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This dataset contains thesurvey answers for the manuscript "Testing a novel knowledge translation intervention for motor learning practice in physical therapy”. For more information please contact Dr. Michal Kafri kafri.michal@gmail.com

Background: Multiple Sclerosis is an incurable, chronic, and progressive disease that affects an individual's function and health-related quality of life (HR-QoL). Self-management refers to activities the individual performs in order to reduce the impact of illness on his function and HR-QoL, and includes aspects such as medical management (treatment by health care professionals) and lifestyle (regular exercise). A subjective aspect of patient activation is also part of the broader approach, and refers to the knowledge, skills, and confidence individuals have to manage their health. Although this approach has been studied in people with Multiple Sclerosis, there is limited data about its associations with activation level, function, and HR-QoL. Objectives: 1. To describe self-management and the level of patient activation among people with Multiple Sclerosis. 2. To examine the correlation between self-management and patient activation and between function, mobility and HR-QoL. Method: A digital survey was conducted and included self-report questionnaires to assess self-management, activation levels, function, mobility and HR-QoL. Results: The survey was completed by 79 people. Self-management and levels of activation were high. Most participants did not receive health-profession treatment. Regression analysis showed that visits to the neurologist and receiving treatments from the health professions contribute to mobility (R2 = 0.05, R2 = 0.16 respectively). Exercise was found to be related to mobility status (r = -0.23, p

Introduction: The perceptions and beliefs of physical therapists play an important role in their clinical behavior. These clinician-related aspects may contribute to the knowledge-action gap in the field of motor learning (ML). Accordingly, this study explored how a sample of physical therapists perceive ML in their practice.Methods: A qualitative phenomenological study was conducted. Twelve physical therapists with a wide range of work experience were purposefully selected. Data were collected through semi-structured interviews and analyzed using content analysis methodology. Themes and categories were identified.Results: We identified five key themes: 1) 'ML within the scope of PT' showed that participants perceived ML as a fundamental part of the profession; 2) 'Understanding of ML' showed that participants had difficulty understanding the field comprehensively; 3) 'Self-efficacy toward the topic of ML' revealed that participants had low self-efficacy about their knowledge of the topic; 4) 'Features of ML implementation' showed that physical therapists tended to implement ML intuitively; and 5) 'Barriers to implementation and ways to facilitate it' showed that lack of knowledge was perceived as a main barrier to implementation.Conclusions: Physical therapists' perceptions of and experiences with ML showed the complexity of the field and the lack of clarity regarding its theoretical content and clinical applications. There is a need to reinforce knowledge of ML among physical therapists at different levels of professional development and to promote self-efficacy toward its use, possibly by increasing ML knowledge and education while emphasizing its clinical context.

Background The importance of motor learning knowledge for physical therapist practice is well known; however, its application is lacking. Conceptual frameworks that place motor learning knowledge within a clinical context are a potential mediator to overcome this gap. Purpose This study aimed to conduct a scoping review of the literature to identify and describe the content of such conceptual frameworks in physical therapy/rehabilitation, including the approaches taken in their development and the “elements” or building blocks of motor learning–based interventions within each conceptual framework. Data Sources The data sources used were PubMed, CINAHL, and PsychInfo databases. Study Selection Articles that were selected had a primary focus on motor learning and its application in physical therapy/rehabilitation and were published between 2000 and 2017. Data Extraction Twelve of 62 relevant articles met the inclusion criteria. Data Synthesis Papers attempted to translate theoretical knowledge into a coherent, clinically accessible conceptual framework via 3 main approaches: synthesizing selected motor learning elements into original new conceptual frameworks, mapping motor learning elements in current clinical practices, and assembling selected motor learning elements. The elements of motor learning that were common across papers included theoretical concepts (such as “meaningful goal setting” and “active involvement”); practice variables (including the type, frequency, and timing of feedback; the focus of instructions; task breakdown; and the amount, variability, and order of practice); and intervention strategies (task specific and mental practice). Psychological aspects related to self-efficacy and motivation were also considered integral. Limitations Papers published before the year 2000 were excluded. Conclusion The scoping review revealed that the presentation of motor learning elements in a coherent framework encompassed very diverse approaches and used different categorization systems. In addition, to fully grasp the complexity of clinical practice, motor learning should be coupled with other fields of knowledge.

BackgroundVirtual reality (VR) enables objective and accurate measurement of behavior in ecologically valid and safe environments, while controlling the delivery of stimuli and maintaining standardized measurement protocols. Despite this potential, studies that compare virtual and real-world performance of complex daily activities are scarce. This study aimed to compare cognitive strategies and gait characteristics of young and older healthy adults as they engaged in a complex task while navigating in a real shopping mall and a high-fidelity virtual replica of the mall.MethodsSeventeen older adults (mean (SD) age = 71.2 (5.6) years, 64% males) and 17 young adults (26.7 (3.7) years, 35% males) participated. In two separate sessions they performed the Multiple Errands Test (MET) in a real-world mall or the Virtual MET (VMET) in the virtual environment. The real-world environment was a small shopping area and the virtual environment was created within the CAREN™ (Computer Assisted Rehabilitation Environment) Integrated Reality System. The performance of the task was assessed using motor and physiological measures (gait parameters and heart rate), MET or VMET time and score, and navigation efficiency (cognitive performance and strategy). Between (age groups) and within (environment) differences were analyzed with ANOVA repeated measures.ResultsThere were no significant age effects for any of the gait parameters but there were significant environment effects such that both age groups walked faster (F(1,32) = 154.96, p (1,32) = 86.36, p (1,32) = 95.71–36.06, p (1,32) = 13.40, p (1,32) = 19.77, p (1,32) = 11.74, p (1,32) = 7.6, p ConclusionsThis comprehensive, ecological approach in the measurement of performance during tasks reminiscent of complex life situations showed the strengths of using virtual environments in assessing cognitive aspects and limitations of assessing motor aspects of performance. Difficulties by older adults were apparent mainly in the cognitive aspects indicating a need to evaluate them during complex task performance.

The field of motor learning (ML) plays a pivotal role in physical therapy (PT), and its implementation has been shown to improve intervention outcomes. The objective of this study was to assess physical therapists' ML-related self-efficacy, self-reported implementation, and environmental workplace factors. An additional aim was to report the psychometric properties of a questionnaire that was developed to assess the above-mentioned constructs.An observational, cross-sectional survey was completed by 289 physical therapists (average age: 38.7 (9.7), with 11.3 (9.7) years of experience and 74% female). Construct validity, internal consistency, and test-retest reliability were tested. The main outcome measures were the scores of the three scales of the questionnaire, referring to self-efficacy in ML, implementation of ML principles, and workplace environment features.The questionnaire had sound psychometric qualities. Respondents perceived ML as an integral part of PT. ML-related self-efficacy and implementation of ML principles were moderate (2.95/5 (0.7) and 3.04/5(0.8), respectively). PT practice had a significant effect on ML-related self-efficacy (Level of self-efficacy might be insufficient to support the systematic implementation of ML principles in practice. Addressing impeding individual- and organizational-level factors might facilitate ML self-efficacy and implementation. Postgraduate education facilitates ML implementation.

Age-related decline in physiological, physical and cognitive functions may interfere with task performance in complex life situations. This study aims to compare the performance of young and older adults during real and simulated complex daily shopping activities considering physiological, motor and cognitive performance. Fifteen adults aged 25.80 ± 4.25 years and 16 older adults aged 72.12 ± 5.58 years were tested in real and simulated shopping malls. Participants performed the Multiple Errands Test (MET) that assesses executive functions during a complex daily task in the real mall. They performed the Virtual MET (VMET) in the simulation while walking on a self-paced treadmill and navigating with a joystick. Gait parameters and Metabolic Equivalents were recorded. The elderly participants performed the MET (4.56 ± 2.12) significantly worse than the younger participants (2.33 ± 1.75, U = 51.00, p

Background and purpose The group of individuals 85 years and over (termed oldest-old) is the fastest-growing population in the Western world. Although daily functional abilities and balance capabilities are known to decrease as an individual grows older, little is known about the balance and functional characteristics of the oldest-old population. The aims of this study were to characterize balance control, functional abilities, and balance self-efficacy in the oldest-old, to test the correlations between these constructs, and to explore differences between fallers and nonfallers in this age group. Methods Forty-five individuals living in an assisted living facility who ambulated independently participated in the study. The mean age was 90.3 (3.7) years. Function was tested using the Late-Life Function and Disability Instrument (LLFDI). Balance was tested with the mini-Balance Evaluation System Test (mini-BESTest) and the Timed Up and Go (TUG) test. Balance self-efficacy was tested with the Activities-Specific Balance Confidence (ABC) scale. Results The mean total function LLFDI score was 63.2 (11.4). The mean mini-BESTest score was 69.8% (18.6%) and the mean TUG time was 12.6 (6.9) seconds. The mean ABC score was 80.2% (14.2%). Good correlation (r > 0.7) was observed between the ABC and the function component of the LLFDI, as well as with the lower extremity domains. Correlations between the mini-BESTest scores and the LLFDI were fair to moderate (r's range: 0.38-0.62). Age and ABC scores were significant independent explanators of LLFDI score (P = .0141 and P = .0009, respectively). Fallers and nonfallers differed significantly across all outcome measures scores, except for TUG and for the "Reactive Postural Control" and "Sensory Orientation" domains of the mini-BESTest. Discussion and conclusions The results of this study provide normative data regarding the balance and functional abilities of the oldest-old, and indicate a strong association between self-efficacy and function. These results emphasize the importance of incorporating strategies that maintain and improve balance self-efficacy in interventions aimed at enhancing the functional level of this cohort.

Most virtual reality rehabilitation of balance and mobility studies about persons post-stoke report body function structure and activity level outcomes of the International Classification of Function. Only a few investigators have reported participation outcomes. Patient-centered approach to incorporating video games into the plan of care would require the use of participation outcomes. The purpose of this double-blind randomized controlled pilot study was to explore the use of the participation outcomes, both to customize the therapy for the participants and to measure patient-relevant outcomes. Methods: Persons in chronic phase post-stroke with residual balance and mobility deficits were randomized to a standard of care (SOC) or Video game-based balance group. An assessor blinded to group assignment measured the activity level measures of the Dynamic Gait Index and gait speed as well as the balance confidence (Activity Balance Confidence Scale: ABC) and participation using the Canadian Occupational Performance Measure (COPM). Therapy was provided for 12 one-hour sessions (3 times a week for 4 weeks). The sessions consisted of a warm-up, sitting balance, standing balance, and choice activities. The video game-based balance group used the Wii sports, Wii Fit, and Wii Active games. Data were analyzed using a 2 (group) × 3 (time) RM Anova with an alpha level set at .05 and adjusted for the time comparison. Emphasis of the analysis was on the within group comparison. Because it was a pilot study, the outcome variables were assessed for clinical meaningfulness with the MDC or MCID within groups. Results Participants in both groups improved their DGI score, the video-based group at follow up and the SOC group at both post and follow-up. Both groups improved their gait speed and retained it at follow-up. The SOC significantly increased the ABC at post but did not retain it at follow up. Both groups improved the beyond the MDC of 10 points on the ABC at follow-up. Both groups improved on COPM performance at post and follow up, both exceeded the MDC of 1.7 points. Only the SOC group had statistically significant clinically meaningful improvements for satisfaction on the COPM both at post and follow up. There were no between group differences for the variables. Conclusion Both groups improved in balance performance and self-efficacy as well as mobility and COPM performance Standard of care, which allowed for greater customization to their participation goals resulted in improvements on COPM satisfaction with participation goals, while the video game based group did not.

BACKGROUND Navigation skills are required for performance of functional complex tasks and may decline due to aging. Investigation of navigation skills should include measurement of cognitive-executive and motor aspects, which are part of complex tasks. OBJECTIVE to compare young and older healthy adults in navigation within a simulated environment with and without a functional-cognitive task. METHODS Ten young adults (25.6±4.3 years) and seven community dwelling older men (69.9±3.8 years) were tested during a single session. After training on a self-paced treadmill to navigate in a non-functional simulation, they performed the Virtual Multiple Errands Test (VMET) in a mall simulation. Outcome measures included cognitive-executive aspects of performance and gait parameters. RESULTS Younger adults' performance of the VMET was more efficient (1.8±1.0) than older adults (5.3±2.7; p

Functional electrical stimulation (FES) to lower extremity (LE) muscles is used by individuals post-stroke as an alternative to mechanical orthotic devices during gait or as a training modality during rehabilitation. Technological developments which improve the feasibility, accessibility and effectiveness of FES systems as orthotic and training devices, highlight the potential of FES for rehabilitating LE function in individuals post-stroke. This study presents a systematic review of the carryover effects of LE FES to motor performance when stimulation is not applied (therapeutic effects) in subjects post-stroke. A description of advances in FES technologies, with an emphasis on systems designed to promote LE function is included, and mechanisms that may be associated with the observed therapeutic effects are discussed. Eligible studies were reviewed for methodological quality, population, intervention and outcome characteristics. Therapeutic effects of FES were consistently demonstrated at the body function and activity levels when it was used as a training modality. Compared to matched treatments that did not incorporate FES, no definite conclusions can be drawn regarding the superiority of FES. When FES was used as an alternative to an orthotic device, it had no superior therapeutic effects at the activity level, yet patients still seemed to prefer it.

Somatosensory stimulation modulates cortical and corticospinal excitability and consequently affects motor output. Therefore, low-amplitude transcutaneous electrical nerve stimulation (TENS) has the potential to elicit favorable motor responses. The purpose of the two presented pilot studies was to shed light on TENS parameters that are relevant for the enhancement of two desirable motor outcomes, namely, electromyographic (EMG) activity and contraction strength of the finger flexors and wrist muscles. In 5 and 10 healthy young adults (in Study I and Study II, respectively) TENS was delivered to the volar aspect of the forearm. We manipulated TENS frequency (150 Hz vs. 5 Hz), length of application (10, 20, and 60 min), and side of application (unilateral, right forearm vs. bilateral forearms). EMG amplitude and grip force were measured before (Pre), immediately after (Post), and following 15 min of no stimulation (Study I only). The results indicated that low-frequency bursts of TENS applied to the skin overlying the finger flexor muscles enhance the EMG activity of the finger flexors and grip force. The increase in EMG activity of the flexor muscles was observed after 20 min of stimulation, while grip force was increased only after 1 h. The effects of uni- and bilateral TENS were comparable. These observations allude to a modulatory effect of TENS on the tested motor responses; however, unequivocal conclusions of the findings are hampered by individual differences that affect motor outcomes, such as in level of attention.

Introduction/Background Dual-task (DT) studies have demonstrated that performing a secondary cognitive task alters gait. However, the tasks employed in these studies are typically of low ecological relevance, and have not emphasized a possible impact of emotional processing on gait parameters. The current work aim was to examine whether gait in old individuals is influenced by simultaneously preforming cognitive-emotional tasks of retrieving autobiographical memories (AM) or imagining future projections (FP), in a dual-task (DT) paradigm. Our working hypothesis was that similar to lab-based cognitive tasks, naturalistic, emotion-evoking processes may lead to alterations in gait execution. Material and method Twenty-four old adults were instructed to recollect AM and FP, in response to cue words that were chosen in preliminary interviews to be personally relevant. A single-task condition (ST) served as baseline and a cognitive verbal fluency task (VF) as an active control. Emotional responses to the tasks were subjectively rated using the Self-Assessment Manikin (SAM) scale, the autonomic-system activity was monitored using the MindWare Impedance Cardiograph, and gait was measured using the APDM's Mobility Lab™. Results AM and FP increased emotional valence relative to ST (P Conclusion The effect of AM and FP on walking characteristics in the elderly showed similar trends to that of VF. Walking was influenced by emotional aspects that accompanied the various tasks.

Objectives To test the effects of a new motor imagery practice approach, in which motor and motivational contents were integrated in order to improve gait in subjects with chronic poststroke hemiparesis. Design A half-crossover study composed of 2 phases. In phase 1, subjects were randomly assigned to receive either the experimental or the control treatment. In phase 2, the subjects who had initially received the control treatment "crossed over" to receive the experimental intervention. Setting The experimental and the control intervention were delivered in the subjects' homes; assessments were performed in a hospital laboratory. Participants Community-dwelling individuals (N=23) with chronic poststroke hemiparesis whose gait was impaired. Interventions The experimental intervention, called integrated motor imagery practice, consisted of imagery scripts aimed at improving home and community walking as well as fall-related self-efficacy. The control treatment consisted of executed exercises to improve the function of the involved upper extremity. Main Outcome Measures In-home walking, indoor and outdoor community ambulation, and fall-related self-efficacy. These were assessed before and after the intervention as well as at a 2-week follow-up. Results In-home walking was significantly improved after application of the experimental intervention ( P ≤.003), but not after the control treatment ( P ≤.68). Community ambulation did not improve. Fall-related self-efficacy was slightly improved by the integrated motor imagery intervention; however, the findings were not unequivocal. Conclusions Home delivery of integrated motor imagery practice was feasible and exerted a positive effect on walking in the home. However, it was ineffective for improving gait in public domains. We speculate that the addition of physical practice to imagery practice may be essential for achieving that end.

A virtual reality (VR) augmented cycling kit (VRACK) was developed to address motor control and fitness deficits of individuals with chronic stroke. In this article, we report on the safety, feasibility, and efficacy of using the VR augmented cycling kit to improve cardiorespiratory (CR) fitness of individuals in the chronic phase poststroke.Four individuals with chronic stroke (47-65 years old and ≥3 years poststroke), with residual lower extremity impairments (Fugl-Meyer 24-26/34), who were limited community ambulators (gait speed range 0.56-1.1 m/s) participated in this study. Safety was defined as the absence of adverse events. Feasibility was measured using attendance, total exercise time, and "involvement" measured with the presence questionnaire (PQ). Efficacy of CR fitness was evaluated using a submaximal bicycle ergometer test before and after an 8-week training program.The intervention was safe and feasible with participants having 1 adverse event, 100% adherence, achieving between 90 and 125 minutes of cycling each week, and a mean PQ score of 39 (SD 3.3). There was a statistically significant (13%; P = 0.035) improvement in peak VO(2), with a range of 6% to 24.5%.For these individuals, poststroke, VR augmented cycling, using their heart rate to set their avatar's speed, fostered training of sufficient duration and intensity to promote CR fitness. In addition, there was a transfer of training from the bicycle to walking endurance. VR augmented cycling may be an addition to the therapist's tools for concurrent training of mobility and health promotion of individuals poststroke.

Gait rehabilitation is a major component of stroke rehabilitation, and is supported by extensive research. The objective of this review was to examine the external validity of intervention studies aimed at improving gait in individuals post-stroke. To that end, two aspects of these studies were assessed: subjects' exclusion criteria and the ecological validity of the intervention, as manifested by the intervention's technological complexity and delivery setting. Additionally, we examined whether the target population as inferred from the titles/abstracts is broader than the population actually represented by the reported samples.We systematically researched PubMed for intervention studies to improve gait post-stroke, working backwards from the beginning of 2014. Exclusion criteria, the technological complexity of the intervention (defined as either elaborate or simple), setting, and description of the target population in the titles/abstracts were recorded.Fifty-two studies were reviewed. The samples were exclusive, with recurrent stroke, co-morbidities, cognitive status, walking level, and residency being major reasons for exclusion. In one half of the studies, the intervention was elaborate. Descriptions of participants in the title/abstract in almost one half of the studies included only the diagnosis (stroke or comparable terms) and its stage (acute, subacute, and chronic).The external validity of a substantial number of intervention studies about rehabilitation of gait post-stroke appears to be limited by exclusivity of the samples as well as by deficiencies in ecological validity of the interventions. These limitations are not accurately reflected in the titles or abstracts of the studies.

BACKGROUND AND PURPOSE High-level gait disorder (HLGD) is a debilitating disorder causing mobility decline in the elderly. Although its clinical characteristics are well described, its anatomical and pathophysiological underpinnings are poorly understood. This study examined the anatomical distribution of white matter (WM) changes in patients with mild to moderate HLGD of the cautious/disequilibrium type, using advanced magnetic resonance imaging (MRI) methods. METHODS Thirteen patients with HLGD, 9 elderly and 13 middle-aged healthy controls were scanned using diffusion tensor imaging, Q-space imaging, and conventional MRI. The regions of significant differences between the HLGD group and the elderly control group were defined, and the mean fractional anisotropy and displacement values of these areas were extracted. RESULTS The HLGD patients had lower fractional anisotropy and higher displacement values in regions related to the motor system, including those along the corticospinal tract and the superior cerebellar peduncles, as well as in cognitive and affective-related areas, including the anterior limbs of the internal capsule and the genu of the corpus callosum. CONCLUSIONS The anatomical distribution associated with HLGD of the cautious/disequilibrium type involves WM pathways that convey motor-related, cognitive and affective-related functions. The underlying pathological process leading to these changes most probably includes demyelination.

Data acquired by functional brain imaging are of a multivariate and complex nature. Selecting relevant topographically specific information for system-level analysis is a highly non-trivial task. This challenge has traditionally been addressed by hypothesis-driven approaches. Recently, data-driven methods making no a priori assumptions about the signal were developed. Here, we present a hybrid approach, selecting data-driven voxels in paradigm-driven measurements in order to identify functional connectivity motifs in the voxel correlations. Our tool is the functional holography (FH) method, originally developed for analyzing electrophysiological recordings and based on analyzing the voxel-voxel correlation matrices. The algorithm selects the relevant voxels using a dendrogram clustering method combined with a unique standard deviation (STD) filter, identifying the voxels with high STD correlations. Functional connectivity motifs are revealed through a dimension-reduction procedure by principal component analysis (PCA) allowing for a reduced three-dimensional holographic presentation space. Information loss due to PCA is retrieved by connecting voxels in the reduced space with lines that are color-coded according to the correlations. Our results show that the FH analysis performed for a single trial reveals interesting motifs, even in a simple motor task: unilateral hand movements yielded two clusters, one in the contralateral M1 region showing neuronal activation and one in the ipsilateral homologues region showing deactivation. Thus, according to a single trial level analysis, of 12-time points alone, we can determine which hand the subject moved. Moreover, using cluster quantification based on eigenvalue entropy calculation, we obtained good separation between right- and left-handed subjects.

This article asked and answered the question of whether there was evidence to support the use of videogames for promotion of wellness and fitness for people poststroke and those with cerebral palsy (CP). A literature search of PubMed, CINAHL, and PEDro using a population, intervention, and outcome (PIO) approach and the key words "stroke (or CP) AND video games (and synonyms) AND energy expenditure (EE) (and synonyms)" was conducted. It yielded two relevant references for people poststroke and five references for people with CP. The literature extraction and synthesis by the categories of the PIO indicated that most studies used only the population of interest, except two that compared the EE with that of healthy controls. The main finding is that both people poststroke (moderate severity) and people with CP (mild severity) can achieve moderate EE playing Wii(™) (Nintendo, Kyoto, Japan), PlayStation(®) (Sony, Tokyo, Japan), and Kinect(™) (Microsoft, Redmond, WA) games. Adults with CP of mild severity played the videogames at vigorous levels, whereas those with severe CP played them at low levels. There appears to be an interaction between development and severity that influences the exercise intensity measured by EE. The findings suggests that videogames are a gateway for wellness promotion.

The purpose of this work was to get insight into the role of frontal trunk and proximal extremity muscles in rolling from supine to side lying. Participants were seventeen hemiparetic patients and 14 healthy subjects. Electromyographic (EMG) activity of the Sternocleidomasoid (ScM), Pectoralis Major (PM), External Oblique (ExO) and Rectus Femoris (RF) muscle pairs was recorded during rolling performance. Analysis included the establishment of EMG response times and magnitudes. For all muscles, initiation of EMG activity was delayed in the patients as compared with the controls. Among the healthy subjects, EMG activity level of the SCM was more enhanced on the mobile than on the stable body side, while activation level of the PM muscle was larger on the stable body side. In the hemiparetic group, the SCM demonstrated similar results as the controls yet, PM activity on the paretic side was lower than on the non-paretic side regardless of rolling direction. The difference in activation level between the corresponding ExO and RF muscles showed inconsistency among the healthy subjects, whereas in the hemipareic group the muscles on the paretic side never displayed higher activation levels than on the non-paretic side. In conclusion, rolling sideways in hemiparetic subjects is characterized by a normal relationship between activation levels of the SCM muscles while the relationship between the corresponding PM, ExO and RF muscles is hampered due to reduced activation level of the muscles on the paretic body side.

Object. The role of functional magnetic resonance (fMR) imaging has become increasingly important in the presurgical mapping of gray matter. Neurosurgical interventions often involve fiber bundles that connect critical functional areas. Recently, diffusion-tensor (DT) imaging has enabled the visualization of fiber bundle direction and integrity, thus providing the ability to delineate clearly white matter from gray matter tissue. The main objective of this study was to improve the presurgical assessment of critical functionality in the vicinity of brain lesions by combining DT and fMR imaging methodologies. Methods. Twenty patients with various space-occupying brain lesions underwent imaging for presurgical evaluation of motor and/or somatosensory functions. The authors focus on five patients with diverse space-occupying brain lesions. Diffusion tensor—based fiber tracking and fMR imaging activation maps were superimposed in three dimensions to visualize pyramidal tracts corresponding to motor and somatosensory regional activation. Conclusions. The combination of DT and fMR imaging for presurgical functional brain mapping provides valuable information that cannot be extracted using either method alone. The validity and sensitivity of noninvasive functional mapping for surgical guidance could be improved by considering results obtained with both methods. Furthermore, the use of three-dimensional visualization seems crucial and unique for viewing and understanding the complicated spatial relationship among the lesion, gray matter activation, and white matter fiber bundles.

Experimental autoimmune neuritis (EAN) has been studied in rat sciatic nerves by a combination of high b-value (1)H and (2)H double quantum filtered (DQF) diffusion MRS. The signal decays of water in the (1)H and (2)H DQF diffusion MRS were found to be not monoexponential and were analyzed using the q-space approach. The q-space analysis of the (1)H diffusion data detected two diffusing components, one having broad and the other having narrow displacement profiles. These components were shown to be very sensitive to the progression of EAN disease. The q-space parameters were found to be abnormal at day 9 postimmunization before the appearance of clinical signs. The assignment of the component with the narrow displacement profile to axonal water has been corroborated by the (2)H DQF diffusion MRS results. The displacement and the relative population of this slow and restricted diffusing component followed the processes of demyelination, axonal loss, and remyelination that occur in EAN. The displacements extracted from the slow-diffusing component with the narrow displacement correlated well with the average size of the axons as deduced from electron microscopy (EM). The component with the broad displacement showed significant changes which were attributed to the formation of endoneurial edema. This observation was also corroborated by the (2)H DQF diffusion MRS experiments. It seems, therefore, that q-space analysis of high b-values diffusion MRS is a promising new approach for early detection and better characterization of the different pathologies associated with EAN. This study demonstrates the utility of high-b-value q-space diffusion MRS for studying white matter-associated disorders in general.

BACKGROUND AND PURPOSE: Energy variables, such as metabolic cost (MC) and energy expenditure (EE), are important characteristics of motor activities that can influence daily activity and have implications for health. In individuals poststroke, these variables have previously been described only for walking. Our goal was to characterize the MC and EE of typical motor activities among individuals in the chronic phase poststroke and compare them with those of able-bodied individuals. METHODS: Eleven individuals with poststroke and 8 able-bodied individuals participated in this study. Four activities were tested: sit-to-walk-to-sit, walking over an obstacle course, walking at a comfortable speed, and reaching for an object while in a standing position. Each activity was performed repeatedly for 8 minutes, while oxygen consumption was recorded. The MC of the activities was calculated by dividing the mean oxygen consumption by walking speed or the number of repetitions. The EE was represented by metabolic equivalents. RESULTS: There was a significant interaction effect of group and activity on MC and EE (P = 0.001 and P = 0.007, respectively). In the participants poststroke, the MC of mobility activities ranged from 0.24 (0.06) to 0.3 (0.06) mL/kg/m, and the MC of the standing activity was 0.1 (0.03) mL/kg/repetition. The MC was higher for the participants poststroke than for the able-bodied participants (P < 0.001). The EE of the participants poststroke ranged from 1.96 (0.4) to 3.83 (0.6) metabolic equivalents and was lower compared with the able-bodied participants (P = 0.001). DISCUSSION AND CONCLUSIONS: Individuals poststroke have high MC and low EE across various motor activities. These findings suggest that rehabilitation programs need to specifically address the energetic domain.Video Abstract available. See Video (Supplemental Digital Content 1, http://links.lww.com/JNPT/A75) for more insights from the authors.

Multiple sclerosis (MS) is an inflammatory disease of the central nervous system (CNS) which affects nearly one million people worldwide, leading to a progressive decline of motor and sensory functions, and permanent disability. High b-value diffusion-weighted MR images (b of up to 14000 s/mm 2 ) were acquired from the brains of controls and MS patients. These diffusion MR images, in which signal decay is not monoexponential, were analyzed using the q-space approach that emphasizes the diffusion characteristics of the slow-diffusing component. From this analysis, displacement and probability maps were constructed. The computed q-space analyzed MR images that were compared with conventional T1, T2 (fluid attenuated inversion recovery (FLAIR)), and diffusion tensor imaging (DTI) images were found to be sensitive to the pathophysiological state of white matter. The indices used to construct this qspace analyzed MR maps, provided a pronounced differentiation between normal tissue and tissues classified as MS plaques by the FLAIR images. More importantly, a pronounced differentiation was also observed between tissues classified by the FLAIR MR images as normal-appearing white matter (NAWM) in the MS brains, which are known to be abnormal, and the respective control tissues. The potential diagnostic capacity of high b-value diffusion q-space analyzed MR images is discussed, and experimental data that explains the consequences of using the q-space approach once the short pulse gradient approximation is violated are presented. Magn Reson Med 47:115‐126, 2002. © 2002 Wiley-Liss, Inc.

This chapter summarizes the current evidence on the validity of upper and lower limb movements made in 2D and 3D VR environments. Movement patterns are considered directly as kinematic performance (e.g., endpoint trajectories) and motor quality measures (e.g., joint rotations) or indirectly as surrogate measures of performance (e.g., heart rate).

Background. Off-the-shelf activity-promoting video games (AVGs) are proposed as a tool for promoting regular physical activity among individuals poststroke. Objective. To characterize the energy expenditure (EE), exercise intensity, and energy metabolism of individuals poststroke, while playing AVGs in different positions, from different consoles, and to compare the performance with comfortable walking and with able-bodied individuals. Methods. Eleven poststroke and 8 able-bodied participants played in standing Wii-Boxing Xbox-Boxing, Wii-Run and Penguin, and also Wii-Boxing in sitting. EE (expressed as metabolic equivalents [METs]); exercise intensity (expressed as %predicted maximal heart rate [HR]), rate of perceived exertion (RPE), and respiratory exchange ratio (RER) were used to characterize the games. Results. Participants’ poststroke EE ranged from 1.81 ± 0.74 to 3.46 ± 1.3 METs and was lower compared with able-bodied participants for Xbox-Boxing ( P = .001), Wii-Boxing in standing ( P = .01), Run ( P < .001), and Penguin ( P = .001). Participants’ poststroke exercise intensity ranged from 49.8 ± 9.3 to 64.7 ± 9.3 %predicted maximal HR and was lower compared with able-bodied participants for Xbox-Boxing ( P = .007) and Run ( P = .005). For participants poststroke, EE of walking at a comfortable did not differ from boxing games in standing or Run. For able-bodied participants only, the EE for Xbox-Boxing was higher than Wii-Boxing (6.5 ± 2.6 vs 4.4 ± 1.1, P = .02). EE was higher in standing versus sitting for poststroke ( P = .04) and able-bodied ( P = .03) participants. There were no significant group differences for RPEs. RER of playing in sitting approached anaerobic metabolism. Conclusions. Playing upper extremity (ie, Boxing) or mobility (ie, Run) AVGs in standing resulted in moderate EE and intensity for participants poststroke. EE was lower for poststroke than for able-bodied participants.

Purpose: Metabolic cost of walking at a comfortable speed for individuals post-stroke is higher than for healthy individuals. However, metabolic cost of other activities, relevant for community activity, such as transfer from sitting to standing and walking over obstacles, has not been reported. Hence, the aim of this study was to measure metabolic cost of mobility and balance activities for individuals post-stroke, and to assess the hypothesis that it will be higher than for healthy individuals. Methods: Eleven post-stroke (7 men, age 49.5±12.2), and 8 healthy (3 men, age 46.8±6.7) individuals of comparable height and weight participated in the study. Gait speed was measured and motor impairment was evaluated using the Fugl-Meyer test. Four activities were tested for their metabolic cost; walking at a comfortable speed, walking over an obstacle course, sit to walk and standing on balance foam while reaching forward. Each activity was performed repeatedly for 8 minutes, while metabolic measures were recorded. In addition, distance covered, or number of repetitions completed, during the activity were recorded. Metabolic cost of each activity was calculated by dividing the mean oxygen consumption of the last four minutes of the activity by the number of repetitions or walking speed. Results: The Fugl-Meyer scores for post-stroke individuals for lower and upper extremities were 23.6±6.5 and 43.6±19.3 respectively. Comfortable gait speed was 0.8±0.3 m/sec. for post-stroke and 1.4±0.1 m/sec. for healthy individuals. Groups were not significantly different in weight and height. Metabolic cost and between-group comparisons are shown in the table. Conclusion: The metabolic cost of the activities was significantly higher for individuals post stroke than for healthy, suggesting that rehabilitation programs should aim to improve economy of movement.

Interactive video gaming has become ubiquitous in the practice of rehabilitation. The Nintendo Wii is one such system. Interactive gaming can promote intensive task-based therapy in a manner that is motivating for the user. Widespread enthusiasm for consoles and their games prompted us to analyze the games for their rehabilitation elements related to improving balance and mobility for individuals poststroke.The purpose of this article is to provide a game analysis for clinical application and evaluation of the game elements for research on interactive video gaming.Using a team of game players and raters, 5 tables (1 for the Wii Sports and 4 for the Wii Fit) were developed and validated. The tables consist of 3 categories: game description, impairments targeted (strength, endurance, balance, and coordination), and feedback provided (knowledge of performance [KP] and knowledge of results [KR]). Two domain content experts established face validity. Construct validity was performed by 2 therapist-raters who had more than 15 years' clinical experience and postgraduate training in motor learning. Observations about the games including the fidelity of the interfaces, the nature of the feedback, and some of the challenges to adapting the games for rehabilitation are presented.An 80% agreement between raters set as the criterion for establishing the construct validity was met for feedback evaluation. There was 100% agreement on impairment ratings. Games provide a greater amount of KR compared with KP.Given the preponderance of KR, therapists will need to monitor motor performance. Adaptation of interactive video consoles for rehabilitation requires careful evaluation of the games' attributes using relevant rehabilitation construits.

Off-the-shelf interactive video games are used in the rehabilitation of individuals post-stroke. However, the potential benefits of using the games for aerobic training have not been tested. The purpose of this preliminary study was to determine feasibility of measuring energy expenditure during interactive video gaming by individuals post-stroke and to characterize the energy demands of specific games. We used indirect calorimetry to measure energy expenditure of one healthy and two post-stroke individuals under four conditions: rest, Wii Fit™ Long Run, Penguin, and Wii Sports™ Boxing. We found that measuring interactive video gaming of people post-stroke was feasible and required mild to moderate exercise activity.

The purpose of this study was to examine the effects of gait speed and unilateral lower limb loading on step time and step length symmetry in healthy adults. Spatiotemporal gait data were collected from 22 healthy subjects (11 men, 11 women), using the GaitRite walkway, under four randomly sequenced test conditions: self-selected speed (SS), fast speed (F), self-selected speed with the right leg loaded (LSS), and the fastest attainable speed with the right leg loaded (LF). The symmetry index, calculated with the formula [((R-L)/0.5 × (R+L)) × 100], was used to quantify step time and step length symmetry. It was found that over-ground gait speed had no significant effects on the symmetry of step time or step length. Unilateral lower limb loading significantly increased step time asymmetry, with longer step time for the loaded leg. Step symmetry was further compromised and became more asymmetrical when, in addition to unilateral leg loading, subjects maximized their gait speed. This effect of fast speed with unilateral leg loading was particularly prominent in relation to step length, with its shortening in the unloaded leg and lengthening in the loaded leg. These observations in healthy subjects may serve as a reference for the assessment of gait symmetry in patients with unilateral lower limb pathologies.

To examine the effects of unilateral and bilateral application of low-dose high-frequency transcutaneous electrical stimulation (TENS) on EMG activity of the finger flexor muscles and on grip force in the right upper extremity.Twelve healthy volunteers received unilateral, bilateral, and placebo (zero intensity) TENS stimulation to the finger flexor muscles in three separate sessions. TENS was delivered for 15 min at 100 Hz, with the amplitude adjusted to the sensory threshold. Testing of the right upper extremity was performed in each session prior to stimulation (pre-test), immediately after stimulation (post-test1), and after a 15-min break (post-test2) which followed post-test1. Outcome variables were EMG activation level and maximal grip force.Unilateral and bilateral TENS stimulation were associated with a significant increase in EMG activity of the finger flexors, both at post-test1 and at post-test2, while no change was recorded following the placebo stimulation. The differences between the effects of unilateral vs bilateral stimulation were not significant. Regarding grip force, enhancement at post-test1 was mainly observed following the unilateral and bilateral stimulation, but not after the placebo stimulation. Yet, at post-test2, force enhancement was significant for all three stimulation conditions.The application of 15 min of TENS stimulation may contribute to subsequent muscular activation level and voluntary force production. Significance. The findings of this preliminary study justify further research on the clinical potential of TENS stimulation to affect voluntary motor output during rehabilitation.

EAN induced in Lewis rats by immunization with peripheral bovine myelin was treated by the Ras inhibitor farnesylthiosalicylate (FTS). Treatment from day 0 with FTS (5 mg/kg intraperitoneally twice daily) attenuated peak clinical scores (mean+/-S.E., 2.5+/-0.5 compared to 4.1+/-0.5 in saline treated controls, p=0.018, t-test) but not recovery. Treatment from day 10 with FTS attenuated peak disability (2.5+/-0.6, p=0.032 compared to saline treated controls) and improved recovery (0.84+/-0.42, untreated controls 2.4+/-0.6, p=0.028 by repeated measures ANOVA). Effects were confirmed by rotarod and nerve conduction studies. An inactive analogue, geranylthiosalicylate, had no clinical effect. Inhibition of Ras is of potential use in the treatment of inflammatory neuropathies.