The first part of this chapter discussed some of the basic principles of motor learning derived from laboratory studies in healthy subjects. Neurorehabilitation is based on the assumption that these motor learning principles can be applied to motor recovery after injury, and that training can lead to permanent improvements in motor function in patients with motor deficits (Krakauer,
2006).
Several key issues must be addressed in the development of rehabilitation interventions based on motor learning principles. First, it is still unclear whether and to what extent motor learning mechanisms themselves may be impaired in patients.
Second, the goals of rehabilitation should be clarified with respect to recovery of impairment versus functional compensation, as learning may make differential contributions to these two processes.
Third, it is necessary to consider which type(s) of motor learning are most relevant to patients. Finally, it needs to be appreciated that recovery is not synonymous with motor learning; endogenous processes triggered by ischemia can themselves lead to recovery (Murphy and Corbett, 2009).
The interaction between learning and spontaneous biological recovery is only beginning to be investigated (Biernaskie et al., 2004; Carmichael, 2010).