Motor learning following unilateral stroke

Objective: To determine the effect of different motor learning schedules on stroke patients' rate of acquisition and retention of a functional movement sequence using the hemiparetic upper limb. Design: Randomized controlled group study using a retention design with two retention trials. Setting: Outpatient neurorehabilitation clinic. Patients: Twenty-four patients with chronic hemiparesis secondary to a single unilateral cerebral stroke without evidence of severe cognitive or language impairment. Main Outcome Measure: The primary hypothesis was that hemiparetic motor learning that occurred under conditions of contextual interference tie, random practice) would be retained better than learning that occurred under conditions of repetitive drill (blocked practice). Results: A significant difference was found among the three groups tie, random-practice, blocked-practice, control) on both the first retention measure (chi(2)=13.50, p <.01) and the second retention measure (chi(2)=12.59, P <.01). More importantly, a significant difference was found between the random-practice and blocked-practice groups on both the first retention measure (U=68.5, p <.01) and the second retention measure (U=62.0, p=.05). Conclusions: Findings provide empirical evidence to support the contention that random practice is more effective than blocked practice, with respect to retention over time, when hemiparetic stroke patients attempt to learn functional motor skills. (C) 1996 by the American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation.