Conclusions

Over the past decade, tremendous advances have been made in developing effective programs to enhance neurorecovery and rehabilitation. For the purposes of this chapter, we distinguish between exercise training and task-specific training designed for skill acquisition. The 1997 call for "well-formulated investigations grounded in available learning theory and research" (Fuhrer and Keith, 1998, p. 560) has only just begun to be addressed. We discussed the top-down model of rehabilitation that focuses on the skills necessary for rehabilitation. We have reviewed the literature relevant to a motor-learning-theory-based design of training that emphasizes the acquisition of skilled functional behaviors and contrasted this with an operant-conditioning approach that focuses on elicited behaviors and spontaneous use. The emergent principles of training from these two learning theories have tremendous implications for future developments in the area of neurorehabili-tation. Further research is needed to better determine the optimal conditions of practice for motor skill learning in individuals with neurologic impairments. We are at an exciting time in rehabilitation medicine, but one that warrants a careful, theory-based analysis as we proceed to develop a scientific rationale for our interventions to promote recovery and rehabilitation.

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