Motor Learning for Stroke Recovery

Overseen By Kristan Leech, PT, DPT, PhD

Age: 18+

Sex: Any

Trial Phase: Phase < 1

Sponsor: University of Southern California

Disqualifiers: Brainstem stroke, Aphasia, Dementia, others

No Placebo Group All trial participants will receive the active study treatment (no placebo)

Compensation: Varies

Number of Visits: 2

Duration: 4 weeks

65 Participants Needed

What You Need to Know Before You Apply

What is the purpose of this trial?

This trial explores how cognitive challenges after a stroke affect relearning to walk. It examines two learning methods: explicit motor learning (conscious) and implicit motor learning (automatic), aiming to identify brain areas involved in this process. The goal is to find better ways to help people regain walking skills after a stroke. Ideal candidates for this trial include those who had a stroke over six months ago, can walk independently for at least five minutes, and have weakness on one side of their body. As an Early Phase 1 trial, this research focuses on understanding how the treatment works in people, offering participants a chance to contribute to groundbreaking insights.

Will I have to stop taking my current medications?

The trial information does not specify whether you need to stop taking your current medications. However, it does exclude those with uncontrolled hypertension and concurrent physical therapy, which might imply some medication considerations.

Is there any evidence suggesting that this trial's treatments are likely to be safe?

Research has shown that motor learning, involving both conscious and unconscious processes, is generally safe and can aid in stroke recovery. These methods are crucial for learning and improving movement skills.

In explicit motor learning, individuals focus on learning with awareness, which has been shown to help stroke survivors improve their motor skills. Implicit motor learning, however, occurs without conscious awareness. Research suggests that stroke survivors can still acquire new skills this way, particularly on the unaffected side of the body.

No major safety concerns have been reported for either method. Studies indicate that both explicit and implicit motor learning are well-tolerated during stroke recovery, with no significant negative effects noted. ^{1 2 3 4 5}

Why are researchers excited about this trial?

Researchers are excited about exploring motor learning techniques for stroke recovery because they offer a fresh approach to rehabilitation. Unlike traditional therapies that often focus on repetitive exercises, these methods dive into how the brain learns new motor skills, both consciously (explicit learning) and unconsciously (implicit learning). By studying the impact of cognitive impairment on these forms of learning, there's potential to tailor recovery strategies that better align with how each stroke survivor's brain rebuilds and adapts. This could lead to more effective, personalized rehabilitation plans and ultimately improve outcomes for those affected by stroke.

What evidence suggests that explicit and implicit motor learning might be effective for stroke recovery?

Research has shown that relearning movement, both consciously and unconsciously, can help people regain motor skills after a stroke. This trial will evaluate explicit motor learning, where participants are aware of the movements they practice, and implicit motor learning, where skills are acquired without conscious thought. Studies have found that explicit motor learning aids recovery from post-stroke weakness, while implicit motor learning benefits tasks requiring multitasking. Both types of learning have improved walking speed and overall recovery in stroke patients, with neither proving superior. Thus, both methods hold value in rehabilitation. ^{6 7 8 9 10}

Who Is on the Research Team?

Kristan Leech, PT, DPT, PhD

Principal Investigator

University of Southern California

Are You a Good Fit for This Trial?

This trial is for older adults who had a stroke at least 6 months ago, can walk (with or without help), and have no severe cognitive deficits, dementia, uncontrolled high blood pressure, ongoing physical therapy for other conditions, or any metal implants that interfere with MRI scans.

Inclusion Criteria

I can walk on my own, even if I need a device to help.

I had a stroke that affected only one side of my body.

I can walk for 5 minutes without needing to stop.

Exclusion Criteria

You are afraid of being in small or confined spaces.

I have difficulty speaking or understanding speech.

I am unable to understand and agree to the study's details.

Timeline for a Trial Participant

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Treatment

Participants undergo biomechanical analyses, neuropsychological assessments, and brain imaging techniques to evaluate motor learning and brain structures post-stroke

4 weeks

2 testing sessions

Follow-up

Participants are monitored for retention of motor learning and changes in step length asymmetry

4 weeks

What Are the Treatments Tested in This Trial?

Interventions

• Explicit motor learning
• Implicit motor learning

Trial Overview The study aims to understand how cognitive impairments after a stroke affect the ability to learn new walking skills. It involves explicit and implicit motor learning tests combined with brain imaging and biomechanical analysis to see how these factors interact.

How Is the Trial Designed?

Group I: Evaluating motor learning and brain structures post-stroke Experimental Treatment 2 Interventions

We will use a single arm design to determine the impact of post-stroke cognitive impairment on two forms of motor learning (implicit and explicit) and evaluate the structural integrity of relevant brain structures in 65 individuals post stroke

Who Is Running the Clinical Trial?

University of Southern California

Lead Sponsor

Trials

956

Recruited

1,609,000+

Published Research Related to This Trial

Adults who had a unilateral stroke can implicitly learn a perceptual-motor task, demonstrating their ability to adapt despite motor impairments.

In a study involving 47 post-stroke participants and 36 control subjects, those with stroke performed slower overall but showed improved performance with practice, indicating that implicit learning mechanisms remain functional after a stroke.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Implicit learning of a perceptual-motor skill after stroke. Pohl, PS., McDowd, JM., Filion, DL., et al.[2019]

This study involves 52 participants with chronic stroke who will practice reaching movements in a virtual reality environment over 9 weeks, aiming to assess the effectiveness of error augmentation feedback on improving upper limb movement patterns.

The research will explore how cognitive impairments and brain injury characteristics affect the ability to learn motor skills implicitly, potentially guiding future rehabilitation strategies for stroke patients.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

The use of enhanced intrinsic feedback for motor learning in stroke survivors: Clinical trial protocol. Rajda, CM., Feldman, AG., Boudrias, MH., et al.[2023]

Stroke patients can learn implicitly using their unaffected side, showing a significant improvement in performance, but they do not show the same ability with their affected side, indicating a limitation in motor learning post-stroke.

Implicit motor learning appears to be as effective as explicit motor learning for stroke patients, but due to high risks of bias and small sample sizes in the studies reviewed, more rigorous research is needed to confirm these findings.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Is Implicit Motor Learning Preserved after Stroke? A Systematic Review with Meta-Analysis. Kal, E., Winters, M., van der Kamp, J., et al.[2018]

In a study involving 17 stroke patients and 21 control participants, implicit motor learning was found to be significantly more effective than explicit learning for stroke patients when performing dual tasks, indicating a potential advantage for rehabilitation strategies.

The results suggest that implicit learning approaches can enhance motor skill acquisition in post-stroke patients, particularly for those with attention and working memory deficits, as evidenced by correlations with performance on the Trail Making Test.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Implicit Motor Learning Strategies Benefit Dual-Task Performance in Patients with Stroke. Arikawa, E., Kubota, M., Haraguchi, T., et al.[2023]

In a study involving 20 participants (10 with unilateral stroke and 10 controls), explicit instructions (EI) improved motor-sequence performance in healthy individuals but hindered performance in stroke patients, indicating a negative impact of EI on implicit learning for those with brain damage.

The findings suggest that rehabilitation strategies for stroke recovery should be tailored based on the location of the stroke, as explicit information may not always enhance motor skill learning in affected individuals.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Impact of explicit information on implicit motor-sequence learning following middle cerebral artery stroke. Boyd, LA., Winstein, CJ.[2022]

In a study involving 179 stroke patients, daily verbal feedback about walking speed significantly improved walking speed at discharge (0.91 m/s) compared to no feedback (0.72 m/s), indicating that performance feedback can enhance motor relearning during rehabilitation.

While the feedback did not affect the length of stay or the proportion of independent walkers, it allowed patients to achieve a walking speed sufficient for community ambulation, highlighting its potential as a simple and effective intervention in stroke recovery.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

International randomized clinical trial, stroke inpatient rehabilitation with reinforcement of walking speed (SIRROWS), improves outcomes. Dobkin, BH., Plummer-D'Amato, P., Elashoff, R., et al.[2021]

Individuals with chronic stroke can still learn motor skills implicitly, but their brain activity patterns differ from healthy individuals during this learning process.

While healthy participants showed a typical decrease in prefrontal cortex activity during implicit learning, stroke survivors relied more on the left middle frontal gyrus, suggesting a shift in brain regions involved in motor learning after stroke.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Implicit sequence-specific motor learning after subcortical stroke is associated with increased prefrontal brain activations: an fMRI study. Meehan, SK., Randhawa, B., Wessel, B., et al.[2022]

In a study involving 79 stroke patients in the chronic phase of recovery, both implicit and explicit motor learning interventions showed no significant difference in improving walking speed after 3 weeks of training, indicating that neither method was superior.

The study suggests that physical therapists can effectively use both implicit and explicit motor learning strategies to enhance walking speed in stroke patients, as both approaches can be tailored to individual needs.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Implicit and Explicit Motor Learning Interventions Have Similar Effects on Walking Speed in People After Stroke: A Randomized Controlled Trial. Jie, LJ., Kleynen, M., Meijer, K., et al.[2021]

Citations

1. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC8282572/

Explicit motor sequence learning after stroke In fact, the learning-based re-acquisition of compromised, or even lost, motor skills appears crucial for recovery from post-stroke hemiparesis ...

2. academic.oup.com academic.oup.com/ptj/article/101/5/pzab017/6106264

Implicit and Explicit Motor Learning Interventions Have Similar ... Implicit motor learning was not superior to explicit motor learning to improve walking speed in people after stroke in the chronic phase of recovery.

3. frontiersin.org frontiersin.org/journals/systems-neuroscience/articles/10.3389/fnsys.2019.00074/full

Principles of Neurorehabilitation After Stroke Based on ... Neurorehabilitation addresses the question of whether recovery can occur after a brain injury like a stroke and how this recovery process could be optimized ...

4. researchprotocols.org researchprotocols.org/2018/5/e142/

The Effects of Implicit and Explicit Motor Learning in Gait ... Gait is one of the most practiced motor skills within rehabilitation in people after stroke because it is an important criterion for discharge ...

5. sciencedirect.com sciencedirect.com/science/article/abs/pii/S0304394010008566

Motor learning after stroke: Is skill acquisition a prerequisite ... Our data suggest that task-specific motor learning may be an important stimulant for neuroplastic change and can remediate maladaptive patterns of brain ...

6. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC10871205/

Explicit and implicit locomotor learning in individuals with ... Motor learning involves both explicit and implicit processes that are fundamental for acquiring and adapting complex motor skills.

7. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC5348298/

Infusing Motor Learning Research Into Neurorehabilitation ... Research over the last decade has provided considerable evidence that has advanced knowledge about how to shape plasticity to enhance recovery after injury.

8. sciencedirect.com sciencedirect.com/science/article/abs/pii/S1388245720300237

Neurophysiology of motor skill learning in chronic stroke Cerebellar tDCS can be used as an effective and safe treatment to promote recovery of upper limb motor function in stroke patients. ChiCTR.org.cn ...

9. link.springer.com link.springer.com/article/10.1007/s10072-024-07815-y

Characterizing practice-dependent motor learning after a ... Practice-dependent on-line motor learning is preserved in stroke survivors, and an inter-limb transfer effect can be observed.

10. journals.plos.org journals.plos.org/plosone/article?id=10.1371/journal.pone.0166376

Is Implicit Motor Learning Preserved after Stroke? A ... Yet, although it is often thought that implicit motor learning is preserved post-stroke, evidence for this claim has not been systematically analysed yet.