Utility and usability of a wearable system and progressive-challenge cued exercise program for encouraging use of the more involved arm at-home after stroke-a feasibility study with case reports.

BACKGROUND: Understanding the role of adherence to home exercise programs for survivors of stroke is critical to ensure patients perform prescribed exercises and maximize effectiveness of recovery. METHODS: Survivors of hemiparetic stroke with impaired motor function were recruited into a 7-day study designed to test the utility and usability of a low-cost wearable system and progressive-challenge cued exercise program for encouraging graded-challenge exercise at-home. The wearable system comprised two wrist-worn MetaMotionR+ activity monitors and a custom smartphone app. The progressive-challenge cued exercise program included high-intensity activities (one repetition every 30 s) dosed at 1.5 h per day, embedded within 8 h of passive activity monitoring per day. Utility was assessed using measures of system uptime and cue response rate. Usability and user experience were assessed using well-validated quantitative surveys of system usability and user experience. Self-efficacy was assessed at the end of each day on a visual analog scale that ranged from 0 to 100. RESULTS: The system and exercise program had objective utility: system uptime was 92 ± 6.9% of intended hours and the rate of successful cue delivery was 99 ± 2.7%. The system and program also were effective in motivating cued exercise: activity was detected within 5-s of the cue 98 ± 3.1% of the time. As shown via two case studies, accelerometry data can accurately reflect graded-challenge exercise instructions and reveal differentiable activity levels across exercise stages. User experience surveys indicated positive overall usability in the home settings, strong levels of personal motivation to use the system, and high degrees of satisfaction with the devices and provided training. Self-efficacy assessments indicated a strong perception of proficiency across participants (95 ± 5.0). CONCLUSIONS: This study demonstrates that a low-cost wearable system providing frequent haptic cues to encourage graded-challenge exercise after stroke can have utility and can provide an overall positive user experience in home settings. The study also demonstrates how combining a graded exercise program with all-day activity monitoring can provide insight into the potential for wearable systems to assess adherence to-and effectiveness of-home-based exercise programs on an individualized basis.

Utility and Usability of Two Forms of Supplemental Vibrotactile Kinesthetic Feedback for Enhancing Movement Accuracy and Efficiency in Goal-Directed Reaching.

Recent advances in wearable sensors and computing have made possible the development of novel sensory augmentation technologies that promise to enhance human motor performance and quality of life in a wide range of applications. We compared the objective utility and subjective user experience for two biologically inspired ways to encode movement-related information into supplemental feedback for the real-time control of goal-directed reaching in healthy, neurologically intact adults. One encoding scheme mimicked visual feedback encoding by converting real-time hand position in a Cartesian frame of reference into supplemental kinesthetic feedback provided by a vibrotactile display attached to the non-moving arm and hand. The other approach mimicked proprioceptive encoding by providing real-time arm joint angle information via the vibrotactile display. We found that both encoding schemes had objective utility in that after a brief training period, both forms of supplemental feedback promoted improved reach accuracy in the absence of concurrent visual feedback over performance levels achieved using proprioception alone. Cartesian encoding promoted greater reductions in target capture errors in the absence of visual feedback (Cartesian: 59% improvement; Joint Angle: 21% improvement). Accuracy gains promoted by both encoding schemes came at a cost in terms of temporal efficiency; target capture times were considerably longer (1.5 s longer) when reaching with supplemental kinesthetic feedback than without. Furthermore, neither encoding scheme yielded movements that were particularly smooth, although movements made with joint angle encoding were smoother than movements with Cartesian encoding. Participant responses on user experience surveys indicate that both encoding schemes were motivating and that both yielded passable user satisfaction scores. However, only Cartesian endpoint encoding was found to have passable usability; participants felt more competent using Cartesian encoding than joint angle encoding. These results are expected to inform future efforts to develop wearable technology to enhance the accuracy and efficiency of goal-directed actions using continuous supplemental kinesthetic feedback.

Extended training improves the accuracy and efficiency of goal-directed reaching guided by supplemental kinesthetic vibrotactile feedback.

Prior studies have shown that the accuracy and efficiency of reaching can be improved using novel sensory interfaces to apply task-specific vibrotactile feedback (VTF) during movement. However, those studies have typically evaluated performance after less than 1 h of training using VTF. Here, we tested the effects of extended training using a specific form of vibrotactile cues-supplemental kinesthetic VTF-on the accuracy and temporal efficiency of goal-directed reaching. Healthy young adults performed planar reaching with VTF encoding of the moving hand's instantaneous position, applied to the non-moving arm. We compared target capture errors and movement times before, during, and after approximately 10 h (20 sessions) of training on the VTF-guided reaching task. Initial performance of VTF-guided reaching showed that people were able to use supplemental VTF to improve reaching accuracy. Performance improvements were retained from one training session to the next. After 20 sessions of training, the accuracy and temporal efficiency of VTF-guided reaching were equivalent to or better than reaches performed with only proprioception. However, hand paths during VTF-guided reaching exhibited a persistent strategy where movements were decomposed into discrete sub-movements along the cardinal axes of the VTF display. We also used a dual-task condition to assess the extent to which performance gains in VTF-guided reaching resist dual-task interference. Dual-tasking capability improved over the 20 sessions, such that the primary VTF-guided reaching and a secondary choice reaction time task were performed with increasing concurrency. Thus, VTF-guided reaching is a learnable skill in young adults, who can achieve levels of accuracy and temporal efficiency equaling or exceeding those observed during movements guided only by proprioception. Future studies are warranted to explore learnability in older adults and patients with proprioceptive deficits, who might benefit from using wearable sensory augmentation technologies to enhance control of arm movements.

When intercepting moving targets, mid-movement error corrections reflect distinct responses to visual and haptic perturbations.

We examined a key aspect of sensorimotor skill: the capability to correct performance errors that arise mid-movement. Participants grasped the handle of a robot that imposed a nominal viscous resistance to hand movement. They watched a target move pseudo-randomly just above the horizontal plane of hand motion and initiated quick interception movements when cued. On some trials, the robot's viscosity or the target's speed changed without warning coincident with the GO cue. We fit a sum-of-Gaussians model to mechanical power measured at the handle to determine the number, magnitude, and relative timing of submovements occurring in each interception attempt. When a single submovement successfully intercepted the target, capture times averaged 410 ms. Sometimes, two or more submovements were required. Initial error corrections typically occurred before feedback could indicate the target had been captured or missed. Error corrections occurred sooner after movement onset in response to mechanical viscosity increases (at 154 ms) than to unprovoked errors on control trials (215 ms). Corrections occurred later (272 ms) in response to viscosity decreases. The latency of corrections for target speed changes did not differ from those in control trials. Remarkably, these early error corrections accommodated the altered testing conditions; speed/viscosity increases elicited more vigorous corrections than in control trials with unprovoked errors; speed/viscosity decreases elicited less vigorous corrections. These results suggest that the brain monitors and predicts the outcome of evolving movements, rapidly infers causes of mid-movement errors, and plans and executes corrections-all within 300 ms of movement onset.

Vibrotactile Perception for Sensorimotor Augmentation: Perceptual Discrimination of Vibrotactile Stimuli Induced by Low-Cost Eccentric Rotating Mass Motors at Different Body Locations in Young, Middle-Aged, and Older Adults.

Sensory augmentation technologies are being developed to convey useful supplemental sensory cues to people in comfortable, unobtrusive ways for the purpose of improving the ongoing control of volitional movement. Low-cost vibration motors are strong contenders for providing supplemental cues intended to enhance or augment closed-loop feedback control of limb movements in patients with proprioceptive deficits, but who still retain the ability to generate movement. However, it remains unclear what form such cues should take and where on the body they may be applied to enhance the perception-cognition-action cycle implicit in closed-loop feedback control. As a step toward addressing this knowledge gap, we used low-cost, wearable technology to examine the perceptual acuity of vibrotactile stimulus intensity discrimination at several candidate sites on the body in a sample of participants spanning a wide age range. We also sought to determine the extent to which the acuity of vibrotactile discrimination can improve over several days of discrimination training. Healthy adults performed a series of 2-alternative forced choice experiments that quantified capability to perceive small differences in the intensity of stimuli provided by low-cost eccentric rotating mass vibration motors fixed at various body locations. In one set of experiments, we found that the acuity of intensity discrimination was poorer in older participants than in middle-aged and younger participants, and that stimuli applied to the torso were systematically harder to discriminate than stimuli applied to the forearm, knee, or shoulders, which all had similar acuities. In another set of experiments, we found that older adults could improve intensity discrimination over the course of 3 days of practice on that task such that their final performance did not differ significantly from that of younger adults. These findings may be useful for future development of wearable technologies intended to improve the control of movements through the application of supplemental vibrotactile cues.

Spatial and temporal influences on discrimination of vibrotactile stimuli on the arm.

Body-machine interfaces (BMIs) provide a non-invasive way to control devices. Vibrotactile stimulation has been used by BMIs to provide performance feedback to the user, thereby reducing visual demands. To advance the goal of developing a compact, multivariate vibrotactile display for BMIs, we performed two psychophysical experiments to determine the acuity of vibrotactile perception across the arm. The first experiment assessed vibration intensity discrimination of sequentially presented stimuli within four dermatomes of the arm (C5, C7, C8, and T1) and on the ulnar head. The second experiment compared vibration intensity discrimination when pairs of vibrotactile stimuli were presented simultaneously vs. sequentially within and across dermatomes. The first experiment found a small but statistically significant difference between dermatomes C7 and T1, but discrimination thresholds at the other three locations did not differ. Thus, while all tested dermatomes of the arm and hand could serve as viable sites of vibrotactile stimulation for a practical BMI, ideal implementations should account for small differences in perceptual acuity across dermatomes. The second experiment found that sequential delivery of vibrotactile stimuli resulted in better intensity discrimination than simultaneous delivery, independent of whether the pairs were located within the same dermatome or across dermatomes. Taken together, our results suggest that the arm may be a viable site to transfer multivariate information via vibrotactile feedback for body-machine interfaces. However, user training may be needed to overcome the perceptual disadvantage of simultaneous vs. sequentially presented stimuli.

Supplemental vibrotactile feedback of real-time limb position enhances precision of goal-directed reaching.

We examined vibrotactile stimulation as a form of supplemental limb state feedback to enhance planning and ongoing control of goal-directed movements. Subjects wore a two-dimensional vibrotactile display on their nondominant arm while performing horizontal planar reaching with the dominant arm. The vibrotactile display provided feedback of hand position such that small hand displacements were more easily discriminable using vibrotactile feedback than with intrinsic proprioceptive feedback. When subjects relied solely on proprioception to capture visuospatial targets, performance was degraded by proprioceptive drift and an expansion of task space. By contrast, reach accuracy was enhanced immediately when subjects were provided vibrotactile feedback and further improved over 2 days of training. Improvements reflected resolution of proprioceptive drift, which occurred only when vibrotactile feedback was active, demonstrating that benefits of vibrotactile feedback are due, in part to its integration into the ongoing control of movement. A partial resolution of task space expansion persisted even when vibrotactile feedback was inactive, demonstrating that training with vibrotactile feedback also induced changes in movement planning. However, the benefits of vibrotactile feedback come at a cognitive cost. All subjects adopted a stereotyped strategy wherein they attempted to capture targets by moving first along one axis of the vibrotactile display and then the other. For most subjects, this inefficient approach did not resolve over two bouts of training performed on separate days, suggesting that additional training is needed to integrate vibrotactile feedback into the planning and online control of goal-directed reaching in a way that promotes smooth and efficient movement. NEW & NOTEWORTHY A two-dimensional vibrotactile display provided state (not error) feedback to enhance control of a moving limb. Subjects learned to use state feedback to perform blind reaches with accuracy and precision exceeding that attained using intrinsic proprioception alone. Feedback utilization incurred substantial cognitive cost: subjects moved first along one axis of the vibrotactile display, then the other. This stereotyped control strategy must be overcome if vibrotactile limb state feedback is to promote naturalistic limb movements.

Vibration Propagation on the Skin of the Arm.

Vibrotactile interfaces are an inexpensive and non-invasive way to provide performance feedback to body-machine interface users. Interfaces for the upper extremity have utilized a multi-channel approach using an array of vibration motors placed on the upper extremity. However, for successful perception of multi-channel vibrotactile feedback on the arm, we need to account for vibration propagation across the skin. If two stimuli are delivered within a small distance, mechanical propagation of vibration can lead to inaccurate perception of the distinct vibrotactile stimuli. This study sought to characterize vibration propagation across the hairy skin of the forearm. We characterized vibration propagation by measuring accelerations at various distances from a source vibration of variable intensities (100-240 Hz). Our results showed that acceleration from the source vibration was present at a distance of 4 cm at intensities >150 Hz. At distances greater than 8 cm from the source, accelerations were reduced to values substantially below vibrotactile discrimination thresholds for all vibration intensities. We conclude that in future applications of vibrotactile interfaces, stimulation sites should be separated by a distance of at least 8 cm to avoid potential interference in vibration perception caused by propagating vibrations.

Effect of Dual Tasking on Vibrotactile Feedback Guided Reaching - a Pilot Study.

Vibrotactile feedback (VTF) has been proposed as a non-invasive way to augment impaired or lost kinesthetic feedback in certain patient populations, thereby enhancing the real-time control of purposeful limb movements and quality of life. We used a dual tasking scenario to investigate the effects of cognitive load and short-term VTF training on VTF-guided reaching. Participants grasped the handle of a planar manipulandum with one hand and received VTF of its motion via a vibrotactile display attached to the non-moving arm. We asked participants to simultaneously perform VTF-guided reaching and a choice reaction time task both before and after training with VTF-guided reaching. Participants readily used VTF to guide goal-directed hand movements in the absence of visual feedback in the dual-task setting, even prior to training. This capability came at the cost of increased movement completion time. Short-term training on VTF-guided reaching induced significant improvements in target capture errors. Pre- and post-training comparisons of dual-task performance found training-related improvements in VTF-guided reach accuracy were resistant to dual-task interference. We found no training-related improvements in movement completion time or button press performance. These results indicate that VTF can be used to complete goal-directed reaches in a dual task situation, and that a single short bout of training sufficed for participants to begin the transition between the cognitive and associative phases of learning for the integration of VTF into the planning and ongoing control of reaching movements.

The arm motion detection (AMD) test.

Stroke can lead to sensory deficits that impair functional control of arm movements. Here we describe a simple test of arm motion detection (AMD) that provides an objective, quantitative measure of movement perception related proprioceptive capabilities in the arm. Seven stroke survivors and thirteen neurologically intact control subjects performed the AMD test. In a series of ten trials that took less than 15 minutes to complete, participants used a two-button user interface to adjust the magnitude of hand displacements produced by a horizontal planar robot until the motions were just perceptible (i.e. on the threshold of detection). The standard deviation of movement detection threshold was plotted against the mean and a normative range was determined from the data collected with control subjects. Within this normative space, subjects with and without intact proprioception could be discriminated on a ratio scale that is meaningful for ongoing studies of degraded motor function. Thus, the AMD test provides a relatively fast, objective and quantitative measure of upper extremity proprioception of limb movement (i.e. kinesthesia).

Following and intercepting scribbles: interactions between eye and hand control.

The smooth pursuit eye movement system appears to be importantly engaged during the planning and execution of interceptive hand movements. The present study sought to probe the interaction between eye and hand control systems by examining their responses during an interception task that included target speed perturbations. On 2/3 of trials, the target increased or decreased speed at various times, ranging from about 300 ms before to 150 ms after the onset of a finger movement directed to intercept the target and was triggered by a GO signal. Additionally, the same 2D sum-of-sines target trajectories were followed with the eyes without interception. The smooth pursuit system responded more quickly if the target speed perturbation occurred earlier during the reaction time (i.e., near the time of the GO signal). Similarly, the finger movement began more quickly if target speed was increased earlier during the reaction time. For early perturbation conditions, the initial direction of the finger movement matched the predicted target intercept using the new target speed. For perturbations occurring after finger movement, onset initial direction of finger movement did not match target interception such that the finger path began to curve toward the perturbed target after about 150-200 ms. The results support the idea of an active process of visual target path extrapolation simultaneously used to guide both the eye and hand.

Target interception: hand-eye coordination and strategies.

This study was designed to define the characteristics of eye-hand coordination in a task requiring the interception of a moving target. It also assessed the extent to which the motion of the target was predicted and the strategies subjects used to determine when to initiate target interception. Target trajectories were constructed from sums of sines in the horizontal and vertical dimensions. Subjects intercepted these trajectories by moving their index finger along the surface of a display monitor. They were free to initiate the interception at any time, and on successful interception, the target disappeared. Although they were not explicitly instructed to do so, subjects tracked target motion with normal, high-gain smooth-pursuit eye movements right up until the target was intercepted. However, the probability of catch-up saccades was substantially depressed shortly after the onset of manual interception. The initial direction of the finger movement anticipated the motion of the target by approximately 150 ms. For any given trajectory, subjects tended to initiate interception at predictable times that depended on the characteristics of the target trajectories [i.e., when the curvature (or angular velocity) of the target was small and when the target was moving toward the finger]. The relative weighting of various parameters that influenced the decision to initiate interception varied from subject to subject and was not accounted for by a model based on the short-range predictability of target motion.

Predicting curvilinear target motion through an occlusion.

When a tracked target is occluded transiently, extraretinal signals are known to maintain smooth pursuit, albeit with a reduced gain. The extent to which extraretinal signals incorporate predictions of time-varying behavior, such as gradual changes in target direction, is not known. Three experiments were conducted to examine this question. In the experiments, subjects tracked a target that initially moved along a straight path, then (briefly) followed the arc of a circle, before it disappeared behind a visible occlusion. In the first experiment, the target did not emerge from the occlusion and subjects were asked to point to the location where they thought the target would have emerged. Gaze and pointing behaviors demonstrated that most of the subjects predicted that the target would follow a linear path through the occlusion. The direction of this extrapolated path was the same as the final visible target direction. In the second set of experiments, the target did emerge after following a curvilinear path through the occlusion, and subjects were asked to track the target with their eyes. Gaze behaviors indicated that, in this experimental condition, the subjects predicted curvilinear target motion while the target was occluded. Saccades were directed to the unseen curvilinear path and pursuit continued to follow this same path at a reduced speed in the occlusion. Importantly, the direction of smooth pursuit continued to change throughout the occlusion. Smooth pursuit angular velocity was maintained for approximately 200 ms following target disappearance. The results of the experiments indicate that extraretinal signals indeed incorporate cognitive expectations about the time-varying behavior of target motion.

Oculomotor responses to gradual changes in target direction.

Smooth pursuit tracking of targets moving linearly (in one dimension) is well characterized by a model where retinal image motion drives eye acceleration. However, previous findings suggest that this model cannot be simply extended to two-dimensional (2D) tracking. To examine 2D pursuit, in the present study, human subjects tracked a target that moved linearly and then followed the arc of a circle. The subjects' gaze angular velocity accurately matched target angular velocity, but the direction of smooth pursuit always lagged behind the current target direction. Pursuit speed slowly declined after the onset of the curve (for about 500 ms), even though the target speed was constant. In a second experiment, brief perturbations were presented immediately prior to the beginning of the change in direction. The subjects' responses to these perturbations consisted of two components: (1) a response specific to the parameters of the perturbation and (2) a nonspecific response that always consisted of a transient decrease in gaze velocity. With the exception of this nonspecific response, pursuit behavior in response to the gradual changes in direction and to the perturbations could be explained by using retinal slip (image velocity) as the input signal. The retinal slip was parallel and perpendicular to the instantaneous direction of pursuit ultimately resulted in changes in gaze velocity (via gaze acceleration). Perhaps due to the subjects' expectations that the target will curve, the sensitivity to the image motion in the direction of pursuit was not as strong as the sensitivity to image motion perpendicular to gaze velocity.

Manual tracking in three dimensions.

Little is known about the manual tracking of targets that move in three dimensions. In the present study, human subjects followed, with the tip of a hand-held pen, a virtual target moving four times (period 5 s) around a novel, unseen path. Two basic types of target paths were used: a peanut-shaped Cassini ellipse and a quasi-spherical shape where four connected semicircles lay in orthogonal planes. The quasi-spherical shape was presented in three different sizes, and the Cassini shape was varied in spatial orientation and by folding it along one of the three bend axes. During the first cycle of Cassini shapes, the hand lagged behind the target by about 150 ms on average, which decreased to 100 ms during the last three cycles. Tracking performance gradually improved during the first 3 s of the first cycle and then stabilized. Tracking was especially good during the smooth, planar sections of the shapes, and time lag was significantly shorter when the tracking of a low-frequency component was compared to performance at a higher frequency (-88 ms at 0.2 Hz vs. -101 ms at 0.6 Hz). Even after the appropriate adjustment of the virtual target path to a virtual shape tracing condition, tracking in depth was poor compared to tracking in the frontal plane, resulting in a flattening of the hand path. In contrast to previous studies where target trajectories were linear or sinusoidal, these complex trajectories may have involved estimation of the overall shape, as well as prediction of target velocity.

Planning and drawing complex shapes.

Arm and hand movements are generally controlled using a combination of sensory-based and memory-based guidance mechanisms. This study examined similarities and differences in visually-guided and memory-guided arm movements, and sought to determine as to what extent certain control principles apply to each type of movement. In particular, the 2/3 power law is a principle that appears to govern the formation of complex, curved hand trajectories; it specifies that the tangential velocity should be proportional to the radius of curvature raised to an exponent of 1/3. A virtual reality system was used to project complex target paths in three-dimensional (3D) space. Human subjects first tracked (with the tip of a handheld pen) a single target moving along an unseen path. The entire target path then became visible and the subject traced the shape. Finally, the target shape disappeared and the subject was to draw it, in the same 3D space, from memory. Most aspects of the movements (speed, path size, shape and arm postures) were very similar across the three conditions. However, subjects adhered to the 2/3 power law most closely in the tracing condition, when the entire target path was visible. Also, only within the tracing condition, there were significant differences in the value of the exponent depending on the size and the spatial orientation of the trajectory. In the tracking and drawing conditions, the exponent was greater than 1/3, indicating that subjects spent more time in areas of tight curvature. This may represent a strategy for learning and remembering the complex shape.

Smooth pursuit tracking of an abrupt change in target direction: vector superposition of discrete responses.

The directional control of smooth pursuit eye movements was studied by presenting human subjects with targets that moved in a straight line at a constant speed and then changed direction abruptly and unpredictably. To minimize the probability of saccadic responses in the interval following the target's change in direction, target position was offset so as to eliminate position error after the reaction time. Smooth pursuit speed declined at a latency of 90 ms, whereas the direction of smooth pursuit began to change later (130 ms). The amplitude of the offset in target position did not affect the subsequent smooth pursuit response. In other experiments, the target's speed or acceleration was changed abruptly at the time of the change in direction. Step changes in speed elicited short-latency responses in smooth pursuit tracking but step changes in acceleration did not. In all instances, the earliest component of the response did not depend on the parameters of the stimulus. The data were fit with a model in which smooth pursuit resulted from the vector addition of two components, one representing a response to the arrest of the initial target motion and the other the response to the onset of target motion in the new direction. This model gave an excellent fit but further analysis revealed nonlinear interactions between the two vector components. These interactions represented directional anisotropies both in terms of the initial tracking direction (which was either vertical or 45 degrees ) and in terms of the cardinal directions (vertical and horizontal).

Interception of targets using brief directional cues.

There are time delays in visuomanual and oculomotor pathways, and some of these time delays may be due to the finite time required to process visual motion signals and to extract accurate information about the speed and direction of the motion. The present experiments were designed to ascertain the time required to obtain a reliable estimate of the direction of target motion. Subjects were asked to indicate the final direction of a moving target, which abruptly changed direction and shortly thereafter disappeared, by pointing to its expected emergence at the boundary of an occlusion. Subjects made small but consistent errors that overestimated the target's change in direction. These errors depended little on the amount of time the target was visible (ranging from 50 to 400 ms) after it changed direction. Pointing direction was strongly correlated with gaze, which was dominated by a saccade initiated shortly after the target changed direction. The pointing errors were explained by the fact that the saccade always intercepted the (occluded) target, but then continued in the same direction toward the boundary of the occlusion. The analysis reveals that target direction was estimated accurately even at the shortest viewing time.

Time constants in the perception of a change in the direction of motion in humans.

Motion signals are subject to spatio-temporal filtering at early stages of processing. In general, motion can be characterized by two parameters: speed and direction. This study sought to determine the time constants for the filtering of the directional component of the motion signal. In a forced-choice discrimination task, subjects were asked to choose the more abrupt change in direction of a target that moved through two 90 degrees corners. At each corner, direction of motion was low-pass filtered. Subjects were able to reliably perform this task if the filter time constants differed by >20 ms.

Sit-to-stand performance of older adults following strength training.

A group of healthy older adults completed an 8-week resistance-training program. For 38 participants (14 men, 24 women; ages 60-90 years; M mass = 73.2 kg, SD = 12.3; M height = 1.65 m, SD = 0.08), pre- and postprogram sit-to-stand performance was analyzed (60 Hz video) focusing on center of mass kinematics surrounding transition. Significant changes were attributed to improved strength. Peak forward, downward, and upward velocities increased (16, 59, and 26%, respectively), and relative transition time was delayed 27%. These behaviors were more similar to those of healthy younger adults. Results also indicated strategy changes. Participants exploited their improved strength, forming a distinctive movement pattern emphasizing stability followed by a brisk rise. These adaptations represent meaningfully improved function in an important daily living activity.