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The purpose was to conduct a structured review and meta-analysis to determine the cumulative effect of bilateral arm training on motor capabilities post stroke. Forty-eight stroke studies were selected from three databases with 25 comparisons qualifying for inclusion in our meta-analysis. We identified and coded four types of bilateral arm interventions with 366 stroke patients. A random effects model using the standardized mean difference technique determined a large and significant effect size (0.734; SE=0.125), high fail-safe N (532), and medium variability in the studies (I(2)=63%). Moderator variable analysis on the type of bilateral training revealed two large and significant effects: (a) BATRAC (0.842; SE=0.155) and (b) coupled bilateral and EMG-triggered neuromuscular stimulation (1.142; SE=0.176). These novel findings provide strong evidence supporting bilateral arm training with the caveat that two coupled protocols, rhythmic alternating movements and active stimulation, are most effective., (Copyright © 2009 Elsevier B.V. All rights reserved.)

There is growing evidence that normal aging may produce declines in some motor tasks but not others. One account of the task-specific aging effects suggests that age-related differences will be evident in tasks that demand high-level processing but not in tasks that can be performed relatively automatically. To test this hypothesis we compared the performance of young and older adults on two bimanual circle drawing tasks that utilize either low-level emergent timing processes (continuous circle drawing) or higher-level event-based timing mechanisms (intermittent circle drawing). The circle drawing tasks were performed with the hands coupled in either a symmetrical or asymmetrical coordination mode and at two individually-determined movement frequencies (comfortable and fast). Older participants were able to match the performance of young adults under both coordination modes and movement frequencies in the bimanual continuous circling task, but showed significantly greater temporal variability when performing the intermittent circling task. The results of the study are in accordance with the view that age-related effects will be observed in tasks in which movement timing is guided by high-level representations but not in tasks involving relatively automatic low-level timing processes., (Copyright © 2009 Elsevier B.V. All rights reserved.)

Primary motor cortex (M1) plays a role in motor learning, although the exact nature of that involvement remains unclear. The present study examined the relationship between motor learning and cortical plasticity by manipulating augmented feedback during motor training. Two groups of 10 participants performed a wrist flexion-extension waveform-tracking task with either concurrent and terminal augmented feedback after every trial (100% FB) or only terminal feedback after every alternate trial (50% FB). Single- and paired-pulse transcranial magnetic stimulation (TMS) was used to assess cortical excitability short-interval intracortical inhibition (SICI) and intracortical facilitation (ICF) before, after, and 24 h following (retention) motor training. The 50% FB group performed better at retention than the 100% FB group, indicative of enhanced learning due to reduced FB scheduling. Cortical excitability did not change during acquisition for either group, however, the 50% FB group had elevated M1 excitability at retention, suggesting M1 involvement in the consolidation of learning. Reduced SICI following practice suggests a reduction of intracortical inhibition during motor skill acquisition. ICF was unchanged. It is concluded that the nature of M1 modulation associated with the acquisition and retention of a novel motor skill appears to vary with the nature and complexity of task requirements., (Copyright © 2010 Elsevier B.V. All rights reserved.)

The motor program is a concept that has had a major influence on theorizing in the field of motor control. However, there has been a lack of consensus as to what exactly is a motor program and its role in movement organization and execution. In 1994 Morris, Summers, Matyas, and Iansek concluded from a review of the application of the motor program concept in the field of physical therapy that continued use of the term may impede progress in the field. In this paper we examine what has happened to the motor program concept in the thirteen years since the previous evaluation. The review indicates that although the term is still being used in different ways, the theoretical existence of a motor program appears to be generally accepted by researchers in experimental psychology, movement science, and neurophysiology. The recent development of powerful brain imaging techniques may allow determination of whether the motor program should be regarded as a metaphorical or literal concept.

It has been suggested that the temporal control of rhythmic unimanual movements is different between tasks requiring continuous (e.g., circle drawing) and discontinuous movements (e.g., finger tapping). Specifically, for continuous movements temporal regularities are an emergent property, whereas for tasks that involve discontinuities timing is an explicit part of the action goal. The present experiment further investigated the control of continuous and discontinuous movements by comparing the coordination dynamics and attentional demands of bimanual continuous circle drawing with bimanual intermittent circle drawing. The intermittent task required participants to insert a 400ms pause between each cycle while circling. Using dual-task methodology, 15 right-handed participants performed the two circle drawing tasks, while vocally responding to randomly presented auditory probes. The circle drawing tasks were performed in symmetrical and asymmetrical coordination modes and at movement frequencies of 1Hz and 1.7Hz. Intermittent circle drawing exhibited superior spatial and temporal accuracy and stability than continuous circle drawing supporting the hypothesis that the two tasks have different underlying control processes. In terms of attentional cost, probe RT was significantly slower during the intermittent circle drawing task than the continuous circle drawing task across both coordination modes and movement frequencies. Of interest was the finding that in the intermittent circling task reaction time (RT) to probes presented during the pause between cycles did not differ from the RT to probes occurring during the circling movement. The differences in attentional demands between the intermittent and continuous circle drawing tasks may reflect the operation of explicit event timing and implicit emergent timing processes, respectively.

The present work investigated the effects of spatial and neuromuscular constraints on the mean states and variability of interlimb coordination patterns performed in the para-sagittal plane of motion in a hand-held pendulum oscillation task. Nine right-handed students had to oscillate two pendulums through wrist adduction-abduction movements. Relative movement direction was manipulated by asking participants to perform both isodirectional and non-isodirectional movements. Participants were required to grab the pendulums either with both forearms in the same neutral or supine posture or with one forearm in neutral while the other one was in prone-inversed position. When both forearms were in a similar posture, isodirectional movements were generated predominantly by simultaneous activation of homologous muscle groups whereas non-isodirectional movements mainly resulted from simultaneous activation of non-homologous muscle groups. When forearms were in dissimilar posture, isodirectional movements were generated predominantly by the simultaneous activation of non-homologous muscle groups whereas non-isodirectional movements mainly resulted from simultaneous activation of homologous muscle groups. Standard deviation of relative phase and absolute error of relative phase were analyzed for each forearm posture condition. We hypothesized that neuromuscular and spatial constraints would affect two different aspects of coordination performance, i.e., pattern stability and accuracy, respectively. Comparison of the results obtained for similar and dissimilar postures suggested that changes of pattern stability were mediated by changes in the nature of the muscle activation patterns that gave rise to wrist movement in each condition. On the other hand, the results also showed that movement direction exclusively affected phase shift. The findings are consistent with the conclusion of Park et al. [Park, H., Collins, D. R., & Turvey, M. T. (2001). Dissociation of muscular and spatial constraints on patterns of interlimb coordination. Journal of Experimental Psychology: Human Perception and Performance, 27, 32-47.] that neuromuscular constraints affect variability of relative phase (attractor strength) and spatial constraints affect the shift of relative phase (attractor location).

This study aimed to examine the effects of directing attention to the spatial dimension of the circle-drawing task on interlimb coordination patterns across limbs. Eighteen participants performed a circle-drawing task involving in-phase and antiphase coordination modes under upper limb, contralateral and ipsilateral limb combinations. Results indicated that (a) coordination pattern stability co-varied with central cost when attentional focus was directed to the spatial dimensions of the interlimb circle-drawing task; (b) attentional focus on the spatial components modified the inherent performance asymmetries between the limbs; (c) finally, attention to the spatial components of the interlimb circle-drawing task modulated movement trajectories and at the same time the stability of temporal coordination.

Studies investigating whether simultaneous bilateral movements can facilitate performance of the impaired limb(s) of stroke patients have returned mixed results. In the present study we compared unilateral limb performance (amplitude, cycle duration) with performance during an interlimb coordination task involving both homologous (both arms, both legs) and non-homologous (one arm, one leg) limbs in stroke participants (n=7) and healthy age-matched controls (n=7). In addition, the effect of on-line augmented visual feedback on interlimb coordination was investigated. Participants performed cyclical flexion-extension movements of the arms and legs in the sagittal plane paced by an auditory metronome (1 Hz). Movement amplitudes were larger and cycle durations shorter during homologous limb coordination than non-homologous coordination. Compared with unilateral movements both groups had reduced movement amplitudes and the stroke group increased cycle duration when interlimb coordination tasks were performed. These effects were most evident during non-homologous (arm and leg) coordination. No evidence of facilitation of the impaired limb(s) was found in any of the interlimb coordination conditions. Augmented visual feedback had minimal effect on the movements of control participants but lead to an increase of cycle duration for stroke participants.

This study aimed to examine the attentional demands of coordinating movement patterns across limbs. Eighteen participants performed a circle drawing task involving in-phase and anti-phase coordination modes under homologous, contralateral and ipsilateral limb combinations. Results indicated that: (a) attentional focus further stabilised coordination patterns with a cost at the central level; (b) there was an inverse relationship between stability and probe reaction time (RT) for all coordination patterns, that is the stronger the coupling between the limbs the lower the central cost. Overall, the results support previous research suggesting that attention plays an important role in sustaining coordination pattern stability and that the co-variation between coordination stability and central cost can also be extended to coordination across limbs.

The present study was designed to test two predictions from the coupled oscillator model of multifrequency coordination. First, it was predicted that multifrequency tasks that match the inherent manual asymmetry (i.e., the preferred hand assigned to the faster tempo) would be easier to learn than tasks that do not match the inherent dynamics (i.e., the non-preferred hand assigned to the faster tempo). Second, in the latter case acquisition of the multifrequency coordination would involve a reorganisation of the coupling dynamics such that the faster hand would exert a greater influence on the slower hand than vice versa. Sixteen right-handed volunteers received extensive training on a 2:1 coordination pattern involving a bimanual forearm pronation-supination task. Participants were randomly assigned to one of two groups: 1L:2R in which the preferred right hand performed the higher frequency, or 2L:1R in which the non-preferred left hand performed the higher frequency. The dynamic stability of the patterns was assessed by the ability of participants to maintain the coordination pattern as movement frequency was increased. Changes in the directional coupling between the hands was assessed by transition pathways and lead-lag relationship evident in a 1:1 anti-phase frequency-scaled coordination task performed prior to and following three practice sessions of the 2:1 task. The predicted differential stability between the multifrequency patterns was evident in the initial acquisition sessions but by the end of training the two patterns evidenced equivalent stability. Unexpectedly, for both groups the fast hand displayed greater variability in amplitude and movement frequency than the slow hand perhaps reflecting anchoring afforded to the slow hand by synchronising movement endpoints with the auditory pacing metronome. Analysis of pre- to post-training changes to the coupling dynamics in the 1:1 anti-phase task support the hypothesis that acquisition of the 2L:1R pattern involved reorganisation of the inherent dynamics., (Copyright 2002 Elsevier Science B.V.)