Do Bernstein’s Stages of Learning Apply after Stroke? A Scoping Review on the Development of Whole-Body Coordination after Cerebrovascular Accidents

Abstract

Stroke is one of the leading causes of disability around the world, presenting unique challenges in motor development during the rehabilitation process. Based on studies in movement and sports science, thorough knowledge has accumulated on the development of movement skills. Through the works of Nikolai Bernstein, it has been established that when learning new skills, people tend to first simplify coordination by ‘freezing’ their degrees of freedom, after which they start building efficiency by ‘releasing’ specific degrees of freedom. If a similar pattern of development can be established post-stroke, it would imply that lessons learned in sports skill acquisition can also be implemented to optimize stroke rehabilitation. The current scoping review aims to assess whether the Bernsteinian freezing-to-releasing stages of learning also apply to developing whole-body movement skills after stroke. To this end, we systematically screened the existing literature for studies involving a longitudinal measure of whole-body coordination after a stroke. Only five articles met the criteria for inclusion, indicating a gap in research on this topic. Based on the observations within these articles, we could neither confirm nor reject whether the freezing-to-releasing process can apply after a stroke. We could, however, hypothesize a detailed description of the freezing-to-releasing process, which can be assessed in future works.

Keywords

• motor control
• stroke
• coordination
• degrees of freedom
• injury management