The power of implicit motor learning 2.0
Application of analogy, errorless and observational learning after stroke

Introduction
Healthcare professionals working in rehabilitation, like physiotherapists and occupational therapists, are experts in supporting relearning of motor tasks in people with a disability. When supporting the learning process of people after stroke, physiotherapists and occupational therapists are confronted with cognitive impairments that often occur within this target group and may hinder the learning process.
New insights from more fundamental research confirm the assumption that implicit learning is an approach that makes motor learning easier for clients with cognitive impairments. However, the results of these studies cannot be generalized to daily practice yet. Therefore, it remains unclear how implicit learning in daily practice, aimed at learning daily movements like walking, should be shaped and whether it is effective to optimally stimulate clients.

In this study it will be established which aspects of walking are improved by using three different applications of implicit motor learning.


Research questions
Which potential effective applications of analogy, errorless and observational learning can be identified for improving gait in clients after stroke?


Design
A cross-sectional experimental study in a motion lab (Maastricht University and Zuyd University of Applied Sciences) with 3D-movement analysis.
Intervention: Within the motion lab (3D motion capture system from Vicon), strategies will be investigated in controlled conditions to examine which applications seem useful. There are several applications of each strategy. Participants will be randomly assigned to own of the three strategies.

There are two measuring points interspersed with one week. At both measuring moments gait analysis will take place as described below (duration approximately one hour). During the first measuring point additional information is retrieved from the participants regarding characteristics and possible effect modifiers.


Population
75-90 clients after stroke in the subacute (> 3 months) and chronic rehabilitation phase (> 6 months).


Outcome measures
Primary outcome variable are changes in temporal and spatial aspects of the gait pattern. Potential confounders will be measured and taken into the analysis.

Applying analogy, errorless and observational learning can for improve gait velocity and temporal-spatial gait parameters in clients after stroke.

There are two measuring points interspersed with one week. At both measuring moments gait analysis will take place as described below (duration approximately one hour).

Every participant will receive one of the implicit learning strategies (analogy, errorless or observational learning). Allocation of the strategies is determined at random. During a session within the gait laboratory, each learning strategy will be applied in three different ways aiming at improving three different characteristics of the gait pattern. Instructions belonging to the application are given to the participant. He/she is encouraged to use these instructions during a short walks. This is repeated 3 times per application. After a short break the same procedure is repeated for the next application.