La intervención motora temprana es esencial en niños con parálisis cerebral; sin embargo, se desconoce su efectividad entre los 3 y los 5años. El objetivo fue determinar la efectividad de la intervención motora temprana en el desarrollo motor de dicha población. Se realizó una revisión sistemática de literatura acerca de intervenciones motoras tempranas realizada en diferentes bases de datos como Pubmed/Medline, PEDro, OTSeeker, Embase y LILACS. Finalmente se seleccionaron 18 artículos, de los cuales 4 presentaron cambios a favor del grupo experimental en los desenlaces desarrollo motor global y función motora manual, con la terapia de integración sensorial y la terapia de movimiento inducido por restricción, respectivamente; no obstante, los resultados no fueron estadísticamente significativos y el nivel de evidencia fue bajo. La intervención motora temprana podría incluirse con precaución para la mejoría del desarrollo motor global y la función manual. Es necesario realizar estudios de mayor calidad metodológica. (AU)
Early motor intervention is essential in children with cerebral palsy; however, it is unknown its effectiveness between 3 to 5years. The objective was to determinate the effectiveness of early motor intervention in the motor development of this population. A systematic literature search was performed in Pubmed/Medline, PEDro, OTSeeker, Embase, and LILACS. Finally, 18 articles were selected, of which 4 showed favorable changes in the experimental group in the outcomes of overall motor development and manual motor function, with sensory integration therapy and movement-induced restriction therapy, respectively; however, the results were not statistically significant, and the level of evidence was low. Early motor intervention could be cautiously considered for improving overall motor development and manual function. Higher-quality methodological studies are necessary. (AU)
Humans , Cerebral Palsy , Physical Therapy Modalities , Motor Skills , Rehabilitation
OBJECTIVE: To investigate whether transcranial direct-current stimulation (tDCS) optimizes the performance of a wheelchair basketball player on precision tasks. METHODS: A right-handed wheelchair basketball player (1.5 points functional class) with myelomeningocele (low lumbar level) participated in this case study. The tDCS neuromodulation protocol was applied throughout 10 interventions of 20 minutes with a current intensity of 2 mA, simultaneously with sport-specific training, 3 times a week for 4 weeks. Anodic stimulation was performed on the right cerebellar hemisphere (CB2) and cathodic stimulation in the left dorsolateral prefrontal cortex. A control participant was submitted to a sham-tDCS stimulation protocol for the same period. Functional performance was assessed before the intervention and after the 5th and 10th interventions using "pass accuracy," "free-throw shooting," and "spot shot" tests. Outcome measures were compared using percentage differences between preintervention, intermediate intervention, and postintervention values. RESULTS: There was a gradual increase in the athlete's total and average scores in all tests performed, with an overall improvement of 78% between the baseline and final assessments, while the control participant had an overall improvement of 6.5%. CONCLUSION: The tDCS protocol was effective in improving performance in precision activities in a wheelchair basketball player.
Athletic Performance , Basketball , Para-Athletes , Transcranial Direct Current Stimulation , Wheelchairs , Humans , Basketball/physiology , Athletic Performance/physiology , Male , Adult , Sports for Persons with Disabilities/physiology , Motor Skills/physiology
Layer 5 neurons of the neocortex receive their principal inputs from layer 2/3 neurons. We seek to identify the nature and extent of the plasticity of these projections with motor learning. Using optogenetic and viral intersectional tools to selectively stimulate distinct neuronal subsets in rat primary motor cortex, we simultaneously record from pairs of corticospinal neurons associated with distinct features of motor output control: distal forelimb vs. proximal forelimb. Activation of Channelrhodopsin2-expressing layer 2/3 afferents onto layer 5 in untrained animals produces greater monosynaptic excitation of neurons controlling the proximal forelimb. Following skilled grasp training, layer 2/3 inputs onto corticospinal neurons controlling the distal forelimb associated with skilled grasping become significantly stronger. Moreover, peak excitatory response amplitude nearly doubles while latency shortens, and excitatory-to-inhibitory latencies become significantly prolonged. These findings demonstrate distinct, highly segregated, and cell-specific plasticity of layer 2/3 projections during skilled grasp motor learning.
Forelimb , Motor Cortex , Neuronal Plasticity , Animals , Forelimb/physiology , Neuronal Plasticity/physiology , Motor Cortex/physiology , Motor Cortex/cytology , Rats , Learning/physiology , Hand Strength/physiology , Neurons/physiology , Male , Pyramidal Tracts/physiology , Motor Skills/physiology , Female , Optogenetics , Rats, Long-Evans
The Peabody Developmental Motor Scales-2 (PDMS-2) has been used to assess the gross and fine motor skills of children (0-6 years); however, the measurement properties of the PDMS-2 are inconclusive. Here, we aimed to systematically review the measurement properties of PDMS-2, and synthesize the quality of evidence using the Consensus-based Standards for the Selection of Health Measurements Instruments (COSMIN) methodology. Electronic databases, including PubMed, EMBASE, Web of Science, CINAHL and MEDLINE, were searched for relevant studies through January 2023; these studies used PDMS-2. The methodological quality of each study was assessed by the COSMIN risk-of-bias checklist, and the measurement properties of PDMS-2 were evaluated by the COSMIN quality criteria. Modified GRADE was used to evaluate the quality of the evidence. We included a total of 22 articles in the assessment. Among the assessed measurement properties, the content validity of PDMS-2 was found to be sufficient with moderate-quality evidence. The structural validity, internal consistency, test-retest reliability and interrater reliability of the PDMS-2 were sufficient for high-quality evidence, while the intrarater reliability was sufficient for moderate-quality evidence. Sufficient high-quality evidence was also found for the measurement error of PDMS-2. The overall construct validity of the PDMS-2 was sufficient but showed inconsistent quality of evidence. The responsiveness of PDMS-2 appears to be sufficient with low-quality evidence. Our findings demonstrate that the PDMS-2 has sufficient content validity, structural validity, internal consistency, reliability and measurement error with moderate to high-quality evidence. Therefore, PDMS-2 is graded as 'A' and can be used in motor development research and clinical settings.
Motor Skills , Humans , Child, Preschool , Child , Reproducibility of Results , Infant , Motor Skills/physiology , Child Development/physiology , Infant, Newborn , Psychometrics
BACKGROUND: Children with Developmental Coordination Disorder (DCD) are diagnosed based on poor motor skills that impact their daily activities. However, this may also lead to lower predilection and participation in physical activities and a higher risk to develop health problems. OBJECTIVE: To determine motor skill related levels in children with moderate and severe DCD and compare that to typically developing children (TD). The study also aimed to determine the level of activities of daily living (ADL) as reported by their parent and self-efficacy as reported by the children. Lastly, the relation of motor skill related fitness, ADL, and self-efficacy has been examined. METHODS: A cross-sectional study has compared TD children (n = 105) and children with DCD (n = 109; 45 moderate DCD and 64 severe DCD) from elementary schools in Tunisia between 7 and 10 years of age. The DCDDaily-Questionnaire and Children's Self-perceptions of Adequacy in and Predilection for Physical Activity Questionnaire have been used to determine ADL and adequacy towards physical activity, respectively. The PERF-FIT has been used to measure motor skill related fitness levels. RESULTS: Large group differences (p = 0.001) were found for ADL and all domains of self-efficacy between TD and DCD children. However, ADL and self-efficacy were not different between moderate and severe DCD. Motor skill related fitness was significantly lower (p = 0.01) for children with DCD than TD children, and between children with moderate and severe DCD. The relation between self-efficacy and DCDDaily-Q was different in the two DCD groups. Slow motor learning was associated with lower perceived enjoyment in physical education in the moderate DCD group, and with lower perceived adequacy in physical education in the severe DCD group. CONCLUSIONS: Children with DCD participate and enjoy physical activity less than their peers. This combination of lower participation, lower predilection to physical activity and lowered motor skill-related fitness is a concern for the present and future health status of children with DCD.
Activities of Daily Living , Motor Skills Disorders , Motor Skills , Self Efficacy , Humans , Motor Skills Disorders/physiopathology , Motor Skills Disorders/psychology , Child , Male , Female , Motor Skills/physiology , Cross-Sectional Studies , Physical Fitness/physiology , Surveys and Questionnaires , Exercise/physiology , Tunisia
BACKGROUND: Knowing how impaired manual dexterity and finger proprioception affect upper limb activity capacity is important for delineating targeted post-stroke interventions for upper limb recovery. OBJECTIVES: To investigate whether impaired manual dexterity and finger proprioception explain variance in post-stroke activity capacity, and whether they explain more variance than conventional clinical assessments of upper limb sensorimotor impairments. METHODS: Activity capacity and hand sensorimotor impairments were assessed using clinical measures in N = 42 late subacute/chronic hemiparetic stroke patients. Dexterity was evaluated using the Dextrain Manipulandum to quantify accuracy of visuomotor finger force-tracking (N = 36), timing of rhythmic tapping (N = 36), and finger individuation (N = 24), as well as proprioception (N = 27). Stepwise multivariate and hierarchical linear regression models were used to identify impairments best explaining activity capacity. RESULTS: Dexterity and proprioceptive components significantly increased the variance explained in activity capacity: (i) Box and Block Test was best explained by baseline tonic force during force-tracking and tapping frequency (adjusted R2 = .51); (ii) Motor Activity Log was best explained by success rate in finger individuation (adjusted R2 = .46); (iii) Action Research Arm Test was best explained by release of finger force and proprioceptive measures (improved reaction time related to use of proprioception; adjusted R2 = .52); and (iv) Moberg Pick-Up test was best explained by proprioceptive function (adjusted R2 = .18). Models excluding dexterity and proprioception variables explained up to 19% less variance. CONCLUSIONS: Manual dexterity and finger proprioception explain unique variance in activity capacity not captured by conventional impairment measures and should be assessed when considering the underlying causes of post-stroke activity capacity limitations.URL: https://www.clinicaltrials.gov. Unique identifier: NCT03934073.
Fingers , Proprioception , Stroke , Upper Extremity , Humans , Female , Male , Proprioception/physiology , Middle Aged , Stroke/physiopathology , Stroke/complications , Aged , Fingers/physiopathology , Fingers/physiology , Upper Extremity/physiopathology , Adult , Motor Skills/physiology , Paresis/physiopathology , Paresis/etiology , Motor Activity/physiology
When applied over the primary motor cortex (M1), anodal transcranial direct current stimulation (a-tDCS) could enhance the effects of a single motor imagery training (MIt) session on the learning of a sequential finger-tapping task (SFTT). This study aimed to investigate the effect of a-tDCS on the learning of an SFTT during multiple MIt sessions. Two groups of 16 healthy young adults participated in three consecutive MIt sessions over 3 days, followed by a retention test 1 week later. They received active or sham a-tDCS during a MIt session in which they mentally rehearsed an eight-item complex finger sequence with their left hand. Before and after each session, and during the retention test, they physically repeated the sequence as quickly and accurately as possible. Both groups (i) improved their performance during the first two sessions, showing online learning; (ii) stabilised the level they reached during all training sessions, reflecting offline consolidation; and (iii) maintained their performance level one week later, showing retention. However, no significant difference was found between the groups, regardless of the MSL stage. These results emphasise the importance of performing several MIt sessions to maximise performance gains, but they do not support the additional effects of a-tDCS.
Fingers , Learning , Motor Cortex , Transcranial Direct Current Stimulation , Humans , Young Adult , Male , Motor Cortex/physiology , Female , Learning/physiology , Fingers/physiology , Adult , Motor Skills/physiology , Imagination/physiology , Psychomotor Performance/physiology
OBJECTIVES: Motor planning is the cognitive process of planning necessary steps for achieving a purposeful movement and is specifically reflected through object manipulation. This study aimed to investigate whether fine motor skills, a surrogate of the motor planning ability of object manipulation, in early childhood are associated with later social skills, in a general-population birth cohort. METHODS: A total of 913 children, participating in the Hamamatsu Birth Cohort for Mothers and Children, were enrolled. Social skills were measured using the Vineland Adaptive Behavior Scales-II, Socialization domain, at age 6 years. Fine motor skills were measured using the Mullen Scales of Early Learning at 14, 24, and 32 months. The associations between fine motor skills at ages 14, 24, and 32 months and social skills at age 6 years were tested separately through multivariable linear regression after adjusting for covariates, including gross motor and language skills at the contemporaneous age, autistic symptoms at age 6 years, and demographic factors. RESULTS: Fine motor skills at 24 and 32 months were significantly associated with social skills at age 6 years (at 24 months: nonstandardized regression coefficient = 1.38 [95% CI, 0.50-2.26], p = 0.002; at 32 months: 1.47 [0.56-2.38], p = 0.001). CONCLUSION: Fine motor skills in early childhood predicted social skills at age 6 years, indicating an association between the complex motor planning ability of object manipulation and later social skills. Children who demonstrate fine motor delay at as early an age as 2 years should be closely monitored by child professionals.
Motor Skills , Social Skills , Child, Preschool , Child , Female , Humans , Cognition , Learning , Mothers
People correct for movement errors when acquiring new motor skills (de novo learning) or adapting well-known movements (motor adaptation). While de novo learning establishes new control policies, adaptation modifies existing ones, and previous work have distinguished behavioral and underlying brain mechanisms for each motor learning type. However, it is still unclear whether learning in each type interferes with the other. In study 1, we use a within-subjects design where participants train with both 30° visuomotor rotation and mirror reversal perturbations, to compare adaptation and de novo learning respectively. We find no perturbation order effects, and find no evidence for differences in learning rates and asymptotes for both perturbations. Explicit instructions also provide an advantage during early learning in both perturbations. However, mirror reversal learning shows larger inter-participant variability and slower movement initiation. Furthermore, we only observe reach aftereffects following rotation training. In study 2, we incorporate the mirror reversal in a browser-based task, to investigate under-studied de novo learning mechanisms like retention and generalization. Learning persists across three or more days, substantially transfers to the untrained hand, and to targets on both sides of the mirror axis. Our results extend insights for distinguishing motor skill acquisition from adapting well-known movements.
Generalization, Psychological , Psychomotor Performance , Humans , Motor Skills , Movement , Reversal Learning , Adaptation, Physiological
OBJECTIVE: To investigate the level of screen time and gross motor movement level and the correlation between them in left-behind children aged 3 to 6 years old in China. METHODS: A randomized whole-group sampling method was used to study 817 left-behind children aged 3-6 years in 15 kindergartens in Xiangcheng city, Henan province. The third version of the Test of Gross Motor Development (TGMD-3) was used to test the children's gross motor movement level, and the screen time questionnaire was used to test the children's screen time level. The relationship between the two and the indicators was explored using Pearson's two-sided correlation and multilevel regression. RESULTS: The average daily screen time of left-behind children aged 3-6 years old increased with age, and the reporting rate of >2 h/d ranged from 22.43% to 33.73%; gross motor movement of left-behind children aged 3-6 years old increased with age, with significant differences between age (p<0.05). There was a low to moderate negative correlation (r = -0.133 to -0.354, p<0.05) between screen time and gross motor movement in children aged 3-6 years, and multiple regression analysis showed that screen time was predictive of gross motor movement in children (p<0.05), with an explanation rate of 21.4%. CONCLUSION: There is a correlation between screen time and gross motor movement development in children aged 3-6 years old left behind, and the gross motor movement ability of children aged 3-6 years old can be developed by reducing screen time and increasing physical activity.
Motor Skills , Screen Time , Child , Humans , Child, Preschool , Cross-Sectional Studies , Exercise , China
Children aged 3-8 are in a critical period for motor development and postural control. Running is a basic motor skill that children need to master in early childhood. While running, children are prone to dangerous events such as falls. This study investigates the kinematic characteristics of running by children associated with different interference tasks, i.e., normalized running, cognitive dual-tasks, and obstacle crossing tasks, and provides a theoretical foundation for the interference mechanism of children's dynamic postural control and for screening of motor disorders. Two hundred children aged 3-8 were recruited. The BTS Bioengineering infrared motion capture system was used to collect spatiotemporal and kinematic running data under three tasks. Repeated measures of variance analysis were used to compare the effects of different interference tasks and ages on children's running signs. The main and interaction effect tests were compared by the Bonferroni method. The results and conclusions are as follows: (1) Running characteristics of early childhood are influenced by interference tasks and age. With interference tasks, the overall characteristics of running by children aged 3-8 showed an increasing trend in running cycle time and a decreasing trend in stride length, step length, cadence, and speed. (2) Both cognitive and obstacle crossing tasks had costs, and cognitive task costs were greater than obstacle crossing costs. Children adopted a "task first" running strategy with different interference tasks. When facing cognitive tasks, their overall joint motion decreased, and they reduced joint motions to promote task completion. When facing obstacle crossing tasks, because of the characteristics of the task itself, children increased joint motions to cope with interference. (3) In terms of age, the running characteristics showed a nonlinear development trend in various indicators, with a degree of recurrence and high variability in adjacent age groups. (4) The dual-task interference paradigm of "postural-cognition" can be used as a motor intervention tool to promote the development of basic motor skills in early childhood.
Gait , Walking , Child , Humans , Child, Preschool , Biomechanical Phenomena , Cognition , Motor Skills
The effects of the use of reduced feedback frequencies on motor learning remain controversial in the scientific literature. At present, there is still controversy about the guidance hypothesis, with some works supporting it and others contradicting it. To shed light on this topic, an experiment was conducted with four groups, each with different feedback frequencies (0%, 33%, 67%, and 100%), which were evaluated three times (pre-test, post-test, and retention) during a postural control task. In addition, we tested whether there was a transfer in performance to another similar task involving postural control. As a result, only the 67% feedback group showed an improvement in their task performance in the post-test and retention evaluations. Nevertheless, neither group showed differences in motor transfer performance compared to another postural control task. In conclusion, the findings of this paper corroborate the hypothesis of guidance and suggest that the use of a reduced frequency of 67% is a better option for improving motor learning than options that offer feedback at a lower frequency, at all trials or not at all.
Learning , Postural Balance , Humans , Young Adult , Feedback , Task Performance and Analysis , Analysis of Variance , Motor Skills
An increasing number of studies have linked engagement in sport or increased physical fitness with improved cognitive performance. Additionally, studies have employed physical activity as an intervention to help with cognition in aging individuals. Despite this, the underlying mechanism (or mechanisms) by which benefits occur remain unclear. We investigated whether improved trainability for individuals engaged in sport or fitness training might underlie such benefits. Specifically, we assessed motor skill performance and learning rates in young adult runners, baseball players, and "control" individuals who did not regularly engage in sport or exercise using an implicit motor sequence learning task. Better initial performance on the task was seen for both the runner group and the baseball group but no benefits were seen for the baseball/runner groups for rates of improvement on the task. This was the case for both non-specific learning (or general motor skill learning-learning not associated with specific sequences of responses) and for sequence-specific learning (or improvement on repeated sequences of responses that participants were not aware of). This pattern may mean that either engagement in sport/physical activity results in improvements that are transferable beyond the context of the sport/training activity or that engagement in sport/exercise may relate to initial differences in the motor competence of an individual. Further work could beneficially investigate learning in more directly cognitive-related tasks and consolidation/improvement of performance over more prolonged time periods. Importantly, assessment of a fitness/sport intervention on performance and learning rates may provide a better context for some of the benefits reported in cross-sectional investigations of the effects of sport/fitness on cognition and aid in determining which differences are due to engaging in exercise and which differences affect the tendency for such engagement.
Sports , Young Adult , Humans , Cross-Sectional Studies , Cognition/physiology , Learning , Exercise , Motor Skills/physiology
Motor skills dynamically evolve during practice and after training. Using magnetoencephalography, we investigated the neural dynamics underpinning motor learning and its consolidation in relation to sleep during resting-state periods after the end of learning (boost window, within 30 min) and at delayed time scales (silent 4 h and next day 24 h windows) with intermediate daytime sleep or wakefulness. Resting-state neural dynamics were investigated at fast (sub-second) and slower (supra-second) timescales using Hidden Markov modelling (HMM) and functional connectivity (FC), respectively, and their relationship to motor performance. HMM results show that fast dynamic activities in a Temporal/Sensorimotor state network predict individual motor performance, suggesting a trait-like association between rapidly recurrent neural patterns and motor behaviour. Short, post-training task re-exposure modulated neural network characteristics during the boost but not the silent window. Re-exposure-related induction effects were observed on the next day, to a lesser extent than during the boost window. Daytime naps did not modulate memory consolidation at the behavioural and neural levels. These results emphasise the critical role of the transient boost window in motor learning and memory consolidation and provide further insights into the relationship between the multiscale neural dynamics of brain networks, motor learning, and consolidation.
Memory Consolidation , Sleep , Learning , Brain , Motor Skills
Training and assessment of agility is often prioritised by soccer coaches and practitioners aiming to develop multi-directional speed. Although the importance of agility is advocated throughout childhood and adolescence, limited data evidence agility performance at different stages of adolescence. The purpose of this study was to examine differences in multi-directional speed performance in youth soccer players spanning an entire soccer academy. A total of 86 male junior-elite soccer players volunteered to participate. Anthropometric data were collected, alongside performance data from a battery of physical tests including sprinting, jumping, change of direction, reaction time, and agility. Bayesian models using log-likelihoods from posterior simulations of parameter values displayed linear or curvilinear relationships between both chronological and biological age and performance in all tests other than agility and reaction time. For agility and reaction time tests, performance improved until ~14 years of age or the estimated age of peak height velocity whereby arrested development in performance was observed. Our results demonstrate that while most performance skills improve as chronological or biological age increases, measures of agility and reaction time may not. These findings support the notion that agility performance is complex and multifaceted, eliciting unique, challenging physical demands and non-linear development.
Athletic Performance , Motor Skills , Reaction Time , Soccer , Humans , Soccer/physiology , Adolescent , Male , Athletic Performance/physiology , Motor Skills/physiology , Reaction Time/physiology , Child , Running/physiology , Bayes Theorem , Age Factors , Exercise Test , Anthropometry
BACKGROUND: Developmental Coordination Disorder (DCD) is a condition characterized by difficulties in motor planning and coordination and affects 5 to 6% of all school-aged children. Children with DCD frequently present with difficulties with academic activities such as handwriting. However, no study to date has comprehensively described mathematical capacity and its potential associated factors in this high-risk group. AIMS: We aimed to describe the frequency and nature of mathematical difficulties of school-aged children with DCD and to evaluate potential factors associated with mathematical performance. METHODS: A total of 55 elementary school-aged children with DCD underwent comprehensive standardized assessments of mathematical, visuoperceptual (VP), attentional, visual-motor integration (VMI), and motor skills. The contribution of each factor to mathematical capacity was established using hierarchical multivariate linear regression models. RESULTS: Children with DCD (9.1 ± 1.5 years, 44 males) had lower overall mathematical capacity compared to normative data (-0.59 SD) on the KeyMath 3rd edition, with poorer performance in basic concepts and problem-solving. Thirty-eight percent of the sample performed below the 15th percentile in overall mathematical skills. VP skills were the most important factors associated with most mathematical domains. Thirty-four percent of the variance of overall mathematical capacity was explained by VP skills, inattention, VMI and motor impairments while controlling for household income (F [5,49]=5.029, p < .0001). CONCLUSION: Children with DCD present with mathematical difficulties in basic concepts and problem-solving, which are partially explained by VP skills. Our findings stress the important of systematically assessing mathematical difficulties children with DCD to ensure they receive the necessary support that leads to academic success.
Academic Success , Motor Skills Disorders , Male , Child , Humans , Motor Skills Disorders/complications , Motor Skills , Problem Solving
BACKGROUND: Physical activity, fundamental motor skills, executive functions and early numeracy have shown to be related, but very little is known about the developmental relations of these factors. PROCEDURE: We followed 317 children (3-6 years) over two years. Fundamental motor skills and executive functions (inhibition+switching, updating) were measured at all time points (T1, T2, T3) and physical activity at T1 and early numeracy at T3. MAIN FINDINGS: Children with better fundamental motor skills at T1 developed slower in inhibition and switching. Fundamental motor skills developed faster in children who had better initial inhibition and switching ability. Vigorous physical activity at T1 was associated with a weaker initial inhibition and switching. The initial level and the developmental rate of updating were related to better early numeracy skills. CONCLUSIONS: Findings indicate that fundamental motor skills and executive functions are developmentally related, and updating is an important predictor for early numeracy in preschoolers.
Executive Function , Motor Skills , Child , Humans , Executive Function/physiology , Motor Skills/physiology , Exercise , Inhibition, Psychological , Mathematics
Sensorimotor impairments are common after stroke requiring stroke survivors to relearn lost motor skills or acquire new ones in order to engage in daily activities. Thus, motor skill learning is a cornerstone of stroke rehabilitation. This article provides an overview of motor control and learning theories that inform stroke rehabilitation interventions, discusses principles of neuroplasticity, and provides a summary of practice conditions and techniques that can be used to augment motor learning and neuroplasticity in stroke rehabilitation.
Stroke Rehabilitation , Stroke , Humans , Stroke/complications , Learning , Stroke Rehabilitation/methods , Motor Skills , Neuronal Plasticity