The importance of different learning stages for motor sequence learning after stroke

Abstract

The task of learning predefined sequences of interrelated motor actions is of everyday importance and has also strong clinical importance for regaining motor function after brain lesions. A solid understanding of sequence learning in stroke patients can help clinicians to optimize and individualize rehabilitation strategies. Moreover, to investigate the impact of a focal lesion on the ability to successfully perform motor sequence learning can enhance our comprehension of the underlying physiological principles of motor sequence learning. In this article, we will first provide an overview of current concepts related to motor sequence learning in healthy subjects with focus on the involved brain areas and their assumed functions according to the temporal stage model. Subsequently, we will consider the question of what we can learn from studies investigating motor sequence learning in stroke patients. We will first focus on the implications of lesion location. Then, we will analyze whether distinct lesion locations affect specific learning stages. Finally, we will discuss the implications for clinical rehabilitation and suggest directions for further research.

Keywords: motor cortex; motor rehabilitation; plasticity; sequence learning; stroke.

Figure 1

Schematic representation of the locations of areas involved in different stages of motor sequence learning. Abbreviations: CB, cerebellum; DLPFC, dorsolateral prefrontal cortex; M1, primary motor cortex; PMA, premotor area; PPC, posterior parietal cortex; pre‐SMA, pre‐supplementary motor area; SMA, supplementary motor area

Figure 2

Schematic representation of the involvement and the interaction of brain areas in the three stages of motor sequence learning. Abbreviations: M1, primary motor cortex; PMA, premotor area; PPC, posterior parietal cortex; pre‐SMA, pre‐supplementary motor area; SMA, supplementary motor area)