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To enhance and sustain movement accuracy, humans make corrections in subsequent trials based on previous errors. Trial-by-trial learning occurs unconsciously and has mostly been studied using reaching movements. Goal-directed projection movements, such as archery, have an inherent delay between releasing an object and observing an outcome (e.g. the arrival position of the object), and this delay may prevent trial-by-trial implicit learning. We aimed to investigate the learning in the projection movement and the impacts of the inherent delay. During the experiment, a joystick was flicked once to transport a cursor from the starting location to a target. To manipulate the length of the delay between the cursor release and outcome observation, the speed of the cursor movement was varied: a fast speed can lead to a short delay. We found trial-by-trial implicit learning under all speed conditions, and the error sensitivity was not significantly different across speed conditions. Furthermore, the error sensitivity depended on the target location, that is, the movement direction. The results indicate that trial-by-trial implicit learning occurred in goal-directed projection movement, despite the length of the inherent delay. Additionally, the degree of this learning was affected by the movement direction.

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In overt movement, internal models make predictions about the sensory consequences of a desired movement, generating the appropriate motor commands to achieve that movement. Using available sensory feedback, internal models are updated to allow for movement adaptation and in-turn better performance. Whether internal models are updated during motor imagery, the mental rehearsal of movement, is not well established. To investigate internal modelling during motor imagery, 66 participants were exposed to a leftwards prism shift while performing actual pointing movements (physical practice; PP), imagined pointing movements (motor imagery; MI), or no pointing movements (control). If motor imagery updates internal models, we hypothesized that aftereffects (pointing in the direction opposite the prism shift) would be observed in MI, like that of PP, and unlike that of control. After prism exposure, the magnitude of aftereffects was significant in PP (4.73° ± 1.56°), but not in MI (0.34° ± 0.96°) and control (0.34° ± 1.04°). Accordingly, PP differed significantly from MI and control. Our results show that motor imagery does not update internal models, suggesting that it is not a direct simulation of overt movement. Furthering our understanding of the mechanisms that underlie learning through motor imagery will lead to more effective applications of motor imagery.

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BACKGROUND: Improvements in movement quality (ie, how well an individual moves) facilitate increases in movement quantity, subsequently improving general health and quality of life. Wearable technology offers a convenient, affordable means of measuring and assessing movement quality for the general population, while technology more broadly can provide constructive feedback through various modalities. Considering the perspectives of professionals involved in the development and implementation of technology helps translate user needs into effective strategies for the optimal application of consumer technologies to enhance movement quality. OBJECTIVE: This study aimed to obtain the opinions of wearable technology experts regarding the use of wearable devices to measure movement quality and provide feedback. A secondary objective was to determine potential strategies for integrating preferred assessment and feedback characteristics into a technology-based movement quality intervention for the general, recreationally active population. METHODS: Semistructured interviews were conducted with 12 participants (age: mean 42, SD 9 years; 5 males) between August and September 2022 using a predetermined interview schedule. Participants were categorized based on their professional roles: commercial (n=4) and research and development (R&D; n=8). All participants had experience in the development or application of wearable technology for sports, exercise, and wellness. The verbatim interview transcripts were analyzed using reflexive thematic analysis in QSR NVivo (release 1.7), resulting in the identification of overarching themes and subthemes. RESULTS: Three main themes were generated as follows: (1) "Grab and Go," (2) "Adjust and Adapt," and (3) "Visualize and Feedback." Participants emphasized the importance of convenience to enhance user engagement when using wearables to collect movement data. However, it was suggested that users would tolerate minor inconveniences if the benefits were perceived as valuable. Simple, easily interpretable feedback was recommended to accommodate diverse audiences and aid understanding of their movement quality, while avoiding excessive detail was advised to prevent overload, which could deter users. Adaptability was endorsed to accommodate progressions in user movement quality, and customizable systems were advocated to offer variety, thereby increasing user interest and engagement. The findings indicate that visual feedback representative of the user (ie, an avatar) should be used, supplemented with concise text or audible instructions to form a comprehensive, multimodal feedback system. CONCLUSIONS: The study provides insights from wearable technology experts on the use of consumer technologies for enhancing movement quality. The findings recommend the prioritization of user convenience and simplistic, multimodal feedback centered around visualizations, and an adaptable system suitable for a diverse audience. Emphasizing individualized feedback and user-centric design, this study provides valuable findings around the use of wearables and other consumer technologies to enhance movement quality among the general population. These findings, in conjunction with those of future research into user perspectives, should be applied in practical settings to evaluate their effectiveness in enhancing movement quality.

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Hyperbaric oxygen (HBO) exposure has recently been reported to be effective in spatial learning and memory. Additionally, HBO exposure considerably improves performance on motor tasks. These findings suggest that HBO exposure may facilitate motor learning. However, the specific effects of HBO exposure on motor learning remain largely unexplored. The present study aimed to investigate the effects of HBO exposure on motor learning tasks. In the experimental animal models (control n = 8, HBO n = 8), the HBO environment was exposed to 100% oxygen with the chamber at 2.0 atmosphere absolute (ATA) for 90min/day for 20 days. The motor learning task was an accelerated rotating bar task (bar width, 3 and 6cm; rotation speed, 4-40rpm; acceleration, 0.4, 0.6, and 0.8rpm/s). The learning task was performed for 3 consecutive days. The HBO group showed a main effect of the day factor on the bar with a width of 6cm, and significant differences were observed for each day comparison. However, no main effect of the day factor was observed in the control group. Additionally, significant differences were found in the bar with a width of 3cm for both groups between days 1 and 2 and between days 1 and 3. In conclusion, these findings suggest that HBO exposure has a positive effect on more challenging motor learning tasks.

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In the manual ball-and-beam task, participants have to control a ball that is rolling continuously on a long and hand-held beam. Since the task can be performed individually, in a solo action setting, as well as collaboratively, in a (dyadic) joint action setting, it allows us to investigate how joint performances arise from individual performances, which we investigate in a series of interrelated studies. Here we focused on individual skill acquisition on the ball-and-beam task in the solo action setting, with the goal to characterize the behavioral dynamics that arise from learning to couple (ball motion) perception and (beam motion) action. By moving a beam extremity up and down to manipulate the beam's inclination angle, the task's objective was to roll the ball as fast as and accurately as possible between two indicated targets on the beam. Based on research into reciprocal aiming tasks, we hypothesized that the emergent dynamics of the beam's inclination angle would be constrained by the size of the targets, such that large targets would evoke a continuous beam movement strategy, while small targets would lead to a discrete beam movement strategy. 16 participants individually practiced the task in two separate six-block sessions. Each block consisted of one trial per target-size condition (small, medium and large). Overall, the number of target hits increased over trials, due to a larger range of motion of the beam's inclination angle, a stronger correlation between the ball and beam motion and a smaller variability of the beam motion. Contrary to our expectations, target size did not appreciably affect the shape of the beam movement patterns. Instead, we found stable inter-individual differences in the movement strategies adopted that were uncorrelated with the number of target hits on a trial. We concluded that multiple movement strategies may lead to success on the task, while individual skill acquisition was characterized by the refinement of behavioral dynamics that emerged in an early stage of learning. We speculate that such differences in individual strategies on the task may affect the interpersonal coordination that arises in joint-action performances on the task.

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BACKGROUND: The neural mechanisms underlying differences in the performance of simulated arthroscopic skills across various skill levels remain unclear. Our primary objective is to investigate the learning mechanisms of simulated arthroscopic skills using functional near-infrared spectroscopy (fNIRS). METHODS: We recruited 27 participants, divided into three groups: novices (n = 9), intermediates (n = 9), and experts (n = 9). Participants completed seven arthroscopic tasks on a simulator, including diagnostic navigation, triangulation, grasping stars, diagnostic exploration, meniscectomy, synovial membrane cleaning, and loose body removal. All tasks were videotaped and assessed via the simulator system and the Arthroscopic Surgical Skill Evaluation Tool (ASSET), while cortical activation data were collected using fNIRS. Simulator scores and ASSET scores were analyzed to identify different level of performance of all participants. Brain region activation and functional connectivity (FC) of different types of participants were analyzed from fNIRS data. RESULTS: Both the expert and intermediate groups scored significantly higher than the novice group (p < 0.001). There were significant differences in ASSET scores between experts and intermediates, experts and novices, and intermediates and novices (p = 0.0047, p < 0.0001, p < 0.0001), with the trend being experts > intermediates > novices. The intermediate group exhibited significantly greater activation in the left primary motor cortex (LPMC) and left prefrontal cortex (LPFC) compared to the novice group (p = 0.0152, p = 0.0021). Compared to experts, the intermediate group demonstrated significantly increased FC between the presupplementary motor area (preSMA) and the right prefrontal cortex (RPFC; p < 0.001). Additionally, the intermediate group showed significantly increased FC between the preSMA and LPFC, RPFC and LPFC, and LPMC and LPFC compared to novices (p = 0.0077, p = 0.0285, p = 0.0446). CONCLUSION: Cortical activation and functional connectivity reveal varying levels of activation intensity in the PFC, PMC, and preSMA among novices, intermediates, and experts. The intermediate group exhibited the highest activation intensity.

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Many studies over the recent decades have attempted the modulation of motor learning using brain stimulation. Alternating currents allow for researchers not only to electrically stimulate the brain, but to further investigate the effects of specific frequencies, in and beyond the context of their endogenous associations. Transcranial alternating current stimulation (tACS) has therefore been used during motor learning to modulate aspects of acquisition, consolidation and performance of a learned motor skill. Despite numerous reviews on the effects of tACS, and its role in motor learning, there are few studies which synthesize the numerous frequencies and their respective theoretical mechanisms as they relate to motor and perceptual processes. Here we provide a short overview of the main stimulation frequencies used in motor learning modulation (e.g., alpha, beta, and gamma), and discuss the effect and proposed mechanisms of these studies. We summarize with the current state of the field, the effectiveness and variability in motor learning modulation, and novel mechanistic proposals from other fields.

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Introduction: In past work we demonstrated different patterns of white matter (WM) plasticity in females versus males associated with learning a lab-based unilateral motor skill. However, this work was completed in neurologically intact older adults. The current manuscript sought to replicate and expand upon these WM findings in two ways: (1) we investigated biological sex differences in neurologically intact young adults, and (2) participants learned a dynamic full-body balance task. Methods: 24 participants (14 female, 10 male) participated in the balance training intervention, and 28 were matched controls (16 female, 12 male). Correlational tractography was used to analyze changes in WM from pre- to post-training. Results: Both females and males demonstrated skill acquisition, yet there were significant differences in measures of WM between females and males. These data support a growing body of evidence suggesting that females exhibit increased WM neuroplasticity changes relative to males despite comparable changes in motor behavior (e.g., balance). Discussion: The biological sex differences reported here may represent an important factor to consider in both basic research (e.g., collapsing across females and males) as well as future clinical studies of neuroplasticity associated with motor function (e.g., tailored rehabilitation approaches).

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Motor learning involves both explicit and implicit processes that are fundamental for acquiring and adapting complex motor skills. However, stroke may damage the neural substrates underlying explicit and/or implicit learning, leading to deficits in overall motor performance. While both learning processes are typically used in concert in daily life and rehabilitation, no gait studies have determined how these processes function together after stroke when tested during a task that elicits dissociable contributions from both. Here, we compared explicit and implicit locomotor learning in individuals with chronic stroke to age- and sex-matched neurologically intact controls. We assessed implicit learning using split-belt adaptation (where two treadmill belts move at different speeds). We assessed explicit learning (i.e., strategy-use) using visual feedback during split-belt walking to help individuals explicitly correct for step length errors created by the split-belts. After the first 40 strides of split-belt walking, we removed the visual feedback and instructed individuals to walk comfortably, a manipulation intended to minimize contributions from explicit learning. We utilized a multi-rate state-space model to characterize individual explicit and implicit process contributions to overall behavioral change. The computational and behavioral analyses revealed that, compared to controls, individuals with chronic stroke demonstrated deficits in both explicit and implicit contributions to locomotor learning, a result that runs counter to prior work testing each process individually during gait. Since post-stroke locomotor rehabilitation involves interventions that rely on both explicit and implicit motor learning, future work should determine how locomotor rehabilitation interventions can be structured to optimize overall motor learning.

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Impaired joint attention is a common feature of autism spectrum disorder (ASD), affecting social interaction and communication. We explored if group basketball learning could enhance joint attention in autistic children, and how this relates to brain changes, particularly white matter development integrity. Forty-nine autistic children, aged 4-12 years, were recruited from special education centers. The experimental group underwent a 12-week basketball motor skill learning, while the control group received standard care. Eye-tracking and brain scans were conducted. The 12-week basketball motor skill learning improved joint attention in the experimental group, evidenced by better eye tracking metrics and enhanced white matter integrity. Moreover, reduced time to first fixation correlated positively with decreased mean diffusivity of the left superior corona radiata and left superior fronto-occipital fasciculus in the experimental group. Basketball-based motor skill intervention effectively improved joint attention in autistic children. Improved white matter fiber integrity related to sensory perception, spatial and early attention function may underlie this effect. These findings highlight the potential of group motor skill learning within clinical rehabilitation for treating ASD.

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Stuttering is progressively reduced when persons who stutter repeatedly read the same text. This reduction has been recently attributed to motor learning with repeated practice of speech-motor sequences. In the present study, we investigated the adaptation effect of 17 bilingual adults who stutter (BAWS). We asked these participants to complete a particular paradigm of reading passages with a 30-minute break between them. Participants were Kannada-English speaking BAWS. We split them into two groups of eight and nine participants, respectively who read in counter-balanced order two passages written in the Kannada and English languages. The averaged data from the two groups resulted in a typical adaptation curve for the five readings when read separately in both languages. When there was a switch from readings in Kannada to readings in English, there was a significant increase in the percentage of syllables stuttered. This increase in dysfluencies reduced the adaptation effect from repeated reading. These findings support the hypothesis that motor learning plays a crucial role in stuttering adaptation when participants read the same passage repeatedly in any language, but the shift in the language read suggests an interference in motor learning. Collectively, our results highlight an interaction effect between motor learning and language proficiency, seen by increased dysfluencies and a reduced adaptation effect in bilingual speakers.

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OBJECTIVES: To evaluate the delivery of rehabilitation using implicit motor learning principles in an acute stroke setting. DESIGN: Pilot, assessor-blind, cluster randomised controlled trial with nested qualitative evaluation. SETTING: Eight inpatient stroke units, UK. PARTICIPANTS: People within 14 days of stroke onset, presenting with lower limb hemiplegia. INTERVENTIONS: Participants at control clusters received usual care. Participants at intervention clusters received rehabilitation using an Implicit Learning Approach (ILA); primarily consisting of reduced frequency instructions/feedback, and promotion of an external focus of attention. Video recording was used to understand the ability of intervention site therapists to adhere to the implicit learning principles, and to compare differences between groups. MEASURES: Ability to recruit and retain clusters/participants; suitability and acceptability of data collection processes; appropriateness of fidelity monitoring methods; and appropriateness of chosen outcome measures. RESULTS: Eight stroke units participated, with four assigned to each group (intervention/control). Fifty-one participants were enrolled (intervention group 21; control group 30). Mean time since stroke was 6 days (SD 3.42; 0-14); mean age was 73 years (SD 14, 25-94). Of those approached to take part, 72% agreed. We found clear differences between groups with respect to the frequency and type of instructional statement. The ILA was acceptable to both patients and therapists. CONCLUSION: It is feasible to evaluate the application and effectiveness of motor learning principles within acute stroke rehabilitation, using a cluster randomised design. A larger study is required to evaluate the benefits of each approach; we provide a range of sample size estimates required for this.

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Previous research suggests that the neural processes underlying specification of movement direction and amplitude are independently represented in the nervous system. However, our understanding of acquisition and consolidation processes in the direction and distance learning remains limited. We designed a virtual air hockey task, in which the puck direction is determined by the hand direction at impact, while the puck distance is determined by the amplitude of the velocity. In two versions of this task, participants were required to either specify the direction or the distance of the puck, while the alternate variable did not contribute to task success. Separate groups of right-handed participants were recruited for each task. Each participant was randomly assigned to one of two groups with a counter-balanced arm practice sequence (right to left, or left to right). We examined acquisition and, after 24 h, we examined two aspects of consolidation: 1) same hand performance to test the durability and 2) the opposite hand to test the effector-independent consolidation (interlimb transfer) of learning. The distance task showed symmetry between hands in the extent of acquisition as well as in both aspects of consolidation. In contrast, the direction task showed asymmetry in both acquisition and consolidation: the dominant right arm showed faster and greater acquisition and greater transfer from the opposite arm training. The asymmetric acquisition and consolidation processes shown in the direction task might be explained by lateralized control and mapping of direction, an interpretation consistent with previous findings on motor adaptation paradigms.

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Stroke remains a significant global health burden, necessitating comprehensive and innovative approaches in rehabilitation to optimize recovery outcomes. This paper provides a thorough exploration of rehabilitation strategies in stroke management, focusing on diagnostic methods, acute management, and diverse modalities encompassing physical, occupational, speech, and cognitive therapies. Emphasizing the importance of early identification of rehabilitation needs and leveraging technological advancements, including neurostimulation techniques and assistive technologies, this manuscript highlights the challenges and opportunities in stroke rehabilitation. Additionally, it discusses future directions, such as personalized rehabilitation approaches, neuroplasticity concepts, and advancements in assistive technologies, which hold promise in reshaping the landscape of stroke rehabilitation. By delineating these multifaceted aspects, this manuscript aims to provide insights and directions for optimizing stroke rehabilitation practices and enhancing the quality of life for stroke survivors.

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We aimed to examine the effects of motor performance improvements produced by practice on corticospinal tract excitability during motor imagery (MI) of identical movements. Participants performed a motor task with no guidelines displayed on the monitor (performance test); the participants only imagined performing the task without performing the movement (MI test), and the participants performed the power output and then adjusted it (exercise). The output force conditions were 20, 40, and 60% of the maximum voluntary contraction, and the objective was for 21 participants to learn each output force condition. The outcome of the performance test was calculated as the difference between the actual motor output and the target. During the MI test, we applied a single transcranial magnetic stimulation during imagery, assessed the corticospinal tract excitability of the right first dorsal interosseous by motor-evoked potential (MEP) amplitude, and recorded the vividness of the MI in each trial. We evaluated performance and MI before practice (Pre-test), after 150 practice sessions (Post-test 1), and after another 150 practice sessions (Post-test 2). The MEP amplitude was significantly reduced at Post-test 2 compared to Pre-test. The vividness of the MI improved with practice. Corticospinal tract excitability during MI decreased as motor performance improved. Thus, actual motor practice was also reflected in the MI of the exercise. Performance improvement was accompanied by a decrease in redundant activity, enhancing the efficiency and appropriateness of the exercise.

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AIM: To assess the adaptive response of older adults with a history of falls in a single Perturbation-Based Balance Training (PBT) session by examining the margin of stability (MoS) and the number of falls. METHODS: Thirty-two older adults with a history of falls underwent a treadmill walking session lasting 20-25 min. During the PBT protocol, participants experienced 24 unexpected perturbations delivered in two ways: acceleration or deceleration of the treadmill belt, with 12 perturbations in each direction. The MoS in the anteroposterior direction was assessed for the first and last perturbations of the session, during the perturbation step (N) and the recovery step (REC), along with the number of falls during the training session. RESULTS: There was no statistically significant difference in MoS between the first and last perturbations (acceleration and deceleration) for steps N and REC. Regarding the number of falls, a significant reduction was found when comparing the first half with the second half of the training session (p = .033). There were 13 falls in the first half and only three in the second half of the PBT session. CONCLUSION: Older adults with a history of falls exhibited an adaptive response with a reduction in the number of falls during a single session of PBT despite not showing changes in the MoS.

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Alterations to sensory feedback can drive robust adaptive changes to the production of consonants and vowels, but these changes often have no behavioral relevance or benefit to communication (e.g., making "head" more like "had"). This work aims to align the outcomes of adaptation with changes known to increase speech intelligibility - specifically, adaptations that increase the acoustic contrast between vowels in running speech. To this end, we implemented a vowel centralization feedback perturbation paradigm that pushes all vowels towards the center of vowel space, making them sound less distinct from one another. Speakers across the adult lifespan adapted to the centralization perturbation during sentence production, increasing the global acoustic contrast among vowels and the articulatory excursions for individual vowels. These changes persisted after the perturbation was removed, including after a silent delay, and showed robust transfer to words that were not present in the sentences. Control analyses demonstrated that these effects were unlikely to be due to explicit pronunciation strategies and occurred in the face of increasingly more rapid and less distinct production of familiar sentences. Finally, sentence transcription by crowd-sourced listeners showed that speakers' vowel contrast predicted their baseline intelligibility and that experimentally-induced increases in contrast predicted intelligibility gains. These findings establish the validity of a sensorimotor adaptation paradigm to implicitly increase vowel contrast and intelligibility in connected speech, an outcome that has the potential to enhance rehabilitation in individuals who present with a reduced vowel space due to motor speech disorders, such as the hypokinetic dysarthria associated with Parkinson's disease.

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Background: The acquisition of motor skills is a key element in many sports. A motor learning principle, which is frequently used to support skill acquisition is the application of different attentional foci. The effectiveness of different attentional foci on performance and the learning of motor skills has been investigated in various sports using randomised controlled trials. The aim of the present study was to investigate the effectiveness of different attentional foci (such as external (EFA) and internal attentional foci (IFA), but also holistic and switching foci) on the performance and learning of a sport-specific motor task in healthy individuals. Methods: This study was a systematic review with network meta-analysis. We followed the Prisma reporting guideline and the Cochrane handbook for systematic reviews. Cinahl, Embase, Medline and Cochrane Central were searched for eligible studies. Network meta-analyses were performed for the post-acquisition, retention and transfer test endpoints. Results: Twelve studies were included in the review. At post-acquisition an EFA was the most effective intervention compared to the control intervention (SMD: 0.9855; 95% CI [0.4-1.57]; p: 0.001). At the retention and transfer test endpoints, a holistic focus of attention had the highest effectiveness compared to an IFA (SMD 0.75; 95% CI [-0.1 to 1.6]; p: 0.09) and (SMD 1.16; 95% CI [0.47-1.86]; p: 0.001). Discussion: For all three endpoints, we analysed a greater effectiveness of an EFA and holistic focus compared to an IFA. Several promising different attentional focus interventions were identified. The largest effects were analysed for a holistic focus. However, only one study used this intervention and therefore there remains uncertainty about the effectiveness. With regard to the inconsistency observed, the analysis at post-acquisition should be interpreted with caution. Modified versions of the EFA were the imagined and the dynamic EFA. Both were only explored in single studies and should therefore be investigated in further follow-up studies that directly compare them.

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Cross-education (CE) is a phenomenon whereby motor training of one limb leads to improved performance in the opposite untrained limb. External pacing of a motor task can enhance CE; however, the influence of different pacing methods is poorly understood. This study explored how motor training with auditory (AP) and visual pacing (VP) impacts CE with a visuomotor force target task. Sixty-one participants performed a unimanual motor task. Participants were randomized into a visual (n = 31) or auditory (n = 30) pacing stimuli condition. The primary outcome was cumulative error scores for each hand, before and after visuomotor training. Pacing type did not yield different magnitudes of CE. However, after adjusting for baseline differences, a significant hand (trained vs. untrained) × practice side (dominant or non-dominant) interaction (p = .013, ηp2 = .106) and a group main effect (p = .036, ηp2 = .165) were observed. Visual pacing resulted in greater improvements in task performance compared to auditory pacing regardless of hand or practice side, while training the dominant limb resulting in a greater interlimb asymmetry regardless of pacing stimulus. These findings have implications for applying pacing strategies during rehabilitation from unilateral injury or neurological impairment.

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Motor learning is often viewed as a unitary process that operates outside of conscious awareness. This perspective has led to the development of sophisticated models designed to elucidate the mechanisms of implicit sensorimotor learning. In this review, we argue for a broader perspective, emphasizing the contribution of explicit strategies to sensorimotor learning tasks. Furthermore, we propose a theoretical framework for motor learning that consists of three fundamental processes: reasoning, the process of understanding action-outcome relationships; refinement, the process of optimizing sensorimotor and cognitive parameters to achieve motor goals; and retrieval, the process of inferring the context and recalling a control policy. We anticipate that this '3R' framework for understanding how complex movements are learned will open exciting avenues for future research at the intersection between cognition and action.

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