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Factors Impacting Explicit Locomotor...

French, Margaret A.

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Factors Impacting Explicit Locomotor Learning Post Stroke.

Record Type:	Electronic resources : Monograph/item
Title/Author:	Factors Impacting Explicit Locomotor Learning Post Stroke./
Author:	French, Margaret A.
Published:	Ann Arbor : ProQuest Dissertations & Theses, : 2021,
Description:	190 p.
Notes:	Source: Dissertations Abstracts International, Volume: 82-10, Section: B.
Contained By:	Dissertations Abstracts International82-10B.
Subject:	Physical therapy. -
Online resource:	https://pqdd.sinica.edu.tw/twdaoapp/servlet/advanced?query=28314124
ISBN:	9798597004761

Factors Impacting Explicit Locomotor Learning Post Stroke.
French, Margaret A.

Factors Impacting Explicit Locomotor Learning Post Stroke. - Ann Arbor : ProQuest Dissertations & Theses, 2021 - 190 p.

Source: Dissertations Abstracts International, Volume: 82-10, Section: B.

Thesis (Ph.D.)--University of Delaware, 2021.

This item must not be sold to any third party vendors.

Stroke results in numerous physical impairments that limit functional mobility and make it the leading cause of long term disability in the United States. A primary goal for rehabilitation professionals and stroke survivors is to improve walking abilities. Despite efforts to improve walking, not every stroke survivor achieves optimal outcomes. This is in part due to our lack of understanding of the processes and factors underlying relearning to walk after stroke. The overall purpose of this work was, therefore, to expand our understanding of locomotor learning and the factors that impact locomotor learning after stroke.To date, sensorimotor adaptation, a largely implicit and automatic form of learning, has been the primary source of our knowledge about locomotor learning; however, this is not the only type of locomotor learning. In fact, clinical practice is dominated by interventions that rely heavily on strategic learning rather than sensorimotor adaptation. Strategic learning is explicit and relies on conscious control. As a result, research focused specifically on this type of learning is needed to improve rehabilitation interventions through a broader understanding of locomotor learning. Thus, this work used a visually-guided walking paradigm to examine explicit, strategic locomotor learning and the factors that impact it after stroke.In Aim 1 we found that stroke survivors were able to learn and remember a new walking as well as healthy adults. Importantly, however, there was significant variability in both stroke survivors and healthy adults. This finding is important because it demonstrates that this type of learning may be appropriate in post-stroke rehabilitation, but optimal only for a subset of individuals.In Aim 2, we showed that cognition explained a significant portion of variability in learning and retention of a new walking pattern. Interestingly, fluid cognition rather than visuospatial working memory, specifically, was found to be a significant predictor of learning and retention. This is important as it suggests that understanding someone's cognitive abilities may help in the design and delivery of more personalized rehabilitation interventions after stroke.Lastly, in Aim 3 we found that exercise priming did not significantly improve retention of the newly learned walking pattern. This is in conflict with previous findings in the upper extremity; however, there are several potential reasons for this discrepancy that should be explored in future work.In summary, this work suggests that strategic locomotor learning and retention is intact in individuals after stroke; however, there is significant intra-subject variability, part of which can be explained by cognitive abilities. This work lays the foundation for future work to further understand the role of cognition in locomotor learning and to explore interventions that can improve explicit, strategic locomotor learning after stroke.

ISBN: 9798597004761Subjects--Topical Terms:

588713
Physical therapy.
Subjects--Index Terms:

Locomotor learning

Factors Impacting Explicit Locomotor Learning Post Stroke.
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300 $a 190 p.
500 $a Source: Dissertations Abstracts International, Volume: 82-10, Section: B.
500 $a Advisor: Reisman, Darcy S.
502 $a Thesis (Ph.D.)--University of Delaware, 2021.
506 $a This item must not be sold to any third party vendors.
520 $a Stroke results in numerous physical impairments that limit functional mobility and make it the leading cause of long term disability in the United States. A primary goal for rehabilitation professionals and stroke survivors is to improve walking abilities. Despite efforts to improve walking, not every stroke survivor achieves optimal outcomes. This is in part due to our lack of understanding of the processes and factors underlying relearning to walk after stroke. The overall purpose of this work was, therefore, to expand our understanding of locomotor learning and the factors that impact locomotor learning after stroke.To date, sensorimotor adaptation, a largely implicit and automatic form of learning, has been the primary source of our knowledge about locomotor learning; however, this is not the only type of locomotor learning. In fact, clinical practice is dominated by interventions that rely heavily on strategic learning rather than sensorimotor adaptation. Strategic learning is explicit and relies on conscious control. As a result, research focused specifically on this type of learning is needed to improve rehabilitation interventions through a broader understanding of locomotor learning. Thus, this work used a visually-guided walking paradigm to examine explicit, strategic locomotor learning and the factors that impact it after stroke.In Aim 1 we found that stroke survivors were able to learn and remember a new walking as well as healthy adults. Importantly, however, there was significant variability in both stroke survivors and healthy adults. This finding is important because it demonstrates that this type of learning may be appropriate in post-stroke rehabilitation, but optimal only for a subset of individuals.In Aim 2, we showed that cognition explained a significant portion of variability in learning and retention of a new walking pattern. Interestingly, fluid cognition rather than visuospatial working memory, specifically, was found to be a significant predictor of learning and retention. This is important as it suggests that understanding someone's cognitive abilities may help in the design and delivery of more personalized rehabilitation interventions after stroke.Lastly, in Aim 3 we found that exercise priming did not significantly improve retention of the newly learned walking pattern. This is in conflict with previous findings in the upper extremity; however, there are several potential reasons for this discrepancy that should be explored in future work.In summary, this work suggests that strategic locomotor learning and retention is intact in individuals after stroke; however, there is significant intra-subject variability, part of which can be explained by cognitive abilities. This work lays the foundation for future work to further understand the role of cognition in locomotor learning and to explore interventions that can improve explicit, strategic locomotor learning after stroke.
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653 $a Strategic learning
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