Assessing the impact of a knowledge translation intervention on physical therapists' self-efficacy and implementation of motor learning practice.

BACKGROUND: The application of motor learning (ML) principles and research in physical therapy can optimize patient outcomes. However, the translation of the accumulated knowledge in ML to clinical practice is limited. Knowledge translation interventions, which are designed to promote changes in clinical behaviors, have the potential to address this implementation gap. We developed, implemented, and evaluated a knowledge translation intervention for ML implementation that focuses on building clinical capacity among physical therapists for the systematic application of ML knowledge in clinical practice. METHODS: A total of 111 physical therapists underwent the intervention, which consisted of the following: (1) an interactive didactic 20-hour course; (2) an illustrated conceptual model of ML elements; and (3) a structured clinical-thinking form. Participants completed the Physical Therapists' Perceptions of Motor Learning (PTP-ML) questionnaire pre and post intervention. The PTP-ML was used to assess ML-related self-efficacy and implementation. Participants also provided post-intervention feedback. A sub-sample (n = 25) provided follow-up feedback more than a year after the completion of the intervention. Pre-post and post-follow-up changes in the PTP-ML scores were calculated. The information gathered from the open-ended items of the post-intervention feedback was analyzed to identify emerging themes. RESULTS: Comparing pre- and post-intervention scores, significant changes were found in the total questionnaire scores, self-efficacy subscale scores, reported implementation subscale scores (P < .0001), and general perceptions and work environment subscale score (P < .005). The mean changes in the total questionnaire and self-efficacy scores also significantly exceeded the Reliable Change Index. In the follow-up sample, these changes were maintained. Participants felt that the intervention helped them organize their knowledge in a structured manner and consciously link their practice elements to concepts in ML. Discussion of clinical cases was reported to be the most valuable educational method, and the illustrated conceptual model of ML elements was the least valued. Respondents also suggested support activities to maintain and enhance the learning experience, including on-site mentorship and hands-on experience. CONCLUSIONS: Findings support the positive effect of an educational tool, most prominently on physical therapists' ML self-efficacy. The addition of practical modeling or ongoing educational support may enhance intervention effects.

Bridging Motor Learning Principles with Physiotherapy Specific Scoliosis Exercises: a Perspective Article.

AIM: This perspective paper illustrates the usefulness of explicitly integrating motor learning terminology with evolving therapeutic approaches. Physiotherapy specific scoliosis exercises (PSSEs) include a growing number of approaches to scoliosis management and serve as an example of this integration. METHODS: Three quintessential patient cases (a young hypermobile adolescent, a post-pubescent teen, and an adult with childhood diagnosis of scoliosis) serve to contrast the clinical decision-making process for a PSSE plan of care when organized within a motor learning framework. CONCLUSIONS AND IMPLICATIONS: As intervention approaches evolve, aligning the unique terminologies from different schools of thought with motor learning constructs would provide a common language for clinicians, academics and researchers to facilitate comparison of approaches and organize intervention care plans. Linking a motor learning framework and terminology to PSSE may facilitate comparison of PSSE treatment approaches by clinicians, academics, and researchers, as well as advance the global quality of care for patients with scoliosis.

COVID-19 social distancing: negative effects on people with Parkinson disease and their associations with confidence for self-management.

BACKGROUND: The purpose of this study was to describe the effects of COVID-19 social distancing on the function, health, and well-being of people with Parkinson disease (PD), and test the association of these effects with patients' activation levels, i.e., their skills and confidence in managing their health. METHODS: Community-dwelling individuals with PD answered an anonymous web-based survey. Part 1 included 27 multiple-choice questions regarding changes in function, health, medical care, and well-being. Part 2 consisted of the Patient Activation Measure, which enquired about skills and confidence in managing one's health. RESULTS: Respondents (N = 142) reported decreases in various function (24.8%-37.3%), health (33.8%-43%), and well-being (26.1%-47.1%) domains. Rehabilitation ceased for 61.2%. Among those reporting a worsening of health, 67.8% associated this with the cessation of rehabilitative treatments or decrease in physical activity. Patients' activation levels were inversely correlated with increased assistance for activities of daily living, increased tiredness, worsening symptoms, and lack of support from family and friends. CONCLUSIONS: Social distancing had a major negative impact on the health and function of people with PD. PRACTICAL IMPLICATIONS: Supporting people with PD skills and confidence in managing health may preserve their physical and mental health during this period of dramatic changes in life's circumstances.

Performance in complex life situations: effects of age, cognition, and walking speed in virtual versus real life environments.

BACKGROUND: Virtual reality (VR) enables objective and accurate measurement of behavior in ecologically valid and safe environments, while controlling the delivery of stimuli and maintaining standardized measurement protocols. Despite this potential, studies that compare virtual and real-world performance of complex daily activities are scarce. This study aimed to compare cognitive strategies and gait characteristics of young and older healthy adults as they engaged in a complex task while navigating in a real shopping mall and a high-fidelity virtual replica of the mall. METHODS: Seventeen older adults (mean (SD) age = 71.2 (5.6) years, 64% males) and 17 young adults (26.7 (3.7) years, 35% males) participated. In two separate sessions they performed the Multiple Errands Test (MET) in a real-world mall or the Virtual MET (VMET) in the virtual environment. The real-world environment was a small shopping area and the virtual environment was created within the CAREN™ (Computer Assisted Rehabilitation Environment) Integrated Reality System. The performance of the task was assessed using motor and physiological measures (gait parameters and heart rate), MET or VMET time and score, and navigation efficiency (cognitive performance and strategy). Between (age groups) and within (environment) differences were analyzed with ANOVA repeated measures. RESULTS: There were no significant age effects for any of the gait parameters but there were significant environment effects such that both age groups walked faster (F(1,32) = 154.96, p < 0.0001) with higher step lengths (F(1,32) = 86.36, p < 0.0001), had lower spatial and temporal gait variability (F(1,32) = 95.71-36.06, p < 0.0001) and lower heart rate (F(1,32) = 13.40, p < 0.01) in the real-world. There were significant age effects for MET/VMET scores (F(1,32) = 19.77, p < 0.0001) and total time (F(1,32) = 11.74, p < 0.05) indicating better performance of the younger group, and a significant environment effect for navigation efficiency (F(1,32) = 7.6, p < 0.01) that was more efficient in the virtual environment. CONCLUSIONS: This comprehensive, ecological approach in the measurement of performance during tasks reminiscent of complex life situations showed the strengths of using virtual environments in assessing cognitive aspects and limitations of assessing motor aspects of performance. Difficulties by older adults were apparent mainly in the cognitive aspects indicating a need to evaluate them during complex task performance.

Testing a new active learning approach to advance motor learning knowledge and self-efficacy in physical therapy undergraduate education.

BACKGROUND: Motor learning (ML) science is foundational for physical therapy. However, multiple sources of evidence have indicated a science-practice gap. Clinicians report low self-efficacy with ML concepts and indicate that the lack of access to systematic training is a barrier for practical implementation. The general goal of this preliminary study was to describe the effects of a new educational intervention on physical therapy student's ML self-efficacy and knowledge. METHODS: Self-efficacy was assessed with the Physical Therapists' Perceptions of Motor Learning questionnaire. Data was acquired from third-semester students before their participation in the ML educational intervention. Reference self-efficacy data was also acquired from physical therapy professionals and first and last-semester students. The educational intervention for third-semester students was designed around an established framework to apply ML principles to rehabilitation. A direct experience, the "Learning by Doing" approach, in which students had to choose a motor skill to acquire over 10 weeks, provided the opportunity to apply ML theory to practice in a personally meaningful way. After the intervention self-efficacy was re-tested. ML knowledge was tested with an objective final exam. Content analysis of coursework material was used to determine how students comprehended ML theory and related it to their practical experience. The Kruskal-Wallis and Mann-Whitney U tests were used to compare self-efficacy scores between the four groups. Changes in self-efficacy after the educational intervention were analyzed with the Wilcoxon test. Spearman rank correlation analysis was used to test the association between self-efficacy and final exam grades. RESULTS: By the end of the intervention, students' self-efficacy had significantly increased (p < 0.03), was higher than that of senior students (p < 0.00) and experienced professionals (p < 0.00) and correlated with performance on an objective knowledge test (p < 0.03). Content analysis revealed that students learned to apply the elements of ML-based interventions present in the scientific literature to a real-life, structured ML program tailored to personal objectives. CONCLUSIONS: Positive improvements were observed after the intervention. These results need confirmation with a controlled study. Because self-efficacy mediates the clinical application of knowledge and skills, systematic, active training in ML may help reduce the science-practice gap.

EMG activity of finger flexor muscles and grip force following low-dose transcutaneous electrical nerve stimulation in healthy adult subjects.

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

High metabolic cost and low energy expenditure for typical motor activities among individuals in the chronic phase after stroke.

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

Association of health behaviors with function and health-related quality of life among patients with Parkinson's disease.

BACKGROUND: Current evidence on chronic conditions favors promotion of health behaviors as a mean to positively impact health outcomes. In Parkinson's disease, performing health behaviors is indicated as a means to fight the long-lasting burden of the disease. Understanding actual engagement in health behaviors and patient activation and their association to function and health-related quality of life is therefore important. Our objectives were, among people with Parkinson's disease: (1) to characterize health behaviors including utilization of rehabilitative treatments, physical activity, and patient activation levels, and (2) to test the associations between these health behaviors and health outcomes. METHODS: A cross-sectional study of 88 people with Parkinson's disease (age 66.84 ± 8.8) was conducted. Participants answered questionnaires measuring health behaviors including utilization of health professions treatments, physical activity, patient activation, and health outcomes consisting of function and health-related quality of life. Linear regression models were conducted to test associations between measured health behaviors, function and health-related quality of life. RESULTS: Participants rarely engage in rehabilitative treatments, but showed high levels of patient activation. Controlled by demographics and disease severity, physical activity and patient activation were associated with function (b = 0.41, p < .001; b = 0.2, p = .02, respectively) and physical activity but not patient activation, which was associated with health-related quality of life (b = 0.19, p = .03). There was also interaction effects of physical activity and non-motor symptoms, and physical activity and motor symptoms on health-related quality of life (b = 0.19, p = .02 and b = - 0.22, p = .01, respectively). CONCLUSIONS: In respect to their potential health-related benefits for people with Parkinson's disease, health professionals' treatments are underutilized. Findings supported the importance of health behaviors for maintaining function and health-related quality of life among people with Parkinson's disease. They also show a differential contribution of motor and non-motor symptoms to the association between physical activity and quality of life. It is suggested that policy makers encourage opportunities for physical activity tailored for people with Parkinson's disease and adopt a proactive stance towards enhancing awareness and use of rehabilitation services. Trial registration NCT05211700, ClinicalTrials.gov ID: NCT05211700 first release 12/30/2021, https://classic. CLINICALTRIALS: gov/ct2/show/NCT05211700.

Feasibility of virtual reality augmented cycling for health promotion of people poststroke.

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

Effects of integrated motor imagery practice on gait of individuals with chronic stroke: a half-crossover randomized study.

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

Socio-Clinical factors associated with Parkinson's disease-related specific self-management behaviours.

OBJECTIVE: To test associations between socio-clinical factors, self-management and patient activation among patients with Parkinson's disease (PD), and to explore the use of regression tree to find the cut-off levels of socio-clinical factors which associate with lower or higher self-management behaviours and patient's activation. METHODS: A cross-sectional study of patients with PD (n = 62) who underwent assessment of their socio-clinical factors including age, gender, cognitive status, comorbidities, disease severity (motor and non-motor symptoms) and social support. The associations of these factors to specific aspects of self-management behaviours including utilization of rehabilitative treatments, physical activity and patient activation were tested. RESULTS: Most patients did not utilize rehabilitative treatments. Non-motor symptoms and cognitive status were significantly associated with physical activity (R2 = 0.35, F(3, 58) = 10.50, p < 0.001). Non-motor symptoms were significantly associated with patient activation (R2 = 0.30, F(1, 30) = 25.88, p < 0.001). Patients with Mini-Mental State Exam score ≤24 performed less physical activity, relative to those with a higher score. Patients with ≤5 non-motor symptoms showed higher activation relative to those with >5. CONCLUSION: In PD, disease-specific clinical characteristics overshadow other personal factors as determinants of self-management behaviours. The role of non-motor symptoms in reduced self-management behaviours and activation is highlighted.

Compensatory movement strategies differentially affect attention allocation and gait parameters in persons with Parkinson's disease.

Persons with Parkinson's disease (PwP) are advised to use compensatory strategies such as external cues or cognitive movement strategies to overcome gait disturbances. It is suggested that external cues involve the processing of sensory stimulation, while cognitive-movement strategies use attention allocation. This study aimed to compare over time changes in attention allocation in PwP between prolonged walking with cognitive movement strategy and external cues; to compare the effect of cognitive movement strategies and external cues on gait parameters; and evaluate whether these changes depend on cognitive function. Eleven PwP participated in a single-group pilot study. Participants walked for 10 min under each of three conditions: natural walking, using external cuing, using a cognitive movement strategy. Attention and gait variables were extracted from a single-channel electroencephalogram and accelerometers recordings, respectively. Attention allocation was assessed by the% of Brain Engagement Index (BEI) signals within an attentive engagement range. Cognitive function was assessed using a neuropsychological battery. The walk was divided into 2-min time segments, and the results from each 2-min segment were used to determine the effects of time and condition. Associations between cognitive function and BEI signals were tested. Findings show that in the cognitive movement strategy condition, there was a reduction in the % of BEI signals within the attentive engagement range after the first 2 min of walking. Despite this reduction the BEI did not consistently differ from natural and metronome walking. Spatiotemporal gait variables were better in the cognitive movement strategy condition relative to the other conditions. Global cognitive and information processing scores were significantly associated with the BEI only when the cognitive movement strategy was applied. In conclusion, the study shows that a cognitive movement strategy has positive effects on gait variables but may impose a higher attentional load. Furthermore, when walking using a cognitive movement strategy, persons with higher cognitive function showed elevated attentive engagement. The findings support the idea that cognitive and attentional resources are required for cognitive movement strategies in PwP. Additionally, this study provides support for using single-channel EEG to explore mechanistic aspects of clinical interventions.

Nintendo wii sports and wii fit game analysis, validation, and application to stroke rehabilitation.

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

Physical therapists' perspectives of the construct of motor learning, and their motor learning-based practice: a qualitative study.

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

Implementation of motor learning principles in physical therapy practice: Survey of physical therapists' perceptions and reported implementation.

INTRODUCTION: The field of motor learning (ML) plays a pivotal role in physical therapy (PT), and its implementation has been shown to improve intervention outcomes. The objective of this study was to assess physical therapists' ML-related self-efficacy, self-reported implementation, and environmental workplace factors. An additional aim was to report the psychometric properties of a questionnaire that was developed to assess the above-mentioned constructs. METHODS: An observational, cross-sectional survey was completed by 289 physical therapists (average age: 38.7 (9.7), with 11.3 (9.7) years of experience and 74% female). Construct validity, internal consistency, and test-retest reliability were tested. The main outcome measures were the scores of the three scales of the questionnaire, referring to self-efficacy in ML, implementation of ML principles, and workplace environment features. RESULTS: The questionnaire had sound psychometric qualities. Respondents perceived ML as an integral part of PT. ML-related self-efficacy and implementation of ML principles were moderate (2.95/5 (0.7) and 3.04/5(0.8), respectively). PT practice had a significant effect on ML-related self-efficacy (p = 0.035) and implementation (p = 0.0031). Respondents who had undergone ML training in their graduate program reported higher ML-related self-efficacy (p = 0.007). Respondents who had postgraduate training in ML reported significantly more extensive implementation (p = 0.024). Lack of knowledge and lack of time were perceived as the major barriers to implementation. CONCLUSIONS: Level of self-efficacy might be insufficient to support the systematic implementation of ML principles in practice. Addressing impeding individual- and organizational-level factors might facilitate ML self-efficacy and implementation. Postgraduate education facilitates ML implementation.

From Motor Learning Theory to Practice: A Scoping Review of Conceptual Frameworks for Applying Knowledge in Motor Learning to Physical Therapist Practice.

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

Functional Performance and Balance in the Oldest-Old.

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

Effects of antecedent TENS on EMG activity of the finger flexor muscles and on grip force.

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

External validity of post-stroke interventional gait rehabilitation studies.

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

Inhibition of Ras attenuates the course of experimental autoimmune neuritis.

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