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Improved motor performance in patients with acute stroke using the optimal individual attentional strategy.

ABSTRACT: It is believed that motor performance improves when individuals direct attention to movement outcome (external focus, EF) rather than to body movement itself (internal focus, IF). However, our previous study found that an optimal individual attentional strategy depended on motor imagery ability. We explored whether the individual motor imagery ability in stroke patients also affected the optimal attentional strategy for motor control. Individual motor imagery ability was determined as either kinesthetic- or visual-dominant by a questionnaire in 28 patients and 28 healthy-controls. Participants then performed a visuomotor task that required tracing a trajectory under three attentional conditions: no instruction (NI), attention to hand movement (IF), or attention to cursor movement (EF). Movement error in the stroke group strongly depended on individual modality dominance of motor imagery. Patients with kinesthetic dominance showed higher motor accuracy under the IF condition but with concomitantly lower velocity. Alternatively, patients with visual dominance showed improvements in both speed and accuracy under the EF condition. These results suggest that the optimal attentional strategy for improving motor accuracy in stroke rehabilitation differs according to the individual dominance of motor imagery. Our findings may contribute to the development of tailor-made pre-assessment and rehabilitation programs optimized for individual cognitive abilities.

SUBMITTER: Sakurada T

PROVIDER: S-EPMC5240116 | biostudies-literature | 2017 Jan

REPOSITORIES: biostudies-literature

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Improved motor performance in patients with acute stroke using the optimal individual attentional strategy.

Sakurada Takeshi T Nakajima Takeshi T Morita Mitsuya M Hirai Masahiro M Watanabe Eiju E

Scientific reports 20170117

It is believed that motor performance improves when individuals direct attention to movement outcome (external focus, EF) rather than to body movement itself (internal focus, IF). However, our previous study found that an optimal individual attentional strategy depended on motor imagery ability. We explored whether the individual motor imagery ability in stroke patients also affected the optimal attentional strategy for motor control. Individual motor imagery ability was determined as either kin ...[more]

PMID: 28094320

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Project description:In complex real-life motor skills such as unconstrained throwing, performance depends on how accurate is on average the outcome of noisy, high-dimensional, and redundant actions. What characteristics of the action distribution relate to performance and how different individuals select specific action distributions are key questions in motor control. Previous computational approaches have highlighted that variability along the directions of first order derivatives of the action-to-outcome mapping affects performance the most, that different mean actions may be associated to regions of the actions space with different sensitivity to noise, and that action covariation in addition to noise magnitude matters. However, a method to relate individual high-dimensional action distribution and performance is still missing. Here we introduce a decomposition of performance into a small set of indicators that compactly and directly characterize the key performance-related features of the distribution of high-dimensional redundant actions. Central to the method is the observation that, if performance is quantified as a mean score, the Hessian (second order derivatives) of the action-to-score function determines how the noise of the action distribution affects performance. We can then approximate the mean score as the sum of the score of the mean action and a tolerance-variability index which depends on both Hessian and action covariance. Such index can be expressed as the product of three terms capturing noise magnitude, noise sensitivity, and alignment of the most variable and most noise sensitive directions. We apply this method to the analysis of unconstrained throwing actions by non-expert participants and show that, consistently across four different throwing targets, each participant shows a specific selection of mean action score and tolerance-variability index as well as specific selection of noise magnitude and alignment indicators. Thus, participants with different strategies may display the same performance because they can trade off suboptimal mean action for better tolerance-variability and higher action variability for better alignment with more tolerant directions in action space.

Project description:Learning a new motor task is a complex cognitive and motor process. Especially early during motor learning, cognitive functions such as attentional engagement, are essential, e.g., to discover relevant visual stimuli. Drawing participant's attention towards task-relevant stimuli-e.g., with task instructions using visual cues or explicit written information-is a common practice to support cognitive engagement during training and, hence, accelerate motor learning. However, there is little scientific evidence about how visually cued or written task instructions affect attentional brain networks during motor learning. In this experiment, we trained 36 healthy participants in a virtual motor task: surfing waves by steering a boat with a joystick. We measured the participants' motor performance and observed attentional brain networks using alpha-band electroencephalographic (EEG) activity before and after training. Participants received one of the following task instructions during training: (1) No explicit task instructions and letting participants surf freely (implicit training; IMP); (2) Task instructions provided through explicit visual cues (explicit-implicit training; E-IMP); or (3) through explicit written commands (explicit training; E). We found that providing task instructions during training (E and E-IMP) resulted in less post-training motor variability-linked to enhanced performance-compared to training without instructions (IMP). After training, participants trained with visual cues (E-IMP) enhanced the alpha-band strength over parieto-occipital and frontal brain areas at wave onset. In contrast, participants who trained with explicit commands (E) showed decreased fronto-temporal alpha activity. Thus, providing task instructions in written (E) or using visual cues (E-IMP) leads to similar motor performance improvements by enhancing activation on different attentional networks. While training with visual cues (E-IMP) may be associated with visuo-attentional processes, verbal-analytical processes may be more prominent when written explicit commands are provided (E). Together, we suggest that training parameters such as task instructions, modulate the attentional networks observed during motor practice and may support participant's cognitive engagement, compared to training without instructions.

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Dataset Information

Improved motor performance in patients with acute stroke using the optimal individual attentional strategy.

Publications

Improved motor performance in patients with acute stroke using the optimal individual attentional strategy.

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