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Implicit and Explicit Motor Learning Interventions Have Similar Effects on Walking Speed in People After Stroke: A Randomized Controlled Trial

OBJECTIVE: Clinicians may use implicit or explicit motor learning approaches to facilitate motor learning of patients with stroke. Implicit motor learning approaches have shown promising results in healthy populations. The purpose of this study was to assess whether an implicit motor learning walkin...

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Autores principales: Jie, Li-Juan, Kleynen, Melanie, Meijer, Kenneth, Beurskens, Anna, Braun, Susy
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Oxford University Press 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8101354/
https://www.ncbi.nlm.nih.gov/pubmed/33482007
http://dx.doi.org/10.1093/ptj/pzab017
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author Jie, Li-Juan
Kleynen, Melanie
Meijer, Kenneth
Beurskens, Anna
Braun, Susy
author_facet Jie, Li-Juan
Kleynen, Melanie
Meijer, Kenneth
Beurskens, Anna
Braun, Susy
author_sort Jie, Li-Juan
collection PubMed
description OBJECTIVE: Clinicians may use implicit or explicit motor learning approaches to facilitate motor learning of patients with stroke. Implicit motor learning approaches have shown promising results in healthy populations. The purpose of this study was to assess whether an implicit motor learning walking intervention is more effective compared with an explicit motor learning walking intervention delivered at home regarding walking speed in people after stroke in the chronic phase of recovery. METHODS: This randomized, controlled, single-blind trial was conducted in the home environment. The 79 participants, who were in the chronic phase after stroke (age = 66.4 [SD = 11.0] years; time poststroke = 70.1 [SD = 64.3] months; walking speed = 0.7 [SD = 0.3] m/s; Berg Balance Scale score = 44.5 [SD = 9.5]), were randomly assigned to an implicit (n = 38) or explicit (n = 41) group. Analogy learning was used as the implicit motor learning walking intervention, whereas the explicit motor learning walking intervention consisted of detailed verbal instructions. Both groups received 9 training sessions (30 minutes each), for a period of 3 weeks, targeted at improving quality of walking. The primary outcome was walking speed measured by the 10-Meter Walk Test at a comfortable walking pace. Outcomes were assessed at baseline, immediately after intervention, and 1 month postintervention. RESULTS: No statistically or clinically relevant differences between groups were obtained postintervention (between-group difference was estimated at 0.02 m/s [95% CI = −0.04 to 0.08] and at follow-up (between-group difference estimated at −0.02 m/s [95% CI = −0.09 to 0.05]). CONCLUSION: Implicit motor learning was not superior to explicit motor learning to improve walking speed in people after stroke in the chronic phase of recovery. IMPACT: To our knowledge, this is the first study to examine the effects of implicit compared with explicit motor learning on a functional task in people after stroke. Results indicate that physical therapists can use (tailored) implicit and explicit motor learning strategies to improve walking speed in people after stroke who are in the chronic phase of recovery.
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spelling pubmed-81013542021-05-10 Implicit and Explicit Motor Learning Interventions Have Similar Effects on Walking Speed in People After Stroke: A Randomized Controlled Trial Jie, Li-Juan Kleynen, Melanie Meijer, Kenneth Beurskens, Anna Braun, Susy Phys Ther Original Research OBJECTIVE: Clinicians may use implicit or explicit motor learning approaches to facilitate motor learning of patients with stroke. Implicit motor learning approaches have shown promising results in healthy populations. The purpose of this study was to assess whether an implicit motor learning walking intervention is more effective compared with an explicit motor learning walking intervention delivered at home regarding walking speed in people after stroke in the chronic phase of recovery. METHODS: This randomized, controlled, single-blind trial was conducted in the home environment. The 79 participants, who were in the chronic phase after stroke (age = 66.4 [SD = 11.0] years; time poststroke = 70.1 [SD = 64.3] months; walking speed = 0.7 [SD = 0.3] m/s; Berg Balance Scale score = 44.5 [SD = 9.5]), were randomly assigned to an implicit (n = 38) or explicit (n = 41) group. Analogy learning was used as the implicit motor learning walking intervention, whereas the explicit motor learning walking intervention consisted of detailed verbal instructions. Both groups received 9 training sessions (30 minutes each), for a period of 3 weeks, targeted at improving quality of walking. The primary outcome was walking speed measured by the 10-Meter Walk Test at a comfortable walking pace. Outcomes were assessed at baseline, immediately after intervention, and 1 month postintervention. RESULTS: No statistically or clinically relevant differences between groups were obtained postintervention (between-group difference was estimated at 0.02 m/s [95% CI = −0.04 to 0.08] and at follow-up (between-group difference estimated at −0.02 m/s [95% CI = −0.09 to 0.05]). CONCLUSION: Implicit motor learning was not superior to explicit motor learning to improve walking speed in people after stroke in the chronic phase of recovery. IMPACT: To our knowledge, this is the first study to examine the effects of implicit compared with explicit motor learning on a functional task in people after stroke. Results indicate that physical therapists can use (tailored) implicit and explicit motor learning strategies to improve walking speed in people after stroke who are in the chronic phase of recovery. Oxford University Press 2021-01-22 /pmc/articles/PMC8101354/ /pubmed/33482007 http://dx.doi.org/10.1093/ptj/pzab017 Text en © The Author(s) 2021. Published by Oxford University Press on behalf of the American Physical Therapy Association. https://creativecommons.org/licenses/by/4.0/This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) ), which permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Original Research
Jie, Li-Juan
Kleynen, Melanie
Meijer, Kenneth
Beurskens, Anna
Braun, Susy
Implicit and Explicit Motor Learning Interventions Have Similar Effects on Walking Speed in People After Stroke: A Randomized Controlled Trial
title Implicit and Explicit Motor Learning Interventions Have Similar Effects on Walking Speed in People After Stroke: A Randomized Controlled Trial
title_full Implicit and Explicit Motor Learning Interventions Have Similar Effects on Walking Speed in People After Stroke: A Randomized Controlled Trial
title_fullStr Implicit and Explicit Motor Learning Interventions Have Similar Effects on Walking Speed in People After Stroke: A Randomized Controlled Trial
title_full_unstemmed Implicit and Explicit Motor Learning Interventions Have Similar Effects on Walking Speed in People After Stroke: A Randomized Controlled Trial
title_short Implicit and Explicit Motor Learning Interventions Have Similar Effects on Walking Speed in People After Stroke: A Randomized Controlled Trial
title_sort implicit and explicit motor learning interventions have similar effects on walking speed in people after stroke: a randomized controlled trial
topic Original Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8101354/
https://www.ncbi.nlm.nih.gov/pubmed/33482007
http://dx.doi.org/10.1093/ptj/pzab017
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