Effect of Sleep on Novel Motor Task Learning in Elderly Individuals
Corresponding Author(s) : Dr Richa N Shah
richa.shah03.rs@gmail.com
International Journal of Allied Medical Sciences and Clinical Research,
Vol. 8 No. 3 (2020): 2020 Volume - 8 Issue-3
Abstract
Purpose and objective:
To study the effect of sleep on novel motor task learning in elderly individuals.
Method:
68 elderly were divided randomly into Sleep group and No sleep group. Evaluation was done using Star excursion balance test (SEBT), Tandem walk test (TWT) and Dynamic Gait Index (DGI) before session. Sleep group subjects practiced novel task in evening at 8 pm and underwent retention testing next morning at 8 am. While in no sleep group they practiced the novel task in morning 8 am and underwent retention testing same day in evening at 8 pm. Novel task included 30 mins session of 3 virtual reality based games. Both groups were then analyzed using Wilcoxon Signed Rank W test within the group and Mann-Whitney U test between the two groups.
Outcome measures:
Primary outcome measures were SEBT, TWT and DGI. Secondary outcome was considered as Stanford Sleepiness Scale before the session.
Results:
Older adults in sleep group (n=32) showed increased performance in SEBT and step length, stride length components of TWT (p<0.05) as compared to no sleep group (p>0.23). However, participants in both groups showed improvement in base of support component of TWT- [sleep group (p<0.05) with (%change-38%) and no sleep group (p=0.08) with (%change-5.8%)]. DGI score also improved in both sleep group (p<0.05) with (%change-16.4%) and no sleep group (p<0.05) with (%change-7.1%).Hence, effect seen in group A was more than in group B (p<0.05)
Discussion:
Present study demonstrates that older adults were able to perform novel tasks better after a night of sleep as compared to older adults who didn’t sleep. It suggests that Sleep dependent offline learning can be applied to both simple and complex tasks. Offline learning refers to memory consolidation which takes place without any active participation of subject itself. It is described in terms with interference technique in which the consolidation of a primary task is disrupted by the immediate performance of a secondary task. If the period is lengthened then the extent of learning is lengthened as well Also, it is found that there is a positive correlation between sleep spindle density and offline motor learning and during different sleep states various neurophysiological changes take place. Therefore with better sleep learning over a novel task can be improved.
Conclusion:
Sleep is effective in novel motor task learning in elderly individuals
Keywords
Sleep
Novel motor task learning
Elderly
Virtual Reality
1.
Dr Snehal Joshi, Dr Richa N Shah. Effect of Sleep on Novel Motor Task Learning in Elderly Individuals. Int. J. of Allied Med. Sci. and Clin. Res. [Internet]. 2020 Sep. 13 [cited 2026 Apr. 29];8(3):587-603. Available from: https://ijamscr.com/ijamscr/article/view/899
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References
-
1. Lopes K, Costa D, Santos L, Castro D, Bastone A. Prevalência do medo de cair em uma população de idosos da comunidade e sua correlação com mobilidade, equilíbrio dinâmico, risco e histórico de quedas. Rev Bras Fisioter. 2009;13(3):223-9. doi: 10.1590/S1413-35552009005000026.
2. Kami?ska Magdalena Sylwia, Miller Agnieszka, Rotter Iwona, Szyli?ska Aleksandra, Grochans El?bieta. The effectiveness of virtual reality training in reducing the risk of falls among elderly people. Clin Interv Aging. 2018;13:2329-38. doi: 10.2147/CIA.S183502, PMID 30532523.
3. Harrington DL, Haaland KY. Skill learning in the elderly: diminished implicit and explicit memory for A motor sequence. Psychol Aging. 1992;7(3):425-34. doi: 10.1037//0882-7974.7.3.425, PMID 1388864.
4. Ehsani Fatemeh, Abdollahi Iraj, Bandpei Mohammad Ali Mohseni, Zahiri Nahid, Jaberzadeh Shapour. Motor learning and movement performance: older versus younger AdultsBasic and clinical neuroscience. Vol. 6. Number 4; October 2015.
5. Shumway-Cook Anne CHAPTER 4. Physiological basis of motor learning and recovery of function, Pg No. In: Motor control: translating research into clinical practice/Anne Shumway cook and Marjorie H. Woollacott. 4th ed; 1947. p.85-9.
6. Cushman Fiery, Adam Morris. Habitual control of goal selection in humans. PNAS. November 10, 2015;112(45):13817-22.
7. Jiang Yuhong V, Koutstaal Wilma, Twedell Emily L. Habitual attention in older and young adults. Psychol Aging. October 2016;31(8):970-80. doi: 10.1037/pag0000139, PMID 27831723.
8. Vakil Eli, Agmon-Ashkenazi Dafna. Baseline performance and learning rate of procedural and declarative memory tasks: younger versus older adults journal of gerontology: psychological Sciences 1997. Vol. 52b(5). p. 229-P234.
9. Taylor Jordan A, Ivry Richard B. The role of strategies in motor learning. Ann N Y Acad Sci. 2012 March;1251:1-12. doi: 10.1111/j.1749-6632.2011.06430.x, PMID 22329960.
10. Rivera-Torres Solymar, Fahey Thomas D, Rivera Miguel A. Adherence to exercise programs in older adults: informative report. Gerontol Geriatr Med. 2019;5:2333721418823604. doi: 10.1177/2333721418823604, PMID 30733977.
11. Ofli Ferda, Kurillo Gregorij, Obdržálek Št?pán, Bajcsy Ruzena, Jimison Holly Brugge, Pavel Misha. Design and evaluation of an interactive exercise coaching system for older adults: lessons learned. IEEE J Biomed Health Inform. 2016 January;20(1):201-12. doi: 10.1109/JBHI.2015.2391671, PMID 25594988.
12. Updated ND25December. Merriam-Webster since 1828; 2017. Novel. Web. 3 Jan. 2018. Available from: Merriam-Webster.Com.
13. Mitry Kobark D, Mehring Carsten. Adaptation paths to novel motor task S Are shaped by prior structure learning. Behavioral/systems/cognitive. J Neurosci. July 18 2012;32(29):9898-908.
14. Shumway-Cook Anne, 1947. Motor control: translating research into clinical practice/Anne Shumway cook andMarjorie H. Woollacott. — CHAPTER 2. Motor learning and recovery of function, Pg No: 30,31. 4th ed.
15. ?ak Marek, Swine Christian, Grodzicki Tomasz. Combined effects of functionally oriented exercise regimens and nutritional supplementation on both the institutionalised and free-living frail elderly (double-blind, randomised clinical trial). BMC Public Health. 2009;9:39. doi: 10.1186/1471-2458-9-39, PMID 19175935.
16. Le Graves Ridgers Nd, Williams K, Stratton G, Atkinson G. Cable Nt. The physiological cost and enjoyment of Wii fit in adolescents, young adults, and older adults. J Phys Act Health. 2010;7. PMID 393401.
17. Agmon Maayan. Pt, Phd, ma, Ba; Cynthia K. Perry, PhD, Arnp; Elizab eth Phelan. Md, Ms: George Demiris, Phd; Huong Q. Nguyen, Phd A Pilot Study Of Wii Fit Exergames To Improve Balance In Older Adults ( J Geriatr Phys Ther2011;34:161-167.
18. Huberty Jennifer L, Ransdell Lynda B, Sidman Cara, Flohr Judith A, Shultz Barry, Grosshans Onie, Durrant Lynne, Et Al. Explaining long-term exercise adherence in women who complete a structured exercise program. Res Q Exerc Sport. 2008;79(3):374-84. doi: 10.1080/02701367.2008.10599501, PMID 18816949.
19. Bohil Corey J, Alicea Bradly, Frank A, Biocca. Virtual reality in neuroscience research and therapy nature reviews. Neuroscience. Vol. 12(December); 2011. p. 752-62.
20. Stickgold Robert, Walker Matthew P. Sleep-dependent memory consolidation and reconsolidation. Sleep Med. 2007 June;8(4):331-43. doi: 10.1016/j.sleep.2007.03.011, PMID 17470412.
21. Al-Sharman Alham, Siengsukon Catherine F. Performance of A functional motor task in enhanced by sleep in middleaged and older adults, Jnpt. J Neurol Phys Ther. 2014;38(3):161-9. doi: 10.1097/NPT.0000000000000048, PMID 24866594.
22. Walker Matthew P, Brakefield Tiffany, Seidman Joshua, Alexandra Morgan J, Hobson Allan, Stickgold Robert. Sleep and time course of motor skill learning, Csh press. Learn Mem. 2003;10(4):275-84. doi: 10.1101/lm.58503.
23. Lo June C, Groeger John A, Santhi NayantaraEtAl, Arbon Emma L, Lazar Alpar S, Hasan Sibah, von Schantz Malcolm, Archer Simon N, Dijk Derk-Jan. Effects of partial and acute total sleep deprivation on performance across cognitive domains, individuals and circadian phase. PLOS ONE. 2012;7(9): E459. doi: 10.1371/journal.pone.0045987, PMID 23029352.
24. Hobson JAllan, Pace-Schott Edward F. The cognitive neuroscience of sleep:neuronal systems, consciousness and learning. Nat Rev Neurosci. 2002;3(9):679-93. doi: 10.1038/nrn915, PMID 12209117.
25. Titz Cora, Karbach Julia. Working memory and executive functions: effects of training on academic achievement. Psychol Res. 2014;78(6):852-68. doi: 10.1007/s00426-013-0537-1, PMID 24389706.
26. Tucker Matthew A, Nguyen Nam, Stick Gold Robert. Experience playing A musical instrument and overnight sleep enhance performance on A sequential typing task Plosone11 (7). p. E0159608.
27. Rodriguez Juan Carlos, Dzierzewski Joseph M, Alessi Cathy A. Sleep problems in the elderly. Med Clin North Am. 2015 March;99(2):431-9. doi: 10.1016/j.mcna.2014.11.013, PMID 25700593.
28. Valériemongrain Suzie Lavoie, Brahimselmaoui Jean Paquet, Dumont Marie. Phase relationships between sleep-wake cycle and underlying circadian rhythms in morningness-eveningness. J Biologicalrhythms. June 2004;19(3):248-57.
29. Buysse Daniel J, Reynolds Charles F Iii, Monk Timothy H, Berman Susan R, Kupfer David J. The Pittsburgh Sleep Quality Index: A new instrument for psychiatric practice and research. Psychiatry Res. 1989;28(2):193-213. doi: 10.1016/0165-1781(89)90047-4, PMID 2748771.
30. Herscovitch Joel, Broughton Roger. Sensitivity of the Stanford sleepiness scale to the effects of cumulative partial sleep deprivation and recovery oversleeping. Sleep. 1981;4(1):83-91. doi: 10.1093/sleep/4.1.83, PMID 7232973.
31. Kinzey SJ, Armstrong CW. The reliability of the Starexcursion test in assessing dynamic balance. J Orthop Sports Phys Ther. 1998;27(5):356-60. doi: 10.2519/jospt.1998.27.5.356.
32. Robertson Marc, Gregory Robert. Concurrent validation of the tandem walk test As A measure of dynamic walking balance in A healthy population. Phys Ther Rehabil: Ssn 2055. 2017;4(1):(Article 12). doi: 10.7243/2055-2386-4-12.
33. Jonsdottir Johanna, Cattaneo D. Reliability and validity of Dgi in persons with chronic stroke. Source PubMed J Apmr. 2007;08:109.
34. Lowry Kristin A, Sebastian Katherine, Perera Subashan, Van Swearingen Jessie, Smiley-Oyen Ann L. Age-related differences in locomotor strategies during adaptive walking. J Mot Behav. 2017 Juil–Aug;49(4):435-40. doi: 10.1080/00222895.2016.1241742, PMID 27870605.
35. Ericsson KA. Attaining excellence through deliberate practice: insights from the study of expert performance. In: Ferrari M, editor, The pursuit of excellence through education. Mahwah, Nj: Erlbaum; 2002. P. 21-56.
36. Anderson JR. Acquisition of cognitive skill. Psychol Rev. 1982;89(4):369-406. doi: 10.1037/0033-295X.89.4.369.
37. Kuriyama Kenichi, Stickgold Robert, Walker Matthew P. Sleep-dependent learning and Motorskill complexity. Learn Mem. 2004;11(6):705-13. doi: 10.1101/lm.76304, PMID 15576888.
38. Kal Elmar, Prosée Rens, Winters Marinus, van der Kamp John. Does implicit motor learning lead to greater automatization of motor skills compared to explicit motor learning? A systematic review. PLOS ONE. 2018;13(9):e0203591. doi: 10.1371/journal.pone.0203591, PMID 30183763.
39. Backhaus Winifried, Braass Hanna, Renné Thomas, Gerloff Christian, Hummel FC. Motor performance is not enhanced by daytime naps in older adults. Front Aging Neurosci. 2016;8:125. doi: 10.3389/fnagi.2016.00125.
References
1. Lopes K, Costa D, Santos L, Castro D, Bastone A. Prevalência do medo de cair em uma população de idosos da comunidade e sua correlação com mobilidade, equilíbrio dinâmico, risco e histórico de quedas. Rev Bras Fisioter. 2009;13(3):223-9. doi: 10.1590/S1413-35552009005000026.
2. Kami?ska Magdalena Sylwia, Miller Agnieszka, Rotter Iwona, Szyli?ska Aleksandra, Grochans El?bieta. The effectiveness of virtual reality training in reducing the risk of falls among elderly people. Clin Interv Aging. 2018;13:2329-38. doi: 10.2147/CIA.S183502, PMID 30532523.
3. Harrington DL, Haaland KY. Skill learning in the elderly: diminished implicit and explicit memory for A motor sequence. Psychol Aging. 1992;7(3):425-34. doi: 10.1037//0882-7974.7.3.425, PMID 1388864.
4. Ehsani Fatemeh, Abdollahi Iraj, Bandpei Mohammad Ali Mohseni, Zahiri Nahid, Jaberzadeh Shapour. Motor learning and movement performance: older versus younger AdultsBasic and clinical neuroscience. Vol. 6. Number 4; October 2015.
5. Shumway-Cook Anne CHAPTER 4. Physiological basis of motor learning and recovery of function, Pg No. In: Motor control: translating research into clinical practice/Anne Shumway cook and Marjorie H. Woollacott. 4th ed; 1947. p.85-9.
6. Cushman Fiery, Adam Morris. Habitual control of goal selection in humans. PNAS. November 10, 2015;112(45):13817-22.
7. Jiang Yuhong V, Koutstaal Wilma, Twedell Emily L. Habitual attention in older and young adults. Psychol Aging. October 2016;31(8):970-80. doi: 10.1037/pag0000139, PMID 27831723.
8. Vakil Eli, Agmon-Ashkenazi Dafna. Baseline performance and learning rate of procedural and declarative memory tasks: younger versus older adults journal of gerontology: psychological Sciences 1997. Vol. 52b(5). p. 229-P234.
9. Taylor Jordan A, Ivry Richard B. The role of strategies in motor learning. Ann N Y Acad Sci. 2012 March;1251:1-12. doi: 10.1111/j.1749-6632.2011.06430.x, PMID 22329960.
10. Rivera-Torres Solymar, Fahey Thomas D, Rivera Miguel A. Adherence to exercise programs in older adults: informative report. Gerontol Geriatr Med. 2019;5:2333721418823604. doi: 10.1177/2333721418823604, PMID 30733977.
11. Ofli Ferda, Kurillo Gregorij, Obdržálek Št?pán, Bajcsy Ruzena, Jimison Holly Brugge, Pavel Misha. Design and evaluation of an interactive exercise coaching system for older adults: lessons learned. IEEE J Biomed Health Inform. 2016 January;20(1):201-12. doi: 10.1109/JBHI.2015.2391671, PMID 25594988.
12. Updated ND25December. Merriam-Webster since 1828; 2017. Novel. Web. 3 Jan. 2018. Available from: Merriam-Webster.Com.
13. Mitry Kobark D, Mehring Carsten. Adaptation paths to novel motor task S Are shaped by prior structure learning. Behavioral/systems/cognitive. J Neurosci. July 18 2012;32(29):9898-908.
14. Shumway-Cook Anne, 1947. Motor control: translating research into clinical practice/Anne Shumway cook andMarjorie H. Woollacott. — CHAPTER 2. Motor learning and recovery of function, Pg No: 30,31. 4th ed.
15. ?ak Marek, Swine Christian, Grodzicki Tomasz. Combined effects of functionally oriented exercise regimens and nutritional supplementation on both the institutionalised and free-living frail elderly (double-blind, randomised clinical trial). BMC Public Health. 2009;9:39. doi: 10.1186/1471-2458-9-39, PMID 19175935.
16. Le Graves Ridgers Nd, Williams K, Stratton G, Atkinson G. Cable Nt. The physiological cost and enjoyment of Wii fit in adolescents, young adults, and older adults. J Phys Act Health. 2010;7. PMID 393401.
17. Agmon Maayan. Pt, Phd, ma, Ba; Cynthia K. Perry, PhD, Arnp; Elizab eth Phelan. Md, Ms: George Demiris, Phd; Huong Q. Nguyen, Phd A Pilot Study Of Wii Fit Exergames To Improve Balance In Older Adults ( J Geriatr Phys Ther2011;34:161-167.
18. Huberty Jennifer L, Ransdell Lynda B, Sidman Cara, Flohr Judith A, Shultz Barry, Grosshans Onie, Durrant Lynne, Et Al. Explaining long-term exercise adherence in women who complete a structured exercise program. Res Q Exerc Sport. 2008;79(3):374-84. doi: 10.1080/02701367.2008.10599501, PMID 18816949.
19. Bohil Corey J, Alicea Bradly, Frank A, Biocca. Virtual reality in neuroscience research and therapy nature reviews. Neuroscience. Vol. 12(December); 2011. p. 752-62.
20. Stickgold Robert, Walker Matthew P. Sleep-dependent memory consolidation and reconsolidation. Sleep Med. 2007 June;8(4):331-43. doi: 10.1016/j.sleep.2007.03.011, PMID 17470412.
21. Al-Sharman Alham, Siengsukon Catherine F. Performance of A functional motor task in enhanced by sleep in middleaged and older adults, Jnpt. J Neurol Phys Ther. 2014;38(3):161-9. doi: 10.1097/NPT.0000000000000048, PMID 24866594.
22. Walker Matthew P, Brakefield Tiffany, Seidman Joshua, Alexandra Morgan J, Hobson Allan, Stickgold Robert. Sleep and time course of motor skill learning, Csh press. Learn Mem. 2003;10(4):275-84. doi: 10.1101/lm.58503.
23. Lo June C, Groeger John A, Santhi NayantaraEtAl, Arbon Emma L, Lazar Alpar S, Hasan Sibah, von Schantz Malcolm, Archer Simon N, Dijk Derk-Jan. Effects of partial and acute total sleep deprivation on performance across cognitive domains, individuals and circadian phase. PLOS ONE. 2012;7(9): E459. doi: 10.1371/journal.pone.0045987, PMID 23029352.
24. Hobson JAllan, Pace-Schott Edward F. The cognitive neuroscience of sleep:neuronal systems, consciousness and learning. Nat Rev Neurosci. 2002;3(9):679-93. doi: 10.1038/nrn915, PMID 12209117.
25. Titz Cora, Karbach Julia. Working memory and executive functions: effects of training on academic achievement. Psychol Res. 2014;78(6):852-68. doi: 10.1007/s00426-013-0537-1, PMID 24389706.
26. Tucker Matthew A, Nguyen Nam, Stick Gold Robert. Experience playing A musical instrument and overnight sleep enhance performance on A sequential typing task Plosone11 (7). p. E0159608.
27. Rodriguez Juan Carlos, Dzierzewski Joseph M, Alessi Cathy A. Sleep problems in the elderly. Med Clin North Am. 2015 March;99(2):431-9. doi: 10.1016/j.mcna.2014.11.013, PMID 25700593.
28. Valériemongrain Suzie Lavoie, Brahimselmaoui Jean Paquet, Dumont Marie. Phase relationships between sleep-wake cycle and underlying circadian rhythms in morningness-eveningness. J Biologicalrhythms. June 2004;19(3):248-57.
29. Buysse Daniel J, Reynolds Charles F Iii, Monk Timothy H, Berman Susan R, Kupfer David J. The Pittsburgh Sleep Quality Index: A new instrument for psychiatric practice and research. Psychiatry Res. 1989;28(2):193-213. doi: 10.1016/0165-1781(89)90047-4, PMID 2748771.
30. Herscovitch Joel, Broughton Roger. Sensitivity of the Stanford sleepiness scale to the effects of cumulative partial sleep deprivation and recovery oversleeping. Sleep. 1981;4(1):83-91. doi: 10.1093/sleep/4.1.83, PMID 7232973.
31. Kinzey SJ, Armstrong CW. The reliability of the Starexcursion test in assessing dynamic balance. J Orthop Sports Phys Ther. 1998;27(5):356-60. doi: 10.2519/jospt.1998.27.5.356.
32. Robertson Marc, Gregory Robert. Concurrent validation of the tandem walk test As A measure of dynamic walking balance in A healthy population. Phys Ther Rehabil: Ssn 2055. 2017;4(1):(Article 12). doi: 10.7243/2055-2386-4-12.
33. Jonsdottir Johanna, Cattaneo D. Reliability and validity of Dgi in persons with chronic stroke. Source PubMed J Apmr. 2007;08:109.
34. Lowry Kristin A, Sebastian Katherine, Perera Subashan, Van Swearingen Jessie, Smiley-Oyen Ann L. Age-related differences in locomotor strategies during adaptive walking. J Mot Behav. 2017 Juil–Aug;49(4):435-40. doi: 10.1080/00222895.2016.1241742, PMID 27870605.
35. Ericsson KA. Attaining excellence through deliberate practice: insights from the study of expert performance. In: Ferrari M, editor, The pursuit of excellence through education. Mahwah, Nj: Erlbaum; 2002. P. 21-56.
36. Anderson JR. Acquisition of cognitive skill. Psychol Rev. 1982;89(4):369-406. doi: 10.1037/0033-295X.89.4.369.
37. Kuriyama Kenichi, Stickgold Robert, Walker Matthew P. Sleep-dependent learning and Motorskill complexity. Learn Mem. 2004;11(6):705-13. doi: 10.1101/lm.76304, PMID 15576888.
38. Kal Elmar, Prosée Rens, Winters Marinus, van der Kamp John. Does implicit motor learning lead to greater automatization of motor skills compared to explicit motor learning? A systematic review. PLOS ONE. 2018;13(9):e0203591. doi: 10.1371/journal.pone.0203591, PMID 30183763.
39. Backhaus Winifried, Braass Hanna, Renné Thomas, Gerloff Christian, Hummel FC. Motor performance is not enhanced by daytime naps in older adults. Front Aging Neurosci. 2016;8:125. doi: 10.3389/fnagi.2016.00125.
2. Kami?ska Magdalena Sylwia, Miller Agnieszka, Rotter Iwona, Szyli?ska Aleksandra, Grochans El?bieta. The effectiveness of virtual reality training in reducing the risk of falls among elderly people. Clin Interv Aging. 2018;13:2329-38. doi: 10.2147/CIA.S183502, PMID 30532523.
3. Harrington DL, Haaland KY. Skill learning in the elderly: diminished implicit and explicit memory for A motor sequence. Psychol Aging. 1992;7(3):425-34. doi: 10.1037//0882-7974.7.3.425, PMID 1388864.
4. Ehsani Fatemeh, Abdollahi Iraj, Bandpei Mohammad Ali Mohseni, Zahiri Nahid, Jaberzadeh Shapour. Motor learning and movement performance: older versus younger AdultsBasic and clinical neuroscience. Vol. 6. Number 4; October 2015.
5. Shumway-Cook Anne CHAPTER 4. Physiological basis of motor learning and recovery of function, Pg No. In: Motor control: translating research into clinical practice/Anne Shumway cook and Marjorie H. Woollacott. 4th ed; 1947. p.85-9.
6. Cushman Fiery, Adam Morris. Habitual control of goal selection in humans. PNAS. November 10, 2015;112(45):13817-22.
7. Jiang Yuhong V, Koutstaal Wilma, Twedell Emily L. Habitual attention in older and young adults. Psychol Aging. October 2016;31(8):970-80. doi: 10.1037/pag0000139, PMID 27831723.
8. Vakil Eli, Agmon-Ashkenazi Dafna. Baseline performance and learning rate of procedural and declarative memory tasks: younger versus older adults journal of gerontology: psychological Sciences 1997. Vol. 52b(5). p. 229-P234.
9. Taylor Jordan A, Ivry Richard B. The role of strategies in motor learning. Ann N Y Acad Sci. 2012 March;1251:1-12. doi: 10.1111/j.1749-6632.2011.06430.x, PMID 22329960.
10. Rivera-Torres Solymar, Fahey Thomas D, Rivera Miguel A. Adherence to exercise programs in older adults: informative report. Gerontol Geriatr Med. 2019;5:2333721418823604. doi: 10.1177/2333721418823604, PMID 30733977.
11. Ofli Ferda, Kurillo Gregorij, Obdržálek Št?pán, Bajcsy Ruzena, Jimison Holly Brugge, Pavel Misha. Design and evaluation of an interactive exercise coaching system for older adults: lessons learned. IEEE J Biomed Health Inform. 2016 January;20(1):201-12. doi: 10.1109/JBHI.2015.2391671, PMID 25594988.
12. Updated ND25December. Merriam-Webster since 1828; 2017. Novel. Web. 3 Jan. 2018. Available from: Merriam-Webster.Com.
13. Mitry Kobark D, Mehring Carsten. Adaptation paths to novel motor task S Are shaped by prior structure learning. Behavioral/systems/cognitive. J Neurosci. July 18 2012;32(29):9898-908.
14. Shumway-Cook Anne, 1947. Motor control: translating research into clinical practice/Anne Shumway cook andMarjorie H. Woollacott. — CHAPTER 2. Motor learning and recovery of function, Pg No: 30,31. 4th ed.
15. ?ak Marek, Swine Christian, Grodzicki Tomasz. Combined effects of functionally oriented exercise regimens and nutritional supplementation on both the institutionalised and free-living frail elderly (double-blind, randomised clinical trial). BMC Public Health. 2009;9:39. doi: 10.1186/1471-2458-9-39, PMID 19175935.
16. Le Graves Ridgers Nd, Williams K, Stratton G, Atkinson G. Cable Nt. The physiological cost and enjoyment of Wii fit in adolescents, young adults, and older adults. J Phys Act Health. 2010;7. PMID 393401.
17. Agmon Maayan. Pt, Phd, ma, Ba; Cynthia K. Perry, PhD, Arnp; Elizab eth Phelan. Md, Ms: George Demiris, Phd; Huong Q. Nguyen, Phd A Pilot Study Of Wii Fit Exergames To Improve Balance In Older Adults ( J Geriatr Phys Ther2011;34:161-167.
18. Huberty Jennifer L, Ransdell Lynda B, Sidman Cara, Flohr Judith A, Shultz Barry, Grosshans Onie, Durrant Lynne, Et Al. Explaining long-term exercise adherence in women who complete a structured exercise program. Res Q Exerc Sport. 2008;79(3):374-84. doi: 10.1080/02701367.2008.10599501, PMID 18816949.
19. Bohil Corey J, Alicea Bradly, Frank A, Biocca. Virtual reality in neuroscience research and therapy nature reviews. Neuroscience. Vol. 12(December); 2011. p. 752-62.
20. Stickgold Robert, Walker Matthew P. Sleep-dependent memory consolidation and reconsolidation. Sleep Med. 2007 June;8(4):331-43. doi: 10.1016/j.sleep.2007.03.011, PMID 17470412.
21. Al-Sharman Alham, Siengsukon Catherine F. Performance of A functional motor task in enhanced by sleep in middleaged and older adults, Jnpt. J Neurol Phys Ther. 2014;38(3):161-9. doi: 10.1097/NPT.0000000000000048, PMID 24866594.
22. Walker Matthew P, Brakefield Tiffany, Seidman Joshua, Alexandra Morgan J, Hobson Allan, Stickgold Robert. Sleep and time course of motor skill learning, Csh press. Learn Mem. 2003;10(4):275-84. doi: 10.1101/lm.58503.
23. Lo June C, Groeger John A, Santhi NayantaraEtAl, Arbon Emma L, Lazar Alpar S, Hasan Sibah, von Schantz Malcolm, Archer Simon N, Dijk Derk-Jan. Effects of partial and acute total sleep deprivation on performance across cognitive domains, individuals and circadian phase. PLOS ONE. 2012;7(9): E459. doi: 10.1371/journal.pone.0045987, PMID 23029352.
24. Hobson JAllan, Pace-Schott Edward F. The cognitive neuroscience of sleep:neuronal systems, consciousness and learning. Nat Rev Neurosci. 2002;3(9):679-93. doi: 10.1038/nrn915, PMID 12209117.
25. Titz Cora, Karbach Julia. Working memory and executive functions: effects of training on academic achievement. Psychol Res. 2014;78(6):852-68. doi: 10.1007/s00426-013-0537-1, PMID 24389706.
26. Tucker Matthew A, Nguyen Nam, Stick Gold Robert. Experience playing A musical instrument and overnight sleep enhance performance on A sequential typing task Plosone11 (7). p. E0159608.
27. Rodriguez Juan Carlos, Dzierzewski Joseph M, Alessi Cathy A. Sleep problems in the elderly. Med Clin North Am. 2015 March;99(2):431-9. doi: 10.1016/j.mcna.2014.11.013, PMID 25700593.
28. Valériemongrain Suzie Lavoie, Brahimselmaoui Jean Paquet, Dumont Marie. Phase relationships between sleep-wake cycle and underlying circadian rhythms in morningness-eveningness. J Biologicalrhythms. June 2004;19(3):248-57.
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