Objective. Clinicians may use implicit or explicit motor learning approaches to facilitatemotor learning of patients with stroke. Implicit motor learning approaches have shown promising results in healthy populations. The purpose of this study was to assess whether an implicit motor learning walking intervention is more effective compared with an explicit motor learning walking intervention delivered at home regarding walking speed in people after stroke in the chronic phase of recovery. Methods. This randomized, controlled, single-blind trial was conducted in the home environment. The 79 participants, who were in the chronic phase after stroke (age = 66.4 [SD = 11.0] years; time poststroke = 70.1 [SD = 64.3] months; walking speed = 0.7 [SD = 0.3] m/s; Berg Balance Scale score = 44.5 [SD = 9.5]), were randomly assigned to an implicit (n = 38) or explicit (n = 41) group. Analogy learning was used as the implicit motor learning walking intervention, whereas the explicit motor learning walking intervention consisted of detailed verbal instructions. Both groups received 9 training sessions (30 minutes each), for a period of 3 weeks, targeted at improving quality of walking. The primary outcome was walking speed measured by the 10-MeterWalk Test at a comfortable walking pace. Outcomes were assessed at baseline, immediately after intervention, and 1 month postintervention. Results. No statistically or clinically relevant differences between groups were obtained postintervention (between-group difference was estimated at 0.02 m/s [95% CI = −0.04 to 0.08] and at follow-up (between-group difference estimated at −0.02 m/s [95% CI = −0.09 to 0.05]). Conclusion. Implicit motor learning was not superior to explicit motor learning to improve walking speed in people after stroke in the chronic phase of recovery. Impact. To our knowledge, this is the first study to examine the effects of implicit compared with explicit motor learning on a functional task in people after stroke. Results indicate that physical therapists can use (tailored) implicit and explicit motor learning strategies to improve walking speed in people after stroke who are in the chronic phase of recovery.
Objectives: To investigate immediate changes in walking performance associated with three implicit motor learning strategies and to explore patient experiences of each strategy. Design: Participants were randomly allocated to one of three implicit motor learning strategies. Within-group comparisons of spatiotemporal parameters at baseline and post strategy were performed. Setting: Laboratory setting. Subjects: A total of 56 community-dwelling post-stroke individuals. Interventions: Implicit learning strategies were analogy instructions, environmental constraints and action observation. Different analogy instructions and environmental constraints were used to facilitate specific gait parameters. Within action observation, only videotaped gait was shown. Main measures: Spatiotemporal measures (speed, step length, step width, step height) were recorded using Vicon 3D motion analysis. Patient experiences were assessed by questionnaire. Results: At a group level, three of the four analogy instructions (n=19) led to small but significant changes in speed (d=0.088m/s), step height (affected side d=0.006m) and step width (d=–0.019m), and one environmental constraint (n=17) led to significant changes in step width (d=–0.040m). At an individual level, results showed wide variation in the magnitude of changes. Within action observation (n=20), no significant changes were found. Overall, participants found it easy to use the different strategies and experienced some changes in their walking performance. Conclusion: Analogy instructions and environmental constraints can lead to specific, immediate changes in the walking performance and were in general experienced as feasible by the participants. However, the response of an individual patient may vary quite considerably.
Background: A significant part of neurological rehabilitation focuses on facilitating the learning of motor skills. Training can adopt either (more) explicit or (more) implicit forms of motor learning. Gait is one of the most practiced motor skills within rehabilitation in people after stroke because it is an important criterion for discharge and requirement for functioning at home. Objective: The aim of this study was to describe the design of a randomized controlled study assessing the effects of implicit motor learning compared with the explicit motor learning in gait rehabilitation of people suffering from stroke. Methods: The study adopts a randomized, controlled, single-blinded study design. People after stroke will be eligible for participation when they are in the chronic stage of recovery (>6 months after stroke), would like to improve walking performance, have a slow walking speed (<1 m/s), can communicate in Dutch, and complete a 3-stage command. People will be excluded if they cannot walk a minimum of 10 m or have other additional impairments that (severely) influence gait. Participants will receive 9 gait-training sessions over a 3-week period and will be randomly allocated to an implicit or explicit group. Therapists are aware of the intervention they provide, and the assessors are blind to the intervention participants receive. Outcome will be assessed at baseline (T0), directly after the intervention (T1), and after 1 month (T2). The primary outcome parameter is walking velocity. Walking performance will be assessed with the 10-meter walking test, Dynamic Gait Index, and while performing a secondary task (dual task). Self-reported measures are the Movement Specific Reinvestment Scale, verbal protocol, Stroke and Aphasia Quality of Life Scale, and the Global Perceived Effect scale. A process evaluation will take place to identify how the therapy was perceived and identify factors that may have influenced the effectiveness of the intervention. Repeated measures analyses will be conducted to determine significant and clinical relevant differences between groups and over time. Results: Data collection is currently ongoing and results are expected in 2019. Conclusions: The relevance of the study as well as the advantages and disadvantages of several aspects of the chosen design are discussed, for example, the personalized approach and choice of measurements.
In my PD research, I want to focus on how collectivity is practiced in the arts, by learning from the Indonesian multidisciplinary art collective ruangrupa’s use of [the international art exhibition] ‘documenta’ as a tool, and the potential of continuing the experiences outside this group and context. The art practices programmed by ruangrupa can be understood as complex and ambiguous where art is not at the center of attention but part of a larger communal productivity. And where it is not sufficient to be merely critical, and merely voice opposition, but to engage, and create alternatives in everyday life [without being problem-solving or social design]. My research concerns the potential of continuing these practices and experiences outside this particular artist group and exhibition context. Ruangrupa’s work reveals problems of the current Western art system, how it is (hierarchically) organized, the implicit rules, norms and values it is based on. Ruangrupa's practice thus serves as an exercise and point of departure to answer questions about forms of self-organization within the art field. Its collective and multidisciplinary art practice implies the question whether it also can serve as a model for living together on a larger scale (also outside the arts), beyond hierarchies of social and professional structures. There is currently a lack of research on these particular art practices, so that they are not easily accessible for non-participants. For the art field in particular, this concerns the question whether contemporary art can and needs to take place outside established Western gallery/museum, art/curatorial paradigms and what can be learned from ruangrupa's and documenta fifteen's blending of art practice with daily life practice. This is also an urgent practical issue for art schools (including my school Willem de Kooning Academy) that increasingly develop art study programs outside the studio and gallery art paradigm.
Tango is among the most widespread world music genres nowadays. However, only partial information about the elements and techniques of composing, arranging and performing tango has been documented and made available so far. This research project aims at investigating tango’s main aspects in the oeuvre of relevant tango musicians, promoting its creative practice and expanding its artistic community. By making the implicit knowledge in scores and recordings explicit and ready for creative use by the greater artistic community, tango can be preserved, on one side; and musicians can experiment and reach new artistic horizons, securing its continuation and development as vivid, contemporary music, on the other. The project has two research questions: 1. What are the main features and techniques of tango music composition, arrangement and performance? 2. How can musicians nowadays integrate these features and techniques into their practice to deepen their understanding and enhance their artistic creations and performances? This research uses a mixed method design, including the analysis of scores and recordings, literature review, interviews, observational studies and experimentation. It expands the artistic community on the topic and bridges two top-notch institutions devoted to tango learning: Codarts and UNSAM (Argentina). The research also endeavours improvements in the Codarts curriculum as it complements and expands its educational programme by providing students with research tools to enhance their creative practice. Theoretical and artistic outcomes will be documented and disseminated in concerts, concert-lectures, papers, articles and a tailor-made website containing compositions, arrangements, videos, text, musical examples and annotated scores, so as to record: a) the musical materials and techniques found in the analysed scores and recordings, together with their applications in practice and performance; b) the artistic processes, reflections and production of the participants; c) information on how to create, arrange and perform tangos.
Sustainable business decision-making as villagers of the world In making our society resilient and future-proof we are faced with many complex and multi-faceted challenges and opportunities. Many promising sustainable initiatives require the proactive contribution of businesses to be successful, but fail to reach the required decision making level of individuals and companies, and thus fail to reach their positive impact. The result is a multiple waste: in creativity and innovation, in investment of the organisations involved, in opportunities to improve society and in our overall belief that we can make the necessary changes. In this project we focus on the reasons why individuals and thus companies act and decide negatively on new and existing sustainable innovations and projects, starting from the perspective that a professional’s and a company’s inherent sustainable decision making is at the heart of truly improving society. The aim is to create multiple value (economic, social and ecological) of SMEs by increasing the success rate of sustainability initiatives out of an implicit business professional’s choice to do so. Based on the theory of psychological distance, we combine exploratory case studies of successful pilots with exploratory research via interviews with business decision makers, to analyse what drives professional’s and companies’ decision making, and how this affects sustainable initiatives. The aim is to propose ways to increase the quality of sustainable decision making, and thus the likelihood of success. The learnings are translated to practical guidelines a SME should consider for executing their business in the most sustainable way, and form a base for further applied research on sustainable business behaviour towards a circular economy.
