{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,21]],"date-time":"2026-08-21T14:00:54Z","timestamp":1787320854971,"version":"build-2736575974"},"reference-count":34,"publisher":"Public Library of Science (PLoS)","issue":"6","license":[{"start":{"date-parts":[[2026,6,22]],"date-time":"2026-06-22T00:00:00Z","timestamp":1782086400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS One"],"abstract":"<jats:p>Individuals with cerebral palsy (CP) are characterized by elevated movement variability. Movement variability has been proposed as a mechanism that facilitates the exploration of diverse movement strategies. However, in the case of CP, this variability is often excessive, potentially impeding effective error correction and motor learning processes. This study aims to investigate motor variability in adults with severe athetoid and ataxic CP profiles, focusing on its impact on error-based and reward-based learning mechanisms. The study included 13 adults with severe CP and a control group of 18 adults without disabilities. The findings revealed that individuals with CP exhibit significantly greater motor variability than the control group, which correlates with higher absolute error rates and a diminished capacity for task-related adjustments. These results suggest that CP negatively affects motor stability and precision, complicating motor learning. Furthermore, it was observed that error-based tasks are more accessible for individuals with CP, as they showed substantial performance improvements following training, in contrast to the reward-based tasks. This study underscores the importance of personalized motor learning interventions for individuals with CP, considering the variability among CP subtypes and the individual characteristics of each person. The research provides essential insights into motor learning adaptation and retention in individuals with severe CP, highlighting the necessity of continuous practice to sustain long-term improvements.<\/jats:p>","DOI":"10.1371\/journal.pone.0349610","type":"journal-article","created":{"date-parts":[[2026,6,22]],"date-time":"2026-06-22T17:21:57Z","timestamp":1782148917000},"page":"e0349610","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":2,"title":["Exploring motor variability in adults with severe athetoid or ataxic cerebral palsy: Impact on error-based and reward-based learning"],"prefix":"10.1371","volume":"21","author":[{"given":"Alba","family":"Roldan","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1742-1691","authenticated-orcid":true,"given":"Mar\u00eda Isabel","family":"Cornejo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francisco J.","family":"Moreno","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Raul","family":"Reina","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carla","family":"Caballero","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2026,6,22]]},"reference":[{"issue":"3","key":"pone.0349610.ref001","doi-asserted-by":"crossref","first-page":"596","DOI":"10.1037\/xhp0000303","article-title":"Can the structure of motor variability predict learning rate?","volume":"43","author":"D Barbado","year":"2017","journal-title":"J Exp Psychol Hum Percept Perform"},{"key":"pone.0349610.ref002","doi-asserted-by":"crossref","first-page":"479","DOI":"10.1146\/annurev-neuro-072116-031548","article-title":"The role of variability in motor learning","volume":"40","author":"AK Dhawale","year":"2017","journal-title":"Annu Rev Neurosci"},{"key":"pone.0349610.ref003","first-page":"12","article-title":"The role of motor variability in motor control and learning depends on the nature of the task and the individual\u2019s capabilities","volume":"38","author":"C Caballero","year":"2017","journal-title":"Eur J Hum Mov"},{"key":"pone.0349610.ref004","doi-asserted-by":"crossref","DOI":"10.3389\/fnhum.2017.00049","article-title":"Motor learning abilities are similar in hemiplegic cerebral palsy compared to controls as assessed by adaptation to unilateral leg-weighting during gait: Part I","volume":"11","author":"DL Damiano","year":"2017","journal-title":"Front Hum Neurosci"},{"key":"pone.0349610.ref005","doi-asserted-by":"crossref","first-page":"183","DOI":"10.1016\/j.cobeha.2018.01.004","article-title":"It\u2019s not (only) the mean that matters: variability, noise and exploration in skill learning","volume":"20","author":"D Sternad","year":"2018","journal-title":"Curr Opin Behav Sci"},{"issue":"2","key":"pone.0349610.ref006","doi-asserted-by":"crossref","first-page":"312","DOI":"10.1038\/nn.3616","article-title":"Temporal structure of motor variability is dynamically regulated and predicts motor learning ability","volume":"17","author":"HG Wu","year":"2014","journal-title":"Nat Neurosci"},{"issue":"6","key":"pone.0349610.ref007","doi-asserted-by":"crossref","first-page":"677","DOI":"10.1093\/ptj\/pzz043","article-title":"Robot reinforcement and error-based movement learning in infants with and without cerebral palsy","volume":"99","author":"THA Kolobe","year":"2019","journal-title":"Phys Ther"},{"issue":"19","key":"pone.0349610.ref008","doi-asserted-by":"crossref","first-page":"6448","DOI":"10.3390\/s21196448","article-title":"Motor synergies measurement reveals the relevant role of variability in reward-based learning","volume":"21","author":"C Caballero","year":"2021","journal-title":"Sensors (Basel)"},{"issue":"1","key":"pone.0349610.ref009","doi-asserted-by":"crossref","first-page":"39","DOI":"10.1152\/jn.00158.2017","article-title":"High variability impairs motor learning regardless of whether it affects task performance","volume":"119","author":"M Cardis","year":"2018","journal-title":"J Neurophysiol"},{"issue":"3","key":"pone.0349610.ref010","doi-asserted-by":"crossref","first-page":"1622","DOI":"10.1152\/jn.00451.2017","article-title":"The cerebellum does more than sensory prediction error-based learning in sensorimotor adaptation tasks","volume":"118","author":"PA Butcher","year":"2017","journal-title":"J Neurophysiol"},{"key":"pone.0349610.ref011","first-page":"19","article-title":"Reward based motor adaptation mediated by Basal Ganglia","volume":"11","author":"T Kim","year":"2017","journal-title":"Front Comput Neurosci"},{"key":"pone.0349610.ref012","doi-asserted-by":"crossref","first-page":"15082","DOI":"10.1038\/nrdp.2015.82","article-title":"Cerebral palsy","volume":"2","author":"HK Graham","year":"2016","journal-title":"Nat Rev Dis Primers"},{"key":"pone.0349610.ref013","doi-asserted-by":"crossref","first-page":"639871","DOI":"10.3389\/fnhum.2021.639871","article-title":"Clinical recognition of sensory ataxia and cerebellar ataxia","volume":"15","author":"Q Zhang","year":"2021","journal-title":"Front Hum Neurosci"},{"issue":"9","key":"pone.0349610.ref014","doi-asserted-by":"crossref","first-page":"741","DOI":"10.1016\/S1474-4422(17)30252-1","article-title":"Clinical presentation and management of dyskinetic cerebral palsy","volume":"16","author":"E Monbaliu","year":"2017","journal-title":"Lancet Neurol"},{"key":"pone.0349610.ref015","doi-asserted-by":"crossref","first-page":"62","DOI":"10.1080\/02640414.2021.1935114","article-title":"Improving the objectivity of the current World Para Swimming motor coordination test for swimmers with hypertonia, ataxia and athetosis using measures of movement smoothness, rhythm and accuracy","volume":"39","author":"AC Maia","year":"2021","journal-title":"J Sports Sci"},{"issue":"3","key":"pone.0349610.ref016","doi-asserted-by":"crossref","first-page":"247","DOI":"10.1177\/1073858404263517","article-title":"Cerebellar control of balance and locomotion","volume":"10","author":"SM Morton","year":"2004","journal-title":"Neuroscientist"},{"issue":"10","key":"pone.0349610.ref017","doi-asserted-by":"crossref","first-page":"2673","DOI":"10.1523\/JNEUROSCI.3303-16.2017","article-title":"Motor learning enhances use-dependent plasticity","volume":"37","author":"F Mawase","year":"2017","journal-title":"J Neurosci"},{"key":"pone.0349610.ref018","doi-asserted-by":"crossref","first-page":"1399","DOI":"10.3389\/fneur.2019.01399","article-title":"The effect of increased gait speed on asymmetry and variability in children with cerebral palsy","volume":"10","author":"SM Br\u00e6ndvik","year":"2020","journal-title":"Front Neurol"},{"issue":"5","key":"pone.0349610.ref019","doi-asserted-by":"crossref","first-page":"292","DOI":"10.1111\/j.1469-8749.2000.tb00093.x","article-title":"The gross motor function classification system for cerebral palsy: a study of reliability and stability over time","volume":"42","author":"E Wood","year":"2000","journal-title":"Dev Med Child Neurol"},{"issue":"7","key":"pone.0349610.ref020","doi-asserted-by":"crossref","first-page":"549","DOI":"10.1017\/S0012162206001162","article-title":"The Manual Ability Classification System (MACS) for children with cerebral palsy: scale development and evidence of validity and reliability","volume":"48","author":"A-C Eliasson","year":"2006","journal-title":"Dev Med Child Neurol"},{"issue":"1","key":"pone.0349610.ref021","doi-asserted-by":"crossref","first-page":"82","DOI":"10.1063\/1.166141","article-title":"Quantification of scaling exponents and crossover phenomena in nonstationary heartbeat time series","volume":"5","author":"CK Peng","year":"1995","journal-title":"Chaos"},{"issue":"2","key":"pone.0349610.ref022","doi-asserted-by":"crossref","first-page":"256","DOI":"10.1007\/s00221-006-0441-7","article-title":"Dynamical structure of center-of-pressure trajectories in patients recovering from stroke","volume":"174","author":"M Roerdink","year":"2006","journal-title":"Exp Brain Res"},{"issue":"4","key":"pone.0349610.ref023","doi-asserted-by":"crossref","first-page":"200","DOI":"10.1097\/JES.0b013e3181877d71","article-title":"The structure of variability in human walking and running is speed-dependent","volume":"36","author":"K Jordan","year":"2008","journal-title":"Exerc Sport Sci Rev"},{"issue":"1","key":"pone.0349610.ref024","doi-asserted-by":"crossref","first-page":"12","DOI":"10.1186\/1743-0003-4-12","article-title":"Fractal time series analysis of postural stability in elderly and control subjects","volume":"4","author":"H Amoud","year":"2007","journal-title":"J Neuroeng Rehabil"},{"issue":"4","key":"pone.0349610.ref025","doi-asserted-by":"crossref","first-page":"041107","DOI":"10.1103\/PhysRevE.65.041107","article-title":"Effect of nonstationarities on detrended fluctuation analysis","volume":"65","author":"Z Chen","year":"2002","journal-title":"Physical Review E"},{"key":"pone.0349610.ref026","doi-asserted-by":"crossref","DOI":"10.7717\/peerj.17575","article-title":"Applying different levels of practice variability for motor learning: More is not better","volume":"12","author":"C Caballero","year":"2024","journal-title":"PeerJ"},{"issue":"4","key":"pone.0349610.ref027","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0226789","article-title":"Quantifying exploration in reward-based motor learning","volume":"15","author":"NM van Mastrigt","year":"2020","journal-title":"PLoS One"},{"key":"pone.0349610.ref028","doi-asserted-by":"crossref","first-page":"623200","DOI":"10.3389\/fneur.2021.623200","article-title":"Performance variability during motor learning of a new balance task in a non-immersive virtual environment in children with hemiplegic cerebral palsy and typically developing peers","volume":"12","author":"M Cheng","year":"2021","journal-title":"Front Neurol"},{"issue":"8","key":"pone.0349610.ref029","doi-asserted-by":"crossref","first-page":"1271","DOI":"10.1080\/09638288.2022.2060333","article-title":"Effectiveness of different extrinsic feedback forms on motor learning in children with cerebral palsy: a systematic review","volume":"45","author":"J Schoenmaker","year":"2023","journal-title":"Disabil Rehabil"},{"issue":"7","key":"pone.0349610.ref030","article-title":"Dissociating error-based and reinforcement-based loss functions during sensorimotor learning","volume":"13","author":"JGA Cashaback","year":"2017","journal-title":"PLoS Comput Biol"},{"issue":"3","key":"pone.0349610.ref031","doi-asserted-by":"crossref","first-page":"242","DOI":"10.1080\/01942638.2021.2010857","article-title":"Feasibility of high repetition upper extremity rehabilitation for children with unilateral cerebral palsy","volume":"42","author":"MJ Metzler","year":"2022","journal-title":"Phys Occup Ther Pediatr"},{"issue":"10","key":"pone.0349610.ref032","doi-asserted-by":"crossref","first-page":"744","DOI":"10.1111\/j.1469-8749.2008.03089.x","article-title":"Content validity of the expanded and revised Gross Motor Function Classification System","volume":"50","author":"RJ Palisano","year":"2008","journal-title":"Dev Med Child Neurol"},{"issue":"4","key":"pone.0349610.ref033","doi-asserted-by":"crossref","first-page":"76","DOI":"10.4103\/ijnpnd.ijnpnd_26_17","article-title":"A systematic review on etiology, epidemiology, and treatment of cerebral palsy","volume":"7","author":"M Rana","year":"2017","journal-title":"Int J Nutr Pharmacol Neurol Dis"},{"issue":"10","key":"pone.0349610.ref034","doi-asserted-by":"crossref","first-page":"885","DOI":"10.1111\/dmcn.12246","article-title":"A systematic review of interventions for children with cerebral palsy: state of the evidence","volume":"55","author":"I Novak","year":"2013","journal-title":"Dev Med Child Neurol"}],"updated-by":[{"DOI":"10.1371\/journal.pone.0355274","type":"correction","label":"Correction","source":"publisher","updated":{"date-parts":[[2026,7,31]],"date-time":"2026-07-31T00:00:00Z","timestamp":1785456000000}}],"container-title":["PLOS One"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0349610","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,22]],"date-time":"2026-06-22T17:22:04Z","timestamp":1782148924000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0349610"}},"subtitle":[],"editor":[{"given":"Yih-Kuen","family":"Jan","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2026,6,22]]},"references-count":34,"journal-issue":{"issue":"6","published-online":{"date-parts":[[2026,6,22]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0349610","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,6,22]]}}}