Visuospatial Working Memory Predicts Strategic Motor Learning With Visual Feedback During Gait After Stroke

Abstract

Background:

Strategic motor learning, guided by visual feedback (VF), is commonly used in post-stroke gait rehabilitation. While visuospatial working memory (VSWM) has been shown to support VF-guided motor correction in upper limb motor learning tasks, its role in locomotor learning after stroke remains unclear.

Objective:

We examined whether VSWM is related to strategic learning by examining the overall accuracy and improvement in accuracy over time with VF-guided locomotor learning in individuals with chronic stroke.

Methods:

Seventy-seven individuals >6 months post-stroke (41 males and 36 females; mean age = 66.3 ± 10.9 years) adapted walking on a split-belt treadmill (2:1 ratio) with real-time VF of step lengths. Feedback was displayed as visual targets on a screen and participants were instructed to use the visual cues to counteract the split-belt perturbation and restore their pre-perturbation step lengths. Strategic learning was assessed using 2 outcomes: overall accuracy and improvement in accuracy over strides during the VF phase. VSWM was assessed with the Spatial Addition subtest of the Wechsler Memory Scale-IV.

Results:

After adjusting for age, sex, time since stroke, and lower extremity Fugl–Meyer score, VSWM explained a significant proportion of the variance in both outcomes (overall accuracy: ΔR² = .085, P = .013; improvement in accuracy: ΔR² = .153, P < .001).

Conclusion:

Our findings suggest that VSWM may be important for strategic locomotor learning with VF in people with chronic stroke, highlighting its potential relevance as a key consideration in designing walking rehabilitation strategies for people after stroke.