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Background and Aims: Functional motor disorders (FMD) present a prevalent, yet misunderstood spectrum of neurological conditions characterized by abnormal movements (i.e., functional limb weakness, tremor, dystonia, gait impairments), leading to substantial disability and diminished quality of life. Despite their high prevalence, FMD often face delayed diagnosis and inadequate treatment, resulting in significant social and economic burdens. The old concept of psychological factors as the primary cause (conversion disorder) has been abandoned due to the need for more evidence about their causal role. According to a predictive coding account, the emerging idea is that symptoms and disability may depend on dysfunctions of a specific neural system integrating interoception, exteroception, and motor control. Consequently, symptoms are construed as perceptions of the body's state. Besides the main pathophysiological features (abnormal attentional focus, beliefs/expectations, and sense of agency), the lived experience of symptoms and their resulting disability may depend on an altered integration at the neural level of interoception, exteroception, and motor control., Methods and Materials: Our proposal aims to elucidate the pathophysiological mechanisms of FMD through a three-stage research approach. Initially, a large cohort study will collect behavioral, neurophysiological, and MRI biomarkers from patients with FMD and healthy controls, employing eXplainable Artificial Intelligence (XAI) to develop a diagnostic algorithm. Subsequently, validation will occur using patients with organic motor disorders. Finally, the algorithm's prognostic value will be explored post-rehabilitation in one subgroup of patients with FMD., Results: Data collection for the present study started in May 2023, and by May 2025, data collection will conclude., Discussion: Our approach seeks to enhance early diagnosis and prognostication, improve FMD management, and reduce associated disability and socio-economic costs by identifying disease-specific biomarkers., Trial Registration: This trial was registered in clinicaltrials.gov (NCT06328790)., Competing Interests: I have read the journal’s policy and the authors of this manuscript have the following competing interests: E. Sarasso and E. Canu have received research support from the Italian Ministry of Health. M. Filippi is Editor-in-Chief of the Journal of Neurology, Associate Editor of Human Brain Mapping, Neurological Sciences, and Radiology, received compensation for consulting services from Alexion, Almirall, Biogen, Merck, Novartis, Roche, Sanofi, speaking activities from Bayer, Biogen, Celgene, Chiesi Italia SpA, Eli Lilly, Genzyme, Janssen, Merck-Serono, Neopharmed Gentili, Novartis, Novo Nordisk, Roche, Sanofi, Takeda, and TEVA, participation in Advisory Boards for Alexion, Biogen, Bristol-Myers Squibb, Merck, Novartis, Roche, Sanofi, Sanofi-Aventis, Sanofi-Genzyme, Takeda, scientific direction of educational events for Biogen, Merck, Roche, Celgene, Bristol-Myers Squibb, Lilly, Novartis, Sanofi-Genzyme, he receives research support from Biogen Idec, Merck-Serono, Novartis, Roche, Italian Ministry of Health, the Italian Ministry of University and Research, and Fondazione Italiana Sclerosi Multipla. F. Agosta is Associate Editor of NeuroImage: Clinical, has received speaker honoraria from Biogen Idec, Italfarmaco, Roche, Zambon and Ely Lilli, and receives or has received research supports from the Italian Ministry of Health, the Italian Ministry of University and Research, AriSLA (Fondazione Italiana di Ricerca per la SLA), the European Research Council, the EU Joint Programme – Neurodegenerative Disease Research (JPND), and Foundation Research on Alzheimer Disease (France). The other authors have declared that no competing interests exist., (Copyright: © 2024 Gandolfi et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Purpose: People with functional movement disorders (FMD) are commonly seen in neurology clinics. Despite a recent increase in research, no standardised treatment pathway across the UK exists. Currently only a few qualitative studies in FMD with a focus on psychological aspects and diagnosis have been published. This study aimed to understand people with FMD perceptions of their physiotherapy treatment., Method: Qualitative web-based interviews were conducted with seven participants and an interpretive phenomenological approach was used to identify themes from the data., Results: Four themes were identified; 1) my brain, mind and body are all me, 2) physiotherapy; what helps and what doesn't, 3) what recovery is to me, and 4) barriers to treatment. Participants desired a combination of psychological and physical approaches, which were holistic, individualised, and delivered by experienced physiotherapists. Limited availability and funding of specialist treatments were barriers to recovery., Conclusion: Holistic management combining psychological and physiological systems seems to be crucial for effective management of FMD. Large variations in physiotherapy treatment exist across the UK. It is hoped that increasing the understanding, amongst healthcare professionals will lead to the development of timely and appropriate pathways for patients that otherwise find themselves lost between medical specialities.IMPLICATIONS FOR REHABILITATIONPatients report more positive experiences when a combined and detailed psychological and physiological explanation to their symptoms is given.An individualised approach working with the patient on activities they find challenging is more preferable than group exercise or impairment based (e.g., strengthening/stretching) treatments.Having a physiotherapist who is experienced in treating functional movement disorders or prepared to learn and understand them helped with adherence to treatment.

Background: People with rare neurological diseases (RNDs) often experience symptoms related to movement disorders, requiring a multidisciplinary approach, including rehabilitation. Telemedicine applied to rehabilitation and symptom monitoring may be suitable to ensure treatment consistency and personalized intervention. The objective of this scoping review aimed to emphasize the potential role of telerehabilitation and teleassessment in managing movement disorders within RNDs. By providing a systematic overview of the available literature, we sought to highlight potential interventions, outcomes, and critical issues. Methods: A literature search was conducted on PubMed, Google Scholar, IEEE, and Scopus up to March 2024. Two inclusion criteria were followed: (1) papers focusing on telerehabilitation and teleassessment and (2) papers dealing with movement disorders in RNDs. Results: Eighteen papers fulfilled the inclusion criteria. The main interventions were home-based software and training programs, exergames, wearable sensors, smartphone applications, virtual reality and digital music players for telerehabilitation; wearable sensors, mobile applications, and patient home video for teleassessment. Key findings revealed positive outcomes in gait, balance, limb disability, and in remote monitoring. Limitations include small sample sizes, short intervention durations, and the lack of standardized protocols. Conclusion: This review highlighted the potential of telerehabilitation and teleassessment in addressing movement disorders within RNDs. Data indicate that these modalities may play a major role in supporting conventional programs. Addressing limitations through multicenter studies, longer-term follow-ups, and standardized protocols is essential. These measures are essential for improving remote rehabilitation and assessment, contributing to an improved quality of life for people with RNDs.

Lower limb exoskeleton rehabilitation robots are used to improve or restore the walking and movement ability of people with lower limb movement disorders. However, the required functions for patients differ based on various diseases. For example, patients with weak muscle strength require power assistance, patients with spinal cord injuries require motion compensation, patients with gait abnormalities require gait correction, and patients with strokes require neural rehabilitation. To design a more targeted lower limb exoskeleton rehabilitation robot for different diseases, this article summarised and compared existing lower limb exoskeleton rehabilitation robots according to their main functions and the characteristics and rehabilitation needs of various lower limb movement disorders. The correlations between the functions of existing devices and diseases were summarised to provide certain references for the development of new lower limb exoskeleton rehabilitation robots.

Individuals with neuromuscular disorders display a combination of motor control deficits and lower limb weakness contributing to knee extension deficiency characterized by exaggerated stance phase knee flexion. There is a lack of evidence for long-term improvement of knee extension deficiency with currently available clinical treatment programs. Our previous work testing a wearable robotic exoskeleton with precisely timed assistive torque applied at the knee showed immediate increases in knee extension during walking for children with cerebral palsy, which continued to improve over an acute practice period. When we applied interleaved assistance and resistance to knee extension, we observed improvements in knee extension and increased muscle activation indicating the potential for muscle strengthening when used over time. There is a need for additional, high-quality trials to assess the impact of dosage, intensity and volume of training necessary to see persistent improvement in lower limb function for these patient populations. This randomized crossover study (ClinicalTrials.gov: NCT05726591) was designed to determine whether 12 weeks of overground gait training with a robotic exoskeleton outside of the clinical setting, following an initial in clinic accommodation period, has a beneficial effect on walking ability, muscle activity and overall motor function. Participants will be randomized to either complete the exoskeleton intervention or continue their standard therapy for 12 weeks first, followed by a crossover to the other study component. The primary outcome measure is change in peak knee extension angle during walking; secondary outcome measures include gait speed, strength, and validated clinical scales of motor function and mobility. Assessments will be completed before and after the intervention and at 6 weeks post-intervention, and safety and compliance will be monitored throughout. We hypothesize that the 12-week exoskeleton intervention outside the clinical setting will show greater improvements in study outcome measures than the standard therapy., Competing Interests: The authors have read the journal’s policy and have the following competing interests: Thomas C. Bulea and Diane L. Damiano are named inventors on U.S. Patent No. 11,801,153 B2, assigned to the authors’ employer (United States Department of Health and Human Services), which covers intellectual property used in the intervention studied in this protocol. This does not alter our adherence to PLOS ONE policies on sharing data and materials., (Copyright: This is an open access article, free of all copyright, and may be freely reproduced, distributed, transmitted, modified, built upon, or otherwise used by anyone for any lawful purpose. The work is made available under the Creative Commons CC0 public domain dedication.)

This study aims to integrate a convolutional neural network (CNN) and the Random Forest Model into a rehabilitation assessment device to provide a comprehensive gait analysis in the evaluation of movement disorders to help physicians evaluate rehabilitation progress by distinguishing gait characteristics under different walking modes. Equipped with accelerometers and six-axis force sensors, the device monitors body symmetry and upper limb strength during rehabilitation. Data were collected from normal and abnormal walking groups. A knee joint limiter was applied to subjects to simulate different levels of movement disorders. Features were extracted from the collected data and analyzed using a CNN. The overall performance was scored with Random Forest Model weights. Significant differences in average acceleration values between the moderately abnormal (MA) and severely abnormal (SA) groups (without vehicle assistance) were observed ( p < 0.05), whereas no significant differences were found between the MA with vehicle assistance (MA-V) and SA with vehicle assistance (SA-V) groups ( p > 0.05). Force sensor data showed good concentration in the normal walking group and more scatter in the SA-V group. The CNN and Random Forest Model accurately recognized gait conditions, achieving average accuracies of 88.4% and 92.3%, respectively, proving that the method mentioned above provides more accurate gait evaluations for patients with movement disorders.

The single-arm feasibility study was planned to evaluate the therapeutic effect of hand arm bimanual intensive training in improving the fine and gross motor functions of hand, and in the reduction of intensity with respect to mirror movement disorder. The sample comprised unilateral spastic cerebral palsy children aged 6-16 years who were having mirror movement disorder and were able to make a gross grip. The hand arm bimanual intensive training was provided to the participants for 6 hours per day for 15 days for a total of 90 hours. Comparison of baseline and post-intervention showed that the functional independence level of children had improved, with improvement in unimanual and bimanual hand performance (p˂0.05). However, there was no improvement seen in the severity of mirror movements (p>0.05). Hence, hand arm bimanual intensive training was found to be effective in increasing the functional independence of cerebral palsy children by improving the hand function, but there was no effect on mirror movement disorder.

Introduction: Functional movement disorder (FMD), a type of functional neurological disorder, is a common reason for consultation with the neurology department. The efficacy of physiotherapy for motor rehabilitation of these patients has been widely studied. The aim of this review is to analyse the available evidence on the effects of physiotherapy on motor symptoms, activity (gait, mobility, balance), perceived health, quality of life, and the cognitive/emotional state of patients with FMD., Methods: This review follows the PRISMA recommendations. Four electronic databases were searched for relevant articles. Our review included randomised controlled trials investigating the effects of a specialised physiotherapy intervention alone or in combination with other therapies as part of a multidisciplinary approach, with results compared against standard physiotherapy., Results: We reviewed 4 studies, including a total of 188 patients. We gathered data on the study population, outcome measures, protocols, and results. According to the Oxford quality scoring system, 3 studies had moderate methodological quality (3-4/5) and the remaining study presented poor methodological quality (< 3)., Conclusions: Physiotherapy improves motor symptoms, activity, perceived health, and quality of life in patients with FMD., (Copyright © 2022 Sociedad Española de Neurología. Published by Elsevier España, S.L.U. All rights reserved.)

Background: Information on specialist physiotherapeutic treatment for functional movement disorders is scarce. Previous studies focussed on functional gait disorders and availability of descriptions of the practical application especially for other body regions is very limited., Cases: We present two illustrative cases, demonstrating the key elements of physiotherapy for the treatment of functional movement disorders beyond gait difficulties. The individual applicability of the specific core elements of physiotherapy, adapted to the individual needs of each patient, are described. We also explain, how different sensory stimuli can be used to shift attention away from symptoms and thus reduce them. Moreover, we discuss how patients' agency can be encouraged and how this results in therapy key moments, contributing to a sustained improvement of symptoms., Conclusion: Thus, our case series are intended to guide clinicians and therapists alike, to promote disease-specific physiotherapy for this common and treatable neuropsychiatric disorder., Competing Interests: The authors have no competing interests to declare., (Copyright: © 2024 The Author(s).)

Background: Treatment of functional movement disorder (FMD) should be individualized, yet factors determining rehabilitation engagement have not been evaluated. Subspecialty FMD clinics are uniquely poised to explore factors influencing treatment suitability and triage., Objectives: To describe our approach and explore factors associated with triage to FMD rehabilitation., Methods: We conducted a retrospective chart review of 158 consecutive patients with FMD seen for integrated assessment by movement disorders neurology and psychiatry, with the purpose of triage to rehabilitation. Demographic and clinical variables were compared between patients triaged to therapy versus no therapy, and logistic regression was used to explore factors predictive of triage outcome. Change in primary outcome scores were analyzed., Results: Sixty-six patients (42%) were triaged to FMD therapy from July 2019 to December 2021. Patients triaged to therapy were more likely to have a constant movement disorder, gait disorder and/or tremor, hyperarousal, readiness for change, and people pleasing traits. Patients triaged to no therapy demonstrated persistent diagnostic disagreement, an inability to appreciate motor symptom inconsistency, low self-agency, a propensity to dissociate, and cluster B traits. 90% of patients triaged to rehabilitation had improved outcomes., Conclusions: The ability to "opt-in" to FMD rehabilitation relies on different factors than those relevant to establishing a diagnosis. Unlike many other neurological disorders, a triage and treatment planning step is recommended to identify those likely to meaningfully engage at that time. Holistic assessment through a transdisciplinary lens, and working collaboratively with the patient is essential to prioritize symptoms, determine engagement, and identify treatment targets., (© 2024 The Authors. Movement Disorders Clinical Practice published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.)

Background : In infants presenting with motor development impairment, early kinesiotherapeutic interventions aim to normalise the pattern of movements and improve recovery. By applying Bobath and Vojta methods, we aimed to identify a combined approach regarding motor deficit in infants with neurological disabilities. Methods : We designed a prospective interventional study on 108 infants with motor developmental delay and applied Bobath, Vojta, or combined Bobath and Vojta therapy in three equal groups. Results : In the combined Bobath and Vojta group, complete motor recovery was achieved for 50% of the participants, with full recovery after six months, whereas in Bobath- or Vojta-only therapy groups, the total recovery for all participants was achieved at seven months. Regarding infants with muscular hypertonia, Bobath therapy initiation demonstrated complete recovery in 5 months in more than 50% of the cases, while for Vojta this was achieved in only 33.57% of the cases. Conclusions : The comparative evaluation conducted by analysing the data regarding the application of the Bobath and Vojta methods showed that combining these two therapies results in a shorter motor deficit recovery time than if a single therapy is applied. These findings have important implications for the selection of rehabilitation therapies in infants with neurological motor development issues.

Spontaneous recovery of ischemic stroke is very limited and often results in the loss of motor and sensory function. Till now, rehabilitative training is the most widely accepted therapy to improve long-term outcome. However, its effectiveness is often suboptimal, largely due to a sharp decline of neuroplasticity in adults. In this study, we hypothesized that a combination of proprioceptive stimulation and rehabilitative training will promote neuroplasticity and functional recovery post injury. To test this hypothesis, we first established a photothrombotic stroke model that lesions the hindlimb sensorimotor cortex. Next, we demonstrated that injecting Cre-dependent AAV-retro viruses into the dorsal column of PV-Cre mice achieves specific and efficient targeting of proprioceptors. With chemogenetics, this method enables chronic activation of proprioceptors. We then assessed effects of combinatorial treatment on motor and sensory functional recovery. Our results showed that pairing proprioceptive stimulation with rehabilitative training significantly promoted skilled motor, but not tactile sensory functional recovery. This further led to significant improvement when compared to rehabilitation training or proprioceptor stimulation alone. Mechanistically, combinatorial treatment promoted cortical layer V neuronal mTOR activity and sprouting of corticospinal axon into the area where proprioceptive afferents terminate in the denervated side of the spinal cord. Serving as a proof of principle, our study thus provided novel insights into the application of combining proprioceptive stimulation and rehabilitative training to improve functional recovery of ischemic stroke and other traumatic brain or spinal cord injuries., (Copyright © 2021 Elsevier Inc. All rights reserved.)

Objectives: The aim of this study was to determine the impact of the COVID-19 pandemic on access to rehabilitation therapies and the impact of changes in therapy access on the physical and mental well-being of children with motor impairment and their caregivers., Design: Caregivers of children younger than 18 yrs with childhood-onset motor impairment (primarily cerebral palsy) completed an anonymous survey through the online platform REDCap between May 5 and July 13, 2020., Results: The survey was completed by 102 participants. Before the pandemic, 92 of 102 children (90%) were receiving one or more therapies; at the time surveyed, 55 children (54%) were receiving any therapies (P < 0.001). More than 40% of the sample reported increased child stress, decreased physical activity, and/or decline in mobility/movement. Participants who reported a decrease in number of therapies at the time surveyed more frequently reported lower satisfaction with treatment delivery (P < 0.001), a decline in child's mobility (P = 0.001), and increased caregiver stress (P = 0.004). Five qualitative themes were identified from open-ended question responses related to therapies and well-being., Conclusions: Access to pediatric rehabilitation therapies was disrupted during COVID-19. Disrupted access may be related to impact on physical and mental health. With the expansion of telehealth, caregiver and child feedback should be incorporated to optimize benefit., Competing Interests: Financial disclosure statements have been obtained, and no conflicts of interest have been reported by the authors or by any individuals in control of the content of this article., (Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.)

The study of functional corticomuscular coupling can reflect the interaction between the cerebral cortex and muscle tissue, thereby helping to understand how the brain controls muscle tissue and the effect of muscle movement on brain function. This study proposes a detection model of the coupling strength between the cortex and muscles. The detection model uses an adaptive selector to choose the optimal long short-term memory network, uses this network to extract the features of electroencephalography and electromyography, and finally transforms time characteristics into the frequency domain. The transfer entropy is used to represent the interaction intensity of signals in different frequency bands. Using this model, we analyze the coupling relationship between the cortex and muscles in the three movements of wrist flexion, wrist extension, and clench fist, and compare the model with traditional wavelet coherence analysis and deep canonical correlation analysis. The experimental results show that our model can not only express the bidirectional coupling relationship between different frequency bands but also suppress the possible false coupling that traditional methods may detect. Our research shows that the proposed model has great potential in medical rehabilitation, movement decoding, and other fields., (Copyright © 2021 Elsevier B.V. All rights reserved.)

Background: The negative discrepancy between residual functional capacity and reduced use of the contralesional hand, frequently observed after a brain lesion, has been termed Learned Non-Use (LNU) and is thought to depend on the interaction of neuronal mechanisms during recovery and learning-dependent mechanisms., Objective: Albeit the LNU phenomenon is generally accepted to exist, currently, no transdisciplinary definition exists. Furthermore, although therapeutic approaches are implemented in clinical practice targeting LNU, no standardized diagnostic routine is described in the available literature. Our objective was to reach consensus regarding a definition as well as synthesize knowledge about the current diagnostic procedures., Methods: We used a structured group communication following the Delphi method among clinical and scientific experts in the field, knowledge from both, the work with patient populations and with animal models., Results: Consensus was reached regarding a transdisciplinary definition of the LNU phenomenon. Furthermore, the mode and strategy of the diagnostic process, as well as the sources of information and outcome parameters relevant for the clinical decision making, were described with a wide range showing the current lack of a consistent universal diagnostic approach., Conclusions: The need for the development of a structured diagnostic procedure and its implementation into clinical practice is emphasized. Moreover, it exists a striking gap between the prevailing hypotheses regarding the mechanisms underlying the LNU phenomenon and the actual evidence. Therefore, basic research is needed to bridge between bedside and bench and eventually improve clinical decision making and further development of interventional strategies beyond the field of stroke rehabilitation.

Objective: To test the hypothesis that impaired body orientation with respect to gravity (lateropulsion) would play a key role in poststroke balance and gait disorders., Methods: Cohort study of 220 individuals consecutively admitted to a neurorehabilitation ward after a first hemisphere stroke (DOBRAS cohort [Determinants of Balance Recovery After Stroke] 2012-2018, ClinicalTrials.gov: NCT03203109), with clinical data systematically collected at 1 month, then at discharge. Primary outcomes were balance and gait disorders, quantified by the Postural Assessment Scale for Stroke and the modified Fugl-Meyer Gait Assessment, to be explained by all deficits on day 30, including lateropulsion assessed with the Scale for Contraversive Pushing. Statistics comprised linear regression analysis, univariate and multivariate analyses, and receiver operating characteristic curves., Results: Lateropulsion was frequent, especially after right hemisphere stroke (RHS, D30, 48%; discharge 24%), almost always in right-handers. Among all deficits, impaired body orientation (lateropulsion) had the most detrimental effect on balance and gait. After RHS, balance disorders were proportional to lateropulsion severity, which alone explained almost all balance disorders at initial assessment (90%; 95% confidence interval [CI] [86-94], p < 0.001) and at discharge (92%; 95% CI 89-95, p < 0.001) and also the greatest part of gait disorders at initial assessment (66%; 95% CI 56-77, p < 0.001) and at discharge (68%; 95% CI 57-78, p < 0.001)., Conclusion: Lateropulsion is the primary factor altering poststroke balance and gait at the subacute stage and therefore should be systematically assessed. Poststroke balance and gait rehabilitation should incorporate techniques devoted to misorientation with respect to gravity., (© 2020 American Academy of Neurology.)

Introduction: Functional Movement Disorders (FMDs) are challenging to treat. We assessed the effect of multidisciplinary inpatient rehabilitation, involving motor retraining, psychotherapy and psychotropic medication on FMD patient function and maintenance of improvement after one year., Methods: FMD patients in a movement disorders clinic were referred for inpatient rehabilitation. Baseline, discharge and one year follow-up measures included: Clinical Global Impression (CGI-severity, CGI-change); Depression and Somatic Symptom Scale (DSSS); Generalized Anxiety Disorder-7 (GAD-7); Patient Health Questionnaire-9 (PHQ-9); Post-traumatic stress disorder check-list for DSM-5 (PCL-5). Outcomes were analyzed with non-parametric models., Results: Seventeen patients completed rehabilitation. Thirteen completed one-year follow-up. Median CGI-severity was "markedly ill." At discharge, movement disorder improved in 93% (median CGI-change = 2, "much improved") as assessed by neurologist and patient. Psychiatrist ratings showed improvement among 86.7%; physiatrist and psychologist ratings were 66.7% and 53.3%, respectively. Symptoms improved on DSSS (Wilcoxon Z = -2.914, p ≤ 0.004); GAD-7 (Z = -3.045, p ≤ 0.002); PHQ-9 (Z = -3.415, p ≤ 0.01) but not PCL-5 (Z = -1.506, p = 0.132). At 1 year, 54% maintained at least minimal improvement by neurologist rating and 77% by patient rating (median CGI-change = 3, "minimally improved"). Improvement was not maintained for DSSS (Wilcoxon Z = -0.385. p = 0.701), GAD-7 (Z = -0.943, p = 0.357) or PHQ-9 (Z = -0.55, p = 0.582)., Conclusions: Multidisciplinary inpatient rehabilitation improved FMD patient function, depression, anxiety and somatic symptoms. One-year follow-up demonstrated minimal sustained improvement and worsening psychopathology, reflecting chronic debility despite initial rehabilitative success., (Copyright © 2020 Elsevier Ltd. All rights reserved.)

Restoration of upper limb motor function and patient functional independence are crucial treatment targets in neurological rehabilitation. Growing evidence indicates that music-based intervention is a promising therapeutic approach for the restoration of upper extremity functional abilities in neurologic conditions such as cerebral palsy, stroke, and Parkinson's Disease. In this context, music technology may be particularly useful to increase the availability and accessibility of music-based therapy and assist therapists in the implementation and assessment of targeted therapeutic goals. In the present study, we conducted a pre-clinical, single-arm trial to evaluate a novel music-based therapeutic device (SONATA) for upper limb extremity movement training. The device consists of a graphical user interface generated by a single-board computer displayed on a 32" touchscreen with built-in speakers controlled wirelessly by a computer tablet. The system includes two operational modes that allow users to play musical melodies on a virtual keyboard or draw figures/shapes whereby every action input results in controllable sensory feedback. Four motor tasks involving hand/finger movement were performed with 21 healthy individuals (13 males, aged 26.4 ± 3.5 years) to evaluate the device's operational modes and main features. The results of the functional tests suggest that the device is a reliable system to present pre-defined sequences of audiovisual stimuli and shapes and to record response and movement data. This preliminary study also suggests that the device is feasible and adequate for use with healthy individuals. These findings open new avenues for future clinical research to further investigate the feasibility and usability of the SONATA as a tool for upper extremity motor function training in neurological rehabilitation. Directions for future clinical research are discussed., Competing Interests: TBJ and VV declare no competing interests. RP and SS are employed engineers at BeSB GmbH Berlin, and NS currently serves as unpaid consultant and informal scientific advisor for BeSB GmbH Berlin. The device presented and tested in this study is a product developed in collaboration between BeSB and MT with potential for commercialization. This commercial affiliation does not alter our adherence to PLOS ONE policies on sharing data and materials.

In recent years, much attention has been paid to motor impairment of persons with Rett Syndrome (RTT), with increasing literature aimed to describe gross motor functioning and musculoskeletal disorders of the RTT population. The aim of this systematic review is to describe clinical evaluation tools used in the last decade to assess motor functioning and musculoskeletal abnormalities of patients with RTT. Thirty-four studies were reviewed and 20 tools were presented. Results showed that only two tools were used to measure functional change after rehabilitative or therapeutic interventions. This review underlies the lack of adequate evaluation tools to assess musculoskeletal abnormalities and deformities in RTT population. The absence of these assessments could be due to a statistical difficulty as it is challenging to build an evaluation tool that can score the entities of the abnormalities related to the amount of disability they cause.

Performing artists are a unique subset of athletes. With the highly repetitive nature of performance training, emphasis on proper technique, ergonomics, and preventive cross-training is vital, as many injuries are due to overuse or poor technique. There are novel medical concerns in performers, including ENT problems, mental health concerns and substance use risks. While music is central to performances, it is also a treatment modality to address cognitive, sensory, and motor dysfunctions in certain neurological conditions. Due to this wide array of issues, it is imperative to understand the specific needs and risks of performers to provide optimal medical care., Competing Interests: Disclosure J. Currey, D. Sheng, A. Neph, C. Cinquini, J. Cuza: none. B.L. Waite, consultant with Level42AI., (Copyright © 2020 Elsevier Inc. All rights reserved.)

Functional movement disorders (FMD) are a common source of disability in neurology.While treatment of FMD can reduce motor severity and disability, the neural mechanisms implicated in such a response remain unclear. We aimed to investigate neural changes in patients with FMD after a one-week multidisciplinary motor retraining (MoRe) treatment program. Fourteen FMD patients completed an emotional Go/No-Go fMRI task before and after MoRe treatment. Standardized pre- and post-treatment videos were rated for motor severity by a blinded reviewer using the psychogenic movement disorder rating scale (PMDRS). PMDRS scores before and after treatment were used for whole-brain regression. PMDRS scores were significantly reduced after MoRe treatment. Worse severity prior to treatment was associated with greater primary motor cortex (M1) activation at baseline and a larger response to treatment. Globally, increased connectivity between bilateral amygdala and premotor regions was observed following treatment. Lower post-treatment PMDRS scores were associated with increased connectivity between amygdala and ventromedial prefrontal cortex, whereas higher post-treatment PMDRS scores (and poorer treatment response) were associated with increased connectivity between amygdala and M1. Motor retraining in FMD may reorganize activity and connectivity in emotion processing and motor planning networks, with shifts in amygdala connectivity from posterior to frontal/prefrontal regions., (Copyright © 2020 Elsevier B.V. All rights reserved.)

Study Design: Secondary outcome measures analysis of a randomized, controlled study., Objective: To assess the effects of hybrid-functional electrical stimulation (FES) rowing on motor and sensory recovery in individuals with spinal cord injury (SCI) 6-18 months post injury., Setting: Outpatient rehabilitation network., Methods: 25 participants 6-12 months after SCI were randomly assigned to hybrid-FES rowing (n = 10) or standard of care (n = 15) groups. The hybrid-FES rowing group completed 6 months of rowing scheduled 3 times per week for 26 weeks at an exercise intensity of 70-85% of maximal heart rate. The standard of care group either participated in an arm ergometer exercise program (n = 6) or a waitlist without an explicit exercise program (n = 9). Changes in motor score and combined sensory score of the International Standards for Neurological Classification of SCI (ISNCSCI) were analyzed., Results: Both groups demonstrated increases in motor and combined sensory scores, but no significant differences were noted between intervention groups (motor difference mean ↑1.3 (95% CI, -1.9 to 4.4), combined sensory difference mean ↓10 (-30 to 18)). There was an average of 63% adherence to the hybrid-FES rowing protocol, with no significant correlation in changes in motor or combined sensory score in the hybrid-FES rowing group with total distance or time rowed., Conclusions: No significant effects to neurologic improvement were found with hybrid-FES rowing when compared with standard of care interventions in individuals with SCI 6-18 months post injury.

Objective: To develop a revised definition of the Bobath concept that incorporates the perspectives of members of the International Bobath Instructors Training Association (IBITA)., Methods: A three-phase consensus building design utilizing (i) focus groups; (ii) survey methods; and, (iii) real-time Delphi. This paper presents the findings from the real-time Delphi, an iterative process to collect and synthesize expert opinions anonymously, provide controlled feedback, with the overall goal of achieving consensus., Results: One hundred and twenty-one IBITA members participated in the real-time Delphi. Over three Delphi Rounds, consensus was reached on six overarching conceptual statements and 11 statements representing unique aspects of Bobath clinical practice. One statement that aimed to describe the Bobath clinical term of "placing" was eliminated in Round One due to participant reservations that a text description was insufficient for this term. Seven statements underwent minor wording revisions in Round Two and Three to improve sentence clarity., Conclusion: Using the real-time Delphi, we were successful in gaining consensus in an expert group on a series of statements on which a revised definition of the Bobath concept could be based., (© 2019 John Wiley & Sons, Ltd.)

Objective: This pilot study proposed and performs initial testing with Exoscore, a design evaluation tool to assess factors related to acceptance of exoskeleton by older adults, during the technology development and testing phases., Background: As longevity increases and our aging population continues to grow, assistive technologies such as exosuits and exoskeletons can provide enhanced quality of life and independence. Exoscore is a design and prototype stage evaluation method to assess factors related to perceptions of the technology, the aim being to optimize technology acceptance., Method: In this pilot study, we applied the three-phase Exoscore tool during testing with 11 older adults. The aims were to explore the feasibility and face validity of applying the design evaluation tool during user testing of a prototype soft lower limb exoskeleton., Results: The Exoscore method is presented as part of an iterative design evaluation process. The method was applied during an exoskeleton research and development project. The data revealed the aspects of the concept design that rated favorably with the users and the aspects of the design that required more attention to improve their potential acceptance when deployed as finished products., Conclusion: Exoscore was effectively applied to three phases of evaluation during a testing session of a soft exoskeleton. Future exoskeleton development can benefit from the application of this design evaluation tool., Application: This study reveals how the introduction of Exoscore to exoskeleton development will be advantageous when assessing technology acceptance of exoskeletons by older adults.

Best practice recommendations in cancer care increasingly call for integrated rehabilitation services to address physical impairments and disability. These recommendations have languished primarily due to a lack of pragmatic, generalizable intervention models. This perspective paper proposes a clinically integrated physical therapist (CI-PT) model that enables flexible and scalable services for screening, triage, and intervention addressing functional mobility. The model is based on (1) a CI-PT embedded in cancer care provider clinics, and (2) rehabilitation across the care continuum determined by the patient's level of functional mobility. The CI-PT model includes regular screening of functional mobility in provider clinics via a patient-reported mobility measure-the Activity Measure for Post-Acute Care, a brief physical therapy evaluation tailored to the specific functional needs of the individual-and a tailored, skilled physical therapist intervention based on functional level. The CI-PT model provides a pragmatic, barrier-free, patient-centric, data-driven approach to integrating rehabilitation as part of standard care for survivors of cancer. The model standardizes CI-PT practice and may be sufficiently agile to provide targeted interventions in widely varying cancer settings and populations. Therefore, it may be ideal for wide implementation among outpatient oncological settings. Implementation of this model requires a shared approach to care that includes physical therapists, rehabilitation administrators, cancer care providers, and cancer center administrators., (© 2020 American Physical Therapy Association.)

Objective: When investigating dose-response relationships in rehabilitation studies, dose is often equated with duration of therapy. However, according to the American College of Sports Medicine, dose consists of the factors frequency, intensity, time, and type. Thereby, especially quantification of intensity needs improvement to have a more precise estimate of the dose. Thus, the aim was to investigate the intensity during mobility-focused, real-life pediatric rehabilitation therapies., Design: Eleven participants (5 girls, 12.5 ± 2.1 yrs old) with neurological disorders and independent mobility wore accelerometers at wrists and ankles and a portable heart rate monitor during several of the following therapies: sports therapy, mobility-focused physiotherapy, medical training therapy, and robot-assisted gait training. Intensity of physical activity was quantified by activity counts (measured via accelerometers) and heart rate., Results: Therapy duration did not correlate with intensity. At the same time, we found significant differences between intensities of different therapies., Conclusion: Different therapies elicit different levels of intensity in children with neuromotor disorders. Heart rate and activity counts are suited to estimate the intensity of a therapy and provide complementary information. We recommend against using the duration of a therapy as a proxy for the dose to make statements about dose-response relationships., To Claim Cme Credits: Complete the self-assessment activity and evaluation online at http://www.physiatry.org/JournalCME CME OBJECTIVES: Upon completion of this article, the reader should be able to: (1) Appraise the importance of measuring the intensity of various types of inpatient rehabilitation therapy for determining the dose; (2) Describe the differences in intensities between different training forms and name factors that influence this intensity; and (3) Discuss the influence of the functional level of a patient on his/her potential to engage in physically intensive therapy sessions., Level: Advanced., Accreditation: The Association of Academic Physiatrists is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.The Association of Academic Physiatrists designates this journal-based CME activity for a maximum of 1.0 AMA PRA Category 1 Credit(s)™. Physicians should only claim credit commensurate with the extent of their participation in the activity.

The characteristic of immersion, involvement and motivation have made serious games an important tool to be used in the medical field. However, there are people that, having some sort of physical disability, are not able to, or do not feel motivated to play. This work presents a strategy to support human- computer interactions for children with a disability in their upper limbs through a wearable device, with the objective of improving access to digital games for the target audience. For the development of this work, the wearable device Myo was used to control a puzzle game as a means of providing the interaction between the individual and the game. In this context, the game is controlled with the movement of the user's upper limb that presents the disability, through the Myo device. For the validation of this research, the game developed was made available for individuals presenting a disability in the upper limbs, from an age range between five and fifteen years old, of the Association of Assistance to the Disabled Child (AACD). Soon, it was noticed that the participants of the research soon could play while utilizing the deficient limb with Myo's support and felt more motivated to play. On the long run, it is expected to contribute to the motivation of patients through technological innovation, so that the process of body consciousness is made more interactive.

Introduction: Exploring characteristics of human movement has long been the focus of clinicians and researchers. Changes in movement coordination strategies have been identified in the presence of pain highlighting the need for assessment in clinical practice. A major development in the understanding of movement related disorders is recognition of individual differences in presentation and consequently the need to tailor interventions based on assessment., Purpose: The purpose of this masterclass is to build a rationale for the clinical assessment of movement coordination strategies, exploring loss of movement choices, coordination variability, and to present a clinical framework for individualised management, including the use of cognitive movement control tests and retraining interventions. An approach for the qualitative rating of movement coordination strategies is presented. A compromised movement system may be one characterised by a lack of ability to access motor abundance and display choice in the use of movement coordination strategies. The identification of lost movement choices revealed during the assessment of movement coordination strategies is proposed as a marker of movement health., Implications for Practice: The health of the movement system may be informed by the ability to display choice in movement coordination strategies. There is evidence that restoring these choices has clinical utility and an influence on pain and improved function. This approach seeks to provide individuals with more flexible problem solving, enabled through a movement system that is robust to each unique challenge of function. This assessment framework sits within a bigger clinical reasoning picture for sustained quality of life., Competing Interests: Declaration of competing interest Sarah Mottram and Lincoln Blandford are employees of Comera Movement Science Ltd, which educates and trains sports, health and fitness professionals to better understand, reduce and manage musculoskeletal injury and pain that can impair movement and compromise performance in their patients, players and clients., (Copyright © 2019 Elsevier Ltd. All rights reserved.)

Purpose: Walking is an attention-demanding task that affects and is affected by cognitive performance. Since treadmill walking (TW) assists gait automaticity, we have hypothesized that TW affects cognitive performance to a smaller extent than overground walking (OW)., Methods: Thirty young adults were recruited. Each subject walked overground over a 20-meter straight hallway at three different speeds (slow, normal and fast). Each task was repeated 3 times under Single Task (OW-ST) and Dual Task (OW-DT) condition, in a randomized sequence. DT was a serial subtraction by 7 starting from a different number (> 100) in each trial. Afterwards, each subject walked on the treadmill at the same three speeds as during OW-ST, while performing the dual task (TW-DT). The correct cognitive response (CCR), calculated from the number of correct responses and mistakes, was compared between rest, OW-DT and TW-DT. Dual-task cost (DTC) was calculated for speed and for CCR., Results: Backward counting diminished normal and fast OW-DT speed by about 15 %. Slow OW-DT speed was not significantly reduced. In turn, OW affected the cognitive performance. DTC for speed during OW-DT increased during normal and fast speed. CCR significantly decreased, more at slower OW-DT speed. Conversely, CCR was not worsened by TW-DT. CCR did not decline at slow TW-DT speed and improved significantly from slow and normal to fast speeds. DTC for CCR resulted smaller in TW-DT than OW-DT., Conclusions: Decline in the cognitive performance during OW-DT is more prominent at slow speed, in keeping with higher demand of attentional resources for this unusual locomotor behaviour. Conversely, motorized TW improves the cognitive performance likely because it reduces the attentional cost of walking. Gait training by TW might improve automaticity in patients with movement disorders., Competing Interests: Declaration of Competing Interest None declared., (Copyright © 2019 Elsevier B.V. All rights reserved.)

A study of the changes in psychophysical function of the human body before and after relaxation sessions and acupuncture application has been conducted. The impact of relaxation sessions on psychophysical performance was studied on a group of university students and postgraduates aged between 18 and 30 years old; the impact of an acupuncture session course - on a group of subjects of a broad age range between 14 and 72, as they underwent rehabilitation therapy for their supportive locomotive apparatus disorders. The recording techniques used included electroencephalography (EEG), psychomotor reaction recording, minute-long time span accuracy reproduction; TST technique (Tactile Solar Test) of meridian and microsystem examination The results of this study suggest that relaxation sessions contribute to the enhancement of neurodynamical performance and mental activity efficiency. After the acupuncture therapy, relaxation effect, and restored tactile sensation on the meridians and microsystems was noted. A conclusion has been made that relaxation sessions and acupuncture may be used to improve psychophysical function.

The interpretation of cerebral palsy (CP) is closely linked to points of view that are no longer acceptable: 1) the idea that it is primarily a motor problem (posture and movement disorder); 2) the idea that it is only a central (cerebral) pathology; 3) the idea that it is a non-progressive disease (fixed encephalopathy). Actually, the problems that contribute to producing the CP clinical picture are several and complex. First of all, building of the action, starting from subject motivation, through motor imagery and subsequent project elaboration. Sequentially, executive planning, disorder often hidden under the most remarkable alteration of motor patterns and muscle tone. Finally, realization, conditioned by the idea that the locomotor apparatus is only and always the victim of an incapable central nervous system. Little known and very neglected perceptive components can contribute to compromising subject motor control. The influences that primitive changes of musculoskeletal system, often depending on site, nature, size and time of the lesion, exert on the possible choices of the central nervous system are often overlooked. Peripheral structures can in fact modify considerably the expression of palsy (understood as the form of adaptive functions) primitively. At least six different sources of error can be identified in the cerebral palsied child. For a rehabilitative intervention with greater possibilities of effectiveness, it is necessary to recognize and evaluate each of them. Especially as regards the prevention of secondary deformities, the responsibility attributed to physiotherapy must be re-evaluated.

Stroke is one of the main causes of long-term disability worldwide, placing a large burden on individuals and society. Rehabilitation after stroke consists of an iterative process involving assessments and specialized training, aspects often constrained by limited resources of healthcare centers. Wearable technology has the potential to objectively assess and monitor patients inside and outside clinical environments, enabling a more detailed evaluation of the impairment and allowing the individualization of rehabilitation therapies. The present review aims to provide an overview of wearable sensors used in stroke rehabilitation research, with a particular focus on the upper extremity. We summarize results obtained by current research using a variety of wearable sensors and use them to critically discuss challenges and opportunities in the ongoing effort towards reliable and accessible tools for stroke rehabilitation. Finally, suggestions concerning data acquisition and processing to guide future studies performed by clinicians and engineers alike are provided.

Background: Residual sensorimotor deficits are common following stroke. While it has been demonstrated that targeted practice can result in improvements in functional mobility years post stroke, there is little to support rehabilitation across the lifespan. The use of technology in home rehabilitation provides an avenue to better support self-management of recovery across the lifespan. We developed a novel mobile technology, capable of quantifying quality of movement with the purpose of providing feedback to augment rehabilitation and improve functional mobility. This mobile rehabilitation system, mRehab, consists of a smartphone embedded in three dimensional printed items representing functional objects found in the home. mRehab allows individuals with motor deficits to practice activities of daily living (ADLs) and receive feedback on their performance. The aim of this study was to assess the usability and consistency of measurement of the mRehab system., Methods: To assess usability of the mRehab system, four older adults and four individuals with stroke were recruited to use the system, and complete surveys to discuss their opinions on the user interface of the smartphone app and the design of the 3D printed items. To assess the consistency of measurement by the mRehab system, 12 young adults were recruited and performed mRehab ADLs in three lab sessions within 1 week. Young adults were chosen for their expected high level of consistency in motor performance., Results: Usability ratings from older adults and individuals with stroke led us to modify the design of the 3D printed items and improve the clarity of the mRehab app. The modified mRehab system was assessed for consistency of measurement and six ADLs resulted in coefficient of variation (CV) below 10%. This is a commonly used CV goal for consistency. Two ADLs ranged between 10 and 15% CV. Only two ADLs demonstrated high CV., Conclusions: mRehab is a client-centered technology designed for home rehabilitation that consistently measures performance. Development of the mRehab system provides a support for individuals working on recovering functional upper limb mobility that they can use across their lifespan.

Background: Gait event detection (GED) is an important aspect in identifying and interpret a user's gait to assess gait abnormalities and design intelligent assistive devices., Research Question: There is a need to develop robust GED models that can accurately detect various gait instances in different scenarios and environments., Methods: This paper presents a novel method of detecting heel strikes (HS) and toe offs (TO) during the user's gait cycle using a modified Long Short-Term Memory (LSTM) networks approach. The method was tested on a database from Movement Analysis in Real-world Environments using Accelerometers (MAREA) (n = 20 healthy subjects) that consisted of walking and running in indoor and outdoor environments with accelerometers positioned on waist, wrist and both ankles. Modifications include oversampling, composite accelerations and optimizing the LSTM network architecture were made., Results: Performance of our modified model was found to be better than six state-of-the-art GED algorithms, with a median F1 score of 0.98 for Heel Strikes and 0.98 for Toe Offs in the scenario of steady walking in an indoor environment, and a median F1 score of 0.94 for Heel Strikes and 0.68 for Toe-offs in the scenario of walking and running in an outdoor environment., Significance: This paper highlights the potential of the single proposed model to be an alternative to the six GED models in gait detection under various conditions., (Copyright © 2019 Elsevier B.V. All rights reserved.)

Purpose: To evaluate the effect of plantar flexor strengthening associated with conventional physical therapy treatment in participants with idiopathic toe walking., Methods: Thirty participants, of both sexes diagnosed with idiopathic toe walking, aged 5 and 11 years, will be recruited and randomized into 2 groups: the control group, who will undergo gait training, triceps surae muscle stretching, anterior tibial muscle strengthening, and motor sensory training, and the intervention group, who will undergo the same training as the control group and, additionally, triceps surae muscle strengthening. The intervention will be performed twice a week for 8 weeks. The participants will undergo a 3-dimensional gait kinematic analysis, passive amplitude of dorsiflexion movement, isometric dynamometry of the anterior tibial and triceps surae muscles, motor coordination, quality of life, and perception of the parents regarding the equinus gait at baseline and at the end of treatment. Quality of life will be reevaluated during a 24-week follow-up.

This paper proposes a free dataset, available at the following link, 1 named KIMORE, regarding different rehabilitation exercises collected by a RGB-D sensor. Three data inputs including RGB, depth videos, and skeleton joint positions were recorded during five physical exercises, specific for low back pain and accurately selected by physicians. For each exercise, the dataset also provides a set of features, specifically defined by the physicians, and relevant to describe its scope. These features, validated with respect to a stereophotogrammetric system, can be analyzed to compute a score for the subject's performance. The dataset also contains an evaluation of the same performance provided by the clinicians, through a clinical questionnaire. The impact of KIMORE has been analyzed by comparing the output obtained by an example of rule and template-based approaches and the clinical score. The dataset presented is intended to be used as a benchmark for human movement assessment in a rehabilitation scenario in order to test the effectiveness and the reliability of different computational approaches. Unlike other existing datasets, the KIMORE merges a large heterogeneous population of 78 subjects, divided into 2 groups with 44 healthy subjects and 34 with motor dysfunctions. It provides the most clinically-relevant features and the clinical score for each exercise. 1 https://univpm-my.sharepoint.com/:f:/g/personal/p008099&#95;staff&#95;univpm&#95;it/EiwbKIzk6N9NoJQx4J8aubIBx0o7tIa1XwclWp1NmRkA-w?e=F3jtBk.

This paper presents the development of a new active assistive eating device, which aims to stabilize the movements of people living with movement disorders, such as spasticity and ataxia. Many people living with upper-body incapacities are unable to eat on their own, due to movement disorders (ex. tremors, spastic motions, lack of muscular tone), resulting from various ailments like Cerebral palsy, Parkinson's disease, Dystonia, Multiple sclerosis, strokes, and Muscular dystrophy). Our past work focused on the development of a purely mechanical device, which involved damping of the system via passive mechanical dampers. This paper extends said work by using active stabilization of user movements. The active assistance enables the design of intelligent algorithms that can assist human movements more efficiently. This active version has the benefits of being easily adjustable; the level of damping can be adjusted in real-time, depending on the user movement; different control modes are offered, and the guiding of user movements is also allowed. Firstly, the mechanical design of the device is presented, followed by the damping arrangement, the electronic design, the control algorithms and finally, the preliminary experiments are mentioned.

Background: Embodied cognition interests physical therapists because efforts to advance motor skills in young infants can affect learning. However, we do not know if simply advancing motor skill is enough to support advances in cognition., Objective: The objective was to examine the effect of 2 interventions on the developing motor skill of sitting and problem solving and to describe the feasibility of using eye-tracking technology to explore visual and motor interaction., Design: This was a longitudinal, randomized comparison of interventions., Methods: Twenty infants with developmental delay and/or cerebral palsy, ranging in age from 8 to 34 months (mean [SD] = 15 [6.9] months), participated in an intervention emphasizing motor-based problem solving, and an intervention focused on advancing motor skill through assistance for attaining optimal movement patterns. Outcome measures were the Gross Motor Function Measure sitting subsection and the Early Problem Solving for Infants test. Active touch and looks were measured with eye-tracking technology., Results: Participants in both groups made significant motor gains from baseline, with no difference between intervention groups on Gross Motor Function Measure change scores. Participants in the problem-solving group showed significant gains in Early Problem Solving for Infants scores over the participants in the optimal movement patterns group. Overall, participants increased active touch of toys and increased concurrent looking with active touching., Limitations: This exploratory study was small, with variation in participants' skills. The sampled behaviors for analysis were a small portion of the overall function of the participant., Conclusions: An intervention using motor-based problem solving could improve infants' problem-solving skill. The use of eye-tracking could help to understand embodied cognition as infants develop, but the challenges of embedding the method in natural settings require further work. Listen to the author interview at https://academic.oup.com/ptj/pages/podcasts., (© 2019 American Physical Therapy Association.)

The hand extension robot orthosis (HERO) glove was iteratively designed with occupational therapists and stroke survivors to enable stroke survivors with severe hand impairment to grasp and stabilize everyday objects, while being portable, lightweight, and easy to set up and use. The robot consists of a batting glove with artificial tendons embedded into the glove's fingers. The tendons are pulled and pushed by a linear actuator to extend and flex the fingers. The robot's finger extension and grasp assistance are automated using inertial measurement unit signal thresholds. Five stroke survivors (Chedoke McMaster Stroke Assessment - Stage of Hand 1-3) put on the HERO Glove in 1-3 minutes, with assistance. The stroke survivors performed significantly better on the Box and Block Test (2.8 more blocks transferred, ) while wearing the HERO Glove than when not wearing the glove. Four stroke survivors could only transfer blocks while wearing the HERO Glove. The HERO Glove enabled these stroke survivors to more fully extend their index finger (an increase of 97.5°, ) and three of five stroke survivors were better able grasp a water bottle. Therapists and stroke survivors suggested increasing the HERO Glove's grip force assistance and valued the glove's portability, lightweight design and potential usefulness in assisting with task-based therapy.

Introduction: A theory-based, task-oriented, community walking programme can increase outdoor walking activity among older adults to optimise functional independence, social participation and well-being. The study objective is to determine if there is a difference in the change in outdoor walking activity from baseline to 10 weeks, 5.5 months and 12 months after receiving a 1-day interactive workshop and outdoor walking programme (Getting Older Adults Outdoors (GO-OUT)) compared with the workshop and weekly reminders (WR) in older adults with difficulty walking outdoors., Methods and Analysis: A randomised controlled trial is being conducted in four urban Canadian communities. We will stratify 240 individuals by site and participant type (ie, individual vs spousal/friend pair) and randomise to either the GO-OUT or WR intervention. The GO-OUT intervention involves a 1-day workshop, where participants complete eight interactive stations to build knowledge and skills to walk outside, followed by a 10-week group outdoor walking programme (two 1-hour sessions/week) led by a physiotherapist or kinesiologist in parks. The WR intervention consists of the same workshop and 10 weekly telephone reminders to facilitate outdoor walking. The primary outcome measure is mean outdoor walking time in minutes/week derived from accelerometry and global positioning system data. GO-OUT is powered to detect an effect size of 0.4, given α=0.05, β=0.20, equal number of participants/group and a 20% attrition rate. Secondary outcomes include physical activity, lifespace mobility, participation, health-related quality of life, balance, leg strength, walking self-efficacy, walking speed, walking distance/endurance and mood., Ethics and Dissemination: GO-OUT has received ethics approval at all sites. A Data Safety Monitoring Board will monitor adverse events. We will disseminate findings through lay summaries, conference presentations and journal articles., Trial Registration Number: NCT03292510 (Pre-results)., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Objective: This study was developed as a consensus-building exercise within the International Bobath Instructors Training Association (IBITA) to develop a revised definition of the Bobath concept., Methods: A three-phase design utilizing (a) focus groups, (b) survey methods, and, (c) real-time Delphi. This paper details Phase 1 and 2., Results: Forty IBITA members participated in five focus groups. Eight broad themes were developed from the focus groups from which the survey statements were developed. There was a high level of agreement on all nine survey statements identifying overarching constructs and on 12 of the 13 statements identifying unique aspects of Bobath clinical practice. Lower scores were attributed to lack of understanding of the term humanistic, Bobath clinical practice addressing multiple domains such as impairments, activities, and participation and limited agreement on the description of the term "placing.", Conclusion: Focus groups and a web-based survey were successful in soliciting the opinions of IBITA members on themes and statements of importance for the development of a revised Bobath definition. The results of Phase 1 and 2 will inform Phase 3, a real-time Delphi, to gain consensus within IBITA on statements on which a revised Bobath definition is to be based., (© 2018 John Wiley & Sons, Ltd.)

Background: There remains a substantial lack of evidence to support the use of foot orthoses as a conservative treatment option for idiopathic toe walking (ITW). Encouraging heel contact during gait is one of the primary goals of most interventions in paediatric ITW., Research Question: Does the combined treatment of high-top boots and orthoses increase the number of heel contacts during gait and change spatio-temporal gait parameters?, Methods: This within subject designed randomised controlled trial recruited fifteen children diagnosed with ITW (n = 10 males). They were fitted with bilateral custom made rigid contoured carbon fibre foot orthoses placed inside high-top boots. To analyze the effect of this treatment, heel contacts and spatio-temporal parameters measured by an 8.3 m Gaitrite® mat were compared to barefoot walking and shod walking., Results: An immediate increase in heel contact (p = 0.021) was observed in the combined treatment only. Gait changes included a large increase in stride time in the combined treatment condition compared to barefoot walking (p = 0.006). This was associated with a decrease in the percentage of swing phase in the gait cycle (p < 0.010), an increase in stance phase (p < 0.010) and an increase in double support time (p < 0.001)., Significance: These results suggest the hardness and thickness of the shoe and stiffness of the orthosis midsole may lead to improved local dynamic stability and foot position awareness with increased sensory feedback provided through the entire length of the foot. Further research is indicated to validate this treatment option on long term outcomes in this population group., (Copyright © 2018. Published by Elsevier B.V.)

Background: Stroke is a leading cause of disability worldwide. The most common impairment resulting from stroke is upper-limb weakness., Objectives: To determine the usefulness and psychometric validity of the upper-limb subscale of the STREAM in an acute stroke population., Methods: Rasch Analysis, including unidimensionality assumption testing, determining model fit, and analysis of: reliability, residual correlations, and differential item functioning., Results: 125 individuals were assessed using the upper-limb subscale of the Stroke Rehabilitation Assessment of Movement (STREAM) tool. Rasch analysis suggests the STREAM is a unidimensional measure. However, when scored using the originally proposed method (0-2), or using the response pattern (0-5) neither variant fit the Rasch model (p < 0.05). Although, the reliability was good (Person-Separation Index - 0.847 and 0.903, respectively). Correcting for the disordered thresholds, and thereby producing the new scoring pattern, led to substantial improvement in the overall fit (chi-square probability of fit - 22%), however, the reliability was slightly reduced (PSI - 0.806)., Conclusions: The study proposes a new scoring method for the upper-limb subscale of the STREAM outcome measure in the acute stroke population.

Background: During gait training in persons with central nervous system (CNS) movement disorders, virtual reality (VR) can offer added value by providing task-specific gait training in more interactive and motivating environments., Objective: To summarize current evidence for the effectiveness of VR-enhanced gait training in persons with CNS movement disorders., Methods: PubMed, Web of Science and CENTRAL were systematically searched for studies using VR during walking to improve gait outcomes (spatiotemporal, functional, kinematic and kinetic). Meta-analyses were performed to estimate pooled effects., Results: Eighteen studies with in total 337 patients were included (12 studies with people post-stroke, 4 with multiple sclerosis, 1 with Parkinson's disease, 1 with traumatic brain injury). Spatiotemporal and functional parameters significantly improved in each population after the VR training. Compared to gait training without VR, differences in favor of VR were found for spatiotemporal and functional parameters only in people post-stroke., Conclusion: VR-enhanced gait training is an effective method to improve spatiotemporal and functional parameters in persons with CNS movement disorders. Current evidence supports that, in comparison to training without VR, for people post-stroke VR-enhanced gait training is more effective to improve gait function. Future research regarding other outcome measures and other CNS movement disorders is necessary.

Mechanical and electrical noise stimulation to the body is known to improve the sensorimotor system. This improvement is related to stochastic resonance (SR), a phenomenon described as a "noise benefit" to various sensory and motor systems. The current study investigated the influence of SR on visuomotor temporal integration and hand motor function under delayed visual feedback in healthy young adults. The purpose of this study was to measure the usefulness of SR as a neurorehabilitation device for disorders of visuomotor temporal integration. Thirty healthy volunteers underwent detection tasks and hand motor function tests under delayed visual feedback, with or without SR. Of the 30 participants, 15 carried out the tasks under delayed visual feedback in the order of SR on-condition, off-condition, off-condition, and on-condition. The remaining 15 participants conducted the experimental tasks in the order of SR off-condition, on-condition, on-condition, and off-condition. Comparisons of the delay detection threshold (DDT), steepness of the delay detection probability curves, box and block test (BBT) scores, and nine-hole peg test (NHPT) scores between the SR on- and off-conditions were performed. The DDT under the SR on-condition was significantly shortened compared with the SR off-condition. There was no significant difference between the SR on- and off-conditions for the steepness of the delay detection probability curves, BBT scores, and NHPT scores. SR improved visuomotor temporal integration in healthy young adults, and may therefore improve movement disorders in patients with impaired visuomotor temporal integration. However, because the current results showed that SR did not improve hand motor function under delayed visual feedback, it may not improve motor function when a large distortion of visuomotor temporal integration is present. Further studies are required considering several limitations of the current study, and future clinical trials are necessary to verify the effects of motor training using SR for the treatment of visuomotor temporal integration disorders., Competing Interests: The authors declare that they have no competing interests.

Background: Movement Disorders (MD) are a class of disease that impair the daily activities of patients, conditioning their sensorimotor, cognitive and behavioural capabilities. Nowadays, the general management of patients with MD is based on rehabilitation, pharmacological treatments, surgery, and traditional splints. Although some attempts have been made to devise specific orthoses for the rehabilitation of patients affected by MD, especially the younger ones, those devices have received limited attention., Main Body: This paper will principally discuss the case of upper limb rehabilitation in Childhood Dyskinesia (CD), a complex motor disease that affects paediatric patients. Through a critical review of the present solutions and a discussion about the neurophysiological characteristics of the disease, the study will lead to the formulation of desirable features of a possible new upper-limb orthosis., Conclusions: Design principles will be derived to provide specialised orthoses for the dynamic control of posture and the stabilisation of voluntary movements: those include using biomechanical actions and enhanced proprioception to support the sensorimotor rehabilitation of the children affected by CD. A similar approach could be advantageously applied in other MD-related conditions, especially with hyperkinetic and/or hypertonic traits.

Background: Functional movement disorders (FMDs) are conditions of abnormal motor control thought to be caused by psychological factors. These disorders are commonly seen in neurologic practice, and prognosis is often poor. No consensus treatment guidelines have been established; however, the role of physical therapy in addition to psychotherapy has increasingly been recognized. This study reports patient outcomes from a multidisciplinary FMD treatment program using motor retraining (MoRe) strategies., Objective: To assess outcomes of FMD patients undergoing a multidisciplinary treatment program and determine factors predictive of treatment success., Design: Retrospective chart review., Setting: University-affiliated rehabilitation institute., Patients: Thirty-two consecutive FMD patients admitted to the MoRe program from July 2014-July 2016., Intervention: Patients participated in a 1-week, multidisciplinary inpatient treatment program with daily physical, occupational, speech therapy, and psychotherapy interventions., Main Outcome Measurements: Primary outcome measures were changes in the patient-rated Clinical Global Impression Scale (CGI) and the physician-rated Psychogenic Movement Disorder Rating Scale (PMDRS) based on review of standardized patient videos. Measurements were taken as part of the clinical evaluation of the program., Results: Twenty-four of the 32 patients were female with a mean age of 49.1 (±14.2) years and mean symptom duration of 7.4 (±10.8) years. Most common movement phenomenologies were abnormal gait (31.2%), hyperkinetic movements (31.2%), and dystonia (31.2%). At discharge, 86.7% of patients reported symptom improvement on the CGI, and self-reported improvement was maintained in 69.2% at the 6-month follow-up. PMDRS scores improved by 59.1% from baseline to discharge. Longer duration of symptoms, history of abuse, and comorbid psychiatric disorders were not significant predictors of treatment outcomes., Conclusions: The majority of FMD patients experienced improvement from a 1-week multidisciplinary inpatient rehabilitation program. Treatment outcomes were not negatively correlated with longer disease duration or psychiatric comorbidities. The results from our study are encouraging, although further long-term prospective randomized studies are needed., Level of Evidence: III., (Copyright © 2018 American Academy of Physical Medicine and Rehabilitation. Published by Elsevier Inc. All rights reserved.)