Neurorehabilitation and Neural Repair

Stroke often results in compensatory movement strategies that combine use of trunk movements with nonuse of the affected upper extremity, which is considered detrimental to recovery.

In this study, we investigate whether compensation and nonuse can be more than a suboptimal counterpart to recovery. We explore the influence of neuromechanics on nonuse and compensation in 22 individuals with stroke and 22 controls.

We asked seated participants to reach a target under 2 nonuse conditions (spontaneous or with minimized trunk compensation) and under 3 arm weight conditions (control, lightened, and weighted).

We replicated the findings that stroke induces more trunk compensation, more anterior deltoid activation and greater effort. We found that, in stroke patients, reduced arm weight decreased nonuse, while in controls, increased arm weight induced trunk compensation similar to what is observed after stroke. Furthermore, reaching with nonuse after stroke required less effort and preserved a force reserve at the shoulder.

Our results show that both poststroke and healthy individuals engage in similar nonuse and compensation in the face of their neuromechanical limitations, as predicted by an optimal control policy aiming to succeed at the task while keeping a force reserve at each joint. We derive 2 theoretical predictions for future clinical research. First, patients whose nonuse yields few functional gains should benefit most from interventions to reduce compensation. Second, improving shoulder strength after stroke should reduce relative muscle activation, thereby decreasing trunk compensation and upper extremity nonuse.

Clinical Trial. NCT04747587.

Augmented reality (AR) and artificial intelligence (AI) have been applied to the assessment and rehabilitation of post-stroke spatial neglect (SN). This study aims to evaluate the feasibility, effectiveness, degree of personalization, and ecological validity of AR, AI, and hybrid methods for SN assessment and rehabilitation.

PubMed, Scopus, Web of Science, Embase, CINAHL, IEEE Xplore, and the ACM Digital Library were searched up to August 2025. Two reviewers independently screened articles, extracted data, and assessed risk of bias and outcome-level certainty.

Of 268 screened studies published between 2000 and 2025, 15 met the inclusion criteria, including 11 assessment studies (8 AI, 1 AR, and 2 hybrid) and 4 AR rehabilitation studies, involving 567 participants. AI assessment methods demonstrated high diagnostic accuracy (area under the curve (AUC) up to 0.95), and 1 AR assessment showed strong diagnostic accuracy (AUC = 0.89). Four AR rehabilitation studies reported acceptable feasibility, with 1 randomized controlled trial (RCT) showing improvements in several neglect outcomes. Ecological validity and personalization were generally very low, and the overall certainty of evidence ranged from low to very low.

Current evidence for AR and AI SN assessment and rehabilitation methods remains insufficient to determine their feasibility, effectiveness, ecological validity, and degree of personalization, largely due to small sample sizes, methodological heterogeneity, and the limited number of RCTs. Future research should focus on developing standardized, scalable frameworks that integrate AR with adaptive AI models, and multicenter RCTs are required to confirm clinical efficacy and long-term functional outcomes.

Fugl-Meyer Assessment of upper and lower extremity is the recommended primary clinical outcome measure of motor function in stroke rehabilitation. However, variations between different manuals undermine the reliability of the assessment, making it difficult to compare results and pool data across trials and centers.

To develop a consensus-based international Fugl-Meyer Assessment (FMA) manual aligned with the original assessment along with agreed recommendations for assessor training. Additionally, the study aims to provide a critical review of current evidence on the measurement properties.

Fourteen experienced health professionals and expert FMA users, working in 3 different continents, 6 countries and 13 research centers, participated in an iterative consensus process to generate a comprehensive agreed FMA manual. Agreement of at least 75% determined by voting was the minimum accepted threshold for each section of the manual. Consensus on assessor training was also sought. The evidence on measurement properties was compiled through a systematic literature review.

Greater than 79% agreement was reached for each section of the final FMA manual. Assessors should have strong foundation in neurorehabilitation and clinical assessment. Novice assessors should undergo structured training including supervised practical training with patients to ensure consistent and accurate scoring. Previous research adherent to the original FMA assessment, confirms strong validity and reliability, but provide limited information of minimal clinically important difference thresholds.

This internationally agreed manual provides a common ground for improved consistency in administration of FMA worldwide and thereby will enable reliable data pooling and increase the comparability of results in future trials and clinical practice.

The subacute phase post-stroke is a critical period for recovery, yet it remains unclear how spontaneous use of the paretic upper extremity (UE) increases during this period.

This longitudinal study aimed to characterize changes in patterns of UE use during the subacute phase, focusing on unimanual and bimanual use, and to examine the influence of different clinical contexts on UE use.

Participants (n = 41; 28.4 [8.0] days since stroke) were assessed at admission to inpatient rehabilitation, prior to discharge, and at 6 months post-stroke. UE use was measured with wrist-worn accelerometers over 7 consecutive days in 3 contexts: daily life, therapy sessions, and functional assessments. Metrics included the use ratio (UR; paretic/non-paretic) and the percentage of unimanual and bimanual use.

UR improved from admission to discharge (P < .001), reflecting a more symmetrical UE use, but no further change was observed after discharge (P = .09). Percentage of unimanual non-paretic use decreased while bimanual use increased across all time points (P ≤ .03). Percentage of unimanual paretic use remained low, with no change over time (P = .28). An effect of context was observed for all variables (P ≤ .003), showing more asymmetric UE use outside of supervised clinical contexts (therapies and assessments).

The subacute phase is characterized by substantial improvements in bimanual UE use during rehabilitation, followed by subtler changes in UE use patterns during the late subacute phase. The discrepancy between UE use during supervised clinical contexts and spontaneous use in daily life highlights the need for accelerometry-based monitoring in clinical practice.

Studies show that beat-based cues from music and metronomes benefit gait in persons with progressive multiple sclerosis (PwPMS) during short walking. While useful for controlled assessment, prolonged walking better reflects real-world function. Adaptive beat-alignment algorithms using biofeedback may enhance synchronization and benefit gait dynamics but their effects in PwPMS remain unknown.

To investigate the effect of walking with and without an adaptive beat-alignment algorithm on synchronization consistency during 8 minutes of walking compared to walking in silence, and its effects on gait. We also examined how clinical factors like dynamic balance and cognition affect synchronization consistency during walking with music and metronomes, with and without adaptive beat alignment.

Healthy controls (HCs) and PwPMS walked for 8 minutes under 5 conditions: silence, music, and metronomes, with or without adaptive beat alignment, at their preferred pace. The algorithm adjusted phase and tempo in real time to restore baseline cadence. We measured synchronization, gait parameters, dynamics, and clinical outcomes.

Twenty-one PwPMS and 18 HCs participated. Adaptive beat-alignment improved synchronization consistency and gait dynamics compared to fixed-tempo walking. Cognitive flexibility and working memory explained 10% of variance in the non-adaptive and 6% in the adaptive conditions, while dynamic balance (40%) impaired synchronization across both algorithms. Auditory cues resulted in slower walking and shorter strides compared to silence.

This study demonstrates the feasibility of adaptive beat-alignment strategies enhancing synchronization consistency and gait dynamics in PwPMS; however, cognitive flexibility, working memory, and dynamic balance influenced synchronization performance.

The long-term impact of traumatic brain injury (TBI) on ageing remains poorly understood without controlled studies.

Cross-sectionally examine how chronic moderate–severe TBI and advancing age interact to affect brain structure and related cognition in adults aged 40 to 90 years who received compensated inpatient rehabilitation in Australia.

Cross-sectional magnetic resonance imaging (MRI) and neuropsychological data were collected from 123 individuals with chronic moderate–severe TBI (6-33 years post-injury; M_age = 59.64) and age- and gender-matched to 74 non-TBI controls (M_age = 62.10). Analyses examined cortical thickness, subcortical volume, and white matter microstructural integrity using tract-based analysis.

Ageing and TBI were independently associated with reduced structural integrity in multiple regions. However, age moderated the effect of TBI on both fornix integrity and left thalamic volume, such that TBI-related reductions were present in adults in their 40s to 70s and 40s to 60s, respectively, but attenuated in the oldest age groups (80+ and 70+, respectively) relative to controls. Fornix and thalamic reductions correlated with poorer cognitive function, with the largest effects in verbal memory and processing speed.

While TBI and ageing were independently associated with changes in brain structure, their interaction manifested distinctly in the bilateral fornix and left thalamus, with TBI-related structural losses in middle-age that diminished in later life as controls experienced typical age-related declines. In adults who received inpatient rehabilitation, moderate–severe TBI may result in initial structural alterations that do not accelerate age-related declines or compound with ageing processes long-term. Age-dependent fornix and thalamic structural changes were strongly associated with cognitive performance, particularly in verbal memory and processing speed.

Medical disease-modifying treatments are lacking in Parkinson’s disease (PD). Physical exercise is potentially an inexpensive and easily accessible disease-modifying therapy, but this remains to be studied using recent promising magnetic resonance imaging (MRI) markers of disease progression. The objective was to determine whether 24 weeks of moderate to high-intensity progressive aerobic exercise affects brain MRI measures in people with PD (pwPD).

A 24-week randomized controlled multicenter trial (with a 24-week follow-up) was conducted, including an exercise group (supervised aerobic exercise followed by self-guided physical activity) and a control group (habitual lifestyle). Patients older than 40 years with mild to moderate impairments (Hoehn & Yahr score ≤3) were randomized (1:1). The primary outcome was R2* (effective transverse relaxation rate) after 24 weeks, which was analyzed using the intention-to-treat principle. Additional outcomes included free water and neuromelanin levels in the substantia nigra, cardiorespiratory fitness, the Movement Disorder Society-sponsored Revision of the Unified Parkinson’s Disease Rating Scale (MDS-UPDRS), and levodopa equivalent daily dose (LEDD).

Seventy participants were randomized to exercise (n = 36) or control (n = 34). R2* did not change over the intervention period (between-group difference: −1.14 [−5.14; 2.87], mean [95%CI]). Similarly, no significant effects were seen in cardiorespiratory fitness (+1.64 mL O2/min/kg [−0.23; 3.51]) and MDS-UPDRS III (−0.7 [−5.3; 4.0]), whereas LEDD increased less following exercise (−78.4 [−154.6; −2.1]).

These findings do not support a neuroprotective effect of progressive aerobic exercise on R2* in pwPD, whereas the intervention appears to benefit the efficacy of levodopa.

Clinicaltrials.gov identifier: NCT04379778.

Dual-task walking poses substantial challenges for individuals with Parkinson’s disease (PD), particularly those with freezing of gait (FOG), as dual-task interference increases fall risk and limits functional mobility.

To investigate dual-task interference at both the behavioral and neural levels in PD individuals with FOG (PDFOG+) and those without FOG (PDFOG−) during dual-task walking involving a demanding manual task.

Seventeen PDFOG− and 17 PDFOG+ participated in this study. Gait performance, manual-task performance, and scalp electroencephalograph (EEG) were recorded in single-task condition and dual-task walking while performing a high attentional-load manual task (an interlocking ring task). The primary behavioral outcomes were dual-task costs (DTC) of gait velocity and ring performance, representing locomotor interference and manual-task interference, respectively. The primary neural outcomes focused on theta-band EEG measures, including regional theta power and inter-regional theta connectivity, given their established role in attentional control during dual-task walking in PDFOG+.

Compared with PDFOG−, PDFOG+ exhibited significantly less DTC of gait velocity and greater DTC of ring performance. At the neural level, PDFOG+ demonstrated attenuated task-dependent modulations of increased theta-band power and decreased theta-band connectivity relative to PDFOG−.

PDFOG+ exhibited an atypical pattern of dual-task interference characterized by preserved gait velocity at the expense of concurrent manual-task performance, together with diminished theta-band attentional modulation. These findings suggest limited flexibility in attentional resource allocation in PDFOG+ and highlight theta-band neural dynamics as a key mechanism underlying maladaptive task-task regulation during walking.

National Taiwan University Hospital Research Ethics Committee: No. NCT03298503.

Children with unilateral spastic cerebral palsy (USCP) exhibit altered corticospinal organization that may influence responsiveness to treatment. Transcranial direct current stimulation (tDCS) may modulate corticospinal excitability, though responses vary widely. Recruitment curves derived from transcranial magnetic stimulation (TMS) can quantify excitability changes.

To evaluate the feasibility, safety, and preliminary effects of combined TMS and anodal tDCS on recruitment curve-derived corticospinal excitability in children with USCP and explore predictors of responsiveness.

In a single-group pre/post study, 20 children with USCP completed TMS-evoked recruitment curve testing before and after 20 minutes of 2mA anodal tDCS. Primary outcomes included changes in S50 (half-maximal motor-evoked potential [MEP] intensity) and slope at the curve inflection point. Secondary outcomes included MEP amplitude-based and model-derived recruitment curve metrics. Safety and tolerability were assessed using a standardized symptom screen.

The protocol was well-tolerated: no serious adverse events occurred, 80% reported no symptoms, and the most common symptom was mild scalp itching. No significant group-level pre/post differences were observed in this preliminary study. Responses were heterogeneous: 11/20 children met the responder definition (ΔS50 < 0). Exploratory analyses identified no consistent clinical or neurophysiologic predictors, although a potential responder pattern was observed in participants with bilateral corticospinal tract patterns.

Although uniform group-level excitability changes were not observed following a single session of 2mA anodal tDCS, recruitment curve metrics were feasible, well-tolerated, and sensitive to interindividual differences. These findings support the use of recruitment curves as feasible tools to characterize variability and inform individualized neuromodulation strategies.

Trial registration number: NCT03402854

Neurorehabilitation is among the most vibrant areas of biomedical research. Its main strategy has been skill-specific practice, which often fails to produce adequate recovery. Now, new recognition of central nervous system (CNS) plasticity, new understanding of skills, and new technologies provide new strategies that enhance the efficacy of practice.

The substrate of a skill is a network of neurons and synapses that extends from cortex to spinal cord and is now called a heksor. A heksor changes continually to maintain the key features of its skill, the attributes that make the skill satisfactory. Muscle activity and kinematics may change; key features are maintained. Heksors share neurons and synapses. Through their concurrent changes, they keep the CNS in a negotiated equilibrium that enables each to maintain its skill. When CNS damage occurs, the goal is to enable damaged heksors to repair themselves.

Two new strategies enhance the efficacy of skill-specific practice. One increases plasticity. A damaged heksor shapes the additional plasticity through practice. The other targets beneficial plasticity to a critical site in a damaged heksor. This improves practice, enabling the heksor to achieve wider beneficial plasticity. In animals and humans, protocols that combine these strategies with practice enhance lasting recovery.

The challenge is to develop, optimize, and validate these combined protocols. Computational modeling can accelerate the process. Controlled trials and comprehensive outcome assessments are essential. Pre-morbid factors and physiological measures may identify biomarkers that can predict efficacy or guide patient-specific protocol design. Many combined protocols will be noninvasive and suitable for home use.

Neurogenic overactive bladder (OAB) among survivors is burdensome. Low-frequency repetitive transcranial magnetic stimulation (rTMS) is a promising non-invasive intervention requiring comprehensive evaluation of its clinical and economic impact.

To evaluate the efficacy, cost-utility, and stroke survivors’ experiences of rTMS for neurogenic OAB.

In this randomized, assessor-blinded, sham-controlled trial, 60 stroke survivors with neurogenic OAB received active rTMS (1200 pulses 80% resting motor threshold [RMT]) or sham (20% RMT) thrice weekly for 4 weeks at contralateral primary motor cortex. The OAB Symptom Score (OABSS), Incontinence Quality of Life (I-QOL), and Brief Resilience Scale (BRS)—were measured at baseline, week 4, and week 8. Repeated measures analysis of covariance evaluated effects. Cost-utility analysis used societal costs and quality-adjusted life years (QALYs). Focus groups involved 12 active-group participants.

Active rTMS (n = 30; 60% male; mean age = 62.1 ± 9.5 years) significantly improved OABSS (mean difference [MD] = 1.81 points, 95% confidence interval [CI] [1.42-2.20], P < .001), I-QOL (MD = 17.48 points, 95% CI [14.18-20.79], P < .001), and BRS (MD = 0.25 points, 95% CI [0.09-0.41], P = .002), at weeks 4 and 8 compared to sham (n = 30; 47% male; mean age = 61.7 ± 8.3 years). Active rTMS was associated with lower societal costs (HK$1267.3 vs HK$1839.0) and higher QALYs (0.691 vs 0.571) than sham. Qualitative data indicated excellent tolerability, symptom relief, and acceptability.

Low-frequency rTMS is clinically effective, safe, acceptable, and potentially cost-saving for post-stroke neurogenic OAB. Larger trials with active comparators and extended follow-up are warranted.

This trial was registered at http://ClinicalTrials.gov (reference number: NCT05557175) before the recruitment of the first participant.

Spinal cord injury (SCI) leads to lifelong disability with highly variable neurological recovery, complicating prognostication and conceptualization of clinical trials. The American Spinal Injury Association Impairment Scale (AIS) is widely used to classify injury severity. Although AIS A injuries are considered sensorimotor complete, they show substantial heterogeneity in residual function and recovery. Data-driven approaches offer an opportunity to uncover latent subgroups beyond conventional classifications. We evaluate whether unsupervised, data-driven clustering can identify distinct subgroups within patients with traumatic SCI and characterize neurological patterns in sensorimotor complete SCI.

We applied an unsupervised clustering model to International Standards of Neurological Classification of Spinal Cord Injury (ISNCSCI) examination scores from the European Multicenter Study about Spinal Cord Injury dataset (3165 patients), to derive neurological groupings independent of predefined ISNCSCI classifications. Clusters were derived from the full cohort, followed by focused analyses of individuals classified as AIS A at their first documented assessment. External reproducibility was evaluated using data from the Sygen clinical trial.

Six distinct clusters were identified. Patients graded as AIS A were represented in 5 clusters, which differed markedly in injury level (paraplegic vs tetraplegic) and indicators of recovery potential, including neurological sparing, upper and lower extremity motor scores, and AIS conversion rates. These patterns were consistently reproduced in the Sygen cohort.

Proposed framework complements conventional AIS grading by revealing distinct neurological conditions related to the variability among patients with baseline sensorimotor complete injuries. Proposed data-driven framework enables more comprehensive prognostic assessments and improves patient stratification in clinical trials.

While non-invasive electrical stimulation is used clinically to enhance motor performance, its efficacy and mechanisms remain unclear. Studies show that personal factors, such as beliefs and expectations of stimulation, can impact how much a person benefits from the stimulation itself. Furthermore, beliefs related to the “closeness is strength of effect” have been observed outside of electrical stimulation contexts, suggesting that the location of stimulation (eg, head and neck) for improving motor performance may impact how much they believe the stimulation will work. This exploratory study investigated beliefs about the optimal target region of stimulation for maximizing the effect of stimulation itself.

Eighty participants (39 females; 46.9 ± 12.6 years) completed an online spatial mapping task in which they were asked to indicate where they would place the electrodes for electrical stimulation to hypothetically enhance specific functions: “hand movement,” “arm movement,” “leg movement,” and “attention/concentration.” Participants selected their placement by clicking a blank human figure in anatomical position. Information about prior use/knowledge of non-invasive stimulation was also collected.

Optimal target region of stimulation was significantly associated with the body movement/function to be enhanced (P < .001). This association was independent of prior non-invasive stimulation knowledge (P = .242) and sex (P = .923).

These findings suggest a pre-existing belief of spatial proximity for electrical stimulation in which placing electrodes closer to the body region of interest would maximize improvement hypothetically.

Peripheral inflammatory markers may serve as indicators of cognitive impairment and depression after ischemic stroke. Post-stroke cognitive impairment hinders rehabilitation and quality of life. Transcranial direct current stimulation (tDCS) is a promising non-invasive intervention, but its link to inflammatory changes and clinical improvement remains unclear.

To evaluate tDCS effects on cognition and depression in stroke patients, and to examine if inflammatory marker changes underlie these effects.

Sixty patients were randomized to an experimental group (EG, n = 30) receiving active tDCS (2 mA, 20 minutes/day over affected dorsolateral prefrontal cortex) or a control group (CG, n = 30) receiving sham stimulation, alongside standard rehabilitation for 4 weeks. Serum interleukin-1β ( IL-1β), interleukin-6 (IL-6), interleukin-10 (IL-10), and tumor necrosis factor-α (TNF-α) levels were measured by enzyme-linked immunosorbent assay (ELISA) pre- and post-intervention. Cognition and depression were assessed using Montreal Cognitive Assessment (MoCA) and Hamilton Depression Scale (HAMD).

Post-intervention, only the EG showed significant reductions in IL-6 and TNF-α (both P < .01), with no change in IL-1β or IL-10 (P > .05). The EG demonstrated greater improvement in MoCA and HAMD scores than the CG (P = .01 and .04). Changes in IL-6 (ΔIL-6) and TNF-α (ΔTNF-α) predicted improvements in MoCA scores (ΔMoCA, R² = .607, P < .01). ΔIL-6 and disease duration predicted improvements in HAMD scores (ΔHAMD, R² = .501, P < .01).

tDCS combined with conventional rehabilitation therapies may reduce pro-inflammatory cytokine levels and improve cognitive and depressive symptoms, supporting its potential application as an anti-inflammatory neurorehabilitation therapy.

Study on the mechanism of transcranial direct current stimulation in the intervention of working memory decline after stroke, https://www.chictr.org.cn/showproj.html?proj=208836, ChiCTR2300077242

Following high-frequency (>100 Hz) deep brain stimulation of the subthalamic nucleus (STN-DBS), some people with Parkinson’s disease (PD) report poorer balance which may contribute to an increased falls risk. However, low-frequency (60 Hz) STN-DBS may improve balance. To better understand the effect of low-frequency STN-DBS, this double-blind randomised crossover study evaluated the acute effects of this therapy on objective measures of balance during standing and gait initiation in people with PD.

Sixteen post-operative PD patients completed standing, walking and clinical assessments while off medication and receiving high- and low-frequency STN-DBS therapy. Changes in balance were measured using a force plate to provide insight into the effect of stimulation strategy on balance during standing and gait initiation.

Linear mixed model analyses indicated that balance during both standing and the locomotion phase of gait initiation was improved with low-frequency STN-DBS, while no difference in the postural phase of gait initiation. These effects were independent of electrode location and total electrical energy delivered. No differences were noted between stimulation conditions for clinical measures of mobility, motor symptom severity, or gait retropulsion.

This study provides evidence for the acute benefits of low-frequency stimulation for improving objective measures of balance during standing and gait initiation in STN-DBS PD patients, independent of DBS electrode contact location. However, the benefits of this alternate therapy may be reduced for patients who experienced significant pre-operative tremor, as low frequency was less effective for managing tremor.

Australian New Zealand

URL: www.anzctr.org.au.

ACTRN12618000944235.

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.

Rehabilitation from motor system dysfunction relies on learning deliberate motor corrections through practice and feedback. This is called explicit motor adaptation. One key source of feedback for this adaptation is the visual error signal between the intended movement and the achieved movement. As people age, both motor dysfunction and visual impairment become more common, potentially compromising the visual feedback signal. Previous work has shown that visual impairment can disrupt the implicit, automatic adjustments made by the sensorimotor system. But how visual impairment influences explicit motor adaptation, a cornerstone of rehabilitation, remains unknown.

To address this gap, we recruited individuals with low vision (LV), defined as uncorrectable visual impairment resulting in functional vision loss, and age-matched controls to complete a visuomotor task designed to isolate 2 components of explicit motor adaptation: discovering a new deliberate sensorimotor strategy and recalling a previously learned one.

Surprisingly, LV was not associated with a measurable impact on either component. Individuals with LV were as effective as controls in both discovering and retrieving successful explicit sensorimotor strategies.

Together, these findings identify explicit strategies as a resilient learning mechanism that can be potentially leveraged in motor rehabilitation, even when visual input is degraded.