Progressive disorders of airway protection, namely cough (dystussia) and swallowing (dysphagia) dysfunction, are highly prevalent in Parkinson’s disease (PD), impacting quality of life and contributing to the development of aspiration pneumonia – a leading cause of death in this population. To date, dysphagia rehabilitation has remained the primary (and often only) treatment target of choice by clinicians managing dysphagia in patients with PD and other neurodegenerative disease. This is a major concern since the progressive nature of PD makes it somewhat unreasonable to expect that treatments can fully rehabilitate swallowing dysfunction and eliminate chronic aspiration. Instead, rehabilitating cough dysfunction can serve as an adjunctive approach to promote pulmonary health. Considering that impairments in motor control and organization are primary features of PD, skill training may have a necessary role in cough rehabilitation. Despite a growing body of research supporting the feasibility and effectiveness of cough skill training, a significant gap remains in our understanding of optimal skill training parameters that maximize treatment outcomes through motor learning. This document addresses this gap in the literature in a series of three research studies. Chapter 1 will begin by reviewing the current body of literature related to normal and disordered mechanisms of airway protection dysfunction in PD, skill training as an efficacious approach to rehabilitate cough dysfunction, and motor learning considerations to maximize treatment outcomes. Chapter 2 will characterize motor performance and learning during a voluntary cough skill training paradigm, and evaluate the contributions of physiologic (i.e., lung volume) and treatment-specific (i.e., biofeedback) factors to treatment response in PD. Chapter 3 will then characterize trajectories of motor performance during multiple sessions of sensorimotor cough skill training and explore the role of task-specific predictors (i.e., variability, motor learning) on motor performance. Chapter 4 will examine the effects of cough skill training with variable practice on motor performance and motor learning and characterize contributions of laryngeal and respiratory subsystems to cough strength. This document will then conclude (Chapter 5) by synthesizing results from these studies and discussing clinical implications, limitations, and potential directions for future research.

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<p>This thesis was specifically designed to explore the role of motor information in behavior and learning in the presence and absence of physical and cognitive challenges. The first experiment examined the role of motor information in the maintenance of standing balance. This study found that light touch (motor information) was most useful when visual condition was challenging, eyes closed. Increased benefit of touch in the presence of challenge suggests that motor information may provide similar information as other senses, and act in a compensatory fashion when those senses are challenged. The second study examined the role of motor information, in the form of enactment, in learning a motor communication task. Results from this study support a role for motor information in enriching the learning environment by strengthening memory to reduce rate of forgetting. The third study examined the role of motor information in disease, using motor-centric instruction and guided movements to teach persons with Alzheimer Dementia to bowl using the Nintendo Wii ^TM. The spared motor learning observed in these participants confirms claims in the literature of spared motor function in persons with dementia and strengthens the claim the motor system can provide compensatory information to support challenged cognitive systems. Taken together, these findings add to the current literature supporting motor pathways with information separable form other sensory pathways and spared motor capacity to learn in dementia.</p> / Doctor of Philosophy (PhD)

<p><strong>Introduction:</strong> Children with acquired brain injury (ABI) receive physiotherapy interventions to promote motor skill relearning. Theoretically-driven motor learning strategies (MLS) may support therapists in this goal, but their use with this complex population is unexplored. Virtual reality (VR) games are popular interventions that may influence therapist use of MLS. A valid, reliable method to examine MLS during usual and VR-based interventions is required.</p> <p><strong>Purpose: </strong>To: 1) identify the active ingredients of VR interventions; 2) develop and examine the psychometric properties of an instrument to measure MLS use; and 3) explore physiotherapists’ perspectives on promoting motor learning within usual and VR-based interventions for children with ABI.</p> <p><strong>Methods:</strong> A scoping review methodology was used to identify the active ingredients of VR interventions. Nineteen experts and clinicians participated in a content validation process to develop an instrument to measure MLS. Inter-rater reliability of the instrument was evaluated within 22 videotaped usual and VR-based physiotherapy sessions with children with ABI. Six therapists participated in qualitative interviews about these interventions.</p> <p><strong>Results:</strong> The scoping review identified<em> </em>11 active ingredients of VR; 6 related to motor learning theory. The Motor Learning Strategy Rating Instrument (MLSRI) was developed. Inter-rater reliability was high (0.81) for usual interventions but low (0.28) for VR-based interventions. Therapists described the importance of considering intervention goals and child characteristics when promoting motor learning; VR was viewed as a complex, motivating intervention that influenced their use of verbal strategies.</p> <p><strong>Conclusions:</strong> A motor learning theoretical framework may be relevant to clinicians and researchers using VR in pediatric rehabilitation. Qualitative findings enhance understanding of how therapists promote motor learning in usual and VR-based physiotherapy interventions for children withABI. The use of MLS can be measured reliably within usual interventions, but further instrument refinements are required to rate MLS use within VR-based physiotherapy for children with ABI.</p> / Doctor of Philosophy (PhD)

<p><strong>Background: </strong>Walking dysfunction is one of the most disabling and persistent of stroke-related sequela. Theory- and research-derived motor learning principles (MLPs) offer an ideal theoretical framework for the development and evaluation of walking-skill focused interventions.</p> <p><strong>Purpose: </strong>To: 1) appraise the degree of adherence to motor learning principles (MLPs) in current post-stroke walking-skill training research; 2) describe the Motor Learning Walking Program (MLWP), a novel, MLPs-framed walking training program; and 3) compare the MLWP to an alternate theory-framed walking-focused intervention in community-dwelling individuals within one year of stroke.</p> <p><strong>Methods: </strong>A scoping review methodology was used to identify the prevalent theoretical frameworks in current post-stroke walking training literature, and to appraise the adherence to selected MLPs in walking-focused interventions. A randomized controlled trial (n=71) was conducted to compare the MLWP to a body-weight-supported treadmill training (BWSTT) intervention.</p> <p><strong>Results: </strong>In the scoping review of 27 walking-focused studies, a minority of investigators explicitly stated a theoretical-framework. Application of MLPs was inconsistent across interventions. In the randomized controlled trial, both intervention groups improved walking function after 5 weeks of training however, there were no significant between-group differences in the primary and secondary outcomes.</p> <p><strong>Conclusions:</strong> To date, there has been limited integration of MLPs into post-stroke walking-skill training literature. This randomized controlled trial is unique in its comparison of two theoretically divergent, yet equally intense, walking-training interventions. While the results were equivocal, future research should continue to explore the impact of application of MLPs on walking-skill recovery after stroke.</p> / Doctor of Philosophy (PhD)

Childhood Apraxia of Speech (CAS) is a pediatric motor-speech disorder which has been controversial due to its difficulty to diagnose and little progress in treatment. The purpose of the present study was to examine a principle of motor learning (PML) within the context of an evidence-based treatment for this disorder, as a way to improve outcomes for children with CAS. In particular, this study examines the role of intensity, specifically, massed versus distributed practice, when treating CAS using a modified form of Dynamic Temporal Tactile Cueing (DTTC; Strand et al., 2006). Two participants with CAS between the ages of 5 and 11 received massed and distributed practice on individualized targets in an single-case alternating treatments design with multiple baselines. Accuracy of speech targets on probe tasks was judged by blinded listeners. Results were interpreted through inspection of graphs and calculation of effect sizes. The results of the study showed that massed practice had a marginal benefit over distributed practice. Implications from this study suggest the importance of continued research examining the role of PML in CAS treatment and the value of using a massed-treatment approach when treating CAS. / Communication Sciences

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The purpose of this investigation was to evaluate the impact of an individualized motor activity program on the level of motor development, perceptual-motor development, physical fitness, self-concept, and academic achievement of learning disabled elementary school children. The participants for this investigation were learning disabled children (N=37), CAs 7 to 12 years, with a mean IQ of 98. They were all drawn from self-contained learning disabled classes in three elementary schools. A three factorial design, treatment (E/C) X age (younger/older) X test (pre/post), with repeated measures on the third factor was used to examine the effects of the intervening treatment on all dependent variables. A multivariate analysis of variance (MANOVA) statistical analysis technique was used to analyze the total effect of the program on the learning disabled children. The instruments used for pre and posttesting were: (1) Project ACTIVE Motor Ability Test, Level III; (2) Project ACTIVE Physical Fitness Test, Level III; (3) Piers-Harris Self-Concept Scale; (4) Thomas' Teacher Rating Scale; and (5) Shape-O Ball Test. The control group participated in a 30 minute traditional physical education program each day for 5 days per week during the 18 weeks of the study. For 5 days per week during the 18 weeks of the study, the experimental group received an individualized motor activity program based on the needs of each individual student. At the completion of the intervention program, the parents and teachers of the children involved in the experimental group were interviewed concerning their views of the impact of the program on the children. When all 12 variables were assessed simultaneously, the MANOVA indicated that there were significant multivariate main effects for age, treatment, and test (p< .05), as well as treatment X test and treatment X age interaction effects (p<.05). The post hoc procedures indicated significant (p <.05) treatment X test interaction which favored the experimental group on all the physical fitness, motor ability, and perceptual-motor variables. Significant treatment X age interaction effect (p <.05) was found on balance, eye-hand coordination, and sit-ups. The results of the teacher and parent interviews demonstrated that they felt that overall the individualized program was very beneficial to those children who participated. It was concluded: (1) the level of physical fitness, motor ability, and perceptual-motor development can be enhanced through participation in an individualized motor activity program; (2) it appears that the global self-concept and academic achievement of learning disabled children cannot be significantly improved through an individualized motor activity program; and (3) the learning disabled child's self confidence as it relates to physical activities as well as social-emotional growth can be enhanced through participation in an individualized motor activity program. / Ed. D.

In this work, we develop models of neural circuits and plasticity rules that underlie different forms of learning and memory, with a focus on learning processes that involve multiple brain regions. We begin by surveying the literature on synaptic plasticity rules and implementations of learning algorithms in the brain. Each subsequent chapter presents a model of how a specific aspect of learning is implemented biologically, based on experimental evidence and normative considerations. We first focus on the neural basis of reinforcement learning in the basal ganglia. We show that in order to enable effective learning when control of behavior is distributed across multiple regions (``off-policy reinforcement learning''), classic models of dopamine activity must be adapted to include an additional action-sensitive component. We also show that the known plasticity rules of direct and indirect-pathway striatal projection neurons are inconsistent with existing models of striatal codes for action. We propose and find experimental support for a new model of striatal activity driven by efferent input. This model is functionally compatible with striatal plasticity rules and enables simultaneous multiplexing of action-selection and learning signals, a necessary ingredient for off-policy reinforcement learning. We next use an off-policy reinforcement learning model to explain a new experimental finding about the conditions under which learned motor skills are consolidated to be driven by the dorsolateral striatum in rats. We then shift our focus to consider consolidation more broadly, proposing a general model of the advantages of systems in which memories and learned behaviors are consolidated from short-term to long-term learning pathways. In particular, our model proposes that such architectures enable selective filtering of the set of experiences used for learning, which can be essential in noisy environments with many extraneous stimuli. In the appendices, we explore other factors relevant to learning algorithms, including the interaction between multiple sensory modalities, and the problem of credit assignment in multi-layer neural networks. In summary, this work presents a varied set of models of different forms of learning in the brain, emphasizing the cooperative role of plasticity rules and multi-regional circuit architecture in producing functionally useful synaptic weight updates.

Autism spectrum disorders are best understood as a complex set of symptoms that impact social, communication, and behavioral skills. Autistic brains have abnormalities in the anatomy, neural architecture, cytoarchitecture, and neurotransmitter systems (Bharath et al., 2019; Dicarlo & Wallace, 2022; Fatemi et al., 2012; Friedman et al., 2006; Karvat & Kimchi, 2014; Xu et al., 2020). This unique neurology may partially explain why motor impairments are so widespread in this population. Motor impairments are present in up to 88% of autistic people, emerging in early life and persisting into adulthood (Kangarani-Farahani et al., 2023; Liu et al., 2014). These deficits exert a cascading impact, contributing to impairments in daily living skills (Miller et al., 2024; Ozboke et al., 2021; Travers et al., 2022). Creating motor phenotypes that describe how a person’s physiology relates to their unique neurology may help with developing more effective interventions. This program investigates the correlation between biomarkers and psychomotor measures in autistic children. From there, an adjunct intervention is deployed to improve neuromodulation while engaging in motor learning. The goal is to move the field of occupational therapy towards a more precise and effective delivery model in order to achieve greater gains with less dosing of therapy.