Implicit and explicit motor learning interventions have similar effects on walking speed in people after stroke: A randomized controlled trial.

 So write this up as a protocol and deliver is to all 10 million yearly stroke survivors

now and into the future.

That would normally be the responsibility of stroke associations but we have fucking failures of stroke associations  instead, so the responsibility falls on your researchers.

 Implicit and explicit motor learning interventions have similar effects on walking speed in people after stroke: A randomized controlled trial.

Physical Therapy , Volume 101(5)

NARIC Accession Number: J86611.  What's this?
ISSN: 0031-9023.
Author(s): Jie, Li-Juan; Kleynen, Melanie Meijer, Kenneth; Beurskens, Anna ; Braun, Susy.
Publication Year: 2021.
Number of Pages: 10.

Abstract: 

Study assessed 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. Explicit motor learning can be referred to as a more conscious form of learning characterized by the generation of verbal knowledge and involvement of cognitive resources. In contrast, implicit motor learning is assumed to take place without much knowledge of the underlying facts and rules of motor skills. In a randomized, controlled, single-blind trial, 79 participants, who were more than 6 months post stroke, were randomly assigned to an implicit or explicit 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-MeterWalk Test at a comfortable walking pace. Outcomes were assessed at baseline, immediately after intervention, and 1 month post intervention. No statistically or clinically relevant differences between groups were obtained postintervention (between-group difference was estimated at 0.02 meters per second (m/s) and at follow-up (between-group difference estimated at −0.02 m/s). Implicit motor learning was not superior to explicit motor learning to improve walking speed in people after stroke in the chronic phase of recovery. Results indicate that physical therapists can use implicit and explicit motor learning strategies to improve walking speed in people after stroke who are in the chronic phase of recovery.
Descriptor Terms: AMBULATION, INTERVENTION, LEARNING, MOBILITY TRAINING, MOTOR SKILLS, PHYSICAL THERAPY, STROKE.


Can this document be ordered through NARIC's document delivery service*?: Y.

Citation: Jie, Li-Juan, Kleynen, Melanie Meijer, Kenneth, Beurskens, Anna , Braun, Susy. (2021). Implicit and explicit motor learning interventions have similar effects on walking speed in people after stroke: A randomized controlled trial.  Physical Therapy , 101(5) Retrieved 8/26/2021, from REHABDATA database.

The Effects of Implicit and Explicit Motor Learning in Gait Rehabilitation of People After Stroke: Protocol for a Randomized Controlled Trial

A research study for walking for you, you will need to know Dutch.  I don't know what implicit vs. explicit means in this case.
The Effects of Implicit and Explicit Motor Learning in Gait Rehabilitation of People After Stroke: Protocol for a Randomized Controlled Trial

Effects of Unilateral Upper Limb Training in Two Distinct Prognostic Groups Early After Stroke

Well shit, treating only the good candidates. What the fuck are those survivors supposed to do that don't have voluntary finger extension? Like me. They didn't even try mCIMT on unfavorable finger extension candidates. They are not even trying to solve the hard survivor cases. You better fucking hope you have a small stroke because researchers obviously do not even try to solve the hard cases.

Effects of Unilateral Upper Limb Training in Two Distinct Prognostic Groups Early After Stroke

The EXPLICIT-Stroke Randomized Clinical Trial

1. Gert Kwakkel, PhD1,2
2. Caroline Winters, MSc1
3. Erwin E. H. van Wegen, PhD1⇑
4. Rinske H. M. Nijland, PhD2
5. Annette A. A. van Kuijk, MD, PhD3
6. Anne Visser-Meily, MD, PhD4
7. Jurriaan de Groot, PhD5
8. Erwin de Vlugt, PhD6
9. J. Hans Arendzen, MD, PhD5
10. Alexander C. H. Geurts, MD, PhD3
11. Carel G. M. Meskers, MD, PhD1
12. on behalf of the EXPLICIT-Stroke Consortium

1. ¹Department of Rehabilitation Medicine, MOVE Research Institute Amsterdam, VU University Medical Center, Amsterdam, The Netherlands
2. ²Amsterdam Rehabilitation Research Center, Reade, Amsterdam, The Netherlands
3. ³Department of Rehabilitation, Radboud University Medical Center, Nijmegen, The Netherlands
4. ⁴Brain Center Rudolf Magnus and Center of Excellence for Rehabilitation Medicine, University Medical Center Utrecht, Utrecht, The Netherlands
5. ⁵Department of Rehabilitation Medicine, Leiden University Medical Center, Leiden, The Netherlands
6. ⁶Department of Biomechanical Engineering, Faculty of Mechanical Engineering, Delft University of Technology, Delft, The Netherlands

1. Erwin E. H. van Wegen, PhD, Department of Rehabilitation Medicine, VU University Medical Center, PO Box 7057, 1007 MB Amsterdam, The Netherlands. Email: e.vanwegen@vumc.nl

Abstract

Background and Objective. Favorable prognosis of the upper limb depends on preservation or return of voluntary finger extension (FE) early after stroke. The present study aimed to determine the effects of modified constraint-induced movement therapy (mCIMT) and electromyography-triggered neuromuscular stimulation (EMG-NMS) on upper limb capacity early poststroke.  

Methods. A total of 159 ischemic stroke patients were included: 58 patients with a favorable prognosis (>10° of FE) were randomly allocated to 3 weeks of mCIMT or usual care only; 101 patients with an unfavorable prognosis were allocated to 3-week EMG-NMS or usual care only. Both interventions started within 14 days poststroke, lasted up until 5 weeks, focused at preservation or return of FE.  

Results. Upper limb capacity was measured with the Action Research Arm Test (ARAT), assessed weekly within the first 5 weeks poststroke and at postassessments at 8, 12, and 26 weeks. Clinically relevant differences in ARAT in favor of mCIMT were found after 5, 8, and 12 weeks poststroke (respectively, 6, 7, and 7 points; P < .05), but not after 26 weeks. We did not find statistically significant differences between mCIMT and usual care on impairment measures, such as the Fugl-Meyer assessment of the arm (FMA-UE). EMG-NMS did not result in significant differences. Conclusions. Three weeks of early mCIMT is superior to usual care in terms of regaining upper limb capacity in patients with a favorable prognosis; 3 weeks of EMG-NMS in patients with an unfavorable prognosis is not beneficial. Despite meaningful improvements in upper limb capacity, no evidence was found that the time-dependent neurological improvements early poststroke are significantly influenced by either mCIMT or EMG-NMS.

Applying explicit and implicit learning models during early gait rehabilitation post stroke: a feasibility trial

This may take forever to infiltrate stroke rehab. I can't ever see our therapists getting away from telling us exactly what to do.
http://www.physiotherapyuk.org.uk/presentation/applying-explicit-and-implicit-learning-models-during-early-gait-rehabilitation-post

Presenter(s): 

Dr Louise Johnson

Abstract: 

Relevance: Motor learning can be either explicit or implicit. Explicit learning is conscious and cognitive, occurring with task specific knowledge. Implicit learning is sub-conscious and unintentional, occurring in the absence of consciously accessible knowledge. Sports science and psychology research shows the benefits of an implicit approach, particularly for retention of motor skills1. Research comparing explicit and implicit learning within stroke rehabilitation is limited. Stroke rehabilitation therapists tend to use an explicit approach; giving frequent, internally-focussed instructions and feedback during motor task practice2. Current practice is therefore at odds with evidence from healthy populations. It is not known whether a more implicit approach to learning would be favourable for the retention of motor skills in people with stroke.
Purpose: Following definition of implicit and explicit learning, guidelines were developed for clinical application. The purpose of this study was to test the ability of physiotherapists to apply the guidelines within an acute stroke setting.
Methods: Double blind feasibility trial using a randomised matched pairs design. Patients were matched for age, baseline function (Berg Balance Score) and presence or absence of an attentional deficit. They received three days of early gait training using either an explicit or implicit approach. The explicit approach used frequent instructions/feedback and an internal focus of attention; the implicit approach reduced the quantity of instructions/feedback, and promoted an external focus of attention. Treatment sessions were digitally recorded, and later analysed using a validated matrix4. Patients and therapists were interviewed post-intervention to gain insight into their perceptions of the two approaches.
Analysis: Analysis identified episodes of instruction and feedback, and categorised them according to their focus of attention. Compliance with the intervention guidelines was achieved if patients in the implicit group received fewer statements of instruction/feedback and a higher proportion of internally focussed statements, when compared to those in the explicit learning group. Comparison was made between groups using a liner regression model. Interviews were transcribed verbatim and thematically analysed.
Results: 21 patients and 3 therapists took part. There were significant differences between groups in terms of the quantity of statements (p< 0.01); and their focus of attention (p< 0.01). Those in the implicit group also had significantly more periods of silence, allowing practice without concurrent verbal input. Interview data found both approaches to be acceptable to patients and therapists, however therapists reported particular challenges with creating an external focus of attention.
Conclusions: It is feasible for therapists to adopt a more implicit approach. Despite this, therapists found the promotion of an external focus of attention (implicit group) challenging. It is recommended that a treatment manual is developed before commencing a Phase II trial.
Impact and Implications: The findings from this phase will be used to design a clinically grounded Phase II Pilot study, which will compare implicit and explicit learning paradigms post stroke. Given the strength of evidence in healthy populations to support the use of implicit strategies for learning motor skills, the findings could have important implications for the delivery of rehabilitation interventions for people with stroke.

Cambridge researchers find practice really could make perfect, and help rehabilitate stroke patients

But I disagree, what about learning faster by doing it wrong?

Practice makes perfect — or does it?

Or explicit vs. implicit learning?

Why the hell don't these people write up stroke protocols so they can be critiqued and criticized?
Cambridge researchers find practice really could make perfect, and help rehabilitate stroke patients

Improving Older Individuals’ Physical Function Over Time With an Implicit-Age-Stereotype Intervention

Does your doctor need to completely change their stroke protocols to implicit vs. explicit interventions?  Does this add proof to this intervention style?

Explicit and implicit motor learning during early gait rehabilitation post stroke

The New York Times discussing this here;
Presumably after reading the full research.
http://newoldage.blogs.nytimes.com/2014/10/30/a-workout-for-the-mind/
A few selected paragraphs here;

Yet the researchers have now reported, in the journal Psychological Science, that an “implicit” intervention works subliminally to strengthen older people’s positive age stereotypes. That leads, in turn, to stronger physical functioning. The effects were still evident three weeks after the intervention ended.

Here’s how it worked with a group of 100 older adults (average age 81) living New Haven, Conn. Once a week over four weeks, these volunteers were exposed to what’s sometimes called an “implicit association” exercise.

Some in the group saw positive words associated with aging — like wise, creative, spry and fit, along with old and senior — flashed on a laptop screen so briefly that while the brain registered them, people couldn’t tell what they said. “Perception without awareness,” as Dr. Levy put it. The sessions lasted about 15 minutes. Other subjects engaged in an “explicit” exercise, in which they were asked to write brief essays about active older people. The researchers controlled for age, sex and health.

As expected, follow-up tests showed that the implicit intervention significantly strengthened positive age stereotypes and self-perceptions of age. Then, one week and three weeks after the final session, participants were given physical tasks: repeatedly standing up from a chair and sitting down, walking across a room, holding poses that challenge balance.

The group exposed to implicit positive messages showed significant improvement in physical function, compared to their status before the experiment began. Those who participated in the explicit intervention and wrote essays showed no improvement.

In fact, the people who underwent four brief exposures to implicit positive messages showed greater physical improvement than a group of a similar aged, enrolled in a different study, that actually exercised for six months.

Explicit and implicit motor learning during early gait rehabilitation post stroke

It is only a 404 page thesis that I'm not going to read. It is your doctors responsibility to keep abreast of current news on stroke, so ask him/her to see if anything in there will change your stroke protocols. My reading of the abstract would have me believe that practically everything my therapists were teaching me were done the wrong way.

Explicit and implicit motor learning during early gait rehabilitation post stroke

Learning can be explicit or implicit.

Explicit learning takes place intentionally, in the presence

of factual task-relevant knowledge; whereas implicit learning takes place unintentionally, without concurrent acquisition of knowledge about task performance.

The relative benefits of implicit learning have been well investigated within healthy populations.  Research consistently demonstrates that skills learnt implicitly are more likely to be retained, and are more robust under secondary task load. However, study protocols tend to involve laboratory

based activities, which do not take into account the complexities of motor learning in natural settings. Direct transferability of the findings to stroke rehabilitation is therefore questionable.

Two factors in explicit and implicit learning are the concepts of attentional capacity and attentional focus.

Attentional capacity refers to the ability to attend to and process incoming

information,  whereas attentional focus refers to the location of attention in relation to specific aspects of the task being performed.

Theories propose that focussing on specific movements(internal focus)

may actually constrain or interfere with automatic control processes that

would normally regulate movement, whereas if attention is focussed towards the movement effect (external focus) the motor system is able to more naturally self-organize, resulting in more effective performance, and learning. An internal focus of attention is therefore allied to

explicit learning; whilst an external focus of attention is allied to implicit l

earning. This research aimed to improve understanding of explicit and implicit learning within early gait rehabilitation post stroke; primarily through the development and testing of explicit and implicit models of learning interventions. It has comprised three phases; a review of the literature;

an observational study to gain insight into current practice; and a

feasibility study to test the ability of therapists to deliver interventions with a bias towards either an explicit or implicit approach. Therapists were found to favour the use of explicit techniques; internally focussed instructions

and feedback statements were used in high quantities. Practice therefore appeared to be at odds with current evidence; albeit primarily from healthy populations.Guidance for the delivery of explicit

and implicit learning models in clinical practice was developed, and then

tested in a feasibility study. Therapists demonstrated the ability to change their practice to bias either explicit or implicit learning; both approaches were found to be acceptable to patients and therapists. Recommendations are made on the content and evaluation of explicit and implicit learning

 

Motor imagery ability in stroke patients: the relationship between implicit and explicit motor imagery measures

I can't tell if this is trying to distinguish between action observation(watching someone elses movements) and visual imagery(imagining yourself doing a movement). So ask your brilliant doctor about it. Only 65 references that you can quiz your doctor about.
http://www.frontiersin.org/Journal/10.3389/fnhum.2013.00790/full?

Sjoerd de Vries^1,2*, Marga Tepper³, Wya Feenstra^3,4, Hanneke Oosterveld¹, Anne M. Boonstra⁴ and Bert Otten¹

• ¹Centre for Human Movement Sciences, University Medical Centre Groningen, University of Groningen, Groningen, Netherlands
• ²Research Centre for Health, Social Work & Technology, School of Applied Psychology, Saxion University of Applied Sciences, Deventer, Netherlands
• ³Department of Rehabilitation Medicine, University Medical Centre Groningen, Groningen, Netherlands
• ⁴‘Revalidatie Friesland’ Centre for Rehabilitation, Beetsterzwaag, Netherlands

There is little consensus on how motor imagery ability should be measured in stroke patients. In particular it is unclear how two methods tapping different aspects of the motor imagery process relate to each other. The aim of this study was to investigate the relationship between implicit and explicit motor imagery ability by comparing performance of stroke patients and controls on a motor imagery questionnaire and a hand laterality judgment task (HLJT). Sixteen ischemic stroke patients (36 ± 13 weeks post-stroke) and 16 controls, matched by age (51 ± 10 years), gender (7 females) and handedness (3 left-handed), performed a HLJT and completed a motor imagery questionnaire. Our study shows that neither in the healthy controls nor in patients, a correlation is found between the HLJT and the motor imagery questionnaire.

Although the patient group scored significantly lower than the control group on the visual motor imagery component (U = 60; p = 0.010) and the kinesthetic motor imagery component (U = 63.5; p = 0.015) of the questionnaire, there were no significant differences between patients and controls on accuracy scores of the HLJT. Analyses of the reaction time profiles of patients and controls showed that patient were still able to use an implicit motor imagery strategy in the HLJT task.

Our results show that after stroke performance on tests that measure two different aspects of motor imagery ability, e.g., implicit and explicit motor imagery, can be differently affected. These results articulate the complex relation phenomenological experience and the different components of motor imagery have and caution the use of one tool as an instrument for use in screening, selecting and monitoring stroke patients in rehabilitation settings.

Lots more at the link.