The Scale for Assessment and Rating of Ataxia Is Reliable and Valid in the Telehealth Setting for Patients With Cerebellar Ataxia.

Objective: Health care has increasingly expanded into a hybrid in-person/telehealth model. Patients with a variety of health conditions, including cerebellar ataxia, have received virtual health evaluations; however, it remains unknown whether some outcome measures that clinicians utilize in the telehealth setting are reliable and valid. The goal of this project is to evaluate the psychometric properties of the Scale for Assessment and Rating of Ataxia (SARA) for patients with cerebellar ataxia in the telehealth setting.

Why do some people with stroke not receive the recommended 45 min of occupational therapy and physiotherapy after stroke? A qualitative study using focus groups.

Objectives: To generate qualitative data on the views of Occupational Therapists and Physiotherapists about why people do not receive the Royal College of Physicians' recommended minimum of 45 minutes (min) of daily therapy after stroke, in order to inform a Delphi study.

Design: Focus group study.

Setting: Stroke services in the South of England.

Why do some people who had a stroke not receive the recommended 45 min of occupational therapy and physiotherapy? A Delphi study.

Objectives: To gain a consensus among therapists for reasons why a person who had a stroke may not receive the Royal College of Physicians' recommended minimum of 45 min of daily therapy.

Design: Three-round remote e-Delphi study.

Setting: National study, based in the UK.

Age-related differences in lower limb muscle activation patterns and balance control strategies while walking over a compliant surface.

Substantial evidence demonstrates that falls in older adults are leading causes of fatal and non-fatal injuries and lead to negative impacts on the quality of life in the aging population. Most falls in older fallers result from unrecoverable limb collapse during falling momentum control in the single limb support (SLS) phase. To understand why older adults are more likely to fall than younger adults, we investigated age-related differences in knee extensor eccentric control, lower limb muscle activation patterns, and their relation to balance control.

Some home-based self-managed rehabilitation interventions can improve arm activity after stroke: A systematic review and narrative synthesis.

Background: There is an increased need for home-based, self-managed, and low maintenance stroke rehabilitation as well as interest in targeting the arm, which often lags behind leg recovery. Previous reviews have not controlled for concurrent standard of care and the ratio of self-managed care to therapist input.

Objectives: To determine the effectiveness of home-based, self-managed and low maintenance programs for upper-limb motor recovery in individuals after stroke.

Age-related differences in stepping stability following a sudden gait perturbation are associated with lower limb eccentric control of the perturbed limb.

Introduction: Falls are a leading cause of severe injuries and a major threat to quality of life in older adults. Elderly fallers demonstrate insufficient eccentric quadriceps control during the weight acceptance phase of initial single limb stance. However, the functional role of eccentric control of the perturbed (leading) leg during walking balance recovery and its age-related differences have not yet been studied; thus we investigated age-related differences in eccentric control at the knee of the perturbed leg and its influence on the postural sway and stability of the trailing leg during balance recovery following unexpected surface drop perturbations.

Development and Psychometric Testing of the Bimanual Assessment Measure for People With Chronic Stroke.

Importance: Few tools are available to assess bimanual deficits after stroke.

Objective: To develop the Bimanual Assessment Measure (BAM), which assesses a person's hand coordination in both preferred and prestroke roles (i.e.

Baseline Predictors of Response to Repetitive Task Practice in Chronic Stroke.

Background: Repetitive task practice reduces mean upper extremity motor impairment in of patients with chronic stroke, but response is highly variable. A method to predict meaningful reduction in impairment in response to training based on biomarkers and other data collected prior to an intervention is needed to establish realistic rehabilitation goals and to effectively allocate resources.

Objectives: To identify prognostic factors and better understand the biological substrate for reductions in arm impairment in response to repetitive task practice among patients with chronic (≥6 months) post-stroke hemiparesis.

Task selection for a sensor-based, wearable, upper limb training device for stroke survivors: a multi-stage approach.

Purpose: Post-stroke survivors report that feedback helps to increase training motivation. A wearable system (M-MARK), comprising movement and muscle sensors and providing feedback when performing everyday tasks was developed. The objective reported here was to create an evidence-based set of upper-limb tasks for use with the system.

The effect of time spent in rehabilitation on activity limitation and impairment after stroke.

Background: Stroke affects millions of people every year and is a leading cause of disability, resulting in significant financial cost and reduction in quality of life. Rehabilitation after stroke aims to reduce disability by facilitating recovery of impairment, activity, or participation. One aspect of stroke rehabilitation that may affect outcomes is the amount of time spent in rehabilitation, including minutes provided, frequency (i.

Trunk kinematics and muscle activation patterns during stand-to-sit movement and the relationship with postural stability in aging.

Background: Stand-to-sit (StandTS) movement is an important functional activity that can be challenging for older adults due to age-related changes in neuromotor control. Although trunk flexion, eccentric contraction of the rectus femoris (RF), and coordination of RF and biceps femoris (BF) muscles are important to the StandTS task, the effects of aging on these and related outcomes are not well studied.

Research Question: What are the age-related differences in trunk flexion, lower extremity muscle activation patterns, and postural stability during a StandTS task and what is the relationship between these variables?

Methods: Ten younger and ten older healthy adults performed three StandTS trials at self-selected speeds.

Contraction Phase and Force Differentially Change Motor Evoked Potential Recruitment Slope and Interhemispheric Inhibition in Young Versus Old.

Interhemispheric interactions are important for arm coordination and hemispheric specialization. Unilateral voluntary static contraction is known to increase bilateral corticospinal motor evoked potential (MEP) amplitude. It is unknown how increasing and decreasing contraction affect the opposite limb.

Methods for an Investigation of Neurophysiological and Kinematic Predictors of Response to Upper Extremity Repetitive Task Practice in Chronic Stroke.

Objective: To demonstrate the feasibility of algorithmic prediction using a model of baseline arm movement, genetic factors, demographic characteristics, and multimodal assessment of the structure and function of motor pathways. To identify prognostic factors and the biological substrate for reductions in arm impairment in response to repetitive task practice.

Design: This prospective single-group interventional study seeks to predict response to a repetitive task practice program using an intent-to-treat paradigm.

Competition for limited neural resources in older adults leads to greater asymmetry of bilateral movements than in young adults.

We previously demonstrated that lateralization in the neural control of predictive and impedance mechanisms is reflected by interlimb differences in control of bilateral tasks. Aging has been shown to reduce lateralization during unilateral performance, presumably due to greater recruitment of the ipsilateral hemisphere. We now hypothesize that aging-related reduction in the efficiency of neural resources should produce greater behavioral asymmetry during bilateral actions that require hemispheric specialization for each arm.

Robot-Assisted Arm Training in Chronic Stroke: Addition of Transition-to-Task Practice.

. Robot-assisted therapy provides high-intensity arm rehabilitation that can significantly reduce stroke-related upper extremity (UE) deficits. Motor improvement has been shown at the joints trained, but generalization to real-world function has not been profound.

Not all brain regions are created equal for improving bimanual coordination in individuals with chronic stroke.

Objective: The now standard cortical stimulation approach of inhibiting contralesional primary motor cortex (cM1) disrupts bimanual coordination while facilitating ipsilesional M1 (iM1) fails to enhance paretic arm function, in severely impaired individuals. We propose an alternative target, enhancing contralesional dorsal premotor cortex (cPMd) to improve bimanual coordination and compare its effects to iM1.

Methods: Fourteen participants with stroke received 5-Hz repetitive transcranial magnetic stimulation (rTMS) on cPMd or iM1 in a repeated cross-over design.

A Perception-Action Approach to Understanding Typical and Atypical Motor Development.

In this chapter, we ask two questions. First, can the study of the perception-action system across time offer a useful model for understanding motor development? Second, can the study of the perception-action system in children with developmental coordination disorder (DCD) inform our understanding of atypical as well as typical motor development? We begin by describing the dynamical systems perspective and a control-theoretic approach that together provide the conceptual framework for our paradigms, methodology, and interpretation of our experiments. Our experimental strategy has been to perturb one or more sensory systems and observe the effect on the motor system.

Handedness results from complementary hemispheric dominance, not global hemispheric dominance: evidence from mechanically coupled bilateral movements.

Two contrasting views of handedness can be described as 1) complementary dominance, in which each hemisphere is specialized for different aspects of motor control, and 2) global dominance, in which the hemisphere contralateral to the dominant arm is specialized for all aspects of motor control. The present study sought to determine which motor lateralization hypothesis best predicts motor performance during common bilateral task of stabilizing an object (e.g.

Neural motor control differs between bimanual common-goal vs. bimanual dual-goal tasks.

Coordinating bimanual movements is essential for everyday activities. Two common types of bimanual tasks are common goal, where two arms share a united goal, and dual goal, which involves independent goals for each arm. Here, we examine how the neural control mechanisms differ between these two types of bimanual tasks.

Comparing the effects of adapting to a weight on one leg during treadmill and overground walking: A pilot study.

Background: Locomotor adaptation has been suggested as a way to improve gait symmetry in individuals post-stroke. Most perturbation methods utilize costly, specialized equipment. The use of a unilateral leg weight may provide a low cost, clinically translatable alternative.

Telehealth, Wearable Sensors, and the Internet: Will They Improve Stroke Outcomes Through Increased Intensity of Therapy, Motivation, and Adherence to Rehabilitation Programs?

Background And Purpose: Stroke, predominantly a condition of older age, is a major cause of acquired disability in the global population and puts an increasing burden on health care resources. Clear evidence for the importance of intensity of therapy in optimizing functional outcomes is found in animal models, supported by neuroimaging and behavioral research, and strengthened by recent meta-analyses from multiple clinical trials. However, providing intensive therapy using conventional treatment paradigms is expensive and sometimes not feasible because of social and environmental factors.

Timing at peak force may be the hidden target controlled in continuation and synchronization tapping.

Timing control, such as producing movements at a given rate or synchronizing movements to an external event, has been studied through a finger-tapping task where timing is measured at the initial contact between finger and tapping surface or the point when a key is pressed. However, the point of peak force is after the time registered at the tapping surface and thus is a less obvious but still an important event during finger tapping. Here, we compared the time at initial contact with the time at peak force as participants tapped their finger on a force sensor at a given rate after the metronome was turned off (continuation task) or in synchrony with the metronome (sensorimotor synchronization task).

Children and Adults Both Learn Motor Sequences Quickly, But Do So Differently.

Both children and adults can learn motor sequences quickly in one learning session, yet little is known about potential age-related processes that underlie this fast sequence acquisition. Here, we examined the progressive performance changes in a one-session modified serial reaction time task in 6- and 10-year-old children and adults. We found that rapid sequence learning, as reflected by reaction time (RT), was comparable between groups.

Effects of Gait Training With Body Weight Support on a Treadmill Versus Overground in Individuals With Stroke.

Objective: To investigate the effects of gait training with body weight support (BWS) on a treadmill versus overground in individuals with chronic stroke.

Design: Randomized controlled trial.

Setting: University research laboratory.

Age-related changes in bilateral upper extremity coordination.

Although evidence exists that changes in sensorimotor function occur with aging, changes in the bilateral coordination of the upper extremities is less understood. Here, we review the behavioral and neural evidence of declines in bilateral coordination as well as the implications these deficits have on function and physical rehabilitation. We begin with an introduction to the two major forms of bilateral coordination, symmetric and non-symmetric and their sub-groupings.