Motor Learning Principles Research Articles

Relationships Between Cognitive Impairments and Motor Learning After Stroke: A Scoping Review.

Stroke is one of the leading causes of chronic disability worldwide. Sensorimotor recovery relies on principles of motor learning for the improvement of movement and sensorimotor function after stroke. Motor learning engages several cognitive processes to effectively learn and retain new motor skills. However, cognitive impairments are common and often coexist with motor impairments after stroke. The specific relationships between poststroke cognitive impairments and motor learning have not been determined. To summarize the existing evidence related to cognitive impairments and motor learning after stroke. Specific goals were to determine: (1) how motor learning is studied in individuals with poststroke cognitive impairments; (2) how cognitive impairments are assessed; (3) which cognitive domains impact motor learning. Over 400 studies were screened for specific inclusion criteria and 19 studies that related poststroke cognitive impairments to motor learning were included. Studies used a wide variety of experimental designs, sample sizes, and measures for cognitive evaluation. Cognitive impairments impacting motor improvement and learning capacity after stroke were reported in all but 4 studies. The most common domains impacting motor learning were attention, executive function, and memory. Detailed cognitive assessments, retention testing, and a combination of clinical and kinematic outcomes are recommended for future studies. The presence of specific cognitive impairments measured with sensitive instruments should be considered when designing effective training interventions for patients with stroke to maximize sensorimotor recovery.

Upper Limb Therapy for Infants and Young Children with Unilateral Cerebral Palsy: A Clinical Framework.

Early detection and rehabilitation interventions are essential to optimise motor function in infants and young children with unilateral cerebral palsy. In this paper we report a clinical framework aimed at enhancing upper limb therapy for infants and young children with unilateral cerebral palsy during a sensitive period of brain development. We describe two major therapeutic approaches based on motor learning principles and evidence: constraint-induced movement therapy and bimanual therapy. These two therapies have demonstrated efficacy in older children and emerging evidence is available for their application to infants younger than 2 years of age. To provide clinicians with guidance as to when to implement these therapies, we discuss the key consideration when undertaking upper limb therapy programs. In addition, we describe the factors to consider when choosing which approach may be suitable for an individual child and family. Detailed strategies for implementing these therapies in infants and young children of different ability levels are given.

Integration of Dysphagia Therapy Techniques into Voice Rehabilitation: Design and Content Validation of a Cross-Therapy Protocol

BackgroundThe intricate relationship between swallowing and phonation, sharing anatomical and physiological substrates, underscores a clinical demand for integrated therapeutic approaches. Existing interventions often address these functions in isolation, overlooking their interconnected dynamics. ObjectiveTo design and validate a cross-therapy protocol incorporating dysphagia therapy techniques (maneuvers/exercises) invoice rehabilitation. This protocol aims to exploit the shared biomechanical components of swallowing and phonation to improve both functions simultaneously in patients with underlying hypofunctional laryngeal pathology. MethodsA descriptive research design was employed, consisting of three phases: a comprehensive literature review and expert discussions in a German seminar format to conceptualize the protocol; detailed analysis and categorization of swallowing maneuvers/exercises; and content validation by a panel of seven experts through a structured evaluation instrument. The process integrated motor learning and exercise physiology principles to ensure the protocol's clinical applicability and theoretical coherence. ResultsThe developed cross-therapy protocol incorporates four core swallowing therapy techniques to voice therapy procedures. Selected swallowing therapy techniques target laryngeal excursion and vocal fold closure because they are critical components of swallowing and phonation. Expert validation yielded a Content Validity Coefficient (CVC) exceeding 0.90 for most items, indicating high consensus on the protocol’s relevance, clarity, and applicability. Adjustments were made based on feedback, enhancing the protocol's precision and user-friendliness. ConclusionWe present a novel, evidence-based therapy protocol for voice and swallowing difficulties resulting from hypofunctional laryngeal pathology. Its development marks a significant step toward bridging the gap between swallowing and voice therapy. Future empirical studies are needed to assess its effectiveness in clinical settings.

A pilot cluster randomised controlled trial, of an IMPlicit learning approach versus standard care, on recovery of mobility following stroke (IMPS)

Objectives To evaluate the delivery of rehabilitation using implicit motor learning principles in an acute stroke setting. Design Pilot, assessor-blind, cluster randomised controlled trial with nested qualitative evaluation. Setting Eight inpatient stroke units, UK. Participants People within 14 days of stroke onset, presenting with lower limb hemiplegia. Interventions Participants at control clusters received usual care. Participants at intervention clusters received rehabilitation using an Implicit Learning Approach (ILA); primarily consisting of reduced frequency instructions/feedback, and promotion of an external focus of attention. Video recording was used to understand the ability of intervention site therapists to adhere to the implicit learning principles, and to compare differences between groups. Measures Ability to recruit and retain clusters/participants; suitability and acceptability of data collection processes; appropriateness of fidelity monitoring methods; and appropriateness of chosen outcome measures. Results Eight stroke units participated, with four assigned to each group (intervention/control). Fifty-one participants were enrolled (intervention group 21; control group 30). Mean time since stroke was 6 days (SD 3.42; 0–14); mean age was 73 years (SD 14, 25–94). Of those approached to take part, 72% agreed. We found clear differences between groups with respect to the frequency and type of instructional statement. The ILA was acceptable to both patients and therapists. Conclusion It is feasible to evaluate the application and effectiveness of motor learning principles within acute stroke rehabilitation, using a cluster randomised design. A larger study is required to evaluate the benefits of each approach; we provide a range of sample size estimates required for this.

COMPREHENSIVE EDUCATIONAL-REHABILITATION APPROACH IN A PERSON POST-STROKE: A CASE STUDY

A stroke occurs due to a disruption in brain circulation, leading to partial or complete loss of motor, sensory, perceptual, or cognitive abilities. This can result in disability and reduced rehabilitation potential. Therefore, the approach to working with individuals who have experienced a stroke is crucial, adapting to their individual needs in a holistic manner. In this context, the aim of this study was to present a comprehensive rehabilitation approach for an 88-year-old patient following a stroke through the implementation of educational-rehabilitation treatment, achieving gradual improvements in the recovery process. Tests such as the Mini-Mental State Examination, Motor Evaluation Scalefor Upper Extremity in Stroke patients, The Barthel Index for Activities of Daily Living, Aphasic Depression Rating Scale, and The Modified Rankin Scale were applied to assess the set goal. The educational-rehabilitation treatment was conducted daily for 45 minutes, for two months within clinical rehabilitation and nine months in home conditions. The treatment was based on the principles of brain neuroplasticity and motor learning, involving cognitive training, motor training, adaptive skills training, relaxation, education and counseling, motivational training, and the promotion of metacognitive abilities. The research data underwent analysis through descriptive statistics, and the findings were visually illustrated in graphical representations. Based on the obtained results, it can be concluded that there is noticeable functional progress in the patient across all evaluated areas.Keywords:stroke, rehabilitation, educational-rehabilitation treatment

Bimanual coordinated motor skill learning in patients with a chronic cerebellar stroke.

Cerebellar strokes induce coordination disorders that can affect activities of daily living. Evidence-based neurorehabilitation programs are founded on motor learning principles. The cerebellum is a key neural structure in motor learning. It is unknown whether and how well chronic cerebellar stroke individuals (CCSIs) can learn to coordinate their upper limbs through bimanual motor skill learning. The aim was to determine whether CCSIs could achieve bimanual skill learning through a serious game with the REAplan® robot and to compare CCSIs with healthy individuals (HIs). Over three consecutive days, sixteen CCSIs and eighteen HIs were trained on an asymmetric bimanual coordination task ("CIRCUIT" game) with the REAplan® robot, allowing quantification of speed, accuracy and coordination. The primary outcomes were the bimanual speed/accuracy trade-off (BiSAT) and bimanual coordination factor (BiCo). They were also evaluated on a bimanual REACHING task on Days 1 and 3. Correlation analyses between the robotic outcomes and clinical scale scores were computed. Throughout the sessions, BiSAT and BiCo improved during the CIRCUIT task in both HIs and CCSIs. On Day 3, HIs and CCSIs showed generalization of BiSAT, BiCo and transferred to the REACHING task. There was no significant between-group difference in progression. Four CCSIs and two HIs were categorized as "poor learners" according to BiSAT and/or BiCo. Increasing age correlated with reduced BiSAT but not BiCo progression. Over three days of training, HIs and CCSIs improved, retained, generalized and transferred a coordinated bimanual skill. There was no between-group difference, suggesting plastic compensation in CCSIs. Clinical trial NCT04642599 approved the 24th of November 2020.

Analysis of Motor Learning Principles Applied in Tasks or Motor Skills Trained by Stroke Patients

Objective: To analyze the principles applied to promote and evaluate motor learning in tasks or motor skills trained by stroke patients. Methods: Articles were included if they used motor learning principles in tasks or motor skills trained by stroke patients. Results: Twelve studies were included in this review. Quality was good for the included studies. Articles used motor learning principle based on practice (N = 12), repetitive training (N = 9), and feedback (N = 5). Conclusions: There are different motor learning principles to promote and evaluate motor learning in stroke patients. These findings could guide clinicians during training of tasks or motor skills.

Sensory manipulation as a countermeasure to robot teleoperation delays: system and evidence

In the realm of robotics and automation, robot teleoperation, which facilitates human–machine interaction in distant or hazardous settings, has surged in significance. A persistent issue in this domain is the delays between command issuance and action execution, causing negative repercussions on operator situational awareness, performance, and cognitive load. These delays, particularly in long-distance operations, are difficult to mitigate even with the most advanced computing advancements. Current solutions mainly revolve around machine-based adjustments to combat these delays. However, a notable lacuna remains in harnessing human perceptions for an enhanced subjective teleoperation experience. This paper introduces a novel approach of sensory manipulation for induced human adaptation in delayed teleoperation. Drawing from motor learning and rehabilitation principles, it is posited that strategic sensory manipulation, via altered sensory stimuli, can mitigate the subjective feeling of these delays. The focus is not on introducing new skills or adapting to novel conditions; rather, it leverages prior motor coordination experience in the context of delays. The objective is to reduce the need for extensive training or sophisticated automation designs. A human-centered experiment involving 41 participants was conducted to examine the effects of modified haptic cues in teleoperations with delays. These cues were generated from high-fidelity physics engines using parameters from robot-end sensors or physics engine simulations. The results underscored several benefits, notably the considerable reduction in task time and enhanced user perceptions about visual delays. Real-time haptic feedback, or the anchoring method, emerged as a significant contributor to these benefits, showcasing reduced cognitive load, bolstered self-confidence, and minimized frustration. Beyond the prevalent methods of automation design and training, this research underscores induced human adaptation as a pivotal avenue in robot teleoperation. It seeks to enhance teleoperation efficacy through rapid human adaptation, offering insights beyond just optimizing robotic systems for delay compensations.

Priming constraint-induced movement therapy with intermittent theta burst stimulation to enhance upper extremity recovery in patients with stroke: protocol for a randomized controlled study.

The treatments based on motor control and motor learning principles have gained popularity in the last 20 years, as well as non-invasive brain stimulations that enhance neuroplastic changes after stroke. However, the effect of intermittent theta burst stimulation (iTBS) in addition to evidence-based, intensive neurorehabilitation approaches such as modified constraint-induced movement therapy (mCIMT) is yet to be investigated. We aim to establish a protocol for a randomized controlled study investigating the efficiency of mCIMT primed with iTBS after stroke. In this randomized controlled, single-blind study, patients with stroke (N = 17) will be divided into 3 groups: (a) mCIMT + real iTBS, (b) mCIMT + sham iTBS, and (c) mCIMT alone. 600-pulse iTBS will be delivered to the primary motor cortex on the ipsilesional hemisphere, and then, patients will receive mCIMT for 1h/session, 3 sessions/week for 5weeks. Upper extremity recovery will be assessed with Fugl-Meyer Test-Upper Extremity and Wolf Motor Function Test. Electrophysiological assessments, such as Motor-Evoked Potentials, Resting Motor Threshold, Short-Intracortical Inhibition, and Intracortical Facilitation, will also be included. In this study, a protocol of an ongoing intervention study investigating the effectiveness of iTBS on ipsilesional M1 prior to the mCIMT in patients with stroke is proposed. This will be the first study to research priming mCIMT with iTBS and it may have the potential to reveal the true effect of the iTBS when it is added to the high-quality neurorehabilitation approaches. Trial registration number: NCT05308667.

Stimulus variability improves generalization following response inhibition training.

The present study examined the effect of stimulus variability and practice order on generalization to novel stimuli following a single session of response inhibition training. Ninety-six young adults practiced the Go/No-go task online in three training conditions: (1) constant (N = 32)-inhibition practiced on one stimulus; (2) variable-blocked (N = 32)-inhibition practiced on 6 stimuli, each in a separate block; and (3) variable-random (N = 32)-inhibition practiced on 6 stimuli in random order. Generalization was measured by comparing groups on inhibition of novel stimuli and a trained stimulus immediately and 24h after training. Consistent with our hypothesis, the variable-random and the variable-blocked groups showed better generalization to the novel items than the constant group, demonstrating the benefit of stimulus variability. The variable-random group also showed better generalization than the variable-blocked group, demonstrating the benefit of presenting stimuli in random order. Participants' capacity for working memory maintenance was found to modulate the effect of practice order. While the benefit of variability was retained 24h after training, the effect of order was not. Results also show generalization to (1) different type of stimuli using the same task and (2) the same stimuli on a different response inhibition task (the Stop-Signal Task), however, the effect of variable practice and order were not evident in these cases. The study findings illustrate the advantage of using variable stimuli presented in random order for generalization and suggest that these principles of motor learning can be applied to learning of cognitive skills.

Effects of a Virtual Reality Cycling Platform on Lower Limb Rehabilitation in Patients With Ataxia and Hemiparesis: Pilot Randomized Controlled Trial.

New interventions based on motor learning principles and neural plasticity have been tested among patients with ataxia and hemiparesis. Therapies of pedaling exercises have also shown their potential to induce improvements in muscle activity, strength, and balance. Virtual reality (VR) has been demonstrated as an effective tool for improving the adherence to physical therapy, but it is still undetermined if it promotes greater improvements than conventional therapy. Our objective was to compare the effect on lower limb range of motion (ROM) when using VR technology for cycling exercise versus not using VR technology. A randomized controlled trial with 20 patients with ataxia and hemiparesis was carried out. The participants were divided into 2 groups: the experimental group (n=10, 50%) performed pedaling exercises using the VR system and the control group (n=10, 50%) performed pedaling exercises without using VR. Measurements of the active and passive ROM of the hip and knee joint were taken before and after a cycling intervention, which consisted of 3 sessions of the same duration but with progressively increasing speeds (4, 5, and 6 km/h). Repeated measures ANOVAs were conducted to compare the preintervention (Ti) and postintervention (Te) assessments within each group. Additionally, the improvement effect of using the VR system was analyzed by comparing the variation coefficient (Δ = 1 - [Te / Ti]) between the preintervention and postintervention assessments for each group. Group comparisons were made using independent 1-tailed t tests. Significant improvements were shown in active left hip flexion (P=.03) over time, but there was no group-time interaction effect (P=.67). Passive left hip flexion (P=.93) did not show significant improvements, and similar results were observed for active and passive right hip flexion (P=.39 and P=.83, respectively). Neither assessments of knee flexion (active left: P=.06; passive left: P=.76; active right: P=.34; passive right: P=.06) nor knee extension showed significant changes (active left: P=.66; passive left: P=.92; active right: P=.12; passive right: P=.38). However, passive right knee extension (P=.04) showed a significant improvement over time. Overall, although active and passive ROM of the knee and hip joints showed a general improvement, no statistically significant differences were found between the groups. In this study, participants who underwent the cycling intervention using the VR system showed similar improvement in lower limb ROM to the participants who underwent conventional training. Ultimately, the VR system can be used to engage participants in physical activity.

Is There a Place for Assessment of Procedural Perceptual-Motor Learning in Pediatric Rehabilitation? A Survey of French Psychomotor and Occupational Therapists

The principles of motor learning have been applied in neurological rehabilitation for years. The underlying assumption is that these principles that have been identified in research on healthy individuals would also apply to those with neurological disorders, making them highly relevant for rehabilitation. However, there is currently no tool dedicated to evaluating motor learning abilities, that refers to procedural perceptual-motor learning (PPML) abilities, before rehabilitation. To address this gap, we created a new tool assessing PPML (EVALuation de l’APprentissage Procedural [EVAL_APP]), based on two experimental tasks known to assess motor sequence learning and visuomotor adaptation. The study aimed to determine whether this tool is suitable for clinical practice and meets care needs by conducting a cross-sectional online survey of psychomotor and occupational therapists in France. The results show that professionals are interested in measuring PPML, and over half of them indicated that they would use the tool. Participants who felt trained about PPML responded positively to the relevance of PPML assessment and to the future use of the EVAL_APP tool. While some parameters of the EVAL_APP tool are well adjusted, others may need improvement to be adapted for children with neurodevelopmental disorders, including Developmental Coordination Disorder. The results are encouraging for pursuing the conception of the new tool by considering the opinion of professionals specialized in pediatric rehabilitation.

Is it only nice in theory? Implementation of motor learning principles in neurorehabilitation among Saudi physical therapists.

Despite earlier recognition of the importance of motor learning principles in neurorehabilitation, research suggests that the motor learning principle is not being entirely utilized in neurorehabilitation. Implementation of motor learning principles has been associated with functional recovery and patient satisfaction. To examine implementation of motor learning principles in neurorehabilitation among Saudi physical therapists including self-efficacy, current practice, attitude and barriers. A cross-sectional survey of physical therapists managing patients with neurological conditions was conducted (n = 345). The survey questionnaire contained items to evaluate self-efficacy, current practice, attitude and barriers toward implementing motor learning principles in neurorehabilitation. The data from the respondents indicated that they had moderate self-efficacy to implement motor learning in neurorehabilitation. Only 30.2% of respondents implement motor learning in their practice to a high degree and some respondents were unaware of the concepts of motor learning. The most reported perceived barriers to motor learning implementation in neurorehabilitation were at the level of the physical therapist (lack of knowledge) and the organization (lack of time). Implementation of motor learning principles among Saudi physical therapists managing patients with neurological conditions was moderate. Self-efficacy, positive attitudes, academic training and organizational support are potential strategies to enhance implementation.

Toe-in and toe-out gait retraining interventions to reduce proxy measures of medial knee joint load in people with medial knee osteoarthritis: Protocol for a randomised placebo-controlled trial

ObjectiveOur primary aim is to determine the effect of a six-week toe-in, toe-out and active placebo gait retraining program on proxy measures of medial knee joint load and varus thrust in people with medial knee osteoarthritis. Our secondary aim is to determine the intervention effects on patient reported outcomes and physical function and determine if changes are maintained at three-months follow-up. MethodsWe will conduct a three-arm randomised placebo-controlled trial. Ninety participants with medial knee osteoarthritis will be randomised and stratified via varus thrust status (presence/absence) to: toe-in, toe-out or placebo gait retraining (an intervention that does not change proxy measures of medial knee joint load). The intervention involves weekly clinician-supervised sessions with biofeedback, knee osteoarthritis education, motor learning and behaviour change principles, and daily gait retraining practice. Primary outcomes are proxy measures of medial knee joint load: knee adduction moment (early- and late-stance peaks and impulse), and varus thrust (presence/absence). Secondary outcomes include pain, physical function, medication and health care utilisation, quality of life, work ability, treatment blinding, intervention credibility and other biomechanical outcomes. Assessment timepoints are at baseline, six weeks (post intensive training), and three-months following the six-week intervention. ConclusionOur trial will determine whether toe-in or toe-out gait retraining is most effective at reducing proxy measures of medial knee joint load and varus thrust in people with medial knee osteoarthritis. This study will also evaluate if toe-in or toe-out gait retraining interventions are superior at improving pain, physical function and quality of life compared to placebo. Clinical trial registrationThis clinical trial protocol is registered with the Australian New Zealand Clinical Trials Registry (ACTRN12621000414819).

Adaptation and Validation of a Serious Game for Motor Learning Training in Children with Cerebral Palsy.

Objective: Children with cerebral palsy (CP) present motor learning disorders and somatosensory dysfunction. Although many protocols use videogames in children with CP, few apply or examine motor learning principles. This study aims at (1) implementing therapist-user-designer collaboration in adapting a videogame to the principles of motor learning and the characteristics of users with CP, and (2) piloting the effectiveness of these adaptations by analyzing the achievement of motor learning parameters (learning rate acquisition, retention, and transfer to motor and somatosensory function). Materials and Methods: Periodical interprofessional meetings conducted to the adaptation of a videogame, requiring the control of a joystick for traveling through a maze, to motor learning principles. In a pilot validation, effects in unilateral upper limb function, gross manual dexterity, and somatosensory thresholds were assessed before and after 10-week training in 13 children with CP. Results: After 10-week training with the adapted serious game, children showed learning rates above 90% and improvement in motor learning parameters along the sessions. Manual dexterity and pronation-supination of the dominant hand improved after training. No significant effects were found on somatosensory thresholds. Conclusion: Serious games are useful as motor learning tools for improving motor function in children with PC. Cooperative work among professionals and users is advisable for designing efficient videogames according to rehabilitation best practices.

Frontiers in Neuromuscular Physical Therapy

Neuromuscular physical therapy, also known as neurological physical therapy, focuses on assessing and treating individuals with conditions affecting the nervous system and muscles. It is crucial in promoting recovery, improving function, and enhancing the quality of life for individuals with neurological disorders. As the field continues to evolve, several new frontiers and advancements have emerged in neuromuscular physical therapy. Some of the recent trends in neuromuscular physical trends include the following. Technology-assisted rehabilitation: The integration of technology has revolutionized neuromuscular physical therapy. Various devices, such as robotic exoskeletons, virtual reality systems, and wearable sensors, are being utilized to enhance treatment outcomes. These technologies provide interactive and engaging platforms for therapy, facilitate repetitive practice, and offer real-time feedback on movement performance. They can be particularly beneficial in promoting motor recovery and functional improvements in individuals with stroke, spinal cord injury, and traumatic brain injury. Motor learning principles: There is an increased focus on incorporating motor learning principles into neuromuscular physical therapy interventions. Motor learning involves acquiring and retaining new motor skills through practice and feedback. By tailoring therapy sessions to optimize motor learning, therapists can facilitate more effective skill acquisition and long-term retention. This may involve techniques such as task-specific training, variable practice, and contextual interference. Brain-computer interfaces (BCIs): BCIs are systems that establish direct communication pathways between the brain and external devices. In the context of neuromuscular physical therapy, BCIs hold promise in neurorehabilitation. They enable individuals with severe motor impairments to control external devices or robotic exoskeletons using brain signals. BCIs can provide opportunities for functional restoration, promote neuroplasticity, and enhance the rehabilitation process for individuals with conditions like spinal cord injury or amyotrophic lateral sclerosis (ALS). Telerehabilitation: With the advancement of telehealth technology, telerehabilitation has gained momentum in neuromuscular physical therapy. Telerehabilitation allows therapists to deliver assessment and treatment remotely, overcoming barriers of geographical distance and accessibility. It enables real-time video consultations, remote exercise monitoring, education, and support. Telerehabilitation has the potential to increase access to care, improve convenience for patients, and enhance the continuity of therapy. Personalized and precision rehabilitation: The concept of personalized and precision medicine is increasingly applied to neuromuscular physical therapy. By considering individual characteristics, such as genetics, biomechanics, and neurophysiology, therapists can tailor interventions to meet specific needs and optimize outcomes. Advanced assessment tools like motion analysis systems and genetic testing can provide valuable insights for personalized treatment planning and targeted interventions. These new frontiers in neuromuscular physical therapy hold great promise in advancing the field and improving outcomes for individuals with neurological conditions. Integrating technology, motor learning principles, brain-computer interfaces, telerehabilitation, and personalized approaches can enhance the effectiveness, accessibility, and individualization of neuromuscular rehabilitation programs.

The use of enhanced intrinsic feedback for motor learning in stroke survivors: Clinical trial protocol

BackgroundStroke can lead to lasting sensorimotor deficits of the upper limb (UL) persisting into the chronic phase despite intensive rehabilitation. A major impairment of reaching after stroke is a decreased range of active elbow extension, which in turn leads to the use of compensatory movements. Retraining movement patterns relies on cognition and motor learning principles. Implicit learning may lead to better outcomes than explicit learning. Error augmentation (EA) is a feedback modality based on implicit learning resulting in improved precision and speed of UL reaching movements in people with stroke. However, accompanying changes in UL joint movement patterns have not been investigated. The objective of this study is to determine the capacity for implicit motor learning in people with chronic stroke and how this capacity is affected by post-stroke cognitive impairments. MethodsFifty-two subjects who have chronic stroke will practice reaching movements 3×/wk. for 9 wk. in a virtual reality environment. Participants will be randomly allocated to 1 of 2 groups to train with or without EA feedback. Outcome measures (pre-, post- and follow-up) will be: endpoint precision, speed, smoothness, and straightness and joint (UL and trunk) kinematics during a functional reaching task. The degree of cognitive impairment, lesion profile, and integrity of descending white matter tracts will be related to training outcomes. ConclusionsThe results will inform us which patients can best benefit from training programs that rely on motor learning and utilize enhanced feedback.Trial status: Ethical approval for this study was finalized in May 2022. Recruitment and data collection is actively in progress and is planned to finish in 2026. Data analysis and evaluation will occur subsequently, and the final results will be published.

Assessing the impact of a knowledge translation intervention on physical therapists’ self-efficacy and implementation of motor learning practice

BackgroundThe application of motor learning (ML) principles and research in physical therapy can optimize patient outcomes. However, the translation of the accumulated knowledge in ML to clinical practice is limited. Knowledge translation interventions, which are designed to promote changes in clinical behaviors, have the potential to address this implementation gap. We developed, implemented, and evaluated a knowledge translation intervention for ML implementation that focuses on building clinical capacity among physical therapists for the systematic application of ML knowledge in clinical practice.MethodsA total of 111 physical therapists underwent the intervention, which consisted of the following: (1) an interactive didactic 20-hour course; (2) an illustrated conceptual model of ML elements; and (3) a structured clinical-thinking form. Participants completed the Physical Therapists’ Perceptions of Motor Learning (PTP-ML) questionnaire pre and post intervention. The PTP-ML was used to assess ML-related self-efficacy and implementation. Participants also provided post-intervention feedback. A sub-sample (n = 25) provided follow-up feedback more than a year after the completion of the intervention. Pre–post and post-follow-up changes in the PTP-ML scores were calculated. The information gathered from the open-ended items of the post-intervention feedback was analyzed to identify emerging themes.ResultsComparing pre- and post-intervention scores, significant changes were found in the total questionnaire scores, self-efficacy subscale scores, reported implementation subscale scores (P < .0001), and general perceptions and work environment subscale score (P < .005). The mean changes in the total questionnaire and self-efficacy scores also significantly exceeded the Reliable Change Index. In the follow-up sample, these changes were maintained. Participants felt that the intervention helped them organize their knowledge in a structured manner and consciously link their practice elements to concepts in ML. Discussion of clinical cases was reported to be the most valuable educational method, and the illustrated conceptual model of ML elements was the least valued. Respondents also suggested support activities to maintain and enhance the learning experience, including on-site mentorship and hands-on experience.ConclusionsFindings support the positive effect of an educational tool, most prominently on physical therapists’ ML self-efficacy. The addition of practical modeling or ongoing educational support may enhance intervention effects.

Exploring the Impact of Two Feedback Types on Speech Intelligibility, Precision, and Naturalness.

This pilot study examined the impact of feedback type on learning a novel speech task, as measured by listener ratings, and will inform procedures for future investigations within a larger sample size. Twenty-four native monolingual English-speaking college-aged adults participated in a single training session to learn novel Hindi phrases. Participants were randomly placed into one of three feedback groups: knowledge of performance (KP), knowledge of results (KR), or a combined KP + KR condition. Participant performance was assessed at 1 day and 1 week post-training. Participant responses were audio recorded and judged for intelligibility, precision, and naturalness by native Hindi speakers, blind to the feedback conditions, via rating scales. At 2 days post-training, participants in the KP and KP + KR feedback conditions were rated as performing better than participants in the KR condition on all three perceptual measures. At 1 week post-training, participants in the KP feedback condition were judged to be superior across all three perceptual measures. Preliminary findings suggest that augmented feedback enhances learning, especially when skills are considered novel and learners are unable to rely on their own internal feedback. These results may have implications for the application of motor learning principles into clinical practice for persons with motor speech disorders.

Neuromuscular Electrical Stimulation in Conjunction with Conventional Swallowing Therapy in the Treatment of Dysphagia Caused by Multiple Sclerosis: A Single-Case Experimental Design

Introduction: Dysphagia as a consequence of multiple sclerosis (MS) puts individuals at higher risk of dehydration, malnutrition, and aspiration pneumonia. This study intended to investigate the effects of a combined program of neuromuscular electrical stimulation (NMES) and conventional swallowing therapy to improve swallow safety and efficiency, oral intake, and physical, emotional, and functional impacts of dysphagia in people with dysphagia and MS. Methods: In this single-case experimental study with ABA design, two participants with dysphagia caused by MS underwent 12 sessions therapy during 6 weeks following a baseline of 4 evaluation sessions. They were evaluated 4 more times in the follow-up phase after therapy sessions. Scores of Mann Assessment of Swallowing Ability (MASA), DYsphagia in MUltiple Sclerosis (DYMUS), and timed test of swallowing capacity were obtained at baseline, during treatment, and in the follow-up phases. The Dysphagia Outcome and Severity Scale (DOSS) based on videofluoroscopic swallow studies, Persian-Dysphagia Handicap Index (Persian-DHI), and Functional Oral Intake Scale (FOIS) were also completed before and after treatment. Visual analysis and percentage of nonoverlapping data were calculated. Results: MASA, DYMUS, FOIS, and DHI scores indicated significant improvement in both participants. Although the scores of the timed test of swallowing capacity in participant 1 (B.N.) and DOSS in participant 2 (M.A.) showed no changes, considerable improvements including reducing the amount of residue and the number of swallows required to clear bolus were seen in the posttreatment videofluoroscopic records of both participants. Conclusion: NMES in conjunction with conventional dysphagia therapy based on motor learning principles could improve the swallowing function and decrease disabling effects of dysphagia on different aspects of life in participants with dysphagia caused by MS.