# Evaluating cognitive impairment as a moderator of locomotor learning in older adults post-stroke

> **NIH NIH K01** · UNIVERSITY OF SOUTHERN CALIFORNIA · 2022 · $125,766

## Abstract

PROJECT SUMMARY
Stroke is a leading cause of long-term disability around the world and disproportionately affects older adults.
After a stroke, older adults commonly exhibit gait dysfunction (e.g., slow, unstable, asymmetric walking), which
is the top patient-reported rehabilitation target. In addition to motor deficits, approximately 70% of people living
with chronic stroke also have post-stroke cognitive impairment (PSCI). While post-stroke gait rehabilitation
interventions effectively mitigate gait dysfunction in aging adults, there remains a significant degree of inter-
individual variability in walking outcomes. We posit this is because current gait rehabilitation interventions are
predominantly structured to leverage explicit versus implicit locomotor learning. Importantly, explicit motor
learning is cognitively demanding. It occurs through intentional changes to a movement based on external
feedback and relies primarily on the dorsolateral prefrontal cortex. Whereas, implicit motor learning is
cerebellum-dependent and occurs more automatically in response to proprioceptive feedback. Despite evidence
of shared neural resources between cognitive and motor processing, the impact of PSCI on the capacity for
these forms of motor learning during walking remains largely unexplored. The overall goal of this proposal is to
demonstrate that PSCI moderates explicit, but not implicit, locomotor learning in older adults with chronic stroke
and identify the role of the dorsolateral prefrontal cortex in this relationship. Under this career development
award, the PI (Leech) will develop skills in neuropsychology, structural neuroimaging, and advanced statistics.
This training will promote the achievement of her long-term career goal: as an independent investigator, to
develop effective, comprehensive, individualized interventions to reduce disability in older adults. This project
has three research aims. Aim 1 will determine the impact of PSCI severity on explicit locomotor learning in older
adults post-stroke. Aim 2 will test the impact of the PSCI severity the capacity for implicit locomotor learning in
the same group of participants. Finally, Aim 3 will examine the role of dorsolateral prefrontal cortex structural
integrity in explicit locomotor learning post-stroke. Older adults with chronic stroke who have a range of PSCI
severity will complete the procedures necessary for all three aims over a total of 2 experimental sessions. We
expect to show that PSCI severity limits an individual’s capacity to learn a more symmetric walking pattern
through explicit, but not implicit, locomotor learning and that this relationship will be mediated by the structural
integrity of the dorsolateral prefrontal cortex. This work will provide necessary scientific foundation for a program
of research to develop an individualized gait rehabilitation intervention anchored to cognitive impairment and a
comprehensive predictive model of locomotor learning in older adults post...

## Key facts

- **NIH application ID:** 10475813
- **Project number:** 5K01AG073467-02
- **Recipient organization:** UNIVERSITY OF SOUTHERN CALIFORNIA
- **Principal Investigator:** Kristan A. Leech
- **Activity code:** K01 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2022
- **Award amount:** $125,766
- **Award type:** 5
- **Project period:** 2021-09-01 → 2026-08-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10475813

## Citation

> US National Institutes of Health, RePORTER application 10475813, Evaluating cognitive impairment as a moderator of locomotor learning in older adults post-stroke (5K01AG073467-02). Retrieved via AI Analytics 2026-05-22 from https://api.ai-analytics.org/grant/nih/10475813. Licensed CC0.

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