Generalizing the predictive relationship between 1-month motor skill retention and Rey–Osterrieth Delayed Recall scores from nondemented older adults to individuals with chronic stroke: a short report

Abstract

Motor learning is fundamental to motor rehabilitation outcomes. There is growing evidence from non-neurological populations supporting the role of visuospatial memory function in motor learning, but current predictive models of motor recovery of individuals with stroke generally exclude cognitive measures, thereby overlooking the potential link between motor learning and visuospatial memory. Recent work has demonstrated that a clinical test of visuospatial memory (Rey–Osterrieth Complex Figure Delayed Recall) may predict 1-month skill learning in older adults; however, whether this relationship persists in individuals with chronic stroke remains unknown. The purpose of this short report was to validate previous findings using Rey–Osterrieth Complex Figure Delayed Recall test scores to predict motor learning and determine if this relationship generalized to a set of individuals post-stroke. Two regression models (one including Delayed Recall scores and one without) were trained using data from non-stroke older adults. To determine the extent to which Delayed Recall test scores impacted prediction accuracy of 1-month skill learning in older adults, we used leave-one-out cross-validation to evaluate the prediction error between models. To test if this predictive relationship generalized to individuals with chronic ischemic stroke, we then tested each trained model on an independent stroke dataset. Results indicated that in both stroke and older adult datasets, inclusion of Delayed Recall scores explained significantly more variance of 1-month skill performance than models that included age, education, and baseline motor performance alone. This proof-of-concept suggests that the relationship between delayed visuospatial memory and 1-month motor skill performance generalizes to individuals with chronic stroke, and supports the idea that visuospatial testing may provide prognostic insight into clinical motor rehabilitation outcomes.

Using whole-brain diffusion tensor analysis to evaluate white matter structural correlates of delayed visuospatial memory and one-week motor skill retention in nondemented older adults: A preliminary study

“…may predict motor therapy outcomes [ 72 ], a visuospatial test is quick and easy to administer during the duration of a typical clinical visit, making it a more feasible alternative in terms of predicting motor rehabilitation responsiveness. Second, we have previously observed the behavioral relationship between cognitive testing and upper-extremity skill retention across patient populations [ 11 , 73 ], suggesting this relationship is not disease-specific and is broadly generalizable across geriatric populations. Given the prevalence of cognitive impairment even in community-dwelling older adults [ 3 , 74 , 75 ], it is plausible that older adults seeking physical therapy for a variety of reasons could have subtle underlying visuospatial impairments that may impede their responsiveness to therapy, regardless of the etiology (i.e., white matter hyperintensities [ 76 ], stroke, etc.).…”

“…To reduce the dimensionality of our statistical model and address collinearity among model predictors (i.e., mitigate the effect of reduced statistical significance due to collinearity between skill retention and visuospatial test scores), principal component analysis (PC) was used to create a ‘composite score’ that represented the shared variance of skill retention and Delayed Recall score for each participant. Since our previous work has shown a relationship between these two variables [ 11 , 28 ], the PC analysis allowed for consideration of only the shared variance between them as an independent variable. Only PCs with an eigenvalue greater than one were carried forward in subsequent analyses.…”

“…Visuospatial function has been linked to upper-extremity motor improvement (i.e., learning) in older adults [ 8 , 9 ] and individuals with stroke pathology [ 10 ]. Although these prior studies used experimenter-derived (i.e., unstandardized) measures of visuospatial function, a recent study demonstrated that the Rey-Osterrieth Complex Figure Delayed Recall (a clinical test of delayed visuospatial memory) predicted upper-extremity skill learning in older adults and individuals with stroke pathology [ 11 ], suggesting a clinical paper-and-pencil test could aid in predicting motor rehabilitation responsiveness.…”

Relating Global Cognition With Upper-Extremity Motor Skill Retention in Individuals With Mild-to-Moderate Parkinson's Disease

“…Thus, a more comprehensive battery of cognitive assessments would determine whether specific cognitive domains (or specific cognitive deficits) more closely predict motor skill retention in this population. For example, visuospatial deficits may interfere with upper-extremity learning ( 23 – 25 , 52 , 53 ), while fluid cognitive skills or executive function may interfere with lower-extremity learning ( 54 ). While these previous studies have not focused on motor learning in PD specifically, the effects of particular cognitive deficits may not be PD-specific but instead generalize to a number of older patient populations who may be receiving motor rehabilitation for a number of reasons (e.g., stroke, joint replacement).…”