Cyclogram-based evaluation of inter-limb gait symmetry in Prader-Willi Syndrome.

BACKGROUND: Prader-Willi syndrome (PWS) is characterized by a complex clinical condition, whose typical features lead to impaired motor and functional skills. To date, limited data is available as regards symmetry of gait in PWS. RESEARCH QUESTION: The aim of this study was to characterize lower-limb asymmetry during gait in a group of Prader-Willi Syndrome (PWS) individuals by using the synchronized cyclograms and to compare it with those of two different control groups, a normal-weight group and an obese group. METHODS: A total of 18 PWS, 30 normal weight (NW) and 28 obese individuals (OG) matched for age, sex and height were assessed via 3D gait analysis. Gait spatio-temporal parameters were computed together with angle-angle diagrams, characterized in terms of their geometric features (i.e. area, orientation, and trend symmetry index). RESULTS: Individuals with PWS exhibit reduced speed, stride length and cadence and increased duration of both stance and double support phase than the other groups. OG was characterized by the same pattern when compared to NW. With respect to inter-limb symmetry, individuals with PWS exhibited significantly larger cyclogram areas at hip joint with respect to the other two groups (203.32 degrees2 vs. 130.73 degrees2 vs. 111.59 degrees2) and significantly higher orientation angle (4.17° vs. 2.11° vs. 1.22°) and Trend Symmetry (3.72 vs. 2.02 vs. 1.21) with respect to the other two groups at knee joint; no differences were found at ankle joint. Both individuals with PWS and those of OG exhibited reduced ROM at knee and ankle joints with respect with normal weight, but no statistically significant differences were observed between PWS and OG. SIGNIFICANCE: The obtained results may provide novel and useful insights to understand better the impairments in motor control associated with this pathological state, supporting clinics in the identification of the best rehabilitation program for this rare pathological state, aimed to improve stability and motor control.

EEG connectivity in functional brain networks supporting visuomotor integration processes in dominant and non-dominant hand movements.

Objective.This study explores the changes in the organization of functional brain networks induced by performing a visuomotor integration task, as revealed by noninvasive spontaneous electroencephalographic traces (EEG).Approach.EEG data were acquired during the execution of the Nine Hole Peg Test (NHPT) with the dominant and non-dominant hands in a group of 44 right-handed volunteers. Both spectral analysis and phase-based connectivity analysis were performed in the theta (ϑ), mu (µ) and beta (ß) bands. Graph Theoretical Analysis (GTA) was also performed to investigate the topological reorganization induced by motor task execution.Main results.Spectral analysis revealed an increase of frontoparietal ϑ power and a spatially diffused reduction ofµand ß contribution, regardless of the hand used. GTA showed a significant increase in network integration induced by movement performed with the dominant limb compared to baseline in the ϑ band. Theµand ß bands were associated with a reduction in network integration during the NHPT. In theµrhythm, this result was more evident for the right-hand movement, while in the ß band, results did not show dependence on the laterality. Finally, correlation analysis highlighted an association between frequency-specific topology measures and task performance for both hands.Significance.Our results show that functional brain networks reorganize during visually guided movements in a frequency-dependent manner, differently depending on the hand used (dominant/non dominant).

Limb Volume Measurements: A Comparison of Circumferential Techniques and Optoelectronic Systems against Water Displacement.

BACKGROUND: Accurate measurements of limb volumes are important for clinical reasons. We aimed to assess the reliability and validity of two centimetric and two optoelectronic techniques for limb volume measurements against water volumetry, defined as the gold standard. METHODS: Five different measurement methods were executed on the same day for each participant, namely water displacement, fixed-height (circumferences measured every 5 (10) cm for the upper (lower limb) centimetric technique, segmental centimetric technique (circumferences measured according to proportional height), optoelectronic plethysmography (OEP, based on a motion analysis system), and IGOODI Gate body scanner technology (which creates an accurate 3D avatar). RESULTS: A population of 22 (15 lower limbs, 11 upper limbs, 8 unilateral upper limb lymphoedema, and 6 unilateral lower limb lymphoedema) participants was selected. Compared to water displacement, the fixed-height centimetric method, the segmental centimetric method, the OEP, and the IGOODI technique resulted in mean errors of 1.2, 0.86, -16.0, and 0.71%, respectively. The corresponding slopes (and regression coefficients) of the linear regression lines were 1.0002 (0.98), 1.0047 (0.99), 0.874 (0.94) and 0.9966 (0.99). CONCLUSION: The centimetric methods and the IGOODI system are accurate in measuring limb volume with an error of <2%. It is important to evaluate new objective and reliable techniques to improve diagnostic and follow-up possibilities.

Improving the reliability of underwater gait analysis using wearable pressure and inertial sensors.

This work addresses the lack of reliable wearable methods to assess walking gaits in underwater environments by evaluating the lateral hydrodynamic pressure exerted on lower limbs. Sixteen healthy adults were outfitted with waterproof wearable inertial and pressure sensors. Gait analysis was conducted on land in a motion analysis laboratory using an optoelectronic system as reference, and subsequently underwater in a rehabilitation swimming pool. Differences between the normalized land and underwater gaits were evaluated using temporal gait parameters, knee joint angles and the total water pressure on the lower limbs. The proposed method was validated against the optoelectronic system on land; gait events were identified with low bias (0.01s) using Bland-Altman plots for the stride time, and an acceptable error was observed when estimating the knee angle (10.96° RMSE, Bland-Altman bias -2.94°). The kinematic differences between the land and underwater environments were quantified, where it was observed that the temporal parameters increased by more than a factor of two underwater (p<0.001). The subdivision of swing and stance phases remained consistent between land and water trials. A higher variability of the knee angle was observed in water (CV = 60.75%) as compared to land (CV = 31.02%). The intra-subject variability of the hydrodynamic pressure on the foot ([Formula: see text] = 39.65%) was found to be substantially lower than that of the knee angle (CVz = 67.69%). The major finding of this work is that the hydrodynamic pressure on the lower limbs may offer a new and more reliable parameter for underwater motion analysis as it provided a reduced intra-subject variability as compared to conventional gait parameters applied in land-based studies.

The Effect of a New Generation of Ankle Foot Orthoses on Sloped Walking in Children with Hemiplegia Using the Gait Real Time Analysis Interactive Lab (GRAIL).

Cerebral palsy poses challenges in walking, necessitating ankle foot orthoses (AFOs) for stability. Gait analysis, particularly on slopes, is crucial for effective AFO assessment. The study aimed to compare the performance of commercially available AFOs with a new sports-specific AFO in children with hemiplegic cerebral palsy and to assess the effects of varying slopes on gait. Eighteen participants, aged 6-11, with hemiplegia, underwent gait analysis using GRAIL technology. Two AFO types were tested on slopes (uphill +10 deg, downhill -5 deg, level-ground). Kinematic, kinetic, and spatiotemporal parameters were analyzed. The new AFO contributed to significant changes in ankle dorsi-plantar-flexion, foot progression, and trunk and hip rotation during downhill walking. Additionally, the new AFO had varied effects on spatiotemporal gait parameters, with an increased stride length during downhill walking. Slope variations significantly influenced the kinematics and kinetics. This study provides valuable insights into AFO effectiveness and the impact of slopes on gait in hemiplegic cerebral palsy. The findings underscore the need for personalized interventions, considering environmental factors, and enhancing clinical and research approaches for improving mobility in cerebral palsy.

Customized Landing Task for ACL Injury Risk Assessment: Kinematic Sex-Related Differences.

BACKGROUND: Women present a higher anterior cruciate ligament (ACL) injury rate than men, suggesting sex-related biomechanical differences. Task characteristics are often fixed for both sexes, possibly affecting the perceived difficulty. We investigated kinematic sex differences across landing tasks for ACL injury risk assessment, adjusted to participants' anthropometrics/performance, and whether different tasks affect kinematic sex comparisons. HYPOTHESIS: Female subjects would exhibit motion patterns more associated with ACL injury risk, and sex-related differences may depend on task type. STUDY DESIGN: Descriptive laboratory study. LEVEL OF EVIDENCE: Level 3. METHODS: A total of 27 female and 29 male amateur players (18-30 years) executed horizontal hop, drop jump (DJ), and DJ followed by vertical or forward jump (length, proportional to maximal forward jump; box, 20% participant's height). An optoelectronic system provided lower limb kinematics at initial contact and peaks until maximum knee flexion (KF), analyzed separately by multivariate analysis of variance (MANOVA) (α = 0.05). RESULTS: At initial contact, the interaction term had significant effects on hip adduction (P < 0.01) and knee abduction (KAb) (P = 0.04); female participants demonstrated higher KAb (P < 0.01) and knee internal rotation (P = 0.05). For peaks analysis, the interaction term had no significant effects on any individual variable, although significant in MANOVA; female participants had higher KAb (P = 0.01) and lower KF (P = 0.04). Task type affected hip flexion and knee angles in both analyses. CONCLUSION: All variables in which significant sex-related differences were found are potential ACL injury risk factors, and all findings indicate that the analyzed female sample exhibited higher injury-related patterns. Although customized, male and female participants showed different landing strategies depending on the task. CLINICAL RELEVANCE: The findings underline how female participants adopted potentially harmful kinematics while executing customized landing tasks (adjusted by subject's anthropometrics/performance), which may enhance risk of ACL injury.

The relationship between jump and sprint performance in preschool children.

BACKGROUND: Physical activity may help prevent the development of adverse health disorders in children. Thus, it is fundamental to assess key physical skills, such as jumping and running, from an early age. Several studies proposed test batteries to evaluate these motor skills in preschoolers, but no research studied their association. Therefore, this study aimed to evaluate the relationship between jump performance, including force production parameters, and sprint performance in preschool children. METHODS: Twenty-nine preschoolers, aged 4 to 5, underwent assessments, including countermovement jumps (CMJ) and standing long jumps (SLJ) on a force plate. Then they performed a 10-meter linear sprint assessed using photocells. RESULTS: Regression models revealed that SLJ distance emerged as a significant predictor (R2=49.3%, P<0.001) of sprint horizontal velocity, while, for sprint momentum (R2=34.3%), both SLJ distance (P=0.004) and SLJ vertical peak force (P=0.036) were found to be significant predictors. CONCLUSIONS: The findings showed that short-distance (i.e., 10 m) linear sprint performance, both velocity and momentum, in preschoolers may be predicted mainly using SLJ assessment. These findings underscore the importance of early motor skill development in shaping physical abilities and their potential relationship in preschool children.

Bioimpedance Vector Analysis-Derived Body Composition Influences Strength and Power in Alpine Skiers.

Purpose: Alpine ski racing is a complex sport where no single factor can exclusively account for performance. We assessed body composition, using bioelectrical impedance vector analysis (BIVA), and our purpose was to study its influence on the strength and power profile of young alpine skiers. Methods: Anthropometric measurements and advanced BIVA parameters were recorded on eighteen alpine ski racers (6 females/12 males; 17.0 ± 1.3 years; 172.2 ± 9.3 cm; 68.5 ± 9.8 kg). Dynamic force and power were assessed using countermovement jumps (CMJ), while maximal isometric strength was evaluated for hip flexion-extension and abduction-adduction movements. Stepwise regression models examined the relationship between BIVA-derived parameters and strength/power variables. Results: Body cellular mass (BCM) positively related to jump height (p = .021, R2 = 74%), jump momentum (p < .001, R2 = 89%), reactive strength index modified (p = .026, R2 = 75%) and peak concentric power (p < .001, R2 = 82%), while intracellular water (ICW) related to peak eccentric (p < .001, R2 = 76%) and concentric force (p < .001, R2 = 77%) as well as to concentric rate of force development together with the phase angle (PhA) (p = .008, R2 = 79% and R2 = 0.015). Regarding isometric assessment, ICW was a significant predictor for all four movement directions, and PhA contributed to hip adduction strength. Conclusions: Body composition, particularly BCM and ICW, significantly predict force- and power-related factors in young alpine skiers.

Early sleep after action observation plus motor imagery improves gait and balance abilities in older adults.

Action observation plus motor imagery (AOMI) is a rehabilitative approach to improve gait and balance performance. However, limited benefits have been reported in older adults. Early sleep after motor practice represents a strategy to enhance the consolidation of trained skills. Here, we investigated the effects of AOMI followed by early sleep on gait and balance performance in older adults. Forty-five older adults (mean age: 70.4 ± 5.2 years) were randomized into three groups performing a 3-week training. Specifically, AOMI-sleep and AOMI-control groups underwent observation and motor imagery of gait and balance tasks between 8:00 and 10:00 p.m. or between 8:00 and 10:00 a.m. respectively, whereas Control group observed landscape video-clips. Participants were assessed for gait performance, static and dynamic balance and fear of falling before and after training and at 1-month follow-up. The results revealed that early sleep after AOMI training sessions improved gait and balance abilities in older adults compared to AOMI-control and Control groups. Furthermore, these benefits were retained at 1-month after the training end. These findings suggested that early sleep after AOMI may represent a safe and easy-applicable intervention to minimize the functional decay in older adults.

Hip joint contact forces are lower in people with femoroacetabular impingement syndrome during squat tasks.

It remains unknown if hip joint forces during squat tasks are altered in people with femoroacetabular impingement syndrome (FAIS). The aim of this study is to compare hip joint forces between people with FAIS and healthy controls during double leg squat and single leg squat tasks and within limbs during a single leg squat task in people with FAIS. Kinematic and kinetic data were collected in eight people with FAIS and eight healthy matched controls using 3D motion capture and force plates. AnyBody Modeling System was used to perform musculoskeletal simulations to estimate hip joint angles, forces, and moments for all participants. Estimates were postprocessed with AnyPyTools and converted into normalized time series to be compared using a 1D statistical nonparametric mapping (SnPM) approach. SnPM with an independent samples t-test model was used to compare people with FAIS to controls, while a paired samples model was used to compare involved to uninvolved limb in people with FAIS. Patients demonstrated lower proximodistal force compared to controls (p < 0.01) and compared to the uninvolved side (p = 0.01) for single leg squat. The smaller joint contact forces in people with FAIS compared to controls could represent a strategy of reduced muscle forces to avoid pain and symptoms during this high demand task. These findings when combined with imaging data could help assess the severity of FAIS on hip related function during higher demand tasks.

Assessment of an IMU-Based Experimental Set-Up for Upper Limb Motion in Obese Subjects.

In recent years, wearable systems based on inertial sensors opened new perspectives for functional motor assessment with respect to the gold standard motion capture systems. The aim of this study was to validate an experimental set-up based on 17 body-worn inertial sensors (Awinda, Xsens, The Netherlands), addressing specific body segments with respect to the state-of-the art system (VICON, Oxford Metrics Ltd., Oxford, UK) to assess upper limb kinematics in obese, with respect to healthy subjects. Twenty-three obese and thirty healthy weight individuals were simultaneously acquainted with the two systems across a set of three tasks for upper limbs (i.e., frontal arm rise, lateral arm rise, and reaching). Root Mean Square error (RMSE) was computed to quantify the differences between the measurements provided by the systems in terms of range of motion (ROM), whilst their agreement was assessed via Pearson's correlation coefficient (PCC) and Bland-Altman (BA) plots. In addition, the signal waveforms were compared via one-dimensional statistical parametrical mapping (SPM) based on a paired t-test and a two-way ANOVA was applied on ROMs. The overall results partially confirmed the correlation and the agreement between the two systems, reporting only a moderate correlation for shoulder principal rotation angle in each task (r~0.40) and for elbow/flexion extension in obese subjects (r = 0.66), whilst no correlation was found for most non-principal rotation angles (r < 0.40). Across the performed tasks, an average RMSE of 34° and 26° was reported in obese and healthy controls, respectively. At the current state, the presence of bias limits the applicability of the inertial-based system in clinics; further research is intended in this context.

Forward and Backward Walking: Multifactorial Characterization of Gait Parameters.

Although extensive literature exists on forward and backward walking, a comprehensive assessment of gait parameters on a wide and homogenous population is missing. Thus, the purpose of this study is to analyse the differences between the two gait typologies on a relatively large sample. Twenty-four healthy young adults participated in this study. By means of a marker-based optoelectronic system and force platforms, differences between forward and backward walking were outlined in terms of kinematics and kinetics. Statistically, significant differences were observed in most of the spatial-temporal parameters, evidencing some adaptation mechanisms in backward walking. Differently from the ankle joint, the hip and knee range of motion was significantly reduced when switching from forward to backward walking. In terms of kinetics, hip and ankle moment patterns for forward and backward walking were approximately mirrored images of each other. Moreover, joint powers appeared drastically reduced during reversed gait. Specifically, valuable differences in terms of produced and absorbed joint powers between forward and backward walking were pointed out. The outcomes of this study could represent a useful reference data for future investigation evaluating the efficacy of backward walking as a rehabilitation tool for pathological subjects.

Cervical Range of Motion Assessment through Inertial Technology: A Validity and Reliability Study.

Inertial technology has spread widely for its comfortable use and adaptability to various motor tasks. The main objective of this study was to assess the validity of inertial measurements of the cervical spine range of motion (CROM) when compared to that of the optoelectronic system in a group of healthy individuals. A further aim of this study was to determine the optimal placement of the inertial sensor in terms of reliability of the measure, comparing measurements obtained from the same device placed at the second cervical vertebra (C2), the forehead (F) and the external occipital protuberance (EOP). Twenty healthy subjects were recruited and asked to perform flexion-extension, lateral bending, and axial rotation movements of the head. Outcome measurements of interest were CROM and mean angular velocities for each cervical movement. Results showed that inertial measurements have good reliability (0.75 < ICC < 0.9). Excellent reliability (ICC > 0.9) was found in both flexion and right lateral bending angles. All parameters extracted with EOP placement showed ICC > 0.62, while ICC < 0.5 was found in lateral bending mean angular velocities both for F and C2 placements. Therefore, the optimal sensor's positioning emerged to be EOP. These results suggest that inertial technology could be useful and reliable for the evaluation of the CROM.

Evaluation of Upper Body and Lower Limbs Kinematics through an IMU-Based Medical System: A Comparative Study with the Optoelectronic System.

In recent years, the use of inertial-based systems has been applied to remote rehabilitation, opening new perspectives for outpatient assessment. In this study, we assessed the accuracy and the concurrent validity of the angular measurements provided by an inertial-based device for rehabilitation with respect to the state-of-the-art system for motion tracking. Data were simultaneously collected with the two systems across a set of exercises for trunk and lower limbs, performed by 21 healthy participants. Additionally, the sensitivity of the inertial measurement unit (IMU)-based system to its malpositioning was assessed. Root mean square error (RMSE) was used to explore the differences in the outputs of the two systems in terms of range of motion (ROM), and their agreement was assessed via Pearson's correlation coefficient (PCC) and Lin's concordance correlation coefficient (CCC). The results showed that the IMU-based system was able to assess upper-body and lower-limb kinematics with a mean error in general lower than 5° and that its measurements were moderately biased by its mispositioning. Although the system does not seem to be suitable for analysis requiring a high level of detail, the findings of this study support the application of the device in rehabilitation programs in unsupervised settings, providing reliable data to remotely monitor the progress of the rehabilitation pathway and change in patient's motor function.

Assessment of functional mobility and gait during a timed up and go test in adults with total blindness.

BACKGROUND: The loss of vision leads to behavioral and motor adaptations that do not necessarily translate to good functioning with regards to daily tasks. AIM: To investigate differences in functional mobility in adults with total blindness, and analyze differences in spatiotemporal gait variables with and without the use of a cane, and wearing shoes or barefoot. METHODS: We used an inertial measurement unit to assess the spatiotemporal parameters of the gait and functional mobility in seven subjects with total blindness and four sighted participants during the timed up and go test (TUG) test performed under conditions: barefoot/shod; and with/without a cane (blind subjects). RESULTS: Significant differences between groups were found in total TUG test time and in the sub-phases when the blind subjects executed the TUG barefoot and without a cane (p < .01). Other differences were found in trunk movement during sit-to-stand, and stand-to-sit where blind subjects when without cane and barefoot, they had a greater range of motion than sighted subjects (p < .01). Also, BMI has a moderate to strong influence in the execution of the TUG in blind subjects (p < .05) CONCLUSION: This study showed that, when using a gait-assistance device and wearing shoes, blind subjects have similar functional mobility and gait as sighted subjects, suggesting that an external haptic reference can compensate for the lack of vision. Knowledge of these differences can provide a better understanding of the adaptive behavior in this population, thereby assisting in minimizing the occurrence of trauma and falls.

Tele-Rehabilitation Interventions for Motor Symptoms in COVID-19 Patients: A Narrative Review.

The COVID-19 pandemic brought new challenges to global healthcare systems regarding the care of acute patients and the delivery of rehabilitation programs to post-acute or chronic patients. Patients who survive severe forms of COVID-19 often report incomplete healing and long-term symptoms. The need of these patients for rehabilitation has been recognized as a public health problem. In this context, the application of tele-rehabilitation has been explored to reduce the burden on healthcare systems. The purpose of this narrative review is to present an overview of the state of the art regarding the application of remote motor rehabilitation programs for paucisymptomatic acute and post-acute COVID-19 patients, with a focus on the motor aspects of tele-rehabilitation. Following an extensive search on PubMed, the Web of Science, and Scopus, specific studies have been reviewed and compared in terms of study objectives and participants, experimental protocols and methods for home-based interventions, functional assessment, and rehabilitation outcomes. Overall, this review suggests the feasibility and the effectiveness of tele-rehabilitation as a promising tool to complement face-to-face rehabilitation interventions. However, further improvements are needed to overcome the limitations and the current lack of knowledge in the field.

Corrigendum to "Energy analysis of gait in patients with down syndrome" [Heliyon 8 (11) (November 2022) Article e11702].

[This corrects the article DOI: 10.1016/j.heliyon.2022.e11702.].

Technological Solutions for Human Movement Analysis in Obese Subjects: A Systematic Review.

Obesity has a critical impact on musculoskeletal systems, and excessive weight directly affects the ability of subjects to realize movements. It is important to monitor the activities of obese subjects, their functional limitations, and the overall risks related to specific motor tasks. From this perspective, this systematic review identified and summarized the main technologies specifically used to acquire and quantify movements in scientific studies involving obese subjects. The search for articles was carried out on electronic databases, i.e., PubMed, Scopus, and Web of Science. We included observational studies performed on adult obese subjects whenever reporting quantitative information concerning their movement. The articles must have been written in English, published after 2010, and concerned subjects who were primarily diagnosed with obesity, thus excluding confounding diseases. Marker-based optoelectronic stereophotogrammetric systems resulted to be the most adopted solution for movement analysis focused on obesity; indeed, wearable technologies based on magneto-inertial measurement units (MIMUs) were recently adopted for analyzing obese subjects. Further, these systems are usually integrated with force platforms, so as to have information about the ground reaction forces. However, few studies specifically reported the reliability and limitations of these approaches due to soft tissue artifacts and crosstalk, which turned out to be the most relevant problems to deal with in this context. In this perspective, in spite of their inherent limitations, medical imaging techniques-such as Magnetic Resonance Imaging (MRI) and biplane radiography-should be used to improve the accuracy of biomechanical evaluations in obese people, and to systematically validate less-invasive approaches.

Influence of Foot Morphology on the Center of Pressure Pattern in Patients with Down Syndrome.

BACKGROUND: The primary aim of this study was to assess how different conformations of the foot in individuals with Down syndrome affected the CoP during walking, and the secondary aim was to evaluate the effect of an excess of mass in young adults and children with Down syndrome and flat foot. The greater investigation of these aspects will allow for more targeted rehabilitation treatments to improve a patient's quality of life. METHODS: The tests were carried out on 217 subjects with Down syndrome, 65 children and 152 young adults, and on 30 healthy individuals, 19 children and 11 young adults. All subjects underwent gait analysis, and the group with Down syndrome was also assessed with baropodometric tests to evaluate foot morphology. RESULTS: The statistical analysis showed that within both the young adult and child groups, the CoP pattern in the anterior-posterior direction reflected a difficulty in proceeding in the walking direction compensated by a medio-lateral swing. The gait of children with Down syndrome was more impaired than that of young adults. In both young adults and children, a higher severity of impairment was found in overweight and obese female individuals. CONCLUSIONS: These results suggest that the sensory deficits and the development of hypotonic muscles and lax ligaments of the syndrome lead to morphological alterations of the foot that, combined with the physical characteristics of short stature and obesity, negatively impact the CoP pattern of people with Down syndrome during walking.

Early sleep after action observation and motor imagery training boosts improvements in manual dexterity.

The systematic observation and imagination of actions promotes acquisition of motor skills. Furthermore, studies demonstrated that early sleep after practice enhances motor learning through an offline stabilization process. Here, we investigated behavioral effects and neurodynamical correlates of early sleep after action observation and motor imagery training (AO + MI-training) on motor learning in terms of manual dexterity. Forty-five healthy participants were randomized into three groups receiving a 3 week intervention consisting of AO + MI-training immediately before sleeping or AO + MI-training at least 12 h before sleeping or a control stimulation. AO + MI-training implied the observation and motor imagery of transitive manual dexterity tasks, whereas the control stimulation consisted of landscape video-clips observation. Manual dexterity was assessed using functional tests, kinematic and neurophysiological outcomes before and after the training and at 1-month follow-up. AO + MI-training improved manual dexterity, but subjects performing AO + MI-training followed by early sleep had significantly larger improvements than those undergoing the same training at least 12 h before sleeping. Behavioral findings were supported by neurodynamical correlates during motor performance and additional sleep-dependent benefits were also detected at 1 month follow-up. These findings introduce a new approach to enhance the acquisition of new motor skills or facilitate recovery in patients with motor impairments.