex virtual gait tasks.MethodsIn this study, we developed an HMD-IVR-based system for training to control wearable lower-limb exoskeletons for people with sensorimotor disorders. The system simulates a virtual walking task of an avatar resembling the sub-tasks needed to trigger steps with an exoskeleton. We ran an experiment with forty healthy participants to investigate the effects of first- (1PP) vs. third-person perspective (3PP) and the provision (or not) of concurrent visual feedback of participants’ movements on the walking performance – namely number of steps, trunk inclination, and stride length –, as well as the effects on embodiment, usability, cybersickness, and perceived workload.ResultsWe found that all participants learned to execute the virtual walking task. However, no clear interaction of perspective and visual feedback improved the learning of all sub-tasks concurrently. Instead, the key seems to lie in selecting the appropriate perspective and visual feedback for each sub-task. Notably, participants embodied the avatar across all training modalities with low cybersickness levels. Still, participants’ cognitive load remained high, leading to marginally acceptable usability scores.ConclusionsOur findings suggest that to maximize learning, users should train sub-tasks sequentially using the most suitable combination of person’s perspective and visual feedback for each sub-task. This research offers valuable insights for future developments in IVR to support individuals with sensorimotor disorders in improving the learning of walking with wearable exoskeletons

Thalamic integration of basal ganglia and cerebellar circuits during motor learning.

The ability to control movement and learn new motor skills is one of the fundamental functions of the brain. The basal ganglia (BG) and the cerebellum (CB) are two key brain regions involved in controlling movement, and neuronal plasticity within these two regions is crucial for acquiring new motor skills. However, how these regions interact to produce a cohesive unified motor output remains elusive. Here, we discovered that a subset of neurons in the motor thalamus receive converging synaptic inputs from both BG and CB. By performing multi-site fiber photometry in mice learning motor tasks, we found that motor thalamus neurons integrate BG and CB signals and show distinct movement-related activity. Lastly, we found a critical role of these thalamic neurons and their BG and CB inputs in motor learning and control. These results identify the thalamic convergence of BG and CB and its crucial role in integrating movement signals.

Kernels of Motor Memory Formation: Temporal Generalization in Bimanual Adaptation.

In daily life, we coordinate both simultaneous and sequential bimanual movements to manipulate objects. Our ability to rapidly account for different object dynamics suggests there are neural mechanisms to quickly deal with them. Here we investigate how actions of one arm can serve as a contextual cue for the other arm, and facilitate adaptation. Specifically, we examine the temporal characteristics that underlie motor memory formation and recall, by testing the contextual effects of prior, simultaneous, and post contralateral arm movements in both male and female human participants. To do so, we measure their temporal generalization in three bimanual interference tasks. Importantly, the timing context of the learned action plays a pivotal role in the temporal generalization. While motor memories trained with post adaptation contextual movements generalize broadly, motor memories trained with prior contextual movements exhibit limited generalization, and motor memories trained with simultaneous contextual movements do not generalize to prior or post contextual timings. This highlights temporal tuning in sensorimotor plasticity: different training conditions yield substantially different temporal generalization characteristics. Since these generalizations extend far beyond any variability in training times, we suggest that the observed differences may stem from inherent differences in the use of prior, current and post-adaptation contextual information in the generation of natural behavior. This would imply differences in the underlying neural circuitry involved in learning and executing the corresponding coordinated bimanual movements.Significance Statement This study addresses a fundamental question in the field of sensorimotor neuroscience of how multiple movements are temporally linked within a single motor memory. We examine the temporal generalization of motor memory formation by varying the timing of contextual movements associated with a learned motor memory across a range of prior, current, and post adaptation movement times using a bimanual motor learning task. We observed distinct patterns of temporal generalization based on whether the contextual movements occurred prior to, simultaneously with, or after the adaptation movement. For the first time, our findings reveal that the timing of contextual movements is crucial in the formation and generalization of motor memories.

Prior coordination solutions shape motor learning and transfer in redundant tasks

Motor learning does not occur on a ‘blank slate’, but in the context of prior coordination solutions. The role of prior coordination solutions is likely critical in redundant tasks where there are multiple solutions to achieve the task goal – yet their influence on subsequent learning is currently not well understood. Here we addressed this issue by having human participants learn a redundant virtual shuffleboard task, where they held a bimanual manipulandum and made a discrete throwing motion to slide a virtual puck towards a target. The task was redundant because the distance traveled by the puck was determined by the sum of the left- and right-hand speeds at the time of release. On the first day, 37 participants in different groups practiced symmetric or asymmetric solutions. On the second day, all participants transferred to a common criterion task, which required an asymmetric solution. Results showed that: (i) the symmetry of the practiced solution affected motor variability during practice, with more asymmetric solutions showing higher exploration of the null space, (ii) when transferring to the common criterion task, participants in the symmetric group showed much higher null space exploration, and (iii) when no constraints were placed on the solution, participants tended to return to the symmetric solution regardless of the solution originally practiced. Overall, these results suggest that the stability of prior coordination solutions plays an important role in shaping learning in redundant motor tasks.

Effects of hyperbaric oxygen pre-exposure on the motor learning acquisition phase

Hyperbaric oxygen (HBO) exposure has recently been reported to be effective in spatial learning and memory. Additionally, HBO exposure considerably improves performance on motor tasks. These findings suggest that HBO exposure may facilitate motor learning. However, the specific effects of HBO exposure on motor learning remain largely unexplored. The present study aimed to investigate the effects of HBO exposure on motor learning tasks. In the experimental animal models (control n = 8, HBO n = 8), the HBO environment was exposed to 100 % oxygen with the chamber at 2.0 atmosphere absolute (ATA) for 90 min/day for 20 days. The motor learning task was an accelerated rotating bar task (bar width, 3 and 6 cm; rotation speed, 4–40 rpm; acceleration, 0.4, 0.6, and 0.8 rpm/s). The learning task was performed for 3 consecutive days. The HBO group showed a main effect of the day factor on the bar with a width of 6 cm, and significant differences were observed for each day comparison. However, no main effect of the day factor was observed in the control group. Additionally, significant differences were found in the bar with a width of 3 cm for both groups between days 1 and 2 and between days 1 and 3. In conclusion, these findings suggest that HBO exposure has a positive effect on more challenging motor learning tasks.

Prioritized adjustments in posture stabilization and adaptive reaching during neuromuscular fatigue of lower-limb muscles.

Neuromuscular fatigue (NMF) induces temporary reductions in muscle force production capacity, affecting various aspects of motor function. Although studies have extensively explored NMF's impact on muscle activation patterns and postural stability, its influence on motor adaptation processes remains less understood. This article investigates the effects of localized NMF on motor adaptation during upright stance, focusing on reaching tasks. Using a force-field perturbation paradigm, participants performed reaching movements while standing upright before and after inducing NMF in the ankle dorsiflexor muscles. Results revealed that despite maintained postural stability, participants in the NMF group exhibited larger movement errors during reaching tasks, suggesting impaired motor adaptation. This was evident in both initial and terminal phases of adaptation, indicating a disruption in learning processes rather than a decreased adaptation rate. Analysis of electromyography activation patterns highlighted distinct strategies between groups, with the NMF group showing altered activation of both fatigued and nonfatigued muscles. In addition, differences in coactivation patterns suggested compensatory mechanisms to prioritize postural stability despite NMF-induced disruptions. These findings underscore the complex interplay between NMF, motor adaptation, and postural control, suggesting a potential role for central nervous system mechanisms in mediating adaptation processes. Understanding these mechanisms has implications for sports performance, rehabilitation, and motor skill acquisition, where NMF may impact the learning and retention of motor tasks. Further research is warranted to elucidate the transient or long-term effects of NMF on motor adaptation and its implications for motor rehabilitation interventions.NEW & NOTEWORTHY We assessed motor adaptation during force-field reaching following exercise-induced neuromuscular fatigue (NMF) on postural muscles. NMF impaired adaptation in performance. Similarly, diverging activation strategies were observed in the muscles. No effects were seen on measures of postural control. These results suggest the remodulation of motor commands to the muscles in the presence of NMF, which may be relevant in settings where participants could be exposed to NMF while learning, such as sports and rehabilitation.

Sex differences in motor learning flexibility are accompanied by sex differences in mushroom spine pruning of the mouse primary motor cortex during adolescence.

Although males excel at motor tasks requiring strength, females exhibit greater motor learning flexibility. Cognitive flexibility is associated with low baseline mushroom spine densities achieved by pruning which can be triggered by α4βδ GABAA receptors (GABARs); defective synaptic pruning impairs this process. We investigated sex differences in adolescent pruning of mushroom spine pruning of layer 5 pyramidal cells of primary motor cortex (L5M1), a site essential for motor learning, using microscopic evaluation of Golgi stained sections. We assessed α4GABAR expression using immunohistochemical and electrophysiological techniques (whole cell patch clamp responses to 100 nM gaboxadol, selective for α4βδ GABARs). We then compared performance of groups with different post-pubertal mushroom spine densities on motor learning (constant speed) and learning flexibility (accelerating speed following constant speed) rotarod tasks. Mushroom spines in proximal L5M1 of female mice decreased >60% from PND35 (puberty onset) to PND56 (Pubertal: 2.23 ± 0.21 spines/10 μm; post-pubertal: 0.81 ± 0.14 spines/10 μm, P < 0.001); male mushroom spine density was unchanged. This was due to greater α4βδ GABAR expression in the female (P < 0.0001) because α4 -/- mice did not exhibit mushroom spine pruning. Although motor learning was similar for all groups, only female wild-type mice (low mushroom spine density) learned the accelerating rotarod task after the constant speed task (P = 0.006), a measure of motor learning flexibility. These results suggest that optimal motor learning flexibility of female mice is associated with low baseline levels of post-pubertal mushroom spine density in L5M1 compared to male and female α4 -/- mice.

Wings of Change: aPKC/FoxP-dependent plasticity in steering motor neurons underlies operant self-learning in Drosophila

Background Motor learning is central to human existence, such as learning to speak or walk, sports moves, or rehabilitation after injury. Evidence suggests that all forms of motor learning share an evolutionarily conserved molecular plasticity pathway. Here, we present novel insights into the neural processes underlying operant self-learning, a form of motor learning in the fruit fly Drosophila. Methods We operantly trained wild type and transgenic Drosophila fruit flies, tethered at the torque meter, in a motor learning task that required them to initiate and maintain turning maneuvers around their vertical body axis (yaw torque). We combined this behavioral experiment with transgenic peptide expression, CRISPR/Cas9-mediated, spatio-temporally controlled gene knock-out and confocal microscopy. Results We find that expression of atypical protein kinase C (aPKC) in direct wing steering motoneurons co-expressing the transcription factor FoxP is necessary for this type of motor learning and that aPKC likely acts via non-canonical pathways. We also found that it takes more than a week for CRISPR/Cas9-mediated knockout of FoxP in adult animals to impair motor learning, suggesting that adult FoxP expression is required for operant self-learning. Conclusions Our experiments suggest that, for operant self-learning, a type of motor learning in Drosophila, co-expression of atypical protein kinase C (aPKC) and the transcription factor FoxP is necessary in direct wing steering motoneurons. Some of these neurons control the wing beat amplitude when generating optomotor responses, and we have discovered modulation of optomotor behavior after operant self-learning. We also discovered that aPKC likely acts via non-canonical pathways and that FoxP expression is also required in adult flies.

Gray matter volume of functionally relevant primary motor cortex is causally related to learning a hand motor task.

Variability in brain structure is associated with the capacity for behavioral change. However, a causal link between specific brain areas and behavioral change (such as motor learning) has not been demonstrated. We hypothesized that greater gray matter volume of a primary motor cortex (M1) area active during a hand motor learning task is positively correlated with subsequent learning of the task, and that the disruption of this area blocks learning of the task. Healthy participants underwent structural MRI before learning a skilled hand motor task. Next, participants performed this learning task during fMRI to determine M1 areas functionally active during this task. This functional ROI was anatomically constrained with M1 boundaries to create a group-level "Active-M1" ROI used to measure gray matter volume in each participant. Greater gray matter volume in the left hemisphere Active-M1 ROI was related to greater motor learning in the corresponding right hand. When M1 hand area was disrupted with repetitive transcranial stimulation (rTMS), learning of the motor task was blocked, confirming its causal link to motor learning. Our combined imaging and rTMS approach revealed greater cortical volume in a task-relevant M1 area is causally related to learning of a hand motor task in healthy humans.

Influence of High-Intensity Interval Training on Neuroplasticity Markers in Post-Stroke Patients: Systematic Review.

Background: Exercise has shown beneficial effects on neuronal neuroplasticity; therefore, we want to analyze the influence of high-intensity interval training (HIIT) on neuroplasticity markers in post-stroke patients. Methods: A systematic review of RCTs including studies with stroke participants was conducted using the following databases (PubMed, LILACS, ProQuest, PEDro, Web of Science). Searches lasted till (20/11/2023). Studies that used a HIIT protocol as the main treatment or as a coadjutant treatment whose outcomes were neural plasticity markers were used and compared with other exercise protocols, controls or other kinds of treatment. Studies that included other neurological illnesses, comorbidities that interfere with stroke or patients unable to complete a HIIT protocol were excluded. HIIT protocol, methods to assess intensity, neuroplasticity markers (plasmatic and neurophysiological) and other types of assessments such as cognitive scales were extracted to make a narrative synthesis. Jadad and PEDro scales were used to assess bias. Results: Eight articles were included, one included lacunar stroke (less than 3 weeks) and the rest had chronic stroke. The results found here indicate that HIIT facilitates neuronal recovery in response to an ischemic injury. This type of training increases the plasma concentrations of lactate, BDNF and VEGF, which are neurotrophic and growth factors involved in neuroplasticity. HIIT also positively regulates other neurophysiological measurements that are directly associated with a better outcome in motor learning tasks. Conclusions: We conclude that HIIT improves post-stroke recovery by increasing neuroplasticity markers. However, a limited number of studies have been found indicating that future studies are needed that assess this effect and include the analysis of the number of intervals and their duration in order to maximize this effect.

Robotic realization of human perceptual changes with lateral balance task

Human motor learning affects not only motion pattern but also perception. On the basis of this idea, we investigated some human-balancing tasks to observe changes in the balance perception. We simulated one of the results to replay the human behavior. In this study, we aim to demonstrate the human adaptive behavior in a motor and sensory system using a robot in a real-world scenario. The subjective upright, i.e., the inclination angle was considered as upright, was evaluated as perception in a balance position, and its lateral shift was determined after a motor-learning task under lateral disturbances. The adaptation dynamics were defined based on our hypothesis that stated that the subjective upright tends to vary toward the posture in which balance can be best maintained. Consequently, the change in the subjective upright similar to the human result was reproduced using a two-link robot that was subjected to the same environmental condition as that in the human experiment.

Interactions between circuit architecture and plasticity in a closed-loop cerebellar system.

Determining the sites and directions of plasticity underlying changes in neural activity and behavior is critical for understanding mechanisms of learning. Identifying such plasticity from neural recording data can be challenging due to feedback pathways that impede reasoning about cause and effect. We studied interactions between feedback, neural activity, and plasticity in the context of a closed-loop motor learning task for which there is disagreement about the loci and directions of plasticity: vestibulo-ocular reflex learning. We constructed a set of circuit models that differed in the strength of their recurrent feedback, from no feedback to very strong feedback. Despite these differences, each model successfully fit a large set of neural and behavioral data. However, the patterns of plasticity predicted by the models fundamentally differed, with the direction of plasticity at a key site changing from depression to potentiation as feedback strength increased. Guided by our analysis, we suggest how such models can be experimentally disambiguated. Our results address a long-standing debate regarding cerebellum-dependent motor learning, suggesting a reconciliation in which learning-related changes in the strength of synaptic inputs to Purkinje cells are compatible with seemingly oppositely directed changes in Purkinje cell spiking activity. More broadly, these results demonstrate how changes in neural activity over learning can appear to contradict the sign of the underlying plasticity when either internal feedback or feedback through the environment is present.

Wings of Change: aPKC/FoxP-dependent plasticity in steering motor neurons underlies operant self-learning in Drosophila.

Motor learning is central to human existence, such as learning to speak or walk, sports moves, or rehabilitation after injury. Evidence suggests that all forms of motor learning share an evolutionarily conserved molecular plasticity pathway. Here, we present novel insights into the neural processes underlying operant self-learning, a form of motor learning in the fruit fly Drosophila. We operantly trained wild type and transgenic Drosophila fruit flies, tethered at the torque meter, in a motor learning task that required them to initiate and maintain turning maneuvers around their vertical body axis (yaw torque). We combined this behavioral experiment with transgenic peptide expression, CRISPR/Cas9-mediated, spatio-temporally controlled gene knock-out and confocal microscopy. We find that expression of atypical protein kinase C (aPKC) in direct wing steering motoneurons co-expressing the transcription factor FoxP is necessary for this type of motor learning and that aPKC likely acts via non-canonical pathways. We also found that it takes more than a week for CRISPR/Cas9-mediated knockout of FoxP in adult animals to impair motor learning, suggesting that adult FoxP expression is required for operant self-learning. Our experiments suggest that, for operant self-learning, a type of motor learning in Drosophila, co-expression of atypical protein kinase C (aPKC) and the transcription factor FoxP is necessary in direct wing steering motoneurons. Some of these neurons control the wing beat amplitude when generating optomotor responses, and we have discovered modulation of optomotor behavior after operant self-learning. We also discovered that aPKC likely acts via non-canonical pathways and that FoxP expression is also required in adult flies.

High-intensity acute exercise impacts motor learning in healthy older adults

Healthy aging is associated with changes in motor sequence learning, with some studies indicating decline in motor skill learning in older age. Acute cardiorespiratory exercise has emerged as a potential intervention to improve motor learning, however research in healthy older adults is limited. The current study investigated the impact of high-intensity interval exercise (HIIT) on a subsequent sequential motor learning task. Twenty-four older adults (aged 55–75 years) completed either 20-minutes of cycling, or an equivalent period of active rest before practicing a sequential force grip task. Skill learning was assessed during acquisition and at a 6-hour retention test. In contrast to expectation, exercise was associated with reduced accuracy during skill acquisition compared to rest, particularly for the oldest participants. However, improvements in motor skill were retained in the exercise condition, while a reduction in skill was observed following rest. Our findings indicate that high-intensity exercise conducted immediately prior to learning a novel motor skill may have a negative impact on motor performance during learning in older adults. We also demonstrated that exercise may facilitate early offline consolidation of a motor skill within this population, which has implications for motor rehabilitation.

Effects of color cues on eye-hand coordination training with a mirror drawing task in virtual environment.

Mirror drawing is a motor learning task that is used to evaluate and improve eye-hand coordination of users and can be implemented in immersive Virtual Reality (VR) Head-Mounted Displays (HMDs) for training purposes. In this paper, we investigated the effect of color cues on user motor performance in a mirror-drawing task between Virtual Environment (VE) and Real World (RW), with three different colors. We conducted a 5-day user study with twelve participants. The results showed that the participants made fewer errors in RW compared to VR, except for pre-training, which indicated that hardware and software limitations have detrimental effects on the motor learning of the participants across different realities. Furthermore, participants made fewer errors with the colors close to green, which is usually associated with serenity, contentment, and relaxation. According to our findings, VR headsets can be used to evaluate participants' eye-hand coordination in mirror drawing tasks to evaluate the motor-learning of participants. VE and RW training applications could benefit from our findings in order to enhance their effectiveness.

Effectiveness of task-specific training for improving balance performance in children with cerebral palsy (CP): a narrative systematic review

IntroductionA body of research has focused on helping children with disabilities stay physically active. As poor balance has been found as a major limitation in physical activities, a systematic review exploring balance intervention programs is warranted.MethodsThe primary aim of this is to systematically evaluate evidence for the effect of task-specific training to improve balance outcomes in ambulant children with cerebral palsy. Seven databases were searched for studies involving ambulant children with cerebral palsy (4–15 years old); balance TST; and balance-related outcomes. The quality of the studies was appraised using the JBI Critical Appraisal Checklists for risk of bias, study design, and quality of evidence. Continuous data were transformed and summarised using standardised mean difference and 95%CI.ResultsSeven randomised controlled trials met the inclusion criteria. The risk of bias was deemed low in most of the studies. Due to heterogeneity of study design and outcome measures, a narrative synthesis was conducted. Positive between-group effects favouring TST were found across the six studies (BBS d = 1.528, 95% CI = 0.7747–2.2813) and follow-up (BBS d = –1.667, 95% CI = –2.459 ÷ –0.874). Despite poor reporting of motor learning strategies, repetitive practice, feedback, and task modulation strategies were used consistently in balance TST.ConclusionsTST could be recommended to be a part of an intervention programme to improve balance performance in children with CP. However, more studies with rigorous study design and adequately powered implementation of a more fun task-oriented training programme are needed.

Dyad motor learning in a wrist-robotic environment: Learning together is better than learning alone

ObjectiveDyad motor practice is characterized by two learners alternating between physical and observational practice, which can lead to better motor outcomes and reduce practice time compared to physical practice alone. Robot-assisted therapy has become an established neurorehabilitation tool but is limited by high therapy cost and access. Implementing dyad practice in robot-assisted rehabilitation has the potential to improve therapeutic outcomes and/or to achieve them faster. This study aims to determine the effects of dyad practice on motor performance in a wrist-robotic environment to evaluate its potential use in robotic rehabilitation settings. MethodsForty-two healthy participants (18–35 years) were randomized into three groups (n = 14): Dyad practice, physical practice with rest and physical practice without rest. Participants practiced a 2 degree-of-freedom gamified wrist movement task for 20 trials using a custom-made wrist robotic device. A motor performance score (MPS) that captured temporal and spatial time-series kinematics was computed at baseline, the end of training and 24 h later to assess retention. ResultsMPS did not differ between groups at baseline. All groups revealed significant performance gains by the end of training. However, dyads outperformed the other groups at the end of training (p < 0.001) and showed higher retention after 24-h (p = 0.02). Median MPS improved by 46.5% in dyads, 25.3% in physical practice-rest, and 33.6% in physical practice-no rest at the end of training compared to baseline. ConclusionCompared to physical practice alone, dyad practice leads to superior motor outcomes in a robot-assisted motor learning task. Dyads still outperformed their counterparts 24-h after practice. Impact statementImproving motor function in complex motor tasks without increasing required practice time, dyad practice can optimize therapeutic resources. This is particularly impactful in robot-assisted rehabilitation regimens as it would help to improve patients' outcomes and increase care efficiency.

Augmented Targeted Training to Improve Balance in Diabetic Neuropathy Patients

Due to its high rates of morbidity, disability and death, diabetes mellitus with its long-term consequences is regarded as a public global health issue. In any specific period, between 12 and 50 percent of people with diabetes suffer with diabetic peripheral neuropathy (DPN). Motor nerve disorders and a loss of proprioception lead to impaired muscle action and imbalance. This study’s main target was to find whether targeted strategy specific training along with verbal and visual feedback improved the efficiency of learning motor tasks that are identical. Out of 30, 15 patients were allotted to interventional group and other 15 were allotted to control group by simple sequential sampling. Patients in control group underwent standard balance training usually given as conventionally, while the interventional group received targeted strategy specific balance training along with augmentation. They received treatment for 2 consecutive weeks; 5 sessions per week. Both groups were assessed using MiniBEST test, before and after 2 weeks of intervention. In within group analysis using Paired t-test, intervention group had significant improvement statistically in all four components of balance, whereas control group showed improvement only in reactive postural control, sensory orientation and anticipatory postural control. In between group analysis using independent t-test, except anticipatory postural control all the other three components of balance showed statistically significant improvement. Augmented Targeted Training is effective in improving balance in DN patients.

Visual stimulation by extensive visual media consumption can be beneficial for motor learning

In this randomized controlled intervention trial, we investigated whether intense visual stimulation through television watching can enhance visual information processing and motor learning performance. 74 healthy young adults were trained in a motor skill with visual information processing demands while being accommodated in a controlled environment for five days. The experimental manipulation (n = 37) consisted of prolonged television watching (i.e., 8 h/day, + 62.5% on average) to induce intense exposure to visual stimulation. The control group (n = 37) did not consume visual media. The groups were compared by motor learning performance throughout the study as well as pre/post visual attention parameters and resting-state network connectivity in functional MRI. We found that the intervention group performed significantly better in the motor learning task (+ 8.21% (95%-CI[12.04, 4.31], t(70) = 4.23, p < 0.001) while showing an increased capacity of visual short-term memory (+ 0.254, t(58) = − 3.19, p = 0.002) and increased connectivity between visual and motor-learning associated resting-state networks. Our findings suggest that the human brain might enter a state of accentuated visuomotor integration to support the implementation of motor learning with visual information processing demands if challenged by ample input of visual stimulation. Further investigation is needed to evaluate the persistence of this effect regarding participants exposed to accustomed amounts of visual media consumption.Clinical Trials Registration: This trial was registered in the German Clinical Trials Register/Deutsches Register klinischer Studien (DRKS): DRKS00019955.