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The development of more effective rehabilitative interventions requires a better understanding of how humans learn and transfer motor skills in real-world contexts. Presently, clinicians design interventions to promote skill learning by relying on evidence from experimental paradigms involving simple tasks, such as reaching for a target. While these tasks facilitate stringent hypothesis testing in laboratory settings, the results may not shed light on performance of more complex real-world skills. In this perspective, we argue that virtual environments (VEs) are flexible, novel platforms to evaluate learning and transfer of complex skills without sacrificing experimental control. Specifically, VEs use models of real-life tasks that afford controlled experimental manipulations to measure and guide behavior with a precision that exceeds the capabilities of physical environments. This paper reviews recent insights from VE paradigms on motor learning into two pressing challenges in rehabilitation research: 1) Which training strategies in VEs promote complex skill learning? and 2) How can transfer of learning from virtual to real environments be enhanced? Defining complex skills by having nested redundancies, we outline findings on the role of movement variability in complex skill acquisition and discuss how VEs can provide novel forms of guidance to enhance learning. We review the evidence for skill transfer from virtual to real environments in typically developing and neurologically-impaired populations with a view to understanding how differences in sensory-motor information may influence learning strategies. We provide actionable suggestions for practicing clinicians and outline broad areas where more research is required. Finally, we conclude that VEs present distinctive experimental platforms to understand complex skill learning that should enable transfer from therapeutic practice to the real world.

Motor skill learning and performance are improved when successful actions are paired with extrinsic rewards, such as money. Positive feedback indicating successful task performance is thought to induce intrinsic reward associated with goal attainment, evidenced by increases in positive affect that correlate with neural reward signaling. However, it is not clear whether the subjective, internal reward processes elicited by positive feedback promote motor learning and performance.Here, we tested the hypothesis that intrinsic reward elicited by positive feedback promotes motor learning and performance. Participants practiced a visuomotor interception task using a joystick, and received feedback during practice indicating success or failure depending on their accuracy. During practice, the accuracy demands were adapted to control and vary the frequency of positive feedback across randomly ordered blocks of practice at either 50%, 70%, or 90%. Performance was measured for each condition as the average accuracy during practice. Learning was estimated by measuring the accuracy pre and post practice in the absence of feedback. We queried participants periodically on their enjoyment of the task to index affective responses to performance feedback.The intrinsic reward elicited by positive feedback, operationalized by the increase in enjoyment immediately following positive versus negative feedback, was positively correlated with learning from pre to post practice. However, increasing the overall amount of positive feedback by lower accuracy demands did not improve performance. These results suggest that experiencing intrinsic reward due to positive feedback benefits motor learning only when it is contingent on good performance.

Huntington disease (HD) is a genetic neurodegenerative disorder characterized by progressive motor dysfunction, cognitive decline, and neuropsychiatric symptoms. Assessing early motor skill deficits in HD mouse models is challenging with traditional behavioral tasks. This study uses a home cage-based lever-pulling task, PiPaw2.0, to evaluate motor learning in 6–7 months-old zQ175 knock-in HD mice in a more naturalistic environment. In this task, mice learn to pull a lever for a water reward, with the requirement to hold the lever within a specific goal range for a required hold time. As the mice improved, the required hold time increased, thereby gradually increasing the task demands. Both wild type (WT) and zQ175 mice initially showed similar task engagement, but zQ175 mice had significant deficits in adapting to increasing hold time. The WT mice refined their strategies over time, shifting from random to more precise lever pulls, while zQ175 mice failed to make this adjustment, maintaining erratic performance. Additionally, in group-housing WT mouse lever performance benefited from peer interactions, an effect absent in zQ175 mice. Post-task neural assessments revealed that WT mice developed experience-mediated synaptic plasticity in the left striatum (contralateral to lever-pulling paw), while zQ175 mice showed no significant changes, consistent with known corticostriatal plasticity impairments in HD mouse models. In conclusion, our findings demonstrate the effectiveness of group-housed, home cage-based assessments for evaluating motor learning and adaptation in HD mouse models. This study provides insights into the motor control and adaptive learning deficits in HD, emphasizing the value of automated home cage systems in advancing neurodegenerative disease research and highlighting the importance of peer influences on performance.

Learning disabilities are hallmarks of congenital conditions caused by prenatal exposure to harmful agents. These include fetal alcohol spectrum disorders (FASDs) with a wide range of cognitive deficiencies, including impaired motor skill development. Although these effects have been well characterized, the molecular effects that bring about these behavioral consequences remain to be determined. We previously found that the acute molecular responses to alcohol in the embryonic brain are stochastic, varying among neural progenitor cells. However, the pathophysiological consequences stemming from these heterogeneous responses remain unknown. Here we show that acute responses to alcohol in progenitor cells altered gene expression in their descendant neurons. Among the altered genes, an increase of the calcium-activated potassium channel Kcnn2 in the motor cortex correlated with motor learning deficits in a mouse model of FASD. Pharmacologic blockade of Kcnn2 improves these learning deficits, suggesting Kcnn2 blockers as a new intervention for learning disabilities in FASD.Mohammad et al. show that prenatal alcohol exposure increases Kcnn2 activity in the mouse cerebral cortex. Blockade of Kcnn2 improves learning deficits in a mouse model of fetal alcohol spectrum disorders.

Introduction: Innovative, inclusive and resource-efficient screening and intervention methods are essential to address motor skill impairment among preschool children and prevent long-term consequences. This study explores the feasibility of implementing a unique motor skill program for preschool children in low- resource rural areas of South Africa, addressing the heightened risk of motor skill impairment in this demographic. Methods: Employing a quantitative pre-post quasi-experimental design with convenience sampling, the research involved assessing children using the second edition of the Movement Assessment Battery for Children (MABC-2) to evaluate their motor skills. Key objectives included assessing the program's recruitment, consent, attrition, adherence, and attendance rates, alongside determining its effect on motor skills. Children who scored less than the 5th percentile of the MABC-2 total score were included in the study and schools were randomly assigned to an intervention and control group. The Hopscotch program was facilitated by an occupational therapist over 8 weeks. Two weekly group sessions focused on gross and fine motor skills through obstacle courses, ball games and craft activities. All participants in the groups were re-assessed following the intervention. The control group received the same intervention following the post-assessment. Quantitative attendance checklists were analyzed to determine consent, assent, attrition and attendance rates. The feasibility of the MABC-2 as a data collection instrument and outcome measure was reported according to test completion rate and cost. The initial effect of the program was determined through analysis of the pre-and post- intervention MABC-2 scores using descriptive statistics while independent samples t-test were used to determine statistically significance of between-group differences. The minimal important difference (MID) for MABC-2 scores was considered to determine the clinical significance of the results. Results: The results revealed a high consent rate (98.08%) and a 0% attrition rate, with significant attendance at program sessions (93.75%). While independent samples t-tests indicated no statistically significant differences in motor skill improvements between the intervention and control groups, analysis considering the MID demonstrated clinically significant improvements in overall motor skill proficiency and balance for the experimental group. The cost of the MABC-2 exceeded the planned budget and amounted to 77% of the total study cost. The duration for testing was one school morning for each pre- and post-test when done by five researchers. Conclusion: The study highlights the feasibility of conducting intervention research in low-resource settings. It notes the challenges of using the MABC-2 due to its cost and time requirements and reports on the initial effect of the program on the motor skills of the participants. Statistical significance of positive results was affected by the small sample size; however, the MID was useful in indicating clinical significance of progress made in general motor skill proficiency and balance. The feasibility study provides valuable insights to effectively plan and conduct a research project and implement a school-based motor skill intervention program in a low-resource area.

Many motor skills require precise coordination between the arms to accomplish. The use of transcranial direct current stimulation (tDCS) has helped to reveal hemispheric contributions to bimanual skills. In this study, three bilateral montages were used to explore hemispheric contributions to a rhythmic bimanual skill: anode left M1/cathode right M1 (LARC), anode right M1/cathode left M1 (RALC), and sham. Stimulation lasted 20-minutes during training. Retention was examined 6-hr after training. Participants ( n  = 46) learned a bimanual 90° relative-phase pattern with a half-cycle movement amplitude goal of 12 cm per arm at self-selected movement frequencies. Greater coordination variability in the 90° pattern emerged early under RALC compared to LARC, with no difference in performance accuracy. Larger movement amplitudes emerged in training with LARC compared to sham but not compared to RALC. tDCS montage had no impact on coordination variability and accuracy of the 90° pattern after the 6-hr delay. Montage was associated with a delayed movement amplitude effect emerging in retention, with larger amplitudes in LARC compared to RALC and sham. The asymmetries observed across training and retention emerged from of an interaction between tDCS and the left-hemisphere’s role in the control of bimanual movements in right-handed individuals.

This reaction time study tested the hypothesis that in the case of finger movements skilled motor control involves the execution of learned hand postures. After delineating hypothetical control mechanisms and their predictions an experiment is described involving 32 participants who practiced 6 chord responses. These responses involved the simultaneous depression of one, two or three keys with either four right-hand fingers or two fingers of both hands. After practicing each of these responses for 240 trials, the participants performed the practiced and also novel chords with the familiar and with the unfamiliar hand configuration of the other practice group. The results suggest that participants learned hand postures rather than spatial or explicit chord representations. Participants practicing with both hands also developed a bimanual coordination skill. Chord execution was most likely slowed by interference between adjacent fingers. This interference seemed eliminated with practice for some chords but not for others. Hence, the results support the notion that skilled control of finger movements is based on learned hand postures that even after practice may be slowed by interference between adjacent fingers.

Sensori-motor development and performance of daily living skills (DLS) remain little explored in children with autism spectrum disorders (ASD). The objective of this study was to determine the impact of sensori-motor skills on the performance of DLS in preschool children with ASD. Thirty-five children, 3–4 years of age, were recruited and assessed with a battery of diagnostic and clinical tests. Children showed atypical sensory responses, very poor motor and DLS. Sensory avoiding, an excessive reaction to sensory stimuli, and fine motor skills were highly correlated with DLS, even when cognitive performance was taken into account. Sensori-motor deficits have an impact on the autonomy of children with ASD and interventions should aim at improving and supporting the development of sensori-motor skills.