Evidence of Motor Skill Learning in Acute Stroke Patients Without Lesions to the Thalamus and Internal Capsule

Audrey Riga, Estelle Gathy, Marisa Ghinet, Chloë De Laet, Benoît Bihin, Maxime Regnier, Maria Leeuwerck, Béatrice De Coene, Laurence Dricot, Benoît Herman, Martin G Edwards, Yves Vandermeeren, Audrey Riga, Estelle Gathy, Marisa Ghinet, Chloë De Laet, Benoît Bihin, Maxime Regnier, Maria Leeuwerck, Béatrice De Coene, Laurence Dricot, Benoît Herman, Martin G Edwards, Yves Vandermeeren

Abstract

Background: It is currently unknown whether motor skill learning (MSkL) with the paretic upper limb is possible during the acute phase after stroke and whether lesion localization impacts MSkL. Here, we investigated MSkL in acute (1-7 days post) stroke patients compared with healthy individuals (HIs) and in relation to voxel-based lesion symptom mapping.

Methods: Twenty patients with acute stroke and 35 HIs were trained over 3 consecutive days on a neurorehabilitation robot measuring speed, accuracy, and movement smoothness variables. Patients used their paretic upper limb and HI used their nondominant upper limb on an MSkL task involving a speed/accuracy trade-off. Generalization was evaluated on day 3. All patients underwent a 3-dimensional magnetic resonance imaging used for VSLM.

Results: Most patients achieved MSkL demonstrated by day-to-day retention and generalization of the newly learned skill on day 3. When comparing raw speed/accuracy trade-off values, HI achieved larger MSkL than patients. However, relative speed/accuracy trade-off values showed no significant differences in MSkL between patients and HI on day 3. In patients, MSkL progression correlated with acute motor and cognitive impairments. The voxel-based lesion symptom mapping showed that acute vascular damage to the thalamus or the posterior limb of the internal capsule reduced MSkL.

Conclusions: Despite worse motor performance for acute stroke patients compared with HI, most patients were able to achieve MSkL with their paretic upper limb. Damage to the thalamus and posterior limb of the internal capsule, however, reduced MSkL. These data show that MSkL could be implemented into neurorehabilitation during the acute phase of stroke, particularly for patients without lesions to the thalamus and posterior limb of the internal capsule.

Registration: URL: https://www.

Clinicaltrials: gov; Unique identifier: NCT01519843.

Keywords: humans; internal capsule; motor skills; robotics; upper extremity.

Figures

Figure 1.
Figure 1.
Task setup. A, Neurorehabilitation robot REAplan (Axinesis, Wavre, Belgium). B, For the CIRCUIT task,, the subjects were instructed to navigate the cursor as fast and accurately as possible inside CIRCUIT. C, For the REACHING task, subjects were asked to reach as fast and accurately as possible toward each of the 4 targets presented in a pseudorandomized order.
Figure 2.
Figure 2.
Motor learning in healthy individuals an acute stroke patients. Top, Progression of the speed/accuracy trade-off (SAT; in arbitrary units [a.u.]) for the healthy individuals and acute stroke patients over 3 consecutive days (D1-D2-D3). There were slight SAT overnight drops and a larger drop between D3T10 and D3G1. Thick black line: group mean; gray lines: individuals. Bottom, Progression of ratioSAT. G indicates generalization (new CIRCUIT).
Figure 3.
Figure 3.
Voxel-based lesion symptom mapping results for the progression from D1T1 to D3T10 of the speed/accuracy trade-off (arbitrary units, in blue) and that of the ratioSAT (in green) projected on the Montreal Neurological Institute template ch2better.nii implemented in MRIcron. During the acute stroke phase, more damage to the thalamus and the posterior limb of the internal capsule correlated with less efficient motor skill learning for the paretic upper limb.

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