Individuals early after anterior cruciate ligament reconstruction show intact motor learning of step length via the split-belt treadmill.

BACKGROUND: Rupturing the anterior cruciate ligament is an orthopedic injury that results in neuromuscular impairments affecting sensory input to the central nervous system. Traditional physical therapy after anterior cruciate ligament reconstruction aims to rehabilitate orthopedic impairments but fails to address asymmetric gait mechanics that are present post-operatively and are linked to the development of post-traumatic osteoarthritis. A first step towards developing gait interventions is understanding if individuals after anterior cruciate ligament reconstruction have the capacity to learn new walking mechanics. METHODS: The split-belt treadmill offers a task-specific approach to examine neuromuscular adaptations in patients after injury. The potential for changing spatiotemporal gait mechanics via split-belt treadmill adaptation has not been tested early after anterior cruciate ligament reconstruction; nor has the ability to retain and transfer newly learned gait mechanics. Therefore, we used a split-belt treadmill paradigm to compare gait adaptation, retention, and transfer to overground walking between 15 individuals 3-9 months after anterior cruciate ligament reconstruction and 15 matched control individuals. FINDINGS: Results suggested individuals after anterior cruciate ligament reconstruction were able to adapt and retain step length symmetry changes as well as controls. There was also evidence of partial transfer to overground walking, similar to controls. INTERPRETATION: Despite disruption in afferent feedback from the joint, individuals early after anterior cruciate ligament reconstruction can learn a new gait pattern using sensorimotor adaptation, retain, and partially transfer the learned gait pattern. This may be a critical time to intervene with gait-specific interventions targeting post-operative gait asymmetries.

Reinforcement Learning during Locomotion.

When learning a new motor skill, people often must use trial and error to discover which movement is best. In the reinforcement learning framework, this concept is known as exploration and has been linked to increased movement variability in motor tasks. For locomotor tasks, however, increased variability decreases upright stability. As such, exploration during gait may jeopardize balance and safety, making reinforcement learning less effective. Therefore, we set out to determine if humans could acquire and retain a novel locomotor pattern using reinforcement learning alone. Young healthy male and female participants walked on a treadmill and were provided with binary reward feedback (indicated by a green checkmark on the screen) that was tied to a fixed monetary bonus, to learn a novel stepping pattern. We also recruited a comparison group who walked with the same novel stepping pattern but did so by correcting for target error, induced by providing real-time veridical visual feedback of steps and a target. In two experiments, we compared learning, motor variability, and two forms of motor memories between the groups. We found that individuals in the binary reward group did, in fact, acquire the new walking pattern by exploring (increasing motor variability). Additionally, while reinforcement learning did not increase implicit motor memories, it resulted in more accurate explicit motor memories compared with the target error group. Overall, these results demonstrate that humans can acquire new walking patterns with reinforcement learning and retain much of the learning over 24 h.

Explicit and implicit locomotor learning in individuals with chronic hemiparetic stroke.

Motor learning involves both explicit and implicit processes that are fundamental for acquiring and adapting complex motor skills. However, stroke may damage the neural substrates underlying explicit and/or implicit learning, leading to deficits in overall motor performance. While both learning processes are typically used in concert in daily life and rehabilitation, no gait studies have determined how these processes function together after stroke when tested during a task that elicits dissociable contributions from both. Here, we compared explicit and implicit locomotor learning in individuals with chronic stroke to age- and sex-matched neurologically intact controls. We assessed implicit learning using split-belt adaptation (where two treadmill belts move at different speeds). We assessed explicit learning (i.e., strategy-use) using visual feedback during split-belt walking to help individuals explicitly correct for step length errors created by the split-belts. The removal of visual feedback after the first 40 strides of split-belt walking, combined with task instructions, minimized contributions from explicit learning for the remainder of the task. We utilized computational modeling to determine the individual contributions of explicit and implicit processes to overall behavioral change. The computational and behavioral analyses revealed that, compared to controls, individuals with chronic stroke demonstrated deficits in both explicit and implicit contributions to locomotor learning, a result that runs counter to prior work testing each process individually during gait. Since post-stroke locomotor rehabilitation involves interventions that rely on both explicit and implicit motor learning, future work should determine how locomotor rehabilitation interventions can be structured to optimize overall motor learning.

Acute pain impairs retention of locomotor learning.

Despite abundant evidence that pain alters movement performance, considerably less is known about the potential effects of pain on motor learning. Some of the brain regions involved in pain processing are also responsible for specific aspects of motor learning, indicating that the two functions have the potential to interact, yet it is unclear if they do. In experiment 1, we compared the acquisition and retention of a novel locomotor pattern in young, healthy individuals randomized to either experience pain via capsaicin and heat applied to the lower leg during learning or no stimulus. On day 1, participants learned a new asymmetric walking pattern using distorted visual feedback, a paradigm known to involve mostly explicit re-aiming processes. Retention was tested 24 h later. Although there were no differences in day 1 acquisition between groups, individuals who experienced pain on day 1 demonstrated reduced retention on day 2. Furthermore, the degree of forgetting between days correlated with pain ratings during learning. In experiment 2, we examined the effects of a heat stimulus alone, which served as a control for (nonpainful) cutaneous stimulation, and found no effects on either acquisition or retention of learning. Thus, pain experienced during explicit, strategic locomotor learning interferes with motor memory consolidation processes and does so most likely through a pain mechanism and not an effect of distraction. These findings have important implications for understanding basic motor learning processes and for clinical rehabilitation, in which painful conditions are often treated through motor learning-based interventions.NEW & NOTEWORTHY Pain is a highly prevalent and burdensome experience that rehabilitation practitioners often treat using motor learning-based interventions. Here, we showed that experimental acute pain, but not a heat stimulus, during locomotor learning impaired 24-h retention of the newly learned walking pattern. The degree of retention loss was related to the perceived pain level during learning. These findings suggest important links between pain and motor learning that have significant implications for clinical rehabilitation.

Effects of an Acute High Intensity Exercise Bout on Retention of Explicit, Strategic Locomotor Learning in Individuals With Chronic Stroke.

BACKGROUND: Exercise priming, pairing high intensity exercise with a motor learning task, improves retention of upper extremity tasks in individuals after stroke, but has shown no benefit to locomotor learning. This difference may relate to the type of learning studied. Upper extremity studies used explicit, strategic tasks; locomotor studies used implicit sensorimotor adaptation (split-belt treadmill). Since walking is an important rehabilitation goal, it is crucial to understand under which circumstances exercise priming may improve retention of a newly learned walking pattern. OBJECTIVE: Determine the impact of exercise priming on explicit, strategic locomotor learning task retention in chronic stroke survivors. METHODS: Chronic stroke survivors (>6 months) performed 2 treadmill walking sessions. Visual feedback was used to train increased step length. Participants were assigned to control group (no exercise), continuous exercise (5 minutes high intensity), or long-interval exercise (15 minutes high/moderate intervals). After day 1 learning, participants either rested or performed exercise. On day 2, retention of the learned walking pattern was tested. RESULTS: All groups learned on day 1 (P < .001). The 2 priming groups showed significant changes in blood lactate and heart rate after exercise priming, the resting control group did not (P < .001). On day 2, there was no significant between-group difference in cued or un-cued task retention (P = .963 and .287, respectively). CONCLUSIONS: Exercise priming did not affect retention of an explicit locomotor task in chronic stroke survivors. Further work should explore subgroups of individuals for whom priming may have selective clinical benefit to locomotor learning.ClinicalTrials.gov Identifier: NCT03726047.

A reliable and efficient adaptive Bayesian method to assess static lower limb position sense.

BACKGROUND: Lower limb proprioception is critical for maintaining stability during gait and may impact how individuals modify their movements in response to changes in the environment and body state, a process termed "sensorimotor adaptation". However, the connection between lower limb proprioception and sensorimotor adaptation during human gait has not been established. We suspect this gap is due in part to the lack of reliable, efficient methods to assess global lower limb proprioception in an ecologically valid context. NEW METHOD: We assessed static lower limb proprioception using an alternative forced choice task, administered twice to determine test-retest reliability. Participants stood on a dual-belt treadmill which passively moved one limb to stimulus locations selected by a Bayesian adaptive algorithm. At the stimulus locations, participants judged relative foot positions and the algorithm estimated the point of subjective equality (PSE) and the uncertainty of lower limb proprioception. RESULTS: Using the Bland-Altman method, combined with Bayesian statistics, we found that both the PSE and uncertainty estimates had good reliability. COMPARISON WITH EXISTING METHOD(S): Current methods assessing static lower limb proprioception do so within a single joint, in non-weight bearing positions, and rely heavily on memory. One exception assessed static lower limb proprioception in standing but did not measure reliability and contained confounds impacting participants' judgments, which we experimentally controlled here. CONCLUSIONS: This efficient and reliable method assessing lower limb proprioception will aid future mechanistic understanding of locomotor adaptation and serve as a useful tool for basic and clinical researchers studying balance and falls.

A reliable and efficient adaptive Bayesian method to assess static lower limb position sense.

Background: Lower limb proprioception is critical for maintaining stability during gait and may impact how individuals modify their movements in response to changes in the environment and body state, a process termed "sensorimotor adaptation". However, the connection between lower limb proprioception and sensorimotor adaptation during human gait has not been established. We suspect this gap is due in part to the lack of reliable, efficient methods to assess global lower limb proprioception in an ecologically valid context. New Method: We assessed static lower limb proprioception using an alternative forced choice task, administered twice to determine test-retest reliability. Participants stood on a dual-belt treadmill which passively moved one limb to stimulus locations selected by a Bayesian adaptive algorithm. At the stimulus locations, participants judged relative foot positions and the algorithm estimated the point of subjective equality (PSE) and the uncertainty of lower limb proprioception. Results: Using the Bland-Altman method, combined with Bayesian statistics, we found that both the PSE and uncertainty estimates had good reliability. Comparison with Existing Methods: Current methods assessing static lower limb proprioception do so within a single joint, in non-weight bearing positions, and rely heavily on memory. One exception assessed static lower limb proprioception in standing but did not measure reliability and contained confounds impacting participants' judgments, which we experimentally controlled here. Conclusions: This efficient and reliable method assessing lower limb proprioception will aid future mechanistic understanding of locomotor adaptation and serve as a useful tool for basic and clinical researchers studying balance and falls.

The Consistency of Prior Movements Shapes Locomotor Use-Dependent Learning.

Repetition is an indispensable component of motor skill acquisition. However, it is unknown how consistent repeated movement patterns must be to engage an implicit "use-dependent" learning mechanism. In this Registered Report, we tackled this question through a combination of computational modeling, simulations, and behavioral experiments involving visually-guided treadmill walking. Our hypotheses were formalized by two distinct computational models: in the two-process Strategy plus Use-Dependent model, use-dependent learning is viewed as a slowly updating and slowly decaying bias in the direction of repeated movements. The Adaptive Bayesian model frames use-dependent learning as an emergent property of quickly adapting prior probabilities of target step lengths. Critically, the Adaptive Bayesian model is much more sensitive to variable practice than the Strategy plus Use-Dependent model. To test these hypotheses, human participants (N = 18, 10 females) learned a novel asymmetric stepping pattern under three conditions with differing amounts of practice consistency during a learning block. We probed use-dependent movement biases immediately postlearning by asking participants to "walk normally" during a washout block with no visual feedback (VF). We found that the total magnitude of use-dependent learning depended on practice consistency during learning, consistent with the Adaptive Bayesian model. However, this dependence faded quickly as biases became similar in magnitude over subsequent strides across all conditions, an observation more consistent with the Strategy plus Use-Dependent model. Simple post hoc adjustments to the Strategy plus Use-Dependent model made clear that these seemingly opposing effects of practice consistency can result from a unitary use-dependent learning process shaped by recent movement history.

Athletes after anterior cruciate ligament reconstruction demonstrate asymmetric intracortical facilitation early after surgery.

Quadriceps dysfunction persists after anterior cruciate ligament reconstruction (ACLR), yet the etiology remains elusive. Inhibitory and facilitatory intracortical networks (ie, intracortical excitability) may be involved in quadriceps dysfunction, yet the investigation of these networks early after ACLR is sparse. The purposes of this study were to examine (a) changes in intracortical excitability in athletes after ACLR compared to uninjured athletes during the course of postoperative rehabilitation, (b) the association between intracortical excitability and quadriceps strength in athletes after ACLR. Eighteen level I/II athletes after ACLR between the ages of 18 to 30 years and eighteen healthy sex, age, and activity matched athletes were tested at three-time points: (a) 2 weeks after surgery, (b) achievement of a "quiet knee" defined as full range of motion and minimal effusion, (c) return to running time point defined as achievement of a quadriceps index ≥80% and at least 12 weeks post-ACLR. Short-interval intracortical inhibition (SICI) and intracortical facilitation (ICF), measured via transcranial magnetic stimulation and isometric quadriceps strength were examined bilaterally at each time point. There was a significant group × limb interaction (P = .017) for ICF. The ACLR group demonstrated asymmetric ICF (greater in the nonsurgical limb) compared to controls and a significant relationship between SICI and quadriceps strength of the surgical limb at the quiet knee time point (P = .018). ACLR individuals demonstrate differential effects on ICF between limbs. Also, SICI is associated with isometric quadriceps strength after ACLR, suggesting increased inhibition of the motor cortex may contribute to impaired quadriceps strength following ACLR.

Use of explicit processes during a visually guided locomotor learning task predicts 24-h retention after stroke.

Implicit and explicit processes can occur within a single locomotor learning task. The combination of these learning processes may impact how individuals acquire/retain the task. Because these learning processes rely on distinct neural pathways, neurological conditions may selectively impact the processes that occur, thus, impacting learning and retention. Thus, our purpose was to examine the contribution of implicit and explicit processes during a visually guided walking task and characterize the relationship between explicit processes and performance/retention in stroke survivors and age-matched healthy adults. Twenty chronic stroke survivors and twenty healthy adults participated in a 2-day treadmill study. Day 1 included baseline, acquisition1, catch, acquisition2, and immediate retention phases, and day 2 included 24-h retention. During acquisition phases, subjects learned to take a longer step with one leg through distorted visual feedback. During catch and retention phases, visual feedback was removed and subjects were instructed to walk normally (catch) or how they walked during the acquisition phases (retention). Change in step length from baseline to catch represented implicit processes. Change in step length from catch to the end of acquisition2 represented explicit processes. A mixed ANOVA found no difference in the type of learning between groups (P = 0.74). There was a significant relationship between explicit processes and 24-h retention in stroke survivors (r = 0.47, P = 0.04) but not in healthy adults (r = 0.34, P = 0.15). These results suggest that stroke may not affect the underlying learning mechanisms used during locomotor learning, but that these mechanisms impact how well stroke survivors retain the new walking pattern.NEW & NOTEWORTHY This study found that stroke survivors used implicit and explicit processes similar to age-matched healthy adults during a visually guided locomotion learning task. The amount of explicit processes was related to how well stroke survivors retained the new walking pattern but not to how well they performed during the task. This work illustrates the importance of understanding the underlying learning mechanisms to maximize retention of a newly learned motor behavior.

Examination of Corticospinal and Spinal Reflexive Excitability During the Course of Postoperative Rehabilitation After Anterior Cruciate Ligament Reconstruction.

OBJECTIVE: To investigate corticospinal and spinal reflexive excitability and quadriceps strength in healthy athletes and athletes after anterior cruciate ligament reconstruction (ACLR) over the course of rehabilitation. DESIGN: Prospective cohort study. METHODS: Eighteen athletes with ACLR and 18 healthy athletes, matched by sex, age, and activity, were tested at (1) 2 weeks after surgery, (2) the "quiet knee" time point, defined as full range of motion and minimal effusion, and (3) return to running, defined as achieving a quadriceps index of 80% or greater. We measured (1) corticospinal excitability, using resting motor threshold (RMT) and motor-evoked potential amplitude at a stimulator intensity of 120% of RMT (MEP120) to the vastus medialis, (2) spinal reflexive excitability, calculating the ratio of the maximal Hoffmann reflex to the maximal M-wave to the vastus medialis, and (3) isometric quadriceps strength. RESULTS: The ACLR group had higher RMTs in the nonsurgical limb and higher MEP120 in the surgical limb at all time points. The healthy-athlete group did not have interlimb differences. The RMT was positively associated with quadriceps strength 2 weeks after surgery; MEP120 was associated with quadriceps strength at all time points. CONCLUSION: Compared to healthy athletes, athletes after ACLR had altered corticospinal excitability that did not change from 2 weeks after surgery to the time of return to running. J Orthop Sports Phys Ther 2020;50(9):516-522. Epub 1 Aug 2020. doi:10.2519/jospt.2020.9329.

Use-dependent plasticity explains aftereffects in visually guided locomotor learning of a novel step length asymmetry.

Studies of upper extremity reaching show that use-dependent plasticity, or learning from repetition, plays an important role in shaping motor behaviors. Yet the impact of repetition on locomotor learning is unclear, despite the fact that gait is developed and practiced over millions of repetitions. To test whether repetition alone can induce storage of a novel walking pattern, we instructed two groups of young healthy subjects to learn an asymmetric walking pattern through two distinct learning paradigms. The first group learned a new pattern through an established visual distortion paradigm, which provided both sensory prediction error and repetition of movement patterns to induce walking aftereffects, and the second received veridical feedback with a target change, which provided only repetition (use-dependent plasticity) to induce aftereffects. When feedback was removed, both groups demonstrated aftereffects in the primary outcome, step asymmetry index. Surprisingly, despite the different task demands, both groups produced similar aftereffect magnitudes, which also had similar rates of decay, suggesting that the addition of sensory prediction errors did not improve storage of learning beyond that induced by the use-dependent process alone. To further characterize the use-dependent process, we conducted a second experiment to quantify aftereffect size in a third group who practiced double the asymmetry magnitude. This new group showed a proportionately greater magnitude of the use-dependent aftereffect. Together, these findings show that the primary driver of storage of a new step length asymmetry during visually guided locomotor learning is repetition, not sensory prediction error, and this effect scales with the learning magnitude.NEW & NOTEWORTHY Use-dependent plasticity, or learning from repetition, is an important process for upper extremity reaching tasks, but its contribution to walking is not well established. Here, we demonstrate the existence of a dose-dependent, use-dependent process during visually guided treadmill walking. We also show that sensory prediction errors, previously thought to drive aftereffects in similar locomotor learning paradigms, do not appear to play a significant role in visually driven learning of a novel step asymmetry during treadmill walking.

Effects of chronic antidepressant use on neurophysiological responses to tDCS post-stroke.

BACKGROUND: Transcranial direct current stimulation (tDCS) induces neuroplastic changes in the motor cortex of healthy individuals and has become a candidate intervention to promote recovery post-stroke. However, neurophysiological effects of tDCS in stroke are poorly understood. Antidepressant medications, which are commonly prescribed post-stroke, have the potential to significantly affect cortical excitability and alter responsiveness to tDCS interventions, yet these effects have not previously been examined. OBJECTIVE/HYPOTHESIS: To examine the effects of chronic antidepressant use, tDCS, and the interaction of the two on motor cortical excitability in people with chronic stroke. Based on previous literature in nondisabled adults, we hypothesized that post-stroke, antidepressant-takers would show decreased baseline motor cortical excitability but enhanced responsiveness to anodal tDCS. METHODS: Twenty-six participants with chronic stroke (17 control, 9 antidepressant) received real and sham anodal tDCS during separate sessions at least a week apart. Motor cortical excitability was measured before and after tDCS was applied to the lesioned hemisphere primary motor cortex. We compared baseline cortical excitability and neurophysiological responses to tDCS between groups and sessions. RESULTS: Baseline motor cortical excitability was not different between control and antidepressant groups. Following anodal tDCS over the ipsilesional primary motor cortex, cortical excitability in the non-lesioned hemisphere decreased in controls, but, surprisingly, increased in antidepressant-takers. CONCLUSIONS: Chronic antidepressant use may not affect motor cortical excitability post-stroke, however it appears to reverse some of the expected effects of tDCS. Therefore future utilization of tDCS in post-stroke neurorehabilitation research should take antidepressant medication status into account.

A single high-intensity exercise bout during early consolidation does not influence retention or relearning of sensorimotor locomotor long-term memories.

A single exercise bout has been found to improve the retention of a skill-based upper extremity motor task up to a week post-practice. This effect is the greatest when exercise intensity is high and exercise is administered immediately after motor practice (i.e., early in consolidation). Whether exercise can affect other motor learning types (e.g., sensorimotor adaptation) and tasks (e.g., walking) is still unclear as previous studies have not optimally refined the exercise parameters and long-term retention testing. Therefore, we investigated whether a single high-intensity exercise bout during early consolidation would improve the long-term retention and relearning of sensorimotor adaptation during split-belt treadmill walking. Twenty-six neurologically intact adults attended three sessions; sessions 2 and 3 were 1 day and 7 days after session 1, respectively. Participants were allocated either to Rest (REST) or to Exercise (EXE) group. In session 1, all groups walked on a split-belt treadmill in a 2:1 speed ratio (1.5:0.75 m/s). Then, half of the participants exercised for 5 min (EXE), while the other half rested for 5 min (REST). A short exercise bout during early consolidation did not improve retention or relearning of locomotor memories one or seven days after session 1. This result reinforces previous findings that the effect of exercise on motor learning may differ between sensorimotor locomotor adaptation and skilled-based upper extremity tasks; thus, the utility of exercise as a behavioral booster of motor learning may depend on the type of motor learning and task.

A short bout of high-intensity exercise alters ipsilesional motor cortical excitability post-stroke.

Background: Acute exercise can increase motor cortical excitability and enhance motor learning in healthy individuals, an effect known as exercise priming. Whether it has the same effects in people with stroke is unclear. Objectives: The objective of this study was to investigate whether a short, clinically-feasible high-intensity exercise protocol can increase motor cortical excitability in non-exercised muscles of chronic stroke survivors. Methods: Thirteen participants with chronic, unilateral stroke participated in two sessions, at least one week apart, in a crossover design. In each session, they underwent either high-intensity lower extremity exercise or quiet rest. Motor cortical excitability of the extensor carpi radialis muscles was measured bilaterally with transcranial magnetic stimulation before and immediately after either exercise or rest. Motor cortical excitability changes (post-exercise or rest measures normalized to pre-test measures) were compared between exercise vs. rest conditions. Results: All participants were able to reach the target high-intensity exercise level. Blood lactate levels increased significantly after exercise (p < .001, d = 2.85). Resting motor evoked potentials from the lesioned hemisphere increased after exercise (mean 1.66; 95% CI: 1.19, 2.13) compared to the rest condition (mean 1.23; 95% CI: 0.64, 1.82), p = .046, d = 2.76, but this was not the case for the non-lesioned hemisphere (p = .406, d = 0.25). Conclusions: High-intensity exercise can increase lesioned hemisphere motor cortical excitability in a non-exercised muscle post-stroke. Our short and clinically-advantageous exercise protocol shows promise as a potential priming method in stroke rehabilitation.

Explicit Awareness does not Modulate Retrograde Interference Effects in Sequence Learning.

Motor sequences are learned explicitly or implicitly based on conscious awareness of the sequence. Interference happens when two sequences are learned successively. Here, we aimed to determine whether implicit and explicit sequence learning are affected differently by retrograde interference. Young healthy volunteers participated in either a control or interference group and either an explicit or implicit learning condition. We used a modified serial reaction time task to induce sequence learning and control awareness. Results showed that the overall amount of sequence learning was greater in the explicit condition compared to implicit. However, sequence learning was equally susceptible to retrograde interference under either condition. We conclude that although susceptible to interference, explicit awareness improves overall sequence learning compared to implicit conditions.

Different Error Size During Locomotor Adaptation Affects Transfer to Overground Walking Poststroke.

BACKGROUND: Studies in neurologically intact subjects suggest that the gradual presentation of small perturbations (errors) during learning results in better transfer of a newly learned walking pattern to overground walking. Whether the same result would be true after stroke is not known. OBJECTIVE: To determine whether introducing gradual perturbations, during locomotor learning using a split-belt treadmill influences learning the novel walking pattern or transfer to overground walking poststroke. METHODS: Twenty-six chronic stroke survivors participated and completed the following walking testing paradigm: baseline overground walking; baseline treadmill walking; split-belt treadmill/adaptation period (belts moving at different speeds); catch trial (belts at same speed); post overground walking. Subjects were randomly assigned to the Gradual group (gradual changes in treadmill belts speed during adaptation) or the Abrupt group (a single, large, abrupt change during adaptation). Step length asymmetry adaptation response on the treadmill and transfer of learning to overground walking was assessed. RESULTS: Step length asymmetry during the catch trial was the same between groups ( P = .195) confirming that both groups learned a similar amount. The magnitude of transfer to overground walking was greater in the Gradual than in the Abrupt group ( P = .041). CONCLUSIONS: The introduction of gradual perturbations (small errors), compared with abrupt (larger errors), during a locomotor adaptation task seems to improve transfer of the newly learned walking pattern to overground walking poststroke. However, given the limited magnitude of transfer, future studies should examine other factors that could impact locomotor learning and transfer poststroke.

A locomotor learning paradigm using distorted visual feedback elicits strategic learning.

Distorted visual feedback (DVF) during locomotion has been suggested to result in the development of a new walking pattern in healthy individuals through implicit learning processes. Recent work in upper extremity visuomotor rotation paradigms suggest that these paradigms involve implicit and explicit learning. Additionally, in upper extremity visuomotor paradigms, the verbal cues provided appear to impact how a behavior is learned and when this learned behavior is used. Here, in two experiments in neurologically intact individuals, we tested how verbal instruction impacts learning a new locomotor pattern on a treadmill through DVF, the transfer of that pattern to overground walking, and what types of learning occur (i.e., implicit vs. explicit learning). In experiment 1, we found that the instructions provided impacted the amount learned through DVF, but not the size of the aftereffects or the amount of the pattern transferred to overground walking. Additionally, the aftereffects observed were significantly different from the baseline walking pattern, but smaller than the behavior changes observed during learning, which is uncharacteristic of implicit sensorimotor adaptation. Thus, experiment 2 aimed to determine the cause of these discrepancies. In this experiment, when VF was not provided, individuals continued using the learned walking pattern when instructed to do so and returned toward their baseline pattern when instructed to do so. Based on these results, we conclude that DVF during locomotion results in a large portion of explicit learning and a small portion of implicit learning. NEW & NOTEWORTHY The results of this study suggest that distorted visual feedback during locomotor learning involves the development of an explicit strategy with only a small component of implicit learning. This is important because previous studies using distorted visual feedback have suggested that locomotor learning relies primarily on implicit learning. This paradigm, therefore, provides a new way to examine a different form of learning in locomotion.

Corticospinal and intracortical excitability differ between athletes early after ACLR and matched controls.

Neuromuscular impairments, such as quadriceps weakness and activation deficits, persist after anterior cruciate ligament reconstruction (ACLR). Recent research demonstrating changes in the function of the primary motor cortex after ACLR posits that quadriceps impairments may be influenced by reduced corticospinal excitability. The purpose of this study was to investigate whether the integrity of the neuromotor axis of the vastus medialis is altered in subjects 2 weeks post-ACLR compared to uninjured control subjects. Eighteen athletes 2 weeks post-ACLR and 18 age and sex matched uninjured control subjects participated in this cross-sectional study. We quantified corticospinal (resting motor threshold, RMT; motor evoked potential amplitudes at 120% RMT, MEP120 ) and intracortical (inhibition and facilitation) excitability using single and paired pulse transcranial magnetic stimulation (TMS), respectively. We assessed spinal-reflex excitability (H-reflex amplitude normalized to maximal M-wave, H/M ratio) using peripheral stimulation. Subjects post-ACLR had higher RMTs (p = 0.001), greater MEP120 amplitudes (p = 0.001), and more asymmetric facilitation (p = 0.041) than the uninjured control subjects. No significant group differences were found for intracortical inhibition (p = 0.289) and H/M ratio (p = 0.332). Our findings indicate that both intracortical and corticospinal excitability of vastus medialis are bilaterally altered in subjects 2 weeks after ACLR. Given persistent neuromuscular deficits seen after ACLR, rehabilitation strategies targeting intracortical and corticospinal deficits may potentially improve clinical outcomes. © 2018 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 36:2941-2948, 2018.

A single exercise bout and locomotor learning after stroke: physiological, behavioural, and computational outcomes.

KEY POINTS: Previous work demonstrated an effect of a single high-intensity exercise bout coupled with motor practice on the retention of a newly acquired skilled arm movement, in both neurologically intact and impaired adults. In the present study, using behavioural and computational analyses we demonstrated that a single exercise bout, regardless of its intensity and timing, did not increase the retention of a novel locomotor task after stroke. Considering both present and previous work, we postulate that the benefits of exercise effect may depend on the type of motor learning (e.g. skill learning, sensorimotor adaptation) and/or task (e.g. arm accuracy-tracking task, walking). ABSTRACT: Acute high-intensity exercise coupled with motor practice improves the retention of motor learning in neurologically intact adults. However, whether exercise could improve the retention of locomotor learning after stroke is still unknown. Here, we investigated the effect of exercise intensity and timing on the retention of a novel locomotor learning task (i.e. split-belt treadmill walking) after stroke. Thirty-seven people post stroke participated in two sessions, 24 h apart, and were allocated to active control (CON), treadmill walking (TMW), or total body exercise on a cycle ergometer (TBE). In session 1, all groups exercised for a short bout (∼5 min) at low (CON) or high (TMW and TBE) intensity and before (CON and TMW) or after (TBE) the locomotor learning task. In both sessions, the locomotor learning task was to walk on a split-belt treadmill in a 2:1 speed ratio (100% and 50% fast-comfortable walking speed) for 15 min. To test the effect of exercise on 24 h retention, we applied behavioural and computational analyses. Behavioural data showed that neither high-intensity group showed greater 24 h retention compared to CON, and computational data showed that 24 h retention was attributable to a slow learning process for sensorimotor adaptation. Our findings demonstrated that acute exercise coupled with a locomotor adaptation task, regardless of its intensity and timing, does not improve retention of the novel locomotor task after stroke. We postulate that exercise effects on motor learning may be context specific (e.g. type of motor learning and/or task) and interact with the presence of genetic variant (BDNF Val66Met).