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Motor learning

Motor learning is the process through which individuals acquire, refine, and retain motor skills via practice and experience, leading to relatively permanent improvements in the ability to execute coordinated movements with reduced variability, enhanced speed, and greater accuracy.^[1]^[2] This field encompasses a broad spectrum of phenomena, from low-level mechanisms that maintain movement calibration to high-level skill acquisition, and is fundamentally driven by practice-induced changes in motor performance.^[1]^[2] Historically, motor learning research has evolved from early task-oriented approaches emphasizing global performance measures in the mid-20th century—such as those proposed by Hull in 1943—to more nuanced models incorporating local error analyses and theoretical frameworks like motor programs and schemas.^[2] Key theories include Keele's 1968 concept of motor programs as stored neural commands for precise actions, and Schmidt's 1975 schema theory, which posits generalized motor programs adaptable to specific contexts through fine-tuning.^[2] More recent models, such as Willingham's 1998 COBALT framework, highlight control-based learning with separable neural representations for planning, execution, and evaluation, enabling dual cognitive and motor modes.^[2] Central to motor learning are distinct mechanisms operating on varying timescales: use-dependent learning through repeated task-specific practice, which fosters long-term neural adaptations; instructive learning via explicit strategies and external feedback for rapid refinements; reinforcement learning driven by success-or-failure outcomes to modulate behavior over moderate periods; and sensorimotor adaptation correcting sensory prediction errors for quick recalibrations.^[1] These processes align with specific neural substrates, including the central nervous system for use-dependent changes, prefrontal cortex for instructive guidance, basal ganglia for reinforcement, and cerebellum for adaptation.^[1] A classic model of progression, proposed by Fitts and Posner, delineates three stages: the cognitive stage of initial, variable performance; the associative stage of refinement and error reduction; and the autonomous stage of automatic, efficient execution.^[1] In practice, motor learning principles have transformed fields like physical therapy and education, shifting from rigid neurophysiological paradigms to evidence-based, patient-tailored interventions that leverage these mechanisms for rehabilitation and skill development.^[1] Ongoing research emphasizes optimizing combinations of these elements to maximize functional outcomes, particularly in diverse populations such as those with neurological impairments.^[1]

Fundamentals

Definition and Scope

Motor learning refers to the acquisition, refinement, and retention of motor skills through practice, experience, and feedback, involving adaptive changes in the internal processes that govern movement execution.^[3] This process results in relatively permanent modifications in an individual's capability to perform skilled actions, stored in long-term memory and demonstrable over time.^[4] Broadly, it encompasses motor adaptation, where movements adjust to environmental perturbations; skill acquisition, which develops novel coordination patterns; and elements of decision-making in action selection.^[5] Motor learning is distinct from motor control, which concerns the real-time coordination and execution of movements using existing capabilities, whereas motor learning emphasizes the improvement and stabilization of skills through repeated exposure.^[6] It also differs from motor development, which describes ontogenetic changes in motor abilities across the lifespan, often driven by maturation rather than targeted practice; in contrast, motor learning focuses on experience-dependent enhancements in specific skills that not all individuals necessarily acquire uniformly.^[7] Key characteristics of motor learning include the benefits of variability in practice, which promotes generalization by exposing learners to diverse conditions, enhancing adaptability beyond the practiced scenarios.^[8] True learning is verified through retention, assessed by performance after a delay without practice to distinguish temporary performance gains from enduring changes, and transfer, where skills apply to novel but related contexts.^[3] These features underscore motor learning's emphasis on durable, flexible improvements rather than immediate proficiency. Representative examples illustrate its scope: learning to ride a bicycle exemplifies a procedural motor skill, involving balance and coordination that become automatic with practice, while typing represents a perceptual-motor skill, integrating visual input with fine finger movements for efficient output.^[9] Such skills progress through stages of increasing efficiency, from initial cognitive effort to fluid execution.^[3]

Stages of Motor Learning

Motor learning progresses through distinct stages as individuals acquire and refine skills, with classic models providing frameworks for understanding this development. One influential model is the three-stage theory proposed by Fitts and Posner, which delineates the cognitive, associative, and autonomous stages.^[10] In the cognitive stage, learners focus on understanding the task requirements, often verbally rehearsing movements and committing frequent errors due to trial-and-error exploration.^[10] Performance is inconsistent and heavily reliant on conscious effort, with high variability in movement execution as the individual constructs a mental representation of the skill.^[10] As practice continues, the learner transitions to the associative stage, where movements are refined through feedback integration, error detection improves, and coordination becomes more fluid.^[10] Finally, in the autonomous stage, skilled execution occurs with minimal conscious control, allowing automaticity and efficient performance even under divided attention.^[10] Gentile's two-stage model complements this by emphasizing goal-oriented progression in motor skill acquisition.^[11] The early stage involves developing basic, goal-directed actions in a stable environment, where learners prioritize achieving the task objective through gross movement patterns.^[11] In the later stage, focus shifts to inter-segmental coordination, enabling adaptability to variable contexts and open skills, such as adjusting to environmental changes during execution.^[11] Across these stages, progression is marked by measurable improvements, including decreased error rates, faster execution times, and reduced cognitive load, as evidenced by enhanced dual-task performance in later phases.^[12] For instance, novices in the initial stages exhibit higher error variability and slower response times, which diminish with practice as automaticity develops, allowing concurrent cognitive demands without performance decrement.^[12] Empirical studies support these transitions through neurophysiological markers, such as electroencephalographic (EEG) changes. Research on motor skill acquisition, like visuomotor adaptation tasks, shows shifts from elevated beta waves (indicating active cognitive processing) in early stages to increased alpha waves (reflecting relaxed, efficient control) in advanced stages, correlating with reduced performance errors over time.^[13] These patterns underscore how brain activity evolves from effortful monitoring to streamlined automation as skills mature.^[13]

Behavioral Approaches

Practice Structures and Interference

Practice structures encompass the organization and scheduling of tasks within training sessions, profoundly impacting the acquisition, retention, and transfer of motor skills. Key approaches include blocked practice, in which repetitions of a single skill occur consecutively before switching tasks, and random practice, which interleaves multiple skills in an unpredictable sequence. Blocked practice promotes quick performance gains during initial learning by allowing focused repetition and reduced cognitive load, but it often results in diminished long-term retention and adaptability to novel contexts. In contrast, random practice introduces greater variability, fostering deeper processing and problem-solving that enhance skill generalization despite slower early progress.^[14]^[15] The contextual interference effect underpins these differences, positing that higher interference during practice—achieved through random scheduling—impedes immediate performance but bolsters enduring memory traces via increased cognitive effort and elaborative rehearsal. Originally conceptualized by Battig (1979) in verbal learning contexts, this effect was adapted to motor skills by Shea and Morgan (1979), who demonstrated that random practice groups outperformed blocked groups in retention and transfer tests following acquisition of barrier knockdown tasks. High contextual interference encourages learners to reconstruct movement schemas on each trial, promoting flexibility and reducing reliance on rote repetition. These structures particularly optimize transitions between cognitive and associative stages of motor learning by aligning variability with evolving skill demands.^[16]^[14] Whole versus part practice methods further refine session organization based on skill complexity and interdependence. Whole practice entails performing the complete movement pattern intact, which is advantageous for simple, continuous skills with high organization, such as learning basic swimming strokes, as it preserves natural timing and coordination. Part practice, conversely, segments the skill into discrete components for sequential mastery, proving more effective for complex, discrete tasks with low inter-part dependencies, like multi-step gymnastics routines. A meta-analysis of 20 studies found whole practice superior for retention in highly interdependent skills, while part methods excelled for low-interdependence ones, guiding practitioners to match methods to task characteristics.^[17] Serial position effects also influence practice schedules, where the order of tasks within a session affects encoding and recall. Skills introduced early (primacy effect) benefit from extended rehearsal time, leading to stronger initial consolidation, while those at the end (recency effect) gain from fresher attention and reduced proactive interference. Middle-position tasks, however, may suffer poorer retention due to bidirectional interference, prompting schedules that distribute critical skills to optimize across positions—such as serial practice, a hybrid blending predictable sequences with variability to mitigate these biases. Empirical evidence from sequence learning paradigms shows primacy and recency advantages persisting into retention tests, informing balanced designs in sports training.^[18] Meta-analytic syntheses underscore the practical impact of these structures, revealing high-interference protocols yield medium effect sizes on retention (Hedges' g ≈ 0.50 in laboratory tasks), translating to substantial 20-30% improvements in skill persistence over blocked approaches in sports-related activities like tennis serves or golf putting. These gains are most pronounced in adults and controlled environments, though benefits attenuate in applied, high-pressure settings.^[19]^[20]

Feedback Mechanisms

In motor learning, feedback mechanisms provide essential augmented information to learners, enabling error detection, correction, and skill refinement beyond what intrinsic sensory cues alone afford. This external feedback, often delivered by coaches, technology, or self-assessment tools, is categorized into two primary types: knowledge of results (KR) and knowledge of performance (KP). The timing, frequency, and specificity of this feedback significantly impact acquisition, retention, and transfer, with optimal strategies balancing guidance during practice against fostering independent error estimation for long-term learning.^[21] Knowledge of results (KR) focuses on the environmental outcome of a movement relative to the intended goal, without detailing the underlying execution. For instance, in a basketball free-throw task, KR might state, "The ball landed 10 centimeters short of the hoop," allowing the learner to infer success or failure based on results. KR schedules vary in frequency; a 100% schedule provides feedback after every trial, while reduced or faded schedules deliver it less often, such as after every other trial initially and then progressively less, to encourage intrinsic processing. Faded KR promotes better retention by reducing dependency on external cues, as demonstrated in studies where reduced frequency led to superior post-acquisition performance compared to constant provision.^[21]^[22] Knowledge of performance (KP), in contrast, addresses the qualitative or quantitative aspects of the movement itself that contribute to the outcome, offering insights into form and technique. An example is coaching feedback like, "Your elbow dropped too low during the swing, reducing power," which can be augmented through video analysis, motion capture, or verbal instruction to highlight biomechanical errors. KP is particularly valuable for complex skills requiring precise coordination, as it targets movement patterns directly, though it demands careful delivery to avoid overwhelming the learner.^[21] Bandwidth feedback refines KR or KP by providing information only when errors exceed a predefined tolerance threshold, such as delivering no feedback for throws within 5% of the target distance. This approach prevents information overload and encourages self-correction for minor deviations, enhancing learning efficiency by focusing on substantial errors. Research shows bandwidth KR increases movement consistency more than 100% relative frequency KR, as it aligns feedback with goal-relevant discrepancies rather than every attempt.^[23] The guidance hypothesis posits that frequent augmented feedback acts as a temporary "crutch," boosting immediate performance by guiding corrections but potentially hindering retention and transfer if over-relied upon, as learners fail to develop internal error-detection skills. Optimal feedback frequency thus involves intermittency to promote cognitive processing and adaptability, with excessive provision degrading long-term learning despite short-term gains. This framework, originally proposed by Schmidt, underscores the trade-off between performance enhancement and skill consolidation.^[24] Empirical evidence supports these mechanisms; for example, in a linear positioning task, participants receiving a 50% faded KR schedule exhibited approximately 35% lower errors on a delayed retention test compared to those under 100% KR, highlighting the benefits of reduced frequency for enduring skill acquisition. Similarly, bandwidth strategies have been shown to facilitate motor program learning by emphasizing meaningful errors, leading to more robust generalization when integrated briefly with variable practice structures. These findings emphasize tailored feedback as a cornerstone of effective motor skill development.^[22]^[23]

Specificity and Transfer of Learning

The specificity of learning hypothesis posits that motor skills acquired in particular contexts exhibit limited transfer to novel situations unless the practice environment closely replicates the target conditions, as skills become tuned to specific sensory, environmental, and task demands.^[25] For instance, practicing a golf swing on a putting green may yield poor performance on actual course grass due to differences in terrain and visual cues, emphasizing the need for context-specific training to optimize real-world application.^[26] Transfer of learning in motor skills can be categorized by its effects and degree of similarity between tasks. Positive transfer occurs when prior practice facilitates performance on a new skill, such as improved throwing accuracy after training with varied ball weights; negative transfer arises when previous learning interferes, like habitual overhand motions hindering underhand adaptations; and zero transfer indicates no influence from prior experience on unrelated tasks.^[18] Additionally, transfer is distinguished as near (to similar contexts, e.g., adapting a tennis serve to squash) or far (to dissimilar ones, e.g., applying balance skills from cycling to gymnastics routines), with near transfer generally more robust due to shared elements.^[27] Schema theory, introduced by Schmidt in 1975, counters strict specificity by proposing that learners develop abstract representations—generalized motor programs paired with recall and recognition schemas—that enable parameterization and adaptation to novel conditions without rote memorization.^[28] Practice variability plays a key role in strengthening these schemas, as exposure to diverse task parameters (e.g., varying speeds or distances in throwing) fosters flexible rules for parameter adjustment, enhancing generalization over constant repetition.^[29] Empirical evidence supports these principles, with laboratory studies showing that varied practice leads to superior transfer compared to constant practice; for example, participants trained on multiple barrier-clearing distances exhibited 24% lower absolute timing errors on novel distances than those trained on a single distance.^[25] Contextual interference, through randomized practice schedules, further enhances such transfer by promoting deeper processing and adaptability.^[30]

Physiological Mechanisms

Neural Substrates

Motor learning relies on a distributed network of brain regions that coordinate movement execution, planning, error detection, and habit formation. The primary motor cortex (M1), located in the precentral gyrus, serves as the principal site for executing voluntary movements by directly projecting to spinal motor neurons.^[31] Adjacent frontal regions, including the premotor cortex (PMC) and supplementary motor area (SMA), contribute to the planning and sequencing of complex actions; the PMC integrates sensory cues with motor output for externally guided movements, while the SMA supports internally generated sequences and bimanual coordination.^[31] These cortical areas form the foundational cortical substrates for initiating and refining motor skills. The cerebellum is essential for fine-tuning motor performance through error correction and precise timing. It maintains forward and internal models that predict the sensory consequences of movements, enabling anticipatory adjustments before feedback arrives.^[32] Climbing fibers from the inferior olive provide critical error signals to Purkinje cells, driving synaptic modifications that refine these predictive models during learning tasks such as adaptation to visuomotor perturbations.^[33] The basal ganglia, a subcortical group comprising the striatum, globus pallidus, subthalamic nucleus, and substantia nigra, facilitate habit formation and action sequencing. Through parallel direct and indirect pathways, it modulates thalamocortical output: the direct pathway promotes selected actions via D1 dopamine receptor excitation, while the indirect pathway suppresses competing ones via D2 receptor inhibition.^[34] Dopamine release from the substantia nigra reinforces successful sequences, consolidating skills into automatic habits during repeated practice.^[35] Functional neuroimaging, particularly fMRI, has revealed dynamic shifts in regional activation across learning phases. Early cognitive stages exhibit widespread cortical involvement, including M1, PMC, SMA, and prefrontal areas, reflecting effortful planning and error monitoring.^[36] As skills advance to autonomous execution, activation narrows to subcortical structures like the basal ganglia and cerebellum, indicating streamlined processing.^[36] Seminal studies from the 1990s onward, such as Karni et al. (1998) on finger sequencing, demonstrated this progression, with initial bilateral activations becoming more focal and contralateral over sessions.^[36] In sequence learning paradigms, Doyon et al. (2009) highlighted basal ganglia dominance in early chunking of movements and cerebellar refinement in timing accuracy, underscoring their complementary roles.^[37] These substrates are linked through cortico-striatal-thalamo-cortical loops that underpin procedural memory formation. Cortical inputs to the striatum converge with dopaminergic modulation, relaying via the thalamus back to motor areas to stabilize learned sequences without conscious awareness.^[38] Such interconnections ensure efficient integration of planning, execution, and adaptation. Neural activation patterns during motor learning align with behavioral stages, transitioning from explicit cortical control to implicit subcortical automation.^[36]

Role of Neuroplasticity

Neuroplasticity refers to the brain's ability to undergo adaptive changes in response to motor learning experiences, enabling the refinement and retention of skilled movements through modifications at synaptic, structural, and molecular levels. These changes primarily occur within neural substrates such as the motor cortex and hippocampus, supporting the encoding and consolidation of motor skills. Synaptic plasticity, a core mechanism, involves the strengthening or weakening of connections between neurons, which underlies the acquisition of new motor behaviors. A key form of synaptic plasticity in motor learning is long-term potentiation (LTP), which enhances synaptic efficacy in the motor cortex following repetitive practice, thereby strengthening neural connections essential for skill execution. LTP in the motor cortex has been observed to persist for extended periods after training, facilitating the stabilization of learned movements. Similarly, LTP in the hippocampus contributes to the spatial and sequential aspects of motor tasks, promoting efficient learning of movement patterns. This process adheres to the Hebbian rule, where coincident pre- and postsynaptic neuronal activity leads to synaptic strengthening, often summarized as "cells that fire together wire together," and has been demonstrated to enhance human motor performance through timed stimulation protocols.^[39]^[40]^[41] Structural neuroplasticity manifests as physical remodeling of neural architecture, including dendritic spine growth in motor areas after intensive practice, which increases the capacity for synaptic connections and supports long-term skill retention. For instance, exercise-induced motor training elevates dendritic spine formation rates in the motor cortex by up to 15% within days, enhancing neuronal excitability and learning outcomes. Additionally, cortical map reorganization occurs, with expanded representations for frequently used body parts; in musicians, prolonged practice leads to enlarged somatosensory and motor cortical maps for trained fingers, reflecting use-dependent adaptations that improve dexterity.^[42]^[43] At the molecular level, brain-derived neurotrophic factor (BDNF) and N-methyl-D-aspartate (NMDA) receptors play crucial roles in synaptic consolidation during motor learning, with BDNF promoting LTP induction and NMDA receptors mediating calcium influx necessary for plasticity. BDNF secretion, triggered by motor activity, activates TrkB receptors to facilitate synaptic potentiation, while NMDA dependency ensures activity-specific changes. Sleep-dependent replay further supports offline learning, where neural ensembles in the motor cortex reactivate task-related patterns during non-rapid eye movement sleep, leading to performance gains of up to 20% in speed without accuracy loss.^[44] Recent studies as of 2025 indicate that hippocampal sharp-wave ripples during brief rests also predict motor performance gains of up to 20% in speed for young adults.^[45] Animal studies, such as those involving skilled reaching tasks, show synaptic strengthening of 43-52% in motor cortex field potentials after 3-6 days of training, persisting for months. Human transcranial magnetic stimulation (TMS) studies confirm use-dependent plasticity, with motor learning enhancing corticospinal excitability and movement biases by 2-3 fold compared to random practice. These changes exhibit a biphasic time course: rapid alterations within hours, driven by initial LTP and spine formation, followed by long-term consolidation over days to weeks, involving structural remodeling and sleep-mediated replay for enduring skill mastery.^[46]^[47]^[48]^[40]

Clinical and Applied Aspects

Disorders of Motor Learning

Developmental coordination disorder (DCD) is a neurodevelopmental condition characterized by significant impairments in the acquisition and execution of coordinated motor skills, affecting approximately 5-6% of school-aged children.^[49] According to DSM-5 criteria, diagnosis requires motor coordination substantially below age expectations, interference with daily activities or academic performance, onset during developmental years, and exclusion of other medical or intellectual conditions as primary causes.^[50] Children with DCD exhibit deficits in motor planning and execution, leading to challenges in skill acquisition such as handwriting, where fine motor control and spatial organization are compromised.^[51] Recent studies indicate a prevalence of around 7% in specific school-age subgroups, highlighting its underrecognition in educational settings.^[52] Apraxia represents another key disorder disrupting motor learning, involving difficulties in performing purposeful movements despite preserved strength, sensation, and comprehension. Ideomotor apraxia manifests as impaired execution of learned gestures, such as pantomiming tool use, even when the individual understands the task and has no primary motor deficits.^[53] Ideational apraxia, in contrast, features errors in sequencing multi-step actions, like preparing a meal, resulting from disrupted conceptualization of motor plans.^[54] These forms often arise post-stroke, with lesions in the left parietal lobe disrupting the transformation of intentions into coordinated actions.^[55] In Parkinson's disease, degeneration of dopaminergic neurons in the basal ganglia leads to impaired habit learning, a core component of procedural motor skill acquisition.^[56] This dopamine loss hinders the reinforcement of stimulus-response associations, resulting in slowed adaptation to repetitive motor tasks and reduced automaticity in skilled movements.^[57] Cerebellar ataxia, stemming from cerebellar damage, causes timing disruptions in error-based learning mechanisms, where individuals struggle to adjust movements based on sensory feedback for precise coordination.^[58] These deficits impair predictive control of trajectories, as seen in reaching tasks with exaggerated variability and poor correction of errors.^[59] Such disorders often disrupt specific neural substrates, including the basal ganglia, underscoring their role in pathological motor adaptations. Assessment of motor learning disorders relies on standardized tools to quantify impairments. For DCD, the Movement Assessment Battery for Children-Second Edition (MABC-2) evaluates manual dexterity, aiming and catching, and balance through age-normed tasks, identifying children scoring below the 15th percentile as at risk.^[60] This instrument demonstrates high validity and reliability for detecting motor coordination deficits in both typically developing and impaired populations.^[61] Individuals with these disorders experience reduced retention and transfer of motor skills, manifesting as substantially lower performance in tasks requiring adaptation and generalization.^[62] For instance, children with DCD show limited carryover of practiced movements to novel contexts, perpetuating challenges in daily functioning and academic participation.^[63]

Interventions in Motor Skill Acquisition

Interventions in motor skill acquisition encompass a range of evidence-based strategies designed to enhance learning and performance, particularly in rehabilitation and athletic contexts, by leveraging principles of neuroplasticity and practice optimization. In stroke rehabilitation, constraint-induced movement therapy (CIMT) is a prominent technique that restricts the use of the unaffected limb to force intensive practice of the affected one, promoting neural reorganization and functional recovery. Developed to counter learned non-use, CIMT typically involves 6 hours of daily task-oriented training for 2 weeks, leading to improved upper extremity function. Randomized controlled trials, such as the EXCITE study, demonstrated significant gains in motor ability, with participants showing improvements in upper-limb function scores like the Wolf Motor Function Test compared to controls.^[64] Updated meta-analyses confirm these effects persist, with moderate to large effect sizes on arm motor activities lasting up to a year post-intervention. Virtual reality (VR) systems complement CIMT by providing immersive, variable practice environments that simulate real-world tasks, enhancing engagement and adaptability. Systematic reviews of RCTs indicate VR training yields significant improvements in motor performance and balance, with effect sizes ranging from 0.4 to 0.8 for upper extremity function in stroke survivors, outperforming conventional therapy in some domains due to its ability to deliver high-repetition, feedback-rich sessions.^[65] In sports and educational settings, mental imagery—also known as motor imagery—serves as a cognitive rehearsal tool to accelerate progression toward the autonomous stage of motor learning, where skills become automatic and less prone to disruption. By mentally simulating movements, athletes can strengthen neural pathways without physical fatigue, leading to enhanced skill acquisition and performance. A systematic review of studies across various sports found motor imagery effective for open and reactive skills, with improvements in accuracy and speed comparable to physical practice.^[66] Dual-task training, which combines motor practice with cognitive demands (e.g., walking while performing mental arithmetic), further aids this transition by reducing interference and building divided attention capacity. Research shows dual-task protocols improve retention and transfer of skills, particularly in complex environments, with participants exhibiting better performance under secondary load after training compared to single-task groups. Periodization in training schedules optimizes contextual interference by alternating high-variability practice blocks with consolidation periods, preventing plateaus and maximizing long-term retention. Frameworks like the PoST model advocate structured skill periodization, where progressive increases in task complexity yield superior learning outcomes in elite sports, as evidenced by longitudinal studies.^[67] Pharmacological aids target underlying neurochemical deficits to bolster motor learning, especially in neurological disorders. In Parkinson's disease, dopamine agonists enhance basal ganglia-dependent procedural learning by mimicking endogenous dopamine signaling, facilitating habit formation and reducing bradykinesia during skill acquisition. Clinical trials demonstrate that agonists like pramipexole improve motor learning rates in reward-based tasks, with effects most pronounced in early-stage patients.^[68] Timing interventions with post-stroke plasticity windows—typically the acute phase within 2-6 weeks—amplifies recovery, as heightened neural excitability allows for greater synaptic reorganization. Early intensive therapies during this period, supported by RCTs, result in better functional outcomes than delayed starts. Technological integrations, such as exoskeletons with adaptive feedback, provide real-time haptic guidance to correct movement errors, promoting precise motor recalibration. Studies on lower-limb exoskeletons report improvements in gait symmetry and endurance for stroke patients, with adaptive algorithms adjusting assistance based on performance metrics to foster independent control.^[69] For aging populations, where neuroplasticity declines, compensatory strategies like spaced practice counteract reduced learning efficiency by distributing sessions over time to enhance consolidation. In older adults, spaced repetition outperforms massed practice for visuospatial and motor tasks, yielding better retention after 24 hours, as it mitigates cognitive overload and supports hippocampal-dependent memory. This approach is particularly effective in rehabilitation, where combining spaced sessions with motor imagery helps older individuals acquire balance and coordination skills, addressing age-related deficits in automaticity. Recent advancements as of 2025 include AI-driven adaptive systems in VR and exoskeletons, which personalize feedback based on real-time performance data to optimize motor learning outcomes in diverse clinical populations.^[70]

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Direct current stimulation promotes BDNF-dependent synaptic ...
We propose that tDCS may improve motor skill learning through augmentation of synaptic plasticity that requires BDNF-secretion and TrkB-activation within M1.
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Sleep-Dependent Reactivation of Ensembles in Motor Cortex ...
Sep 18, 2015 · These offline improvements were linked to both replay of task-related ensembles during non-rapid eye movement (NREM) sleep and temporal shifts ...
[46]
Plasticity of the Synaptic Modification Range | Journal of Neurophysiology | American Physiological Society
### Key Findings on Synaptic Strengthening After Motor Learning
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Motor Learning Enhances Use-Dependent Plasticity - PMC
Mar 8, 2017 · We then delivered 15 TMS-evoked thumb movements to ensure similar level of performance and use-dependent plasticity (UDP; pre2-training session) ...
[48]
Diagnosis and management of developmental coordination disorder
Developmental coordination disorder is a prevalent childhood disability affecting 5%–6% of school-aged children. The disorder has long been underrecognized and ...
[49]
Developmental Coordination Disorder DSM-5 315.4 (F82) - Theravive
Diagnostic Criteria. The acquisition and execution of coordinated motor skills is substantially below that expected for the patient's age and opportunities for ...
[50]
Assessment, diagnosis, and management of developmental ...
Sep 20, 2021 · Developmental coordination disorder (DCD) is a neurodevelopmental condition that affects 5% to 6% of school-aged children.
[51]
The prevalence of developmental coordination disorder in children
Sep 25, 2024 · The prevalence of children with DCD was found to be 5%. A subgroup analysis showed that prevalence was 7% [95% confidence interval (CI) 4%–10%] and 4% (95% CI ...
[52]
Update on Apraxia - PMC - NIH
Ideomotor apraxia may be seen following injury to brain regions other than the frontal and parietal areas typically associated with apraxia. For example ...
[53]
Limb Apraxias: The Influence of Higher Order Perceptual and ...
Dec 21, 2022 · In contrast, ideomotor apraxia was thought to involve damage to the left parietal cortex. Its role was thought to transform movement ideas into ...
[54]
Limb apraxia and the left parietal lobe - PMC - NIH
Focusing primarily on limb apraxia after left parietal stroke, this chapter examines the neuroanatomic substrates of apraxia, and reviews historical accounts ...Classic Theories Of Apraxia · Anatomic And Cognitive... · Future Directions And...
[55]
The role of the basal ganglia in learning and memory
However, subsequent work has demonstrated that Parkinson's disease patients are impaired at some but not all types of non-declarative learning tasks, as ...
[56]
Impaired Formation and Expression of Goal-Directed and Habitual ...
Oct 24, 2021 · Our results showed that during the instrumental training phase, PD patients had impaired learning not only of the standard and congruent ...
[57]
The cerebellum does more than sensory prediction error-based ...
Individuals with cerebellar pathology are impaired in sensorimotor adaptation. This deficit has been attributed to an impairment in error-based learning, ...
[58]
Can patients with cerebellar disease switch learning mechanisms to ...
Jan 28, 2019 · Patients with an impaired cerebellum have SPE learning deficits, leading to poor performance during motor adaptation tasks (Martin et al., 1996; ...
[59]
https://academic.oup.com/brain/article/142/3/662/5303332
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Validity and reliability of the movement assessment battery second ...
Apr 28, 2022 · The MABC-2 test can be considered a valid and reliable motor skill assessment tool for children with and without motor impairment.
[61]
Motor learning in developmental coordination disorder
Jun 22, 2023 · Taken together, our findings suggest that adolescents with DCD and low motor competence may have limited transfer of brain activity to tasks ...
[62]
Pediatric care for children with developmental coordination disorder ...
DCD is sometimes called a motor learning deficit, as these children have difficulties learning to perform all kinds of motor skills in daily life, whereas their ...