Practice Structure on Motor Learning in Post-Stroke Patients

Background: The literature indicates that, in relation to motor learning, healthy subjects benefit more from random practice than from constant practice. However, this effect is not well known in post-stroke patients. Objective: The goal of this study was to investigate the effects of practice structure on motor learning in post-stroke patients. Methods: Participants included an experimental group (EG) of post-stroke patients: 17 males and females; and a control group (CG) of healthy individuals: 17 males and females. At the acquisition phase, all participants performed 30 trials of a coincident timing task. Nine individuals from each group practiced constantly (C) at a stimulus propagation speed of 3 mph, and eight from each group practiced randomly (R) at speeds of 2, 3, and 5 mph. Subsequent phases included: 1) transfer, 2) retention after 15 minutes, and 3) retention after 3 days. Each of these phases included 20 trials: 10 at a speed of 1 mph, and 10 at a speed of 4 mph. Intra- and inter-group comparisons were made employing an alpha level of 0.05 (5%).

Utilized was Bassin's anticipation timer (Lafayette Instruments #50575), which is comprised of a control screen, one 1.52 m gutter with 32 diodes placed on it linearly, and a response button. The screen has a digital display, with commands that permit the operator to control the stimulus propagation speed and the preparatory interval speed. Once activated, the screen exhibits an alert signal, and, after the preparatory interval, it initiates the propagation of a luminous stimulus, lighting the 32 diodes successively. The task required participants to press the response button simultaneously with the illumination of the last diode. The digital display showed the error measure (em): that is, the difference between the illumination of the last diode and the response.

change in performance during the acquisition; performance exhibited during the transfer phase was maintained during retention phases 1 and 2; and differences between the groups during the transfer phase and retention phases

Inclusion Criteria: First cerebrovascular accident Lesion covering the middle and the anterior cerebral artery territories Presence of hemiplegia or hemiparesis Mini-Mental State Examination (MMSE) score above 24 (19) Sufficient attention and comprehension to perform the task Absence of other associated neurological diseases. Exclusion Criteria: Acute medical problems Uncorrected vision loss Previous history of psychiatric admission History of multiple strokes, transient ischemic attacks Pathology of the less affected, ipsilateral to stroke upper extremity that would affect ability to perform the task Score of 23 or less on the MMSE Difficulty in comprehension of verbal command and simple instructions Aphasia of comprehension.