Implicit and Explicit Motor Learning Interventions Have Similar Effects on Walking Speed in People After Stroke: A Randomized Controlled Trial.
Study Goal
The researchers aimed to compare the effectiveness of implicit versus explicit motor learning approaches in improving walking speed for chronic stroke survivors.
Results Summary
The study found no statistically or clinically significant differences in walking speed improvement between implicit and explicit motor learning interventions post-intervention or at follow-up. Both approaches showed similar efficacy in improving walking speed for chronic stroke survivors.
Population
Chronic stroke survivors (mean age 66.4 years, mean time post-stroke 70.1 months, mean walking speed 0.7 m/s).
Effective Dosage
9 training sessions (30 minutes each) over 3 weeks.
Duration
3 weeks (with follow-up at 1 month post-intervention).
Interactions
None mentioned
| Intervention | Direction | Endpoint | Population | Dosage | Impact | Claim # |
|---|---|---|---|---|---|---|
implicit motor learning walking intervention | no change | walking speed | people after stroke in the chronic phase of recovery | no statistically or clinically relevant differences | is not superior to explicit motor learning | #1 |
implicit motor learning walking intervention | no change | walking speed | people after stroke in the chronic phase of recovery | 0.02 m/s [95% CI = -0.04 to 0.08] | no statistically or clinically relevant differences between groups were obtained postintervention | #2 |
implicit motor learning walking intervention | no change | walking speed | people after stroke in the chronic phase of recovery | -0.02 m/s [95% CI = -0.09 to 0.05] | no statistically or clinically relevant differences between groups were obtained at follow-up | #3 |
implicit motor learning walking intervention | increase | walking speed | people after stroke who are in the chronic phase of recovery | - | can be used to improve | #4 |
explicit motor learning walking intervention | increase | walking speed | people after stroke who are in the chronic phase of recovery | - | can be used to improve | #5 |
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.