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      Using a Delphi Technique to Seek Consensus Regarding Definitions, Descriptions and Classification of Terms Related to Implicit and Explicit Forms of Motor Learning

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          Abstract

          Background

          Motor learning is central to domains such as sports and rehabilitation; however, often terminologies are insufficiently uniform to allow effective sharing of experience or translation of knowledge. A study using a Delphi technique was conducted to ascertain level of agreement between experts from different motor learning domains (i.e., therapists, coaches, researchers) with respect to definitions and descriptions of a fundamental conceptual distinction within motor learning, namely implicit and explicit motor learning.

          Methods

          A Delphi technique was embedded in multiple rounds of a survey designed to collect and aggregate informed opinions of 49 international respondents with expertise related to motor learning. The survey was administered via an online survey program and accompanied by feedback after each round. Consensus was considered to be reached if ≥70% of the experts agreed on a topic.

          Results

          Consensus was reached with respect to definitions of implicit and explicit motor learning, and seven common primary intervention strategies were identified in the context of implicit and explicit motor learning. Consensus was not reached with respect to whether the strategies promote implicit or explicit forms of learning.

          Discussion

          The definitions and descriptions agreed upon may aid translation and transfer of knowledge between domains in the field of motor learning. Empirical and clinical research is required to confirm the accuracy of the definitions and to explore the feasibility of the strategies that were identified in research, everyday practice and education.

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          Most cited references18

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          Motor learning in man: a review of functional and clinical studies.

          This chapter reviews results of clinical and functional imaging studies which investigated the time-course of cortical and subcortical activation during the acquisition of motor a skill. During the early phases of learning by trial and error, activation in prefrontal areas, especially in the dorsolateral prefrontal cortex, is has been reported. The role of these areas is presumably related to explicit working memory and the establishment of a novel association between visual cues and motor commands. Furthermore, motor associated areas of the right hemisphere and distributed cerebellar areas reveal strong activation during the early motor learning. Activation in superior-posterior parietal cortex presumably arises from visuospatial processes, while sensory feedback is coded in the anterior-inferior parietal cortex and the neocerebellar structures. With practice, motor associated areas of the left-hemisphere reveal increased activity. This shift to the left hemisphere has been observed regardless of the hand used during training, indicating a left-hemispheric dominance in the storage of visuomotor skills. Concerning frontal areas, learned actions of sequential character are represented in the caudal part of the supplementary motor area (SMA proper), whereas the lateral premotor cortex appears to be responsible for the coding of the association between visuo-spatial information and motor commands. Functional imaging studies which investigated the activation patterns of motor learning under implicit conditions identified for the first, a motor circuit which includes lateral premotor cortex and SMA proper of the left hemisphere and primary motor cortex, for the second, a cognitive loop which consists of basal ganglia structures of the right hemisphere. Finally, activity patterns of intermanual transfer are discussed. After right-handed training, activity in motor associated areas maintains during performance of the mirror version, but is increased during the performance of the original-oriented version with the left hand. In contrary, increased activity during the mirror reversed action, but not during the original-oriented performance of the untrained right hand is observed after left-handed training. These results indicate the transfer of acquired right-handed information which reflects the mirror symmetry of the body, whereas spatial information is mainly transferred after left-handed training. Taken together, a combined approach of clinical lesion studies and functional imaging is a promising tool for identifying the cerebral regions involved in the process of motor learning and provides insight into the mechanisms underlying the generalisation of actions.
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            Implicit sequence-specific motor learning after subcortical stroke is associated with increased prefrontal brain activations: an fMRI study.

            Implicit motor learning is preserved after stroke, but how the brain compensates for damage to facilitate learning is unclear. We used a random effects analysis to determine how stroke alters patterns of brain activity during implicit sequence-specific motor learning as compared to general improvements in motor control. Nine healthy participants and nine individuals with chronic, right focal subcortical stroke performed a continuous joystick-based tracking task during an initial functional magnetic resonance images (fMRI) session, over 5 days of practice, and a retention test during a separate fMRI session. Sequence-specific implicit motor learning was differentiated from general improvements in motor control by comparing tracking performance on a novel, repeated tracking sequence during early practice and again at the retention test. Both groups demonstrated implicit sequence-specific motor learning at the retention test, yet substantial differences were apparent. At retention, healthy control participants demonstrated increased blood oxygenation level dependent (BOLD) response in left dorsal premotor cortex (PMd; BA 6) but decreased BOLD response left dorsolateral prefrontal cortex (DLPFC; BA 9) during repeated sequence tracking. In contrast, at retention individuals with stroke did not show this reduction in DLPFC during repeated tracking. Instead implicit sequence-specific motor learning and general improvements in motor control were associated with increased BOLD response in the left middle frontal gyrus BA 8, regardless of sequence type after stroke. These data emphasize the potential importance of a prefrontal-based attentional network for implicit motor learning after stroke. This study is the first to highlight the importance of the prefrontal cortex for implicit sequence-specific motor learning after stroke. Copyright © 2010 Wiley-Liss, Inc.
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              Analogy versus explicit learning of a modified basketball shooting task: performance and kinematic outcomes.

              The effects of differential instructional sets on motor skill acquisition were investigated using performance outcome and kinematic measures. Participants were provided with a single analogical instruction (analogy learning), a set of eight explicit (technical) instructions (explicit learning), or were not instructed (control). During a learning phase, participants (n=9 for each condition) performed a modified basketball shooting task over 3 days (160 trials per day). On the fourth day, participants performed a test phase consisting of two 40-trial retention tests, separated by a 40-trial secondary task transfer test, and completed a verbal protocol describing in detail the techniques that they had used to perform the task. No performance differences were found during the two retention tests, indicating similar amounts of learning for all groups. During the transfer test, performance deteriorated for both the explicit and control conditions, but not for the analogy condition. Participants in the analogy condition reported significantly fewer technical rules. Although no group differences were reported for kinematic variables, identification of movement components supported the claim that explicit learners exert conscious control over their movements, whereas analogy learners use a more implicit (unconscious or automatic) mode of movement control.
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                Author and article information

                Contributors
                Role: Editor
                Journal
                PLoS One
                PLoS ONE
                plos
                plosone
                PLoS ONE
                Public Library of Science (San Francisco, USA )
                1932-6203
                2014
                26 June 2014
                : 9
                : 6
                : e100227
                Affiliations
                [1 ]Research Centre for Autonomy and Participation of people with a chronic illness, Zuyd University of Applied Sciences, Faculty of Health, Heerlen, the Netherlands
                [2 ]Adelante Rehabilitation Centre, Department of Brain Injury, Hoensbroek, the Netherlands
                [3 ]Department of Health Services Research, CAPHRI, School for Public Health and Primary Care, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands
                [4 ]Centre of Expertise Geriatric Rehabilitation and Chronic Somatic Care, Sevagram Zorgcentra, Heerlen, the Netherlands
                [5 ]Research Centre for Technology in Care, Zuyd University of Applied Sciences, Heerlen, the Netherlands
                [6 ]Adelante Centre of Expertise in Rehabilitation and Audiology, Hoensbroek, the Netherlands
                [7 ]Department of Rehabilitation Medicine, CAPHRI, School for Public Health and Primary Care, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands
                [8 ]Department of Sport and Health Sciences, University of Exeter, Exeter, United Kingdom
                [9 ]Department of Family Practice, CAPHRI, School for Public Health and Primary Care, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands
                [10 ]Institute of Human Performance, University of Hong Kong, Hong Kong, China
                [11 ]Department of Sport and Leisure Studies, University of Waikato, New Zealand
                University of Münster, Germany
                Author notes

                Competing Interests: The authors have declared that no competing interests exist.

                Conceived and designed the experiments: MK SMB MHB MAL SMR JH MRW AJB RSWM. Performed the experiments: MK SMB. Analyzed the data: MK SMB MAL. Wrote the paper: MK SMB MHB MAL SMR JH MRW AJB RSWM.

                Article
                PONE-D-13-44037
                10.1371/journal.pone.0100227
                4072669
                24968228
                9c2a90f6-9beb-4698-a794-b96ffd1b75d6
                Copyright @ 2014

                This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

                History
                : 11 October 2013
                : 24 May 2014
                Page count
                Pages: 11
                Funding
                This study was financially supported by Stichting Alliantie Innovatie (Innovation Alliance Foundation), RAAK-international (Registration number: 2011-3-33int). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
                Categories
                Research Article
                Biology and Life Sciences
                Anatomy
                Nervous System
                Motor System
                Neuroscience
                Cognitive Science
                Cognitive Psychology
                Learning
                Learning and Memory
                Medicine and Health Sciences
                Critical Care and Emergency Medicine
                Trauma Medicine
                Neurorehabilitation and Trauma
                Health Care
                Health Care Policy
                Screening Guidelines
                Treatment Guidelines
                Physiotherapy
                Mental Health and Psychiatry
                Dementia
                Neurology
                Neurodegenerative Diseases
                Movement Disorders
                Parkinson Disease
                Sports and Exercise Medicine
                Research and Analysis Methods
                Research Assessment
                Research Reporting Guidelines
                Specimen Preparation and Treatment
                Mechanical Treatment of Specimens
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                Electroporation
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                Sociology of Knowledge

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