Explicit motor sequence learning with the paretic arm after stroke

Abstract

Purpose: Motor sequence learning is important for stroke recovery, but experimental tasks require dexterous movements, which are impossible for people with upper limb impairment. This makes it difficult to draw conclusions about the impact of stroke on learning motor sequences. We aimed to test a paradigm requiring gross arm movements to determine whether stroke survivors with upper limb impairment were capable of learning a movement sequence as effectively as age-matched controls.

Materials and methods: In this case-control study, 12 stroke survivors (10–138 months post-stroke, mean age 64 years) attempted the task once using their affected arm. Ten healthy controls (mean 66 years) used their non-dominant arm. A sequence of 10 movements was repeated 25 times. The variables were: time from target illumination until the cursor left the central square (onset time; OT), accuracy (path length), and movement speed.

Results: OT reduced with training (p < 0.05) for both groups, with no change in movement speed or accuracy (p > 0.1). We quantified learning as the OT difference between the end of training and a random sequence; this was smaller for stroke survivors than controls (p = 0.015).

Conclusions: Stroke survivors can learn a movement sequence with their paretic arm, but demonstrate impairments in sequence specific learning.

Implications for Rehabilitation

• Motor sequence learning is important for recovery of movement after stroke.

• Stroke survivors were found to be capable of learning a movement sequence with their paretic arm, supporting the concept of repetitive task training for recovery of movement.

• Stroke survivors showed impaired sequence specific learning in comparison with age-matched controls, indicating that they may need more repetitions of a sequence in order to re-learn movements.

• Further research is required into the effect of lesion location, time since stroke, hand dominance and gender on learning of motor sequences after stroke.

Keywords:

• Motor sequence learning
• stroke
• upper limb
• impairment

Acknowledgements

We thank the late Roger Woledge for writing the Matlab Programme and Tony Christopher and Lindsey Marjoram for technical support.

Disclosure statement

The authors report no conflicts of interest.