Motor Learning of a cognitive-motor task after stroke

The aim of this study was investigated a maze learning in stroke individuals. Forty participants assigned into two groups: experimental (stroke participants; n = 20) and control (neurologically healthy participants; n = 20). The study involved an acquisition phase, a transfer test, and a short-and longterm retention tests. The task consisted in complete a maze, with paper and pen, in the shortest time possible. The dependent variables were execution time and error. Data were analyzed with an Anova- two way with Repeated Measures for these variables. Results showed learning for both groups, but with the experimental group having worse performance compared to control group mainly related error. It was also seen the impact promoted in the task has impaired both groups in the transfer test performance

Motor learning in children with cerebral palsy

INTRODUÇÃO: a Paralisia Cerebral (PC) tem como característica causar alterações na postura e movimento que dificultam a realização de atividades funcionais. Diante das dificuldades motoras, a reabilitação torna-se essencial e tem como uma opção basear-se na aprendizagem motora. Porém, é importante a investigação do processo de aprendizagem motora em indivíduos com PC para viabilizar a organização de programas de tratamento mais efetivos. OBJETIVO: analisar o processo de aprendizagem motora em crianças com PC. MÉTODO: Para a realização deste trabalho utilizou-se um grupo experimental (GE) e um grupo controle (GC) ambos formados por 4 crianças pareadas em relação ao gênero (um do gênero feminino e três do gênero masculino) e idade (entre sete e doze anos). A tarefa consistia em realizar um caminho em um labirinto, no menor tempo possível. O trabalho consistiu de duas fases, sendo inicialmente a fase de aquisição (AQ) e depois as transferências (Imediata-TI; Curto Prazo-TC e Longo Prazo-TL). RESULTADO: Verificou-se que não houve diferença estatisticamente significante entre a AQ e as transferências avaliadas com os valores a seguir: TI (z = -1,83 e p = 0,07), TC (z = -1,83 e p = 0,07) e a TL [GE (z = -1,83 e p = 0,07) e GC (z = -1,46 e p = 0,14)]. CONCLUSÃO: No processo de aprendizagem da tarefa de labirinto, analisando-se os resultados entre as fases de AQ e Transferência não se observou diferença, ou seja, os indivíduos com PC mostraram capacidade de aprendizagem preservada por meio da adaptação da tarefa, fato este que ocorreu de forma equivalente aos indivíduos sem paralisia cerebral.INTRODUCTION: cerebral palsy (CP) has the characteristic of causing changes in posture and movement that hamper the achievement of functional activities. In the face of motor disabilities, rehabilitation becomes essential and is an option based on motor learning. However, it is important to research the motor learning process in individuals with CP to make the organization of treatment programs more effective. OBJECTIVE: Analyse the motor learning in children with CP. METHOD: For the realization of this work, an experimental group (EG) and a control group (CG) was used, comprised of four children matched in relation to gender (one female and three masculine) and age (between seven and twelve years). The task was to conduct a path into a maze in the shortest time possible. The work consisted of two phases, being initially an acquisition phase (AQ) and then transfers (immediate-IM; short-term-ST and long-term-LT). RESULT: It was found that there was no statistical significance difference between AQ and transfers evaluated with the following values: IM (z= -1.83, p=0.07), ST (z= -1.83, p=0.07) and LT [EG (z= -1.83, p=0.07) and CG (z= -1.46, p=0.14)]. CONCLUSION: In the process of maze task learning, when analyzing the results between phases AQ and transfer, significant difference was not observed, which means that individuals with CP showed learning capacity through task adaptation equivalent to individuals without cerevral palsy

Neurocognitive disorders and motor learning: a scoping review

Os transtornos cognitivos podem prejudicar um ou vários processos de função cognitiva que são importantes durante a aprendizagem/reaprendizagem de habilidades motoras. A aprendizagem motora é essencialmente um processo guiado por mecanismos cognitivos-perceptuais e motores, desta forma, naturalmente pode ser impactada caso estes mecanismos estejam comprometidos. Os transtornos cognitivos têm características específicas de acordo com a condição de saúde e podem produzir comprometimentos distintos, de modo que a aprendizagem pode ser afetada em diversas formas. Objetivo: Realizar uma revisão de escopo para investigar o impacto do comprometimento cognitivo (déficits de atenção, memória, planejamento e funções executivas) na aprendizagem motora. Material e métodos: Realizamos uma busca nas bases de dados Pubmed, Medline e Embase a procura de estudos que avaliaram a influência da cognição na aprendizagem motora. Esta revisão foi divida em três estudos com as seguintes condições de saúde: Doença de Alzheimer e Comprometimento cognitivo leve, Acidente Vascular Cerebral e Doença de Parkinson. O estudo seguiu as diretrizes do PRISMA-ScR (Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews) e foi registrado na OSF (Open Science Framework). Resultados: A busca inicial conjunta resultou em 9.436 publicações. Para o estudo AD e CCL foram elegíveis 15 estudos, no estudo de AVC 5 estudos e no estudo de DP 12 estudos. Nossos resultados incluíram publicações de nível baixo a alto risco de viés metodológico. Os delineamentos experimentais variaram entre as publicações incluídas, pois as abordagens encontradas eram diferentes e contemplavam: aprendizagem implícita, modelo clássico e adaptação motora, não sendo passíveis de comparação. Foram encontradas muitas avaliações cognitivas, e a cognição foi estratificada de diversas formas. De maneira geral, 2 avaliações foram as mais utilizadas: o Mini exame de estado mental e a Escala de memória de Wechsler. O impacto da cognição na aprendizagem foi relatado em todos os estudos incluídos e em todas as condições de saúde pesquisadas. Ainda, a gravidade do comprometimento cognitivo e características relacionadas a condição de saúde dos indivíduos com AVC e DP também influenciaram a aprendizagem de habilidades motoras. Conclusão: O comprometimento cognitivo afeta a aprendizagem motora. Além disso, a diversidade dos estudos é marcante e mostra o quanto ainda há possibilidades de pesquisa neste campo. Porém, é importante destacar o papel das características da condição de saúde e do comprometimento cognitivo para uma melhor análise da aprendizagem motoraCognitive disorders can impair one or several processes of cognitive function that are important during learning/relearning of motor skills. Motor learning is essentially a process guided by cognitive-perceptual and motor mechanisms, so it can naturally be impacted if these mechanisms are compromised. Cognitive disorders have specific characteristics according to the health condition and can produce different impairments. Therefore, motor learning can be affected in different ways. Aim: To conduct a scoping review to investigate the impact of cognitive impairment (deficits in attention, memory, planning and executive functions) on motor learning. Material and methods: We searched the Pubmed, Medline and Embase databases looking for studies that evaluated the influence of cognition on motor learning. This review was divided into three studies in these health conditions: Alzheimer\'s Disease and Mild Cognitive Impairment, Stroke and Parkinson\'s Disease. The study followed PRISMA-ScR (Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews) guidelines and was registered in the OSF (Open Science Framework). Results: The initial joint search resulted in 9,436 publications. Fifteen studies were eligible for the AD and MCI study, 5 studies for the stroke study and 12 studies for the PD study. Our results included publications from low to high risk of methodological bias. The experimental designs varied among the publications included. Mainly, the approaches found were different and included: implicit learning, classic model and motor adaptation, not being subject to comparison. Many cognitive assessments were found, and cognition was stratified in several ways. In general, two assessments were the most used: the Mini Mental State Examination and the Wechsler Memory Scale. The impact of cognition on learning was reported across all included studies and across all health conditions surveyed. Furthermore, the severity of cognitive impairment and characteristics related to the health condition of individuals with stroke and PD also influenced the learning of motor skills. Conclusion: Cognitive impairment affects motor learning. In addition, the diversity of the studies is remarkable and shows how much there are still possibilities for research in this field. However, characteristics of the health condition and cognitive impairment play an important role to the analysis of motor learnin

Learning a motor skill task with different levels of complexity in post stroke subjects

Introdução: Ainda não é conhecido na literatura se os sujeitos pós-AVC têm a capacidade de aprender ações complexas. Os estudos existentes apresentam falhas metodológicas, assim como na implementação da complexidade da tarefa. Este trabalho investigou os efeitos da manipulação da complexidade da tarefa na aprendizagem motora desta população. Método: Vinte e quatro sujeitos pós-AVC (Grupo experimental - GE) e vinte e quatro sujeitos saudáveis (Grupo controle - GC) foram selecionados e divididos em dois experimentos: baixa complexidade e alta complexidade. Foram desenvolvidas duas tarefas denominadas de baixa e de alta complexidade, com variação não só no número de elementos, mas também na carga de processamento exigida para a execução da mesma, as quais deram origem ao experimento 1 e 2, respectivamente. Esta tarefa era executada em ambiente de realidade virtual, a partir do deslocamento do centro de pressão para controle dos objetos móveis na tela. O delineamento foi constituído de 150 tentativas para a fase de aquisição, dividida em 3 dias de prática. Após 4 dias sem prática foi realizado o teste de retenção (RET) e transferência (TR). A alteração realizada no teste de TR foi na direção do deslocamento dos objetos. As variáveis dependentes de ambos experimentos foram: pontuação e tempo de execução. Para cada variável dependente foi conduzido uma Anova two-way com medidas repetidas (2 grupos x 4 momentos) seguido de post hoc de Tukey para identificar os momentos das mudanças. Resultados: No experimento 1, para a variável pontuação ambos os grupos melhoraram o desempenho ao longo da aquisição e o mantiveram no teste de retenção. Não houve diferença entre o GC e GE. Para a variável tempo de execução, o GC diferenciou-se do GE em todos os momentos (Início e final da aquisição, teste de retenção e transferência), apresentando pior desempenho. No experimento 2, tanto para a variável pontuação, quanto para tempo de execução o GE diferenciou-se do GC no final da aquisição e no teste de RET. Conclusão: Os sujeitos pós-AVC foram capazes de aprender a tarefa de baixa complexidade, mas esta aprendizagem não foi passível de generalização. Quanto a tarefa de alta complexidade, os sujeitos do GE não aprenderam a tarefa, sendo muito impactados pelo aumento de complexidade. Possivelmente, os déficits cognitivos relacionados ao planejamento e sequenciamento de ações impactaram na aquisição da habilidade de alta complexidade e não prejudicaram a aprendizagem da tarefa de baixa complexidadeIntroduction: It is not yet known in the literature wether post stroke subjects have the ability to learn complex actions. The studies have methodological flaws as well as the implementation of the complexity of the task. This study aimed to investigate the effects of manipulation of task complexity in motor learning in this subjects. Method: Twenty-four post stroke subjects (experimental group - EG) and twenty-four healthy subjects (control group - CG) were selected and divided into two experiments: low complexity and high complexity. Two tasks were developed, low and high complexity, with changing not only on the number of elements, but also on the processing load required, which led to the experiment 1 and 2, respectively. This task was performed in a virtual reality environment, considering the displacement of the center of pressure for controlling the objects move on the screen. The design consisted of 150 trials for the acquisition phase, divided into three days of practice. After 4 days was performed retention test (RET) and transfer (TR). The TR test included the change in the direction of the objects movement. The dependent variables of both experiments were: score and runtime. For each dependent variable was conducting a two-way ANOVA with repeated measures (2 groups x 4 times) followed by Tukey post hoc. Results: In experiment 1, in regards to the variable score, both groups improved performance and kept in the retention test. There was no difference between the CG and EG. For the variable runtime, the CG differed from EG at all times (Beginning and end of the acquisition, RET and TR), with worse performance. In Experiment 2, both the variable score runtime, the EG differed from the CG at the end of acquisition and RET test. Conclusion: The post-stroke subjects were able to learn a low complexity task, but this learning was not generalized. As the higher complex task, post stroke subjects have not learned the task, being very impacted by the increase of complexity. Possibly the cognitive deficits related to planning and sequencing actions impacted the acquisition of the higher complex skill and not affected the low complexity task learnin

Does cognitive impairment caused by neurological disorders affect motor learning? A scoping review.

This scoping review aims are to conduct a scoping review of published studies that measure or mentioned the impact of cognitive impairment on motor learning in adult neurological disease populations. Specifically, we will relate the experimental design, cognitive assessment used, evaluate the impact on motor learning and connect this impairment to a motor behavior-memory framework

Motor learning in post stroke subjects: the effects of practice conditions on the temporal synchronization

<div><p>Abstract AIMS The aim of this study was to investigate the effects of practice schedule on the motor learning of a synchronization timing task in post-stroke subjects. Subjects and METHODS Seventeen post-stroke individuals were assigned to the experimental group and for the control group were selected seventeen healthy individuals. At the acquisition phase, all participants performed 30 trials of a coincident timing task. Nine individuals from each group practiced constantly and eight from each group practiced randomly, with speed changes in the task. Subsequent phases included: 1) immediate transfer test and 2) long term transfer test after 3 days. Data were analyzed in relation to absolute, variable, and constant errors to assess the performance concerning accuracy, consistence, and direction of responses, respectively. RESULTS All groups increased their accuracy through the practice and were able to adapt it in different speeds. The stroke subjects were more variable in their motor responses. There was no effect of the practice schedule on motor learning, regardless the presence or absence of the neurologic damage. CONCLUSION Post stroke individuals were able to learn a synchronizing task and the capacity of adapt their performance after speed perturbation was preserved. There was no effect of the practice schedule on motor learning.</p></div

Development and preliminary research on the measure properties of a perceptual and motor demands assessment protocol for virtual reality systems

The virtual reality has been frequently required in rehabilitation settings. However, it still lacks specificity, making it necessary to establish specific criteria to classify the most relevant aspects of electronic games to allow interventions based on virtual reality. Therefore, the purpose of this study is to develop a “Perceptual and motor demands assessment protocol for virtual reality systems” and to investigate its content validity and intra and inter observer agreement. The protocol was created through a literature review including classical studies as well as a review of recent articles about motor behavior, physical training, cognitive neuroscience and virtual reality. The previous versions were presented in study group meetings and congresses, and modified accordingly to suggestions of experts. Three examiners used the final version to analyze twice the total of 20 videos of individuals in a virtual environment and answered a questionnaire about its content validity. Most of the obtained values were classified as “good” (concordance from 80% to 89%) or “excellent” (concordance from 90% to 100%) by the three examiners and the protocol’s content validity was adequate. The protocol is valid, applicable and practical for analyzing different requirements of electronic games in a virtual environment

Global economic burden of unmet surgical need for appendicitis

Background There is a substantial gap in provision of adequate surgical care in many low- and middle-income countries. This study aimed to identify the economic burden of unmet surgical need for the common condition of appendicitis. Methods Data on the incidence of appendicitis from 170 countries and two different approaches were used to estimate numbers of patients who do not receive surgery: as a fixed proportion of the total unmet surgical need per country (approach 1); and based on country income status (approach 2). Indirect costs with current levels of access and local quality, and those if quality were at the standards of high-income countries, were estimated. A human capital approach was applied, focusing on the economic burden resulting from premature death and absenteeism. Results Excess mortality was 4185 per 100 000 cases of appendicitis using approach 1 and 3448 per 100 000 using approach 2. The economic burden of continuing current levels of access and local quality was US $92 492 million using approach 1 and$73 141 million using approach 2. The economic burden of not providing surgical care to the standards of high-income countries was $95 004 million using approach 1 and$75 666 million using approach 2. The largest share of these costs resulted from premature death (97.7 per cent) and lack of access (97.0 per cent) in contrast to lack of quality. Conclusion For a comparatively non-complex emergency condition such as appendicitis, increasing access to care should be prioritized. Although improving quality of care should not be neglected, increasing provision of care at current standards could reduce societal costs substantially

Global economic burden of unmet surgical need for appendicitis

Background There is a substantial gap in provision of adequate surgical care in many low- and middle-income countries. This study aimed to identify the economic burden of unmet surgical need for the common condition of appendicitis. Methods Data on the incidence of appendicitis from 170 countries and two different approaches were used to estimate numbers of patients who do not receive surgery: as a fixed proportion of the total unmet surgical need per country (approach 1); and based on country income status (approach 2). Indirect costs with current levels of access and local quality, and those if quality were at the standards of high-income countries, were estimated. A human capital approach was applied, focusing on the economic burden resulting from premature death and absenteeism. Results Excess mortality was 4185 per 100 000 cases of appendicitis using approach 1 and 3448 per 100 000 using approach 2. The economic burden of continuing current levels of access and local quality was US $92 492 million using approach 1 and$73 141 million using approach 2. The economic burden of not providing surgical care to the standards of high-income countries was $95 004 million using approach 1 and$75 666 million using approach 2. The largest share of these costs resulted from premature death (97.7 per cent) and lack of access (97.0 per cent) in contrast to lack of quality. Conclusion For a comparatively non-complex emergency condition such as appendicitis, increasing access to care should be prioritized. Although improving quality of care should not be neglected, increasing provision of care at current standards could reduce societal costs substantially