Visuospatial Working Memory Predicts Strategic Motor Learning With Visual Feedback During Gait After Stroke

Strategic motor learning, guided by visual feedback (VF), is commonly used in post-stroke gait rehabilitation. While visuospatial working memory (VSWM) has been shown to support VF-guided motor correction in upper limb motor learning tasks, its role in locomotor learning after stroke remains unclear.

We examined whether VSWM is related to strategic learning by examining the overall accuracy and improvement in accuracy over time with VF-guided locomotor learning in individuals with chronic stroke.

Seventy-seven individuals >6 months post-stroke (41 males and 36 females; mean age = 66.3 ± 10.9 years) adapted walking on a split-belt treadmill (2:1 ratio) with real-time VF of step lengths. Feedback was displayed as visual targets on a screen and participants were instructed to use the visual cues to counteract the split-belt perturbation and restore their pre-perturbation step lengths. Strategic learning was assessed using 2 outcomes: overall accuracy and improvement in accuracy over strides during the VF phase. VSWM was assessed with the Spatial Addition subtest of the Wechsler Memory Scale-IV.

After adjusting for age, sex, time since stroke, and lower extremity Fugl-Meyer score, VSWM explained a significant proportion of the variance in both outcomes (overall accuracy: ΔR² = .085, P = .013; improvement in accuracy: ΔR² = .153, P < .001).

Our findings suggest that VSWM may be important for strategic locomotor learning with VF in people with chronic stroke, highlighting its potential relevance as a key consideration in designing walking rehabilitation strategies for people after stroke.