[REVIEW] Sleep and Motor Learning: Implications for Physical Rehabilitation After Stroke – Full Text HTML

Sleep is essential for healthy brain function and plasticity underlying learning and memory. In the context of physical impairment such as following a stroke, sleep may be particularly important for supporting critical recovery of motor function through similar processes of reorganization in the brain. Despite a link between stroke and poor sleep, current approaches to rehabilitative care often neglect the importance of sleep in clinical assessment and treatment. This review assimilates current evidence on the role of sleep in motor learning, with a focus on the implications for physical rehabilitation after stroke. We further outline practical considerations for integrating sleep assessment as a vital part of clinical care.


The adult brain is highly adaptable, even after injury it often exhibits an impressive capacity for reorganization. Activity in the brain during sleep is thought to be critically involved in supporting these processes of plasticity. Briefly, sleep can be thought of as a state of consciousness, or alternations in consciousness, which oscillates between states of reduced awareness of external real-world stimuli to a complete loss of consciousness (1). While the precise mechanisms have yet to be clearly defined, sleep has been associated with many important functions, including those of the immune and memory systems (2–5). In memory, sleep is consistently attributed a particularly prominent role in supporting time-sensitive processes associated with the consolidation of memories. Consolidation here refers to dynamic processes in the brain that occur after initial (“on-line”) memory encoding takes place, such as when we practice a new skill. Subsequent (“off-line”) mechanisms of consolidation serve to further process these new memory traces, for instance, to enable the integration of knowledge and long-term memory storage.

One reason memory consolidation may be particularly important in a clinical context is because of how it applies to neurological rehabilitation, such as motor recovery after lesion to the brain. Here, the primary aim of physical rehabilitation is to facilitate recovery of functional motor capacity after initial impairment. Another way to look at physical rehabilitation, therefore, is as a form of motor learning, or relearning, which in turn may tap into some of the same processes of memory formation and consolidation as other forms of procedural memory (6, 7). Consequently, experimental insights into processes in the brain that support motor memory are likely to have more wide-ranging application that may benefit understanding and development of useful strategies for improving long-term rehabilitative outcomes in the clinic. The primary objective of this review is to provide an assimilation of current evidence on the role of sleep in motor learning and to identify specific factors of learning and consolidation that may have important implications for rehabilitation. For the purposes of this review, we will focus primarily on sleep-dependent motor memory with relevance to physical rehabilitation after stroke, although many of the discussion points included here will likely apply more broadly to other types of memory and rehabilitation. Meanwhile, what is some of the evidence linking sleep, in particular, to motor memory?

Continue —> Frontiers | Sleep and Motor Learning: Implications for Physical Rehabilitation After Stroke | Sleep and Chronobiology


Figure 1. Motor learning and sleep-dependent consolidation. After a period of consolidation following training on an explicit motor sequence-learning task performed on a standard keyboard or button box, young, healthy adults consistently demonstrate marked performance improvements after sleep, whereas an equivalent period awake during the day does not provide significant off-line gains. Adapted from Gudberg et al. (13).


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