Motor control and learning principles for rehabilitation of upper limb movements after brain injury

The old adage ‘Practice makes perfect’ is perhaps most frequently heard in the context of motor skills. Performance improves when people have the opportunity to try out movements and are given feedback about the outcome of those movements so that they can then revise their movements to seek a better outcome. This is as true of normal skills learning as it is of the recovery across a wide range of sensorimotor disabilities (e.g., stroke-hemiparesis, spinal cord-paraplegia, anoxic-cerebral palsy), from central to peripheral (e.g., brain damage to peripheral nerve damage), acute to chronic and young to old. In a 1997 synthesis of intervention trials to improve motor recovery following stroke, Duncan suggested, that the patient will require much more opportunity to practice if motor control is to improve (Duncan, 1997). Indiscriminate practice, however, is not always perfect, rather ‘Perfect practice makes perfect’. How can we define ‘perfect practice’? In this chapter we draw on current research in behavioural neuroscience to consider the elements of movement control and what is the relevance to rehabilitation of motor function after brain damage. We take upper limb movement and object manipulation as our