Implicit and explicit motor learning interventions have similar effects on walking speed in people after stroke: a randomized controlled single blind trial

Abstract

Background: Therapists may use (more) implicit or (more) explicit motor learning approaches to facilitate motor skill learning of stroke patients. The use of implicit motor learning approaches has shown promising results in healthy populations. Objective: To assess whether an implicit motor learning walking intervention is more effective compared to an explicit motor learning walking intervention delivered at home with regard to walking speed in people after stroke in the chronic phase of recovery. Design: Randomized controlled single blind trial. Setting: Home environment. Patients: 79 people in the chronic phase after stroke (66.4{+/-}11.0 years; 70.1{+/-}64.3 months after stroke; walking speed 0.7{+/-}0.3 m/s; Berg Balance Scale score 44.5{+/-}9.5) were randomly assigned to an implicit (n=39) or explicit (n=41) group. Intervention: 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 nine training sessions, 30 minutes each, for a period of three weeks. Measurements: The primary outcome was walking speed measured by the 10-Meter Walk Test. Outcome measures were assessed at baseline, immediate and 1-month post intervention. Results: No statistically or clinically relevant differences between groups were obtained post intervention (between-group difference estimated 0.02 m/s [95% CI -0.04 to 0.08] and at follow-up (between-group difference estimated -0.02 m/s [95% CI -0.09 to 0.05], p=0,563). Limitations: The treatment effects may have been diluted by noise accompanied with research within real life settings, complex tasks and a representative sample. Conclusions: Implicit motor learning was not superior to the explicit motor learning to improve walking speed in people after stroke in the chronic phase of recovery.