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Executive Function Is Associated With Off-Line Motor Learning in People With Chronic Stroke

Al-dughmi, Mayis PT; Al-Sharman, Alham PT, PhD; Stevens, Suzanne MD; Siengsukon, Catherine F. PT, PhD

Journal of Neurologic Physical Therapy: April 2017 - Volume 41 - Issue 2 - p 101–106
doi: 10.1097/NPT.0000000000000170
Research Articles
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Background and Purpose: Sleep has been shown to promote off-line motor learning in individuals following stroke. Executive function ability has been shown to be a predictor of participation in rehabilitation and motor recovery following stroke. The purpose of this study was to explore the association between executive function and off-line motor learning in individuals with chronic stroke compared with healthy control participants.

Methods: Seventeen individuals with chronic stroke (>6 months poststroke) and 9 healthy adults were included in the study. Participants underwent 3 consecutive nights of polysomnography, practiced a continuous tracking task the morning of the third day, and underwent a retention test the morning after the third night. Participants underwent testing on 4 executive function tests after the continuous tracking task retention test.

Results: Participants with stroke showed a significant positive correlation between the off-line motor learning score and performance on the Trail-Making Test from Delis-Kaplan Executive Function System (r = 0.652; P = 0.005), while the healthy control participants did not. Regression analysis showed that the Trail-Making Test–Delis-Kaplan Executive Function System is a significant predictor of off-line motor learning (P = 0.008).

Discussion and Conclusions: This is the first study to demonstrate that better performance on an executive function test of attention and set-shifting predicts a higher magnitude of off-line motor learning in individuals with chronic stroke. This emphasizes the need to consider attention and set-shifting abilities of individuals following stroke as these abilities are associated with motor learning. This in turn could affect learning of activities of daily living and impact functional recovery following stroke.

Video Abstract available for more insights from the authors (see Video, Supplemental Digital Content 1,

Departments of Physical Therapy and Rehabilitation Science (A.L-D., C.F.S.) and Neurology (S.S.), University of Kansas Medical Center, Kansas City; and Department of Rehabilitation Sciences, Jordan University of Science and Technology, Irbid, Jordan (A.A-S.).

Correspondence: Catherine F. Siengsukon, PT, PhD, Department of Physical Therapy and Rehabilitation Science, University of Kansas Medical Center, 3901 Rainbow Blvd, Mailstop 2002, Kansas City, KS 66160 (

This work was supported by the Scientist Development grant (09SDG2060618) awarded to C.F.S. from the American Heart Association.

Supplemental digital content is available for this article. Direct URL citation appears in the printed text and is provided in the HTML and PDF versions of this article on the journal's Web site (

The authors declare no conflict of interest.

© 2017 Academy of Neurologic Physical Therapy, APTA